Electronic Health Record

Jessica Austin - Slides 3-13Shaun Baker - Slides 18-33

Kayla Boro - Slides 14–17, 34-38, 39, 41

Victoria Blankenship - Slides 1-2, 40, 42-44

Introduction • Some of us have been nurses for

several years and others are just getting their career started. One thing we have in common is we will all be working with computer systems to put in and retrieve data. The following slides are a framework of information to help nurses understand and evaluate the Electronic Health Record (EHR).

What is a Clinical Information System

(CIS)?• “A CIS is a collection of various

information technology applications that provides a centralized repository of information related to patient care across distributed locations.

• This repository represents the patient’s history of illnesses and interactions with providers by encoding knowledge capable of helping clinicians decide about the patient’s condition, treatment options, and wellness activities (McGonigle & Mastrian, 2009).

What is a Clinical Information System

(CIS)?• The repository also encodes the status

of decisions, actions underway for those decisions, and relevant information that could help in performing those actions. The database could also hold other information about the patient including genetic, environmental, and social contexts (McGonigle & Mastrian, 2009) .”

Key players involved in choosing, implementing, and

revising a CIS• Implementation should involve those who work with patients (end users) to improve the interface, accuracy, and security.• Medical Staff/Clinicians• Performance improvement analysts • Executive leadership/CEO• Key stakeholders• System administrators• Tech support• Education team(McGonigle & Mastrian, 2009)

Key players involved in choosing, implementing, and

revising a CIS • Implementation of such systems

requires that they be designed to interface with legacy systems, privacy and security, and clinician resistance to learning new technology (McGonigle & Mastrian, 2009).

The 8 ESSENTIAL components of the EHR• Health Information and Data

• The patient data required to make sound clinical decisions. The patient and all healthcare providers should have access to be able to make clinical decisions.

• Results Management• The ability to manage results of all types

electronically, including lab and radiology procedure reports, both current and historical. The patient and all health care providers should have access to tie patient results together.

The 8 ESSENTIAL components of the EHR

continued….• Order Entry Management

• The ability of a clinician to enter medication and other care orders, including lab, micro, pathology, radiology, nursing, supply orders, ancillary services, and consultations directly into a computer. Physicians and licensed personnel should have access to input orders and patients may view orders

The 8 ESSENTIAL components of the EHR

continued….• Decision Support

• The computer reminders and alerts to improve the diagnosis and care of a patient including screening for correct drug selection and dosing, medication interactions with other medications, preventative health, reminders in areas such as vaccinations, health risk screening and detection, and clinical guidelines for patient disease treatment. The patient and all healthcare providers should have access to help make decisions and protect the patient.

The 8 ESSENTIAL components of the EHR

continued….• Electronic Communication and

Connectivity• The online communication among

healthcare team members, their care partners, and patients including e-mail, web messaging, and integrated health record within and across settings, institutions, and telemedicine. The patient and healthcare providers should have access to allow communication among the members.

The 8 ESSENTIAL components of the EHR

continued….• Patient Support

• The patient education and self-monitoring tools, including interactive computer-based patient education, home telemonitoring, and telehealth systems. The patient and healthcare providers should have access to patient support.

The 8 ESSENTIAL components of the EHR

continued….• Administrative Processes

• The electronic scheduling, billing, and claims management systems including electronic scheduling for inpatient and outpatient visits and procedures, electronic insurance eligibility validation, claim authorization and prior approval, identification of possible research study participants, and drug recall support. The patient and healthcare providers should have access to allow information to be organized and used for analysis/research.

The 8 ESSENTIAL components of the EHR

continued…• Reporting and Population Health

Management• The data collection tools to support public

and private reporting requirements including data represented in a standardized terminology and machine readable format. The patient and healthcare providers should have access to share patient information and compare data (McGonigle & Mastrian, 2009).

Clinical Decision Making System in a CIS• What is the clinical decision

making system?• “Tools that provide the clinicians,

staff, patient, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times to enhance health and healthcare (McGonigle & Mastrian, 2009).”

Clinical Decision Making System in a CIS• What it needs: Easy access• Needs to be user-friendly• Keep system up-to-date• Follows latest research• Evidence-Based practice • Update with all new EBP guidelines (McGonigle & Mastrian, 2009)

Clinical Decision Making System in a CIS• Company examples that design

CIS systems:• Visual Dx• Dxplain• Diagnosis Pro• TheraDoc, Inc.• Epic(McGonigle & Mastrian, 2009)

Safety and Security• Health information and

communication technologies (EHR)applications are set up with volatile degree of knowledge and achievement with the objective of improving health care/ nursing operation, management, patient care, and information management.

Safety and Security• Utilities most widely supported

include clinical and administrative email/texting; financial, and human resource procedure and administration; logistical management of health division tasks and patient information and health education.

Safety and Security• Much of past information in

healthcare was kept on paper files and stored in cabinets or managers desks, patient information was just a sheet away from being lost or thrown in regular trash, but now technology has our paper locked behind multiple firewalls of electronic data encryption.

Safety and Security• Multiple bits of private personnel

data stored in mass computer banks awaiting a hackers fun stop to destroy a company or a persons life.

