DR.ANJALATCHI MUTHUKUMARAN
M.SC (N)MD(AM)MBA(HA)MA(SOC)PH.D(N)
VICE PRINCIPAL
ERA COLLEGE OF NURSING ,ERA
UNIVERSITY
SARFRAZGANJ , LUCKNOW -226003
Unit-IV
Electronic Health Record (EHR)

Model of EHR/EMR

Syllabus
learning outcomes
 Unit-iv
 Total hours theory : 04 hrs
 Total practical hours : 04 hrs
 To explain the use of electronic health records in
nursing practices
 To describe the latest trends in electronic health
records standards and interoperability

Teaching and learning activities
 Lecture method
 Discussion method
 Practice on simulated EHS system
 Practical session
 Visit to health informatics department of a hospital
to understand the use of EHR in nursing practice

Abbreviation
 EHR-Electronic Health Record
 EMR-Electronic Medical Record
 PHR-patient Health Record
 NHIN-National Health Information Network
 CPR-computer Based Patient Record
 HITECH-Health Information Technology For
Economic and Clinical health Act
 MIPPA-Medicare Improvement for patient and
provider Act

Continued
 HIE-health Information Exchanges
 HIT-Health Information Technology
 PMS-Practice of management System
 PDA-personal Digital Assistant
 ROI-Return Of Investment
 ARRA-American Recovery and Reinvestment Act
 CMS-Centre for Medicare and Medicaid services
 PACS- Picture Archiving and communication System
 HIPPA- Health Insurance Portability and
Accountability Act

Terminology
 EHR: An electronic (digital) collection of medical
information about a person that is stored on a
computer.
 EMR: An Electronic Medical Records (EMR)
Nurse uses modern technology to manage and
organize patient health information.

Terminology
 Health :Health, according to the World Health
Organization, is "a state of complete physical, mental
and social well-being and not merely the absence of
disease and infirmity“
 Records: A record is a permanent written
communication that documents information
relevant to a client's health care
management, e.g. a client chart is a continuing
account of client's health care status and need.
 Electronic :

Terminology
 SOAP- notes should include Subjective,
Objective, Assessment, and Plan
 An electronic health record (EHR) is a digital version
of a patient’s paper chart.
 EHRs are real-time, patient-centered records that
make information available instantly and securely to
authorized users. While an EHR does contain the
medical and treatment histories of patients, an EHR
system is built to go beyond standard clinical data
collected in a provider’s office and can be inclusive of
a broader view of a patient’s care.

Continued
 HIPPA-Health Insurance Portability and
Accountability Act.1996 (Insurance: Medical
insurance) In the U.S., HIPAA is an act that protects
people covered by health insurance and makes rules
about storing personal medical data.

Learning objectives
 To introduce the topic
 To list the abbreviation used in topic
 To describe the terminology used in topic
 To define the EHR and EMR
 To enlist the purpose of EMR/EHR
 To enlist the general purpose ?
 To describe the core function?
 To discuss the components of EHR?
 To discuss the health care standard
 To describe the application of EMR in hospital services
 To explain the data privacy and security

Definition of EMR
What is EMR?
 An electronic medical record (EMR) is a digital version of
the patient-specific medical information that is
traditionally kept in a paper "chart" or medical record
Nursing informatics
 Nursing informatics is “a combination of computer
science, information science, and nursing science
designed to assist in the management and processing of
nursing data, information and knowledge to support the
practice of nursing and the delivery of nursing care.

Meaning of EMR
 Electronic medical health record means health related
information on an individual within one health
organization .
 An EHR system is a computerized, organized collection
of individual patients’ healthcare information in a digital
format
 Functions
 – Store
 – Share
 – Transmit electronic data

History of EMR
 tate of Electronic Health Records (EHRs) in 1992
and their evolution by 2015 and where EHRs are
expected to be in 25 years.
 September 2013
 In September 2013 the Ministry of Health &
Family Welfare (MoH&FW) notified the Electronic
Health Record (EHR) Standards for India.

