Final report ehr1


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Final report ehr1

  1. 1. [Electronic Health Record] Chapter 1 Introduction Gujarat Technological University 1.1 Phase-1 Summary Team-ID: 130010355 Project-Team Member: [Department of Computer Science & Engineering] Page 1
  2. 2. [Electronic Health Record] 1.2 Phase-II Summary This document outlines the software requirements for an electronic health record (EHR) data analysis clinical decision support system. It will cover the overall [Department of Computer Science & Engineering] Page 2
  3. 3. [Electronic Health Record] description of the system, specific requirements as well as modeling requirements, diagrams and a description of a prototype to be built to demonstrate the system’s functionality. 1.3 Introduction of Problem Published requirements for the EHR are available principally via ISO18308. They are statements defining the generic features necessary in any Electronic Health Record (EHR) for it to be communicable and complete, retain integrity across systems, countries and time, and be a useful and effective ethico-legal record of care. Examples of requirements are provided in four themes: EHR functional Requirements; Ethical, legal, and security requirements; Clinical requirements; Technical requirements. 1.4 Problem statement And Explanation 1.4.1 Problem Statement Problem lists can be a healthcare organization’s best friend or worst nightmare. Electronic record systems can extend the benefits or compound the issues. The same forces that make problem lists valuable for patient care and secondary data uses can also create barriers to clinical efficiency. This practice brief explores the use and maintenance of problem lists in health records with a special focus on how electronic environments support additional functionality for sharing information and supporting continuity of care. 1.4.2 Description Computer-based hospital information systems emerged in the late 1960s. At that time they were primarily used for collecting and routing orders and accessing laboratory test results. These early systems collected clinical information, but their major purpose was to capture charges to comply with reimbursement requirements, not assist physicians with delivering patient care. Dr. Lawrence Weed introduced the problem-oriented medical record more than 40 years ago. It was a new concept for health record keeping that reflected the physician’s logical thinking for delivering patient care. Weed suggested that the primary organization of the medical record should be by medical problem and that all diagnostic and therapeutic plans be linked to a specific problem. [Department of Computer Science & Engineering] Page 3
  4. 4. [Electronic Health Record] Historically, the information retrieved from a patient-physician relationship centered on what is termed the “problem list.” In many settings the problem list has evolved into a virtual table of contents in an EHR presenting a holistic view of the patient. In the problem-oriented medical record model all data associated with the patient can be linked to a list of problems. Safe and efficient patient care relies on a clinical workflow that assesses problems documents interventions, and evaluates the effects of treatment. The problem list is expected to support these activities in an effective and concise fashion. Technology offers the opportunity to achieve this goal while retaining information across the healthcare systems and reducing redundant processes. 1.5 Usefulness of Project to Industry/User/Society This project is useful to doctors as it totally reduces the paperwork from their side for writing prescriptions in paper and it reduces lot of time in viewing the past records of patients on paper. Whereas, on patient side with the help of patient ID the patient can schedule appointment in our system with doctor & also with the help of Case ID it will differentiate that how many times the particular patient had fixed cases in our system. For e.g.; Suppose Patient having ID=1 has registered with our system. During appointment, it will get Case ID related to particular or diagnosis he selects. For another problem he will get another Case ID so that he can view his/her past problems more genuinely. In short single patient has one P_ID & many case ID. The system will improve the quality of medical care by providing a wealth of data from various sources to medical professionals, by promoting the use of best practices and tracking treatment. 1.5.1 Project Plan • GANTT CHART:- Gantt chart is a project scheduling technique. Progress can be represented easily in a Gantt chart, by coloring each milestone when completed. The project will start in the month of January and end after 4 months at the end of April. A Gantt chart is a graphical representation of the duration of tasks against the progression of time. It is a useful tool for planning and scheduling projects. A Gantt chart is helpful when monitoring a project's progress. A Gantt chart lays out the order in which the tasks need to be carried out. A Gantt chart is a type of bar chart that illustrates a project schedule. Gantt charts illustrate the start and finish dates of the terminal elements and summary elements of a project. Terminal elements and summary elements comprise the work breakdown [Department of Computer Science & Engineering] Page 4
