1. Electronic Health Records12
Electronic Health Records

2. Learning Outcomes (cont.)
12.1 List four medical mistakes that will be greatly decreased through the use of EHR.
12.2 Differentiate among electronic medical records, electronic health records, and personal health records
12.3 Contrast the advantages and disadvantages of electronic health records

3. Learning Outcomes (cont.)
12.4 Illustrate the steps in creating a new patient record and correcting an existing record using EHR software.
12.5 Describe some of the capabilities of EHR software programs.
12.6 Explain how you might alleviate a patient’s security fears surrounding the use of EHR.

4. Introduction Electronic health records Eliminates duplication forms
Simply review information
Electronic health records enable a specialist to have a patient’s information before the patient arrives at the office.
No need to fill out the patient’s medical history each time.
The specialist only has to review the information with the patient to verify that everything is correct.

5. A Brief History of Electronic Medical Records
Paper records becoming inadequate
Medical errors due to
Lost or misfiled records
Mishandled patient messages
Inaccurate and illegible documents
Mislabeled or illegible lab or medication orders
Learning Outcome: List four medical mistakes that will be greatly decreased through the use of EHR.
In the early 1990s, it became apparent that paper medical records were inadequate. The increasing need for coordination of care, rising healthcare costs, and the alarming increase in medical errors.
Most of these errors can be traced to communication problems, including:
Lost or misfiled paper records
Mishandled or “forgotten” patient messages
Inaccurate or unreadable information in a paper medical record
Mislabeled or unreadable laboratory or prescription orders
President George W. Bush signed an executive order in August of 2006 to promote the overall efficiency and quality of healthcare in America.
These goals will help to control the rising cost of healthcare
Most Americans will have access to electronic health records by 2014.
A decrease in medical errors through record legibility and uniformity of records
An increase in information available among patients, medical providers, and the insurance carriers.
The electronic record is quickly becoming the physician’s most important business and legal record.

6. Excellent! Apply Your Knowledge
What are the four errors that stem from communication problems?
ANSWER: They are:
Lost or misfiled records
Mishandled patient messages
Inaccurate and illegible documents
Mislabeled or illegible lab or medication order
Learning Outcome: List four medical mistakes that will be greatly decreased through the use of EHR.
Excellent!

7. Electronic Records Electronic medical record (EMR)
Electronic health record (EHR)
Continuity of care
Reduction in errors
Decreased costs
Personal health record (PHR)
Learning Outcome: Differentiate among electronic medical records, electronic health records, and personal health records
Electronic medical record (EMR) – an electronic record of health-related information for an individual patient that is created, compiled, and managed by providers and staff members located within a single healthcare organization.
Electronic health record (EHR) – If that same information on an individual patient is created, managed, and gathered in a manner that conforms to nationally recognized interoperability standards. It can be utilized by members of more than one healthcare organization.
These EHRs are the federal government’s ultimate goal.
Any provider with an interoperable EHR system will have access.
They will facilitate continuity of care, reduce in medical errors, and decrease healthcare costs
Personal health record (PHR) – an electronic version of the comprehensive medical history and record of a patient’s lifelong health, collected and maintained by the individual patient. Refer to Table 12-1 Basic differences between Electronic Health Records and Personal Health Records.
No matter what form a patient record takes, protected health information (PHI) is involved and is covered by HIPAA laws.

8. Nice Job! Apply Your Knowledge Match the following:
PHI that is collected an maintained by the patient
conforms to national interoperability standards
not a legal record
used by a single healthcare organization
covered by HIPAA
ANSWER:
EHR
PHR
EMR
PHR
EHR
PHR
Learning Outcome: Differentiate among electronic medical records, electronic health records, and personal health records
EMR
All three
Nice Job!

9. Advantages and Disadvantages of EHR
Government mandate steps
Use all major functions of EHR
Use EHR to send and receive clinical information
Learning Outcome: Contrast the advantages and disadvantages of electronic health records.
The federal government has mandated EHR for eligible Medicare providers by 2015.
There are financial incentives for providers who demonstrate “meaningful use” of EHR for Medicare or Medicaid patients until 2014.
Meaningful use includes the following steps:
Step 1 requires the provider to use all major functions of a certified EHR program.
Step 2 includes all of step 1 and adds that EHR must be used to send and receive clinical information such as lab orders and reports.

