The Computable Patient Record; eMR 5.0 The Next Generation · 2018-05-03 · The Computable Patient...
Transcript of The Computable Patient Record; eMR 5.0 The Next Generation · 2018-05-03 · The Computable Patient...
Family Medicine Forum 2014 Workshop Saturday November 15th 2014
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The Computable Patient Record; eMR 5.0 The Next Generation J. Hughes; S. Simkus; A. Singer; M. Cotran; SYMBA The title of this workshop is based on the definition of the Gartner Fifth Generation electronically enabled medical record (eMR) called the “Mentor”
1st: The Collector - simple systems that provide a site-specific solution for the need to access clinical data which is imported through scanning or other forms of aggregation
2nd: The Documenter - basic systems that clinicians use at the point of care to adequately document rather than merely access clinical data
3rd: The Helper - Systems that include episodic and encounter data and use decision support tools to assist clinicians, functional in at the minimum both ambulatory and inpatient settings
4th: The Partner - Advanced systems that provide more decision support capabilities and that are operational and accessible across the continuum of care, and providing sufficient credibility as to become the patient's legal medical record
5th: The Mentor - Complex and fully integrated systems that include all previous capabilities and that are a main source of decision support in guiding patient care for both clinicians and consumers
The average eMR in Canada today functions at a level that is stuck between the first and third generations. Clinicians have unreasonable expectations for their eMRs because the profession has not taken the time and effort to specify what is required of these complex applications and have been offered electric versions of the paper record. “The problems of healthcare are rapidly approaching crisis proportions… The application of computer technology offers hope, but… will require a
much greater commitment than is presently true of the medical academic community.”
G. Octo Barnett 1969 (Founder Massachusetts General Hospital Computer Laboratory)
Family Medicine Forum 2014 Workshop Saturday November 15th 2014
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To be satisfied with our eMRs the clinical information and process content of the medical record must be specified sufficiently to make it computable;
• To get past the document manger EMR and achieve the “quality and productivity revolutions” seen elsewhere in society with computer technology we need machine “computation” of the medical record
S: (n) calculation, computation, computing (the procedure of calculating; determining something by mathematical or logical methods) AND We must reinvent the processes of clinical information gathering, storing, processing and retrieval; this is the science of “Informatics”
• “merely automating the form, content and procedures of the current patient records will perpetuate their deficiencies and will be insufficient to meet emerging user needs”
• R.S. Dick;; E.B. Stein: “The Computer Based Patient Record;; An Essential Technology for Health Care”;; Institute of Medicine, National Academy of Science 1991
To achieve this reinvention we must not only study what is;
• “If communities were the size of cells and if hospitals, pharmacies, laboratories, patients and physicians were the size of sub cellular particles,
• no doubt they would be the subjects of a great deal of research, and much more would be known about their relationships and pathophysiology.” Weed, Lawrence;; “Medical Records, Medical Education, and Patient Care”;; The Press of Case Western Reserve University; 1969
BUT ALSO realize that this healthcare “system” we work in is not a system but a cottage industry devoid of any standards for clinical process or information content.
National Academy of Sciences “BUILDING A BETTER DELIVERY SYSTEM
A New Engineering/Health Care Partnership”
Family Medicine Forum 2014 Workshop Saturday November 15th 2014
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Proctor P. Reid, W. Dale Compton, Jerome H. Grossman, and Gary Fanjiang, Editors 2005
“provides a framework and action plan for a systems/informatics approach to health care delivery based on a partnership between
engineers and health care professionals” This is the same realization that the NHS has come to after spending 12 billion pounds on eMRs.
