12 - Electronic health records, computerized physician order entry (CPOE) and electronic prescribing Flashcards Preview

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1

Describe the historical evolution of the medical record​

JUST Diagnosis & Treatment
then
Paper-Based Medical records
many issues
2000s --> wave of medical errors / deaths
ELECTRONIC HEALTH RECORDS
2009 -> Obama --> EHR requirements
then
2014 --> 70% of PCP with EHR

2

•Define types of electronic patient records and systems

Electronic Medical Record = EMR
medical record in digital format = standard medical/clinical data

Electronic Health Record = EHR
ULTIMATE LEVEL in computerized parient reords
has comprehensive patient history --> accessed by patients
across >1 health care organization

Personal Health Records = PHR
just managed by patient

3

•List potential benefits of electronic health records (EHR)

File Sharing

Test Results UPDATED

FILING
correct / chronological order
filed in one place

EASILY RETRIEVABLE

4

•List potential CHALLENGES of electronic health records (EHR)

Lack of USER-FRIENDLINESS

lack of Interoperability

COST

inability to CUSTOMIZE w/o ventdor help

INTERFERENCE w/ patient information

5

•Identify the required functions of a comprehensive EHR

"Meaningful Use"

Medicare EHR Insentive Program

defined as the use of EHR in a meaningful manner:

–Improving quality, safety, efficiency, and reducing health disparities

Engage patients and families in their health

–Improve care coordination

–Improve population and public health

Ensure adequate privacy and security protection for personal health information

6

•Describe trends in adoption of EHR in the US

INCREASED SIGNIFICANTLY
4/5 hospitals have basic EHR system

due to 
PAYMENT INCENTIVES
from the government
Record Adoption / Meaningful Use

7

HITECH 

The Health Information Technology for Economic and Clinical Health Act 

provided HHS with the authority to establish programs
to IMPROVE 
health care quality / safety / efficiency
through the 
PROMOTION OF HEALTH TECHNOLOGY

Incentive payments through MEDICARE / MEDICAID
when they use EHR's privately/securely

MEANINGFUL USE OF EHR

8

ONC 
 Office of the National Coordinator of Health IT

HEALTH IT CERTIFICATION PROGRAM

came in response to HITECH from HHS 
(health and human services)

containing many detailed requirements,
designed primarily to assure that such technology could support provider qualification for federal incentives
under the CMS EHR Incentive Programs

9

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

 

END of the Meaningful Use Program Incentives
VVV
integrated into the 
Medicare Quality Payment Program = QPP

10

MIPS

Merit Based Incentive Payment System
that integrated:
Meaningful Use = Medicare EHR Incentive Program
+
VBPM Value Based Payment Modifier
+
PQRS = Physician Quality Reporting Program

11

Federal HIT Strategic Plan, 2015-2020

Health Information Technology's
Plan to

guide the nation's shift toward focusing on better health and delivery system reform

SHARED UNDERTAKING
need efforts of state / local / other stakeholders

12

Key principles to guide future oversight framework

Health IT & Digital Health

encourage INNOVATION

be RISK-BASED

be STABLE + PREDICTABLE

be ACCOUNTABLE to the public & be enforceable

LEANRING HEALTH SYSTEM
continuous improvement / innovation

13

Disadvanteges of EHR to 
practice's daily operations

Spending too much time ENTERING DATA
that is NOT directly related to patient care/outcomes

Disrupt practice workflow

EYE CONTACT --> patients

 

14

Benefits of PHR

Patient Health Records

EMPOWER patients to be more involved with own Healthdecisions

PROMOTES SELF CARE & RESPONSIBILITY

15

Challenges of PHR

Patient Health Record

CONSUMER
Awareness / Literacy / Access
Percieved advantages / TRUST

INDUSTRY
EMR inter-operability
certification / security+privacy
sustainability

16

Trends in Individuals Use of Health IT:

