Download - Electronic Medical Record Features
Electronic Medical Record
Features
Electronic Medical Record Definition
An Electronic Medical Record is a computer based information system that includes data and functionality with the following characteristics.
Provide secure, reliable and real-time access to patient health information where and when it is needed to support care.
Capture and manage episodic and longitudinal electronic health record information.
Function as clinicians’ primary information resource during the provision of patient care.
Assist with planning and delivering evidence-based care to individuals and groups of patients.
Support continuous quality improvement, utilization review, risk management and performance management.
Capture information necessary for reimbursement.
Provide longitudinal, appropriately masked information to support clinical research, public health reporting and population health initiatives.
Support clinical trials.
As defined by HIMSS (July 9, 2003)
Electronic Medical Record Key Components
Order Entry Data Dictionaries Order Management Clinical Data Repository Order Communications Results Reporting
Clinical Documentation Drug Database Clinical Pathways Customer Relation
Management Clinical Decision Support Interfaces
As defined by HIMSS (July 9, 2003)
•Lab Results
•Radiology Reports
•Radiology images
•Medications
•Operative Notes
•E.R. Notes
•Encounter History
•Appointment
•Scanned Order Scripts
•Progress Notes
•Therapy Notes
•History & Physical
•Allergies
•Demographics
•EKGs
•Scanned Advanced Directives
•Patient Lists
EMR Data Types
Electronic Medical Record System Features (page 1)
Order EntryDesigned for use by physicians/clinicians
Includes:Order sets
Checking for:Duplicate ordersDrug interactions
AllergiesDose-range
Online medication administration record (MAR)Work lists (task generation from orders)
Clinical Pathways
Practice guidelines and protocolsStandardsWork lists
Order Management
Knowledge-based orders (KBO)Advanced order entry and advanced clinical
decision supportIncludes:
Alerting with a rules engineLinks to knowledge basesClinical pathway ordering
Prescription ordering
Order Communications
Capture and transmission of ordersIncludes:
Single ordersMulti-disciplinary orders
Order setsCharging
Requisitions
Customer Portal
Health:Content and mall item searches
Personal health:Diary and reminders
Online questionnaires for the medical record
Physician Portal
Reference librarySecure messaging
Results viewerPrescription management
Referral managementHand-held wireless solutions
Employee Portal
Personalized work viewsWork flow tools
Content management/publishingSearch/calendar/directories
Hand-held wireless solutions
Data Dictionaries
Enterprise-wideCoherent data, even if data sources are in
different nomenclatures
Customer Relation Management
Customer Relationship Management (CRM)portals:
CustomerPhysicianEmployee
Integrated Clinical Information System Features
Electronic Medical Record System Features (page 2)
Clinical Documentation
Includes:Flow sheets
Intake and outputChart audit trail
History of access to patient chartsWhoWhatWhen
Results Reporting
Structured data from:Flow sheets
Ancillary systemsLaboratory, Radiology, Pharmacy, etc.
Knowledge Based Orders
Medical knowledge embedded into anapplication to guide practitioners providing
patient careArden syntax rules engine/editor
Arden syntax = industry standard for writing“rules”
Real-time interactive knowledge engineMulti-dimensional real time alerts
Initiated by the application:Synchronous – at the time of the order
Asynchronous – after the order has been placed
Clinical Data Repository
Health Data Repository (HDR)Automates the process of:
Gathering,Translating,
Organizing, andStoring all the patient’s data.(clinical, financial, and administrative)
Ensures quick access to the patient’s data
Clinical Decision Support
Prospective evidence-based careMeasure variance
Predict actionable informationAutomated aggregation of data
Measure work flow and operational efficiencyRetrospective analysis
Cost versus quality of careLength of stay versus outcomeRetrospective efficacy review
Pathways built from historical dataTrend Analysis
ResearchAnalysis across populations
Disease management analysisKnowledge-driven alerts
Arden syntax rules engine/editorMulti-dimensional real time alerts
Alerting across the continuum of care
Drug Database
Provide clinical content, e.g., Multum, First DataBank
Includes:Drug names and product information
Disease namesCoding systems
Side effect informationTherapeutic duplication checking
Interfaces
Systems feeding into the CDR (via interfaces) toautomate results reporting, e.g.,
Admission/registrationLaboratoryRadiologyPharmacy
Other ancillary systemsTranscription
Document imaging and PACSPatient accounting/billing
Devices feeding into the CDR (via interfaces) toautomate results reporting and/or collection of
device data, e.g.,IV pumps
Blood gas analyzersVitals (blood pressure, respiratory rate)
Heart rate monitorsVentilators
Infusion pumps
Integrated Clinical Information System Features
Electronic Medical Record Environment
Functionality that is recommended to be integrated into an EMR
Functionality that can be interfaced or integrated
Healthcare industry experts recommend that all hospitals integrate several core EMR functions through a single product.
