Chapter 4Electronic Health Records

Reflective Summary: Review and reflect on the Lab Registration for Medical Billing and Coding Discussion Board. Based on your review and reflection of  new learning's in this course, write at least 3 paragraphs on the following:

What have you learned from others' responses? What were the most compelling points from the

interaction with your fellow students? How did participating in this discussion help in

your understanding of the Discussion Board task? What is still unclear after the discussion with your

classmates that needs to be clarified?

• From the 1960s to the present, many terms have been used to describe automated medical records systems. The terms used to describe these systems have changed due to the advancement of technology and because automated systems have evolved from single computer applications to combination of numerous systems that are networked together.

• In the period 1970-1980, the term computerized medical records was used to describe the early medical record automation attempts. The early automation efforts focused on the development of alerts, medication administration records, provider orders communication, and notes.

Automation was primary used in the following types of systems: patients registration, finance, laboratory, radiology, pharmacy, nursing, and respiratory therapy. During the 1970s, most computerized medical records were developed in university settings for use that was tailored to the needs of the developing entity; therefore, these early systems could not be easily implemented at other facilities.

Throughout the 1980s, the development of automated systems was slow, nut the vision of electronic record systems was a goal of the health care industry. The Institute of Medicine (IOM), in 1991, released a report entitled The Computer-based Patient Record: An Essential Technology for Health Care. The vision for this report was to develop automated systems that would provide a longitudinal patient record.

A longitudinal patient record contains records from different episodes of care, providers, and facilities that are linked to form a view, over time, of a patient’s health care encounters.

The IOM concluded that this could be accomplished through a computer-based patient record (CPR) . The term CR was used to describe a broader view of the patient record than was present in the 1990s.

The medical record today is a compilation of pertinent facts of patient’s life and health history, including past and present illnesses and treatment, written by the health professionals contributing to that patient’s care.

The medical record must be complied in a timely manner and contain sufficient data to identify the patient, support the diagnosis or reason for health care encounter, justify the treatment, and accurately document the results.

As a broader concept of health care has developed, the term “health record” has emerged and is often used interchangeably with “medical records.” There are differences in the terms, however, just as there are differences between “medical care” and “health care.”

The ideal concept of a health record is a single repository of all data on an individual health care consumer’s health status. This would include birth records, immunization records, reports of all physical examinations, as well as records of all illnesses and treatments performed in any health care setting.

Computer applications in health care have closely followed the development of computers generally

In hospitals, and other health care facilities, computers were first used for billing, payroll, accounts management, and so forth

The first computer systems used in healthcare date to the early 1960s

The health information professional now deals with both computerized and manual patient records as well as computerized systems in the health information department.

Health information practitioners must be skilled in the areas that this technology requires.

1960s – Primarily administrative and financial

applications.Mainframe computersShared systems

1970s –Turnkey systemsSlightly more interest in clinical applicationsTransaction processing

1980s – Personal computers and microcomputersStand-alone systems

1990s –IOM CPR studyRecognition of need for systems integrationFocus on clinical systems and enterprise

wide systems

Growth of Internet and intranets

2000s –Advancements in EMR and CPR systemsContinued growth of Internet and Web

interfacesVirtual medical record RHIOs

First major category of IS Support patient care ▪ Quality improvement▪ Peer review▪ Research

A health care information system is an arrangement of data, processes, people, and information technology that interacts to collect, process, store, and provide output of the information required to support the health care facility (Wager, Lee, & Glaser, 2005).

In many organizations, change management and computerization are unwelcome upgrades and are often sabotaged by the very people they are intended to help. Reception of these may be affected by the workplace culture, including workforce age, nationality, experience, and so on. Both communication and wise planning will be critical to success

How to go about selecting the medical record information system

How to develop a budget for the information system

How to select the team How to determine the applicable

committees for the project The barriers that the new system will

face

EMR, EHR (electronic health record) CPR (computer-based patient record)

(1) Improved quality, outcomes, and safety▪ (2) Improved services and satisfaction▪ (3) Improved efficiency, productivity, and cost

reduction

Several different terms are used to describe the various forms of the EHR CPR – Computer-based patient record,

1980s EMR – Electronic medical record, 1990s

Primary Care Physicians (PCPs)Continuity of Care Record (CCR)Pharmacy Benefits Manager (PBM)

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Considered one that captures data from any number of computer systems in the healthcare organization and is used at the point of care (POC) to support clinical decision making.

• 2003 President Bush included their promotion in an executive order to create an Office of the National Coordinator for Health Information Technology (ONC); however, the concept of an EHRis not new.

