Assignment 1

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ESSNTLSINHEALTHINFORMATICSchapter1.pptx

Introduction to Healthcare Informatics, Second Edition

Chapter 3:

The Electronic Health Record

© 2017 American Health Information Management Association

© 2017 American Health Information Management Association

Objectives

Review the evolution in the development of the electronic health record

Articulate the issues surrounding the deployment and implementation of the electronic health record

Compare the differences in electronic health record systems

Describe HITECH funding

Compare the advantages and disadvantages of the electronic health record

Consider the current status and documented outcomes of EHR utilization

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Introduction

Electronic health record (EHR)

Paper medical record

Episode of care

Differences between paper and electronic health records

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History

Health information systems

Clinical information systems

CPOE

Clinical decision making

Evidence-based medicine

E-prescribing

Health and Medicine Division (HMD)

ONC

ARRA

HITECH

Meaningful Use (MU)

Regional Extension Centers

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Percent of Hospitals with EHR

Hospital EHR adoption Percent of hospitals with an EHR
2008 2009 2010 2011 2012 2013 2014 2015
All hospitals with a basic EHR* 9% 12% 16% 28% 44% 59% 76% 84%
All small hospitals with a basic EHR* 6% 8% 11% 22% 39% 53% 70% 81%
All rural hospitals with a basic EHR* 6% 8% 11% 22% 36% 53% 70% 80%
All critical access hospitals with a basic EHR* 4% 7% 10% 20% 35% 54% 68% 80%
All hospitals with a certified EHR -- -- -- 72% 85% 94% 97% 96%
*Basic EHR with clinician notes  

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Components of the EHR

Integrated applications

EHR concept overview

CEHRT

Clinical documentation

Supports meaningful use

© 2017 American Health Information Management Association

© 2017 American Health Information Management Association

Meaningful Use (MU) Criteria

Stage 1 Meaningful use criteria focus on: Stage 2 Meaningful use criteria focus on: Stage 3 Meaningful use criteria focus on:
Electronically capturing health information in a standardized format More rigorous health information exchange (HIE) Improving quality, safety, and efficiency, leading to improved health outcomes
Using that information to track key clinical conditions Increased requirements for e-prescribing and incorporating lab results Decision support for national high-priority conditions
Communicating that information for care coordination processes Electronic transmission of patient care summaries across multiple settings Patient access to self-management tools
Initiating the reporting of clinical quality measures and public health information More patient-controlled data Access to comprehensive patient data through patient-centered HIE
Using information to engage patients and their families in their care   Improving population health

© 2017 American Health Information Management Association

Stage of Meaningful Use (MU) by 1st Year

First Year Demonstrating M U Stage of Meaningful Use
2015 2016 2017 2018 2019 and Future Years
2011 Modified Stage 2 Modified Stage 2 Modified Stage 2 or 3 Stage 3 Stage 3
2012 Modified Stage 2 Modified Stage 2 Modified Stage 2 or 3 Stage 3 Stage 3
2013 Modified Stage 2 Modified Stage 2 Modified Stage 2 or 3 Stage 3 Stage 3
2014 Modified Stage 2 Modified Stage 2 Modified Stage 2 or 3 Stage 3 Stage 3
2015 Modified Stage 2 Modified Stage 2 Modified Stage 2 or 3 Stage 3 Stage 3
2016 NA Modified Stage 2 Modified Stage 2 or 3  Stage 3 Stage 3
2017 NA NA Modified Stage 2 or 3 Stage 3 Stage 3
2018 NA NA NA Stage 3 Stage 3
2019 and Future Years NA NA NA NA Stage 3

© 2017 American Health Information Management Association

Primary and Secondary Uses of EHR System

Primary uses Secondary uses
Patient care delivery Education
Patient care management Regulation
Patient care support processes Research
Financial and other administrative processes Public health policy and homeland security
Patient self-management Policy support

