Introduction_to_Healthcare_Informatics_Second_EditionChapter_3The

Introduction to Healthcare Informatics, Second Edition

Chapter 3:

The Electronic Health Record

Objectives

Review the evolution in the development of the electronic health record

Articulate the issues surrounding the deployment and implementation of the electronic health record

Compare the differences in electronic health record systems

Describe HITECH funding

Compare the advantages and disadvantages of the electronic health record

Consider the current status and documented outcomes of EHR utilization

Introduction

Electronic health record (EHR)

Paper medical record

Episode of care

Differences between paper and electronic health records

History

Health information systems

Clinical information systems

CPOE

Clinical decision making

Evidence-based medicine

E-prescribing

Health and Medicine Division (HMD)

ONC

ARRA

HITECH

Meaningful Use (MU)

Regional Extension Centers

Percent of Hospitals with EHR

Hospital EHR adoption	Percent of hospitals with an EHR
	2008	2009	2010	2011	2012	2013	2014	2015
All hospitals with a basic EHR*	9%	12%	16%	28%	44%	59%	76%	84%
All small hospitals with a basic EHR*	6%	8%	11%	22%	39%	53%	70%	81%
All rural hospitals with a basic EHR*	6%	8%	11%	22%	36%	53%	70%	80%
All critical access hospitals with a basic EHR*	4%	7%	10%	20%	35%	54%	68%	80%
All hospitals with a certified EHR	--	--	--	72%	85%	94%	97%	96%
*Basic EHR with clinician notes

Components of the EHR

Integrated applications

EHR concept overview

CEHRT

Clinical documentation

Supports meaningful use

Meaningful Use (MU) Criteria

Stage 1 Meaningful use criteria focus on:	Stage 2 Meaningful use criteria focus on:	Stage 3 Meaningful use criteria focus on:
Electronically capturing health information in a standardized format	More rigorous health information exchange (HIE)	Improving quality, safety, and efficiency, leading to improved health outcomes
Using that information to track key clinical conditions	Increased requirements for e-prescribing and incorporating lab results	Decision support for national high-priority conditions
Communicating that information for care coordination processes	Electronic transmission of patient care summaries across multiple settings	Patient access to self-management tools
Initiating the reporting of clinical quality measures and public health information	More patient-controlled data	Access to comprehensive patient data through patient-centered HIE
Using information to engage patients and their families in their care		Improving population health

Stage of Meaningful Use (MU) by 1st Year

First Year Demonstrating M U	Stage of Meaningful Use
	2015	2016	2017	2018	2019 and Future Years
2011	Modified Stage 2	Modified Stage 2	Modified Stage 2 or 3	Stage 3	Stage 3
2012	Modified Stage 2	Modified Stage 2	Modified Stage 2 or 3	Stage 3	Stage 3
2013	Modified Stage 2	Modified Stage 2	Modified Stage 2 or 3	Stage 3	Stage 3
2014	Modified Stage 2	Modified Stage 2	Modified Stage 2 or 3	Stage 3	Stage 3
2015	Modified Stage 2	Modified Stage 2	Modified Stage 2 or 3	Stage 3	Stage 3
2016	NA	Modified Stage 2	Modified Stage 2 or 3	Stage 3	Stage 3
2017	NA	NA	Modified Stage 2 or 3	Stage 3	Stage 3
2018	NA	NA	NA	Stage 3	Stage 3
2019 and Future Years	NA	NA	NA	NA	Stage 3

Primary and Secondary Uses of EHR System

Primary uses	Secondary uses
Patient care delivery	Education
Patient care management	Regulation
Patient care support processes	Research
Financial and other administrative processes	Public health policy and homeland security
Patient self-management	Policy support

Core Functionality

Health information and data

Results management

Order entry/management

Decision support

Electronic communication and connectivity

Patient support

Administrative processes and reporting

Reporting and population health

Clinical Function Examples in EHR

Health information and data

Patient demographic information

Patient problem list

Patient medication lists

Clinical notes

Minimum data set

Notes including medical history and follow-up notes

Clinical Function Examples in EHR (continued)

Results management

Viewing lab results

Viewing imaging results

Electronic images are returned

Clinical Function Examples in EHR (continued)

Order entry management

Computerized orders for prescription

Computerized orders for labs

Computerized orders for radiology

Orders sent electronically for prescriptions

Orders sent electronically for labs

Orders sent electronically for radiology

Clinical Function Examples in EHR (continued)

