Transcript Week_4-2_Lecture_EHR_Notex

Electronic Health Records
LIS 4785 Introduction to Health Informatics
Fall 2015 Week 4-2
Instructor: Dr. Sanghee Oh
Announcements
• Final project proposal (Due 9/22, Tuesday).
– Problem statement
– Evidence
– Potential solutions
• Wiki Term Selection (Due 9/24, Thursday)
Final Project 2-Page Proposal
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Each group needs to submit a 2 page project outline (problem statement,
evidence, potential solutions).
The problem statement should address the 5 “W”s;
– Who does the problem affect? (e.g., patients, physicians, researchers, organizations,
etc.)
– What is the problem? What impact is the issue causing?
– When does the problem occur? When does it need to be fixed?
– Where does the problem occur? (e.g., homes, hospitals, health organizations, etc.)
– Why is it important to solve the problem? What will happen when the problem is
fixed? What would happen if the problem is not fixed?
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Statistical evidence which shows the critical status of the problem in the
field should be included with appropriate citation of resources.
3 or 4 potential solutions that your final project application can offer
should be addressed. Your group will develop prototypes of applications,
targeting the potential solutions, throughout the semester.
Writing/Citation Style: Follow the APA Style Guideline
Purdue OWL: APA Format Guideline (Available
at: http://owl.english.purdue.edu/owl/resource/560/01/
Wiki Term Selection (9/24)
• Go to healthinformatics.wikispaces.com and review the existing
terms.
• Retrieve them if a term that you’d like to review is in the library.
• You should choose one from the existing terms and one new term
related to health IT.
– Do not select a name of diseases unless it is related to Health IT.
• Once a student decides his/her three terms, post them in Google
Drive LIS 4785 Wiki Term Selection by September 24th, 11:59 pm.
Students will be able to access the list of terms that their classmates
choose.
• Every student needs to review a different term.
Show and Tell
• Matt Farrell
Topics Covered Last Class Session
• HL7 (Health Level 7)
• XML (Extensible Markup Language), or ebXML (Electronic
Business XML)
• LOINC (Logical Observations, Identifiers, Names, and Codes)
• ICD-9 (International Classification of Disease, Version 9)
• SNOMED (Systematized Nomenclature of Medicine)
• HTTP (Hypertext Transfer Protocol)
• FTP (File Transfer Protocol)
• HIPPA (Health Insurance Portability and Accountability Act)
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Numbers assigned to __________________ a
medical practitioner may provide to a patient
including medical, surgical and diagnostic
services.
They are then used by _____________ to
determine the amount of reimbursement that
a practitioner will receive by an insurer when
he or she performs that service.
CPT codes are developed, maintained and
copyrighted by the AMA (American Medical
Association)
Examples
– 99214: an office visit
– 99397: a preventive exam if you are over
65
– 90658: a flu shot
Medicare uses HCPCS codes (Healthcare
Common Procedure Coding System) which
are an adjusted form of CPT code.
Why Do We Need Standards in Healthcare?
Why Do We Need Data Standards?
• “The healthcare delivery system today employs
____________________________________________, both within a
single organization and across multiple organizations.
For example, a hospital may have a laboratory
system from one vendor, a pharmacy system
from another vendor, and a patient care
documentation system from a third vendor.
Physicians affiliated with the hospital also have
different systems in their offices, yet need
access to data from the hospital on their
patients.” (Source: 2000 NCVHS Report)
• Standards provide ______________________________________ that
enable ______________________between systems and/or devices.
• Ideally, data exchange schema and standards should permit data to be
_________ between clinician, lab, hospital, pharmacy, and patient
regardless of ___________________________________ in order to
improve healthcare delivery.
What are EHRs?
4 Things to Know about EHRs
AthenaHealth CEO Jonathan Bush talks about electronic health records (USA
Today, May 2015: https://www.youtube.com/watch?v=mdKLcBG3Mz4)
What are EHRs?
• The simplest definition:
– ________________________________________________
• ___________________________, which makes information
available instantly, "whenever and wherever it is needed".
• Contain information about a patient's medical history, diagnoses,
medications, immunization dates, allergies, radiology images, and
lab and test results
• Offer access to _______________________ that providers can
use in making decisions about a patient's care
• Automate and streamline providers' workflow
• Increase organization and accuracy of patient information
• Support key market changes in payer requirements and consumer
expectations
PHR, EMR, and EHR
EMR and EHR
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EMRs:
– An electronic record of health-related information on an
individual that can be created, gathered, managed, and consulted
by authorized clinicians and staff
____________________________.
– An electronic version of the traditional record used by
____________________.
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EHRs:
– An electronic record of health-related information on an
individual that conforms to nationally recognized interoperability
standards and that can be created, managed, and consulted by
authorized clinicians and staff
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– The availability and use of communication standards, such as
nomenclatures, vocabularies, and coding structures, in order to
share and exchange patient data across multiple facilities.
EMR, EHR, and PHR
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EMRs:
– An electronic record of health-related information on an
individual that can be created, gathered, managed, and consulted
by authorized clinicians and staff
____________________________.
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EHRs:
– An electronic record of health-related information on an
individual that conforms to nationally recognized interoperability
standards and that can be created, managed, and consulted by
authorized clinicians and staff
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PHRs:
– An electronic record of health-related information on an
individual that conforms to nationally recognized interoperability
standards and that can be drawn from multiple sources while
being ______________________________________.
