EHR

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An Electronic Health Record (commonly abbreviated as EHR; also referred to erroneously as or confused with Electronic Medical Record - EMR or Computerized Patient Record - CPR) is a term used to describe a medical or health provider IT system designed to implement some or all of the "Meaningful Use" guidelines.



Specifications


Terms

For a summary of see:

EHR

Electronic Health Record (EHR) systems are any infrastructure used to collect, store, retrieve, exchange, analyze and otherwise re-purpose for uses other than the basic archival purposes for which it may have been recorded (such as performing preventative medicine or monitoring functions) information about a patient, group of patients or specific organization's employees covered under a health provider insurance agreement (i.e. potential patients).

DATA: Inter-office 

(The data is designed to be exchanged and reused amongst multiple clinics or hospitals and their subsequent departments, partners and providers).

EMR

Electronic Medical Record (EMR) systems are any software used to collect, store and retrieve information about a patient digitally at a specific healthcare provider facility.

DATA: Intra-office

(The data never leaves a single clinic or hospital; although it may travel to different departments in the same clinic or hospital).


PHR

Personal Health Record (PHR) systems are any consumer software used by an individual to collect, store and retrieve information about their own lifestyle or health status digitally (though in some cases an individual may have devised a manual/analog means of collecting such information such as via pen and paper or some form of hand-written health journal).

DATA: Extra-office

(The data is controlled by the patient/individual; unless they wish to share it in whole or some portion of it, then it will never be seen by any of that patient/individual's healthcare providers).


HIS

Hospital Information System (HIS)[13]

ADT

Admission, Discharge and Transfer (ADT) system.[14]


RIS

Radiology Information System (RIS) is any software, hardware or system used for collecting, storing, sharing and analyzing a Hospital or Clinic's Radiology department data (such as high-resolution images, patient data, histories, etc).[15]


PACS

Picture Archiving and Communication Systems (PACS).

DICOM

Digital Imaging and COommunications in Medicine (DICOM).


LIS

Lab Information System (LIS) or Lab Information Management Solution (LIMS) are common acronyms for describing software, hardware and systems for use in a laboratory setting to support diagnosis, research and testing activities and report findings to the appropriate departments or sources.

ORU

Clinical Observation ResUlt (ORU) message provides structured, patient-oriented clinical data between systems (for example, a Hospital's Cardiology department could send EKG results to a family Physician’s office). ORU messages also can be used for linking orders and results to clinical trials (i.e. new drugs or new devices).[16]

ORM

ORder Message (ORM) is a messaging format for any request for medical materials (e.g., 500 ml of 2.5% saline) or services (e.g., a range of motion study, an EKG, a lipid panel, etc.). Orders are usually for a particular patient, but they can also be for a department (e.g., floor stock) or for a non-patient (e.g., an environment study where no specific patient is involved.)[17]


BIS

Bispectral Index System (BIS) is a monitor for brain activity for use before, during and after Aenesthetic usage. It can detect when a patient is going to wakeup, or sense pain, etc.

DFT

Detailed Financial Transactions (DFT) messages describe a financial transaction transmitted between the DSS/Order Filler and the Charge Processor. The DSS/Order Filler verifies that the procedure has been completed. The Charge Processor receives patient demographics, account information, etc. for ADT/Patient Registration. The Charge Processor also receives the posted charges and serves as a component of the financial system.[18]



Meaningful Use

Meaningful Use describes the fulfilment of specific criteria for effective deployment of EHRs as well as the formal legal requirements and guidelines set out by the United States government in cooperation with for qualifying for government subsidies (before 2017) and avoiding additional taxes, billing fees or reductions in payments (after 2015) in the United States under the Health Information Technology for Economic and Clinical Health (HITECH) portion of the American Recovery and Reinvestment Act (ARRA) of 2009.[19]

In short, Meaninful Use means that:

A certified EHR[20] is deployed in a manner that demonstrates significant improvement in quality of healthcare provided.[21][22][23][24]

Stage 1

For Stage 1 (2011-2018), if you were to build an EHR from scratch, your system must enable its users (i.e. clinic & hospitals) to achieve 15 core objectives and 5/10 menu objectives out of the 25 total Meaningful Use objectives (first 15 core, next 10 menu):

