Powerpoint on the benefits of adding an Electronic Health Record in health system.

1. The Electronic Health Record 1 NUR 3563 Spring 2011

2. Table of Contents Introduction: Kendra Frana (3) The EHR Components: Sarah Williams (4-12) Cost: Kendra Frana (13-15) Structure of EHR: Tricia Manson (16-18) Safety: Aubrey McElroy (19-23) Education : Cindy Todd (24-28) Conclusion: Aubrey McElroy (29-30) References: All members (31-33) 2 Created by: Cindy Todd

3. Introduction The Electronic Health Record (EHR) provides vital pieces of information about patients health care information. There are multiple items included in this information such as: vital signs, patient demographics, progress notes, history, medications, labs, and radiology reports. The EHR provides a great way for healthcare clinicians to follow patients information by accessing computers linked within the clinical area where patients are. This presentation discusses the multiple areas associated with evaluating an EHR/EMR. 3 Created by: Kendra Frana

4. The EHR There are many different definitions for EHR. The one referenced the most and in our book consists of 8 main components. If you can gain a basic understanding of these components, you will have a good understanding of the EHR. (McGonigle & Mastrian 2009, p. 221) 4 Created by: Sarah Williams

5. 8 Components to the EHR 1. Health Information and DATA This is the basic patient information including demographics, diagnoses, allergies, etc. Most employees will need access to this information from doctors to admitting personnel. 2. Results Management This is a location for current as well as historical lab results, radiology and procedure reports, etc. This information should be limited to those that are directly caring for the patient in the hospital or the primary care physician. (McGonigle & Mastrian, 2009,p.222) 5 Created by: Sarah Williams

6. 8 Components to the EHR 3. Order Entry management This is the ability to enter orders of any kind directly into the computer. This should be limited to providers with ordering privileges or the nurses that have the ability to take verbal orders or input orders given directly by the provider. 4. Decision Support This is the ability to have reminders or “pop-ups” regarding medication interactions, vaccination reminders, health risk screening, etc. Reminders should be specific to the person in the EHR. An aide doesn’t need a reminder that a patient is due for a mammogram, however an allergy reminder would be appropriate. (McGonigle & Mastrian, 2009, p.222) 6 Created by: Sarah Williams

7. 8 Components to the EHR 5. Electronic Communication and Connectivity This is a way of communication among healthcare team members, their partners, and the patient through e-mail, Web messaging, etc. This should be limited to those with direct patient care such as the provider and the nurses. Systems such as Office Communicator can be helpful in clinics where there are multiple people caring for the same 6. Patient Support This is the ability for patients to monitor their healthcare at home through computer-based patient education, home monitoring, etc. For example, there are websites that patients can download health information from home such as BP and HR monitoring that allow the provider to monitor them without a clinic visit. This information should be limited to the provider specifically requesting the information patient. (McGonigle & Mastrian, 2009, p.222) 7 Created by: Sarah Williams

8. 8 Components to the EHR 7. Administrative Processes This is the ability to electronically do scheduling, billing, pre approval, insurance eligibility, etc. Access to this information is typically only needed by clerical staff such as receptionist, schedulers, billing and coding and admitting. 8. Reporting and Population Health Management This is the ability to integrate data collection tools that are specific to a certain patient population such as pediatrics. There are additional programs that can be added in pediatrics areas that calculate medication doses for infants and children that would not be needed in an adult patient care setting. (McGonigle & Mastrian, 2009, p. 222-23) 8 Created by: Sarah Williams

9. 8 Components to the EHR Each of these components are very important to the smooth operation of the EHR. There are obviously high safety risks when it comes to making all of the patient’s records so easily accessible. With the right safety measures and conscious employees, patients can feel comforted knowing their information is being kept confidential. (CMPA, 2008) 9 Created by: Sarah Williams

10. Who Should Have Access to the EHR? Limits should be set as to what information each employee has. For example: An aide doesn’t need access to order entry, the complete patient history, procedure reports, etc. Obviously an aide would have limited access to only the areas of care that they are responsible for such as vital signs, diet, activity, ADLs, etc. Employees that change positions or transfer to a different department are going to require access to different information. For example: a nurse working in dialysis is going to need access to different information if they transfer to the Cath Lab. 10 Created by :Sarah Williams

11. Monitoring Accessed Information One way to monitor who is accessing certain patient information is with an audit trail. This allows security to make sure only those that need to be looking at patient information are looking at it. This is one way St. John’s is monitoring their employees and keeping patient information confidential. (CMPA, 2008) 11 Created by: Sarah Williams

12. Monitoring Accessed Information Another way confidentiality is being enforced is by electronic signatures. At St. John’s, when there is a high profile patient such as a Federal Medical patient, a special log in is needed to monitor who is accessing the EHR. This ensures that only those providing care are going into the chart. 12 Created by: Sarah Williams

13. Cost There are four main components for an EMR/HER EMR Software Licensing Implementation Hardware Ongoing Support, Maintenance, and Enhancements (newcreationit.com,2011) 13 Created by: Kendra Frana

14. Cost, cont. Software Licensing Average licensing for a FULL/True EMR starts at about $10,000.00. Average licensing for a Light/Entry level EMR starts at $1,000.00. Implementation Usually an hourly rate between $75.00-$150.00 Average implementation time per provider is 35 hours. 25 hours of training and 10 hour to setup the computer/network. (emrexperts.com, 2010) 14 Created by: Kendra Frana

