Health Management Information Systems Electronic Health Records Lecture a This material Comp6_Unit3a was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC

Electronic Health Records Learning Objectives 2 1.State the similarities and differences between an electronic medical record (EMR) and electronic health record (EHR) (Lecture a) 2.Identify attributes and functions of an EHR (Lecture a) 3.Describe the perspectives of health care providers and the public regarding acceptance of or issues with an EHR, which can serve as facilitators of or major barriers to its adoption (Lecture a) 4.Explain how the use of an EHR can affect patient care safety, efficiency of care practices, and patient outcomes (Lecture a) Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Electronic Health Records Learning Objectives 3 4.Discuss how Health Information Exchange (HIE) and Nationwide Health Information Network (NHIN) impact health care delivery and the practice of health care providers (Lecture b) 5.Outline issues regarding governmental regulation of EHR systems, such as meaningful use of interoperable health information technology and a qualified R (Lecture b) 6.Summarize how the Institute of Medicine’s Vision for 21st Century Health Care and Wellness may impact health management information systems (Lecture b) 7.Identify how ongoing developments in biomedical informatics can affect future uses and challenges related to health information systems (Lecture b) Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Purpose of a Patient (Medical) Record 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a “To recall observations, to inform others, to instruct students, to gain knowledge, to monitor performance, and to justify interventions” Serves as the legal business record

Electronic Medical Record (EMR) Electronic record of health-related information on an individual –Within one health care organization 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EMR Purpose Provide an electronic equivalent of an individual’s legal medical record –Intra-organizational 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Electronic Health Record (EHR) Electronic record of health-related information on an individual –Across more than one health care organization 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHR Purpose Provide an electronic equivalent of an individual’s health record for use by providers and staff across more than one health care organization Support efficient, high-quality integrated health care, independent of the place and time of health care delivery 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EMR Versus EHR EMREHR A record of medical care created, managed, and maintained by one health care organization (intra- organizational) A repository of individual health records that reside in numerous information systems and locations (inter-organizational) Integration of health care data from a participating collection of systems from one health care organization Aggregation of health-related information into one record focused around a person’s health history, i.e., a comprehensive, longitudinal record Consulted by authorized clinicians and staff within one health care organization. Consulted by authorized clinicians and staff across more than one health care organization Data continuity throughout one health care organization Data interoperability across different organizations Table 3.1 EMR and EHR Comparison 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHRs Versus Paper Records EHRs can make a patient’s health information available when and where it is needed EHRs can bring a patient’s total health information together in one place, and always be current EHRs can support better follow-up information for patients EHRs can improve patient and provider convenience 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHRs Versus Paper Records EHRs –Can link information with patient computers to point to additional resources –Don’t just “contain” or transmit information, they also compute with it –Can improve safety 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHRs Versus Paper Records EHRs can –Deliver more information in more directions While reducing “paperwork” time for providers –Improve privacy and security –Reduce costs 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Attributes of an EHR Provides secure, reliable, real-time access to patient health record information, where and when it is needed to support care Captures and manages episodic and longitudinal electronic health record information 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Attributes continued Functions as clinicians’ primary information resource during the provision of patient care Assists with the work of planning and delivering evidence-based care to individual and groups of patients Supports continuous quality improvement, utilization review, risk management, and performance monitoring 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Attributes continued Captures the patient health-related information needed for reimbursement Provides longitudinal, appropriately masked information to support clinical research, public health reporting, and population health initiatives Supports clinical trials 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

HL7 EHR Functions Direct care functions Supportive functions Information infrastructure functions 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Direct Care Functions SubsetExamples Care managementIdentify and maintain a patient record Manage patient demographics Manage problem lists Clinical decision supportSupport for standard care plans, guidelines, protocols Support for medication and immunization administration Orders, referrals, results and care management Operations Management and Communication Clinical workflow tasking Support clinical communication Support for provider-pharmacy communication Table 3.2 HL EHR-S Functional Model Direct Care Functions Subsets with Examples 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Supportive Functions Clinical Support Measurement, Analysis, Research and Reports Administrative and Financial 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Information Infrastructure Functions Security Health record information and management Registry and directory services Standard terminologies and terminology services Standards-based interoperability Business rules managementorkflow management 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Standards for Certification of EHR Technology Content exchange standards –NCPDP SCRIPT Standard –HL7 Clinical Document Architecture (CDA), CCD Vocabulary standards –SNOMED CT –LOINC Privacy and security standards –NIST encryption algorithm –NIST hashing algorithm 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHR Acceptance Health care provider –Increasing momentum for widespread adoption and implementation of EHRs ARRA/HITECH Authorized Testing and Certification Body by the Office of the National Coordinator 21 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHR Acceptance Public –Harris Interactive Survey from 2005 Mixed Feelings –45% EHR system important Concern over –Privacy –Increase rather than decrease of medical errors 22 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHR Acceptance: Public Harris Interactive Survey –All physicians treating me should have access to information contained in my EMR Percent answering "Strongly/Somewhat Agree" –78% in 2009 –78% in 2010 –An EMR would be a valuable tool to track the progress of my health Percent answering "Strongly/Somewhat Agree" –72% in 2009 –71% in Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Barriers to Adoption Cost of conversion Perceived lack of ROI Technical and logistical challenges Privacy and security concerns 24 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHR Effect on Patient Care Safety Reduces the need to repeat tests Reduces the number of lost reports Supports provider decision making 25 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHR Effect on Efficiency Improves accessibility of patient information Integrates data from multiple internal and external sources Facilitates the co-ordination of health care delivery 26 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

EHR Effect on Patient Outcomes Has the potential to Improve the quality of patient care Help providers practice better medicine Provide seamless exchange of information among providers 27 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Electronic Health Records Summary – Lecture a 28 Defined an EMR and EHR Explained similarities and differences Identified EHR attributes and functions Discussed the issues surrounding EHR adoption and implementation Described the impact of EHRs on patient care Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a

Electronic Health Records References – Lecture a 29 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a References AHIMA e-HIM Work Group on Maintaining the Legal EHR. (2005). Update: Maintaining a legally sound health record—paper and electronic. Journal of AHIMA 76(10), 64A-L. Retrieved from Blumenthal, D. (2009, April 9). Stimulating the adoption of health information technology. New England Journal of Medicine 360, Retrieved from Handler, T., Holtmeier, R., Mtezger, J., Overhage, M., Taylor, S., & Underwood, C. (2003, July 7). HIMSS electronic health record definitional model version 1.0. Retrieved from Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule, 45 CFR Part 170 (July 28, 2010). Retrieved from Harris Interactive. (2010, June 17). Few Americans using 'E-' medical records. Retrieve from 414/Default.aspx Health Level Seven International. (n.d.). About HL7. Retrieved from Health Level Seven International. (2007). HL EHR-S functional model. Retrieved from Radiological Society of North America. (2005, September). IHE moves EHR goals forward. Retrieved from

Electronic Health Records References – Lecture a 30 Health IT Workforce Curriculum Version 3.0/Spring 2012 Health Management Information Systems Electronic Health Records Lecture a References Reiser, S. J. (1991). The clinical record in medicine. Part 1:Learning from cases. Annals of Internal Medicine, 114, The National Alliance for Health Information Technology. (2008, April 28). Defining key health information technology terms. Retrieved from healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_848133_0_0_18/10_2_hit_terms.pdf U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2010, July13). Electronic health records at a glance. Retrieved from y=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll =&pYear=&year=&desc=false&cboOrder=date Charts, Tables, Figures 3.1Table: EMR and EHR Comparison 3.2 Table: HL EHR-S Functional Model Direct Care Functions Subsets with Examples