Health Management Information

Systems
Health Information Systems Overview

Lecture b
This material (Comp 6 Unit 2) was developed by Duke University, funded by the Department of Health and Human Services, Office of
the National Coordinator for Health Information Technology under Award Number IU24OC000024. This material was updated by
Normandale Community College, funded under Award Number 90WT0003.

This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of
this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
 Health Information Systems
Overview Learning Objectives
• Examine the challenges presented by
emerging trends in information technology,
social media, and global communications;
and
• Discuss the advantages and
disadvantages of using the Internet as a
platform for health care applications.

2
 Impact of Emerging Technologies

• Convergence of media and emergence of

the Internet results in a networked
communication infrastructure
• Facilitates access to health information
and health-related support services
• Expands the communication choices for
health professionals, patients, and
consumers
3
 IT Trends

• Tele-technology
• IT Security
• Interoperability
• Mobile technology
• Social media
• Cloud-based technology

4
 Social Media

• Social networks
• Blogs
• Forums
• Wikis
• Photo video
• Podcasts

5
 Cloud-Based Technology

• Computing where data and services are

delivered via the Internet
– Systems typically not maintained and stored
at the place of use
– Example: Google Docs and other document
storage sites.

6
 Challenges Presented

• Concerns with privacy and security

• Risk of liability
• Lack of law or legislation governing the
boundaries
• Lack of payment for engagement
• Lack of frequent data updates
• Resistance by health care providers
7
 Impact of the Internet

• Increase in informed consumers

• Availability of online PHRs
• New forms of communication
• Accessibility of health care products for
purchasing

8
 Internet Advantages

• Cost effective
• Faster deployment
• Little or no IT support needed
• Designed for sharing
• Better technology for mobile computing

9
 Internet Disadvantages

• Privacy
– The right of a patient to control disclosure of
protected health information
• Security
– Access control and protection
• Scalability
– System growth with user/data growth

10
 Health Information Systems
Overview Summary
• Definition of an information system and its
characteristics
• Types of information systems that support
the health care enterprise requirements
• Types of technologies that support health
care information systems
• Challenges of emerging trends
• Advantages and disadvantages of using
the Internet
11
 Health Information Systems Overview
References – Lecture b
References
American Medical Informatics Association (AMIA). (2013). Glossary or acronyms and terms commonly
used in informatics. Retrieved from https://www.amia.org/glossary
Centers for Disease Control and Prevention. (2011, May). Social media at CDC. Retrieved from
http://www.cdc.gov/SocialMedia/Tools/
CDC and the National Cancer Institute . (2011, May). Health communication basics. Retrieved from
http://www.cdc.gov/healthcommunication/HealthBasics/WhatIsHC.html
Daniel, H., & Snyder Sulmasy, L. (2015). American College of Physicians: Policy Recommendations to
Guide the Use of Telemedicine in Primary Care Settings: AN American College of Physicians
Position Paper. Retrieved from http://annals.org/article.aspx?articleid=2434625
Mell, P., & Grance, T. (2009, October). The NIST definition of cloud computing. Retrieved from
http://www.nist.gov/itl/cloud/upload/cloud-def-v15.pdf
Kaplan, A. M. & Haenlein, M. (2010). Users of the world unite! The challenges and opportunities of
social media. Business Horizons 53(1), 59-68.
U.S. Department of Health and Human Services. (2000). Healthy people 2010: Objectives for
improving health. Retrieved from
http://www.healthypeople.gov/2010/Document/tableofcontents.htm#volume1
U.S. Department of Health and Human Services. (2006, June). Expanding the reach and impact of
consumer e-Health tools. Retrieved from
http://www.health.gov/communication/ehealth/ehealthtools/pdf/ehealthreport.pdf

12
Health Management Information
Systems
Electronic Health Records

Lecture a
This material (Comp 6 Unit 3) was developed by Duke University, funded by the Department of Health and Human Services, Office of
the National Coordinator for Health Information Technology under Award Number IU24OC000024. This material was updated by
Normandale Community College, funded under Award Number 90WT0003.

