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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_cost8/9/2019 SUMMARY of the Electronic Health Record
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Governance, privacy and legal issues
Privacy
Liability and Accountability (streamlined by the HIPAA and other regulatory and compliance agencies)
Long Term Preservation of Records
Standards
Customization