Clinical Information Systems
Nawanan Theera-Ampornpunt, MD, PhD
Faculty of Medicine Ramathibodi Hospital
Jun 29, 2013
http...
2003 M.D. (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
Deputy Chief,...
Class Outline
• Health Care & Health IT
• Clinical Information Systems
• Electronic Health Records
Health Care & Health IT
Manufacturing
Image Source: Guardian.co.uk
Banking
Image Source: Cablephet.com
Health care
ER - Image Source: nj.com
• Life-or-Death
• Many & varied stakeholders
• Strong professional values
• Evolving standards of care
• Fragmented, poorl...
• Large variations & contextual dependence
Why Health care Isn’t Like Any Others?
Input Process Output
Patient
Presentatio...
But...Are We That Different?
Input Process Output
Transfer
Banking
Value-Add
- Security
- Convenience
- Customer Service
L...
Input Process Output
Assembling
Manufacturing
Raw
Materials
Finished
Goods
Value-Add
- Innovation
- Design
- QC
But...Are ...
But...Are We That Different?
Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value-Add
- Technolog...
Information is Everywhere
in Health Care
Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Re...
Still Many Other Forms of Health IT
m-Health
Health Information
Exchange (HIE)
Biosurveillance
Information Retrieval
Telem...
Why Adopting Health IT?
“To Computerize”“To Go paperless”
“Digital Hospital”
“To Modernize”
“To Get a HIS”
“To Have EMRs”
...
• “Don’t implement technology just for
technology’s sake.”
• “Don’t make use of excellent technology.
Make excellent use o...
Health IT: What’s In A Word?
Health
Information
Technology
Goal
Value-Add
Tools
• Safety
• Timeliness
• Effectiveness
• Efficiency
• Equity
• Patient-centeredness
Dimensions of Quality Healthcare
(IOM, ...
• Guideline adherence
• Better documentation
• Practitioner decision making
or process of care
• Medication safety
• Patie...
Fundamental Theorem of Informatics
(Friedman, 2009)(Friedman, 2009)
Is There A Role for Health IT?
(IOM, 2000)
Landmark IOM Reports
(IOM, 2001)(IOM, 2000)
• Humans are not perfect and are bound to make
errors
• Highlight problems in the U.S. health care system
that systematica...
• Health care is very complex (and inefficient)
• Health care is information-rich
• Quality of care depends on timely avai...
• Perception errors
To Err Is Human
Image Source: interaction-dynamics.com
Image Source: aafp.org
• Lack of Attention
To Err Is Human
• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59
• Print subscr...
• It already happens....
(Mamede et al., 2010; Croskerry, 2003; Klein, 2005)
• What if health IT can help?
What If This Ha...
Health IT Across Settings
M/B/H Informatics As A Field
(Shortliffe, 2002)
M/B/H Informatics As A Field
(Hersh, 2009)
Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic
Health
Re...
Still Many Other Forms of Health IT
m-Health
Health Information
Exchange (HIE)
Biosurveillance
Information Retrieval
Telem...
Health IT in Clinical Settings
(“Clinical Information Systems”)
• Master Patient Index (MPI)
• Admit-Discharge-Transfer (ADT)
• Electronic Health Records (EHRs)
• Computerized Physician ...
• Pharmacy applications
• Laboratory Information System (LIS)
• Radiology Information System (RIS)
• Specialized applicati...
Workflow
Hospital Information System
Master
Patient
Index (MPI)
ADT
Scheduling
Order
Pharmacy IS
Operation
Theatre
Billing...
HIT Systems (Inpatient)
Clinical Decision Support:
“Any system designed to
improve clinical decision making
related to dia...
Master Patient Index (MPI)
• A hospital’s list of all patients
• Functions
– Registration/identification of patients (HN)
...
Admission-Discharge-Transfer (ADT)
• Functions
– Supports Admission, Discharge & Transfer of patients
(“patient management...
