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Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a This material Comp8 _Unit1a was developed.

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Presentation on theme: "Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a This material Comp8 _Unit1a was developed."— Presentation transcript:

1 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a This material Comp8 _Unit1a 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 Elements of a Typical Electronic Health Record System Learning Objectives 1.Identify the core elements that comprise an EHR system (Lecture a) 2.Describe the use of client and server hardware for access to and storage of EHRs (Lecture a, b) 3.Describe network needs for access to and storage of EHRs (Lecture b) 4.Identify the application software and back-end data storage software needed for a comprehensive, effective health IT system (Lecture a, b) 2 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

3 Why Implement an EHR? 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a “Information technology … holds enormous potential for transforming the health care delivery system” - Institute of Medicine (IOM), Crossing the Quality Chasm, 2001

4 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a A New Health System for the 21st Century IOM (2001): Six aims for improving health care quality 1.Safe 2.Effective 3.Patient-centered 4.Timely 5.Efficient 6.Equitable (IOM, 2001)

5 Patient Record System IOM (1991): Any “patient record system” includes: –People –Data –Rules and procedures –Processing and storage devices –Communication and support facilities (Dickinson et al, 2003) 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

6 Core EHR Functions: US Government Orders for therapies (e.g. medications) Orders for tests Reporting of test results Physician notes (Torrey, 2011) 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

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 (Dickinson et al, 2003) 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

8 EHR Systems: Then and Now The early years –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. (Pawola, 2011; Medical Software Associates) 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

9 EHR Systems: Then and Now (cont’d) The 1990s –Improvements in computing power and connectivity spurred progress. –EMRs began to be adopted by some practices. –Rapid progression of technology meant technology was outdated almost as soon as it was installed. (Pawola, 2011; Medical Software Associates) 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

10 EHR Systems: Then and Now (cont’d) 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. (Pawola, 2011; Medical Software Associates) 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

11 CPR vs. EMR vs. EHR CPR: Electronic record with full interoperability within an enterprise (hospital, clinic, practice) EMR: Commonly found in ambulatory care and physicians practices EHR: Designed for interoperability and accessibility across disparate organizations (Pawola, 2011; Garrett & Seidman, 2011) 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

12 Potential Advantages of EHR Systems "Legacy" EHR systems have often fallen short for a variety of reasons, but overall potential benefits include: –Better, more accurate documentation –More efficient storage & retrieval of records –Higher quality of care, fewer errors –Lower insurance premiums and operating costs (Dickinson et al, 2003; Gurley, 2004; Steele, 2009; Greenhalgh et al, 2009) 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

13 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a Hardware and Software Hardware –Physical devices or 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.

14 Software Elements – Pre-EHR 14 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a 1.1 Figure: (MITRE, 2006)

15 Software Elements – Post-EHR 15 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a 1.2 Figure: (MITRE, 2006)

16 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” but is generally not recommended.. (Wikipedia, 2010) 16 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

17 Client-Server Model 17 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a 1.3 Figure: (Neal, 2011) Advantages: –Data resides on the server, which generally has safer controls –Easier to manage and update –Less resource-intensive for the client

18 18 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a Elements of a Typical Electronic Health Record System Summary – Lecture a EHRs offer potential long-term benefits over traditional methods. EHRs require both hardware and software components. Client-server model is predominant in EHR software models.

