EHR Functions Task 1 PDF

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Functions in EHR, first, study the chapters in book...

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Talah Kharoufeh Student ID 001489626 C802-Foundations in Healthcare Information Management Task 1 29 December 2020

Acute Care Functions Electronic health record technology has advanced and developed to include an array of functions to improve efficiency and quality of care. The EHR is composed of four main categories of information systems: source systems, supporting infrastructure, core clinical systems, and connectivity systems. In the acute care setting, core clinical systems are fundamental in supporting the clinical information needs of frontline care teams and enabling efficiency of data share at the point of care. The applications under core clinical systems support specific clinical functionality and are the applications that comprise the EHR as well as define whether an organization has a functional EHR. In 2003, the Institute of Medicine (IOM) structured a functional model of an EHR system to help in developing appropriate software. The report was titled “Key Capabilities of an EHR System”. The report outlined eight key core functions that an EHR should be able to execute to improve overall quality of care (Amatayakul, 2017, p.14-17). Since then, key elements have been added, updated, and revised to keep up with the revolution of technology in healthcare. Today’s EHR system uses core clinical system applications such as point-of-care charting systems, medication management systems, clinical decision support systems, and reporting systems, as well as others. Point-of-care charting systems provide the ability for healthcare personnel to document patient findings, assessments, history, progress, and more while with the patient in care. Medication management systems, such as CPOE and EMAR, allow healthcare personnel to track and record from the point of order to medication administration. Clinical decision support (CDS) systems are computerized programs that analyze and integrate data to provide suggestions and prompts to assist providers by using evidence-based guidance. Reporting systems create and

prepare patient reporting like visit summaries and patient follow-up lists, as well as quality reporting to generate new information from existing data.

Use of Acute Care Functions The core clinical functions of the EHR are constructed and designed to provide a mechanism for sharing data collected from various sources in order to continue to improve overall quality of healthcare. Once a strategy to implement the applications to achieve optimization are developed, a migration path can be used to help focus the initiative to achieve the goals of improved health, healthcare, and experience. Point of care documentation allows for clinician use of the EHR to view, document, and chart any findings or actions. In the healthcare setting, the most common type of POC documenting is nursing documentation. Most hospitals incorporate POC initially with nurse assessments and care planning and can further be categorized into separate standard assessments with templates. When individual information is placed into the template, it's given a critical action point. The automation of the alerts provides the nurse with a critical value so that he/she doesn’t have to remember each standard along with its critical value. This allows the nurse more time and focus on the assessment with his/her own clinical knowledge. An example of this is a nurse taking an assessment for a patient that has a family history of congestive heart failure. The assessment is done by the nurse asking the patient specific questions, and when the input data shows the patient does have a history of CHF, the critical action is to educate the patient on potential risks and prevention. The automation also supports nurse staffing by patient acuity by alerting

clinical reference to how many nurses are needed at a time, given the nature of the patients. Another feature being investigated with nurse documentation is the ability to undergo a patient safety program through an automated alert system that responds to abnormal vital signs that would indicate an oncoming emergency and potentially improve overall safety. Although nurse documentation has varying opinions across the healthcare world, the integration of an automated alert system in response to point of care action can prove to be a tool in improving overall safety and potentially save lives (Beattie, 2019). The emphasis of the development and implementation of medication management is significant because of the overwhelming number of errors in terms of medication reconciliation. Medication reconciliation is the process of verifying medications at each point of patient transfer. Attention is being placed on an automated closed-loop medication management that integrates all components of medication ordering, verifying, dispensing, and administering in order to avoid human error and provide safe and effective patient care (Amatayakul, 2017, p. 452). To ensure appropriate medication administration and to improve patient safety, EHR components of CPOE and EMAR are required for earning incentives under the Meaningful Use (MU) program. Electronic medication administration record (EMAR) refers to technology that automatically documents the administration of medication using electronic tracking sensors so that the prescription is always legible and there is no room for reading errors. The information of the drug is then available for clinicians to follow prescription data like dosage, refills, type, classification, patient refill history, etc. The physician is able to order, refill, and add to the EMAR to ensure accurate prescribing without the risk of illegible writing (MEDe-care, 2013). Computerized physician order entry (CPOE) is the process where providers

can directly enter orders so that they’re legible and accurate and receive alerts or reminders that could be acted upon immediately in order to reduce errors (Shah et al., 2016). For example, a patient visits the doctor with an infected eye stye. The doctor follows basic treatment and prescribes the patient a broad-spectrum antibiotic. Whilst inputting the requested prescription, the CPOE system sends back an alert stating that this patient is allergic to penicillin. The doctor can now be more specific as to which antibiotic is most appropriate. The human error was caught and a potential danger of an adverse drug event to a patient was avoided. Clinical decision support (CDS) systems aid healthcare by enabling the analysis of patient data and using that data to help formulate decision-making accuracy. Some of the tools the CDS encompasses include computerized alerts and reminders, clinical guidelines, condition-specific orders, patient data reports and summaries, document templates, and relevant reference information among others. The interactive incorporation of these tools provides healthcare personnel with knowledge and patient-specific information to enhance health and the healthcare experience. It works by initiating a trigger, the event that causes a decision support rule, like ordering a new laboratory test. Input data can be newly input or be already stored information about the patient such as demographics, medical history, and reason of admission. Next, the information system may give back interventions which are possible actions in order to deliver information like logging a new medication prescription. Now are the offered steps, or the next action to be taken by the recipient such as a dangerous drug interaction (USA.GOV, 2018).

