1. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Chapter 1 The Electronic Health Record

2. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 1.1 Overview of the Electronic Health Record 1.2 History of the Electronic Health Record 1.3 EHR Terminology 1.4 Government Involvement in the EHR 1.5 Healthcare Processes and the EHR 1.6 Barriers and Benefits to the EHR 1.7 The Future of the Electronic Health Record Chapter 1 Learning Outcomes

3. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Ambulatory American Recovery and Reinvestment Act (ARRA) Best Practice Guidelines Centers for Medicare and Medicaid Services (CMS) Electronic Health Record (EHR) Electronic Medical Record (EMR) E-prescribing Health Information Exchange (HIE) Health Information Technology (HIT) Health Information Technology for Economic and Clinical Health (HITECH) Act Inpatient Interoperability Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) Medicare Part A Medicare Part B Office of the National Coordinator for Health Information Technology (ONC) Outpatient Patient Portal Personal Digital Assistant (PDA) Personal Health Record (PHR) Point of Care Practice Management System (PMS) Return on Investment (ROI) Chapter 1 Key Terms

4. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.1 Overview of the Electronic Health Record

5. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. An EHR system is a computerized, organized collection of individual patients’ healthcare information in a digital format Functions – Store – Share – Transmit electronic data What is an electronic health record (EHR)? LO 1.1

6. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. EHR programs collect health information for individual patients in inpatient and outpatient settings – Saves in a digital format – Collects information that is typical of what you would see in paper records – Interfaces with external healthcare computer programs – Transmits labs, orders, prescriptions, and results electronically – Produces comprehensive reports on diagnoses and diseases for governmental reporting The Concept LO 1.1

7. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Example of EHR in SpringCharts LO 1.1

8. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. EHR Models LO 1.1

9. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.2 History of the Electronic Health Record

10. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Purpose: – To improve patient medical care by having information accessible for informed medical decision making Started: – 1960s First Facilities to use EHR Systems: – Mayo Clinic in Rochester, Minnesota – University Hospital in Burlington, Vermont – Latter Day Saints Hospital in Salt Lake City, Utah History of EHR LO 1.2

11. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Improved Functionality: – 1960-1980s Enter Independent Medical Offices: – 1990s – Called practice management systems – Designed for fiscal management Vendors Proliferate: – 2000s Governmental Mandates and Funding: – Current – Causing acceleration of EHRs History of EHR, cont. LO 1.2

12. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.3 EHR Terminology

13. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. EHR Terminology LO 1.3

14. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.4 Government Involvement in the EHR

15. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. 1991 – IOM called for eliminating paper records by 2001 2004 – Bush created the ONC position and empowered HHS to promote EHRs 2008 – Obama promised to sponsor adoption of EHRs through stimulus package 2008 – Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) 2009 – Health Information Technology for Economic and Clinical Health (HITECH) Act provided $19.2 billion to accelerate use of EHRs over 5 years (part of ARRA – American Recovery and Reinvestment Act of 2009) Dates to Remember LO 1.4

16. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Bonus from CMS – Participants meeting certain requirements were eligible for this bonus Beacon Community Program – 17 communities were chosen across the US to receive grants in exchange for documenting best practices and working to establish national goals Regional Extension Centers – Provide training and support services to assist primary healthcare providers in adopting EHRs – Offer information and guidance to help with EHR implementation and achieving meaningful use to qualify for incentive payments – Give technical assistance as needed HITECH Act LO 1.4

17. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.5 Healthcare Processes and the EHR

18. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Paper – chart must be located, pulled, handled, and refiled EHR – multiple providers can access at same time Review comparison of workflow in paper vs. EHR in Table 1.2 Accessibility LO 1.5

19. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.6 Barriers and Benefits of the EHR

20. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Lack of standards Unknown costs and return on investment Difficulties operating EHR systems Significant changes in clinical/clerical processes Lack of trust and safety Barriers to the EHR LO 1.6

21. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Enhanced accessibility to clinical information Improved patient safety Enhanced quality of patient care Greater efficiency and savings Benefits of the EHR LO 1.6

22. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.7 The Future of the Electronic Health Record

23. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. EHR is here to stay Federal government continues to encourage development of National Electronic Healthcare Infrastructure National Health Information Network (NHIN) – part of the federal government’s goal to digitize patients’ health records and designed on a common platform for health information exchange (HIE) PDAs provide instant access to information at point-of-care Future of EHR LO 1.7

24. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.1 Define the concept of an electronic health record (EHR) EHR – Collection of health information of patients that is stored in a digital format EHRs can interface with external computer programs There are three distinct models of EHR programs – Distribution-based, Facility-based, and Web-based Chapter 1 Summary

25. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.2 Explain key events in the history of EHRs Initial creation – 1960s Improved functionality – 1970-1980 Practice management systems – 1990s Government mandates – 2010 Chapter 1 Summary

26. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.3 Distinguish between the terms commonly used to refer to EHRs CPR—Computer-Based Patient Record EMR—Electronic Medical Record EHR—Electronic Health Record CCD/CCR—Continuity of Care Document/ Continuity of Care Record PHR—Personal Health Record Chapter 1 Summary

27. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.4 Describe the government’s involvement in EHRs 2004 – Bush created the ONC position 2008 – Medicare Improvements for Patients and Providers Act (MIPPA) 2009 – Health Information Technology for Economic and Clinical Health (HITECH) Act 2009 – Obama introduces economic recovery plan 2010– Beacon Community Cooperative Agreement 2010– Health Information Technology Extension Program Chapter 1 Summary

28. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.5 Differentiate between medical office processes that use a paper chart and an EHR Processes that change with the implementation of an EHR : Scheduling an appointment Documenting the physical examination Distributing patient education material Recording vital signs and the chief complaint Checking out the patient Reviewing the patient’s healthcare info Entering billing data Checking the status of wellness screenings Sending healthcare records to other Reviewing the clinician’s notes physicians Readying the patient for physician exam Processing lab and medical tests results Preparing charts / verifying insurance coverage Ordering in-house tests Processing prescriptions Checking in the patient Completing the physician’s note Verifying the patient’s identification Ordering outside tests Collecting patient healthcare information Completing the superbill Signing official forms Chapter 1 Summary

29. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. Benefits Enhanced accessibility to clinical information Improved patient safety Enhanced quality of patient care Greater efficiency and savings Barriers Lack of standards Unknown cost and return on investment Difficulties operating EHR systems Significant changes in clinic/clerical processes Lack of trust and safety Chapter 1 Summary LO 1.6 Summarize the major barriers and benefits of using an EHR

30. © 2013 The McGraw-Hill Companies, Inc. All rights reserved. LO 1.7 Describe potential developments in the future of the EHR National Health Information Network (NHIN) will provide a common platform Funding for EHR programs available through the Challenge Grants program The PDA, wireless networks, and high-speed Internet access will increase speed of access to information Clinical data will no longer reside exclusively in a physician’s office, but will be available wherever the Internet is available to form the computer-based patient record (CPR) Chapter 1 Summary