Download - Comp3 Unit15a Lecture Slides

Terminology in Healthcare and Public Health Settings

Electronic Health RecordsLecture a – Introduction to the EHR

This material Comp3_Unit15 was developed by The University of Alabama at Birmingham, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

1U24OC000023

Introduction to the EHRLearning Objectives

• Identify the functions of the health record• Describe the American Recovery and Reinvestment

Act of 2009 (ARRA) including the portion of the bill called the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009

• Define meaningful use

2Health IT Workforce Curriculum Version 3.0/Spring 2012

Terminology in Healthcare and Public Health Settings Electronic Health Records

Lecture a

Functions of the Health Record• Document patient care• Provide communication among healthcare team

members• Establish financial and legal record• Support research and continuous quality improvement• Create repository of the clinical thought processes

recording ideas and impressions over the period of care• Archive (at a single point) all clinical data for long-term

use



Lecture a

Electronic Health Record“an electronic version of a patient’s medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that person’s care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations laboratory data and radiology reports”

Source: (Centers for Medicare and Medicaid Services, 2012)(Office of the National Coordinator, 2012)(Latour & Maki, 2010).



Lecture a

Past and Future• Improved Technology• Government Support• Receptivity of Healthcare Professionals• Receptivity of Patients

= Use of Electronic Records

= Amount of Data



Lecture a

• Data rich and information poor?

Source: (LaTour & Maki, 2010)



Lecture a

Rights of Information• Right information: accurate, free from error, and

meaningful• Right person: communicated to the person who should

respond• Right time: given to the decision-maker within a few

minutes or hours• Right place: accessible at the point of care • Right amount: decisions can be made faster when

appropriately-selective information is available

Source: (HIMSS, 2010)



Lecture a

American Recovery and Reinvestment Act (ARRA)

• $19B for Health Information Technology for Economic and Clinical Health (HITECH)

• Centers for Medicare and Medicaid Services (CMS)– Incentive Payment, Meaningful Use

• Office of the National Coordinator for Health Information Technology (ONC)– Oversees Certification Standards

Source: (ONC)



Lecture a

HIT Regulations

• American Recovery and Reinvestment Act of 2009 (ARRA)– Create and save jobs– Invest in education and training– Promoting energy efficiency– Invest in healthcare



Lecture a

HIT Regulations

• Health Information Technology for Economic and Clinical Health Act (HITECH)– Promotes adoption of EHR by healthcare

providers– Offers financial incentives for demonstrating

meaningful use of EHR

Source: (ONC)



Lecture a

Meaningful Use“The effective use of information to support

better decision-making and more effective care processes that improve health outcomes and reduce cost growth”

• Enhance data capture and sharing• Advance clinical processes• Improve outcomes

Source: (The Markle Foundation, 2009)



Lecture a

Regional Extension Centers (RECs)

•Offer technical assistance and guidance on meaningful use•Over 60 RECs serving a defined area•Promote nationwide health information exchange

Source: (ONC)



Lecture a

Data Capture and Sharing• Improving quality, safety and efficiency of care• Engaging patients and families• Improving care coordination• Improving population and public health• Ensuring privacy and security protections

Source: (CDC)



Lecture a

Engage Patients and Families

• Patient eAccess on Request (including discharge summary/ instructions from hospital)

• Patient eAccess to Record (Patient portal)

• Clinical Summaries each Visit (Portal, email, CD, USB, paper)



Lecture a

Improve Care Coordination

• Exchange health information with other providers

• Medication reconciliation• Summary care record for

each transition or referral: transfers with summary

Source: (Latour & Maki, 2010)



Lecture a

Improve Population and Public Health

• eSubmit to immunization registries (hospitals also submit to Department of Public Health)

• eSubmit Syndromic Surveillance to Department of Public Health



Lecture a

Meaningful Use Rule• Final revisions to Stage 1

criteria made on July 13, 2010

• Final revisions to Stage 2 released on August 23, 2012



Lecture a

Sources: (CMS. 2012)

Meaningful Use StagesStage 1 – electronic data capturing and sharingStage 2 – advanced clinical processes; includes patient access and exchange of dataStage 3 – improved outcomes; final revisions not yet released



