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Discover & share this Animated GIF with everyone you know. GIPHY is how you search, share, discover, and create GIFs.

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A. Components of Electronic Health Records

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A. Components of Electronic Health Records

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An Electronic Health Record (EHR) is an electronic version of a patients medical history, that is maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care under a particular provider, including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports (CMS.gov, 2022).

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Components of Electronic Health Records                                                                                             

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Components of Electronic Health Records                                                                                             

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It is important to realize that there is a difference between Electronic Medical Records (EMR) and Electronic Health Records (EHR): https://www.rasmussen.edu/degrees/healthsciences/blog/emr-versus-ehr/

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Components of the Electronic Health Record

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Components of the Electronic Health Record

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The Foundation of Knowledge Model is a conceptual framework that can be utilized for a better understanding of the  building blocks of healthcare informatics.

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B. Advantages of Electronic Health Records

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B. Advantages of Electronic Health Records

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EHRs and the ability to exchange health information electronically can help you provide higher quality and safer care for patients while creating tangible enhancements for organizations. EHRs help providers better manage care for patients and provide better health care by:

Providing accurate, up-to-date, and complete information about patients at the point of care

Enabling quick access to patient records for more coordinated and efficient care

Securely sharing electronic information with patients and other clinicians

Helping providers more effectively  diagnose patients, reduce medical errors, and provide safer care

Improving patient and provider interaction and communication, as well as health care convenience

Enabling safer, more reliable prescribing

Helping promote legible, complete documentation and accurate, streamlined coding and billing

Enhancing privacy and security of patient data

Helping providers improve productivity and work-life balance

Enabling providers to improve efficiency and meet their business goals

Reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health (HealthIt.gov, 2022).

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Electronic Health Records can improve patient care by:
Reducing the incidence of medical error by improving the accuracy and clarity of medical records.
Making the health information available, reducing duplication of tests, reducing delays in treatment, and patients well informed to take better decisions.
Reducing medical error by improving the accuracy and clarity of medical records (CMS.gov, 2022).

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The use of Standard Terminology in clinical practice has the capability to improve communication, quality of care and interoperability (Fennelly, et al., 2021).

According to the World Health Organization (WHO), Standardized Terminology is a “compilation of terms used in the clinical assessment, management and care of patients, which includes agreed definitions that adequately represent the knowledge behind these terms and link with a standardized coding and classification system," (Fennelly, et al., 2021).

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doi: 10.1016/j.ijmedinf.2021.104431.

Affiliations

¹ Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland. Electronic address: orna.fennelly@ucdconnect.ie.

² Office of the Nursing and Midwifery Services Director, Health Service Executive (HSE), Ireland. Electronic address: loretto.grogan1@hse.ie.

³ Northern Ireland Practice & Education Council for Nursing and Midwifery, Northern Ireland. Electronic address: Angela.Reed@nipec.hscni.net.

⁴ School of Human and Health Sciences, University of Huddersfield, England. Electronic address: N.Hardiker@hud.ac.uk.

Free article

Free article

doi: 10.1016/j.ijmedinf.2021.104431.

Affiliations

¹ Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland. Electronic address: orna.fennelly@ucdconnect.ie.

² Office of the Nursing and Midwifery Services Director, Health Service Executive (HSE), Ireland. Electronic address: loretto.grogan1@hse.ie.

³ Northern Ireland Practice & Education Council for Nursing and Midwifery, Northern Ireland. Electronic address: Angela.Reed@nipec.hscni.net.

⁴ School of Human and Health Sciences, University of Huddersfield, England. Electronic address: N.Hardiker@hud.ac.uk.

Abstract

Aim: To explore the use and impact of standardized terminologies (STs) within nursing and midwifery practice.

Introduction: The standardization of clinical documentation creates a potential to optimize patient care and safety. Nurses and midwives, who represent the largest proportion of the healthcare workforce worldwide, have been using nursing-specific and multidisciplinary STs within electronic health records (EHRs) for decades. However, little is known regarding ST use and impact within clinical practice.

Methods: A scoping review of the literature was conducted (2019) across PubMed, CINAHL, Embase and CENTRAL in collaboration with the Five Country Nursing and Midwifery Digital Leadership Group (DLG). Identified studies (n = 3547) were reviewed against a number of agreed criterion, and data were extracted from included studies. Studies were categorized and findings were reviewed by the DLG.