Electronic Signature
Clinical Data Repository
Clinical Decision Support
Physician Inbox
Alerts and Reminders
Charting Information Clinical Documentation
Patient History and Physical
Problem List
Vital Signs
Order Management
Pharmacy
Context Systems
Laboratory ResultsRadiology Reports
PACS - ImagesOperative Notes
Drug InformationPatient Encounter Information
Patient SchedulesPhysician Schedules
EKGsInpatient / Outpatient Progress
NotesDischarge Summaries
Medical RecordsEMPI
Billing
Technology Enablers
Voice Recognition
Mobile - Wireless Access
Workflow Engine
Web - Remote Access
Electronic Medical Record
Electronic Medical RecordBenefits & Costs
Benefits Reduction in time used documenting clinical encounters (enabling more patient visits) Improvements in encounter coding (resulting in increased reimbursement) Eliminating paper charts and their associated costs Reduction in dictation and transcription costs Reduction in time and effort to locate and assemble paper chart information Automated charge capture Lower malpractice & risk of embezzlement Optimization in the utilization of non-physician providers Elimination of duplicate data entry Ability to attract caregivers through state-of-the-art systems and access to patient
information Increased patient satisfaction through improved patient care
Costs Initial costs for the application, implementation effort, and computer hardware Infrastructure costs associated with implementing and expanding the system Additional technical staff to support increased complexity in the application and environment Initial and ongoing training costs associated with set up and usage of the EMR Ongoing maintenance costs for vendor support and system upgrades
Electronic Medical RecordImplementation Options
Medium Size Hospital - Integrated EMR
High End, Large Hospital - Integrated EMR
Multiple Vendors (Best of Breed) EMR
Integrated front end for multiple back-end systems
Integrated EMR products that are lower in cost than industry leaders target small and medium sized hospitals. They tend to have all of the critical core features needed by most hospitals and several niche features that distinguish their product from others in the marketplace. Risks are increased for financial stability and product longevity. They tend to have adequate resources to provide excellent support to end users.
Integrated EMR products that lead the industry target large to medium sized hospitals. They tend to devote resources to develop the best features for all clinical components of an EMR. Costs to purchase, implement, and support the systems are significant. Customizing the system to meet an institutions specific needs is costly.
Selecting separate vendors and products to build an EMR can result in securing the best functionality for each clinical area, however the end result of integrating these functions may not result in a cohesive system. The initial costs of all components as well as the ongoing maintenance and operations is generally higher than an integrated solution. The complexity of coordinating the implementation, interfaces, and ongoing support of this type of solution is higher than an integrated solution.
EMR functionality may be achieved by utilizing software that provides an integrated EMR look and feel while accessing existing multiple back end systems. Costs and functionality will vary depending upon the availability and platforms for existing back-end systems. This option can provide a low cost solution to implement, however may be complex to implement and support. The level of functionality may be limited and depends upon the capabilities of the existing back-end systems.
