WEEK 2 SEMINAR HI300 - Unit 2 Adapted from AHIMA Press AGENDA Week 1 Review Announcements and Reminders Week 2 Topics Overview Week 2 Assignments * Read the Unit 2 Reading Resources Participate on the Discussion Board Attend Seminar Complete the Unit 2 Assignment Unit 2- What Should You Be Doing? Before Electronic Health Records….. http://www.youtube.com/watch?v=dTs0CwQcU14&list=PL397565867520650B * IntroductionAmerican Recovery and Reinvestment Act of 2009’s definition of “qualified EHR”: A qualified EHR “includes patient demographic and clinical health information, such as medical history and problem lists, and has capacity to provide clinical decision support, support physician order entry, capture and query information relevant to health care quality, and exchange health information with and integrate such information from other sources.” What’s The Difference? * https://www.youtube.com/watch?v=y85HfTG4UpU EHR VS. EMRElectronic Health Record (EHR)An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization. Electronic Medical Record (EMR)An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one healthcare organization. * EHR SystemsBegins with acquiring source systems. Source systems supply the EHR and other applications with data. Examples of Source Systems: Administrative and Financial SystemsRegistration, admission, discharge and transfer (R-ADT)Patient financial systems (PFS)Many of these transactions mandated HIPAA, Affordable Care ActAncillary or Departmental SystemsLaboratory Information SystemsRadiology Information SystemsPharmacy Information Systems Core EHR Applications5 components to consider with EHR Results management: enables diagnostic study of results to be reviewed as a report and processed. Allows users to compare, trend and graph results. Lab results most common. Clinical documentation: Point of care charting. Use of templates to gather patient information. Closed-loop medication management: ensures patient safety from beginning to end (ordering drug ---- administering drug). E-prescribing, medication reconciliation, Medication 5 Rights Clinical decision support : helps physicians, nurses and other clinical staff make decisions about patient care Analytical Reporting : Processing data to reveal new information. EHR can provide more robust functions to analyze data Evolution of EHRIn 1980s, the Institute of Medicine recommended new technologies were needed to improve state of medical records.Quality of care and patient safety focal points!Many hospitals started early! Physicians wanted electronic access from their offices to the hospital’s labs to view test results.Frustration gre ...

1. WEEK 2 SEMINAR
HI300 - Unit 2
Adapted from AHIMA Press
AGENDA
Week 1 Review
Announcements and Reminders
Week 2 Topics Overview
Week 2 Assignments
*
Read the Unit 2 Reading Resources
Participate on the Discussion Board
Attend Seminar
Complete the Unit 2 Assignment
Unit 2- What Should You Be Doing?
Before Electronic Health Records…..
http://www.youtube.com/watch?v=dTs0CwQcU14&list=PL3975
65867520650B
*

2. IntroductionAmerican Recovery and Reinvestment Act of
2009’s definition of “qualified EHR”:
A qualified EHR “includes patient demographic and clinical
health information, such as medical history and problem lists,
and has capacity to provide clinical decision support, support
physician order entry, capture and query information relevant to
health care quality, and exchange health information with and
integrate such information from other sources.”
What’s The Difference?
*
https://www.youtube.com/watch?v=y85HfTG4UpU
EHR VS. EMRElectronic Health Record (EHR)An electronic
record of health-related information on an individual that
conforms to nationally recognized interoperability standards
that can be created, managed and consulted by authorized
clinicians and staff across more than one healthcare
organization.
Electronic Medical Record (EMR)An electronic record of
health-related information on an individual that can be created,
gathered, managed, and consulted by authorized clinicians and
staff within one healthcare organization.
*
EHR SystemsBegins with acquiring source systems. Source
systems supply the EHR and other applications with data.
Examples of Source Systems:
Administrative and Financial SystemsRegistration, admission,

3. discharge and transfer (R-ADT)Patient financial systems
(PFS)Many of these transactions mandated HIPAA, Affordable
Care ActAncillary or Departmental SystemsLaboratory
Information SystemsRadiology Information SystemsPharmacy
Information Systems
Core EHR Applications5 components to consider with EHR
Results management: enables diagnostic study of results to be
reviewed as a report and processed. Allows users to compare,
trend and graph results. Lab results most common.
Clinical documentation: Point of care charting. Use of templates
to gather patient information.
Closed-loop medication management: ensures patient safety
from beginning to end (ordering drug ---- administering drug).
E-prescribing, medication reconciliation, Medication 5 Rights
Clinical decision support : helps physicians, nurses and other
clinical staff make decisions about patient care
Analytical Reporting : Processing data to reveal new
information. EHR can provide more robust functions to analyze
data
Evolution of EHRIn 1980s, the Institute of Medicine
recommended new technologies were needed to improve state of
medical records.Quality of care and patient safety focal
points!Many hospitals started early! Physicians wanted
electronic access from their offices to the hospital’s labs to
view test results.Frustration grew with the hybrid record.
Document imaging came into play. Then came…. Electronic
signatures, digital dictationHospital EHR implementation more
complex than physician offices.

