Ehr Principles And Trends Analysis
Key terms of EHRs and examples in various types of care settings
1. Health Information System:
According to WHO, is the underpinning for decision making in health field and is essential for health system policies development and implementation, governance and regulation, health research, human resources development, health education and training, service delivery and financing. It has four keys functions: data generation, compilation, analysis and synthesis, and communication and use. In addition ensures their overall quality, relevance and timeliness, and converts data into information for health related decision making.
Further, the system provides an alert and early warning capability, supporting patient and health facility management, enabling planning, supporting and stimulating research, permitting health situation and trends analysis, supporting global reporting communication of …show more content…
health to diverse users.
Finally, it helps to identify problems and needs, make evidence based decisions on health policy and allocate scarce resources optimally.
Example of the Health Information System:
In 1983, CLAP / SMR published the Perinatal Information System (SIP). The SIP is a product of consensus among hundreds of technical professionals in the Region convened periodically by CLAP / SMR for review and is part of the tools (tool kit) PAHO to improve the quality of care for mothers and newborn.
SIP objectives are: serve as a basis for planning care verify and monitor the implementation of evidence-based practices standardize data collection adopting standards facilitating communication between the different levels reliable statistics available locally encourage compliance facilitate training of health personnel record data of legal interest facilitate the audit characterize the population served assess the quality of care operational conduct epidemiological investigations
2. Clinical data repository.
Data repository – a database that incorporates special indexing and management functions to capture, sort, process and present information back to users – specific to a patient and in a split second of time. (Health Information Management, concepts, Principles, and Practice, 3th Ed. Glossary)
Clinical Data Repository (CDR): A database that focuses on clinical information (instead of financial or administrative data). It collects patient information from various clinical sources and presents that information in a single document. (Health Information Management, concepts, Principles, and Practice, 3th Ed. Glossary)
CDRs centralize pertinent patient data so that providers may quickly access a file at the point of care, minimizing administrative duties so that physicians may spend more time at the bedside. Clinical data repositories allow for better care quality and cost reduction.
Some of the functions of a CDR include:
• Admission and discharge information
• Lab history and results
• Patient profiles
• List of medications and dosing schedule
• Access to radiology multimedia
• Coding
• Progress notes
• Discharge summaries
CDRs are relational databases that have been optimized to perform online transaction processing. Every time a user enters data, retrieves data, views data and is supplied an alert specific to a given patient that action is considered a transaction. A CDR is typically used for processing transactions and even though they may be very complex, each transaction doesn’t require processing an immense amount of data at one time.
Even though a clinical data repository is good at gathering data, it can’t provide the full depth of information necessary for cost and quality improvements because it wasn’t designed for this type of use. If complex analyses are needed, it would be more appropriate to use clinical data warehouse (CDW).
Example of CDR:
The following article shows us the example of usage the clinical data repository PRO-ACT to access ALS clinical trials data.
“The PRO-ACT database: Design, initial analyses, and predictive features”.
Atassi N, Berry J, Shui A, Zach N, Sherman A, Sinani E, Walker J, Katsovskiy I, Schoenfeld D, Cudkowicz M, Leitner M.
Objective:
To pool data from completed amyotrophic lateral sclerosis (ALS) clinical trials and create an open-access resource that enables greater understanding of the phenotype and biology of ALS.
Methods:
Clinical trials data were pooled from 16 completed phase II/III ALS clinical trials and one observational study. Over 8 million de-identified longitudinally collected data points from over 8,600 individuals with ALS were standardized across trials and merged to create the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database. This database includes demographics, family histories, and longitudinal clinical and laboratory data. Mixed effects models were used to describe the rate of disease progression measured by the Revised ALS Functional Rating Scale (ALSFRS-R) and vital capacity (VC). Cox regression models were used to describe survival data. Implementing Bonferroni correction, the critical p value for 15 different tests was p = 0.003.
Results:
The ALSFRS-R rate of decline was 1.02 (±2.3) points per month and the VC rate of decline was 2.24% of predicted (±6.9) per month. Higher levels of uric acid at trial entry were predictive of a slower drop in ALSFRS-R (p = 0.01) and VC (p < 0.0001), and longer survival (p = 0.02). Higher levels of creatinine at baseline were predictive of a slower drop in ALSFRS-R (p = 0.01) and VC (p < 0.0001), and longer survival (p = 0.01). Finally, higher body mass index (BMI) at baseline was associated with longer survival (p < 0.0001).
