Chapter 3 Electronic Health Records
Which of the following are challenges in hospitals' ability to attest to Stage 2 meaningful use?
Cost, lack of interoperability, and physician resistance to use the technology
Electronic medication administration records (eMAR)
Use of technology and bar coding to track medications from when ordered to when given to the patient
President George W. Bush
_______ noted in his 2004 State of the Union address "By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care" that the issue of EHR came to the forefront for the American people and significant federal investment in health IT was initiated.
a comprehensive EHR system is important to
provide appropriate information to enhance patient care
picture archiving and communication systems (PACS)
provide storage of electronic images and reports.
Regional Extension Centers (RECs)
provide support and serve as resources for healthcare providers for EHR implementation and use; were established by the ONC to assist primary care providers in quickly becoming adept and meaningful users of EHRs
eight core functions that EHR system
1.Health information and data 2.Results management 3.Order entry/management 4.Decision support 5.Electronic communication/connectivity 6.Patient support 7.Administrative processes and reporting 8.Reporting and population health management see image for examples
Health Information and Management Systems Society (HIMSS)
A cause-based not-for-profit organization exclusively focused on providing global leadership for the optimal use of IT and management systems for the betterment of healthcare. The HIMSS mission is to lead healthcare transformation through the effective use of health information technology
American Recovery and Reinvestment Act (ARRA)
An economic stimulus bill created to help the United States recover from the downturn of the economy with a total amount of $787 billion allocated to the recovery; In 2009 provided a significant impetus to HIT through the allocation of over $20 billion in funds to promote HIT
Computerized provider (physician) order entry (CPOE)
Applications that allow providers to write orders for medications or other treatments and transmit them electronically
Structured data
Binary, computer-readable data
The program that currently certifies EHR systems that meet meaningful use
CEHRT
____ are a key factor in the exchange of data, which is the sharing of data between systems and organizations.
EHRs
_____ are designed to create an electronic record to bring together information from disparate systems that are in compliance with standards for the purpose of supporting quality of care, administrative functions, and research.
EHRs
clinical outcomes
Eventual outcomes of the meaningful use initiatives should be improved_____ and health of populations as a whole, improved efficiency and transparency in the provision of care, and considerably more data that can be used for research.
______ are the reasons for the increased deployment of EHRs.
Funding initiatives, reimbursement considerations, and regulations
Benefits of EHR
However, once the information is maintained electronically the information from all episodes of care can be accessed at one time, from many different locations, and in different formats than the original record. Other benefits of the EHR are the ability of multiple authorized individuals to access it at the same time as opposed to a paper record, which can only be accessed by one person at a time. EHRs also provide alerts and reminders about preventive services and provide information to support diagnostic and therapeutic decision making. EHRs are a key factor in the exchange of data, which is the sharing of data between systems and organizations.
Health Information Technology for Economic and Clinical Health (HITECH) Act
One part of ARRA. Designated funding to modernize the healthcare system by promoting and expanding the adoption of health information technology. HITECH provided $20 billion in Medicare and Medicaid incentive payments to physicians and hospitals for meaningful use of EHRs and $2.6 billion to support ONC initiatives
Primary and secondary uses of an EHR system
Primary uses: Patient care delivery Patient care management Patient care support processes Financial and other administrative processes Patient self-management Secondary uses: Education Regulation Research Public health policy and homeland security Policy support
Clinical information systems (CIS)
Systems designed to facilitate the management of the activities of various clinical departments and to provide electronic charge capture and results reporting
______ data tends to be more descriptive and provides better communication for patient care.
Unstructured
laboratory information system (LIS)
a system for the integration of laboratory information related to the processing and storage of medical tests (physician orders for the tests and reports of results) that interfaces with the EHR to provide this information for inclusion in individual patient records.
Certification Electronic Health Information Technology (CEHRT) criteria
a system meets the technological capability, functionality, and security requirements adopted by HHS (Health and Human Service) in addition to being secure and interoperable
Interoperability standards
allow different health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities
computer-based patient record (CPR)
an electronic patient record that provides complete and accurate data, alerts, reminders, clinical decision support, links to medical knowledge, and other aids
electronic health record (EHR)
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 organization
Clinical documentation
any manual or electronic notation (or recording) made by a physician, or other healthcare clinician, that is associated with a patient's medical condition and treatment
Interfaces
are hardware or software that enable disparate (different) CIS and HIS software systems to communicate with each other.
Radiology information systems (RIS)
brings together patient radiology data with images and includes patient tracking, scheduling, and reporting of results.
