18 pages-Single-spaced-Class Journal

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IS531_Lecture-4.ppt

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Lecture 4

Electronic Health Record

(Chapter 14)

Learning Objectives . . .

Define electronic health record (EHR).

Define electronic medical record (EMR).

Define computer-based patient record (CPR).

Similarities and differences between the EHR, EMR, and the CPR.

Attributes of the CPR for today’s EHR.

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Learning Objectives

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

Benefits associated with the EHR.

Concerns in implementation of the EHR.

Current status of the EHR.

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Electronic Patient Record (EPR)

Relevant info for the current episode of care

Not necessarily a lifetime record

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Electronic Medical Record (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)

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*EMR Components*

Results reporting

Data repository

Decision support

Clinical messaging and e-mail

Documentation

Order entry

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Electronic Health Record (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

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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)

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. . . 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

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Computer-Based Patient Record (CPR)

Comprehensive lifetime record

Attributes identified by the Institute of Medicine (IOM) provide the basis for today’s understanding of the EHR

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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

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. . . EHR Attributes

Captures data for:

Quality improvement
Utilization review
Risk management
Resource planning
Performance management

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. . . 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

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Continuity of Care 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

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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 Use

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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 …

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. . .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.

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General 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

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Nursing 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…

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Healthcare 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

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Healthcare 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

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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

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. . . 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)

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Driving Forces for EHR

Compliance with regulatory and reimbursement issues

Meaning Use to improve the quality of care

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Issues in EHR Implementation

Electronic Infrastructure

Common Vocabulary

Data Integrity

Master File Maintenance

Data Ownership

Privacy & Confidentiality

Development / Maintenance Costs

Caregiver Resistance

Timeline for Implementation

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* 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.

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* 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

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* Data Integrity *

Due to incorrect entry, data tampering, system failure

Data may be entered/modified from many 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

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* 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

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* 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

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* 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

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* Development/Maintenance Costs *

For a provider office: ~ $54,000.00

For a hospital: ~ 5,000.000.00

Not include annual maintenance cost

Need “incentives”

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* 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”

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* 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

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Current 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.

From Obamacare to “Nobodycare” !!!

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Summary

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

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