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Electronic Health Record (EHR) AJ Rosario, MD, MPH Victoria Wangia, MS  Saeed Hamdan, MD, PHD Public Health Informatics Fe...
Electronic Health Record:  Where are we now? AJ Rosario, MD, MPH April 15, 2004 Centers for Disease Control and Prevention...
Outline <ul><li>Definition </li></ul><ul><li>Core functionalities  </li></ul><ul><li>Uses </li></ul><ul><li>Beneficial out...
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Automated health record <ul><li>Electronic Health Record </li></ul><ul><ul><li>(EHR) </li></ul></ul><ul><li>Electronic Hea...
Automated health record <ul><li>Electronic Health Record (EHR) </li></ul><ul><li>It is also referred to </li></ul><ul><ul>...
Defining the EHR <ul><li>“ is any information relating to the health of an individual… </li></ul><ul><li>resides in electr...
Defining the EHR <ul><li>Individual health status and condition </li></ul><ul><li>System functions  </li></ul><ul><li>Mult...
Collaborative Effort for EHR <ul><li>Department of Health and Human Services (DHHS) </li></ul><ul><li>Institute of Medicin...
1991 IOM’s Computerized Patient Record definition <ul><ul><ul><li>“ The set of components that form the mechanism by which...
2003 IOM’s Letter Report  <ul><li>Key Capabilities of an  </li></ul><ul><li>Electronic Health Record System </li></ul>
2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information  </li></ul>
2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information  </li></ul><ul>...
2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information  </li></ul><ul>...
2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information  </li></ul><ul>...
2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information  </li></ul><ul>...
Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order manag...
Core Functionalities <ul><li>Health information and data </li></ul><ul><ul><li>Problem List </li></ul></ul><ul><ul><li>Pro...
Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Results management </li></ul><ul><ul><li>Labora...
Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order manag...
Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order manag...
Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order manag...
Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order manag...
Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order manag...
Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order manag...
Primary Uses <ul><li>Patient Care Delivery </li></ul><ul><li>Patient Care Management </li></ul><ul><li>Patient Care Suppor...
Secondary Uses <ul><li>Education </li></ul><ul><li>Regulation </li></ul><ul><li>Research </li></ul><ul><li>Public Health a...
Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of car...
Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul>
Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of car...
Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of car...
Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of car...
Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of car...
Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of car...
Examples <ul><li>Veterans Health Administration (VHA) </li></ul><ul><ul><li>Computerized Patient Record System (CPRS) </li...
                                                   
Challenges <ul><li>Provider & staff acceptance  </li></ul><ul><li>Infrastructure and application costs </li></ul><ul><li>T...
Primary Care and Public Health Interactions <ul><li>patient-centered data source </li></ul><ul><ul><li>clinical decision s...
Healthcare and Public Health Services <ul><li>EHR: foundation of integration </li></ul>HealthCare Public Health
References <ul><li>Key Capabilities of an Electronic Health Record System: Letter Report. Committee on Data Standards for ...
Acknowledgements <ul><li>Atreja, Ashish  </li></ul><ul><li>Bertolli, Jeanne  </li></ul><ul><li>Dania, Frank  </li></ul><ul...
Thank you!  AJ Rosario, MD, MPH [email_address] ? EHR
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Ehr overview nip

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Ehr overview nip

  1. 1. Electronic Health Record (EHR) AJ Rosario, MD, MPH Victoria Wangia, MS Saeed Hamdan, MD, PHD Public Health Informatics Fellows April 15, 2004
  2. 2. Electronic Health Record: Where are we now? AJ Rosario, MD, MPH April 15, 2004 Centers for Disease Control and Prevention National Immunization Program Immunization Registry Support Branch
  3. 3. Outline <ul><li>Definition </li></ul><ul><li>Core functionalities </li></ul><ul><li>Uses </li></ul><ul><li>Beneficial outcomes and potential applications </li></ul><ul><li>Challenges and progress towards EHR implementation </li></ul>
  4. 4. 1935
  5. 5. 2004
  6. 6. 1935
  7. 7. 2004
  8. 8. 1935
  9. 9. 2004
  10. 10. 1918
  11. 11. 2004
  12. 12. Automated health record <ul><li>Electronic Health Record </li></ul><ul><ul><li>(EHR) </li></ul></ul><ul><li>Electronic Health Record System </li></ul><ul><ul><li>(EHR-S) </li></ul></ul>
