Chapter 1 - EHR

Electronic systems involve changes at every level of health care and by everyone that ___ or ___ with healthcare.

Works or Interacts.

EHR will create a data repository of information collected by each system, enabling.

Patient reminders, alerts for practitioners, order tracking, and transfer of information between health care settings.

Data Repository available for providers when they see a patient. It includes all patients?

Payment identifiers, patient visit history, problem list, medications, reports, diagnostic and therapeutic procedures and results, image orders, and treatment plans.

HITECH Act of 2009

Provides Medicare and Medicaid incentive payments for EHR implementation if criteria are met and funds Health Information Exchanges (HIEs), and Regional Health IT Extension Centers (RECs), at the state, and regional levels.

EHR other major components such as sharing of diagnostic and treatment information among providers would include items such as.

Reduce duplicate testing, minimize adverse drug and treatment effects, and allowing telemonitoring.

Exchanges that are organized by geographic regions, such as sate or part of a state may be referred to as a?

Regional Health Information Organization (RHIO).

"Meaningful Use"

Relates to the actual ways that the EHR must be used to support patient care and specific ways that quality of care must be measured to receive incentive payments from Medicaid and Medicare Services as determined by the federal HITECH Act.

Interoperability.

The capacity of systems to communicate and exchange information with one another.

A fully functional EHR is robust product that can have a huge impact on both?

The care provided and the processes performed in the health care provider setting

The National Alliance for Heath Information Technology published a report in 2008 that provided definitions for Electronic Medical Record and Electronic Health Record. What is the difference.

The word "interoperability" distinguishes an EHR from a EMR.

Benefits of EHR, improves quality of care.

Timely diagnostic and therapy reports mean that treatment is more focused. Evaluation of treatment steps vs outcomes helps identify best practices and establish diagnosis based treatment protocols.

EHR system could produce reminders to patients that they need?f

To schedule an appointment or supply the service and diagnostic information needed to submit a bill to a third party for payment.

It is estimated that by year ___ less than half of practices and implemented components of an electronic health record (EHR) system and far fewer had fully functional systems.

2010.

CDC study on EHR

28.8% of office-based physicians had electronic records. 17.4% had hybrid (paper and electronic) records.

Benefits of EHR, improves clinical decisions, supporting evidence-based medicine.

Access to medical treatment and medication research literature provides current information while under care. Imaging capabilities provides opportunities for providers to exchange information for expert opinion.

Benefits of EHR, improves patient communication and satisfaction.

Accurate treatment decision-faster recovery. Patient can contribute medical information and gain access to help them better understand treatment -true partners in their care. Patient alerts automatically-timely screening and follow up.

Electronic Health Record (EHR)

An electronic health 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 health care organization.

Electronic Medical Record (EMR)

An electronic records of health related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

Certification Commission for Health Care Information Technology. (CCHIT)

An independent, nonprofit organization formed to establish functional, interoperability, and security criteria to certify EHR products as meeting those criteria.

Accountable Care Organizations.

Another type of network of health care providers that are tied together not only for the purpose of better serving a group of patients, but also for reducing cost for that selected patient population while focusing on maintaining quality of care.

Benefits of EHR, increase staff recruitment and productivity.

Appropriate use of documentation templates and ease of data entry impacts productivity.

Alerts.

Automated notices to practitioners of information that requires immediate or special attention.

EHR other major components such as accessing research information would include items such as

Best practices, treatment protocols, and access to expert knowledge bases.

Computers have been used in healthcare environments for decades. What are some of the uses?

Billing and patient accounts, scheduling and patient registrations, transferring diagnostic test results, researching, and communicating, tracking referrals, administrative features.

A basic EHR system is defined as one that?

Captures patient demographics, a patient problem list, clinical notes, orders for prescriptions, and that permits viewing of laboratory and imaging results.

In 2004, three national health care information management and technology associations came together to form the?

Certification Commission for Healthcare Information Technology (CCHIT).

The EHR also requires careful attention to ___ and ___ as well as a large financial investment.

Confidentially, security precautions.

Centers for Medicare and Medicaid Services (CMS) through its contracted state Quality Improvement Organization (QIO) - CMS provided.

Consultation to primary care practices with 10 or fewer physicians regarding the choice and implementation or EHR systems. In return, the QIO received selected diagnostic and patient care information. An online interactive training site, free education to small and medium physician practices on how to implement technology adoption.

Benefits of EHR, easily provides data for research or disease monitors

Data links transfers information required for approved research projects. Public Health Reporting and health data compiled-research and diagnosis earlier interventions.

The Certification Commission for Health Care Information Technology (CCHIT) is an independent, nonprofit commission received a contract from US Department of Health and Human Services to?

Develop functional standards and a testing process to certify EHR products. First efforts focused on setting criteria and a certification process for ambulatory EHR products.

Benefits of EHR, decrease cost of care.

Efficiencies incorporated from additional information available reduced duplications of testing. Save money, number of malpractice cases reduced result of decreased risk of error. Savings from elimination of paper record handling., photocopying, storage, streamlined procedures.