EHR reporting can include a number of things. It can be a simple list of patients that may need a follow-up, or it can be analyzing of sophisticated data mining. EHR systems are not very efficient at producing reports because of the complexity of software integration and the limited amount of structured data being collected in hospitals. As a part of the MU program, incentives have been promoted and the interest and demand of reporting functionality has increased (Amatayakul, 2017, p. 469). The requirement includes the electronic generation of clinical quality measures (eCQM). Electronic clinical quality measures are tools that help assess and track the quality of all health care services provided by using data through the EHR. They can be measures of processes, experiences, outcomes of patient care, observations, and treatments that can be in accordance to care coordination, patient safety, use of healthcare resources, and clinical effectiveness. Measuring these factors help to ensure that the quality of care provided is effective, safe, efficient, and patient-centered. CMS uses the reports on these measures to assess the quality of healthcare delivered to Medicaid recipients and Medicare beneficiaries that can aid in improvements in efficiency and healthcare (CMS, 2020).

Introducing New Technology When it comes to organizations keeping up with technology and regulations of an EHR, it’s important to consider various strategies to allow for a smooth integration process. It takes advanced planning and research within the healthcare organization in proper vendor selection. Because EHR components vary and cater to the organization, strategic and tactical planning is crucial in vendor selection because of the dominance of certain vendors and the organization's

hesitance in straying off in the EHR components they ’ve already invested in. Healthcare organizations will always need to consider vendors for new types of health IT that other vendors can’t supply. It may not be ideal to select one vendor due to the ever-changing IT components and new vendors will have to be considered. In order to develop a migration path to achieve the vision of the EHR and health IT, a functional needs assessment can be done. A functional needs assessment draws from data and informational needs and converts them into EHR functions to look for when differentiating among st vendors whose products may or may not be satisfied. One strategy an organization may take when approaching the integration of new technology in vendor selection is the acquisition strategy. Acquisition strategy compares the preferences of having one primary vendor versus a mix of vendors. There are three pathways to take with acquisition strategy. A best-of-breed strategy uses different vendors to supply different components that is in their niche and observes the various systems and the ways in which they share and exchange data. Best-of-fit strategy works the other way and uses a single vendor to supply all necessary functions and components. The difficulty is that best-ofbreed can be costly and best-of-fit can lack in operational strength. Because of that, many organizations are leaning towards a rip and repalce acquisition strategy where all the applications are replaced over a short period of time from a most ideal vendor. But because of the cost, it’s not the model strategy. The last common type of acquisition strategy is called dualcore strategy. It uses two vendors, one vendor in support of administrative applications and another vendor supporting operational and clinical applications. The advantage to this has to do with the retention of the computer software working together but can be a disadvantage because of required interfaces for the dual functionality. Ultimately, the organization must

narrow the field to their specific needs to attain the most efficient process when integrating with older technology (Amatayakul, 2017, p. 207) . Outpatient Applications The functions that an EHR supports between an ambulatory and acute care environment vary because of their differences in workflow and needs. In the acute care setting, mass amounts of information are collected in short periods of time, but the need to access patient data over time is not very relevant. In the outpatient setting, little data is collected at each individual time, but typically build on that information over numerous visits. Considering the nature of the physician visit, the need to access that patient data becomes imperative. For example, a person visits their primary care physician most often, and the ability to access all past information can determine the next treatment or give insight in explaining a diagnosis. An important functionality in ambulatory care is integration of multiple data points in a single view. This influences the type of human-computer interface devices needed in outpatient settings. Typically, this a laptop that clinicians can use mobile from room to room. Another element related in data integration of the outpatient setting is patient identification. It is typically relied upon paper sign-in sheets and verbal validation, but with an EHR, new techniques like photo identification are available. In general, clinical-end users rely on the efficiency of the EHR in outpatient setting function to ensure interoperability within the organization as well as between the ambulatory and hospital settings. A few of these functions include scheduling, patient summary, and e-prescribing. Scheduling, registration/patient check-in, in-basket, and checkout are all related functions, beginning with scheduling and refers to interactions between the patient and the clinic, and the documentation of all activity. Patient clinical

