EMRs, EHRs, PHRs, questions and answers Emily Barey, RN, MSN Director of Nursing Informatics Epic systems, Verona, wisconsin

Welcome Emily Barey RN, MSN Director of Nursing Informatics, Epic Verona, Wisconsin Role of the industry vendor

What is an EMR? EHR? PHR? Electronic Medical Record is the digital version of the paper chart, located at the clinic or hospital where you receive care Electronic Health Record is a broader data set written by the entire care team; designed to follow the patient across different care settings Personal Health Record is like an EHR but entirely entered and managed by the patient It’s about location, location, location It is also about who is authoring and who is managing the record. Whose responsibility is it to update EMRs? Does the patient have to do it, or is it done for them? [Similar: What if the EMR is incomplete, and you want more descriptive data in it? How is this accomplished, by the patient or a professional? What is EMR as distinct from PHR? http://www.healthit.gov/providers-professionals/faqs/what-are-differences-between-electronic-medical-records-electronic

What is in an electronic record? Before EHR Past History & Problems Medications you take Allergies you have Clinical notes Vital signs Scanned documents Results and Images After EHR

Can I see my record? Patient Portal vs. PHR What is shared? Shared record with your doctor via a portal Personal health record that you enter all the data What is shared? Determined by organization and capability of software vendor Proxy access Consent to see your child’s record or elderly parent, spouse Content variations in EMRs: Mayo Clinic patients can see visit notes in their “EMR” (actually PHR) from home. Some discussion of how this varies depending on vendor and clinic (consumers did not understand why other people in the room didn’t have the same access to the same content they did…)

A clinician point of view Why use an EHR? A clinician point of view A patient point of view Accessibility Legibility Alerts & Reminders Avoid duplication and decrease cost Follow patient preferences Research More! A shared record with you Better care Convenience Continuity of care But sometimes they still ask me the same questions, why? The software system The policy of the healthcare organization Learning a new paradigm to verify and update How far back does EMR data go? Concerns about losing the EMR: Before adopting EMR, concerns about having access to older data—one system decided to keep both print copies and electronic copies. How much do EMRs impact the amount of work a doctor has to do?

Who Uses an EHR? Nursing Home Hospital Your Home Doctor’s Office Do ALL of your medical records get digitized and are available for viewing online, or just those from a certain medical center? Your Home Doctor’s Office Surgery Center

Why doesn’t it ALWAYS work? How does my record move electronically? Interoperability Why doesn’t it ALWAYS work? How does my record move electronically? Computers can talk to each other Often they need an interpreter Government standards determine the “language” the EHR computers must send messages to each other in Basic data set today, growing all the time what can be shared Some EHR systems can’t send messages yet in the standard language Role of EHR Certification Government program called Meaningful Use requires use of an EHR that can send standard messages Are the experts going to work on some sort of universal basic transfer so that someday records really can be digitally shared with little hassle to either office or patient? How are EMRs regulated?

Lack of Interoperability What if my doctor or hospital doesn’t use an EHR? Copy & Fax Machines US Postal System You carry your record It isn’t available Are the experts going to work on some sort of universal basic transfer so that someday records really can be digitally shared with little hassle to either office or patient?

Is my record safe? HIPAA & HITECH Health Insurance Portability & Accountability Act Health Information Technology for Economic & Clinical Health Act Sharing the record to coordinate care Audit trails of access How malleable are EMRs? Can the patient change them? Who else can view and change them? Where does authority control come in? How secure is patient information stored in an EMR? [Similar: Are there privacy issues? How do systems protect against identity theft? How do I know my medical data is safe? General: HIPAA confusion v. medical privacy 1. http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html 2. http://www.healthit.gov/patients-families/protecting-your-privacy-security

Questions To ask your Provider Can you sign up for access to your shared medical record? Can your provider share your record electronically with other providers if necessary?