Building a Consensus For the Building a Consensus For the Electronic Health RecordElectronic Health Record

Norma MuscellaNorma MuscellaSese WilliamsSese WilliamsThomas ColleyThomas Colley

Theresa SchenfeldTheresa SchenfeldJacksonville UniversityJacksonville University

April 14, 2013April 14, 2013

Today'Today'ssObjectivesObjectives& Agenda& Agenda

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DefinitionsDefinitions

EHR-An EHR-An electronic health record is electronic health record is defined as a defined as a systematic collection of electronic health information systematic collection of electronic health information about a patient. about a patient.

It is a record in digital format that is theoretically capable of It is a record in digital format that is theoretically capable of being shared across different health care settings. In being shared across different health care settings. In some cases this sharing can occur by way of network-some cases this sharing can occur by way of network-connected enterprise-wide information systems and connected enterprise-wide information systems and other information networks or exchanges. other information networks or exchanges.

EHRs may include a range of data, including EHRs may include a range of data, including demographics, medical history, medication and allergies, demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology immunization status, laboratory test results, radiology images, vital signs, personal statistics like age, weight, images, vital signs, personal statistics like age, weight, and billing information.and billing information.

Not to be confused with EMRNot to be confused with EMR

EMR-EMR-a digital version of the paper charts in the clinician’s office. An a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to:example, EMRs allow clinicians to:Track data over time. Track data over time. Easily identify which patients are due for preventive screenings or Easily identify which patients are due for preventive screenings or checkups. checkups. CheckCheck how their patients are doing on certain parameters such as how their patients are doing on certain parameters such as blood pressure readings or vaccinations. blood pressure readings or vaccinations. MonitorMonitor and improve overall quality of care within the practice. and improve overall quality of care within the practice.But the information in EMRs doesn’t travel easily out of the practice. But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.In that regard, EMRs are not much better than a paper record.

Why Electronic?Why Electronic?

““By computerizing health records, we can avoid dangerous medical By computerizing health records, we can avoid dangerous medical mistakes, reduce costs, and improve care.”mistakes, reduce costs, and improve care.”

With a subsequent adoption of ten-year plan through the With a subsequent adoption of ten-year plan through the Health Health Information Technology for Economic and Clinical HealthInformation Technology for Economic and Clinical Health (HITECH) Act of 2009 (HHS Press Release, 2010; Center for Health (HITECH) Act of 2009 (HHS Press Release, 2010; Center for Health Statistics, 2005).Statistics, 2005).

----President George W. Bush, State of the Union Address, January 20, 2004. President George W. Bush, State of the Union Address, January 20, 2004.

EHR’S reduce errorsEHR’S reduce errors

Automatically checks for conflicts when new medications are orderedAutomatically checks for conflicts when new medications are ordered

Enables clients and providers to have reliable access to patient Enables clients and providers to have reliable access to patient education opportunitieseducation opportunities

Assist providers with cross check of symptoms and provides probable Assist providers with cross check of symptoms and provides probable list of diagnosislist of diagnosis

Supports evidence based decisions at point of careSupports evidence based decisions at point of care

Exposes potential safety problems when they occur and can help Exposes potential safety problems when they occur and can help providers quickly and systematically identify and correct operational providers quickly and systematically identify and correct operational problemsproblems

Enhances research, monitoring and benchmarking for improvement in Enhances research, monitoring and benchmarking for improvement in clinical qualityclinical quality

With electronic health records, providers With electronic health records, providers have the information they need to provide have the information they need to provide the best possible care. Providers will know the best possible care. Providers will know more about their patients and their health more about their patients and their health history before they walk into the history before they walk into the examination room. examination room.

EHR will change healthcareEHR will change healthcare

The information gathered by the primary The information gathered by the primary care provider tells the emergency care provider tells the emergency department clinician about the patient’s life department clinician about the patient’s life threatening threatening allergyallergy, so that care can be , so that care can be adjusted appropriately, even if the patient adjusted appropriately, even if the patient is unconscious. is unconscious.

Improve patient safety and clinical outcomes

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Patient EmpowermentPatient Empowerment

A patient can log on to his own record and A patient can log on to his own record and see the trend of the lab results over the see the trend of the lab results over the last year, which can help motivate him to last year, which can help motivate him to take his medications and keep up with the take his medications and keep up with the lifestyle changes that have improved the lifestyle changes that have improved the numbers.numbers...

