Total hours theory : 04 hrs
Total practical hours : 04 hrs
To explain the use of electronic health records in
To describe the latest trends in electronic health
records standards and interoperability
Teaching and learning activities
Practice on simulated EHS system
Visit to health informatics department of a hospital
to understand the use of EHR in nursing practice
EHR-Electronic Health Record
EMR-Electronic Medical Record
PHR-patient Health Record
NHIN-National Health Information Network
CPR-computer Based Patient Record
HITECH-Health Information Technology For
Economic and Clinical health Act
MIPPA-Medicare Improvement for patient and
HIE-health Information Exchanges
HIT-Health Information Technology
PMS-Practice of management System
PDA-personal Digital Assistant
ROI-Return Of Investment
ARRA-American Recovery and Reinvestment Act
CMS-Centre for Medicare and Medicaid services
PACS- Picture Archiving and communication System
HIPPA- Health Insurance Portability and
EHR: An electronic (digital) collection of medical
information about a person that is stored on a
EMR: An Electronic Medical Records (EMR)
Nurse uses modern technology to manage and
organize patient health information.
Health :Health, according to the World Health
Organization, is "a state of complete physical, mental
and social well-being and not merely the absence of
disease and infirmity“
Records: A record is a permanent written
communication that documents information
relevant to a client's health care
management, e.g. a client chart is a continuing
account of client's health care status and need.
SOAP- notes should include Subjective,
Objective, Assessment, and Plan
An electronic health record (EHR) is a digital version
of a patient’s paper chart.
EHRs are real-time, patient-centered records that
make information available instantly and securely to
authorized users. While an EHR does contain the
medical and treatment histories of patients, an EHR
system is built to go beyond standard clinical data
collected in a provider’s office and can be inclusive of
a broader view of a patient’s care.
HIPPA-Health Insurance Portability and
Accountability Act.1996 (Insurance: Medical
insurance) In the U.S., HIPAA is an act that protects
people covered by health insurance and makes rules
about storing personal medical data.
To introduce the topic
To list the abbreviation used in topic
To describe the terminology used in topic
To define the EHR and EMR
To enlist the purpose of EMR/EHR
To enlist the general purpose ?
To describe the core function?
To discuss the components of EHR?
To discuss the health care standard
To describe the application of EMR in hospital services
To explain the data privacy and security
Definition of EMR
What is EMR?
An electronic medical record (EMR) is a digital version of
the patient-specific medical information that is
traditionally kept in a paper "chart" or medical record
Nursing informatics is “a combination of computer
science, information science, and nursing science
designed to assist in the management and processing of
nursing data, information and knowledge to support the
practice of nursing and the delivery of nursing care.
Meaning of EMR
Electronic medical health record means health related
information on an individual within one health
An EHR system is a computerized, organized collection
of individual patients’ healthcare information in a digital
– Transmit electronic data
History of EMR
tate of Electronic Health Records (EHRs) in 1992
and their evolution by 2015 and where EHRs are
expected to be in 25 years.
In September 2013 the Ministry of Health &
Family Welfare (MoH&FW) notified the Electronic
Health Record (EHR) Standards for India.
Concept of EMR/EHR
EHR programs collect health information for individual
patients in inpatient and outpatient settings
– Saves in a digital format
– Collects information that is typical of what you would
see in paper records
– Interfaces with external healthcare computer programs
– Transmits labs, orders, prescriptions, and results
– Produces comprehensive reports on diagnoses and
diseases for governmental reporting
What are the six main objectives of an EHR
These functions include:
health information and data.
electronic communication and connectivity.
administrative processes and reporting.
reporting and population health.
Purpose of EMR
Purpose of EMR Provide the electronic
equivalent of the patient chart
Bring together all of the data about a patient into a
Support patient care and improve its quality
Support and enhance physician decision making
provide individual health related information in
GENERAL PURPOSES EMR/EHR
Nursing’s data needs fall into four domains:
Nurse need data about client care,
provider staffing, administration of care and
the organization, and
knowledge based research.