Results: One hundred and eighty three studies met the inclusion criteria. These were conducted across 25 different countries and in various healthcare settings, utilising mainly nursing-specific (most commonly NANDA-I, NIC, NOC and the Omaha System) and less frequently local, multidisciplinary or medical STs (e.g., ICD). Within the studies, STs were evaluated in terms of Measurement properties, Usability, Documentation quality, Patient care, Knowledge generation, and Education (pre and post registration). As well as the ST content, the impact of the ST on practice depended on the healthcare setting, patient cohort, nursing experience, provision of education and support in using the ST, and usability of EHRs.

Conclusion: Employment of STs in clinical practice has the capability to improve communication, quality of care and interoperability, as well as facilitate value-based healthcare and knowledge generation. However, employment of several different STs and study heterogeneity renders it difficult to aggregate and generalize findings.

Keywords: Classification; Nurse midwives; Nurses; Review; Standardized nursing terminology; Terminology.

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national center for biotechnology information

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Use of standardized terminologies in clinical practice: A scoping review - PubMed

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Employment of STs in clinical practice has the capability to improve communication, quality of care and interoperability, as well as facilitate value-based healthcare and knowledge generation. However, employment of several different STs and study heterogeneity renders it difficult to aggregate and ...

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D. Ownership of Electronic Health Records

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D. Ownership of Electronic Health Records

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McGonigle and Mastrian (2021), on page 281, suggest that successful ownership of EHR may be defined by the level of clinician adoption of the EHR tool itself.

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What if your healthcare information was widely and easily available to everyone? What if a prospective employee, your partner, or even your friends and family were able to see your private data? That is a terrifying concept. And it has happened, thanks to unprofessional and criminal actions by certain EHRs and by hackers.

The concept of healthcare and EHR data ownership carries many implications for patients, providers and medical practices. While it is widely agreed that EHR vendors do not own the medical data, that has not prevented unscrupulous vendors from winning court disputes that resulted in serious financial losses and massive PR hits for medical providers.

Because of this, practices can often feel as though they are in a dangerous relationship with vendors, who are holding their data hostage for ransom. These considerations make the discussion of data ownership critical for any physician or medical practice that utilizes Electronic Health Records.

Defining Data and Data Ownership

Healthcare data comes from a variety of sources. The main source is the patient themselves. They are the ones who provide data to providers(who input it into their EHR system) and to platforms such as patient portals. Another source of data is from the physician or healthcare team, in the form of clinical findings and observations. Results from laboratory studies or radiology, along with data from other external healthcare providers or practices, also contribute to EHRs.

There are a number of parties who can lay claim to healthcare data. This makes grappling with who has more of a claim over EHR data ownership, even more complicated. Patients, providers, vendors, and the medical practice itself all have an investment in healthcare data and there is often uncertainty over who has the most right to EHR data ownership.

According to the Journal of Medical Internet Research, over 53% of patients believe that they own their healthcare data. There is a valid argument here, since the data is the patients. But then why do 43% of providers believe they own the healthcare data? Well, without them, the data would not be in the system. Same goes for any additional findings that came to light after the patient was admitted.

Feeling confused on which side seems more right? You're not alone. Amazingly, both of these groups report that 20% simply don't know who owns the data.

Establishing Data Ownership

The best method of minimizing disputes over EHR data ownership is prevention. Measures such as establishing data ownership early, defining terms and enforcing guidelines are critical to minimizing trouble down the road. With EHR vendors, defining conditions of data exportation, in the event the practice wishes to end a business relationship, is critical.

For all parties, the concept of access must also be clearly defined. Terms include practice or provider access to data from the vendor's servers, as well as patient access to healthcare data via portals or other mechanisms. The most common source of disputes is when a party wishes to leave the relationship; either the practice decides to select a different EHR vendor, or a patient wishes to port their data to a new provider.

Vendor Red Flags

For a medical practice, establishing terms of EHR data ownership must begin at the time of vendor selection. Identifying warning signs during this process can help providers avoid much larger issues in the future.

When choosing an EHR, keep an eye out for red flags such as unstructured data formatting (i.e. PDF instead of CCDA), an inability to meet the National Coordinator for Health Information Technology's certification requirements, or restrictive contracts that demand exorbitant financial charges to port data in the event of a vendor switch.

Establishing productive EHR data ownership for a healthcare organization, takes careful planning.

