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Building consensus for EHR

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Amanda Smith

on 9 April 2013

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Transcript of Building consensus for EHR

Introduction to
Health Records the journey to the top! Determining the needs/wants for an EHR/EMR system Benefits of Electronic Health Records (EHRs) System integration and implementation Conquering Mount EMR: Building consensus for
electronic health records By: Amanda Smith
Jeanette Pascale
Tammy Richardson
Cie Tinsley What is an electronic health record? An electronic health record (EHR) is a computerized medical record created in an organization that delivers care, such as a hospital or physician's office. Benefits of EHRs: Electronic medical records are usually part of a local stand-alone health information system that allows storage, retrieval and modification of records. One of the largest benefits to switching from paper based charting to an EHR system is because it improves quality and convenience of patient care Snapshot of improved health care quality and convenience for providers using EHR Provides quick
access to patient records Utilizes
tools, which results
in real-time
quality reporting Legible, complete
documentation that
facilitates accurate
coding and billing Interfaces with
other EHRs Safer, more
prescribing Which all result in... Snapshot of
improved health care
quality and
convenience for
patients using EHR Reduced need
to fill out
the same forms
at each office visit Reliable point of care information and reminders notifying providers of
important health
interventions Convenience of
electronically sent
to pharmacy Patient portals
for online
with providers Electronic referrals
allowing easier
access to
follow-up care
with specialists With EHRs, patients'
health information
is available
in one place, when and
where it is needed Which all result in... EHRs can be the foundation for quality improvements EHRs place accurate and complete information about patients' health and medical history at providers' fingertips, which better enables providers to give the best possible care, at the point of care Practices can extract reports on patient and disease registries to track patient care as well as facilitate quality improvement discussions during clinical meetings EHRs support provider
decision making Improved aggregation, analysis, and communication of patient information

Clinical alerts and reminders

Support for diagnostic and therapeutic decisions

Built-in safeguards against potential adverse events E-prescribing Heath care convenience matters Providers and their staff
can file insurance
claims immediately
from the providers office Providers can
access patient
files remotely EHRs foster
participation Can help ensure high-quality care, providers can give patients full and accurate information about all their medical evaluations and diagnoses Enable providers identify
symptoms earlier, which
allows providers to be
more proactive Create an avenue for
communication with
their patients,
providers can manage
electronically and
email their patients Patients fill in the information from their
own records and memories, and the
information is stored on patients'
computers or the internet Personal health record (PHR) is an electronic application used
by patients to maintain and manage their own health information Tethered or connected PHRs are linked to a specific health care organization's EHR system or to a health plan's information system, the patient can access the information through a secure portal EHRs can reduce errors, improve patient safety, and support better patient outcomes Automatically checks for problems whenever a new medication is prescribed and alerts the clinician to potential conflicts

Information gathered by a primary care provider and recorded in EHR tells a clinician in the emergency department about a patient's life threatening allergy, even if a patient is unconscious

EHRs can aid in diagnosis, by enabling providers to have reliable access to a patient's complete health information, and this comprehensive picture can help providers diagnose patients' problems sooner

EHRs can expose potential safety problems when they occur, and can also help providers quickly and systematically identify and correct operational problems, in a paper-based system this could take years Risk management and liability prevention
Provides clinical alerts and reminders

Improves aggregation, analysis and communication

Supporting diagnostic and therapeutic decision making

Gathers all relevant information in one place

Support for therapeutic decisions

Enabling evidence-based decisions at point of care

Preventing adverse events

Providing built-in safeguards against prescribing treatments that would result in adverse events

Enhancing research and monitoring for improvement in clinical quality Need for
care coordination Leveraging an EHR across the continuum
of care allows for: Better integration among providers by improved information
sharing Viewable and up to
date medication
and allergy lists,
with order entry
at point of care or
off-site Standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-
based medicine Access to experts
for rural health care providers by sharing best practices and allowing for specialized
care through
telemedicine Population
management trended
data and
treatment and
outcome studies EHR's effect
on revenue Reduction of time and resources
needed for manual charge entry
resulting in
more accurate billing and reduction in lost charges Eligible health care providers may qualify for incentive programs Up to $27 billion in EHR incentive payments, or as much as $44,000 (through Medicare) or $63,750 (through Medicaid) per eligible health care professional (http://www.healthit.gov)

Eligible hospitals can qualify for incentive payments totaling $2 million or more (http://www.healthit.gov) Determining the needs/wants
for an
system When developing an Electronic Health Records (EHR) system, there are many things to keep in mind. It is important to understand the cost associated with all technology, thus one should keep in mind that any decision for such a system should be made with a clear understanding of the goals that are being looked to achieve with the system, not only for today, but also for the future. The creativity of an EHR must be one that is meaningful and one that serves a true purpose. First and foremost patient privacy and security must be maintained .Some of the uses of an EHR include but are not limited to improved quality, safety, efficiency, health disparities, and care coordination. Patients have a sense of independence when evolved in their health, so it is equally important to create a system that will engage the patient and family in their health care (Hebda & Czar 2009). An ideal EHR system will have record standardization but interfaces that can be customized to each provider environment (Implementing EHR's [online]). With that being said let's talking about the options a healthcare provider or facility may include in their EHR system.... Active Medication List- having an electronic list of active medications helps streamline visits, allows for the most efficient use of the entire clinical staff, and makes coverage during medication administration safer and easier

Ability to record Vital Signs- According to the CMS accurate, documented vital signs are an important component of patient care. They provide essential, baseline data for treatment decisions and historical trends. This historical information allows for recognition of acute or chronic changes that may prove significant. Electronic Physician Order Entry - This process would allow for orders to be incorporated with patient information such as other prescriptions, and lab results which can be checked for related problems or errors.