summary is the organization of all patient information and is one of the most vital and desired functions in outpatient EHR. The summary is available for both the provider and the patient and is a requirement of the Meaningful Use (MU) program. E-prescribing and CPOE are specialized functions that allow the ordering of medications, tests, referrals, etc. electronically for ease of use and tracking. Outpatient Application Use Scheduling is inclusive to registration/patient check-in, in-basket, and checkout and vary by the EHR and preferred clinic workflow. The scheduling function is initially used to locate and record the time the patient is to be seen. Some outpatient systems also provide a patient portal that permits the patient to schedule or make any changes to an appointment time. For clinicalend users, some scheduling systems prompt staff to look at the patient’s benefits eligibility and then supply required information about the patient’s insurance logistics such as whether a patient has a deductible or co-insurance amount. After scheduling, a patient self-administered history assessment is encouraged. This can be done either online if a patient portal is available or the patient might be asked to arrive to their appointment early to complete the assessment at a kiosk. The assessment includes medical history, demographics, insurance scanners, cameras, and payment devices, and the patient is able to take their time and answer without pressure for accurate data to enter the EHR and essentially save time on the faculty end to allow more time for patient discussion. The self-administered history assessment is a useful way for collect comprehensive and consistent data so that when the physician is ready to see the patient, all pertinent information is ready. There is also the incorporation of patientprovided documentation in the EHR. This is any prior documents from a patients’ personal

health record (PHR), brought in by the patient, that could serve to be relevant to their current visit. The in-basket function is a schedule and reminder function that responds to faculty by providing workflow information. For example, in a physician office setting, the function alerts medical staff that the patient has arrived, when the patient is in the exam room, and how long the patient has been waiting. It also lists the results to review once the exam is complete such as prescription requests. Lastly, there’s check-out. Check-out functions with an EHR include scheduling the next appointment, paying deductibles, and further patient instruction or education. These materials are patient-specific and are generated by the EHR. The patients appreciate the nature of the education and improves overall quality of care (Amatayakul, 2017, p.490-495). Patient clinical summary is intended to inform the patient about their visit and health. The summary is generated by the EHR at the end of each visit, per individual. For the provider, the summary shows patient demographics, health problems, current medications, a list of recent visits and available test results. The summary can be used to clarify health results, provide education, and reinforce importance of self-care advice. It provides an opportunity for the clinician to verbally review the information with the patient like medication instruction and follow-up care. This can prove to be essential in the patient-physician relationship and overall ensures that patients understand what transpired during their appointment and what to do before their next visit (HEALTH IT, 2018). Computerized provider order entry (CPOE) and e-prescribing are important applications to the clinical-end users of outpatient settings. CPOE allows the ordering of laboratory tests, making referrals, and issuing other nonmedication orders. The ordering in the clinic setting

entails the documentation of all that was ordered for the patient but also a clinical alert to external parties. E-prescribing is a specialized case of CPOE in ambulatory settings. It is the writing of a prescription to be filled by some external pharmacy, instead of directly from the hospital like acute-care facilities. The system is able to produce a legible paper copy as well as an electronic transaction, depending on the preference of the patient. There are a few distinctions when it comes to CPOE in acute-care settings versus e-prescribing in ambulatory settings. E-prescribing is exclusively used to route prescriptions to retail pharmacies that have been written in an office or written on patient discharge from a hospital or emergency room. Physicians are also alerted in terms of what medications are covered by the patient’s insurance and what the cost would be to the patient. In that case, they can compare and contrast in order to find the right-fit drug at a price the patient can afford. The managing of refill requests and renewal of prescriptions is another widely used function with e-prescribing systems. Instead of the patient having to call in when a refill is needed or the pharmacy needing to call the physician, the system can request these transactions (Altexsoft, 2020). Model Comparison Health information exchange (HIE) allows healthcare professionals and patients to appropriately access and securely share a patient’s medical information electronically to improve the speed, quality, safety and cost of patient care. There are primarily two architectures for exchanging health information: the consolidated model and the federated model. The consolidated model, also called the centralized model, connects various payer, provider, and public health data sources through one single data pool. Individual organizations have the ability to tap into the aggregated data repository, which can then respond to queries

from providers. The model is simple and is a good way of collecting data from multiple sources to one warehouse managed by a strong central authority. This model can be effective for community-level data analytics and health management because of the central location of data storage, however there are limitations to this model. The actual exchange of information isn’t always smooth since the model is better at collecting data rather than flowing it back into the provider ecosystem. Providers are more likely to receive back reports from the HIE rather than perform their own analytics. The federated model, on the other hand, deliberately avoids the single data warehouse strategy. Instead, data remains at its source and healthcare providers have control over their own patient information. There are two forms of the federated model architecture: consistent and inconsistent federated form. The consistent federated model is similar to consolidated architecture where the data repository is divided but is managed centrally. Inconsistent federated form in which each participant maintains its own data in its own systems and processes connections individually (Bresnick, 2015). In conclusion, a consolidated m...