comp5 unit6b lecture slides

History of Health Information Technology in the U.S.History of Electronic Health Records

(EHRs)Lecture b – Evolution of Functional

Requirements for EHRsThis material Comp5_Unit 6 was developed by The University of Alabama Birmingham, funded by the Department of Health

and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 1U24OC000023

History of Electronic Health RecordsLearning Objectives

2

• Describe some early examples of electronic medical records

• Discuss lessons learned from the early EHR implementations

• Discuss how the attributes that were identified for a computer-based patient record in the 1991 Institute of Medicine report relate to the concept of meaningful use

• Discuss differences between the terms electronic health record (EHR) and personal health record (PHR)

Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Functional

Requirements for EHRs Lecture b

IOM Criteria for CPR

• The Computer-Based Patient Record• 1991• Criteria for CPR

Source: (Dick, et al.,1991)

3Health IT Workforce Curriculum Version 3.0/Spring 2012




• The Computer-Based Patient Record– Two editions: 1991 and 1997

• Recommendations for CPR– Gold standard– Vendor community

Source: (Dick, et al., 1997)





• Problem list





• Problem list• Health status measures





• Problem list• Health status measures• Rationale for decision making





• Problem list• Health status measures• Rationale for decision making• Records integration

– Other settings– Other time periods







• Protection of confidentiality







• Protection of confidentiality• Timely access

– Simultaneous – Remote




IOM Criteria for CPR• Tailored views




IOM Criteria for CPR• Tailored views• Access to local and remote databases

– Medical literature– Clinical guidelines

Source: (Miller, et al., 2005)






• Clinical problem solving assistance– Decision support tools







• Structured data entry by physicians– Defined vocabulary








• Assessment– Quality and cost








• Assessment– Quality and cost

• Flexible and expandable 16Health IT Workforce Curriculum

Version 3.0/Spring 2012



Cover Sheet of VISTA EHR

Health IT Workforce Curriculum Version 3.0/Spring 2012

History of Health Information Technology in the U.S. Evolution of Functional Requirements for EHRs Lecture b

17

Electronic Health Record System Capabilities

• IOM Committee on Data Standards – 2003• CPR versus EHR

– EHR assumes involvement of patients

Source: (Institute of Medicine, 2003)





• Direct care functions

• Supportive functions

• Information infrastructure





• Direct care functions– Care management– Clinical decision support– Operations management and communication





• Direct care functions– Care management– Clinical decision support– Operations management and communication

• Supportive functions– Clinical support (e.g., demographics)– Measurement, analysis, research,

reporting– Administrative and financial





• Information Infrastructure Functions– Security– Records management– Unique identity, registry and directory

services– Health informatics and terminology standards– Interoperability– Management of business rules– Workflow




Meaningful Use

• Major current recommendations– Computerized Provider Order Entry (CPOE)– Clinical Decision Support (CDS)– Electronic Prescribing (E-prescribing)– Structured documentation of quality measures– Up-to-date problem lists and diagnoses– Providing patients with health information

electronically – Information exchange




History of Electronic Health Records (EHRs)Summary

• 1991 IOM report still the gold standard• Most systems today still do not meet all of

the IOM criteria• Early systems met many of the criteria• Broader development of EHRs with

HITECH




Some of the material in this presentation is also included in the following book and is used with permission:

Smaltz DH, Berner ES. The executive’s guide to electronic health records. Chicago IL: Health Administration Press; 2007.




History of Electronic Health RecordsReferences – Lecture b

References•Dick RS, Steen EB, Detmer DE. The computer-based patient record: an essential technology for healthcare. Revised Edition. Washington, DC: National Academy Press; 1997.•Institute of Medicine. Committee on Data Standards for Patient Safety, Board of Health Care Services. Key capabilities of an electronic health record system. Letter report. Washington (DC): The National Academies Press; 2003 Jul.•Miller RA, Waitman LR, Chen S, Rosenbloom ST. The anatomy of decision support during inpatient care provider order entry (CPOE): empirical observations from a decade of CPOE experience at Vanderbilt. J Biomed Inform. 2005 Dec;38(6):469-85.•Smaltz DH, Berner ES. The executive’s guide to electronic health records. Chicago (IL): Health Administration Press; 2007.ImagesSlide 17: Available from: http://www.va.gov/VISTA_MONOGRAPH/docs/2008_2009_VistAHealtheVet_Monograph_FC_0309




http://www.va.gov/VISTA_MONOGRAPH/docs/2008_2009_VistAHealtheVet_Monograph_FC_0309

comp5 unit6b lecture slides

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