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Lecture 2

Lecture 2. History and Current use of Clinical Information Systems. Definitions

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Lecture 2

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  1. Lecture 2 History and Current use of Clinical Information Systems

  2. Definitions • An Information System is an arrangement of information (data), processes, people, and information technology that interact to collect, process, store, and provide as output the information needed to support the organization • Information Technology describes the combination of computer technology (hardware and software) with data and telecommunications technology (data, image, and voice networks). CH 4 History and Evolution of Health Care Information Systems

  3. Administrative Information System • Primarily administrative or financial information • Used to support management functions and general operations • Human Resource Management, Materials Management, Patient Accounting or Billing, Staff Scheduling • Clinical Information System • Contains clinical or health-related information used by providers in diagnosing, treating, and monitoring • Department: radiology, pharmacy, laboratory systems • Clinical decision support: medication admin, CPOE, EMR Types of Health Care Information Systems

  4. History and Evolution

  5. Policy and market innovations and correlations with IT • Demand for IT driven largely by the market (follow the money). The dollar seems to be a better motivator than “doing the right thing” • 1991 IOM report – The Computer-Based Patient Record: an Essential Technology for Health Care • Called on the adoption of computer-based records by the year 2001 • HIPAA in 1996 • IOM: To Err is Human (2000) • IOM Patient Safety: Achieving a New Standard for Care (2004) History and Evolution

  6. The systems • The electronic medical record • CPR(computer-based patient record)EMR • An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff in one health care organization. Ch 5: Current and Emerging Use of Clinical Information Systems

  7. Core Functions • Health information and data (diagnoses, medications, allergies, demographics, narratives) • Results management (test and procedure results) • Order entry and support • Decision support (computerized decision support capabilities such as reminders, alerts and diagnosing) EMR

  8. Practice Fusion EMR Demo • www.Practicefusion.com

  9. HIMSS EMR Adoption Model

  10. HIMMS EMR Adoption Model

  11. HIMMS EMR Adoption Model

  12. HIMMS EMR Adoption Model

  13. Baylor Scott&White (3 Hospitals) • Children’s Medical Center (2 Hospitals) • Texas Health Resources (11 Hospitals) • https://www.himssanalytics.org/emram/stage7caseStudies.aspx Stage 7 Hospitals in Texas

  14. AMA: “The EHR has been reduced to a tool for billing, compliance and litigation that has sustained negative impacts on doctors’ productivity” • Documenting a full clinical encounter is pure torment • The government mandates that doctors use an EHR, the EHR vendors’ templates can create confusion and the appearance of fraud, which opens the door for payers to decline reimbursement. EHRs and Docs

  15. Recent evidence that EHRs perpetuate fraud • Easier to “upcode” • EHRs produce more complete and accurate documentation, and this could be leading medical providers to seek reimbursement for services they have always been providing but weren’t properly documenting before. • CMS has history of billing and so can look for trends in billing. EHRs and Docs

  16. Recommendations: • Code of ethics for both EHR vendors and Users to design and use the systems correctly and shared accountability for ensuring compliant documentation and coding practices AHIMAAmerican Health Information Management Association

  17. Recommendations: • Organization guidelines to assure the features of an EHR are used correctly, addressing issues such as acceptable ways to capture information, limitations on certain features, and correct copy/paste procedures AHIMAAmerican Health Information Management Association

  18. Recommendations: • National set of coding guidelines by CMS • Education and training on EHR use for all who access it. AHIMAAmerican Health Information Management Association

  19. Meaningful Use of Electronic Health Records, April 2011 through May 2012. Adoption of EHR

  20. As of the end of 2012, 62,226 had attested to meaningful use under the Medicare program. • Or about 12.5% of the 509,328 eligible physicians. • 9.8% of specialists • 17.8% of primary care providers • 1.9% in Alaska to 24.2% in North Dakota • Epic, Allscripts, eClinicalWorks, GE Healthcare, and NextGen accounted for almost 60% Physician Adoption

