Nursing Information and technology

1. Shared Care and
Electronic Health Record

2. ELECTRONIC HEALTH RECORD
• Electronic Health Record (EHR) is an electronic version of
patient's health record that was historically created, used and
stored on a paper chart.
• EHRs are real-time.
• Since they are electronic, EHRS can make patient information
available instantly and securely to the concerned personnel.

3. Definition of Electronic Health Record (EHR)
• "The Electronic Health Record (EHR) is a longitudinal electronic record
of patient health information generated by one or more encounters in
any care delivery system. Included in this information are patient
demographics, progress notes, problems, medications, vital signs,
past medical history, immunizations, laboratory data, and radiology
reports.The EHR automates and streamlines the clinician's workflow.
The EHR has the ability to generate a complete record of a clinical
patient encounter, as well as supporting other care-related activities
directly or indirectly via interface, including evidence-based decision
support, quality management, and outcome's reporting.“
(-National Institute of Health report, 2006)
•

4. Features of Electronic Health Record (EHR)
• EHRS contain health information created and managed by
authorized providers in a digital
• EHRS contain real time information.
• EHRS can help share information across health providers in
different health care organizations (hospitals, specialists,
laboratories, pharmacies, workplace clinics, emergency facilities,
medical imaging facilities).

5. Contents of Electronic Health Record (EHR)
• An EHR contains following data, including but not limited to:
• Patient Demographics
• Immunization Dates
• Allergies
• Medical histories
• Administrative and Billing data
• Vital signs
• Radiology images
• Lab andTest Results
• Diagnoses
• Medications and pharmacy prescriptions
• Progress notes

6. Need of Electronic Health Record
• (1)Patient Documentation
• The patient EHR documentation contains patient history, pharmacy
prescription, laboratory results, medical imaging results, etc.
• The EHR contains documentation about face-to-face encounters between
doctor and patient.The documentation can be accessed by patient and
other authorized user that helps provide more efficient patient care.

7. • (2)Quality Assurance
• EHR is the central data base for all the patient information.
• This information is tracked by physicians and specialists to determine
patient's condition to provide quality healthcare.
• The information is also used to determine if appropriate tests are run to
determine patient's condition.
• The EHR data can also be used to track information required for insurance
companies.

8. • (3)Tracking Patient Cost
• EHR stores data from all the tests ordered by healthcare providers. Without
electronic records, it is tedious for hospitals to track patient statistics such
as number of days of stay and tests run on the patient among other services.
• Thus, EHR helps to track utilization of resources by the patients that further
helps in financial reporting. Not only does it help the healthcare facilities for
record-keeping, but it also helps them in allotting resources and budget for
each patient. Since EHR contains real-time data, thus it also helps hospitals
and healthcare providers to provide efficient healthcare and track costs.

9. • (4)Portability of Health Records
• Recording data in EHR is required for patients to conveniently take their
medical data in case they want to consult a different physician, or are
referred to a specialist in a different healthcare facility.
• In case of paper-based records, it is likely that few records are not
transferred or the required information is not completely available that
would lead to duplication of tests, delayed diagnosis and hence inefficient
healthcare quality for the patient.

10. • (5)Billing
• EHR technology shall be the pillar for proper documentation.This can be
used by hospitals to follow up for accurate billing, taking into account the
tests run and the diagnosis.
• Since EHR will also have patient identification, thus this data can be used for
medical insurance claims and limit the chances for inaccurate claims and
frauds.

11. • (6)Patient Confidentiality
• EHR must have robust security system in order to uphold patient
confidentiality.
• EHR utilize network firewall security and passwords in order to provide
access to the medical records only to authorized users.
• Paper records cannot be audited in a way an EHR can be, since every person
accessing an EHR would be recorded.
• Hence, to provide complete security to the patient and his medical data,
EHR is important.

