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Standard of Electronic Health Record. Definition and Scope. Electronic medical record Departmental EMR Inter-departmental EMR Hospital EMR Inter-hospital EMR Electronic patient record Computerised patient record Electronic health care record Electronic client record Virtual EHR
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Definition and Scope • Electronic medical record • Departmental EMR • Inter-departmental EMR • Hospital EMR • Inter-hospital EMR • Electronic patient record • Computerised patient record • Electronic health care record • Electronic client record • Virtual EHR • Personal health record • Digital medical record • Clinical data repository • Computerised medical record • Population health record
The basic–generic EHR • The basic–generic definition for the EHR is a repository of information regarding the health status of a subject of care, in computer processable form. • no assumptions about the health system of any country or region • no assumptions about the type of information in the record
The shareable EHR The sharing of EHR information can take place at three different levels : • Level 1 • Level 2 • Level 3 = The Integrated Care EHR
Purpose of the EHR(primary) • The primary purpose of the EHR is to provide a documented record of care that supports present and future care by the same or other clinicians. • The primary beneficiaries are the patient and the clinician(s).
Purpose of the EHR(Secondary) • medico-legal – evidence of care provided, indication of compliance with legislation, reflection of the competence of clinicians, • quality management – continuous quality improvement studies, utilisation review, performance monitoring (peer review, clinical audit, outcomes analysis), benchmarking, accreditation, • education – training of clinicians and other health professionals, • research – development and evaluation of new diagnostic modalities, disease prevention measures and treatments, epidemiological studies, population health analysis, • public and population health - access to quality information to enable the effective determination and management of real and potential public health risks. • policy development – health statistics analysis, trends analysis, casemix analysis, • health service management – resource allocation and management, cost management, reports and publications, marketing strategies, enterprise risk management, and • billing/finance/reimbursement – insurers, government agencies, funding bodies.
The key role of interoperability There are two main levels of shareability or interoperability of information: • functional interoperability – the ability of two or more systems to exchange information (so that it is human readable by the receiver) • semantic interoperability – the ability for information shared by systems to be understood at the level of formally defined domain concepts (so that information is computer processable by the receiving system).
four pre-requisites of interoperability • a standardised EHR reference model • standardised service interface models • a standardised set of domain-specific concept models • standardised terminologies
Standard Organization • ASTM(The American Society for Testing and Materials ) • CEN/TC251 (ComitéEuropéen de Normalisation Technical Committee 251 "Health Informatics“) • DICOM(Digital Imaging and Communications in Medicine) • EBI (European BioInformatics Institute) • ETSI (European Telecommunications Standards Institute) • HL7(Health Level 7) • HIMSS(Healthcare Information and Management Systems Society) • IEEE (Institute of Electrical and Electronics Engineers) • ISO/TC215 (International Organisation for Standardization Technical Committee 215 "Health Informatics" ) • OASIS (Organisation for the Advancement of Structured Information Standards) • Regenstrief Institute (Logical Observation Identifiers Names and Codes )
ISO (International Organization for Standardization) is the world's largest developer and publisher of International Standards. • ISO is a non-governmental organization that forms a bridge between the public and private sectors • Founded on 23 February 1947 • It is headquartered in Geneva, Switzerland • ISO has 157 national members
TC 215 - Health informatics Standardization in the field of information for health, and Health Information and Communications Technology (ICT) to achieve compatibility and interoperability between independent systems. Also, to ensure compatibility of data for comparative statistical purposes (e.g. classifications), and to reduce duplication of effort and redundancies.
Organizations in liaison CDISC - Clinical Data Interchange Standards Consortium, Inc. DICOM - Digital Imaging and Communications in Medicine Standards Committee ICN - International Council of Nurses IHTSDO - International Health Terminology Standards Development Organization IMIA - International Medical Informatics Association UNECE - United Nations Economic Commission for Europe W3C - World Wide Web Consortium WHO - World Health Organization
Subcommittee/Working Group • TC 215/WG 1 Data structure • TC 215/WG 2 Data interchange • TC 215/WG 3 Semantic content • TC 215/WG 4 Security • TC 215/WG 5 Health cards • TC 215/WG 6 Pharmacy and medicines business • TC 215/WG 7 Devices • TC 215/WG 8 Business requirements for Electronic Health Records • TC 215/WG 9
ISO TC215 Scope • Health informatics – generally interpreted as ISO/OSI Level 7 • Some groups work in Levels 1-6 by reference to other standards.