Comp 11 EHR Configuration

MYCIN

MYCIN attempted to diagnosis two infectious diseases, meningitis and bacteremia, the latter being infection of the blood. IF/Then Rule based

Vision

view of the future

Bayes' Theorem

we can calculate a probability of something, such as a diagnosis of a disease that is based on a prior probability

Mission

who you serve

Meaningful Use 5 Principles

1) Improving quality, safety & efficiency 2) Engage patients in care 3) increasing coordination of care 4) improve population health status 5) ensure privacy & security

Triggers

Are events that cause rules to be invoked

Clinical Data Repository

A frequently updated database that provided users with direct access to detailed patient-level data

Ad Hoc Reports

A one time report that does not persist in a system.

Acute care hospitals

Acute care hospitals have an organized structure that includes medical staff, nursing services and diagnostic and therapeutic services. They have inpatient beds and provide around-the-clock care.

Alerts

Alert clinicians in critical situations. Alerts are usually used to detect and report adverse events.

RFP Includes

An RFP answers the questions of how a vendor will meet the individual organization system needs. Includes summary of costs & addresses support of project from beginning to end.

MU Stage 1

Collect & share data

clinical event monitors

Components are Event, condition and action. Generates an Alert.

Data Repository

Data warehouse, or Data storage. An open-structure database that is not dedicated to the software of any particular vendor

Migration Project Team

Developing a team for the migration project includes finding both clinical and non-clinical champions. Include champions, end users, technology specialist, & workflow analysts

Assessment and Evaluation

Developing an assessment and evaluation of the EHR and the implementation is a part of quality improvement. Asking end users about the implementation generates possibilities for improving the system during upgrades and maintenance. Suggestions for training may also arise which may give trainers new ideas for engaging the users and improving training materials.

Direct Data Entry

Direct data entry is most desirable since it results in discrete, structured data that can be easily analyzed and reported.

MU Stage 2

E-prescribing, structured lab results, electronic transmission of patient care summaries

EH

Eligible Hospital

EP

Eligible professional

Extended Care

Extended care differs from acute and ambulatory care in that there is an emphasis on treating patients where they reside, be it in nursing homes, personal residences or senior residence housing. The intent is to reduce the cost of health care, increase the quality of care, and creatively resolve health care issues.

Scoring & Heuristics (CDS)

For each of the findings in a disease, there would be two measures: evoking strength and frequency. Evoking strength is the likelihood of a disease given a finding whereas frequency is the likelihood of a finding given a disease.

critical access hospitals

Government regulations limit the number of beds that a critical access hospital may have and require that the hospital be a specific distance from other hospitals in order to be able to be classified as critical access. This typically means that the critical access hospitals are located in more rural areas. The reimbursement regulations that apply to critical access hospitals are different than other acute care hospitals.

HIE

Health information exchange represents the mobilization of healthcare information electronically. It supports the flow of information within organizations, between organizations, between different modules of an EHR, between different EHRs, across regions, between regions or states and ultimately across the nation. HIE supports the flow of information to the person and place where it is needed at the time it is required and in a manner that is secure and preserves patient privacy. It also means that the information arrives in a form that is usable by the person needing it.

Evoking Strength

How likely a disease is present given a symptom

Frequency

How likely a symptom does not occur when a disease is present, Evoking strength looks for disease from matching symptoms, while frequency refutes a disease thru non-matching symptoms.

MU Stage 3

Improved outcomes

Request for Proposals (RFP)

Is an open request to vendors for specific answers to the needs of an organization. The RFP is a legal document towards the migration process.

Arden Syntax

It is a procedural language that allows delivery of what are called medical logic modules, or MLMs. These MLMs then allow sharing of decision support roles across different systems. It is also now a standard, ASTM E1460, and has also been recently converted to XML, or extensible markup language.

Go-Live

Means the system is ready for the users, the users may not be ready.

Quality Measures

Measures of processes, experience, and/or outcomes of patient care, observations or treatment that relate to one or more quality aims for health care such as effective, safe, efficient, patient-centered, equitable, and timely care.

