12 - Electronic health records, computerized physician order entry (CPOE) and electronic prescribing Flashcards
Describe the historical evolution of the medical record
JUST Diagnosis & Treatment
then
Paper-Based Medical records
many issues
2000s –> wave of medical errors / deaths
ELECTRONIC HEALTH RECORDS
2009 -> Obama –> EHR requirements
then
2014 –> 70% of PCP with EHR
•Define types of electronic patient records and systems
Electronic Medical Record = EMR
medical record in digital format = standard medical/clinical data
Electronic Health Record = EHR
ULTIMATE LEVEL in computerized parient reords
has comprehensive patient history –> accessed by patients
across >1 health care organization
Personal Health Records = PHR
just managed by patient
•List potential benefits of electronic health records (EHR)
File Sharing
Test Results UPDATED
FILING
correct / chronological order
filed in one place
EASILY RETRIEVABLE
•List potential CHALLENGES of electronic health records (EHR)
Lack of USER-FRIENDLINESS
lack of Interoperability
COST
inability to CUSTOMIZE w/o ventdor help
INTERFERENCE w/ patient information
•Identify the required functions of a comprehensive EHR
“Meaningful Use”
Medicare EHR Insentive Program
defined as the use of EHR in a meaningful manner:
–Improving quality, safety, efficiency, and reducing health disparities
–Engage patients and families in their health
–Improve care coordination
–Improve population and public health
–Ensure adequate privacy and security protection for personal health information
•Describe trends in adoption of EHR in the US
- *INCREASED SIGNIFICANTLY**
- *4/5 hospitals** have basic EHR system
due to
PAYMENT INCENTIVES
from the government
Record Adoption / Meaningful Use
HITECH
The Health Information Technology for Economic and Clinical Health Act
provided HHS with the authority to establish programs
to IMPROVE
health care quality / safety / efficiency
through the
PROMOTION OF HEALTH TECHNOLOGY
Incentive payments through MEDICARE / MEDICAID
when they use EHR’s privately/securely
MEANINGFUL USE OF EHR
ONC
Office of the National Coordinator of Health IT
HEALTH IT CERTIFICATION PROGRAM
came in response to HITECH from HHS
containing many detailed requirements,
designed primarily to assure that such technology could support provider qualification for federal incentives
under the CMS EHR Incentive Programs
(health and human services)
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
END of the Meaningful Use Program Incentives
VVV
integrated into the
Medicare Quality Payment Program = QPP
MIPS
Merit Based Incentive Payment System
that integrated:
Meaningful Use = Medicare EHR Incentive Program
+
VBPM = Value Based Payment Modifier
+
PQRS = Physician Quality Reporting Program
Federal HIT Strategic Plan, 2015-2020
Health Information Technology’s
Plan to
guide the nation’s shift toward focusing on better health and delivery system reform
SHARED UNDERTAKING
need efforts of state / local / other stakeholders
Key principles to guide future oversight framework
Health IT & Digital Health
encourage INNOVATION
be RISK-BASED
be STABLE + PREDICTABLE
be ACCOUNTABLE to the public & be enforceable
LEANRING HEALTH SYSTEM
continuous improvement / innovation
Disadvanteges of EHR to
practice’s daily operations
Spending too much time ENTERING DATA
that is NOT directly related to patient care/outcomes
Disrupt practice workflow
EYE CONTACT –> patients
Benefits of PHR
Patient Health Records
EMPOWER patients to be more involved with own Healthdecisions
PROMOTES SELF CARE & RESPONSIBILITY
Challenges of PHR
Patient Health Record
CONSUMER
Awareness / Literacy / Access
Percieved advantages / TRUST
INDUSTRY
EMR inter-operability
certification / security+privacy
sustainability
Trends in Individuals Use of Health IT:
2012 - 2014
- *Almost Half of Americans used a**
- *Selected Type of Health IT**
in 2014
apps / patient portals / websites
Stage 2 of “Meaningful Use”
Advance Clinical Process
2014
INCREASED REQUIREMENTS for E PRESCRIBING
CPOE
Lab Reports / Radiology Tests
Medications / Consultation Requests
Nursing orders
Computer Provider Order Entry
often used in Hospitals / institutional settings
enter ORDERS into COMPUTER rather than writing
CPOE Systems INTERCEPT ERRORS
can integrate orders w/ patient information
CDSS
Clinical Decision Support System
any piece of software
that takes as input information about a clinical situation
and that produces output inferences that
can ASSIST practitioners in their
Decision making & be JUDGED as INTELLIGENT
by the program’s users
CDSS Functions
Integrated into CPOE
default values –> drug doses / routes / frequencies
checks –> allergies / drug-lab value / DI’s
reminders
drug guidelines
or STAND ALONE
to provide advice on:
drug selection / dosage / duration
CDS
Clinical Decision Support
Order-Patient Interaction
Ex.
