Electronic health records

ELECTRONIC HEALTH RECORDS Presented by Mrs. Senthilnayaki Ramasubbu.RN.RM.MSc(N)

ELECTRONIC HEALTH RECORD (EHR)• Electronic health record, is the electronic version of

the client data found in the traditional paper record.• EHRs are defined as “a longitudinal electronic record

of patient health information generated by one or more encounters in any care delivery setting.

EHR:

Roles of EHR

• Represents patient’s health history• Medium of Communication among health care

practitioners• Legal document for health care• Source for clinical outcomes and health

services research• Resource for practitioner education• Alerts, reminders, quality improvement

Data components documented in EHR An electronic health record should contain important data such as;

• Patient profile and demographics• Medical history

includes information about allergies, illness, immunization, disorder and diseases.

• Medicine taken and its compatibility with drug interaction

• Records of appointment

Data components documented in EHRs:

• admission nursing note, • daily charting,• physical assessment, • present complaints (e.g. symptoms), • diagnoses, tests, procedures, treatment, • nursing care plan, • medication administration, progress notes• laboratory data, and radiology reports• referral, • Discharge history,• Billing records

Components of EHR

• Clinical decision support system (CDSS), • Computerized physician order entry

(CPOE) systems, and • Health information exchange (HIE).

CLINICAL DECISION SUPPORT SYSTEM (CDSS)

• A CDS system is a software that assists the provider in making decisions with regard to patient care. • CDSS provides physicians and nurses with

real-time diagnostic and treatment recommendations.

Functions of CDSS• Managing clinical complexities• Monitoring medication errors• Avoiding duplicate and unnecessary tests• Supporting clinical diagnosis &Treatment plan processes• Promoting use of best practices & condition specific

guidelines & • Population based management.• providing the latest information about a drug, • cross-referencing a patient allergy to a medication, and • alerts for drug interactions and other potential patient issues

Patient safety with EHR

Researchers found that computerized physician reminders increased the use of influenza and pneumococcal vaccinations from practically 0% to 35% and 50%, respectively, for hospitalized patients.

Prevention of complication with EHR Willson et al, found a significant association between computerized reminders and pressure ulcer prevention in hospitalized patients.

They found a 5% decrease in the development of pressure ulcers 6 months after the implementation of computerized reminders that targeted hospital nurses.

Best uses of practice with EHR

• Rossi and Every, found that computerized reminders as part of a CDSS have been linked to an 11.3% increase in appropriate hypertension treatment in a primary care setting.

Decreased cost of care with EHR• Tierney et al found a 14.3% decrease

in the number of diagnostic tests ordered per visit and a 12.9% decrease in diagnostic test costs per visit when using an EHR with CDS and CPOE components.

Computerized physician order entry(CPOE)

Computerized physician order entry(CPOE)

• CPOE is a software that allow physicians to enter orders directly into the computer rather than doing so on paper.

Example • drugs,• laboratory tests, • radiology,• physical therapy

Benefits of CPOE

• Eliminates potentially dangerous medical errors caused by poor penmanship of physicians. • Eliminate errors caused by unclear

telephone orders • It also makes the ordering process

more efficient because nursing and pharmacy staffs do not need to seek clarification or to solicit missing information from illegible or incomplete orders. • Enhances patient safety

Evidence

Studies suggest that serious medication errors can be reduced by 55% when a CPOE system is used alone, and by 83% when coupled with a CDS system that creates alerts based on what the physician orders.• Using a CPOE system, especially when it is

linked to a CDS, can result in improved efficiency and effectiveness of care.

Health information exchange

Health information exchange

HIE is the process of sharing patient’s electronic health information between different organizations and can create many efficiencies in the delivery of health care.

Once health data are available electronically to providers, EHRs facilitate the sharing of patient information through HIE.

Health information exchange-Benefits• Allows for the secure and potentially real-

time sharing of patient information, • HIE can reduce costly redundant tests • HIE facilitates the exchange of this

information via EHRs, which can result in much more cost-effective and higher-quality care.

Technologies involved in EHR

• Picture archiving and communications system• Bar coding• Radio frequency identification• Automated dispensing medicines• Electronic medication administration

records

PICTURE ARCHIVING AND COMMUNICATIONS SYSTEM

Picture archiving and communications system:

This technology captures and integrates diagnostic and radiological images from various devices, stores them, and disseminates them to a medical record, a clinical data repository, or other points of care.e.g., x-ray, MRI, computed tomography scan

Bar coding

An optical scanner is used toelectronically capture information encoded on a product. Initially, it is used for medication.

BAR CODING

• It consist of bar code readers , a portable computers with wireless connection.• The nurse can verify

patients as well as drugs.

