Electronic Health Record Discussion Questions

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ELECTRONIC HEALTH RECORDS Understanding and Using Computerized Medical Records

CHAPTER LESSON

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Using the Internet to Expedite Patient Care

CHAPTER ELEVEN ONE

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

The Impact of Technology

• Adopting an EHR changes way clinicians work.

• Implementation of an EHR enables patient records to be used in ways that paper medical records cannot.

• Flexibility of Internet and its ability to get information to and from almost any point in a worldwide network has a lot of potential for healthcare.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

The Internet and the EHR

• Internet is influencing changes in healthcare: – People shop for doctors online. – Insurance companies provide online

participating provider lists. – Physician specialty associations, and state

and local medical societies offer web sites that help patients locate provider near them.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

The Internet and the EHR

• Internet is influencing changes in healthcare (cont.): – Patients use Internet for research. – Many medical practices have their own web

sites. – The ONC strategies call for use of technology

to make health information available to patient.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

The Internet and the EHR

• ONC Committee Recommendations – Patient access to self-management tools. – Patient access to personal health records,

populated with information in real time. – Secure patient–provider messaging. – Access to comprehensive patient data. – Participation in health information exchange

(HIE).

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Decision Support Via the Web

• Internet offers easy access to web sites that provide information.

• Important to obtain information from sites that can be depended on for accurate and quality information to guide their care.

• Medscape® (see Figure 11-2 in the text); source of objective, credible, relevant clinical information and educational tools.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Decision Support Via the Web

• Professional organization sites for other healthcare professionals are reliable sources of information on guidelines, practice standards, continuing education credits, upcoming conferences, and online networking opportunities.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 63: Internet Medical Research

• In this exercise you will need access to the Internet.

• You will visit two web sites to obtain information for patient education.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 63: Internet Medical Research

• Case Study – Arnie Greensher is a 66-year-old male who is

beginning cancer treatment. • Step 1

– Start your web browser. – Enter the following URL address:

www.careindividualized.com.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 63: Internet Medical Research

• Step 2 – Locate and click on link for Patient.

• Step 3 – Choose from any of patient information

documents; click on it. – When document is displayed, review it and

print only first page. – Give printout to your instructor.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 63: Internet Medical Research

• Case Study – Brenda Green is a 54-year-old established

patient with a history of hypertension and possible peripheral arterial disease of the legs.

– She has been prescribed Coumadin, a drug which has specific dangers.

– Follow the steps below to locate the answers to the questions in step 6.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 63: Internet Medical Research

• Step 4 – Start your web browser. – Enter the following URL address:

www.webmd.com.

http://www.webmd.com

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 63: Internet Medical Research

• Step 5 – When web page is displayed, type Coumadin

in search field; click on button labeled “Search.”

– A page of search results will be displayed. – Locate and click on link “Drug Information.” – Locate and click on link “Coumadin Oral.”

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 63: Internet Medical Research

• Step 6 – From information displayed on page answer

the following questions:  What is the generic drug name for Coumadin?  What is a very serious (possibly fatal) effect of this

drug?  What lab test is used to monitor the effect of this

drug?

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Integrated Decision Support

• Decision support: ability of EHR systems to store or quickly locate materials relevant to findings of current case.

• Decision support documents are selected and linked to system by each individual practice.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Integrated Decision Support

• Understanding the Internet – Multiple computers connected together to

exchange data in private networks that can be accessed only by users in that network (local- area networks [LAN] or wide-area networks [WAN]).

– Internet is worldwide public network that can be accessed by any computer anywhere.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Integrated Decision Support

• Understanding the Internet (cont.) – Internet is a very large network of networks. – Internet Protocol encloses data in packets

that have an address on them. – Packets are sent through various networks

making up the Internet until they arrive at their address.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Secure Internet Data

• Internet is not secure. • Encryption uses mathematical algorithm to

convert readable data into encoded or scrambled data.

• Authorized recipient decrypts message back to its original form using a mathematical key.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Secure Internet Data

• Secured socket layer (SSL) adds security by encrypting content of web pages and automatically decrypting it when it is received to display web page.

• Virtual private network (VPN) uses Internet to transport packets of data; it has its own software that encrypts and decrypts the packets between sending and receiving systems.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Remote EHR Access for the Provider

• Most secure method of connecting is through direct dial; prevents unauthorized persons from accessing system.

• Requires modem and phone line for every user who needs remote access at same time as someone else.

• Can only access the EHR from phone numbers that have been preprogrammed for modem to dial back.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Remote EHR Access for the Provider

• Remote access by using the Internet. • Allows clinician to access records from

anywhere he or she can connect to Internet.

• Security for direct access to office computer on Internet usually requires a VPN.