This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of
this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
 Electronic Health Records
Learning Objectives
1. State the similarities and differences between an
electronic medical record (EMR) and electronic health
record (EHR)
2. Identify attributes and functions of an EHR
3. Describe the perspectives of health care providers and
the public regarding acceptance of or issues with an
EHR, which can serve as facilitators of or major barriers
to its adoption
4. Explain how the use of an EHR can affect patient care
safety, efficiency of care practices, and patient
outcomes

14
 Electronic Medical Record (EMR)

• Electronic record of health-related

information on an individual
– Within one health care organization

15
 EMR Purpose

• Provide an electronic equivalent of an

individual’s legal medical record
– Intra-organizational

16
 Purpose of a Patient (Medical) Record

• “To recall observations, to inform others,

to instruct students, to gain knowledge,
to monitor performance, and to justify
interventions”
• Serves as the legal business record

17
 Electronic Health Record (EHR)

• Electronic record of health-related

information on an individual
– Across more than one health care
organization

18
 EHR Purpose

• Provide an electronic equivalent of an

individual’s health record for use by
providers and staff across more than one
health care organization
• Support efficient, high-quality integrated
health care, independent of the place and
time of health care delivery

19
 EMR Versus EHR
EMR EHR
A record of medical care created, A repository of individual health
managed, and maintained by one records that reside in numerous
health care organization (intra- information systems and locations
organizational) (inter-organizational)
Integration of health care data from a Aggregation of health-related
participating collection of systems from information into one record focused
one health care organization around a person’s health history, i.e.,
a comprehensive, longitudinal record
Consulted by authorized clinicians and Consulted by authorized clinicians and
staff within one health care staff across more than one health care
organization. organization
Data continuity throughout one health Data interoperability across different
care organization organizations

Table 3.1
20
EMR and EHR Comparison
 EHRs Versus Paper Records

• EHRs can make a patient’s health information

available when and where it is needed
• EHRs can bring a patient’s total health
information together in one place, and always be
current
• EHRs can support better follow-up information
for patients
• EHRs can improve patient and provider
convenience

21
 EHRs Versus Paper Records – 2

• EHRs
– Can link information with patient computers to
point to additional resources
– Don’t just “contain” or transmit information,
they also compute with it
– Can improve safety

22
 EHRs Versus Paper Records - 3

• EHRs can
– Deliver more information in more directions
o While reducing “paperwork” time for providers

– Improve privacy and security

– Reduce costs

23
 Attributes of an EHR

• Provides secure, reliable, real-time access

to patient health record information, where
and when it is needed to support care
• Captures and manages episodic and
longitudinal electronic health record
information

24
 Attributes continued (2)

• Functions as clinicians’ primary information

resource during the provision of patient care
• Assists with the work of planning and delivering
evidence-based care to individual and groups of
patients
• Supports continuous quality improvement,
utilization review, risk management, and
performance monitoring

25
 Attributes continued (3)

• Captures the patient health-related

information needed for reimbursement
• Provides longitudinal, appropriately
masked information to support clinical
research, public health reporting, and
population health initiatives
• Supports clinical trials

26
 HL7 EHR Functions

• Direct care functions

• Supportive functions
• Information infrastructure functions

27
 Direct Care Functions
Subset Examples
Manage clinical history Manage lists of clinical history
Manage allergy list
Manage medication history
Manage orders Medication orders
Manage lab test orders
Manage blood product orders
Dietary orders
Manage sets of orders for specific
diagnoses
Manage care coordination and Provide functionality to coordinate
reporting care with other providers
Communicate the care provided to
other providers

Table 3.2 28
HL7 2014 EHR-S Functional Model Care Provisions Subsets with Examples
 Administrative Support Functions

• Manage Patient Demographics

• Manage Communication
• Manage Provider Information

29
 Other EHR Functions
• Care Provision Support Functions
– Includes record management, functions that support result
reporting, and support for patient education
• Population Health Support Functions
– Support for health maintenance and prevention, donor
management, and public health related updates
• Record Infrastructure Functions
– This includes record lifecycle, record synchronization, and
record archive and restore functions
• Trust Infrastructure Functions
– This important functional area includes security, audit and
database backup and recovery features

30
Standards for Certification of EHR
Technology
• Content exchange standards
– NCPDP SCRIPT Standard
– HL7 Clinical Document Architecture (CDA), CCD

• Vocabulary standards
– SNOMED CT
– LOINC
• Privacy and security standards
– NIST encryption algorithm
– NIST hashing algorithm

31
 EHR Acceptance

• Health care provider

– Increasing momentum for widespread
adoption and implementation of EHRs
o Changing reimbursement for patient care, focusing
on managing patients across the continuum of
care and between providers
o Authorized Testing and Certification Body by the
Office of the National Coordinator

