Chapter 18
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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.
http://www.rand.org/topics/electronic-medical-records.html

The former government Website HealthIT.hhs.gov has been reorganized and moved to Health IT.gov. 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

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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.
http://en.wikipedia.org/wiki/Continuity_of_Care_Document

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.
http://www.corepointhealth.com/resource-center/hl7-resources/ccd

What Is the HL7 Continuity of Care Document? Brief history and links to more information.
http://www.hl7standards.com/blog/2007/02/15/what-is-hl7-continuity-of-care-document/

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.
http://www.healthit.gov/

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.
http://www.billianshealthdata.com/Knowledge/Blog/2010/2010/April/EMRx_A_
Nursing_Perspective.html

Five Rights of Data Administration. Modeled after our rights in drug administration, there is a lot of truth in this one page piece,
www.medhealthworld.com/wp-content/uploads/2011/09/SymantecInfograph-5Rights-Final.pdf

A tongue in cheek ballad about going live. fun!
http://www.youtube.com/watch?v=lXWOTk79Zr4&feature=share

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.
http://www.healthit.gov/providers-professionals/learn-basics-ehrs

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.
http://links.govdelivery.com/track?type=click&enid=ZWFzPTEmbWFpbGluZ2lkPTIwM
TIwODIzLjk5OTE3OTEmbWVzc2FnZWlkPU1EQi1QUkQtQlVMLTIwMTIwODIzLjk5OTE3OT
EmZGF0YWJhc2VpZD0xMDAxJnNlcmlhbD0xNzEzMDMzNiZlbWFpbGlkPW1lcnlsQGFta
WEub3JnJnVzZXJpZD1tZXJ5bEBhbWlhLm9yZyZmbD0mZXh0cmE9TXVsdGl2YXJp
YXRlSWQ9JiYm&&&102&&&http://www.ofr.gov/OFRUpload/OFRData/2012-20982_PI.pdf

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.
http://www.advisory.com/Research/IT-Strategy-Council/Resources/2012/Read-ONC-proposed-rule-for-the-EHR-technology-certification-criteria

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.
http://www.advisory.com/Research/IT-Strategy-Council/Resources/Posters/2012/Meaningful-use-the-whiteboard-story

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)

http://www.worh.org/hit/2012/02/proposed-stage-1-revision-and-stage-2-objective-and-cqm-tables/

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.
http://www.cms.gov/EHRIncentivePrograms/Downloads/EHRIncentProgtimeline508V1.pdf

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.
www.cdc.gov/nchs/data/databriefs/db79.pdf

EHR Incentives & Certification. Brief overview of the program from those who brought you meaningful use,.
http://www.healthit.gov/providers-professionals/ehr-incentives-certification

The Meaningful Use Attestation Calculator: Meeting the Requirements for Meaningful Use from CMS.
http://www.cms.gov/apps/ehr/

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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.
http://jeny.ipro.org/attachment.php?attachmentid=1411&d=1146681801

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.
http://www.medpagetoday.com/Columns/9965

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."
http://www.nap.edu/catalog.php?record_id=13281

Project Planning

Project Management Tools. A free online course in project management. It is broken into small manageable parts with lots of cross linking.
http://www.mindtools.com/pages/main/newMN_PPM.htm

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.
http://en.wikipedia.org/wiki/Project_management

Trelles-Duckett, Alicia. All about Project Management. An excellent source of information with great links.
http://managementhelp.org/projectmanagement/index.htm

Mobile Cart Evaluation

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

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

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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.
www.himss.org/content/files/CostBenefitofEMRs.pdf

Return on Investment. A brief overview with a bibliography of print material other than that above.
http://www.informatics-review.com/wiki/index.php/Return_on_investment

EHR and the Return on Investment. Thorough discussion of the difficulties in measuring ROI with electronic health records.
http://www.himss.org/content/files/EHR-ROI.pdf

Design

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.
http://www.maya.com/the-feed/missing-the-point-in-the-design-of-electronic-medical-records

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.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1480192/

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.
healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_907505_0_0_18/09(10)-0091-2-EF.pdf

