ELECTRONIC

HEALTH RECORDS
Presented by Mrs. Senthilnayaki Ramasubbu.RN.RM.MSc(N)
ELECTRONIC HEALTH RECORD (EHR)
• Electronic health record, is the electronic version
of the client data found in the traditional paper
record.
• EHRs are defined as “a longitudinal electronic record
of patient health information generated by one or
more encounters in any care delivery setting.
EHR:
Roles of EHR
• Represents patient’s health history
• Medium of Communication among health care
practitioners
• Legal document for health care
• Source for clinical outcomes and health
services research
• Resource for practitioner education
• Alerts, reminders, quality improvement
Data components documented in
EHR
An electronic health record should contain important data such as;

• Patient profile and demographics

• Medical history
includes information about allergies, illness,
immunization, disorder and diseases.
• Medicine taken and its compatibility with drug
interaction
• Records of appointment
Data components documented in
EHRs:
• admission nursing note,
• daily charting,
• physical assessment,
• present complaints (e.g. symptoms),
• diagnoses, tests, procedures, treatment,
• nursing care plan,
• medication administration, progress notes
• laboratory data, and radiology reports
• referral,
• Discharge history,
• Billing records
Components of EHR
• Clinical decision support system (CDSS),
• Computerized physician order entry
(CPOE) systems, and
• Health information exchange (HIE).
CLINICAL DECISION SUPPORT
SYSTEM (CDSS)
• A CDS system is a software that assists the
provider in making decisions with regard
to patient care.
• CDSS provides physicians and nurses with
real-time diagnostic and treatment
recommendations.
Functions of CDSS
• Managing clinical complexities
• Monitoring medication errors
• Avoiding duplicate and unnecessary tests
• Supporting clinical diagnosis &Treatment plan processes
• Promoting use of best practices & condition specific
guidelines &
• Population based management.
• providing the latest information about a drug,
• cross-referencing a patient allergy to a medication, and
• alerts for drug interactions and other potential patient issues
Patient safety with EHR
Researchers found that computerized
physician reminders increased the use of influenza
and pneumococcal vaccinations from practically 0%
to 35% and 50%, respectively, for hospitalized
patients.
Prevention of complication
with EHR
Willson et al, found a significant association
between computerized reminders and pressure
ulcer prevention in hospitalized patients.
They found a 5% decrease in the
development of pressure ulcers 6 months after the
implementation of computerized reminders that
targeted hospital nurses.
Best uses of practice with EHR
• Rossi and Every, found that computerized
reminders as part of a CDSS have been linked to
an 11.3% increase in appropriate hypertension
treatment in a primary care setting.
Decreased cost of care with
EHR
• Tierney et al found a 14.3% decrease
in the number of diagnostic tests
ordered per visit and a 12.9%
decrease in diagnostic test costs per
visit when using an EHR with CDS and
CPOE components.
Computerized physician order
entry(CPOE)
Computerized physician order
entry(CPOE)
• CPOE is a software that allow physicians to enter
orders directly into the computer rather than
doing so on paper.
Example
• drugs,
• laboratory tests,
• radiology,
• physical therapy
Benefits of CPOE
• Eliminates potentially dangerous
medical errors caused by poor
penmanship of physicians.
• Eliminate errors caused by unclear
telephone orders
• It also makes the ordering process
more efficient because nursing and
pharmacy staffs do not need to seek
clarification or to solicit missing
information from illegible or
incomplete orders.
• Enhances patient safety
Evidence
Studies suggest that serious
medication errors can be reduced by 55%
when a CPOE system is used alone, and by
83% when coupled with a CDS system that
creates alerts based on what the physician
orders.
• Using a CPOE system, especially when it is
linked to a CDS, can result in improved
efficiency and effectiveness of care.
Health information exchange
Health information exchange
HIE is the process of sharing patient’s
electronic health information between different
organizations and can create many efficiencies in
the delivery of health care.
Once health data are available electronically
to providers, EHRs facilitate the sharing of patient
information through HIE.
Health information exchange-
Benefits
• Allows for the secure and potentially real-
time sharing of patient information,
• HIE can reduce costly redundant tests
• HIE facilitates the exchange of this
information via EHRs, which can result in
much more cost-effective and higher-
quality care.
Technologies involved in EHR
• Picture archiving and communications
system
• Bar coding
• Radio frequency identification
• Automated dispensing medicines
• Electronic medication administration
records
PICTURE ARCHIVING AND
COMMUNICATIONS SYSTEM
Picture archiving and
communications system:
This technology captures and
integrates diagnostic and radiological images
from various devices, stores them, and
disseminates them to a medical record, a
clinical data repository, or other points of
care.
e.g., x-ray, MRI, computed tomography scan
Bar coding
An optical scanner is used to
electronically capture information encoded on a
product. Initially, it is used for medication.
BAR CODING
• It consist of bar code
readers , a portable
computers with wireless
connection.
• The nurse can verify
patients as well as drugs.
Radio frequency
identification
Radio frequency identification
This technology tracks
patients throughout the
hospital, and links lab and
medication tracking through a
wireless communications
system.
It is neither mature nor widely
available, but may be an
alternative to bar coding.
ADM:
Automated dispensing medicines are
computerized drug storage devices which
allow medications to be stored and
dispensed near the point of care while
controlling and tracking the drug
distribution.
Benefits
• Reduces pharmacy labor by 90%
• Reduces technician labor by 72%
• Lowers drug inventory by 20%
• Cuts missing medications by 92%
• Lowers expired medication cost by 54%
Electronic medication
administration records
Electronic medication
administration records
• The EMAR alerts the nurse about the next dose
or cautions about the medications
• Nurses take the cart near to the patient, scan the
medication and the patient wrist band
Benefits of EHR
• Improved access to the medical record.
• Decreased time spent in documentation.
• Increased time for client care.
• Improved quality care.
• Facilitation of data collection for research.
• Improved communication and decreased potential
for error.
• Creation of a lifetime clinical record facilitated by
information systems.
The benefits of EHRs
clinical outcomes:
• improved quality,
• reduced medical errors,
organizational outcomes:
- financial and
- operational benefits,
societal outcomes
• improved ability to conduct research,
• improved population health,
• reduced costs
Drawbacks
• Financial issues,
• changes in workflow,
• temporary loss of productivity associated with
EHR adoption,
• privacy and security concerns,
Drawbacks
Financial issues, including
• adoption and implementation costs,
• ongoing maintenance costs, and
• loss of revenue associated with temporary loss
of productivity.
Barriers to adoption of EHR
Mohamed Khalifa, MD, conduced a study on
Barriers to Health Information Systems and Electronic Medical
Records Implementation. A Field Study of Saudi Arabian
Hospitals

