Electronic Health Record Systems:

1. Electronic Health Record Systems: U.S. Federal Initiatives and Public/Private Partnerships

2. Electronic Health Record (EHR) An electronic health record is a digital collection of patient health information compiled at one or more meetings in any care delivery setting. A patient's record typically includes patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, etc.

3. Defining Electronic Health Record Systems The term EHR-S is often used interchangeably with computerized patient record, clinically information system, electronic medical record, and many others. As a term EHR-S is recognized internationally by including the word system, the term forces a distinction between an EHR, which is physical or logical repository of data, and EHR-S, which can be made up of one or more applications. At the time of writing, international organization for the standardization (ISO) had drafted its standard for EHR definition, escape, and context, ISO 20514; the final version was expected in 2005 or 2006.

6. EHRs • April 2004: Pres. of US issued an executive order that called for an action to put EHR in place • this order give momentum to efforts across health care community to use HIT to improve healthcare • Can meet clinical and business needs • Manage health care data and information in a way that it is patient-centered and information- rich • The involvement of nurses is critical to such as efforts

7. The IOM’s 1991 definition of computer-based patient record system is currently the basis for domestic and international definitions of an EHR-S: Longitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or healthcare provided to an individual. Immediate electronic access to person and population level information by authorized, and only authorized, users. Provision of knowledge and decision support that enhances the quality, safety, and efficiency of patient care. Support of efficient processes for healthcare delivery.

8. FEDERAL INITIATIVES “GOVERNMENT as a Provider and Early Adopter” • 2 examples of Initiation of Systems in the 1990’s: • Department of Veterans Affairs (VA) and National Institutes of Health (NIH) • VA’S original clinical information system: - Department of Defense - Indian Health Service

9. DEPARTMENT OF VETERANS AFFAIRS • CPRS (Computerized Patient Record System) • a new interface that provides a single place for healthcare providers to review and update phr and order medications, special procedures, x-rays, nursing orders, diets, and laboratory tests. • 2004, MyhealtheVet as an internet tool for personal health management.

10. DEPARTMENT OF DEFENSE Providers have computerized physician order entry capability that enables them to order lab tests and radiology exam and issue prescriptions electronically for over 10 yrs.

11. INDIAN HEALTH SERVICE • IHS has long been a pioneer in using computer technology to capture clinical and public health data. • RPMS ( Resource and Patient Management System) – have access to decades of personal health information and epidemiologic data on local population.

12. “GOVERNMENT as a Leader” • Federal Agencies helps in decreasing the cost and risk of acquisition and providing incentives for their use • Its activities focused on the adoption of terminologies and standards, grants for community demonstrations of data exchange • Pursuing the development of a public-private national health information network to facilitate EHR-S deployment

13. Office of the National Coordinator for Health Information Technology The executive order of 2004 created of ONCHIT to coordinate HIT efforts in the federal sector and to collaborate with the private sector in driving HIT adoption across the healthcare system. • This is positioned to bring together public and private entities for accelerating solutions to known problems • To assist in the collaborative effort , the strategic framework envisions a health information technology leadership panel, a private interoperability consortium for the development of a national info network, private certification of HIT products

14. The National Committee on Vital and Health Statistics • NCVHS presented the concept of an infrastructure that emphasizes health-oriented interactions and information sharing among individuals and institutions, rather than simply the physical, technical, and data systems that make those interactions possible. • NHII ( National Health Information Infrastructure) • encompasses tools such as clinical practice guidelines, educational resources for the public and professionals , geographic information

15. Goals of the Strategic Framework

16. GOAL 1 • Inform Clinical Practice • Centers largely on efforts to bring EHRs directly into clinical practice. • Clinicians across American will have information tools when and where they need them. • Strategies • Incentivize electronic health record (EHR) adoption • Reduce risk of EHR investment • Promote EEHR diffusion in rural and underserved areas

17. Interconnect Clinicians • Will allow for the secure movement of health information so that EHRs will realize their full benefit. • Will allow information to be portable and to move with consumers from one point of care to another. • Will require an interoperable infrastructure to help clinicians get access to critical health care information when their clinical and/or treatment decisions are being made • Strategies • Foster regional collaborations • Develop a national health information network • Coordinate federal health information systems GOAL 2

