Electronic health records

1. ELECTRONIC HEALTH RECORDS Presented by Mrs. Senthilnayaki Ramasubbu.RN.RM.MSc (N)

2. ELECTRONIC HEALTH RECORD (EHR)   E lectronic health record ,  is the electronic version of the client data found in the traditional paper record . EHRs are defined as “a longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting.

3. EHR:

4. Roles of EHR Represents patient’s health history Medium of Communication among health care practitioners Legal document for health care Source for clinical outcomes and health services research Resource for practitioner education Alerts, reminders, quality improvement

5. Data components documented in EHR An electronic health record should contain important data such as; • Patient profile and demographics • Medical history includes information about allergies, illness, immunization , disorder and diseases . • Medicine taken and its compatibility with drug interaction • Records of appointment

6. Data components documented in EHRs: admission nursing note, daily charting, physical assessment, present complaints (e.g. symptoms), diagnoses, tests, procedures, treatment, nursing care plan, medication administration, progress notes laboratory data, and radiology reports referral, Discharge history, Billing records

7. Components of EHR Clinical decision support system (CDSS), C omputerized physician order entry (CPOE) systems, and H ealth information exchange (HIE).

8. CLINICAL DECISION SUPPORT SYSTEM (CDSS) A CDS system is a software that assists the provider in making decisions with regard to patient care . CDSS provides physicians and nurses with real-time diagnostic and treatment recommendations .

9. Functions of CDSS Managing clinical complexities Monitoring medication errors Avoiding duplicate and unnecessary tests Supporting clinical diagnosis &Treatment plan processes Promoting use of best practices & condition specific guidelines & Population based management. providing the latest information about a drug, cross-referencing a patient allergy to a medication, and alerts for drug interactions and other potential patient issues

10. Patient safety with EHR Researchers found that computerized physician reminders increased the use of influenza and pneumococcal vaccinations from practically 0% to 35% and 50%, respectively, for hospitalized patients.  

11. Prevention of complication with EHR Willson et al, found a significant association between computerized reminders and pressure ulcer prevention in hospitalized patients. They found a 5% decrease in the development of pressure ulcers 6 months after the implementation of computerized reminders that targeted hospital nurses .

12. Best uses of practice with EHR Rossi and Every,   found that computerized reminders as part of a CDSS have been linked to an 11.3% increase in appropriate hypertension treatment in a primary care setting.

13. Decreased cost of care with EHR Tierney et al found a 14.3% decrease in the number of diagnostic tests ordered per visit and a 12.9% decrease in diagnostic test costs per visit when using an EHR with CDS and CPOE components.

14. Computerized physician order entry(CPOE)

15. Computerized physician order entry(CPOE) CPOE is a software that allow physicians to enter orders directly into the computer rather than doing so on paper. Example drugs, laboratory tests, radiology, physical therapy

16. Benefits of CPOE Eliminates potentially dangerous medical errors caused by poor penmanship of physicians. Eliminate errors caused by unclear telephone orders It also makes the ordering process more efficient because nursing and pharmacy staffs do not need to seek clarification or to solicit missing information from illegible or incomplete orders. Enhances patient safety

17. Evidence S tudies suggest that serious medication errors can be reduced by 55 % when a CPOE system is used alone,  and by 83% when coupled with a CDS system that creates alerts based on what the physician orders. Using a CPOE system, especially when it is linked to a CDS, can result in improved efficiency and effectiveness of care.

18. Health information exchange

19. Health information exchange HIE is the process of sharing patient’s electronic health information between different organizations  and can create many efficiencies in the delivery of health care . Once health data are available electronically to providers, EHRs facilitate the sharing of patient information through HIE.

20. Health information exchange- Benefits Allows for the secure and potentially real-time sharing of patient information, HIE can reduce costly redundant tests HIE facilitates the exchange of this information via EHRs, which can result in much more cost-effective and higher-quality care.

21. Technologies involved in EHR Picture archiving and communications system Bar coding Radio frequency identification Automated dispensing medicines Electronic medication administration records

22. PICTURE ARCHIVING AND COMMUNICATIONS SYSTEM

23. Picture archiving and communications system: This technology captures and integrates diagnostic and radiological images from various devices, stores them, and disseminates them to a medical record, a clinical data repository, or other points of care . e.g ., x-ray, MRI, computed tomography scan

24. Bar coding An optical scanner is used to electronically capture information encoded on a product . Initially, it is used for medication.

25. BAR CODING It consist of bar code readers , a portable computers with wireless connection. The nurse can verify patients as well as drugs.

26. Radio frequency identification

27. Radio frequency identification This technology tracks patients throughout the hospital, and links lab and medication tracking through a wireless communications system. It is neither mature nor widely available, but may be an alternative to bar coding.

