November 2009 | | Issue 11

Legal Health Records

EHR and LHR Are Distinct Entities

By upgrading an existing paper or hybrid legal health record to a true e-LHR system, hospitals save significant financial and human resources, regardless of their HITECH Act reimbursement status.

By George Abatjoglou

Electronic legal health-record (e-LHR) technology is fundamentally separate and distinct from clinical electronic health-record (EHR) systems, and has been impacted by the confusion around the American Recovery and Reinvestment Act (ARRA). Even though e-LHRs run on separate systems and offer their own return on investment and value proposition independent of any clinical systems, many hospitals are unclear about whether they can or should pursue their e-LHR plans in conjunction with ARRA initiatives.

Here are some key differences between a legal health record (LHR) and an EHR, and an analysis of the relevance of the LHR to qualifying for healthcare IT reimbursement under the HITECH Act.

The EHR is designed to give providers the most relevant and up-to-date clinical information available on a patient so that they can provide the safest, highest-quality care possible. It contains all of the patient's conditions, allergies, vitals readings and lab tests. The LHR is the hospital's business-health record, and is designed to document and support billing, quality assurance, legal and administrative processes. It contains some of the same information as the EHR (e.g., care provided, clinical justification for that care), but it contains only a specific subset of the information in the EHR, combined with information from billing, admissions, and other systems and processes.

For many hospitals, the LHR is still the complete paper chart kept post-discharge; for others, it is an electronic record combining data maintained electronically in transcription, EHR, lab, radiology information systems/picture archive and communication systems (RIS/PACS) and other systems, and any handwritten notes or orders scanned into a document-management system.

Whether paper or electronic, the LHR is a static set of information that does not change once the record is complete. There are many variations in what subset of that record will be reproduced and delivered, depending on the purpose (examples include: coding, payer communications, subpoenas, audits) and the statutory and contractual regulations that apply. The master LHR, from which purpose-specific versions are produced, has certain characteristics, including that it:

  • reflects the care provided during a specific timeframe - usually one hospital admission - and for a specific purpose or set of purposes (e.g., the delivery of a baby);
  • contains the clinical justification of that care, including diagnoses, demographic information, lab results; and
  • is finite, complete and unalterable - unlike an EHR, which is constantly updated with new clinical information and subsequent episodes of care.

The HITECH Act is designed to generate economic stimulus for the healthcare industry, while providing incentives to move healthcare organizations to more efficient EHR and regional health-information organization/health-information exchange (RHIO/HIE)-based care processes. Fundamentally, though, the HITECH Act is aimed at incenting the adoption and sustained use of clinical systems such as EHRs, e-prescribing, computer physician order entry (CPOE) and clinical documentation systems. It does not provide incentives to adopt and use administrative systems.

Therefore, qualifying for HITECH Act stimulus funds has virtually nothing to do with the LHR. In fact, as requirements for the EHR under the HITECH Act continue to evolve, the LHR will remain a constant requirement.

Clinical systems can help deliver some administrative efficiencies, but they also introduce new challenges. The benefits associated with improved LHR processes, in general, and e-LHR systems, in particular, are independent of the underlying systems they access.

By upgrading an existing paper or hybrid LHR to an e-LHR system, hospitals can save significant financial and human resources, regardless of their HITECH Act-reimbursement status. A typical 100-bed hospital can expect the following financial benefits:

  • FTEs dedicated to paper-chart management can be redirected to higher-value processes.
  • More than $100,000 in supplies and services related to paper charting can be eliminated.
  • As much as 1,000 square feet of dedicated storage and paper-chart workspace can be repurposed to revenue-generating uses.
  • At least two discharged not final billed days associated with locating and working with paper charts can be eliminated.
  • At least a one percent improvement in case mix can be achieved, with more-accurate documentation associated with an e-LHR.
  • At least 0.5 percent of denials can be eliminated.

The EHR and the LHR are two fundamentally distinct entities, with different uses and constituents. Being a paperless hospital in the 21st century will require the adoption of an e-LHR system to complement the clinical EHR roadmap. An e-LHR system should interface with any stimulus-qualifying system and, more importantly, should also yield immediate return on investment, regardless of the state of the organization's EHR or migration to a new EHR.

George Abatjoglou is chief executive officer for eWebHealth.

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