National Health Services Joint WG 2012
“Technical standards alone do not ensure the ability for information systems to transfer interpretable health data around the NHS so that they can be reliably manipulated and understood.” “… this problem can be considerably simplified by the clinical professions agreeing on standard clinical representations for the content of medical/healthcare records.” A 5th Generation eMR requires that we create standards for the clinical information and process content of the medical record; “Two hundred years ago enlightened physicians understood that empiricism needed to be replaced by a more formal and testable way to characterize disease and its treatment. The tool they used then was the scientific method. Today we are in an analogous situation. Now the demand is that we replace the organizational processes and structures that force the arbitrary selection amongst treatments with ones that can be formalized, tested, and applied rationally.”
“Four rules for the reinvention of health care” Enrico Coiera, BMJ 2004;328:1197-1199 (15 May),
THAT utilize 1) Standard unambiguous medical terminology
• S: (n) terminology, nomenclature, language (a system of words used to name things in a particular discipline)
• e.g. the “Systematized Nomenclature of Medicine;; Clinical Terms” (SNOMED CT)
Family Medicine Forum 2014 Workshop Saturday November 15th 2014
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2) Clinical Information Models
What is a Model?
“Man tries to make for himself in the way that suits him best a simplified and intelligible picture of the world and thus to over come (sig. understand) the world of experience, for which he tries to some extent to substitute this cosmos (sig. picture) of his. This is what the painter, the poet, the speculative philosopher and the natural scientist do, each in his own fashion... one might suppose that there are any number of possible systems... all with an equal amount to be said for them; and this opinion is no doubt correct, theoretically. But evolution has shown that at any given moment out of all conceivable constructions one has always proved itself absolutely superior to all the rest.” Einstein, A. “The World as I See It” (1931)
3) and the will to do a better job
• “If we accept the limits of discipline and form as we keep data in the medical record, the physician’s task will be better defined
• …and the art of medicine will gain freedom at the level of interpretation and be released from the constraints that disorder and confusion always impose.” Weed, Laurence; 1968
The choice is ours, We can turn this;
Family Medicine Forum 2014 Workshop Saturday November 15th 2014
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into this;
Family Medicine Forum 2014 Workshop Saturday November 15th 2014
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At the end of this session, participants will be able to: -define informatics and its application to achieve safer more effective and efficient clinical practice -recognize the difference between computable and non computable clinical record content -articulate the informatics requirements necessary for an eMR to be a computable medical record Context The most common thing a doctor deals with on a daily basis is information. It has been fifty years since Laurence Weed defined the information requirements necessary for a medical record to be computable; twenty five years since Dick and Stein identified clinical information computability as necessary to achieve improved safety, efficiency and effectiveness in healthcare and fifteen years since Starfield et al decried the lack of information management standards in clinical care and the resultant
Family Medicine Forum 2014 Workshop Saturday November 15th 2014
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morbidity. The failure of electronically enabled medical records to achieve information computability jeopardizes the adoption of eMRs and prevents the improvements in healthcare that should have already been achieved. The science of medical information has been declared a U.S. American Board Certified Medical Specialty. It is a mature science and holds the answer to achieving the computable patient record. This session will introduce the fundamentals of informatics and teach participants how to identify and use informatics in their clinical practice. The following are a complete slide set for the workshop. Not all slides will be used.
1
Attheen
dofthisse
ssion,participants
willbeableto
:
1.Ͳdefineinform
aticsa
nditsa
pplicationto
achievesaferm
oreeffectiveand
efficientclinicalpractice
2.Ͳrecognizeth
ediffe
rencebe
tween
compu
tableandno
ncompu
tableclinical
record
conten
trecordco
nten
t3.
Ͳarticulatetheinform
aticsreq
uirements
necessaryfora
neM
Rtobea
compu
tablemed
icalre
cord
WhatisInformatics?
S:(n)informationscience
S:(n)informationscience,
inform
atics,inform
ationprocessin
g ,
IP(the
sciencesco
ncerne
dwith
gathering,m
anipulating,storing,
retrieving,and
classifyingrecorded
inform
ation ))
http://w
ordn
etweb
.prin
ceton.ed
u/
“The
pivotalco
ncep
tofinformaticsisthe
mod
el.”
