Aga Khan University Hospital

Year 4 Leadership Management students

Electronic Health
Record & Hopsital
Information
Management System

Ms. Salimah Shamim Taufiq Kirmani

BScN, MSc Health Informatics
Senior Manager EHR Training

April 22, 2024

Objectives
01 02 03
Define Nursing
Definition & History Significance &
Informatics &
of Electronic Health Benefits of EHR
Role of Nurse
Record (EHR)
Informatics

04 05 06
AKUH EHR
AKU EHR Introduction of
implementation
Project Goal Meditech Expanse
Scope, plans &
EHR
Timeline

07 08 09
Challenges and Standard
Data Security Content in EHR
Limitation
 Electronic Health
Records - Defined
EHRs are digital versions of patients' paper
charts.
They contain comprehensive patient
information, including medical history,
diagnoses, medications, treatment plans,
immunization dates, allergies, radiology images,
and laboratory test results.

Unlike traditional paper records, electronic record

accessible in real-time, facilitating seamless
communication among healthcare providers
involved in a patient's care.
(National Coordinator for Health Information
Technology, May 2019)
 History of EHR
1960s 1970s 1980s
Development of the
first EHR US Federal Institute of Medicine
(known as Clinical Government began (IOM) was the first
Information using an EHR; to argue the need of
Systems); It was primarily for using EHRs to
Initially Academic data access and improve patient
Medical Centers storage and NOT records
developed their own designed for end-
systems users

1990s 2000 - now

Computers became
more powerful and More than 80% of
commercial US and Canadian
vendors began hospitals adopted
replacing EHRs EHR
 EHR is a Tool
Define our goals and use EHR
Tool to achieve them.

Simply using the System

(Meditech, Epic, Cerner)
is not our goal.

Achieve better patient care;

anything less is not acceptable.

IT staff are the builders.

Clinical staff are the architects.

 ❖ Enhanced Access to Patient Information.
❖ Improved Care Coordination via Integration among
various application and system.
Enhanced Efficiency (reduce waiting time and
Significance of ❖
redundancy).
EHR ❖ Patient Engagement and Empowerment.
❖ Interoperability and Continuity of Care.
❖ Regulatory Compliance and Patient Privacy (role
base access).
❖ Future Readiness, Innovation & Workflow
Optimization (pharmacy drug delivery process).
 Benefits of EHR
Improved Reduced medical Accurate and Streamlined Easy system
standard of care errors and coordinated communication transition through
and patient enhanced care treatment among healthcare update or
experience delivery providers integration

Reduced Increased Improved patient Evidence-based Patient

operational cost accuracy and information access practice engagement and
with enhanced payment facilitation empowerment
productivity timeliness
EHR: Clinical Informatics Professionals

Clinical
Informatics

Health Telehealth or
Bio Informatics
Informatics Telemedicinal

Medical informatics
Teleconsultation
Pathological Nursing informatics
Mobile Health
Molecular Pharmacy informatics
Remote Pt Monitoring
Cellular Dental Informatics
Health Monitoring
Genetics Imaging/Radiology
Wearable
Informatics
 Defination

Nursing Informatics is a science which Integrates

Nursing Practice, its information and knowledge and
their management with Information and
Communication Technologies to promote the health of
people, families and communities worldwide.

(International Medical Informatics Association 2019)

 Why Nurse Informatic is Important?

• To participate in building of technical solution that nurses can rely to provide

optimum patient care (eMAR).

• To analyze & supervising the data to improve patient outcomes (Administration

record).
• Quality nursing practice by transformation of data into useful information (HAPU).

• Enhance nurses’ decision-making regarding the delivery of care (EWS).

• Improve clinical practices by accurate & timely recording of various assessment

and care provided by nurses (Devise Integration and Automated Alerts).

• Many Hospitals in Pakistan having complete electronic documentation.

• To bridge the gap between health delivery and powerful technology systems.
 • Develop a standardized software configuration
deployable across all regions where AKUH
operates.

• Establish a single longitudinal record for each

patient within one system in each region.
AKU EHR Project
Goal • Meet JCI Quality Measures.

• Enable reporting and data mining capabilities

across the entire region.

• Implement standardized processes.

• Ensure consistent usage of nomenclature.

