EHR Quiz 1

Electronic Medical Record (EMR)

--------- was widely used as the terminology migrated away from computer-based patient record. Then, it began to be used for software that did not contain high-end functionalities such as health maintenance and disease management, care alerts, patient Internet access, interconnectivity with providers outside the practice, and interoperability with external medical testing facilities.

When and how were EHRs used in independent medical offices?

-1990s - originally called practice management systems -Designed for fiscal management

What is the USA Patriot Act and Homeland Security?

-Allows for the disclosure of PHI in relationship to terrorism -HIPPA allows for disclosure of information to law enforcement under certain limited circumstances

What is the Competency Model Clearinghouse (CMC)?

-Critical Work Functions for EHR Competencies: -Understand the use of technology in maintaining electronic health records. -Create and update documents within the EHR using electronic tools and applications (including portable computing devices, word processing, spreadsheets, databases, and desktop presentation applications). -Locate and retrieve information in the electronic health record for various purposes. -Understand the ONC's mission and functions as they pertain to EHRs' application, certification, and meaningful use. -Utilize mainstream software to complete job-specific tasks, and understand the interaction between mainstream and EHR technology. -Follow security and privacy policies and procedures for the use of networks, including intranet and Internet. Critical Work Functions for EHR Competencies -Follow confidentiality and security measures to protect electronic health information. -Differentiate between primary and secondary health data sources and databases. -Identify classification and systematic health-related terminologies for coding and information retrieval. -Know the policies and procedures related to populating and using the health data content within primary and secondary health data sources and databases. -Resolve minor technological problems associated with using an EHR. -Utilize basic IT troubleshooting processes to identify the root cause of an IT-related problem. -Utilize IT help desk for problem resolution where necessary to maximize efficiency and effectiveness.

Describe the technology of EHRs.

-Data Entry Methods -Templates -Portability -Network -Internet and Intranet -Web-based EHRs

Describe a CPOE

-Defined: Means by which a physician or clinician electronically transmits instructions for a patient's treatment or the ordering of tests to a testing facility -one of the core objectives for Meaningful Use -Benefits include function in EHRs -more expedient order completion -reduction in errors related to handwriting -opportunity to check for duplicate or incorrect tests

What is the future of the EHR?

-EHR is here to stay -Federal government continues to encourage development of National Electronic Healthcare Infrastructure -NHIN: part of the federal government's goal to digitize patients' health records and designed on a common platform for HIE -PDAs provide instant access to information at point-of-care

What causes some privacy concerns?

-Email -Encryption issues -Patient Portals -Electronic Signatures -Must be validated -Document cannot be changed post-signature

What are the benefits to the EHR?

-Enhanced accessibility to clinical information -Improved patient safety -Enhanced quality of patient care -Greater efficiency and savings

Office of the National Coordinator for HIT (ONC)

-Established in 2004 -Within the Office of the Secretary for HHS -Purpose: -To serve as a resource for the entire health system -To support HIT adoption -To promote a nationwide health information exchange -Goal: -Improving healthcare in the United States -Authorized several testing centers to certify EHR products -Created the American National Standards Institute (ANSI) Healthcare Information Technology Standards Panel (HITSP) in 2005 to continue efforts of interoperability in healthcare

Name some notable adopted standards

-Health Level Seven (HL7) -The National Council on Prescription Drug Programs (NCPDP) -The Institute of Electrical and Electronic Engineers 11073 Medical Device Communication Standard (IEEE) -Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT)

What are the barriers to the EHR?

-Lack of standards -Unknown costs and ROI -Difficulties operating EHR systems -Significant changes in clinical/clerical processes -Lack of trust and safety

What were the 1st facilities to use EHRs?

-Mayo Clinic in Rochester, Minnesota -University Hospital in Burlington, Vermont -Latter Day Saints Hospital in Salt Lake City, Utah

What are HIPAA's core regulations for the EHR industry?

-Password management -Unique user identification -Access authorization -Accounting of PHI disclosures -Data backup, storage, and security -Auditing abilities -Code sets

During what time frame was there improved functionality of the EHR?

1960s to 1980s

When did vendors of EHRs proliferate?

2000s

Current Procedural Terminology (CPT)codes

5 digit codes which were developed by the AMA and adopted by insurance carriers and managed care companies as the means for identifying common medical procedures.

Practice Management System (PMS)

A software program that manages, among other things, financial transactions, both charges and payments; the billing of insurance claims; and the issuing of patient statements.

Health Information Technology for Economic and Community Health (HITECH)Act

Bonus from CMS Participants meeting certain requirements were eligible for this bonus Beacon Community Program 17 communities were chosen across the US to receive grants in exchange for documenting best practices and working to establish national goals Regional Extension Centers Provide training and support services to assist primary healthcare providers in adopting EHRs Offer information and guidance to help with EHR implementation and achieving meaningful use to qualify for incentive payments Give technical assistance as needed Introduced the first federally mandated "data breach notification requirement" which expanded HIPAA to include "business associates" Increases compliance obligations and privacy regulations Specified methodology for encrypting PHI

What is significant about 2004?