EnricoCo
iera;“Gu
idetoHealth
Inform
atics”
1997
“Amod
elis…asim
plified
and
intelligible
pictureofth
eworldofexperience…
”(AlbertE
instein1931)
2
“You
can’tmeasureitifyou
can’tmod
elit”
(PeterPhaal1994)
“You
can’tm
anageitifyoucan’tm
easure
it”(W
.Edw
ardsDem
ing;J.P.M
organandothe
rs)
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grat
ion
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initi
on (I
DE
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odel
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simpleclinicalm
odel
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licBP
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licBP
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ical
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men
t Mod
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r Sy
stol
ic B
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ssur
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mHg
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cSy
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s
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t Arm
Body
Loca
tion
Body
Loca
tion
# 8
data
Sittin
g
Patie
ntPos
ition
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ntPos
ition
3
OrderEntryAPI(a
dapted
from
HaroldSolbrig
) . . .
Application
COS
Service
Interface
Data
Attheen
dofthisse
ssion,participants
willbeableto
:
1.Ͳdefineinform
aticsa
nditsa
pplicationto
achievesaferm
oreeffectiveand
efficientclinicalpractice
2.Ͳrecognizeth
ediffe
rencebe
tween
compu
tableandno
ncompu
tableclinical
record
conten
trecordco
nten
t3.
Ͳarticulatetheinform
aticsreq
uirements
necessaryfora
neM
Rtobea
compu
tablemed
icalre
cord
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ompu
tabl
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atie
nt R
ecor
d
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umen
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ality
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tions
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ocie
ty w
ith
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pute
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mpu
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ical
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rd
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alcu
latio
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ompu
tatio
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ompu
ting
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proc
edur
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ca
lcul
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eter
min
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ethi
ng b
ym
athe
mat
ical
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logi
cal m
etho
ds)
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putable
4
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putable
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table
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dno
men
clatureofm
edicine
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2
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table
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licBP
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licBP
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Clin
ical
Info
rmat
ion
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el fo
r Sy
stol
ic B
lood
Pre
ssur
e
data
138 m
mHg
quals
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cSy
stolic
BPOb
s
data
Righ
t Arm
Body
Loca
tion
Body
Loca
tion
# 15
data
Sittin
g
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ntPos
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nyon
e?
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nIuseaword,䇻䇻Hu
mptyDu
mptysaidinara
ther
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htI
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ne,䇺䇺itmeansjustwhatIcho
oseittom
ean—
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ermoreno
rless.䇻䇻
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estio
nis,䇻䇻saidAlice,䇺䇺whe
theryou
canmakewords
meansom
anydiffe
rentth
ings.䇻䇻
䇺䇺Thequ
estio
nis,䇻䇻saidHum
ptyDu
mpty,䇺䇺whichisto
be
䇻䇻
master—
thatisall.䇻䇻
䇾Alice'sA
dventuresinW
onderland䇿;1865
Charle
sLutw
idge
Dodgson(akaLew
isCarroll).
5
Sem
antic
s•
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chie
ve “m
achi
ne c
ompu
tatio
n” o
f the
m
edic
alre
cord
it’s
cont
entm
ustb
em
edic
al re
cord
its
cont
ent m
ust b
e ca
ptur
ed a
nd s
tore
d in
a s
eman
ticfo
rm
that
is a
cces
sibl
e to
the
mac
hine
.•
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is d
one
by u
sing
info
rmat
ion
mod
els
and
met
a da
ta; e
.g. W
eb 2
.0 u
ses
exte
nsib
le m
ark
up la
ngua
ge (X
ML)
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edic
al re
cord
s us
e H
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linic
al
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men
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ctur
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DA
) and
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enE
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pes
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inology?