Abstract
• Background:
Despite the positive effects of Health Information Systems and
Electronic Medical Records use in medical and healthcare practices,
the adoption rate of such systems is still low and meets resistance
from healthcare professionals. Barriers appear when they approach
systems implementation. We need to understand these factors in
the context of Saudi Arabian hospitals to enhance EMR adoption.
This process should be treated as a change project.
• Objectives:
To identify, categorize, and analyze barriers perceived by different
healthcare professionals to the adoption of EMRs in order to provide
suggestions on beneficial actions and options.

• Methods
The study used a questionnaire to collect data from a random sample of
healthcare professionals of two major Saudi hospitals, one private and
the other is governmental, 158 valid respondents participated in the
survey equally from both hospitals and then the results were analyzed to
describe and evaluate various barriers.
• Results
The study identified six main categories of barriers, which are consistent
with those reported in recent published research. 1) Human Barriers,
related to the beliefs, behaviors and attitudes, 2) Professional Barriers,
related to the nature of healthcare jobs, 3) Technical Barriers, related to
computers and IT, 4) Organizational Barriers, related to the hospital
management, 5) Financial Barriers, related to money and funding and 6)
Legal and Regulatory Barriers, related to laws, regulations and
legislations. The six categories of barriers were validated with the
participants of the pilot sample.

• Conclusions
Human barriers as well as financial barriers are the two major categories
of barriers and challenges in the way of successful implementation of
EMRs.
Conclusion

• EHR adoption must be considered

one of main approaches that diversify
our focus on quality improvement
and cost reduction.
• Over time, providers and researchers
will be eager to quantify the returns
that are expected from these
investments.
Referrences
• IOM. Crossing the quality chasm: a new health system for the 21st
century. Washington, DC: Institute of Medicine; 2001. [PubMed]
• Dexter PR, Perkins S, Overhage JM, et al. A computerized reminder
system to increase the use of preventive care for hospitalized
patients. N Engl J Med. 2001;345(13):965–970. [PubMed]
• Willson D, Ashton C, Wingate N, et al. Computerized support of
pressure ulcer prevention and treatment protocols. Proc Annu Symp
Comput Appl Med Care. 1995:646–650. [PMC free article][PubMed]
• Rossi RA, Every NR. A computerized intervention to decrease the use
of calcium channel blockers in hypertension. J Gen Intern
Med. 1997;12(11):672–678. [PMC free article] [PubMed]
• Tierney WM, Miller ME, McDonald CJ. The effect on test ordering of
informing physicians of the charges for outpatient diagnostic tests. N
Engl J Med. 1990;322(21):1499–1504. [PubMed]
• Bates DW, Leape LL, Cullen DJ, et al. Effect of computerized
physician order entry and a team intervention on prevention of
serious medication errors. JAMA. 1998;280(15):1311–
1316. [PubMed]
• Bates DW, Teich JM, Lee J, et al. The impact of computerized
physician order entry on medication error prevention. J Am Med
Inform Assoc. 1999;6(4):313–321. [PMC free article] [PubMed]
• The National Alliance for Health Information Technology. Report to
the Office of the National Coordinator for Health Information
Technology on Defining Key Health Information Technology
Terms. [Accessed April 18,
2011].http://healthit.hhs.gov/portal/server.pt/community/healthit_
hhs_gov__reports/1239.
• Walker J, Pan E, Johnston D, et al. The value of health care
information exchange and interoperability. Health Aff
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• http://www.patientkeeper.com/blog/2011/11/03/nurses-
benefit-from-cpoe-too/
• http://fgraham1.wordpress.com/2009/01/14/computerized-
physician-order-entry-and-electronic-medication-
administration-record/
• http://www.sciencedirect.com/science/article/pii/S18770509
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