Electronic Health Records

HIS 501 Module 2 January 2013

Agenda
Terms EHR Defined History Attributes Functions Benefits Certification Documentation methods NEEHR Perfect

Terms
CMR Computerized Medical Record CPR Computer-based Medical Record CCR Continuity of Care Record EHR Electronic Health Record EMR Electronic Medical Record EPR Electronic Patient Record PHR Personal Health Record PMRI Pt. Medical Record Information

Electronic Health Record

an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations laboratory data and radiology reports

Office of the National Coordinator, 2012

Evolutionary Trends in Health Records

In the beginning, .. Early Man began to use tools, crude as they were

We evolved and so did our tools to provide real information

Table 3.1 EMR and EHR Comparison EMR

EMR Vs. EHR

EHR A repository of individual health records that reside in numerous information systems and locations (inter-organizational) Aggregation of health-related information into one record focused around a persons health history, i.e., a comprehensive, longitudinal record Consulted by authorized clinicians and staff across more than one health care organization

A record of medical care created, managed, and maintained by one health care organization (intraorganizational) Integration of health care data from a participating collection of systems from one health care organization Consulted by authorized clinicians and staff within one health care organization.

Data continuity throughout one health Data interoperability across different care organization organizations

1967

Brief EHR History

1988

LDS Hospital in Utah began using the Health Evaluation through Logical Programming (HELP) software5 which pioneered decision support features6

1969

Science Applications International Corporation (SAIC)'s Composite Health Care System (CHCS) won a $1.02 billion contract for all United States and OCONUS military health care centers.10 It is still the foundation for the Department of Defense's electronic health records.

Harvard's Computer Stored Ambulatory Record (COSTAR) software was implemented6

1992
Epic releases EpicCare (the first Windows-based EMR)1
Allscripts launched its first software program an electronic prescribing solution for physicians13

Development of Dukes The Medical Record (TMR) began8

Technicon Medical Information Management System (TDS), originally a Lockheed product, began implementation at El Camino Hospital in CA and was a groundbreaking CPOE system12

1998

1971

2003
Kaiser Permanente chooses Epic for a $1.8 billion implementation1

1979 Judith Faulkner (eventual Epic founder) launches

Human Services Computing Inc., conducting data analysis for government and the UWMadison psychology department1

1985

1967

1983 Epic Systems Corp. is formed and releases

Cadence (patient scheduling software)1

The VA began use of the Decentralized Hospital Computer Program (DHCP) (still in use today)11

1999
eClinicalWorks founded
14

2003

1975 COSTAR (the Computer Stored Ambulatory Record), Barnett, et al., developed Harvard, placed
in the public domain in 1975 and implemented in hundreds of sites worldwide

Larry Weed and Jan Schultz develop the Problem-Oriented Medical Information System (PROMIS)2

1976

THERESA began use at Emory University's Grady Memorial Hospital in Georgia9 and is notable for its success in direct physician data entry5

EHR Attributes
1. Provides secure, reliable, real-time access to patient health record information where and when it is needed to support care. 2. Captures and manages episodic and longitudinal electronic health record information 3. Functions as clinicians primary information resource during the provision of patient care. 4. Assists with the work of planning and delivering evidence-based care to individual and groups of patients.
HIMSS Electronic Health Record Definitional Model Version 1.0 November 2003

EHR Attributes
5. Captures data used for continuous quality improvement, utilization review, risk management, resource planning, and performance management. 6. Captures the patient health-related information needed for medical records and reimbursement. 7. Provides longitudinal, appropriately masked information to support clinical research, public health reporting, and population health initiatives. 8. Supports clinical trials and evidenced-based research.
HIMSS Electronic Health Record Definitional Model Version 1.0 November 2003

Institute of Medicine Core Functions

Health information and data Result management Order management Decision support Electronic communication and connectivity Patient support Administrative processes and reporting Reporting and population health

 Patient Demographics Scheduling Clinical documentation

o Options- template vs. unstructured o Management o Scanning

Referrals Order entry Results management

o Abnormals o Trends/graphs

EHR Functions

Summary lists
o Problems o Allergies o Medications

Clinical and administrative workflow tasking ePrescribing

o Drug interaction o Formulary mgmt o Refills

Health maintenance reminders Immunization record

 Charge capture & coding

o Medical necessity o Automated coding o E&M coding & compliance

EHR Functions
Practice messaging
o Internal o External

Decision support Clinical practice guidelines Imaging

Population/disease management Patient portals Patient data entry mHealth Participatory health Messaging

Components of EHR

Benefits
Better/faster data access Improved documentation Improvised accessibility
o 24/7 o More than one at a time

Improved Care Coordination

Increases data integrity and quality Increases productivity Increases satisfaction for caregivers Decreases redundant data collection Allows data comparison from prior visits Ongoing record Supports decision support

Inherent Challenges for EMR Adoption

People
Culture Integration vs. Functionality Individual Motivation

Systems
Legacy Vs. New

Availability
Best of Breed Vendor Strategies

Loss of personal control (notes)

Personnel Cost Fear of Computerization

Business Practice
Clear Vision and Priorities
Strategic Plan Work Flows Process vs. Task Orientation Data Ownership Access and Security Patience and Time Cost!

