http://www.clinfowiki.org/wiki/api.php?action=feedcontributions&user=Mho2&feedformat=atomClinfowiki - User contributions [en]2024-03-29T09:38:33ZUser contributionsMediaWiki 1.22.4http://www.clinfowiki.org/wiki/index.php/Reconciliation_of_the_cloud_computing_model_with_US_federal_electronic_health_record_regulationsReconciliation of the cloud computing model with US federal electronic health record regulations2015-04-16T03:50:08Z<p>Mho2: </p>
<hr />
<div>== Indroduction ==<br />
A publication in 2012 issue of the Journal of the American Medical Informatics Association (JAMIA)(2012), Eugene Schweitzer examined the challenges faced by developers of cloud based electronic health records (EHR) related to compliance with federal regulations.<ref name=" Schweitzer"> Schweitzer, E. J. (2012). Reconciliation of the cloud computing model with US federal electronic health record regulations. Journal of the American Medical Informatics Association, 19(2), 161-165. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277612/pdf/amiajnl-2011-000162.pdf </ref> Of specific relevance to EHR development are the regulations pertaining to security and privacy. Schweitzer identifies several advantages offered by cloud computing architecture and maintains that this model can achieve a required level of regulatory compliance through business associate agreements with cloud service providers if these agreements specify compliance requirements and terms for the sharing of liability. <br />
== Cloud Computing ==<br />
Cloud computing is an information technology (IT) architecture that provides resources as a service to a subscribing customer through an internet connection. Resources could include networks, storage, applications or telecommunications systems. The [http://csrc.nist.gov/publications/nistpubs/800-145/SP800-145.pdf National Institute of Standards and Technology (NIST)] presents the following five essential characteristics of cloud computing:<br />
* 1) On-Demand self service. Customers access the resources immediately and without human intervention or response.<br />
* 2) Broad Network Access. Resources are delivered in formats that enable access by a variety of devices (e.g. desktop, mobile device)<br />
* 3) Resource Pooling. The cloud provider pools and dynamically allocates resources to meet the fluctuating demands of customers.<br />
*4) Rapid elasticity. Resources such as network bandwidth, processor capacity and memory are rapidly scaled in response to customer demand such that the customer is presented with the appearance of unlimited resources.<br />
* 5) Measured Service. The cloud provider monitors and reports the customer's use of services<br />
<br />
Because the expense of [[EHR]] implementation remains a significant barrier to adoption by many providers, and this expense is largely tied to infrastructure, cloud computing has emerged as an architecture to providers seeking an alternative to on premise infrastructure. NIST supports further promotion of cloud computing due to its potential for significant cost savings and IT agility. One type of cloud service, [http://en.wikipedia.org/wiki/Platform_as_a_service Platform as a Service, or PAAS], has great potential for EHR proliferation. PAAS would not only provide the EHR software in a cloud based environment, it would also provide the customer with tools and access to the base product to allow user customization and additional development. This provision for local customization is of particular interest of EHR customers who have, to date, expressed reluctance to depend on a product over which they have little or no developmental control.<br />
== Federal Security and Privacy Regulation ==<br />
The [[Health Insurance Portability and Accountability Act (HIPAA) | Health Insurance Portability and Accountability Act of 1996 (HIPAA)]] called for regulatory safeguards for electronic [[Protected Health Information (PHI) | protected health information]] (ePHI). In essence, HIPAA established provisions for improving healthcare through efficient health data exchange, and reducing costs, as well as providing patients with enhanced rights over their medical record information including; having access to their own records, controlling access to their records. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) act added clarity and strength to the privacy and security rules with definitions for responsible parties, expectations and penalties.<br />
== Security Measures, Concerns and Solutions ==<br />