Misys, Meditech, Quadramed, CPSI, Dairyland, HMS
Cerner SiemensEpicMcKesson
Several InterSystems - Ensemble, CacheMcKesson - Horizon PortalHealthvision
$$
$1.5 - 5M
$$$
$6-15M
$$$
$10-15M
$
$1-3M
Description / Main Characteristics
Major Vendors / Products
Electronic Medical Record Implementation Options - Advantages
Medium Size Hospital - Integrated EMR
High End, Large Hospital - Integrated EMR
Multiple Vendors (Best of Breed) EMR
Integrated front end for multiple back-end systems
Lower cost than High-end to implement
Typically have best functionality and integration
Best functionality for each functional need
Potential low cost to implement
Single vendor reduced complexity of install and support
Stability of large company Can implement in stages Leverages existing investments
Core functions of EMR available Proven mature software using industry standard tools
Most vendors have mature interfacing capabilities
May be customized for specific hospital needs
Reduced complexity of infrastructure and technology pieces
Large install base with most end-users
Will only purchase functions that are needed
Can leverage existing historical data
Seamless integration results in ease of use for end-users
Scalable solutions for medium and large hospitals
Can implement in stages - as areas become ready
Excellent reporting capabilities through a single repository
Seamless integration results in ease of use for end-users
Potential to implement some key features quickly
Most vendors provide good end user support
Excellent reporting capabilities through a single repository
Will not pay for unnecessary functions
Leaders in the industry often introduce new features
Most provide adequate functionality to meet specific needs of all areas.Possible to implement all new core functions together
Pros
Electronic Medical Record Implementation Options - Disadvantages
Medium Size Hospital - Integrated EMR
High End, Large Hospital - Integrated EMR
Multiple Vendors (Best of Breed) EMR
Integrated front end for multiple back-end systems
Potentially less functionality than higher end system
High cost to implement and support
High cost to implement a fully functional solution
Depends upon existing data to be accurate and in certain formats.
Dependence upon single vendor may be a risk if not satisfied
May implement un-needed features High complexity in implementing and supporting multiple vendors
Integration may not be as seamless as integrated EMR
Some smaller companies not financially stable
Systems typically not able to be customized
May be incompatibilities between vendor products
May not provide all EMR type features easily
Scalability may issue if system grows significantly
Dependence upon single vendor may be a risk if not satisfied
Large effort to research and select systems for all affected areas
May need to purchase other 3rd party pieces to provide all required functionality
Smaller companies have more potential to merge with other companies
Availability and cost for support resources may be an issue
Increased support issues by using multiple vendors
Can be complex to implement and support
If proprietary technologies - integration may be limited
High range in cost depending upon what exists and what functionality is requiredWill not replace need to upgrade core systems as issue occur with them
Cons / Risks
Electronic Medical Record Major Vendor Comparisons
Selection Criteria
Vendor (Integrated Suites) Total Installs % of Installs301-400 Bed Size
Target Markets Vision Cost Functionality Technology Risk
Meditech 487 23.87% 39 Middle $ $$ $$$ $ $McKesson 365 17.89% 62 Mid -HI $ $$ $$ $$ $Siemens (not Soarian) 340 16.67% 35 Mid-HI $$ $$$ $$ $$ $$Cerner 274 13.43% 30 High End $$$ $$$ $$$ $$$ $$$IDX 109 5.34% 15 Mid-HI $ $$ $$ $$ $$$CPSI 103 5.05% 3 Low End $ $ $$ $$ $Eclipsys 97 4.75% 17 High End $$ $$$ $$ $$$ $$Self Developed 97 4.75% 12 Low-MidEpic 69 3.38% 6 High End $$$ $$$ $$$ $$$ $$$Misys 62 3.04% 26 Middle $$$ $$ $$ $$ $$Quadramed 37 1.81% 6 Middle End $ $$ $$ $ $$$
Subtotal Of top 10 vendors 204042 VENDORS WITH < 37 INSTALLS 203Vendor Unknown 24Sample size=3970 Acute hospitals
Source: HIMSS Analytics 2005EmergisoftPyxis
Best of Breed VendorsIdocCDR Web
Electronic Medical RecordIndustry Trends - Priorities
Healthcare Industry Priorities - Most Important Applications (Next Two Years)
38%40%
43%46%
