Transcript Lecture Note 4

Lecture 4
Electronic Health Record
(Chapter 14)
http://www.csun.edu/~dn58412/IS531/IS531_SP16.html
Learning Objectives . . .
1. Define electronic health record (EHR).
2. Define electronic medical record (EMR).
3. Define computer-based patient record
(CPR).
4. Similarities and differences between
the EHR, EMR, and the CPR.
5. Attributes of the CPR for today’s EHR.
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Learning Objectives
6. Meaningful Use and the adoption and
use of the EHR in health care industry
7. Benefits associated with the EHR.
8. Concerns in implementation of the
EHR.
9. 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*
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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, Xray, 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
• 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
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Meaningful Use …
• Meaningful use compliance will result in:
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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
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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
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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 *
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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.
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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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