Visioning and Strategic HIT Toolkit Planning Health Information

Visioning and Strategic HIT Toolkit Planning Health Information Technology Toolkit for Critical Access and Small Hospitals http: //www. stratishealth. org/HIT_Toolkit_hospitals

Presenter • Margret Amatayakul RHIA, CHPS, CPHIT, CPEHR, FHIMSS President, MargretA Consulting, LLC Schaumburg, IL • Independent consultant, who focuses on achieving value from electronic health records, HIPAA/HITECH, and health information exchange. Developer of tools in Toolkit • Adjunct faculty College of St. Scholastica, Duluth, MN, masters program in health informatics • Founder and former executive director Computer-based Patient Record Institute, associate executive director AHIMA, associate professor University of Illinois • Active participant in standards development, former HIMSS BOD, and co-founder of and faculty for Health IT Certification 2

Stratis Health ● Stratis Health is a nonprofit organization that leads collaboration and innovation in health care quality and safety, and serves as a trusted expert in facilitating improvement for people and communities ● Stratis Health works toward its mission through initiatives funded by federal and state government contracts, and community and foundation grants, including serving as Minnesota’s Medicare Quality Improvement Organization (QIO) ● Stratis Health operates the Health Information Technology Services Center for health care organizations seeking to use health information technology in support of their clinical transformation 3

Agenda • • • Envision. . . HIT vs. EHR vs. EMR Purposes of EHR Conceptual model of technical concepts Reality in acute care and ambulatory care Progress toward the vision 4

HIT vs. EHR • Health information technology (HIT): a general concept that describes the technology that supports management of health information for many purposes • Electronic health record (EHR): is a specific set of applications that provide an “electronic record of health-related information on an individual including 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 electronic health information with and integrate such information from other sources” (Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009) Hardware that enables system use Software that directs computer devices People to support and use systems Policy that drives adoption of systems Process that helps achieve results Copyright © 2009, MargretA Consulting, LLC. Used with permission of author. 5

EHR • Encompasses broader view of a health record moving from notion of a location for keeping track of patient care events to a resource with enhanced utility • Merely automating the form, content, and procedures of current patient records will perpetuate their deficiencies and will be insufficient to meet emerging user needs Institute of Medicine: Computer-based Patient Record: An Essential Technology for Health Care, 1991, 1997 • Longitudinal collection of electronic health information for and about persons; immediate electronic access to person- and populationlevel information by authorized, and only authorized, users; provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care; and support of efficient processes for health care delivery Key Capabilities of an Electronic Health Record System, 2003 6

EHR vs. EMR • Electronic medical record (EMR) sometimes refers to: – Physician office EHR – Hospital document imaging system – Non-interoperable record of health-related information • EHR is term used by: – Federal government, including in HITECH – Institute of Medicine (IOM) – Health Level Seven (HL 7) • Primary organization to develop interoperability in health care information systems; adopts the term EHR system – Certification Commission for Healthcare Information Technology (CCHIT) 7

Purposes of EHR • Improve quality of care: data availability, links to knowledge sources • Enhance patient safety: context-sensitive reminders/alerts, clinical decision support, automated surveillance, disease management, drug/device recall • Support health maintenance: preventive care and wellness - patient reminders, summaries, tailored instructions, remote evaluation, home monitoring • Increase productivity: data capture and reporting formats tailored to user, streamlined workflow support, patient-specific care plans and protocols • Reduce hassle factors: improve satisfaction for clinicians, consumers, and caregivers - managing schedules, registration, referrals, medication refills, work queues, automatically generating administrative data • Support revenue enhancement: accurate and timely eligibility and benefits, cost-efficacy analysis, clinical trial recruitment, rules-driven coding support, accountability reporting/outcomes measures, contract management • Support predictive modeling: contribute to development of evidence-based health care guidance • Maintain patient confidentiality: as health information is securely exchanged among all stakeholders, including across the continuum of care and with individuals 8