• Mid-1960s efforts to address clinical information systems (CISs)

• Mid-1980s the Institute of Medicine (IOM) identified that new technologies should be considered for improving the state of medical records

• 1991 - The Computer-based Patient Record: An Essential Technology for Health Care. To change the thinking about the medical records purpose

• COLD – computer output to laser disk – capture print images of lab results and other documents that are in stand-alone electronic systems and make them available for viewing on a computer monitor.

Which of the following is an example of an ancillary system:

CDS EDMS Lab system PHR

Lab System

Provide vital clinical and administrative support services to patients, medical staff, visitors, and employees

In the regional health information organization (RHIO),patients would most likely be identified using: Master person index Medical Record number Record locator services Unique patient identifier

Record locator services

The ideal EHR system is generally considered one that captures data from multiple sources and is used at the point of care to support clinical decision making.

Clinical Data Repository – (CDR) database that manages data from different source systems in the hospital to other provider setting

• Health Insurance Portability and Accountability Act (HIPPA) of 1996

• 2001 – National Committee on Vital and Health Statistics (NCVHS) – proposed a national health information infrastructure (NHII) that would be a set of technologies, standards, applications, systems, values, and laws that support all facets of provider health-care, individual health, and public health.

VAPersonal digital assistants (PDAs)Electronic data interchange (EDI)

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The Certification Commission on Health Information Technology will provide P4P incentives for adoption of EHRs?

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The budget is the heart of a company's financial plan. It is truly an instrument that places monetary value on business activities (Baker & Baker, 2006). To help understand budgeting as it relates to the health care industry, the American Hospital Association (as cited in Baker & Baker, 2006) has put together four objectives that outline the budgeting process.

To provide a written expression, in quantitative terms, of a hospital’s policies and plans

To provide a basis for the evaluation of financial performance in accordance with a hospital's policies and plans

To provide a useful tool for the control of costs

To create cost awareness throughout the organization

Regardless of the type of budget, the most important factor is the variance of the budget. The variance is the difference between the actual results and the budgeted result. When calculating the variance of a static budget, the static budget variance is the actual results less the static budget amount. Variance analysis for a flexible budget is a bit more complex. It can involve volume variance, quantity variance, and also price variance.

Flexible budgets in regard to health care are important due to diagnosis-related groups. When DRGs came into effect for hospitals, flexible budgets became increasingly useful (Baker & Baker, 2006). Flexible budgets should address the areas of workload, control, and planning. Although flexible budgets are not as routine as static budgets, they are essential to financial management

After examining budget types, it is important to address capital expenditure budgets. These are budgets surrounding the acquisition of assets to the company (Baker & Baker, 2006). Common capital expenditures include the purchasing of land, buildings, and even equipment.

These budgets surround the issues of long-term finances. Another common name for a capital expenditure budget is capital spending plan (Baker, 2006). The first part of the capital expenditure budget should be about the assets already existing. This is spending that helps maintain the current assets. The second part of this type of budget is about the acquisition of new capital assets.

Community hospital has a single-vender hospital information system (HIS) that provides typical financial and administrative information systems services, including laboratory, radiology, and pharmacy information systems and order-entry/results review. Other ancillary departments such as dietary, physician therapy, nursing, and others are not online. The hospital participates in a cardiac care registry but abstracts data from their paper charts to contribute to the registry.

The health plans servicing the community are starting to offer incentives for use of health information technology if positive patient outcomes can be identified. Community hospital is considering acquiring a Computerized physician order entry (CPOE) system to reduce medication errors. Physicians who are affiliated with Community Hospital have expressed interest in acquiring HER systems for their practices but are waiting for the hospital to make a vendor decision concerning CPOE.

They believe that if they acquire an EHR from the same vendor as the hospital, they will be able to write orders from their offices fro patients who are in the hospital, have better access to the information they need to monitor their patients, and be able to tap into other providers’ EHR systems when they are covering in the emergency department.

The hospital and representative physicians are reviewing vendor products but are confused by what various vendors are telling them. One vendor has suggested that the hospital does not have the type of pharmacy information system that would support CPOE and thus would have to also buy a new pharmacy system. A vendor selling EDMS has suggested scanning and COLD feeding all the current charts forms from all provider settings into one repository so that they would be readily available when needed in an emergency.

In the meantime, a couple of physicians purchased a stand-alone electronic prescribing devise. The can send prescriptions to the major chain pharmacies in the community, but not to the community pharmacy, nor are they told they can get an interface written between the device and the clinical pharmacy in the hospital that would be needed for CPOE.