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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 TWO

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

Secure Messaging

• E-Visits – Allows patient to be treated by clinician for

nonurgent health problems without patient having to come into office.

– E-visits are secure and they gather symptom and HPI information, creating documented medical encounter.

– E-visits are reimbursed as a legitimate E&M visit.

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

Provider-to-Patient E-Mail

Communication • Security Rule allows for EPHI to be sent

over electronic open network as long as it is protected.

• Patient can e-mail a doctor or medical facility containing information about medical condition, even if e-mail is not encrypted.

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

Provider-to-Patient E-Mail

Communication • Clinician has to be very guarded replying

through unencrypted e-mail. • Preferred alternative is to use secure web

site for communication between patient and provider.

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

Workflow of an E-Visit

• Begins with patient-entered symptom, history, and history of present illness information.

• Patient must already be established patient with practice and have medical records on file.

• Patient answers questions and selects reason for visit from a list.

• E-visits are only used for nonurgent visits.

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

Workflow of an E-Visit

• When interview is complete, the data entered by patient is recorded in the EHR and clinician is notified that E-visit is ready to review.

• E-visits can be directed to “doctor on call,” allowing practicing partners to share “E- visit” duty.

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

Workflow of an E-Visit

• Clinician reviews patient-entered data, reviews relevant patient medical records, and replies to patient.

• Clinician can prescribe electronically during the E-visit.

• Doctor's response can include patient education material and comments or care instructions from doctor.

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

Mayo Clinic Study of E-visits

• Largest study of Internet use for online care (E-visits) using structured history was conducted in the Department of Family Medicine at Mayo Clinic in Rochester, Minnesota.

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

Mayo Clinic Study of E-visits

• Study showed feasibility of online visits to educate, treat, and bill patients.

• Extent of conditions possible for treatment by online care was far ranging and managed with a minimum of message exchanges by using structured histories.

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

California Study

• Independent study sponsored by Blue Shield of California.

• Most patients and doctors in study preferred a web visit to an office visit for nonurgent medical needs.

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

California Study

• Providers found that the E-visit gathered important details and eliminated multiple messages back and forth that occur when trying to provide patient care via e-mail.

• Patients found that time spent scheduling, driving, parking, and waiting was saved with an E-visit.

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

Guided Exercise 66: Patient Requests an E-Visit

• Case Study – Jacob Silverstein is a 46-year-old male with a

history of hypertension and diabetes. – He is on medication and has regular check-

ups at his family practice. – He has an issue with his medication and is

going to try an online E-visit instead of coming to the office.

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

Guided Exercise 66: Patient Requests an E-Visit

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

textbook to log into MyHealthProfessionsKit.com

– When welcome page is displayed, click on link “Activities and Exercises” or select “Activities” from drop-down list; click on button labeled “Go.”

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

Guided Exercise 66: Patient Requests an E-Visit

• Step 2 – Locate and click on link Exercise 66 in the

menu on the left. – 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 of textbook will be displayed.

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

Guided Exercise 66: Patient Requests an E-Visit

• Step 3 – Locate section labeled “E-visits for

Established Patients;” click on link “E-visit.” – “Welcome to Family Care E-visit” web page is

displayed.

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

Guided Exercise 66: Patient Requests an E-Visit

• Step 4 – Key difference between E-visit and pre-visit

questionnaire is that providers collect a copay at time of E-visit.

– Portal includes simulated payment information; you will not be charged.

– Do not enter any personal credit card data.

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

Guided Exercise 66: Patient Requests an E-Visit

• Step 4 (cont.) – Locate and click on button labeled “Start

Interview.” – Center portion of web page will look similar to

Figure 11-12.

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

Guided Exercise 66: Patient Requests an E-Visit

Figure 11-12: Patient interview screen for an E-visit.

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

Guided Exercise 66: Patient Requests an E-Visit

• Step 5 – Enter the following:  Enter your name or student ID.

– Patient information:  First Name: Jacob  Last Name: Silverstein  Click circle next to Male

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

Guided Exercise 66: Patient Requests an E-Visit

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

Date of Birth fields and select from the drop- down lists: April, 4, and 1966.

– Compare your screen to Figure 11-12. – When everything has been entered correctly,

locate and click on button labeled “Next.”

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

Guided Exercise 66: Patient Requests an E-Visit

• Step 6 – Reason for Visit screen will be displayed. – Locate and click on “Cough” in list of reasons

(Figure 11-13). – Locate and click on button labeled “Next.”

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

Guided Exercise 66: Patient Requests an E-Visit

Figure 11-13: Reason for visit “Cough” selected from list.

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

Guided Exercise 66: Patient Requests an E-Visit

• Step 7 – Interview process will start. – For each question in the Table on page 449

and 450 in the text locate and 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 66: Patient Requests an E-Visit

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

free-text note box is displayed to allow patient to enter messages in their own words.

– Leave box empty. – Locate and click on button labeled “Next.”

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

Guided Exercise 66: Patient Requests an E-Visit

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

your work. – Compare your screen to Figure 11-14 of the

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

repeat exercise, making certain you answer each of the questions in steps 6 through 8 correctly.

