Nur 3563 group project team 6 ehr

NUR 3563 Spring 2011 1

The Electronic Health Record

Created by: Cindy Todd 2

Table of Contents

Introduction: Kendra Frana (3) The EHR Components: Sarah Williams (4-

12) Cost: Kendra Frana (13-15) Structure of EHR: Tricia Manson (16-18) Safety: Aubrey McElroy (19-23) Education : Cindy Todd (24-28) Conclusion: Aubrey McElroy (29-30) References: All members (31-33)

Created by: Kendra Frana 3

Introduction

The Electronic Health Record (EHR) provides vital pieces of information about patients health care information. There are multiple items included in this information such as: vital signs, patient demographics, progress notes, history, medications, labs, and radiology reports. The EHR provides a great way for healthcare clinicians to follow patients information by accessing computers linked within the clinical area where patients are. This presentation discusses the multiple areas associated with evaluating an EHR/EMR.

Created by: Sarah Williams 4

The EHR

There are many different definitions for EHR. The one referenced the most and in our book consists of 8 main components. If you can gain a basic understanding of these components, you will have a good understanding of the EHR.

(McGonigle & Mastrian 2009, p. 221)


8 Components to the EHR

1. Health Information and DATA This is the basic patient information including

demographics, diagnoses, allergies, etc. Most employees will need access to this information from doctors to admitting personnel.

2. Results Management This is a location for current as well as

historical lab results, radiology and procedure reports, etc. This information should be limited to those that are directly caring for the patient in the hospital or the primary care physician. (McGonigle & Mastrian, 2009,p.222)



3. Order Entry management This is the ability to enter orders of any kind directly

into the computer. This should be limited to providers with ordering privileges or the nurses that have the ability to take verbal orders or input orders given directly by the provider.

4. Decision Support This is the ability to have reminders or “pop-ups”

regarding medication interactions, vaccination reminders, health risk screening, etc. Reminders should be specific to the person in the EHR. An aide doesn’t need a reminder that a patient is due for a mammogram, however an allergy reminder would be appropriate. (McGonigle & Mastrian, 2009, p.222)



5. Electronic Communication and ConnectivityThis is a way of communication among healthcare team

members, their partners, and the patient through e-mail, Web messaging, etc. This should be limited to those with direct patient care such as the provider and the nurses. Systems such as Office Communicator can be helpful in clinics where there are multiple people caring for the same

6. Patient Support This is the ability for patients to monitor their healthcare at

home through computer-based patient education, home monitoring, etc. For example, there are websites that patients can download health information from home such as BP and HR monitoring that allow the provider to monitor them without a clinic visit. This information should be limited to the provider specifically requesting the information patient. (McGonigle & Mastrian, 2009, p.222)



7. Administrative Processes This is the ability to electronically do scheduling, billing, pre

approval, insurance eligibility, etc. Access to this information is typically only needed by clerical staff such as receptionist, schedulers, billing and coding and admitting.

8. Reporting and Population Health Management This is the ability to integrate data collection tools

that are specific to a certain patient population such as pediatrics. There are additional programs that can be added in pediatrics areas that calculate medication doses for infants and children that would not be needed in an adult patient care setting. (McGonigle & Mastrian, 2009, p. 222-23)



Each of these components are very important to the smooth operation of the EHR.

There are obviously high safety risks when it comes to making all of the patient’s records so easily accessible.

With the right safety measures and conscious employees, patients can feel comforted knowing their information is being kept confidential. (CMPA, 2008)

Created by :Sarah Williams 10

Who Should Have Access to the EHR?

Limits should be set as to what information each employee has. For example: An aide doesn’t need access to order entry, the

complete patient history, procedure reports, etc. Obviously an aide would have limited access to only the areas of care that they are responsible for such as vital signs, diet, activity, ADLs, etc.

Employees that change positions or transfer to a different department are going to require access to different information. For example: a nurse working in dialysis is going to need access to different information if they transfer to the Cath Lab.


Monitoring Accessed Information

One way to monitor who is accessing certain patient information is with an audit trail.

This allows security to make sure only those that need to be looking at patient information are looking at it.

This is one way St. John’s is monitoring their employees and keeping patient information confidential. (CMPA, 2008)


Monitoring Accessed Information

Another way confidentiality is being enforced is by electronic signatures.

At St. John’s, when there is a high profile patient such as a Federal Medical patient, a special log in is needed to monitor who is accessing the EHR.

This ensures that only those providing care are going into the chart.

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Cost

There are four main components for an EMR/HER

1. EMR Software Licensing2. Implementation3. Hardware4. Ongoing Support, Maintenance, and

Enhancements

(newcreationit.com,2011)

Created by: Kendra Frana

14

Cost, cont.

Software Licensing Average licensing for a FULL/True EMR starts at

about $10,000.00. Average licensing for a Light/Entry level EMR

starts at $1,000.00. Implementation

Usually an hourly rate between $75.00-$150.00 Average implementation time per provider is 35

hours. 25 hours of training and 10 hour to setup the computer/network. (emrexperts.com, 2010)


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Cost, cont.

Hardware Tablet PC $2,500.00 Workstation $1,000.00 Server $2,000.00

Support and Maintenance Ongoing support costs will come from an

annual support contract with the software vendor for updates and technical support. Also, the need of hardware/network support through a local IT representative. (americanmedical.com, 2011)


Created by: Tricia Manson 16

How should a CIS be structured

Simple and easy to use Must be easy to get to within the system

itself Software should be updated every time

new EBP research comes out CIS being used should send automatic

updates to download when new information is available

(Biohealthmatics.com)


How often should it be updated with new EBP guidelines

It is important for health care providers to have a support system in the CIS for medication administration, ordering, and diagnosing. Since EBP comes out with new research all the time, it is important for the CIS to stay current in order to give the best and most complete care possible to every patient.

