IPC final exam - lab values, medical records Flashcards
Laboratory values are ____ data that complement the clinical impression
SOAP
S: Subjective
O: Objective lab values in this portion
A: Assessment
P: Plan
lab data is objective data
Clinical Pearls When Interpreting Lab Data
are normal values the same between labs
do normal values vary based on age, gender, weight and height, what is an example
Laboratory errors can happen due to
technical error, what are some errors that could happen
- math
- specimen
- time
- preservative
- food substance affecting what
what should be done if lab error is expected
Normal values may vary from lab to lab depending on the techniques and reagents used
- MCPHS reference lab values document on Bb (no need to memorize it!)
Normal values may vary depending on the patient’s age, gender, weight, height
- Example: hematocrit/hemoglobin
Laboratory errors can happen due to
technical error
- improper calculation
- inadequate specimen
- incorrect sampling timing
- improper sample preservation
- food substances affecting specimen
- medication interference with lab tests
If laboratory error is suspected, the test should be repeated
Lab values present a ____ of what is going on with the ____!
what should you look for
what should you think about
Patient: 140 mEq/L, are they in the normal range for Na+
Lab values present a snapshot of what is going on with the patient!
Look at previous labs
Look at trends
Think about which labs need to be ordered
Think how frequently labs should be ordered
the normal range for Na+:
135-147 mEq/L
The PATIENT is in the normal range!
Complete Blood Count (CBC) provides values for:
Harry
Had a
White
Robe but
Molly
Made
Macaroni
Pie
Hemoglobin (Hgb)
Hematocrit (Hct)
White blood cells (WBCs)
Red blood cells (RBCs)
Mean corpuscular volume (MCV)
Mean corpuscular hemoglobin (MCH)
Mean corpuscular hemoglobin concentration (MCHC)
Platelets (Plt)
Basic metabolic panel (BMP) or Chem-7 includes:
Suzie
Plays the
Clarinet
But
Bobby plays
Chess really
Good
Sodium (Na+)
Potassium (K+)
Chloride (Cl-)
Bicarbonate (HCO3-)
Blood urea nitrogen (BUN)
Creatinine (SCr)
Glucose (Glu)
this is what the fish bone displays :)
Comprehensive metabolic panel (CMP) includes:
Ally
Always
Asks
Awesome
Thoughts
Constantly
BMP or Chem-7
Albumin
Alkaline phosphatase (ALP)
Alanine aminotransferase (ALT)
Aspartate aminotransferase (AST)
Total bilirubin
Calcium
some are liver function test
Liver function tests (LFTs) may vary slightly between labs, but generally include what molecules and tests
Always
Asks
And trust
God
Totally
Always
Pray
Intentionally
Aspartate Aminotransferase (AST)
Alanine Aminotransferase (ALT)
Alkaline Phosphatase (ALP)
gamma - Glutamyl Transpeptidase (GGT)
Total bilirubin
Albumin
PT
INR
what is Sensitivity of a test
what is a highly sensitive test
what is specificity of a test
what is a highly specific test
what is the ideal test, what are examples
how much Sensitivity & Specificity does the home pregnancy test have and if what
The sensitivity of a test is its ability to designate an individual with a disease as positive.
A highly sensitive test = with few false negative results, = and fewer cases of disease are missed
Example: COVID-19 test: Antigen test versus PCR
- so patient really has the disease
The specificity of a test is its ability to designate an individual who does not have a disease as negative.
A highly specific test = with few false positive results
Example: pregnancy test, rapid strep test
An Ideal test is highly sensitive and highly specific
Home pregnancy tests have 100% sensitivity and specificity if hCG ≥ 25 mIU/mL
- Reminder: watch the YouTube video posted on Bb
Shorthand Schematics or “Fishbones”
what molecules does it contain
what is the position of each
Hgb at the __ o’clock
Plt at __ o’clock
Hct at __ o’clock
WBC at ___ o’clock
Na, Cl, BUN in the ___ row
K, CO2 (or HCO3-), SCr in ___ row
blood glucose at far ____
and X and fishbones
with:
Hgb
Plt
Hct
WBC
memorize the position
Hgb at the 12 o’clock
Plt at 3 o’clock
Hct at 6 o’clock
WBC at 9 o’clock
Na, Cl, BUN in the top row
K, CO2 (or HCO3-), SCr in bottom row
blood glucose at far right
Causes of hypERnatremia:
- high [ ] of ___
- water
what kind of drug can cause this
Causes of hypOnatremia:
- XS of what
- what 3 diseases is associated with this
- what drug can cause this
Causes of hypERnatremia:
- ↑ Na+ intake
- Dehydration:
—-Gastroenteritis
—–Diabetes insipidus (DI)
Drugs:
- Hypertonic saline
Causes of hypOnatremia:
- Excess body water (dilutional hyponatremia),
for example:
- Heart failure
- cirrhosis
- SIADH (fluid overload)
Drugs from Top 200:
Thiazide diuretics:
- chlorthalidone
- HCTZ
Sodium (Na+) - Normal range: 135-147 mEq/L
Causes of hypERchloremia:
- water
- DI
Causes of hypOchloremia:
- puke
- SI..
