Week 4 Healthcare Informatics Podcast

Copyright © 2021 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.

CHAPTER 11

The Electronic Health Record and Clinical Informatics

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Objectives

 Describe the common components of an electronic health record.

 Assess the benefits of implementing an electronic health record.

 Explore the ownership of an electronic health record.

 Evaluate the flexibility of the electronic health record in meeting the needs of clinicians and patients.

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History of Adoption of Electronic Health Records

 In January 2004, President Bush raised the profile of electronic health records in his State of the Union address by outlining a plan to ensure that most Americans would have an electronic health record by 2014.

 This goal was reaffirmed by President Obama.

 The American Recovery and Reinvestment Act of 2009 (ARRA) includes the HITECH Act and sought to specifically incentivize health organizations and providers to become meaningful users of EHRs.

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ARRA Requirements

 Providers and hospitals must use a certified EHR that meets a set of standard functional definitions to be eligible for the increased reimbursement incentive.

 DHHS initially granted two organizations the authority to accredit EHRs: the Drummond Group and the Certification Commission for Healthcare Information Technology.

 In 2015, there were 5 recognized bodies for testing and certifying EHRs (HealthIT.gov 2015a).

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Certification Criteria

 Developed by the National Institute of Standards and Technology (NIST)

 Each iteration of testing procedures seeks to make the EHR more robust and functional to meet the needs of patients and users.

 Current certification criteria were developed in 2015 and can be viewed at this website https://www.healthit.gov/topic/certification-ehrs/2015-edition-test-method

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EHR Adopted in Stages

 Higher stages of the electronic medical record adoption model include more sophisticated use of decision support tools and medication administration tools, with Stage 7 consisting of EHRs that have data sharing and warehousing capabilities and complete interface with emergency and outpatient facilities (HIMSS Analytics, 2015).

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Definition of EHR

 A data warehouse or repository of information regarding the health status of a client, replacing the former paper-based medical record

 The systematic documentation of a client’s health status and health care in a secured digital format, meaning that it can be processed, stored, transmitted, and accessed by authorized interdisciplinary professionals for the purpose of supporting efficient, high-quality health care across the client’s healthcare continuum.

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Essential Components (1 of 3)

 Health information and data: the patient data required to make sound clinical decisions, including demographics, medical and nursing diagnoses, medication lists, allergies, and test results (IOM, 2003).

 Results management: the ability to manage results of all types electronically, including laboratory and radiology procedure reports, both current and historical (IOM, 2003).

 Order entry management: the ability for a clinician to enter medication and other care orders directly into a computer, including laboratory, microbiology, pathology, radiology, nursing, supply orders, ancillary services, and consults (IOM, 2003).

 Decision support: the computer reminders and alerts to improve the diagnosis and care of a patient.

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Essential Components (2 of 3)

 Electronic communication and connectivity: the online communication among healthcare team members, their care partners, and patients, including e-mail, web messaging, and an integrated health record within and across settings, institutions, and telemedicine (IOM, 2003).

 Patient support: the patient education and self-monitoring tools, including interactive computer-based patient education, home telemonitoring, and telehealth systems (IOM, 2003).

 Administrative processes: the electronic scheduling, billing, and claims management systems, including electronic scheduling for inpatient and outpatient visits and procedures, electronic insurance eligibility validation, claim authorization and prior approval, identification of possible research study participants, and drug recall support (IOM, 2003).

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Essential Components (3 of 3)

 Reporting and population health management: the data collection tools to support public and private reporting requirements, including data represented in a standardized terminology and machine-readable format (IOM, 2003).

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Health Level Seven International (HL 7)

 Also focuses on EHR standards and functionality

 Concentrates on developing the behind-the-scenes programming standards (Level seven is the application level of the Open Systems Interconnection model) for interfaces to ensure interoperability and connectivity among systems.

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Benefits of EHR

 Better health care by improving all aspects of patient care, including safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency, and equity. (HealthIT.gov 2014)

 Better health by encouraging healthier lifestyles in the entire population, including increased physical activity, better nutrition, avoidance of behavioral risks, and wider use of preventative care.

