HCI-112 Chapter 1 What Is the Electronic Health Record?

Wireless

Users are free to 'roam' and not tied to one technology-currently tablets are changing the landscape

LAN-Local Area Network

____ allows for a 'build as you go' approach to buying and installing hardware

biometric scanners

______ can scan parts of the human body to identify and authenticate the individual.

Bar code scanners

______ convert lines to numeric equivalents,

Well known input technologies

Pointing Devices Mice Track pads Touchscreens Keyboards Barcode and RFID scanners Fingerprint readers Eye-tracking devices for the disabled

Standards of EHR

Provide a foundation of interoperability between systems. Implementation across a region or nationally requires uniformity in - Clinical and business processes of healthcare service providers. - Information structure of healthcare data. - Quality of healthcare services

Cloud systems

The evolution of the 'cloud' is providing a cost-effective means to share applications across multiple computers/devices. Users can access applications via a web browser from anywhere or via an intr-a-net

Other Considerations in EHR

The role of clinical coding systems The role of standard frameworks

Clinical decision support

The system reviews the patient record and makes recommendations based on the data input by the physician.

Access to Knowledge Resources

This feature allows the physician to review literature and studies related to a specific diagnosis as they are inputting the diagnosis in to the patient record. This increases the chance that the current knowledge will influence the clinicians decisions

Intranet (Intr-a-net)

is an *internal or private network* that can only be accessed within the confines of a company, university, or organization.

These eight functional areas are part of the Health Level 7 organization standards by which commercial products (HIS software) should be evaluated for which EHR systems should provide supporting features/functions

Health information and data Patient support Results management Electronic communication and connectivity Decision-support management Reporting and population health Order entry/management Administrative processes

Best-of-Breed: Interfaced

- Advantages Build system "as-you-go". Customizable. Select from best products available. - Disadvantages Costly. Many interfaces required. Manage multiple vendors. Back-up/availability more difficult.

Hybrid

- Advantages Build system "as-you-go". Moderately Customizable. Fewer vendors than best-of-breed. Data integration less costly than best-of-breed. Back-up/availability better. - Disadvantages Multiple interfaces required. Manage multiple vendors.

Unified Database: Integrated

- Advantages Not Customizable. Single vendor. No interfaces required (or very few). Complete data integration. Back-up/availability best. - Disadvantages Tied to one vendor (may have less desirable applications in some areas). Cheaper option, Limited in features

ASP vs Client Server

- Application Service Provider Cheaper start-up cost Cheaper Hardware Needs Broadband access. If the service is down, the EHR is down Not Highly customizable since it is a service offerings Internet Security Threats - Client-Server Higher start-up cost Higher Hardware cost Local Access using existing network infrastructure Customization Possible Service Security Breaches are possible.

Healthcare Information Technology allows for:

- Better record keeping that can follow patient. - Ability to record more sophisticated tests, medications, treatments

some factors that can affect implementation of EHR

- Changes in clinical workflow. - Privacy and security. - Unique identification. - Interoperability. - Consistent use of standards. - Ethical, legal issues

Significance of EHR

- Helps provide integrated view of healthcare records. - Makes it easier to maintain health information of patients. - Is more efficient in complex environments. - Potentially provides better patient care. - Often provides improved quality of care. - Reduces health care delivery costs. - Accelerates research.

Functions of Electronic heath records (EHR)

- Store and provide access to retrieval of health information. - Integrate data from various sources. - Work in synchronization of the original workflow of the healthcare organization efficiently and effectively. - Provide reminders, prompts, and alerts. - Empower patients to access their health information, thus allowing the patient to be involved in their own healthcare. - Improve the quality of the care. - Decrease patient/insurance costs as providers will no longer need to duplicate tests.

User Authentication

- User passwords - Biometric Identification Biometric ID is superior to passwords, its much more difficult to steal and they cannot be forgotten.