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enclature,language
(a
tf
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ofw
ordsusedtonam
ethingsin
a
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ipline)
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e䇾System
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icine;ClinicalTerm
s䇿(SNOMED
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rms
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amentalm
otivationforthe
design
andph
ilosoph
yof
theProb
lem
Orie
nted
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ilosoph
yofth
eProb
lemͲOrie
nted
Med
icalRecord(POMR)isth
ebe
liefthatthe
med
icalre
cordisth
ecentralm
ediumof
commun
icationandthefirstre
positoryof
know
ledgeinth
epracticeofclinicalm
edicine.
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icalrecordsmed
icaled
ucationan
dpa
tient
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icalre
cords,m
edicaledu
catio
n,and
patient
care:The
problem
Ͳorie
nted
recordasa
basicto
ol;䇿
Weed,La
wrenceL.1970
Attheen
dofthisse
ssion,participants
willbeableto
:
1.Ͳdefineinform
aticsa
nditsa
pplicationto
achievesaferm
oreeffectiveand
efficientclinicalpractice
2.Ͳrecognizeth
ediffe
rencebe
tween
compu
tableandno
ncompu
tableclinical
record
conten
trecordco
nten
t3.
Ͳarticulatetheinform
aticsreq
uirements
necessaryfora
neM
Rtobea
compu
tablemed
icalre
cord
6
䇾Da
taDisc
ipline䇿
䇾Ifweacceptth
elim
itsofd
isciplineandform
k
dt
ith
dil
dth
aswekeep
datainth
emed
icalre
cordth
eph
ysician䇻
staskwillbebe
tterdefined
…andthearto
fmed
icinewillgainfreedo
mat
thelevelofinterpretationandbe
released
from
theconstraintsthatd
isorderand
confusionalwaysimpo
se.䇿
Weed,La
uren
ce;1968
The
shor
t fal
ls fo
und
can
be a
ttrib
uted
to
thre
e do
mai
ns:
a.M
ON
EY:
Pro
vide
rs a
nd v
endo
rs a
re re
luct
ant t
o ex
pens
eth
eco
ding
ofap
plic
atio
nsfo
rasm
all
expe
nse
the
codi
ng o
f app
licat
ions
for a
sm
all
poor
ly d
efin
ed m
arke
t.
b. S
TAN
DA
RD
S: T
he a
bsen
ce o
f nat
iona
l sta
ndar
ds
for t
he c
linic
al in
form
atio
n an
d pr
oces
s co
nten
t of
the
eMR
to w
hich
ven
dors
and
pro
mot
ers
can
build
with
con
fiden
ce th
at th
eir i
nves
tmen
t is
safe
.
c. S
YS
TEM
S M
OD
ELS
: For
mal
sys
tem
s m
odel
s of
th
e Fa
mily
Med
icin
e te
achi
ng c
ente
r env
ironm
ent,
and
the
heal
thca
re d
eliv
ery
sect
or in
gen
eral
are
re
quire
d fo
r cod
ing
com
plex
inte
grat
ed s
oftw
are
appl
icat
ions
.
NationalH
ealth
ServicesJointW
G20
12
“Techn
icalstandardsa
lone
dono
tensure
theabilityfo
rinformationsystem
sto
transferinterpretablehe
althdataarou
nd
theNHS
soth
atth
eyca
nbe
reliably
yy
manipulated
and
und
erstoo
d.”
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ealth
ServicesJointW
G20
12
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isprob
lemca
nbe
con
siderably
simplified
bytheclinicalprofessions
agreeing
onstandardclinical
representatio
nsfo
rthe
contento
fmed
ical/health
carere
cords.”