15. Cost, cont. Hardware Tablet PC $2,500.00 Workstation $1,000.00 Server $2,000.00 Support and Maintenance Ongoing support costs will come from an annual support contract with the software vendor forupdates and technical support. Also, the need of hardware/network support through a local IT representative. (americanmedical.com, 2011) 15 Created by: Kendra Frana

17. Must be easy to get to within the system itself

18. Software should be updated every time new EBP research comes out

19. CIS being used should send automatic updates to download when new information is available(Biohealthmatics.com) 16 Created by: Tricia Manson

20. How often should it be updated with new EBP guidelines It is important for health care providers to have a support system in the CIS for medication administration, ordering, and diagnosing. Since EBP comes out with new research all the time, it is important for the CIS to stay current in order to give the best and most complete care possible to every patient. (Informatics-review.com) 17 Created by: Tricia Manson

22. VisualDx

23. Dxplain

24. QMR (Quick Medical Reference)

25. Diagnosis Pro

26. LliadBiohealth.com 18 Created by: Tricia Manson

27. EHR Safety 19 Created by: Aubrey McElroy

29. Availability

33. Firewalls

34. Use of Proxy servers to monitor and limit access to certain websites or topics

35. Intrusion detection systems allow monitoring of who is using the program and what files are accessed.(McGonigle & Mastrain, 2009) 22 Created by: Aubrey McElroy

36. EHR Safety Your system will need to maintain technical support contracts for both hardware and software to ensure routine maintenance, backups and the IS department to troubleshoot problems as they occur. (McKesson Provider Technologies. (2010) “It is everyone’s responsibility to diligently monitor for unauthorized access of their networks, data, and/or information(McGonigle & Mastrian (2009).” 23 Created by: Aubrey McElroy

37. EHR Education 24 Created by: Cindy Todd

39. We use powerful motivators (such as merit increases and staff privileges) to commit to project

40. We award CME’s for participation

41. Make sure everyone understands and believes the investment will pay off in the long run(Jimenez,2010, p. 22-23) 25 Created by: Cindy Todd

43. Get outside help from professionals to implement the new EHR and study the programs carefully to match the needs of the environment so more work is not created

44. Learn the basics first and then work up to the whole system. Let this be a step by step process.

45. Only go live when ready, be prepared for setbacks, and be patient for the results of increased productivity(Lewis , 2010, p. 36-38) 26 Created by: Cindy Todd

47. Make sure the system purchased is user friendly and easy to navigate

48. Sufficient amount of training before and after the implementation

49. PLANNING IS KEY!!! (McGonigle & Mastrain, 2009,p.229)27 Created by: Cindy Todd

51. Don’t just train with computers use practice time, instructor-led, hands-on

52. Set up a post training areas to account for changes28 Created by: Cindy Todd

53. Conclusion Things to remember when evaluating an EHR... Have a well rounded group to customize and implement an EHR suited for your company The purpose of the EHR for your company Clinical structure Safety considerations Cost Educational needs for employees 29 Created by: Aubrey McElroy

54. Conclusion “We believe that the central point of an EHR is to gain quality and efficiency in caring for the patient. The patient’s health conditions and whole health history are available to the Healthcare Professional to aid in diagnosis, therapy planning, and patient care (Campos, C.J., Salinas, M.D., Sigulem, D., Wainer, J. (2008).” 30 Created by: Aubrey McElroy

55. References American Medical Software. (2011). Benefit Analysis. http://americanmedical.com/ehr-stimulus-center/cost-benefit-analysis/ Biohealthmatics.com. Retrieved from http://www.biohealthmatics.com/ Campos, C.J., Salinas, M.D., Sigulem, D., Wainer, J. (2008). Security requirements for a lifelong electronic health record system: An opinion. Open Med Inform Journal. 160–165. doi:10.2174/1874431100802010160. Drewniak, R. (2009). EHR implementations: Success lies beyond the build. Health Leaders Media. Retrieved from www.healthleadersmedia.com 31 Created by: All members

56. References EMR Experts. (2010). EMR ROI (Return on Investment). http://www.emrexperts.com/emr-roi/index.php Informatics-review.com Retrieved from http://informatics-review.com/ Jimenez, A. (2010). E-learning supports EHR implementations: in addition to meaningful use, we need to define meaningful training. Health Management Technology, 31(11), 22-23. McGonigle, D. & Mastrain, K. (2009). Nursing informatics and the foundation of knowledge. (pp. 185-191 ,219-237).Jones and Bartlett: Sudbury, MA. 32 Created by: All members

57. References McKesson Provider Technologies. (2010) A Guide to Successfully Implementing Electronic Health Records. Retrieved from: http://www.practicereadyehr.com/pdf/EHR101.pdf New Creation Information Technologies Advancing Healthcare IT. (2007). EMR Software Pricing. http://newcreationit.com/electronic-medical-records/custom-emr-software-pricing The Canadian Medical Protective Association (CMPA). (2008, August). Electronic health records: A medical liability perspective. Retrieved April 5, 2011, from http://www.cmpa-cpm.ca/cmpapd04/docs/submissions_papers/com_electronic_health_records-e.cfm 33 Created by: All members