Concept of EMR/EHR
 EHR programs collect health information for individual
patients in inpatient and outpatient settings
 – Saves in a digital format
 – Collects information that is typical of what you would
see in paper records
 – Interfaces with external healthcare computer programs
 – Transmits labs, orders, prescriptions, and results
electronically
 – Produces comprehensive reports on diagnoses and
diseases for governmental reporting

What are the six main objectives of an EHR
These functions include:
 health information and data.
 result management.
 order management.
 decision support.
 electronic communication and connectivity.
 patient support.
 administrative processes and reporting.
 reporting and population health.

Purpose of EMR
Purpose of EMR Provide the electronic
equivalent of the patient chart
Bring together all of the data about a patient into a
single source
Support patient care and improve its quality
Support and enhance physician decision making
 provide individual health related information in
printed form

GENERAL PURPOSES EMR/EHR
 Nursing’s data needs fall into four domains:
 Nurse need data about client care,
 provider staffing, administration of care and
 the organization, and
 knowledge based research.
The first three are distinct areas, whereas research
interacts with all of the other three.

The four areas and the source for the data are:
 Client: client care/ clinical care and its evaluation,
clinical data, and client outcomes. Source: the client
record.
 Provider: professional data, caregiver outcomes, and
decision maker variables. Source: personnel records,
national data banks, and links to client records.
 Administrative: management and resource oversight,
administrative data, system outcomes, and contextual
variables. Source: executive/ managerial data and fiscal
and regulatory data.
 Research: knowledge base development. Source:
existing and newly gathered data and relational data
bases.

8 Core Functions of EHRs
 Health information and data.
 Results management.
 Order entry and management.
 Clinical decision support.
 Electronic communication and connectivity.
 Patient support.
 Administrative processes.
 Reporting and population health management.

Most important part of EHR
 Billing System
Billing records are an important part of hospital
profitability, productivity, and efficiency. That's why
they're one of the key components of an EHR system
as they can track all the charges that a patient occurs
while undergoing care.

Types of EHR Systems
 Physician-Hosted System. Physician-hosted
systems very basically mean that all data is hosted on
a physician's own servers. ...
 Remotely-Hosted System. Remotely-hosted
systems shift the storage of data from the physician
to a third party. ...
 Remote Systems.

12-Point Medical Record Checklist :
What Is Included in a Medical...
 1.Patient Demographics: Face sheet, Registration form
 2.Financial Information:
 3.Consent and Authorization Forms: ...
 4.Release of information: ...
 5.Treatment History: ...
 6.Progress Notes: ...
 7.Physician's Orders and Prescriptions: ...
 8.Radiology Reports:
 9. Nursing Notes:
 10. Medication List:
 11. HIPAA Notice of Privacy Practices:
 12. Patient Confidentiality:

Examples of electronic health records
 EHRs include information like your age, gender,
ethnicity, health history, medicines, allergies,
immunization status, lab test results, hospital
discharge instructions, and billing information.
 OPD registration
 IPD registration
 Progress notes
 Vital monitoring
 Blood transfusion
 Laboratory test etc

Health care standard EMR

Standardized clinical Health Records

Hospital base medical devices connectivity

EMR application scope

Out patient uses of EMR

Drawing application of EMR

In patient Record of EMR

Patient link base health record

Equipment interface and PACS

Imaging interface

EMR interfaces

Data Privacy Protected Health
Information
Information that relates to patient past, present, or
future, physical or mental health or condition of an
individual
Information regarding payment for the healthcare to
an individual
Information regarding the delivery of health services
Information is or can be reasonably identifiable
Information is transmitted or held in electronic form
or any other form or medium, including paper

Data security use of EMR
Administrative safeguards
Security management process
Assigned security Responsibility
Workforce security
Information access management
Security awareness training
Security incident procedures
Contingency plan
Evaluation
Business associate contracts &
others
Physical Safeguards
Facility access controls
Workstation use
Workstation security
Device and media controls
Technical Safeguards
Access controls
Audit controls
Integrity
Person or entity authentication
Transmission security