4. Transition StateEHR’s are still being implementedMany offices
have a hybrid recordMany organizations still print
everythingSome organizations scan all paper documents
Health Information Technology For Economic And Clinical
Health (HITECH)
https://www.youtube.com/watch?v=GzeUKKWvC0o
*
Health Information Technology For Economic And Clinical
Health (HITECH)Government Initiative - Made ONC (Office of
the National Coordinator) permanent
2004 – ONC promoted adoption of EHR through supporting
regulatory exceptions to anti-kickback laws so that hospitals
could make limited donations of EHRs to physicians. Instead,
vendor products went through a certification process and were
evaluated against a set of non-biased standards.
ONC has a YouTube Channel with lots of great information!
https://www.youtube.com/user/HHSONC
Health Information Technology For Economic And Clinical
Health (HITECH)Meaningful Use (MU incentive program)

5. Ability to demonstrate quality improvement through use of
EHR.
Promotes health information exchange.
After 2014 sanctions for those who have not adopted an EHR.
Downward adjustment to Medicare reimbursements.
Doesn’t require a complete EHR to be considered MU.
Local Efforts And ChallengesEHR vendors
May not be able to keep up with demand
Meeting HL7 EHR system functional requirements
Interoperability
Meaningful use
ICD-10-CM
Healthcare ProfessionalsMany physicians may not be interested
in EHRMobile devices may be first step toward implementing
technologyAnother early step is e-prescribingNursing and allied
health professionals seek organizations with EHR
PatientsUntil now, patients have had little interaction with
EHRPatient may be concerned about privacy and securityMany
organizations are educating patients on the EHR and allowing
them to:
Schedule appointments
Pay bills
Educational material
Informed consents
Enter health history
E-visit

6. Data Exchange StandardsHealth Level Seven (HL7)
https://www.youtube.com/watch?v=qewOJPxz4-c
Data Exchange StandardsDifferent databases may be located in
different systems but need to exchange data. Data exchange
should ensure vocabulary standards and data comparability .
Health Level Seven (HL7)
Family of standards that aid exchange of dataDigital Imaging
and Communications in Medicine (DICOM)Helps exchange x-
rays, CT scansNational Council for Prescription Drug Programs
(NCPDP)
Physician practice electronic prescribing system to retail
pharmacy
Data Compatibility StandardsEnsuring meaning of term is
consistent across usersSemanticsSemantic
interoperabilityStandard vocabularyControlled vocabulary
Data Capture TechnologyTechnologies that make data capture
easier
Discrete data entry through point-and-click fields, drop down
menus, structured templates, or macros
Speech and handwriting recognition
Handheld and wireless devices
Direct data capture from a medical device attached to a patient

7. Patient data entry
Natural language processing
Acquisition Of EHR SystemsRequires extensive planning and
organizationReadiness assessment
Determine barriers
Lack of appreciation for EHR
Costs
EHR IMPLEMENTATION ISSUESMay need staff trained in
health informaticsVery time
consumingAdoptionTrainingExecutive supportPatient’s concern
for privacy and securityLegal and regulatory mattersE-
prescribing
PLANNINGPlanning includes:
Organizing the project
Developing a migration path
Communicating to stakeholders
Developing a strategy and plan to manage changeEHR steering
committeeStaff required
IT staff
Support staff
Project managerMigration path
EHR SELECTIONBest of fitDual coreBest of breedRip-and-
replace

8. INFORMATION MANAGEMENT IN AN ELECTRONIC
ENVIRONMENTNew roles for HIM professionals
Data analysts
Information brokers
Data set developers
Data miners
Workflow analysts
Data security managers
Database administrators
DATA QUALITYAHIMA Data Quality ModelEHR increases
potential for poor data quality
Copy and paste
Macros
Standard orders
Others techniques that “reuse” dataPotential for discrepancies
between comment fields and structured data
DATA QUALITYDetermining if entries are made by authorized
individuals
Sharing passwordsHandling amendments, corrections, and
deletions
RETENTIONStates generally allow destruction after 7 to 10
years from time records was created and last used
Exception is records of minorsElectronic records consume little
spaceElectronic media is durable but concerns regarding
readability of old media

9. ADMISSIBILITYPrinted electronic record may not look like
traditional recordElectronic records will have to be printed or
EHR retrieved in court
FUTURE DIRECTIONS IN INFORMATION
TECHNOLOGYEvery 18 months some form of technology is
replaced with new technology.Will create challenges for HIM
professionalsExamples of changes
Internet and web-based technologies
Natural language processing
DISCUSSION BOARD TIPS
Search the Web for information on the issue of usability and
making the EHR more user friendly.
Compose a response discussing:
Some of the key issues clinicians have using today’s EHRs
The proposed means to overcome these issues?
Define meaningful use and how it relates to today’s EHR.
*
ASSIGNMENT TIPS CON’T
What are the physicians trying to accomplish through buying
the same EHR product at their hospital? What are the pros and
cons?
Why are the physicians not able to send a medication order to
the hospital from their e-prescribing device?
What is the difference between scanning, COLD feeding, and

10. point-of-care (POC) data entry?
How could the hospital improve upon its data quality?
Consider the real world case study and what the physicians are
trying to accomplish by purchasing these products. When you
think about the system development life cycle, use what you
learned in Unit 1 to determine how this could help in
accomplishing the goals associated with this case study. Discuss
each phase of the systems development life cycle and how it
would impact this case.
*
UNIT ASSIGNMENTS
Participate in Discussion Board Issues with usability in EHR
Complete Assignment Read Case Study, Page 1013-1014
*