12. ROLE OF ELECTRONIC HEALTH RECORD (EHR)
• The EHR needs to represent the responsibilities and intentions within
shared care process to support effective clinical workflow and to recognise
the differing culture of use of information amongst nurses and doctors even
if the information is common.The role of a EHR can be outlined in a few
summarized points:
• (1)EHR supports patient involvement:The electronic health record
accesses the patient information and also accommodates patient decision
support and self-care. It also protects the personal privacy and maintain
confidentiality of the patient data. EHR also ensures accountability of health
professionals and reduces room for negligence.

13. • (2) EHR supports patient healthcare: Electronic health records contain the
medical history of patient, and with advancement in technology, this data
can be used to anticipate the future health problems and actions required in
terms of preventive care.
• (3)EHR supports communication: Electronic Health Records enable easy
transfer of records between departments within the same healthcare facility
or among different healthcare facilities EHR enables patient and doctors to
access data anywhere and anytime, and also supports selective retrieval of
information. EHR supports collaborative care and case management.

14. • (4)EHR supports management and quality improvement: EHR supports
continuous professional assessment and enhances the efficiency of the
healthcare professionals, while providing justification of diagnoses and
actions. EHR also facilitates management tasks and reduces routine
reporting.
• (5)EHR supports population healthcare: Electronic Health Records provide
evidence for development and evaluation of national health programs and
can support developing of policies by government for public welfare. EHR
systems should also identify patient characteristics to inform
commissioning decisions and reduce inequality in access to public
healthcare services.
• (6)EHR supports enquiry and learning: Electronic Health records support
medical education as well as clinical research.

15. CHARACTERISTICS OF A GOOD ELECTRONIC
HEALTH RECORD (EHR)
• Easy to find
• Accurate
• Systematized
• Complete and provide the information on the basis of which new findings are interpreted.
• Proper structure to store the information,
• To ensure good data quality.
• The structure should be appropriate to the needs of the clinicians.
• Comprehensive
• Grouped together under headings and subheadings in a meaningful way.
• Both medically and legally acceptable

16. BENEFITS OF ELECTRONIC HEALTH RECORD (EHR)
• EHRS help provide higher quality of care for patients, including safety,
effectiveness, education, timeliness, efficiency and patient-centeredness.
1. EHR provides complete, accurate and real-time information about
patients.
2. EHR helps provide efficient and coordinated care by enabling quick access
to patient records.
3. EHRS enable sharing electronic information with patients and clinicians
securely, without compromising patient's safety and privacy.
4. EHR help the medical providers to effectively diagnose patients, and
provide safer care by reducing197medical errors. It thus helps to improve
the performance of health professionals.

17. 5. EHRS help reduce administrative and operation cost.
6. EHRS also contain prescription that helps eliminate medical drug errors.
7. EHR improves patient and the healthcare provider interaction thereby
increasing healthcareconvenience.
8. EHR helps bring down redundancy and consequently costs, through
decreased duplication oftesting and paperwork, and thus improves
coordination of health care services. EHR helps to allocate resources and
budgeting in a hospital.
9. EHR encourages healthy lifestyle by increasing physical activity,
avoidance of behavioural risks and wider use of preventive care.

18. APPLICATIONS OF ELECTRONIC HEALTH RECORDS
application description
Administrative
applications
EHR has some administrative applications. It includes patient registration that records patient
demographics (name, age, sex, address, contact, insurance information, patient's complaint). Each
patient is assigned a unique patient ID, used only by a particular healthcare provider.
Laboratory
systems
The Electronic Health Records (EHR) should be interfaced with laboratory information system for
exchange of patient data, lab orders, schedules, testing results and other administrative functions.
Radiology
systems
The Electronic Health Records (EHR) should be interfaced with radiology information system, similar
to laboratory information systems, for exchange of patient data and digital radiology images.
Clinical
documentation
Since clinicians and nurses document a lot of patient information ranging from reports, assessment,
vital signs, transcription documents, etc., hence clinical documentation is also a large part of the EHR.
Pharmacy
systems
EHR should have the right prescription and the number of doses to be taken at the right time, which
would help pharmacies to automate filling prescriptions.This would also reduce drug errors and help
EHR procuring the right medicines timely.

