THE ELECTRONIC

HEALTH RECORD AND

CLINICAL INFORMATICS
CHAPTER 14
AHIMA - THE AMERICAN
HEALTH INFORMTION
MANAGEMENT ASSOCIATION

01
The ELECTRONIC HEALTH RECORDS COMPETENCY
MODEL has six levels:

1. Personal Effectiveness Competencies

2. Academic Competencies
3. Workplace Competencies
4. Industry-wide Technical Competencies
5. Industry-Sector Technical Competencies
6. Management Competencies

02
“By computerizing health records, we can
avoid dangerous medical mistakes, reduce
costs and improve care.”

-George W. Bush

03
EHR CERTIFICATION
CRITERIA

04
FIVE KEY DOMAINS:

1. Economic Stability
2. Education
3. Health and Health Care
4. Neighborhood and Built Environment
5. Social and Community Context

05
The Eight Components of EHR:

1. Health Information and Data

2. Results Management
3. Order Entry Management
4. Decision Support
5. Electronic Communication and Connectivity
6. Patient Support
7. Administrative Processes
8. Reporting And Population Health Management

0606
 Advantages of Electronic
Health Records
the four most common benefits cited for EHRs were
(1) increased delivery of guidelines-based care,
(2) enhanced capacity to perform surveillance and monitoring for disease
conditions,
(3) reduction in medication errors, and
(4) decreased use of care (Chaudhry et al., 2006; HealthIT.gov, 2012).

07
 Advantages of Electronic
Health Records
EHR advantages include simple benefits, such as no longer having to
interpret poor handwriting and handwritten orders, reduced turnaround time
for laboratory results in an emergency department, and decreased time to
administration of the first dose of antibiotics in an inpatient nursing unit
(HealthIT.gov, 2012; Husk & Waxman, 2004; Smith et al., 2004).

08
A more recent description of the benefits of an EHR by HealthIT.gov (2014) emphasizes
that EHRs hold the promise of transforming healthcare; specifically, EHRs will lead to:

• Better health care by improving all aspects of patient care, including safety,
effectiveness, patient centeredness, communication, education, timeliness, efficiency,
and equity
• Better health by encouraging healthier lifestyles in the entire population, including
increased physical activity, better nutrition, avoidance of behavioral risks, and wider
use of preventative care
• Improved efficiencies and lower healthcare costs by promoting preventative medicine
and improved coordination of healthcare services, as well as by reducing waste and
redundant tests
• Better clinical decision making by integrating patient information from multiple
sources (para. 4)

09
 Standardized Terminology
and the EHR
The need for standardizing terminologies is becoming increasingly
important due to the trend toward value-based care reimbursements and the
need for interoperable EHRs. An important distinction needs to be made
between interface terminologies (NANDA, NIC, or NOC) and reference
terminologies (SMOMED-CT, LOINC).

10
 Ownership of Electronic
Health Records
The process of becoming a
successful owner of an EHR has
multiple steps and requires
integrating the EHR into the
organization's operations and
longterm vision, as well as into the
clinician's day-to-day practice.
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 Ownership of Electronic
Health Records
Successful ownership of an EHR may be defined
in part by the level of clinician adoption of the
tool, and this section reviews key steps and
strategies for the selection, implementation and
evaluation, and optimization of an EHR in pursuit
of that goal.

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 Flexibility and Expandability
Health care is as unique as the patients themselves. It
is delivered in a variety of settings, for a variety of
reasons, over the course of12a patient’s lifetime. In
addition, patients rarely receive all their care from one
healthcare organization; indeed, choice is a cornerstone of the American
healthcare system.

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 Why does EHR need to be flexible
and expandable???

LEHR must be flexible and expandable to meet the

needs of patients and caregivers in all these settings,
despite the challenges.

14
 At a very basic level, there is as yet no EHR system
available that can provide all functions for all
specialties to such a degree that all clinicians would
successfully adopt it. Consider oncology as an
example. Most systems do not yet provide the
advanced ordering features required for the complex
treatment planning undertaken in this field.

These systems will continue to evolve and support interprofessional

collaboration as more healthcare professionals are exposed to the
power of these systems to support their work and become better able
to articulate their specific better

15
 “Implementing an
EMR is a complex and difficult multidisciplinary effort
that will stretch an organization’s skills and capacity for
change” (Chin, 2004, p. 47)

16
 ARRA has also set the expectation that despite the
large number of settings in which a patient may receive
care, a minimum set of data from those records must
flow or “interoperate” among each setting and the
unique EHR systems used in those settings.

Continuity of Care Document (CCD) - This dataset

includes patient demographics, medication, allergy,
and problem lists, among other things, and the
formatting and exchange of the CCD is required to be
supported by EHR vendors and healthcare
organizations seeking ARRA meaningful use
incentives. The document formatted according to HL7
standards is both machine readable and human
readable

17
 patient privacy is a pivotal issue in determining
how far and how easy it will be to share data across
healthcare organizations. In addition to the Health
Insurance Portability and Accountability Act privacy
rules, many states have regulations in place related to
patient confidentiality..
In 2007, Governor Tim Pawlenty announced the
creation of the Minnesota Health Information Exchange
(State of Minnesota, Office of the Governor, 2007).
Although the intentions of the exchange were to
promote patient safety and increase healthcare
efficiency across the state, it raised significant
concerns about security and privacy.
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Accountable Care Organizations
and the EHR
EHRs with data-sharing capabilities are central to the
support of Accountable Care Organizations (ACOs), a
payment incentive program established by the CMS
(2015). As discussed elsewhere, this program of
shared medical and financial responsibility is designed
to provide quality, coordinated care while limiting.

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20
The Future
Despite the challenges, the future of EHRs is an
exciting one for patients and clinicians alike. Benefits may be
realized by implementing stand-alone EHRs as described
here, but the most significant transformation will come as
interoperability is realized between system.

The future also holds tremendous potential for HER features

and functions that will include not only more sophisticated
decision support and clinical reporting
capacity, but also improved support for all healthcare
professionals, improved biomedical device integration,
ease of use and intuitiveness, and access through
more hardware platforms.
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 SUMMARY
It is an important time for health care and technology.
EHRs have come to the forefront and will remain
central to shaping the future of health care. In an ideal
world, all nurses, from entry-level personnel to
executives, will have a basic competency in nursing
informatics that will enable them to participate fully in
shaping the future use of technology in the practice at
a national level and wherever care is delivered. Such
initiatives as Technology Informatics Guiding Education
Reform (TIGER) and the important nursing terminology
work are imperative for better integration and,
ultimately, more visibility of nursing contributions to
health care
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