 Meditech Overview:
• Meditech is one of the leading company
specializing in EHR software development.
• It aimed to enhance the quality of clinicians'
interactions with patients.
Introduction of Comprehensive Platform:
Meditech • The platform integrates patient data,
streamlines clinical workflows, and facilitates
Expanse EHR communication among healthcare
professionals.
• Designed to ensure clinical data accessibility
with a single click across the healthcare
network.
• System developed with input from clinicians.

For Clinician by Clinician

 EHR Scope at AKUH, Pakistan

Hyderabad

Karimabad

Kharadar
Main Campus

Garden

Clinical Labs across PK

Medical & Diagnostic

Centers across PK Home Health Care
EHR Implementation Plan for Karachi
Go–Live
Content Review, Design & Build
Dec 24 – Jan 26 Sep 26

Stakeholder buying/ Integration End-users

Engagement Iteration 1 Training
Testing
Aug 23 – Dec 24 Mar 25 May – Aug 26
Feb 26
Identify SMEs & Dictionary Trainers/SU
Super Users Mock Testing
Training Application Training Training
Aug 23 - May 24 Live
Oct 24 to Jan 25 May 25 – Aug 25 Mar – Apr 26 Aug 26

Training Material & Video Mock Testing Iteration 2 Readiness Asst

October 23 to Nov 25 Mar 26 June 26 July 26
18 Months 18 Months 18 Months 18 Months

Process Review and Mapping

Dec 24 – Jan 26

Customized Report Build

Dec 24 - Jan 26
DEPENDENCIES:
MEDITECH EXPANSE 2.2 Version, Test instance, Completion of build process, Availability of SMEs / Champions / SUs
Challenges with EHR Integration
Interfacing Health Data Health Data
Issues Exchange Security

Training Workflow
Related Issues Disruptions
Strategies to Overcome these Challenges
Application
Program Interfaces
AKUH, Nairobi robust interface
engines “Mirth” with standard
HL7 language utilize for
Interfacing, to facilitate seamless
data exchange between
different software applications
with meditech such SIS, Agfa,
VRS, Elsevier etc.
Also ensure seamless
integration with various devices
such as ICU monitors.
Health Data
Exchange
At AKUH Nairobi,
Establishing robust interfaces with
various applications, such as Laboratory
(Lab), Radiology (Rad), Pharmacy
(PHA), and so on to ensure timely
access to critical information for
diagnosis and treatment.
This helps to prioritize & streamlined
data exchange to enhance patient care
outcomes by reducing diagnostic delays
and improving treatment decision-
making.
 Strategies to Overcome these Challenges

Health Data Workflow Education &

Security Disruptions Training
Implement a Role-Based Role-based training approach,
Conduct workflow analysis
Access Control (RBAC) tailored to specific user roles
and optimization.
model to ensure data and workflows.
security and regulatory Identify and address
compliance. Blended learning approach i.e.
potential challenges early in
Web-Based Training (WBT)
the implementation process
Implemented robust and Instructor-Led Training
to minimize disruptions to
monitoring and auditing (ILT).
patient care e.g., Pharmacy
mechanisms via audit logs drug delivery.
to detect and investigate Continual support mechanism
any unauthorized access or for fostering ongoing learning
suspicious activity. and adaptation.
 Data security in EHR
Security issues in EHRs can compromise patient data confidentiality and privacy.
Implementing Essential Security Measures, to safeguard patient data and prevent
unauthorized access is vital in EHR.
Five Key Steps for Data Security in EHR include:
1. Strong Access Controls and User Authentication: by ensuring Role-Based Access &
multi-factor authentication, like passwords and access PIN control
2. Data Encryption: by converting data into an unreadable format
3. Regular Risk Assessments and Audits
4. Software Updates and Patching: Stay up to date with security patches from software
vendors to address potential risk and enhancing overall security.
5. Staff Training on Security Protocols: Train employees on data security protocols and
the importance of protecting patient information.
Challenges & Lessons Learned from AKUH, Nairobi Implmentation

Incentives for
Lack of Role-based Go-Live data resources Adequate SUs
stakeholder buy-in application should not clash Subject Matter must be identified
& engagement training with JCIA Audits Experts (SME), 8-10 months
Superusers (SU) before Go-Live

