Electronic Health Record(EHR)

AJ Rosario, MD, MPHAJ Rosario, MD, MPHVictoria Wangia, MS Victoria Wangia, MS

Saeed Hamdan, MD, PHDSaeed Hamdan, MD, PHD

Public Health Informatics FellowsPublic Health Informatics Fellows

April 15, 2004April 15, 2004

Electronic Health Record: Electronic Health Record: Where are we now?Where are we now?

AJ Rosario, MD, MPHAJ Rosario, MD, MPH

April 15, 2004April 15, 2004Centers for Disease Control and PreventionCenters for Disease Control and Prevention

National Immunization ProgramNational Immunization ProgramImmunization Registry Support BranchImmunization Registry Support Branch

Outline

DefinitionDefinition Core functionalities Core functionalities UsesUses Beneficial outcomes and potential Beneficial outcomes and potential

applicationsapplications Challenges and progress towards EHR Challenges and progress towards EHR

implementationimplementation

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Automated health record

Electronic Health RecordElectronic Health Record

(EHR)(EHR) Electronic Health Record SystemElectronic Health Record System

(EHR-S)(EHR-S)

Automated health record

Electronic Health Record (EHR)Electronic Health Record (EHR)It is also referred toIt is also referred to

Electronic Healthcare Record (EHCR),Electronic Healthcare Record (EHCR),Electronic Patient Record (EPR), Electronic Patient Record (EPR), Electronic Medical Record (EMR),Electronic Medical Record (EMR),Computer-based patient record (CPR), Computer-based patient record (CPR), Computerized Patient Record (CPR)Computerized Patient Record (CPR)

Defining the EHR

““is any information relating to the health is any information relating to the health of an individual…of an individual…

resides in electronic system (s)…resides in electronic system (s)… for the primary purpose of providing for the primary purpose of providing

health care and health-related services.”health care and health-related services.”

Defining the EHR

Individual health status and conditionIndividual health status and condition System functions System functions MultimediaMultimedia

Collaborative Effort for EHR

Department of Health and Human Services (DHHS)Department of Health and Human Services (DHHS)

Institute of Medicine (IOM)Institute of Medicine (IOM)

Health Level Seven (HL7)Health Level Seven (HL7)

1991 IOM’s Computerized Patient Record definition

““The set of components that form The set of components that form the mechanism by which patient the mechanism by which patient records are created, used, stored, records are created, used, stored, and retrieved.”and retrieved.”

2003 IOM’s Letter Report

Key Capabilities of an Key Capabilities of an

Electronic Health Record SystemElectronic Health Record System

2003 IOM’s Letter Report definition

““(1) longitudinal collection of electronic health (1) longitudinal collection of electronic health information information

2003 IOM’s Letter Report definition

““(1) longitudinal collection of electronic health (1) longitudinal collection of electronic health information information

(2) immediate electronic access to person- (2) immediate electronic access to person- and population- level informationand population- level information

2003 IOM’s Letter Report definition

““(1) longitudinal collection of electronic health (1) longitudinal collection of electronic health information information

(2) immediate electronic access to person- (2) immediate electronic access to person- and population- level informationand population- level information

(3) Provision of knowledge and decision-(3) Provision of knowledge and decision-supportsupport

2003 IOM’s Letter Report definition

““(1) longitudinal collection of electronic health (1) longitudinal collection of electronic health information information

(2) immediate electronic access to person- (2) immediate electronic access to person- and population- level informationand population- level information

(3) Provision of knowledge and decision-(3) Provision of knowledge and decision-supportsupport

(4) Support of efficient processes for health (4) Support of efficient processes for health care delivery.”care delivery.”

2003 IOM’s Letter Report definition

““(1) longitudinal collection of electronic health (1) longitudinal collection of electronic health information information

(2) immediate electronic access to person- (2) immediate electronic access to person- and population- level informationand population- level information

(3) Provision of knowledge and decision-(3) Provision of knowledge and decision-supportsupport

(4) Support of efficient processes for health (4) Support of efficient processes for health care delivery.”care delivery.”

