Health Management Information Systems

1. Health Management Information Systems Electronic Health Records Lecture a This material Comp6_Unit3a was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.

2. Electronic Health RecordsLearning Objectives • State the similarities and differences between an electronic medical record (EMR) and electronic health record (EHR) (Lecture a) • Identify attributes and functions of an EHR (Lecture a) • Describe the perspectives of health care providers and the public regarding acceptance of or issues with an EHR, which can serve as facilitators of or major barriers to its adoption (Lecture a) • Explain how the use of an EHR can affect patient care safety, efficiency of care practices, and patient outcomes (Lecture a) Health Management Information Systems Electronic Health Records Lecture a

3. Electronic Health RecordsLearning Objectives • Discuss how Health Information Exchange (HIE) and Nationwide Health Information Network (NHIN) impact health care delivery and the practice of health care providers (Lecture b) • Outline issues regarding governmental regulation of EHR systems, such as meaningful use of interoperable health information technology and a qualified R (Lecture b) • Summarize how the Institute of Medicine’s Vision for 21st Century Health Care and Wellness may impact health management information systems (Lecture b) • Identify how ongoing developments in biomedical informatics can affect future uses and challenges related to health information systems (Lecture b) Health Management Information Systems Electronic Health Records Lecture a

4. Purpose of a Patient (Medical) Record • “To recall observations, to inform others, to instruct students, to gain knowledge, to monitor performance, and to justify interventions” • Serves as the legal business record Health Management Information Systems Electronic Health Records Lecture a

5. Electronic Medical Record (EMR) • Electronic record of health-related information on an individual • Within one health care organization Health Management Information Systems Electronic Health Records Lecture a

6. EMR Purpose • Provide an electronic equivalent of an individual’s legal medical record • Intra-organizational Health Management Information Systems Electronic Health Records Lecture a

7. Electronic Health Record (EHR) • Electronic record of health-related information on an individual • Across more than one health care organization Health Management Information Systems Electronic Health Records Lecture a

8. EHR Purpose • Provide an electronic equivalent of an individual’s health record for use by providers and staff across more than one health care organization • Support efficient, high-quality integrated health care, independent of the place and time of health care delivery Health Management Information Systems Electronic Health Records Lecture a

9. EMR Versus EHR Table 3.1 EMR and EHR Comparison Health Management Information Systems Electronic Health Records Lecture a

10. EHRs Versus Paper Records • EHRs can make a patient’s health information available when and where it is needed • EHRs can bring a patient’s total health information together in one place, and always be current • EHRs can support better follow-up information for patients • EHRs can improve patient and provider convenience Health Management Information Systems Electronic Health Records Lecture a

11. EHRs Versus Paper Records • EHRs • Can link information with patient computers to point to additional resources • Don’t just “contain” or transmit information, they also compute with it • Can improve safety Health Management Information Systems Electronic Health Records Lecture a

12. EHRs Versus Paper Records • EHRs can • Deliver more information in more directions • While reducing “paperwork” time for providers • Improve privacy and security • Reduce costs Health Management Information Systems Electronic Health Records Lecture a

13. Attributes of an EHR • Provides secure, reliable, real-time access to patient health record information, where and when it is needed to support care • Captures and manages episodic and longitudinal electronic health record information Health Management Information Systems Electronic Health Records Lecture a

14. Attributes continued • Functions as clinicians’ primary information resource during the provision of patient care • Assists with the work of planning and delivering evidence-based care to individual and groups of patients • Supports continuous quality improvement, utilization review, risk management, and performance monitoring Health Management Information Systems Electronic Health Records Lecture a

15. Attributes continued • Captures the patient health-related information needed for reimbursement • Provides longitudinal, appropriately masked information to support clinical research, public health reporting, and population health initiatives • Supports clinical trials Health Management Information Systems Electronic Health Records Lecture a

16. HL7 EHR Functions • Direct care functions • Supportive functions • Information infrastructure functions Health Management Information Systems Electronic Health Records Lecture a

17. Direct Care Functions Table 3.2 HL7 2007 EHR-S Functional Model Direct Care Functions Subsets with Examples Health Management Information Systems Electronic Health Records Lecture a

18. Supportive Functions • Clinical Support • Measurement, Analysis, Research and Reports • Administrative and Financial Health Management Information Systems Electronic Health Records Lecture a

19. Information Infrastructure Functions • Security • Health record information and management • Registry and directory services • Standard terminologies and terminology services • Standards-based interoperability • Business rules managementorkflow management Health Management Information Systems Electronic Health Records Lecture a