While it might be more expensive upfront, every practice would benefit from finding an EHR that is designed with your needs in mind, meaning, among other things, that you own your data and have complete administrative control.

HIPAA violations are not only a source of bad PR and an expensive lawsuit, it is also news that will lead to decreased trust from patients, which would lead to them leaving. This means that: 1. There will be decreased revenue. 2. The practice taking a hit overall. 3. Most importantly, lots of people missing out on getting care.

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Who Owns the EHR Data in Your EHR system? | blueEHR Blog

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What if your healthcare information was widely and easily available to everyone? What if a prospective employee, your partner, or even your friends and family were able to see your private data? That is a terrifying concept. And it has happened, thanks to unprofessional and criminal actions by certain EHRs and by hackers.

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F. Accountable Care Organizations and the EHR    

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F. Accountable Care Organizations and the EHR    

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The link posted is a great overview of Accountable Care Organizations and Automated Virtual Care.

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Accountable care and accountable care organizations: CMS Innovation Center. Innovation Center. (n.d.). Retrieved October 31, 2022, from https://innovation.cms.gov/key-concepts/accountable-care

CMS.gov. (2022). Electronic Health Records. https://www.cms.gov/Medicare/E-Health/EHealthRecords
Automated Virtual Accountable Care. YouTube. (2021, February 5). Retrieved October 31, 2022, from https://youtu.be/ft5W-q2VOBM

Electronic Health Records drive the future of Healthcare. HPE. (2021, March 2). Retrieved October 31, 2022, from https://www.hpe.com/us/en/insights/articles/cloud-to-the-rescue-ehrs-as-a-service-drives-future-of-healthcare-2103.html

Fennelly, O., Grogan, L., Reed, A., & Hardiker, N. R. (2021). Use of standardized terminologies in clinical practice: A scoping review. International journal of medical informatics, 149, 104431. https://doi.org/10.1016/j.ijmedinf.2021.104431
HealthIT.gov. (2022). What are the advantages of Electronic Health Records? https://www.healthit.gov/faq/what-are-advantages-electronic-health-records

Jweaver. (2022, September 12). 2022 clinical workflow flexibility challenges in the EHR: Defining the problem (part One). HIMSS. Retrieved November 2, 2022, from https://www.himss.org/resources/2022-clinical-workflow-flexibility-challenges-ehr-defining-problem-part-one

McGonigle, D., & Mastrian, K. G. (2021). Nursing Informatics and the Foundation of Knowledge (5th ed.). Burlington, MA: JB Learning. ISBN-13: 978-1284220469

Mikk, J., Topol, E., & Sleeper, T. (2017). The pathway to patient data ownership and better health. JAMA. https://pubmed.ncbi.nlm.nih.gov/28973063/

Ruesink, M. (2018). EMR vs. EHR: Understanding the differences in digital records. EMR vs. EHR: Understanding the Differences in Digital Records | Rasmussen University. https://www.rasmussen.edu/degrees/healthsciences/blog/emr-versus-ehr/

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Roughly forty percent of patients are unaware of electronic health record availability via patient portals.

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application FairWarning. The software tracks whether employees or clinicians have legitimate reasons for opening particular records.

Because the software records anyone who accesses a record, "you can't hide from the EHR anymore like you could with a paper chart," Rosenhagen says. He contends the EHR provides a more secure environment than paper records did.

Courion, which developed similar software, has clients such as Miami Children's Hospital, Quest Diagnostics, and Memorial Sloan Kettering Cancer Center. They use its software to automatically update hires and terminations to limit access to authorized personnel retrieving legitimate information, says Courion's Zannetos.

The right to patient records changes over time, creating an added challenge. Parents, for example, control access to children's EHRs -- while they're children.

"Once they turn 18 you've got to turn that off and give access to the 18-year-old, who's supposedly no longer a child," says Zannetos, father of two young adults. Zannetos says the healthcare industry needs to learn from the credit card industry, and how it considers a wide range of factors to spot fraud. "We have to constantly watch through the very complex connections between people, apps, access rights, and what they're doing, and raise alerts when things look like they're out the norm," he says.

IT departments also must guard against patients' errors. All too often consumers use the same password for multiple sites. If a breach occurs at an unrelated site, users might think their data is secure but cyberthieves could now have the password that protects their personal health information, Zannetos says. Organizations might want to enforce frequent password changes, require multicharacter passwords, or assign passwords to consumers, rather than allowing them to use their own creation.