Radio frequency identification

Radio frequency identification

This technology tracks patients throughout the hospital, and links lab and medication tracking through a wireless communications system. It is neither mature nor widely available, but may be an alternative to bar coding.

ADM:

Automated dispensing medicines are computerized drug storage devices which allow medications to be stored and dispensed near the point of care while controlling and tracking the drug distribution.

Benefits

• Reduces pharmacy labor by 90%• Reduces technician labor by 72%• Lowers drug inventory by 20%• Cuts missing medications by 92%• Lowers expired medication cost by 54%

Electronic medication administration records

Electronic medication administration records

• The EMAR alerts the nurse about the next dose or cautions about the medications• Nurses take the cart near to the patient, scan the

medication and the patient wrist band

Benefits of EHR

• Improved access to the medical record. • Decreased time spent in documentation. • Increased time for client care. • Improved quality care.• Facilitation of data collection for research. • Improved communication and decreased potential

for error. • Creation of a lifetime clinical record facilitated by

information systems.

The benefits of EHRs

clinical outcomes: • improved quality, • reduced medical errors,

organizational outcomes: - financial and - operational benefits, societal outcomes

• improved ability to conduct research, • improved population health, • reduced costs

Drawbacks

• Financial issues, • changes in workflow, • temporary loss of productivity associated with

EHR adoption, • privacy and security concerns,

Drawbacks

Financial issues, including • adoption and implementation costs,• ongoing maintenance costs, and• loss of revenue associated with temporary loss

of productivity.

Barriers to adoption of EHR

Mohamed Khalifa, MD, conduced a study onBarriers to Health Information Systems and Electronic Medical Records Implementation. A Field Study of Saudi Arabian Hospitals

Abstract• Background:

Despite the positive effects of Health Information Systems and Electronic Medical Records use in medical and healthcare practices, the adoption rate of such systems is still low and meets resistance from healthcare professionals. Barriers appear when they approach systems implementation. We need to understand these factors in the context of Saudi Arabian hospitals to enhance EMR adoption. This process should be treated as a change project.

• Objectives:To identify, categorize, and analyze barriers perceived by different healthcare professionals to the adoption of EMRs in order to provide suggestions on beneficial actions and options.

• MethodsThe study used a questionnaire to collect data from a random sample of healthcare professionals of two major Saudi hospitals, one private and the other is governmental, 158 valid respondents participated in the survey equally from both hospitals and then the results were analyzed to describe and evaluate various barriers.

• ResultsThe study identified six main categories of barriers, which are consistent with those reported in recent published research. 1) Human Barriers, related to the beliefs, behaviors and attitudes, 2) Professional Barriers, related to the nature of healthcare jobs, 3) Technical Barriers, related to computers and IT, 4) Organizational Barriers, related to the hospital management, 5) Financial Barriers, related to money and funding and 6) Legal and Regulatory Barriers, related to laws, regulations and legislations. The six categories of barriers were validated with the participants of the pilot sample.

• ConclusionsHuman barriers as well as financial barriers are the two major categories of barriers and challenges in the way of successful implementation of EMRs.

Conclusion

• EHR adoption must be considered one of main approaches that diversify our focus on quality improvement and cost reduction.•Over time, providers and researchers

will be eager to quantify the returns that are expected from these investments.

Referrences• IOM. Crossing the quality chasm: a new health system for the 21st

century. Washington, DC: Institute of Medicine; 2001. [PubMed]• Dexter PR, Perkins S, Overhage JM, et al. A computerized reminder

system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345(13):965–970. [PubMed]

• Willson D, Ashton C, Wingate N, et al. Computerized support of pressure ulcer prevention and treatment protocols. Proc Annu Symp Comput Appl Med Care. 1995:646–650. [PMC free article][PubMed]

• Rossi RA, Every NR. A computerized intervention to decrease the use of calcium channel blockers in hypertension. J Gen Intern Med. 1997;12(11):672–678. [PMC free article] [PubMed]

• Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990;322(21):1499–1504. [PubMed]

• Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280(15):1311–1316. [PubMed]

• Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999;6(4):313–321. [PMC free article] [PubMed]

• The National Alliance for Health Information Technology. Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms. [Accessed April 18, 2011].http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__reports/1239.

• Walker J, Pan E, Johnston D, et al. The value of health care information exchange and interoperability. Health Aff (Millwood) 2005;Suppl:W5-10–15-18. [PubMed]

• http://www.patientkeeper.com/blog/2011/11/03/nurses-benefit-from-cpoe-too/

• http://fgraham1.wordpress.com/2009/01/14/computerized-physician-order-entry-and-electronic-medication-administration-record/

• http://www.sciencedirect.com/science/article/pii/S1877050913008375