Integration Interoperability

Devices/Mobility
Portals/Single Signon

Staff resistance
Fear of Job Loss

Compromise

Compromise

Compromise

Certified EHR
Meaningful Use Eligible health care providers must adopt and meaningfully use a certified EHR that has been certified by an ONC Authorized Testing and Certification Body (ONC-ATCB). Certification Commission for Healthcare Information Technology (CCHIT) formed to reduce risk to providers adopting an EHR.

Founding of CCHIT
Founded by three HIT associations:
American Health Information Management Assoc (AHIMA) Healthcare Information and Management Systems Society (HIMSS) The National Alliance for Health Information Technology (Alliance)

Formed panel to nominate first Commissioners Provided seed funding and resources First official meeting Sept 14, 2004

Mission of CCHIT
To accelerate the adoption of robust, interoperable HIT throughout the US healthcare system, by creating an efficient, credible, sustainable mechanism for the certification of HIT products.

Slide 18

Standards and Certification Create Tipping Points for New Technologies

The IBM-standard PC launched the personal computing revolution

The Ethernet networking standard gave PCs connectivity

The Wi-fi standard made it wireless

Slide 19

Functionality Work Group Spreadsheet Right Portion

MORE

Evidence on Availability

Conformance Criteria and Test Specifications

To be developed (Phase II): 2005 Criteria and 2006-07 Roadmap

Slide 20

2008 Certification of Ambulatory July 16, Certification EHRs 2008 Commission for Note: Items that are Provisional for 2008 are highlighted in Healthcare Information yellow. Technology 2008 The Certification Commission for Healthcare Information
Technology

Procedure 1.21 Using a template, record vital signs at todays visit: BP 90/55 Height 40 Weight 40 lbs Temperatur e 98.6 (F) Pulse 80 Respiratory rate 20

Expected Result Items are captured and displayed as discrete data elements. Discrete data means that each separate element of the data needs to be stored in its own field. Jurors will look for a separate data field for each element.

Actual Result

Pass/Fail Pass Fail

AM 08.13

Criteria and Reference

The system shall provide the ability to capture patient vital signs, including blood pressure, heart rate, respiratory rate, height, and weight, as discrete data. The system shall provide templates for inputting data in a structured format as part of clinical documentation. The system shall capture patient growth parameters: including weight, height or length, head circumference; and vital signs including: blood pressure, temperature, heart rate, respiratory rate, and severity of pain as discrete elements of structured data. The system shall capture patient growth parameters: including weight, height or length, head circumference; and vital signs including: blood pressure, temperature, heart rate, respiratory rate, and severity of pain as discrete elements of structured data.

Comments Note: If Applicant does not use template to input vital signs data in a structured format, have them execute the test procedure, and then demonstrate use of a template to input structured data.

AM 08.19

CH 02.01

The following TWO steps apply to Child Health Certifications: Document that Pain level is captured there is no pain as a numeric pain Pass (i.e. pain level scale. = 0 or any scale that the system provides). Illustrate pain level. Chosen elements 1.21. When height, will be displayed. 02 weight and vital Pass signs are recorded, document that all fall within the pediatric norms for heart rate, respiratory rate, BP and Temperature. 2008 Test Script AMB+CH v08.04 FINAL.doc
1.21. 01

Fail

CH 02.01

Fail

CH 02.01

The system shall capture patient growth parameters: including weight, height or length, head circumference; and vital signs including: blood pressure, temperature, heart rate, respiratory rate, and severity of pain as discrete elements of structured data. The system shall include the ability to use age- specific and/or heightspecific normative data for a vital sign(s).

CH 04.01

Page 21 of 95

Documentation Methods
Note creation options:
Templates
Clinical discipline Specialty Or type of note

Macros
Combination of keys generate a user predefined text set

Voice Recognition Software/Embedded dictation

Structured documentation Copy and paste

Tailored assessments

Health IT Workforce Curriculum Version 3.0/Spring 2012

Special Topics in Vendor-Specific Systems EHR Functionality

Documentation:
Methods of Information Capture
Unstructured:
Semistructured: Structured:
Health IT Workforce Curriculum Version 3.0/Spring 2012

Narrative free-text notes

Structured headings with some free-text entry

Check boxes in MAR Flow sheet vital signs and patient assessment
Special Topics in Vendor-Specific Systems EHR Functionality

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