Visioning and Strategic
HIT Toolkit
Planning
Health Information
Technology Toolkit
for Critical Access
and Small Hospitals
http://www.stratishealth.org/HIT_Toolkit_hospitals
Presenter
• Margret Amatayakul
RHIA, CHPS, CPHIT, CPEHR, FHIMSS
President, Margret\A Consulting, LLC
Schaumburg, IL
• Independent consultant, who focuses on achieving value from
electronic health records, HIPAA/HITECH, and health information
exchange. Developer of tools in Toolkit
• Adjunct faculty College of St. Scholastica, Duluth, MN, masters
program in health informatics
• Founder and former executive director Computer-based Patient
Record Institute, associate executive director AHIMA, associate
professor University of Illinois
• Active participant in standards development, former HIMSS BOD,
and co-founder of and faculty for Health IT Certification
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Stratis Health
● Stratis Health is a nonprofit organization that leads
collaboration and innovation in health care quality
and safety, and serves as a trusted expert in
facilitating improvement for people and communities
● Stratis Health works toward its mission through
initiatives funded by federal and state government
contracts, and community and foundation grants,
including serving as Minnesota’s Medicare Quality
Improvement Organization (QIO)
● Stratis Health operates the Health Information
Technology Services Center for health care
organizations seeking to use health information
technology in support of their clinical transformation
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Agenda
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Envision . . .
HIT vs. EHR vs. EMR
Purposes of EHR
Conceptual model of technical concepts
Reality in acute care and ambulatory care
Progress toward the vision
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HIT vs. EHR
• Health information technology (HIT): a general concept
that describes the technology that supports management of health
information for many purposes
• Electronic health record (EHR): is a specific set of
applications that provide an “electronic record of health-related information
on an individual including patient demographic and clinical health
information, such as medical history and problem lists, and has capacity to
provide clinical decision support, support physician order entry, capture and
query information relevant to health care quality, and exchange electronic
health information with and integrate such information from other sources”
(Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009)
Hardware
that enables
system use
Software
that directs
computer
devices
People
to support
and use
systems
Policy
that drives
adoption of
systems
Process
that helps
achieve
results
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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EHR
• Encompasses broader view of a health record  moving from
notion of a location for keeping track of patient care events to a
resource with enhanced utility
• Merely automating the form, content, and procedures of current
patient records will perpetuate their deficiencies and will be
insufficient to meet emerging user needs
Institute of Medicine:
Computer-based Patient Record: An Essential Technology for Health Care, 1991, 1997
• Longitudinal collection of electronic health information for and about
persons; immediate electronic access to person- and populationlevel information by authorized, and only authorized, users;
provision of knowledge and decision-support that enhance the
quality, safety, and efficiency of patient care; and support of efficient
processes for health care delivery
Key Capabilities of an Electronic Health Record System, 2003
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EHR vs. EMR
• Electronic medical record (EMR) sometimes refers to:
– Physician office EHR
– Hospital document imaging system
– Non-interoperable record of health-related information
• EHR is term used by:
– Federal government, including in HITECH
– Institute of Medicine (IOM)
– Health Level Seven (HL7)
• Primary organization to develop interoperability in health care information
systems; adopts the term EHR system
– Certification Commission for Healthcare Information
Technology (CCHIT)
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Purposes of EHR
• Improve quality of care: data availability, links to knowledge sources
• Enhance patient safety: context-sensitive reminders/alerts, clinical decision
support, automated surveillance, disease management, drug/device recall
• Support health maintenance: preventive care and wellness - patient
reminders, summaries, tailored instructions, remote evaluation, home monitoring
• Increase productivity: data capture and reporting formats tailored to user,
streamlined workflow support, patient-specific care plans and protocols
• Reduce hassle factors: improve satisfaction for clinicians, consumers, and
caregivers - managing schedules, registration, referrals, medication refills, work queues,
automatically generating administrative data
• Support revenue enhancement: accurate and timely eligibility and benefits,
cost-efficacy analysis, clinical trial recruitment, rules-driven coding support, accountability
reporting/outcomes measures, contract management
• Support predictive modeling: contribute to development of evidence-based
health care guidance
• Maintain patient confidentiality: as health information is securely
exchanged among all stakeholders, including across the continuum of care
and with individuals
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Reality in Hospitals
Other
systems
Other
systems
R-ADT/
HIS
MD
LIS
Operations
Rx
RIS
Interface Engine
PFS
Charges
Portal
EDMS
Remote
Monitoring
Storage
Processor
(RN)
EMAR
POC
CPOE
CDS
CDR
Humancomputer
interface
Humancomputer
interface
CDW
e.g.,
CMS
Hospital
Compare
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of author.