  5. 5. [Electronic Health Record] structure of the project. Gantt charts also show the dependency relationships between activities. Gantt charts can be used to show current schedule status. The Gantt chart is constructed with a horizontal axis representing the total time span of the project, broken down into increments (days, weeks, or months). The Gantt chart is constructed with a vertical axis representing the tasks that make up the project. System Design Detailed Design Coding Unit Testing Test Plan Testing Working  February March April May Month Fig-1.5.1 Gantt chart [Department of Computer Science & Engineering] Page 5
  6. 6. [Electronic Health Record] 1.6 Technology Requirements • System Requirements:- Front-End:- Microsoft ASP.NET with C# Database: - MySQL Server 2008 Software: - Microsoft Visual Studio 2010 Operating System: - XP/Win7/Win8 Reporting Tool: - Microsoft SAP Crystal Report • Hardware Requirements:- Microprocessor: - Pentium IV series or above. Memory: - 512 MB Minimum. Hard-Disk Space: - 10 GB Minimum. 1.7 Background Theory 1.7.1 Characteristics of Electronic Health Record Systems The Electronic Health Record (EHR) System will facilitate the staff of the hospitals to have electronic health records of patients. The following will be the main characteristics of the EHR:  Create, update and view patient’s electronic health records  Add medical documents, images and scanned copies to patients health record [Department of Computer Science & Engineering] Page 6
  7. 7. [Electronic Health Record]  Able to search for patient’s from all the Drexel network of hospitals.  Provide referrals to Drexel Specialists  Generate e-prescriptions Terminals and laptops at particular hospital systems will be able to connect to it using a web service. The data entered and uploaded will be saved on the data servers. This data will be accessible by all the hospitals in the network. If a patient has visited that hospital earlier, his record will be updated with the existing conditions and no new record will be created. 1.7.2 Basic Concept and Terminology An electronic health record is a collection of patient health information generated by one or more meetings in any care delivery setting. An EHR typically includes patient demographics, progress notes, problems, and medications, vital signs, past medical history, immunizations, laboratory data and radiology reports. It’s said to streamline clinicians’ workflow, and it has the ability to generate a complete record of a clinical patient encounter. EHRs focus on the total health of the patient. They go beyond standard clinical data collected in the provider’s office and include a broader view of the patient’s care. EHRs’ most notable benefit includes a secure sharing of data, which, in turn, results in more open communication and more involvement on the patient’s part. 1.7.3 Various Terminologies Used In EHR Physician office: A place where nonfederally employed physicians provide direct patient care in the 50 states and the District of Columbia; excludes radiologists, anesthesiologists, and pathologists. Any EMR/EHR system: Obtained from "yes" responses to the question, "Does this practice use electronic medical records or electronic health records (not including billing records)?" Basic EMR/EHR system: A system that has all of the following functionalities: patient history and demographics, patient problem lists, physician clinical notes, [Department of Computer Science & Engineering] Page 7
  8. 8. [Electronic Health Record] comprehensive list of patients' medications and allergies, computerized orders for prescriptions, and ability to view laboratory and imaging results electronically. Intent to apply for Medicare or Medicaid EHR Incentive Programs: "Medicare and Medicaid offer incentives to practices that demonstrate 'meaningful use of health IT.' At this practice, are there plans to apply for these incentive payments?" Chapter 2 Literature Survey 2.1 Literature Review about EHR Several evidence-based reviews conclude that some types of health information technology (IT), particularly electronic health records (EHRs) with advanced functionalities, have reduced medication errors and improved care processes, adherence to evidence-based guidelines, patient engagement, and patient satisfaction. Despite these potential benefits, health care providers were initially slow to adopt EHRs. In 2008, approximately 1.5 percent of non-federal acute care hospitals reported having a comprehensive EHR system and 7.6 percent had a basic EHR system. Similarly, approximately 17 percent of office-based physicians used an EHR that met the criteria of a basic system in 2008. The purpose of this literature review is to provide examples of how organizations are implementing and optimizing the use of health IT/EHRs from peer-reviewed publications and the gray literature by examining the context and organization specific factors, barriers and facilitators, and “lessons learned” associated with the successful implementation and optimal use of EHR systems. HITECH states that the “[The Office of the National Coordinator [ONC] shall prepare a report that identifies lessons learned from major public and private health care systems in their implementation of health information technology”. [Department of Computer Science & Engineering] Page 8