- what drugs can cause this
Causes of hypERchloremia:
- Dehydration
- Diabetes insipidus
Causes of hypOchloremia:
- Prolonged vomiting (lose Cl from stomach)
- SIADH
Drugs from Top 200: Acid suppressants because they decrease HCl production:
H2 blockers:
- famotidine
PPIs:
- omeprazole, pantoprazole, esomeprazole, lansoprazole, dexlansoprazole
CHLORide (Cl-) - Normal range: 95 – 105 mEq/L .
Potassium (K+) - Normal range: 3.5 – 5 mEq/L.
Causes of hypERkalemia:
- what organ failure
- water
- massive ____ damages from what
- what about the blood specimen
what Drugs from Top 200 can cause this
Causes of hypOkalemia:
- lose of what
what Drugs from Top 200 can cause this
Causes of hypERkalemia:
- Renal failure
- Dehydration
- Massive cell damage: burns, injuries
- Hemolyzed blood specimen (falsely elevated)
Drugs from Top 200:
- ACEIs: quinapril, Ramipril, benazepril, enalapril, lisinopril
- ARBs: losartan, valsartan, irbesartan
- Potassium-sparing diuretics: Spironolactone
- Others drugs: Potassium supplements
Causes of hypOkalemia:
- Severe diarrhea and/or vomiting
Drugs from Top 200:
- Thiazide diuretics: chlorthalidone, HCTZ
- Loop diuretics: furosemide
CO2 content or HCO3- Normal range 22 – 28 mEq/L
Causes of increased CO2 content
- metabolic what
Causes of decreased CO2 content
- metabolic what
what Drugs from Top 200 can cause this
CO2 content vs CO2 gas (lungs; acidic)
Causes of increased CO2 content
- Metabolic alkalosis
Causes of decreased CO2 content
- Metabolic acidosis
Drugs:
- salicylate toxicity
Do not confuse CO2 content with CO2 gas
- CO2 content in plasma is mostly HCO3- , regulated by the kidneys, & is a base
- CO2 gas is regulated by the lungs & is acidic
Blood Urea Nitrogen (BUN) is a marker of renal function. Urea nitrogen is produced in the liver (from protein breakdown) blood cleared by kidneys (Normal range 6 – 20 mg/dL)
Causes of ↑ BUN (Azotemia)
- what organ failure
- high what diet
- water
what Drugs from Top 200 can cause this
Causes of ↓ BUN
- what organ failure
Causes of ↑ BUN (Azotemia)
- Acute or chronic renal failure
- High-protein diet
- Dehydration
Drugs that are nephrotoxic:
- From Top 200: NSAIDs ibuprofen
Causes of ↓ BUN
- Liver failure
Serum Creatinine (SCr): product of normal breakdown of muscle tissue and is excreted by glomerular filtration in the kidneys = marker of renal function (Normal range: 0.6 – 1.2 mg/dL)
Causes of increased SCr
- what organ dysfunction
- water
- workout
What drugs can cause this
Causes of decreased SCr
- muscle
Causes of increased SCr:
- Renal dysfunction
- Dehydration
- Vigorous exercise (just like for increase Hgb!)