19 Elements of a Typical Electronic Health Record System References – Lecture a References DesRoches, C.M., et al. (2008). Electronic health records in ambulatory care: a national survey of physicians. N Engl J Med; 359:50-6. http://www.nejm.org/doi/full/10.1056/NEJMsa0802005http://www.nejm.org/doi/full/10.1056/NEJMsa0802005 Dickinson, G., Fischetti, L., & Heard, S. (Eds.). (2003). HL7 EHR System Functional Model and Standard. Retrieved July, 2010, from HIMSS.org: http://www.himss.org/Content/Files/EHR_Functional_Model_Ballot.pdfhttp://www.himss.org/Content/Files/EHR_Functional_Model_Ballot.pdf Garrett, P., & Seidman, J. (2011, January 4). EMR vs EHR: What is the difference. Heath IT Buzz. Retrieved December, 2011, from http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr- difference/http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr- difference/ Greenhalgh, T., et al. (2009). Tensions and paradoxes in electronic patient record research: a systematic literature review using the meta-narrative method. Milbank Quarterly. Retrieved June 2011 from http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf Gurley, L. (2004). Advantages and disadvantages of electronic medical records. Retrieved from http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf Institute of Medicine (2001, March 1). Crossing the quality chasm: a new health system for the 21st century. Retrieved June 30, 2010, from http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdfhttp://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf Maons, D. (2011, November11). EHRs are inevitable, experts say. Heathcare IT News. Retrieved from http://www.healthcareitnews.com/news/ehrs-are-inevitable-experts-say http://www.healthcareitnews.com/news/ehrs-are-inevitable-experts-say Medical Associates. Electronic Medical Record. Retrieved September 2011 from http://www.medical- software.org/electronic-medical-record.html http://www.medical- software.org/electronic-medical-record.html Pawola, L. (2011, February 22). The history of the electronic health record. Health Informatics and Health Information Management. Retrieved December 2011 from http://healthinformatics.uic.edu/the-history-of-the- electronic-health-record/http://healthinformatics.uic.edu/the-history-of-the- electronic-health-record/ 19 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

20 Elements of a Typical Electronic Health Record System References – Lecture a References (cont’d) Steele, E. (2009, December 16). Research explains why EHRs won’t achieve “Meaningful Use”. Retrieved Nov 2011 from http://blog.srssoft.com/2009/12/research-explains-why-ehrs-won%e2%80%99t-achieve- %e2%80%9cmeaningful-use%e2%80%9d/http://blog.srssoft.com/2009/12/research-explains-why-ehrs-won%e2%80%99t-achieve- %e2%80%9cmeaningful-use%e2%80%9d/ Torrey, T. (2011, April 11). What is an EMR (Electronic Medical Record) or EHR (Electronic Health Record)? Retrieved June, 2011, from patients.about.com: http://patients.about.com/od/electronicpatientrecords/a/emr.htmhttp://patients.about.com/od/electronicpatientrecords/a/emr.htm Torrieri, M. (2011, August 23). EHR adoption grows slowly, steadily at small practices. Retrieved from http://www.searchmedica.com/resource.html?rurl=http%3A%2F%2Fwww.physicianspractice.com%2Fblog%2Fcon tent%2Farticle%2F1462168%2F1933985%3FCID%3Drss&q=Kleaveland&c=pm&ss=physiciansPractice&p=Conve ra&fr=true&ds=0&srid=3 http://www.searchmedica.com/resource.html?rurl=http%3A%2F%2Fwww.physicianspractice.com%2Fblog%2Fcon tent%2Farticle%2F1462168%2F1933985%3FCID%3Drss&q=Kleaveland&c=pm&ss=physiciansPractice&p=Conve ra&fr=true&ds=0&srid=3 Wikipedia. (2011, August). Client server model. Retrieved June 2011 from Wikipedia.com: http://en.wikipedia.org/wiki/Client%E2%80%93server http://en.wikipedia.org/wiki/Client%E2%80%93server Charts, Tables, Figures 1.1 Figure: Electronic Health Data — Pre-EHR. MITRE. (2006). Electronic Health Records Overview. Available from http://www.ncrr.nih.gov/publications/informatics/EHR.pdf Used with permission. http://www.ncrr.nih.gov/publications/informatics/EHR.pdf 1.2 Figure: Electronic Health Data — Post-EHR. MITRE. (2006). Electronic Health Records Overview. Available from http://www.ncrr.nih.gov/publications/informatics/EHR.pdf. Used with permission. http://www.ncrr.nih.gov/publications/informatics/EHR.pdf 1.3 Figure: Client Server Model. Neal, Scott. (2011). Used with permission. 20 Health IT Workforce Curriculum Version 3.0/Spring 2012 Installation and Maintenance of Health IT Systems Elements of a Typical Electronic Health Record System Lecture a

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