InformationWeek 2014 Healthcare IT Priorities Survey of 322 healthcare technology professionals, February 2014.

Some providers have moved beyond portals and extend complete access to patients through the Open Notes initiative, says David Harlow, principal at The Harlow Group, a healthcare legal and consulting firm. In March, for example, WellSpan Health began offering patients access to office-visit notes, as well as lab results, physicals information, immunizations, and imaging studies.

"It means really sitting side by side with a patient in front of the computer screen, rather than having the computer screen between the doctor and patient, in order to share that information in real-time during the office visit," Harlow says. "It's a real culture change."

To promote access to all electronic records, regardless of providers' EHRs, the federal government and participating partners use Blue Button, a technology that lets consumers click on a blue link to view online, download, and share their records. Although not all providers participate today, HealthIT.gov claims the roster is expanding rapidly.

All for one, one for all
There is a point at which patients lose control of their data; that is when identifiable information is removed and organizations use the vast collection of health data for analytics.

"If it's de-identified, then it's not considered to be that patient's information anymore," Harlow says.

HIPAA recommends one formal process to de-identify data. It requires stripping out all potentially identifiable information, an approach that safeguards patients but deprives researchers, he says. Statistical de-identification, which uses techniques that allow inclusion of certain demographic points, is more valuable to researchers, Harlow adds. Optum Labs, for example, uses multiple de-identification steps when it receives data from Humedica and provides pockets of data to authorized researchers, says Paul Wallace, chief medical officer at Optum Labs. Both approaches satisfy HIPAA rules to preserve patient anonymity, although statistical deidentification -- while more useful -- is also more costly.

Organizations use this statistical de-identified patient data for everything from healthcare and provider quality control and treatment improvement, to researching new medicines and finding new relationships between disease cause and effect.

However, statistically de-identifying data isn't perfect. In a study last year, the Whitehead Institute for Biomedical Research, a nonprofit research and teaching institution with programs in cancer research, developmental biology, genetics, and genomics, was able to re-identify 50 people who had sent personal DNA data in genomics studies such as the 1000 Genomes Report. The odds of being named from a de-identified database were 4 in 10,000, according to a 2005 study. Since that year, consumers share more identifiable information via social media and apps, and more information is digitally available, so perhaps it's more likely to be identified today.

Rather than de-identify data, researchers should be held responsible for protecting personal data and privacy, recommends an article on the Association for Computing Machinery's website written by Jon P. Daries, Justin Reich, Jim Waldo, Elise Young, Jonathan Whittinghill, Daniel Thomas Seaton, Andrew Dean Ho, and Isaac Chuang. Although they focused on students in higher education, the authors argue de-identification forces changes to data that threaten analysis and weaken the results. Too much concern for de-identifying could stifle important research, they say.

Patients worried about their data being re-identified might lie to medical professionals, to hide alcohol, drug, or physical abuse, or conceal embarrassing symptoms. Others are concerned insurers or employers will combine readily available credit card information with health data to paint clear pictures about consumers' cigarette, fast food, or liquor purchases.

Although one person's information speaks solely to that individual's health, the records of an entire population paint a broader picture, one that holds clues to cures, treatments, and prevention. Consumers might generate their personal health data, but they don't own their records. If we're all to reap the benefits of that collective knowledge, it's up to organizations that steward this data to protect it from those that seek to use it for illegal, unethical, or harmful purposes.

Download the entire September issue of InformationWeek Healthcare.

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application FairWarning. The software tracks whether employees or clinicians have legitimate reasons for opening particular records. Because the software records anyone who accesses a record, "you can't hide from the EHR anymore like you could with a paper chart," Rosenhagen says. He contends the EHR provides a more secure environment than paper records did.

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Offering cloud services with EHR allows for more storage, IT specialists, and adaptability with built in security and privacy.

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Electronic health records in the cloud, provided as a service, can be the cure for the digital ills providers and patients suffer. It also brings new opportunities.

Electronic health records are no longer a nice to have. The future of medical care-with lower costs and better care as the goals-requires systems where medical records are easily transportable. Existing systems are helpful, but the lack of standards in stand-alone systems, coupled with utilization issues, has thwarted the potential of EHR.