 Improved efficiencies and lower healthcare costs by promoting preventative medicine and improved coordination of healthcare services, as well as by reducing waste and redundant tests.

 Better clinical decision making by integrating patient information from multiple sources.

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EHR Benefits to Patients

 Personal access to records

 Ability to correct incorrect information

 Patient portals, access to physicians

 Secure information exchange, maintenance reminders for chronic illness care

 Identifying medication interactions

 Big data for population health management

 Greater efficiency and quality of care resulting in cost savings

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Standard EHR Administrative and Reference Terminologies

 ICD_10 International Classification of Diseases version 10: medical diagnosis code set

 CPT Current Procedural Terminology: used to code procedures for billing

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Clinical Terminologies

 SNOMED-CT Systematized Nomenclature of Medicine: comprehensive clinical terminology

 LOINC Logical Observation Identifier Names and Codes: universal codes for laboratory and clinical observations

 RxNorm: terminology system for drug names providing links to drug vocabularies and interaction software

 For updates: https://www.nlm.nih.gov/hit_interoperability.html

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Standardizing Terminologies

 Important to support interoperability and information exchange.

 Unified Medical Language System® (UMLS®) and the Metathesaurus® support terminology integration efforts and online searches (not a terminology system).

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Ownership

 The process of becoming a successful owner of an EHR has multiple steps and requires integrating the EHR into both the organization’s day-to-day operations and long-term vision, and the clinician’s day-to-day practice.

 The first step of ownership is typically a vendor selection process.

 EHR certification ensures that a quality product will be selected.

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System Selection

 Select a system based on the organization’s current and predicted needs.

 The criteria should include both subjective and objective items that cover topics such as common clinical workflows, decision support, reporting, usability, technical build, and maintenance of the system.

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Implementation

 Implementation planning should occur concurrently with the selection process, particularly the assessment of the scope of the work, initial sequencing of the EHR components to be implemented, and resources required.

 The implementation plan should also account for the long-term optimization of the EHR.

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Flexibility and Expandability (1 of 2)

 Financial and patient privacy hurdles must also be overcome to achieve an expansive EHR.

 The Department of Health and Human Services recently loosened regulations so that physicians may now be able to receive healthcare IT software, hardware, and implementation services from hospitals in an effort to alleviate the cost burden on individual providers and foster adoption of the EHR.

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Flexibility and Expandability (2 of 2)

 Patient privacy is a pivotal issue to determining how far and how easy it will be to share data across healthcare organizations.

 For health information exchanges to reach their full potential, the public must be able to trust that their privacy will be protected, or else the healthcare industry risks that patients may not share a full medical history, or worse yet, may not seek care, effectively making the exchange useless.

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Future

 Despite the challenges, the future of EHRs is an exciting one for patient and clinician alike.

 Benefits may be realized by stand-alone EHRs as described here, but the most significant transformation will come as interoperability is realized between systems.

 There is a wealth of descriptive data available pointing to the benefits of an EHR.

 Healthcare professionals must stay engaged in the evolution of EHRs and help shape their direction.

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Thought-Provoking Questions

 What are the implications for healthcare professional education as the electronic health record (EHR) becomes the standard for caring for patients?

 What are the ethical considerations related to interoperability and a shared electronic health record?

 You are asked about a diagnosis with which you are unfamiliar. Where would you start looking for information? How would you determine the validity of the information?

 Think about the documentation and knowledge management functions of your specialty. If you had the opportunity to create a wish list, what would you include in an EHR to support your work?

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References

 HealthIT.gov. (2015a). Certification Bodies and Testing Laboratories. http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-lab oratories

 Healthcare Information and Management Systems Society (HIMSS) Analytics. (2015). EMRAM stage criteria. http://www.himssanalytics.org/research/emram-stage-criteria

 Healthcare Information and Management Systems Society (HIMSS). (2009). HIMSS Davies Organizational Award application: MultiCare. Retrieved October 2010 from https://www.himss.org/2009-davies-organizational-award-winner-multicare

 Institute of Medicine (IOM). (2003). Key capabilities of an electronic health record system: Letter report. Washington, DC: National Academies Press.