Bed Management (from ADT System)
Insurance Eligibility System
• Functions
– Determines if a patient is eligible or is covered by a particular
insurance sch...
Appointment Scheduling
• Functions
– Records appointments of patients
– Pre-specified number of open slots
– Ability to po...
Computerized Physician Order Entry
(CPOE)
Values
• No handwriting!!!
• Structured data entry: Completeness, clarity,
fewer mistakes (?)
• No transcription errors!
•...
• The real place where most of the
values of health IT can be achieved
– Expert systems
• Based on artificial intelligence...
– Alerts & reminders
• Based on specified logical conditions
• Examples:
–Drug-allergy checks
–Drug-drug interaction check...
Example of “Alerts & Reminders”
– Evidence-based knowledge sources e.g. drug
database, literature
– Simple UI designed to help clinical decision
making
• ...
Clinical Decision Support Systems
(CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISIO...
Clinical Decision Support Systems
(CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISIO...
Clinical Decision Support Systems
(CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISIO...
Clinical Decision Support Systems
(CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISIO...
Clinical Decision Support Systems
(CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISIO...
• CDSS as a replacement or supplement of
clinicians?
– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
Cli...
Clinical Decision Support Systems
(CDSSs)
Issues
• Alert sensitivity & alert fatigue
Clinical Decision Support Systems
(CDSSs)
Issues
• Unintended Consequences (e.g. workarounds)
Nursing Applications
Functions
• Document nursing assessments, interventions & outcomes
• Facilitate charting & vital sign...
Pharmacy Applications
Functions
• Streamlines workflow from medication orders to dispensing and
billing
• Reduces medicati...
Stages of Medication Process
Ordering Transcription Dispensing Administration
CPOE
Automatic
Medication
Dispensing
Electro...
Laboratory Information System (LIS)
Functions
• Receives and processes lab orders
• Matches tube & specimen
• Internal wor...
Imaging Applications
Picture Archiving and Communication System (PACS)
• Captures, archives, and displays electronic image...
Billing System
• Functions
– Calculates service charges for services provided
– Calculations based on patient’s insurance ...
Enterprise Resource Planning
• Some Functions
– Finance
• Accounting
• Budgeting
• Cost control and management
– Materials...
The Bigger Picture:
Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Strategic
Operational
ClinicalAdministrative
4 Quadrants of Hospital IT
CPOE
ADT
LIS
EHRs
CDSS
HIE
ERP
Business
Intelligen...
Electronic Health Records/
Electronic Medical Records
What Is A Medical Record?
What Is A Medical Record?
• A record or documentation of a patient’s
medical history, examination, and treatments.
• Medic...
Potential Uses of Medical Records
• Continuity of providing care
– Note important information for later use
– Especially i...
Potential Uses of Medical Records
• Communications between providers
– Referral to specialists or other physicians
– Consu...
Potential Uses of Medical Records
• Claims and reimbursements
– What services were provided to the patient
– How (and how ...
Data Elements in Medical Records
• Patient demographics
• General information about each visit (visit = encounter)
– Type ...
Data Elements in Medical Records
• Clinical findings by physicians (“Physical examination”)
– Any important positive (usua...
Data Elements in Medical Records
• “Problems” or “Diagnoses”
– Summary of problems relevant to this visit
• Treatments
– M...
Data Elements in Medical Records
• Inpatient clinical notes
– Admission notes
– Orders (medications, procedures, investiga...
“Electronic” Medical Records
• Electronic Medical Records (EMRs) vs.
Electronic Health Records (EHRs)
• Debate about simil...
Longitudinal Records
• Records documented over time (multiple encounters)
• Ideally, “life-long” is a complete record of t...
Electronic Medical
Records (EMRs)
Computer-Based
Patient Records
(CPRs)
Electronic Patient
Records (EPRs)Electronic Health...
• Are they just electronic documentation?
