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Informatics > Informatics 4- Electronic Health Records > Flashcards

Informatics 4- Electronic Health Records Flashcards

1
Q

history

A
  • 1970- clinical computer would be common in the not too distant future
  • 1991- institute of medicine (IOM) recommended electronic health records as a solution for many of problems facing modern medicine (replacing staff shortage with computers)
  • the American recovery and reimbursement act (ARRA) of 2009 was a major game changer- meaningful use + certified* EHRs -> makes more money
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2
Q

2 parts of CPU

A
  • arithmetic (AOU) and logic unit
  • control unit- sends information all over the motherboard
  • uses 1 and 0
  • this is why we use 1 and 0
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3
Q

electronic health record definitions

A
  • electronic medical records (EMRs)
  • computerized medical records (CMRs)
  • electronic clinical information systems (ECIS)
  • computerized patient records (CPRs)
  • personal health records (PHRs)
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4
Q

electronic medical record

A
  • an electronic record of health related information on an individual that can be created, gathered, managed and consulted by authorized clinicians and staff within one healthcare organizations
  • individual record seen by one person and one organization**
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5
Q

electronic health record

A
  • an electronic record of health related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization
  • everything else is built around this -> EMR, PHR etc.
  • more than one health care organization**
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6
Q

PHR

A
  • personal health record
  • an electronic record of health related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared and controlled by the individual
  • your health record and only you can use it -> not the orgniazation
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7
Q

needs for electronic health record

A
  • paper records are severely limited
  • illegible handwriting
  • unstructured data
  • expensive to copy, transport and store
  • easy to destroy
  • difficult to analyze and determine who has seen it
  • negative impact on environment
  • slow/difficult retrieval of medical data
  • paper charts are missing as much as 25% of the time
  • accessible to one healthcare worker at a time
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8
Q

need for improved efficiency and productivity

A
  • goal to have patient information available to anyone who needs it, when they need it and where they need it
  • EHRs reduced redundant paperwork and interface with billing programs that submits claims electronically
  • EHRs improve overall office productivity, but increase work of clinicians, particularly with regard to data entry
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9
Q

quality of care and patient saftey

A
  • improved legibility of clinical notes
  • improved access anytime and anywhere
  • reduced duplication
  • reminders of tests or preventive services are due
  • clinical reminders about patient allergies, correct dosage of drugs, etc.
  • electronic problem summary at a gland
  • EHR alone is not enough -> need disease management module
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10
Q

public expectations

A
  • decrease medical errors
  • reduce healthcare costs
  • influence decisions about selecting a personal physician
  • better customer satisfaction through fewer lost charts, faster refills and improved delivery of patient educational
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11
Q

governmental expectations

A
  • EHRs integral to healthcare reform
  • major focal point of the HITECH act
  • goal to have interoperable electronic health records
  • higher quality
  • better outcomes
  • government is the biggest payer of insurance -> better quality -> more pay
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12
Q

financial savings

A
  • EHRs could save $44 billion yearly and eliminate more than $10 in rejected claims per patient per outpatient visit
  • savings from eliminated chart rooms and record clerks; need for transcriptions
  • fewer callbacks from pharmacists
  • reduced labor for copying, faxing and mail expenses, chart pulls and
  • more efficient patient encounters mean more patients
  • decrease malpractice
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13
Q

technological advances

A
  • internet and world wide web make the application service provider (ASP) possible
  • computer speed, memory and bandwidth
  • mobile technologies
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14
Q

best place to store information

A

-nuclear silo

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15
Q

need for aggregated data

A
  • in order to make evidence based decisions, clinicians need high quality data that should:
  • derive from multiple sources: inpatient and outpatient care, acute and chronic care settings, urban and rural care and population at risk
  • accomplished with EHR and discrete structured data
  • healthcare data needs to be aggregated to achieve statistical significance
  • statistics
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16
Q

need for integrated data

A
  • integrate with health information organizations
  • integrate with analytical software for data mining to examine optimal treatments, etc.
  • integrate with genomic data- where/how people live
  • integrate with local, state, and federal governments for quality reporting and public health issues
  • integrate with algorithms and artificial intelligence
  • statistical significant change in treatment
  • powerful
17
Q

EHR as a transformational tool

A
  • improvement in standardization of care, care coordination and population health
  • artificial intelligence and use of computerized simulation models
  • if a certain treatment has a good outcome -> continue care and standardize it
18
Q

need for coordinated care

A

-having more than one physician mandates good communication between the primary care physician, the specialist and the patient

19
Q

institute of medicines vision for EHRs

A
  • key capabilities of an electronic health record system: letter report (2003)
  • 8 core functions for EHRs
    1. health information and data
    2. result management
    3. order management
    4. decision support*** tell you if youre doing the right or wrong thing for the pt. -> looks at stats of treatment and outcomes
    5. (private) electronic communication and connectivity
    6. patient support and education
    7. administration processes and reporting
    8. reporting and population health
20
Q