Patients can receive electronic copies of Patients can receive electronic copies of their medical records and share their their medical records and share their health information securely over the health information securely over the Internet with their families.Internet with their families.

Provide clinicians, staff and

patients with necessary tools and

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The lab results run last week are already in The lab results run last week are already in the record to tell the specialist what she the record to tell the specialist what she needs to know without running duplicate needs to know without running duplicate tests. tests.

Build the electronic health record with

evidence-based content

Build the electronic health record with

evidence-based content

The clinician’s notes from the patient’s The clinician’s notes from the patient’s hospitalhospital stay can help inform the stay can help inform the discharge instructions and follow-up care discharge instructions and follow-up care and enable the patient to move from one and enable the patient to move from one care setting to another more smoothly.care setting to another more smoothly.

BenefitsBenefits

Enhance the patient experienceEnhance the patient experience

Provide clinicians and staff with necessary Provide clinicians and staff with necessary tools and information across the tools and information across the healthcare spectrumhealthcare spectrum

Standardize information collected and Standardize information collected and saved for the patients’ EHRsaved for the patients’ EHR

Strategically position patients and Strategically position patients and clinicians for the futureclinicians for the future

Why Electronic?Why Electronic?

Increase patient safetyIncrease patient safety

Conform to government mandates in Conform to government mandates in regards to Affordable care act and regards to Affordable care act and meaningful usemeaningful use

What is Meaningful Use?What is Meaningful Use?

The set of standards defined by the Centers The set of standards defined by the Centers for Medicare & Medicaid Services (CMS) for Medicare & Medicaid Services (CMS) Incentive Programs that governs the use Incentive Programs that governs the use of electronic health records and allows of electronic health records and allows eligible providers and hospitals to earn eligible providers and hospitals to earn incentive payments by meeting specific incentive payments by meeting specific criteria. criteria.

What is involved?What is involved?

Electronic physician documentation in all patient Electronic physician documentation in all patient care areascare areasElectronic prescribingElectronic prescribingIntegration of laboratory resultsIntegration of laboratory resultsNursing documentationNursing documentationInpatient Inpatient computerized physician order entrycomputerized physician order entry (CPOE)(CPOE)Medication management including Medication management including bar-coded bar-coded medication administrationmedication administration (BCMA) (BCMA)Clinical reportingClinical reportingScanning archive and data repositoryScanning archive and data repository

More definitions!More definitions!

CPOE-a process of electronic entry of medical practitioner CPOE-a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly instructions for the treatment of patients (particularly hospitalized patients) under his or her care. hospitalized patients) under his or her care.

These orders are communicated over a computer network These orders are communicated over a computer network to the medical staff or to the departments (pharmacy, to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the laboratory, or radiology) responsible for fulfilling the order. order.

CPOE decreases delay in order completion, reduces errors CPOE decreases delay in order completion, reduces errors related to handwriting or transcription, allows order entry related to handwriting or transcription, allows order entry at the point of care or off-site, provides error-checking for at the point of care or off-site, provides error-checking for duplicate or incorrect doses or tests, and simplifies duplicate or incorrect doses or tests, and simplifies inventory and posting of charges. inventory and posting of charges.

CPOE Key BenefitsCPOE Key Benefits

Saves time by eliminating duplicative processes Saves time by eliminating duplicative processes and allows the clinician to articulate care from and allows the clinician to articulate care from anywhere, anytime anywhere, anytime Reduces medication errors and adverse drug Reduces medication errors and adverse drug eventseventsProvides error-checking for duplicate or incorrect Provides error-checking for duplicate or incorrect doses or testsdoses or testsSimplifies posting of chargesSimplifies posting of chargesPotential to decrease errors related to Potential to decrease errors related to handwriting or transcription, decrease handwriting or transcription, decrease turnaround time, decrease length of stay and turnaround time, decrease length of stay and decrease cost of caredecrease cost of care

Built in alerts!Built in alerts!

Not only are Not only are prescription errors prescription errors reduced in the reduced in the translation between translation between the doctors office and the doctors office and pharmacy, but CPOE pharmacy, but CPOE lessen the likelihood lessen the likelihood of harmful drug of harmful drug interactions due to interactions due to built in alerts. built in alerts.

