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101 Cards in this Set
- Front
- Back
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EHR |
Electronic Health Record
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EMR |
Electronic Medical Record
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(R-ADT)
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Registration-Admission, Discharge, Transfer
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(PMS)
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Practice Management System
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(PFS)
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Patient Financial Services
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(EDMS)
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Electronic Document Management Systems
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(OC/RR)
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Order Communication/Results Retrieval Systems
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(POC)
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Point-of-Care
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*What is the maximum incentive for a Medicaid eligible provider to receive through the EHR meaningful use incentive program?
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$63,750
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(CPOE)
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Computerized Provider Order Entry Systems
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(e-Rx)
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E- Prescribing
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(EMAR/BC- MAR)
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Electronic/Bar-Code Medication Administration Record
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(CDR)
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Clinical Data Repository
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(CDS)
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Clinical Decision Support
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(CDW)
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Clinical Data Warehouse
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(PHRs)
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Personal Health Records
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(HIE)
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Health Information Exchange
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*Electronic Health Record
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A comprehensive record of a patient's history, demographics, ability to view lab and image results etc
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Compare and contrast EHR and EMR
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EHR gathers from EMR
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Identify major functions of an EHR
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Health info and data, results management, order entry management, clinical decision support, electronic communication, patient support, admin processes, reporting and population health management
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Identify major obstacles to EHR adoption
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High capital cost, pushback from doctors, ROI is low, some doctors don't take medicare or medicaid, high maintenance cost
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Identify 3 major safety issues with EHRs
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Data security, patient identification, releasing data that hasn't been de-identified, interoperability
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*Explain pros and cons of EHR customization
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Pros: more specific to your practice? Saved codes? The EHR adapts for each practice to be more user friendly •Cons: interoperability
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*Describe the benefits of discrete data over free text
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Discrete = structured (numerical values, sets of choices) but also standard, uniform
•Free text= unstructured, narrative, more descriptive |
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*EHR
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An electronic version of a patient's health information
•Includes a comprehensive patient history; broad picture |
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*EMR
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An electronic version of a patient's health information from one practice
•Only includes information from one doctor's office; more of a local version kept in one practice |
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*PHR
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Personal health record
•Health information compiled and maintained by you •Not protected by HIPAA •All info input by the person, can be leaving out info |
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*Certified EHR
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EHR that meets meaningful use standards
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*Electronic Prescribing
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Allows a physician to write a prescription that is electronically transmitted to a pharmacy in such as way that the data goes directly into the pharmacy's computer system
•No re-entry of data on the pharmacy's end •Saves time and leaves much less room for human error |
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*ONC
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Office of the National Coordinator for Health IT They are the ones that determine whether an EHR is certified
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Templates
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Preset format for a document
•Can be done with Rx and SOAP notes |
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*T/F - An EHR can only be certified as a "complete" product
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F
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*clinical messaging
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this technology allows for electronic exchange of information through a secure portal via the internet |
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*Discrete data
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Structured data
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*Free text
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Unstructured data; narrative
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Drug-drug interaction
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How drugs interact with one another
•EHRs are useful in identifying drug-drug interactions; flags will pop up in the system, and with allergies, and age |
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*Clinical quality measure
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Tools that help measure and track the quality of health care services provided by eligible providers
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(CQM)
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Clinical quality measure
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*Clinical decision support
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Designed to help physicians and other health care professional with clinical decision-making tasks in the clinical workflow
•EX: ◦Present alerts for preventive services and wellness ◦patient -specific dosing and warnings ◦Support for drug interaction checking |
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What are the benefits of an EHR?
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Increased delivery of guideline based care
•Enhanced ability to perform surveillance and monitoring for disease conditions •Reduction in medical errors •More efficient use of resources and reduction of patient utilization of health care system |
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Difference between EHR, EMR, & PHR?
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EHR are a comprehensive view of a patient's health information, EMR are only a record from one healthcare provider such as one doctor's office, PHR are compiled and maintained by the patient themselves (only semi accurate not covered by HIPAA)
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*What are some of the obstacles to EHR adoption?
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Lack of capital and uncertain Return on investment (ROI), Vendor product selection, Interoperability
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*What is clinical decision support and why is it important?
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Systems designed to help physicians and other health care professional with clinical decision-making tasks in the clinical workflow
•Important because it helps physicians make better decisions; increased quality of care and enhanced health outcomes; helps avoid medical errors and adverse events; improved efficiency and patient-provider satisfaction, reminders for preventative care |
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Describe the structure on one clinical decision support rule
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Present alerts for preventive services and wellness
•Identify drug interactions warnings at the point of medication ordering |
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Examples of discrete data
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Temp, height
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*Examples of text data
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Narrative data, Provider's notes
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When would you use one versus the other
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Sometimes you need more details
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*Electronic Medical Record (EMR)
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An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization.
