Special Topics in Vendor-Specific Systems Unit 4 EHR Functionality

Health IT Workforce Curriculum Version 1.0/Fall 2010 Outline EHR functionality Results Review Computerized Provider Order Entry (CPOE) Documentation Billing Messaging Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Results Review Linked to laboratory information system e.g., bacterial cultures, complete blood count, therapeutic drug levels Laboratory results Linked to radiology (imaging) information system Used with Picture Archiving Communications Systems (PACS) which manage digital radiography e.g., radiology reports, X-rays, CAT scans, MRI images Imaging results Critical results notification Viewing formats Table/flowsheet format Graph for display of trends Vendor system differences Laboratory results Linked to laboratory information system e.g., bacterial cultures, complete blood count, therapeutic drug levels Imaging results Linked to radiology (imaging) information system Used with Picture Archiving Communications Systems (PACS) which manage digital radiography e.g., radiology reports, X-rays, CAT scans, MRI images Vendor system differences Critical results notification Viewing formats Table/flowsheet format Graph for display of trends Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Computerized Provider Order Entry (CPOE) System used for direct entry of 1 or more types of orders by a provider into a system that transmits those orders electronically to the appropriate department (Armstrong, 2000) Medications, Nursing, Laboratory, Radiology/imaging, Provider referrals, Blood bank, Physical therapy, Occupational therapy, Respiratory therapy, Rehabilitation therapy, Dialysis, Provider consults, Discharge and transfer Medications, Nursing, Laboratory, Radiology/imaging, Provider referrals, Blood bank, Physical therapy, Occupational therapy, Respiratory therapy, Rehabilitation therapy, Dialysis, Provider consults, Discharge and transfer System used for direct entry of 1 or more types of orders by a provider into a system that transmits those orders electronically to the appropriate department (Armstrong, 2000) Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

CPOE (cont.) Unintended Consequences Wrong patient selected from list Wrong drug selected from list Changes workflow, may decrease interdisciplinary communication Potential to alleviate patient safety problems by limiting Illegible handwriting Use of dangerous abbreviations Verbal orders Transcription errors Potential to alleviate patient safety problems by limiting Illegible handwriting Use of dangerous abbreviations Verbal orders Transcription errors Unintended Consequences Wrong patient selected from list Wrong drug selected from list Changes workflow, may decrease interdisciplinary communication Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

CPOE: Vendor System Differences Online formularies e-prescribing Medication prescriptions in ambulatory setting Health plan formulary Transmission of the prescription directly to pharmacy Online formularies e-prescribing Medication prescriptions in ambulatory setting Health plan formulary Transmission of the prescription directly to pharmacy Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

