1. Functional EHR Systems
CHAPTER
TWO
TWO
Functional EHR Systems

2. Cataloging Images
Process of scanning documents or importing scanned images into image system.
Not only capturing image but tying it to correct patient and entering data in computer about document.

3. Cataloging Images
Document images scanned and cataloged into EHR by many different people.
Quality control is most important.
Catalog data is entered by hand; in some instances image cataloging can be automated.
Barcode to identify catalog data.
Optical Character Recognition (OCR) software.

4. Guided Exercise 6: Importing and Cataloging Images
In this exercise you will catalog a scanned report and 2 diagnostic images for a patient.
You will need access to the Internet.

5. Guided Exercise 6: Importing and Cataloging Images
Step 1
Start web browser program; follow steps listed inside cover of textbook to select discipline; click on book cover that matches this Electronic Health Records textbook; log in.
When welcome page displayed, click on link “Activities and Exercises” or select “Activities” from drop-down list; click button labeled “Go.”

6. Guided Exercise 6: Importing and Cataloging Images
Step 2
Locate and click on link Exercise 6.
Information about exercise will be displayed.
Locate and click link “Click here to start the Document/Image System program.”
Document image system screen will be displayed (see Figure 2-3).

7. Guided Exercise 6: Importing and Cataloging Images
Step 2 (cont.)
Position mouse pointer over word “Select” in Menu bar at top of screen; click mouse button once.
Move mouse pointer vertically down list over word “Patient.”
Click mouse to invoke Patient Selection window (Figure 2-10).

8. Guided Exercise 6: Importing and Cataloging Images
Figure 2-10: Selecting Sally Sutherland from Patient Selection window.

9. Guided Exercise 6: Importing and Cataloging Images
Step 3
Find patient named Sally Sutherland in Patient Selection window.
Position mouse pointer over patient name and double-click mouse.
Once patient is selected, patient's name, age, and sex are displayed in title at top of window.
Catalog pane displays message “No Documents or Images” because Sally has no documents or images in catalog.

10. Guided Exercise 6: Importing and Cataloging Images
Step 4
You are going to import a file that has already been scanned but not yet cataloged.
Locate and click on Toolbar button labeled “Import”.
The “Open Media File” window, displaying available files, will open.
Compare your screen to Figure 2-11.

11. Guided Exercise 6: Importing and Cataloging Images
Figure 2-11: Open Media window displays after clicking Import icon.

12. Guided Exercise 6: Importing and Cataloging Images
Step 5
Locate and click on thumbnail image of radiologist report document (suth70943rpt.tif).
Locate and click on button labeled “Open.”
Compare your screen to Figure 2-12.

13. Guided Exercise 6: Importing and Cataloging Images
Figure 2-12: Data entry fields in Catalog pane; Image Viewer displays imported Radiology report.

14. Guided Exercise 6: Importing and Cataloging Images
Step 6
Imported file displays in Image Viewer pane and data entry fields replace catalog list.
Fields shown in Figure 2-12 are minimum for most Document/Image systems.
Actual fields in catalog record will differ by software vendor or medical facility.
Image imported should be radiologist's report.

15. Guided Exercise 6: Importing and Cataloging Images
Step 6 (cont.)
Catalog pane reminds you that it has not been saved into patient's EHR.
First two fields in catalog pane are determined automatically; Document/Image System recognizes you have imported file and that you are performing a manual entry of catalog data.

16. Guided Exercise 6: Importing and Cataloging Images
Step 6 (cont.)
Category field uses short mnemonic codes to represent longer category names.
Category field is already set to “RAD.”

17. Guided Exercise 6: Importing and Cataloging Images
Step 7
First field you will enter is date of original document for reference.
Note that system will automatically record other dates for audit purposes.
Look at image displayed; locate date of report, May 23, 2012.
Enter 5/23/2012.

18. Guided Exercise 6: Importing and Cataloging Images
Step 8
Final field to complete is description; only first portion displayed in catalog list.
Put most important information at beginning of description.
In this case, type: Mammogram Rpt - Dr. Gold.

19. Guided Exercise 6: Importing and Cataloging Images
Step 8 (cont.)
Compare your fields to left pane of Figure 2-12.
If everything is correct, click on button labeled “Save.”

20. Guided Exercise 6: Importing and Cataloging Images
Figure 2-12: Data entry fields in Catalog pane; Image Viewer displays imported Radiology report.

21. Guided Exercise 6: Importing and Cataloging Images
Step 9
Catalog pane will now display cataloged listing (Figure 2-13).

22. Guided Exercise 6: Importing and Cataloging Images
Figure 2-13: Cataloged mammogram report.

23. Guided Exercise 6: Importing and Cataloging Images
Step 9 (cont.)
Catalog corresponding diagnostic images.
Locate and click on Toolbar button labeled “Import.”
Open Media window (Figure 2-11) will be displayed.

