comp6 unit3a lecture slides

Health Management Information Systems

Electronic Health Records

Lecture aThis material Comp6_Unit3a was developed by Duke University, funded by the Department of Health and Human Services,

Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.

Electronic Health RecordsLearning Objectives

2

1. State the similarities and differences between an electronic medical record (EMR) and electronic health record (EHR) (Lecture a)

2. Identify attributes and functions of an EHR (Lecture a)3. Describe the perspectives of health care providers and the public

regarding acceptance of or issues with an EHR, which can serve as facilitators of or major barriers to its adoption (Lecture a)

4. Explain how the use of an EHR can affect patient care safety, efficiency of care practices, and patient outcomes (Lecture a)

Health IT Workforce Curriculum Version 3.0/Spring 2012

Health Management Information Systems Electronic Health Records

Lecture a

Electronic Health RecordsLearning Objectives

3

4. Discuss how Health Information Exchange (HIE) and Nationwide Health Information Network (NHIN) impact health care delivery and the practice of health care providers (Lecture b)

5. Outline issues regarding governmental regulation of EHR systems, such as meaningful use of interoperable health information technology and a qualified R (Lecture b)

6. Summarize how the Institute of Medicine’s Vision for 21st Century Health Care and Wellness may impact health management information systems (Lecture b)

7. Identify how ongoing developments in biomedical informatics can affect future uses and challenges related to health information systems (Lecture b)



Lecture a

Purpose of a Patient (Medical) Record

4Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture a

• “To recall observations, to inform others, to instruct students, to gain knowledge, to monitor performance, and to justify interventions”

• Serves as the legal business record

Electronic Medical Record (EMR)

• Electronic record of health-related information on an individual– Within one health care organization


Health Management Information SystemsElectronic Health Records

Lecture a

EMR Purpose

• Provide an electronic equivalent of an individual’s legal medical record – Intra-organizational



Lecture a

Electronic Health Record (EHR)

• Electronic record of health-related information on an individual– Across more than one health care

organization



Lecture a

EHR Purpose

• Provide an electronic equivalent of an individual’s health record for use by providers and staff across more than one health care organization

• Support efficient, high-quality integrated health care, independent of the place and time of health care delivery



Lecture a

EMR Versus EHR

EMR EHRA record of medical care created, managed, and maintained by one health care organization (intra-organizational)

A repository of individual health records that reside in numerous information systems and locations (inter-organizational)

Integration of health care data from a participating collection of systems from one health care organization

Aggregation of health-related information into one record focused around a person’s health history, i.e., a comprehensive, longitudinal record

Consulted by authorized clinicians and staff within one health care organization.

Consulted by authorized clinicians and staff across more than one health care organization

Data continuity throughout one health care organization

Data interoperability across different organizations

Table 3.1 EMR and EHR Comparison



Lecture a

EHRs Versus Paper Records

• EHRs can make a patient’s health information available when and where it is needed

• EHRs can bring a patient’s total health information together in one place, and always be current

• EHRs can support better follow-up information for patients

• EHRs can improve patient and provider convenience



Lecture a


• EHRs – Can link information with patient computers to

point to additional resources– Don’t just “contain” or transmit information,

they also compute with it – Can improve safety



Lecture a


• EHRs can– Deliver more information in more directions

• While reducing “paperwork” time for providers – Improve privacy and security– Reduce costs



Lecture a

Attributes of an EHR

• Provides secure, reliable, real-time access to patient health record information, where and when it is needed to support care

• Captures and manages episodic and longitudinal electronic health record information



Lecture a

Attributes continued• Functions as clinicians’ primary information

resource during the provision of patient care• Assists with the work of planning and delivering

evidence-based care to individual and groups of patients

• Supports continuous quality improvement, utilization review, risk management, and performance monitoring



Lecture a

Attributes continued

• Captures the patient health-related information needed for reimbursement

• Provides longitudinal, appropriately masked information to support clinical research, public health reporting, and population health initiatives

• Supports clinical trials



Lecture a

HL7 EHR Functions

• Direct care functions• Supportive functions• Information infrastructure functions



Lecture a

Direct Care Functions

Subset ExamplesCare management Identify and maintain a patient record

Manage patient demographicsManage problem lists

Clinical decision support Support for standard care plans, guidelines, protocolsSupport for medication and immunization administration Orders, referrals, results and care management

Operations Management and Communication

Clinical workflow taskingSupport clinical communicationSupport for provider-pharmacy communication

Table 3.2HL7 2007 EHR-S Functional Model Direct Care Functions Subsets with Examples



