Electronic health record - Wikipedia, th…
Electronic health record
From Wikipedia, the free encyclopedia
An electronic health record (EHR) (also electronic patient record (EPR) or computerised patient record) is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations. It is a record in digital format that is capable of being shared across different health care settings, by being embedded in network-connected enterprise-wide information systems. Such records may include a whole range of data in comprehensive or summary form, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, and billing information. Its purpose can be understood as a complete record of patient encounters that allows the automation and streamlining of the workflow in health care settings and increases safety through evidence-based decision support, quality management, and outcomes reporting.
Sample view of an electronic health record based on images
1 Terminology 2 Philosophical views of the EHR 3 History 4 Advantages 4.1 Reduction of cost 4.2 Improve quality of care 4.3 Promote evidence-based medicine 4.4 Record keeping and mobility 5 Disadvantages 5.1 Costs 5.2 Time 6 Governance, privacy and legal issues 6.1 Privacy Concerns 6.2 Legal issues 6.2.1 Liability 6.2.2 Legal Interoperability 6.3 Regulatory compliance 7 Technical issues 7.1 Standards 7.1.1 Customization 7.2 Long-term preservation and storage of records 7.3 Synchronization of records 8 eHealth and teleradiology 9 National contexts 9.1 United States 9.1.1 Incentives and Penalties 9.1.2 Meaningful Use 9.1.3 Start-up costs 9.1.4 Software maintenance costs 9.1.5 Training costs 9.1.6 Implementations 9.2 England 9.3 Australia 9.4 Canada 9.5 Estonia 9.6 UAE 10 See also 11 References 12 External links
Sample view of an electronic health record
 Fast access to medical literature and current best practices in medicine are hypothesised to enable proliferation of ongoing improvements in healthcare efficacy. and 33 percent paid more than $6.000 adverse drug events and save about $1 billion per year if installed in all hospitals. They challenged the Rand Corp. th…
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Improve quality of care
The implementation of electronic health records (EHR) can help lessen patient sufferance due to medical errors and the inability of analysts to assess quality. In a project initiated by the Office of the National Coordinator for Health Information (ONC).Wikipedia. CPOE can tremendously decrease medical errors: CPOE could eliminate 200. but hierarchically ordered and layered. Even though the use of health IT could generate cost savings for the health system at large that might offset the EHR's cost. EHRs improve quality. about a third of respondents paid between $500 and $3. Coordinating these appointments via paper records is a time-consuming procedure. 2009 produced several articles raising doubts about EHR benefits.8/20/2010
Electronic health record . Many international patients travel to US cities with academic research centers for specialty treatment or to participate in Clinical Trials. but not every practice gets that far. national or regional level) so that various systems can easily share information. it might reduce his or her income. In the current global medical environment. During compilation while hospitalisation or ambulant serving of the patient. as well as the need to increase information technology staff to maintain the system. in real life. "Office-based physicians in particular may see no benefit if they purchase such a product—and may even suffer financial harm." If a physician performs tests in the office. surveyors found that hospital administrators and physicians who had adopted EHR noted that any gains in efficiency were offset by reduced productivity as the technology was implemented. Such hurdles can be overcome once the software has some data. Medicare would receive about $23 billion of the potential savings per year. EHR systems are claimed to help reduce medical errors by providing healthcare workers with decision support. A third paid between $3. Naturally. the use of health IT could reduce the number of duplicated diagnostic tests. easing to get access on details is improved with browser capabilities applied to screen presentations also cross referring to the respective coding concepts ICD. depending on what's included. The U. how robust the system is. and not in small physician offices. Realistically. Physicians do tend to see at least short-term decreases in productivity as they implement an EHR. However. Improved usage of EHR is achieved if the presentation on screen or on paper is not just longitudinal. the best practices in software engineering and medical informatics must be deployed. many physicians might not be able to reduce their office expenses or increase their revenue sufficiently to pay for it.
Critics point out that while EHRs may save the "health system" money. those who buy the systems.000 per physician. may not benefit financially. They spend more time entering data into an empty EHR than they used to spend updating a paper chart with a simple dictation. patients whose physicians use them may feel that their privacy is more at risk than if paper records were used. "Given the ease at which information can be exchanged between health IT systems. If savings are allocated using the current level of spending from the National Health Accounts."