7
AVacuum
ofLeade
rship
“The
problem
sofh
ealth
care
arerapidly
hiii
iTh
approachingcrisisp
ropo
rtions…The
applicationofcom
putertechn
ologyoffers
hope
,but…willre
quire
am
uchgreater
commitm
entthanispresently
true
ofthe
med
icalacade
miccom
mun
it y.”y
G.OctoBa
rnett1
969(Fou
nderM
assachusetts
Gene
ralH
ospitalCom
puterLaboratory)
To a
chie
ve th
e hi
gher
leve
l eM
R
func
tiona
lity
and
usab
ility
•Th
e eM
R c
onte
nt m
ust b
e se
man
tical
ly m
achi
ne
com
puta
ble
and
henc
e w
e ne
ed a
䇾co
mpu
tabl
e䇿M
ReM
R.
•P
hysi
cian
s, a
s th
e cl
inic
al d
omai
n ex
perts
, mus
t sh
ow le
ader
ship
in th
e pr
oces
s of
def
inin
g th
e cl
inic
al
cont
ent s
tand
ards
for t
he 䇾
com
puta
ble䇿
eMR
. •
The
skill
s ne
eded
to d
efin
e th
e cl
inic
al c
onte
nt a
nd
use
of 䇾
com
puta
ble䇿
eMR
s to
the
bene
fit o
f our
ti
ttb
tht
tdi
lt
dt
dpa
tient
s m
ust b
e ta
ught
to m
edic
al s
tude
nts
and
resi
dent
s in
trai
ning
if w
e ar
e to
pro
duce
so
phis
ticat
ed p
hysi
cian
con
sum
ers
and
user
s of
eM
Rs.
Compu
tableMed
icalRecords
•Implem
entatio
ninanacadem
icte
aching
unit
andtheeffectofsub
Ͳoptim
alsy
stem
sondata
quality
Fram
ework
8
Info
rmat
ion
Man
agem
ent
Ilite
rally
satthe
reandwith
…[EMR]didnothave
sulpha
which
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rallysa
tthe
reand
with
thepatie
ntplaying
thesaurus,how
manywords
cantherebe
fork
idne
yor
kidn
eydise
ase…
sulpha,w
hich
everybod
yknow
s…theEM
Rdo
esn’t
likeitinnormal
doctororn
urseta
lk.
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wayofq
uicklyfind
ing
inform
ation…
.theydidn’th
avetherig
ht
kind
offolde
rs.
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kflo
w: C
linic
al P
roce
sses
Andifthepe
rson
comes
inandthey’re
onado
zenmed
sand
cumbe
rsom
eno
tuserfrie
ndly
Andifthepe
rson
com
esin,and
they
reonado
zenmed
sand
theysa
y,“Ineedthem
allrefilledtoday,”
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ahe
adoftim
eno
wand
say,thisisgoingtota
ke
15m
inutes.....
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them
specifically
abou
tthe
irparkingwhe
reareyou
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emsp
ecificallyabo
utth
eirp
arking,w
hereareyou
parked
and
how
muchtim
edo
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have
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kflo
w: S
cope
and
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karo
unds
li
ht
[t]
tt
…learning
how
to[n
ot]getontoa
slipp
eryslo
pewith
cliniciansdoing
workthatco
uldbe
don
ebyso
meo
ne
else….
Iwou
ldjustfind
somekind
of
aworkaroun
dthatIcouldget
thatpatientoutth
edo
or
with
outp
ullingmyhairou
t
Wor
kflo
w: T
ime
You’resp
ending
prob
ably5to
7
[Inpu
tting]familyhistoryliterallynow
cantake20to25minutesbecause
eachfamilym
embe
rwith
eachofth
eir
minutesfind
ing
theform
.
med
icalproblem
s,hasto
been
tered
individu
ally.
9
Wor
kflo
w: T
each
ing
youcouldsitinadifferen
troo
m
andview
thecharta
sthe
patient
isbe
ingseen
.
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aching
hasprobably
been
hampe
red;we’re
so
...wearetalkingto
thepatie
nt,notto
thecompu
ter.
been
ham
pered;wereso
preo
ccup
iedwith
trying
toget
throughtheday.