Drugs: nephrotoxic drugs
- from Top 200:
Acyclovir, NSAIDs, cyclosporine
Causes of decreased SCr
Inactive elderly (low muscle mass)
Glucose - Normal range 70 – 99 mg/dL
Causes of hypERglycemia
- DM
- what kind of infection
What drugs can cause this
Causes of hypOglycemia
- missing what
What drugs can cause this
Causes of hypERglycemia
- Diabetes mellitus (DM)
- Sepsis - blood infection
Drugs from Top 200:
- Corticosteroids: prednisone, prednisolone, methylprednisolone
- Atypical antipsychotics: aripiprazole, risperidone, quetiapine, olanzapine
Causes of hypOglycemia
Missing a meal
Drugs from Top 200:
- sulfonylureas: glimepiride, glipizide, glyburide
- Insulin overdose
Calcium (Ca): 98-99% in skeletal bones & teeth, remainder in blood, muscles, other tissues (Total Ca normal range: 8.5 – 10.5 mg/dL)
In the blood how much calcium is in an ionized “free” state what does it do
In the blood how much calcium is bound to proteins (albumin)
what can occur due to low albumin levels
what kind of Ca2+ is usually reported in labs
In the blood
≈ half of the calcium is in an ionized “free” state exerts physiologic functions
≈ half of the calcium is bound to proteins (albumin)
Pseudohypocalcemia can occur due to low albumin levels
- calculate corrected calcium when albumin < 4 g/dL
total Ca is usually reported in labs
Corrected calcium = reported serum calcium + 0.8 (4 – patient’s albumin) - for therapeutics
Some causes of Calcium imbalance
Causes of hypERcalcemia
Drugs:
- what drug toxicity
- from top 200
Causes of hypOcalcemia
- what deficiency
- what disease
Drugs from Top 200:
Causes of hypERcalcemia
- Malignancies
Drugs:
- Vitamin D toxicity
- From Top 200: Thiazides: HCTZ, chlorthalidone
Causes of hypOcalcemia
- Vitamin D deficiency
- Renal disease
Drugs from Top 200:
- Loop diuretics: furosemide
SIADH - what is it referring to
DI - is Na+ high or low
SIADH - soaked inside
In DI, sodium is high
what % are RBC, WBCs/Plt, Plasma in spun down sample
RBCs are about ___%
WBCs and Plt about __%
plasma about ___%
what does the plasma have
RBCs are about 40-45%
WBCs and Plt about 5%
plasma about 55%
plasma has Chem-7
sodium and chloride relationship
go up together and go down together
calcium & phosphorus relationship
more calcium = less phosphate
less calcium = more phosphate
Phosphate (PO4-) - Normal range: 2.5 – 4.5 mg/dL
Causes of hypERphosphatemia
- what organ dysfunction
- increased what intake
what drugs cause this
Causes of hypOphosphatemia
- is the nutrition good
what drugs cause this
Causes of hypERphosphatemia
- Renal dysfunction
- Increased phosphate intake
Drugs:
- Increased vitamin D intake
- Laxatives
Causes of hypOphosphatemia
- Malnutrition
Drugs:
- Overuse of aluminum-containing antacids
- Overuse of calcium-containing antacids
Magnesium (Mg) - Normal range 1.5 – 2.4 mEq/L
Causes of hypERmagnesemia
- what is the one cause
What drugs cause hypermagnesmia
Causes of hypOmagnesemia
- rectal
- food
- poor
What drugs cause this
Causes of hypERmagnesemia
Renal failure
Drugs:
- Magnesium supplements
- Magnesium-containing antacids
- Magnesium-containing laxatives
Causes of hypOmagnesemia
- Diarrhea
- Vomiting
- Malabsorption
Drugs from Top 200:
- furosemide, HCTZ, chlorthiazide
- PPIs (example: omeprazole, pantoprazole, esomeprazole, lansoprazole, dexlansoprazole)
Albumin: a predominant serum-binding protein that transports various substances including medications. It is synthesized only in the liver(Normal range: 3.5 – 5 g/dL)
Causes of hypOalbuminemia
- cirrhosis in what organ
- is the nutrition good
- syndrome where
Causes of hypOalbuminemia
- Liver cirrhosis(defective synthesis)
- Malnutrition (decreased synthesis)
- Nephrotic syndrome (increased loss)
One consequence of hypoalbuminemia
One consequence of hypoalbuminemia is that drugs that are usually protein-bound become free in the plasma, allowing for higher drug levels, more rapid hepatic metabolism, or both
Complete Blood Count (CBC) Complete Blood Count (CBC)
WBC
Hgb
Hct
RBC
Reticulocytes
