Health Management Information Systems

1. Health Management Information Systems Electronic Health Records Lecture a This material (Comp 6 Unit 3) 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. This material was updated by Normandale Community College, funded under Award Number 90WT0003. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/

2. Electronic Health RecordsLearning Objectives • State the similarities and differences between an electronic medical record (EMR) and electronic health record (EHR) • Identify attributes and functions of an EHR • 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 • Explain how the use of an EHR can affect patient care safety, efficiency of care practices, and patient outcomes

3. Electronic Medical Record (EMR) • Electronic record of health-related information on an individual • Within one health care organization

4. EMR Purpose • Provide an electronic equivalent of an individual’s legal medical record • Intra-organizational

5. 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

6. Electronic Health Record (EHR) • Electronic record of health-related information on an individual • Across more than one health care organization

7. 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

8. EMR Versus EHR Table 3.1 EMR and EHR Comparison

9. 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

10. 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

11. EHRs Versus Paper Records • EHRs can • Deliver more information in more directions • While reducing “paperwork” time for providers • Improve privacy and security • Reduce costs

12. 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

13. 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

14. 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

15. HL7 EHR Functions • Direct care functions • Supportive functions • Information infrastructure functions

16. Direct Care Functions Table 3.2 HL7 2014 EHR-S Functional Model Care Provisions Subsets with Examples

17. Administrative Support Functions • Manage Patient Demographics • Manage Communication • Manage Provider Information

18. Other EHR Functions • Care Provision Support Functions • Includes record management, functions that support result reporting, and support for patient education • Population Health Support Functions • Support for health maintenance and prevention, donor management, and public health related updates • Record Infrastructure Functions • This includes record lifecycle, record synchronization, and record archive and restore functions • Trust Infrastructure Functions • This important functional area includes security, audit and database backup and recovery features

19. 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

20. EHR Acceptance • Health care provider • Increasing momentum for widespread adoption and implementation of EHRs • Changing reimbursement for patient care, focusing on managing patients across the continuum of care and between providers • Authorized Testing and Certification Body by the Office of the National Coordinator

21. EHR Acceptance • Public • Ancker, et al (2013) surveyed the public on their perceptions of electronic health records • Improved quality • 66% thought EHRs would improve quality of care • Particularly true for patients whose doctor had an EHR in use • Concern over • Privacy, but not correlated with patients whose doctor used an EHR

22. 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

23. Barriers to Adoption • Cost of conversion • Perceived lack of ROI • Technical and logistical challenges • Privacy and security concerns

24. EHR Effect on Patient Care Safety • Reduces the need to repeat tests • Reduces the number of lost reports • Supports provider decision making

25. EHR Effect on Efficiency • Improves accessibility of patient information • Integrates data from multiple internal and external sources • Facilitates the coordination of health care delivery • Provides the ability to “hard wire” processes

26. 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 • Improve patient engagement in their own care

27. 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

28. 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 Ancker, J., Silver, M., Miller, M., & Kaushal, R. (2013, January 1). Consumer experience with and attitudes toward health information technology: A nationwide survey. Journal of American Medical Informatics Association, Jan 2013, 20 (1) 152-156 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

29. Electronic Health RecordsReferences – Lecture a References Health Level Seven International. (n.d.). About HL7. Retrieved from http://www.hl7.org/about/index.cfm?ref=nav Health Level Seven International. (2014). HL7 2007 EHR-S functional model, Release 2. Retrieved from http://www.hl7.org/ehr/downloads/index.asp Radiological Society of North America. (2005, September). IHE moves EHR goals forward. Retrieved from http://www.rsna.org/Publications/rsnanews/sep05/ihe.cfm 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

30. Electronic Health RecordsLecture a This material 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. This material was updated by Normandale Community College, funded under Award Number 90WT0003.