Atlas ELECTRONIC HEALTH RECORDSlisarnelson.com/files/117442352.pdf · EHR, EMR, PHR Historical Marker •EHR –Electronic Health Records – –Legal record of what happened to the

© Copyright 2008 Lisa R. Nelson

ELECTRONIC HEALTH RECORDS

Atlas

Navigator’s Guide for Technology Adoption

By

Lisa Nelson, Jeremy Music, Steve Treacy,

Sharron Lee, and Terry Pientok

1


What is driving us?

• Soaring health care costs

• Macro economic pressures

• Micro economic problems

• Dissatisfaction with current quality

• Growing population, increasing portion >65

• Rising life expectancy


What path do we take?

• Most believe digital technology holds the answer

• Leaders are locking onto this course

• Wheels of change are in motion

• We’re on the right road, but we’ve got a long way to go

3


EHR, EMR, PHR Historical Marker

• EHR – Electronic Health Records –

– Legal record of what happened to the patient during their encounter at a health care facility.

• EMR – Electronic Medical Records –

– Subset of the EHR maintained by a health care provider about a patient.

• PHRs – Personal Health Records –

– Pertinent health information on an individual that is managed and controlled by the individual.

* Definitions proposed by U.S. Congressional Budget Office in conjunction with the National Alliance

for Health Information Technology and BearingPoint, Inc.

4


EHR Population

U P S T R E A M M A I N S T R E A M D O W N S T R E A M

FEDERAL

AND

STATE

GOVERNMENTSVENDORS

IDNs

HMOs

HOSPITALS

PHYSICIANSPATIENTS

5


Construction Zone

• Cultural Beliefs

• Hardware and Devices

• Standards

• Integration and Interoperability

6


Integration & Interoperability Crossroad

• Definition

– Integration - describes bringing subsystems together into one system to ensure that the individual subsystems function together as a whole.

– Interoperability - describes the ability of diverse systems to work together in order to exchange data via a common set of standard formats, read and write the same file formats and use the same communication protocols.

7


Interoperability

• Two levels of Interoperability– Functional – readable by the receiver

– Semantic – information is understood

• Semantic interoperability is absolutely necessary for the automatic information exchange and is where the real value of utilizing decision support systems and care planning applications

8


Roadblocks

• Cross reference of clinical, quality, financial and patient satisfaction data

• Data replication

• Maintenance of multiple systems

9


Integration and Interoperability Landscape

10


Interoperability Through Language Clinical Terminology

• Clinical terminology is the structured language used within a clinical environment to describe the treatment of patients. – Systematized Nomenclature of Medicine--

Clinical Terms (SNOMED CT)

– LOINC (Logical Observations Identifiers, Names, Codes)

– International Classification of Disease (ICD)

– Current Procedural Terminology (CPT)

11


Patient Care Domain

• Lower Layer Standards– IEEE 802.11b and g– Ethernet– USB– RS-232

• Upper Layer Device Messaging Standards– Proprietary– IEEE 1073 – Point-of-Care

12


Enterprise Domain

– Digital Imaging and Communications in Medicine (DICOM)

– Health Level Seven (HL7)

– Integrating the Healthcare Enterprise (IHE)

13


Data Protection and Security

• How will data be secured?

• Application of technology to healthcare has generated growing concern regarding privacy and security of medical information.

– HIPAA, Title II

– Health Insurance Reform, Security Standards Final Rule (February 2003)

14


Layers of Data Security

Procedural Controls

Separation of Duties, Standard Procedures, Documentation, Authorization Requirements, Auditing

Information System Controls

Input, Processing, Output, and Storage Controls

Information System Security

Physical Facility Control

Physical Protection, Computer Failure Controls, Telecommunications Controls, Insurance

15


Data Storage Junction

• Data storage qualities:

– Physical

• Tangible location of data placement.

– Logical

• Virtual representation demonstrating the manner in which data is placed.

16


Physical Storage

• Storage Media– Definition:

• Storage media is technology used to place, keep, and retrieve data.

• Files– Definition:

• A collection of information that a computer uses. It is always in a particular format.

• Databases– Definition:

• Database is a collection of information arranged for ease and speed of search and retrieval.

17


Logical Storage

18


Refocus on the Roadmap to Integration and Interoperability

• EHR systems- not uncommon to have separate databases for each business unit

• Key factor for integration and interoperability is the ability to interchange data between databases.

19


Where do we go from here?

20


Government

• Motivating Factors As a purchaser of services through Medicare and Medicaid

payments, the government is interested in improving the quality and value

• ActionsThe key desired actions of government are to:

– Facilitate development of national standards and code sets

– Provide grant funding

– Provide payment incentives

– Accelerate investment in RHIO

21


Health Insurers

• Pay for Performance

22


Hospitals

• Collaboration with other hospitals/clinics

• Formation of RHIOs (Regional Healthcare Information Organizations)

23


Physicians

• Devote more time to training to become computer savvy

• Adapt and adopt work processes in order to maximize the use of EHR systems

24


Individuals• Create a Personal Health Record (PHR)

• Take ownership for your health records and the health records of your children, parents

• Hold medical providers and pharmacies responsible for helping you create and maintain your records

• Encourage politicians to keep EHR on “the agenda”

• Suggest employers create incentive programs for employees who are actively track their health indicators

25


EHR Adoptionat

Blackstone Valley Community Health Center, RI

26


Accelerating EHR Adoptions• 3 different PM systems, 1990-2005

• Single-vendor PM+EMR+DMR, 2007

• Leveraging implementation experience

• Integration & Interoperability, now and future

27


Conclusion

• There’s much that a navigator of EHR adoption must know

• Many good reasons why

• Lots of options how

• Better quality healthcare delivered more cost effectively

28

Atlas ELECTRONIC HEALTH RECORDSlisarnelson.com/files/117442352.pdf · EHR, EMR, PHR Historical Marker •EHR –Electronic Health Records – –Legal record of what happened to the

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