  1. Make use of Computerized Provider Order Entry (CPOE)
    Measure: CPOE is used for at least 80 percent of all orders
  2. Implement drug-drug, drug-allergy, drug-formulary checks
    Measure: The EP has enabled this functionality
  3. Maintain an up-to-date problem list of current and active diagnoses based on ICD-9-CM, ICD-10 or SNOMED CT®
    Measure: At least 80 percent of all unique patients seen by the EP have at least one entry or an indication of none recorded as structured data.
  4. Generate and transmit permissible prescriptions electronically (eRx)
    Measure: At least 75 percent of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology.
  5. Maintain active medication list
    Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient is not currently prescribed any medication) recorded as structured data.
  6. Maintain active medication allergy list
    Measure: At least 80 percent of all unique patients seen by the EP have at least one entry (or an indication of “none” if the patient has no medication allergies) recorded as structured data.
  7. Record demographics
    Measure: At least 80 percent of all unique patients seen by the EP or admitted to the eligible hospital have demographics recorded as structured data
  8. Record and chart changes in vital signs
    Measure: For at least 80 percent of all unique patients age 2 and over seen by the EP, record blood pressure and BMI; additionally, plot growth chart for children age 2 to 20.
  9. Record smoking status for patients 13 years old or older
    Measure: At least 80 percent of all unique patients 13 years old or older seen by the EP “smoking status” recorded
  10. Incorporate clinical lab-test results into EHR as structured data
    Measure: At least 50 percent of all clinical lab tests results ordered by the EP or by an authorized provider of the eligible hospital during the EHR reporting period whose results are in either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data.
  11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, and outreach
    Measure: Generate at least one report listing patients of the EP with a specific condition.
  12. Report ambulatory quality measures to CMS or the States
    Measure: For 2011, an EP would provide the aggregate numerator and denominator through attestation as discussed in section II.A.3 of this proposed rule. For 2012, an EP would electronically submit the measures are discussed in section II.A.3. of this proposed rule.
  13. Send reminders to patients per patient preference for preventive/ follow-up care
    Measure: Reminder sent to at least 50 percent of all unique patients seen by the EP that are 50 and over
  14. Implement five clinical decision support rules relevant to specialty or high clinical priority, including for diagnostic test ordering, along with the ability to track compliance with those rules
    Measure: Implement five clinical decision support rules relevant to the clinical quality metrics the EP is responsible for as described further in section II.A.3.
  15. Check insurance eligibility electronically from public and private payers
    Measure: Insurance eligibility checked electronically for at least 80 percent of all unique patients seen by the EP
  16. Submit claims electronically to public and private payers
    Measure: At least 80 percent of all claims filed electronically by the EP.
  17. Provide patients with an electronic copy of their health information upon request (including diagnostic test results, problem list, medication lists, and allergies)
    Measure: At least 80 percent of all patients who request an electronic copy of their health information are provided it within 48 hours.
  18. Provide patients with timely electronic access to their health information (including lab results, problem list, medication lists, allergies)
    Measure: At least 10 percent of all unique patients seen by the EP are provided timely electronic access to their health information
  19. Provide clinical summaries to patients for each office visit
    Measure: Clinical summaries provided to patients for at least 80 percent of all office visits.
  20. Capability to exchange key clinical information among providers of care and patient authorized entities electronically (i.e. problem list, medication list, allergies, and diagnostic test results)
    Measure: Performed at least one test of certified EHR technology’s capacity to electronically exchange key clinical information.
  21. Perform medication reconciliation at relevant encounters and each transition of care
    Measure: Perform medication reconciliation for at least 80 percent of relevant encounters and transitions of care.
  22. Provide summary care record for each transition of care and referral
    Measure: Provide summary of care record for at least 80 percent of transitions of care and referrals.
  23. Capability to submit electronic data to immunization registries and actual submission where required and accepted
    Measure: Performed at least one test of certified EHR technology’s capacity to submit electronic data to immunization registries.
  24. Capability to provide electronic syndromic surveillance data to public health agencies and actual transmission according to applicable law and practice
    Measure: Performed at least one test of certified EHR technology’s capacity to provide electronic syndromic surveillance data to public health agencies (unless none of the public health agencies to which an EP or eligible hospital submits such information have the capacity to receive the information electronically).
  25. Protect electronic health information maintained using certified EHR technology through the implementation of appropriate technical capabilities
    Measure: Conduct or review a security risk analysis in accordance with the requirements under Section 45 CFR 164.308 (a)(1) and implement security updates as necessary.