  9. 9. [Electronic Health Record] Fig 2.1 Percentage of office based EHR physician with EHR System: US 2001-2013 2.2 Comparative Statements about EHR With the government backing the concept of electronic health records (EHR), and with technology being used in every walk of life, more and more hospitals are looking into implementing EHR systems. A national survey of U.S. hospitals was conducted in February/March 2005 to identify the status of EHR systems in hospitals regarding the core functionalities implemented (as identified by the Institute of Medicine), and to determine the perceived benefits, risks, and barriers to adoption of EHR systems in relation to the size of the hospital. The overall status of EHR systems and the effects of using them are topics of growing interest to researchers. A recent study, conducted in 2006 by the Healthcare Financial Management Association (HFMA), surveyed senior healthcare finance executives at hospitals and health systems of various sizes and regions. The purpose was to identify how healthcare financial executives view the barriers to EHR adoption and the actions government can take to encourage adoption. Based on the 176 responses, the functions in which the greatest number of hospitals reported significant progress were order entry (38 percent), results management (27 percent), and electronic health information/data capture (23 percent). The most significant barriers were lack of national information standards and code sets (62 percent), lack of available funding (59 percent), concern about physician (51 percent), and lack of interoperability (50 percent). Health information technology professionals and governmental leaders are promoting EHRs. David Brailer, former national coordinator for health information technology, emphasized the important role that EHR systems play in improving quality, increasing patient safety, increasing operational efficiency, and reducing costs. President Bush [Department of Computer Science & Engineering] Page 9
  10. 10. [Electronic Health Record] announced that most Americans will have EHRs within the next 10 years to allow doctors and hospitals to share patient records nationwide. 2.3 Motivation Survey about EHR 2.3.1 Time and Effort Studies dating back to 1996 cite concerns with the speed of entry and limited physician acceptance of electronic healthcare documentation systems. Clinicians frequently complain that a system requires too many clicks to get to the problem list and that using the documentation system takes too much effort and cuts into patient time. The amount of human resources required to create and maintain the patient problem list is often significant. Healthcare providers and organizations should plan ahead to include the number of hours required to support this feature in clinical and administrative workflows in EHR systems. 2.3.2 Search Functionality for Providers Physicians who are accustomed to writing down their diagnosis on paper problem lists in some cases are now required to electronically search through thousands of options to retrieve the specific diagnosis needed to accurately describe the patient’s disease process. This frustrating process may lead to incorrect or nonspecific data in a patient’s medical record due to inefficient search capability. 2.3.3 Multiple Uses and Needs The problem list serves a variety of uses for clinicians and no clinicians in diverse healthcare settings. It can provide a succinct view of a patient’s health status and therefore must be used and maintained to meet different needs. A primary care physician is concerned with chronic and acute conditions. A specialty provider may focus only on a subset of problems relevant to that area of medicine. An emergency provider may address only the critical acute presenting problems. Other clinicians may use the problem list for tracking conditions that should be addressed for specific care delivery goals. Coding professionals use the problem list to confirm or clarify documentation found in other parts of the health record. To address billing needs, the problem list may be used as a source of diagnostic information. Problem list entries may be linked or integrated with other parts of the EHR to minimize duplication and improve documentation. Key information about a patient (e.g., drug-seeking behavior or other [Department of Computer Science & Engineering] Page 10
  11. 11. [Electronic Health Record] pertinent facts affecting care or treatment) may be added to the problem list as a means of communication to all providers, since the problem list is intended for review at every patient encounter. 2.3.4 Administrative Maintenance Administrative management issues surrounding an EHR problem list must be resolved during the mass customization of a data entry platform. The primary challenge is to provide tools that balance patient care with the taxonomy of data standardization. The flexibility required by a variety of clinicians to document complex, patient-oriented care. is at odds with the structure required by a standardized set of terminology describing discrete conditions, events, and measurable outcomes. 2.2.5 Clinical Management Maintenance A significant barrier facing the clinical end user is problem list clutter. Without careful management, the shared problem list accumulates multiple diagnoses and symptoms that may or may not be accurate to the patient’s true condition. Eventually, the list may become useless due to length and inaccuracy, and often the list is either appended to or displayed with each patient encounter. If the list is filled with inaccuracies, the clinical documentation is viewed as suspect and becomes a potential liability. [Department of Computer Science & Engineering] Page 11