• Or do they have some other values?
Diag-
nosis
History
& PE
Treat-
ments
...
E...
• Literature suggests improvement in health care
through
– Guideline adherence
– Better documentation
– Practitioner decis...
• Patient Demographics
• Physician Notes
• Computerized Medication Order Entry
• Computerized Laboratory Order Entry
• Com...
EHR Adoption: Thailand (2011)
Estimate (Partial or Complete
Adoption)
Nationwide
Basic EHR, combined inpatient &
outpatien...
EHR/HIS Adoption in Thailand (2004)
Pongpirul et al., 2004
EHR/HIS Adoption in Thailand (2011)
HOSxP
50%
Self-developed or outsourced
16%
Hospital OS
7%
SSB
4%
Mit-Net
2%
MRecord
2%...
EHRs and the Bigger Picture
Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
Google Flu Trends (Biosurveillance)
Source: Google.org/FluTrends
• EHRs (or EMRs) are both
– Electronic documentation of patient care and
– a broad term for an information system used to
...
• There are various kinds of applications in
hospitals
• HIS often refers to the “Front Office” part of
hospital IT
• Some...
Questions?
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Clinical Information Systems

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Clinical Information Systems

  1. 1. Clinical Information Systems Nawanan Theera-Ampornpunt, MD, PhD Faculty of Medicine Ramathibodi Hospital Jun 29, 2013 http://www.slideshare.net/nawanan
  2. 2. 2003 M.D. (Ramathibodi) 2009 M.S. in Health Informatics (U of MN) 2011 Ph.D. in Health Informatics (U of MN) Deputy Chief, Informatics Division Faculty of Medicine Ramathibodi Hospital nawanan.the@mahidol.ac.th http://groups.google.com/group/ThaiHealthIT Research interests: • EHRs & health IT applications in clinical settings • Health IT adoption • Health informatics education & workforce development • Standards and interoperability A Bit About Myself
  3. 3. Class Outline • Health Care & Health IT • Clinical Information Systems • Electronic Health Records
  4. 4. Health Care & Health IT
  5. 5. Manufacturing Image Source: Guardian.co.uk
  6. 6. Banking Image Source: Cablephet.com
  7. 7. Health care ER - Image Source: nj.com
  8. 8. • Life-or-Death • Many & varied stakeholders • Strong professional values • Evolving standards of care • Fragmented, poorly-coordinated systems • Large, ever-growing & changing body of knowledge • High volume, low resources, little time Why Health care Isn’t Like Any Others?
  9. 9. • Large variations & contextual dependence Why Health care Isn’t Like Any Others? Input Process Output Patient Presentation Decision- Making Biological Responses
  10. 10. But...Are We That Different? Input Process Output Transfer Banking Value-Add - Security - Convenience - Customer Service Location A Location B
  11. 11. Input Process Output Assembling Manufacturing Raw Materials Finished Goods Value-Add - Innovation - Design - QC But...Are We That Different?
