HIPAA Privacy and Security: Integration with the Electronic Medical Record (session 5.02)

1. HIPAA Privacy and Security: Integration with the Electronic Medical Record (session 5.02) Ronald B. Margolis, CIO, ICPO University of New Mexico Health Sciences Center/Hospitals June 6, 2003

2. About University Hospitals and Health Sciences Center • Single Academic Health Center in the state • Albuquerque is large metro; NM is Rural • 400 Tertiary Beds • Additional 125 Beds: • Children’s Hospital • Mental Health Center • Children’s Psychiatric Hospital • Children’s Rehabilitation Hospital

3. HIPAA and the EMR Issues… Does HIPAA fit well into the EMR picture ? How does it integrate with the electronic record ?

4. Major Functional Areas of the EMR HIM Administration HIPAA Reporting Tele- medicine Data Warehouse Radiology Lab Security Clinical

5. General Goals of technology and EMR • Improve healing environment for patients and visitors. • Improve operational environment for medical and administrative personnel. • Develop platform for rollout of new clinical and administrative applications. • Reduce costs and operational inefficiencies.

6. Integrated Technology Systems Media Telephone Mobile Telephone Tele- medicine Data Network Wireless Data EMS Clinical Systems Security

7. The HIPAA Overlay • Systems Perspective: HIPAA adds a layer • User Perspective: HIPAA adds a significant complication – more to learn • Administrative Perspective: HIPAA adds a big mandate with downside risk

8. Five levels of integration APPLICATION & TRAINING INTEGRATION SYSTEMS INTEGRATION NETWORK INTEGRATION CABLE INTEGRATION INFRASTRUCTURE INTEGRATION

9. HIPAA Overlays • Application level • Ongoing training and consistency • Systems integration • Network integration level

10. Focus on Clinical Impacts of HIPAA • Application Level • Vendor software • User training • Scheduling and Flow impact -- operations • Communication impact -- eMail • Education/training impact -- compliance

11. Clinician Benefits… • Unifies systems, services and medical record…opportunity to reduce chaos • Improved availability of data • Reduction of errors from lost orders, illegibility, misfiling and current notes • Competitive advantage, e.g., Leapfrog, HIPAA Compliance, Syndromic surveillance

12. More Clinician Benefits • Joint stakeholders with Administration • Assure consistency with protocols • Provides support for policies and documentation • Improves workflow between units • Enhances patient safety • Tracks accesses and disclosures

13. The clinician’s complaints • Takes longer for CPOE • Already have more patients than time • VA – Vista experience • Computer speed and reliability • HIPAA tracks everything • Staff has overreacted with HIPAA

14. Improves access Communications CPOE eliminates errors and mistakes Opportunity to track all disclosures Incorporates messages into MR Rules based checking at order entry improves order efficiency and structure Supports the case for clinical pathways and best practices Bottom Line Benefits

15. Structure is beneficial in a medical record. Graphic courtesy of Health Technology Center

16. Benefits to the system • Quality and availability of the record • Increases documentation compliance • Increases security • Reduces clerical tasks for ancillaries • Complicated order sets are made easier • Patient lists & flowsheets >efficiencies • Historical data for research & HIPAA

17. Emotions During the Project Life Cycle Vision drives Culture Culture Vision Enthusiasm Adoption Acceptance Optimism Perseverance Concern Commitment Other Priorities Confusion Pessimism Danger Zone Abandon the Project Time

18. Your turn for … questions