…wikipedia. to avoid failures that can cause injury to the patient and violations to privacy. these benefits may only be realized if the EHR systems are interoperable and wide spread (for example. Computerized Physician Order Entry (CPOE)—one component of EHR—increases patient safety by listing instructions for physicians to follow when they prescribe drugs to patients.org/…/Electronic_health_rec…
. For example.
Record keeping and mobility
EHR systems have the advantages of being able to connect to many electronic medical record systems.000 per physician for their EHR. and private payers would receive $31 billion per year. that improvement in efficiency would be unlikely to increase the income of many physicians. estimates of savings. Congressional Budget Office concluded that the cost savings may occur only in large integrated institutions like Kaiser Permanente.
The steep price of EHR and provider uncertainty regarding the value they will derive from adoption in the form of return on investment has a significant influence on EHR adoption. patients are shopping for their procedures. physicians. and how many providers use it. and as workflow in the practice changes.000. Studies also call into question whether. Also.It is also easier to check in their records whether a patient as been admitted to such a medical centre or if they have any allergies since they have been admitted before. EHR price tags range widely. Asked what they paid in an online survey.
Promote evidence-based medicine
EHRs provide access to unprecedented amounts of clinical data for research that can accelerate the level of knowledge of effective medical practices. DRG and medical procedures information. as physicians learn to use templates for data entry.S.
but psychotherapy records can also be disclosed without the client's knowledge or permission. Patricia Galvin. Her therapist had assured her that her records would be confidential. the DHHS takes no action on complaints under HIPAA. but federal investigators report that there is no clear strategy to protect the privacy of patients as the promotions of the electronic medical records expands throughout the United States. Ontario and Quebec. HIPAA has special restrictions on psychotherapy records. habits. th…
One major issue that has risen on the privacy of the U. Different countries may have diverging legal requirements for the content or usage of electronic health records. physician office staff. according to the Journal. Stanford gave the insurer her therapy notes. and the general medical record wasn't covered by HIPAA restrictions. (especially when fundamental legal incompatibilities are involved) Exploring these issues is therefore often necessary when implementing cross-border EHR solutions. One of the most vocal critics of EMRs.” If protection and security are not part of the systems developed.8/20/2010
was considered similar to PIPEDA: Alberta. has claimed that the number of people who will need to have access to such a truly interoperable national system. This liability concern was of special concern for small EHR system makers. Supporters of EHRs have argued that there needs to be a fundamental shift in “attitudes.
Consumer Credit Act 2006 HIPAA Health Level 7
…wikipedia. to check if the fellow has a cocaine habit. and medical records are disclosed under court orders in legal actions such as claims arising from automobile accidents.
Liability Legal liability in all aspects of healthcare was an increasing problem in the 1990s and 2000s. According to the Wall Street Journal.