EHR systems have long promised big goals: to increase efficiency and accuracy, to improve collaboration between physicians and care teams, and to ultimately achieve greater clarity in treating patients. Yet efforts overall have fallen short, in part because hundreds of EHR systems are in common use, from the stand-alone doctor's office to the large healthcare enterprise.

Medical professionals regularly need to work with different healthcare systems, each using their own version of an on-premises EHR system, requiring medical staff to learn multiple systems. In addition, large healthcare systems have been struggling with getting their existing systems to change with their businesses: Consolidation, insurance changes, and even the pandemic have changed the ways and the speed at which their existing EHR systems have had to adapt.

All this creates a window of opportunity for EHR as a service.

"There's still plenty of room for improvement," says Mutaz O. Shegewi, research director of provider IT transformation strategies at I DC Health Insights. With cloud-based EHRs, he says, patients and medical workers are finally able to work in ways EHR advocates have long envisioned. EHR as a service explicitly addresses the problems that have troubled stand-alone EHR systems. And by providing a solution to these problems, EHR as a service is attracting investments even from the healthcare systems that were early adopters of first-generation EHR.

As EHR moves to the cloud, especially as EHR as a service, long-promised aspirations are beginning to become reality, offering the promise of not just replacing paper medical records but enabling technology for advances in patient care, the majority of which require simpler and more flexible access to each patient's medical records.

Crash course: EHR as a service

EHR as a service is the logical growth path for medical records. It brings a level of flexibility and availability to a world traditionally dominated by huge numbers of large racks of paper records. The overhead alone of maintaining all that information on paper has resulted in significant inertia. Making EHR available across the medical enterprise in an as-a-service form eases the transition to a fully digital platform.

However, it is more than a cloud version of traditional EHR software. Healthcare providers have heard the pitch of the benefits of EHR before but have remained skeptical. Much of what ailed earlier EHR systems is rooted in the limitations of on-premises software: complex technical issues, inability to scale and widely integrate, inability to share between institutions and providers, design and reporting inflexibility, and difficulty of use, to name a few. Moving to a cloud-based, software-as-a-service model jettisoned those issues and finally freed the potential in the software that healthcare providers had long sought.

In a nutshell, EHR as a service provides cross-platform mobility and anytime, anywhere access, as well as several other advantages.

One big one: It better prepares the healthcare system to deal with the unexpected, such as the pandemic. If there is one thing 2020 taught the medical industry it is that the ability to make rapid transformations in an industry that favors stability and predictability is now a top priority. With cloud-based EHR, what has been a roadblock to rapid transformation can suddenly become an agile part of the business model.

How does that happen? Cloud-based EHR relieves IT burdens, spurs innovation, and creates new opportunities.

As Daniel Cooper, managing director at consultancy Lolly:co, says, "It removes the burden of security from the healthcare provider and frees them to concentrate on patient care. Previously, the healthcare provider must assume the burden of both security and privacy of patient records. With the ever-growing cyber insecurity, the burden is getting heavier and heavier."
Please read: Why healthcare is such a juicy ransomware target
Just as important, EHR as a service enables scaling to accommodate long-term growth and spikes in demand. "If the health facility grows and you need a larger capacity to hold patient records, scaling is seamless and you will have zero issues with data integration," Cooper adds.

Cloud-based EHR is trending

For all of these reasons, cloud-based EHR is trending upward, with total spending projected to double from an early-adopter perspective in 2018 to a $44 billion market by 2023, even as healthcare organizations have already heavily invested in EHR systems and IT budgets are tight.

Keep in mind that the basic premise of EHR isn't new. It's the idea of EHR as a service gaining significant traction in the industry that is causing the shift in attitudes about what a good EHR system represents. According to a report by the global nonprofit organization Healthcare Information and Management Systems Society (HIMSS), EHR digital data quality suffered "a long list of concerns, including incompleteness, duplication, inconsistent organization, fragmentation, and an inadequate use of coded data within EHR workflows."

According to HIMSS, its earlier studies, as well as studies conducted by other organizations, found that initial adoptions of EHR applications worked well independently for local needs but not across clinician disciplines. For more than 4 million U.S. practitioners, EHR is handled by one or more of 100 certified EHR systems. And, HIMSS points out, "they all started using these EHR [systems] at virtually the same time."

"Despite market saturation and investments made, U.S. hospitals were still replacing and making additional investments in EHRs," Shegewi says, meaning workflow optimization is key for organizations focused on next-generation clinical documentation. "EHR ranked first for cloud workloads, reflecting perceived benefits of a move to the cloud for clinical documentation," Shegewi notes, adding that European providers are on a similar trajectory.