Special Needs of Pediatric Clinics. A video that provides detailed information about what these are:
gunston.gmu.edu/healthscience/740/Presentations/InformationNeedsPediatrics.ppt

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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.
http://en.wikipedia.org/wiki/Flowchart

Free flow chart template for Excel
2003 - http://spreadsheets.about.com/od/tipsandfaqs/f/flowchart.htm
2007/10 - http://spreadsheets.about.com/od/excelformatting/qt/090805-excel-flowchart-template.htm

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.
http://www.breezetree.com/articles/what-is-a-flow-chart.htm

Planning

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.
http://www.agilemodeling.com/essays/activeStakeholderParticipation.htm

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.
www.wvsma.com/shared/content_objects/ehr_resources/2004mf_hitorgchange.pdf

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.
http://today.java.net/pub/a/today/2003/12/23/sixSigns.html

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.
http://www.aafp.org/fpm/2007/0200/p33.html

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Selecting a Vendor

How to write an RFP (Request for proposal). Very instructive. Follow up with the second article on what to ask vendors.
http://www.olcsoft.com/select_1200.htm

How to perform Software Vendor Checks. Description of things to do before deciding on a vendor.
http://www.olcsoft.com/select_references.htm

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.
http://histalk2.com/2009/08/12/histalk-interviews-ross-koppel/

Top Hospital Electronic Health Records Vendors Rated by Client Satisfaction, 2011 Black Book Rankings Announce Inpatient EHR Leaders.
http://www.prweb.com/releases/2011/02/prweb5051454.htm

Implementation

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."
http://jamia.bmj.com/content/early/2011/06/09/amiajnl-2011-000165.full

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!
http://www.healthit.gov/providers-professionals/ehr-implementation-steps

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!
http://www.beckershospitalreview.com/healthcare-information-technology/is-your-ehr-implementation-in-trouble-10-things-to-check.html

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.
http://cisevaluation.com/CISIES_Administrations.html

Beaudoin, Jack (2007). NYU completes "big bang" CPOE. Discusses the procedures they had in place for a go-live big band approach.
http://www.healthcareitnews.com/news/nyu-completes-big-bang-cpoe
http://cisevaluation.com/CISIES_Administrations.html

Conn, Joseph (2007). Calgary Health Region brings 'big bang' back. Narrative with many good ideas for preparing for implementation.
http://www.modernhealthcare.com/article/20070801/FREE/70801005

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.
http://www.hrsa.gov/healthit/toolbox/HealthITAdoptiontoolbox/
SystemImplementation/index.html

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Evaluation/Maintenance

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).
http://onlinelibrary.wiley.com/doi/10.1111/j.1945-1474.2010.00128.x/full

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.
healthit.ahrq.gov/portal/server.pt/gateway/PTARGS_0_807442_0_0_18/AHRQ_
Evaluation%20Toolkit.pdf

Clinical Information System Questionnaire (CISQ). This questionnaire evaluates the implementation of a clinical information system. (Added October 30, 2010)
http://cisevaluation.com/CISIES_Administrations.html

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.
http://bmj.bmjjournals.com/cgi/content/full/326/7394/860?maxtoshow=&HITS=
10&hits=10&RESULTFORMAT=1&titleabstract=evaluating%252Bcomputerised%
252Bhealth%252Binformation

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.
http://www2.computer.org/plugins/dl/pdf/proceedings/hicss/1999/0001/04/00014011 .pdf

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Websites from the Text in Chapter 18

“The ‘Meaningful Use’ Regulation for Electronic Health Records” http://www.nejm.org/doi/full/10.1056/NEJMp1006114

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 http://www.nejm.org/doi/abs/10.1056/NEJMp1006114.doi:10.1056/NEJMp1006114(No longer available)

HITECH Act http://healthit.hhs.gov/

CMS incentive programs http://www.cms.gov/ehrincentiveprograms/

Official “do not use” abbreviation list is available online at http://www.jointcommission.org/NR/rdonlyres/2329F8F5-6EC5-4E21-B932-54B2B7D53F00/0/dnu_list.pdf (No longer available). Instead go to www.csuchico.edu/~dmccafferty/JCAHO%20Do%20Not%20Use%20List.doc

