Evolving Electronic Health Records: Trends and Impact

1. Terminology in Health Care and Public Health Settings Unit 15 Overview / Introduction to the EHR

2. Last Next Ten Years • Improved Technology • Government Support • Receptivity of Healthcare Professionals • Receptivity of Patients = Use of Electronic Records = Amount of Data Health IT Workforce Curriculum Version 1.0/Fall 2010

3. Health IT Workforce Curriculum Version 1.0/Fall 2010

4. The Electronic Health Record • Common acronyms for electronic records for patient data • EHR: electronic health record (across the lifespan) • CBMR: computer based medical record • CPR: computerized patient record • EMR: electronic medical record • EPR: electronic patient record • PHR: personal health record Health IT Workforce Curriculum Version 1.0/Fall 2010

5. Functions of the Health Record • Document patient care • Provide communication among healthcare team members • Financial and legal record • Research and continuous quality improvement • Repository of the clinical thought processes recording ideas and impressions over the period of care • Single point at which all clinical data are archived for long-term use Health IT Workforce Curriculum Version 1.0/Fall 2010

6. Attributes of the EHR • Enormous capabilities of data storage in a small space • Accessible from remote sites to multiple people at the same time • Information retrieval can be almost instantaneous • Provide clinical alerts, expert systems, and reminders Health IT Workforce Curriculum Version 1.0/Fall 2010

7. Attributes of the EHR • Can link the clinician to protocols • Create customized views • Improve risk management • Provide outcomes assessment • More accurate capture of financial charges and billing efficiency • Increases patient satisfaction Health IT Workforce Curriculum Version 1.0/Fall 2010

8. Data rich and information poor? Health IT Workforce Curriculum Version 1.0/Fall 2010

9. Rights of Information • Right information: must be accurate, free from error, and meaningful • Right person: communicated to the person who will respond to them • Right time: crucial to the health of an individual, give to the decision-maker within a few minutes or hours • Right place: must be accessible at the point of care • Right amount: decisions can be made faster when only the information desired is available Health IT Workforce Curriculum Version 1.0/Fall 2010

10. American Recovery and Reinvestment Act (ARRA) • $19B for HITECH –Health Information Technology for Economic and Clinical Health • Center for Medicaid and Medicare Services (CMS) • Incentive Payment, Meaningful Use • Office of the National Coordinator for Health Information Technology (ONC) • Certification Standards Health IT Workforce Curriculum Version 1.0/Fall 2010

11. Meaningful Use “The effective use of information to support better decision-making and more effective care processes that improve health outcomes and reduce cost growth” • Data Capture and Sharing • Advanced Clinical Processes • Improved Outcomes The Markel Foundation: Connecting for Health, “Achieving the Health IT Objectives of the American Recovery and Reinvestment Act” April 2009 Health IT Workforce Curriculum Version 1.0/Fall 2010

12. Data Capture and Sharing • Improve Quality, Safety and Efficiency • Engage Patients and Families • Improve Care Coordination • Improve Population and Public Health • Ensure Privacy and Security Protections Health IT Workforce Curriculum Version 1.0/Fall 2010

13. Improve Quality • Use CPOE • Formulary Checks • Problem List • e‐Prescribe • Rx List • Rx Allergy List • Record Demographics • Record physiological data • Growth charts for children between 2 and 20 • Record Smoking (> 13 Yrs) • Structured Lab Results • List Patient by Condition • Report Quality Measures • Patient Reminders (50 Yrs or >) • Clinical Decision Support ("Relevant to Clin Quality Measures“) • Check Eligibility • Submit Electronic Claims Health IT Workforce Curriculum Version 1.0/Fall 2010

14. Engage Patients and Families • Patient e‐Access on Request (Including Discharge Summary/ Instructions from hospital) • Patient e‐Access to Record (Patient Portal) • Clinical Summaries each Visit (Portal, email, CD, USB, Paper) Health IT Workforce Curriculum Version 1.0/Fall 2010

15. Improve Care Coordination • Exchange Health Info with other Provider • Medication Reconciliation • Summary Care Record for each Transition/Referral:Transfers w/Summary Health IT Workforce Curriculum Version 1.0/Fall 2010

16. Improve Population and Public Health • e‐Submit to Immunization Registries (Hospital also submits to Department of Public Health) • Syndromic Surveillance to Department of Public Health Health IT Workforce Curriculum Version 1.0/Fall 2010

17. Final Revisions to the ARRA Meaningful Use Rule • Final revisions to the rule July 13, 2010 • http://www.ofr.gov/OFRUpload/OFRData/2010-17210_PI.pdf Health IT Workforce Curriculum Version 1.0/Fall 2010

18. Summary of Objectives The “Meaningful Use” Regulation for Electronic Health Records. NEJM, July 13th, 2010 http://healthcarereform.nejm.org/?p=3732 Health IT Workforce Curriculum Version 1.0/Fall 2010