1 Medical Informatics and Electronic Medical Records Integrating Clinical Decision Support Systems Lori Fitterling, MLS Digital Services/Reference Librarian KCUMB Fall CME 2014 Scientific Seminar September 20, 2014
2 Objectives Define Medical Informatics Define Electronic Medical Records Demonstrate some Clinical Decision Support Systems and explain how they integrate with EMRs Future considerations
3 To improve the quality of our health care while lowering its cost, we will make the immediate investments necessary to ensure that, within five years, all of America s medical records are computerized. President-Elect Barack Obama, Jan. 8, 2009
4 Medical Informatics Information Science Computer Science Health Care What is Health Informa1cs?
5 What is Medical Informatics? The analysis, use and dissemination of medical data and information through the application of computers to various aspects of health care and medicine. (MeSH) National Library of Medicine Includes terminology, semantics, information mapping, data capture, indexing, retrieval, interpretation, and dissemination.
6 Four Areas of Medical Informatics Knowledge Management Clinical Informa4on Management Communica4on Decision Making
7 Four Areas of Medical Informatics Knowledge Management Medical journals Medical reference books Consumer health information Communication Telemedicine patients Shared calendars Social media Clinical Information Management Electronic health records Billing/coding systems Ordering systems Decision Making Point of Care databases Drug interaction tools
8 Shift to Merge Systems into ONE System Knowledge Management Clinical Informa4on Management Communica4on Decision Making
9 Four Areas of Medical Informatics Knowledge Management Medical journals Medical reference books Consumer health information Communication Telemedicine patients Shared calendars Social media Clinical Information Management Electronic health records Billing/coding systems Ordering systems Decision Making Point of Care databases Drug interaction tools
10 Electronic Medical Records What are they really? EMRs have integration and interoperability within one health system EHRs electronic health records are the patient care system can be shared by other systems ECRs electronic clinical records EPRs electronic patient records PHRs personal health records
11 EMRs represent the impact of technology in health care Major shift away from paper records Combines data analytics, data mining and Big Data
12 Electronic Health Records Electronic record of patient health information It encompasses: Patient demographics Progress notes Medications Vital signs Past medical history Immunizations Laboratory data Radiology Reports
13 Meaningful Use Regulation for EHRs Healthcare Information and Management Systems Society says -- EHR technology is "meaningful" when it has capabilities that include: e-prescribing, exchanging electronic health information, provide clinical decision support to support practitioner order entry and submitting clinical quality measures Officials say physicians must meet the definition within a specified time frame, which as described in the American Recovery and Reinvestment Act of HITECH Act
14 Meaningful Use Centers for Medicare & Medicaid Services
15 Meaningful Use Update September 4, 2014 The final rule provides additional flexibility by allowing eligible professionals, eligible hospitals and critical access hospitals to use the 2011 Edition certified EHR technology or a combination of 2011 and 2014 Edition certified EHR technology for the 2014 EHR reporting period (Bowman, FierceEMR, 8/29).
16 Choice of Electronic Medical Records Systems EPIC, CERNER, MEDITECH top three vendors 2013 for EMR software (Gregg, 2014). The EHRs market expected to reach $9.3 billion annually by the end of 2015 (Gregg, 2014). Other vendors: GE Healthcare, McKesson, Misys, Siemens, Allscripts, NextGen, eclinicalworks, CPSI, Healthland, athenahealth, and SOAPWare
17 Positive Impact Improved documentation Better coordination of care Increased administration efficiency Empower patients Patient safety Tracks compliance Financial incentives (Eligible Medicare physicians could receive up to $44,000 over 5 years, Hsiao, 2014).
18 Negative Impact Changes to workflow Changes in work distribution Complicated technology systems need user support Ongoing training more work for physicians Patient confidentiality, security issues
20 Implementation/Adoption Issues Privately owned hospitals less likely to invest in EHRs than public hospitals Costs of EHRs outweighs the benefits Suitable software speed, reliability, flexibility Hardware in terms of mobile equipment, access to computers
21 Implementation/Adoption Issues Needs the support of management Strong leader roles Implementation strategy/plan User involvement Physicians are the most influential medical care providers, and their resistance can delay EHRs implementation
23 Clinical Decision Support Systems Brings evidence-based information to Point of Care decision making Organized clinical knowledge Patient information/education Practice Guidelines How information is displayed/format
24 Compliance Meaningful use must implement one clinical decision support rule that includes diagnostic test ordering, and be able to track compliance.
25 The use of clinical decision support systems is expected to increase in light of the Health Information Technology for Economic and Clinical Health (HITECH) Act, which stipulates that health care providers must demonstrate the meaningful use of health IT by 2015 or face reduced Medicare reimbursements beginning in (TechTarget
26 Clinical Decision Support Systems UpToDate Clinical Key -- FirstConsult EBSCO DynaMed Access Medicine (McGraw Hill) Johns Hopkins ABX Guide Clinical Pharmacology VisualDx
27 Computerized Information Retrieval--InfoButton HL7 Context-Aware Knowledge Retrieval (InfoButton) Standard BUTTON added to EHRs Health Level 7 UpToDate integration Visual DX Clinical Key InfoButton
28 EMRs Add Patient-Centered Access Remote delivery of services Patient portal Patient Education: Medline, UpToDate, Clinical Key Social Media Facebook, Twitter, Google+, YouTube, LinkedIn
29 EMRs Add Web Based Services Request medication refills #1 Mobile text messages patients checking/texting their BPs, blood sugar, etc. Patient check-in Patient Portal that includes chat services and virtual patient encounters E-visits less expensive Facebook/Twitter/LinkedIn presence knowledge/information transfer