Reviewing the outcomes EHR
 One year later, the project has expanded to many
avenues of nursing, including RN orientation, preceptor
classes, and individual unit education.
 Subsequent auditing (3, 6, and 9 months after
education) shows improved documentation in areas with
significant effect on patient care and safety, including
these 3-month results:
 admission medication reconciliation—from 52% to 70%
 isolation indication—39% to 100%
 plan of care appropriate for patient’s chief com- plaint—
83% to 100%

Continued
 plan of care related to patient co-morbidities— 30%
to 87%
 education level—4% to 17%
 safe patient handling—4% to 13%.
 discharge planning—4% to 17%.

Assessment method
 Essay
 Short answer
 Objectives
 Checklist

Question related topic
 Define the EHR?
 Define EMR?
 List out the concept of EHR?
 List out the main Objectives of HER?
 Discuss the Core Function of HER?
 Enlist the type of HER system?
 Describe the components of EHR?
 List out Example of HER?

Fill in the Blanks
 1. HIPP Act started in ----------------------
 2. HER records initiated in -------------------year------
 3. In ------------------ the Ministry of Health & Family
Welfare (MoH&FW) notified the Electronic Health
Record (EHR) Standards for India.

Summary
 Till now we discussed about EMR and its
significance of health care services like , meaning,
aim, purpose, standard, application , challenges of
patient information in computer form, interfaces,
data security etc.

Conclusion
 I hope you all understand about the electronic health
records and importance in health care services. If
you got chance to do application of knowledge and
skill in EHR/EMR of future. Will you all able to
apply this knowledge confidently without any
interruption.

References
1. Affordable Care Act (ACA). 2010. healthcare.gov/glossary/affordable- care-act Agency for
Healthcare Research and Quality (AHRQ). Slide set: National quality strategy overview.
2017. ahrq.gov/workingforquality/nqs/overview.htm
2. American EMRs Association (ANA). Nursing: Scope and standards of practice. Silver
Spring, MD: 2010;
EMRsbooks.org nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principles-of-
nursing-documentation.pdf
3. Beck SL, Weiss ME, Ryan-Wenger N, et al. Measuring nurses’ impact on health care quality:
Progress, challenges, and future directions. Med Care. 2013;51(4 Suppl 2):S15-22.
4. Bowman S. Impact of electronic health record systems on information integrity: Quality and
safety implications. Perspect Health Inf Manag. 2013;10:1c.
5. Conn J. Joint Commission puts focus on EHR, patient safety. Modern Healthcare. July 3,
2013. modernhealthcare.com/article/20130703/blog/307039936
6. Gibbs G. Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further
Education Unit; 1988.
7. Hendrich A, Chow MP, Skierczynski BA, Lu Z. A 36-hospital time and motion study: How do
medical-surgical nurses spend their time? Perm J. 2008;12(3):25-34.
8. Joint Commission, The. Sentinel event alert 54: Safe use of health information technology.
March 31, 2015. jointcommission.org/assets/1/6/SEA_54_HIT_4_26_16.pdf

Thank you

Electronic health records (EHR)
 Learning objectives :
 Illustrate the steps in creating a new patient record
and correcting an existing record using EHR
software.
 Describe some of the capabilities of EHR software
programs.
 Explain how you might alleviate a patient’s security
fears surrounding the use of EHR.

Continued

EHR terminology

Introduction
Electronic health records
 Eliminates duplication forms
Simply review information
 Electronic health records enable a specialist to have a
patient’s information before the patient arrives at the
office.
 No need to fill out the patient’s medical history each
time.
 The specialist only has to review the information with the
patient to verify that everything is correct.

Definition of EHR
 Electronic health record means health related
information on an individual across the more than
one health organization.