32
 EHR Acceptance - 2

• Public
– Ancker, et al (2013) surveyed the public on
their perceptions of electronic health records
o Improved quality
§ 66% thought EHRs would improve quality of care
§ Particularly true for patients whose doctor had an EHR in
use
o Concern over
§ Privacy, but not correlated with patients whose doctor
used an EHR

33
 EHR Acceptance: Public

• Harris Interactive Survey

– All physicians treating me should have access
to information contained in my EMR
o Percent answering "Strongly/Somewhat Agree"
§ 78% in 2009
§ 78% in 2010
– An EMR would be a valuable tool to track the
progress of my health
o Percent answering "Strongly/Somewhat Agree"
§ 72% in 2009
§ 71% in 2010
34
 Barriers to Adoption

• Cost of conversion
• Perceived lack of ROI
• Technical and logistical challenges
• Privacy and security concerns

35
EHR Effect on Patient Care Safety

• Reduces the need to repeat tests

• Reduces the number of lost reports
• Supports provider decision making

36
 EHR Effect on Efficiency

• Improves accessibility of patient

information
• Integrates data from multiple internal and
external sources
• Facilitates the coordination of health care
delivery
• Provides the ability to “hard wire”
processes

37
 EHR Effect on Patient Outcomes

• Has the potential to

o Improve the quality of patient care
o Help providers practice better medicine
o Provide seamless exchange of information among
providers
o Improve patient engagement in their own care

38
 Electronic Health Records
Summary – Lecture a
• Defined an EMR and EHR
• Explained similarities and differences
• Identified EHR attributes and functions
• Discussed the issues surrounding EHR
adoption and implementation
• Described the impact of EHRs on patient
care

39
 Electronic Health Records
References – Lecture a
References
AHIMA e-HIM Work Group on Maintaining the Legal EHR. (2005). Update: Maintaining a legally sound
health record—paper and electronic. Journal of AHIMA 76(10), 64A-L. Retrieved from
http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_028509.hcsp?dDocName=b
ok1_028509
Ancker, J., Silver, M., Miller, M., & Kaushal, R. (2013, January 1). Consumer experience with and
attitudes toward health information technology: A nationwide survey. Journal of American Medical
Informatics Association, Jan 2013, 20 (1) 152-156
Blumenthal, D. (2009, April 9). Stimulating the adoption of health information technology. New England
Journal of Medicine 360,1477-1479. Retrieved from
http://www.nejm.org/doi/full/10.1056/NEJMp0901592
Handler, T., Holtmeier, R., Mtezger, J., Overhage, M., Taylor, S., & Underwood, C. (2003, July 7).
HIMSS electronic health record definitional model version 1.0. Retrieved from
http://www.providersedge.com/ehdocs/ehr_articles/HIMSS_EMR_Definition_Model_v1-0.pdf
Health Information Technology: Initial Set of Standards, Implementation Specifications, and
Certification Criteria for Electronic Health Record Technology; Final Rule, 45 CFR Part 170 (July
28, 2010). Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf
Harris Interactive. (2010, June 17). Few Americans using 'E-' medical records. Retrieve from
http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/ctl/ReadCustom%20Default/mi
d/1508/ArticleId/414/Default.aspx
Health Level Seven International. (n.d.). About HL7. Retrieved from
http://www.hl7.org/about/index.cfm?ref=nav
40
 Electronic Health Records
References – Lecture a, continued
References
Health Level Seven International. (n.d.). About HL7. Retrieved from
http://www.hl7.org/about/index.cfm?ref=nav
Health Level Seven International. (2014). HL7 2007 EHR-S functional model, Release 2. Retrieved
from http://www.hl7.org/ehr/downloads/index.asp
Radiological Society of North America. (2005, September). IHE moves EHR goals forward. Retrieved
from http://www.rsna.org/Publications/rsnanews/sep05/ihe.cfm
Reiser, S. J. (1991). The clinical record in medicine. Part 1:Learning from cases. Annals of Internal
Medicine, 114, 902-907.
The National Alliance for Health Information Technology. (2008, April 28). Defining key health
information technology terms. Retrieved from
healthit.hhs.gov/portal/server.pt/gateway/PTARGS_0_10741_848133_0_0_18/10_2_hit_terms.pdf
U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. (2010,
July13). Electronic health records at a glance. Retrieved from
https://www.cms.gov/apps/media/press/factsheet.asp?Counter=3788&intNumPerPage=10&check
Date=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkN
ewsType=6&intPage=&showAll=&pYear=&year=&desc=false&cboOrder=date