  12. 12. [Electronic Health Record] Chapter 3 Design 3.1 UML Diagrams 3.4.1 E-R Diagram [Department of Computer Science & Engineering] Page 12
  13. 13. [Electronic Health Record] Fig3.4.1. E-R Diagrams An ER model is an abstract way of describing a database. 3.4.2 Data Flow Diagrams A data flow diagram (DFD) is a graphical representation of the flow of data through an information system. A data flow diagram can also be used for the visualization of data processing (structured design). A data flow diagram could be a context level diagram (LEVEL 0), LEVEL 1, LEVEL 2. • CONTEXT LEVEL DIAGRAM (LEVEL 0) [Department of Computer Science & Engineering] Page 13
  14. 14. [Electronic Health Record] This level shows the overall context of the system and its operating environment and shows the whole system as just one process. • LEVEL 1 This level (level 1) shows all processes at the first level of numbering, data stores, external entities and the data flows between them. The purpose of this level is to show the major high level processes of the system and their interrelation • LEVEL 2 This level is a decomposition of a process shown in a level 1 diagram, as such there should be level 2 diagrams for each and every process shown in a level 1 diagram. DFD DIAGRAMS FOR EHR SYSTEM: [Department of Computer Science & Engineering] Page 14
  15. 15. [Electronic Health Record] [Department of Computer Science & Engineering] Page 15
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  17. 17. [Electronic Health Record] [Department of Computer Science & Engineering] Page 17
  18. 18. [Electronic Health Record] [Department of Computer Science & Engineering] Page 18
  19. 19. [Electronic Health Record] 3.4.3 Use-case Diagram [Department of Computer Science & Engineering] Page 19
  20. 20. [Electronic Health Record] Use case diagrams are considered for high level requirement analysis of a system. So when the requirements of a system are analyzed the functionalities are captured in use cases. So we can say that uses cases are nothing but the system functionalities written in an organized manner. Now the second things which are relevant to the use cases are the actors. Actors can be defined as something that interacts with the system. The actors can be human user, some internal applications or may be some external applications. So in a brief when we are planning to draw an use case diagram we should have the following items identified. • Functionalities to be represented as an use case • Actors • Relationships among the use cases and actors. SYMBOLS & NOTATIONS:  Actor: An actor represents a role that an outsider takes on when interacting with the business system. For instance, an actor can be a customer, a business partner, a supplier, or another business system. Every actor has a name:  Association: An association is the relationship between an actor and a business use case. It indicates that an actor can use a certain functionality of the business system—the business use case:  Business Use-Case: [Department of Computer Science & Engineering] Page 20
  21. 21. [Electronic Health Record] A business use case describes the interaction between an actor and a business system, meaning it describes the functionality of the business system that the actor utilizes:  Include Relationship: They include relationship is a relationship between two business use cases that signifies that the business use case on the side to which the arrow points is included in the use case on the other side of the arrow. This means that for one functionality that the business system provides, another functionality of the business system is accessed. USE-CASE DIAGRAM FOR EHR SYSTEM:- [Department of Computer Science & Engineering] Page 21
  22. 22. [Electronic Health Record] Fig 3.4.3 Use-Case Diagram Description: - In our use-case diagram, there are 3 main actors involved in our system which is doctor, patient & laboratory. Here, doctor is generalized into 4 types which we include in our project & they are dermatologist, gynecologist, orthopedic & general physician. 3.4.4 Class Diagram [Department of Computer Science & Engineering] Page 22