  12. 12. But...Are We That Different? Input Process Output Patient Care Health care Sick Patient Well Patient Value-Add - Technology & medications - Clinical knowledge & skills - Quality of care; process improvement - Information
  13. 13. Information is Everywhere in Health Care
  14. 14. Various Forms of Health IT Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS)
  15. 15. Still Many Other Forms of Health IT m-Health Health Information Exchange (HIE) Biosurveillance Information Retrieval Telemedicine & Telehealth Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, I Personal Health Records (PHRs)
  16. 16. Why Adopting Health IT? “To Computerize”“To Go paperless” “Digital Hospital” “To Modernize” “To Get a HIS” “To Have EMRs” “To Share data”
  17. 17. • “Don’t implement technology just for technology’s sake.” • “Don’t make use of excellent technology. Make excellent use of technology.” (Tangwongsan, Supachai. Personal communication, 2005.) • “Health care IT is not a panacea for all that ails medicine.” (Hersh, 2004) Some Quotes
  18. 18. Health IT: What’s In A Word? Health Information Technology Goal Value-Add Tools
  19. 19. • Safety • Timeliness • Effectiveness • Efficiency • Equity • Patient-centeredness Dimensions of Quality Healthcare (IOM, 2001)
  20. 20. • Guideline adherence • Better documentation • Practitioner decision making or process of care • Medication safety • Patient surveillance & monitoring • Patient education/reminder Value of Health IT
  21. 21. Fundamental Theorem of Informatics (Friedman, 2009)(Friedman, 2009)
  22. 22. Is There A Role for Health IT? (IOM, 2000)
  23. 23. Landmark IOM Reports (IOM, 2001)(IOM, 2000)
  24. 24. • Humans are not perfect and are bound to make errors • Highlight problems in the U.S. health care system that systematically contributes to medical errors and poor quality • Recommends reform that would change how health care works and how technology innovations can help improve quality/safety Landmark IOM Reports: Summary
  25. 25. • Health care is very complex (and inefficient) • Health care is information-rich • Quality of care depends on timely availability & quality of information • Clinical knowledge body is too large • Short time during a visit • Practice guidelines are put “on-the-shelf” • “To err is human” Why We Need Health IT
  26. 26. • Perception errors To Err Is Human Image Source: interaction-dynamics.com
  27. 27. Image Source: aafp.org • Lack of Attention To Err Is Human
  28. 28. • Cognitive Errors - Example: Decoy Pricing The Economist Purchase Options • Economist.com subscription $59 • Print subscription $125 • Print & web subscription $125 Ariely (2008) 16 0 84 The Economist Purchase Options • Economist.com subscription $59 • Print & web subscription $125 68 32 # of People # of People To Err Is Human
  29. 29. • It already happens.... (Mamede et al., 2010; Croskerry, 2003; Klein, 2005) • What if health IT can help? What If This Happens in Healthcare?
  30. 30. Health IT Across Settings
  31. 31. M/B/H Informatics As A Field (Shortliffe, 2002)
  32. 32. M/B/H Informatics As A Field (Hersh, 2009)
  33. 33. Various Forms of Health IT Hospital Information System (HIS) Computerized Provider Order Entry (CPOE) Electronic Health Records (EHRs) Picture Archiving and Communication System (PACS)
  34. 34. Still Many Other Forms of Health IT m-Health Health Information Exchange (HIE) Biosurveillance Information Retrieval Telemedicine & Telehealth Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, I Personal Health Records (PHRs)
  35. 35. Health IT in Clinical Settings (“Clinical Information Systems”)
  36. 36. • Master Patient Index (MPI) • Admit-Discharge-Transfer (ADT) • Electronic Health Records (EHRs) • Computerized Physician Order Entry (CPOE) • Clinical Decision Support Systems (CDSSs) • Picture Archiving and Communication System (PACS) • Nursing applications • Enterprise Resource Planning (ERP) Enterprise-wide Hospital IT
  37. 37. • Pharmacy applications • Laboratory Information System (LIS) • Radiology Information System (RIS) • Specialized applications (ER, OR, LR, Anesthesia, Critical Care, Dietary Services, Blood Bank) • Incident management & reporting system Departmental IT
  38. 38. Workflow Hospital Information System Master Patient Index (MPI) ADT Scheduling Order Pharmacy IS Operation Theatre Billing Clinical Notes LIS RIS PACS CCIS Medical Records Portals Modified from Dr. Artit Ungkanont’s slide
  39. 39. HIT Systems (Inpatient) Clinical Decision Support: “Any system designed to improve clinical decision making related to diagnostic or therapeutic processes of care.” From Dr. Artit Ungkanont’s slide
  40. 40. Master Patient Index (MPI) • A hospital’s list of all patients • Functions – Registration/identification of patients (HN) – Captures/updates patient demographics – Used in virtually all other hospital service applications