EHR Adoption
Source: http://dashboard.healthit.gov/
EHR Adoption
• Recovery Act, HITECH Incentive Program
EHR Benefits
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EHR Benefits
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– Reduce costs through
decreased paperwork and
reduced duplication of testing.
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– Enable quick access to patient
records for more coordinated,
efficient care.
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– Provide accurate, up-to-date,
and complete information
about patients at the point of
care.
– Improve patient and provider
interaction and
communication, as well as
health care convenience.
– Helping providers improve
productivity and work-life
balance.
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- Securely share electronic
information with patients and
other clinicians.
- Enable safer, more reliable
prescribing.
- Help promote legible, complete
documentation and accurate,
streamlined coding and billing.
- Enhance privacy and security of
patient data
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- Help providers more effectively
diagnose patients, reduce
medical errors, and provide safer
care.
- Enable providers to improve
efficiency and meet their
business goals.
EHR Barriers
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EHR Barriers
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– The cost to implement and
maintain an EHR are high.
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– Ownership of the patient record
becomes complex.
– Who would be responsible for
updating, and ensuring data
accuracy?
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– Data integrity refers to the
accuracy and consistency of stored
and transmitted data.
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– The shared data can be
compromised when information is
entered incorrectly or deliberately
altered or when the system
protection are not working
correctly.
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– EHR/PHR system attacks
– EHR could allow access to
personal data without adequate
projection
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– Disagreement on which
terminology to use, lack of
standards, cultural and language
barriers, interpretation of
meaning, etc.
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– Lack of computer skills,
complexity of application, lack of
available hardware or difficulty
of adjusting to change.
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– Frustrating experience of using
EHRs due to usability issues
– EHR could increase workload,
and decrease productivity and
efficacy.
Top 100 EHR/EMR Vendors
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Cerner PowerChart Ambulatory HER
EpicCare Ambulatory - Core EMR
Allscripts Professional™ EHR“
NextGen Ambulatory HER
athenahealth athenaClinicals
GE Health Centricity
eClinicalWorkscare
McKesson iKnowMed EHR, Horizon Ambulatory, Paragon
Abraxas Medical Solutions (Merge Healthcare) iconnect Network
Vitera Healthcare Solutions Vitera Intergy, Vitera Stat, Vitera
Medical Manager
And more from
http://medicaleconomics.modernmedicine.com/medicaleconomics/news/top-100-ehr-companies-part-1-4
Cerner PowerChart Ambulatory EHR
Cerner PowerChart Ambulatory EHR
Cerner PowerChart Ambulatory EHR
Cerner EHR iPhone App
More screenshots of EHRs/EMRs
• http://www.ehrscreenshots.com/
EHR Elements
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Health information and data
Results management
Order entry
Decision support
Electronic communication and connectivity
Patient support
Administrative processes
Reporting and population health management
• Find here for the details: http://ed-informatics.org/healthcare-itin-a-nutshell-2/emr-vs-ehr-vs-phr/
Major components of EHRs
• ______________________________
• ______________________________
• ______________________________
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• An EHR feature that processes orders for medications, lab tests,
imaging, consults and other diagnostic tests.
Computerized Physician Order Entry (CPOE)
• Reduce medication errors
– Outcomes the issue of illegibility
– Fewer errors associated with ordering drugs with similar
names or trailing zeroes
– Able to link to adverse drug event (ADE) report systems
– Reduce under and over prescribing
– Make prescriptions to reach the pharmacy quicker
– Identify the prescribing physicians
– Point out treatment and drugs of choice
– Easily integrated with clinical decision support systems (CDSS)
• Reduce costs
• Reduce variation of care
______________________________
• An electronic system to support a prescriber's ability to
electronically send an accurate, error-free and understandable
prescription directly to a pharmacy from the point-of-care.
E-Prescribing through an EHR
Source: http://dashboard.healthit.gov/
Advantages of e-prescribing
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Legible and complete prescriptions that help eliminate handwriting
errors and decrease pharmacy “callbacks” and rejected scripts
Abbreviations and unclear decimal points are avoided.
The wait to pick up prescriptions potentially is reduced
Fewer duplicated prescriptions
Better compliance with fewer drugs not filled or picked up.
Potential to reduce workload for pharmacists
Timely notification of drug alerts and updates
Better use of generic or preferred drugs
The ability to check patient-level and patient-level formulary status
and patient copays
The process is secure and HIPPA compliant
Offer ability to look up drug history, drug-drug interactions, allergies
and compliance
Provide a single view of prescriptions from multiple clinicians
Issues/challenges associated with eprescribing
• Alerts, in general are viewed as nuisances, by physicians, unless
they are very specific, highly important and are educational.
Issues/challenges associated with eprescribing
• 11.7% error rates on e-prescribing from a report of outpatient
electronic prescription in 2011
– About a third had the potential to cause ADEs (No actual
ADEs)
– Two thirds of the errors due to omissions of drug does,
instructors, etc.
• The refill process had more problems and errors than the initial
new prescription process.
– Most of refills can be still done by fax.
• Some pharmacies don’t accept e-scripts because of the fees.
• Physicians write sigs(abbreviations) are not patient-friendly and
pharmacists have to rewrite them.
• Physicians often receive duplicate requests from pharmacies.
Quiz
• Week 5 Quiz will be available on Canvas by this Friday. (An
announcement of the quiz release will be provided).
• Week 5 Quiz is due 9/22 (3:35 pm, before the class starts)