28. ADM: Automated dispensing medicines are computerized drug storage devices which allow medications to be stored and dispensed near the point of care while controlling and tracking the drug distribution.

29. Benefits Reduces pharmacy labor by 90% Reduces technician labor by 72% Lowers drug inventory by 20% Cuts missing medications by 92% Lowers expired medication cost by 54%

30. Electronic medication administration records

31. Electronic medication administration records The E MAR alerts the nurse about the next dose or cautions about the medications Nurses take the cart near to the patient, scan the medication and the patient wrist band

32. Benefits of EHR Improved access to the medical record.   Decreased time spent in documentation.  Increased time for client care.  Improved quality care. Facilitation of data collection for research.  Improved communication and decreased potential for error.  Creation of a lifetime clinical record facilitated by information systems.

33. The benefits of EHRs clinical outcomes: improved quality, reduced medical errors, organizational outcomes: - financial and - operational benefits, societal outcomes improved ability to conduct research, improved population health, reduced costs

34. Drawbacks F inancial issues, changes in workflow, temporary loss of productivity associated with EHR adoption, privacy and security concerns,

35. Drawbacks Financial issues, including adoption and implementation costs , ongoing maintenance costs , and loss of revenue associated with temporary loss of productivity .

36. Barriers to adoption of EHR Mohamed Khalifa ,  MD, conduced a study on Barriers to Health Information Systems and Electronic Medical Records Implementation. A Field Study of Saudi Arabian Hospitals  Abstract Background: Despite the positive effects of Health Information Systems and Electronic Medical Records use in medical and healthcare practices, the adoption rate of such systems is still low and meets resistance from healthcare professionals. Barriers appear when they approach systems implementation. We need to understand these factors in the context of Saudi Arabian hospitals to enhance EMR adoption. This process should be treated as a change project.

37. Objectives : To identify, categorize, and analyze barriers perceived by different healthcare professionals to the adoption of EMRs in order to provide suggestions on beneficial actions and options. Methods The study used a questionnaire to collect data from a random sample of healthcare professionals of two major Saudi hospitals, one private and the other is governmental, 158 valid respondents participated in the survey equally from both hospitals and then the results were analyzed to describe and evaluate various barriers.

38. Results The study identified six main categories of barriers, which are consistent with those reported in recent published research. 1) Human Barriers, related to the beliefs, behaviors and attitudes, 2) Professional Barriers, related to the nature of healthcare jobs, 3) Technical Barriers, related to computers and IT, 4) Organizational Barriers, related to the hospital management, 5) Financial Barriers, related to money and funding and 6) Legal and Regulatory Barriers, related to laws, regulations and legislations. The six categories of barriers were validated with the participants of the pilot sample. Conclusions Human barriers as well as financial barriers are the two major categories of barriers and challenges in the way of successful implementation of EMRs.

39. Conclusion EHR adoption must be considered one of main approaches that diversify our focus on quality improvement and cost reduction . Over time, providers and researchers will be eager to quantify the returns that are expected from these investments.

40. Referrences  IOM. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: Institute of Medicine; 2001. [ PubMed ]  Dexter PR, Perkins S, Overhage JM, et al. A computerized reminder system to increase the use of preventive care for hospitalized patients. N Engl J Med. 2001;345(13):965–970. [ PubMed ] Willson D, Ashton C, Wingate N, et al. Computerized support of pressure ulcer prevention and treatment protocols.  Proc Annu Symp Comput Appl Med Care. 1995:646–650. [ PMC free article ][ PubMed ] Rossi RA, Every NR. A computerized intervention to decrease the use of calcium channel blockers in hypertension. J Gen Intern Med. 1997;12(11):672–678. [ PMC free article ] [ PubMed ] Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of informing physicians of the charges for outpatient diagnostic tests. N Engl J Med. 1990;322(21):1499–1504. [ PubMed ]

41.  Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized physician order entry and a team intervention on prevention of serious medication errors. JAMA. 1998;280(15):1311–1316. [ PubMed ]  Bates DW, Teich JM, Lee J, et al. The impact of computerized physician order entry on medication error prevention. J Am Med Inform Assoc. 1999;6(4):313–321. [ PMC free article ] [ PubMed ] The National Alliance for Health Information Technology. Report to the Office of the National Coordinator for Health Information Technology on Defining Key Health Information Technology Terms. [Accessed April 18, 2011]. http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_ gov __reports/1239 .  Walker J, Pan E, Johnston D, et al. The value of health care information exchange and interoperability. Health Aff (Millwood) 2005;Suppl:W5-10–15-18. [ PubMed ]

42. http:// www.patientkeeper.com/blog/2011/11/03/nurses-benefit-from-cpoe-too/ http://fgraham1.wordpress.com/2009/01/14/computerized-physician-order-entry-and-electronic-medication-administration-record / http://www.sciencedirect.com/science/article/pii/S1877050913008375