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Building a consensus for the electronic health record
1. Building a Consensus For the
Electronic Health Record
Norma Muscella
Sese Williams
Thomas Colley
Theresa Schenfeld
Jacksonville University
April 14, 2013
3. Definitions
EHR-An electronic health record is defined as a
systematic collection of electronic health information
about a patient.
It is a record in digital format that is theoretically capable of
being shared across different health care settings. In
some cases this sharing can occur by way of network-
connected enterprise-wide information systems and
other information networks or exchanges.
EHRs may include a range of data, including
demographics, medical history, medication and allergies,
immunization status, laboratory test results, radiology
images, vital signs, personal statistics like age, weight,
and billing information.
4. Not to be confused with EMR
EMR-a digital version of the paper charts in the clinician’s office. An
EMR contains the medical and treatment history of the patients in
one practice. EMRs have advantages over paper records. For
example, EMRs allow clinicians to:
Track data over time.
Easily identify which patients are due for preventive screenings or
checkups.
Check how their patients are doing on certain parameters such as
blood pressure readings or vaccinations.
Monitor and improve overall quality of care within the practice.
But the information in EMRs doesn’t travel easily out of the practice.
In fact, the patient’s record might even have to be printed out and
delivered by mail to specialists and other members of the care team.
In that regard, EMRs are not much better than a paper record.
5. Why Electronic?
“By computerizing health records, we can avoid dangerous medical
mistakes, reduce costs, and improve care.”
With a subsequent adoption of ten-year plan through the Health
Information Technology for Economic and Clinical Health
(HITECH) Act of 2009 (HHS Press Release, 2010; Center for Health
Statistics, 2005).
--President George W. Bush, State of the Union Address, January 20, 2004.
6. EHR’S reduce errors
Automatically checks for conflicts when new medications are ordered
Enables clients and providers to have reliable access to patient
education opportunities
Assist providers with cross check of symptoms and provides probable
list of diagnosis
Supports evidence based decisions at point of care
Exposes potential safety problems when they occur and can help
providers quickly and systematically identify and correct operational
problems
Enhances research, monitoring and benchmarking for improvement in
clinical quality
7. With electronic health records, providers
have the information they need to provide
the best possible care. Providers will know
more about their patients and their health
history before they walk into the
examination room.
9. The information gathered by the primary
care provider tells the emergency
department clinician about the patient’s life
threatening allergy, so that care can be
adjusted appropriately, even if the patient
is unconscious.
10. Improve
patient safety and
clinical outcomes
10
11. Patient Empowerment
A patient can log on to his own record and
see the trend of the lab results over the
last year, which can help motivate him to
take his medications and keep up with the
lifestyle changes that have improved the
numbers..
12. Patients can receive electronic copies of
their medical records and share their
health information securely over the
Internet with their families.
13. Provide
clinicians,
staff and
patients with
necessary
tools and
information
13
14. The lab results run last week are already in
the record to tell the specialist what she
needs to know without running duplicate
tests.
15. Build the electronic
Build the electronic
health record with
health record with
evidence-based content
evidence-based content
16. The clinician’s notes from the patient’s
hospital stay can help inform the
discharge instructions and follow-up care
and enable the patient to move from one
care setting to another more smoothly.
17. Benefits
Enhance the patient experience
Provide clinicians and staff with necessary
tools and information across the
healthcare spectrum
Standardize information collected and
saved for the patients’ EHR
Strategically position patients and
clinicians for the future
19. What is Meaningful Use?
The set of standards defined by the Centers
for Medicare & Medicaid Services (CMS)
Incentive Programs that governs the use
of electronic health records and allows
eligible providers and hospitals to earn
incentive payments by meeting specific
criteria.
20. What is involved?
Electronic physician documentation in all patient
care areas
Electronic prescribing
Integration of laboratory results
Nursing documentation
Inpatient computerized physician order entry
(CPOE)
Medication management including bar-coded
medication administration (BCMA)
Clinical reporting
Scanning archive and data repository
21. More definitions!
CPOE-a process of electronic entry of medical practitioner
instructions for the treatment of patients (particularly
hospitalized patients) under his or her care.
These orders are communicated over a computer network
to the medical staff or to the departments (pharmacy,
laboratory, or radiology) responsible for fulfilling the
order.