Typing Game http://www.freetypinggame.net/

GCFreeLearn http://www.gcflearnfree.org/

HP Learning Center http:// www.hp.com/go/learningcenter (No longer available) Instead go to http://h30440.www3.hp.com/learningcenter/

Nursing-Informatics.com http://www.nursing-informatics.com/

Project Management Institute http://www.pmi.org

Duke University Project Management website http://www.oit.duke.edu/enterprise/project-mgt/

The Department of Health and Human Services http://www.hhs.gov/ocr/privacy/hipaa/ understanding/index.html (No longer available). Instead go to http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html

Business Continuity Planning Workgroup for Healthcare Organizations http://www.bcpwho.org/ (No longer available) Instead go to http://www.himss.org/content/files/Code%20173_BusinessContinuityPlanning_
Health%20Mgmt%20Tech_2008.pdf

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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 http://www.nejm.org/doi/abs/10.1056/NEJMp1006114.doi:10.1056/NEJMp1006114 (No longer available)

Business Continuity Planning Workgroup for Healthcare Organizations. (2010). About business continuity planning workgroup for healthcare organizations. Retrieved September 18, 2010, from http://www.bcpwho.org/ (No longer available) Instead go to http://www.himss.org/content/files/Code%20173_BusinessContinuityPlanning_Health
%20Mgmt%20Tech_2008.pdf

Department of Health and Human Services. (2010). Summary of the HIPAA security rule. Retrieved September 18, 2010, from http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html

Duke Office of Information Technology. (n.d.). Project management. Retrieved September 19, 2010, from http://www.oit.duke.edu/enterprise/project-mgt/

Garets, D., & Davis, M. (2005, October). Electronic patient records: EMRs and EHRs. Retrieved November 7, 2005, 2005, from http://www.healthcare-informatics.com/issues/2005/10_05/garets.htm. (No longer available)

Healthcare IT News Staff. (2007, April 12). Continuity of care standards reach milestone. Healthcare IT News. Retrieved from http://www.healthcareitnews.com/news/continuity-care-standards-reach-milestone

Health Information and Management Systems Society. (2010). Electronic health record (EHR). Retrieved November 9, 2010, from http://www.himss.org/ASP/topics_ehr.asp

Investopedia. (n.d.). Cost–benefit analysis. Retrieved September 19, 2010, from http://www.investopedia.com/terms/c/cost-benefitanalysis.asp

Kibbe, D. C. (2010). Unofficial FAQs about the ASTM CCR standard. Retrieved September 18, 2010, from http://www.centerforhit.org/online/chit/home/project-ctr/astm/unofficialfaq.html

Kohn, L. T., Corrigan, J. M. & Donaldson, M. S. (Eds.). (2000). To err is human: Building a safer health system. Retrieved from http://www.nap.edu/catalog/9728.html#toc

Mayer, H. (2010, August 27). Report: EHR adoption rates low. DotMed News. Retrieved from http://www.dotmed.com/news/story/14044

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

Public Safety Canada. (2009, September 21). A guide to business continuity planning. Retrieved September 18, 2010, from
http://www.publicsafety.gc.ca/prg/em/gds/bcp-eng.aspx

Recovery.gov. (2010). The recovery act. Retrieved September20, 2010, from http://www.recovery.gov/

Rowley, R. (2009, April 30). EHR bloggers: Who “owns” a patient’s medical record? Retrieved November 9, 2010, from
http://www.ehrbloggers.com/2009/04/who-owns-patients-medical-record.html

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 http://www.tigersummit.com/uploads/TIGER_Collaborative_Exec_Summary_040509.pdf

The Joint Commission. (2010, June 17). The official “do not use” list of abbreviations. Retrieved September 18, 2010, from http://www.jointcommission.org/PatientSafety/DoNotUseList/ (No longer available) Instead go to www.csuchico.edu/~dmccafferty/JCAHO%20Do%20Not%20Use%20List.doc

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Created January 25, 2012

© 1999- 2013 Linda Q. Thede & Jeanne P. Sewell

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