Chapter 18
home glossary index



Basic Electronic Healthcare Information Systems


Author Additions to Chapter 18

Rand Objective Analysis Effective Solutions: Electronic Medical Records. This site contains links to current published articles that look realistically at EMRs. Some articles are freely available and others require a subscrition to the publishing journal. If you have access to online journals through your hospital or educational institution you may have free access from those sources.

The former government Website has been reorganized and moved to Health Unfortunately, some of the items that were formerly available are not longer there. However, this expanded site has well organized information about health IT for professionals, patients, and researchers.

Websites That Expand on Chapter 18's Knowledge

Go to the top of the page

Continuity of care record (document) - CDD

Continuity of Care Document from Wikipedia. This is a very thorough, source about the CDD with links to relative materials.

CCD - Continuity of Care Document. A less technical overview of the CDD. BTW a RIM is a Reference Information Model. Provides information about what is included in a CDD.

What Is the HL7 Continuity of Care Document? Brief history and links to more information.

Electronic Medical/Healthcare Records

Putting the I in Health IT. An overall site with links to many areas. There are areas for providers, patients, and policies. This site is no longer available.

Reichard, L. (2010, April 10). Electronic Medical Records: A Nursing Perspective from the Front Lines. A good description of how a well designed EMR functions along with some suggestions for those contemplating an EMR.

Five Rights of Data Administration. Modeled after our rights in drug administration, there is a lot of truth in this one page piece,

A tongue in cheek ballad about going live. fun!

Learn EHR Basics. Very basic description with links to information about meaningful use, security, and EHR incentives from the folks who brought you all these wonderful things.

EHR Certification

ONC. Health Information Technology: Standards, Implementation Specifications, and
Certification Criteria for Electronic Health Record Technology, 2014 Edition; Revisions to the Permanent Certification Program for Health Information Technology.

From ANIA implementation specifications and certification criteria for electronic health record technology, 2014 edition. If you choose to open the bookmarked version be sure to uncheck McAffee security check unless this is your virus checker or you want to buy it. I have not used this checker and it may (or may not) be safe, but my "red flag" went up - mixing virus checkers is often the road to problems.

Meaningful Use

Meaningful Use: The Whiteboard Story. Chart that contains both stage 1 and stage 2 criteria in a way that they could be printed on a large poster, or translated to an Excel spreadsheet for use in tracking progress. This is in pdf format.

Rural Health IT. What Meaningful Use means to rural. Four Excel spreadsheets as below.

  1. Proposed Changes to Stage 1 grid (excel version)
  2. Proposed Stage 2 Objectives grid (excel version)
  3. Proposed Stage 2 Hospital CQM grid (excel version)
  4. Proposed Stage 2 EP CQM grid (excel version)

Publicly available tools for Meaningful Use Stage 2.

Meaningful Use - the Whiteboard Story

Bookmark version of the ONC proposed rule on Standards and Certification

Bookmark version of the CMS proposed rule on Meaningful Use Stage 2

Milestone Time lines for Meaningful Use from CMS.

Hsiao, C.-J., E. Hing, et al. (2011). Electronic Health Record Systems and Intent to Apply for Meaningful Use Incentives Among Office-based Physician Practices: United States, 2001–2011. NCHS Data Brief: 8. Gives the criteria for first stage meaningful use.

EHR Incentives & Certification. Brief overview of the program from those who brought you meaningful use,.

The Meaningful Use Attestation Calculator: Meeting the Requirements for Meaningful Use from CMS.

Go to the top of the page

Systems Life Cycle

EHR Implementation Road map. A table of format of things for IT to consider in the different phases of the life cycle. A Word document.

Nelson, Rosemarie. (2008, June 30).Implementing an EHR: Do a Time line. Although aimed at provider practices, this paper has many excellent suggestions for any healthcare system. Take a look at the entering data link - there the author discusses scanning versus keying in data.

Planning Systems

Strategies and Priorities for Information Technology at the Centers for Medicare and Medicaid Services. A free downloadable or readable on line book that "reviews CMS plans for its IT capabilities in light of challenges and makes recommendations on how business processes, practices, and information systems can best be developed to meet today's and tomorrow's demands."

Project Planning

Project Management Tools. A free online course in project management. It is broken into small manageable parts with lots of cross linking.

Project Management from Wikipedia. A very informative site that looks at all the phases of project management, has links to Gantt charts and Critical Path Method.

