Healthcare Information Management Barry Smith 1

Goals of Electronic Health Records from the clinician’s perspective Remembering what you did and why Conveying that information to colleagues Justifying billing Legal defense Data for research Clinical decision support 2

Goals of Electronic Health Records from a wider community perspective Primary uses: billing, billing, billing... Secondary uses –continuity of care (avoiding siloing of data) –evidence-based medicine –diagnostic decision support –support for clinical trials –virtual clinical research –personalized medicine –(Obamacare) save money 3

What an EHR requires Effective user interfaces Trained personnel Safety (EHR should help to make your hospital safer; it should not kill your patient) Data security Controlled vocabulary, and coherent taxonomy (… ontology …) 4

Where does an EHR fit ? Basic: Identity Patient record Clinician workflow Comprehensive: Notifications Security / access control With thanks to Tom Beale / openEHR.org 5

© Ocean Informatics 2005

EHRs – some alternatives Epic, Allscripts, Eclipsys, Cerner... VA OpenEHR / CEN −EHRs for hospitals −EHRs for small practices (including dentists, ophthalmologists, …) 7

Epic, Allscripts, Eclipsys... (Examples of commercial products) PRO: Get the job done CON: Expensive Allow only limited secondary uses –continuity of care X –safety ? –evidence-based medicine ? –diagnostic decision support ? –clinical trials X 8

with thanks to 9 the problem of continuity of care: patients move around

10 f f f f f synchronic and diachronic problems of semantic interoperability (across space and across time) f

The Data Model That Nearly Killed Me by Joe Bugajski “If data cannot be made reliably available across silos in a single EHR, then this data cannot be made reliably available to a huge, heterogeneous collection of networked systems.” 11

EPIC, etc. will provide a way to capture and represent some of what is needed in a form that is usable by computers (somewhat) by you yourself but not by other clinics, hospitals and researchers... 12

13 f f How to link EHR data?f f f how can we link EHR 1 to EHR 2 in a reliable, trustworthy, useful way, which both systems can understand ? f EHR 1 EHR 2