Lecture 4

Electronic Health Record

(Chapter 14)
http://www.csun.edu/~dn58412/IS531/IS531_S
P15.html

Learning Objectives . . .
1. Define electronic health record (EHR).
2. Define electronic medical record (EMR).
3. Define computer-based patient record
(CPR).
4. Similarities and differences between
the EHR, EMR, and the CPR.
5. 12 attributes of the CPR for todays
EHR.
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Learning Objectives
6. Meaningful Use and the adoption and
use of the EHR in health care industry
7. Benefits associated with the EHR.
8. Concerns in implementation of the
EHR.
9. Current status of the EHR.

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Electronic Patient Record

(EPR)
Relevant info for the current episode of
care
Not necessarily a lifetime record

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Electronic Medical Record

(EMR)
Legal record created in hospitals and
ambulatory environments that is the
source of data for the EHR.
Single encounter/episode of treatment, no
info from previous visits or to future visits
Structured data (predefined format with
discrete data
Unstructured data (text report)
Electronic imaging (ultrasonography, MRI)
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*EMR Components*

Results reporting
Data repository
Decision support
Clinical messaging and e-mail
Documentation
Order entry

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Electronic Health Record

(EHR)
Longitudinal electronic record of patient
health information generated by one or
more encounters in any care delivery
setting
Interoperability standards to exchange info
outside a single healthcare delivery system
Supports other care-related activities
directly or indirectlyevidence-based
decision support, quality management, and
outcomes reporting
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Levels of Automation . . .
Stage 0: Not all ancillary systems (Lab, X-ray,
Pharmacy) are operational
Stage 1: Major ancillary clinical systems
installed
Stage 2: A clinical data repository(CDR)
stores info from major ancillary clinical
systems
Stage 3: Basic clinical documentation
required, CDR storage retrieval (picture
archiving communication systems-PACS)
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. . . Levels of Automation
Stage 4: Computerized provider order
entry(CPOE), support for evidence-based
practice
Stage 5:Barcode medication administration
(BCMA), radio frequency identification (RFID)
integrated with CPOE and pharmacy
Stage 6:Full physician documentation,
decision support, alerts, full PACS
Stage 7:Fully electronic paperless
environment
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Computer-Based Patient
Record (CPR)
Comprehensive lifetime record
Attributes identified by the Institute of
Medicine (IOM) provide the basis for
todays understanding of the EHR

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EHR Attributes . . .
Secure, reliable access where and when
needed
Records and manages episodic and
longitudinal information
Primary information source during care
Assists with planning and delivery of
evidence-based care

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. . . EHR Attributes
Captures data for:
Quality improvement
Utilization review
Risk management
Resource planning
Performance management

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. . . EHR Attributes
Captures information needed for medical
record and reimbursement purposes
Longitudinal, masked information supports
clinical research, public health reporting,
and population health initiatives
Supports clinical trials and evidence-based
research

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Continuity of Care
Document (CCD)
Intended to improve continuity of care
when clients move between various points
of care
Comprised of summaries from many types
of caregivers
Snapshot, not a comprehensive record

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Meaningful Use
Meaningful use is using certified electronic
health record (EHR) technology to:
Improve quality, safety, efficiency, and
reduce health disparities
Engage patients and family
Improve care coordination, and
population and public health
Maintain privacy and security of patient
health information
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Meaningful Use
Meaningful use compliance will result in:

Better clinical outcomes

Improved population health outcomes
Increased transparency and efficiency
Empowered individuals
More robust research data on health systems

Meaningful use sets specific objectives that

eligible professionals (EPs) and hospitals must
achieve to qualify for Centers for Medicare &
Medicaid Services (CMS) Incentive Programs.
http://www.healthit.gov/providers-professionals/meaningful-usedefinition-objectives

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. . .Meaningful Use
Penalties imposed for failure to achieve
Meaningful Use by 2015
Stage 1: electronic capture and sharing
health info in coded format, use it to track
conditions and coordinate care (Cf. Box 141,2, pp.281-282)
Stage 2: Ability to use HIT at the point of
care
Stage 3: improvement in safety, quality,
efficiency and expanded HER functionality.
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General Benefits of the EHR

