© 2013 the mcgraw-hill companies, inc. all rights reserved. chapter 1 the electronic health record
TRANSCRIPT
© 2013 The McGraw-Hill Companies, Inc. All rights reserved.
Chapter 1
The Electronic Health Record
© 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
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• 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
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LO 1.1 Overview of the Electronic Health Record
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• 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
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• 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
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Example of EHR in SpringCharts
LO 1.1
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EHR Models
LO 1.1
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LO 1.2 History of the Electronic Health Record
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• 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
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• 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
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LO 1.3 EHR Terminology
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EHR Terminology
LO 1.3
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LO 1.4 Government Involvement in the EHR
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• 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
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• 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
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LO 1.5 Healthcare Processes and the EHR
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• 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
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LO 1.6 Barriers and Benefits of the EHR
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• 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
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• Enhanced accessibility to clinical information
• Improved patient safety• Enhanced quality of
patient care• Greater efficiency and
savings
Benefits of the EHR
LO 1.6
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LO 1.7 The Future of the Electronic Health Record
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• 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
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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
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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
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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
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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
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LO 1.5 Differentiate between medical office processes that use a paper chart and an EHRProcesses 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
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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
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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