Conclusion:
The PRO-ACT database is the largest publicly available repository of merged ALS clinical trials data.
We report that baseline levels of creatinine and uric acid, as well as baseline BMI, are strong predictors of disease progression and survival.
3. Clinical decision support system (CDSS)
Clinical decision support system (CDSS): A special subcategory of clinical information systems that is designed to help healthcare providers make knowledge-based clinical decision. (Health Information Management, concepts, Principles, and Practice, 4th Ed. Glossary 902)
The main purpose of modern CDSS is to assist clinicians at the point of care. This means that a clinician would interact with a CDSS to help determine diagnosis, analysis, etc. of patient data.
There have always been errors that occur within the healthcare industry, thus trying to minimize them as much as possible in order to provide quality patient care. Four areas that can be addressed with the implementation of CDSS are:
1. Medical error
2. Medication error
3. Adverse drug events
4. Lessen
error
An example of how a CDSS might be used by a clinician comes from the subset of CDSS (Clinical Decision Support System), DDSS (Diagnosis Decision Support Systems). A DDSS would take the patients data and propose a set of appropriate diagnoses. The doctor then takes the output of the DDSS and figures out which diagnoses are relevant and which are not.
Another important classification of a CDSS is based on the timing of its use. Doctors use these systems at point of care to help them as they are dealing with a patient, with the timing of use as either pre-diagnosis, during diagnoses, or post diagnoses.
-Pre-diagnoses CDSS systems are used to help the physician prepare the diagnoses. -CDSS used during diagnoses help review and filter the physician’s preliminary diagnostic choices to improve their final results. -And post-diagnoses CDSS systems are used to mine data to derive connections between patients and their past medical history and clinical research to predict future events http://en.wikipedia.org/wiki/Clinical_decision_support_system#Role_.26_Characteristics 4. Computerized provider order entry systems (CPOE):
Are designed to replace paper based ordery system of hospitals.
Is a process of electronic health entry of medical practitioners instructions for the treatment of patients (particularly hospitalizes patients) under their care. These orders are communicated over a computer network to the medical staff or to the departments responsible for fulling the order.
It decreases delay in order completion inventory and posting of charges.
CPOE is a form of patient management software and the same time a medical device that provides medical information to be used in the treatment or diagnosis of patient. It can also contribute to the patient by performing analysis, or providing treatment or diagnosis functionally that replaces the decision and judgment of a physician.
Example:
VAGINAL CANDIDIASIS
CLOTRIMAZOLE OVULE 500mg DAILY DOSE PER 5 DAYS.
The system it is going to advise to the physician that the dose of 500mg is a single dose not a daily one, and if he wants to indicate a daily dose then need to change the medication to 100mg daily for 5 days and also will specified route of administration.
5. Electronic Health Records (EHRs).
EHR – a comprehensive system of applications that access to longitudinal (from birth to death) health information about individual across the continuum of care, assist in documentation, support clinical decision-making, and provide for knowledge-building.
Definition of EHR proposed by National Alliance for Health Information technology: “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 healthcare organization”(NAHIT 2008).
The key difference between EHR and EMR is that EHR being interoperable and EMR not. Interoperability refers to ability of two different systems to exchange data with each other.
EHR key concepts:
1) Structured data – values of variables that computer can process (for example age, sex and chief complaints). Structural data are essential for all forms of clinical decision support (CDS) and for producing both internal reports for patient recall, quality improvement, and research as well as to meet external accountability reporting.
2) Unstructured data – narrative notes which may be typed into comment fields, or dictated, transcribed, or handwritten into electronic system, as well as images.
3) The ability for many applications to exchange and process data. These applications may vary by type of care delivery organization.
The core EHR functionalities, according to Institute of Medicine (IOM 2003) are:
Health information and data
Results management
Order entry and management
Decision support
Electronic communication and connectivity
Patient support
Administrative process
Reporting and population health management
Example:
The following article shows us the example of usage PHRs and EHRs by physicians and nurse practitioners while communicating with patients in the examination rooms.
“Patient experiences with electronic medical records: Lessons learned”
Dale Rose, DHA, MS, RN, CENP (Director of Ambulatory Nursing)1, Louiseann T. Richter, EdD (Adjunct Faculty), & Jane Kapustin, PhD, CRNP, BC-ADM, FAANP, FAAN (Professor, Assistant Dean for the Masters and DNP Programs)
Abstract
Purpose: To describe the lived experience of patients communicating with their nurse practitioners and physicians while using paper health records (PHRs) and electronic health records (EHRs) in the examination rooms. The significance of the study lies in the salience of communication between the patient and provider in promoting optimal clinical outcomes and the highest level of patient satisfaction.
