Transcript EHR_ch02_Standards and Features of Electronic Health Records

Standards and Features of
Electronic Health Records
Chapter 2
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Chapter 2 Learning Outcomes
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2.1 History of EHR Standards
2.2 EHR Functionality
2.3 Privacy and Security of the EHR
2.4 EHR Implementation and Technology
2.5 Electronic Health Record Competencies
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Chapter 2 Key Terms
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Application Server Provider (ASP)
Certification Commission for Health
Information Technology (CCHIT)
Computer on Wheels (COW)/Workstation
on Wheels (WOW)
Computerized provider order entry (CPOE)
Consolidated Health Informatics (CHI)
Current Procedural Terminology (CPT)
codes
Drug Formulary
Eligible Professional (EP)
Encrypting
Health Insurance Portability and
Accountability Act (HIPAA)
Health Level Seven (HL7)
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Healthcare Common Procedure Coding
System (HCPCS) codes
• Institute of Medicine (IOM)
• International Classification of Diseases
(ICD) codes
• Intranet
• Local Area Network (LAN)
• Meaningful Use (MU)
• National Committee on Vital and Health
Statistics (NCVHS)
• Protected Health Information (PHI)
• Server
• Structured Data
• Tablet
• Telehealth Services
• Template
• Test Script
• Wireless Connectivity
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LO 2.1 History of EHR
Standards
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Health Insurance Portability and
Accountability Act (HIPAA)
• Passed in 1996
• To establish standards for accountability and
criteria for protection and confidentiality of
electronically transported health information
• In 2000, the National Committee on Vital and
Health Statistics proposed national standards
to improve patient care
LO 2.1
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Consolidated Health Informatics (CHI)
• An initiative of the U.S. Office of Management
and Budget (OMB)
• Released the first set of EHR standards
– Common vocabulary
– Standard methods for transmission
• Goal was to make 20 agencies interoperable
• Not legally required, but heavily suggested
LO 2.1
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Notable Adopted Standards
• Health Level Seven (HL7)
• The National Council on Prescription Drug
Programs (NCPDP)
• The Institute of Electrical and Electronic
Engineers 11073 Medical Device
Communication Standard (IEEE)
• Systematized Nomenclature of Medicine
Clinical Terms (SNOMED CT)
LO 2.1
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Institute of Medicine (IOM)
• Determined eight main functions of the EHR
• Four most notable:
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Health Information and Patient Data
Results Management
Order Entry/Management
Medical Decision Support
LO 2.1
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The Certification Commission for Health
Information Technology (CCHIT)
• Organized in July 2004
• Supported by AHIMA, HIMSS, and NAHIT
• Work focused in three main HIT areas:
– Ambulatory healthcare EHRs for office-based
healthcare providers
– Inpatient EHRs for hospitals and health systems
– Network components through which EHRs
interoperate and share information
LO 2.1
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Office of the National Coordinator for
Health Information Technology (ONC)
• Established in 2004
• Within the Office of the Secretary for HHS
• Purpose:
– To serve as a resource for the entire health system
– To support HIT adoption
– To promote a nationwide health information exchange
• Goal:
– Improving healthcare in the United States
• Authorized several testing centers to certify EHR products
• Created the American National Standards Institute (ANSI)
Healthcare Information Technology Standards Panel (HITSP)
in 2005 to continue efforts of interoperability in healthcare
LO 2.1
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LO 2.2 EHR Functionality
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HITECH Act
• Provides financial incentives, assistance,
online tools, and resources for providers to
implement, use, and prove meaningful use
(MU) of electronic health record
• ATCB certification signifies to each eligible
professional (EP) and hospitals that the EHR
technology has the capabilities to meet MU
goals and objectives
LO 2.2
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Meaningful Use
• Defined:
– Demonstrably effective use of an EHR
program, determined via tangible, ONCestablished functionalities
• ARRA specifies three main components:
– Use of a certified EHR in a specified
significant manner
– Use of certified EHR technology for
electronic exchange of health information
to improve healthcare quality
– Use of certified EHR technology to submit
clinical quality reports and other measures
• EPs must demonstrate use of 15 core
objectives via use of certified EHR for 90
days
LO 2.2
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Core Objectives
1. Create computerized physician order entry (CPOE).
2. Generate and transmit permissible prescriptions electronically (eRx).
3. Report a total of 6 ambulatory clinical quality measures to CMS.
4. Implement one clinical decision support rule.
5. Provide patients with an electronic copy of their health information,
upon request.
6. Provide clinical summaries for patient for each office visit.
7. Perform drug–drug and drug–allergy interaction checks.
8. Enable a user to electronically record, modify, and retrieve patient
demographic data, including preferred language, gender, race,
ethnicity, and date of birth.
9. Maintain an up-to-date problem list of current and active diagnoses
based on ICD-9 or SNOMED CT.
LO 2.2
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Core Objectives, continued
10. Maintain the patient’s active medication list.
11. Maintain the patient’s active medication allergy list.
12. Record and chart changes in patient’s vital signs:
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Height
Weight
Blood pressure
Calculate and display BMI
Plot and display growth charts for children 2–20 years (including BMI)
13. Record smoking status for patients 13 years old or older.
14. Exchange key clinical information among providers of care and
patient-authorized entities electronically.