CPOE decreases delay in order completion, reduces errors
related to handwriting or transcription, allows order entry
at the point of care or off-site, provides error-checking for
duplicate or incorrect doses or tests, and simplifies
inventory and posting of charges.
22. CPOE Key Benefits
Saves time by eliminating duplicative processes
and allows the clinician to articulate care from
anywhere, anytime
Reduces medication errors and adverse drug
events
Provides error-checking for duplicate or incorrect
doses or tests
Simplifies posting of charges
Potential to decrease errors related to
handwriting or transcription, decrease
turnaround time, decrease length of stay and
decrease cost of care
23. Built in alerts!
Not only are
prescription errors
reduced in the
translation between
the doctors office and
pharmacy, but CPOE
lessen the likelihood
of harmful drug
interactions due to
built in alerts.
24. How do we arrive?
Every journey has a
beginning
25. The journey begins…..
Investigate:
What do I want my Electronic Record to
do for me?
How much am I willing to spend?
How long will it take?
Do I have the infrastructure in place or will
that be an additional expense?
26. Assemble Group
Financial officer
Computer literate staff (Informatics
Nurse)
Information Technician
Frontline staff familiar with work flow
Risk management
Patient registration
Financial services
28. Define Goals
Assemble lists of “wants” and “musts”.
Invite vendors to demonstrate functionality
Incorporate questions regarding
“personalizing” applications.
Assess security
Determine down time applications, how
long, how often and how much of the
system is affected.
29. Choose Vendor!
Begin to build ….
Flow from admission
To Discharge
Stop in all departments along the way
Evaluate
Modify
30. Establish a timeline
Define users
Manage hardware and software
purchases
Install servers, cables wireless and wired
networks
Verify that HIPAA privacy, security and
breach notification policies are in place
Develop internal training plan
Develop policies and procedures to
support new technology and vocabulary.
31. TEST
In the test domain, a patient will be created
along with a problem list. That patient will
mimic a typical admission and followed
through a hospital visit.
.
32. TRAIN
End users will follow a typical patient in
the train domain
Use blended learning strategy
Simulated charts
Small classes with classroom assistants to
help those not comfortable with computers
Questions are validated and answered
34. Go Live
Minimize vacation time
Vendor and super users available real
time.
Anticipate challenges develop an “issues
log”
Celebrate facility achievement
35. In Conclusion
Successful conversion to EHR will take significant
energy and resources.
Preparedness assessments must be thorough.
Detailed mapping of workflow with standard
operating procedures and emergent situations
studied with the inclusion of clinicians.
All end users must be trained.
Access provided must be tailored to job class
Comprehensive security planning is essential.
The OneCare Program is one of the most important priorities we ’ve ever undertaken—it is one of the ways in which we’ll transform health care. We will do this by creating a universal health record for each CHI patient—regardless of where they receive care. This new way of providing care will continue to break down barriers between care sites and providers. It will allow us to provide comprehensive, coordinated care along the continuum. As a result, the OneCare Program will fundamentally change how we deliver care at CHI.
More specifically, the OneCare Program will help us to improve patient safety and clinical outcomes. How? First, eliminating handwriting from the system will make the environment much safer for our patients. We’ve all heard the stories about illegible orders or prescriptions. By removing this variable from how we deliver care, we will create a safer environment. Second, the clinical standardization work will result in better overall outcomes. Right now, we are using the collective wisdom of our MBO clinicians to design clinical standards that we will all use. We will also continue to update these standards as time goes on—resulting in continuous clinical improvement. We have seen other health systems embark on similar journeys and they have watched their outcomes improve with this new consistency. What ’s more, these systems have also been able to use the power of the information they’ve gathered to make improvements over time.
Once we ’re live with all of the OneCare projects, we will also improve the experience for our staff and clinicians. We know it will take some time, but once we have a complete system that is populated with data, we will greatly improve the speed and effectiveness for our teams. How? It ’s simple really— By having all of the information they need at their fingertips, and By increasing the speed with which we send orders. I know that there will be a time in the future when we will wonder what we did without OneCare.
That national build will include evidence-based content. We will ensure that the clinical standards and order sets are the best ones for our patients—that they will produce the best outcomes possible.