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*Electronic Health Record (EHR)
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An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one organization.
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*Qualified EHR
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Electronic record of health-related information on an individual that includes demographic and clinical health information, medical history, and problem lists; and has the capacity to provide clinical decision support, support physician order entry, capture and query information relevant to health care quality and exchange electronic health information with other sources.
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What are the fundamental elements of an EHR?
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Collects and integrates source data, captures and enables use of data at POC, Supports clinical decision making, quality measurement reporting and improvement and health information exchange.
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*Which landmark report served as a wake-up call for healthcare organizations that medical errors were happening in alarming numbers
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To Err is Human
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*What are the three primary components of the meaningful use program?
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Certification program, standards &criteria and objectives & measures.
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What are the five priorities for adoption of EHR?
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Improve quality, safety, and reduce health disparities; engage patients and their families in their health care; improve care coordination; improve population and public health; ensure adequate privacy and security protection for confidential information.
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What organizations created forerunners of the first commercial products and delivered major efforts to automate clinical information?
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Stanford University and El Camino Hospital, Latter Day Saints (Now Intermountain Healthcare), Massachusetts General hospital, Kaiser Permanente, and Regenstrief Institute.
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*What were the early limiting factors of EHRs?
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Limited to the environments in which they were uniquely created. They lacked product "commercialization". The processes were unique for each organization and could not be readily and broadly implemented. They lacked source systems.
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Landmark efforts were made towards EHRs in the 80s and 90s by which organization?
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Institute of Medicine (IOM)
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What did IOM envision?
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a longitudinal record of events that supports user's access to complete and accurate data, alerts and reminders, clinical decision support systems, and links to medical knowledge.
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*T/F - Meaningful use criteria represents the minimum capabilities that an EHR must possess in order to earn incentives
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T
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What two publications were IOMs "Wake Up Call"?
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"To Err is Human: Building a Safer Health System" (1999) where they identified that at least 44,000 and perhaps as many as 98,000 hospitalized Americans die every year from medical errors. "Preventing Medication Errors" (2007) Where they uncovered that medication errors insure 1.5M people and cost $3.5B per year.
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What controversies arose in the adoption of EHR?
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Errors and near misses have occurred often as a result of not using the EHR properly. The FDA interest in regulating EHRs as medical devices. Skepticism about degree to which EHRs will improve quality, with this, most studies were old and anecdotal evidence is strong.
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What are some benefits of the EHR?
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* Improve quality of healthcare
* Enhance patient safety * Support health maintenance * Increase productivity * Reduce hassle factors * Support revenue enhancement * Support predictive modeling * Maintain patient confidentiality |
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*T/F
Clinical messaging systems only uses the facility's intranet as a means of information access |
F |
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*EHR is a system of components that meet the following criteria:
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* Integrates data from multiple sources
* Captures data at the point of care * Supports clinical decision making |
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What are the EHR system components?
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* Hardware - enables system use
* Software - directs computer devices * People - supports and use systems * Policy - drives adoption of system * Process - helps achieve results |
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*What is the EHR migration path?
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The sequence in which various source sytems, clinical applications, and supporting infrastructures are implemented, given unique organizational needs, recognizing existing infrastructure, culture, resources, and goals of the organization, reflecting potential dependencies among components, and as appropriate for nature of healthcare organization.
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electronic document management system
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captures images of forms for storage in a system |
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*What are the four main categories of information systems that contribute to and comprise an EHR?
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* Source Systems
* Core Clinical Systems * Supporting Infrastructure * Connectivity Systems |
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*What are source systems?
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They collect data that relate in any way to the health record (ancillary or departmental systems, specialized source systems, smart peripherals "smart infusion pumps")
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*What are core clinical systems?
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They enable use of data at the point of care. They support specific clinical functionality and are often the applications that define whether a care delivery organization has an EHR:
* Results management * POC charting * Medication Management (CPOE, EMAR) *Clinical decision support *Reporting |
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*Which of the following terms best describes an electronic record used within one healthcare organization?
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EMR
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What is the supporting infrastructure?
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Integrates data from applications internal to a given care delivery organization (Clinical data repository, Rules engine, knowledge sources, report writers, storage systems, human-computer interfaces, and clinical data warehouse).
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*What are connectivity systems?
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They support the integration of data across different organizations and with patients or their caregivers. (HIE, Continuity of care record or continuity of care document, PHR)
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*What sequence are applications most often implemented in?