National initiatives and funding incentives have drawn attention to ___. Important efforts to use computers to record and access full range of a patient's office experience in a coordinate manner.

Electronic Health Records.

Data Repository

Electronic holding place for data.

Benefits of EHR, increase practice efficiency.

Eliminates duplicate data entry. Multiple people can access record at same time. Provider documentation is recorded as it occurs, eliminates backlog and chartings. Bills submitted and paid on an timely basis. Work streamlines.

Centers for Medicare and Medicaid Services (CMS)

Federal Government office that oversees the Medicare and Medicaid programs.

EHR products are inspected for their?

Functionality, interoperability, and security.

In 2010, less than ___ of practices had implemented components of an EHR.

Half.

Eligible Providers.

Health care providers that are qualified b regulations to participate in Medicare's or Medicaid's "meaningful use" incentive programs.

EHR other major components such as communicating with practitioners and patients would.

Help practices manage their own care.

Benefits of electronic records

Improve clinical decisions, supporting evidence based medicine, decrease errors, improve quality of care, increase efficiency, improve patient communication and satisfaction, easily provide data for research or disease monitors, decrease cost of care, and increase staff recruitment and productivity.

HITECH Act 2009. Eligible providers and hospitals can qualify for Medicaid and Medicaid.

Incentive payments when they implement an EHR product that has been certified by one of the organizations approved by the Federal government and use in ways that meet "meaningful use". HITECH Act is helping fund HIEs and RECs at state or regional levels.

A fully functional EHR system is defied as one that?

Includes all functions of the basic system, plus medical history and follow-ups, orders for tests, prescription and test orders sent electronically, warnings of drug interaction, or contradictions, highlighting of out of range test levels and reminders for guidelines based interventions.

The EHR functional criteria expanded upon a list of 8 functions identified by?

Institute of Medicine.

Benefits of EHR, improves coordination of care.

Interoperability-Records and patient care between health care organizations and health care providers. Pharmacy orders can be sent electronically.

The first certified ambulatory EHR vendor products were announced in?

July 2006. In 2007, CCHIT began certifying inpatient products and has expanded to other types of health care settings since then.

Impediments to EHR Adoption.

Lack of funding, lack of physician or staff support, insufficient tie or knowledge to purchase, install, and implement, reluctance to make workflow changes, costs overriding benefits, difficulty in transferring to new system, security and confidentially precautions, technology barriers, products and vendors that change frequently, patient fears, and human resistance to change.

Health Information Technology for Economic and Clinical Health Act (HITECH).

Legislation authorizing a process to certify organizations to perform product reviews on behalf of the government and to award grants for further adoptions of EHR's.

The goal of the Office of the National Coordinator for Health Information Technology (ONC)>

Made electronic health records a primary focus of that office. The goal was to have a national system, or National Health Information Network (NHIN), in place by 2014, that permits sharing of health care provision. These efforts are aimed at reducing errors in medical treatment, decreasing costs, and increasing quality of health care in the US>

Health Information Exchange (HIE)

National, regional, or local efforts established for electronic sharing of patient health care data among care providers, subdivisions of the NHIN, that also may referred to as SNOs.

Efforts are under way at ____, ____, and ____ levels to encourage the adoption of EHRs.

National. Regional. and State...

Continuity of Care

One model for this type of data sharing consist of a standard set of patient data that can be sent from one provider to another in order to assist in a patient's transfer from one health care setting to another.

EHR other major components such as reporting required information to public health agencies would include items such as.

Sexually transmitted diseases or a disease incidence, authorized data could be sent directly to licensing or accrediting organizations.

EHR in the future could be developed with?

Smart cards, implanted computer chips, and assessed even in international databases.

Effective 2006 federal Stark regulations were loosened to permit?

Some sharing of the costs of new systems between health care providers and health care organizations, several states have provided low interest loans programs to support small physician practices with access to fund for EHR implementation projects, some large health care systems are offering small clinics access to their EHR system through a technology sharing arrangement. This shared arrangement reduces EHR startup and maintenance cost while providing the practice with all benefits of an EHR.

Health Level Seven (HL7) is an example of what?

Standards Organization.

The groups that make up a number of government agencies, voluntary groups, and health related associations that are involved in providing guidelines to assist in making the EHR more uniform are called?

Standards Organizations. Some focus on EHR while others develop standards in other areas as well.

Many regional and local groups in many geographical area within the US have formed?

Sub-Networks Organizations also referred to as Health Information Exchanges (HIE). Example the VA.

The HITECH Act also includes several other efforts to encourage EHR adoption. For example; funding was provided to .

Support States to establish health information exchange (HIE) capability among health care providers and hospitals, establish Regional Health Information Technology Extension Centers (RECs) to offer technical assistance, guidance and information on best practices to support and accelerate health care providers efforts to become meaningful users of EHRs, and fund research focused on achieving breakthrough advances to address well documented problems that have impeded adoption.

Benefits of EHR, decreases errors.

System drug alerts highlight potential medication interactions or when diagnosis and gender do not agree. Documentation is legible.

The current understanding of what an EHR has evolved as ____, ____, and ____ needs have grown.

Technology, systems capabilities, and healthcare information.