EHR in Healthcare

1. By: Janelle Chevalier (3-7)
Cara McMahon (8-18)
Marcus Selvidge (2 &19-22)
Amanda Wright (23-27)

2. EHR have become almost a necessity in the healthcare
industry. Since the invention of computers occurred,
industries have been devising plans to save money, time,
and increase productivity. EHR although very expensive to
set up have a true benefit for the patients we care for.
Before EHR, patients information was scattered in paper
charts and files, many times difficult and time consuming
finding pieces of the puzzle. Now most of the information
is at the click of your mouse. As technology improves, it is
likely we will see EHR’s become more advanced to meet
patients needs. This presentation breaks down the specific
portions of the EHR in the healthcare industry.
Introduction

3.  It combines hardware and software
 It is used as a telecommunication network
 Used to collect, create, and distribute useful information
 It is used within an organization for effectiveness and efficiency
What is a Computer Information
System (CIS)

4. When choosing a system you want to do extensive
research on an Information System Vendor.
Cooperation usually see a need for having a CIS and
management would be the one to push for this system
When choosing a system management should get staff
involved to get feedback. This would help the success of
the CIS (Winder 09).
When choosing a vendor you want to make sure that
vendor will not only meet your needs now but also in
the future.
Choosing, Revising, and Implementing
CIS Systems

5.  Health Information and Data
 Includes patient data to make clinical decisions
 Medical and Nursing diagnosis
 Medication lists, Allergies, and test results
 Results Management
 Manages results of all types electronically, including labs and radiology
procedure reports current and historical
 Order Entry Management
 This is where clinician enters orders which include medication,
care orders, labs, microbiology, pathology, radiology, nursing,
supply orders, ancillary services and consultations.
Eight Components of Electronic Health
Records

6.  Decision Support
 Computer alerts to help improve the diagnosis and care of the patient for
example screening for correct drug selection, dose, and interaction
 Electronic Communication and Connectivity
 Online communication among healthcare teams
 This includes email, web messaging, integrated health records,
and telemedicine
 Patient Support
 Includes patient education, home telemonitoring, telehealth systems, and
patient education
Eight Components Cont.

7.  Administrative Processes
 Includes electronic scheduling, billing, and claims management
 Keeps a schedule for inpatient and outpatient visit
 Procedures, electronic insurance eligibility validation, claim authorization
and prior approval.
 Reporting and Population Health Management
 This is the Data collection tools
 It supports public and private reporting requirements including data
represented in a standardized terminology and machine-readable format.
 Finally the EHR system “MUST” follow appropriate privacy and security
standards when it comes to HIPPA regulations. Only persons who should
have access to the EHR are the people who are providing care for that
patient.
Eight Components cont.

8.  According to the American National Standard E.H.R components are
made to mimic traditional paper charts. The structure must include
information on the:
1. Patient- such as registration
2. Provider- who is taking care of the patient
3. Problems- current and past problems
4. Encounters- such as notes
5. Orders- such as medication orders
6. Services- such as nursing interventions
7. Observations- free text information about the patient
EHR Structure Components

9. The E.H.R is structured to where individuals can look up
information differently. The information can be looked up
through different perspectives such as:
 Chronological data
 Episode
 Problem
 Topic
Perspectives of the EHR

10.  According to the American National Standard there are
two specific ways for recording data in the E.H.R.
1. Free text- such as dictations, codes, and number values
( i.e. vital signs)
2. Structured data- such as multiple choice information (
i.e. choosing within normal limits for a patient with
normal lung sounds)
Data Entry

11.  “In order to incorporate EBP into the practice of clinical
nursing the information needs to be embedded in the
E.H.R so that it is part of the work flow.” ( McGonigle &
Mastrian, 2009, p.209)
 There is uncertainty of how often the E.H.R must be
updated with EBP but the incorporation alone has been
a big step in comparison to how things were after the
year of 1999
Evidence Based Practice in the EHR

12.  Today EBP is widely accepted as best practice and
promotes a high level of patient safety
 Up until 1999 EBP practice was pushed away due to
high cost
 It was discovered by the Institute of Medicine in 1999
that, “48,000 to 98,000 deaths occurred from medical
mistakes” ( Gugerty, 2006, p.23)
 After that year EBP was widely accepted and is
incorporated into E.H.R system products
EBP History

13. Below are a list of some E.H.R vendors:
 Practice Fusion- www.practicefusion.com
 Mxsecure- www.mxsecure.com
 MD care- www.mdcareplus.com
 GE Centricity
 Next Gen
 eClinicalWorks
 Greenway
 Aprima
 Pulse
 Athena
 Waiting Room Solutions
EHR Companies