Red Blood Cells Indices (MCV, MCH, MCHC), Platelets
White Blood Cell (WBC) count = leukocyte count: total number of WBCs in a given volume of blood (Normal range: 3.2 – 11.3 x 103 cells/mm3)
never let monkeys eat bananas- what does each first letter indicate
Causes of increased WBCs/Leukocytosis
- what does left shift mean
- what else could be going on
drugs
Causes of decreased WBCs/Leukopenia
- what kind of therapy
never let monkeys eat bananas
- neutrophils
- lymphocytes
- monocytes
- eosinophils
- basophils
Causes of increased WBCs/Leukocytosis
- Infection
- Leukemia
“left shift” refers to infection or leukemia, increase in bands (immature neutrophils)
- Trauma, stress
Drugs from Top 200: corticosteroids: - prednisone, prednisolone, methylprednisolone
Causes of decreased WBCs/Leukopenia
Drugs:
- Chemotherapy
Red Blood Cell (RBC) count = Erythrocyte Count: Actual amount of RBCs per unit of blood (Normal range: M: 4.3 – 5.9 x 106 cells/microliter, F: 3.5 – 5 x 106 cells/microliter)
how many Hgb does a single erythrocyte have
A single erythrocyte can contain 300 million hemoglobin (Hgb) molecules, therefore, conditions that affect Hgb count will affect RBC count
Hemoglobin (Hgb) is the oxygen-carrying compound found in RBCs (Normal range for adults: M: 14 – 18 g/dL, F: 12 – 16 g/dL)
Causes of increased Hgb:
- smoking
- smokers
- gym
- mountain
- a type of cancer
Causes of decreased Hgb:
- are there enough blood cells
- is there blood retained
- having a baby?
drugs
- glucophage
- ibuprofen, naproxen pharm category
Causes of increased Hgb:
- COPD
- Chronic smokers
- Regular vigorous exercise
- Living at high altitude
- Polycythemia vera: a cancer that produces a lot of RBCs
Causes of decreased Hgb:
- Anemia
- Blood loss
- Pregnancy
Drugs from Top 200:
- Metformin
- NSAIDs (may cause bleeding): ibuprofen, naproxen, meloxicam, diclofenac, celecoxib
Hematocrit (Hct): percentage volume of blood occupied by RBCs.AKA, packed cell volume (PCV) (Normal range: M: 39-49 %, F: 33-43 %)
Causes of increased Hct:
- same as what
- water
Causes of decreased Hct:
what is the rule of thumb
Causes of increased Hct:
Same as hemoglobin
Dehydration
Causes of decreased Hct:
Same as hemoglobin
Rule of thumb: Hct value = 3 X Hgb value
normal
anemia
polycythemia
dehydration
normal = 45%
anemia = 30%
polycythemia = 70%, produce lots of RBCs due to cancer
dehydration = 70%, less plasma
so measure Hgb instead of Hct
Platelets: critical for blood clot formation(Normal range: 150, 000 – 450, 000 cells/microliter)
Causes of ↑ Platelets (thrombocytosis)
- tumor
- which organ is removed
- chronic ___ disorders
- a type of cancer
Causes of ↓ Platelets (thrombocytopenia)
- what kind of disorders
- ITP
- what kind of therapy and is there radiation
what drugs can cause this
Causes of ↑ Platelets (thrombocytosis)
- Malignancy
- Splenectomy
- Chronic inflammatory disorders
- Polycythemia vera
Causes of ↓ Platelets (thrombocytopenia)
- Autoimmune disorders:
- Idiopathic thrombocytopenia purpura (ITP)
- Chemotherapy, radiation
Drugs from Top 200:
- Valproic acid
what are the 2 Coagulation Tests
PT, INR
Prothrombin Time (PT) is the time it takes the blood to clot; PT = 10 – 13 seconds in patients not on anticoagulants
Causes of increased PT:
- what organ disease
- what vitamin defificny
- what factors deficiency
what drugs cause this
what does the liver manufacture
Causes of increased PT:
- Liver disease
- Vitamin K deficiency
- Clotting factors deficiency
Drugs: anticoagulants
- Example Top 200: warfarin, rivaroxaban
liver manufactures proteins and clotting factors
PT may vary due to the thromboplastin used
blood sample with citrate - binds calcium
centrifuge
discard blood cells
get plasma-calcium, thromboplastin includes tissue factor and phospholipids
fibrin clot
International Normalized Ratio (INR) is used to standardize PT; adjusts PT ratio based on sensitivity of thromboplastin used to perform test
what kind of med is it used to monitor
what does the INR range depend on
what is the normal INR
Used to monitor warfarin therapy