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Reality in Ambulatory Care
PACS
Images
PMS
LIS
Operations
Relational
Database
eRx
Hospital
- Demographics
- Scheduling
- Dictation
- Transcription
- CPOE
Charges
Fax
(or CDR)
Portal
CDS – POC - CPOE
CCR/ Scanning
CCD
PHR
Storage
External
CDW
e.g.,
D.M. or Iz.
Registry
Processor
Human-computer
interface
Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of author.
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HIT Toolkit
Glossary of Terms
CCR/CCD
Continuity of care record/document – standard data content/transmission to send for referrals
CDR
Clinical data repository – database optimized for processing patient transactions, e.g., posting vital signs
CDSS
Clinical decision support system – software that processes discrete data according to logical rules to
provide reminders and alerts
CDW
Clinical data warehouse – database optimized for translational data analysis, e.g., data mining
CPOE
Computerized provider order entry – system that provides CDS at the point of order entry
Discrete (or structured) data = individual values of data that are entered via templates and which are computable; e.g., patient
blood pressure; lab result; name of medication; in contrast to unstructured scanned images, narrative notes, dictation
EDMS
Electronic document management system – document imaging, email, efax, and other digital document
(e.g., dictation) storage and retrieval
E-MAR/BC-MAR
Electronic medication administration record (forms)/bar-code MAR for positive patient identification
eRx
Electronic prescribing system – supports drug selection & transmits prescription to retail pharmacy
Human computer interface = data entry devices, such as workstations, tablets, slates, speech recognition, personal digital
assistants (PDAs), and smart phones
LIS
Laboratory information system that manages operations of a clinical laboratory
O/E
Order entry system used by nursing staff to transcribe handwritten orders
PACS
Picture archiving and communication system – for x-rays and other clinical images
POC Charting
Clinical documentation at the point of care, using clinical practice guidelines/critical pathways and CDS
PHR
Personal health record – patient contributed data in many forms
PMS/HIS/PFS
Practice management system/Hospital information system/patient financial services – applications for
operations, e.g., scheduling, admitting, billing, etc.
RIS
Radiology information system that manages operations of a radiology department
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
Data vs. Information
CDR vs. CDW
Unstructured
information
H&P
Patient ID
Height
Weight
Labs
Patient ID
Test
Result
Alert
Data Repository
Patient ID
+
Lab Test
DKB
Height
+ Result
Weight
Drug & Dose
Data
Warehouse
Pt1 ht
wt
dose
outcome
Pt2 ht
wt
dose
X% Outcome
Orders
Patient ID
Drug
Dose
Structured data
to provide
clinical decision support
Structured data for
Analytical Processing
and Data Mining
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Reality of Today/ Vision for
Tomorrow
• An EHR is a system that
– Collects data from multiple sources
– For use in clinical decision making
– At the point of care
• Even this definition is elusive for many organizations
today
• This definition is primarily focused on care delivery.
There has been little demand from providers/supply of
product to date for:
– Various reporting functions – for quality, P4P, population health
– Health information exchange functionality
– Personal health record (PHR) support
Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.
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Implementation vs. Adoption
• Implementation –
•
software and
hardware installation,
system build, testing,
training, go-live
• Adoption – users
using system to
achieve benefits
“EHR Half Life”
– Half of all who ponder do
something about EHR
– Half of all who sign a
contract implement EHR
– Half of all who implement
EHR
• Implement all components
• Achieve full use
• Use all functionality
Goal of HIT Toolkit is to help you achieve full adoption
Copyright © 2007-8, Margret\A Consulting, LLC
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For More Support
Contact:
Stratis Health
2901 Metro Dr., Suite 400
Bloomington, MN 55425
952-854-3306
1-877-787-2847 (toll free)
www.stratishealth.org
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