HI Unit 2 Seminar Option 2
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HI300Unit2.pptWEEK 2 SEMINAR
HI300 - Unit 2
Adapted from AHIMA Press
AGENDA
Week 1 Review
Announcements and Reminders
Week 2 Topics Overview
Week 2 Assignments
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Read the Unit 2 Reading Resources
Participate on the Discussion Board
Attend Seminar
Complete the Unit 2 Assignment
Unit 2- What Should You Be Doing?
Introduction
- American Recovery and Reinvestment Act of 2009’s definition of “qualified EHR”:
A qualified EHR “includes 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 health information with and integrate such information from other sources.”
EHR VS. EMR
- Electronic Health Record (EHR)
- An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization.
- Electronic Medical Record (EMR)
- An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization.
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EHR Systems
- Begins with acquiring source systems. Source systems supply the EHR and other applications with data.
- Examples of Source Systems:
- Administrative and Financial Systems
- Registration, admission, discharge and transfer (R-ADT)
- Patient financial systems (PFS)
- Many of these transactions mandated HIPAA, Affordable Care Act
- Ancillary or Departmental Systems
- Laboratory Information Systems
- Radiology Information Systems
- Pharmacy Information Systems
Core EHR Applications
- 5 components to consider with EHR
Results management: enables diagnostic study of results to be reviewed as a report and processed. Allows users to compare, trend and graph results. Lab results most common.
Clinical documentation: Point of care charting. Use of templates to gather patient information.
Closed-loop medication management: ensures patient safety from beginning to end (ordering drug ---- administering drug). E-prescribing, medication reconciliation, Medication 5 Rights
Clinical decision support : helps physicians, nurses and other clinical staff make decisions about patient care
Analytical Reporting : Processing data to reveal new information. EHR can provide more robust functions to analyze data
Evolution of EHR
- In 1980s, the Institute of Medicine recommended new technologies were needed to improve state of medical records.
- Quality of care and patient safety focal points!
- Many hospitals started early!
- Physicians wanted electronic access from their offices to the hospital’s labs to view test results.
- Frustration grew with the hybrid record. Document imaging came into play.
- Then came…. Electronic signatures, digital dictation
- Hospital EHR implementation more complex than physician offices.
Transition State
- EHR’s are still being implemented
- Many offices have a hybrid record
- Many organizations still print everything
- Some organizations scan all paper documents
Health Information Technology For Economic And Clinical Health (HITECH)
https://www.youtube.com/watch?v=GzeUKKWvC0o
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Health Information Technology For Economic And Clinical Health (HITECH)
- Government Initiative - Made ONC (Office of the National Coordinator) permanent
2004 – ONC promoted adoption of EHR through supporting regulatory exceptions to anti-kickback laws so that hospitals could make limited donations of EHRs to physicians. Instead, vendor products went through a certification process and were evaluated against a set of non-biased standards.
ONC has a YouTube Channel with lots of great information! https://www.youtube.com/user/HHSONC
Health Information Technology For Economic And Clinical Health (HITECH)
- Meaningful Use (MU incentive program)
Ability to demonstrate quality improvement through use of EHR.
Promotes health information exchange.
After 2014 sanctions for those who have not adopted an EHR.
Downward adjustment to Medicare reimbursements.
Doesn’t require a complete EHR to be considered MU.
Local Efforts And Challenges
- EHR vendors
May not be able to keep up with demand
Meeting HL7 EHR system functional requirements
Interoperability
Meaningful use
ICD-10-CM
Healthcare Professionals
- Many physicians may not be interested in EHR
- Mobile devices may be first step toward implementing technology
- Another early step is e-prescribing
- Nursing and allied health professionals seek organizations with EHR
Patients
- Until now, patients have had little interaction with EHR
- Patient may be concerned about privacy and security
- Many organizations are educating patients on the EHR and allowing them to:
Schedule appointments
Pay bills
Educational material
Informed consents
Enter health history
E-visit
Data Exchange Standards
- Different databases may be located in different systems but need to exchange data.
- Data exchange should ensure vocabulary standards and data comparability .
- Health Level Seven (HL7)
Family of standards that aid exchange of data
- Digital Imaging and Communications in Medicine (DICOM)
- Helps exchange x-rays, CT scans
- National Council for Prescription Drug Programs (NCPDP)
Physician practice electronic prescribing system to retail pharmacy
Data Compatibility Standards
- Ensuring meaning of term is consistent across users
- Semantics
- Semantic interoperability
- Standard vocabulary
- Controlled vocabulary
Data Capture Technology
- Technologies that make data capture easier
Discrete data entry through point-and-click fields, drop down menus, structured templates, or macros
Speech and handwriting recognition
Handheld and wireless devices
Direct data capture from a medical device attached to a patient
Patient data entry
Natural language processing
Acquisition Of EHR Systems
- Requires extensive planning and organization
- Readiness assessment
Determine barriers
Lack of appreciation for EHR
Costs
EHR IMPLEMENTATION ISSUES
- May need staff trained in health informatics
- Very time consuming
- Adoption
- Training
- Executive support
- Patient’s concern for privacy and security
- Legal and regulatory matters
- E-prescribing
PLANNING
- Planning includes:
Organizing the project
Developing a migration path
Communicating to stakeholders
Developing a strategy and plan to manage change
- EHR steering committee
- Staff required
IT staff
Support staff
Project manager
- Migration path
EHR SELECTION
- Best of fit
- Dual core
- Best of breed
- Rip-and-replace
INFORMATION MANAGEMENT IN AN ELECTRONIC ENVIRONMENT
- New roles for HIM professionals
Data analysts
Information brokers
Data set developers
Data miners
Workflow analysts
Data security managers
Database administrators
DATA QUALITY
- AHIMA Data Quality Model
- EHR increases potential for poor data quality
Copy and paste
Macros
Standard orders
Others techniques that “reuse” data
- Potential for discrepancies between comment fields and structured data
DATA QUALITY
- Determining if entries are made by authorized individuals
Sharing passwords
- Handling amendments, corrections, and deletions
RETENTION
- States generally allow destruction after 7 to 10 years from time records was created and last used
Exception is records of minors
- Electronic records consume little space
- Electronic media is durable but concerns regarding readability of old media
ADMISSIBILITY
- Printed electronic record may not look like traditional record
- Electronic records will have to be printed or EHR retrieved in court
FUTURE DIRECTIONS IN INFORMATION TECHNOLOGY
- Every 18 months some form of technology is replaced with new technology.
- Will create challenges for HIM professionals
- Examples of changes
Internet and web-based technologies
Natural language processing
DISCUSSION BOARD TIPS
Search the Web for information on the issue of usability and making the EHR more user friendly.
Compose a response discussing:
Some of the key issues clinicians have using today’s EHRs
The proposed means to overcome these issues?
Define meaningful use and how it relates to today’s EHR.
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ASSIGNMENT TIPS CON’T
What are the physicians trying to accomplish through buying the same EHR product at their hospital? What are the pros and cons?
Why are the physicians not able to send a medication order to the hospital from their e-prescribing device?
What is the difference between scanning, COLD feeding, and point-of-care (POC) data entry?
How could the hospital improve upon its data quality?
Consider the real world case study and what the physicians are trying to accomplish by purchasing these products. When you think about the system development life cycle, use what you learned in Unit 1 to determine how this could help in accomplishing the goals associated with this case study. Discuss each phase of the systems development life cycle and how it would impact this case.
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UNIT ASSIGNMENTS
Participate in Discussion Board
- Issues with usability in EHR
Complete Assignment
- Read Case Study, Page 1013-1014
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