Electronic health record . So. and the insurer denied her benefits based on what Galvin claims was a misinterpretation of the notes. The surge in the per capita number of attorneys and changes in the tort system caused an increase in the cost of every aspect of healthcare. Accountability among all the parties that are involved in the processing of electronic transactions including the patient. Stanford had merged her notes with her general medical record. In some communities. many companies are moving forward in the development. Appel. Failure or damages caused during installation or utilization of an EHR system has been feared as a threat in lawsuits. however. network for electronic health records is the strategy to secure the privacy of patients. and insurance companies. doctors. Some smaller companies may be forced to abandon markets based on the regional liability climate. mostly removing this legal obstacle. which he estimates to be 12 million.” The privacy threat posed by the interoperability of a national network is a key concern. In 2006. the private sector know the importance of privacy and the security of the systems and continue to advance well ahead of the federal government with electronic health records. standardized formatting of data electronically exchanged and federalization of security and privacy practices among the private sector. exceptions to the Stark rule were enacted to allow hospitals to furnish software and training to community providers. Legal Interoperability In cross-border use cases of EHR implementations. In 2007. people will not trust the technology nor will they participate in it. saw a psychologist at Stanford Hospital & Clinics after her fiance committed suicide.Wikipedia. a lawyer in San Francisco. which can require radical changes of the technical makeup of the EHR implementation in question. By law. British Columbia. the additional issue of legal interoperability arises. Within the private sector. For example.S. But after she applied for disability benefits. is the key to successful advancement of the EHR in the U.S. and healthcare technology was no exception.org/…/Electronic_health_rec…
. awareness. This includes two ideas. A challenge to this practice has been raised as being a violation of Stark rules that prohibit hospitals from preferentially assisting community healthcare providers. hospitals attempt to standardize EHR systems by providing discounted versions of the hospital's software to local healthcare providers. will inevitable lead to breaches of privacy on a massive scale. Former US president Bush called for the creation of networks. establishment and implementation of medical record banks and health information exchange." This is a significant barrier for the adoption of an EHR. Appel has written that while "hospitals keep careful tabs on who accesses the charts of VIP patients. hospitals and other health care providers. Private companies have promised to have “stringent privacy policies and procedures. and capabilities in the areas of privacy and security” of individual’s health records if adoption of an EHR is to occur. companies are required to follow all HIPAA standards and adopt the same information-handling practices that have been in effect for the federal government for years. Larger EHR providers (or government-sponsored providers of EHRs) are better able to withstand legal assaults. New York University Professor Jacob M. the Government Accountability Office reports that there is a “jumble of studies and vague policy statements but no overall strategy to ensure that privacy protections would be built into computer networks linking insurers." they are powerless to act against "a meddlesome pharmacist in Alaska" who "looks up the urine toxicology on his daughter's fiance in Florida.
The field will need to come to consensus on the length of time to store EHRs. insurance companies. There is. thus balancing workloads. Ruotsalainen and Manning have found that the typical preservation time of patient data varies between 20 and 100 years. Olhede and Peterson report that “the basic XML-format has undergone preliminary testing in Europe by a Spri project and been found suitable for EU purposes. which are subject to change over time. but are not limited to. considerations about long-term storage of electronic health records are complicated by the possibility that the records might one day be used longitudinally and integrated across sites of care. hospitals. One proposed solution to the challenge of long-term accessibility and usability of data by future systems is to standardize information fields in a time-invariant way.
Electronic health record ." In addition to the TNA archive described by Ruotsalainen and Manning.org/…/Electronic_health_rec…
. Synchronization programs for distributed storage models. used. overall requirements for the design and security of the system and its archive will vary and must function under ethical and legal principles specific to the time and place. edited. th…
This customization can often be done so that a physician's input interface closely mimics previously utilized paper forms. as in the project www. Again.
Long-term preservation and storage of records
An important consideration in the process of developing electronic health records is to plan for the long-term preservation and storage of these records. The ability of electronic health record systems to provide this function is a key benefit and can improve healthcare delivery.” The required length of storage of an individual electronic health record will depend on national and state regulations. Development and maintenance of these interfaces and customizations can also lead to higher software implementation and maintenance costs. their research "describes a co-operative trusted notary archive (TNA) which receives health data from different EHRsystems. Radiologists will be able to serve multiple health care facilities and read and report across large geographical areas.Wikipedia. To allow for global shared workflow."
Synchronization of records
When care is provided at two different facilities. In one example of how an EHR archive might function. However. The evolution of technology is such that the programs and systems used to input information will likely not be available to a user who desires to examine archived data. and missing records when a non-customized EMR system was utilized. it is certain that length of time will exceed the average shelf-life of paper records.
