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HIS and EHR. HIMA 4160 Fall 2009. Acronyms. HIS: Health Information Systems EHR: Electronic Health Records EMR : Electronic Medical Records. Data, Information, and Knowledge. Level of conception. Data – factual Information – meaning of data Knowledge – model for information. Example.

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his and ehr

HIS and EHR

HIMA 4160

Fall 2009

acronyms
Acronyms

HIS: Health Information Systems

EHR: Electronic Health Records

EMR: Electronic Medical Records

HIMA 4160 Fall 2009

data information and knowledge
Data, Information, and Knowledge
  • Level of conception.
  • Data – factual
  • Information – meaning of data
  • Knowledge – model for information

HIMA 4160 Fall 2009

example
Example
  • Data – Body temperature 103
  • Information – The patient is having a fever
  • Knowledge -- The knowledge used to generate the information: if a patient temperature is > 100 F, he might a fever (or hyperthermia).

HIMA 4160 Fall 2009

data information knowledge
Data Information Knowledge

Concrete

Abstract

Factual

Conceptual

Volatile

Stable

HIMA 4160 Fall 2009

information system
Information System
  • General term cover all three levels
  • Database – data level
  • Information storage and retrieval system – information level
  • Knowledge system – knowledge level

HIMA 4160 Fall 2009

components
Components

Information System

HIMA 4160 Fall 2009

where is the information system located
Where is the information system located?
  • In-house – developed and managed in the health care organization
  • Shared – developed and managed at the vendor site
  • Turnkey system – developed by vendor, installed and managed by health care organization
  • Stand-alone – lack of information sharing. Legacy system.

HIMA 4160 Fall 2009

trends of health care information systems
Trends of Health care Information Systems
  • Integration
  • Continuality
  • Standards
  • Consumer oriented

HIMA 4160 Fall 2009

current applications of information systems in health care
Current applications of information systems in health care
  • Clinical information systems – serving clinical activities
    • Hospital information system
    • Patient monitoring system
    • Nursing information system
    • Laboratory information system
    • Pharmacy information system
    • Computer based patient record
    • Others

HIMA 4160 Fall 2009

hospital information systems
Hospital Information Systems
  • Provide communication among health facility workers and support organizational information needs for operations, planning, patient care, and documentation.
  • Communication, coordination
  • Various across different hosptials

HIMA 4160 Fall 2009

freidman and martin model
Freidman and Martin Model

HIS should have following functions

  • Central application
  • Business and financial function
  • Communications and Networking
  • Department management
  • Medical documentation
  • Medical decision support

HIMA 4160 Fall 2009

core hospital function
Core hospital function
  • Patient management
    • Scheduling
    • RADT (registration, admission, discharge, and transfer)
    • RADT provides basic patient information to other clinical systems.

HIMA 4160 Fall 2009

business and financial functions
Business and financial functions
  • Payroll
  • General ledger
  • Accounts receivable
  • Insurance

HIMA 4160 Fall 2009

communications and network
Communications and Network
  • Connect different systems.
  • Need data standards to communicate.
  • This is a disadvantage of paper based system.

HIMA 4160 Fall 2009

departmental management system
Departmental management system
  • Needs of individual department
  • Pharm, lab, radiology, dietary, pathology, etc
  • The trend is to integrate these systems while maintaining their functional independence.

HIMA 4160 Fall 2009

medical documentations system
Medical documentations system
  • Medical record
  • Will be paperless
  • Provide support to managerial and administrative decision making
  • In order to do so, the medical record has to be digitalized and codified.

HIMA 4160 Fall 2009

decision support system
Decision support system
  • Help clinicians make decision
  • Not replace clinicians
  • data from various sources – hard to managed by human
  • Often integrated into physician order entry system
  • focal role in decreasing medical errors

HIMA 4160 Fall 2009

patient monitoring system
Patient monitoring system
  • Physiological data
  • Emergency room, operating room, intensive are, critical care
  • Can give real time alert

HIMA 4160 Fall 2009

nursing information system
Nursing information system
  • Support nurse care process
  • Clinical and managerial

HIMA 4160 Fall 2009

laboratory information system
Laboratory Information System
  • Associated with lab test
  • Usually already available in the instrument
  • Various types of lab tests have different demands

HIMA 4160 Fall 2009

pharmacy information system
Pharmacy Information System
  • Data related to drug usage for patient
  • Also can help decreasing medication errors

HIMA 4160 Fall 2009

computer based patient record
Computer based patient record
  • IOM 1991 report first proposed the concept
  • Other names include electronic health record (EHR), electronic medical record (EMR).
  • It is not a single computer product or program
  • Based an changed model of managing patient data
  • Computer and information technology is necessary but not sufficient factor.