Reality in Hospitals Other systems R-ADT/ HIS MD LIS Operations Rx RIS Interface Engine PFS Charges Portal EDMS Remote Monitoring Storage Processor (RN) EMAR POC CPOE CDS CDR Humancomputer interface CDW e. g. , CMS Hospital Compare Copyright © 2007 -8, MargretA Consulting, LLC. Used with permission of author. 9

Reality in Ambulatory Care PACS Images PMS LIS - Demographics - Scheduling - Dictation - Transcription - CPOE Operations Relational Database e. Rx Hospital Charges Fax (or CDR) Portal CDS – POC - CPOE CCR/ Scanning CCD PHR Storage External CDW e. g. , D. M. or Iz. Registry Processor Human-computer interface Copyright © 2007 -8, MargretA Consulting, LLC. Used with permission of author. 10 10

HIT Toolkit Glossary of Terms CCR/CCD Continuity of care record/document – standard data content/transmission to send for referrals CDR Clinical data repository – database optimized for processing patient transactions, e. g. , posting vital signs CDSS Clinical decision support system – software that processes discrete data according to logical rules to provide reminders and alerts CDW Clinical data warehouse – database optimized for translational data analysis, e. g. , data mining CPOE Computerized provider order entry – system that provides CDS at the point of order entry Discrete (or structured) data = individual values of data that are entered via templates and which are computable; e. g. , patient blood pressure; lab result; name of medication; in contrast to unstructured scanned images, narrative notes, dictation EDMS Electronic document management system – document imaging, email, efax, and other digital document (e. g. , dictation) storage and retrieval E-MAR/BC-MAR Electronic medication administration record (forms)/bar-code MAR for positive patient identification e. Rx Electronic prescribing system – supports drug selection & transmits prescription to retail pharmacy Human computer interface = data entry devices, such as workstations, tablets, slates, speech recognition, personal digital assistants (PDAs), and smart phones LIS Laboratory information system that manages operations of a clinical laboratory O/E Order entry system used by nursing staff to transcribe handwritten orders PACS Picture archiving and communication system – for x-rays and other clinical images POC Charting Clinical documentation at the point of care, using clinical practice guidelines/critical pathways and CDS PHR Personal health record – patient contributed data in many forms PMS/HIS/PFS Practice management system/Hospital information system/patient financial services – applications for operations, e. g. , scheduling, admitting, billing, etc. RIS Radiology information system that manages operations of a radiology department Copyright © 2009, MargretA Consulting, LLC. Used with permission of author.

Data vs. Information CDR vs. CDW Unstructured information H&P Patient ID Height Weight Labs Patient ID Test Result Orders Patient ID Drug Dose Alert Data Repository Patient ID + Lab Test DKB Height + Result Weight Drug & Dose Structured data to provide clinical decision support Data Warehouse Pt 1 ht wt dose outcome Pt 2 ht wt dose X% Outcome Structured data for Analytical Processing and Data Mining Copyright © 2009, MargretA Consulting, LLC. Used with permission of author. 12

Reality of Today/ Vision for Tomorrow • An EHR is a system that – Collects data from multiple sources – For use in clinical decision making – At the point of care • Even this definition is elusive for many organizations today • This definition is primarily focused on care delivery. There has been little demand from providers/supply of product to date for: – Various reporting functions – for quality, P 4 P, population health – Health information exchange functionality – Personal health record (PHR) support Copyright © 2009, MargretA Consulting, LLC. Used with permission of author. 13

Implementation vs. Adoption • Implementation – • “EHR Half Life” software and – Half of all who ponder do something about EHR hardware installation, – Half of all who sign a system build, testing, contract implement EHR training, go-live – Half of all who implement • Adoption – users EHR using system to • Implement all components achieve benefits • Achieve full use • Use all functionality Goal of HIT Toolkit is to help you achieve full adoption Copyright © 2007 -8, MargretA Consulting, LLC 14 14

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