eHealth and teleradiology
The sharing of patient information between health care organizations and IT systems is changing from a "point to point" model to a "many to many" one. Records have the potential to be created. of course.epsos. other combinations of EHR systems and archive systems are possible. More time must be spent by both the implementation team and the healthcare provider to understand the workflow needs. Customizing the software when it is released yields the highest benefits because it is adapted for the users and tailored to workflows specific to the institution. however. are only useful once record standardization has occurred. and patients. higher costs involved to implementation of a customized system initially. While it is currently unknown precisely how long EHRs will be preserved. The European Commission is supporting moves to facilitate cross-border interoperability of e-health systems and to remove potential legal hurdles. and viewed by multiple independent entities. the market for e-health and teleradiology is evolving more rapidly than any laws or regulations. Mandl et al. The variety of languages spoken is a problem and multilingual reporting templates for all anatomical regions are not yet available. increased overtime. such as with XML language. TNA can store objects in XML-format and prove the integrity of stored data with the help of event records. stores data together with associated meta-information for long periods and distributes EHR-data objects. The biggest challenges will relate to interoperability and legal clarity. Additionally. methods to ensure the future accessibility and compatibility of archived data with yet-to-be developed retrieval systems. and a peer-to-peer file synchronization program (as has been developed for other peer-to-peer networks). Two models have been used to satisfy this problem: a centralized data server solution.8/20/2010
customization. Customization can have its disadvantages. studies will be locked when they are being read and then unlocked and updated once reading is complete. Merging of already existing public healthcare databases is a common software challenge. At the same time they reported negative effects in communication. Spri has advised the Swedish National Board of Health and Welfare and the Swedish National Archive to issue directives concerning the use of XML as the archive-format for EHCR (Electronic Health Care Record) information.
…wikipedia. it may be difficult to update records at both locations in a coordinated fashion. In some countries it is almost forbidden to practice teleradiology.eu/. timestamps and archive e-signatures. These entities include. have noted that “choices about the structure and ownership of these records will have profound impact on the accessibility and privacy of patient information. primary care physicians. and how to ensure the physical and virtual security of the archives.
safety. hospitals and doctors will be subject to financial penalties under Medicare if they are not using electronic health records. Software maintenance costs Furthermore. In the United States. Clinical Laboratory systems). and efficiency standards The detail definition of “meaningful use” is to be rolled out in 3 stages over a period of time until 2015. permanent or temporary.200 per month (including the amortization of startup investment).000 per provider over a five-year period. estimated it achieved net savings of $5 million to $10 million per year following installation of a computerized physician order entry system that reduced serious medication errors by 55 percent. In order to receive the EHR stimulus money. there are no penalty provisions for Medicaid. Some physicians are skeptical of such published cost-savings claims. Older practitioners who are less experienced in the use of electronic health record systems will retire over time.8 million annually by establishing electronic access to laboratory results and reports. just as for training in the use of any other hospital system. panelists estimated that purchasing and installing EHR will cost over $32. th…
to 3% over 3 years. Physicians desire modular upgrades and ability to continually customize. Training costs Training of employees to use an EHR system is costly. Healthcare vendors are pushing HIE as a way to allow EHR systems to pull disparate data and function on a more interoperable level.6 million in annual savings by replacing paper medical charts with EHRs for outpatients and about $2.org/…/Electronic_health_rec…
Electronic health record . the HITECH act (ARRA) requires doctors to show "meaningful use" of an EHR system. A study of the effects of EHRs in primary care settings published in the American Journal of Medicine estimated net benefits from EHR use of over $86.000 per physician. and maintenance about $1. With the widespread adoption of the Veterans Health Information Systems and Technology Architecture (VistA) electronic health record system at all VA facilities. Vendor costs account for 60-80% of these costs. Start-up costs In a 2006 survey.Wikipedia. will also require training as they are hired.g. New employees. Health information exchange (HIE) has emerged as a core capability for hospitals and physicians to achieve "meaningful use" and receive stimulus funding. Some proponents of EHR systems suggest that startup costs will be recouped within 3 years. Brigham and Women’s Hospital in Boston. Starting in 2015. Details of each stage are hotly debated by various groups. without large-scale reimplementation. A November 2006 survey of a widely available open source EHR reported startup costs of only $1083 – $7500/provider and $67 – $750/month per provider. a substantial majority of healthcare providers train at a VA facility sometime during their career. Costs for upgrades and associated regression testing can be particularly high where the applications are governed by FDA regulations (e. however. lack of adequate funding was cited by 729 health care providers as the most significant barrier to adopting electronic records. Some types of software and operating systems require full-scale re-implementation periodically. As of June 2010. Another large hospital generated about $8. few recently-trained medical professionals will be inexperienced in electronic health record systems. Implementations
…wikipedia. Massachusetts. There are exceptions. At the American Health Information Management Association conference in October 2006. Most software systems require frequent updates. Meaningful Use The meaningful use of EHRs intended by the US government incentives is categorized as follows: Improve care coordination Reduce healthcare disparities Engage patients and their families Improve population and public health Ensure adequate privacy and security The Obama Administration’s Health IT program intends to use federal investments to stimulate the market of electronic health records: Incentives: to providers who use IT Strict and open standards: To ensure users and sellers of EHRs work towards the same goal Certification of software: To provide assurance that the EHRs meet basic quality. often at a significant ongoing cost. They believe the data is skewed by vendors and by others who have a stake in the success of EHR implementation. which disrupts not only the budget but also workflow. Only stage 1 has been defined while the remaining stages will evolve over time. software technology advances at a rapid pace. Many are resistant to invest in a system which they are not confident will provide them with a return on their investment.
