http://dn58412/is531/is531_sp15.html lecture 4 electronic health record (chapter 14)

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Lecture 4Electronic Health Record

(Chapter 14)

Learning Objectives . . .Learning Objectives . . .

1. Define electronic health record (EHR).2. Define electronic medical record (EMR).3. Define computer-based patient record

(CPR).4. Similarities and differences between

the EHR, EMR, and the CPR.5. 12 attributes of the CPR for today’s

EHR.

IS 531 : Lecture 4 2

Learning ObjectivesLearning Objectives

6. Meaningful Use and the adoption and use of the EHR in health care industry

7. Benefits associated with the EHR.8. Concerns in implementation of the

EHR.9. Current status of the EHR.


Electronic Patient Record Electronic Patient Record (EPR) (EPR)

• Relevant info for the current episode of care

• Not necessarily a lifetime record


Electronic Medical Record Electronic Medical Record (EMR)(EMR)

• Legal record created in hospitals and ambulatory environments that is the source of data for the EHR.

• Single encounter/episode of treatment, no info from previous visits or to future visits

• Structured data (predefined format with discrete data

• Unstructured data (text report)• Electronic imaging (ultrasonography, MRI)


*EMR Components**EMR Components*

• Results reporting• Data repository• Decision support• Clinical messaging and e-mail• Documentation• Order entry


Electronic Health Record Electronic Health Record (EHR)(EHR)

• Longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting

• Interoperability standards to exchange info outside a single healthcare delivery system

• Supports other care-related activities directly or indirectly—evidence-based decision support, quality management, and outcomes reporting


Levels of Automation . . .Levels of Automation . . .

• Stage 0: Not all ancillary systems (Lab, X-ray, Pharmacy) are operational

• Stage 1: Major ancillary clinical systems installed

• Stage 2: A clinical data repository(CDR) stores info from major ancillary clinical systems

• Stage 3: Basic clinical documentation required, CDR storage retrieval (picture archiving communication systems-PACS)


. . . Levels of Automation. . . Levels of Automation

• Stage 4: Computerized provider order entry(CPOE), support for evidence-based practice

• Stage 5:Barcode medication administration (BCMA), radio frequency identification (RFID) integrated with CPOE and pharmacy

• Stage 6:—Full physician documentation, decision support, alerts, full PACS

• Stage 7:—Fully electronic paperless environment


Computer-Based Patient Computer-Based Patient Record (CPR)Record (CPR)

• Comprehensive lifetime record • Attributes identified by the Institute of

Medicine (IOM) provide the basis for today’s understanding of the EHR


EHR Attributes . . .EHR Attributes . . .

• Secure, reliable access where and when needed

• Records and manages episodic and longitudinal information

• Primary information source during care• Assists with planning and delivery of

evidence-based care


. . . EHR Attributes. . . EHR Attributes

• Captures data for: – Quality improvement– Utilization review– Risk management – Resource planning– Performance management


. . . EHR Attributes. . . EHR Attributes

• Captures information needed for medical record and reimbursement purposes

• Longitudinal, masked information supports clinical research, public health reporting, and population health initiatives

• Supports clinical trials and evidence-based research


Continuity of Care Continuity of Care Document (CCD) Document (CCD)

• Intended to improve continuity of care when clients move between various points of care

• Comprised of summaries from many types of caregivers

• “Snapshot,” not a comprehensive record



• Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and

reduce health disparities Engage patients and family Improve care coordination, and

population and public health Maintain privacy and security of patient

health information

Meaningful UseMeaningful Use


•Meaningful use compliance will result in: Better clinical outcomes Improved population health outcomes Increased transparency and efficiency Empowered individuals More robust research data on health systems

•Meaningful use sets specific objectives that eligible professionals (EPs) and hospitals must achieve to qualify for Centers for Medicare & Medicaid Services (CMS) Incentive Programs.http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives

Meaningful Use …Meaningful Use …

. . .Meaningful Use. . .Meaningful Use• Penalties imposed for failure to achieve

Meaningful Use by 2015• Stage 1: electronic capture and sharing

health info in coded format, use it to track conditions and coordinate care (Cf. Box 14-1,2, pp.281-282)

• Stage 2: Ability to use HIT at the point of care

• Stage 3: improvement in safety, quality, efficiency and expanded HER functionality.