Module specific user Need well Resistance

manuals & tip sheets In-house WBT trained & Leadership
should be compiled instead of Med dedicated team Resource support
and provided to Power to support at Constraints
users before training implementation
 Components of an EHR System
Clinical
Summary Lists Dictations/ Physician Order Drug Interaction
documentations
(Meds, Allergies, Transcription Entry Check; Formulary
(Direct entry,
Problems/ (Voice- (Prescriptions) Management
structured notes,
Diagnosis) Recognized) (Refill)
formatted data)

Results Clinical Document

Clinical workflow Management Charge Management
testing (Abnormal Results Capture/Billing (Document Decision Support
Warning, Trending, Scanning,
Graphing) Import/Export)

Disease Communication /
Clinical Practice Management & Messaging Accessibility and
Guidelines Registry (Provider, Patient, Device Integration Security
Third Parties)
Standard content Inventory (Partial)
Inpatient Outpatient

❖ 77 Inpatient Physician Documentation Templates ❖ 270 Ambulatory Order Sets

❖ 51 ED Documentation Templates ❖ 500 Ambulatory Documentation
❖ 40+ Acute Flowsheets/Clinical Panels Templates
❖ 1 ED Clinical Panel ❖ 95 Ambulatory Widgets
❖ 18 Inpatient Patient Lists ❖ 89 Ambulatory Flowsheets
❖ 4 ED Patient Lists ❖ Protocols
❖ 156 Care Plans ❖ Patient Questionnaires
❖ 773 Assessments ❖ Registries
❖ 30 Nursing Status Boards ❖ Home Care Content Library
❖ Surveillance Profiles ❖ Oncology Library (NCCN)
❖ Clinical Decision Support Interventions
❖ Business and Clinical Analytics Dashboards- as
contracted
 Why Standard Content?
01 02 03 04
Save the time Supports future
Reduces variation Supports quality
required by the state best
and compliance
organization to practice
reporting
develop workflows

05 06 07
Evidence-based Supports structured
Reduces redundancy
clinical decision
algorithms
Thank you
Do you have any questions?

Ms. Salimah Shamim Taufiq Kirmani

BScN, MSc Health Informatics
EHR Senior Training Manager
References
❖ Gatiti, P., Ndirangu, E. ., Mwangi, J. ., Mwanzu, A., & Ramadhani, T. (2021). Enhancing Healthcare Quality in
Hospitals through Electronic Health Records: A Systematic Review. Journal of Health Informatics in Developing
Countries, 15(2). https://www.jhidc.org/index.php/jhidc/article/view/330
❖ Tracie Risling (2017) “Educating the nurses of 2025: Technology trends of the next decade” Nurse Education in
Practice: Vol.22, 89-92
❖ Lynn M. NAGLE, Walter SERMEUS, and Alain JUNGER (2017) “Evolving Role of the Nursing Informatics Specialistt”
Forecasting Informatics Competencies for Nurses in the Future of Connected Health.
❖ Helena Blažun Vošner, PhD, PhD, Heather Carter-Templeton, PhD, RN-BC, Jernej Završnik, PhD, Peter Kokol, PhD
(2020) “Nursing Informatics A Historical Bibliometric Analysis” CIN: Computers, Informatics, Nursing: Vol.38
❖ Patricia F. Brennan (1996) “Nursing Informatics: The Emerging Field” American Medical Informatics Association.
❖ Carol J. BICKFORD (2017) “The Professional Association’s Perspective on Nursing Informatics and Competencies n
the US” Forecasting Informatics Competencies for Nurses in the Future of Connected Health
❖ Charlene Ronquillo, MSN, RN; Leanne M. Currie, PhD, RN; Paddy Rodney, PhD, RN (2016) “The Evolution of Data
Information-Knowledge-Wisdom in Nursing Informatics” Advances in Nursing Science: Vol.39
❖ WILLIAM HERSH, MD (2006) “Who are the Informaticians? What We Know and Should Know” HERSH, Who Are
the Informaticians?
❖ Basil, N. N., Ambe, S., Ekhator, C., & Fonkem, E. (2022). Health Records Database and Inherent Security Concerns: A
Review of the Literature. Cureus, 14(10), e30168. https://doi.org/10.7759/cureus.30168