week 5 (exam 1) Flashcards
What are some BIG issues with US healthcare system?
- it is not interconnected (different doctors don’t communicate with each other)
- expensive!!
- not everyone is covered
- inconsistent quality
- medical errors
- takes too long for new research to affect practice
- baby boomers getting older
- Struggling to improve early detection capabilities
why is it important to have interconnected health care systems?
Complete medical record always available
Decision support available
Link between medical care & public health
Consumers can access their medical records
Payment systems streamlined
What’s the problem with paper records in healthcare?
illegible
hard to store
hard to find
hard to share
very individualized
expensive to copy
hard to find information in it
negative environmental impact
pages can fall out
get mixed up
misfiled
What’s missing in a paper chart?
Lab results - 45%
letters/dictations - 39%
Radiology results - 28%
Hx and physical exams - 27%
Pathology results - 15%
What are the 3 types of Health Records?
EMR: Electronic Medical Record
EHR: Electronic Health Record
PHR: Personal Health Record
explain what a EMR is?
EMR: Electronic version of a paper-based health record.
Single organization
Legal record
Might have a patient portal to let patients view certain components, but not interactive
explain what a EHR is?
EHR: Electronic record of health-related information that is created and SHARED across more than one health care organization
More comprehensive
EMR with interoperability
Provides interactive patient access
Advantages of Electronic health records
Increased quality—decreased errors, reminders, reduced duplication
Increased communication between providers
Access to medical history, previous procedures/tests
Decision support tools
Increased data for public health
Cost savings: one estimate $44 billion yearly
Paper reduction
Why is computerized physician order entry a good thing?
Allows for orders for medications, lab tests, x-rays, consults and other diagnostic tests
Thought to reduce medication errors, reduce costs, reduce variation in care
Explain Clinical Decision Support Systems (what is it and types)
Any software that directly aids clinical decision making for patient-specific recommendations
—–Most offer recommendations, clinician makes the decision
Types:
Knowledge support
Medication ordering: allergies, drug-drug
interactions
Reminders: e.g. age 40 and female: mammogram
Order sets and protocols: e.g. pneumonia
Differential diagnosis
Public health alerts
CDSS works best if it’s……
Clinical Decision support system
Part of the regular workflow and provided at the point-of-care
Provides recommendations, not just information
What things need to be considered when creating a CDSS?
Need to have existing guidelines in place, e.g. vaccination schedule
Represent knowledge
- -Tables
- —Each row contains a condition and an action
- -Rules
- —If-then
- -Flowcharts
- -Model-based knowledge: incorporates statistical models
Define the system architecture, including who will use, where they will use, strategies for updating content
Test and evaluate
name some barriers to Electronic Record Use
Cost (Hardware, software, training, obsolescence and upgrades, lowered productivity, data storage, might be running two systems)
Physicians’ attitudes
Loss of productivity
Workflow changes
Usability issues
Lack of standards
Privacy concerns
Practices/hospitals lack IT staff
Inadequate proof of benefit
—E-iatrogenesis: patient harm caused at least in part by the application of health information technology
What are some FACILITATORS to Electronic Record Use?
Financial incentives
Training and technical support
Access to list of certified vendors
Access to information at point-of-care when physician needs it
Evidence of effectiveness
explain the HITECH Act of ARRA (2009)?
The American Recovery and Reinvestment Act provides $19.2 billion to encourage the adoption of EHR systems and their “meaningful use.”
To participate:
- -Eligible Professional
- —Medicare: MDs, dentists, podiatrists, optometrists, chiropractors; not hospital-based
–Register for reimbursement
–Use certified EHRs
–Demonstrate meaningful use
What are some of the meaningful use areas of policy? (what things was considered reimbursable?)
Improve patient care and reduce disparities
Engage patients and families in their care
Improve coordination of care
Improve population and public health
Ensure adequate privacy and security protections for personal health information
Examples of Stage TWO CORE OBJECTIVES (really long)
Computerized order entry for medications, labs, radiology
Generate/transmit prescriptions
Record demographics
Record and chart changes in vital signs
Record smoking status
Use clinical decision support for high-priority health conditions
Give patients online access
Provide pts w/ office visit summaries
Protect privacy and security of patient data
Exchange key clinical information among clinicians or other entities
Generate lists of pts by condition
Determine which pts. should receive reminders
Submit data to immunization registries
Use secure messaging to communicate with patients