  13. 13. Automated health record <ul><li>Electronic Health Record (EHR) </li></ul><ul><li>It is also referred to </li></ul><ul><ul><li>Electronic Healthcare Record (EHCR), </li></ul></ul><ul><ul><li>Electronic Patient Record (EPR), </li></ul></ul><ul><ul><li>Electronic Medical Record (EMR), </li></ul></ul><ul><ul><li>Computer-based patient record (CPR), </li></ul></ul><ul><ul><li>Computerized Patient Record (CPR) </li></ul></ul>
  14. 14. Defining the EHR <ul><li>“ is any information relating to the health of an individual… </li></ul><ul><li>resides in electronic system (s)… </li></ul><ul><li>for the primary purpose of providing health care and health-related services.” </li></ul>
  15. 15. Defining the EHR <ul><li>Individual health status and condition </li></ul><ul><li>System functions </li></ul><ul><li>Multimedia </li></ul>
  16. 16. Collaborative Effort for EHR <ul><li>Department of Health and Human Services (DHHS) </li></ul><ul><li>Institute of Medicine (IOM) </li></ul><ul><li>Health Level Seven (HL7) </li></ul>
  17. 17. 1991 IOM’s Computerized Patient Record definition <ul><ul><ul><li>“ The set of components that form the mechanism by which patient records are created, used, stored, and retrieved.” </li></ul></ul></ul>
  18. 18. 2003 IOM’s Letter Report <ul><li>Key Capabilities of an </li></ul><ul><li>Electronic Health Record System </li></ul>
  19. 19. 2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information </li></ul>
  20. 20. 2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information </li></ul><ul><li>(2) immediate electronic access to person- and population- level information </li></ul>
  21. 21. 2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information </li></ul><ul><li>(2) immediate electronic access to person- and population- level information </li></ul><ul><li>(3) Provision of knowledge and decision-support </li></ul>
  22. 22. 2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information </li></ul><ul><li>(2) immediate electronic access to person- and population- level information </li></ul><ul><li>(3) Provision of knowledge and decision-support </li></ul><ul><li>(4) Support of efficient processes for health care delivery.” </li></ul>
  23. 23. 2003 IOM’s Letter Report definition <ul><li>“ (1) longitudinal collection of electronic health information </li></ul><ul><li>(2) immediate electronic access to person- and population- level information </li></ul><ul><li>(3) Provision of knowledge and decision-support </li></ul><ul><li>(4) Support of efficient processes for health care delivery.” </li></ul>
  24. 24. Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order management </li></ul><ul><li>Decision support </li></ul><ul><li>Electronic communication and connectivity </li></ul><ul><li>Patient support </li></ul><ul><li>Administrative processes </li></ul><ul><li>Reporting & population health management </li></ul>
  25. 25. Core Functionalities <ul><li>Health information and data </li></ul><ul><ul><li>Problem List </li></ul></ul><ul><ul><li>Procedures </li></ul></ul><ul><ul><li>Diagnoses </li></ul></ul><ul><ul><li>Medication List </li></ul></ul><ul><ul><li>Allergies </li></ul></ul><ul><ul><li>Demographics </li></ul></ul><ul><ul><li>Clinical narratives </li></ul></ul><ul><ul><li>Laboratory test results </li></ul></ul>
  26. 26. Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Results management </li></ul><ul><ul><li>Laboratory test </li></ul></ul><ul><ul><li>Radiology procedure </li></ul></ul><ul><ul><li>Pathology reports </li></ul></ul>
  27. 27. Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order management </li></ul><ul><ul><li>Computerized entry </li></ul></ul><ul><ul><li>Electronic prescribing </li></ul></ul><ul><ul><li>Electronic orders </li></ul></ul>
  28. 28. Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order management </li></ul><ul><li>Decision support </li></ul><ul><ul><li>Improve clinical performance </li></ul></ul><ul><ul><li>Access to knowledge bases </li></ul></ul><ul><ul><li>Ensure preventive practices </li></ul></ul><ul><ul><li>Identify drug interactions </li></ul></ul><ul><ul><li>Facilitate diagnoses and treatments </li></ul></ul><ul><ul><li>Detect adverse events/ outbreaks </li></ul></ul>
  29. 29. Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order management </li></ul><ul><li>Decision support </li></ul><ul><li>Electronic communication and connectivity </li></ul><ul><ul><li>Secure use of e-mail and web messaging </li></ul></ul>
  30. 30. Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order management </li></ul><ul><li>Decision support </li></ul><ul><li>Electronic communication and connectivity </li></ul><ul><li>Patient support </li></ul><ul><ul><li>Interactive education </li></ul></ul><ul><ul><li>Home monitoring and self-testing </li></ul></ul>
  31. 31. Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order management </li></ul><ul><li>Decision support </li></ul><ul><li>Electronic communication and connectivity </li></ul><ul><li>Patient support </li></ul><ul><li>Administrative processes </li></ul><ul><ul><li>Scheduling systems </li></ul></ul>
  32. 32. Core Functionalities <ul><li>Health information and data </li></ul><ul><li>Result management </li></ul><ul><li>Order management </li></ul><ul><li>Decision support </li></ul><ul><li>Electronic communication and connectivity </li></ul><ul><li>Patient support </li></ul><ul><li>Administrative processes </li></ul><ul><li>Reporting and population health </li></ul><ul><ul><li>Uniform data standards </li></ul></ul>