The desired INR range depends on the indication of warfarin therapy
- Target INR = 2-3 or 2.5-3.5
Normal INR (for patients not taking warfarin) = 1
warfarin: “alright, alright break it up, you guys!” a blood thinner
Immunologic Tests
ESR
Erythrocyte Sedimentation Rate (ESR) measures rate of erythrocyte settlement in anticoagulated blood
what raises the ESR
is it a specific diagnostic test
what is it used to support
Infections or inflammatory disorders = erythrocytes settle more quickly = ↑ ESR
Nonspecific diagnostic test
Used to support a diagnosis or monitor progress of inflammation or infection
Gastrointestinal Tests
ALT
AST
ALP
GGT
Bilirubin
Amylase
Lipase
Alanine Aminotransferase (ALT): enzyme present in high concentrations in the liver tissue (Normal range 0 – 35 International Units/L)
Causes of high ALT:
- what organ disease
what drugs cause this
- for HTN
- Ph
- toxicity to what drug
does the liver produce more or less ALT or AST
- ↑ > 3 x upper limit SIGNIFICANT
- Specific marker of liver disease
Causes of high ALT:
- Liver disease
Drugs from Top 200:
- HMG-CoA reductase inhibitors (statins): atorvastatin, lovastatin, pravastatin, simvastatin
- Phenytoin
- APAP toxicity
liver produces more ALT than AST
Aspartate Aminotransferase (AST): an enzyme in the liver, heart, kidney, pancreas, lungs, and skeletal muscles (Normal range 0 – 35 International Units/L)
what causes it to elevate
is it more or less of a specific marker for liver disease
what would indicate liver disease
what drugs
- toxcity to what drug
Injury to these tissues higher AST
Less specific marker of liver disease than ALT
AST : ALT > 2:1 (more than twice) means alcoholic liver disease
Drugs:
- APAP toxicity
Cardiac Tests
CK, CK-MB, Troponin, CRP
Creatine Kinase (CK) may be fractionated to isoenzymes
Causes of elevated total CK:
- is there injury
- was there an operation
- Rhabdomyolysis (lol)
what drugs cause this
for HTN
for hyperlipidemia
Causes of elevated CK-MB:
- heart attack
- what time does it begin to rise, when can you not measure it
- when does it peak
- when does it return to normal
Causes of elevated total CK:
- Trauma
- Surgery
- Rhabdomyolysis
Drugs from Top 200:
- Statins
- Fibrates: fenofibrate
Causes of elevated CK-MB:
- Acute myocardial infarction (AMI)
- Begins to rise in 4 – 8 hours, cannot measure before 4 hours
- Peaks in 12 – 24 hours
- Returns to normal in 2 – 3 days
Troponins
- where are they found and when is it released
- begins to rise after how many hours
- what are they sensitive markers for
C-reactive protein (CRP)
- where is it produced
- what is it a diagnosis of
- is it specific or unique it one disease
- what 2 things can it help monitor
Troponins are proteins found in cardiac muscles, released during cardiac injury
- Begin to rise in 4 hours
- Sensitive markers of cardiac injury
C-reactive protein (CRP) is produced in the liver
- Diagnosis of inflammatory conditions like rheumatoid arthritis
- Not specific; not unique to one disease
- Can help monitor disease progress and flares
Which of the following laboratory tests would you monitor to assess a patient’s diabetes management?
A. Sodium
B. Potassium
C. Glucose
D. Chloride
C. Glucose
Which of the following medications may cause an increase in creatine kinase (CK)?
A. Simvastatin
B. Lisinopril
C. Hydrochlorothiazide
D. Furosemide
A. Simvastatin
lisinopril raises K+ levels
HCTZ would cause hyponatremia & hypokalemia
furosemide would cause hypokalemia & hypocalcemia
where is Cl in the fishbone?
up, middle box
start with the +
then -
then kidney
then glucose at the far right
Which of the following electrolyte imbalances may result from a patient being dehydrated?
A. Hypernatremia
B. Hyperkalemia
C. Hyperchloremia
D. All of the above
D. All of the above
because all of the ions will be depleted
You are on APPE rotation with the ICU team. When preparing for rounds, you note that there was a new admission last night—patient AB who was struck by a car. Which laboratory tests would you expect to see in this patient’s chart?
