WEEK 2 SEMINAR
HI300 – Unit 2
Adapted from AHIMA Press
AGENDA
Week 1 Review
Announcements and Reminders
Week 2 Topics Overview
Week 2 Assignments
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Read the Unit 2 Reading Resources
Participate on the Discussion Board
Attend Seminar
Complete the Unit 2 Assignment
Unit 2- What Should You Be Doing?
Before Electronic Health Records…..
http ://www.youtube.com/watch?v=dTs0CwQcU14&list=PL397565867520650B
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Introduction
American Recovery and Reinvestment Act of 2009’s definition of “qualified EHR”:
A qualified EHR “includes 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 health information with and integrate such information from other sources.”
What’s The Difference?
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EHR VS. EMR
Electronic Health Record (EHR)
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization.
Electronic Medical Record (EMR)
An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization.
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EHR Systems
Begins with acquiring source systems. Source systems supply the EHR and other applications with data.
Examples of Source Systems:
Administrative and Financial Systems
Registration, admission, discharge and transfer (R-ADT)
Patient financial systems (PFS)
Many of these transactions mandated HIPAA, Affordable Care Act
Ancillary or Departmental Systems
Laboratory Information Systems
Radiology Information Systems
Pharmacy Information Systems
Core EHR Applications
5 components to consider with EHR
Results management: enables diagnostic study of results to be reviewed as a report and processed. Allows users to compare, trend and graph results. Lab results most common.
Clinical documentation: Point of care charting. Use of templates to gather patient information.
Closed-loop medication management: ensures patient safety from beginning to end (ordering drug —- administering drug). E-prescribing, medication reconciliation, Medication 5 Rights
Clinical decision support : helps physicians, nurses and other clinical staff make decisions about patient care
Analytical Reporting : Processing data to reveal new information. EHR can provide more robust functions to analyze data
Evolution of EHR
In 1980s, the Institute of Medicine recommended new technologies were needed to improve state of medical records.
Quality of care and patient safety focal points!
Many hospitals started early!
Physicians wanted electronic access from their offices to the hospital’s labs to view test results.
Frustration grew with the hybrid record. Document imaging came into play.
Then came…. Electronic signatures, digital dictation
Hospital EHR implementation more complex than physician offices.
Transition State
EHR’s are still being implemented
Many offices have a hybrid record
Many organizations still print everything
Some organizations scan all paper documents
Health Information Technology For Economic And Clinical Health (HITECH)
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Health Information Technology For Economic And Clinical Health (HITECH)
Government Initiative – Made ONC (Office of the National Coordinator) permanent
2004 – ONC promoted adoption of EHR through supporting regulatory exceptions to anti-kickback laws so that hospitals could make limited donations of EHRs to physicians. Instead, vendor products went through a certification process and were evaluated against a set of non-biased standards.
ONC has a YouTube Channel with lots of great information! https://www.youtube.com/user/HHSONC
Health Information Technology For Economic And Clinical Health (HITECH)
Meaningful Use (MU incentive program)
Ability to demonstrate quality improvement through use of EHR.
Promotes health information exchange.
After 2014 sanctions for those who have not adopted an EHR.
Downward adjustment to Medicare reimbursements.
Doesn’t require a complete EHR to be considered MU.
Local Efforts And Challenges
EHR vendors
May not be able to keep up with demand
Meeting HL7 EHR system functional requirements
Interoperability
Meaningful use
ICD-10-CM
Healthcare Professionals
Many physicians may not be interested in EHR
Mobile devices may be first step toward implementing technology
Another early step is e-prescribing
Nursing and allied health professionals seek organizations with EHR
Patients
Until now, patients have had little interaction with EHR
Patient may be concerned about privacy and security
Many organizations are educating patients on the EHR and allowing them to:
Schedule appointments
Pay bills
Educational material
Informed consents
Enter health history
E-visit
Data Exchange Standards
Health Level Seven (HL7)
https ://www.youtube.com/watch?v=qewOJPxz4-c
Data Exchange Standards
Different databases may be located in different systems but need to exchange data.
Data exchange should ensure vocabulary standards and data comparability .
Health Level Seven (HL7)
Family of standards that aid exchange of data
Digital Imaging and Communications in Medicine (DICOM)
Helps exchange x-rays, CT scans
National Council for Prescription Drug Programs (NCPDP)
Physician practice electronic prescribing system to retail pharmacy
Data Compatibility Standards
Ensuring meaning of term is consistent across users
Semantics
Semantic interoperability
Standard vocabulary
Controlled vocabulary
Data Capture Technology
Technologies that make data capture easier
Discrete data entry through point-and-click fields, drop down menus, structured templates, or macros
Speech and handwriting recognition
Handheld and wireless devices
Direct data capture from a medical device attached to a patient
Patient data entry
Natural language processing
Acquisition Of EHR Systems
Requires extensive planning and organization
Readiness assessment
Determine barriers
Lack of appreciation for EHR
Costs
EHR IMPLEMENTATION ISSUES
May need staff trained in health informatics
Very time consuming
Adoption
Training
Executive support
Patient’s concern for privacy and security
Legal and regulatory matters
E-prescribing
PLANNING
Planning includes:
Organizing the project
Developing a migration path
Communicating to stakeholders
Developing a strategy and plan to manage change
EHR steering committee
Staff required
IT staff
Support staff
Project manager
Migration path
EHR SELECTION
Best of fit
Dual core
Best of breed
Rip-and-replace
INFORMATION MANAGEMENT IN AN ELECTRONIC ENVIRONMENT
New roles for HIM professionals
Data analysts
Information brokers
Data set developers
Data miners
Workflow analysts
Data security managers
Database administrators
DATA QUALITY
AHIMA Data Quality Model
EHR increases potential for poor data quality
Copy and paste
Macros
Standard orders
Others techniques that “reuse” data
Potential for discrepancies between comment fields and structured data
DATA QUALITY
Determining if entries are made by authorized individuals
Sharing passwords
Handling amendments, corrections, and deletions
RETENTION
States generally allow destruction after 7 to 10 years from time records was created and last used
Exception is records of minors
Electronic records consume little space
Electronic media is durable but concerns regarding readability of old media
ADMISSIBILITY
Printed electronic record may not look like traditional record
Electronic records will have to be printed or EHR retrieved in court
FUTURE DIRECTIONS IN INFORMATION TECHNOLOGY
Every 18 months some form of technology is replaced with new technology.
Will create challenges for HIM professionals
Examples of changes
Internet and web-based technologies
Natural language processing
DISCUSSION BOARD TIPS
Search the Web for information on the issue of usability and making the EHR more user friendly.
Compose a response discussing:
Some of the key issues clinicians have using today’s EHRs
The proposed means to overcome these issues?
Define meaningful use and how it relates to today’s EHR.
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ASSIGNMENT TIPS CON’T
What are the physicians trying to accomplish through buying the same EHR product at their hospital? What are the pros and cons?
Why are the physicians not able to send a medication order to the hospital from their e-prescribing device?
What is the difference between scanning, COLD feeding, and point-of-care (POC) data entry?
How could the hospital improve upon its data quality?
Consider the real world case study and what the physicians are trying to accomplish by purchasing these products. When you think about the system development life cycle, use what you learned in Unit 1 to determine how this could help in accomplishing the goals associated with this case study. Discuss each phase of the systems development life cycle and how it would impact this case.
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UNIT ASSIGNMENTS
Participate in Discussion Board
Issues with usability in EHR
Complete Assignment
Read Case Study, Page 1013-1014
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