Trelles-Duckett, Alicia. All about Project Management. An excellent source of information with great links.

Mobile Cart Evaluation

Although this is about evaluation, it belongs in the planning stage!

Mobile Cart Evaluation
Cornell University (includes ergonomics)
Pomona Valley Hospital

Go to the top of the page

ROI (Return on Investment)

Wang,Samuel J.; Bardon, Christiana G.; Kittler, Anne F.; Goldszer, Robert C.; Fairchild, David G.; Sussman, Andrew J. (2003). A Cost-Benefit Analysis of Electronic Medical Records in Primary Care. Excerpta Medica Inc.

Return on Investment. A brief overview with a bibliography of print material other than that above.

EHR and the Return on Investment. Thorough discussion of the difficulties in measuring ROI with electronic health records.


Note: There is a lot if cross-over between good design and usability. Be sure to check that section.

Missing the Point in the Design of Electronic Medical Records. An excellent paper providing examples of unintended consequences of poorly designed electronic records. A must read. Good design is part of usability.

Sharda, Pallav; Das, Amar K.& Patel, Vimla. (2003).Specifying Design Criteria for Electronic Medical Record Interface Using Cognitive Framework. American Medical Informatics Association Annual Symposium Proceedings, 594-598.

Electronic Health Record Usability: Interface Design Considerations. Report prepared for the Agency for Healthcare Research and Quality by Dan Armijo Cheryl McDonnell Kristen Werner of the James Bell Associates and The Altarum Institute. An excellent resource.

Special Needs of Pediatric Clinics. A video that provides detailed information about what these are:

Go to the top of the page

Flow charting

A good basic overview of flow charting. Although focusing on computer programming it is not difficult to use for designing one in healthcare. Could be used to trace work flow as well as design an electronic health system.

Free flow chart template for Excel
2003 -
2007/10 -

Nicholas Hebb. What is a Flow Chart? Has some good information and high level examples. When you click on the chart to see it enlarged, click outside the chart to return to the text.


Ambler, S. (2001). Active Stakeholder Participation. An excellent white paper addressing the need for both management and users to be part of this process. Ends with a list of the rights and responsibilities of stakeholders. Very current today.

Høstgaard, Anna Marie, Nøhr, Christian. Dealing with Organizational Change when Implementing EHR Systems. Paper from MEDINFO 2004. Although title implies implementation, looks at things that must be considered before implementation.

Snyder, Carolyn (2003). Six Signs You Should Use Paper Prototyping. An excellent paper explaining not only when to use paper prototyping, but how to use it.

Adler, Kenneth G. (2007). How to Successfully Navigate Your EHR Implementation. Although really aimed at physicians who are implementing systems in their offices, the information is still good. Author misses testing and usability, but what is there is good.

Go to the top of the page

Selecting a Vendor

How to write an RFP (Request for proposal). Very instructive. Follow up with the second article on what to ask vendors.

How to perform Software Vendor Checks. Description of things to do before deciding on a vendor.

An excellent interview with Dr. Ross Kopel about the state of the HIT industry. Should be required reading for anyone working with vendors or contemplating a new HIT system.

Top Hospital Electronic Health Records Vendors Rated by Client Satisfaction, 2011 Black Book Rankings Announce Inpatient EHR Leaders.


Banas, C. A., Erskine, A. R., Sun, S., & Retchin, S. M. (2011). Phased implementation of electronic health records through an office of clinical transformation. [Research Support, N.I.H., Extramural]. Journal of the American Medical Association, 18(5), 721-725. doi: 10.1136/amiajnl-2011-000165. "Herein we outline HIT implementation strategies at an academic health center with an office of clinical transformation."

How to Implement EHRs. A helpful site describing 6 steps from assesing readiness to continued quality improvement with links to a little more information about each step. The FAQs in the links may prove the best source of detail information. Use the links from tabs on the top of the page too!

Herman, Bob (2011, August 17) Is Your EHR Implementation in Trouble? 10 Things to Check. You have to slide down a little on this page to get to this great article. Emphasizes the importance of clinical users!

Gugerty, Brian. He has developed surveys for Pre and Post Implementation that gauge the attitudes of staff. Would be helpful pre to gauge need for change management.

Beaudoin, Jack (2007). NYU completes "big bang" CPOE. Discusses the procedures they had in place for a go-live big band approach.

Conn, Joseph (2007). Calgary Health Region brings 'big bang' back. Narrative with many good ideas for preparing for implementation.