[26][27][28][29]


Stage 2

For Stage 2 (2014-2020) guidelines[31] which take the interoperability and electronic reporting requirements up a notch towards true standardization[32], if you were to build an EHR from scratch, your system must meet Stage 1 requirements plus achieve an additional 17 core objectives and 3/5 menu objectives out of the 22 total Meaningful Use objectives (first 17 core, next 5 menu):

  1. Use computerized provider order entry (CPOE) for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines.
  2. Generate and transmit permissible prescriptions electronically (eRx).
  3. Record the following demographics: preferred language, sex, race, ethnicity, date of birth
  4. Record and chart changes in the following vital signs: height/length and weight (no age limit); blood pressure (ages 3 and over); calculate and display body mass index (BMI); and plot and display growth charts for patients 0-20 years, including BMI.
  5. Record smoking status for patients 13 years old or older
  6. Use clinical decision support to improve performance on high-priority health conditions.
  7. Provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the EP.
  8. Provide clinical summaries for patients for each office visit.
  9. Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities.
  10. Incorporate clinical lab-test results into Certified EHR Technology as structured data
  11. Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research, or outreach.
  12. Use clinically relevant information to identify patients who should receive reminders for preventive/follow-up care and send these patients the reminders, per patient preference
  13. Use clinically relevant information from Certified EHR Technology to identify patient-specific education resources and provide those resources to the patient.
  14. The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation
  15. The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide a summary care record for each transition of care or referral
  16. Capability to submit electronic data to immunization registries or immunization information systems except where prohibited, and in accordance with applicable law and practice
  17. Use secure electronic messaging to communicate with patients on relevant health information

[33]

Eligible Professional Menu Objectives

  1. Capability to submit electronic syndromic surveillance data to public health agencies except where prohibited, and in accordance with applicable law and practice.
  2. Record electronic notes in patient records.
  3. Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHRT.
  4. Record patient family health history as structured data.
  5. Capability to identify and report cancer cases to a public health central cancer registry, except where prohibited, and in accordance with applicable law and practice.
  6. Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice.

[34]


Stage 3

Finally, Stage 3 (2016-2021) may actually produce a set of standards that could be utilized or adopted internationally (especially in developing countries without the resources to focus on Haelthcare IT but who must focus Health budget on actual care). Most likely, existing standards such as HL7, LOINC, SNOMED CT, DICOM and their derivatives will continue to be core components. Some areas of possible new standards are around Immunization, Disease Mapping, Drug Interactions, Real-time Monitoring and Scheduling. At this point, in order to gain a competitive advantage, EHR's will probably integrate with the Gene Ontology & Disease Ontology to do cellular-level interventions, diagnosis and preventative medicine.






