Assignment 1
KpatelIntroduction 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
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© 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 |
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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 |
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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
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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)
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© 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% |
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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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