Topic: Health Informatics

Description: [?]

Preferred language style: English (U.S.)Electronic Health Records: Lessons learned and the way forwardDetails captured within the assessment summary under assessment. Readings available under assessment.

Answer the following questions: –

* Make a list of the arttributes you think an EHR should have in each of the following environments: hospital, orivate practice, community health, residential aged care facility

* Discuss the differences/similarities of the EHR functions in different settings.

Example answer Student

Electronic Health Records: Lessons learned and the way forward.

Due: 18 April 2011

Details captured within the assessment summary under assessment. Readings available under assessment.

Answer the following questions: –

* Make a list of the attributes you think an EHR should have in each of the following environments: hospital, private practice, community health, residential aged care facility.

* Discuss the differences/similarities of the EHR functions in different settings.

In this discussion I will allude to ‘perfect world’ solutions whereby all end users are fully credentialed and registered health professionals which includes those personnel required to access patient information from administration perspectives and are appropriately authorised to do so. Where the electronic health records (EHRs) are transferable between authorised users across health for the primary purpose of delivery of health care to the individual involved and the available information available to those users is specifically relevant to the care they are delivering.

From the outset it would appear obvious that EHRs in an ideal world where interoperability exists across the spectrum of health services must share common information and attributes. Principally this information would include but not be limited to information which uniquely identifies individual patients such date of birth (DOB), gender, full name, place of birth and some form of unique identifier e.g. a unique number or an electronic card. In a report by Tang, P., (2003) such information could be included in the subset referred to as the “longitudinal collection of electronic health information for and about persons” and would assist in the requirement of “immediate electronic access to person level information by authorised users”. Conversely attributes of the EHR in different health settings will vary dependant on the requirements of the environment and one could also argue the need to maintain confidentiality on the basis of the type of information and importantly its relevance to other health care professionals.

The following list of attributes includes a set referred to as common attributes which has application across the entire health sphere. The attributes described in all sections, although not exhaustive, attempt to address the eight core functionalities of an EHR system identified by Tang, P., (2003 ) as “health information data, results management, order entry/management, decision support, electronic communication and connectivity, patient support, administrative processes and reporting and population health management” and the key attributes and essential requirements as described by Handler, T., et. al. (2010).

Common Attributes:

* ‘Front page” data providing immediate access to all authorised users of key patient identifying data as discussed and most importantly ensuring ‘right patient’.

* Supporting data which is relevant to all health care providers such as known allergies defined by Handler, T., et. al. (2010) as “patient historical data (applicable across visits and across continuum of care)”.

* Functionality to enable electronic requests of relevant results (e.g. pathology and imaging), reports, referrals and current treatments (e.g. medications) from the point of service provider.

* Built in function in order to de-identify information for the purposes of research, gathering of statistics, policy support, regulation and national security as described by Tang, P., (2003).

* Patient self management tools.

* Standardised clinical vocabularies.

* Ability to adapt to the requirements of the users with response times appropriate to clinical settings and user acceptance.

* “In built security, reliability and real time access” Handler, T., et. al. (2010).

* Standardised “EHR ontologies (i.e. content and structure of the data entities in relation to each other)”, National Institutes of Health (2006).

* Auto prompt features relating to both administrative and clinical functions. Examples of such prompts may include appointment reminders, allergy alerts or clinically initiated system driven prompts when such things as potential adverse drug interactions are identified.

* Clinical decision support.

* Meets regulated industry standards and abides by government legislation including privacy acts.

* Affordability.

* Permits electronic signatures where approved by law.

* Improves efficiency of care delivery and clinical output

As stated by Tang, P. (2003) the core functionalities formulated by the Institute of Medicine committee, with respect to EHRs, must meet the criteria of improving patient safety, supporting the delivery of effective patient care, facilitating the management of chronic conditions, improving efficiency and feasibility of implementation are all supported by the common attributes described.

Hospital Attributes:

* Permission levels controlling read and write access based on the principle of need to know.

* Interface with all departments including but not limited to diagnostics, admissions and discharges, patient billings and pharmacy.

* Responsiveness and flexibility e.g. more than one practitioner can access a patients EHR at any time and transition between EHRs is seamless and controlled.

* Ready access to computer hardware in any department.

* The ability to record the majority of patient care data/information electronically which also support audit requirements.

Private Practice Attributes:

* Electronic access to all referral information including diagnostic results.

Community Health Attributes:

* Ability for care providers to interface electronically with patients in their homes.

* Ability to book appointments electronically.

* Ability for patients to self report progress such as blood glucose readings.

* Secure means however ideally world wide web (www) based.

* Relevant, informative, reliable and demystified education tools for patients pertinent to their conditions and electronic access to available resources including support groups.

Residential Aged Care Facility Attributes:

* Electronic tools supporting administration of medications and with inbuilt clinical decision support.

* Care planning software to support patient handover and longitudinal patient care.

Comparison of EHRs functions in different settings.

As discussed common functionality, regardless of setting, ideally should meet the criteria and functions as described by Tang (2003) and Handler, et.al. (2010). Evidence that implementation of EHRs in any setting must be supported by evidence that the EHR is effective and user friendly as described by Handler, this includes improved patient safety and outcomes, compliance of all users, improved interdisciplinary communication and reduction of duplication of effort. Of key importance, where attributes vary because of the nature of the setting, is the need for EHRs to be designed to meet the requirements of the users and the organisations for which they are designed, to ultimately improve delivery of care to the patient.

National Institutes of Health National Center for Research Resources, (2006). Electronic Health Records Overview. Retrieved from: http://www.ncrr.nih.gov/publications/informatics/ehr.pdf

Tang, P., (2003). Key Capabilities of an Electronic Health Record

System: Letter Report. Retrieved from: https://learning.secure.griffith.edu.au/webapps/portal/frameset.jsp?tab=courses&url=/bin/common/course.pl?course_id=_91554_1&frame=top

Handler, T., Holtmeier, G., Metzger, J., Overhage, M., Taylor, S. and Underwood, C., (2010). Electronic Health Record Attributes and Essential Requirements. Retrieved from:https://learning.secure.griffith.edu.au/webapps/portal/frameset.jsp?tab=courses&url=/bin/common/course.pl?course_id=_91554_1&frame=top