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Slides for lecture on "What can EHR do for you?  Common physician concerns and the evidence for it"

Slides for lecture on components of EHR
Listen to Dr. Slater's lecture on electronic health records (46 minutes)

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Introduction to Electronic Health Records
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Introduction to
Electronic Health Records

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.

Assigned Reading

  1. Waegemann CP.  Status report on 2002:  Electronic Health Records More

  2. Alliance for Health Reform.  A reporter's  toolkit for health information technology More

  3. American Hospital Association.  Continued Progress: Hospital Use of Information Technology, February 2007.  More

  4. 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

  5. Read about Electronic Health records on the Wikipedia

Presentations

  1. See slides for this lecture  Slides

  2. The lecture on introduction to electronic health records is presented in two parts:

What you know?

 

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.

  1. What percent of hospitals have an Electronic Health Record (fully or partially functional)?

  2. What percent of physicians enter their hospital orders into a computer, i.e. have access to Computerized Physician Order Entry (CPOE)? 

  3. What legislative efforts related to EHR were afoot in Congress in 2007?

  4. What are the different types of personal health records?

  5. List various methods of controlling security of health data based on frequency of their use?

  6. What is the extent of adoption of Electronic Health Record in United States clinics (not hospitals)?

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This page was organized by Farrokh Alemi, Ph.D.  Last date of revisions was on 06/26/08.  This page is part of a course on Integrated Information Systems