The first three are distinct areas, whereas research
interacts with all of the other three.
The four areas and the source for the data are:
Client: client care/ clinical care and its evaluation,
clinical data, and client outcomes. Source: the client
Provider: professional data, caregiver outcomes, and
decision maker variables. Source: personnel records,
national data banks, and links to client records.
Administrative: management and resource oversight,
administrative data, system outcomes, and contextual
variables. Source: executive/ managerial data and fiscal
and regulatory data.
Research: knowledge base development. Source:
existing and newly gathered data and relational data
8 Core Functions of EHRs
Health information and data.
Order entry and management.
Clinical decision support.
Electronic communication and connectivity.
Reporting and population health management.
Most important part of EHR
Billing records are an important part of hospital
profitability, productivity, and efficiency. That's why
they're one of the key components of an EHR system
as they can track all the charges that a patient occurs
while undergoing care.
Types of EHR Systems
Physician-Hosted System. Physician-hosted
systems very basically mean that all data is hosted on
a physician's own servers. ...
Remotely-Hosted System. Remotely-hosted
systems shift the storage of data from the physician
to a third party. ...
12-Point Medical Record Checklist :
What Is Included in a Medical...
1.Patient Demographics: Face sheet, Registration form
3.Consent and Authorization Forms: ...
4.Release of information: ...
5.Treatment History: ...
6.Progress Notes: ...
7.Physician's Orders and Prescriptions: ...
9. Nursing Notes:
10. Medication List:
11. HIPAA Notice of Privacy Practices:
12. Patient Confidentiality:
Examples of electronic health records
EHRs include information like your age, gender,
ethnicity, health history, medicines, allergies,
immunization status, lab test results, hospital
discharge instructions, and billing information.
Laboratory test etc
Data Privacy Protected Health
Information that relates to patient past, present, or
future, physical or mental health or condition of an
Information regarding payment for the healthcare to
Information regarding the delivery of health services
Information is or can be reasonably identifiable
Information is transmitted or held in electronic form
or any other form or medium, including paper
Data security use of EMR
Security management process
Assigned security Responsibility
Information access management
Security awareness training
Security incident procedures
Business associate contracts &
Facility access controls
Device and media controls
Person or entity authentication
Reviewing the outcomes EHR
One year later, the project has expanded to many
avenues of nursing, including RN orientation, preceptor
classes, and individual unit education.
Subsequent auditing (3, 6, and 9 months after
education) shows improved documentation in areas with
significant effect on patient care and safety, including
these 3-month results:
admission medication reconciliation—from 52% to 70%
isolation indication—39% to 100%
plan of care appropriate for patient’s chief com- plaint—
83% to 100%
plan of care related to patient co-morbidities— 30%
education level—4% to 17%
safe patient handling—4% to 13%.
discharge planning—4% to 17%.
Question related topic
Define the EHR?
List out the concept of EHR?
List out the main Objectives of HER?
Discuss the Core Function of HER?
Enlist the type of HER system?
Describe the components of EHR?
List out Example of HER?
Fill in the Blanks
1. HIPP Act started in ----------------------
2. HER records initiated in -------------------year------
3. In ------------------ the Ministry of Health & Family
Welfare (MoH&FW) notified the Electronic Health
Record (EHR) Standards for India.
Till now we discussed about EMR and its
significance of health care services like , meaning,
aim, purpose, standard, application , challenges of
patient information in computer form, interfaces,
data security etc.
I hope you all understand about the electronic health
records and importance in health care services. If
you got chance to do application of knowledge and
skill in EHR/EMR of future. Will you all able to
apply this knowledge confidently without any
1. Affordable Care Act (ACA). 2010. healthcare.gov/glossary/affordable- care-act Agency for
Healthcare Research and Quality (AHRQ). Slide set: National quality strategy overview.
