1. HIPAA Privacy and Security: Integration with the Electronic Medical Record (session 5.02)
Ronald B. Margolis, CIO, ICPO
University of New Mexico Health Sciences Center/Hospitals
June 6, 2003

2. About University Hospitals and Health Sciences Center
Single Academic Health Center in the state
Albuquerque is large metro; NM is Rural
400 Tertiary Beds
Additional 125 Beds:
Children’s Hospital
Mental Health Center
Children’s Psychiatric Hospital
Children’s Rehabilitation Hospital

3. HIPAA and the EMR Issues…
Does HIPAA fit well into the EMR picture ? How does it integrate with the electronic record ?

4. Major Functional Areas of the EMR
HIM
Administration
HIPAA
Reporting
Tele-
medicine
Data Warehouse
Radiology
Lab
Security
Clinical

5. General Goals of technology and EMR
Improve healing environment for patients and visitors.
Improve operational environment for medical and administrative personnel.
Develop platform for rollout of new clinical and administrative applications.
Reduce costs and operational inefficiencies.

6. Integrated Technology Systems
Media
Telephone
Mobile
Telephone
Tele-
medicine
Data Network
Wireless
Data
EMS
Clinical
Systems
Security

7. The HIPAA Overlay Systems Perspective: HIPAA adds a layer
User Perspective: HIPAA adds a significant complication – more to learn
Administrative Perspective: HIPAA adds a big mandate with downside risk

8. Five levels of integration
APPLICATION & TRAINING INTEGRATION
SYSTEMS INTEGRATION
NETWORK INTEGRATION
CABLE INTEGRATION
INFRASTRUCTURE INTEGRATION

9. HIPAA Overlays Application level Ongoing training and consistency
Systems integration
Network integration level

10. Focus on Clinical Impacts of HIPAA
Application Level
Vendor software
User training
Scheduling and Flow impact -- operations
Communication impact --
Education/training impact -- compliance

11. Clinician Benefits…
Unifies systems, services and medical record…opportunity to reduce chaos
Improved availability of data
Reduction of errors from lost orders, illegibility, misfiling and current notes
Competitive advantage, e.g., Leapfrog, HIPAA Compliance, Syndromic surveillance

12. More Clinician Benefits
Joint stakeholders with Administration
Assure consistency with protocols
Provides support for policies and documentation
Improves workflow between units
Enhances patient safety
Tracks accesses and disclosures

13. The clinician’s complaints
Takes longer for CPOE
Already have more patients than time
VA – Vista experience
Computer speed and reliability
HIPAA tracks everything
Staff has overreacted with HIPAA

14. Bottom Line Benefits Improves access Communications
CPOE eliminates errors and mistakes
Opportunity to track all disclosures
Incorporates messages into MR
Rules based checking at order entry improves order efficiency and structure
Supports the case for clinical pathways and best practices

15. Structure is beneficial in a medical record.
Graphic courtesy of Health Technology Center

16. Benefits to the system Quality and availability of the record
Increases documentation compliance
Increases security
Reduces clerical tasks for ancillaries
Complicated order sets are made easier
Patient lists & flowsheets >efficiencies
Historical data for research & HIPAA

17. Emotions During the Project Life Cycle
Vision drives Culture
Culture
Vision
Enthusiasm
Adoption
Acceptance
Optimism
Perseverance
Concern
Commitment
Other
Priorities
Confusion
Pessimism
Danger Zone
Abandon the Project
Time

18. Your turn for …
questions