HIMA 4160 Fall 2009

current status
Current status
  • Focus on integration
  • Government support
    • http://www.cnn.com/2004/ALLPOLITICS/04/27/bush.healthcare.ap/
    • National Health Information Infrastructure
    • ARRA
  • Standardization
    • HL7

HIMA 4160 Fall 2009

administrative and management applications in health care
Administrative and Management Applications in Health care
  • Financial information system
  • Accounting information systems
  • Human recourse management information systems
  • Material management information system
  • Facilities management information system
  • Management planning and decisin support system

HIMA 4160 Fall 2009

trends in health information system
Trends in Health Information System
  • Computer based patient record
    • National health information infrastructure
    • Medical errors
  • E-Health and e-HIM
    • Web based technology
  • Standards
  • Privacy and Security
  • Technology
    • Wireless
    • Voice recognition
    • Data warehouse and data mining
  • Enterprise information management
  • Virtual information system – results of integration, standardization, and personalization.

HIMA 4160 Fall 2009

what is an electronic health record
What is an Electronic Health Record?

Before we answer that, what is a patient record?

  • commonly referred to as the patient's chart or medical record
  • amalgam of all the data acquired and created during a patient's course through the heath care system

HIMA 4160 Fall 2009

purpose of a patient record
Purpose of a Patient Record

"to recall observations, to inform others, to instruct students, to gain knowledge, to monitor performance, and to justify interventions"

Reiser, S. (1991). The Clinical Record in Medicine. Part 1: Learning from Cases. Annals of Internal Medicine, 114(10): 902-907

HIMA 4160 Fall 2009

purpose of patient records
Purpose of Patient Records
  • create the basis for the historical data
  • support communication among providers
  • anticipate future health problems
  • record standard preventive measures
  • identify deviation from expected trends
  • provide a legal record
  • support clinical research and public health

HIMA 4160 Fall 2009

weakness of the paper record system
Weakness of the Paper Record System
  • Pragmatic and Logistical issues.
    • Can I find the data I need when I need them?
    • Can I find the medical record in which they are recorded?
    • Can I find the data within the record
    • Can I find what I need quickly?
    • Can I read and interpret the data once I find them?
    • Can I update the data reliably with new observations in a form consistent with the requirements for future access by me or other people?
  • Redundancy and Inefficiency
  • Influence on Clinical Research

HIMA 4160 Fall 2009

difference between paper and electronic health records
Difference between Paper and Electronic Health Records
  • Accessibility
  • Legibility
  • Adaptive
  • Structure
  • Reusability
  • Flexibility

HIMA 4160 Fall 2009

value of an ehr is determined by
Value of an EHR is determined by
  • Comprehensiveness of information
  • Duration of use and retention of data
  • Degree of structure of data
  • Ubiquity of access

HIMA 4160 Fall 2009

influences on ehr
Influences on EHR
  • Disease Pattern Change
  • Health Care Delivery System Change
  • Specialization of Medicine
  • Advances of Computer and Information Technology

HIMA 4160 Fall 2009

primary and secondary uses of an ehr
Primary and Secondary Uses of an EHR
  • Primary Uses
    • Patient Care Delivery
    • Patient Care Management
    • Patient Care Support Processes
    • Financial and Other Administrative Processes
    • Patient Self-Management
  • Second Uses
    • Education
    • Regulation
    • Research
    • Public Health and Homeland Security
    • Policy Support

HIMA 4160 Fall 2009

core functionalities
Core Functionalities
  • Health Information and Data
  • Results management
  • Order entry/management
  • Decision support
  • Electronic communication and connectivity
  • Patient support
  • Administrative processes
  • Reporting and population health management

HIMA 4160 Fall 2009

health information and data
Health Information and Data
  • Key Data
    • Problem list
    • Procedures
    • Diagnoses
    • Medication list
    • Allergies
    • Demographics
    • Diagnostic test results
    • Radiology results
    • Health maintenance
    • Advance directives
    • Dispositions
    • Level of service