24. Guided Exercise 6: Importing and Cataloging Images
Figure 2-11: Open Media window displays after clicking Import icon.

25. Guided Exercise 6: Importing and Cataloging Images
Step 9 (cont.)
Click on center Thumbnail (mammogram image “suth70943mam2.tif).
Locate and click on button labeled “Open.”

26. Guided Exercise 6: Importing and Cataloging Images
Step 10
Enter catalog data in Catalog entry fields:
Date: 5/23/2012
Description: Mammogram right breast w/abnormality
Compare your screen to Figure 2-14.

27. Guided Exercise 6: Importing and Cataloging Images
Figure 2-14: Cataloged mammogram image.

28. Guided Exercise 6: Importing and Cataloging Images
Step 10 (cont.)
Click button labeled “Save.”
Catalog pane will now display two listings.

29. Guided Exercise 6: Importing and Cataloging Images
Step 11
Catalog the other mammogram image by clicking Toolbar button labeled “Import.”
When Open Media window appears, click on left Thumbnail (mammogram image “suth70943mam1.tif).
Locate and click on button labeled “Open.”

30. Guided Exercise 6: Importing and Cataloging Images
Step 11 (cont.)
Enter catalog data in Catalog entry fields:
Date: 5/23/2012
Description: Mammogram left breast
Click button labeled “Save.”
Catalog pane will display three listings.
Exercise is concluded.
Exit and close your browser.

31. Picture Archival and Communication System (PAC)
At many facilities, digital images (x-rays, CAT scans) reside on separate Picture Archival and Communication System (PAC).
These images can be associated with radiology report in the EHR.
They appear to be part of the EHR record, even though they are on a separate system.
Diagnostic image is not actually imported into the EHR, but linked to patient EHR record.

32. Importing Text to the EHR
Text data consists of words, sentences, and paragraphs, but is not fielded data.
Text records are searchable by computer.
Text data can be dynamically reformatted for display on smaller devices.

33. Importing Coded EHR Data
Importing coded data produces a better EHR and eliminates need to re-key data or scan reports into chart.
Most medical devices have ability to transfer data they have collected to a computer.

34. Importing Coded EHR Data
Health Level 7 (HL7)
Nonprofit organization and leading messaging standard used by healthcare computer systems to exchange information.
Comprised of healthcare providers, institutions, government representatives, software developers.

35. Importing Coded EHR Data
Health Level 7 (HL7) (cont.):
Uses a consensus process to arrive at specifications acceptable to everyone involved.
Specifications are independent of any application or vendor.
Successful because it is very flexible.

36. Importing Coded EHR Data
DICOM: Digital Imaging and Communications in Medicine.
Standard used for medical images.
Most widely used format for storing and sending diagnostic images.
Standard for communication between diagnostic imaging equipment and image processing software.

37. Importing Coded EHR Data
CDISC: Clinical Data Interchange Standards Consortium.
Focus of HL7 is to facilitate message standards for a broad range of healthcare.
CDISC specific focus on clinical drug trials.
Standards enable sponsors, vendors, and clinicians to acquire and exchange data used in clinical trials.

38. Importing Coded EHR Data
Biomedical devices can output important and useful medical information that can be received and stored as data in patient's EHR.
HL7 often used to exchange demographic information.
Many biomedical devices in hospitals have capability of exporting data to the EHR.

39. Importing Coded EHR Data
Telemonitors
Patients with chronic conditions monitored at home using these devices.
Store readings and transfer data to doctor's system either by using modem and phone line or by downloading from device during a patient encounter.
Advantage: allows provider to study values measured many times over course of patient's normal daily activity.

40. Importing Coded EHR Data
Figure 2-17: An IQholter™ worn by the patient gathers cardio data.

41. Importing Coded EHR Data
Regional Health Information Organizations (RHIO) and the Office of National Coordinator for Health Information Technology's development of a national health information network (NHIN) are examples of projects to enable electronic transfer of health records between providers.

42. Importing Coded EHR Data
RHIOs encourage exchange of patient's health information across medical practices.
Obstacles include:
Technical
Economic
Political issues

43. Patient-Entered Data
Only patient has information about what symptoms were present at outset of illness.
Only patient knows outcome of medical treatment of those symptoms.
Patient is source of past medical, family, and social history.

44. Patient-Entered Data
Patient-entered data is a more accurate reflection of a patient's complaints.
Patients who can review their histories are better prepared for visit.
Patient-entered data saves time and allows triage nurse to focus on review of information with patient rather than on keying of data.

45. Patient-Entered Data
Allows clinician more time to discuss treatment plan with patient.
Patient-entered data is reviewed by doctor or nurse during exam and before being merged into the EHR.

46. Provider-Entered Data
Surest source of reliable coded EHR data is that entered by providers (doctor, nurse, medical assistant) during patient encounter using a standardized nomenclature.