Data sources: The study used a qualitative, phenomenological design. Audio- taped focus group interviews were conducted with 21 patients from a diabetes clinic in Baltimore, Maryland. Patients had visits with the provider before and after implementation of EHRs in the clinic.
Conclusions: The four themes that emerged from the three focus groups included communication issues, patient preferences for electronic records, safety and security concerns, and transition problems with implementation of EHRs.
Implications for practice: Potential benefits for nurse practitioners implementing the recommendations in this study include enhanced communication between patients and providers while using EHRs, increased patient satisfaction, higher levels of nurse practitioner and physician satisfaction, and avoidance of communication issues during implementation of EHR systems.
Full text of the article available here: http://onlinelibrary.wiley.com/doi/10.1002/2327-6924.12170/abstract
6. Personal health record (PHR)
Personal Health Record (PHR): An electronic or paper health record maintained and updated by an individual for himself or herself. (Health Information Management, concepts, Principles, and Practice, 4th Ed. Glossary 939).
A personal health record, or PHR, is a health record where health data and information related to the care of a patient is maintained by the patient.
As a patient I can decide what I put in my personal health record. In general, though, it needs to include anything that helps me and my health care providers manage my health — starting with the basics: my primary care doctor's name and phone number…….Dr. Smith, 501-623-4421
Allergies, including drug allergies…….penicillin
My medications, including dosages……..Metformin 500mg twice daily
Chronic health problems, such as high blood pressure……hypertension, diabetic
Major surgeries, with dates….appendicitis
Family history…..hypertension, diabetic, obesity
Immunization history….MMR
I can also add information about what I am doing to prevent disease, such as:
Cholesterol level and blood pressure…..200, 140/90
Exercise and dietary habits….jogging, no salt diet, limit sugar
Health goals, such as stopping smoking or losing weight…..lose 10 pounds http://en.wikipedia.org/wiki/Personal_health_record Example:
Here is an example of a Personal health record log, can take it when visiting doctor.
1. Health Information System:
According to WHO, is the underpinning for decision making in health field and is essential for health system policies development and implementation, governance and regulation, health research, human resources development, health education and training, service delivery and financing. It has four keys functions: data generation, compilation, analysis and synthesis, and communication and use. In addition ensures their overall quality, relevance and timeliness, and converts data into information for health related decision making.
Further, the system provides an alert and early warning capability, supporting patient and health facility management, enabling planning, supporting and stimulating research, permitting health situation and trends analysis, supporting global reporting communication of …show more content…
health to diverse users.
Finally, it helps to identify problems and needs, make evidence based decisions on health policy and allocate scarce resources optimally.
Example of the Health Information System:
In 1983, CLAP / SMR published the Perinatal Information System (SIP). The SIP is a product of consensus among hundreds of technical professionals in the Region convened periodically by CLAP / SMR for review and is part of the tools (tool kit) PAHO to improve the quality of care for mothers and newborn.
SIP objectives are: serve as a basis for planning care verify and monitor the implementation of evidence-based practices standardize data collection adopting standards facilitating communication between the different levels reliable statistics available locally encourage compliance facilitate training of health personnel record data of legal interest facilitate the audit characterize the population served assess the quality of care operational conduct epidemiological investigations
2. Clinical data repository.
Data repository – a database that incorporates special indexing and management functions to capture, sort, process and present information back to users – specific to a patient and in a split second of time. (Health Information Management, concepts, Principles, and Practice, 3th Ed. Glossary)
Clinical Data Repository (CDR): A database that focuses on clinical information (instead of financial or administrative data). It collects patient information from various clinical sources and presents that information in a single document. (Health Information Management, concepts, Principles, and Practice, 3th Ed. Glossary)
CDRs centralize pertinent patient data so that providers may quickly access a file at the point of care, minimizing administrative duties so that physicians may spend more time at the bedside. Clinical data repositories allow for better care quality and cost reduction.
Some of the functions of a CDR include:
• Admission and discharge information
• Lab history and results
• Patient profiles
• List of medications and dosing schedule
• Access to radiology multimedia
• Coding
• Progress notes
• Discharge summaries
CDRs are relational databases that have been optimized to perform online transaction processing. Every time a user enters data, retrieves data, views data and is supplied an alert specific to a given patient that action is considered a transaction. A CDR is typically used for processing transactions and even though they may be very complex, each transaction doesn’t require processing an immense amount of data at one time.