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

Guided Exercise 66: Patient Requests an E-Visit

Figure 11-14: Completed interview for E-visit.

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

Guided Exercise 66: Patient Requests an E-Visit

• Step 10 – At bottom of Interview Report screen are two

buttons labeled “Print” and “Save.” – When everything is correct, locate and click

on button to either print or save to a file. – Once you have your print out or file output,

close browser and proceed to Exercise 67.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 1 – Start Student Edition

software. – Click Select on Menu

bar; then click Patient. – In Patient Selection

window, locate and click on Jacob Silverstein.

Figure 11-15: Select patient Jacob Silverstein.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 2 – Click Select on Menu

bar again; then click Existing Encounter.

– Select 5/29/2012 7:30 PM e-Visit.

– Encounter note data from E-visit will be displayed.

Figure 11-16: Select the E-visit encounter for 5/29/2012.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 3 – When encounter is displayed, locate and click

on Manage tab at bottom of screen. – Review HPI data supplied by patient

displayed in right pane; locate and click on tab labeled “Medications” in left pane.

– Compare your screen to Figure 11-17. – Review Mr. Silverstein's prescription history. – Note that new drug was prescribed on

5/11/2012.

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

Guided Exercise 67: Clinician Completes the E-Visit

Figure 11-17: Medications tab showing prescription history.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 4 – Locate and click on

tab labeled “Problem List” and then click on “Hypertension” to highlight it.

– Click on Flowsheet button on Toolbar.

Figure 11-18: Problem tab with Hypertension highlighted.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 5 – Scroll Flowsheet downward until your screen

looks like Figure 11-19. – Locate and click on red button for

Assessment:  Hypertension (red button)

– Locate Medications, Vaccines section near bottom of Flowsheet.

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

Guided Exercise 67: Clinician Completes the E-Visit

Figure 11-19: Flowsheet with Hypertension and Lisinopril circled in red.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 5 (cont.) – Click on description “Ordered Lisinopril”

(circled in Figure 11-19). – The entire row will become highlighted. – Do not click the red or blue buttons.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 6 – Locate and click on down arrow in Entry

Details “Prefix” field. – Select “discontinue” from drop-down list. – Locate and click on Flowsheet button on

Toolbar to close Flowsheet. – Locate and click on Encounter tab at bottom

of screen.

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

Guided Exercise 67: Clinician Completes the E-Visit

Figure 11-20: Select “discontinue” from Prefix drop-down list.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 7 – Click on Dx tab in left pane. – Locate and click on Search button on Toolbar

at top of screen. – When search dialog window is displayed, type

“adverse,” and then click on button in dialog window labeled “Search.”

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 7 (cont.) – Compare your results to left pane of Figure

11-21. – Locate and click on red button for following

finding:  Adverse effect of drug therapy (red button)

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

Guided Exercise 67: Clinician Completes the E-Visit

Figure 11-21: Dx: Adverse effect of drug therapy.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 8 – Click on Rx tab in left pane. – Locate and click on Search button on Toolbar

at top of screen. – When search dialog window displayed, type

“Amlodipine;” then click on button in dialog window labeled “Search.”

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 8 (cont.) – Highlight finding

“Calcium Channel Blockers Amlodipine Maleate;” then click Rx button on Toolbar at top of screen.

– This will invoke Rx Writer.

Figure 11-22: Highlight Calcium Channel Blockers Amlodpine Maleate.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 9 – Select dosage “10

milligram tab” and then double-click on it.

Figure 11-23: Select the 10 milligram tablet in the Rx Dosage Inquiry window.

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

• Step 10 – Rx Brand window will

be displayed (not shown in textbook).

– There is only one brand, “Amvaz”; double-click on it.

Guided Exercise 67: Clinician Completes the E-Visit

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

• Step 11 – Rx Writer will display;

enter the information in Sig fields.

– When everything is correct, locate and click button labeled “Save Rx.”

• Sig Information: – Quantity: 1 – Freq: daily – Per Day: 1 – Route: by mouthDays:

30 – Amount: 30 – Refills: 3 – Generic: Y

Guided Exercise 67: Clinician Completes the E-Visit

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

Guided Exercise 67: Clinician Completes the E-Visit

Figure 11-24: Rx Writer prescription for Amlodipine.

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

Guided Exercise 67: Clinician Completes the E-Visit

• Step 12 – Click on Print button on Toolbar at top of your

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

“Current Encounter;” click on button to either print or export a file.

– Compare your printout or file output to Figure 11-25 in the textbook.

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

Patient Access to Electronic Health Records

• Providing patients with timely electronic access to their health information.

• Providing patients with electronic copy of their health information upon request.

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

Patient Access to Electronic Health Records

• Providing inpatients with electronic copy of their discharge instructions and procedures at time of discharge, upon request.

• Sending reminders to patients per patient preference for preventive/follow-up care.

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

The Patient-Centered Medical Home

• Patient-Centered Medical Home (PCMH) is an approach to providing comprehensive primary care for children, youth and adults.