10. Advantages and Disadvantages of EHR (cont.)
Clinical decisions support (in development)
High priority conditions
Enrolling patients in PHR
Accessing comprehensive data
Improving population health
E prescribing
Incentives
Learning Outcome: Contrast the advantages and disadvantages of electronic health records.
The proposal for step 3, which is not yet completed, states that in addition to continuing with steps 1 and 2, the provider will participate in clinical decisions support for national, high priority conditions, enrolling patients in PHR, accessing comprehensive patient data, and improving population health.
Included with this mandate is the use of electronic prescribing (E prescribing) to transmit prescriptions electronically to pharmacies.
Incentive program
If a provider is eligible for both Medicare and Medicaid. He may receive the incentive for only one.
Eligible providers must also meet specific criteria outlined by each program regarding percentage of the practice that consists of Medicare or Medicaid patients and must demonstrate meaningful use of the EHR program for each quarter the provider participates in the program.
The maximum amount an eligible provider can earn from the Medicare program is $44,000 and the maximum total incentive payment from the Medicaid program is $63,750. .

11. Disadvantages of EHR Programs
Costly
Staff training requirement
IT staff may be needed
Possible damage to system and software and or required upgrades
Learning Outcome: Contrast the advantages and disadvantages of electronic health records.
Cost is the primary reason most providers give for not implementing electronic records in their offices.
Some physicians simply do not have the initial financial outlay available or feel the time needed to recoup the initial cost to implement the program does not justify the initial financial outlay.

12. Advantages of EHR Programs
Fewer lost medical records
Eliminated transcription costs
Increased readability/legibility
Ease of chart access for multiple users
Chart availability outside of office hours
Learning Outcome: Contrast the advantages and disadvantages of electronic health records.
Fewer lost medical records – charts do not require pulling or re-filing

13. Advantages of EHR Programs (cont.)
Increased access to patient education materials
Decreased duplication of test orders
More efficient transfer of records
More efficient billing processes
Greatly decreased storage needs
Learning Outcome: Contrast the advantages and disadvantages of electronic health records.

14. Advantages of EHR Programs (cont.)
Accessed from other locations
Physician’s home
Satellite offices
Used in teleconferences
Learning Outcome: Contrast the advantages and disadvantages of electronic health records.
Access from any computer at any time to review or update the file.
During teleconferences people in different locations can look at the same record.
Access by healthcare providers with satellite offices in different cities or different parts of a city, or by a physician who is covering a practice while the patient’s usual doctor is out of town.

15. Correct! Apply Your Knowledge
What is the main reason medical practices are not implementing EHRs?
ANSWER: Cost
Correct!
Learning Outcome: Contrast the advantages and disadvantages of electronic health records.

16. Working With an Electronic Health Record
Basic rules unchanged
Creating a New Patient Record
Correcting an EHR
Learning Outcome: Illustrate the steps in creating a new patient record and correcting an existing record using EHR software.
The basic rules for working with a medical record do not change when that record is electronic instead of paper.
Creating a New Patient Record using EHR Software
Even though EHR programs will eventually be required to communicate with each other, there will be differences. All programs will have a type of template that will require completion for each new patient.
Refer to Procedure 12-1 Creating a New Patient Record using EHR Software
Correcting an Electronic Health Record
Once information has been saved, it cannot be changed in any way . Double-check your work prior to clicking “save.”
An addendum with the omitted or corrected information must be made as soon as possible once the error or omission is noted.
Refer to Procedure 12-2 Making an Addition or Addendum (correction) to an Electronic Health Record
SpringChart™ EHR Live activity: Building a Patient Face Sheet
Refer to CONNECT to see a video about Creating a New Patient Record Using an EHR Program .

17. Working With an EHR (cont.)
Be familiar with the hardware and software
Keep password secure
Check entries carefully before saving
Learning Outcome: Illustrate the steps in creating a new patient record and correcting an existing record using EHR software.
Refer to Points on Practice: Working with Electronic Health Records

18. Apply Your Knowledge F T F
Right!
Apply Your Knowledge
Which statements are true and which are false?
____ All EHR programs will be the same.
___ The basic rules for working with an EHR are the same as for a paper record
____ Once you make a mistake in an EHR, there is nothing you can do to correct it.
ANSWER:
Although programs must communicate with each other, they may not be the same. F T
Learning Outcome: Illustrate the steps in creating a new patient record and correcting an existing record using EHR software. F
You can make an addendum with the correct information.

19. Other Functions of EHR Programs
Tickler files
Specialty specific
Customized
Templates
Learning Outcome: Describe some of the capabilities of EHR software programs.
Tickler Files
Files that need periodic attention
Alerts staff members about patients who are due for yearly checkups and patients who require follow-up care
Electronically scanned images of patient thumbprints or photos help keep track of records and assists with patient security by identifying the patient at the time of each visit.
Specialty Specific
EHR software programs may be customized to suit a specific specialty and style of a physician’s office.
Templates or “check offs” enable the physician to add entire sentences or phrases with the click of a mouse, instead of typing the same information repetitively.

