1. Component 8 Installation and Maintenance of Health IT Systems Unit 1a Elements of a Typical Electronic Health Record System This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.

2. What We’ll Cover IOM healthcare improvement initiative and the role of technology Electronic Health Record (EHR) systems –Defined –Then & now –Advantages EHR software elements –Client-server model –Server vs. client applications –EHR model & components EHR hardware components –Servers: internal vs. external –Clients: workstations; laptops and tablets –Miscellaneous hardware: PDAs; scanning and medical equipment Network elements –WAN, LAN –Remote access –Assessing network needs Component 8/Unit 1a2Health IT Workforce Curriculum Version 2.0/Spring 2011

3. “Information technology … holds enormous potential for transforming the health care delivery system” - Institute of Medicine (IOM), Crossing the Quality Chasm, 2001 Component 8/Unit 1a3Health IT Workforce Curriculum Version 2.0/Spring 2011

4. A New Health System for the 21st Century IOM (2001): six aims for improving health care quality –Safe –Effective –Patient-centered –Timely –Efficient –Equitable Component 8/Unit 1a4Health IT Workforce Curriculum Version 2.0/Spring 2011

5. Patient Record System IOM (1991): Any “patient record system” includes: –People –Data –Rules and procedures –Processing and storage devices –Communication and support facilities Component 8/Unit 1a5Health IT Workforce Curriculum Version 2.0/Spring 2011

6. Core EHR Functions: US Government Orders for therapies (e.g. medications) Orders for tests Reporting of test results Physician notes Component 8/Unit 1a6Health IT Workforce Curriculum Version 2.0/Spring 2011

7. Core EHR Functions: IOM Provides longitudinal health data on individuals Provides immediate, yet secure, electronic access Provides knowledge to enhance quality, safety, and efficiency of care Supports efficient processes of care Component 8/Unit 1a7Health IT Workforce Curriculum Version 2.0/Spring 2011

8. EHR Systems: Then and Now Then… Earlier EHR systems required extremely expensive computer hardware. Core components usually ran on UNIX and often incurred high training costs. Rapid progression of technology meant technology was outdated almost as soon as it was installed. Component 8/Unit 1a8Health IT Workforce Curriculum Version 2.0/Spring 2011

9. EHR Systems: Then and Now Now… Fast, low-cost PC systems permeate the workplace, often less than $500 each. Improved network protocols make updating and maintenance easier and more cost-effective. Ubiquitous, easy to use graphical systems reduce training costs. Component 8/Unit 1a9Health IT Workforce Curriculum Version 2.0/Spring 2011

10. Advantages to EHR Systems Better, more accurate documentation More efficient storage & retrieval of records Higher quality of care, fewer errors Lower insurance premiums and operating costs Component 8/Unit 1a10Health IT Workforce Curriculum Version 2.0/Spring 2011

11. Hardware and Software Hardware - Consists of the physical components that make up a computer system. Software - Computer programs and accompanying data needed to tell the computer what to do and how to behave. Component 8/Unit 1aHealth IT Workforce Curriculum Version 2.0/Spring 2011 11

12. Software Elements: Pre-EHR Component 8/Unit 1aHealth IT Workforce Curriculum Version 2.0/Spring 2011 12 Lab ResultsAdministrationPharmacy Network Point of Care Lab Application Admin Application Pharmacy Application Each department maintains its own separate database to capture patient data. The provider must access each of the patient’s records individually using separate applications and compile through a manual process.

13. Software Elements: Post-EHR Component 8/Unit 1aHealth IT Workforce Curriculum Version 2.0/Spring 2011 13 Lab ResultsAdministrationPharmacy Network Point of Care Lab Results Administrative Options Medications Each department captures the data which is compiled and managed through a central database. The EHR system integrates the data from these dissimilar entities and presents patient information in an organized, standardized, manner.

14. Client-Server Model Most of today’s EHR systems are based on the client– server model. Software: the collection of programs and related data that contain the instructions for what the computer should do Servers: service providers –Servers run “server application” software designed to meet client requests. Clients: service requesters –Client software is designed to “request” information from a server and then present it to the user in an efficient manner. A server and client may reside on the same “box”. Component 8/Unit 1a Health IT Workforce Curriculum Version 2.0/Spring 2011 14

15. Client-Server Model Component 8/Unit 1aHealth IT Workforce Curriculum Version 2.0/Spring 2011 15 Advantages: Data resides on the server, which generally has safer controls. Easier to manage and update Less resource-intensive for the client Secure web server Client workstation/laptop with interface application Database servers

16. References Blumenthal D & Tavenner M. “The ‘Meaningful Use’ Regulation for Electronic Health Records.” N Engl J Med 2010; 363:501-504. http://www.nejm.org/doi/full/10.1056/NEJMp1006114 http://www.nejm.org/doi/full/10.1056/NEJMp1006114 “Client-Server Model.” Wikipedia. –http://en.wikipedia.org/wiki/Client%E2%80%93server “Crossing the Quality Chasm.” IOM. 2001.:6-15. –http://books.google.com/books?id=vAfn5LFcGfEC&printsec=frontcover&dq=Cros sing+the+Quality+Chasm&source=bl&ots=7FrNdxx_SJ&sig=H-mEij5yiFUvIH- c2ZALcT0nCMQ&hl=en&ei=apghTNyEEYWdlgeGr- XCAQ&sa=X&oi=book_result&ct=result&resnum=5&ved=0CCcQ6AEwBA#v=on epage&q&f=false DesRoches CM et al. “Electronic Health Records in Ambulatory Care — A National Survey of Physicians”. N Engl J Med 2008; 359:50-6. http://www.nejm.org/doi/full/10.1056/NEJMsa0802005 http://www.nejm.org/doi/full/10.1056/NEJMsa0802005 Component 8/Unit 1aHealth IT Workforce Curriculum Version 2.0 Spring 2011 16

17. References “The Electronic Medical Record.” Medical Software Associates. –http://medical-software.org/electronic-medical-record.html. “HL7 EHR System Functional Model and Standard.” 2003. –http://www.himss.org/Content/Files/EHR_Functional_Model_Ballot.pdf “More Physicians Using Electronic Medical Records.” About.com. July 2006. –http://patients.about.com/gi/o.htm?zi=1/XJ&zTi=1&sdn=patients&cdn=health&tm=149&f=10&su=p736.9.336. ip_&tt=2&bt=0&bts=1&zu=http%3A//www.cdc.gov/nchs/pressroom/06facts/electronic.htm Component 8/Unit 1aHealth IT Workforce Curriculum Version 2.0/Spring 2011 17