Unstructured Data

Not readable by a computer Ex: documents, transcribed notes, imaging

MU & EHR_

Some of the Meaningful Use objectives that may be met as a result of an EHR implementation include the utilization of CPOE, the reporting of hospital clinical quality measures to the Centers for Medicare & Medicaid Services (CMS) or the state, protecting electronic health information, and providing a summary of the care record for each transition of care or referral.

EHR_Certification

Required for MU, and financial incentives

Migration to an EHR_

Review or develop organizations mission and vision, then develop goals for EHR_ migration.

health care data sets

used for collection of national information. Each data set is made up of specified data items to be collected.

data capture methods

Some of these are entering data directly, including templates or screens completed by the user, scanning handwritten documents, transcribing text reports created by using dictation or speech recognition and interfacing or feeding data from other information systems such as laboratory systems, radiology systems, blood pressure monitors, or electrocardiographs.

Order Sets

Streamline the ordering process, best managed at the department level, translates published guidelines into local workflow. Reduces error and variability, improves efficiency.

Data Dictionary Purpose

Supports infrastructure, interoperability, provides clarity, provides structure

Data Architecture

The configuration, structure, and relationships of hardware (the machinery of the computer including input/output devices, storage devices, and so on) in an information system." The architecture provides a framework for hardware and software configuration.

Data Infrastructure

The data infrastructure, however, focuses on the data needs to operate a health care organization. In a certified EHR, we look not only at the operational end of the organization, but also at the clinical needs and the concerns around the meaningful use of data collected.

Strategic Plan

The process of establishing the overall plan, the purpose and goals.

An EHR project needs three kinds of leaders.

These are a physician champion, a CEO, and a skilled project manager."

Change Agents

These are individuals who see the need to move forward and are willing to deliver on the goals and objectives of the strategic plan for an EHR.

super-users

Those that champion a new system may become more technically savvy than others. These super-users play an important part in encouraging others to embrace the change, and further understand the use of the system.

Life Cycle

User Needs Assessment, Prototype Development, System Selection, System Implementation, Maintenance

Change Management

When change occurs on a large scale a change management program is often led by the human resource management department staff or an education team of clinicians and staff who are champions of the change. The components of the change management program will focus on the human resources. A change management program begins with an assessment of knowledge and attitudes of the users.

practice management

Within practice management there are the basic functions of scheduling, check-in, in-basket and checkout.

CPOE

a computer system that allows direct entry of medical orders by the person with the licensure and privileges to do so." Best practice includes CDS, e-prescribing

Data Set

a group or set of facts (data) with uniform definitions to be used for a special use.

Developing Goals

develop goals that are reasonable, measurable and tactical. First step; describing and planning Second step; develop a timeline Third step; assure financial and human resources

Raw Data

each fact collected is considered raw data.

Patient-Flow Management systems

help to identify the location of the patient at all times and ensure that staff is at the proper locations.

Why CDS

improves quality, patient safety, costs, prevents errors & deaths

Organization Development (OD)

includes setting goals to improve the effectiveness of the change. The major focus of OD is on the total system and its interdependent parts. It is guided by a change agent, change team, or line management.

Data Dictionary

is a descriptive list of names, definitions, and attributes of data elements to be collected in an information system or data base. A data dictionary supports the infrastructure and the interoperability of the systems of the electronic health record within an organization. Ex: ICD, CPT

Request for Information (RFI)

is a tool to ask vendors about their products.

Templates

makes entering data quicker and easier, can provide default values

patient clinical summary

may display some demographic information, a problem list, a current medication list, a listing of recent visits and results that are available for review.

CDS

provides clinicians, staff, patients, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times to enhance health and health care.

Structured Data

readable by a computer Ex: Registration data

Clinical documentation

refers to patient progress notes, lab results. In other words this is a "paper medical record."

Reminders

remind clinicians to perform various actions

Needs Assessment

the process of identifying the system technology and software that is needed to advance to an EHR.