Lecture a

Supportive Functions

• Clinical Support• Measurement, Analysis, Research and

Reports• Administrative and Financial



Lecture a

Information Infrastructure Functions

• Security• Health record information and management• Registry and directory services• Standard terminologies and terminology services• Standards-based interoperability• Business rules management and Workflow management



Lecture a

Standards for Certification of EHR Technology

• Content exchange standards– NCPDP SCRIPT Standard – HL7 Clinical Document Architecture (CDA), CCD

• Vocabulary standards– SNOMED CT– LOINC

• Privacy and security standards– NIST encryption algorithm– NIST hashing algorithm



Lecture a

EHR Acceptance

• Health care provider– Increasing momentum for widespread

adoption and implementation of EHRs• ARRA/HITECH• Authorized Testing and Certification Body by the

Office of the National Coordinator



Lecture a

EHR Acceptance

• Public– Harris Interactive Survey from 2005

• Mixed Feelings– 45% EHR system important

• Concern over – Privacy – Increase rather than decrease of medical errors



Lecture a

EHR Acceptance: Public• Harris Interactive Survey

– All physicians treating me should have access to information contained in my EMR

• Percent answering "Strongly/Somewhat Agree"– 78% in 2009 – 78% in 2010

– An EMR would be a valuable tool to track the progress of my health

• Percent answering "Strongly/Somewhat Agree"– 72% in 2009 – 71% in 2010



Lecture a

Barriers to Adoption

• Cost of conversion• Perceived lack of ROI• Technical and logistical challenges• Privacy and security concerns



Lecture a

EHR Effect on Patient Care Safety

• Reduces the need to repeat tests• Reduces the number of lost reports• Supports provider decision making



Lecture a

EHR Effect on Efficiency

• Improves accessibility of patient information

• Integrates data from multiple internal and external sources

• Facilitates the co-ordination of health care delivery



Lecture a

EHR Effect on Patient Outcomes

• Has the potential to • Improve the quality of patient care• Help providers practice better medicine• Provide seamless exchange of information among

providers



Lecture a

Electronic Health RecordsSummary – Lecture a

28

• Defined an EMR and EHR• Explained similarities and differences• Identified EHR attributes and functions• Discussed the issues surrounding EHR

adoption and implementation• Described the impact of EHRs on patient

care



Lecture a

Electronic Health RecordsReferences – Lecture a



Lecture a

References• AHIMA e-HIM Work Group on Maintaining the Legal EHR. (2005). Update: Maintaining a legally sound health

record—paper and electronic. Journal of AHIMA 76(10), 64A-L. Retrieved from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_028509.hcsp?dDocName=bok1_028509

• Blumenthal, D. (2009, April 9). Stimulating the adoption of health information technology. New England Journal of Medicine 360,1477-1479. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMp0901592

• Handler, T., Holtmeier, R., Mtezger, J., Overhage, M., Taylor, S., & Underwood, C. (2003, July 7). HIMSS electronic health record definitional model version 1.0. Retrieved from http://www.providersedge.com/ehdocs/ehr_articles/HIMSS_EMR_Definition_Model_v1-0.pdf

• Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule, 45 CFR Part 170 (July 28, 2010). Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf

• Harris Interactive. (2010, June 17). Few Americans using 'E-' medical records. Retrieve from http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/ctl/ReadCustom%20Default/mid/1508/ArticleId/414/Default.aspx

• Health Level Seven International. (n.d.). About HL7. Retrieved from http://www.hl7.org/about/index.cfm?ref=nav• Health Level Seven International. (2007). HL7 2007 EHR-S functional model. Retrieved from

http://www.hl7.org/ehr/downloads/index_2007.asp• Radiological Society of North America. (2005, September). IHE moves EHR goals forward. Retrieved from

http://www.rsna.org/Publications/rsnanews/sep05/ihe.cfm

Electronic Health RecordsReferences – Lecture a



Lecture a

References • Reiser, S. J. (1991). The clinical record in medicine. Part 1:Learning from cases. Annals of Internal Medicine, 114,

902-907. • The National Alliance for Health Information Technology. (2008, April 28). Defining key health information

technology terms. Retrieved from healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_848133_0_0_18/10_2_hit_terms.pdf

• U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2010, July13). Electronic health records at a glance. Retrieved from https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3788&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=false&cboOrder=date

Charts, Tables, Figures 3.1 Table: EMR and EHR Comparison3.2 Table: HL7 2007 EHR-S Functional Model Direct Care Functions Subsets with Examples

comp6 unit3a lecture slides

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