18. GOAL 3 • Personalize Care • Consumer-centric information helps individuals have choice, control and the ability to manage their own wellness and assists with their personal health care decisions. • Strategies • Encourage use of Personal Health Records • Enhance informed consumer choice • Promote use of telehealth systems

19. Improve Population Health • Population health improvement requires the collection of timely, accurate, and detailed clinical information. • Population health also requires the reporting of critical findings to public health officials, clinical trials and other research, and feedback to clinicians. • Strategies • Unify public health surveillance architectures • Steamline quality and health status monitoring • Accelerate research and dissemination of evidence GOAL 4

20. Agency for Healthcare Research and Quality • 2003-2004 > AHRQ unveiled a major HIT portfolio, with grants, contracts, and other activities to demonstrate the role of HIT in improving patient safety and quality of care • The objective of this projects was to provide healthcare facilities and providers with the information they need to make informed clinical and purchasing decisions about using HIT

21. The three dimensions of the National Health Information Infrastructure and examples of their content

22. Centers for Medicare and Medicaid Services • Within HHS, the CMS has initiated several pilot projects to promote health in IT. • May 2004, CMS awarded $100,000 grant to American Academy of Family Physicians (AAFP) • 3 year Care Management Performance Demonstration Program- is intended to promote continuity of care, help stabilize medical conditions, prevent or minimize acute exacerbations of chronic conditions, and reduce adverse health outcomes, such as adverse drug interactions. • At the end of 2004, CMS launched the Chronic Care Improvement Program (CCIP), - offer self-care guidance and support to chronically ill beneficiaries

23. Public – Private Partnership A number of collaborative efforts are focused on the use of HER-Ss and HIT to improve care. • Connecting for Health • A large private collaborative with federal participants supported by the Markle and Robert Wood Johnson Foundations. • addressing the barriers to development of an interconnected health information infrastructure. • It brings together several dozen of the leading healthcare provider and payer organizations, HIT vendors, and representatives of federal and state agencies • July 2004, CoH released an incremental “roadmap” that laid out near term actions necessary to achieving electronic connectivity

24. eHealthInitiative • Is an independent, nonprofit affiliated organization established to foster improvement in the quality, safety, and efficiency of healthcare through information and IT, • Its membership brings together hospitals and other providers, practicing clinicians, community organizations, payers, employers, community-based organizations, HIT suppliers, manufacturers, and academic organizations. • the major program of this is Connecting Communities

25. For Better Health • a nearly $4 million program that provides seed funding and technical support to multistakeholdercollaboratives within communities ( both geographic and nongeographic) that are using electronic health information exchange and other HIT tools to drive improvements in healthcare quality, safety, and efficiency. • is implementing activities on a national, regional, and local basis that will lay the foundation for an interconnected, electronic, standard-based health information infrastructure to support patients, clinicians, and those responsible for population health

26. Institute of Medicine • 1991 > has championed the advantages of use of IT to improve healthcare • 1997 > the computer-based patient record was revised and republished • 2002 > report in Leadership by Example: Coordinating Government Roles in Improving Health Care Quality, the IOM showcased federal programs and encouraged the development of an information infrastructure for the comparison of data to evaluate performance • 2003 > IOM issued a report, Key Capabilities of an Electronic Health Record System, Letter Report

27. Identified key functions of EHRs in four settings: • Hospitals • Ambulatory care • Nursing homes • Care in the Community

28. Certification Commission for Health Information Technology • HIMSS (Health Information and Management Systems) • AHIMA (American Health Information Management Information Management Association) • NAHIT (National Alliance For Health Information Technology) • GOAL: is to support Goal 1, Strategy 2, “Reduce risk of EHR Investment”

29. Health Level Seven • An international, not-for-profit, volunteer standards organization • Known for its large body of work in the production of technical specifications for the transfer of healthcare data • this transport mechanism, known as messaging • Supported by public and private groups, the HL7’s EHR Technical Committee developed a draft standard for trial use, known as DSTU • The HL7 EHR-S functional model contains a list of functions in 3 categories : direct care, supportive, and information infrastructure.

30. Direct care functions – are familiar to clinicians; contained to user interface, these functions are needed to support direct care delivery • Supportive Functions – involve secondary use of the data captured via the direct care function; these functions are needed to support enhanced functions for direct care and advanced information handling needs for the organization. • Information Infrastructure section – is the “backend” of the system; unfamiliar to many clinicians, this is considered essential by informatics and technical staff

31. FINI! “Thanks for listening.”