15. Protect electronic health information created or maintained by the
certified EHR technology through the implementation of appropriate
technical capabilities.
LO 2.2
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Menu Set Objectives
Five of the following objectives have to be selected to qualify for incentives:
1. Perform drug-formulary checks.
2. Document clinical lab test results as structured data.
3. Generate lists of patients by specific conditions.
4. Send reminders to patients per patient preference for preventive/follow-up
care.
5. Provide patients with timely electronic access to their health information.
6. Use certified EHR technology to identify patient-specific education resources
and provide to patient.
7. Perform medication reconciliation.
8. Create summary of care record for each transition of care/referrals.
9. Submit electronic data to immunization registries/systems (public health
objective).
10. Provide electronic surveillance data to public health agencies (public health
objective).
LO 2.2
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Computerized Provider Order Entry
(CPOE)
• Defined:
– Means by which a physician or clinician
electronically transmits instructions for a
patient’s treatment or the ordering of
tests to a testing facility
• CPOE is one of the core objectives for
Meaningful Use
• Benefits of the CPOE function in EHRs
– more expedient order completion
– reduction in errors related to handwriting
– opportunity to check for duplicate or
incorrect tests
LO 2.2
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LO 2.3 Privacy and
Security of the EHR
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Protected Health Information
Regulated under HIPAA, PHI includes any
information (past, present, or future) about
health status, provision of healthcare
(including mental health), and payment for
healthcare that can be linked to a specific
individual
LO 2.3
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USA Patriot Act and Homeland Security
• Allows for the disclosure of PHI in
relationship to terrorism
• HIPPA allows for disclosure of information to
law enforcement under certain limited
circumstances
LO 2.3
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HIPAA’s Core Regulations for the EHR
Industry
Password Management
Unique User Identification
Access Authorization
Accounting of PHI Disclosures
Data Backup, Storage, and Security
Auditing Abilities
Code Sets
LO 2.3
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Health Information Technology for
Economic and Clinical Health (HITECH) Act
• Introduced the first federally mandated “data
breach notification requirement” which
expanded HIPAA to include “business
associates”
• Increases compliance obligations and privacy
regulations
• Specified methodology for encrypting PHI
LO 2.3
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Other Privacy Concerns
LO 2.3
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LO 2.4 EHR
Implementation and
Technology
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EHR Implementation and Technology
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Data Entry Methods
Templates
Portability
Network
Internet and Intranet
Web-based EHRs
LO 2.4
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LO 2.5 Electronic Health
Record Competencies
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Electronic Health Record Competencies
• MAERB and CAAHEP are developing core
curricula for EHR competencies within health
professional education programs
LO 2.5
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Competency Model Clearinghouse (CMC)
• Critical Work Functions for EHR Competencies:
– Understand the use of technology in maintaining electronic health
records.
– Create and update documents within the EHR using electronic tools
and applications (including portable computing devices, word
processing, spreadsheets, databases, and desktop presentation
applications).
– Locate and retrieve information in the electronic health record for
various purposes.
– Understand the ONC’s mission and functions as they pertain to
EHRs’ application, certification, and meaningful use.
– Utilize mainstream software to complete job-specific tasks, and
understand the interaction between mainstream and EHR
technology.
– Follow security and privacy policies and procedures for the use of
networks, including intranet and Internet.
LO 2.5
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Competency Model Clearinghouse (CMC)
• Critical Work Functions for EHR Competencies
– Follow confidentiality and security measures to protect electronic
health information.
– Differentiate between primary and secondary health data sources
and databases.
– Identify classification and systematic health-related terminologies
for coding and information retrieval.
– Know the policies and procedures related to populating and using
the health data content within primary and secondary health data
sources and databases.
– Resolve minor technological problems associated with using an EHR.
– Utilize basic IT troubleshooting processes to identify the root cause
of an IT-related problem.
– Utilize IT help desk for problem resolution where necessary to
maximize efficiency and effectiveness.
LO 2.5
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Chapter 2 Summary
LO 2.1 Identify major events in the development
of standards for the EHR
• HIPAA
• CHI
• IOM
• CCHIT
• ONC
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Chapter 2 Summary
LO 2.2 Describe meaningful use (MU) criteria,
including specific EHR functions that meet MU
requirements.
• 5-year incentive program
• EHR certification program
• Meaningful Use incentive program
• CPOE standard feature in EHR
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Chapter 2 Summary
LO 2.3 Describe key privacy and security issues
related to EHRs.
• USA Patriot Act and Homeland Security
• HIPAA and Privacy/Security
• Health Information Technology for Economic
and Clinical Health Act (HITECH)
• Other Privacy Concerns
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Chapter 2 Summary
LO 2.4 Explain the basic technology used in EHR
implementation.
• Modes of Data Entry
• Network Technologies
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Chapter 2 Summary
LO 2.5 List EHR competencies identified by the
Competency Model Clearinghouse.
• Core curricula are being developed
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