Trends in EHR

Purpose of patient record
 Purpose of a Patient (medical) Record “to recall
observations, to inform others, to instruct students,
to gain knowledge, to monitor performance, and to
justify interventions” Reiser, S. (1991).

A Brief History of Electronic Medical
Records
 Paper records becoming inadequate
 Medical errors due to Lost or misfiled records
 Mishandled patient messages
 Inaccurate and illegible documents
 Mislabeled or illegible lab or medication orders

History of the Electronic Health Record
 Purpose:
 – To improve patient medical care by having
information accessible for informed medical decision
making Started:
 – 1960s First Facilities to use EHR Systems:
 – Mayo Clinic in Rochester, Minnesota
 – University Hospital in Burlington, Vermont
 – Latter Day Saints Hospital in Salt Lake City, Utah
History of EHR

Continued
 Improved Functionality:
 – 1960-1980s Enter Independent Medical Offices:
 – 1990s
 – Called practice management systems
 – Designed for fiscal management
 Vendors Proliferate:
 – 2000s
 Governmental Mandates and Funding:
 – Current
 – Causing acceleration of EHRs

Learning Outcome:
 List four medical mistakes that will be greatly decreased through the
use of EHR.
 In the early 1990s, it became apparent that paper medical records
were inadequate.
 The increasing need for coordination of care, rising healthcare costs,
and the alarming increase in medical errors.
Most of these errors can be traced to communication
problems, including:
 Lost or misfiled paper records
 Mishandled or “forgotten” patient messages
 Inaccurate or unreadable information in a paper medical record
 Mislabeled or unreadable laboratory or prescription orders

Reason for Adaptation of EHR
 President George W. Bush signed an executive order in
August of 2006 to promote the overall efficiency and
quality of healthcare in America.
 These goals will help to control the rising cost of
healthcare
 Most Americans will have access to electronic health
records by 2014.
 A decrease in medical errors through record legibility
and uniformity of records
 An increase in information available among patients,
medical providers, and the insurance carriers.
 The electronic record is quickly becoming the physician’s
most important business and legal record.

Government Involvement in EHR system
 1991 – IOM called for eliminating paper records by 2001
 2004 – Bush created the ONC position and empowered
HHS to promote EHRs
 2008 – Obama promised to sponsor adoption of EHRs
through stimulus package
 2008 – Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA)
 2009 – Health Information Technology for Economic
and Clinical Health (HITECH) Act provided $19.2 billion
to accelerate use of EHRs over 5 years (part of ARRA –
American Recovery and Reinvestment Act of 2009)

Continued
 Bonus from CMS
– Participants meeting certain requirements were eligible for
this bonus
 Beacon Community Program
– 17 communities were chosen across the US to receive grants in
exchange for documenting best practices and working to
establish national goals Regional
 Extension Centers
– Provide training and support services to assist primary
healthcare providers in adopting EHRs
– Offer information and guidance to help with EHR
implementation and achieving meaningful use to qualify for
incentive payments
– Give technical assistance as needed HITECH Act

Shared system of EHR

Electronic Records
Electronic medical record (EMR)
Electronic health record (EHR)
 Continuity of care
 Reduction in errors
 Decreased costs
Personal health record (PHR) – an electronic version
of the comprehensive medical history and record of a
patient’s lifelong health, collected and maintained by
the individual patient.

EHR Models
 Web based personal health care model
 Distribution base model
 Facility base model

Type of Records Used EHR/EMR

Type of EHR records
Personal health record (PHR)
Learning Outcome: Differentiate among electronic
medical records, electronic health records, and
personal health records
Electronic medical record (EMR) – an electronic
record of health-related information for an
individual patient that is created, compiled, and
managed by providers and staff members located
within a single healthcare organization.