2012 - 2014
 

Almost Half of Americans used a
Selected Type of Health IT

in 2014

apps / patient portals / websites

17

Stage 2 of "Meaningful Use"

Advance Clinical Process
2014

INCREASED REQUIREMENTS for E PRESCRIBING

18

CPOE

 

Lab Reports / Radiology Tests
Medications / Consultation Requests

Nursing orders

Computer Provider Order Entry

often used in Hospitals / institutional settings
enter ORDERS into COMPUTER rather than writing

CPOE Systems INTERCEPT ERRORS
can integrate orders w/ patient information

19

 

CDSS

Clinical Decision Support System

any piece of software 
that takes as input information about a clinical situation 
and that produces output inferences that 
can ASSIST practitioners in their
Decision making & be JUDGED as INTELLIGENT
by the program's users

20

CDSS Functions

Integrated into CPOE
default values --> drug doses / routes / frequencies
checks --> allergies / drug-lab value / DI's
reminders
drug guidelines

or STAND ALONE
to provide advice on:
drug selection / dosage / duration

21

CDS

Clinical Decision Support

Order-Patient Interaction

Ex.
Med-Lab Alert = HEPARIN ALERT
DDI = drug-drug interaction alert
Assessment Prompts

22

July 2006 Institute of Medicine Report:
Recommended that all healthcare organizations use
 electronic prescribing systems
and other technologies by 2010 to prevent medication errors

CPOE + CDSS

ONLY <2% of hospitals
 
had FULLY implemented CPOE systems
17% had CPOE in 1 inpatient unit

21.7% of hospitals
reported SOME LEVEL of CPOE

"Leapfrog's Standard"

23

BENEFITS of

CPOE / CDSS

HALF of medication errors occur @ the stage of DRUG ORDERING
can reduce errors by 50%+

CPOE can also REDUCE:
length of stay / repeat tests / turnaround lab times
COST

24

Potential for HARM

of CPOE +/- CDSS

•Incorrect default dosing suggestion

•Entering data for wrong patient

ALERT FATIGUE

–Sensitivity: the ability of capturing true errors

–Specificity: the ability of not setting off false alarm

Hardware, software instability

25

Sensitivity vs Specificity

in terms of CPOE / CDSS 
Warnings / Alarms

ALERT FATIGUE

Sensitivity:
the ability of capturing TRUE ERRORS

 

Specificity:
the ability of NOT setting off FALSE ALARMS

26

E-prescribing:
Potential benefits

•Decrease in medication errors

•Time savings

•Patient convenience

Prompts for drug-specific dosing information

•Expedited refill requests

Facilitated communication
between physicians, pharmacists, and others

Validated third-party coverage for formulary drugs

•Reduced costs

Vital patient-specific information

More accurate drug databases; checks for interactions

27


Barriers to increased electronic prescribing
 

•Insufficient staff training

Clinician resistance:
may take more time to type than handwrite; physician culture

Connectivity not universal

Costs of setting up and maintaining system

Transaction fees

Software vendor readiness
(becoming less problematic)

28

Surescripts

LARGEST Electronic Prescribing Network
networked sytem for electronically accessing

PBM & Prescription History
as well as for
Electronically ROUTING prescriptions --> patient's pharmacy

29

NCPDP SCRIPT Standard

 Standard created by the National Council for Prescription Drug Programs

there is NOT 1 absoulte standard for EDI
(electronic data interchange)

Standards for electronic transmission of prescriptions
from prescriber to pharmacy
most widely accepted = SCRIPT by NCPDP
 see www.ncpdp.org

30

What has been Driving the Growth in e-Rx ?

Government Incentives
MIPPA = Medical improvement for Phys / Providers Act
HITECH = Health information technology for Economic + Clinical Health

Broadening of Certification Programs
CCHIT

Gvmt + NGO education + awareness programs

STATE & Regional level INITIATIVES

Payer / PBM initiatives