A. AST/ALT
B. Hgb/Hct
C. ESR
worry about their bleeding/bleed
B. Hgb/Hct
tells if you have bleeding
AST/ALT tells about liver function
ESR tells also check for inflammation or infection in your body. This is an immunological test
You are a student on your APPE rotation and asked to recommend a dose for a medication that is adjusted for renal function. Which laboratory value specific to your patient do you need to know?
A. Glucose
B. Serum creatinine
C. Sodium
D. AST
B. Serum creatinine
with poor function, should be elevated
if low, then could be elderly where they have low muscle mass
Infections can result in an elevated WBC count with a left-shift
A. True
B. False
true
“Left Shift”
Increase in bands (immature neutrophils) due to:
- Infection
- Leukemia
What is a Medical Record?
According to Stedman’s Medical Dictionary:
A chronologically written account that includes a patient’s initial complaint(s) and medical history, physical findings, results of diagnostic tests and procedures, any therapeutic medicines or procedures, and subsequent developments during the course of the illness.”
Legal set of documents that are a record of a patient’s private medical information
AKA “The Chart”
- legal set of documents
What is a Medical Record?
Historically: medical records were actual paper in folders kept in physician’s office
Most hospitals/institutions/physician offices now utilize:
- Electronic medical records (EMR) or also called Electronic health records (EHR)
- Personal health records (PHR)- maintained by patient
Why use an Electronic Medical Record?
Central point for all medical data for a patient
- Eliminate the majority of paper documentation
- Communication across all healthcare institutions
Even though this concept sounds like each patient would only need 1 EMR, often a patient has
- 1 for in-patient
- 1 for ambulatory setting since there are different requirements/sections of a medical record depending on the location of the care being provided (more to come on this)
Who Can Use/View a Medical Record?
Health care providers
- Able to view and use the chart for the patients they are responsible for
- ILLEGAL to access a patient’s chart if not currently under their care, protected by HIPAA
Patient
- Can view and in some cases, add/change their own chart (more to come on this)
- cannot access chart
Where is a Medical Record Located?
how do you access it
-what must you obtain
- may have limited access depending on what
- with appropriate credentials, what can you view
Must obtain a username and password for specific EMR
May have limited access depending on your credentials
With appropriate credentials, able to view the EMR from anywhere there is a computer (even off-site)
Components of In-patient Medical Record
History and physical (H&P)
- Emergency Department notes (possibly)
Progress notes - how are they doing, every 24 hours
Procedure reports - stitching wound, setting a broken leg, catheter, IV, etc, anything is done to the patient
Laboratory and imaging data
Consults - with other specialties
Orders - nutrition,
Allergies - meds, environmental
Medication administration record (MAR)/home medication list - documents meds and when to take them
Social work/case management notes
Components of Ambulatory Medical Record
Demographics - family, surgical
Allergies
Problem list - what are all of their chronic conditions
Social, family, and surgical histories
Vitals/laboratory values
Immunization records
Notes/Documentation on previous visits, were you with me or the provider that I’m working with
“Tasks” or referrals to other healthcare providers
- Consult notes sent from other healthcare providers
What is a Personal Health Record?
what is the definition
what is it managed by
what can it include information from who
what can it help patients do
are they separate or can they replace the legal record of any healthcare provider
what are they distinct from
what does pmhx and osa mean
Definition: An electronic application used by patients to maintain and manage their health information in a private, secure, and confidential environment
Managed by patients
Can include information from a variety of sources, including healthcare providers and patients themselves
Can help patients securely and confidentially store and monitor health information, such as diet plans or data from home monitoring systems, as well as patient contact information, diagnosis lists, medication lists, allergy lists, immunization histories, and much more
Separate from, and do not replace, the legal record of any health care provider
Are distinct from portals that simply allow patients to view provider information or communicate with providers
pmhx: past medical history
OSA: obstructive sleep apnea
C = critical
What is the Difference Between a PHR and EMR?
EMR: Accessed and utilized by health care providers only. Owned and maintained by doctors’ offices, hospitals, or health insurance plans.
