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Electronic Health Record

Electronic Health Record. HLST 2040. Agenda. Assignment 2- Changes announced by Sai What is electronic health record (EHR)? •Why do we need EHR system? •What is possible by EHR system? • Who are some vendors? •What are the pros and cons?

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Electronic Health Record

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  1. Electronic Health Record HLST 2040

  2. Agenda • Assignment 2- Changes announced by Sai • What is electronic health record (EHR)? •Why do we need EHR system? •What is possible by EHR system? •Who are some vendors? •What are the pros and cons? •Where do we stand in adoption and what is next?

  3. Assignment 2 • To be done in a group of 3 people – Due Nov.9 • Research the internet and find a healthcare software program. • What does the program do? Who is the vendor who is making it? • How does it help the healthcare professional? How much does it cost? • Is there a sample customer whose story can be cited by you • Only 1 person submits it on behalf of the others

  4. Terminology • Pg.211 of the text •Several terms have been used to describe EHR Book OPINES THAT Electronic Medical Record (EMR) =EHR This is not correct • Computerized Patient Record (CPR) • Computer-based Health Record (CHR) • Longitudinal Patient Record • Electronic Chart

  5. Videos on EHR • The access to information is one of the main barriers that healthcare professionals encounter when trying to increase their efficiency to meet productivity goals. • Provider view • http://www.youtube.com/watch?v=QYXQRA3zgqM • Patient view • http://www.youtube.com/watch?v=cxZy-Vnu0c0&feature=related

  6. Definition of EHR • See pg.210 • The concept of a longitudinal record of patient’s health and healthcare— (ideally) from cradle to grave. • –In theory the EHR is, therefore, a combination of the bulk of the primary care EPR for a patient together with linking information from other record systems for that patient in sufficient detail to all health-care related decision-making.

  7. Need for EHR • Population • Aging & chronic conditions leading to complex health needs with many health visits/encounters • Consumer pressure due to increasing health literacy, Internet as one reason • Increasing Mobility • Changes in family structure

  8. Changing times-EHR is needed • The Old World • Provider-focused • Illness • Site-of-care • Episode Management • Supply Management • Solitary decision making • Efficiency • De-centralized, generalized care • The New World • Patient & family-focused • Wellness • Continuum of care • Disease Management • Demand Management • Collaborative, evidence-based decisions • Effectiveness • Centralized, specialized care

  9. A Typical Year in Canada Source: Canada Health Infoway

  10. Paper-based Records –Ancient classic –Inadequate in meeting the needs of modern healthcare –Inefficient – difficulty in obtaining information –Organized chronologically • Handwriting problems

  11. Advantages of Paper Records • Requires no/little training • Fast for current practice activities • Portable and unbreakable • Accepts many types of data • Low associated costs – view of finance department • Lesser legal aspects – provider view

  12. Disadvantages of Paper Records • Can be lost, incomplete or illegible • Used for only one task at a time • Passive • Laborious storage, retrieval and research • Vulnerable to error (no warnings) • Duplication of information

  13. According to CHI • In contrast to paper-based records, health records stored in electronic format require less space and fewer administrative resources to maintain, • They can be shared and readily accessed by all of an individual’s healthcare providers, regardless of location. • They are also more likely to contain complete and up-to-date personal health information about an individual.

  14. Organization of a paper-based record • Time oriented – According to the date and time of appointment • Source oriented –From where the information is coming • Problem oriented - Arranged according to the problem or disease, then date

  15. Facts, Myths and beliefs • People believe that we already have ehealth/EHR. •The magnitude of the challenge is wildly underestimated at all levels. • Needed investment. • Required time. • Impact of legacy systems and lack of data standards. • Limitations of human resources. • Effects of massive dependence on consultants.

  16. Facts, Myths and Beliefs •The roles of (theoretical and actual) and limitations on various agencies are not understood. •Most believe that other countries and jurisdictions have got it all worked out. •Many think that we know everything we need to know to do it. •Most don’t recognize that many challenges are human-based.

