This course focuses on electronic health
records (EHR). Electronic health records are used in hospitals, physician
offices, integrated health maintenance
organizations, and other generators and users of
health information. Consumers may also maintain their own personal
electronic health record. The uses of electronic health records in the
health care industry is growing.
Electronic Health Record may be defined as a
database and associated application software that a provider maintains regarding
patient's wellness and encounters with various health care services.
A comprehensive electronic health record has a large number of subsystems.
Almost no one needs all the subsystems. What a physician's office needs
and what an acute hospital need maybe quite different. Here are a set of basic, standard or add-on
subsystems.
The basic sub system of EHR may include Accounts Receivable, Consolidated Mail,
Outpatient Pharmacy, Controlled Substances, Current Procedural Terminology
(CPT), Diagnostic Related Group (DRG), Grouper Drug Accountability/Inventory,
Interface, Duplicate Record Merge: Patient Merge, Event Capture, Medications,
Inpatient Medications - Intravenous Inpatient Medications - Unit Dose,
Integrated Billing, Laboratory, Laboratory Electronic Data Interchange, Lexicon
Utility, Master Patient Index, Master Patient Index/Patient Demographics,
National Drug File, Outpatient Pharmacy, Patient Information Management Systems
(Admission, Discharge, Transfer, Registration), Pharmacy Benefits Management,
Pharmacy Data Management, Radiology/Nuclear Medicine, and Scheduling.
The standard EHR may include Adverse Reaction Tracking,
Authorization/Subscription Utility, Automated Information Collection System (AICS),
Automated Medical information Exchange (AMIE), Automatic Replenishment/Ward
Stock, Clinical Reminders, Consults/Request Tracking, CPRS, Dietetics, Generic
Code Sheet, Health Summary, Integrated Funds Distribution, Control Point
Activity, Accounting and Procurement (IFCAP), Patient Care Encounter, Problem
List, Text Integration, Utilities, and Vitals/Measurements.
Add-ons to Electronic Health Record may include Equipment/Turn-In, Request Fee
Basis, Hepatitis C Extract, Home Based Primary Care, Immunology Case Registry,
Incident Reporting, Intake and Output, Library, Medicine Clinical Services,
Mental Health, Minimal Patient Dataset, Network Health Exchange, Nursing,
Occurrence Screen, Oncology, Patient Identification Card, Personnel and
Accounting Integrated Data, Pharmacy Prescription Practices, Police and
Security, Primary Care Management Module, Prosthetics, Quality: Audiology And
Speech Analysis And Reporting, Record Tracking, Resident Assessment
Instrument/Minimum Data Set, Risk Assessment (Surgery), Social Work, Spinal Cord
Dysfunction, Surgery, Survey Generator, Visual Impairment Service Team,
Voluntary Timekeeping, and Women's Health.
As you can see, it is difficult to define what is an electronic
health record. The definition changes often and components included or
excluded vary depending on various vendors. Claudine Beron's lecture in a
later section in this course provides detailed information on various components
of VistA. Figure 1 allows one to glance at the various sub-systems and how
they relate to each other. Because electronic health records are complex
and large, at any one point several components of the system may be in the
process of changing. In Figure 1, systems implemented and in heavy use,
systems implemented and in moderate use, system purchased but not implemented
and systems planned but not purchased are shown in different colors, .
Figure 1: Claudine Baron's description of Various Components of Electronic
Health record in One Setting
The current consensus can be found at several web
sites, one of which is the free Wikipedia site. Instead of re-writing this
emerging consensus, we use it as the text for our reading.
From this reading you should be able to understand the various components of
Electronic Health Records and the broad issues involved with Electronic Health
Records.
The Wikipedia site also provides information on common issues within
Electronic Health Records. These include interoperability, privacy,
integration with legacy systems, social and organizational barriers, preserving
archives of records, and legal status of electronic health records. Of
course, an important issue in implementation of electronic health records is the
initial cost of purchasing these systems and the cost of operating these
systems. This introductory session covers these topics briefly and later
in the course we return to these topics in more depth.
Waegemann CP. Status
report on 2002: Electronic Health Records
More►
Alliance for Health Reform.
A reporter's toolkit for health information technology
More►
American Hospital
Association. Continued Progress: Hospital Use of Information
Technology, February 2007.
More►
Hansen D. Health IT
bill advances in Senate. American Medical News, July 2007
More►
See also: Hansen D, Lawmakers focus on federal role in promoting health IT
systems. American Medical News, July 2007
More►
Read about Electronic Health
records on the
Wikipedia►
Advanced learners like you,
often need different ways of understanding a topic. Reading is just one way of
understanding. Another way is through writing about what you have read.
The enclosed assessment is designed to get you to think more about the concepts
taught in this session.
What percent of hospitals
have an Electronic Health Record (fully or partially functional)?
What percent of physicians
enter their hospital orders into a computer, i.e. have access to
Computerized Physician Order Entry (CPOE)?
What legislative efforts
related to EHR were afoot in Congress in 2007?
What are the different types
of personal health records?
List various methods of
controlling security of health data based on frequency of their use?
What is the extent of
adoption of Electronic Health Record in United States clinics (not
hospitals)?
Ask your question and we will post your
question and our answer to it here. It may take 24 hours to answer your
question. Alternatively read
answers to questions asked by others.
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