Comp6 Unit3a Lecture Slides

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.
Learning Objectives
2
1. State the similarities and differences between an electronic medical
record (EMR) and electronic health record (EHR) (Lecture a)
2. Identify attributes and functions of an EHR (Lecture a)
3. 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)
4. Explain how the use of an EHR can affect patient care safety,
efficiency of care practices, and patient outcomes (Lecture a)
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Health Management Information Systems
Lecture a
Learning Objectives
3
4. 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)
5. Outline issues regarding governmental regulation of EHR systems,
such as meaningful use of interoperable health information
technology and a qualified R (Lecture b)
6. Summarize how the Institute of Medicines Vision for 21st Century
Health Care and Wellness may impact health management
information systems (Lecture b)
7. Identify how ongoing developments in biomedical informatics can
affect future uses and challenges related to health information
systems (Lecture b)

Lecture a
Purpose of a Patient (Medical) Record
4
Lecture a
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
Electronic Medical Record (EMR)
Electronic record of health-related
information on an individual
Within one health care organization
5
Lecture a
EMR Purpose
Provide an electronic equivalent of an
individuals legal medical record
Intra-organizational

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

7
Lecture a
EHR Purpose
Provide an electronic equivalent of an
individuals 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
Lecture a
EMR Versus EHR
EMR EHR
A record of medical care created,
managed, and maintained by one
health care organization (intra-
organizational)
A repository of individual health
records that reside in numerous
information systems and locations
(inter-organizational)
Integration of health care data from a
participating collection of systems from
one health care organization
Aggregation of health-related
information into one record focused
around a persons health history, i.e.,
a comprehensive, longitudinal record
Consulted by authorized clinicians and
staff within one health care
organization.
Consulted by authorized clinicians and
staff across more than one health care
organization
Data continuity throughout one health
care organization
Data interoperability across different
organizations
Table 3.1
EMR and EHR Comparison

9
Lecture a
EHRs Versus Paper Records
EHRs can make a patients health information
available when and where it is needed
EHRs can bring a patients 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
Lecture a
EHRs
Can link information with patient computers to
point to additional resources
Dont just contain or transmit information,
they also compute with it
Can improve safety

11
Lecture a
EHRs can
Deliver more information in more directions
While reducing paperwork time for providers
Improve privacy and security
Reduce costs
12
Lecture a
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
Lecture a
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
Lecture a
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
Lecture a
HL7 EHR Functions
Direct care functions
Supportive functions
Information infrastructure functions
16
Lecture a
Direct Care Functions
Subset Examples
Care management Identify and maintain a patient record
Manage patient demographics
Manage problem lists
Clinical decision support Support for standard care plans,
guidelines, protocols
Support for medication and
immunization administration
Orders, referrals, results and care
management
Operations Management and
Communication
Clinical workflow tasking
Support clinical communication
Support for provider-pharmacy
communication
Table 3.2
HL7 2007 EHR-S Functional Model Direct Care Functions Subsets with Examples

17
Lecture a
Supportive Functions
Clinical Support
Measurement, Analysis, Research and
Reports
Administrative and Financial
18
Lecture a
Information Infrastructure
Functions
Security
Health record information and management
Registry and directory services
Standard terminologies and terminology services
Standards-based interoperability
Business rules management and Workflow management
19
Lecture a
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
Lecture a
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
21
Lecture a
EHR Acceptance
Public
Harris Interactive Survey from 2005
Mixed Feelings
45% EHR system important
Concern over
Privacy
Increase rather than decrease of medical errors

22
Lecture a
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
Lecture a
Barriers to Adoption
Cost of conversion
Perceived lack of ROI
Technical and logistical challenges
Privacy and security concerns
24
Lecture a
EHR Effect on Patient Care Safety
Reduces the need to repeat tests
Reduces the number of lost reports
Supports provider decision making

25
Lecture a
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
26
Lecture a
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
27
Lecture a
Summary Lecture a
28
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
Lecture a
References Lecture a
29
Lecture a
References
AHIMA e-HIM Work Group on Maintaining the Legal EHR. (2005). Update: Maintaining a legally sound health
recordpaper 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

References Lecture a
30
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=&checkKe
y=&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

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