• Running programs over a VPN slower and complicated to set up and maintain.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Remote EHR Access for the Provider

• Remote access provided by EHR system. • Some EHR vendors have created special

software within their system that allows access and interact with the EHR through Internet via a SSL secured web site.

• Confines remote access to isolated web server instead of facility's entire network.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Remote EHR Access for the Provider

• Practicing Medicine Online

– E-health: application of Internet and other related technologies in healthcare industry to improve access, efficiency, effectiveness, and quality of clinical and business processes utilized by healthcare organizations, practitioners, patients, and consumers to improve health status of patients.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Remote EHR Access for the Provider

• Telemedicine

– Uses communication technology to deliver medical care to patient in another location; can be practiced in real time or asynchronously.

– Store-and-forward telemedicine: allows doctor requesting a consult to send case information that is saved and then reviewed and responded to later by a specialist.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Remote EHR Access for the Provider

• Telemedicine (cont.) – Store-and-forward telemedicine is not suitable

to remote, robotic, or guided surgery; all of which must be conducted in real time.

– Benefit of telemedicine is that it makes high- level medical expertise available to remote and rural areas.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Teleradiology

• Transmission of diagnostic images from one location to another.

• Purpose of having images “read” by radiologist at receiving end.

• State laws may require radiologist to be licensed by state from which images are sent.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Patient Entry of Symptoms and History

• EHR systems facilitate documentation at point of care.

• Patient is source of past medical, family, and social history, and symptoms.

• Clinician's time with patient spent entering patient's symptom into visit documentation.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Patient Entry of Symptoms and History

• Instant Medical History™, automated patient data entry component for the EHR. – Can be administered on a kiosk or Tablet PC

in waiting room, in subwaiting area, in exam room, or at home via the web.

– Physician can review information entered by patient; more time for explaining diagnosis and educating patient.

– Patient's time and effort to enter data are rewarded.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Workflow Using Patient-Entered Data

Figure 11-4: Workflow of patient entering his own data.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Workflow Using Patient-Entered Data

1. When patient arrives, receptionist, nurse, or medical assistant asks patient to complete medical history and reason for visit using computer in private area of waiting room.

2. Patient is given access to kiosk or other computer to enter his or her own history and symptom information using computer-guided questionnaire.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Workflow Using Patient-Entered Data

3. Nurse and patient review patient-entered symptoms and history together.

4. Physician examines patient and discusses reason for visit and reviews with patient HPI information now in chart. – Encounter note completed at point of care.

5. Patient given copy of encounter note along with patient education materials or prescriptions.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Improved Patient Information

• Patients willing and eager to answer computer interview about their reason for visit.

• Time doctor has saved from having to input symptoms and history can be focused fully on patient and used for counseling and education.

• Patient able to engage in mutual process of documenting visit.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• In this exercise you will take on role of patient who is completing “paperwork” for upcoming appointment online.

• You will need access to the Internet for this exercise.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Case Study – Tomas Martiniz is a 24-year-old male who

injured his knee when he jumped off a loading dock at work.

– He has an appointment at the Family Care medical clinic.

– He is going online to complete his medical questionnaire in advance.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 1 – Start your web browser program. – Follow steps listed inside the cover of this

textbook to log into MyHealthProfessionsKit. – When welcome page is displayed, click on

link “Activities and Exercises” or select it from drop-down list and click on button labeled “Go.”

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 2 – Locate and click on link Exercise 64 in the

menu on left of screen. – Information about exercise will be displayed. – Locate and click link “Click here to start the

web portal program.” – Sample provider web portal shown in Figure

11-6 will be displayed.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Workflow Using Patient-Entered Data

Figure 11-6: Simulated provider web page used for exercises in Chapter 11.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 3 – Locate section of web portal labeled “Already

have an appointment?” – Click on link “Medical Questionnaire.” – Web page, “Get started preparing for your

next doctor's visit,” will be displayed. • Step 4

– Locate and click on button labeled “Start Interview.”

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 5 – Enter the following:  Student Name or ID: Enter either your name or

student ID as directed by your instructor.  Patient Information:  First Name: Tomas  Last Name: Martiniz  Click on circle next to Male.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 5 (cont.) – Click on down arrow buttons in each of the

Date of Birth fields; select from drop-down lists: October, 7, and 1987.

– Compare your screen to Figure 11-7. – When everything entered correctly, locate and

click on button labeled “Next.”

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

Figure 11-7: Student ID and patient information portion of interview.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 6 – Reason for visit screen will be displayed. – Locate free text field (circled in red in Figure

11-8) and type: Knee pain. – When finished typing, locate and click on

button labeled “Next.”

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

Figure 11-8: Reason for visit: Knee pain.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 7 – Software at web site will conduct interview by

asking Mr. Martiniz questions listed in table, one question at a time.