  33. 33. Primary Uses <ul><li>Patient Care Delivery </li></ul><ul><li>Patient Care Management </li></ul><ul><li>Patient Care Support Processes </li></ul><ul><li>Financial and Administrative Processes </li></ul><ul><li>Patient Self-Management </li></ul>
  34. 34. Secondary Uses <ul><li>Education </li></ul><ul><li>Regulation </li></ul><ul><li>Research </li></ul><ul><li>Public Health and Homeland Security </li></ul><ul><li>Policy Support </li></ul>
  35. 35. Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of care </li></ul><ul><li>Timely data entry/ Improved documentation </li></ul><ul><li>Legibility/ Enhanced data quality </li></ul><ul><li>Enhanced security/ Controlled Access </li></ul><ul><li>Guideline dissemination </li></ul>
  36. 36. Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul>
  37. 37. Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of care </li></ul>
  38. 38. Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of care </li></ul><ul><li>Timely data entry/ Improved documentation </li></ul>
  39. 39. Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of care </li></ul><ul><li>Timely data entry/ Improved documentation </li></ul><ul><li>Legibility/ Enhanced data quality </li></ul>
  40. 40. Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of care </li></ul><ul><li>Timely data entry/ Improved documentation </li></ul><ul><li>Legibility/ Enhanced data quality </li></ul><ul><li>Enhanced security/ Controlled Access </li></ul>
  41. 41. Potential Benefits <ul><li>Patient safety/ Reduced medical errors </li></ul><ul><li>Accessibility/ Enhanced quality of care </li></ul><ul><li>Timely data entry/ Improved documentation </li></ul><ul><li>Legibility/ Enhanced data quality </li></ul><ul><li>Enhanced security/ Controlled Access </li></ul><ul><li>Guideline dissemination </li></ul>
  42. 42. Examples <ul><li>Veterans Health Administration (VHA) </li></ul><ul><ul><li>Computerized Patient Record System (CPRS) </li></ul></ul><ul><li>Department of Defense (DoD) </li></ul><ul><ul><li>Composite Health Care System (CHCS) II </li></ul></ul><ul><li>Indian Health Service (IHS) </li></ul><ul><ul><li>Resource and Patient Management System (RPMS) </li></ul></ul><ul><ul><li>IHS Electronic Health Record (IHS-EHR) </li></ul></ul><ul><ul><li>http://www.ihs.gov/CIO/EHR/ </li></ul></ul>
  43. 43.                                                    
  44. 44. Challenges <ul><li>Provider & staff acceptance </li></ul><ul><li>Infrastructure and application costs </li></ul><ul><li>Training </li></ul><ul><li>Standardization </li></ul><ul><li>Regulatory issue </li></ul><ul><li>Expertise in health informatics </li></ul>
  45. 45. Primary Care and Public Health Interactions <ul><li>patient-centered data source </li></ul><ul><ul><li>clinical decision support </li></ul></ul><ul><ul><li>management of health services </li></ul></ul><ul><li>non-patient data sources </li></ul>
  46. 46. Healthcare and Public Health Services <ul><li>EHR: foundation of integration </li></ul>HealthCare Public Health
  47. 47. References <ul><li>Key Capabilities of an Electronic Health Record System: Letter Report. Committee on Data Standards for Patient Safety, Institute of Medicine, 2003. </li></ul><ul><li>Electronic Health Record: Public Health Perspectives. White Paper. Public Health Data Standards Consortium Ad Hoc Task Force on EHR-PH, Baltimore, MD, Draft – February 25, 2004. </li></ul><ul><li>Garrett N and Yasnoff W. Disseminating Public Health Practice Guidelines in Electronic Medical Record Systems. J Public Health Management Practice, 2002, 8(3), 1-10. </li></ul><ul><li>Miller C. The Electronic Medical Record: A Definition and Discussion. Top Health Inform Manage, 1993, 13(3), 20-29. </li></ul><ul><li>Hays H. The IHS Electronic Health Record Project. The IHS Primary Care Provider. November 2003, Volume 28 Number 11, 1-4. </li></ul><ul><li>Dick RS, Steen EB (eds). The Computer-based Patient Record – An Essential Technology for Health Care, rev ed. Washington, DC: National Academy Press; 1997:55 </li></ul><ul><li>Murphy GF, Hanken MA and Waters KA. Electronic Health Records: Changing the Vision. Saunders; 1999. </li></ul><ul><li>http://www.himss.org/content/mindmaps/EHR/multi-maps/introduction/introduction.htm </li></ul>
  48. 48. Acknowledgements <ul><li>Atreja, Ashish </li></ul><ul><li>Bertolli, Jeanne </li></ul><ul><li>Dania, Frank </li></ul><ul><li>Fischetti, Linda </li></ul><ul><li>Garrett, Nedra </li></ul><ul><li>Griffith, Stan </li></ul><ul><li>Hamdan, Saeed </li></ul><ul><li>Hays, Howard </li></ul><ul><li>Khan, Nabeel </li></ul><ul><li>Li, Wenkai </li></ul><ul><li>Magno, Peng </li></ul><ul><li>Martin, Tonya </li></ul><ul><li>Monegain, Bernie </li></ul><ul><li>Richards, Janise </li></ul><ul><li>Steindel, Steve </li></ul><ul><li>Tomines, Alan </li></ul><ul><li>Wangia, Vicky </li></ul><ul><li>Williams, Warren </li></ul>
  49. 49. Thank you! AJ Rosario, MD, MPH [email_address] ? EHR

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