and federal governments.
Estonia is the first country in the world that has implemented a nationwide EHR system. the LDSI is currently limited in its scope.P. This software called 'CONNECT' uses Nationwide Health Information Network standards and governance to make sure that health information exchanges are compatible with other exchanges being set up throughout the country.pubmedcentral. The goal of the NHS is to have 60.org/ASP/topics_ehr.
Australia is dedicated to the development of a lifetime electronic health record for all its citizens.Electronic Health Record (EHR) (http://www.fcgi? artid=1550638) in J Med Internet Res 7(1) 2. HealthConnect is the major national EHR initiative in Australia. especially allergy and pharmaceutical information.000. EHRs.22(4):99-101.” Unlike the CHDR.Wikipedia. One attribute for the start of implementing EHRs in the States is the development of the Nationwide Health Information Network which is a work in progress and still being developed. and is made up of territory.8/20/2010
Electronic health record . states. 4 ^ El t i H lth R d O i (htt // ih / bli ti /i f ti /EHR df)
The Canadian province of Alberta started a large-scale operational EHR system project in 2005 called Alberta Netcare. giving full access of it to its citizens. the National Health Service (NHS) in the United Kingdom also began an EHR system. allowing all of the VA facilities to access and interpret the patient records. and Terry. The Laboratory Data Sharing and Interoperability (LDSI) application is a new program being implemented to allow sharing at certain sites between the VA and DoD of “chemistry and hematology laboratory tests. The CONNECT initiative is a Federal Health Architecture project that was conceived in 2007 and initially built by 20 various federal agencies and now comprises more than 500 organizations including federal agencies. However. MediConnect is a related program that provides an electronic medication record to keep track of patient prescriptions and provide stakeholders with drug alerts to avoid errors in prescribing.nih. CONNECT is an open source software solution that supports electronic health information exchange.himss. healthcare providers. and health IT vendors.D. The US Indian Health Service uses an EHR similar to VistA called RPMS. T. May 2010. state. the plan has been greatly delayed and frequently criticised. The program shares data by translating the various vocabularies of the information being transmitted. The plan involves a gradual roll-out commencing May 2006. The Department of Veterans Affairs works with Kaiser Permanente to further develop a software which allows to share information with private health care providers. 2005 The Emergence of National Electronic Health Record Architectures in the United States and Australia: Models. N. VistA Imaging is also being used to integrate images and co-ordinate PACS into the EHR system. Costs. meaningful use. between the Department of Veteran Affairs (VA) and the Department of Defense (DoD) in the United States. 
Continuity of Care Record DICOM Electronic medical record eMix European Institute for Health Records (EuroRec) Health informatics Health information management EN 13606 Personal health record List of open source healthcare software Health information exchange
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As of 2005. th…
Clinical Data Repository/Health Data Repository (CDHR)is a program that allows for sharing of patient records. 
Abu Dhabi is leading the way in using national EHR data as a live longitudinal cohort in the assessment of risk of cardiovascular disease.consultantlive. insurers.gov/articlerender. This started with the North Carolina Healthcare Information and Communication Alliance founded in 1994 and who received funding from Department of Health and Human Services. providing general practitioners in England access to the National Programme for IT (NPfIT). and a model EMR (http://dbt. ^ Gunter. Drug Benefit Trends.asp) 3.
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