Charts, Tables, Figures

3.1 Table: EMR and EHR Comparison
3.2 Table: HL7 2007 EHR-S Functional Model Direct Care Functions Subsets with Examples
41
Health Management Information
Systems
Electronic Health Records

Lecture b
This material (Comp 6 Unit 3) was developed by Duke University, funded by the Department of Health and Human Services, Office of
the National Coordinator for Health Information Technology under Award Number IU24OC000024. This material was updated by
Normandale Community College, funded under Award Number 90WT0003.

This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of
this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/
 Electronic Health Records
Learning Objectives
1. Discuss how Health Information Exchange (HIE) and
Nationwide Health Information Network (NwHIN) impact
health care delivery and the practice of health care
providers
2. Outline issues regarding governmental regulation of
EHR systems, such as meaningful use of interoperable
health information technology and a qualified EHR
3. Summarize how the Institute of Medicine’s Vision for
21st Century Health Care and Wellness may impact
health management information systems
4. Identify how ongoing developments in biomedical
informatics can affect future uses and challenges
related to health information systems 43
 Health Information Exchange
(HIE)
• Electronic movement of health-related
information among organizations
according to nationally recognized
standards
– It is important to not confuse the “verb” HIE
with the “noun” HIE. The verb expresses the
process of exchanging information, whether
via a centralized database or via point-to-point
exchange. The noun describes a database
which stores health information and facilitates
exchange. 44
 Perspectives on Health
Information Exchange
• Models of HIE architecture
– Centralized
o Shared repository

– Federated
o Or decentralized
o Data source organization maintains custodianship
and control over the patient’s medical record
– Hybrid
o Mixture

45
 HIE Impact

• Health care delivery

– Clinical and financial
– Patient satisfaction
• Practice of health care providers
– Real-time patient data at the point-of-care
– Access to patients’ longitudinal test results
– Productivity gains

46
 Nationwide Health Information
Network (NwHIN)
• Standards
• Protocols
• Legal agreements
• Specifications
• Services

47
 Nationwide Health Information
Network

(HHS, 2010, p. 6)
48
 Perspectives on the NwHIN

• Helps achieve the goals of HITECH

• Critical part of the national health IT
agenda
• Enable health information
– To follow the consumer
– Be available for clinical decision making
– To support appropriate use of health
information

49
 NwHIN Evolution

• Driven by emerging technology, users,

uses, and policies
• NHIN Direct Project
– Expand the standards and service
descriptions available
– Address the key Stage 1 requirements for
Meaningful Use
– Provide an easy "on-ramp"

50
 Impact of NwHIN

• Health care delivery

– Establishes a standards-based infrastructure
– Increases the ability to collect and store
aggregated data
• Practice of health care providers
– Provides a care coordination exchange
platform

51
 Governmental Efforts Related to
EHRs
• Office of the National Coordinator for Health
Information Technology (ONC) Initiatives
– Nationwide Health Information Network (NwHIN)
– State-Level Health Initiatives
o State Health Policy Consortium (SHPC)
o State-level Health Information Exchange Consensus Project
o State Alliance for e-Health
o Health Information Security and Privacy Collaboration
(HISPC)

52
 Governmental Efforts Related to
EHRs
• ARRA
– HITECH Programs
o Meaningful use of interoperable health information
technology and qualified EHRs
§ Certified electronic health record technology
§ “Qualified EHR”
– HIT Advisory Committees

53
 Governmental Efforts Related to
EHRs
• Office of the National Coordinator for
Health Information Technology Authorized
Testing and Certification Body (ONC-
ATCB)
– Established to ensure that “Certified EHR
Technology” will be available for adoption

54
 Certified EHR Technology

• Complete EHR or a combination of EHR

Modules, each of which:
– Meets the requirements included in the
definition of a Qualified EHR; and
– Has been tested and certified in accordance
with the certification program established by
the National Coordinator as having met all
applicable certification criteria adopted by the
Secretary