Behavioral healthcare
broad array of psychiatric services provided in acute, long-term, and ambulatory care settings; includes treatment of mental disorders, chemical dependency, mental retardation, and developmental disabilities, as well as cognitive rehabilitation services
The summary findings indicated that _____ was one of the most commonly identified barriers to implementing the EHR.
cost
Primary uses of the EHR system are the __________ and the secondary uses involve aggregating patient data to improve the delivery of healthcare.
direct recording of care on individual patients
inpatient EHR's components may include
financial and administrative applications, clinical systems, CPOE, electronic medication administration records (EMARs) (use of technology and bar coding to track medications from when ordered to when given to the patient), clinical data repositories, clinical decision support, document imaging, and PACS.
Health and Medicine Division (HMD)
formerly Institute of Medicine (IOM), an independent, nonprofit organization that works outside of government to provide unbiased and authoritative advice to decision makers and the public
Evidence-based medicine
healthcare services based on clinical methods that have been thoroughly tested through controlled, peer-reviewed biomedical studies; Relies on clinical expertise and the best research-based clinical evidence
Much of the growth in adoption of EHRs can be attributed to the _____ supporting the purchasing of systems to facilitate the meeting of meaningful use requirements for reporting and to the monetary penalties for not having an EHR.
incentive program
An ____ system is one that has been designed to bring together multiple information systems, and allows them to communicate in a timely and effective manner and work together as one system
integrated
The _______ is the key component for an EHR system to provide the seamless sharing of patient information.
interoperability
Integration
involves ensuring that all aspects of an information system communicate appropriately and function as a uniform system
episode of care
is the specific instance of a condition or illness with a defined time frame of care in which the patient is treated.
Meaningful use
is using certified electronic health record (EHR) technology to: (1) improve quality, safety, efficiency, and reduce health disparities, (2) engage patients and family, (3) improve care coordination, and population and public health, and (4) maintain privacy and security of patient health information" (HealthIT 2015). ANOTHER DEFINITION: The use of a certified EHR in a meaningful manner such as for e-prescribing; clinical decision support; maintenance of a problem list of current and active diagnoses; the exchange of health information; and the submission of quality or other measures. This is evaluated as part of the EHR Incentive Program of CMS
Office of the National Coordinator for Health Information Technology (ONC)
legislated in 2009 in the HITECH Act; the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information
Ambulatory (EHR) record is ______ rather than episodic.
longitudinal
unstructured data
nonbinary, human-readable information
EHRs provide the means for the focus to be more on the patient's health _____ rather than the condition present at a specific time.
over time (overall health)
e-prescribing
practitioners can use electronic devices to write and submit prescription orders directly to a participating pharmacy
The information exchange requires interoperability systems and policies defined for supporting the exchange while_______ of the information.
protecting the privacy and security
comprehensive EHR system
quite complex and supports more than the data needed for meaningful use purposes. The systems are also used for capturing diagnostic and treatment information such as medications, lab, x-ray, and other clinical information in addition to the administrative uses. The element that is identified as administrative in nature includes those data that accurately identify the patient, such as the name and other demographics, and the registration, admissions, discharge, and transfer information, including such things as chief complaint and patient disposition. A vital administrative consideration is the unique patient identifier, which is at the core of an EHR because it is the means by which all information from the various components is linked to the patient. For confidentiality and security purposes the patient identifier is unique to the organization and not known outside the organization.
source systems
refer to other computer systems that feed information into the EHR, which would also need to be corrected according to policy when corrections are made in the EHR. Refer to any system or file that captures or holds data of interest.
Examples of clinical functions in an EHR
see page 89 for table
health information systems (HISs)
set of components and procedures organized with the objective of generating information which improve health care management decisions at all levels of the health system
HIMSS adoption model
the HIMSS adoption model that can serve as a benchmark for others in their pursuit of implementing technology (pg 92)
Interoperability
the capability of different information systems and software applications to communicate and exchange data.
Clinical decision support (CDS)
the process in which individual data elements are represented in the computer by a special code to be used in making comparisons, trending results, and supplying clinical reminders and alerts
A disadvantage of unstructured data is
typically more descriptive
Enterprise integration
under HITECH means the electronic linkage of healthcare providers, health plans, the government, and other interested parties, to enable the electronic exchange and use of health information among all the components in the healthcare infrastructure in accordance with applicable law (AHIMA 2014, 55).
A vital administrative consideration is the _____, which is at the core of an EHR because it is the means by which all information from the various components is linked to the patient. For confidentiality and security purposes the patient identifier is unique to the organization and not known outside the organization.
unique patient identifier
