HIT ToolkitVisioning and Strategic Planning

Health Information Technology Toolkit for Physician Offices

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Presenter• Margret Amatayakul

RHIA, CHPS, CPHIT, CPEHR, FHIMSS

President, Margret\A Consulting, LLCSchaumburg, IL

• Independent consultant, who focuses on achieving value from electronic health records, HIPAA/HITECH, and health information exchange. Developer of tools in Toolkit

• Adjunct faculty College of St. Scholastica, Duluth, MN, masters program in health informatics

• Founder and former executive director Computer-based Patient Record Institute, associate executive director AHIMA, associate professor University of Illinois

• Active participant in standards development, former HIMSS BOD, and co-founder of and faculty for Health IT Certification

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Stratis Health● Stratis Health is a nonprofit organization that leads

collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities

● Stratis Health works toward its mission through initiatives funded by federal and state government contracts, and community and foundation grants, including serving as Minnesota’s Medicare Quality Improvement Organization (QIO)

● Stratis Health operates the Health Information Technology Services Center for health care organizations seeking to use health information technology in support of their clinical transformation

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• Envision . . . • HIT vs. EHR vs. EMR • Purposes of EHR• Conceptual model of technical concepts• Reality in ambulatory care and acute care• Progress toward the vision

Agenda

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HIT vs. EHR

• Health information technology (HIT): a general concept that describes the technology that supports management of health information for many purposes

• Electronic health record (EHR): is a specific set of applications that provide an “electronic record of health-related information on an individual including patient demographic and clinical health information, such as medical history and problem lists, and has capacity to provide clinical decision support, support physician order entry, capture and query information relevant to health care quality, and exchange electronic health information with and integrate such information from other sources” (Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009)

Softwarethat directscomputerdevices

People to supportand usesystems

Policythat drivesadoption ofsystems

Hardwarethat enablessystem use

Processthat helpsachieveresults

Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

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• Encompasses broader view of a health record moving from notion of a location for keeping track of patient care events to a resource with enhanced utility

• Merely automating the form, content, and procedures of current patient records will perpetuate their deficiencies and will be insufficient to meet emerging user needs

Institute of Medicine:Computer-based Patient Record: An Essential Technology for Health Care, 1991, 1997

• Longitudinal collection of electronic health information for and about persons; immediate electronic access to person- and population-level information by authorized, and only authorized, users; provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care; and support of efficient processes for health care delivery

Key Capabilities of an Electronic Health Record System, 2003

EHR

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• Electronic medical record (EMR) sometimes refers to:– Physician office EHR

– Hospital document imaging system

– Non-interoperable record of health-related information

• EHR is term used by:– Federal government, including in HITECH

– Institute of Medicine (IOM)

– Health Level Seven (HL7) • Primary organization to develop interoperability in health care information

systems; adopts the term EHR system

– Certification Commission for Healthcare Information Technology (CCHIT)

EHR vs. EMR

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Purposes of EHR• Improve quality of care: data availability, links to knowledge sources

• Enhance patient safety: context-sensitive reminders/alerts, clinical decision support, automated surveillance, disease management, drug/device recall

• Support health maintenance: preventive care and wellness - patient reminders, summaries, tailored instructions, remote evaluation, home monitoring

• Increase productivity: data capture and reporting formats tailored to user, streamlined workflow support, patient-specific care plans and protocols

• Reduce hassle factors: improve satisfaction for clinicians, consumers, and caregivers - managing schedules, registration, referrals, medication refills, work queues, automatically generating administrative data

• Support revenue enhancement: accurate and timely eligibility and benefits, cost-efficacy analysis, clinical trial recruitment, rules-driven coding support, accountability reporting/outcomes measures, contract management

• Support predictive modeling: contribute to development of evidence-based health care guidance

• Maintain patient confidentiality: as health information is securely exchanged among all stakeholders, including across the continuum of care and with individuals

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Reality in Ambulatory Care

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Processor

PMS LIS

PACSImage

s

Relational Database

(or CDR)

Human-computerinterface

Charges

Fax

Operations

ExternalCDWe.g.,

D.M. or Iz.Registry

Storage

Hospital- Demographics- Scheduling- Dictation- Transcription- CPOE

CCR/CCD

PHR

eRx

Scanning

Portal

CDS – POC - CPOE

Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of author.