55
 “Qualified EHR” Definition

– Electronic record of health related information

o Patient demographic and clinical health information

– Capacity to provide specific functions

56
 Governmental Efforts Related to
EHRs
• Federal Advisory Committees
– HIT Policy Committee
– HIT Standards Committee

57
 A Vision for 21st Century Health
Care and Wellness
• IOM vision
– Systematically organized and acculturated
health care system
– Easy and rewarding for providers and patients
to do
o The right thing
o At the right time
o In the right place
o In the right way

58
 Information-Intensive Aspects of
IOM’s Vision
• Important health care IT capabilities
– Comprehensive data on patients’ conditions,
treatments, and outcomes
– Cognitive support for health care
professionals and patients
– Cognitive support for health care
professionals
– Instruments and tools

59
 Information-Intensive Aspects of
IOM’s vision
• Important health care IT capabilities
– Rapid integration of new instrumentation,
biological knowledge, treatment modalities,
etc.
– Accommodation of the growing heterogeneity
of locales for the provision of care
– Empowerment of patients and their families in
effective management of health care
decisions and execution

60
 Guiding Principles of IOM’s Vision

• Principles for evolutionary change

– Focus on improvements in care
– Seek incremental gain from incremental effort
– Record available data
– Design for human and organizational factors
– Support the cognitive functions of all
caregivers

61
 Guiding Principles of IOM’s Vision

• Principles for radical change

– Architect information and workflow systems
– Archive data for subsequent re-interpretation
– Create technologies that identify and
eliminate ineffective work processes
– Create technologies that clarify the context of
data

62
 Electronic Health Records
Summary
• Defined an EMR and EHR
• Explained similarities and differences
• Identified EHR attributes and functions
• Discussed the issues surrounding EHR adoption
and implementation
• Described the impact of EHRs on patient care
• Addressed external influences

63
 Electronic Health Records
References – Lecture b
References
Department of Health and Human Services. (n.d.). Nationwide health information network: Background
and scope. Retrieved from https://www.healthit.gov/policy-researchers-implementers/nwhin-
history-background
Department of Health and Human Services. (2011, November 7). EHR incentive programs overview.
Retrieved from https://www.cms.gov/ehrincentiveprograms/#BOOKMARK1
Healthcare Information and Management Systems Society. (2009, March). Health information
exchanges: Similarities and differences. Retrieved from http://www.himss.org/health-information-
exchanges-similarities-and-differences
Health Information Technology for Economic and Clinical Health Act of 2009. Public Law 111-5,
Section 3000(13) (2009a).
Health Information Technology for Economic and Clinical Health Act of 2009. Public Law 111-5,
Section 3001(b) (2009b).
Health Information Technology: Initial Set of Standards, Implementation Specifications, and
Certification Criteria for Electronic Health Record Technology; Final Rule, 45 CFR Part 170 (July
28, 2010). Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf
Stead W.W., & Lin H.S. (eds.). (2009). Computational technology for effective health care: Immediate
steps and strategic directions. Washington (DC): National Academies Press.
The Direct Project. (2010, October 11). The direct project overview. Retrieved from
http://wiki.directproject.org/file/view/DirectProjectOverview.pdf
64
 Electronic Health Records
References – Lecture b
References
The Office of the National Coordinator for Health Information Technology. (2010, August). State-Level
initiatives. Retrieved from
http://healthit.hhs.gov/portal/server.pt/community/healthit_hhs_gov__state_level_initiatives/1154
The Office of the National Coordinator for Health Information Technology. (2010, September). HITECH
temporary certification program for EHR technology. Retrieved from
https://www.healthit.gov/sites/default/files/hie-interoperability/ehr-certification-program-data-
sheett.pdf
The Office of the National Coordinator for Health Information Technology. (2011, November). Health IT
policy committee. Retrieved from https://www.healthit.gov/facas/health-it-policy-committee
The Office of the National Coordinator for Health Information Technology. (2011, November). Health IT
standards committee. Retrieved from https://www.healthit.gov/facas/health-it-standards-committee
The Office of the National Coordinator for Health Information Technology. (2017). Health IT Terms.
Retrieved from https://www.healthit.gov/policy-researchers-implementers/glossary
Images
Slide 7: Department of Health and Human Services. (2010, April). Nationwide health information
network (NHIN) exchange architecture overview DRAFT v.0.9. Retrieved from
https://www.healthit.gov/sites/default/files/nhin-architecture-overview-draft-20100421-1.pdf

65