EMR , EHR, PHR and the implications for the e-Health policies in Romania

1. EMR, EHR, PHR and the implications for the e-Health policies in Romania Traian IONESCU, PhD

2. Agenda • Definitions • PHR, EMR, EHR • Benefits of EHR • Challenges of EHR • Conclusions

3. Definitions • There are several concepts that are used with approximately the same meaning: • Personal Health Record (PHR), • Electronic Medical Record (EMR), • Electronic Patient Record (EPR), • Electronic Health Record (EHR) and • Computerized Patient Record (CPR)

4. Definitions They refer to the electronic collection of medical information, performed by the patient himself or herself, by a particular health-care institution, or by a global, integrated system. A systematic collection of electronic health information about individual patients or populations in a digital form.

5. PHR • Personal Health Record (PHR) Definition: PHR “are records kept by a patient to make his or her navigation through the healthcare system more efficient”. • Personal information • Self-care trackers • Audit logs • Medication alerts • Patient ID in relation to healthcare institutions

6. EMR Electronic Medical Record (EMR) Definition: “Digital records kept by your doctor's office, your insurance company or the facilities where you are a patient”. • Provider notes • Clinical orders • Drug prescriptions • Results of investigations • Patient unique identifier • Insurance information

7. EHR • Electronic Health Record (EHR) Definition 1: EHR is “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting”

8. Content • Personal information • Self-care trackers • Audit logs • Medication alerts • Provider notes • Clinical orders • Drug prescriptions • Results of investigations • Infrastructure data • Planning and policy • Surveillance systems • Health disparities data • Healthcare • Provider • Dimension • Personal Health Dimension • Population Health Dimension

9. Content • Patient ID • Health Insurance • Consent forms • Medication alerts • Vital statistics • Population health risks • Communicable diseases • Registries • Public education material • Inspection reports • Environmental hazards • Healthcare • Provider • Dimension • Personal Health Dimension • Population Health Dimension

10. Content • Patient ID • Health Insurance • Consent forms • Medication alerts • Vital statistics • Population health risks • Communicable diseases • Registries • Public education material • Inspection reports • Environmental hazards • De-identified information • Mandatory reporting • Community directories • Public health services • Survey data • Healthcare • Provider • Dimension • Personal Health Dimension • Population Health Dimension

11. Benefits of EHR • Intuitive, seamless and automated solutions for connecting, collaborating, and informing across the healthcare institutions • Patients, physicians and other healthcare professionals may access the needed information in real-time and take immediate action in respect to the whole patient history. • Workforce decrease in nursing industry, associated with a continuous workload increase

12. Benefits of EHR • Reengineering of working processes, to ensure increased efficiencies, generate improvements in quality of care, and realize the maximum benefits of an automated environment.

13. Benefits of EHR • Patient data can be captured, aggregated and presented to all interested stakeholders • Healthcare institutions can be run based on business intelligence and organizational goals • Key performance indicators are easier to compute • Monitor, and collaboration between multiple professionals for complex cases is more effective.  

14. Benefits of EHR • Moreover, EPR collections represent a valuable support for organizing preventive programs, for monitoring chronic diseases, for medical research and for education.  

15. Benefits of EHR • Improved patient care • EPRs are expected to improve quality and patient care, introducing: • richness and details concerning each patient, • freshness or currency of the data, • relevance of the data collected to clinical trial work

16. Benefits of EHR • Improved patient care • More efficient tracking of patients and costs. • Repeating expensive tests can be avoided and more time may be spent with patients effectively

17. Benefits of EHR • Implementation • EMR systems are completed, tested, and implemented in many institutions, so the expertise of the installing teams should be increased, and lessons learned can be applied to new implementations. • Test data suites can be better developed, test cases can be easily understood, and more training materials may be provided.

18. Benefits of EHR • Implementation • Moreover, design improvement ideas may be collected from multiple institutions, which may result in improved functionality (or may result in a system built on multiple compromises). • Interoperability with the clinical trial management systems or data repositories

19. Benefits of EHR • Implementation • EPRs are also expected to provide better documentation and improved audit capabilities. • This can be leveraged by supporting consistency of medical terms and codes, both within the EHR itself and also with the codes and terms used by clinical trial protocols.

20. Benefits of EHR • Improved business • EHRs are expected to bring important benefits to the business of healthcare. • The business model and workflow processes embedded in these systems should be designed to meet the needs of as many potential health care institutions as possible.