2. American EMRs Association (ANA). Nursing: Scope and standards of practice. Silver
Spring, MD: 2010;
3. Beck SL, Weiss ME, Ryan-Wenger N, et al. Measuring nurses’ impact on health care quality:
Progress, challenges, and future directions. Med Care. 2013;51(4 Suppl 2):S15-22.
4. Bowman S. Impact of electronic health record systems on information integrity: Quality and
safety implications. Perspect Health Inf Manag. 2013;10:1c.
5. Conn J. Joint Commission puts focus on EHR, patient safety. Modern Healthcare. July 3,
6. Gibbs G. Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further
Education Unit; 1988.
7. Hendrich A, Chow MP, Skierczynski BA, Lu Z. A 36-hospital time and motion study: How do
medical-surgical nurses spend their time? Perm J. 2008;12(3):25-34.
8. Joint Commission, The. Sentinel event alert 54: Safe use of health information technology.
March 31, 2015. jointcommission.org/assets/1/6/SEA_54_HIT_4_26_16.pdf
Electronic health records (EHR)
Learning objectives :
Illustrate the steps in creating a new patient record
and correcting an existing record using EHR
Describe some of the capabilities of EHR software
Explain how you might alleviate a patient’s security
fears surrounding the use of EHR.
Electronic health records
Eliminates duplication forms
Simply review information
Electronic health records enable a specialist to have a
patient’s information before the patient arrives at the
No need to fill out the patient’s medical history each
The specialist only has to review the information with the
patient to verify that everything is correct.
Definition of EHR
Electronic health record means health related
information on an individual across the more than
one health organization.
Purpose of patient record
Purpose of a Patient (medical) Record “to recall
observations, to inform others, to instruct students,
to gain knowledge, to monitor performance, and to
justify interventions” Reiser, S. (1991).
A Brief History of Electronic Medical
Paper records becoming inadequate
Medical errors due to Lost or misfiled records
Mishandled patient messages
Inaccurate and illegible documents
Mislabeled or illegible lab or medication orders
History of the Electronic Health Record
– To improve patient medical care by having
information accessible for informed medical decision
– 1960s First Facilities to use EHR Systems:
– Mayo Clinic in Rochester, Minnesota
– University Hospital in Burlington, Vermont
– Latter Day Saints Hospital in Salt Lake City, Utah
History of EHR
– 1960-1980s Enter Independent Medical Offices:
– Called practice management systems
– Designed for fiscal management
Governmental Mandates and Funding:
– Causing acceleration of EHRs
List four medical mistakes that will be greatly decreased through the
use of EHR.
In the early 1990s, it became apparent that paper medical records
The increasing need for coordination of care, rising healthcare costs,
and the alarming increase in medical errors.
Most of these errors can be traced to communication
Lost or misfiled paper records
Mishandled or “forgotten” patient messages
Inaccurate or unreadable information in a paper medical record
Mislabeled or unreadable laboratory or prescription orders
Reason for Adaptation of EHR
President George W. Bush signed an executive order in
August of 2006 to promote the overall efficiency and
quality of healthcare in America.
These goals will help to control the rising cost of
Most Americans will have access to electronic health
records by 2014.
A decrease in medical errors through record legibility
and uniformity of records
An increase in information available among patients,
medical providers, and the insurance carriers.
The electronic record is quickly becoming the physician’s
most important business and legal record.
Government Involvement in EHR system
1991 – IOM called for eliminating paper records by 2001
2004 – Bush created the ONC position and empowered
HHS to promote EHRs
2008 – Obama promised to sponsor adoption of EHRs
through stimulus package
2008 – Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA)
2009 – Health Information Technology for Economic
and Clinical Health (HITECH) Act provided $19.2 billion
to accelerate use of EHRs over 5 years (part of ARRA –
American Recovery and Reinvestment Act of 2009)
Bonus from CMS
– Participants meeting certain requirements were eligible for
Beacon Community Program
– 17 communities were chosen across the US to receive grants in
exchange for documenting best practices and working to
establish national goals Regional
– Provide training and support services to assist primary
healthcare providers in adopting EHRs
– Offer information and guidance to help with EHR
implementation and achieving meaningful use to qualify for
– Give technical assistance as needed HITECH Act
Electronic medical record (EMR)
Electronic health record (EHR)
Continuity of care
Reduction in errors
Personal health record (PHR) – an electronic version
of the comprehensive medical history and record of a
patient’s lifelong health, collected and maintained by
the individual patient.