  17. Why should we move to an Electronic Health Record? • The healthcare industry generates more information than any other industry •The healthcare industry is one of the least automated industries • Many other reasons are outlined on the next slide

  18. Functions of the Health Record • Document patient care • Order and result management • Provide electronic communication and connectivity among healthcare team members • Decision Support • Patient support • Provide financial and legal records • Reporting and Population Health • Research • Continuous quality improvement

  19. Current Problems with Electronic Records • Partial records at multiple sites •Within a site, only one copy of the record available. •Charts are unavailable when required for clinical decision making. •Multiple versions of clinical information exist with no clarity as to the most current. •No convenient access to institutional records when required by community physicians.

  20. Components of an EHR • Person Identifier: A universal code that uniquely identifies each individual within the health system. •Facility Identifier: A universal code that uniquely identifies each institution or centre that provides services within the health system. •Provider Identifier: A universal code that uniquely identifies each health care provider within the health system. •Device identifier used to identify major medical devices (e.g. EMRs, x-rays) for audit and evaluation purposes.

  21. Components of EHR-2 • Health Information: Health data in a standardized format (e.g. diagnosis, x-rays, prescriptions) that are the result of interactions between individuals and their health care providers. •Administrative Information: Standardized data that support administrative functions, such as billing.

  22. Source: Canada Health Infoway

  23. What can you see in an EHR? • https://www.infoway-inforoute.ca/images/stories/AnimatedEHRwithCallouts_DH3.gif

  24. Some examples of components of an EHR • Drug information systems (DIS) are a core component of a comprehensive pan-Canadian electronic health record. • The principal objective of the DIS program is to give authorized pharmacists, physicians and nurses access to a patient’s secure and complete medication profile, as well as decision support tools to assist them in improving patient safety and health outcomes.

  25. Video on DIS • Video on how DIS is linking the patient safety to EHR • Better management of chronic conditions

  26. Benefits of an EHR • https://www.infoway-inforoute.ca/index.php/resources/video-gallery/ehr-benefits

  27. Disadvantages of EHR • Considerable start-up costs Hardware, software - PG.216 • Training • Upgrades • Change the organizational culture • Confidentiality and security are serious concerns • Less-portable; breakable • Who will enter data? • Personnel reduced in some areas • Increased for system maintenance • Downtime

  28. Challenges to implementing EHR • Listed on pg.220 • Organizational Culture – pg. 224 • Cost • Lack of standards – A few years ago there was a dispute between the Vendors and the provinces • www.cmaj.ca/content/182/9/888.full • Lack of policies data privacy, confidentiality and security –pg. 222 • Consumer buy-in •difficulties in integration with other systems

  29. EHR Problems from an IT Implementation perspective

  30. Main Problems in Implementation • To succeed in the automation of healthcare information, three fundamental issues must be addressed: • Capture • Manage • Exchange

  31. Capture • Inputs – processes capturing different types of information notes of healthcare professionals • data from patients • Data generated from practice management tasks Scheduling • Billing • reports of prescriptions • Lab tests • Radiology •Outputs – information provided to different users • healthcare professionals: direct or sharing • patients • secondary users

  32. 2nd Problem- Management • Multiple sources and types of health-related data bring need for health information management •This management is achieved through the aggregation and analysis of collected data Requires structured and codified data elements •The structured and codified EPR provides full management capability for data related to: • Disease • Patient • Practice • Population

  33. 3rd Problem- Exchange • Electronic exchange of healthcare information is achieved through: • Task-related transactions usually using HL7 protocol • Billing, laboratory results, prescriptions and x-ray reports • Access to an EMR or file through a secure connection on a LAN, WAN or over the Web • Reports exchanged via e-mail • Secure full chart exchange, collaboration and synchronization through the Web

  34. Ontario’s Vision for Year 2020 • All Ontario hospitals will have integrated, shared health records for kids and adults • •Cancer patients, cardiac patients, chronic and rehab patients, emergency patients will all have electronic charts accessible to their health care providers throughout Ontario • •Health care decisions will be based on all data, information and knowledge available to providers, regardless of location

  35. Benefits of Electronic Health Record to Patients • improved health care and decreased risks • integrated health services • do not have to repeat basic information, such as name, address • increased confidence knowing that all health care professionals have access to all relevant parts of their medical history • access to their own health records helps patients to make informed decisions about their health • avoidance of duplicate, invasive and/or expensive tests • reduced waiting lists

  36. Vendors of Electronic Health Records • xWave • Cerner Powerchart • Telus Electronic Health Record • Allscripts

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