Computer-Based Patient Record Systems Ileana Lulic, Ivor Kovic University of Rijeka, School of Medicine My patients

Definition Advantages and disadvantages Functional components Data entry and display Challenges ahead Discussion Outline Friday, July 22, 2005

Definition

Advantages and disadvantages

Functional components

Data entry and display

Challenges ahead

Discussion

Definition Patient record = Patient’s chart = Medical record Time-Oriented Source-Oriented Problem-Oriented 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion Friday, July 22, 2005

Patient record = Patient’s chart = Medical record

Time-Oriented

Source-Oriented

Problem-Oriented

Definition CPR is a repository of electronically maintained information about individual’s lifetime health status and health care stored such that it can serve multiple legitimate users of the record. Friday, July 22, 2005 Computer Based Patient Record = CPR 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

CPR is a repository of electronically maintained information about individual’s lifetime health status and health care stored such that it can serve multiple legitimate users of the record.

Computer Based Patient Record = CPR

Advantages of CPR Flexible and adaptable Aggregation of data Data analyses Accessibility Remote access Legibility Structured data Fewer data errors Reusability of data Decision support Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Flexible and adaptable

Aggregation of data

Data analyses

Accessibility

Remote access

Legibility

Structured data

Fewer data errors

Reusability of data

Decision support

Disadvantages of CPR Larger initial investment Risk of failure Resistance of users Input problems Security problems Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Larger initial investment

Risk of failure

Resistance of users

Input problems

Security problems

CPR assessment Factors used to determinate the degree to which a CPR demonstrates benefits Comprehensiveness of information Duration of use and retention of data Degree of structure of data Ubiquity of access Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Factors used to determinate the degree to which a CPR demonstrates benefits

Comprehensiveness of information

Duration of use and retention of data

Degree of structure of data

Ubiquity of access

Functional components Integrated view of patient data Clinical decision support Clinician order entry Access to knowledge resources Integrated communication support Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Integrated view of patient data

Clinical decision support

Clinician order entry

Access to knowledge resources

Integrated communication support

Functional components Primary purpose of a CPR HL7 SNOMED, LOINC, ICD Interface engines User friendly view of patient data Friday, July 22, 2005 1. Integrated view of patient data 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Primary purpose of a CPR

HL7

SNOMED, LOINC, ICD

Interface engines

User friendly view of patient data

Functional components Reminders and alerts At the right time Possibility of override Friday, July 22, 2005 2. Clinical decision support, 3. Clinician order entry, 4. Access to knowledge resources 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Reminders and alerts

At the right time

Possibility of override

Functional components Communication between team members Remote location office, hospital, ER, physician’s home, patient’s home Example: ER at Brighman and Womens Hospital Friday, July 22, 2005 5. Integrated communication support 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Communication between team members

Remote location

office, hospital, ER, physician’s home, patient’s home

Example:

ER at Brighman and Womens Hospital

Data entry Most difficult and labor-intensive step in the maintenance Requires two separate procedures: Data Capture Data Input Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Most difficult and labor-intensive step in the maintenance

Requires two separate procedures:

Data Capture

Data Input

Data Capture Difficult when there are multiple sources of data Information can: Go unnoticed Be illegible Be available in insufficient detail Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Difficult when there are multiple

sources of data

Information can:

Go unnoticed

Be illegible

Be available in insufficient detail

Data Input Costly in personnel time Entered by physician or other personnel Data may be entered in: Free text form Coded form Form that combines both Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Costly in personnel time

Entered by physician or other personnel

Data may be entered in:

Free text form

Coded form

Form that combines both

Data Input Include 1. Patient history 2. Findings from the physical examination 3. Interpretation of the patient’s findings 4. Diagnostic and treatment plan Can be entered: By transcription of dictated or written notes By transcription of encounter forms Direct data entry by physicians Continuous speech recognition Friday, July 22, 2005 Physicians’ notes 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Include

1. Patient history

2. Findings from the physical examination

3. Interpretation of the patient’s findings

4. Diagnostic and treatment plan

Can be entered:

By transcription of dictated or written notes

By transcription of encounter forms

Direct data entry by physicians

Continuous speech recognition

Data Input Validity checks: - range checks - pattern checks - computed checks - consistency checks - delta checks - spelling checks Friday, July 22, 2005 Error prevention 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Validity checks:

- range checks

- pattern checks

- computed checks

- consistency checks

- delta checks

- spelling checks

Data Display Can be presented in numerous formats 1. Flowsheets - data organized according to time - problem, patient or specialty specific 2. Summaries and Abstracts - highlight important components 3. Turnaround documents - present information and ask questions 4. Dynamic displays - search tools - flowsheets or graphics Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Can be presented in numerous formats

1. Flowsheets

- data organized according to time

- problem, patient or specialty specific

2. Summaries and Abstracts

- highlight important components

3. Turnaround documents

- present information and ask questions

4. Dynamic displays

- search tools

- flowsheets or graphics

Challenges ahead Evolution of technology Users’ information needs User interfaces Standards Legal and social issues Costs and benefits Leadership Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Evolution of technology

Users’ information needs

User interfaces

Standards

Legal and social issues

Costs and benefits

Leadership

Discussion 1 Security of CPR - issues - how to improve it - compared to paper-based record Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

Security of CPR

- issues

- how to improve it

- compared to paper-based record

Discussion 2 User interface - how important it is ? - examples of what can go wrong if it is poorly designed Suggested reading: Medical Usability: How to Kill Patients Through Bad Design http://www.useit.com/alertbox/20050411.html Friday, July 22, 2005 1. Definition 2. Advantages and disadvantages 3. Functional components 4. Data entry and display 5. Challenges ahead 6. Discussion

User interface

- how important it is ?

- examples of what can go wrong if it is poorly designed

Suggested reading:

Medical Usability: How to Kill Patients Through Bad Design

http://www.useit.com/alertbox/20050411.html

Contact Ileana Lulic Tel: + 385 91 2530660 Kustosijski venec 34 e-mail: [email_address] 10 000 Zagreb Croatia Ivor Kovic Tel: + 385 91 1234598 S.J.Bujkove 3 e-mail: [email_address] 51 000 Rijeka Croatia Department of Medical Informatics, Rijeka School of Medicine http://mi.medri.hr Science Trek Journal Club http:// mi.medri.hr/stc Friday, July 22, 2005 English version coming soon

Ileana Lulic Tel: + 385 91 2530660

Kustosijski venec 34 e-mail: [email_address]

10 000 Zagreb

Croatia

Ivor Kovic Tel: + 385 91 1234598

S.J.Bujkove 3 e-mail: [email_address]

51 000 Rijeka

Croatia

Department of Medical Informatics, Rijeka School of Medicine

http://mi.medri.hr

Science Trek Journal Club

http:// mi.medri.hr/stc