Web based personal health care model
Distribution base model
Facility base model
Type of EHR records
Personal health record (PHR)
Learning Outcome: Differentiate among electronic
medical records, electronic health records, and
personal health records
Electronic medical record (EMR) – an electronic
record of health-related information for an
individual patient that is created, compiled, and
managed by providers and staff members located
within a single healthcare organization.
Electronic health record (EHR) – If that same
information on an individual patient is created,
managed, and gathered in a manner that conforms
to nationally recognized interoperability standards.
It can be utilized by members of more than one
These EHRs are the federal government’s ultimate
goal. Any provider with an interoperable EHR
system will have access.
They will facilitate continuity of care, reduce in
medical errors, and decrease healthcare costs
Health care process of EHR
Paper – chart must be located, pulled, handled, and
EHR – multiple providers can access at same time
Review comparison of workflow in paper vs. EHR in
Barriers and Benefits of the EHR
Barriers to the EHR
Lack of standards
Unknown costs and return on investment
Difficulties operating EHR systems
Significant changes in clinical/clerical processes
Lack of trust and safety
Benefits of the EHR
Enhanced accessibility to clinical information
Improved patient safety
Enhanced quality of patient care
Greater efficiency and savings
Future of EHR
EHR is here to stay
Federal government continues to encourage
development of National Electronic Healthcare
Infrastructure National Health Information Network
– part of the federal government’s goal to digitize
patients’ health records and designed on a common
platform for health information exchange (HIE)
PDAs provide instant access to information at point-
Advantages and Disadvantages of EHR
Government mandate steps
Use all major functions of HER
Use EHR to send and receive clinical information
Learning Outcome: Contrast the advantages and
disadvantages of electronic health records.
The federal government has mandated EHR for eligible
Medicare providers by 2015.
There are financial incentives for providers who
demonstrate “meaningful use” of EHR for Medicare or
Medicaid patients until 2014.
Meaningful use includes the following steps:
Step 1 requires the provider to use all major
functions of a certified EHR program.
Step 2 includes all of step 1 and adds that EHR must
be used to send and receive clinical information such
as lab orders and reports.
clinical decisions support (in development)
High priority conditions
Enrolling patients in PHR
Accessing comprehensive data
Improving population health
Advantages of EHR Programs
Fewer lost medical records
Eliminated transcription costs
Ease of chart access for multiple users
Chart availability outside of office hours
Increased access to patient education materials
Decreased duplication of test orders
More efficient transfer of records
More efficient billing processes
Greatly decreased storage needs
Accessed from other locations
Physician’s home Satellite offices
Used in teleconferences
Disadvantages of EHR Programs
Requirement IT staff may be needed
Possible damage to system and software and or
Working With an Electronic Health
Basic rules unchanged
Creating a New Patient Record
Correcting an EHR
Be familiar with the hardware and software
Keep password secure
Check entries carefully before saving
Learning Outcome: Illustrate the steps in creating a new
patient record and correcting an existing record using
Refer to Points on Practice: Working with Electronic
Other Functions of EHR Programs
Learning Outcome: Describe some of the capabilities of EHR software
Tickler Files Files that need periodic attention Alerts staff members about
patients who are due for yearly checkups and patients who require follow-
Electronically scanned images of patient thumbprints or photos help keep
track of records and assists with patient security by identifying the patient
at the time of each visit.
