electronic health records

Electronic Health Records &

Public Health Informatics

By Aakifa Ishtiaq, SEECS, NUST

Practitioners use records to capture their clinical findings and conclusions

Until recently, medical records have been captured on paper and are the property of the recording provider

“To Err Is Human” – many misconceptions resulting in lapse in patient care

Background

An evolving concept defined as the systematic collection of electronic health information about individuals and populations that can be transferred between health care centers.

Electronic Health Record

The systematic application of information science, computer science and technology to public health practice, research and learning

Public Health Informatics

Paper charts are neither interactive nor intuitively designed

Printed reminders and cautions can be easily overlooked

Physicians are notorious for illegible handwriting-as less as 65% of the written medical charts can be fully read

Disadvantages of Paper Records

No data sharing - written records remain in the providers office

Take a lot of space

Disorganization or disaster in office can result in information loss

Intuitive formatting and enhanced interaction

Eliminating unnecessary procedures reducing health care expenditures

Greater co-ordination and data sharing

No data loss

Helper applications-provide patient specific feedback in real time

Advantages of EHR

Provides alerts to the doctor to health needs or relevant research

Improved decisions on part of the clinician

Empowers patient in self management of chronic diseases

Helps track prior medical history and treatment of the patient

Collaboration between patient and doctor

Expensive software and computer purchase

Software maintenance expense

Dependent upon reliable operation

Disadvantages of EHR

Loss of revenue

Local vs. global perspective

Security

Learning curve

Overconfidence in personal physician skill

Factors for slow acceptance of EHR

Info-buttons

Computerized Provider Order Entry

Clinical Decision Support

Personal Health Record

Clinical Data Repository

Tools in EHR

Contact specific links from one information system to another resource

Provide relevant contextual information

significantly increase the percentage of met information needs at the point of care

Info-buttons

Allows provider orders to be written electronically either in the hospital or out-patient settings

Eliminates hand writing misinterpretation

Computerized Provider Order Entry(CPOE)

Provides intelligently filtered clinical knowledge and patient related information

Improves patient care

CPOE and CDS often work in tandem to ensure patient is being treated appropriately

Clinical Decision Support(CDS)

Enables the patient to keep track of their own personal health information

Provides educational material to assist in self management of chronic disease

Enables patients to take input from home monitoring devices such as glucometers, blood pressure monitors, etc

Personal Health Record(PHR)

Telemedicine allows communication of medical information to remote provider for consultation.

frequency of required appointments for a patient can be determined

Improves quality of care

Reduces cost through cost avoidance

The database that stores all the health information of the EHR

Clinical Data Repository(CDR)

One of the vital features of EHR

Readable data is dependent upon adherence to standards

Absence of robust standards could undermine the benefits of EHR adoption altogether

Standards have been developed for adoption by EHR vendors and RHIO members to allow data to be exchanged between systems in RHIO

Standardization

CCHIT - the only certification body endorsed to evaluate EHR’s for adherence to standards.

IHE Eye care Connectathons - test interoperability of equipment and EHR’s to determine how well they integrate

Health Level 7 (HL7) - a series of standards designed to allow data exchange and interoperability of EHR’s.

DICOM - centered on medical imaging

Standards in EHR

Registries

Disease Surveillance Systems

Geographic Information System

Tools in Public Health Informatics

Databases used to track patients:

a particular disease

exposure to risk factor

those who have undergone certain procedure

Registries

Estimating incidence

Providing a population for researchers to study

Trending a disease’s impact over time

Uses

Ongoing systematic collection, analysis and interpretation of health related data essential to planning, implementation and evaluation of public health practice

Disease Surveillance Systems

Evaluate threats to public health

Detect epidemics

Generate research questions

Assess current attempts to control health threats

To stay on top of changes in infectious agents or health practices

Uses

Tracking patients relative to their location

Ease spatial tracking in public health

Global Information System

In infectious disease tracking

Applications where spatial information is relevant e.g.

Sheen’s evaluation of costs

Benefits of optometric referrals in Wales

Uses

EHR will dramatically change the way in which clinicians practice

Enable creation of more legible records helpful for multiple practitioners

CDR and RHIO will act as a bridge enabling team work in patient care

Safeguarding populations from outbreaks

Conclusion

ELECTRONIC HEALTH RECORDS AND PUBLIC HEALTH INFORMATICS By Kevin M. Jackson, OD, MPH, FAAO, CDR, MSC, USN http://webpages.charter.net/oldpostpublishing/oldpostpublishing/Section%202,%20Principles%20of%20Public%20Health/Sect%202,%20Electronic%20Health%20Records%20and%20Public%20Health%20Informatics%20by%20Jackson.pdf

Reference