  23. 23. [Electronic Health Record] A class diagram is an illustration of the relationships and source code dependencies among classes in the Unified Modeling Language (UML). In this context, a class defines the methods and variables in an object, which is a specific entity in a program or the unit of code representing that entity. Class diagrams are useful in all forms of object-oriented programming (OOP). SYMBOLS & NOTATIONS:-  Active classes:- Active classes initiate and control the flow of activity, while passive classes store data and serve other classes. Illustrate active classes with a thicker border.  Associations:- Associations represent static relationships between classes. Place association names above, on, or below the association line. Use a filled arrow to indicate the direction of the relationship. Place roles near the end of an association. Roles represent the way the two classes see each other. CLASS-DIAGRAM FOR EHR SYSTEM:- [Department of Computer Science & Engineering] Page 23
  24. 24. [Electronic Health Record] Fig 3.4.4 Class Diagram Description: - In Class Diagram, There are various classes like doctor, patient, etc. in our System which functions same as we explained in use case diagram. 3.4.5 Sequence Diagram A sequence diagram is an interaction diagram that details how operations are carried out: what messages are sent and when. Sequence diagrams are organized according to time. [Department of Computer Science & Engineering] Page 24
  25. 25. [Electronic Health Record] SYMBOLS & NOTATIONS:  Class roles:- Class roles describe the way an object will behave in context. Use the UML object symbol to illustrate class roles, but don't list object attributes.  Activation:- Activation boxes represent the time an object needs to complete a task.  Lifelines:- Lifelines are vertical dashed lines that indicate the object's presence over time. SEQUENCE DIAGRAM FOR EHR SYSTEM:- [Department of Computer Science & Engineering] Page 25
  26. 26. [Electronic Health Record] Fig.3.4.5 Sequence Diagram Description: - In sequence diagram, there are 4 objects in our system like patient, doctor, Laboratory and database. Here, patient can view his previous records by logging through in our system. Also doctor can diagnosis & prescribe medicines to patients, generates medicines report if lab test not required. Otherwise doctor will add lab test & send to laboratory. Laboratory will select the lab test given by doctor & perform lab test & generate lab tests reports. Finally, doctor view the lab test report & generates E- prescription. 3.4.6 Collaboration Diagram [Department of Computer Science & Engineering] Page 26
  27. 27. [Electronic Health Record] A collaboration diagram describes interactions among objects in terms of sequenced messages. Collaboration diagrams represent a combination of information taken from class, sequence, and use case diagrams describing both the static structure and dynamic behavior of a system. SYMBOLS & NOTATIONS:-  Class Roles:- Class roles describe how objects behave. Use the UML object symbol to illustrate class roles, but don't list object attributes.  Association Roles:- Association roles describe how an association will behave given a particular situation.  Messages:- Unlike sequence diagrams, collaboration diagrams do not have an explicit way to denote time and instead number messages in order of execution. Sequence numbering can become nested using the Dewey decimal system. For example, nested messages under the first message are labeled 1.1, 1.2, 1.3, and so on. The a condition for a message is usually placed in square brackets immediately following the sequence number. COLLABORATION DIAGRAM FOR EHR SYSTEM:- [Department of Computer Science & Engineering] Page 27
  28. 28. [Electronic Health Record] Fig 3.4.7 Collaboration Diagram Description: - In collaboration diagram, there are same objects as we explained in sequence diagram, which describes the same flow as in sequence diagram. Chapter 4 Implementation [Department of Computer Science & Engineering] Page 28
  29. 29. [Electronic Health Record] After having the user acceptance of the new system developed, the implementation phase begins. Implementation is the stage of a project during which theory is turned into practice. During this phase, all the programs of the system are loaded onto the user's computer. During this phase, all the programs of the system are loaded onto the user's computer. After loading the system, training of the users starts. Main topics of such type of training are: • How to execute the package • How to enter the data • How to process the data (processing details) • How to take out the reports After the users are trained about the computerized system, manual working has to shift from manual to computerized working. The following two strategies are followed for running the system: In our System there are various modules in our system from which system flow will continues smoothly. Here, we will consider only those modules that our system has major dependent on it. These Modules are displayed in snapshots below:- 4.1 WORKING DEMO:- EHR HOMEPAGE [Department of Computer Science & Engineering] Page 29
  30. 30. [Electronic Health Record] Fig. EHR Homepage Description: - This is our homepage of our system. In this page, we have 3 logins for patient, doctor & laboratory. For Patient, he/she first of all registers on our page by clicking on signup menu. PATIENT SIGNUP [Department of Computer Science & Engineering] Page 30
