Lecture #8 INSTRUCTOR

CHAPTER 14
The Electronic
Health Record and
Clinical Informatics
Copyright © 2022 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com.
Objectives
 Describe the common components of an electronic health record (EHR).
Copyright © 2022 by Jones & Bartlett Learning, LLC an Ascend Learning Company. www.jblearning.com
 Assess the benefits of implementing an EHR.
 Explore the ownership of an EHR.
 Evaluate the flexibility of the EHR in meeting the needs of clinicians and
patients.
 Examine the impact on patient outcomes when social determinants of health
are included in the EHR.
 Significance of EHRs to nursing cannot be underestimated.
Introduction (1 of 2)
Introduction (2 of 2)
 Electronic Health Records Competency Model is divided into six levels:
 **Why so important to be competent?
 Personal Effectiveness Competencies
 Academic Competencies
 Workplace Competencies
 Industry-Wide Technical Competencies
 Industry-Sector Technical Competencies
 Management Competencies level shared with Occupation Specific Requirements
Setting the Stage (1 of 3)
 US healthcare system faces the enormous challenge of improving the quality of

care while simultaneously controlling costs.
 EHRs were proposed as one solution to achieve this goal (Institute of Medicine,
2001).
 In January 2004, President Bush raised the profile of EHR in his State of the
Union address by outlining a plan to ensure that most Americans would have an
EHR by 2014.
 President Obama continued the effort with the American Recovery and
Reinvestment Act of 2009 (ARRA).
 Included the HITECH Act to specifically incentivize health organizations and
providers to become “meaningful users” of EHRs
 HIMSS Analytics (2015) reported that 1,313 hospitals in the US have achieved
Stage 6 with full physician documentation, a robust CDSS, and electronic
access to medical images.
 Healthcare IT News (2015) reported that over 200 hospitals have achieved
Stage 7 and are totally paperless, and that more organizations are added every
day.
Components of EHRs: Overview
ARRA Requirements
 Providers and hospitals must use a certified EHR that meets a set of standard
functional definitions to be eligible for the increased reimbursement incentive.
 HHS has granted two organizations the authority to accredit EHRs:
 Drummond Group
 Certification Commission for Healthcare Information Technology
Social Determinants of Health (SDOH)
 **Most Important thing ever**
 The economic and social conditions in relation to their diffusion and distribution
among the population that actually influence individual and group differences
and disparities in health status
 Conditions in the environment people are born, play, grow, learn, live, work, and
age in that impact and affect a wide range of health, functioning, and quality of
life outcomes and risks. They have an effect on our life expectancy, morbidity,
and mortality.
EHR 8 Essential Components
 Health information and data

 Results management
 Order entry management
 Decision support
 Electronic communication and connectivity
 Patient support
 Administrative processes
 Reporting and population health management
Health Information and Data
 The patient data required to make sound clinical decisions, including

demographics, medical and nursing diagnoses, medication lists, allergies, and
test results
 A comprehensive EHR will also contain nursing assessments and problem lists.
Results Management
 Ability to manage results of all types electronically, including:

 Laboratory and radiology procedure reports, both current and historical
Order Entry Management
 Ability for a clinician to enter medication and other care orders directly into a
computer, including:
 Laboratory, microbiology, pathology, radiology, nursing, and supply orders
 Ancillary services
 Consultations
Decision Support
 Computer reminders and alerts used to improve the diagnosis and care of a
patient
Electronic Communication and Connectivity
 The online communication among healthcare team members, their care partners,
and patients, including:
 Email and web messaging
 An integrated health record within and across settings, institutions, and telemedicine
Patient Support
 Patient education and self-monitoring tools, including:
 Interactive computer-based patient education
 Home telemonitoring
 Telehealth systems
Administrative Processes
 The electronic scheduling, billing, and claims management systems, including:

