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SUMMARY of the Electronic Health Record (EHR) DEVELOPMENT
1960s- Hospital Information Systems (HIS) were developed
primarily to process financial transactions and serve asbilling and
accounting systems.- A few HISs emerged that documented and
processed a limited number of medical orders and nursing care
activities.- Vendors of computer systems began to enter the
healthcare field and market software applications for
various hospital functions.
1970s Nurses assisted in the design and development of nursing
applications for the HISs- Computer based management information
systems (MIS) were contracted by large community health
services to be developed.- Primarily this public MISs provided
statistical information whereas homehealth agencies provided
billing
and other information required for reimbursement of patient
services (Medicare, Medicaid, etc)- NOTE: HISs are information
systems use in HOSPITALS whereas MIS are information systems use
OUTSIDE
the HOSPITAL (e.g. community health)
1980s Computer-based record systems (CPRs) became subsystems of
the HIS.- This move aided in the development of individualized
computer based patient record systems, e.g. in form
of clinical information systems (CIS) specific to nursing
practice, laboratory information systems, radiologicinformation
systems, etc.)
- Many mainframe HISs emerged with nursing subsystems (order
entry emulating Kardex, results reporting,vital signs and narrative
nursing notes)
NOTE: A hospital information system (HIS), variously also called
clinical information system (CIS) is a comprehensive,integrated
information system designed to manage the administrative, financial
and clinical aspects of a hospital.It can be composed of one or a
few software components with specialty-specific extensions as well
as of a large variety of sub-systems in
medical specialties (e.g. Laboratory Information System,
Radiology Information System).
CISs are sometimes separated from HISs in that the:CIS -
concentrate on patient-related and clinical-state-related data
(electronic patient record)HIS- keep track ofadministrative
issues.The distinction is not always clear and there is
contradictory evidence against a consistent use of both terms.
1990s post 2000
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The CPRI was founded in 1992-a unique organization representing
all stakeholders in healthcare, focusing on clinicalapplications of
information technology. It initiates and coordinates activities to
facilitate and promote the routine useof computer-based patient
records (CPRs).A CPR project evaluation was established in 1993
with four fundamental criteria:
A. Management
B. FunctionalityC. TechnologyD. Impact
The criteria also provided the foundation for the Nicholas E.
Davies Award of Excellence Program. The program isfounded on the
belief that healthcare organizations benefit when collective
experiences and lessons learned areshared. It is intended to award
and bring to national attention excellence in the implementation of
CPRs. During its10 year existence, the Davies program has had four
criteria revisions and seen its terminology updated from CPR toEMR
and todays HER.
REMEMBER: EHR/EMR/CPR is similar terms referring an evolving
concept defined as a systematic collection of electronic
healthinformation about individual patients or populations. But
these terms have distinctions. EMR is existing in a single agency
or hospital exclusive for
the utilization of that agency and its affiliates. When EMRs of
agencies are shared and are stored in a single server database as
what exists today(thanks to advanced networking) it is known as
EHR. EPR or Electronic Patient Record may be also used
interchangeably with these terms.It is a record in digital format
that is capable of being shared across different health care
settings, by being embedded in network-connectedenterprise-wide
information systems. Such records may include a whole range of data
in comprehensive or summary form,including demographics, medical
history, medication and allergies, immunization status, laboratory
test results, radiology images, and billinginformation.Its purpose
can be understood as a complete record of patient encounters that
allows the
1. automation and streamlining of the workflow in health care
settings2. increases safety through evidence-based decision
support, quality management, and outcomes reporting3. serve as
database of all patients informations.
ADVANTAGES
Reduction of cost
Improve quality of care
Promote evidence-based medicine
Record keeping and mobility
DISADVANTAGES
Costs
http://en.wikipedia.org/wiki/Electronic_health_record#Reduction_of_costhttp://en.wikipedia.org/wiki/Electronic_health_record#Improve_quality_of_carehttp://en.wikipedia.org/wiki/Electronic_health_record#Promote_evidence-based_medicinehttp://en.wikipedia.org/wiki/Electronic_health_record#Record_keeping_and_mobilityhttp://en.wikipedia.org/wiki/Electronic_health_record#Improve_quality_of_carehttp://en.wikipedia.org/wiki/Electronic_health_record#Promote_evidence-based_medicinehttp://en.wikipedia.org/wiki/Electronic_health_record#Record_keeping_and_mobilityhttp://en.wikipedia.org/wiki/Electronic_health_record#Reduction_of_cost