19. CHALLENGES OF CAPTURING RICH PATIENT
HISTORIES IN A COMPUTABLE FORM
1. High Implementation Cost:The EHR systems can be very costly.These are
integrated with several other departments, and also needto be transferred
securely between various clinicians and even health care facilities. Small
hospitals,thus, would not be able to implement as it would exhaust their capital
budget unless they are aligned with a larger healthcare facility.
2. Increased Documentation Time:The clinicians and nurses would take time to
move from paper-based system to EHR and there may also be initial hesitation to
switch to a new system.This resistance would lead to delay in documentation
and ruin efficiency to be gained post EHR implementation.

20. 3. System Limitation:As already stated, EHR would make up a significant
expenditure from the healthcare capital budget.This would also require all
the facilities to be equipped with compatible hardware and software, high
speed internet, server rooms, IT staff and backup systems. Slow system
due to software or poor network, or system crash could be another
challenge faced by EHR.
4. Data Security: EHR system security is another huge challenge. Since EHR
contains sensitive patient information, it should be accessible only by
patient (or/and his family) and relevant stakeholders. Electronic medical
records could be a target for hackers and lead to medical identity theft.
EHRS thus face a serious challenge of maintaining data security and
integrity.
5. Inability to Realize Benefits: The benefits of EHR can only be realized
when the government has meaningful policies and rules in medical care
and medical payments.

21. LATEST GLOBAL DEVELOPMENT AND
STANDARD
• Efficient access to a citizen's Integrated Electronic Health Record
(I-EHR) is considered to be the cornerstone for the support of
continuity of care, the reduction of avoidable mistakes, and the
provision of tools and methods to support evidence-based
medicine.

22. •EHRSThen and Now
• Initially, EHRs were developed and used at a number of
academic inpatient and outpatient medical facilities but none
contained all the information in the paper chart and most
EHRS today are still a hybrid collection of computerized and
paper data.
• The increase of third party applications being used within
EHRS required additional and specific interfaces to be
developed. It soon became obvious that standards were
needed.

23. •EHR Standards in India
• The Ministry of Health and FamilyWelfare (MoH&FW) notified
the EHR standards for India in 2013 to introduce a uniform
standard-based system for creation and maintenance of
EHRs.
• It was later modified in 2016 in line with the developments.
The Indian government acknowledged the need to develop
standards applicable to EHR and constituted an experts
committee to recommend the standards.

24. •EHR Standards-2016
• The Government of India planned to introduce a uniform
system for maintenance of EMR by healthcare providers in the
country.
• To accomplish this task, an expert committee was set up to
monitor the development of standards for EMR and EHR, as
well as the standards for its adoption and implementation in
the country.
• After due consideration, 'Electronic Health Record Standards
for India' were finalized and approved by the MOHFW
(Ministry of Health and FamilyWelfare), Government of India.

25. • MOHFW has also established an Integrated Health Information
Platform (IHIP), with objectives outlined as below:
• Enabling the creation of standards compliant Electronic Health Records
(EHRS) of the citizens pan-India.
• Ensuring that the EHRS are standards-complaint as approved.
• Integration and interoperability of the EHRs through a comprehensive
health information exchange (HIE) as part of centralized accessible
platform.
• The integrated health information platform (IHIP) is envisioned to facilitate
improvement in there forms of treatment and care of the public health by
enabling better continuity of care, secure and confidential health records
management.
• It also envisions to enable better diagnosis of diseases, reduction in patient
re-visits and prevention of medical errors, while ensuring better
affordability and optimal information exchange to support better decision
support system.

26. FUTURE OF EHRTECHNOLOGIES
• The EHR technologies will rapidly continue to evolve as the adoption increases among countries
at difference pace.
• There is a wide scope to increase interoperability of EHRs between different health facilities
within a country
• In time, when all healthcare providers would have installed and begin using EHR technologies as
well as share data, the possibilities to improve care through better data collection and analysis
will evolve.
• In the future, data-mined health data would open up new opportunities to improve healthcare
and lower costs.
• It will also be used to predict potential patients who could develop chronic diseases.
• The health data can be collected and used to compare best treatment options.
• This would also help reduce health care costs through use of data analysis.