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Core Functionality

Health information and data

Results management

Order entry/management

Decision support

Electronic communication and connectivity

Patient support

Administrative processes and reporting

Reporting and population health

© 2017 American Health Information Management Association

Clinical Function Examples in EHR

Health information and data

Patient demographic information

Patient problem list

Patient medication lists

Clinical notes

Minimum data set

Notes including medical history and follow-up notes

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Clinical Function Examples in EHR (continued)

Results management

Viewing lab results

Viewing imaging results

Electronic images are returned

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Clinical Function Examples in EHR (continued)

Order entry management

Computerized orders for prescription

Computerized orders for labs

Computerized orders for radiology

Orders sent electronically for prescriptions

Orders sent electronically for labs

Orders sent electronically for radiology

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Clinical Function Examples in EHR (continued)

Decision support

Warnings of drug interactions or contraindications are returned

Out of range lab levels are highlighted

Reminders for guideline-based interventions and screenings

Access to online clinical guidelines

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Clinical Function Examples in EHR (continued)

Electronic communications and connectivity

Electronic health information exchange (eHIE)

Access to shared patient histories

Continuity of Care Document (CCD)

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Clinical Function Examples in EHR (continued)

Patient support

Patient portal to HER

e-mail communication with clinicians

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Clinical Function Examples in EHR (continued)

Administrative processes

Scheduling/appointments

Billing

Inventory

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Clinical Function Examples in EHR (continued)

Reporting and population health management

Disease reports

Disease registries

Quality measured and improvement reports

Patient safety

Immunization information exchange

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Inpatient EHR

Components

Financial and administrative applications

Clinical systems

CPOE

Electronic medical administration records (EMAR)

Clinical data repositories

Clinical decision support

Document imaging

Picture archiving and communication system (PACS)

© 2017 American Health Information Management Association

© 2017 American Health Information Management Association

Sue Biedermann (SB) - The source at the bottom is not what is in the new version of the text. It should be Amatayakul 2013. I can't get this illustration to copy out of my copy of the chapter. Can your please change this or even just remove the citationn from the slide. Thanks.

HIMSS Adoption Model

Stage 0: Hospital has not installed all 3 key ancillary systems (laboratory, pharmacy, and radiology)

Stage 1: All 3 major ancillary clinical systems installed

Stage 2: Major ancillary systems feed data to a clinical data repository (CDR)

Stage 3: Nursing/clinical documentation implemented and integrated with CDR for at least one inpatient service

Stage 4: CPOE added to nursing and CDR environment with 2nd level of clinical decision support capabilities

Stage 5: Closed loop medication administration with bar coded unit dose medications environment fully implemented

Stage 6: Full physician documentation with structured templates and discrete data implemented for at least one inpatient care service area

Stage 7: Hospital no longer uses paper charts to delivery and manage care and has mixture of discrete data, documented images, and medical images within its EMR environment

© 2017 American Health Information Management Association

Adoption levels through 2015

Stage Cumulative capabilities 2015 Final (N = 5,460)
Stage 7 Complete EMR; CCD transactions to share data; data warehousing; data continuity with ED, ambulatory, OP 4.2%
Stage 6 Physician documentation (structured templates), full CDSS (variance and compliance), full R-PACS 27.1%
Stage 5 Closed loop medication administration 35.9%
Stage 4 CPOE, clinical decision support (clinical protocols) 10.1%
Stage 3 Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology 16.4%
Stage 2 CDR, controlled medical vocabulary, CDS, may have document imaging; HIE capable 2.6%
Stage 1 Ancillaries—Lab, Radiology, Pharmacy—All installed 1.7%
Stage 0 All three ancillaries not installed 2.1%
    100.1%

© 2017 American Health Information Management Association

Ambulatory EHRs

Practice management systems (PMSs)

Complete versus modular

Certified EHRs

HITECH

Meaningful Use

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Long Term Care EHRs

Minimum Data Set (MDS)

Electronic functionality limited

Potential processing changes

Benefits to LTC environment

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Behavioral Healthcare EHR

Inpatient or ambulatory

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Enterprise EHR

Patient health over time

Enterprise integration

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