CPOE: Vendor System Differences (cont.) Decision Support Functionalities Dosing recommendations and calculations Customized order sets Bar coding scanning technology Medication administration process (pharmacy – administration) Right patient gets the right drug at the right time Alerts Allergy alert Drug-interaction checking Laboratory alerts Medication reconciliation process Outpatient – Emergency Department – Hospital Admission – Inpatient Course – Hospital Discharge Decision Support Functionalities Dosing recommendations and calculations Customized order sets Bar coding scanning technology Medication administration process (pharmacy – administration) Right patient gets the right drug at the right time Alerts Allergy alert Drug-interaction checking Laboratory alerts Medication reconciliation process Outpatient – Emergency Department – Hospital Admission – Inpatient Course – Hospital Discharge Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 CPOE Meaningful use criteria: Non-hospital setting: CPOE used for at least 80% of all orders e-prescribing used for at least 75% of all prescriptions Hospital setting: CPOE used for at least 10% of all orders Medication reconciliation performed for at least 80% of relevant encounters & transitions of care Non-hospital setting: CPOE used for at least 80% of all orders e-prescribing used for at least 75% of all prescriptions Hospital setting: CPOE used for at least 10% of all orders Medication reconciliation performed for at least 80% of relevant encounters & transitions of care Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Documentation: Multiple disciplines Physician Nurse Social worker Physical Therapist Respiratory Therapist Other clinicians Physician Nurse Social worker Physical Therapist Respiratory Therapist Other clinicians Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Documentation: Electronic capture of clinical information Clinical notes Visit Note, Discharge Summary, Peri-operative Note Patient assessments Vital Sign Flowsheet Clinical reports Medication Administration Record (MAR) Advance Directives and Consents For procedures Visit Note, Discharge Summary, Peri-operative Note Clinical notes Vital Sign Flowsheet Patient assessments Medication Administration Record (MAR) Clinical reports For procedures Advance Directives and Consents Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Documentation: Methods of information capture Narrative free-text notes Unstructured: Structured headings with some free-text entry Semi-structured: Check boxes in MAR Flow sheet vital signs and patient assessment Structured: Unstructured: Narrative free-text notes Semi-structured: Structured headings with some free-text entry Structured: Check boxes in MAR Flow sheet vital signs and patient assessment Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Documentation: Potential Barriers to Implementation Workflow implications Increased documentation time Overuse of checkboxes may impact cognitive processes Increased documentation time Overuse of checkboxes may impact cognitive processes Workflow implications Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Documentation: Vendor System Differences Note creation options: Templates Clinical discipline Specialty Or type of note Macros Combination of keys generate a user predefined text set Voice Recognition Software/Embedded dictation Copy and paste Structured documentation Tailored assessments Templates Clinical discipline Specialty Or type of note Macros Combination of keys generate a user predefined text set Voice Recognition Software/Embedded dictation Copy and paste Structured documentation Tailored assessments Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Legal Issues Discovery of electronic records for legal purposes Centers for Medicare and Medicaid and Joint Commission Accepted standards for Legal Health Record HIPAA privacy rule Organizations identify “designated record set” How the information is used (e.g., was it used to provide patient care?), not where is resides, determines if it is part of the legal record Discovery of electronic records for legal purposes Centers for Medicare and Medicaid and Joint Commission Accepted standards for Legal Health Record HIPAA privacy rule Organizations identify “designated record set” How the information is used (e.g., was it used to provide patient care?), not where is resides, determines if it is part of the legal record Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Billing ICD-9-CM codes (The International Classification of Diseases, 9th Revision, Clinical Modifications) ICD-10-CM in October 2013 CPT codes (Current Procedural Terminology) All vendor systems support these All vendor systems support these ICD-9-CM codes (The International Classification of Diseases, 9th Revision, Clinical Modifications) ICD-10-CM in October 2013 CPT codes (Current Procedural Terminology) Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Billing ICD-9-CM codes Hospital discharge summary or Outpatient visit note CPT codes Procedure (e.g., surgery) CPT codes E/M (Evaluation and Management) Level of evaluation & management service performed at patient visit Professional billing (Physicians’ and Nurse Practitioners’ services) ICD-10-PCS Inpatients billing by hospitals Hospital billing Professional billing (Physicians’ and Nurse Practitioners’ services) ICD-9-CM codes Hospital discharge summary or Outpatient visit note CPT codes Procedure (e.g., surgery) CPT codes E/M (Evaluation and Management) Level of evaluation & management service performed at patient visit Hospital billing ICD-10-PCS Inpatients billing by hospitals Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Messaging Internal e-mail Secure email for patients EHR linked automatic text page Intraoffice group communications Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 Messaging (cont.) Copy chart or lab results to another provider with a note Telephone message documentation Patient scheduling Referral letter or consultation report Patient follow-up deficiency alerts Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010

Health IT Workforce Curriculum Version 1.0/Fall 2010 References Armstrong, C. W. (2000). American Hospital Association guide to computerized physician order-entry systems. Chicago, IL: American Hospital Association Component 14/Unit 4 Health IT Workforce Curriculum Version 1.0/Fall 2010