Please read: Electronic health records are beginning to deliver on their promise

Other technologies trending or maturing in healthcare-including Internet of Medical Things device integration and remote patient care-are driving the need for cloud-based EHR as well.

The growing connectivity between smart things and devices within hospital settings and diagnostic procedures comprise a significant market force that is pushing the need for interoperability and automation, including notations and results on patient records. The continuing surge in telemedicine and remote patient care is proving to be a second but equal market force.
Please read: Telehealth: How virtual can medicine get?
According to Forrester's predictions for this year, "Consumer interest in digital health devices will accelerate as individuals appreciate the convenience of at-home monitoring, insight into their health, and the reduced cost of connected health devices." As such, the need for real-time integration of results from these numerous consumer devices into patient records will grow and continue the momentum of cloud-based EHR adoption and expansion rates.

But other driving forces are pushing cloud-based EHR adoption as well. An American Medical Association (AMA) report reveals a long-standing but worsening problem: physician burnout: "EHRs brought many benefits to doctors' offices and hospitals, but they also shifted a number of clerical responsibilities to physicians, from billing and coding to prescribing medicine electronically."

A study published in JAMA before the pandemic began pushing doctors to extreme levels of physical and mental endurance found that EHR use factors added significantly to physicians' stress and burnout. Specifically, the study found these EHR factors to be the worst offenders:

Information overload

Slow system response times

Excessive data entry

Inability to navigate systems quickly

"Note bloat"

Fear of missing something

Notes geared toward billing, not patient care

This is no small matter, with the AMA predicting the situation could quickly lead to a shortage in clinicians.

"Physician burnout as a whole is a multifaceted problem, but people are retiring early or going part time because they're spending so much time on the computer, they don't feel they get enough time to take care of their patients," says Philip J. Kroth, MD, MS, a lead author of the study cited in the AMA report. He chairs the biomedical informatics department at Western Michigan University Homer Stryker M.D. School of Medicine.

"More and more of what we enter into the record is for things other than direct patient care, like quality control and to support billing," Dr. Kroth says. "We should be able to redesign the workflow process so more people can help enter data into the EHR to reduce this burden on physicians, or at least make the data-entry requirements more judicious."

Beyond all the factors behind the uptick in EHR as a service is a need for continuity. That means future-proofing to stop the budget overruns caused by EHR being handled as an acute rather than chronic problem. Cloud-based EHR enables fast iterations, updates, upgrades, and innovations in an efficient, cost-effective manner, with little to no downtime.

Future-proofing to manage change

Savvy healthcare organizations know that every penny in the budget counts and that there is no room for waste or heavy IT forklifts brought on by the winds of change. That is truer today than ever, with COVID-19 overwhelming critical care units and staff while draining profits from elective surgery, routine diagnostic care, and other patient care revenue streams.

In such a demanding environment, it is crucial to be ready for anything.

"It's imperative to keep pace or outpace change," says Oded Shihor, strategist and worldwide healthcare industry lead, GreenLake portfolio management, at Hewlett Packard Enterprise.

"Moving EHR to a cloud platform lifts considerable burdens for healthcare organizations and makes it easier to respond to new challenges and opportunities," Shihor explains. "For example, moving to HIMSS level 7 can be accelerated, complexity can be reduced, and hybrid EHRs can be better managed after M&A consolidations." The HIMSS eight-stage model (0-7) measures healthcare organizations' adoption and utilization of EHR functions.

There are many other marked and notable advantages in features and functionality of next-generation, cloud-based EHR. According to IDC, those include but are not limited to:

Advanced interoperability integrations and emerging standards

Clinical workflow optimization catering to end-user needs, specialties, preferences, service lines, and patient dispositions

Broadening use cases such as population health, social determinants of health, claims, consumer research, and patient-generated data integrations

Community developer ecosystems and platforms such as EHR application marketplaces

Role-based workflows and specialty EHRs

Enterprise-wide mobility for seamless charting, tablet mobile charge capture, and e-prescribing-all with anytime, anywhere access

Cross genomic repository and real-world evidence integration

Personalized care planning and predictive therapeutic analytics

Genomics-driven analytics (actionable genomics and genetic risk profiling)

Anticipatory medicine (exome sequencing) integration

Remote patient monitoring to manage chronic conditions

Patient financial engagement, such as claims-based AI algorithms, propensity-to-pay dashboards and tools, cost of care patient responsibility calculator, and educational tools

Managing change, challenges, and opportunities are the keys to providing premium patient care and sustaining the enterprise.

