Electronic Health Records

Bruce Slater, MD, MPH

University of Wisconsin

School of Medicine and Public Healthb.slater@hosp.wisc.edu

Objectives

• Compare the History of Paper and Electronic Patient Records

• Describe Major Elements of the Electronic Health Record

• Explain how the Electronic Health Record is Different to the Paper Patient Chart

Introduction

• Healthcare lags in information system use• Computers are used in financial

transactions• Some clinicians use the web for information• Only a few MDs store records electronically• Computers could solve efficiency, access

and quality needs for providers who adopt

Definitions

• EPR - Electronic Patient Record

• EMR - Electronic Medical Record

• CbPR - Computer-based Patient Record

• CPRS - Computer Patient Record System

• EHR – Electronic Health Record

• Client-Server

• ASP - Application Service Provider

History of Physical Records

• Shaman - oral traditions

• Hospitals - written ward records

• Florence Nightingale - patient records

• Source Oriented Records

• Problem Oriented Records

• Lost & Incomplete Records

History of Virtual Records

• PROMIS - Problem Oriented Medical Information System - Larry Weed, MD

• COSTAR - Computer Stored Ambulatory Record

• Practice Partner

• Medicalogic/Logician/GE Centricity

• EpicCare

• The Web

History of Virtual Records

• PROMIS - Problem Oriented Medical Information System - Larry Weed, MD

• COSTAR - Computer Stored Ambulatory Record

• Practice Partner

• Medicalogic/Logician/Centricity

• EpicCare

• The Web

Elements of Paper Medical Records

• Physical Folder

• Labels and Flags

• Demographic and Insurance Page

• Problem and Medication/Allergy List

• Dividers

• Progress Notes and Consults

• Results of Tests and Imaging

Elements of Paper Medical Records

• Physical Folder

• Labels and Flags

• Demographic and Insurance Page

• Problem and Medication/Allergy List

• Dividers

• Progress Notes and Consults

• Results of Tests and Imaging

Elements of Paper Medical Records

• Physical Folder

• Labels and Flags

• Demographic and Insurance Page

• Problem and Medication/Allergy List

• Dividers

• Progress Notes and Consults

• Results of Tests and Imaging

Elements of Electronic Health Records

• No Physical Location - a Virtual Record

• Multiple kinds of Labels and Flags

• Demographic and Insurance Tables

• Problem/Medication/Allergy Checking

• Dividers of any kind imaginable

• Progress Notes and Consults

• Results and Actual Tests and Imaging

Elements of Electronic Health Records

• No Physical Location - a Virtual Record

• Multiple kinds of Labels and Flags

• Demographic and Insurance Tables

• Problem/Medication/Allergy Checking

• Dividers of any kind imaginable

• Progress Notes and Consults

• Results and Actual Tests and Imaging

Elements of Electronic Health Records not in Paper Records

• Security• Transportability• Flexibility• Consistency• Reminders• Intelligence• Link-Outs

• Provider Education• Patient Education• Patient Participation• Problem Orientation• Audit• Demand

Management• Access Management

Elements of Electronic Health Records not in Paper Records

• Security• Transportability• Flexibility• Consistency• Reminders• Intelligence• Link-Outs

• Provider Education • Patient Education• Patient Participation• Problem Orientation• Audit• Demand

Management• Access Management

Elements of Electronic Health Records not in Paper Records

• Security• Transportability• Flexibility• Consistency• Reminders• Intelligence• Link-Outs

• Provider Education• Patient Education• Patient Participation• Problem Orientation• Audit• Demand

Management• Access Management

Elements of Electronic Health Records not in Paper Records

• Security• Transportability• Flexibility• Consistency• Reminders• Intelligence• Link-Outs

• Provider Education• Patient Education• Patient Participation• Problem Orientation• Audit• Demand

Management• Access Management

Electronic Health Records in Electronic Commerce

• Merge into Patient’s and Provider’s Lives

• Create a Need

• Fulfill the Need

• Extend the Need

• Assimilate Information into their Lives

Electronic Health Records and the Clinical Data Repository

• Patient-centered Real-time

• Operational Coded

• Clinical Data

• Data Dictionary

• Provider Interface is Built on the Repository

• Population based Care and Research

Examples

• Practice Partner

• Logician Internet

• Patient Profile v 4.0

Practice Partner

Screen shot here then demo

Logician Internet

Patient Profile v4.0

Summary/Conclusions

• Electronic Health Records will change healthcare

• We have only seen the first engagements of the war between the bricks and the clicks

• The next conflict will be bricks versus bricks with clicks.

• Patients may be able to shape the future

Questions and Discussion