Transcript Chapter 2 Electronic Health Records - MCST-CS

Chapter 2
Electronic Health Records
Learning Objectives
After reading this chapter the reader should be able to:
• State the definition and history of electronic health records
• Describe the limitations of paper based health records
• Identify the benefits of electronic health records
• List the key components of an electronic health record
• Describe the 2009 Medicare and Medicaid reimbursement
for electronic health records
• Describe the benefits of computerized order entry and
clinical decision support systems
• State the obstacles to purchasing and implementing an
electronic health record
There is no universally accepted definition of an
EHR. As more functionality is added the
definition will need to be broadened.
Importantly, EHRs are also known as electronic
medical records (EMRs), computerized medical
records (CMRs), electronic clinical information
systems (ECIS) and computerized patient records
(CPRs).
The definition of EHR
An electronic health record (EHR) is an evolving
concept defined as a systematic collection of
electronic health information about individual
patients or populations. It is a record in digital
format that is theoretically capable of being shared
across different health care settings.
EHRs may include a range of data, including
demographics, medical history, medication and
allergies, immunization status, laboratory test
results, radiology images, vital signs, personal stats
like age and weight, and billing information.
Electronic Health Record Adoption
Outpatient (Ambulatory) EHR Adoption:
In 2008 a study was conducted to rate the adoption of
EHR in outpatient clinics. In this study a sample of 5000
physicians was selected. The return rate of the survey was
just over 60%. The most significant finding was that only
4% of respondents reported using a comprehensive EHR
(order entry capability and decision support), whereas
13% reported using a basic EHR system. The adoption
rate was higher for large medical groups or medical
centers. Given the fact that most experts believe only
comprehensive EHRs will impact patient safety and
improve the quality of medical care, the 4% adoption rate
is disturbing
Inpatient EHR Adoption:
In March 2009 an article about inpatient EHR adoption.
They surveyed all members of the American Hospital
Association and had a return rate of 63% (3049 hospitals).
Their results showed that 7.6% of the respondents
reported a basic EHR system and only 1.5% reported a
comprehensive EHR. Again, large urban and/or academic
centers had the highest adoption rates. The scale they
used rated hospitals from 0, meaning hospitals with an
EHR with no functionality installed, to 7 indicating a fully
functional paperless system. As of March 2009, only two
hospital systems in the US had attained level 7 adoption.
Many physicians believe that purchasing an EHR is not their
responsibility and therefore someone else should pick up the
tab. Others are concerned that they will purchase the wrong
system and waste money and others are simply overwhelmed
with the task of implementing and training for a completely
different system. As a group, physicians are not noted for
embracing innovation. In their defense, new technologies
should be shown to improve patient care, save time or money,
in order to be accepted.
There are over three hundred EHR vendors but only about ten
to twenty seem to be consistently successful in terms of a
large client base. If the selection and purchase of EHRs was
easy they would already be universal.
The Stimulus Package and EHR
Reimbursement
In order to be reimbursed there must be
“meaningful use” that, at a minimum, means
that an EHR:
• Must include e-prescribing
• Provides the electronic exchange of
information (interoperability)
• Is capable of producing quality reports
• Must be certified
Relationship between EHR, PHR and
EMR
The consensus is that:
• The EHR is the larger system that includes the
EMR and PHR and interfaces with multiple other
electronic systems locally, regionally and nationally
• The EMR, on the other hand, is the electronic
patient record located in an office or hospital
• The PHR is a collection of health information by
and for the patient.
There is overlap between the EMR and the PHR,
since the PHR can be part of the EMR.
In May 2008 the National Alliance for Health Information Technology released the
following
definitions in an effort to standardize terms used in HIT:
Electronic Medical Record:
“An electronic record of health-related information on an individual that can be
created, gathered, managed and consulted by authorized clinicians and staff within
one healthcare organization”.
Electronic Health Record:
“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 across more than one healthcare
organization”.
Personal Health Record: “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 managed, shared and controlled by
the individual”.
Why do we need Electronic Health
Records?
• The paper record is severely limited
• The need for improved efficiency and
productivity.
• Quality of care and patient safety.
• Public expectations
• Governmental expectations.
• Financial savings.
• Technological Advances.
• Older and more complicated patients require
more coordinated care.
Electronic Health Record Key
Components
• The following components are desirable in any EHR system.
The reality is that many EHRs do not currently have all of
these functions.
• Clinical Decision Support Systems (CDSS) to include alerts,
reminders and clinical practice guidelines. CDSS is associated
with computerized physician order entry (CPOE).
• Secure messaging (e-mail) for communication between
patients and office staff and among office staff. Telephone
triage capability is important
• An interface with practice management software,
scheduling software and patient portal (if present). This
feature will handle billing and benefits determination.
Check companion PDF
Computerized Physician Order Entry
(CPOE)
CPOE is an EHR feature that processes orders for
medications, lab tests, x-rays, consults and other
diagnostic tests.
Reduce medication errors.
Reduce costs.
Reduce variation of care.
Clinical Decision Support Systems
(CDSS)
CDSS is
“any software designed to directly aid in clinical
decision making in which characteristics of
individual patients are matched to a computerized
knowledge base for the purpose of generating
patient specific assessments or recommendations
that are then presented to clinicians for
consideration”
Therefore, CDSS should have a broader definition
than just alerts and reminders.
EHR Successes and Failures
Electronic Health Record Examples
• OpenVista