Chapter 6 – Data Handling and EPR

Electronic Health Record Systems: Government Initiatives and Public/Private Partnerships EHR is systematic collection of electronic health information about individual patients or populations which may include demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information.demographicsimmunization EHR - s EHR

EHR/EMR/CPR

Benefits of EHR Improved data integrity - information is more readable, better organized and more accurate and complete Increased productivity - easy access to information whenever it is needed Improved quality of care - supports clinical decision making processes for physician and nurses Increased satisfaction for care givers - easy access to client data as well as other services, including drug information access, rules-based decision support, and literature searches

Electronic Health Record Systems EHR-s, by including the word system, it is made up of one or more applications compared to EHR which is physical or repository of data It includes people, data, rules and procedures, processing and storage devices (e.g. paper, pen, hardware, software), and communication and support facilities. EHR is just a part of EHR-s which is broader in scope Set of components that form the mechanism by which patient records are created, used, stored and retrieved.

EHR-s includes the following: Longitudinal collection of electronic health information Immediate electronic access to person, and population –level information and only authorized users Provision of knowledge and decision support that enhances the quality, safety, and efficiency of patient care; and Support of efficient processes for health care delivery

EHR-s framework

Government Initiatives towards EHR-s US Government as early provider of EHR-s 1. Department of Veterans Affairs (VA) 2. Department of Defense (DoD) They are two examples of the initiation of systems in the 1970s that were actively used by clinicians VA supports EHR-s and all the components of EHR. All electronic records are password protected to guarantee patient privacy

Other features of EHR-s A checking system that alerts clinician if an order they are entering could cause a problem A notification system that immediately alerts clinician to clinically significant events A visual posting system that alerts health care providers to issues including crisis notes, adverse reactions and advance directives A template to automatically create reports A clinical reminder system that alerts on examinations, immunizations, patient education and laboratory tests, need to be performed. Remote data viewing to allow clinicians to patient’s medical history at all facilities

Government agencies promote EHR-s Decrease the cost of EHR-s utilization and provide incentives for their use Activities are focused on the development and adoption of terminologies and standards, grants for community demonstrations of data exchange and other pilot projects Pursue the development of a public-private national health information network to facilitate EHR-s utilization

Agency for Health Care Research and Quality (AHRQ) Awards $2 million dollars in 2004 to selected hospitals towards the enhancement of IHS EHR. AHRQ contracted over $18 million dollars for a health information technology resource center to provide technical assistance, serve as a repository for best practices and disseminate tools to explore the adoption and use of HIT to improve patient safety and quality care.

Public –Private Partnerships A number of collaborative efforts are focused on the use of EHR-s and HIT to improve care Among these private sector organizations are those formed specifically to address issues of connectivity, HIT, and standards development

Private Organizations Markle and Robert Wood Johnson Foundations, Connecting for Health - organized several several working groups focusing in on understanding business and organizational issues of community-based information exchange eHealth initiative - independent, non profit affiliated organizations established to foster improvement in the quality, safety and efficiency of health care through information and IT.

Institute of Medicine (IOM) - Identified key functions of EHR in four setting: hospitals, ambulatory care, nursing homes and care in the community The Health Information Management Systems (HIMSS), American Health Information Management Association (AHIMA) and National Alliance for Health Information Technology (NAHIT) established the Certification Commission for Health Information Technology (CCHIT) to reduce risk of EHR investment CHIT Certified program is an independently developed certification that includes a rigorous inspection of an EHR’s integrated functionality, interoperability and security using criteria developed by CCHIT’s broadly representative, expert work groups.

Health Level Seven (HL7) global authority on standards for interoperability of health information technology with members in over 55 countries not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.