 Electronic scheduling for inpatient and outpatient visits and procedures
 Electronic insurance eligibility validation
 Claim authorization and prior approval
 Identification of possible research study participants
 Drug recall support
Reporting and Population Health Management
 The data collection tools to support public and private reporting requirements,
including:
 Data represented in a standardized terminology and machine-readable format
Definition of EHR
 A data warehouse or repository of information regarding the health status of a
client, replacing the former paper-based medical record
 The systematic documentation of a client’s health status and health care in a
secured digital format
 It can be processed, stored, transmitted, and accessed by authorized
interdisciplinary professionals in supporting health care across the client’s healthcare
continuum.
Advantages of EHRs
 Increased delivery of guidelines-based care
 Enhanced capacity to perform surveillance and monitoring for disease
conditions
 Reduction in medication
 Decreased use of care
 Cost benefit
 Ability to identify patients who qualify for research studies or who qualify for
prescription drug benefits
Davis Award (1 of 2)
 Recognizes successful EHR use
 A recent winner demonstrated:
 A significant avoidance of medication errors because of barcode scanning alerts
 A $3 million decrease in medical records expenses as a result of going paperless
 A 5% reduction of duplicate laboratory orders by using computerized provider order
entry alerting
Davis Award (2 of 2)
 Another winner
 Noted a 13% decrease in adverse drug reactions by using computerized physician
order entry
 Noted reduced MRSA infections from 9.8 per 10,000 discharges to 6.4 per 10,000
discharges in less than a year
Ownership of EHRs
 Adopting EHRs involves multiple steps and requires integrating the EHR into
both the organization’s day-to-day operations and long-term vision, and the
clinician’s day-to-day practice.
 The first step of ownership is typically a vendor selection process.
 EHR certification ensures that a quality product will be selected.
System Selection
 Select a system based on the organization’s current and predicted needs.
 The criteria should include both subjective and objective items that cover topics
such as common clinical workflows, decision support, reporting, usability,
technical build, and maintenance of the system.
Implementation
 Implementation planning occurs in the selection process, during assessment of:
 Scope of the work
 Initial sequencing of the EHR components
 Resources required
 The implementation plan should also account for the long-term optimization of
the EHR.
Flexibility and Expandability (1 of 2)
 Financial and patient privacy hurdles must be overcome to achieve an expansive
EHR.
 Physicians may now receive healthcare IT software, hardware, and
implementation services from hospitals in an effort to alleviate the cost burden on
individual providers and foster adoption of the EHR.
Flexibility and Expandability (2 of 2)
 Patient privacy determines how extensively and easily data can be shared
across healthcare organizations.
 For health information exchanges (HIEs) to reach their full potential, the public
must be able to trust that their privacy will be protected.
 Or else risk that patients may not share a full medical history or not seek care
The Future (1 of 4)
 Despite the challenges, the future of EHRs is an exciting one for patient and
clinician alike.
 Benefits may be realized by stand-alone EHRs as described here, but the most
significant transformation will come as interoperability is realized between
systems.
The Future (2 of 4)
 A wealth of descriptive data points to the benefits of an EHR.
 Nursing must stay engaged in this evolution and help shape its direction, as it
has already proven to have a significant impact on our practice and our patients.
 Implementation of robust and interoperable EHRs is becoming more
commonplace.
The Future (3 of 4)
 Expect to see:
 More EHRs housed in the cloud
 Usable patient portals
 Better mobile applications for the HER
 Expansion of telemedicine applications for rural patients and those with chronic
illnesses
 Precision medicine advances supported by data analytics
The Future (4 of 4)
 EHRs have come to the forefront and will remain central to shaping the future of
health care.
 All nurses should have a basic competency in nursing informatics to participate
fully in shaping the future use of technology in the practice.
Summary
 It is an important time for health care and technology. EHRs are evolving to
include SDOH, AI, blockchain **what is blockchain?** and patient engagement
strategies.
 EHRs 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.

Lecture #8 INSTRUCTOR

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CHAPTER 14

 Describe the common components of an electronic health record (EHR).

 Electronic Health Records Competency Model is divided into six levels:

 US healthcare system faces the enormous challenge of improving the quality of

 Most Important thing ever

 Health information and data

 The patient data required to make sound clinical decisions, including

 Ability to manage results of all types electronically, including:

 The electronic scheduling, billing, and claims management systems, including:

 Increased delivery of guidelines-based care

 Recognizes successful EHR use

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