CHIM305 Module 4

What is an EHR?   Overview:  Defined as a secure, real-time, point-of-care longitudinal record of patient health information that is generated by one or more encounters in the delivery care setting  Makes data available to HCPs anywhere by connecting with full interoperability on the organization's integrated databases, while protecting patient privacy, confidentiality, and patient's right to have control over the data  EHR also referred to as computerized medical records (CPR), electronic medical records (EMR), and personal health records (PHR) o Differentiation among these terms refers to volume and access o EMR includes patient's record in an individual organization (e.g. hospital, physician's office) o PHR is information that can be accessed and updated by individual patient (e.g. diet, exercise plans, medications, allergies, etc.) in addition to EMR content o CPR is used interchangeable with EHR   Core Data Set:  Defined as the record of clinical patient encounters and support for other care-related activities that function as the clinician's primary information resource during the provisioning of care  Elements: o Demographic information o Problem list o Screenings o Continuity of care record content o Information on insurance o Advanced directives o Support functional status o Problems o Family history o Social history o Medical alerts o Medication allergies o Immunizations o Vital signs o Results o Procedures o Encounters o Plan of care o Healthcare providers o Referrals   Core Functions of an EHR Incorporate:  Source: https://pubmed.ncbi.nlm.nih.gov/12680044/  Functions: o Health information and data o Results management o Order management o Decision support o Patient support o Administrative processes and reporting o Reporting on population and health o Electronic communication and connectivity   Is There a Business Case for EHR?   Overview:  Costs: o Requires significant upfront investments for implementation (including training and/or conversions of existing systems) o Ongoing operating implications for support, maintenance, upgrades, contracts, etc.  Will healthcare organizations save money? o Yes, sometimes (e.g. automating labs or implementing diagnostic imaging systems can reduce ongoing operating costs in departments for labour, film, processing) o But there may be corresponding increases in technology costs and ongoing support  Some studies indicate that documenting or placing orders electronically takes more time than working on paper o While there may be improvements in patient safety, there are additional costs that our healthcare system must be willing to absorb  In order to achieve a full EHR, we need: o Technology of a standards-driven infrastructure of computers o Documentation systems o Secure networks o Communication protocols o Ability to link patient data from one organization with all of the other organizations where the patient has received care (done with unique patient identifiers e.g. health card number)

Healthcare Information and Management Systems Society (HIMSS) Analytics   EMR Adoption Model:  Source: https://www.himss.org/what-we-do-solutions/maturity-models-emram  HIMSS analytics has created an EMR adoption model that identifies levels of EMR capabilities ranging from limited ancillary department systems through a paperless EMR environment o Developed a methodology and algorithms to automatically score >5000 US and approx. 700 Canadian hospitals in their database relative to their IT-enabled clinical transformation status, to provide peer comparisons for hospital organizations as they strategize their path to a complete EMR and participation in an EHR   EMRAM in Action:  Supporting gaps in EMR usage (model measures maturity of EMR workflows using global benchmarks to help identify problem-areas)  Proven roadmap for digital transformation  Improving data access and patient outcomes (EMRAM helps unify and safely share data from multiple sources)  Eliminating grunt work (helps automate repetitive clinical and admin tasks and integrate global best practices into existing EMR workflows)   Roadmap Overview   Stage 0:  Organization has not installed all of the 3 key ancillary department systems (laboratory, pharmacy, radiology)   Stage 1:  All 3 major ancillary clinical systems are installed (e.g. laboratory, pharmacy, radiology)   Stage 2:  Major ancillary clinical systems feed data to a clinical data repository (CDR) that provides physician access for reviewing all orders and results  CDR contains a controlled medical vocabulary and clinical decision support/rules engine (CDS) for rudimentary conflict checking o Information from document imaging systems may be linked to the CDR at this stage  Hospital may be health information exchange (HIE) capable at this stage and can share whatever information it has in the CDR with other patient care stakeholders   Stage 3:  Nursing/clinical documentation (e.g. vital signs, flow sheets, nursing notes, eMAR) is required, implemented, and integrated with the CDR for at least one inpatient service in the hospital o Care plan charting is scored with extra points o Electronic medical administration record is implemented  First level of CDS is implemented to conduct error checking with order entry (e.g. drug/drug, drug/food, drug/lab conflict checking normally found in the pharmacy information system)  Medical image access from picture archive and communication systems (PACS) is available for access by physicians outside the radiology department via the organization's intranet

Key Points:  It's important not to just automate a manual process but to focus on workflow, improvements, and desired outcomes   Why Transformation Efforts Fail:  Source: John Kotter  Reasons: o No sense of urgency o No powerful guiding coalition o No clear vision o Under-communication of the vision o Inability (unwillingness) to remove obstacles or to empower others to do so o No plans for (or creation of) short-term wins o Premature declaration of victory o No ability to “anchor” the changes into the culture!    So What Can Be Done?  Quote: Competitive strategy is about being different. It means deliberately choosing a different set of activities to deliver a unique mix of value.  Actions: o Envision the future – create the vision and sense of urgency  "The best way to predict the future is to invent it" o Explore the possibilities – create a guiding coalition o Empower the patient – remove obstacles o Enable the provider – communicate the vision o Embrace technology – consolidate improvements and celebrate success o Enhance the process – institutionalize new approaches o Achieving excellence is the goal   Envision the Future:  Create a sense of urgency  Build great systems  Create learning environments  Align incentives  Evaluate costs/benefits  Challenge the status quo  Create a Culture of Creativity  Build in privacy functions  Map workflows  Focus on improvements   Explore the Possibilities:  Stretch the boundaries  Take calculated risks  Avoid negativity  Create a guiding coalition  Don’t assume/speculate  Don’t excuse the chaos  Solve the mysteries; simplify the puzzles  Create a Culture of Exploration   Empower the Patient:  Educate the patient  Create partnerships  Provide evidence  Challenge assumptions  Create a Culture of Trust   Enable the Provider:  Support learning environments  Define expectations; remove barriers  Align incentives  Own the outcome  Provide simulation opportunities  Create a Culture of Collaboration   Embrace Technology:  Leverage investments  Pilot solutions  Promote good ideas  Reward innovation  Consolidate improvements  Celebrate success  Partner with colleagues/vendors  Create a Culture of Excitement   Enhance the Process:  Create a sense of urgency  Forget the past  Learn from other industries  Forgive mistakes