This document provides an overview of major health care information systems including electronic medical records (EMR), electronic health records (EHR), personal health records (PHR), and legal health records (LHR). It discusses the definitions, components, benefits, and challenges of each system. The document emphasizes that health care information systems can improve patient care, administrative functions, and overall health care operations if implemented successfully. However, significant financial investment, user training, and overcoming resistance to change are necessary for full adoption and utilization of these systems.

1. NEWVISION UNIVERSITY
TBILISI, (GEORGIA)
PRESENTATION
SUBJECT – Managing Information in Health Care
TOPIC – Major Health Care Information Systems (EMR, EHR, PHR, LHR)
Professor- NAME- RAMESHWAR DAYAL SAINI
Dr. Natalia Kalandarishvili SAMESTER- /||TH

2. Healthcare Information System(HIS)
What is Healthcare Information System ?
Definition -
HIS is a process whereby health data (input) are recorded, stored, retrieved and
processed for decision-making (output).

3. How does it beneficial?
HIS is beneficial to …
• Doctors
• Administration
• Management
• Daily Operations
• Patients
Objectives:
• Assist in streamlining operations
• Improving Patients care.
• Helps in improving administration and control
• Assist in improving fund management
• Helps in effective revenue management
• Improving Overall Relations

4. Four Pillars of HIS Innovation

5. Necessary for successful health care information system-

6. Major Health Care Information Systems (EMR, EHR, PHR, LHR)
1. Electronic medical record
Definition:
An electronic medical record (EMR) is the legal patient record that is created
in digital format in
hospitals and ambulatory environments. Electronic medical records may
include demographics,
medical history, medication and allergies, immunization status, laboratory
test results, radiology
images, vital signs, personal stats like age and weight, and billing information.
Types of EMR
-Service based EMR
-Web based EMR

7. Benefits of EMR:
Electronic Medical Records (EMR) is a software database application designed to organize and improve medical office workflow.
Each phase of the patient encounter can be duplicated by the EMR system – increasing efficiency, productivity, and revenue.
• Increased Revenues
• Reduced Expenses
• Reduced Malpractice Costs
• Reduced Medical Errors
• Improved Quality of Care
• Improved Documentation and Accuracy
• Better Access to Medical Information
• Enhanced Security
• Save Time
• Receive Federal/State Incentives
Disadvantages:
• Technical matters (uncertain quality, functionality, ease of use, lack of integration) with other applications.
• Financial matters - particularly applicable to non-publicly funded health service systems (initial costs for hardware and
software, maintenance, upgrades, replacement)
• Resources issues - training and re-training
• Resistance by potential users - implied changes in working practices.
• Certification, security, ethical matters; privacy and confidentiality issues
• Incompatible with other systems.

8. Usage:
• Even though EMR systems with a computerized provider order entry (CPOE) have existed for
more than 30 years, fewer than 10 percent of hospitals as of 2006 have a fully integrated system.
•In the United States, 38.4% of office-based physicians reported using fully or partially electronic
medical record systems (EMR) in 2008.
•However, the same study found that only 20.4% of all physicians reported using a system
described as minimally functional and including the following features: orders for prescriptions,
orders for tests viewing laboratory or imaging results, and clinical notes.
•The CDC more recently reported that the EMR adoption rate has steadily risen to 48.3 percent
at the end of 2009.
Privacy Concern:
A major concern is adequate confidentiality of the individual records being managed
electronically.
According to the LA Times, roughly 150 people (from doctors and nurses to technicians and
billing clerks) have access to at least part of a patient's records during a hospitalization, and over
600,000 payers, providers and other entities that handle providers' billing data have some
access.
In the United States, this class of information is referred to as Protected Health Information (PHI)
and its management is addressed under the Health Insurance Portability and Accountability Act
(HIPAA) as well as many local laws.

9. Supported Specialties:
Electronic Medical Record Software for:
• Cardiology
• Dermatology
• Endocrinology
• ENT/Otolaryngology
• Family Practice
• Gastroenterology
• General Surgery
• Internal Medicine
• Neurology
• OB-GYN
• Ophthalmology
• Orthopedics
• Pain Management
• Pediatrics
• Podiatry

10. 2. Electronic Health Record (EHR)
An evolving concept defined as the systematic collection of electronic health information about
individuals and populations that can be transferred between health care centers.