Continued
Electronic health record (EHR) – If that same
information on an individual patient is created,
managed, and gathered in a manner that conforms
to nationally recognized interoperability standards.
It can be utilized by members of more than one
healthcare organization.
 These EHRs are the federal government’s ultimate
goal. Any provider with an interoperable EHR
system will have access.
 They will facilitate continuity of care, reduce in
medical errors, and decrease healthcare costs

Patient health Record Models

Benefit of Electronic Health Record To Patients

Advantages and disadvantages of EHR

Health care process of EHR
Accessibility
 Paper – chart must be located, pulled, handled, and
refiled
 EHR – multiple providers can access at same time
 Review comparison of workflow in paper vs. EHR in
Data arranging

Advantages and disadvages

Barriers and Benefits of the EHR
Barriers to the EHR
 Lack of standards
 Unknown costs and return on investment
 Difficulties operating EHR systems
 Significant changes in clinical/clerical processes
 Lack of trust and safety

Benefits of the EHR
 Enhanced accessibility to clinical information
 Improved patient safety
 Enhanced quality of patient care
 Greater efficiency and savings

Future of EHR
 EHR is here to stay
 Federal government continues to encourage
development of National Electronic Healthcare
Infrastructure National Health Information Network
(NHIN)
 – part of the federal government’s goal to digitize
patients’ health records and designed on a common
platform for health information exchange (HIE)
 PDAs provide instant access to information at point-
of-care

Advantages and Disadvantages of EHR
 Government mandate steps
 Use all major functions of HER
 Use EHR to send and receive clinical information
 Learning Outcome: Contrast the advantages and
disadvantages of electronic health records.
 The federal government has mandated EHR for eligible
Medicare providers by 2015.
 There are financial incentives for providers who
demonstrate “meaningful use” of EHR for Medicare or
Medicaid patients until 2014.

Continued
Meaningful use includes the following steps:
 Step 1 requires the provider to use all major
functions of a certified EHR program.
 Step 2 includes all of step 1 and adds that EHR must
be used to send and receive clinical information such
as lab orders and reports.

Continued
 clinical decisions support (in development)
 High priority conditions
 Enrolling patients in PHR
 Accessing comprehensive data
 Improving population health
 E prescribing
 Incentives

Advantages of EHR Programs
 Fewer lost medical records
 Eliminated transcription costs
 Increased readability/legibility
 Ease of chart access for multiple users
 Chart availability outside of office hours

Continued
 Increased access to patient education materials
 Decreased duplication of test orders
 More efficient transfer of records
 More efficient billing processes
 Greatly decreased storage needs
 Accessed from other locations
 Physician’s home Satellite offices
 Used in teleconferences

Disadvantages of EHR Programs
 Costly
 Staff training
 Requirement IT staff may be needed
 Possible damage to system and software and or
required upgrades

Working With an Electronic Health
Record
 Basic rules unchanged
 Creating a New Patient Record
 Correcting an EHR
 Be familiar with the hardware and software
 Keep password secure
 Check entries carefully before saving
Learning Outcome: Illustrate the steps in creating a new
patient record and correcting an existing record using
EHR software.
Refer to Points on Practice: Working with Electronic
Health Records

Other Functions of EHR Programs
 Tickler files
 Specialty specificCustomized
 Templates
 Learning Outcome: Describe some of the capabilities of EHR software
programs.
 Tickler Files Files that need periodic attention Alerts staff members about
patients who are due for yearly checkups and patients who require follow-
up care
 Electronically scanned images of patient thumbprints or photos help keep
track of records and assists with patient security by identifying the patient
at the time of each visit.
 Specialty Specific EHR software programs may be customized to suit a
specific specialty and style of a physician’s office.
 Templates or “check offs” enable the physician to add entire sentences or
phrases with the click of a mouse, instead of typing the same information
repetitively.