20. Standards for Certification of EHR Technology • Content exchange standards • NCPDP SCRIPT Standard • HL7 Clinical Document Architecture (CDA), CCD • Vocabulary standards • SNOMED CT • LOINC • Privacy and security standards • NIST encryption algorithm • NIST hashing algorithm Health Management Information Systems Electronic Health Records Lecture a

21. EHR Acceptance • Health care provider • Increasing momentum for widespread adoption and implementation of EHRs • ARRA/HITECH • Authorized Testing and Certification Body by the Office of the National Coordinator Health Management Information Systems Electronic Health Records Lecture a

22. EHR Acceptance • Public • Harris Interactive Survey from 2005 • Mixed Feelings • 45% EHR system important • Concern over • Privacy • Increase rather than decrease of medical errors Health Management Information Systems Electronic Health Records Lecture a

23. EHR Acceptance: Public • Harris Interactive Survey • All physicians treating me should have access to information contained in my EMR • Percent answering "Strongly/Somewhat Agree" • 78% in 2009 • 78% in 2010 • An EMR would be a valuable tool to track the progress of my health • Percent answering "Strongly/Somewhat Agree" • 72% in 2009 • 71% in 2010 Health Management Information Systems Electronic Health Records Lecture a

24. Barriers to Adoption • Cost of conversion • Perceived lack of ROI • Technical and logistical challenges • Privacy and security concerns Health Management Information Systems Electronic Health Records Lecture a

25. EHR Effect on Patient Care Safety • Reduces the need to repeat tests • Reduces the number of lost reports • Supports provider decision making Health Management Information Systems Electronic Health Records Lecture a

26. EHR Effect on Efficiency • Improves accessibility of patient information • Integrates data from multiple internal and external sources • Facilitates the co-ordination of health care delivery Health Management Information Systems Electronic Health Records Lecture a

27. EHR Effect on Patient Outcomes • Has the potential to • Improve the quality of patient care • Help providers practice better medicine • Provide seamless exchange of information among providers Health Management Information Systems Electronic Health Records Lecture a

28. Electronic Health RecordsSummary – Lecture a • Defined an EMR and EHR • Explained similarities and differences • Identified EHR attributes and functions • Discussed the issues surrounding EHR adoption and implementation • Described the impact of EHRs on patient care Health Management Information Systems Electronic Health Records Lecture a

29. Electronic Health RecordsReferences – Lecture a References AHIMA e-HIM Work Group on Maintaining the Legal EHR. (2005). Update: Maintaining a legally sound health record—paper and electronic. Journal of AHIMA 76(10), 64A-L. Retrieved from http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_028509.hcsp?dDocName=bok1_028509 • Blumenthal, D. (2009, April 9). Stimulating the adoption of health information technology. New England Journal of Medicine 360,1477-1479. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMp0901592 • Handler, T., Holtmeier, R., Mtezger, J., Overhage, M., Taylor, S., & Underwood, C. (2003, July 7). HIMSS electronic health record definitional model version 1.0. Retrieved from http://www.providersedge.com/ehdocs/ehr_articles/HIMSS_EMR_Definition_Model_v1-0.pdf • Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule, 45 CFR Part 170 (July 28, 2010). Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf • Harris Interactive. (2010, June 17). Few Americans using 'E-' medical records. Retrieve from http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/ctl/ReadCustom%20Default/mid/1508/ArticleId/414/Default.aspx • Health Level Seven International. (n.d.). About HL7. Retrieved from http://www.hl7.org/about/index.cfm?ref=nav • Health Level Seven International. (2007). HL7 2007 EHR-S functional model. Retrieved from http://www.hl7.org/ehr/downloads/index_2007.asp • Radiological Society of North America. (2005, September). IHE moves EHR goals forward. Retrieved from http://www.rsna.org/Publications/rsnanews/sep05/ihe.cfm Health Management Information Systems Electronic Health Records Lecture a

30. Electronic Health RecordsReferences – Lecture a References • Reiser, S. J. (1991). The clinical record in medicine. Part 1:Learning from cases. Annals of Internal Medicine, 114, 902-907. • The National Alliance for Health Information Technology. (2008, April 28). Defining key health information technology terms. Retrieved from healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_848133_0_0_18/10_2_hit_terms.pdf • U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2010, July13). Electronic health records at a glance. Retrieved from https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3788&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=6&intPage=&showAll=&pYear=&year=&desc=false&cboOrder=date Charts, Tables, Figures • 3.1 Table: EMR and EHR Comparison 3.2 Table: HL7 2007 EHR-S Functional Model Direct Care Functions Subsets with Examples Health Management Information Systems Electronic Health Records Lecture a