30 Something to Think About Do EMRs limit physician critical thinking?
31 Future Up in the cloud with EMRs Apps Clinical teaching of EMRs Genomic data integration Google Glass
32 Bibliography Amatayaku, M, Lazarus, SS. (2005) Electronic Health Records: Transforming Your Medical Practice. Medical Group Management Association, Englewood, CO. Berry LL, Beckham D, Dettman A, Mead R. Toward a Strategy of Patient-Centered Access to Primary Care. Mayo Clin Proc Sep 2. pii: S (14) doi: /j.mayocp [Epub ahead of print] Review. PubMed PMID: Blumenthal D, Tavenner M. The "meaningful use" regulation for electronic health records. N Engl J Med Aug 5;363(6): doi: / NEJMp Epub 2010 Jul 13. PubMed PMID: Boonstra A, Versluis A, Vos JF. Implementing electronic health records in hospitals: a systematic literature review. BMC Health Serv Res Sep 4;14(1): 370. doi: / PubMed PMID: ; PubMed Central PMCID: PMC Chi J, Kugler J, Chu IM, Loftus PD, Evans KH, Oskotsky T, Basaviah P, Braddock CH 3rd. Medical students and the electronic health record: 'an epic use of time'. Am J Med Sep;127(9): doi: /j.amjmed Epub 2014 Jun 4. PubMed PMID: Del Fiol G, Huser V, Strasberg HR, Maviglia SM, Curtis C, Cimino JJ. Implementations of the HL7 Context-Aware Knowledge Retrieval ("Infobutton") Standard: challenges, strengths, limitations, and uptake. J Biomed Inform Aug;45(4): doi: /j.jbi Epub 2012 Jan 2. PubMed PMID: ; PubMed Central PMCID: PMC Fowler SA, Yaeger LH, Yu F, Doerhoff D, Schoening P, Kelly B. Electronic health record: integrating evidence-based information at the point of clinical decision making. J Med Libr Assoc Jan;102(1):52-5. doi: / PubMed PMID: ; PubMed Central PMCID: PMC Hristidis V, Varadarajan RR, Biondich P, Weiner M. Information discovery on electronic health records using authority flow techniques. BMC Med Inform Decis Mak Oct 22;10:64. doi: / PubMed PMID: ; PubMed Central PMCID: PMC Hsiao CJ, Hing E, Ashman J. Trends in electronic health record system use among office-based physicians: United States, Natl Health Stat Report May 20;(75):1-18. PubMed PMID: Kullar R, Goff DA. Transformation of antimicrobial stewardship programs through technology and informatics. Infect Dis Clin North Am Jun;28(2): doi: /j.idc Epub 2014 Apr 5. PubMed PMID: Nguyen L, Bellucci E, Nguyen LT. Electronic health records implementation: An evaluation of information system impact and contingency factors. Int J Med Inform Jul 22. pii: S (14) doi: /j.ijmedinf [Epub ahead of print] Review. PubMed PMID:
33 Bibliography Ozdalga E, Ozdalga A, Ahuja N. The smartphone in medicine: a review of current and potential use among physicians and students. J Med Internet Res Sep 27;14(5):e128. Review. PubMed PMID: ; PubMed Central PMCID: PMC Romano MJ, Stafford RS. Electronic health records and clinical decision support systems: impact on national ambulatory care quality. Arch Intern Med May 23;171(10): doi: /archinternmed Epub 2011 Jan 24. PubMed PMID: ; PubMed Central PMCID: PMC Sheikh A, Jha A, Cresswell K, Greaves F, Bates DW. Adoption of electronic health records in UK hospitals: lessons from the USA. Lancet Jul 5;384(9937):8-9. doi: /S (14) PubMed PMID: Silverman H, Ho YX, Kaib S, Ellis WD, Moffitt MP, Chen Q, Nian H, Gadd CS. A novel approach to supporting relationshipcentered care through electronic health record ergonomic training in preclerkship medical education. Acad Med Sep; 89(9): doi: /ACM PubMed PMID: ; PubMed Central PMCID: PMC Skolnik, NE. (2011) Electronic Medical Records: A Practical Guide for Primary Care. Humana Press, Springer Science +Business Media, LLC., New York, NY. Struik MH, Koster F, Schuit AJ, Nugteren R, Veldwijk J, Lambooij MS. The preferences of users of electronic medical records in hospitals: quantifying the relative importance of barriers and facilitators of an innovation. Implement Sci Jun 5;9:69. doi: / PubMed PMID: ; PubMed Central PMCID: PMC Sun GH, Eisenberg LD, Ermini EB, Lee KJ, Nielsen DR, Rubin KY, Das S update on meaningful use of electronic health records: recommendations from the AAO-HNS Medical Informatics Committee. Otolaryngol Head Neck Surg Apr;146(4): doi: / Epub 2012 Jan 12. PubMed PMID: Warboys I, Mok WY, Frith KH. Electronic Medical Records in Clinical Teaching. Nurse Educ Jul 25. [Epub ahead of print] PubMed PMID: Wylie MC, Baier RR, Gardner RL. Perceptions of Electronic Health Record Implementation: a Statewide Survey of Physicians in Rhode Island. Am J Med Jun 16. pii: S (14) doi: /j.amjmed [Epub ahead of print] PubMed PMID:
34 Bibliography YouTube: Health Informatics: https://www.youtube.com/watch?v=rfxewuq1ce4 YouTube: HITECH (2010): https://www.youtube.com/watch?v=gzeukkwvc0o YouTube: Google Glass: https://www.youtube.com/watch?v=ssldtfwbv3e#t=122 Images from Google Images