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s th
e da
ta b
eing
ent
ered
into
the
EM
R d
atab
ase
accu
rate
ly
repr
esen
twha
twe
thin
kit
shou
ld?
repr
esen
t wha
t we
thin
k it
shou
ld?
Com
plet
enes
s-B
P R
ecor
d vs
. Bill
ing
(Hyp
erte
nsio
n)
AB
CD
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WR
HA
Aver
age
BP
Rec
ord
Com
plet
enes
s In
dica
tor-
Hyp
erte
nsio
n(%
)81
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7289
%93
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4809
%56
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%74
45%
Hyp
erte
nsio
n (%
)81
.22%
72.8
9%93
.23%
48.0
9%56
.37%
94.9
2%74
.45%
Dat
a Q
ualit
y G
oal=
100
%
November 28, 2103
Con
sist
ency
of C
aptu
re –
Soci
al
Det
erm
inan
ts o
f Hea
lthA
BC
DE
FW
RH
A Av
erag
e
103
Alco
hol U
se25
.66%
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.77%
2.34
%21
.65%
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2%23
.41%
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cco
Use
31.4
7%29
.46%
30.2
7%9.
45%
39.3
9%63
.65%
33.9
5%
Empl
oym
ent
20.7
0%21
.74%
11.5
8%5.
66%
15.6
5%42
.46%
19.6
3%
November 28, 21
t Hou
sing
5.40
%4.
45%
6.04
%3.
58%
21.1
5%46
.24%
14.4
8%
10
Com
plet
enes
s -D
iabe
tes
vs.
Insu
lin/P
O H
ypog
lyce
mic
(exc
ludi
ng m
etfo
rmin
)
AB
CD
EF
WR
HA
Aver
age
Prob
lem
Lis
t C
ompl
eten
ess
Indi
cato
r-D
iabe
tes
(%)
85.9
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November 28, 2103Electron
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zIfsystem
sweim
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erelyreplicate
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rprocessweloosethetrue
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rprocessweloosethetrue
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zThisdatash
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ehavealong
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quire
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li
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ote??
Basic
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uiremen
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Com
puterͲ
basedPatie
ntRecord
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tath
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outthe
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supp
ort
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rulesthata
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ported
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dwillworkbe
causedataisstandardize
d
Emerging
Trend
s•
With
interope
rableEH
Rsystem
sandintegrated
decision
sup
portand
careplanning
tools,clinicians
willbebetterabletocoo
rdinatethebe
stpossib
lepatientcareacrossallpartso
fthe
organiza
tion.
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view
200
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entsaday
Plti
hlth
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it
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tik
ft
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evelop
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ndim
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othindividu
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lepatientpop
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oing
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llyintegrated
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velopm
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ntriskand
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•Ch
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anagem
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Rsequ
ippe
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portand
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lswillhelpph
ysiciansm
anageinform
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itorthe
outcomesof
patie
ntswith
chron
iccon
ditio
nslikeCOPD
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ord
iabetes,according
toare
portfrom
theAg
ency
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ealth
careQualityandRe
search(A
HRQ).
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rson
alize
dmed
icine:The
evolutio
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med
icinerequ
iresh
ealth
careto
overcom
ethebarriersofinterop
erability,stand
ards,datasharing,priv
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ictivemod
eling.The
goal,
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portfrom
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kingsInstitution,is“s
eamlessand
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igita
lif
tii
ldi
ilii
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id
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inform
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claim
sdata,inorde
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ctive,and
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rson
alize
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•https://www.clinicalkey.com/in
fo/blog/eh
rsͲgoing
ͲwidelyͲim
plem
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lpful/
11
Lind
berg
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edicinene
edsthe
helpof
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scompu
tertechn
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s•forthe
storageandretrievaloffactsofcareof
theirind
ividualpatients
•inorderto
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esefactsimmed
iatelyinth
espectrum
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ilarstudiesareobservatio
nson
othe
rpatientsinthesameho
spita
lorregion
•inorderto
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eeverygrow
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masso
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med
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wledge196
8
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•EH
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ouldperform
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nctio
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rph
ysicians,rathe
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ingthem
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ph
ysicians,rathe
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rden
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ingworkun
lessitdire
ctly
affectscarede
livery.
