EMR EHR

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Health Management Information
Systems
Electronic Health Records
Lecture a
This material Comp6_Unit3a was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.
Electronic Health Records
Learning Objectives
1. State the similarities and differences between an electronic medical
record (EMR) and electronic health record (EHR) (Lecture a)
2. Identify attributes and functions of an EHR (Lecture a)
3. Describe the perspectives of health care providers and the public
regarding acceptance of or issues with an EHR, which can serve
as facilitators of or major barriers to its adoption (Lecture a)
4. Explain how the use of an EHR can affect patient care safety,
efficiency of care practices, and patient outcomes (Lecture a)
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
2
Electronic Health Records
Learning Objectives
4. Discuss how Health Information Exchange (HIE) and Nationwide
Health Information Network (NHIN) impact health care delivery and
the practice of health care providers (Lecture b)
5. Outline issues regarding governmental regulation of EHR systems,
such as meaningful use of interoperable health information
technology and a qualified R (Lecture b)
6. Summarize how the Institute of Medicine’s Vision for 21st Century
Health Care and Wellness may impact health management
information systems (Lecture b)
7. Identify how ongoing developments in biomedical informatics can
affect future uses and challenges related to health information
systems (Lecture b)
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
3
Purpose of a Patient (Medical) Record
• “To recall observations, to inform others,
to instruct students, to gain knowledge,
to monitor performance, and to justify
interventions”
• Serves as the legal business record
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
4
Electronic Medical Record (EMR)
• Electronic record of health-related
information on an individual
– Within one health care organization
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
5
EMR Purpose
• Provide an electronic equivalent of an
individual’s legal medical record
– Intra-organizational
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
6
Electronic Health Record (EHR)
• Electronic record of health-related
information on an individual
– Across more than one health care
organization
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
7
EHR Purpose
• Provide an electronic equivalent of an
individual’s health record for use by
providers and staff across more than one
health care organization
• Support efficient, high-quality integrated
health care, independent of the place and
time of health care delivery
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
8
EMR Versus EHR
Table 3.1
EMR and EHR Comparison
EMR
EHR
A record of medical care created,
managed, and maintained by one
health care organization (intraorganizational)
A repository of individual health
records that reside in numerous
information systems and locations
(inter-organizational)
Integration of health care data from a
Aggregation of health-related
participating collection of systems from information into one record focused
one health care organization
around a person’s health history, i.e.,
a comprehensive, longitudinal record
Consulted by authorized clinicians and Consulted by authorized clinicians and
staff within one health care
staff across more than one health care
organization.
organization
Data continuity throughout one health
care organization
Health IT Workforce Curriculum
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Data interoperability across different
organizations
Health Management Information Systems
Electronic Health Records
Lecture a
9
EHRs Versus Paper Records
• EHRs can make a patient’s health information
available when and where it is needed
• EHRs can bring a patient’s total health
information together in one place, and always be
current
• EHRs can support better follow-up information
for patients
• EHRs can improve patient and provider
convenience
Health IT Workforce Curriculum
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Health Management Information Systems
Electronic Health Records
Lecture a
10
EHRs Versus Paper Records
• EHRs
– Can link information with patient computers to
point to additional resources
– Don’t just “contain” or transmit information,
they also compute with it
– Can improve safety
Health IT Workforce Curriculum
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Health Management Information Systems
Electronic Health Records
Lecture a
11
EHRs Versus Paper Records
• EHRs can
– Deliver more information in more directions
• While reducing “paperwork” time for providers
– Improve privacy and security
– Reduce costs
Health IT Workforce Curriculum
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Health Management Information Systems
Electronic Health Records
Lecture a
12
Attributes of an EHR
• Provides secure, reliable, real-time access
to patient health record information, where
and when it is needed to support care
• Captures and manages episodic and
longitudinal electronic health record
information
Health IT Workforce Curriculum
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Health Management Information Systems
Electronic Health Records
Lecture a
13
Attributes continued
• Functions as clinicians’ primary information
resource during the provision of patient care
• Assists with the work of planning and delivering
evidence-based care to individual and groups of
patients
• Supports continuous quality improvement,
utilization review, risk management, and
performance monitoring
Health IT Workforce Curriculum
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Health Management Information Systems
Electronic Health Records
Lecture a
14
Attributes continued
• Captures the patient health-related
information needed for reimbursement
• Provides longitudinal, appropriately
masked information to support clinical
research, public health reporting, and
population health initiatives
• Supports clinical trials
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
15
HL7 EHR Functions
• Direct care functions
• Supportive functions
• Information infrastructure functions
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
16
Direct Care Functions
Table 3.2
