1. Respiratory Therapy Department Integration to EHR November 4, 2009 MMI – 405: HIT Integration, Interoperability, and Standards Suzi Birz, Nicki Cliffer, Lincoln Farnum, Debbie Michaelson

2. Best Ever Hospital Best City, IL Agenda November 4, 20092 Where We Left Off Use of Standards Information System Requirements Next Steps

3. Best Ever Hospital Best City, IL Where We Left Off November 4, 20093 Best Ever Hospital Best City, IL

4. Best Ever Hospital Best City, IL Business Issue Respiratory Care Services implemented a Respiratory Care Management Information System Best Ever Hospital has deployed an integrated electronic medical record that does not have a Respiratory Care module Modules for other ancillary services have been deployed including pharmacy, laboratory, and imaging. November 4, 20094

5. Best Ever Hospital Best City, IL Assumptions RCMIS Access via handheld RT Charting Order entry by Respiratory Therapists RT Order Lists and Work Assignments Calculate productivity EHR Access via handheld Order Entry, Update, Discontinue Order Review View RT Results/Progress Note November 4, 20095

6. Best Ever Hospital Best City, IL Use of Standards November 4, 20096

7. Best Ever Hospital Best City, IL Standards November 4, 20097 TransactionStandardHow Used ADT, Orders, Results, Billing Data, Charges HL7Facilitate the electronic interchange of clinical, financial, and administrative information among health care oriented computer systems Billing data, chargesICD; CPTFacilitate the use of diagnoses and procedures ResultsLOINCFacilitate the exchange and pooling of clinical results ResultsASTMAs necessary, to facilitate “plug-and- play” integration of laboratory automation Ventilator dataMIBAutomatically acquire data from ventilators

8. Best Ever Hospital Best City, IL Drawing placeholder November 4, 20098

9. Best Ever Hospital Best City, IL Information System Requirements November 4, 20099

10. Best Ever Hospital Best City, IL Interface Functional Requirements November 4, 200910 EHRRCMIS Demographic, Visit, Location Data RCMIS Orders EHR Ventilator & Monitoring Equipment Data RCMIS EHR RCMIS Results RCMIS EHR Respiratory care billing MISCELLANEOUS Integrity checking - HIPAA Security Rule Secure data transmission - HIPAA Security Rule & ARRA Privacy Breach Rules

11. Best Ever Hospital Best City, IL Sending System Data (New or Updated) Receiving System EHRDemographic DataRCMIS EHRVisit informationRCMIS EHRLocationRCMIS EHR Results EHR RCMIS Bedside Monitoring EquipmentMonitor dataRCMIS VentilatorsMonitor dataRCMIS Billing infoEHR Orders not needing review Reviewed Orders RCMIS Respiratory therapy ordersEHR RCMIS Orders RCMIS EHR RCMIS Order Changes EHR RCMIS EHR RCMIS Discontinued Orders EHR RCMIS November 4, 200911

12. Best Ever Hospital Best City, IL Next Steps November 4, 200912

13. Best Ever Hospital Best City, IL Finalize the Integration of RCMIS and EHR Diagram of information architecture Origin of individual data elements Flow of data sets between systems Bring the findings back to this group on November 18, 2009 November 4, 200913

14. Best Ever Hospital Best City, IL References 1.University of Connecticut Health Center. Respiratory Therapy Department. Retrieved October, 2009, from http://nursing.uchc.edu/unit_manuals/respiratory/index.html. http://nursing.uchc.edu/unit_manuals/respiratory/index.html 2.Johns Hopkins Medicine. Respiratory Care Services at Johns Hopkins. Retrieved October, 2009, from http://www.hopkinsmedicine.org/respcare.http://www.hopkinsmedicine.org/respcare 3.Medical College of Georgia. Respiratory Therapy. Retrieved October, 2009 from http://www.mcg.edu/sah/respther/index.html.http://www.mcg.edu/sah/respther/index.html 4.Quality Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academy of Sciences; 2001:39-40,100. 5.Aspden P, Wolcott JA, Bootman JL et al., eds. Preventing medication errors. Washington,DC: National Academies Press; 2007:4. 6.Safe practices for better healthcare: a consensus report. Washington, DC: National Quality Forum; 2003. 7.Joint Commission on the Accreditation of Healthcare Organizations. Proposed revisions to Standards MM.4.10 and MM.8.10. Retrieved October, 2009, from www.jointcommission.org.www.jointcommission.org 8.Williams, B. 1990. How to do an ROI (return on investment). Healthc Inform 7(2):30-2. 9.Ford, Richard M. Respiratory Care Management Information Systems. RESPIRATORY CARE. (2004); 49(4): 367-377. 10.Pullen, EE. Computers help provide better care. RESPIRATORY THERAPY. (1980); 10(4): 25-27. 11.Nelson, Steven B. Conference Summary: Computers in Respiratory Care. RESPIRATORY CARE. (2004) 49(5): 531-536. 12.Mussa, CC. Respiratory care informatics and the practice of respiratory care. RESPIRATORY CARE. (2008); 53(4): 488-499. 13.Clinivision. Mobile Patient Charting System. Retrieved October 2009 from http://clinivision.com/products/.http://clinivision.com/products/ 14.Unified Medical Language System (UMLS). United States National Library of Medicine National Institutes of Health. Referenced October 2009 from http://www.nlm.nih.gov/research/umls/knowledge_sources/metathesaurus/mapping_projects/loinc.html.http://www.nlm.nih.gov/research/umls/knowledge_sources/metathesaurus/mapping_projects/loinc.html 15.Vawdrey, David, et al. Assessing Data Quality in Manual Entry of Ventilator Settings. J Am Med Inform Assoc. 2007;14:295–303. 16.ScienceDirect.com; http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B75DF-4BVBRPC- B&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1076766201&_rerunOrigin=google&_acct=C000050 221&_version=1&_urlVersion=0&_userid=10&md5=321a5b066da5c9b201c60fb32d8cb5cahttp://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B75DF-4BVBRPC- B&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&_docanchor=&view=c&_searchStrId=1076766201&_rerunOrigin=google&_acct=C000050 221&_version=1&_urlVersion=0&_userid=10&md5=321a5b066da5c9b201c60fb32d8cb5ca November 4, 200914