Portability of Patient Information-The ability to exchange clinical information to all that are involved in the patient's total episode of care is essential for effective and efficient coordinated care. Having the information in such an electronic format makes the possibility of information exchanging that much easier. The information can be shared regardless of where the patients are receiving care

Security- the EHR must be one that is built not only efficient but also secure. By applying the appropriate safeguards that comply with the HIPAA Privacy Rule, can help avoid some of the common security gaps that lead to violation and protection of patient information Patient and Family Engagement-Patients are more likely to be involved and take a positive stance in their health care when they have a sense of control. Therefore is it important to provide patient's with a source that will provide timely electronic access to their health information. A few of those examples include but are not limited to lab results, problem list, medication lists, and allergies. In addition, the appropriate patient education materials such as links to relevant information, extensive articles, and images for the patient should be incorporated.

Preservation and Storage-Depending on national and state law regulations, the requirements for the time data must be stored may vary, however it is important to have a system that supports the data store element of an EHR. In addition when creating the storage element the long term accessibility and compatibility must also be taken into consideration. *User Friendly- One of the ultimate goals of implementing an EHR is for a user friendly environment. Simplicity should have a process that allows all end users the ability the use the system without a long learning process. The systems efficient should also allow the capture of data required to manage what is needed for the patient's condition, and to maximize the possibilities of great patient outcomes. This allows for speed in the processes as well as increased productivity. Steps to
system integration
and implementation *Placement of Implementation Committee
-works with various vendors to select EHR
-works through entire implementation process: planning to go live
Assesses Usability-
*vendor products selected that meet the clinic's identified needs
*usability analysis has been shown to decrease end-user problems
and reduce cost of change requests (Corrao 2010).
*system maintenance and help desk will be offsite and be readily available
24/7 *Purpose of Implementation committee:
-Assures Information security-protection of patient information
-Assures information availability and integrity
-Provides better organized data integrity will be increase productivity *Committee consists of:
-Project leader-The clinic's Nurse Administrator (Ideally informatics savvy)
-Team Members-will be cross-trained as Super Users (dual role necessary as it's smaller staff/smaller IS)
-Selected from each role; (Physician, RN, Medical Assistant, Administrative assistant) *System analysis-

-Supports family practice; patient records, decision support tools, preventive care, and disease management (Lau 2012)
-Ensures compliance with state and federal regulations
-Tests interface design-template design, reliability, speed (supports pt. care and flow)
-Coordinates integration with offsite: laboratory results, PACS (radiology),
affiliated hospitals medical records/portals
-Checks availability of remote access *Developing hardware: Network Infrastructure
-network requirements
-memory capacity
-processing power
-wireless internet
-anticipate future needs (system maintenance & upgrades) *Workstations: Centralized workstations at Front desk and Physician/APN offices
*Patient care providers will utilize Point of care documentation with mobile netbooks

*Training:Onsite training with vendor support
-Assessment of end users training needs
End users are who will use the EHR (Administrative:front desk, billing, managers; Providers:MD, APN; RNs and Medical Assistants)
-Classroom training;short, given after hours
-Provides access codes for user authentication and login
-Overview and instruction of use of EHR (workflow)
-Assesses computer literacy
-Reinforced with CBT, online learning modules available 24/7
-Vendor and Superuser present consistently during "go live" Patient flow, use of EHR in clinic

*Point of access starts at scheduling an appointment:
Each patient has their own identifier (like a medical record number with subsequent
encounter numbers for billing)
-With appt. scheduling basic demographics inputted by call taker
-Established patients can schedule appts. online, as they would have access code

*Upon arrival: Confirm patient identification/billing, medical history (on arrival
fills out medical history questionnaires and they are inputted into the system
if not completed PTA)

*Examination: input of VS, Ht/Wt. Point of care (glucose, urine dip), inputted by assistant or nurse utilizing mobile netbook template chosen for provider-well visit or chief complaint
-Provider-CPOE and H&P can be done via mobile device, or initiate on mobile
device and completed in provider's office area

*EKG, Rx, referrals for specialist, lab/rad. testing, F/U
Pt given verbal instructions at this time

*Checkout:Verification of instructions, RX given, referrals given, schedule follow up.

*Visit integrated into EHR once all components completed and electronically signed. References Benefits of electronic health records. (2013) Retrieved March 30, 2013 from

Corrao, N., Robinson, A., Swiernik, M., & Naeim, A.(2010). Importance of testing for usability when selecting and implementing an electronic health or medical record system.Journal of Oncology Practice,6(3),120.DOI: http://dx.doi.org/10.1200/JOP.200017

Hebda, T., & Czar, P. (2013).Handbook of informatics for nurses & healthcare professionals
(5th ed.). Upper Saddle River, NJ:Pearson,171-229.

Implementing EHR's [online] Available at:
http://www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures/drug-interaction-check, [accessed March 29, 2013]

Lau, F., Price, M., Boyd, J., Partridge, C., Bell, H., & Raworth, R.(2012).Impact of electronic medical record on physician practice in office settings: a systematic review.BMC Medical Informatics and Decision Making,12(10),7. Retrieved from http://www.biomedcentral.com/1472-6947/12/10

What Makes HER User Friendly? [online] Available at:
http://www.poweryourpractice.com/what-makes-your-ehr-user-unfriendly/, [accessed March 29, 2013]

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