General Benefits of the EHRGeneral Benefits of the EHR• Improved data integrity:

– readable, better organized, accurate, complete• Improved productivity:

– access data whenever, wherever for timely decision

• Increased quality of care: – tailored views, “dash-board”

• Increased satisfaction for caregivers:– easy access to client data and related services


Nursing BenefitsNursing Benefits

• Decreased redundant data collection• Allowed data comparison from prior visits• Ongoing access, update record at bedside• Improved documentation and quality of

care• Supported timely decision• Etc…


Healthcare Provider BenefitsHealthcare Provider Benefits

• Better/faster/simultaneous data access• Improved documentation, reporting• Prompted to ensure administration of

treatments and medications• Supported automation of critical pathways /

workflows• Improved efficiency: eligibility, early

warning of status changes


Healthcare Enterprise BenefitsHealthcare Enterprise Benefits

• Better record security • Fewer lost records• Instant notice of eligibility/procedure

authorization• Decreased need and cost for record storage,

x-ray film, filing …• Decreased length of stay due to waiting• Faster turnaround for accounts • Increased compliance with regulatory

requirements


Patient Benefits . . .Patient Benefits . . .

• Decreased wait time for treatment• Increased access/control over health

information• Increased use of best practices/decision

support • Increased ability to ask informed questions• Quicker turnaround time for ordered

treatments


. . . Patient Benefits. . . Patient Benefits

• Greater clarity to discharge instruction• Increased responsibility for own care• Alerts and reminders for appointments and

scheduled tests• Increased satisfaction and understanding of

choices

• Issue: When a patient could access his/her own health information like in other online services ? (Pros, Cons)


Driving Forces for EHRDriving Forces for EHR

• Compliance with regulatory and reimbursement issues

• Meaning Use to improve the quality of care


Issues in EHR ImplementationIssues in EHR Implementation

• Electronic Infrastructure• Common Vocabulary• Data Integrity• Master File Maintenance• Data Ownership• Privacy & Confidentiality• Development / Maintenance Costs• Caregiver Resistance• Timeline for Implementation


* Electronic Infrastructure ** Electronic Infrastructure *

• Requires a linkage of various HIS via a network infrastructure

• Agreement on nature and format of client data to be stored, exchanged, and retrieved by various internal/external stakeholders

• Data communication standards• Interoperability, comparability, POC data

capture of longitudinal electronic record• “Master Patient Index (MPI)”: a universal

client identifier.


* Standard Vocabulary ** Standard Vocabulary *

• To generalize research findings across settings, countries

• To compare patient outcomes from may sources

• To facilitate communication with other disciplines and delivery systems


* Data Integrity ** Data Integrity *

• Due to incorrect entry, data tampering, system failure

• Data may be entered/modified from may different encounters

• “Input mask” to safeguard against incomplete / erroneous entry

• “Audit trail”: tracking who, when, what changes in each data element

• Policies and procedures for update/ modify/ recover data


* Master File Maintenance ** Master File Maintenance *

• Frequent update and maintenance • Major system updates may change database

structure : version control to avoid data lost• “Version control”: backup data from old

system until new system functions properly


* Data Ownership ** Data Ownership *

• Paper medical records are the property of the creators with full responsibilities: storage, accuracy

• Many providers share / update the same electronic data in many sites, who is the responsible owner in HER ?

• Meaning Use: patients “own” their data and should have full access


* Privacy & Confidentiality ** Privacy & Confidentiality *

• The easy of data sharing by many people/facilities/agencies may compromise privacy and confidentiality of patient data

• “Access control”: user-IDs, passwords, authorized access level (Create, Read, Update, Delete)

• Private encryption keys, biometric authentication

• “Electronic Signature”: system automatically and permanently affixes user identification, date and time log to each entry


* Development/Maintenance Costs ** Development/Maintenance Costs *

• For a provider office: ~ $54,000.00• For a hospital: ~ 5,000.000.00• Not include annual maintenance cost• Need “incentives”


* Caregiver Resistance ** Caregiver Resistance *

• EHRs are perceived as lacking essential features and awkward/inconvenience to use

• Some people have been unable / unwilling to use computers !

• Professionals don’t want to change their “familiar”, “traditional” practices

• Rather pay penalties than bear EHR implementing cost

• May even refuse patients• Need “incentives”


* Timeline for Implementation ** Timeline for Implementation *

• Rushing to meet the deadline may commit to a poor purchasing decision

• May sacrifice patient safety• Should prepare for culture changes, work

redesign in the institution


Current StatusCurrent Status

• Bush called for adoption of the EHR by 2014.

• Departments of Defense, Health and Human Services, Veterans Administration, and Centers for Medicare and Medicaid Services mandated the EHR for their facilities and operations.


SummarySummary

• Most of the potential benefits associated with the use of health information technology are contingent upon the implementation of the EHR.


http://dn58412/is531/is531_sp15.html lecture 4 electronic health record (chapter 14)

Documents

ehr attributes

todays ehr

based care

pacs stage

pharmacy stage

source of data

operational stage

evidencebased practice