Even though a clinical data repository is good at gathering data, it can’t provide the full depth of information necessary for cost and quality improvements because it wasn’t designed for this type of use. If complex analyses are needed, it would be more appropriate to use clinical data warehouse (CDW).
Example of CDR:
The following article shows us the example of usage the clinical data repository PRO-ACT to access ALS clinical trials data.
“The PRO-ACT database: Design, initial analyses, and predictive features”.
Atassi N, Berry J, Shui A, Zach N, Sherman A, Sinani E, Walker J, Katsovskiy I, Schoenfeld D, Cudkowicz M, Leitner M.
Objective:
To pool data from completed amyotrophic lateral sclerosis (ALS) clinical trials and create an open-access resource that enables greater understanding of the phenotype and biology of ALS.
Methods:
Clinical trials data were pooled from 16 completed phase II/III ALS clinical trials and one observational study. Over 8 million de-identified longitudinally collected data points from over 8,600 individuals with ALS were standardized across trials and merged to create the Pooled Resource Open-Access ALS Clinical Trials (PRO-ACT) database. This database includes demographics, family histories, and longitudinal clinical and laboratory data. Mixed effects models were used to describe the rate of disease progression measured by the Revised ALS Functional Rating Scale (ALSFRS-R) and vital capacity (VC). Cox regression models were used to describe survival data. Implementing Bonferroni correction, the critical p value for 15 different tests was p = 0.003.
Results:
The ALSFRS-R rate of decline was 1.02 (±2.3) points per month and the VC rate of decline was 2.24% of predicted (±6.9) per month. Higher levels of uric acid at trial entry were predictive of a slower drop in ALSFRS-R (p = 0.01) and VC (p < 0.0001), and longer survival (p = 0.02). Higher levels of creatinine at baseline were predictive of a slower drop in ALSFRS-R (p = 0.01) and VC (p < 0.0001), and longer survival (p = 0.01). Finally, higher body mass index (BMI) at baseline was associated with longer survival (p < 0.0001).
Conclusion:
The PRO-ACT database is the largest publicly available repository of merged ALS clinical trials data.
We report that baseline levels of creatinine and uric acid, as well as baseline BMI, are strong predictors of disease progression and survival.
3. Clinical decision support system (CDSS)
Clinical decision support system (CDSS): A special subcategory of clinical information systems that is designed to help healthcare providers make knowledge-based clinical decision. (Health Information Management, concepts, Principles, and Practice, 4th Ed. Glossary 902)
The main purpose of modern CDSS is to assist clinicians at the point of care. This means that a clinician would interact with a CDSS to help determine diagnosis, analysis, etc. of patient data.
There have always been errors that occur within the healthcare industry, thus trying to minimize them as much as possible in order to provide quality patient care. Four areas that can be addressed with the implementation of CDSS are:
1. Medical error
2. Medication error
3. Adverse drug events
4. Lessen
error
An example of how a CDSS might be used by a clinician comes from the subset of CDSS (Clinical Decision Support System), DDSS (Diagnosis Decision Support Systems). A DDSS would take the patients data and propose a set of appropriate diagnoses. The doctor then takes the output of the DDSS and figures out which diagnoses are relevant and which are not.
Another important classification of a CDSS is based on the timing of its use. Doctors use these systems at point of care to help them as they are dealing with a patient, with the timing of use as either pre-diagnosis, during diagnoses, or post diagnoses.
-Pre-diagnoses CDSS systems are used to help the physician prepare the diagnoses. -CDSS used during diagnoses help review and filter the physician’s preliminary diagnostic choices to improve their final results. -And post-diagnoses CDSS systems are used to mine data to derive connections between patients and their past medical history and clinical research to predict future events http://en.wikipedia.org/wiki/Clinical_decision_support_system#Role_.26_Characteristics 4. Computerized provider order entry systems (CPOE):
Are designed to replace paper based ordery system of hospitals.
Is a process of electronic health entry of medical practitioners instructions for the treatment of patients (particularly hospitalizes patients) under their care. These orders are communicated over a computer network to the medical staff or to the departments responsible for fulling the order.
It decreases delay in order completion inventory and posting of charges.