electronic health records key components

A

Clinical decision support systems (CDSS) to include alerts, reminders and clinical practice guidelines
Secure messaging (e-mail) for communication between patients and office staff and among office staff
An interface with practice management software, scheduling software and patient portal (if present). This feature will handle billing and benefits determination
Managed care module for physician and site profiling
Referral management feature
Retrieval of lab and x-ray reports electronically
Retrieval of prior encounters and medication history
Computerized Physician Order Entry (CPOE) for inpatient and ambulatory order entry
Electronic patient encounter
Multiple ways to input information into the encounter should be available: free text (typing), dictation, voice recognition and templates
Ability to input or access information via smartphone or tablet PC
Remote access from the office, hospital or home
Electronic prescribing
Integration with a picture archiving and communication system (PACS)
Knowledge resources for physician and patient, embedded or linked
Public health reporting and tracking
Ability to generate quality reports for reimbursement
Problem summary list that is customizable and includes the major aspects of care, diagnoses, allergies, surgeries and medications. Also, the ability to label the problems as acute or chronic, active or inactive. Information should be coded with ICD-9/10 or SNOMED CT so it is structured data.
Ability to scan in text or use optical character recognition (OCR)
Ability to perform evaluation and management (E & M) determination for billing
Ability to create graphs or flow sheets of lab results or vital signs
Ability to create electronic patient lists and disease registries
Preventive medicine tracking that links to clinical practice guidelines
Security and privacy compliance with HIPAA standards
Robust backup systems
Ability to generate a Continuity of Care Document (CCD) or Continuity of Care Record (CCR)
Support for client server and/or application service provider (ASP) option

21
Q

computerized physician order entry (CPOE)

A
  • more than just electronic prescribing
  • reduce medication errors
  • embed rules
  • inpatients and outpatient CPOE
  • reduced length of stay and overall costs in addition to decreased medication costs
  • reduce variation of care
  • requires a change in work flow and not just new technology
  • changed EMR forever
  • when from paper to digital
  • tells you when your making a mistake
  • reminds you about things
22
Q

clinical decision support systems (CDSS)

A
  • a broader definition than just alerts and reminders
  • knowledge support
  • calculators
  • graphs and registries
  • medication ordering support
  • computerized reminders
  • order sets (groups of pre-established inpatient orders that are related to a symptom or diagnosis)
  • differential diagnosis (diagnostic possibilities)
  • radiology CDSS
  • laboratory CDSS
  • public health alerts
  • differential diagnosis- it could be this or that -> investigate
23
Q

electronic prescribing

A

-Legible and complete prescriptions that help eliminate handwriting errors and decrease pharmacy “callbacks” and rejected scripts
-Abbreviations and unclear decimal points are avoided
-The wait to pick up prescriptions potentially is reduced
-Fewer duplicated prescriptions
-Better compliance with fewer drugs not filled or picked up
-Potential to reduce workload for pharmacists
-Timely notification of drug alerts and updates
-Better use of generic or preferred drugs
-The ability to check plan-level and patient level formulary status and patient copays
-E-prescribing can interface with practice and drug management software
-The process is secure and HIPAA compliant
-It is the HIT platform for future clinical decision support, alerts and reminders
-Digital records improve data analysis of prescribing habits.
-Ability to look up drug history, drug-drug interactions, allergies and compliance.
-Provides a single view of prescriptions from multiple clinicians
-Applications have the ability to check eligibility, co-pays and it can file drug insurance claims.
-Overall, reduced cost of prescribing
confirmed allergy to a drug, drug-drug interaction, dosage, duplication
-Challenges still exist

24
Q

practice management integration

A
  • designed to capture all of the data from a patient encounter necessary to obtain reimbursement for services provided
  • used to analyze trends and payment management
  • offer patient scheduling software that further increases efficiency -> book appt online
  • PM can be integrated with HER
  • not advisable to combine business aspects of health information with clinical aspects
25
Q

electronic health record and meaningful use challanges

A
  • potential savings, yet expensive
  • physician resistance- more work for clinicians
  • loss of productivity
  • generation of new kinds of errors
  • unfavorable work flow changes
  • reduced physicians patient interaction- focus on technology, not patient -> unfavorable changes in communication patterns and practices
  • learning curve and usability- never ending demands for system changes
  • quality reports tied to physician reimbursements
  • lack of communication standards
  • privacy concerns
  • inadequate proof of benefit
  • overdependence on technology
26
Q

meaningful use of EHR

A
  • improve quality, saftey, efficiency and reduce health disparities
  • engage patients and families
  • improve care coordination
  • ensure adequate privacy and security of personal health information
  • improve population and public health
  • 3 processes to accomplish this are: e-prescribing, health information exchange and the production of quality reports
  • 3 stages- 1st stage (2011-2013), 2nd stage in 2014, and then move to its 3rd stage in 2017 (proposed)
27
Q

logical steps to selecting and implementing an EHR

A
  • practice transformation projects
  • socio-technical economic initiatives
  • not simple IT projects
  • questions to ponder:
  • why is the practice doing this?
  • who should be involved?
  • how will this impact end-users and how should they be prepared?
  • what will be the major barriers?
  • what should the practice start doing now to overcome identified barriers and is it ready for change?
  • how will the change be managed?
  • pre-implementation, implementation and post-implementation
28
Q

pre-implementation

A
  • begins with deciding whether to purchase an EHR and ends with singing a contract with a vendor for a specific HER
  • organizations needs
  • current state
  • selected software’s abilities and limitations
  • choosing EHR that will be used
  • consider critical steps in implementation, such as workflow mapping
29
Q

implementation

A
  • starts with signing of contract and ends with go-live date
  • people, process, or technology issues
  • alternatively: team, tactics and technology
  • key people issues are leadership, change management, goal establishment and expectation setting
  • a project manager, a senior administrative sponsor, and a clinical champion (physician and/or nurse)
30
Q

post-implementation

A
  • remains in effect for the duration of EHR use
  • maintaining, reassessing and improving EHRs content and capabilities, facility workflows/processes, and staff training with a focus on continuous improvement and patient safety
31
Q

data mining

A
  • type in age, range, sex, and key words
  • searches all the patients charts
  • gives you data on patients
  • helps treat the patients
  • powerful

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