  31. 31. [Electronic Health Record] Fig. Patient signup Description: This is the patient signup page. In this page, new patient will enter all the details which are required by our system for further processing. In this page, every patient is assigned P_ID automatically when he/she registers with our system & this id will be used when patient makes or fixed appointment with doctor. Here, as soon as patient will enter his/her id & all her basic details such as name, gender, age etc. will be retrieved automatically. PATIENT LOGIN [Department of Computer Science & Engineering] Page 31
  32. 32. [Electronic Health Record] Fig. patient login Description: This is our patient’s login page. In this page patient will login with our by giving username & password which he/she will give during registration. After that patient will selects hospital & then it will go for make or request an appointment to doctor. MAKE APPOINTMENT [Department of Computer Science & Engineering] Page 32
  33. 33. [Electronic Health Record] Fig. Make Appointment Description: - This is our make appointment page. In this page, patient will request for an appointment with doctor of particular area or department. In this page, patient is assigned with case_id, so this id will be used by doctors in order to retrieve basic details of patients while prescribing medicines, adding lab tests etc. Also the case_id will also be used by laboratory section in order to know details of patients for which he/she has to perform lab tests. VIEW APPOINTMENT [Department of Computer Science & Engineering] Page 33
  34. 34. [Electronic Health Record] Fig. View Appointment Description: - This is the view appointment page. This page is viewed by doctors after login in order to view appointments that are requested by patients of particular diagnosis type. From diagnosis type, it will select the diagnosis page of that particular department in which the doctor treats the patient. OUR MODULES:  Dermatologist: [Department of Computer Science & Engineering] Page 34
  35. 35. [Electronic Health Record]  Gynecologist:- [Department of Computer Science & Engineering] Page 35
  36. 36. [Electronic Health Record]  Orthopedic:- [Department of Computer Science & Engineering] Page 36
  37. 37. [Electronic Health Record]  General Physician:- [Department of Computer Science & Engineering] Page 37
  38. 38. [Electronic Health Record] 4.2 MODULES FLOW:- [Department of Computer Science & Engineering] Page 38
  39. 39. [Electronic Health Record] Fig.Diagnosis Page(orthopaedic) [Department of Computer Science & Engineering] Page 39
  40. 40. [Electronic Health Record] Fig. Diagnonise diseases [Department of Computer Science & Engineering] Page 40
  41. 41. [Electronic Health Record] Fig. Medicines Page (Orthopedic) [Department of Computer Science & Engineering] Page 41
  42. 42. [Electronic Health Record] Fig.Select Labtest(orthopaedic) [Department of Computer Science & Engineering] Page 42
  43. 43. [Electronic Health Record] Fig. Perform labtest(laboratory section_Orthopedic) [Department of Computer Science & Engineering] Page 43
  44. 44. [Electronic Health Record] Fig. Labtest Report(Laboratory Side) Chapter 5 [Department of Computer Science & Engineering] Page 44
  45. 45. [Electronic Health Record] Testing & Analysis Chapter 6 [Department of Computer Science & Engineering] Page 45
  46. 46. [Electronic Health Record] Expected Outcomes & Conclusion Expected Outcomes When health care providers have access to Electronic health records (EHRs) patients receive better medical care. EHRS can improve the ability to diagnose diseases and reduce—even prevent—medical errors, improving patient outcomes. • EHRs aid in diagnostics. • EHRs can reduce errors, improve patient safety, and support better patient outcomes o A qualified EHR not only keeps a record of a patient's medications or allergies, it also automatically checks for problems whenever a new medication is prescribed and alerts the clinician to potential conflicts. o Information gathered by a primary care provider and recorded in an EHR tells a clinician in the emergency department about a patient's life- threatening allergy, and emergency staff can adjust care appropriately, even if the patient is unconscious. o EHRs can expose potential safety problems when they occur, helping providers avoid more serious consequences for patients and leading to better patient outcomes. o EHRs can help providers quickly and systematically identify and correct operational problems. In a paper-based setting, identifying such problems is much more difficult, and correcting them can take years. • EHRs May Improve Risk Management By: o Providing clinical alerts and reminders o Improving aggregation, analysis, and communication of patient information o Making it easier to consider all aspects of a patient's condition o Supporting diagnostic and therapeutic decision making o Gathering all relevant information (lab results, etc.) in one place o Support for therapeutic decisions [Department of Computer Science & Engineering] Page 46