Core Functionalities Health information and dataHealth information and data Result managementResult management Order managementOrder management Decision supportDecision support Electronic communication and connectivityElectronic communication and connectivity Patient supportPatient support Administrative processesAdministrative processes Reporting & population health managementReporting & population health management

Core Functionalities Health information and dataHealth information and data

Problem ListProblem List ProceduresProcedures DiagnosesDiagnoses Medication ListMedication List AllergiesAllergies DemographicsDemographics Clinical narrativesClinical narratives Laboratory test resultsLaboratory test results

Core Functionalities Health information and dataHealth information and data Results managementResults management

Laboratory test Laboratory test Radiology procedureRadiology procedure Pathology reportsPathology reports

Core Functionalities Health information and dataHealth information and data Result managementResult management Order managementOrder management

Computerized entryComputerized entry Electronic prescribingElectronic prescribing Electronic ordersElectronic orders

Core Functionalities Health information and dataHealth information and data Result managementResult management Order managementOrder management Decision supportDecision support

Improve clinical performanceImprove clinical performance Access to knowledge basesAccess to knowledge bases Ensure preventive practicesEnsure preventive practices Identify drug interactionsIdentify drug interactions Facilitate diagnoses and treatmentsFacilitate diagnoses and treatments Detect adverse events/ outbreaksDetect adverse events/ outbreaks

Core Functionalities Health information and dataHealth information and data Result managementResult management Order managementOrder management Decision supportDecision support Electronic communication and Electronic communication and

connectivityconnectivity Secure use of e-mail and web Secure use of e-mail and web

messagingmessaging

Core Functionalities Health information and dataHealth information and data Result managementResult management Order managementOrder management Decision supportDecision support Electronic communication and connectivityElectronic communication and connectivity Patient supportPatient support

Interactive educationInteractive education Home monitoring and self-testingHome monitoring and self-testing

Core Functionalities Health information and dataHealth information and data Result managementResult management Order managementOrder management Decision supportDecision support Electronic communication and connectivityElectronic communication and connectivity Patient supportPatient support Administrative processesAdministrative processes

Scheduling systemsScheduling systems

Core Functionalities Health information and dataHealth information and data Result managementResult management Order managementOrder management Decision supportDecision support Electronic communication and connectivityElectronic communication and connectivity Patient supportPatient support Administrative processesAdministrative processes Reporting and population healthReporting and population health

Uniform data standardsUniform data standards

Primary Uses

Patient Care DeliveryPatient Care Delivery Patient Care ManagementPatient Care Management Patient Care Support ProcessesPatient Care Support Processes Financial and Administrative ProcessesFinancial and Administrative Processes Patient Self-ManagementPatient Self-Management

Secondary Uses

EducationEducation RegulationRegulation ResearchResearch Public Health and Homeland SecurityPublic Health and Homeland Security Policy SupportPolicy Support

Potential Benefits Patient safety/ Reduced medical errorsPatient safety/ Reduced medical errors Accessibility/ Enhanced quality of careAccessibility/ Enhanced quality of care Timely data entry/ Improved Timely data entry/ Improved

documentationdocumentation Legibility/ Enhanced data qualityLegibility/ Enhanced data quality Enhanced security/ Controlled AccessEnhanced security/ Controlled Access Guideline disseminationGuideline dissemination

Potential Benefits Patient safety/ Reduced medical errorsPatient safety/ Reduced medical errors

Potential Benefits Patient safety/ Reduced medical errorsPatient safety/ Reduced medical errors Accessibility/ Enhanced quality of careAccessibility/ Enhanced quality of care

Potential Benefits Patient safety/ Reduced medical errorsPatient safety/ Reduced medical errors Accessibility/ Enhanced quality of careAccessibility/ Enhanced quality of care Timely data entry/ Improved Timely data entry/ Improved

documentationdocumentation

Potential Benefits Patient safety/ Reduced medical errorsPatient safety/ Reduced medical errors Accessibility/ Enhanced quality of careAccessibility/ Enhanced quality of care Timely data entry/ Improved Timely data entry/ Improved

documentationdocumentation Legibility/ Enhanced data qualityLegibility/ Enhanced data quality

Potential Benefits Patient safety/ Reduced medical errorsPatient safety/ Reduced medical errors Accessibility/ Enhanced quality of careAccessibility/ Enhanced quality of care Timely data entry/ Improved Timely data entry/ Improved

documentationdocumentation Legibility/ Enhanced data qualityLegibility/ Enhanced data quality Enhanced security/ Controlled AccessEnhanced security/ Controlled Access

Potential Benefits Patient safety/ Reduced medical errorsPatient safety/ Reduced medical errors Accessibility/ Enhanced quality of careAccessibility/ Enhanced quality of care Timely data entry/ Improved Timely data entry/ Improved

documentationdocumentation Legibility/ Enhanced data qualityLegibility/ Enhanced data quality Enhanced security/ Controlled AccessEnhanced security/ Controlled Access Guideline disseminationGuideline dissemination