  41. 41. Admission-Discharge-Transfer (ADT) • Functions – Supports Admission, Discharge & Transfer of patients (“patient management”) – Provides status/location of admitted patients – Used in assessing bed occupancy – Linked to billing, claims & reimbursements
  42. 42. Bed Management (from ADT System)
  43. 43. Insurance Eligibility System • Functions – Determines if a patient is eligible or is covered by a particular insurance scheme – Determines the services covered by the patient’s insurance plan – May need to link with the eligibility verification system of the government agencies
  44. 44. Appointment Scheduling • Functions – Records appointments of patients – Pre-specified number of open slots – Ability to postpone/cancel appointments – Displays list of patients with appointments in a specific date – Ability to adjust number of open slots
  45. 45. Computerized Physician Order Entry (CPOE)
  46. 46. Values • No handwriting!!! • Structured data entry: Completeness, clarity, fewer mistakes (?) • No transcription errors! • Entry point for CDSSs • Streamlines workflow, increases efficiency Computerized Physician Order Entry (CPOE)
  47. 47. • The real place where most of the values of health IT can be achieved – Expert systems • Based on artificial intelligence, machine learning, rules, or statistics • Examples: differential diagnoses, treatment options Clinical Decision Support Systems (CDSSs) (Shortliffe, 1976)
  48. 48. – Alerts & reminders • Based on specified logical conditions • Examples: –Drug-allergy checks –Drug-drug interaction checks –Drug-disease checks –Drug-lab checks –Drug-formulary checks –Reminders for preventive services or certain actions (e.g. smoking cessation) –Clinical practice guideline integration Clinical Decision Support Systems (CDSSs)
  49. 49. Example of “Alerts & Reminders”
  50. 50. – Evidence-based knowledge sources e.g. drug database, literature – Simple UI designed to help clinical decision making • E.g., Abnormal Lab Highlights Clinical Decision Support Systems (CDSSs)
  51. 51. Clinical Decision Support Systems (CDSSs) External Memory Knowledge Data Long Term Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN From a teaching slide by Don Connelly, 2006
  52. 52. Clinical Decision Support Systems (CDSSs) External Memory Knowledge Data Long Term Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Abnormal lab highlights
  53. 53. Clinical Decision Support Systems (CDSSs) External Memory Knowledge Data Long Term Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Drug-Allergy Checks
  54. 54. Clinical Decision Support Systems (CDSSs) External Memory Knowledge Data Long Term Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Drug-Drug Interaction Checks
  55. 55. Clinical Decision Support Systems (CDSSs) External Memory Knowledge Data Long Term Memory Knowledge Data Inference DECISION PATIENT Perception Attention Working Memory CLINICIAN Diagnostic/Treatment Expert Systems
  56. 56. • CDSS as a replacement or supplement of clinicians? – The demise of the “Greek Oracle” model (Miller & Masarie, 1990) Clinical Decision Support Systems (CDSSs) The “Greek Oracle” Model The “Fundamental Theorem” (Friedman, 2009)
  57. 57. Clinical Decision Support Systems (CDSSs) Issues • Alert sensitivity & alert fatigue
  58. 58. Clinical Decision Support Systems (CDSSs) Issues • Unintended Consequences (e.g. workarounds)
  59. 59. Nursing Applications Functions • Document nursing assessments, interventions & outcomes • Facilitate charting & vital sign recording • Utilize standards in nursing informatics • Populate and documents care-planning • Support communication within teams & between shifts – e-Kardex • Risk/incident management
  60. 60. Pharmacy Applications Functions • Streamlines workflow from medication orders to dispensing and billing • Reduces medication errors, improves medication safety • Improves inventory management
  61. 61. Stages of Medication Process Ordering Transcription Dispensing Administration CPOE Automatic Medication Dispensing Electronic Medication Administration Records (e-MAR) Barcoded Medication Administration Barcoded Medication Dispensing
  62. 62. Laboratory Information System (LIS) Functions • Receives and processes lab orders • Matches tube & specimen • Internal workflow within labs – Order processing – Specimen registration & processing – Lab results validation & reporting – Specimen inventory • Lab results viewing
  63. 63. Imaging Applications Picture Archiving and Communication System (PACS) • Captures, archives, and displays electronic images captured from imaging modalities • Often refers to radiologic images but sometimes used in other settings as well (e.g. cardiology, endoscopy, pathology, ophthalmology) • Values: reduces space, costs of films, loss of films, parallel viewing, remote access, image processing & manipulation, referrals Radiology Information System (RIS) or Workflow Management • Supports workflow of the radiology department, including patient registration, appointments & scheduling, consultations, imaging reports, etc.