This article/content was written by the individual writer identified and does not necessarily reflect the view of Hewlett Packard Enterprise Company.

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Electronic health records drive the future of healthcare

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Electronic health records in the cloud, provided as a service, can be the cure for the digital ills providers and patients suffer. It also brings new opportunities. Electronic health records are no longer a nice to have. The future of medical care-with lower costs and better care as the goals-requires systems where medical records are easily transportable.

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Defining the Problem: Flexible Workflows in the Electronic Health Record (EHR)

The Electronic Health Record Association (EHRA) Clinician Experience Workgroup met with the HIMSS Physician Committee shortly after HIMSS 2021 to discuss areas of shared focus and create plans for collaboration over the next year. Our groups already agree on the quality, safety and efficiency-of-care benefits, to both providers and patients, that EHRs have brought. We also agree that there is more work to be done to improve and deepen the impact of these tools on care delivery, documentation and clinician satisfaction. The focus of our meeting was to decide where action was most urgently needed to raise the bar for EHRs. One topic that was of interest was the sense that EHRs lacked flexibility within clinical workflows. This series will provide a summary of our discussion, the areas of focus we agreed upon, as well as some of the promising solutions we discussed.

The two groups collaborated on a brainstorming exercise to clarify the problem space. They modified IBM's 'As-Is Scenario Map' to allow physician stakeholders to share specific points where they had hit the 'limit' of EHR flexibility. The exercise asked physicians to add virtual post-it notes to a personal whiteboard as they reflected on what they were doing, thinking, or feeling when they last experienced inflexibility in the EHR. Those various boards were then brought together, and facilitators did an initial affinity grouping of the ideas that had been shared. The goal of the affinity grouping was to discover the 'phases' or 'facets' of flexibility that seemed to be concurrent across the participants. This affinity grouping was brought back to the group for a second session of discussion and clarification.

After clarifying and refining the ideas that had been shared, four categories of concerns were identified:

Learning about the EHR

Personalizing the EHR

Understanding the patient

Providing care

Learning about the EHR

As noted in two recent studies, training and optimization are the biggest predictors of provider satisfaction and wellbeing (1,2). Surprisingly, this category had the least consensus and fewest urgent issues during the exercise. Our interpretation of this is that while training and mastery of the EHR are clearly important for success, there are significant variations in organizational and EHR vendor recommended training and optimization methods. As a result, there is not a clear path forward. Having a system that is intuitive to learn, with training and flexibility built in, might offer a very attractive alternative to current "change management" mandates. The concept of a teaching and learning system is a challenge being tackled throughout the software industry. EHR vendors are an important part of solving this complex challenge.

Our next post will focus on Personalizing the EHR and Understanding the Patient. We'll wrap up the series with thoughts on Providing Care in the EHR and solutions.

References

1. Longhurst, CA, et al. Local Investment in Training Drives Electronic Health Record User Satisfaction. Appl Clin Inform 2019;10:331-5.

2. Shah, T, et al. Electronic Health Record Optimization and Clinician Well-Being: A Potential Roadmap Toward Action. National Academy of Medicine 2020; https://doi.org/10.31478/202008a

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2022 Clinical Workflow Flexibility Challenges in the EHR: Defining the Problem (Part One)

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The Electronic Health Record Association (EHRA) Clinician Experience Workgroup met with the HIMSS Physician Committee shortly after HIMSS 2021 to discuss areas of shared focus and create plans for collaboration over the next year. Our groups already agree on the quality, safety and efficiency-of-care benefits, to both providers and patients, that EHRs have brought.

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1. Is there a difference in Electronic Medical Records (EMR) and Electronic Health Records (EHR)? If so, what is the difference?

2. Do you agree that there are more advantages to EHR implementation than disadvantages? If so, why?

3.  Why is standardized terminology important within EHR systems?

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Accountable Care Organizations and the EHR    

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Accountable Care Organizations and the EHR    

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The link posted is a great overview of Accountable Care Organizations and Automated Virtual Care, services offered with Medicare and Medicaid.

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What is an Accountable Care Organization (ACO)?