Video Input

- Webcams - Digital cameras - Digital camcorders

Large Amounts Of Routing Data often resides in paper forms, such as insurance claim forms. To enable automated computer processing of these paper there are some steps

- it needs to be entered into computer systems - Bulk scanning and upload of these forms is the standard process for entering them into computer systems

Specialized Scanners

1- Bar code scanners 2- biometric scanners 3- optical mark recognition (OMR ) 4- optical character recognition (OCR) 5- magnetic ink character recognition (MICR )

EHR INTEGRATION MODELS

1- Best-of-Breed: Interfaced 2- Hybrid 3- Unified Database: Integrated

EHR Supporting Technologies

1. Databases (core) 2. Delivery Model 3. DATA input Technologies-Devices 4. Networking-Infrastructure 5. DATA Security-Authentication and Encryption 6. Conformance to Standardization (HL7)

Five Functional Components of an EHR system

1. Integrated view of patient data 2. Clinical decision support 3. Clinician order entry 4. Access to knowledge resources 5. Integrated communication and reporting support

Computerized Physician Order Entry (CPOE) Components:

1.Clinical Documentation 2.Picture Archiving and Communication Systems 3.Electronic Medication Administration Records 4.Ambulatory Electronic Health Record Systems

Ancillary Components for Outpatient Systems:

1.Disease Registry and Preventative Medicine 2.Two-Way Laboratory Interfaces 3.E-Prescribing 4.Laboratory Management System

Most Common Hospital IT Applications

1.Master Patient Index 2.Pharmacy Information System 3.Radiology Information System 4.Picture Archiving System 5.Nursing Information System 6.Hospital Information system 7.Charts Management/Medical Records System 8.Practice Management System 9.Laboratory Management System

Integrated Care EHR

A *database* of electronic heath records

Computer-based Patient Record (CPR)

A *life-time* health record of a patient, including records *from all specialties*.

optical mark recognition (OMR )

A common ________ application is the use of "bubble sheets" for multiple-choice tests used by schools. The student indicates the answer on the test by filling in the corresponding bubble

Personal Health Record (PHR)

A record that is managed and controlled by the patient.

Electronic Medical Record (EMR)

An EHR within a healthcare organization. Also considered a* single episode *in the patient's care.

Application Service Provider

Cheaper start-up cost Cheaper Hardware Needs Broadband access. If the service is down, the EHR is down Not Highly customizable since it is a service offerings Internet Security Threats

Batch Processing

Entering a large quantity of data into a computer system and processing it all at one time

Biometric Identification

Fingerprint Iris scanning Voice Facial Recognition

Client-Server

Higher start-up cost Higher Hardware cost Local Access using existing network infrastructure Customization Possible Service Security Breaches are possible.

Delivery Model

I. Application Service Provider (PUBLIC CLOUD-SAAS) II. Client-Server (PRIVATE CLOUD)

Clinician order entry

Integrated EHR systems allow for a review of the patients record and alerts the medical professional to potential issues with the order being placed. Think back to the example of the young girl who received too much insulin.

Audio Input

Microphones Electronic keyboards Digital audio recorders

Electronic Patient Record (EPR)

Similar to the CPR, this record only focuses on the current* relevant information*.

eye-tracking

Some of the most innovative input devices are designed to help the disabled, such as _____ devices that use gaze direction as the pointing device.

Integrated Communication and Reporting Support

allows all members of the patients healthcare team to review and coordinate care. This function also alerts the physician as to abnormal test results or other results of importance so action can be take quickly.

optical character recognition (OCR)

convert handwritten text to digital text

MICR "magnetic ink character recognition"

is a technology used to verify the legitimacy or originality of paper documents, especially checks. Special ink, which is sensitive to magnetic fields, is used in the printing of certain characters on the original documents. Information can be encoded in the magnetic characters. غالبا تستخدم في البنوك

Advantages of EHR

•Accessibility •Multimedia •Data Collection •Controlled Access •Legibility

Standards that guide the development of EHR systems

•HL7 •HIPAA •LOINC-lab test observations •DICOM-radiology •SNOMED-medical terminology

Disadvantages to EHR

•Investment •Training •Support •Catastrophic Failure •Time for physicians to input information •Bandwidth

The EHR is also known as:

•Patient record •Patient chart •Medical record •Electronic Medical Record (EMR) •Electronic Patient Record (EPR)