11. Disadvantage of paper record:
 Paper charts are neither interactive nor intuitively designed
 Printed reminders and cautions can be easily overlooked
 Physicians are notorious for illegible handwriting-as less as 65% of the written medical charts can be fully rea
 No data sharing - written records remain in the providers office
 Take a lot of space
 Disorganization or disaster in office can result in information lossd
Advantage of EHR :
 Intuitive formatting and enhanced interaction
 Eliminating unnecessary procedures reducing health care expenditures
 Greater co-ordination and data sharing
 No data loss
 Helper applications-provide patient specific feedback in real time
 Provides alerts to the doctor to health needs or relevant research
 Improved decisions on part of the clinician
 Empowers patient in self management of chronic diseases
 Helps track prior medical history and treatment of the patient
 Collaboration between patient and doctor

12. Disadvantage of EHR:
Expensive software and computer purchase
Software maintenance expense
Dependent upon reliable operation
Factor for slow for acceptance of EHR:
 Loss of revenue
 Local vs. global perspective
 Security
 Learning curve
 Overconfidence in personal physician skill
Tool in EHR:
 Info-buttons:
- Contact specific links from one information system to another resource
- Provide relevant contextual information
- significantly increase the percentage of met information needs at the point of care
 Computerized Provider Order Entry (CPOE):
- Allows provider orders to be written electronically either in the hospital or outpatient settings
- Eliminates hand writing misinterpretation
 Clinical Decision Support (CDS):
- Provides intelligently filtered clinical knowledge and patient related information
- Improves patient care
- CPOE and CDS often work in tandem to ensure patient is being treated appropriately

13. • Personal Health Record:
- Enables the patient to keep track of their own personal health information
- Provides educational material to assist in self management of chronic disease
- Enables patients to take input from home monitoring devices such as glucometers, blood pressure
monitors, etc
- Telemedicine allows communication of medical information to remote provider for consultation.
- frequency of required appointments for a patient can be determined
- Improves quality of care
- Reduces cost through cost avoidance
• Clinical Data Repository (CDR):
- The database that stores all the health information of the HER
Importance of EHR:
- EHR will dramatically change the way in which clinicians practice
- Enable creation of more legible records helpful for multiple practitioners
- CDR and RHIO will act as a bridge enabling team work in patient care
- Safeguarding populations from outbreaks

14. 3. Personal Health Record (PHR)
What is PHR?
• A Personal Health Record ( PHR ) is an electronic application used by patients to maintain and
manage their health information in a private, secure, and confidential environment.
• It is operated by institutions (such as hospitals) and contains data entered by clinicians or billing
data to support insurance claims.
• The intention of a PHR is to provide a complete and accurate summary of an individual's
medical history which is accessible online.
• The health data on a PHR might include patient-reported outcome data, lab results, data from
devices such as wireless electronic weighing scales or collected passively from a smartphone.
Delivery Platforms
• Paper based
• PC-based
• Web-based
• Portable Devices

15. What would people do with a PHR?
• Email their doctor
• Track immunizations
• Note mistakes in their record
• Transfer information to the new doctor
• Receive and track their test results
SMART Patient
• Self assured
• Motivated
• Aware
• Resourceful
• Talented
Benefits of PHR
• Improve Patient Engagement
• Coordinate and combine information from multiple providers
• Helps to ensure that patient information is available
• Reduces administration cost
• Encourages family health management
• Enhance patient communication
• Track and assess your health
• Make the most of a doctor’s visit
• Manage your health between visits

16. Improve Patient Engagement
- Much of what your patients do for their health happens
outside clinical settings.
- When your patients can track their health over time and
have information and tools to manage their health, they can
be more engaged in their health and health care.
Coordinate and Combine
PHRs can promote better health care by helping your patients manage information from various providers and improve care
coordination.
Availability of Patient Information
Online PHRs can ensure your patients’ information is available in
emergencies and when your patients are traveling.
Reduces Administration Cost
- Your organization can reduce administrative costs by using a PHR to
provide patients with easy access to electronic prescription refill and
appointment scheduling applications.
- With PHRs, your staff can spend less time searching for patientrequested
information and responding to patient questions.