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Rssh
ouldhelpph
ysiciansviewpatient
inform
ationmorequ
icklyandefficiently.And
theysh
ouldsu
pport–
notinterferewith
–ph
ysiciando
cumentatio
nofpatientstoriesa
nd
py
psoun
d,accurateeviden
ceͲbased
decision
making.
•https://www.clinicalkey.com/in
fo/blog/eh
rsͲ
goingͲwidelyͲim
plem
entedͲwidelyͲhe
lpful/
EHRweaknessesͲ
workflow
interrup
tionsand
interope
rability
•Clinicalworkflowinterrup
tionsand
interope
rabilityaretw
oofth
emostsignificantw
eaknessesw
ithinEHR
s,sa
y59
f
dhil12
6i
percen
tofsurveyrespon
dents,while12.6pe
rcen
tcite
system
expen
seasa
majorro
adblocktoEHR
im
plem
entatio
nanduse.
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Rsdisrup
tclinicalworkflowbecauseth
ey’re
unableto
mirrororcaptureth
ewaysp
hysic
ianswork,according
toa
majority
ofsurveyrespon
dents.Physic
iansareund
er
pressureto
captureaneverͲin
creasin
gstackofinform
ation
oneverypatie
ntknow
ingthat
onlyapo
rtionof
that
oneverypatient,kno
wingthatonlyapo
rtionofth
at
inform
ationrelatestoadiagno
sticortreatmen
tdecision
.•
https://www.clinicalkey.com/in
fo/blog/eh
rsͲgoing
ͲwidelyͲ
implem
entedͲwidelyͲhe
lpful/
EHRvend
orsm
ayhavelostsighto
fclinicalneeds
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ysiciansbelieveth
atEHR
ven
dorsm
ayhavelost
sightofclinicalneedsfo
rworkflowfu
nctio
nalityand
ibili
di2014
f150
interope
rability,accordingtoa2014surveyof1
50
providersrep
ortedinHealth
ITOutcomes.
•Facedwith
anoverwhe
lmingim
perativetocom
pleteMU
certificatio
n,EHR
sare“teaching
toth
etest.”
“EHR
manufacturershavebe
comesofo
cusedon
ensuringtheir
softw
areisMUͲcertifiedthatm
anyhavelostsighto
fthe
functio
nalitythatistrulyim
portanttohe
althprovide
rs,”
says
Health
ITOutcomes
edito
rin
chiefK
enCo
ngdo
nsaysHealth
ITOutcomes
edito
rͲinͲchiefKen
Con
gdon
.•
https://www.clinicalkey.com/in
fo/blog/eh
rsͲgoing
ͲwidelyͲ
implem
entedͲwidelyͲhe
lpful/
12
Physiciandissatisfactio
nwith
EHR
sis
rampant
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ackon
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rden
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puterized
do
cumen
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ingdataentryand
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rworkflow
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if
li
dd
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ort.Suchusageissuesofte
ntransla
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duced
timeforclinicalcare,dataanalysisandeviden
ceͲbased
de
cisio
nͲmaking,according
toa2013repo
rtfro
mRAN
DandtheAm
erican
HospitalA
ssociatio
n(AHA
).•
Physicians’com
plaintsrangefrom
dataen
try,usability,
inefficiency,andlesstimeforp
atientcare,to
limite
ddata
exchangebetweenEH
Rsand
erosio
nofclinical
documen
tatio
ndo
cumen
tatio
n.•
https://www.clinicalkey.com/in
fo/blog/eh
rsͲgoing
ͲwidelyͲ
implem
entedͲwidelyͲhe
lpful/
Med
icalte
rms
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•Whatimpressio
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Tabu
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