21. Benefits of EHR • Improved business • Improved workflow across different institutions: orders are complete, legible, and entered immediately. • Similarly, consent management features support adherence to review board requirements

22. Challenges of EHR • The technical environment is rapidly changing, and it is difficult to implement these changes quickly, especially if the needs of multiple hospitals must be considered. • Backwards compatibility (the ability to upgrade without losing data or functionality) is desired, but the more complex the system, the more difficult it is to produce technical enhancements that meet the user community’s needs.

23. Challenges of EHR • Data Integration Challenges • EHRs have to collect and integrate a great quantity of non-homogenous data • Free text, like progress notes, is very difficult to place in a certain context and to integrate with other pieces of information.

24. Challenges of EHR • Data Integration Challenges • A structured form serves better for the purpose of data integration. However, structured data that uses concepts or vocabularies not appropriate for the domain do not produce useful results.

25. Challenges of EHR • EHRs have to manage distributed data, stored in disparate computer systems, operated by disparate healthcare providers, potentially from multiple countries. • There is a major issue in knowing what data is where, what currency it may have, and whether it is accurate. • A common approach to the location issue is to form a central index pointing to the sources of data for each patient.

26. Challenges of EHR • An issue in forming a consolidated record from diverse sources is consistency. • Thus, each extract from a source system should carry time and data stamps and the assembling process should check these in forming a verified timeline. • However, healthcare data has a reputation for inaccuracy and incompleteness(e.g. the misquotation of Patient IDs leads to either failure to compose a complete record or the miss-assembly of records).

27. Challenges of EHR • Large-scale information management • The large amount of information stored in EPRs may lead to problems like: • slow system response, • system crashes, • multiple screens, • increasing documentation time and decreasing interdisciplinary communication, • and impaired critical thinking through the overuse of checkboxes and other automated documentation.

28. Challenges of EHR • Patient identification • The Identification of Data is a major point of difficulty. • The major areas where patient misidentification can occur include drug administration, phlebotomy, blood transfusions, and surgical interventions.

29. Challenges of EHR • Patient identification • Patient identification should be based on the following 5 elements (WHO, 2007): • 1. Policy - Emphasize that health-care providers have primary responsibility for checking/verifying a patient’s identity, while patients should be actively involved and should receive education on the importance of correct patient identification.

30. Challenges of EHR Patient identification • 2. Admission - Upon admission and prior to the administration of care, use at least two identifiers to verify a patient’s identity, neither of which should be the patient’s room number.

31. Challenges of EHR Patient identification • 3. Patient Identifiers • Standardize the approaches to patient identification among different facilities within a health-care system. • Develop an organizational protocol for identifying patients without identification or with the same name. • Use other non-verbal approaches, such as biometrics, for comatose patients.

32. Challenges of EHR Patient identification • 4. Intervention • Even if they are familiar to the health-care provider, check the details of a patient’s identification to ensure the right patient receives the right care. • 5. Patient • Involve patients in the process of patient identification.

33. Challenges of EHR • Single Sign-on and Federated Authentication Services • A major barrier in the minds of users - the fragmented nature of applications and the need to log on to each independently. • A mechanism that permits a user to sign on but once and then access all systems to which he is entitled is highly useful.

34. Challenges of EHR • Role-based Access Control • It is likely that a healthcare professional will play a number of professional roles and use a number of applications.

35. Challenges of EHR • Role-based Access Control • Depending on his or her role, the professional will need to access different part of applications, access different data and use different display layouts. • Further given professional ID and role, a list of patients with whom the professional has the appropriate care relationship can be pre-prepared

36. Challenges of EHR • Privacy • Patient Data belongs to the patient; it is subject to data protection legislation • There are two techniques for assuring privacy: • Anonymization • Pseudonymization • For EPR privacy one should make patient-related data available at point of need to those, and only those, who have a real and justified need to know them.

37. Challenges of EHR • Trust • EHR systems should ensure that all data recorded, stored, retrieved and presented is in context, accurate, timely and relevant. • Similarly, requests for action must happen, quickly, accurately and completely with appropriate confirmations.

38. Challenges of EHR • Interoperability • Nowadays, EPR systems use different standards for vocabularies, user identification, and patient identification. • In terms of interoperability, the challenge is to draw together accurate, relevant data from many diverse sources and systems and to present that data in a coherent, fit for purpose, format.

39. Challenges of EHR • Interoperability • Further the capability of carrying out a single business process across many systems and ensuring complete and accurate execution is required.

40. Conclusions • Some important benefits of EPR systems are: • connectivity, • collaboration support, • workforce problem compensation, • data integration, • business intelligence, • research support, education support, • accessibility, • efficiency • improved care

41. Q & A Traian.Ionescu@siveco.ro