1. Visioning and Strategic Planning
Health Information Technology Toolkit for Physician Offices

2. 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

3. 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

4. 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

5. 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.

6. 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

7. 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)

8. 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

9. 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 © , Margret\A Consulting, LLC. Used with permission of author. 9

10. 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 © , Margret\A Consulting, LLC. Used with permission of author.

11. 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, , 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.

12. 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.

13. 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

14. 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 © , Margret\A Consulting, LLC

15. For More Support Contact: Stratis Health 2901 Metro Dr., Suite 400
Bloomington, MN 55425
(toll free)