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* R-ADT/PMS (Registration-Admission-Discharge-Transfer system)
* Patient Financial Services/Billing * Administrative Systems *EDMS (Electronic Document Management System) * OC/RR (Order Communications/Results Retrieval) * Ancillary/Clinical Departments (labs, pharmacy, radiology) *Clinical Messaging Systems/Portals * Registries |
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*What are the core clinical applications?
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*Results management
* POC charting * CPOE/e-Rx and EMAR/BC-MAR * Clinical decision support *Reporting |
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What is structure data?
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Refers to data that have been predefined in a table or checklist (drop-down menu options, check boxes/radio buttons). It allows for accurate and distinct elements of documentation to be captured precisely and used in subsequent processing by computer.
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*source systems
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examples of these systems include: pharmacy, lab,and radiology systems |
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*What is the maximum incentive for a Medicare eligible provider to receive through the EHR meaningful use incentive program?
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$44,000
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*What is unstructured data?
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Refers to narrative data entered via keyboarding in a comment field, dictation/transcription, speech recognition, or scanning of handwritten documents. Individual data elements not able to be processed by computer.
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What is the purpose of results management?
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It enables results in structured data form not only to be viewed, but also processed into tables and graphs, and compared with other structured data.
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*What is a clinical data repository (CDR)
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It is a relational database that is optimized for processing many transactions with data from multiple source systems. It forms the basis for ambulatory EHRs; but in a hospital, a CDR may not be acquired until many source systems and core clinical applications are implemented.
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What is Telehealth?
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It is the use of medical information exchanged from one site to another via electronic communications to improve, maintain, or assist patients' health status. Home monitoring may be a part of telehealth or independent.
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What is Health Information Exchange (HIE)?
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It is the seamless exchange of health information across disparate organizations.
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*Clinical data warehouse
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a database allows for sophisticated analysis of data |
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What is clinical transformation?
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Is it a comprehensive, ongoing approach to care delivery excellence that offers value while measurably improving quality, enhancing service, and reducing costs through the effective alignment of people, process, and technology.
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What are some clinical data limitations?
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* Clinical data are textual and contextual *Clinicians prefer to narrate a description rather than select from a pick list
*Context in which a term is used may determine the definition of the term * Standard vocabulary initiatives are working to improve vocabulary limitations |
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*What are some technological limitations?
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*Physical limitations such as input devices not totally being mobile and network connectivity demands being huge.
*Many hospitals have old, legacy systems; these often don't support newer, web-based applications. *Vendors tend to offer highly proprietary systems, where different vendor products will not work with one another. |
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What are some cost and value limitations?
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*Complexity of EHR results in high cost.
*cash flow and capital is limited *Time required for adoption and workflow changes is great *Value proposition is difficult *There is no reimbursement incentive to keep people well in a "fee-for-service" environment. |
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What are some standardization limitations?
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*Widespread adoption of standards is limited.
*Standards are needed to write interfaces to connect one system to another *Standard terminology is needed to make data in one system comparable to data in another system. *Standard practices are not widely acceptable to clinicians. |
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What are some change limitations?
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*Many clinicians still do not routinely use computers; some have never used a computer.
*EHR is more than an automated documentation system; clinical transformation requires changes in the practice of medicine- supported by technology |
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*Which application would come first in a EHR implementation
(EMAR, PACS, CDDS, or HIE) |
PACS |
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What are some implementation strategies?
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*Determine readiness
*Plan the migration path *Select the right EHR system for the environment *Carefully plan implementation, including: Mapping and analysis of current processes and workflows; design and testing of new processes and workflows. Understand data requirements and information flows. Clinician review and approval of all decision support. Comprehensive training for all. Thoughtful chart conversion, turnover, and go-live. *Measure successes and lessons learned at critical junctures. |
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*smart peripherals
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these devices are directly connected to an information system that enables the data to be captured into the EHR |
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*Which federal government organization is responsible for overseeing the HIT Certification program for EHRs?
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ONC
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*Clinical data repository
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a database allows for healthcare data to be captured and stored in one location |
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*Structured data is also known as
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discrete
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*bar code medication administration record
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this technology allows for drug identification when medication is being administered to the patients |
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*clinical documentation improvement
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a process used to improve documentation and enhance code assignments |
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*computerized provider order entry
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allows orders for test to be placed in the computer |
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*clinical decision support
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this technology is used to help process information that will help provide information foe making clinical decisions |
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What does population health do?
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It collects and reports data through automatic links, assists in disease-management efforts, provides for public alerts concerning possible health threats, and streamlines communications between providers and public health organizations.
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