– For each question there will be buttons labeled with various answers to the question.

– Additional buttons allow you to skip a question or go back to previous question.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 7 (cont.) – See Interview Question Table on text pages

437 and 438. – For each question in the table in your

textbook, locate click on indicated button. – If you make an error, click on button labeled

“Previous Question” and correct your error.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 8 – When you have reached the end of interview,

a free-text note box is displayed to allow patient to enter additional comments in his or her own words.

– Type: “I jumped off a loading dock at work.” – Locate and click on button labeled “Next.”

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 9 – Final screen of interview allows you to review

your work. – Compare your screen to Figure 11-9 in the

textbook, scrolling window as necessary. – If any differences (other than patient's age),

repeat exercise, making certain you answer each of questions in steps 6 and 7 correctly.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Guided Exercise 64: Experiencing Patient-Entered HPI

• Step 10 – At bottom of interview report screen are two

buttons labeled “Print” and “Save.” – Save button will save report to a file, similar to

Export button. – When everything is correct, locate and click

on button to either print or save to a file as directed by your instructor.

– Once you have your printout or file output, close browser and proceed to Exercise 65.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 65: Reviewing Patient-Entered Data

• In this exercise you will take on the role of the nurse, to review data Mr. Martiniz has entered.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 65: Reviewing Patient-Entered Data

• Case Study – Tomas Martiniz is a 24-year-old male who has

an appointment May 28, 2012, at 9:00 AM. – He has used the Internet to complete his

medical questionnaire in advance. – The data has been merged into the EHR to

initiate the encounter note for his visit.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 65: Reviewing Patient-Entered Data

• Step 1 – Start Student Edition

software. – Click Select on Menu

bar; then click Patient. – In Patient Selection

window, locate and click on Tomas Martiniz.

Figure 11-10: Select patient Tomas Martiniz.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 65: Reviewing Patient-Entered Data

• Step 2 – Click Select on Menu

bar again; then click Existing Encounter.

– Select 5/28/2012 9:00 AM Office Visit.

– Encounter note from that date will be displayed.

Figure 11-11: Select existing encounter for May 28, 2012.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 65: Reviewing Patient-Entered Data

• Step 3 – Click on Print button on Toolbar at top of

screen to invoke Print Data window. – Be certain there is check mark in box next to

“Current Encounter;” then click on button labeled “Print and Close,” even if you normally exported a file in previous exercises.

– You will need a printed copy for next step.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 65: Reviewing Patient-Entered Data

• Step 4 – Compare answers from interview report you

printed in previous exercise with encounter note you have just printed.

– On your printed encounter note identify and draw a circle around any instances where terminology is different.

Electronic Health Records: Understanding and Using Computerized Medical Records, Second Edition Richard Gartee

Critical Thinking Exercise 65: Reviewing Patient-Entered Data

• Step 4 (cont.) – If there were any differences, why would the

patient's terminology and medical nomenclature be different?

– When you are finished, give your interview report or output file to your instructor.

Slide Number 1
The Impact of Technology
The Internet and the EHR
The Internet and the EHR
The Internet and the EHR
Decision Support Via the Web
Decision Support Via the Web
Critical Thinking Exercise 63: �Internet Medical Research
Critical Thinking Exercise 63: �Internet Medical Research
Critical Thinking Exercise 63: �Internet Medical Research
Critical Thinking Exercise 63: �Internet Medical Research
Critical Thinking Exercise 63: �Internet Medical Research
Critical Thinking Exercise 63: �Internet Medical Research
Critical Thinking Exercise 63: �Internet Medical Research
Integrated Decision Support
Integrated Decision Support
Integrated Decision Support
Secure Internet Data
Secure Internet Data
Remote EHR Access for the Provider
Remote EHR Access for the Provider
Remote EHR Access for the Provider
�Remote EHR Access for the Provider�
�Remote EHR Access for the Provider�
Remote EHR Access for the Provider
Teleradiology
Patient Entry of Symptoms and History
Patient Entry of Symptoms and History
Workflow Using Patient-Entered Data
Workflow Using Patient-Entered Data
Workflow Using Patient-Entered Data
Improved Patient Information
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Workflow Using Patient-Entered Data
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Guided Exercise 64: �Experiencing Patient-Entered HPI
Critical Thinking Exercise 65: Reviewing Patient-Entered Data
Critical Thinking Exercise 65: Reviewing Patient-Entered Data
Critical Thinking Exercise 65: Reviewing Patient-Entered Data
Critical Thinking Exercise 65: Reviewing Patient-Entered Data
Critical Thinking Exercise 65: Reviewing Patient-Entered Data
Critical Thinking Exercise 65: Reviewing Patient-Entered Data
Critical Thinking Exercise 65: Reviewing Patient-Entered Data