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 EHR to Improve Patient Health

CHAPTER NINE TWO

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

The Importance of Childhood Immunizations

• Immunization slows down or stops disease outbreaks.

• Vaccines prevent disease in people who receive them; protect those who come into contact with unvaccinated individuals.

• If child is not vaccinated and is exposed to a disease germ, child's body may not be strong enough to fight disease.

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

The Importance of Childhood Immunizations

• Through childhood immunization, able to control infectious diseases that were common: – Polio – Measles – Diphtheria; Pertussis (whooping cough) – Rubella (German measles) – Mumps; Tetanus – Haemophilus influenzae type b (Hib)

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

The Importance of Childhood Immunizations

• At regular intervals, the well baby will receive one or more vaccines.

• By two years, child is protected against array of diseases.

• When pediatrician uses EHR system, information from previous immunizations is readily at hand.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• In this exercise, you will use Manage tab to verify what immunizations child has had.

• Case Study – Before concluding Tyrell Williams's six-month

checkup, the clinic will compare his immunization records with the immunization schedule recommended by the CDC and administer any vaccines for which he is due.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 1 – Start Student Edition software. – Locate and click Select on Menu bar; then

click Patient. – In Patient Selection window, locate and click

on Tyrell Williams as you have previously (see Figure 9-1).

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 2 – Click Select on Menu bar; then click Existing

Encounter. – Position mouse pointer on first encounter in

list, dated 5/25/2012 11:00 AM and click on it (shown in Figure 9-15).

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 3 – Locate and click on tab labeled “Manage” at

bottom of your screen. – Click on tab in left pane labeled “Vaccines.” – Vaccine list can be sorted in two ways. – If you click mouse on column header labeled

“Finding,” vaccines are sorted into group.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 3 (cont.) – If you click mouse on column header for date,

list will be reordered so that you can see which vaccines were administered during each well-baby checkup.

– Click mouse on column header labeled “Finding” so that vaccines are sorted by type.

– Compare your screen to Figure 9-22.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

Figure 9-22: Patient Management Vaccines tab history for Tyrell Williams.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 3 (cont.) – Immunizations must be acquired over time. – Vaccines cannot be given all at once. – Several require repeated applications over a

period of time; some cannot be given to children under age of one year.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 3 (cont.) – CDC and state health departments have

designed schedule to immunize children and adolescents from birth through 18 years.

– See Figure 9-23: Immunization schedule from the CDC.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

Figure 9-23: Immunization schedule from the CDC.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 4 – Compare vaccine list on screen to CDC

schedule (Figure 9-23). Notice following: – Tyrell was born November 10, 2011.  He had his first dose of Hepatitis B (HepB) before

leaving hospital on 11/11/2005.  He had his second dose during his 2-month

checkup on 01/10/2012.  He could receive his third dose during this visit or

at his 12-month visit.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 4 (cont.) – Compare his DTaP (Diphtheria, Tetanus,

Pertussis) vaccines to CDC schedule.  He had his first dose of DTaP during his 2-month

checkup on 01/10/2012.  He had his second dose during his 4-month

checkup on 03/14/2012.  He is due for his third dose during this visit.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 4 (cont.) – Compare his Haemophilus influenzae type B

(Hib) doses to CDC schedule.  He had his first dose of Hib during his 2-month

checkup on 01/10/2012.  He had his second dose during his 4-month

checkup on 03/14/2012.  He is due for his third dose during this visit.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 4 (cont.) – Compare his IPV (Inactivated Polio Virus)

doses to CDC schedule.  He had his first dose of IPV during his 2-month

checkup on 01/10/2012.  He had his second dose during his 4-month

checkup on 03/14/2012.  He is due for his third dose during this visit.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 4 (cont.) – Compare his Pneumococcal Conjugate (PCV)

doses to CDC schedule.  He had his first dose of PCV during his 2-month

checkup on 01/10/2012.  He had his second dose during his 4-month

checkup on 03/14/2012.  He is due for his third dose during this visit.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 4 (cont.) – Of vaccines remaining on CDC schedule, he

is too young for Varicella vaccine and Measles, Mumps, Rubella (MMR) vaccine; not administered before 12 months.

– He is old enough for flu shot, but office visit occurs in May and annual flu shots are not available until fall.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 5 – Now that clinician has clear picture of

patient's immunization needs, they can be ordered and administered.