Improved data integrity:
readable, better organized, accurate, complete
Improved productivity:
access data whenever, wherever for timely
decision
Increased quality of care:
tailored views, dash-board
Increased satisfaction for caregivers:
easy access to client data and related services

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Nursing Benefits
Decreased redundant data collection
Allowed data comparison from prior visits
Ongoing access, update record at bedside
Improved documentation and quality of
care
Supported timely decision
Etc

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Healthcare Provider Benefits

Better/faster/simultaneous data access
Improved documentation, reporting
Prompted to ensure administration of
treatments and medications
Supported automation of critical pathways /
workflows
Improved efficiency: eligibility, early
warning of status changes

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Healthcare Enterprise Benefits

Better record security
Fewer lost records
Instant notice of eligibility/procedure
authorization
Decreased need and cost for record storage,
x-ray film, filing
Decreased length of stay due to waiting
Faster turnaround for accounts
Increased compliance with regulatory
requirements
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Patient Benefits . . .
Decreased wait time for treatment
Increased access/control over health
information
Increased use of best practices/decision
support
Increased ability to ask informed questions
Quicker turnaround time for ordered
treatments

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. . . Patient Benefits
Greater clarity to discharge instruction
Increased responsibility for own care
Alerts and reminders for appointments and
scheduled tests
Increased satisfaction and understanding of
choices
Issue: When a patient could access his/her
own health information like in other online
services ? (Pros, Cons)
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Driving Forces for EHR

Compliance with regulatory and
reimbursement issues
Meaning Use to improve the quality of
care

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Issues in EHR Implementation

Electronic Infrastructure
Common Vocabulary
Data Integrity
Master File Maintenance
Data Ownership
Privacy & Confidentiality
Development / Maintenance Costs
Caregiver Resistance
Timeline for Implementation
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* Electronic Infrastructure *
Requires a linkage of various HIS via a
network infrastructure
Agreement on nature and format of client
data to be stored, exchanged, and retrieved
by various internal/external stakeholders
Data communication standards
Interoperability, comparability, POC data
capture of longitudinal electronic record
Master Patient Index (MPI): a universal
client identifier.
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* Standard Vocabulary *
To generalize research findings across
settings, countries
To compare patient outcomes from may
sources
To facilitate communication with other
disciplines and delivery systems

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* Data Integrity *
Due to incorrect entry, data tampering,
system failure
Data may be entered/modified from may
different encounters
Input mask to safeguard against
incomplete / erroneous entry
Audit trail: tracking who, when, what
changes in each data element
Policies and procedures for update/ modify/
recover data
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* Master File Maintenance *

Frequent update and maintenance
Major system updates may change database
structure : version control to avoid data lost
Version control: backup data from old
system until new system functions properly

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* Data Ownership *
Paper medical records are the property of the
creators with full responsibilities: storage,
accuracy
Many providers share / update the same
electronic data in many sites, who is the
responsible owner in HER ?
Meaning Use: patients own their data and
should have full access

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* Privacy & Confidentiality *

The easy of data sharing by many
people/facilities/agencies may compromise
privacy and confidentiality of patient data
Access control: user-IDs, passwords,
authorized access level (Create, Read, Update,
Delete)
Private encryption keys, biometric authentication
Electronic Signature: system automatically and
permanently affixes user identification, date and
time log to each entry

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* Development/Maintenance Costs *

For a provider office: ~ $54,000.00

For a hospital: ~ 5,000.000.00
Not include annual maintenance cost
Need incentives

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* Caregiver Resistance *
EHRs are perceived as lacking essential
features and awkward/inconvenience to use
Some people have been unable / unwilling to
use computers !
Professionals dont want to change their
familiar, traditional practices
Rather pay penalties than bear EHR
implementing cost
May even refuse patients
Need incentives
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* Timeline for Implementation *

Rushing to meet the deadline may commit to
a poor purchasing decision
May sacrifice patient safety
Should prepare for culture changes, work
redesign in the institution

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Current Status
Bush called for adoption of the EHR by
2014.
Departments of Defense, Health and
Human Services, Veterans Administration,
and Centers for Medicare and Medicaid
Services mandated the EHR for their
facilities and operations.

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Summary
Most of the potential benefits associated
with the use of health information
technology are contingent upon the
implementation of the EHR.

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