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Reality in Hospitals

CDR

Interface Engine

Human-computerinterface

CDSEMAR

Human-computerinterface

EDMS

Processor

Operations

PFS

RIS

Charges

Storage

LIS Rx

CPOE

R-ADT/ HIS

Othersystems

Othersystems

MD Portal

(RN)

POCCDW

e.g., CMS

Hospital Compare

RemoteMonitoring

Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of author.

Glossary of Terms

CCR/CCD Continuity of care record/document – standard data content/transmission to send for referrals

CDR Clinical data repository – database optimized for processing patient transactions, e.g., posting vital signs

CDSS Clinical decision support system – software that processes discrete data according to logical rules to provide reminders and alerts

CDW Clinical data warehouse – database optimized for translational data analysis, e.g., data mining

CPOE Computerized provider order entry – system that provides CDS at the point of order entry

Discrete (or structured) data = individual values of data that are entered via templates and which are computable; e.g., patient blood pressure; lab result; name of medication; in contrast to unstructured scanned images, narrative notes, dictation

EDMS Electronic document management system – document imaging, email, efax, and other digital document (e.g., dictation) storage and retrieval

E-MAR/BC-MAR Electronic medication administration record (forms)/bar-code MAR for positive patient identification

eRx Electronic prescribing system – supports drug selection & transmits prescription to retail pharmacy

Human computer interface = data entry devices, such as workstations, tablets, slates, speech recognition, personal digital assistants (PDAs), and smart phones

LIS Laboratory information system that manages operations of a clinical laboratory

O/E Order entry system used by nursing staff to transcribe handwritten orders

PACS Picture archiving and communication system – for x-rays and other clinical images

POC Charting Clinical documentation at the point of care, using clinical practice guidelines/critical pathways and CDS

PHR Personal health record – patient contributed data in many forms

PMS/HIS/PFS Practice management system/Hospital information system/patient financial services – applications for operations, e.g., scheduling, admitting, billing, etc.

RIS Radiology information system that manages operations of a radiology department

HIT Toolkit

Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

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Data vs. InformationCDR vs. CDW

H&PPatient IDHeightWeight

LabsPatient IDTestResult

OrdersPatient IDDrugDose

Data Warehouse

Pt1 ht wt dose outcomePt2 ht wt dose

X% Outcome

Structured data forAnalytical Processing

and Data Mining

Structured data to provide

clinical decision support

Patient ID + Lab TestHeightWeight Drug & Dose

Data Repository

DKB

+ Result

Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

AlertUnstructured

informationinformation

Reality of Today/ Vision for Tomorrow• An EHR is a system that

– Collects data from multiple sources– For use in clinical decision making– At the point of care

• This definition is elusive for many organizations today• This definition is primarily focused on care delivery.

Little demand from providers/supply of product to date for:– Various reporting functions – for quality, P4P, population health– Health information exchange functionality– Personal health record (PHR) support

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Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

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Implementation vs. Adoption• Implementation –

software and hardware installation, system build, testing, training, go-live

• Adoption – users using system to achieve benefits

• “EHR Half Life”– Half of all who ponder do

something about EHR– Half of all who sign a

contract implement EHR– Half of all who implement

EHR• Implement all components• Achieve full use• Use all functionality

Goal of HIT Toolkit is to help you achieve full adoption

Copyright © 2007-8, Margret\A Consulting, LLC

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Contact:

Stratis Health

2901 Metro Dr., Suite 400

Bloomington, MN 55425

952-854-3306

1-877-787-2847 (toll free)

www.stratishealth.org

For More Support

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