HL7 2007 EHR-S Functional Model Direct Care Functions Subsets with Examples
Subset
Examples
Care management
Identify and maintain a patient record
Manage patient demographics
Manage problem lists
Clinical decision support
Support for standard care plans,
guidelines, protocols
Support for medication and
immunization administration
Orders, referrals, results and care
management
Operations Management and
Communication
Clinical workflow tasking
Support clinical communication
Support for provider-pharmacy
communication
Health IT Workforce Curriculum
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Health Management Information Systems
Electronic Health Records
Lecture a
17
Supportive Functions
• Clinical Support
• Measurement, Analysis, Research and
Reports
• Administrative and Financial
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
18
Information Infrastructure
Functions
•
•
•
•
•
•
Security
Health record information and management
Registry and directory services
Standard terminologies and terminology services
Standards-based interoperability
Business rules managementorkflow management
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
19
Standards for Certification of EHR
Technology
• Content exchange standards
– NCPDP SCRIPT Standard
– HL7 Clinical Document Architecture (CDA), CCD
• Vocabulary standards
– SNOMED CT
– LOINC
• Privacy and security standards
– NIST encryption algorithm
– NIST hashing algorithm
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
20
EHR Acceptance
• Health care provider
– Increasing momentum for widespread
adoption and implementation of EHRs
• ARRA/HITECH
• Authorized Testing and Certification Body by the
Office of the National Coordinator
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
21
EHR Acceptance
• Public
– Harris Interactive Survey from 2005
• Mixed Feelings
– 45% EHR system important
• Concern over
– Privacy
– Increase rather than decrease of medical errors
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
22
EHR Acceptance: Public
• Harris Interactive Survey
– All physicians treating me should have access
to information contained in my EMR
• Percent answering "Strongly/Somewhat Agree"
– 78% in 2009
– 78% in 2010
– An EMR would be a valuable tool to track the
progress of my health
• Percent answering "Strongly/Somewhat Agree"
– 72% in 2009
– 71% in 2010
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
23
Barriers to Adoption
•
•
•
•
Cost of conversion
Perceived lack of ROI
Technical and logistical challenges
Privacy and security concerns
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
24
EHR Effect on Patient Care Safety
• Reduces the need to repeat tests
• Reduces the number of lost reports
• Supports provider decision making
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
25
EHR Effect on Efficiency
• Improves accessibility of patient
information
• Integrates data from multiple internal and
external sources
• Facilitates the co-ordination of health care
delivery
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
26
EHR Effect on Patient Outcomes
• Has the potential to
• Improve the quality of patient care
• Help providers practice better medicine
• Provide seamless exchange of information among
providers
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
27
Electronic Health Records
Summary – Lecture a
•
•
•
•
Defined an EMR and EHR
Explained similarities and differences
Identified EHR attributes and functions
Discussed the issues surrounding EHR
adoption and implementation
• Described the impact of EHRs on patient
care
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
28
Electronic Health Records
References – Lecture a
References
•
AHIMA e-HIM Work Group on Maintaining the Legal EHR. (2005). Update: Maintaining a legally sound health
record—paper and electronic. Journal of AHIMA 76(10), 64A-L. Retrieved from
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_028509.hcsp?dDocName=bok1_028509
•
Blumenthal, D. (2009, April 9). Stimulating the adoption of health information technology. New England Journal of
Medicine 360,1477-1479. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMp0901592
•
Handler, T., Holtmeier, R., Mtezger, J., Overhage, M., Taylor, S., & Underwood, C. (2003, July 7). HIMSS
electronic health record definitional model version 1.0. Retrieved from
http://www.providersedge.com/ehdocs/ehr_articles/HIMSS_EMR_Definition_Model_v1-0.pdf
•
Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria
for Electronic Health Record Technology; Final Rule, 45 CFR Part 170 (July 28, 2010). Retrieved from
http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf
•
Harris Interactive. (2010, June 17). Few Americans using 'E-' medical records. Retrieve from
http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/ctl/ReadCustom%20Default/mid/1508/ArticleId/
414/Default.aspx
•
Health Level Seven International. (n.d.). About HL7. Retrieved from http://www.hl7.org/about/index.cfm?ref=nav
•
Health Level Seven International. (2007). HL7 2007 EHR-S functional model. Retrieved from
http://www.hl7.org/ehr/downloads/index_2007.asp
•
Radiological Society of North America. (2005, September). IHE moves EHR goals forward. Retrieved from
http://www.rsna.org/Publications/rsnanews/sep05/ihe.cfm
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
29
Electronic Health Records
References – Lecture a
References
•
Reiser, S. J. (1991). The clinical record in medicine. Part 1:Learning from cases. Annals of Internal Medicine, 114,
902-907.
•
The National Alliance for Health Information Technology. (2008, April 28). Defining key health information
technology terms. Retrieved from
healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_848133_0_0_18/10_2_hit_terms.pdf
•
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2010, July13).
Electronic health records at a glance. Retrieved from
https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3788&intNumPerPage=10&checkDate=&checkKe
y=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll
=&pYear=&year=&desc=false&cboOrder=date
Charts, Tables, Figures
3.1 Table: EMR and EHR Comparison
3.2 Table: HL7 2007 EHR-S Functional Model Direct Care Functions Subsets with Examples
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Electronic Health Records
Lecture a
30
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