• Cyber security thus was developed due to the increasing threats to security of patient data from multiple sources that tend on stealing or corrupting data.

Safety and Security• Cyber security consist of several

forms of security from secondary companies that monitor the internet and intranet for malicious threats such as viruses/worms / and trojans that are developed by outside sources made to steal or corrupt data.

HIPAA Considerations• “Assess and plan communication

awareness requirements Develop and plan a HIPAA awareness communication plan Conduct an awareness program to promote organizational involvement Monitor communication efforts for effectiveness Review brochures and promotion items as to how HIPM is mentioned in literature (DHHS, 2003).”

Safety and Security• “Assess and plan communication

awareness requirements Develop and plan a HIPAA awareness communication plan Conduct an awareness program to promote organizational involvement Monitor communication efforts for effectiveness Review brochures and promotion items as to how HIPM is mentioned in literature (DHHS, 2003).”

Safety and Security• Individuals, as fitting to their

professional roles, should be aware of the relevant security risks, required preventive measures, and assume responsibility and take steps to enhance the security of information systems and networks they deal with.

Safety and Security• “How individuals gain access to

such a secure network makes the network more secure by simply adding the password activated accounts to access patient information and thus adding more security allowing only certain access to certain levels of discipline determined by entrusted individuals to decide who has what access (U.S. Government, 2003).”

Safety and Security• Having access to secured cyber

space for patient information brings another question of ethics, people who have access should respect the privacy and potential of “not to do any harm” when given special access to information that is not yours.

Safety and Security• When a medical facility chooses a

security network to protect their patients its good to consider both a internal team and external team to watch the network and setup security development tools.

• The network should have rules and regulations built on integrity policies written by the operating facility and enforced by the network team.

Safety and Security• Data from the network should be

backed up by separate computing networks with internal saving devices setup to save data materials every five minutes to ensure data will not be lost and then backed up onto a CD drive or digital media as hard copies of the data daily.

• This ensures data is captured and contained in the system so that it can be accounted for on a timed basis once again ensuring integrity.

Costs/ Finance

• EMR in the health care world are far from cheap systems range from hundreds of thousands to millions of dollars, depending on size, information bank, productivity, security, ease of use, and individual training on product use and software.

Costs/ Finance • Compatibility issues also raise cost

depending on other equipment and software providers that may have to alter their products to fit or run with the new EHR.

• Purchasing of EMR’s should be relied upon credibility of the company and a track record along with several studies and test runs of the actual product.

Costs/ Finance

• Selecting a product that fits the system needs along with the capability to upgrade or improve in the future along with ongoing education to the staff with each upgrade should be considered.

Costs/ Finance • IT support personnel should also

be considered: What if problems arise? Who will do the upgrades? When will the upgrades occur? Will they affect my staff’s productivity? Who can my staff call when the problem occurs and will they be available 24 hours a day?

• Many questions should be reasoned with before a purchase of any EHR.

Education• “The success or failure of an

informatics solution can be directly related to the education that was provided (McGonigle & Mastrian, 2009).”

• Originally, nurses teaching Informatics had no formal education• Acquired Skills by:

• On-the-job training• Attending classes to learn about the

system

Education

• There are formal ways to become an educator.

• Graduate classes offered at various universities

Education• Two certifications that are available

• American Nurses Credentialing Center Exam• Must be an RN/BSN w/ 2 years of

experience.

• CPHIMS (Certified professional in healthcare information and management systems)• Open to anyone who is involved in

healthcare informatics.

Education• Many ways education can be

implemented• Important: Remember everyone

learns differently.• It is the Educator’s job to:

• Develop education materials• Implement a plan to teach the

materials• Provide education about the system

• New employees• System Launch• Upgrades

Education• Initial education requirements for

staff include• A basic computer class

• This helps with staff who are unfamiliar with computers

• 20 hours of education upon implementation of EHR

• “Super users” are often used to help with the class• Show the information as the

instructor is talking

Education

• Updates can be implemented by:• Handouts• Additional class time• Educational computer simulation

• Many have certificates that print when you complete the cours

Education• Example of a handout

Education

• Technology is always changing• It is important that everyone stays

up-to-date• Additional re-education is

determined by each institution • Refresher courses may be needed if

the individual has not been familiar with the system for long periods of time.

Conclusion

Despite the challenges, the future of EHR’s is an exciting one for patient and clinician alike. Benefits may be realized by stand-alone EHR’s as described here, but the most significant transformation will come as interoperability is realized between systems (McGonigle & Mastrian, 2009

References • Department of Health and Human

Services-HIPAA AdministrativeSimplification informationhttp://aspe.os.dhhs.gov/admnsimp

• http://cisevaluation.com/uploads/CISESArticle.pdf

• McGonigle, D. &Mastrian, K. (2009). Nursing informatics and the foundation of knowledge. Sudbury, MA: Jones and Barlett Publishers.

References

• U. S. Government (2003) .The National Strategy to Secure Cyberspace.The White House, February 2003. Available online at:http://www.whitehouse.gov/pcipb/cyberspace_strategy.pdf