50%52%52%52%
ElectronicMedicalRecord
ClinicalInformation
Systems
Bar CodedMedicationsManagement
ComputerizedPhysician
Order Entry
Clinical DataRepository
PACS EnterpriseWide
InformationSharing
Point of CareDecisionSupport
Based Upon Hospital Leadership Identifying Top Several Priorities.Source: HIMSS 15th Annual Leaderhip Survey - 2004
Electronic Medical RecordIndustry Trends – Current Status
Electronic Medical Record - Current Healthcare Industry Status
No plans20%
Fully Operational19%
Partially Operational
37%
Plan to Implement23%
Unknown1%
Source: 15th Annual HIMSS Leadership Survey, Sponsored By Superior Consulting (2004)
Electronic Medical Record EMR Implementation Stages
EMR Stage Definition / Systems
% of all hospitals in
stage 0-100 Beds
No Stage Lack lab, radiology, and pharmacy reqd. for stage 1 29.39 45
Stage 1 Major ancillary systems installed (Lab, Rx, Radiology) 20.47 18
Stage 2
Major systems feed to Clinical Data Repository (CDR) that provides physicians access for retrieving and viewing results. Information from document imaging systems may be linked to CDR at this stage. 47.54 35
Stage 3
Nursing documentation, charting, care plans, and eMAR is implemented and fed to the CDR. The first level of Clinical Decision Support (CDSS) is implemented to conduct error checking. Some level of PACS is available for access by physicians via intranet. 1.73 1
Stage 4CPOE for use by any clinician is added to the nursing and DCR environment along with second level CDSS related to evidence based medicine protocols. 0.84 1
Stage 5
Closed loop medication administration environment is fully implemented. The eMar and bar coding, RFID are implemented and integrated with CPOE and Pharmacy to maximize point of care patient safety processes for medication administration. 0.03
Stage 6
Full physician documentation/charting is implemented with all of the above. Level 3 of clinical decision support provides guidance for all clinician activities related to protocols and outcomes in the form of variance and compliance alerts. A full compliment PACS system provides medical images to physicians via an intranet and displaces all film based images. 0
Stage 7
Clinical information can be readily shared via electronic transactions or exchange of electronic records with all entities within a regional health network. The medical record is completely electronic/paperless. This stage allows the Care Delivery Organization to support the true electronic health record. 0
* Source HIMSS Analytics 2005 - based upon input from 3927 hospitals
HIMSS Analytics Clinical Transformation Stages
Electronic Medical Record Electronic Medical Record (EMR) vs. Electronic Health Record (EHR)
Electronic Medical Records Electronic Health Records
The legal record of the Care Delivery Organization (CDO)
Subset (ie. Continuitiy of Care Record (CCR) or Care Record Summary (CRS) from various CDOs where patient has had an encounter
A record of clinical services for patient encounters in a Care Delivery Organization Owned by the patient
Owned by the CDOCommunity, state, or regional emergence today - or nationwide in the future
These systems are being sold by enterprise vendors and installed by hospitals, health systems, clinics, etc.
Provides interactive patient access as well as the ability for the patient to append information
May have patient access to some results information through a portal, but it is not interactive
Connected by National Health Information Network (NIHN)
Does not contain other CDO encounter information
Electronic Medical RecordPotential Implementation Approach
Implementation Modules
TimeFrameDefine Requirements / Business CaseSystem Evaluation and SelectionAcquire Clinical Repository Acquire EMR Hardware + 3rd party softwareInstall Base EMR componentsIntegrate ADT/Reg, Patient InformationIntegrate Lab ResultsIntegrate Radiology ReportsIntegrate Meds / Pharmacy InformationResults Reporting (Load data from existing sources)Add scanned documentsOrder ManagementElectronic SignatureChartingNursing DocumentationAdd order types Order EntryPatient SchedulingData Warehouse + Clinical Decision SupportPhysician PortalPhysician Office Base System IntegrationEKGsER integrationOR IntegrationCPOE
Short Term PhaseFoundation &
IntegrationAddition of Key
Functions
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