14.  It is important that organizations make several plans in case of a disaster
resulting in a power outage.
 Normally a healthcare organization has ways to properly back up patient
information but in case of an unexpected disaster those files will be lost
forever.
 The best solution for health care organizations is to make sure that they
have off site back up storage available.
 “ A practice hosted E.H.R. cannot provide the level of record recovery
without special planning and strategy because the practice hosted system
resides in the practice.” (Strafford, 2010)
 A highly recommended offsite back up company can be found at
www.amazingcharts.com
 The average cost from Amazingcharts.com for offsite back up is
$250/year.
EHR Safety

15. “In 2003 nationwide survey by computing technology association found
human error was most likely because of problems with security breaches.” (
McGonigle & Mastrian, 2009, p. 187)
8% of the breaches were from technical problems and 63% were from
human error. (McGonigle & Mastrian, 2009, p.187)
McGonigle and Mastrian give several suggestions to protecting the E.H.R
such as:
Decreasing physical factors i.e. removing USB devices
Firewalls
Proxy Servers
Spyware
Antivirus software/hardware
Limiting internet access to employees
Viruses, Worms, & Hackers

16.  The user must first agree to terms related to HIPAA
 The Privacy Rights Clearinghouse states that those who
have access to the E.H.R are healthcare providers,
government agencies, medication information bureau
and insurance companies (2011)
 Accessed is gained according to the Privacy Rights
Clearing house when the patient gives consent to let
others see them
 McGonigle and Mastrian state that group titles also
allow for appropriate access (2009, p. 186)
Access to the EHR

17.  Using network securing devices such as, “ encryption,
passwords, firewalls, retinal recognition” ( McGonigle
& Mastrian, 2009, p.175)
 Dedicated phone lines
 Nurses acting as privacy offers ensuring that policies
and procedures are consistent with HIPAA regulations
 Avoiding “shoulder surfing”. ( McGonigle & Mastrian,
2009, p. 175
HIPAA Considerations

18.  McGonigle and Mastrian state that, “ the patient’s
rights must be protected in the face of a healthcare
provider’s duty to his or her employer and society at
large when initiating care and assigning finite
healthcare resources.” ( 2009, p. 160)
 It is also the healthcare providers duty to use ethical
frameworks when making ethical decisions.
Ethical Considerations

19.  According to a study published by the Partners Healthcare System in
Boston, average annual savings from utilization of electronic records
are $86,400 per year for a single health care provider.
 Direct Costs may include:
 Initial set-up fee’s
 Recurring software costs for license renewals and updates
 Repair costs to damaged equipment
 Training expenses for new employees
 Reduced labor costs because electronic technology is generally faster
(Ingram 2011)
Budgeting for EHR

20.  When purchasing an EHR for a facility, you can generally expect an expensive up front cost
initially for hardware, software, training, and installation fees. However, over time you can
expect to see capital gains increase once system has been in place.
 Strategies for purchasing an EHR for your facility
 Begin the search with the “right”-size vendors
 Beware of vendors of high-end systems that are offering “community hospital pricing
 Share the costs with end users, and involve clinicians in the selection process
 Consider all of the costs
 Be sure to factor in the costs of additional internal staff that will be required to operate the
EHR system. This may include IT staff, Nurse Informaticist, and a Chief medical information
officer (CMIO).
 Don’t rush into an EHR purchase
 Don’t ignore an incumbent vendor
 Don’t replace the hospital’s entire revenue cycle applications
(Swab & Ciotti 2010)
Purchasing EHR

21.  Pay careful attention to your tech support to uncover what is covered in
your package. Meaning are there tech support 24/7 for help or does the
EHR tech support mainly provide Q & A answers by searching through a
database.
 To ensure you know exactly how things are done use these tips:
 Research the support team through web searches, twitter, articles, or even
calling other customers they follow to determine if they are satisfied.
 Determine how available they are for help: 24/7, calling, email? How long
does it take on average to get a reply?
 Is the support offered locally or internationally? What language do they
speak compared to your employees, because this may make things
increasing difficult to get a problem solved.
(Zieger 2011)
Technical Support

22.  Once an EHR is initiated by a health care facility, there will be
portions throughout that may need changed slightly or re-
developed/updated. Of course all of your staff have already been
trained to use each part of the EHR in place. Below are several
ways that are helpful to update the users of the system without
spending countless hours and dollars.
 Short video clips
 Short handouts that can be passed around during staff meetings
 Short demonstrations with small groups
 It’s important to note that when new updates or changes are made,
make sure users are informed early so that less time is required to
go over each one. The more updates that are to be taught, the
longer it will take.
Continuing Education