Bush created the ONC position and empowered HHS to promote EHRs.

Centers for Medicare and Medicaid Services (CMS)

By meeting certain requirements for EHRs that began in 2011, providers receive a bonus or incentive payment from the ___________________________.

Computer on Wheels/Work Station On Wheels

COW/WOW

What is significant about 2008?

Obama promised to sponsor adoption of EHRs through stimulus package and MIPPA

American Recovery and Reinvestment Act (ARRA)

On February 17, 2009, President Obama signed the ___________________________ which provided $787 billion to accelerate the nation's economic recovery through investments in infrastructure, unemployment benefits, transportation, education, and healthcare.

Medicare Part A

Part of the federally funded Medicare insurance program that covers hospitals, skilled nursing facilities, home health agencies, and other non- ambulatory services. (Impacted by MIPPA)

Medicare Part B

Part of the federally funded Medicare insurance program that covers medical providers' supervision, outpatient hospital care, diagnostic tests, ambulance services, and other ambulatory services. (impacted by MIPPA)

the main functions of an EHR

Store, share and transmit electronic data

Personal Digital Assistant (PDA)

Term was first used in 1992 by Apple Computer CEO John Sculley. These handheld mobile devices function as a personal information manager.

What's significant about 1991?

The IOM called for eliminating paper records by 2001

e-prescribing

The use of computerized tools, usually embedded in an EHR program, to create and sign prescriptions for medicines, thereby replacing handwritten prescriptions. Then, they are sent to pharmacies over the Internet via a clearinghouse.

Certification Commission for Health Information Technology (CCHIT)

Their mission was to accelerate the adoption of HIT by creating an efficient, credible, and sustainable product certification program. -Organized in July 2004 -Supported by AHIMA, HIMSS, and NAHIT -Work focused in three main HIT areas: -Ambulatory healthcare EHRs for office-based healthcare providers -Inpatient EHRs for hospitals and health systems -Network components through which EHRs interoperate and share information

Return On Investment (ROI)

This measure, expressed as a percentage, is the amount earned from a company's total purchase or investment, calculated by dividing the total capital into earnings or financial benefits.

encrypting

To be transmitted securely, computer data is changed from its original form, making the data unintelligible to unauthorized parties, and then decrypted back into its original form for use.

overall purpose of the EHR

To improve patient medical care by having information accessible for informed medical decision making

Eligible Professional (EP)

To participate in the HITECH Act incentive program for MU on an ONC-certified EHR program, this person qualifying under Medicare must be a doctor of either medicine, osteopathy, dental surgery, dental medicine, podiatry, optometry, or chiropractic. Individuals qualifying under the Medicaid program must be a doctor of medicine or osteopathy, nurse practitioner, certified nurse-midwife, dentist, or qualifying physician assistant.

Health Level 7

a computer messaging and vocabulary standard for demographic information, units of measure, immunizations, and clinical encounters for text-based reports.

drug formulary

a database of approved medications in drug therapy categories that includes information on the preparation, safety, effectiveness, and cost of the medications.

Continuity of Care Record (CCR)

a healthcare provider-oriented record comprising a core set of data considered to be the most relevant summary of a patient's medical healthcare.

Meaningful Use (MU)

a healthcare providers' use of certified EHR technology in ways that can be measured significantly in quality (e.g., e-prescribing) and in quantity (e.g., set percentage of patients). By demonstrating this with an ONC-certified EHR program, providers then can receive stimulus money, as set up through the HITECH Act of 2009. -Defined: -Demonstrably effective use of an EHR program, determined via tangible, ONC-established functionalities -ARRA specifies three main components: -Use of a certified EHR in a specified significant manner -Use of certified EHR technology for electronic exchange of health information to improve healthcare quality -Use of certified EHR technology to submit clinical quality reports and other measures -EPs must demonstrate use of 15 core objectives via use of certified EHR for 90 days

Computer-based Patient Record

a lifetime patient record that includes all information from all specialties, including dentistry and psychology

server

a main computer designed to provide services to clients, workstations, or desktop computers over a local area network or the Internet. Many network software programs have this and a workstation component.

inpatient

a person who is admitted to the hospital and stays overnight or for an indeterminate amount of time, usually several days or weeks.

outpatient

a person who is not hospitalized for 24 hours or more but may visit a hospital, a medical clinic, or other healthcare facility for diagnosis or treatment.

tablet

a portable, handheld computer that allows users to document directly on the screen with a stylus pen or by touch.

intranet

a privately maintained computer network that provides secure accessibility to authorized people and enables sharing of software, databases, and files.

template

an electronic file with a predesigned or set format and structure. It serves as a model for letters, faxes, and reports that need to be filled in to be completed.

Institute Of Medicine (IOM)

an independent, nonprofit organization that works outside the government to provide unbiased and authoritative medical advice to decision makers and the public. -Determined eight main functions of the EHR -Four most notable: 1. Health Information and Patient Data 2. Results Management 3. Order Entry/Management 4. Medical Decision Support

International Classification of Diseases (ICD) codes

codes that are the international standard diagnostic classification for all medical data concerning the incidence and prevalence of disease in large populations and for other health management purposes.

