1. Electronic Health Records Bruce Slater, MD, MPH University of Wisconsin School of Medicine and Public Health b.slater@hosp.wisc.edu

2. Objectives Compare the History of Paper and Electronic Patient Records Describe Major Elements of the Electronic Health Record Explain how the Electronic Health Record is Different to the Paper Patient Chart

3. Introduction Healthcare lags in information system use Computers are used in financial transactions Some clinicians use the web for information Only a few MDs store records electronically Computers could solve efficiency, access and quality needs for providers who adopt

4. Definitions EPR - Electronic Patient Record EMR - Electronic Medical Record CbPR - Computer-based Patient Record CPRS - Computer Patient Record System EHR – Electronic Health Record Client-Server ASP - Application Service Provider

5. History of Physical Records Shaman - oral traditions Hospitals - written ward records Florence Nightingale - patient records Source Oriented Records Problem Oriented Records Lost & Incomplete Records

6. History of Virtual Records PROMIS - Problem Oriented Medical Information System - Larry Weed, MD COSTAR - Computer Stored Ambulatory Record Practice Partner Medicalogic/Logician/GE Centricity EpicCare The Web

7. History of Virtual Records PROMIS - Problem Oriented Medical Information System - Larry Weed, MD COSTAR - Computer Stored Ambulatory Record Practice Partner Medicalogic/Logician/Centricity EpicCare The Web

8. Elements of Paper Medical Records Physical Folder Labels and Flags Demographic and Insurance Page Problem and Medication/Allergy List Dividers Progress Notes and Consults Results of Tests and Imaging

9. Elements of Paper Medical Records Physical Folder Labels and Flags Demographic and Insurance Page Problem and Medication/Allergy List Dividers Progress Notes and Consults Results of Tests and Imaging

10. Elements of Paper Medical Records Physical Folder Labels and Flags Demographic and Insurance Page Problem and Medication/Allergy List Dividers Progress Notes and Consults Results of Tests and Imaging

11. Elements of Electronic Health Records No Physical Location - a Virtual Record Multiple kinds of Labels and Flags Demographic and Insurance Tables Problem/Medication/Allergy Checking Dividers of any kind imaginable Progress Notes and Consults Results and Actual Tests and Imaging

12. Elements of Electronic Health Records No Physical Location - a Virtual Record Multiple kinds of Labels and Flags Demographic and Insurance Tables Problem/Medication/Allergy Checking Dividers of any kind imaginable Progress Notes and Consults Results and Actual Tests and Imaging

13. Elements of Electronic Health Records not in Paper Records Security Transportability Flexibility Consistency Reminders Intelligence Link-Outs Provider Education Patient Education Patient Participation Problem Orientation Audit Demand Management Access Management

14. Elements of Electronic Health Records not in Paper Records Security Transportability Flexibility Consistency Reminders Intelligence Link-Outs Provider Education Patient Education Patient Participation Problem Orientation Audit Demand Management Access Management

15. Elements of Electronic Health Records not in Paper Records Security Transportability Flexibility Consistency Reminders Intelligence Link-Outs Provider Education Patient Education Patient Participation Problem Orientation Audit Demand Management Access Management

16. Elements of Electronic Health Records not in Paper Records Security Transportability Flexibility Consistency Reminders Intelligence Link-Outs Provider Education Patient Education Patient Participation Problem Orientation Audit Demand Management Access Management

17. Electronic Health Records in Electronic Commerce Merge into Patient’s and Provider’s Lives Create a Need Fulfill the Need Extend the Need Assimilate Information into their Lives

18. Electronic Health Records and the Clinical Data Repository Patient-centered Real-time Operational Coded Clinical Data Data Dictionary Provider Interface is Built on the Repository Population based Care and Research

19. Examples Practice Partner Logician Internet Patient Profile v 4.0

20. Practice Partner Screen shot here then demo

21. Logician Internet

22. Patient Profile v4.0

23. Summary/Conclusions Electronic Health Records will change healthcare We have only seen the first engagements of the war between the bricks and the clicks The next conflict will be bricks versus bricks with clicks. Patients may be able to shape the future

24. Questions and Discussion