EHR Customization and Overview Resource Patient Management System Overview
Presenter: Phil Taylor, RN Clinical Consultant Medsphere Systems Corporation 2
EHR Structure Overview for Public Health Nursing Phil Taylor, RN Clinical Consultant Mr. Taylor is a clinical consultant contractor with Medsphere Systems Corporation. He has been contracted through IHS to provide Electronic Health Record (EHR) consultation and education. Mr. Taylor will not be promoting Medsphere Corporation through this education. 3
Objectives At the end of this session, participants should be able to: Recognize the complexity and importance of precise information technology configuration, and it s relationship to PHN documentation process Express PHN information technology requirements in precise terms of EHR to appropriate parties 4
Content Provide an overview of Electronic Health Record data storage structures Identify data structures as reflected through a GUI interface Differentiate roles and responsibilities of EHR team at facility and user levels; Clinical Application Coordinator, Site Manager, Nurse Informaticist, PHN EHR Super User, PHN EHR User 5
Computers in Health Care In the 1970's, health care agencies began to realize that computerization of health care data might provide better quality of patient care. 6
RPMS Development In 1978 DHCP (Decentralized Hospital Computer Program) was deployed in 20 VA Medical Centers. In the early 1980's, in parallel with the VA's DHCP, PHS-IHS began deploying RPMS (Resource and Patient Management System). 7
PCC While the VA's DHCP was focused on hospital care, IHS s RPMS emphasized outpatient clinics. To accomplish this, the clinical component of RPMS, PCC (Patient Care Component), was developed by IHS. PCC was deployed starting in 1984. 8
RPMS and VistA In the intervening years, many of the elements of RPMS have been re-incorporated into the VA VistA System and enhancements to VistA and CPRS (Computerized Patient Record System) have been brought over into RPMS. 9
RPMS and VistA RPMS and VA VistA continue to practice technology sharing as new developments occur in each system. 10
VA Fileman The "heart" of RPMS is VA FileMan (short for VA File Manager). VA FileMan is the database engine that captures, stores and retrieves all the information within RPMS. 11
Fileman FileMan was designed using the MUMPS programming language to support the complex information storage and processing needs of hospitals and health care providers. 12
RPMS CHUI While RPMS is very good at capturing data and producing reports, the end-user interface of RPMS and FileMan is not always easy to use. RPMS uses a command line interface, also known as "roll and scroll" or CHUI (CHaracter User Interface). This interface requires users to navigate a complex menu system with cryptic commands and conventions. 13
Interface for RPMS Non-technical, clinical users of RPMS wanted a more "modern" and easier to use interface (i.e. point and click). 14
EHR Deployment About 2004, IHS began deploying a new Graphical User Interface (GUI) for RPMS. This interface is called Electronic Health Record (RPMS-EHR). RPMS-EHR combines the powerful database capabilities of RPMS with a familiar and comfortable GUI. 15
EHR Deployment Implementation of the RPMS-EHR GUI, required sites to upgrade and install VA software "packages" to support all the functionalities of this new interface. 16
EHR Deployment EHR required significant changes to RPMS. Prior to RPMS-EHR, most clinically significant information was stored in PCC. 17
EHR Deployment With the importation of VA software "packages" to support RPMS-EHR, much of the clinical data must now be stored within the corresponding "package. For example Laboratory test data is now stored within the Laboratory Package. To maintain compatibility with RPMS processes, this data is automatically linked and copied into PCC. 18
Data Location Since many of the RPMS-EHR components come from the VA, these components will only look for data within the corresponding package and do not look in PCC. Thus the RPMS-EHR Lab components will only display test results from the Lab Package. If Lab data is entered directly into PCC, it can only be accessed in RPMS-EHR via a Health Summary that can extract data from PCC and the Lab Component will report no data. 19
EHR Integrates with RPMS Packages EHR Case Management RCIS Surgery PCC Data Entry Elder Care Patient Registration Laboratory Emergency Room PCC Patient Database Behavioral Health System Dental Women s Health Immunization Public Health Nursing Radiology Pharmacy Appointment System CHR 20
New RPMS Packages New software "packages" that were added to RPMS with the implementation of EHR were the Orders Package, Consults Package, Clinical Reminders package and the Text Integration Utilities Package (Notes). 21
RPMS-EHR adds Four New Packages OE/RR Orders (CPRS) Consults PCC Patient Database Clinical Reminders TIU Notes 22
EHR Framework RPMS-EHR can be described as a "wrapper" supporting a modular system of components" that are held within a structure called the VueCentric Framework. 23
EHR Framework Integration of these RPMS components into a single user interface allows a provider to have a more comprehensive view of the clinical process. 24
EHR Framework The VueCentric framework allows RPMS-EHR to be highly configurable and customizable to meet the various needs of clinical users. 25
EHR Deployment Since 2006, this GUI (RPMS-EHR) has been deployed at over 320 sites within the IHS system. 26
RPMS Applications The IHS Electronic Health Record is not limited to RPMS-EHR, but is actually a suite of applications including: Resource and Patient Management System (RPMS CHUI) RPMS-EHR icare VistA Imaging RPMS Behavioral Health System IHS Patient Registration GUI IHS Scheduling GUI Clinical Reporting System GUI Visual Diabetes Management System Bar Code Medication Administration (BCMA) Generic Retrieval Utility (GRU) 27
RPMS Data All of these applications are part of a unified system using the same RPMS Fileman database. 28
Data Each Pod of information can be managed by different parties LAB controls Lab files, Immunization Team controls Immunization package, etc. RPMS Overview 29
Roles in Managing Data Administrators: Site Manager CAC IT Package Managers Super Users: Some permissions based on need and expertise Users: Responsible for input of accurate DATA 30
Learning a New Language Various Roles do not always speak the same language 31
For instance EHR Visit Location Type of Visit RPMS Clinic Name Service Category 32
In Summary Integrated Data Packages such as RPMS and Fileman provide a powerful system for capturing and storing complex patient data and has the ability to generate Reports as needed. Data are available via a number of software applications used by IHS including EHR, icare, CRS. 33
Questions & Discussion 34