• PCMH Standards – Access and Communication – Patient Tracking and Registry Functions – Care Management – Patient Self-Management Support

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

The Patient-Centered Medical Home

• PCMH Standards (cont.) – Electronic Prescribing – Test Tracking – Referral Tracking – Performance Reporting and Improvement – Advanced Electronic Communication

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

The Personal Health Record

• Personal Health Record (PHR): Online services independent of any one medical group offer patients ability to maintain their own medical records online.

• Record maintained online by patient can contain data from patient visits at multiple practices.

• Online PHR is available everywhere.

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

The Personal Health Record

• Kaiser-Permanente, one of the largest healthcare providers in United States, has implemented what is perhaps largest PHR to date.

• There are numerous organizations developing and sponsoring web-based PHR.

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

Critical Thinking Exercise 68: Researching the PHR

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

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

Critical Thinking Exercise 68: Researching the PHR

• Step 1 – Start your web browser. – Listed below are six PHR web sites. – Your local hospital, health insurance plan, or

certain government programs may also offer PHR that you may use for this exercise.

– Select at least two sites to use for your research.

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

Critical Thinking Exercise 68: Researching the PHR

• Step 1 (cont.) – www.google.com/health – www.myphr.com – www.healthvault.com – www.mymediconnect.net – www.ihealthrecord.org – www.webmd.com/phr

http://www.google.com/health

http://www.myphr.com

http://www.healthvault.com/

http://www.mymediconnect.net

http://www.ihealthrecord.org

http://www.webmd.com/phr

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

Critical Thinking Exercise 68: Researching the PHR

• Step 2 – Type URL of your first choice in address field

of your web browser. – When web site is displayed, read information

provided about that organization's PHR. – Many of the sites offer a demonstration

version; if one is available click on it. – Take notes or print pages of the web site. You

will use these in step 4.

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

Critical Thinking Exercise 68: Researching the PHR

• Step 3 – Type second URL you have chosen in

address field of your web browser. – Study information presented on second site,

taking notes or printing pages as you did in step 2.

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

Critical Thinking Exercise 68: Researching the PHR

• Step 4 – Write a comparative analysis of web sites you

have visited. Include following information in your report:  What entity owns or operates the PHR web site?  Is the owner a nonprofit or for-profit corporation?

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

Critical Thinking Exercise 68: Researching the PHR

• Step 4 (cont.) – Compare features offered by the two PHR.  Were there any significant advantages of one over

the other? – Compare the two PHR for ease of use. – When you have finished, give your completed

report to your instructor.

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

Chapter Summary

• Internet is one of the key technologies impacting healthcare.

• It not only facilitates remote access for clinician, but gives provider instant access to medical research and medical libraries for decision support.

• Patients research their conditions using the Internet.

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

Chapter Summary

• Patients are sending e-mail to their doctors asking medical questions.

• EPHI, which is sent over Internet, needs to be secured.

• Remote provider access to EHR via Internet usually involves setting up a VPN or using SSL encryption.

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

Chapter Summary

• Telemedicine provides specialist consultation to patients in remote locations.

• Teleradiology allows a radiologist to interpret diagnostic images from another location.

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

Chapter Summary

• Providers are setting up secure web sites, where patients can see their medical information and consult with their doctor using secure messaging.

• Patient data can become a significant contributor to the EHR.

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

Chapter Summary

• E-visit allows patients to be treated by their regular physician for nonurgent health problems without having to come into office.

• E-visit gathers symptom and HPI information and creates a documented encounter.

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

Chapter Summary

• Patient-Centered Medical Home is a model for providing primary care.

• PCMH standards encourage electronic orders, results, and communication with patients.

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

Chapter Summary

• PHR (Personal Health Records) enable patients to manage their health by maintaining their own electronic copies of their health records.

• PHR is secure, private, owned, and managed by patient.

• Patients control who can access their records.

Slide Number 1
Secure Messaging
�Provider-to-Patient E-Mail Communication�
�Provider-to-Patient E-Mail Communication�
Workflow of an E-Visit
Workflow of an E-Visit
Workflow of an E-Visit
Mayo Clinic Study of E-visits
Mayo Clinic Study of E-visits
California Study
California Study
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 66: �Patient Requests an E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Slide Number 44
Slide Number 45
Guided Exercise 67: �Clinician Completes the E-Visit
Guided Exercise 67: �Clinician Completes the E-Visit
Patient Access to Electronic Health Records
Patient Access to Electronic Health Records
The Patient-Centered Medical Home
The Patient-Centered Medical Home
The Personal Health Record
The Personal Health Record
Critical Thinking Exercise 68: Researching the PHR
Critical Thinking Exercise 68: Researching the PHR
Critical Thinking Exercise 68: Researching the PHR
Critical Thinking Exercise 68: Researching the PHR
Critical Thinking Exercise 68: Researching the PHR
Critical Thinking Exercise 68: Researching the PHR
Critical Thinking Exercise 68: Researching the PHR
Chapter Summary
Chapter Summary
Chapter Summary
Chapter Summary
Chapter Summary
Chapter Summary
Chapter Summary