Examples

Veterans Health Administration (VHA)Veterans Health Administration (VHA) Computerized Patient Record System Computerized Patient Record System

(CPRS)(CPRS) Department of Defense (DoD)Department of Defense (DoD)

Composite Health Care System (CHCS) IIComposite Health Care System (CHCS) II Indian Health Service (IHS)Indian Health Service (IHS)

Resource and Patient Management Resource and Patient Management System (RPMS)System (RPMS)

IHS Electronic Health Record (IHS-EHR)IHS Electronic Health Record (IHS-EHR) http://www.ihs.gov/CIO/EHR/http://www.ihs.gov/CIO/EHR/

                           

                       

Challenges

Provider & staff acceptance Provider & staff acceptance Infrastructure and application costsInfrastructure and application costs TrainingTraining StandardizationStandardization Regulatory issueRegulatory issue Expertise in health informatics Expertise in health informatics

Primary Care and Public Health Interactions patient-centered data sourcepatient-centered data source

clinical decision supportclinical decision support management of health servicesmanagement of health services

non-patient data sourcesnon-patient data sources

Healthcare and Public Health Services EHR: foundation of integrationEHR: foundation of integration

HealthCare Public Health

References Key Capabilities of an Electronic Health Record System: Letter Report. Committee on Key Capabilities of an Electronic Health Record System: Letter Report. Committee on

Data Standards for Patient Safety, Institute of Medicine, 2003.Data Standards for Patient Safety, Institute of Medicine, 2003. Electronic Health Record: Public Health Perspectives. White Paper. Public Health Data Electronic Health Record: Public Health Perspectives. White Paper. Public Health Data

Standards Consortium Ad Hoc Task Force on EHR-PH, Baltimore, MD, Draft – February Standards Consortium Ad Hoc Task Force on EHR-PH, Baltimore, MD, Draft – February 25, 2004.25, 2004.

Garrett N and Yasnoff W. Disseminating Public Health Practice Guidelines in Electronic Garrett N and Yasnoff W. Disseminating Public Health Practice Guidelines in Electronic Medical Record Systems. J Public Health Management Practice, 2002, 8(3), 1-10.Medical Record Systems. J Public Health Management Practice, 2002, 8(3), 1-10.

Miller C. The Electronic Medical Record: A Definition and Discussion. Top Health Inform Miller C. The Electronic Medical Record: A Definition and Discussion. Top Health Inform Manage, 1993, 13(3), 20-29.Manage, 1993, 13(3), 20-29.

Hays H. The IHS Electronic Health Record Project. The IHS Primary Care Provider. Hays H. The IHS Electronic Health Record Project. The IHS Primary Care Provider. November 2003, Volume 28 Number 11, 1-4.November 2003, Volume 28 Number 11, 1-4.

Dick RS, Steen EB (eds). The Computer-based Patient Record – An Essential Technology Dick RS, Steen EB (eds). The Computer-based Patient Record – An Essential Technology for Health Care, rev ed. Washington, DC: National Academy Press; 1997:55for Health Care, rev ed. Washington, DC: National Academy Press; 1997:55

Murphy GF, Hanken MA and Waters KA. Electronic Health Records: Changing the Vision. Murphy GF, Hanken MA and Waters KA. Electronic Health Records: Changing the Vision. Saunders; 1999.Saunders; 1999.

http://www.himss.org/content/mindmaps/EHR/multi-maps/introduction/introduction.htmhttp://www.himss.org/content/mindmaps/EHR/multi-maps/introduction/introduction.htm

Acknowledgements Atreja, Ashish Atreja, Ashish Bertolli, Jeanne Bertolli, Jeanne Dania, Frank Dania, Frank Fischetti, Linda Fischetti, Linda Garrett, Nedra Garrett, Nedra Griffith, Stan Griffith, Stan Hamdan, Saeed Hamdan, Saeed Hays, HowardHays, Howard Khan, Nabeel Khan, Nabeel

Li, Wenkai Li, Wenkai Magno, PengMagno, Peng Martin, Tonya Martin, Tonya Monegain, Bernie Monegain, Bernie Richards, Janise Richards, Janise Steindel, Steve Steindel, Steve Tomines, Alan Tomines, Alan Wangia, VickyWangia, Vicky Williams, WarrenWilliams, Warren

Thank you!

AJ Rosario, MD, MPHAJ Rosario, MD, MPHarosario@cdc.govarosario@cdc.gov

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EHR