Decision support

Warnings of drug interactions or contraindications are returned

Out of range lab levels are highlighted

Reminders for guideline-based interventions and screenings

Access to online clinical guidelines

Clinical Function Examples in EHR (continued)

Electronic communications and connectivity

Electronic health information exchange (eHIE)

Access to shared patient histories

Continuity of Care Document (CCD)

Clinical Function Examples in EHR (continued)

Patient support

Patient portal to HER

e-mail communication with clinicians

Clinical Function Examples in EHR (continued)

Administrative processes

Scheduling/appointments

Billing

Inventory

Clinical Function Examples in EHR (continued)

Reporting and population health management

Disease reports

Disease registries

Quality measured and improvement reports

Patient safety

Immunization information exchange

Inpatient EHR

Components

Financial and administrative applications

Clinical systems

CPOE

Electronic medical administration records (EMAR)

Clinical data repositories

Clinical decision support

Document imaging

Picture archiving and communication system (PACS)

Sue Biedermann (SB) - The source at the bottom is not what is in the new version of the text. It should be Amatayakul 2013. I can't get this illustration to copy out of my copy of the chapter. Can your please change this or even just remove the citationn from the slide. Thanks.

HIMSS Adoption Model

Stage 0: Hospital has not installed all 3 key ancillary systems (laboratory, pharmacy, and radiology)

Stage 1: All 3 major ancillary clinical systems installed

Stage 2: Major ancillary systems feed data to a clinical data repository (CDR)

Stage 3: Nursing/clinical documentation implemented and integrated with CDR for at least one inpatient service

Stage 4: CPOE added to nursing and CDR environment with 2nd level of clinical decision support capabilities

Stage 5: Closed loop medication administration with bar coded unit dose medications environment fully implemented

Stage 6: Full physician documentation with structured templates and discrete data implemented for at least one inpatient care service area

Stage 7: Hospital no longer uses paper charts to delivery and manage care and has mixture of discrete data, documented images, and medical images within its EMR environment

Adoption levels through 2015

Stage	Cumulative capabilities	2015 Final (N = 5,460)
Stage 7	Complete EMR; CCD transactions to share data; data warehousing; data continuity with ED, ambulatory, OP	4.2%
Stage 6	Physician documentation (structured templates), full CDSS (variance and compliance), full R-PACS	27.1%
Stage 5	Closed loop medication administration	35.9%
Stage 4	CPOE, clinical decision support (clinical protocols)	10.1%
Stage 3	Nursing/clinical documentation (flow sheets), CDSS (error checking), PACS available outside Radiology	16.4%
Stage 2	CDR, controlled medical vocabulary, CDS, may have document imaging; HIE capable	2.6%
Stage 1	Ancillaries—Lab, Radiology, Pharmacy—All installed	1.7%
Stage 0	All three ancillaries not installed	2.1%
		100.1%

Ambulatory EHRs

Practice management systems (PMSs)

Complete versus modular

Certified EHRs

HITECH

Meaningful Use

Long Term Care EHRs

Minimum Data Set (MDS)

Electronic functionality limited

Potential processing changes

Benefits to LTC environment

Behavioral Healthcare EHR

Inpatient or ambulatory

Enterprise EHR

Patient health over time

Enterprise integration

Introduction to Healthcare Informatics, Second Edition

Chapter 2:

Ethics

Objectives

Articulate a definition of ethics

Use basic ethical terms and concepts

Explain the importance of ethical issues related to technology

Analyze ethical issues related to health informatics

Apply the AHIMA Code of Ethics to ethical scenarios

Apply the steps of the ethical decision-making process to a given scenario

Develop policies and procedures for ethics related to informatics

Defining Ethics

Ethics is a field of study that deals with moral principles, theories, and values;

In healthcare, ethics is a formal decision-making process for dealing with the competing perspectives and obligations of the people who have an interest in a common problem

Ethical decision-making is a process where everyone must contemplate others’ perspectives, even if they disagree on the issue

Values and Morals

Morals are the principles of right conduct that an individual adopts

Values are what ethics and morals are based on; the beliefs or standards on which judgment is based

Ethical Terms

Autonomy: the freedom of an individual to choose their own actions

Beneficence: doing good for others

Nonmaleficence: doing no harm to others

Justice: treating all people fairly

Legal Influence

HIPAA

HITECH

GINA

HIPAA Omnibus Rule

Ethical Standards of Practice

Code of Ethics: a statement of ethical principles regarding business practices and professional behavior

Professional obligation to follow

AHIMA Code of Ethics

Selected principles that address patient information and informatics:

I. Advocate, uphold and defend the individual’s right to privacy and the doctrine of confidentiality in the use and disclosure of information

III. Preserve, protect and secure personal health information in any form or medium and hold in the highest regards health information and other information of a confidential nature obtained in an official capacity, taking into account the applicable statutes and regulations

X. Facilitate interdisciplinary collaboration in situations supporting health information practice (AHIMA 2011)

Policies and Procedures

Operationalize laws and regulations consistent with codes of ethics

Facilitate autonomy, beneficence, and nonmaleficence

The Ethics Committee

Consultation

Policies and procedures

Educational activities

Clinical and organizational ethical situations

Potential Ethical Issues

Provisioning of care

Using health information

Protected health information

Electronic health records

Genetics

Other Potential Ethical Concerns

Electronic health records

Personal health records

Release of information

Health information exchange

Social networking

Health Literacy

The ability to obtain, process, and understand basic health information

HHS plan goals:

Develop and disseminate accurate, accessible, actionable health and safety information

Promote changes in the healthcare system that improve the health information, communication, informed decision making, and access to health services

Incorporate accurate, standards-based, and developmentally appropriate health and science information and curricula in child care and education through the university level

HHS Plan Goals (continued)

Support and expand local efforts to provide adult education, English language instruction, and culturally and linguistically appropriate health information services in the community

Build partnerships, develop guidance, and change politics

Increase basic research and the development, implementation, and evaluation of practices and interventions to improve health literacy

Increase dissemination and use of evidence-based health literacy practices and interventions

14

Ethical Decision Making

Assessing potential

Identifying

Evaluating

Deciding on a course of action

Preventing future occurrences

Example of an Ethical Decision-Making Matrix

Steps	Information
1. What is the question?
2. What is my “gut” reaction
3. What are the facts?	Known	To be gathered
4. What are the values? Stakeholders:	Patient: HIM Professional(s): Healthcare professional(s): Administrators: Society: Others as appropriate:
5. What are my options?
6. What should I do?
7. What justifies my choice?	Justified	Not justified
8. How can I prevent this problem?

Introduction to Healthcare Informatics, Second Edition

Chapter 1:

Foundations of Healthcare Informatics

Learning Objectives

Examine the evolution of the field of health informatics

Interpret the health informatics core competencies

Apply the terms related to health informatics

Compare the methods associated with health informatics

Determine the need for current policies and procedures to support electronic health records and use of data

Articulate ethical issues associated with health informatics

Contrast the major roles associated with the field of health informatics

Key Terms

Informatics

Health informatics

Health information technology

Relationship Aspects of Health Informatics

Clinical Data

Technology

Financial/

Administrative

History of Health Informatics

Meaningful use of information

Standards

PCPI

AMA

ASTM

HL7

VSAC

SNOMED CT

LOINC

HIPAA

RxNORM

NDF-RI

HUGN

5

History of Health Informatics

Resources specific to the electronic exchange of data

DICOM

RxNORM

HL7

NCPDP

ASC X12

6

Core Competencies

Increased reliance on technology

Sophisticated software and systems

Core competencies (AMIA/AHIMA)

Information literacy and skills

Health informatics skill using the EHR

Privacy and confidentiality of health information

Health information/data technical security

Basic computer literacy skills

7

CAHIIM Domain III: Informatics, Analysis and Data Use

Subdomains

Health Information Technology

Information Management Strategic Planning

Analytics and Decision Support

Health Care Statistics

Research Methods

Consumer Informatics

Health Information Exchange

Information Integrity and Data Quality

Transforming Data into Informatics

Source: Wiedermann 2014

Biomedical Informatics

Translational biomedical informatics

Clinical research informatics

Clinical informatics

Other Applications of Healthcare Informatics

Consumer informatics

Public health informatics

Population health

Genomics

Telemedicine

E-health

Policies in Support of Healthcare Informatics

New ways of maintaining and accessing patient information

Paper, electronic, and hybrid

Privacy and security, compliance with HIPAA, availability of information as needed

Expanded use of the data

Meaningful use

Monitoring alerts

Information governance

Methods for Creating Systems to Support Health Informatics

Recognize the language of healthcare

Clinical decision support

Software support – compatibility and interoperability

Decision analysis

Data mining

Ethics

Definition

Challenges

Issues

Key Roles

HIM Professionals

C-Level Positions: CIO, CCIO, CMO, CKO

Physicians

Information Technology Specialists

Scribes

Sample Job Description for Health Information Technology Specialist

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