(Informatics-review.com)


Companies that design clinical decision making systems for the CIS

Thera Coc, Inc. VisualDx Dxplain QMR (Quick Medical Reference) Diagnosis Pro Lliad

Biohealth.com

Created by: Aubrey McElroy 19

EHR Safety


EHR Safety

The three main areas to look for when evaluating a secure network are:

(McGonigle & Mastrian (2009).

Confidentiality AvailabilityIntegrity

•An EHR system should offer highly granular security, allowing system administrators to define access and privileges according to the respective roles of the staff. (McKesson Provider Technologies (2010)


EHR Safety

Limit access given to health care professionals who have completed HIPAA training and competencies only.

Enforce a strong password policy throughout the system with timed resets.

Institute an operating system that “locks down” all computers after a predetermined amount of time.

How do we protect our patient’s information?

(McGonigle & Mastrian (2009).


EHR SafetyWHAT OR WHO WILL CONTINUALLY

MONITOR THE SYSTEM? The IS (information systems)

department will provide the man power to implement and run: Anti-virus software Firewalls Use of Proxy servers to monitor

and limit access to certain websites or topics

Intrusion detection systems allow monitoring of who is using the program and what files are accessed.

(McGonigle & Mastrain, 2009)


EHR Safety

Your system will need to maintain technical support contracts for both hardware and software to ensure routine maintenance, backups and the IS department to troubleshoot problems as they occur. (McKesson Provider Technologies. (2010)

“It is everyone’s responsibility to diligently monitor for unauthorized access of their networks, data, and/or information(McGonigle & Mastrian (2009).”


EHR Education


EHR Education

How do we get everyone trained in a short period of time in a program that will be vital to our practice? We use Technology E-learning We use powerful motivators (such as merit

increases and staff privileges) to commit to project

We award CME’s for participation Make sure everyone understands and believes

the investment will pay off in the long run(Jimenez,2010, p. 22-23)


EHR Education

What have other places learned from the implementation process? Be sure the entire staff knows when, why, and how the

transition will occur. Get outside help from professionals to implement the

new EHR and study the programs carefully to match the needs of the environment so more work is not created

Learn the basics first and then work up to the whole system. Let this be a step by step process.

Only go live when ready, be prepared for setbacks, and be patient for the results of increased productivity

(Lewis , 2010, p. 36-38)


EHR Education

How to deal with push back from employees resistant to the change ? Involve them in decisions

from the beginning Make sure the system

purchased is user friendly and easy to navigate

Sufficient amount of training before and after the implementation

PLANNING IS KEY!!! (McGonigle & Mastrain, 2009,p.229)


EHR Education

How do we roll out this large undertaking and make sure we are ready?

Increase staffing numbers

Don’t just train with computers use practice time, instructor-led, hands-on

Set up a post training areas to account for changes

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Conclusion

Things to remember when evaluating an EHR...

Have a well rounded group to customize and implement an EHR suited for your company

The purpose of the EHR for your company Clinical structure Safety considerations Cost Educational needs for employees

Created by: Aubrey McElroy

30

Conclusion

“We believe that the central point of an EHR is to gain quality and efficiency in caring for the patient. The patient’s health conditions and whole health history are available to the Healthcare Professional to aid in diagnosis, therapy planning, and patient care (Campos, C.J., Salinas, M.D., Sigulem, D., Wainer, J. (2008).”

Created by: Aubrey McElroy

Created by: All members 31

References

American Medical Software. (2011). Benefit Analysis. http://americanmedical.com/ehr-stimulus-center/cost-benefit-analysis/

Biohealthmatics.com. Retrieved from http://www.biohealthmatics.com/

Campos, C.J., Salinas, M.D., Sigulem, D., Wainer, J. (2008). Security requirements for a lifelong electronic health record system: An opinion. Open Med Inform Journal. 160–165. doi:10.2174/1874431100802010160.

Drewniak, R. (2009). EHR implementations: Success lies beyond the build. Health Leaders Media. Retrieved from www.healthleadersmedia.com


ReferencesEMR Experts. (2010). EMR ROI (Return on Investment).

http://www.emrexperts.com/emr-roi/index.php

Informatics-review.com Retrieved from http://informatics-review.com/

Jimenez, A. (2010). E-learning supports EHR implementations: in addition to meaningful use, we need to define

meaningful training. Health Management Technology, 31(11), 22-23.

McGonigle, D. & Mastrain, K. (2009). Nursing informatics and the foundation of knowledge. (pp. 185-191 ,219-237). Jones and Bartlett: Sudbury, MA.


ReferencesMcKesson Provider Technologies. (2010) A Guide to

Successfully Implementing Electronic Health Records. Retrieved from: http://www.practicereadyehr.com/pdf/EHR101.pdf

New Creation Information Technologies Advancing Healthcare IT. (2007). EMR Software Pricing. http://newcreationit.com/electronic-medical-records/custom-emr-software-pricing

The Canadian Medical Protective Association (CMPA). (2008, August). Electronic health records: A medical liability perspective. Retrieved April 5, 2011, from http://www.cmpa-cpm.ca/cmpapd04/docs/submissions_papers/com_electronic_health_records-e.cfm

Nur 3563 group project team 6 ehr

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