– Locate and click on Forms button on Toolbar. – Locate and click on form labeled “Pediatric 6

Month” as in Exercise 54. – If you need assistance, refer to Figure 9-3.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 6 – Locate and click on tab labeled

“Immunizations” at top of form. – Locate section labeled “Vaccines at 6

Months”; click check box for each of the following:  Y DTaP (dose 3)  Y Haemophilus influ B (dose 3)  Y IPV (dose 3)  Y Pneumococcal Conjugate (dose 3)

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 6 (cont.) – Compare your screen to Figure 9-24. – Locate and click on tab labeled “Encounter” at

bottom of screen.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

Figure 9-24: Pediatric 6-month form—Immunization tab.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 7 – 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;” then click on button to either print or export a file.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

• Step 7 (cont.) – Compare your printout or file output to Figure

9-25. – If correct, hand in to your instructor. – If there are any differences, review previous

steps in exercise and find your error.

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

Critical Thinking Exercise 59: Determine Your Adult Immunizations

• Step 1 – CDC provides free online service to determine

adult immunization needs. – Start web browser; type URL in address: – http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

• Step 2 – Locate and click on link “Adolescent & Adult

Vaccine Quiz,”; then on link “Take the Quiz.”

http://www.cdc.gov/vaccines/recs/schedules/adult-schedule.htm

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

Critical Thinking Exercise 59: Determine Your Adult Immunizations

• Step 3 – Follow on-screen instructions.

• Step 4 – Print out your immunization schedule. – You do not have to turn it into your instructor.

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

Patients' Involvement in Their Own Healthcare

• Must become involved in their own healthcare to manage and prevent diseases.

• By giving patient copy of exam note at conclusion of visit: – Stimulates compliance. – Improves patient's recollection of clinician's

advice.

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

Patient-Entered Data Graphs

• Measuring blood pressure at home and keeping log that they bring to doctor's office when they have a checkup.

• See Figure 9-26 for example of graph of blood pressure readings from February to May.

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

Guided Exercise 58: Reviewing and Ordering Vaccines

Figure 9-26: Graph of blood pressure readings from February to May. Courtesy of Primetime Medical Software and Instant Medical History.

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

Patient-Entered Data Graphs

• Shared information results in shared decision making.

• Patients look actively at issues of illness, treatment regime, and desired outcome.

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

Preventative Care Screening

• Best way to ensure preventive services are delivered appropriately is to make evidence-based information available at point of care.

• Evidence-based guidelines means analyzing scientific evidence from current research and studies to determine effectiveness of preventive services.

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

Preventative Care Screening

• Using data in EHR, computer is able to find appropriate guideline based on patient's age and sex, add to it based on patient's problem list and history findings, reduce intervals based on abnormal values of previous test results.

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

Preventative Care Screening

• Using this information, clinician can order tests, discuss important health care options, recommend lifestyle changes at point of care.

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

Chapter Summary

• In this chapter you learned: – To create a pediatric growth chart. – About pediatric forms. – To document a well-baby checkup using a

wellness form.

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

Chapter Summary

• Baby's length, weight, head circumference measured on each visit.

• Measurements can be plotted on a graph called growth chart.

• Lines on chart (percentiles) represent percentage of population that was same size at same age.

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

Chapter Summary

• For older children, CDC recommends using Body Mass Index (BMI).

• Gender specific and age specific for children, but single BMI chart used for adults of both genders.

• CDC has replaced older weight-for-stature charts with new BMI charts.

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

Chapter Summary

• Immunizations must be acquired over time.

• Vaccines cannot all be given at once. • CDC recommends immunizations are

aligned with well-baby visit intervals. • Disease prevention through periodic

screening and early detection can save lives.

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

Chapter Summary

• Preventive guidelines (health maintenance guidelines) can be generated by EHR system.

• Using this information, clinician can order tests, discuss important healthcare options, recommend lifestyle changes at point of care.

Slide Number 1
The Importance of Childhood Immunizations
The Importance of Childhood Immunizations
The Importance of Childhood Immunizations
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Guided Exercise 58: �Reviewing and Ordering Vaccines
Critical Thinking Exercise 59: �Determine Your Adult Immunizations
Critical Thinking Exercise 59: �Determine Your Adult Immunizations
Patients' Involvement in Their Own Healthcare
Patient-Entered Data Graphs
Guided Exercise 58: �Reviewing and Ordering Vaccines
Patient-Entered Data Graphs
Preventative Care Screening
Preventative Care Screening
Preventative Care Screening
Chapter Summary
Chapter Summary
Chapter Summary
Chapter Summary
Chapter Summary