Security and confidentiality of EHR
 Access code
 Limits access
 Date and time stamp
 Release of information policy
 Backup

Learning Outcome
 Learning Outcome: Explain how you might alleviate a patient’s security
fears surrounding the use of EHR .
 All users have individual access codes and passwords.
 The access code will allow each user to access only the areas of the record
that the user is entitled to, based on job description.
 Access codes insert a date and time stamp within the medical record,
including the user’s initials, so that office administration and the patient
may know who is accessing each medical record.
 A procedure should be in place to document when someone requests
information from the patient file, if the patient has given permission to
release that information, and when it was released.
 Protecting the confidentiality of patient records in computer files is the
greatest concern of electronic health records. Electronic healthcare records
should be kept just as secure as paper healthcare records.
 Careful key entry is essential to maintaining accurate electronic health files.
 Electronic files must be backed up on a regular basis to avoid accidental
data loss.

Other measure for security
 Know the confidentiality and security features
 No negativity
 Pamphlet explaining HER
 Show the patient his/her record
 Explain access to patient

Barriers to Adoption
 Cost of conversion
 Perceived lack of ROI
 Technical and logistic challenges
 Privacy and security concerns

EHR Affect on Patient Care
 Safety
 Reduces the need to repeat tests
 Reduces the number of lost reports
 Supports provider decision making

EHR Affect on Efficiency
 Improves accessibility of patient information
 Better data capture at the point of care
 Integrates data from multiple internal and external
sources
 Facilitates the co-ordination of health care delivery

EHR Affect on Patient Outcomes
 Has the potential to
 Improve the quality of patient care
 Help providers practice better medicine
 Provides seamless exchange of information among
providers Component

Summary
 The electronic medical record is an electronic record
of health-related information for an individual
patient.
 An electronic health record is created, managed, and
gathered in a manner that conforms to nationally
recognized interoperability standards.
 A personal health record is an electronic version of
the comprehensive medical history and record of a
patient’s lifelong health that is collected and
maintained by the individual patient.

Question related to topic
 Define EHR?
 List the Purpose of EHR?
 State the Model?
 Enlist the type of EHR?
 List out the terminology used in EHR?
 Advantages of EHR?
 Disadvantages of EHR?
 Benefits of EHR?
 Barrier of EHR?

Short answer questions
Define the concept of an electronic health record
(EHR) EHR ?
 – Collection of health information of patients that is
stored in a digital format EHRs can interface with
external computer programs
List out the Models of EHR?
 There are three distinct models of EHR programs –
Distribution-based, Facility-based, and Web-based

Fill in the blanks ------
 Initial creation – -------1960s
 Improved functionality – -----1970-1980
 Practice management systems –---- 1990s
 Government mandates – -----2010

State the full form of Abbreviations
 CPR—Computer-Based Patient Record
 EMR—Electronic Medical Record
 EHR—Electronic Health Record
 CCD/CCR—Continuity of Care Document/
Continuity of Care Record
 PHR—Personal Health Record
 HIPPA-
 HITEC-

Objective type questions and answer
 2004 – Bush created the ONC position
 2008 – Medicare Improvements for Patients and
Providers Act (MIPPA)
 2009 – Health Information Technology for
Economic and Clinical Health (HITECH) Act
 2009 – Obama introduces economic recovery plan
 2010– Beacon Community Cooperative Agreement
 2010– Health Information Technology Extension
Program

What are the future changes of EHR
LO 1.7 Describe potential developments in the future of the
EHR
National Health Information Network (NHIN) will provide
a common platform
Funding for EHR programs available through the
Challenge Grants program
The PDA, wireless networks, and high-speed Internet
access will increase speed of access to information
The Clinical data will no longer reside exclusively in a
physician’s office, but will be available wherever the
Internet is available to form the computer-based patient
record (CPR)

Questions and answer
 What are the four errors that stem from
communication problems?
 ANSWER:
 They are:
 Lost or misfiled records
 Mishandled patient messages
 Inaccurate and illegible documents
 Mislabeled or illegible lab or medication order
Learning Outcome: List four medical mistakes that
will be greatly decreased through the use of EHR.

 PHI that is collected an maintained by the patient
conforms to national interoperability standards not a
legal record used by a single healthcare organization
covered by HIPAA
 ANSWER:
 HER
 PHR
 EMR