Tools


Resources


Tutorials


External Links




References

  1. wikipedia: UMLS
  2. wikipedia: ICD-10
  3. wikipedia: ICD-11
  4. wikipedia: HL7
  5. wikipedia: HL7 aECG
  6. aECG Implementation Guide: http://www.amps-llc.com/website/documents/UsefulDocs/aECG_Implementation_Guide.pdf
  7. wikipedia:Dicom#Parts_of_the_DICOM_standard DICOM
  8. Any WADO Web Viewers available?: http://fixunix.com/dicom/49841-any-wado-web-viewers-available.html#vbseo_vhtml_16
  9. Request for Comment - Stage 2 Definition of Meaningful Use of Electronic Health Records (EHRs) [PDF - 126 KB]: http://healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_0_5383_1472_17094_43/http;/wci-pubcontent/publish/onc/public_communities/u_z/wg_month_pages/mu_jan_portlet/files/nr_mu_rfc__v_4__2011_01_05.pdf
  10. ICD-10: https://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10
  11. List and Glossary of Medical terms in English: http://users.ugent.be/~rvdstich/eugloss/EN/lijst.html
  12. Delaware Healthcare Association Glossary of Health Care Termsand Acronyms: http://www.deha.org/Glossary/GlossaryHome.htm
  13. (Not) Just Another Interface: http://www.anticlue.net/archives/000615.htm
  14. What is an HL7 ADT Feed?: http://www.hl7standards.com/blog/2008/07/18/what-is-an-hl7-adt-feed/
  15. Radiology Information System (RIS): http://searchhealthit.techtarget.com/definition/Radiology-Information-System-RIS
  16. What Is an ORU Message?: http://www.hl7standards.com/blog/2006/10/05/what-is-an-oru-message/
  17. What Is an ORM Message?: http://www.hl7standards.com/blog/2006/10/05/what-is-an-orm-message/
  18. What Is a DFT Message?: http://www.hl7standards.com/blog/2006/10/05/what-is-a-dft-message/
  19. Meaningful Use and Beyond (BOOK): http://www.amazon.com/Meaningful-Use-Beyond-Guide-Health/dp/1449305024?tag=bcmo-20
  20. List of "Meaningful Use" Certified EHRs: http://oncchpl.force.com/ehrcert
  21. Meaningful Use FAQs: http://www.nextgen.com/Stimulus/FAQ.aspx?page=MU&RequestId=16e09cb%20CMS%20Educational%20Resources%20for%20EHR%20Incentive%20Programs%20and%20MU
  22. EHR Incentive Program resources: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/EducationalMaterials.html
  23. Meaningful Use for Hospitals: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Eligible_Hospital_Information.html
  24. Meaningful Use guide for Providers (doctors & small clinics): http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf
  25. Meaningful Use - meaningful and useful links: http://www.himss.org/ASP/topics_meaningfuluse.asp
  26. Meaningful Use - Stage 1: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/MU_Stage1_ReqOverview.pdf
  27. Eligible Provider "Meaningful Use" Criteria: http://www.healthcareitnews.com/news/eligible-provider-meaningful-use-criteria
  28. 692 Pages of Government Meaningful Use Regulation: http://www.emrandhipaa.com/emr-and-hipaa/2010/01/03/692-pages-of-government-meaningful-use-regulation/
  29. Official ONC-ATCB Certified EHR List: http://www.emrandehr.com/2010/11/04/official-onc-atcb-certified-ehr-list/
  30. EHR - Meaningful Use criteria: http://www.practicefusion.com/pages/ehr-meaningful-use-criteria.html
  31. Reporting periods, attestation in Stage 2 Meaningful Use: http://ehrintelligence.com/2012/08/27/reporting-periods-attestation-in-stage-2-meaningful-use/
  32. EHR Interoperability Key For Meaningful Use Stage 2: http://www.informationweek.com/healthcare/interoperability/ehr-interoperability-key-for-meaningful/240006244
  33. Meaningful Use - Stage 2: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_MeaningfulUseSpecSheet_TableContents_EPs.pdf
  34. Meaningful Use Stage 2 - spec sheets: https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/Stage2_EP_SpecSheets.zip
  35. HHS announces Stage 2 Meaningful Use final rule: http://ehrintelligence.com/2012/08/23/hhs-announces-stage-2-meaningful-use-final-rule/
  36. Stage 2 Meaningful Use key resources: http://ehrintelligence.com/2012/08/29/stage-2-meaningful-use-key-resources/
  37. Feds issue EMR meaningful use guidelines: http://www.massdevice.com/news/feds-issue-emr-meaningful-use-guidelines
  38. HHS - Electronic Health Records and Meaningful Use - OFFICIAL ANNOUNCEMENT: http://healthit.hhs.gov/portal/server.pt?open=512&objID=2996&mode=2
  39. wikipedia: VistA
  40. New Brunswick launches its first EMR program: http://www.canhealth.com/tfdnews0653.html
  41. Finding meaning in meaningful use: http://www.govhealthit.com/blog/finding-meaning-meaningful-use
  42. EHR Bargains Review - Amazing Charts* (Survival Tips for Small Practices): http://onhealthtech.blogspot.ca/2010/06/ehr-bargains-review-amazing-charts.html

See Also

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