20. Other Functions of EHR Programs (cont.)
Electronic schedulers
Advantages
Disadvantage
Learning Outcome: Describe some of the capabilities of EHR software programs.
Electronic Schedulers
Advantages over the traditional appointment book:
Multiple users at any time.
Can use search to locate an appointment.
Can keep a listing of patients who want an earlier appointment if one becomes available.
Can search for appointments by time frame or by appointment type.
Disadvantage of electronic schedulers - if the computer is down, appointments cannot be made and the day’s schedule is not accessible. Print out a copy of each day’s schedule at the beginning of the day.
Some EHR scheduler programs also include appointment reminder and confirmation programs to automatically remind patients of their appointments.
Refer to Procedure 12-3 Creating an Appointment Matrix for an Electronic Scheduling System and Procedure 12-4 Scheduling a Patient Appointment using an Electronic Scheduler .

21. Other Functions of EHR Programs (cont.)
Eligibility verification and referral management
Billing and coding
Learning Outcome: Describe some of the capabilities of EHR software programs.
Eligibility Verification and Referral Management
Online insurance verification
Electronic transmission of referrals among the PCP, the specialist, and the insurance plan involved.
Ability to track the number of visits allowed by the referral, the time frame involved, and the number of visits left
Billing and Coding Software
Electronic coding of medical records, and electronic claims submission to insurance carriers.
Procedure and diagnosis codes may be automatically chosen by the software program or may be coded and inserted manually by the office medical coder
The electronic claim is submitted to the insurance carrier.
Generates a billing statement listing the total amount of the charges, the amount paid by the insurance plan, deductibles, and the copayment or coinsurance balance due from the patient.

22. Other Functions of EHR Programs (cont.)
Report generators
Electronic prescriptions
Learning Outcome: Describe some of the capabilities of EHR software programs.
Report Generators
Types of reports that may be produced include:
Patient statistics
Patient demographic
Office A/R (accounts receivable) and A/P (accounts payable)
Office statistics
Revenue generated by specific procedures
Other tracking mechanisms to assist the office business manager in tracking both profitable and non-profitable procedures for the practice.
Patient and insurance carrier aging reports to see who is or who is not paying the office claims and statements promptly.
Electronic Prescriptions
Entry of prescriptions, which may be transmitted directly to the pharmacy or printed and given to the patient.
Allergies or medication interactions can cause a flag for an ordered prescription

23. Other Functions of EHR Programs (cont.)
Ancillary order integration
Patient access
Learning Outcome: Describe some of the capabilities of EHR software programs.
Ancillary Order Integration
Orders can be submitted to the lab or ancillary office electronically at the time the patient appointment is made
Once the testing is complete, the results of the test(s) are transmitted back to the office as soon as they are available, allowing for immediate upload to the patient’s medical record.
Decreases wait time for results.
Patient Access – provide patient portals
Access routine information
Perform routine tasks, like making an appointment, accessing a child’s immunization record, or even paying a balance on his or her account online through the office patient portal.

24. Impressive! Apply Your Knowledge Match the following: ANSWER:
Tickler file
Electronic scheduler
Eligibility verification
Billing and coding
Report generator
Prescription writer
Ancillary order integration
Patient access
flags allergies
checks insurance coverage
sends an alert for follow-up care
may send a reminder to the patient
allow for electronic claims to insurance companies
office statistics
make an appointment or pay a bill
submits orders to the lab 6 3 1 2 4
Learning Outcome: Describe some of the capabilities of EHR software programs 5 8 7
Impressive!

25. Security and Confidentiality and EHR
Access code
Limits access
Date and time stamp
Release of information policy
Backup
Learning Outcome: Explain how you might alleviate a patient’s security fears surrounding the use of EHR .
All users have individual access codes and passwords.
The access code will allow each user to access only the areas of the record that the user is entitled to, based on job description.
Access codes insert a date and time stamp within the medical record, including the user’s initials, so that office administration and the patient may know who is accessing each medical record.
A procedure should be in place to document when someone requests information from the patient file, if the patient has given permission to release that information, and when it was released.
Protecting the confidentiality of patient records in computer files is the greatest concern of electronic health records. Electronic healthcare records should be kept just as secure as paper healthcare records.
Careful key entry is essential to maintaining accurate electronic health files.
Electronic files must be backed up on a regular basis to avoid accidental data loss.