17. Family Health Management
- Having a system for tracking and updating health care information
- can help caregivers, such as those caring for
• young children
• elderly parents
• Spouses
to manage their patients’ care and coordinate with you to improve health care quality.
Enhance Patient Communication
Many PHRs allow direct, secure communication between patients and
providers.
PHRs can make communicating with your patients faster and easier.
With open lines of communication, you can be informed and
intervened earlier if health problems arise.
This improves the provider – patient relationship.
Track and Assess your health
Record and track your progress toward your health goals, such as –
• lowering your cholesterol level

18. Make the most of Doctor Visits
Be ready with questions for your doctor and information you want to
share, such as blood pressure readings since your last visit.
Manage your Health
Upload and analyse data from home-monitoring devices such as a
blood pressure cuff.
Remind yourself of your doctor's instructions from your last
appointment.

19. 4. Legal Health Record (LHR)
What is LHR?
-A legal health record (LHR) is the documentation of patient health information that is created by a health care organization. The LHR is used within the
organization as a business record and made available upon request from patients or legal services.
- There is no specific set of regulations for legal health records; however, they must meet standards set by federal and state laws. After meeting these
basic standards, it is up to the discretion of the individual healthcare organization to decide what is and is not appropriate to reveal.
- For years healthcare organizations have struggled to define their legal health records and align them with the designated record set required by the
HIPAA privacy rule. Questions often arise about the differences between the two sets because both identify information that must be disclosed upon
request.
Criteria for LHR:
The same criteria that organizations used to determine what paper records to retain and include in their legal health records and designated record sets
can be applied to electronic records. Questions organizations must ask include:
- What information can be stored long term?
- What is clinically useful long term?
- What is the cost of storage?
- How can the organization effectively and succinctly assemble the EHR for long-term use?
Legal Health Record Role
- Support the decisions made in a patient's care
- Support the revenue sought from third-party payers
- Document the services provided as legal testimony regarding the patient's illness or injury, response to treatment, and caregiver decisions
- Serve as the organization's business and legal record
- The legal health record is typically used when responding to formal requests for information for evidentiary purposes. It does not affect the
discoverability of other information held by the organization.

20. When defining the legal health record, healthcare organizations should consider:
• The available functions in the EHR system that may generate relevant information. For example, does the EHR have clinical
decision support, digital image import, or patient portals? Will information sent to or by the patient through the portal be
inserted into the record and considered part of the legal record?
• The storage capacity and cost for the required retention period of the health record. For example, what is the cost and storage
capacity for WAVE files, transcribed records, and scanned documents or images?
• The data's importance for long-term use. For example, organizations should define how to differentiate between different
types of raw data. Some source documentation for test results, whether digital or paper, generally is considered useful only for
short-term use (e.g., EEG tracings).
• Whether the EHR system is able to provide both readable electronic and paper copies of all components of the legal health
record.
Why Does The EHR need to be a LEGAL HEALTH RECORD?
- Simply, a healthcare organization must have a health record. Its “health record” must, by definition, meet all statutory,
regulatory, and professional requirements for clinical purposes as well as for business purposes.
- If the record does not qualify as a legal record, it becomes hearsay and therefore is much less legally valid for business or for
medical-legal purposes.
- Unless the practice intends to maintain separate paper records that comply with legal requirements, its EHR, to be a legal
record, must
- conform to the same requirements as health records in general and for business records on computers more specifically.

21. Conclusion:
• Explain why healthcare information systems must fit into the workflow of people
• Relate trends in the healthcare industry to cost factors
• Synthesize a vision for healthcare information systems based on trends in information technology and economics
The study of health information systems is multi-disciplinary. In particular, the topic benefits from the fields of healthcare,
management, and information systems. As distinct from a typical book in management information systems, this book looked
exclusively at the experiences gained from healthcare.

22. Referance:
- ELECTRONIC HEALTH RECORDS AND PUBLIC HEALTH INFORMATICS By Kevin M. Jackson, OD, MPH, FAAO, CDR, MSC, USN
http://webpages.charter.net/oldpostpublishing/oldpostpublishing/Section%202,%20Principles%20of%20Public%20Health/Sect%
202,%20Electronic%20Health%20Records%20and%20Public%20Health%20Inform atics%20by%20Jackson.pdf
- http://en.wikipedia.org/wiki/Electronic_medical_record
- http://www.emrexperts.com/
- http://www.youtube.com/watch?v=MOwML1N3TpM&feature=related
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