  64. 64. Billing System • Functions – Calculates service charges for services provided – Calculations based on patient’s insurance coverage and eligibility – Records amount of money paid by the patient and remaining amount – Sends information to accounting or Back Office ERP to send reimbursement claims to government agencies
  65. 65. Enterprise Resource Planning • Some Functions – Finance • Accounting • Budgeting • Cost control and management – Materials Management • Procurement • Inventory management – Human Resources • Recruitment, evaluation, promotion & disciplinary actions • Payroll
  66. 66. The Bigger Picture: Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home
  67. 67. Strategic Operational ClinicalAdministrative 4 Quadrants of Hospital IT CPOE ADT LIS EHRs CDSS HIE ERP Business Intelligence VMI PHRs MPI Word Processor Social Media PACS
  68. 68. Electronic Health Records/ Electronic Medical Records
  69. 69. What Is A Medical Record?
  70. 70. What Is A Medical Record? • A record or documentation of a patient’s medical history, examination, and treatments. • Medical Record vs. Health Record – Essentially the same
  71. 71. Potential Uses of Medical Records • Continuity of providing care – Note important information for later use – Especially important in chronic diseases (e.g. hypertension, diabetes) or in follow-up (e.g. after surgery) • Patient safety – Preventing something bad because of lack of information – Such as drug allergies, list of current medications, “problem list”
  72. 72. Potential Uses of Medical Records • Communications between providers – Referral to specialists or other physicians – Consulting among physicians – Communications between physicians and nurses, pharmacists, physical therapists, etc. – Transfer from a hospital to another • Medico-legal purposes – e.g. Court evidence against malpractice – What was done or provided to the patient? Why? By whom? When? – Was the care provided up to the professional standard?
  73. 73. Potential Uses of Medical Records • Claims and reimbursements – What services were provided to the patient – How (and how much) will the hospitals/doctors be paid? – Audit of medical records by “payers” • Patient’s uses – Health insurance claims – Self-education & self-care • Clinical research – Find ways to improve health care through new knowledge
  74. 74. Data Elements in Medical Records • Patient demographics • General information about each visit (visit = encounter) – Type (outpatient, inpatient, emergency) – Date/Time – Location (clinic or ward) “Clinical Notes” • Patient’s problems (“Patient history”) – Chief complaint – Present illness – Past history – Family and social history
  75. 75. Data Elements in Medical Records • Clinical findings by physicians (“Physical examination”) – Any important positive (usually abnormal) findings – Also important negative (usually normal) findings • “Investigations” – Laboratory tests (blood tests, urine, etc.) – Radiological examinations (X-rays, CT, MRI, ultrasound) – Other diagnostic procedures • Electrocardiography (EKG/ECG) -- heart’s function • Electroencephalography (EEG) -- brain wave scans • Etc.
