Electronic Health Records

1. Electronic Health Records Bruce Slater, MD, MPH University of Wisconsin School of Medicine and Public Health b.slater@hosp.wisc.edu

2. Objectives • Compare the History of Paper and Electronic Patient Records • Describe Major Elements of the Electronic Health Record • Explain how the Electronic Health Record is Different to the Paper Patient Chart

3. Introduction • Healthcare lags in information system use • Computers are used in financial transactions • Some clinicians use the web for information • Only a few MDs store records electronically • Computers could solve efficiency, access and quality needs for providers who adopt

4. Definitions • EPR - Electronic Patient Record • EMR - Electronic Medical Record • CbPR - Computer-based Patient Record • CPRS - Computer Patient Record System • EHR – Electronic Health Record • Client-Server • ASP - Application Service Provider

5. History of Physical Records • Shaman - oral traditions • Hospitals - written ward records • Florence Nightingale - patient records • Source Oriented Records • Problem Oriented Records • Lost & Incomplete Records

6. History of Virtual Records • PROMIS - Problem Oriented Medical Information System - Larry Weed, MD • COSTAR - Computer Stored Ambulatory Record • Practice Partner • Medicalogic/Logician/GE Centricity • EpicCare • The Web

7. History of Virtual Records • PROMIS - Problem Oriented Medical Information System - Larry Weed, MD • COSTAR - Computer Stored Ambulatory Record • Practice Partner • Medicalogic/Logician/Centricity • EpicCare • The Web

8. Elements of Paper Medical Records • Physical Folder • Labels and Flags • Demographic and Insurance Page • Problem and Medication/Allergy List • Dividers • Progress Notes and Consults • Results of Tests and Imaging

9. Elements of Paper Medical Records • Physical Folder • Labels and Flags • Demographic and Insurance Page • Problem and Medication/Allergy List • Dividers • Progress Notes and Consults • Results of Tests and Imaging

10. Elements of Paper Medical Records • Physical Folder • Labels and Flags • Demographic and Insurance Page • Problem and Medication/Allergy List • Dividers • Progress Notes and Consults • Results of Tests and Imaging

11. Elements of Electronic Health Records • No Physical Location - a Virtual Record • Multiple kinds of Labels and Flags • Demographic and Insurance Tables • Problem/Medication/Allergy Checking • Dividers of any kind imaginable • Progress Notes and Consults • Results and Actual Tests and Imaging

12. Elements of Electronic Health Records • No Physical Location - a Virtual Record • Multiple kinds of Labels and Flags • Demographic and Insurance Tables • Problem/Medication/Allergy Checking • Dividers of any kind imaginable • Progress Notes and Consults • Results and Actual Tests and Imaging

13. Security Transportability Flexibility Consistency Reminders Intelligence Link-Outs Provider Education Patient Education Patient Participation Problem Orientation Audit Demand Management Access Management Elements of Electronic Health Records not in Paper Records

14. Security Transportability Flexibility Consistency Reminders Intelligence Link-Outs Provider Education Patient Education Patient Participation Problem Orientation Audit Demand Management Access Management Elements of Electronic Health Records not in Paper Records

15. Security Transportability Flexibility Consistency Reminders Intelligence Link-Outs Provider Education Patient Education Patient Participation Problem Orientation Audit Demand Management Access Management Elements of Electronic Health Records not in Paper Records

16. Security Transportability Flexibility Consistency Reminders Intelligence Link-Outs Provider Education Patient Education Patient Participation Problem Orientation Audit Demand Management Access Management Elements of Electronic Health Records not in Paper Records

17. Electronic Health Records in Electronic Commerce • Merge into Patient’s and Provider’s Lives • Create a Need • Fulfill the Need • Extend the Need • Assimilate Information into their Lives

18. Electronic Health Records and the Clinical Data Repository • Patient-centered Real-time • Operational Coded • Clinical Data • Data Dictionary • Provider Interface is Built on the Repository • Population based Care and Research

19. Examples • Practice Partner • Logician Internet • Patient Profile v 4.0

20. Practice Partner Screen shot here then demo

21. Logician Internet

22. Patient Profile v4.0

23. Summary/Conclusions • Electronic Health Records will change healthcare • We have only seen the first engagements of the war between the bricks and the clicks • The next conflict will be bricks versus bricks with clicks. • Patients may be able to shape the future

24. Questions and Discussion