CPOE is a form of patient management software and the same time a medical device that provides medical information to be used in the treatment or diagnosis of patient. It can also contribute to the patient by performing analysis, or providing treatment or diagnosis functionally that replaces the decision and judgment of a physician.
Example:
VAGINAL CANDIDIASIS
CLOTRIMAZOLE OVULE 500mg DAILY DOSE PER 5 DAYS.
The system it is going to advise to the physician that the dose of 500mg is a single dose not a daily one, and if he wants to indicate a daily dose then need to change the medication to 100mg daily for 5 days and also will specified route of administration.
5. Electronic Health Records (EHRs).
EHR – a comprehensive system of applications that access to longitudinal (from birth to death) health information about individual across the continuum of care, assist in documentation, support clinical decision-making, and provide for knowledge-building.
Definition of EHR proposed by National Alliance for Health Information technology: “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 healthcare organization”(NAHIT 2008).
The key difference between EHR and EMR is that EHR being interoperable and EMR not. Interoperability refers to ability of two different systems to exchange data with each other.
EHR key concepts:
1) Structured data – values of variables that computer can process (for example age, sex and chief complaints). Structural data are essential for all forms of clinical decision support (CDS) and for producing both internal reports for patient recall, quality improvement, and research as well as to meet external accountability reporting.
2) Unstructured data – narrative notes which may be typed into comment fields, or dictated, transcribed, or handwritten into electronic system, as well as images.
3) The ability for many applications to exchange and process data. These applications may vary by type of care delivery organization.
The core EHR functionalities, according to Institute of Medicine (IOM 2003) are:
Health information and data
Results management
Order entry and management
Decision support
Electronic communication and connectivity
Patient support
Administrative process
Reporting and population health management
Example:
The following article shows us the example of usage PHRs and EHRs by physicians and nurse practitioners while communicating with patients in the examination rooms.
“Patient experiences with electronic medical records: Lessons learned”
Dale Rose, DHA, MS, RN, CENP (Director of Ambulatory Nursing)1, Louiseann T. Richter, EdD (Adjunct Faculty), & Jane Kapustin, PhD, CRNP, BC-ADM, FAANP, FAAN (Professor, Assistant Dean for the Masters and DNP Programs)
Abstract
Purpose: To describe the lived experience of patients communicating with their nurse practitioners and physicians while using paper health records (PHRs) and electronic health records (EHRs) in the examination rooms. The significance of the study lies in the salience of communication between the patient and provider in promoting optimal clinical outcomes and the highest level of patient satisfaction.
Data sources: The study used a qualitative, phenomenological design. Audio- taped focus group interviews were conducted with 21 patients from a diabetes clinic in Baltimore, Maryland. Patients had visits with the provider before and after implementation of EHRs in the clinic.
Conclusions: The four themes that emerged from the three focus groups included communication issues, patient preferences for electronic records, safety and security concerns, and transition problems with implementation of EHRs.
Implications for practice: Potential benefits for nurse practitioners implementing the recommendations in this study include enhanced communication between patients and providers while using EHRs, increased patient satisfaction, higher levels of nurse practitioner and physician satisfaction, and avoidance of communication issues during implementation of EHR systems.
Full text of the article available here: http://onlinelibrary.wiley.com/doi/10.1002/2327-6924.12170/abstract
6. Personal health record (PHR)
Personal Health Record (PHR): An electronic or paper health record maintained and updated by an individual for himself or herself. (Health Information Management, concepts, Principles, and Practice, 4th Ed. Glossary 939).
A personal health record, or PHR, is a health record where health data and information related to the care of a patient is maintained by the patient.
As a patient I can decide what I put in my personal health record. In general, though, it needs to include anything that helps me and my health care providers manage my health — starting with the basics: my primary care doctor's name and phone number…….Dr. Smith, 501-623-4421
Allergies, including drug allergies…….penicillin
My medications, including dosages……..Metformin 500mg twice daily
Chronic health problems, such as high blood pressure……hypertension, diabetic
Major surgeries, with dates….appendicitis
Family history…..hypertension, diabetic, obesity
Immunization history….MMR
I can also add information about what I am doing to prevent disease, such as:
Cholesterol level and blood pressure…..200, 140/90
Exercise and dietary habits….jogging, no salt diet, limit sugar
Health goals, such as stopping smoking or losing weight…..lose 10 pounds http://en.wikipedia.org/wiki/Personal_health_record Example:
Here is an example of a Personal health record log, can take it when visiting doctor.