  76. 76. Data Elements in Medical Records • “Problems” or “Diagnoses” – Summary of problems relevant to this visit • Treatments – Medications – Surgical procedures – Advice to patients – Admission (hospitalization) • Plans – Surgeries – More investigations to be done later – Follow-up appointments
  77. 77. Data Elements in Medical Records • Inpatient clinical notes – Admission notes – Orders (medications, procedures, investigations, nursing care, etc.) – Medication administration records – Vital signs and other measurements – Results of lab tests and radiological examinations – Progress notes – Discharge summary
  78. 78. “Electronic” Medical Records • Electronic Medical Records (EMRs) vs. Electronic Health Records (EHRs) • Debate about similarities & differences • Summary – Definitions subjective, depending on how people think – EMRs mostly refer to electronic documentation of medical care at one visit – EHRs mostly refer to electronic documentation that is longitudinal in nature (may be several visits) – EMRs commonly used in Thailand (but means the same as EHRs)
  79. 79. Longitudinal Records • Records documented over time (multiple encounters) • Ideally, “life-long” is a complete record of the patient’s health
  80. 80. Electronic Medical Records (EMRs) Computer-Based Patient Records (CPRs) Electronic Patient Records (EPRs)Electronic Health Records (EHRs) Personal Health Records (PHRs) The Confusing Acronyms Hospital Information Systems (HIS)
  81. 81. • Are they just electronic documentation? • Or do they have some other values? Diag- nosis History & PE Treat- ments ... Electronic Health Record (EHR) Systems
  82. 82. • Literature suggests improvement in health care through – Guideline adherence – Better documentation – Practitioner decision making or process of care – Medication safety – Patient surveillance & monitoring – Patient education/reminder – Cost savings and better financial performance Literature Shows Benefits of Health IT
  83. 83. • Patient Demographics • Physician Notes • Computerized Medication Order Entry • Computerized Laboratory Order Entry • Computerized Laboratory Results • Problem Lists • Medication Lists • Discharge Summaries • Diagnostic Test Results • Radiologic Reports Functions That Should be Part of EHR Systems
  84. 84. EHR Adoption: Thailand (2011) Estimate (Partial or Complete Adoption) Nationwide Basic EHR, combined inpatient & outpatient settings 49.8% Comprehensive EHR, combined 5.3% order entry of medications, combined 90.2% order entry of all orders, combined 79.4% Basic EHR: a score > 1 in a 5-point scale for IT support for demographics, MD notes, nursing assessments (inpatient only), discharge summaries (inpatient only), test results, order entry for medications Comprehensive EHR: a score > 3 in a 5-point scale for Basic EHR functions + electronic image viewing, order entry for lab tests and radiologic tests, drug-allergy alerts, drug-drug alerts
  85. 85. EHR/HIS Adoption in Thailand (2004) Pongpirul et al., 2004
  86. 86. EHR/HIS Adoption in Thailand (2011) HOSxP 50% Self-developed or outsourced 16% Hospital OS 7% SSB 4% Mit-Net 2% MRecord 2% H.I.M. Professional 2% MedTrak/ TrakCare 2% HoMC 2% None 2% THIADES 2% HIMS 1% Abstract ePHIS 1% Other 7% Theera-Ampornpunt, 2011 [Dissertation]
  87. 87. EHRs and the Bigger Picture
  88. 88. Health Information Exchange (HIE) Hospital A Hospital B Clinic C Government Lab Patient at Home
  89. 89. Google Flu Trends (Biosurveillance) Source: Google.org/FluTrends
  90. 90. • EHRs (or EMRs) are both – Electronic documentation of patient care and – a broad term for an information system used to improve the process of patient care through better documentation and other care processes such as ordering medications, lab tests, or x-rays and viewing lab results and x- ray reports (among others) Summary
  91. 91. • There are various kinds of applications in hospitals • HIS often refers to the “Front Office” part of hospital IT • Sometimes HIS refers to the entire hospital IT • HIS and EHRs are used to support clinical workflows, improve decision-making and care quality, and reduce costs • EHRs and HIS are just one piece of the big puzzle for the whole healthcare system Summary
  92. 92. Questions?

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