  47. 47. [Electronic Health Record] o Enabling evidence-based decisions at point of care o Preventing adverse events o Providing built-in safeguards against prescribing treatments that would result in adverse events o Enhancing research and monitoring for improvements in clinical quality • Using EHRs to Improve Quality of Care o Breast Cancer o Diabetes o Chlamydia o Colorectal Cancer • Using EHRs to Improve Documentation and Coding o Based on level of medical decision-making, ~50% of visits under-coded o Rural family practice implementing EHR + Practice Management (EPM) system o Increased case mix (type or mix of patients treated by a hospital or unit) by 10% over 2 years from 1.34 to 1.47 o EHR documentation templates in multi-specialty clinic • EHRs can improve public health outcomes EHRs can also have beneficial effect on the health of groups of patients. Providers who have electronic health information about the entire population of patients they serve can look more meaningfully at the needs of patients who:  Suffer from a specific condition  Are eligible for specific preventive measures  Are currently taking specific medications This EHR function helps providers identify and work with patients to manage specific risk factors or combinations of risk factors to improve patient outcomes. [Department of Computer Science & Engineering] Page 47
  48. 48. [Electronic Health Record] • E-prescription Paper prescriptions can get lost or misread. With electronic prescription (e- prescribing), doctors communicate directly with the pharmacy. An e-prescribing system can save lives (by reducing medication errors and checking for drug interactions), lower costs, and improve care. It is more convenient, cheaper for doctors and pharmacies, and safer for patients. In short, e-prescribing is an important, high-visibility component of progress in health information exchange. • Improve in Efficiency and Saving cost o Improved medical practice management through integrated scheduling systems that link appointments directly to progress notes, automate coding, and managed claims o Time savings with easier centralized chart management, condition- specific queries, and other shortcuts o Easy access to patient information from anywhere o Tracking electronic messages to staff, other clinicians, hospitals, labs, etc. o Automated formulary checks by health plans o Order and receipt of lab tests and diagnostic images o Links to public health systems such as registries and communicable disease databases • Electronic Health Records Reduce Paperwork o EHRs can reduce the amount of time providers spend doing paperwork. o Administrative tasks, such as filling out forms and processing billing requests, represent a significant percentage of health care costs. EHRs can increase practice efficiencies by streamlining these tasks, significantly decreasing costs. o In addition, EHRs can deliver more information in additional directions. EHRs can be programmed for easy or even automatic delivery of information that needs to be shared with public health agencies or for the purpose of quality measurement. [Department of Computer Science & Engineering] Page 48
  49. 49. [Electronic Health Record] • Electronic Health Records Reduce Duplication of Testing Because EHRs contain all of a patient's health information in one place, it is less likely that providers will have to spend time ordering—and reviewing the results of—unnecessary or duplicate tests and medical procedures. Less utilization means fewer costs. Conclusion: An electronic health record (EHR) is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations. It is a record in digital format that is theoretically capable of being shared across different health care settings. The system is designed to re-present data that accurately captures the state of the patient at all times. EHR will improve health care professional’s decision & patients’ outcome. The widespread use of EHR is inevitable due to HITECH Act .It allows for an entire patient history to be viewed without the need to track down the patient’s previous medical record volume and assists in ensuring data is accurate, appropriate and legible. It reduces the chances of data replication as there is only one modifiable file, which means the file is constantly up to date when viewed at a later date and eliminates the issue of lost forms or paperwork. Due to all the information being in a single file, it makes it much more effective when extracting medical data for the examination of possible trends and long term changes in the patient and also Healthcare Organization that use EHR have seen a reduction in mortality, complication & cost. Healthcare Organization that use EHR have seen a reduction in mortality, complication & cost. [Department of Computer Science & Engineering] Page 49
  50. 50. [Electronic Health Record] References • Leffingwell, Dean and Widrig, Don (2003) Managing Software Requirements: A Use- Case Approach, 2nd. Edition, Addison Wesley Longman. • Team #5‟s Project Proposal document: Info627_assignment0_Team5.doc • Sumanth Nalluru, Anusha Shetty, Fangwu Wei, “Health Records System at Drexel Convenient Care Center” ,2010. • James Drallos, Jordan Clare, Joseph Korolewicz, Daniel Laboy, “EMR data Analysis”. • David LLOYD , Dipak KALRA, “EHR Requirements”. • Fredric Blavin, Christal Ramos, Arnav Shah, Kelly Devers, “ • Lessons from the Literature on Electronic Health Record Implementation”,2013. • William R. Hersh, “The Electronic Medical Record: Promises and Problems”, Biomedical Information Communication Center, Oregon Health Sciences University, BICC, 3 18 1 S. W. Sam Jackson Park Rd., Portland, OR 97201. [Department of Computer Science & Engineering] Page 50