  21. Barriers to Adoption • Cost • Lack of knowledge • Workflow challenges • Lack of interoperability Physician Adoption

  22. 44.4% of acute care hospitals had a basic EHR system in 2012. • It was 12.2% in 2009. Hospital Adoption

  23. Basic vs. Comprehensive EHR

  24. Basic vs. Comprehensive EHR

  25. Basic vs. Comprehensive EHR

  26. Basic vs. Comprehensive EHR

  27. Demographics • As older physicians retire and a new cohort enters, resistance lessens. • Fear factor is dissipating – even among older physicians. Reasons for increases

  28. Government incentives • 2006 HHS granted Stark law exceptions and anti-kickback safe harbors to hospitals so they could help affiliated practices finance EMRs and other technology. • About 1/3 of hospitals have offered financial assistance for EMRs and more than 60% offer physicians access to the hospital’s EMR • HITECH Reasons for increases

  29. Improved Quality, Outcomes, and Safety • Improved Efficiency, Productivity? • Time Savings? • Cost Reduction? • Improved Service and Satisfaction? Value of EMR

  30. Identified by the Leapfrog Group as one of the Four Leaps in Hospital Quality, Safety and Affordability (CPOE, Evidence-Based Referral, ICU “intensivist” staffing, Safe Practice Score). • A CPOE accepts physician orders electronically, replacing handwritten or verbal orders Computerized Provider Order Entry (CPOE)

  31. Also provides decision support at the point of ordering (duplicate test, drug-drug interactions, allergies, etc). Might also show the physician the cost of the drug • Also called CPOM (management) to highlight that it is not just “entering orders” but more about managing orders. Computerized Provider Order Entry (CPOE)

  32. Meditech CPOE Demo • https://www.youtube.com/playlist?list=PLE05A6B2F84BB81E3

  33. CPOE seen as a major obstacle to getting to Meaningful Use. • For Stage 1: • More than 30% of unique patients with at least one medication in their medication list have at least one medication entered using CPOE • For Stage 2: • More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE CPOE Adoption

  34. Involves major change in workflow • Most hospitals have named a Chief Medical Information Officer – physician champion. • Cerner, Eclipsys and Epic are the biggest vendors in CPOE, with Cerner having the most live hospitals. (McKesson and MEDITECH also in game) CPOE Adoption

  35. CPOE Resistance

  36. CPOE and Workflow

  37. About half of medication errors occur during the ordering process (CPOE), but errors also occur in dispensing, administering, and monitoring medications. • Bar-code-enabled point of care (BPOC) • The five rights: • The right drug • to the right patient • through the right route • at the right dose • at the right time. Electronic Medication Administration System eMAR

  38. Patient wristband with barcode • Provider identification band with barcode • Bar-codes on the medication • Linked to orders • http://www.chartmeds.com/Demos.aspx eMAR

  39. The use of medical information exchanged from one site to another via electronic communications to improve patients’ health. • Specialist referral services • Remote patient monitoring • Two delivery methods • Store and forward – digital images from one location to another. Teleradiology and teledermatology https://www.youtube.com/watch?v=UyoooVg0CJQ https://www.youtube.com/watch?v=mXgmX0k1se8 Telemedicine

  40. Interactive videoconferencing – face to face consultation. Urban to rural. • Peripheral devices such as stethoscope • eICU • http://searchhealthit.techtarget.com/definition/Electronic-Intensive-Care-Unit-eICU • Telesurgery Telemedicine

  41. Telehealth includes the use of technology to access remote health information, diagnostic images, and education • Email communication • Refilling prescriptions • Registering patient • Scheduling appointments Telehealth

  42. An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards that can be drawn from multiple sources while being managed, shared, and controlled by the individual • Consumer-empowerment • Comprehensive • Longitudinal • Individual controls Personal Health Record

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