23.  “The Health Information Technology Act (2009) requires all healthcare facilities to fully adopt
EHRs by 2014. This will change how nurses practice, underscoring the importance of teaching
students about informatics and the other topics and skills they need to provide high-quality care.”
 Many hospitals are implementing and educating their nurses differently. With researching many
hospitals and how they are bring EHR into their hospital, I have found that it takes many different
steps, and teaching to get every single nurse of all generations on the same understanding
 The article from America Nurse Today, has implemented teaching students in the nursing
programs before graduation about EHR. This was called AES, or Academic Education Solution.
 “Integrating AES across nursing curricula provides an appropriate environment for teaching
students about EBP, standardized nursing language, and the IOM’s core competencies, while
giving them the experience of an informatics-intensive healthcare environment.”
 This type of education was broken down into two semesters. The first semester the students were
taught about documentation on wound care and medication administration. Once the students
were taught the information, they were made to perform check offs in front of one of the faculty
at their school.
 In the second semester included students learned more about the EHR, and used the system to
take care of pretend patients, with the guidance of their instructors.
 “Students must learn how to identify, find, use, and evaluate information to successfully apply
evidence-based principles for delivery of culturally competent and safe care. Access to such data
as patients’ current vital signs, medication history, and alerts for drug incompatibility can
dramatically increase the quality of nursing care. Clear, concise, readily accessible information
stimulates critical thinking, resulting in better clinical decisions grounded in evidence-based
care.”
* (Meyer, Sternberger, & Toscos, 2011)
Educating Student Nurses on EHR

24. There are a number of barriers that prevent the integration of
EHRs into health professional education. Three main barriers are:
 A shortage of faculty who are familiar with differing types of
EHRs
 A shortage of health informatics professionals who can
implement such systems
 A shortage of opportunities to access multiple differing types
of EHRs within the context of a health professional student
academic program
* (Borycki, Joe, Armstrong, Bellwood, & Campbell, 2011)
Educating Nurses on EHR

25.  Gain acceptance
 Involve them in the selection process
 Have staff nurses be a part of the process of choosing
the EHR program
 Provide training
 Training should include hands on training
 Must provide support
* (Wilson, 1999-2011)
Steps to Educating Nurses

26. EPIC is a EHR that was started in Spring of 2009. For this nurses and
health care providers were assigned to take certain classes at
different times. These classes included the basic knowledge of the
EPIC system, and then the more in depth charting used my nurses and
physicians. The classes were usually in about 4-5 hour blocks that
were in about 8-9 different days. The classes were taught by
informatics people who worked on computers and who had extensive
training in the program. These people were sometimes from different
states, where the hospitals that they worked at had already
implemented EPIC. After the classes were taught to the nurses, the
hospital provided SUPER USERS (people who had more training on
EPIC, who were present on the first few weeks of the beginning of
EHR, to allow help to those who needed it). The hospital does go
through several updates per year, where the nurses are required to go
to more EPIC training to better understand the updates for the system.
EPIC at St. John’s

27. Electronic Health Record is defined as “a computerized system where
patient records are created, used, exchanged, stored and
retrieved.” (What is an Electronic Health Record or EHR)? Having an
Electronic Health Record in place at a hospital can allow not only the
hospital but the health care providers a better chance for greater
patient care. Although some of the older generation nurses do argue
about how EHR is taking away from actual hands on patient care.
EHR, is allowing all health care providers for each patient to work
together to make the best of that patients’ care. As we have learned
throughout working in a hospital with EHR, and throughout this
slideshow, technology shouldn’t be thought as a burden but as a way
to know our patient, and every part of our patients’ history.
Conclusion

28. McGongile, D. & Mastrain, K. (2009). Nursing informatics and the foundation of knowledge. Jones &
Bartlett: Sudbury, MA.
NIH National Center for Research Resources . (2006). Electronic health records overview. Retrieved from:
http://www.ncrr.nih.gov/publications/informatics/ehr.pdf.
Wikipedia. (2011). Information systems. Retrieved from:
http://en.wikipedia.org/wiki/Information_systems.
Winden K. (1990). A step-to-step approach to choosing an information systems. Retrieved
from: http://www.k2healthtech.com/content/docs/Provider_Article.pdf.
American National Standard (2000) Standard guide for content and structure of the electronic health
record. Retrieved from
www.musc.edu/infoservices/lanvision/Regulations_Policies_Guidelines/ASTMEMRGuide.pdf
Gugerty, B. (2006) The holy grail: Cost-effective healthcare evidence transparently and consistently used
by clinicians. Retrieved from http://www.himss.org/content/files/him/20-3/07_column_holygrail.pdf
Privacy Rights Clearinghouse (2011) Fact sheet 8: Medical records privacy. Retrieved from
https://www.privacyrights.org/fs/fs8-med.htm
John (2006) Overwhelming list of emr companies. Retrieved from
http://www.emrandhipaa.com/administrator/2006/02/21/overwhelming-list-of-emr-companies/
McGonigle, D., & Mastrian, K. ( 2009) Nursing informatics and the foundation of knowledge. Sudbury, MA.
Jones and Bartlett Publishers.
References

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