PHR: Record controlled by the patient and may use information from a wide array of sources (providers and patients)
Important: a PHR is separate from the legal EMR
Two Types of PHR are:
Standalone PHR’s:
- patients provde info based on what
- where is this stored
- what can patients determine
Tethered/Connected PHR’s:
- what is.it linked to
- how can patients access their own health records
- kept condifental through what act
- what type of portal is this
Example of Personal Health Record
- what app on iphone, what does it include
Standalone PHRs:
- Patients provide information based on their memory or records
- Stored on the patient’s computer or internet
- Patients can determine if they want to share this with providers or others.
Tethered/Connected PHR’s:
- Linked to a specific healthcare organization’s electronic health record (EHR) system or to a health plan’s information system
- Patients can access their own records through a secure portal and see, for example, the trend of their lab results over the last year, their immunization history, or due dates for screenings
- Kept confidential through the HIPAA privacy act
- “Patient Portal”
Example of Personal Health Record:
Health app for iPhones
- Includes Medical ID: makes critical information available via lock screen for use by first responders in emergency
Fully Transparent Medical Records via PHR
Patients can access doctor visit notes:
- Summary of conversation
- Symptoms patient described
- Doctor’s findings from physical exam
Patients have legal rights to medical records, but difficult and potentially costly to obtain
Fully Transparent Medical Records via PHR goals
Goals:
- Improve communication between patients and providers
- Improve medication adherence
Comparison of EMR vs. Paper Record
which is better for
- storage
- legibility
- access
- security
- cost
- storage - EMR is better
- legibility - EMR is better
- access - EMR is better
- security - equal for EMR (could be cyber security, or someone could look over your shoulder) & paper (someone could break in, can be easy to print out and leave somewhere
- cost - EMR (more expensive up front, long process, training people, working out bugs) and paper (is expensive)
What are some other Benefits of an EMR?
is it easy or hard to share info or to track
easy to share info. between offices
easier to track
traditional paper charts vs electronic health records
which is faster to transcribe
how many pieces of paper for each student and how many patients does a physician see in a week
how much paper do we save
- EHR faster to type in
- 10-13 pieces of paper for each patent and physician sees 50-99 patients in a week so it wil cut down a lot
- savings: 100B
- 4.5M ambulatory visits related to adverse drug events occur annually in the U.S
Comparing In-patient vs Ambulatory EMR
Sample software
Data presented
Versatility
Ordering systems
Laboratory information
Consultation vs. referral
Sample software-
inpatient: epic or Cerner
ambulatory: Allscripts or Athena health
Data presented
inpatient: episode based
ambulatory: longitudinal
Versatility
inpatient: versatile due to all consultants writing into the same chart
ambulatory: less versatile; very specific to that particular practice
Ordering systems
inpatient: Computerized Physician Order Entry (CPOE)
Can only order medications from inpatient pharmacy
ambulatory: Require access to order medications from various pharmacies
Laboratory information
Consultation vs. referral
Comparing EMR to paper records, which is better/requires fewer resources in terms of STORAGE
A- EMR
B- Paper
A- EMR
Comparing EMR to paper records, which is better/requires fewer resources in terms of ACCESS TO RECORDS
A- EMR
B- Paper
A- EMR
- do not have to be in a location or someone certain
It is okay to access your neighbor’s EMR to see what medications they are taking
A
True
B
False
B
False
It is okay to access your own EMR to review what your PCP documented after your recent visit
A
True
B
False
B
False
Where in a patient’s EMR would you look to find their most recent potassium level?
A
H&P (history and physical)
B
Lab data
C
Imaging data
D
Consult notes
E
Procedure notes
B
Lab data
Where in a patient’s EMR would you look to find a note from endocrine detailing plans to manage the patient’s glucose?
A
H&P
B
Lab data
C
Imaging data
D
Consult notes
E
Procedure notes
D
Consult notes
What are some Benefits of a PHR?
what kind of communication can be had
what can be refilled
whos engagement does it improve
coordinate info between who
what can it ensure
what can it encourage
being able to have patient-provider communication
med refills
improve patient engagement
coordinate info. from multiple providers
ensure important info. is available for an emergency
encourage family health management
Fully Transparent Medical Records via PHR
benefits
risks
Benefits:
- more education about their health
- better understanding of their own health status
- will prevent forgetting directions or info/reduce med errors and increase adherence
Risks:
- malpractice if the physician did something wrong
- may not know med abbreviations
- may not fully understand what they read and could be hurt :( could cause confusion and miscommunication
