Visioning and Strategic Planning Health Information Technology Toolkit for Physician Offices

Presenter Margret Amatayakul RHIA, CHPS, CPHIT, CPEHR, FHIMSS President, Margret\A Consulting, LLC Schaumburg, IL Independent consultant, who focuses on achieving value from electronic health records, HIPAA/HITECH, and health information exchange. Developer of tools in Toolkit Adjunct faculty College of St. Scholastica, Duluth, MN, masters program in health informatics Founder and former executive director Computer-based Patient Record Institute, associate executive director AHIMA, associate professor University of Illinois Active participant in standards development, former HIMSS BOD, and co-founder of and faculty for Health IT Certification 2 2

Stratis Health Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities Stratis Health works toward its mission through initiatives funded by federal and state government contracts, and community and foundation grants, including serving as Minnesota’s Medicare Quality Improvement Organization (QIO) Stratis Health operates the Health Information Technology Services Center for health care organizations seeking to use health information technology in support of their clinical transformation

Agenda Envision . . . HIT vs. EHR vs. EMR Purposes of EHR Conceptual model of technical concepts Reality in ambulatory care and acute care Progress toward the vision

HIT vs. EHR Health information technology (HIT): a general concept that describes the technology that supports management of health information for many purposes Electronic health record (EHR): is a specific set of applications that provide an “electronic record of health-related information on an individual including patient demographic and clinical health information, such as medical history and problem lists, and has capacity to provide clinical decision support, support physician order entry, capture and query information relevant to health care quality, and exchange electronic health information with and integrate such information from other sources” (Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009) Software that directs computer devices People to support and use systems Policy that drives adoption of systems Process that helps achieve results Hardware that enables system use Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

EHR Encompasses broader view of a health record  moving from notion of a location for keeping track of patient care events to a resource with enhanced utility Merely automating the form, content, and procedures of current patient records will perpetuate their deficiencies and will be insufficient to meet emerging user needs Institute of Medicine: Computer-based Patient Record: An Essential Technology for Health Care, 1991, 1997 Longitudinal collection of electronic health information for and about persons; immediate electronic access to person- and population-level information by authorized, and only authorized, users; provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care; and support of efficient processes for health care delivery Key Capabilities of an Electronic Health Record System, 2003

EHR vs. EMR Electronic medical record (EMR) sometimes refers to: Physician office EHR Hospital document imaging system Non-interoperable record of health-related information EHR is term used by: Federal government, including in HITECH Institute of Medicine (IOM) Health Level Seven (HL7) Primary organization to develop interoperability in health care information systems; adopts the term EHR system Certification Commission for Healthcare Information Technology (CCHIT)

Purposes of EHR Improve quality of care: data availability, links to knowledge sources Enhance patient safety: context-sensitive reminders/alerts, clinical decision support, automated surveillance, disease management, drug/device recall Support health maintenance: preventive care and wellness - patient reminders, summaries, tailored instructions, remote evaluation, home monitoring Increase productivity: data capture and reporting formats tailored to user, streamlined workflow support, patient-specific care plans and protocols Reduce hassle factors: improve satisfaction for clinicians, consumers, and caregivers - managing schedules, registration, referrals, medication refills, work queues, automatically generating administrative data Support revenue enhancement: accurate and timely eligibility and benefits, cost-efficacy analysis, clinical trial recruitment, rules-driven coding support, accountability reporting/outcomes measures, contract management Support predictive modeling: contribute to development of evidence-based health care guidance Maintain patient confidentiality: as health information is securely exchanged among all stakeholders, including across the continuum of care and with individuals

Reality in Ambulatory Care PACS Images LIS Charges PMS Operations eRx Relational Database (or CDR) External CDW e.g., D.M. or Iz. Registry Hospital Demographics Scheduling Dictation Transcription CPOE Fax Portal CDS – POC - CPOE Scanning CCR/ CCD Processor Storage PHR Human-computer interface Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of author. 9

e.g., CMS Hospital Compare Reality in Hospitals LIS Rx RIS Other systems Other systems Operations R-ADT/ HIS PFS Charges Interface Engine MD Portal EDMS Remote Monitoring EMAR (RN) POC CPOE CDS CDW e.g., CMS Hospital Compare Storage CDR Processor Human- computer interface Human- computer interface Copyright © 2007-8, Margret\A Consulting, LLC. Used with permission of author.

Glossary of Terms HIT Toolkit CCR/CCD Continuity of care record/document – standard data content/transmission to send for referrals CDR Clinical data repository – database optimized for processing patient transactions, e.g., posting vital signs CDSS Clinical decision support system – software that processes discrete data according to logical rules to provide reminders and alerts CDW Clinical data warehouse – database optimized for translational data analysis, e.g., data mining CPOE Computerized provider order entry – system that provides CDS at the point of order entry Discrete (or structured) data = individual values of data that are entered via templates and which are computable; e.g., patient blood pressure; lab result; name of medication; in contrast to unstructured scanned images, narrative notes, dictation EDMS Electronic document management system – document imaging, email, efax, and other digital document (e.g., dictation) storage and retrieval E-MAR/BC-MAR Electronic medication administration record (forms)/bar-code MAR for positive patient identification eRx Electronic prescribing system – supports drug selection & transmits prescription to retail pharmacy Human computer interface = data entry devices, such as workstations, tablets, slates, speech recognition, personal digital assistants (PDAs), and smart phones LIS Laboratory information system that manages operations of a clinical laboratory O/E Order entry system used by nursing staff to transcribe handwritten orders PACS Picture archiving and communication system – for x-rays and other clinical images POC Charting Clinical documentation at the point of care, using clinical practice guidelines/critical pathways and CDS PHR Personal health record – patient contributed data in many forms PMS/HIS/PFS Practice management system/Hospital information system/patient financial services – applications for operations, e.g., scheduling, admitting, billing, etc. RIS Radiology information system that manages operations of a radiology department Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

Data vs. Information CDR vs. CDW Unstructured information Data Warehouse Pt1 ht wt dose outcome Pt2 ht X% Outcome Structured data for Analytical Processing and Data Mining Alert H&P Patient ID Height Weight Structured data to provide clinical decision support Patient ID + Lab Test Height Weight Drug & Dose Data Repository DKB + Result Labs Patient ID Test Result Orders Patient ID Drug Dose ? Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author.

Reality of Today/ Vision for Tomorrow An EHR is a system that Collects data from multiple sources For use in clinical decision making At the point of care This definition is elusive for many organizations today This definition is primarily focused on care delivery. Little demand from providers/supply of product to date for: Various reporting functions – for quality, P4P, population health Health information exchange functionality Personal health record (PHR) support Copyright © 2009, Margret\A Consulting, LLC. Used with permission of author. 13

Implementation vs. Adoption Implementation – software and hardware installation, system build, testing, training, go-live Adoption – users using system to achieve benefits “EHR Half Life” Half of all who ponder do something about EHR Half of all who sign a contract implement EHR Half of all who implement EHR Implement all components Achieve full use Use all functionality Goal of HIT Toolkit is to help you achieve full adoption Copyright © 2007-8, Margret\A Consulting, LLC

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