26. Reassuring Others about EHR Security and Confidentiality
Know the confidentiality and security features
No negativity
Pamphlet explaining EHR
Show the patient his/her record
Explain access to patient
Learning Outcome: Explain how you might alleviate a patient’s security fears surrounding the use of EHR .
Be knowledgeable about all the confidentiality and security aspects of the office EHR program.
Never display negativity about the new program
Suggest the office create a pamphlet or flyer for the patients regarding the office EHR program and assist in preparing the document for the patients.
Show the patient his own medical record and how information is entered, maintained and saved, including the back-up process. Explain the security systems that are in place.
Explain the office access process to the patients, including the fact that they may view the list of people or companies who have accessed their information, when the access took place, and why.

27. Right! Apply Your Knowledge
What does the use of access codes enable medical practice do?
ANSWER: Access codes can be set to limit a person’s access to a medical record based on his/her job description. They also enable a medical practice to track who has accessed a medical record as well as when they accessed it.
Learning Outcome: Explain how you might alleviate a patient’s security fears surrounding the use of EHR .
Right!

28. In Summary
12.1 Medical mistakes that will be greatly decreased or eliminated with EHR include:
lost or misfiled paper records
mishandled or “forgotten” patient messages
inaccurate or unreadable information in a paper medical record
mislabeled or unreadable laboratory or prescription orders.

29. In Summary (cont.)
12.2 The electronic medical record is an electronic record of health-related information for an individual patient. An electronic health record is created, managed, and gathered in a manner that conforms to nationally recognized interoperability standards. A personal health record is an electronic version of the comprehensive medical history and record of a patient’s lifelong health that is collected and maintained by the individual patient.
12.2 The electronic medical record is an electronic record of health-related information for an individual patient that is created, compiled, and managed by providers and staff members located within a single healthcare organization. An electronic health record is created, managed, and gathered in a manner that conforms to nationally recognized interoperability standards, so that members of more than one healthcare organization can utilize it. A personal health record is an electronic version of the comprehensive medical history and record of a patient’s lifelong health, which is collected and maintained by the individual patient

30. In Summary (cont.) Disadvantages include:
12.3 Advantages of EHR include: (not inclusive)
Fewer lost records
No transcription costs
Readability/legibility
Access for multiple users
Chart availability
Decreased duplication of tests
Disadvantages include:
Cost
Need for training
Possible need for F/T or P/T IT personnel
Need for computer hardware/software upgrades or changes
12.3 Advantages of EHR include: fewer lost medical records; elimination of transcription costs; increased readability/legibility of charts; ease of chart access for multiple users; chart availability outside of office hours; increased access to patient education materials; decreased duplication of medical tests; more efficient records transfer; more efficient billing processes using electronic billing methods; and decreased need for storage space.
Disadvantages include: cost, need for training, possible need for F/T or P/T IT personnel, need for computer hardware/software upgrades or changes

31. In Summary (cont.)
12.4 The same rules apply with EHR as for paper- based medical records when initiating or documenting in a patient’s electronic health record. Follow the basic steps in Procedure 12-1 for setting up a new patient EHR and 12-2 for correcting or making an addition in an existing patient’s electronic health record.

32. In Summary (cont.)
12.5 Aside from housing patient electronic health records, many EHR programs also can perform the following functions: tickler files, specialty-specific software, electronic scheduler, eligibility verification and referral management, billing and coding capabilities, report generation, electronic prescriptions and ancillary order integration, and a patient access portal.

33. In Summary (cont.)
12.6 Be knowledgeable of the office EHR program and never display a negative attitude about it. Assist in preparing written information for the patients regarding the EHR program. Show the patient his EHR, and explain how the information is entered, maintained, and kept secure. Understand and be able to explain the backup process for the EHR program. Understand the office access policy as it pertains to HIPAA and explain it to the patients.
12.6 Be knowledgeable on all aspects of the office EHR program and never display a negative attitude about it. Assist in preparing written information for the patients regarding the EHR program, including how the patient’s medical information will remain confidential and secure. When the patient is in the office, offer to show the patient his EHR and demonstrate adding information, explaining how the information is entered, maintained, and kept secure. Understand and be able to explain the backup process for the EHR program. Understand the office access policy as it pertains to HIPAA and explain it to the patients.

34. End of Chapter 12
The over-all point is that new technology will not necessarily replace old technology, but it will date it. By definition. Eventually, it will replace it.
~ Steve Jobs