The electronic patient record
The patient record
• Notes made by physician
• Long history
Paper records
• Lloyd George
envelope
• Can be very large
• Advantages
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–
–
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Simplicity
Availability
Economy
Durability
• Problems
– Availability
– Legibility
– Analysis
Message types
• Data-oriented
– Different data types kept separate
• Task-oriented
– Different tasks kept separate
• Template-oriented
– Hybrid
– Cross-reference task <-> data
Record structures
• Integrated or time oriented
– What happened at each episode
– Data-oriented
• Source oriented
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–
–
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Examination notes
X-ray reports
Lab tests
Also data-oriented
The Problem-oriented
medical record
• Lawrence Weed
• SOAP
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–
–
–
Subjective
Objective
Assessment
Plan
• Separate section for each problem
• Template-driven (partially)
Protocol-driven
•
•
•
•
Standard procedure (e.g. diabetes)
Template
Always record same sequence of data
Task-oriented
The electronic
patient record
• Definition : the Patient Record held in
electronic form whose Custodian(s)
work within a single autonomous
organisation
• Can be active : …support users by
[providing] alerts, reminders, decision
support… medical knowledge etc.
Issues
• Standards especially in terminology
– Narrative text vs coding
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•
•
•
•
Privacy and confidentiality
Data entry by health professionals
Integration
Decision support
(Shortliffe)
EPR structure
• Source oriented
– Data from many sources are combined
• Time oriented
– Time is stamped on each piece of data
• Problem oriented
– Data should be linked to show physicians
reasoning and progress of problem
• Protocol driven
Predecessors of EPR
• HISS – Hospital information support
systems
• PAS – Patient administration systems
– Demographic details
– Admission
– Discharge
• Departmental systems
EPR in general practice
• Well-established (since 1970’s)
• Widely-used (90% of practices)
• Useful
– Prescribing
– Registers
– Clinical information
EPR in hospitals
• Plans since Information for Health – 1998
• Few successful implementations (3%)
EPR level 1
• Clinical administrative data
– Patient administration
– Departmental systems (separate)
EPR level 2
• Integrated clinical diagnosis and treatment
support
• Level 1 plus:
– Patient master index integrated with
Departmental systems
EPR level 3
• Clinical activity support
• Level 2 plus:
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Clinical orders
Results reporting
Prescribing
Multi-professional care pathways
EPR level 4
• Level 3 plus
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Electronic access to knowledge bases
Embedded guidelines
Rules
Electronic alerts
Expert system support
EPR level 5
• Level 4 plus
– Special clinical modules
– Document imaging
EPR level 6
• Level 5 plus
– Telemedicine
– Multi-media applications
– Picture archiving and support systems
Targets
• 2002 – 35% at EPR level 3
• 2005 – all at EPR level 3
The Electronic Health
Record ISO/DTR 20514
A repository of information regarding
the health status of a subject of
care in computer processable form,
stored and transmitted securely, and
accessible by multiple authorised
users. It has a standardised or
commonly agreed logical information
model which is independent of EHR
systems.
EHR continued
Its primary purpose is the
support of continuing, efficient and
quality integrated health care and it
contains information which is
retrospective, concurrent, and
prospective
Further reading
• ISO/CEN TC 251 13606
http://www.prorecireland.ie/Gerard%20Freriks
.ppt
• http://www.prorecireland.ie/4%20Thomas%20
Beale.ppt
• HL7 Reference Information Model
• http://www.hl7.org.au/HL7-V3-Resrcs.htm
• OpenEHR
• http://www.openehr.org/getting_started/t_openehr
_primer.htm