- *Med-Lab Alert** = HEPARIN ALERT
- *DDI** = drug-drug interaction alert
- *Assessment Prompts**
July 2006 Institute of Medicine Report:
Recommended that all healthcare organizations use
electronic prescribing systems
and other technologies by 2010 to prevent medication errors
CPOE + CDSS
ONLY <2% of hospitals
had FULLY implemented CPOE systems
17% had CPOE in 1 inpatient unit
21.7% of hospitals
reported SOME LEVEL of CPOE
“Leapfrog’s Standard”
BENEFITS of
CPOE / CDSS
HALF of medication errors occur @ the stage of DRUG ORDERING
can reduce errors by 50%+
CPOE can also REDUCE:
length of stay / repeat tests / turnaround lab times
COST
Potential for HARM
of CPOE +/- CDSS
•Incorrect default dosing suggestion
•Entering data for wrong patient
ALERT FATIGUE
–Sensitivity: the ability of capturing true errors
–Specificity: the ability of not setting off false alarm
• Hardware, software instability
Sensitivity vs Specificity
in terms of CPOE / CDSS
Warnings / Alarms
ALERT FATIGUE
Sensitivity:
the ability of capturing TRUE ERRORS
Specificity:
the ability of NOT setting off FALSE ALARMS
_E-prescribing:
Potential benefits_
•Decrease in medication errors
•Time savings
- Patient convenience
- Prompts for drug-specific dosing information
•Expedited refill requests
•Facilitated communication
between physicians, pharmacists, and others
•Validated third-party coverage for formulary drugs
•Reduced costs
- Vital patient-specific information
- More accurate drug databases; checks for interactions
Barriers to increased electronic prescribing
•Insufficient staff training
•Clinician resistance:
may take more time to type than handwrite; physician culture
- Connectivity not universal
- Costs of setting up and maintaining system
- Transaction fees
•Software vendor readiness
(becoming less problematic)
Surescripts
LARGEST Electronic Prescribing Network
networked sytem for electronically accessing
PBM & Prescription History
as well as for
Electronically ROUTING prescriptions –> patient’s pharmacy
NCPDP SCRIPT Standard
Standard created by the National Council for Prescription Drug Programs
there is NOT 1 absoulte standard for EDI
(electronic data interchange)
Standards for electronic transmission of prescriptions
from prescriber to pharmacy
most widely accepted = SCRIPT by NCPDP
see www.ncpdp.org
What has been Driving the Growth in e-Rx ?
- *Government Incentives**
- *MIPPA** = Medical improvement for Phys / Providers Act
- *HITECH** = Health information technology for Economic + Clinical Health
- *Broadening of Certification Programs**
- *CCHIT**
Gvmt + NGO education + awareness programs
STATE & Regional level INITIATIVES
Payer / PBM initiatives
MIPPA
Medicare Improvements for Patients & Providers Act
of 2008
INCREASED
the PERCENT of E-PRESCRIBING
using EHR
Who pays for E-prescribing?
Start-up costs
- *PHYSICIANS**
- MAY pay* for the software, BUT usually insurers subsidize
- *PHARMACIES**
- *MUST PAY** the vendors –> monthly/transaction fees
PAYERS + PBMS
pay TRANSACTION FEES to deliver formulary/benefit info
