1. The electronic patient record

2. The patient record Notes made by physician Long history

3. Paper records Lloyd George envelope Can be very large Advantages –Simplicity –Availability –Economy –Durability Problems –Availability –Legibility –Analysis

4. Message types Data-oriented –Different data types kept separate Task-oriented –Different tasks kept separate Template-oriented –Hybrid –Cross-reference task data

5. Record structures Integrated or time oriented –What happened at each episode –Data-oriented Source oriented –Examination notes –X-ray reports –Lab tests –Also data-oriented

6. The Problem-oriented medical record Lawrence Weed SOAP –Subjective –Objective –Assessment –Plan Separate section for each problem Template-driven (partially)

7. Protocol-driven Standard procedure (e.g. diabetes) Template Always record same sequence of data Task-oriented

8. The electronic patient record Definition : the Patient Record held in electronic form whose Custodian(s) work within a single autonomous organisation Can be active : …support users by [providing] alerts, reminders, decision support… medical knowledge etc.

9. Issues Standards especially in terminology –Narrative text vs coding Privacy and confidentiality Data entry by health professionals Integration Decision support (Shortliffe)

10. EPR structure Source oriented –Data from many sources are combined Time oriented –Time is stamped on each piece of data Problem oriented –Data should be linked to show physicians reasoning and progress of problem Protocol driven

11. Predecessors of EPR HISS – Hospital information support systems PAS – Patient administration systems –Demographic details –Admission –Discharge Departmental systems

12. EPR in general practice Well-established (since 1970’s) Widely-used (90% of practices) Useful –Prescribing –Registers –Clinical information

13. EPR in hospitals Plans since Information for Health – 1998 Few successful implementations (3%)

14. EPR level 1 Clinical administrative data –Patient administration –Departmental systems (separate)

15. EPR level 2 Integrated clinical diagnosis and treatment support Level 1 plus: –Patient master index integrated with Departmental systems

16. EPR level 3 Clinical activity support Level 2 plus: –Clinical orders –Results reporting –Prescribing –Multi-professional care pathways

17. EPR level 4 Level 3 plus –Electronic access to knowledge bases –Embedded guidelines –Rules –Electronic alerts –Expert system support

18. EPR level 5 Level 4 plus –Special clinical modules –Document imaging

19. EPR level 6 Level 5 plus –Telemedicine –Multi-media applications –Picture archiving and support systems

20. Targets 2002 – 35% at EPR level 3 2005 – all at EPR level 3

21. The Electronic Health Record ISO/DTR 20514 A repository of information regarding the health status of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorised users. It has a standardised or commonly agreed logical information model which is independent of EHR systems.

22. EHR continued Its primary purpose is the support of continuing, efficient and quality integrated health care and it contains information which is retrospective, concurrent, and prospective

23. Further reading ISO/CEN TC 251 13606 http://www.prorecireland.ie/Gerard%20Freriks.ppt http://www.prorecireland.ie/Gerard%20Freriks.ppt http://www.prorecireland.ie/4%20Thomas%20 Beale.ppt http://www.prorecireland.ie/4%20Thomas%20 Beale.ppt HL7 Reference Information Model http://www.hl7.org.au/HL7-V3-Resrcs.htm OpenEHR http://www.openehr.org/getting_started/t_openehr _primer.htmhttp://www.openehr.org/getting_started/t_openehr _primer.htm