How do we arrive?How do we arrive?

Every journey has a Every journey has a beginningbeginning

The journey begins…..The journey begins…..

Investigate:Investigate:

What do I want my Electronic Record to What do I want my Electronic Record to do for me?do for me?

How much am I willing to spend?How much am I willing to spend?

How long will it take?How long will it take?

Do I have the infrastructure in place or will Do I have the infrastructure in place or will that be an additional expense?that be an additional expense?

Assemble GroupAssemble Group

Financial officerFinancial officerComputer literate staff (Informatics Computer literate staff (Informatics Nurse)Nurse)Information TechnicianInformation TechnicianFrontline staff familiar with work flow Frontline staff familiar with work flow Risk managementRisk managementPatient registrationPatient registrationFinancial services Financial services

Middle Middle

Define GoalsDefine Goals

Assemble lists of “wants” and “musts”.Assemble lists of “wants” and “musts”.

Invite vendors to demonstrate functionalityInvite vendors to demonstrate functionality

Incorporate questions regarding Incorporate questions regarding “personalizing” applications.“personalizing” applications.

Assess securityAssess security

Determine down time applications, how Determine down time applications, how long, how often and how much of the long, how often and how much of the system is affected.system is affected.

Choose Vendor!Choose Vendor!Begin to build ….Begin to build ….

Flow from admissionFlow from admission

To DischargeTo Discharge

Stop in all departments along the wayStop in all departments along the way

EvaluateEvaluate

ModifyModify

Establish a timelineEstablish a timeline

Define usersDefine usersManage hardware and software Manage hardware and software purchasespurchasesInstall servers, cables wireless and wired Install servers, cables wireless and wired networksnetworksVerify that HIPAA privacy, security and Verify that HIPAA privacy, security and breach notification policies are in placebreach notification policies are in placeDevelop internal training planDevelop internal training planDevelop policies and procedures to Develop policies and procedures to support new technology and vocabulary.support new technology and vocabulary.

TESTTEST

In the test domain, a patient will be created In the test domain, a patient will be created along with a problem list. That patient will along with a problem list. That patient will

mimic a typical admission and followed mimic a typical admission and followed through a hospital visit. through a hospital visit.

..

TRAINTRAIN

End users will follow a typical patient in End users will follow a typical patient in the train domainthe train domain

Use blended learning strategyUse blended learning strategy

Simulated chartsSimulated charts

Small classes with classroom assistants to Small classes with classroom assistants to help those not comfortable with computershelp those not comfortable with computers

Questions are validated and answeredQuestions are validated and answered

CelebrationCelebration

Go LiveGo Live

Minimize vacation timeMinimize vacation time

Vendor and super users available real Vendor and super users available real time.time.

Anticipate challenges develop an “issues Anticipate challenges develop an “issues log”log”

Celebrate facility achievementCelebrate facility achievement

In ConclusionIn Conclusion

Successful conversion to EHR will take significant Successful conversion to EHR will take significant energy and resources.energy and resources.

Preparedness assessments must be thorough. Preparedness assessments must be thorough.

Detailed mapping of workflow with standard Detailed mapping of workflow with standard operating procedures and emergent situations operating procedures and emergent situations studied with the inclusion of clinicians. studied with the inclusion of clinicians.

All end users must be trained. All end users must be trained.

Access provided must be tailored to job classAccess provided must be tailored to job class

Comprehensive security planning is essential. Comprehensive security planning is essential.

ReferencesReferences

http://www.physicianspractice.com/ehr-stimulus-complete-primerhttp://www.physicianspractice.com/ehr-stimulus-complete-primerhttp://www.omnimd.com/meaningful-use/emr-vs-ehrhttp://www.omnimd.com/meaningful-use/emr-vs-ehrhttp://georgewbush-whitehouse.archives.gov/infocus/technology/economic_policy200404/chap3.htmlhttp://georgewbush-whitehouse.archives.gov/infocus/technology/economic_policy200404/chap3.htmlHebda, T. & Czar,P (2005). Hebda, T. & Czar,P (2005). Handbook of Handbook of

Informatics for nurses and healthcare Informatics for nurses and healthcare professionals.professionals. Upper Saddle River, New Jersey: Upper Saddle River, New Jersey: Pearson.Pearson.