Healthcare Common Procedure Coding System (HCPCS) codes

codes that are used by HHS's Centers for Medicare & Medicaid Services (CMS) to identify medical supplies such as durable medical equipment and medical procedures. Coding supplies ensures uniformity for billing and financial reimbursement.

concepts of an EHR (what it can do)

collect health information for individual patients in inpatient and outpatient settings: -Saves in a digital format -Collects information that is typical of what you would see in paper records -Interfaces with external healthcare computer programs -Transmits labs, orders, prescriptions, and results electronically -Produces comprehensive reports on diagnoses and diseases for governmental reporting

Electronic Health Record (EHR)

computerized, organized collection of individual patients' healthcare information in a digital format.

Health Information Technology (HIT)

deals with the storage, retrieval, sharing, and use of electronic healthcare information involving computer hardware and software.

Application Service Provider (ASP)

enables access to an EHR via the Internet; the EHR software and database are housed and maintained by a separate company in a remote location.

Local Area Network (LAN)

enables multiple computers to communicate with one another, typically using a main server for the database, and can be customized to a healthcare facility's needs.

Consolidated Health Informatics (CHI)

in 2003 this was an initiative of the U.S. Office of Management and Budget (OMB), which released the first set of EHR standards. The goal was to make the approximately 20 federal agencies involved in healthcare and health-related missions interoperable. -Establish common vocabulary -Standard methods for transmission -Not legally required, but heavily suggested

test script

in software testing it is a set of instructions that is performed on the system to ensure the system functions as expected.

When did the EHRs start

in the 1960s

structured data

information that is organized in a coded manner so that it is identifiable, storable, retrievable, and analyzable in a computer system. Conversely, free text is unidentifiable.

Best Practice Guidelines

methods that have consistently shown superior results and are used as a benchmark or standard until improvements are discovered or developed.

Describe the accessibility of the EHR

multiple providers can access at same time

ambulatory

out patient facilities covered by medicare parts a and b

Health Information Portability Accountability Act (HIPAA)

passed by Congress in 1996. This legal act enforces standards for electronic patient health, administrative, and financial data.

Protected Health Information (PHI)

regulated under HIPAA, it includes any information (past, present, or future) about health status, provision of healthcare (including mental health), and payment for healthcare that can be linked to a specific individual.

telehealth services

services that use electronic and communication technology to deliver medical information and services over large and small distances through a standard telephone line.

interoperability

the ability of a software program to accept, send, and communicate data from its database to and from multiple vendors' software programs.

wireless connectivity

the ability to make and maintain a connection between two or more points in a telecommunications system without using "hard" wires or cables. It allows for viewing of data between computer systems and transfer of data from one computer system to another, using electromagnetic waves.

Personal Health Record (PHR)

the patient can access it via the Internet to the medical office's website to store and update personal medical information. Also allows the patient to make inquiries of the healthcare provider regarding prescriptions, appointments, and other concerns.

point of care (POC)

the time and place the healthcare provider gives the patient medical care.

Health Information Exchange (HIE)

the transmission of healthcare information electronically across organizations within a region, community, or hospital system.

Medicare Improvements for Patients and Providers Act (MIPPA)

was enacted by Congress in 2008, this 275-page piece of legislation blocked scheduled cuts in Medicare's payments to physicians and increased benefits to low-income beneficiaries and other vulnerable areas of the population.

patient portal

where a patient can securely log in to access their personal health information

Continuity of Care Document (CCD)

Continuity of Care Record aka

Name the different models of EHRs

Distribution based, web-based personal healthcare, and facility-based

What are the objectives medical facilities have to prove to qualify for incentives from the HITECH Act?

Five of the following objectives have to be selected to qualify for incentives: 1. Perform drug-formulary checks. 2. Document clinical lab test results as structured data. 3. Generate lists of patients by specific conditions. 4. Send reminders to patients per patient preference for preventive/follow-up care. 5. Provide patients with timely electronic access to their health information. 6. Use certified EHR technology to identify patient-specific education resources and provide to patient. 7. Perform medication reconciliation. 8. Create summary of care record for each transition of care/referrals. 9. Submit electronic data to immunization registries/systems (public health objective). 10. Provide electronic surveillance data to public health agencies (public health objective).

National Committee on Vital Health Statistics (NCVHS)

Formed in 1949 and restructured following the passage of HIPAA, they are an advocate for uniform health data sets, particularly for underrepresented populations. This advisory committee has responsibility for providing recommendations on health information policy and standards to the Department of Health and Human Services (HHS).

What caused the accelerated use of EHRs?

Governmental mandates and funding

What is significant about 2009?

Health Information Technology for Economic and Clinical Health (HITECH) Act provided $19.2 billion to accelerate use of EHRs over 5 years (part of ARRA)

Who is responsible for EHR competencies?

MAERB and CAAHEP are developing core curricula for EHR competencies within health professional education programs