System Implementation. A site that includes information about a broad spectrum of activities from a detailed workflow analysis to the formal go-live of the new system.

Go to the top of the page


Watkins. Katherine; Horvitz-Lennon, Marcela; Caldarone, Leah Barnes; Shugarman, Lisa R.; Smith, Brad; Mannle, Thomas E.;  Kivlahan. Daniel R. & Pincus, Harold Alan. (2010). Developing Medical Record-Based Performance Indicators to Measure the Quality of Mental Healthcare. Journal for Healthcare Quality 33(1).

Cusack CM, Poon EG. Health Information Technology Evaluation Toolkit. Prepared for the AHRQ National Resource Center for Health Information Technology under contract No. 290-04- 0016. AHRQ Publication No. 08-0005-EF. Rockville, MD: Agency for Healthcare Research and Quality. October 2007.

Clinical Information System Questionnaire (CISQ). This questionnaire evaluates the implementation of a clinical information system. (Added October 30, 2010)

Littlejohns, P.; Wyatt, J. C.; Garvican, L. (2003). Evaluating computerised health information systems: Hard lessons still to be learnt. British Medical Journal 326, 860-863. [Electronic Version]. This article reviews a project in South Africa, but is equally applicable anywhere.

Ribière, Vincent; LaSalle, Anita J.; Khorramshahgo, Reza & Gousty, Yvon (1999). Hospital Information Systems Quality: A Customer Satisfaction Assessment Tool. Despite its age, and depth, this article provides a lot of food for thought. Avoids the usual "happiness" surveys which reveal little about problem areas. Before evaluating a systems take a look at this article. .pdf

Go to the top of the page

Websites from the Text in Chapter 18

“The ‘Meaningful Use’ Regulation for Electronic Health Records”

From Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 363(6), 501–504. Retrieved from longer available)


CMS incentive programs

Official “do not use” abbreviation list is available online at (No longer available). Instead go to

Typing Game


HP Learning Center http:// (No longer available) Instead go to

Project Management Institute

Duke University Project Management website

The Department of Health and Human Services understanding/index.html (No longer available). Instead go to

Business Continuity Planning Workgroup for Healthcare Organizations (No longer available) Instead go to

Go to the top of the page


Websites from the Reference List in Chapter 18

Blumenthal, D., & Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 363(6), 501–504. Retrieved from (No longer available)

Business Continuity Planning Workgroup for Healthcare Organizations. (2010). About business continuity planning workgroup for healthcare organizations. Retrieved September 18, 2010, from (No longer available) Instead go to

Department of Health and Human Services. (2010). Summary of the HIPAA security rule. Retrieved September 18, 2010, from

Duke Office of Information Technology. (n.d.). Project management. Retrieved September 19, 2010, from

Garets, D., & Davis, M. (2005, October). Electronic patient records: EMRs and EHRs. Retrieved November 7, 2005, 2005, from (No longer available)

Healthcare IT News Staff. (2007, April 12). Continuity of care standards reach milestone. Healthcare IT News. Retrieved from

Health Information and Management Systems Society. (2010). Electronic health record (EHR). Retrieved November 9, 2010, from

Investopedia. (n.d.). Cost–benefit analysis. Retrieved September 19, 2010, from

Kibbe, D. C. (2010). Unofficial FAQs about the ASTM CCR standard. Retrieved September 18, 2010, from

Kohn, L. T., Corrigan, J. M. & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Retrieved from

Mayer, H. (2010, August 27). Report: EHR adoption rates low. DotMed News. Retrieved from

National Coordinating Council for Medication Error Reporting and Prevention. (2010). National coordinating council for medication error reporting and prevention. Retrieved September 18, 2010, from

Public Safety Canada. (2009, September 21). A guide to business continuity planning. Retrieved September 18, 2010, from (2010). The recovery act. Retrieved September20, 2010, from

Rowley, R. (2009, April 30). EHR bloggers: Who “owns” a patient’s medical record? Retrieved November 9, 2010, from

Technology Informatics Guiding Education Reform. (2009). The TIGER initiative: Collaborating to integrate evidence and informatics into nursing practice and education. An executive summary. Retrieved September 16, 2010, from

The Joint Commission. (2010, June 17). The official “do not use” list of abbreviations. Retrieved September 18, 2010, from (No longer available) Instead go to

Go to the top of the page

Created January 25, 2012

home glossary index Home Glossary Contents of this page