Lecture a

Stage 1 – 17 Core Objectives



Lecture a

Use CPOE Record Smoking (> 13 yrs)Formulary Checks Structured Lab Results

Problem List List Patient by Condition ePrescribe Report Quality MeasuresRx List Submit Electronic Claims

Rx Allergy List Record Physiological Data

Record Demographics Check EligibilityGrowth charts for children between 2 and 20

Clinical Decision Support ("Relevant to Clinical Quality Measures“)

Patient Reminders (50 yrs or older)

Source: (Blumenthal & Tavenner, 2010)

Stage 2 – Enhances EHR Access & Quality Measures

• Stage 2 builds on Stage 1 by refining measures. For example, hospitals and providers are required to

– permit patients to view online, download & transmit their personal healthcare information

– use CPOE for greater than 60% medications, 30% lab and 30% radiology

– electronically record demographics on more than 80% of patients

– enter electronic progress report for more than 30% of patients



Lecture a

Electronic Health RecordsLecture A – Summary

• Identify the functions of the health record• Describe the American Recovery and Reinvestment Act

of 2009 (ARRA) including the portion of the bill called the Health Information Technology for Economic and Clinical Health Act (HITECH) of 2009

• Define meaningful use, including Stage 1 and 2



Lecture a

Electronic Health RecordsReferences – Lecture a



Lecture a

References • AHIMA (2012). Stage 2 Meaningful Use Final Rule Released. Available from

http://journal.ahima.org/2012/08/23/stage-2-meaningful-use-final-rule-released/• CDC. Meaningful Use. Introduction. Centers for Disease Control and Prevention. Available from:

http://www.cdc.gov/ehrmeaningfuluse/introduction.html• Centers for Medicare & Medicaid Services. Electronic health records overview. [Internet].

Available from: https://www.cms.gov/EHealthRecords/ • CMS. (August 2012) Stage 1 Changes Tipsheet. Available from

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage1ChangesTipsheet.pdf

• CMS. (August 2012) Stage 2 Overview Tipsheet. Available from http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf

• Blumenthal D, Tavenner R. The “meaningful use” regulation for electronic health records. N Engl J Med. 2010 Jul 13. Available from: http://healthcarereform.nejm.org/?p=3732&query=home

• HIMSS. CDS Five Rights. Clinical Decision Support Wiki. Available from: http://himssclinicaldecisionsupportwiki.pbworks.com/w/page/18288541/CDS%205%20Rights

• LaTour KM, Maki SE. Health information management concepts, principles and practice. Chicago: AHIMA, 2010.

http://journal.ahima.org/2012/08/23/stage-2-meaningful-use-final-rule-released/

http://www.cdc.gov/ehrmeaningfuluse/introduction.html

https://www.cms.gov/EHealthRecords/



http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf

http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2Overview_Tipsheet.pdf

http://healthcarereform.nejm.org/?p=3732&query=home

http://himssclinicaldecisionsupportwiki.pbworks.com/w/page/18288541/CDS%205%20Rights

Electronic Health RecordsReferences – Lecture a



Lecture a

References • ONC. HITECH Programs. The Office of the National Coordinator for Health Information

Technology. Available from: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__hitech_programs/1487

• Office of the National Coordinator for Health IT. Health IT terms. [Internet] Available from: http://healthit.hhs.gov/portal/server.pt/community/health_it_hhs_gov__glossary/1256

• ONC. About ONC. The Office of the National Coordinator for Health Information Technology. Available from: http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__onc/1200

• ONC. Health Information Technology Extension Program. Office of the National Coordinator for Health Information Technology. Available from: http://www.healthit.hhs.gov/portal/server.pt?open=512&objID=1335&mode=2

• The Markle Foundation. Achieving the Health IT Objectives of the American Recovery and Reinvestment Act. The Markle Foundation: Connecting for Health, [Internet] 2009 April. Available from: http://www.markle.org/publications/403-achieving-health-it-objectives-american-recovery-and-reinvestment-act

ImagesSlides 6, 15, 16, 17, 18: Clip Art. Available from: Microsoft clips online. Used with permission from

Microsoft.

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