HIMA 4160 Fall 2009

health information and data1
Health Information and data
  • Minimum Data Set (MDS) for nursing homes
    • From CMS
    • Support Long Term Care
    • Current Version 3.0

HIMA 4160 Fall 2009

health information and data2
Health Information and Data
  • Narrative (clinical and patient narrative)
    • Free text
    • Template based
    • Deriving structures from unstructured text
      • NLP
    • Structured and coded
      • Signs and symptoms
      • Diagnoses
      • Procedures
      • Level of service
    • Treatment plan
      • Single discipline
      • interdiscipline

HIMA 4160 Fall 2009

health information and data3
Health Information and Data
  • Patient Acuity/Severity of Illness/ Risk Adjustment
    • Nursing workload
    • Severity adjustment
  • Capture of identifiers
    • People and roles
    • Products/devices
    • Places (including directions)

HIMA 4160 Fall 2009

results management
Results Management
  • Results Reporting
    • Laboratory
    • Microbiology
    • Pathology
    • Radiology
    • Consult
  • Results notification
  • Multiple views of data/presentations
  • Multimedia support

HIMA 4160 Fall 2009

order entry management
Order Entry/Management
  • Computerized provider order entry
    • Electronic prescribing
    • Laboratory
    • Microbiology
    • Pathology
    • Radiology
    • Ancillary
    • Nursing
    • Supplies
    • Consults

HIMA 4160 Fall 2009

decision support
Decision Support
  • Access to knowledge sources
    • Domain knowledge
    • Patient education
  • Drug alert
    • Drug dose defaults
    • Drug dose checking
    • Allergy checking
    • Drug interaction checking
    • Drug-lab checking
    • Drug-condition checking
    • Drug-diet checking

HIMA 4160 Fall 2009

decision support1
Decision Support
  • Other rule-based alert (e.g., significant lab trends, lab test)
  • Reminders
    • Preventive services
  • Clinical guidelines and pathways
    • Passive
    • Context-sensitive passive
    • Integrated
  • Chronic Disease Management

HIMA 4160 Fall 2009

decision support2
Decision Support
  • Clinician work list
  • Incorporation of patient and/or family preference
  • Diagnostic decision support
  • Use of epidemiologic data
  • Automated real-time surveillance
    • Detect adverse vents and near misses
    • Detect disease outbreaks
    • Detect bioterrorism

HIMA 4160 Fall 2009

electronic communication and connectivity
Electronic Communication and Connectivity
  • Provider to provider
  • Team coordination
  • Patient-provider
    • Email
    • Secure web messaging
  • Medical Devices
  • Trading partners (external)
    • Outside pharmacy
    • Insurer
    • Laboratory
    • Radiology
  • Integrated medical record
    • Within setting
    • Cross-setting
      • Inpatient-outpatient
      • Other cross-setting
    • Cross-organizational

HIMA 4160 Fall 2009

patient support
Patient Support
  • Patient education
    • Access to patient education materials
    • Custom patient education
    • Tracking
  • Family and informal caregiver education
  • Data entered by patient, family, and/or informal caregiver
    • Home monitoring
    • Questionnaires

HIMA 4160 Fall 2009

administrative processes
Administrative Processes
  • Scheduling management
    • Appointments
    • Admissions
    • Surgery/procedure schedule
  • Eligibility determination
    • Insurance eligibility
    • Clinical trial recruitment
    • Drug recall
    • Chronic disease management

HIMA 4160 Fall 2009

reporting and population health management
Reporting and Population Health Management
  • Patient safety and quality reporting
    • Clinical dashboard
    • External accountability reporting
    • Ad hoc reporting
  • Public health reporting
    • Reportable diseases
    • Immunizations
  • De-identifying data
  • Disease registry

HIMA 4160 Fall 2009

ehr adoption
EHR adoption
  • Ambulatory (NEJM 2008)
    • 4% fully functional EHR
    • 13% basic system
    • Small and solo practices struggle

HIMA 4160 Fall 2009

ehr adoption1
EHR Adoption

HIMA 4160 Fall 2009

barriers
Barriers
  • Standardization of Clinical Information
  • Cost of implementation and maintenance
  • Physicians' readiness to adopt the EHR
  • Privacy issues and patients’ concerns with information sharing.
  • Legal liability

HIMA 4160 Fall 2009