Electronic Health Records (EHR)

Notes from module 4 of the Interprofessional Health Informatics course I’m working on (plus side side reading that I did to fill in some blanks/learn more about some things mentioned in the course)

• electronic health record (EHR) = “an electroic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization” (US Health & Human Services)
  • interprofessional: includes clinicians and other types of staff
  • sharing of health information is a fundamental goal of the EHR
• benefits of EHRs:
  • ready access to latest information –> allows for more coordinated, patient-centred care
  • can be life-saving (or reduce errors/give better treatment), make treatment more timely, cost-saving, better transitions, improve population
    • e.g., system tells clinician about a life-threatening allergy
    • e.g., quicker access to test results, so clinician knows what they need to know
    • e.g., information from a hospital stay can inform discharge instructions, make transition to another setting
    • e.g., with patient portals, patients can see their own data and understand how their choices affect health outcomes
• US Institute of Medicine (2003) proposed 8 core functions of an EHR:
  1. health information and data
  2. results management
  3. order management
  4. decision support
  5. electronic communication
  6. patient support
  7. administrative processes
  8. population health reporting

Meaningful Use

• in the US under the HITECH Act, there are financial incentives for the “Meaningful Use” of certified EHR technology to improve patient care – to get this money, hospitals/clinics/doctor’s office need to demonstrate they are “meaningfully using” their EHR by meeting certain criteria; starting in 2015, anyone who is “Medicare-eligible” will have a “payment reduction” taken off their payments if they don’t meet “Meaningful Use” benchmarks

The core objectives of Meaningful Use Stage 1 as of 2014 (Source: cms.gov):

1. use computerized provider order entry (CPOE) for medication orders directly by any licensed healthcare provider who can enter orders into the medical record
2. implement drug-drug and drug-allergy interaction checks
3. maintain up-to-date problem list of current and active diagnoses
4. maintain active medication list
5. maintain active medication allergy list
6. record all of the following demographic information (preferred language, gender, race, ethnicity, date of birth, and date and preliminary cause of death (in the event of death in the hospital))
7. record and chart changes in vital signs (height, weight, blood pressure, BMI, growth  charts for children aged 0-20 years including BMI)
8. record smoking status for patients 13+ years
9. implement 1 clinical decision support rule related to a high priority hospital condition with the ability to track compliance with that rule.
10. provide patients the ability to view online, download, and transmit information about a hospital admission
11. protect EHR information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

There is also a “menu” of other items from which you have to pick of 5 of 10 (and at least one has to be a Public Health measure):

1. Submit electronic data to immunization registries
2. Submit electronic data on reportable lab results to public health agencies
3. Submit electronic syndromic surveillance data to public health agencies
4. Implement drug formulary checks
5. Record whether a patient 65 years old or older has an advance directive
6. Incorporate clinical lab-test results into EHR
7. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
8. Use certified EHR technology to identify patient-specific education resources and provide them to patients if appropriate
9. Perform medication reconciliation
10. Provide summary of care record for each transition of care or referral

The core objectives of Meaningful Use Stage 2 as of 2014 (Source: cms.gov) – (note: some of these are the same as Stage 1 and some add some additional things):

1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders
2. Record demographic information
3. Record and chart changes in vital signs
4. Record smoking status for patients 13 years old or older
5. Use clinical decision support to improve performance on high-priority health conditions
6. Provide patients the ability to view online, download and transmit their health information within 36 hours after discharge
7. Protect electronic health information created or maintained by the certified EHR technology
8. Incorporate clinical lab-test results into EHR
9. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach
10. Use certified EHR technology to identify patient-specific education resources and provide them to patients if appropriate
11. Perform medication reconciliation
12. Provide summary of care record for each transition of care or referral
13. Submit electronic data to immunization registries
14. Submit electronic data on reportable lab results to public health agencies
15. Submit electronic syndromic surveillance data to public health agencies
16. Automatically track medications with an electronic medication administration record (eMAR)

There is also a “menu” of other items from which you have to pick 3 of 6:

1. Record whether a patient 65 years old or older has an advance directive
2. Record electronic notes in patient records
3. Imaging results accessible through the EHR
4. Record patient family health history
5. Generate and transmit permissible discharge prescriptions electronically (eRx)
6. Provide structured electronic lab results to ambulatory providers

• in addition to the above, need to code information using ICD-9-CM or SNOMED CT (standards)
• has “Meaningful Use” been a success? It’s too soon to know (we need more time for effects to happen and evaluation to be conducted), but there are some anecdotes that suggest there have been some successes