Specialty Specific EHR software programs may be customized to suit a
specific specialty and style of a physician’s office.
Templates or “check offs” enable the physician to add entire sentences or
phrases with the click of a mouse, instead of typing the same information
Learning Outcome: Explain how you might alleviate a patient’s security
fears surrounding the use of EHR .
All users have individual access codes and passwords.
The access code will allow each user to access only the areas of the record
that the user is entitled to, based on job description.
Access codes insert a date and time stamp within the medical record,
including the user’s initials, so that office administration and the patient
may know who is accessing each medical record.
A procedure should be in place to document when someone requests
information from the patient file, if the patient has given permission to
release that information, and when it was released.
Protecting the confidentiality of patient records in computer files is the
greatest concern of electronic health records. Electronic healthcare records
should be kept just as secure as paper healthcare records.
Careful key entry is essential to maintaining accurate electronic health files.
Electronic files must be backed up on a regular basis to avoid accidental
Other measure for security
Know the confidentiality and security features
Pamphlet explaining HER
Show the patient his/her record
Explain access to patient
Barriers to Adoption
Cost of conversion
Perceived lack of ROI
Technical and logistic challenges
Privacy and security concerns
EHR Affect on Patient Care
Reduces the need to repeat tests
Reduces the number of lost reports
Supports provider decision making
EHR Affect on Efficiency
Improves accessibility of patient information
Better data capture at the point of care
Integrates data from multiple internal and external
Facilitates the co-ordination of health care delivery
EHR Affect on Patient Outcomes
Has the potential to
Improve the quality of patient care
Help providers practice better medicine
Provides seamless exchange of information among
The electronic medical record is an electronic record
of health-related information for an individual
An electronic health record is created, managed, and
gathered in a manner that conforms to nationally
recognized interoperability standards.
A personal health record is an electronic version of
the comprehensive medical history and record of a
patient’s lifelong health that is collected and
maintained by the individual patient.
Question related to topic
List the Purpose of EHR?
State the Model?
Enlist the type of EHR?
List out the terminology used in EHR?
Advantages of EHR?
Disadvantages of EHR?
Benefits of EHR?
Barrier of EHR?
Short answer questions
Define the concept of an electronic health record
(EHR) EHR ?
– Collection of health information of patients that is
stored in a digital format EHRs can interface with
external computer programs
List out the Models of EHR?
There are three distinct models of EHR programs –
Distribution-based, Facility-based, and Web-based
Fill in the blanks ------
Initial creation – -------1960s
Improved functionality – -----1970-1980
Practice management systems –---- 1990s
Government mandates – -----2010
State the full form of Abbreviations
CPR—Computer-Based Patient Record
EMR—Electronic Medical Record
EHR—Electronic Health Record
CCD/CCR—Continuity of Care Document/
Continuity of Care Record
PHR—Personal Health Record
Objective type questions and answer
2004 – Bush created the ONC position
2008 – Medicare Improvements for Patients and
Providers Act (MIPPA)
2009 – Health Information Technology for
Economic and Clinical Health (HITECH) Act
2009 – Obama introduces economic recovery plan
2010– Beacon Community Cooperative Agreement
2010– Health Information Technology Extension
What are the future changes of EHR
LO 1.7 Describe potential developments in the future of the
National Health Information Network (NHIN) will provide
a common platform
Funding for EHR programs available through the
Challenge Grants program
The PDA, wireless networks, and high-speed Internet
access will increase speed of access to information
The Clinical data will no longer reside exclusively in a
physician’s office, but will be available wherever the
Internet is available to form the computer-based patient
Questions and answer
What are the four errors that stem from
Lost or misfiled records
Mishandled patient messages
Inaccurate and illegible documents
Mislabeled or illegible lab or medication order
Learning Outcome: List four medical mistakes that
will be greatly decreased through the use of EHR.
PHI that is collected an maintained by the patient
conforms to national interoperability standards not a
legal record used by a single healthcare organization
covered by HIPAA