In addition to the standard set of over 40 HIPAA security stipulations, [[The Cloud and it's impact on Health IT|cloud computing]] faces some particular challenges. Of particular concern to a cloud-based EHR service is multi-tenancy characteristic of the shared resource model. Drilling down further, one finds a challenge regarding the dynamic scaling of pooled data storage resources. The mechanism(s) for data isolation are of critical importance. On possible solution would be a "cloud community" that would dedicate sets of shared resources to EHR only, thus allowing the vendor to focus on the applicable challenged of isolation, encryption in a shared environment, and others.<br />
Schweitzer asserts that the requirement for all third parties accessing ePHI enter into a Business Associate Contract is of critical importance with the cloud provider. Considering the central role of the cloud provider in the maintenance of the EHR, Schweitzer suggests that the contract also contain specific obligations for maintaining and monitoring security metrics including periodic audits. He also recommends specific assignment of liability for breaches. As this may be a contentious item in contract negotiations, Schweitzer reminds the reader that the HITECH act specified the business associate as carrying the same responsibility and liability for breach-related penalties as a provider.<br />
<br />
== Conclusions ==<br />
While concerns remain about the value and sufficiency of cloud based computing for EHR, Schweitzer believes that these concerns are on the decline. In addition to technical strategies evolving to address concerns like customer configuration, legal strategies are also needed to address the challenges of regulatory compliance. Schweitzer maintains that specific inclusions in a business associate agreement will be critical to providers for whom adoption of a cloud based EHR is an effective way to overcome the cost barrier of EHR adoption. <br />
==Comment==<br />
According to Rodrigues et al (2013), Cloud service providers can protect privacy and security of patient information through the following steps:<br />
*By setting a Role-based access,<br />
*Through monitoring network security, specially during exchange of information with an outside net work party,<br />
*Using data inscription, digital signature and auditing system logs.<br />
Besides that, Cloud service providers must be compliant with various certifications such as: SAS70 Type II, PCI DSS Level 1, ISO 27001, and the US Federal Information Security Management Act (FISMA). [http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3757992/]<br />
<br />
== References ==<br />
<references/><br />
[[Category: Other Technologies]]<br />
[[Category: EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Reconciliation_of_the_cloud_computing_model_with_US_federal_electronic_health_record_regulationsReconciliation of the cloud computing model with US federal electronic health record regulations2015-04-16T03:48:18Z<p>Mho2: </p>
<hr />
<div>== Indroduction ==<br />
A publication in 2012 issue of the Journal of the American Medical Informatics Association (JAMIA)(2012), Eugene Schweitzer examined the challenges faced by developers of cloud based electronic health records (EHR) related to compliance with federal regulations.<ref name=" Schweitzer"> Schweitzer, E. J. (2012). Reconciliation of the cloud computing model with US federal electronic health record regulations. Journal of the American Medical Informatics Association, 19(2), 161-165. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277612/pdf/amiajnl-2011-000162.pdf </ref> Of specific relevance to EHR development are the regulations pertaining to security and privacy. Schweitzer identifies several advantages offered by cloud computing architecture and maintains that this model can achieve a required level of regulatory compliance through business associate agreements with cloud service providers if these agreements specify compliance requirements and terms for the sharing of liability. <br />
== Cloud Computing ==<br />
Cloud computing is an information technology (IT) architecture that provides resources as a service to a subscribing customer through an internet connection. Resources could include networks, storage, applications or telecommunications systems. The [http://csrc.nist.gov/publications/nistpubs/800-145/SP800-145.pdf National Institute of Standards and Technology (NIST)] presents the following five essential characteristics of cloud computing:<br />
* 1) On-Demand self service. Customers access the resources immediately and without human intervention or response.<br />
* 2) Broad Network Access. Resources are delivered in formats that enable access by a variety of devices (e.g. desktop, mobile device)<br />
* 3) Resource Pooling. The cloud provider pools and dynamically allocates resources to meet the fluctuating demands of customers.<br />
*4) Rapid elasticity. Resources such as network bandwidth, processor capacity and memory are rapidly scaled in response to customer demand such that the customer is presented with the appearance of unlimited resources.<br />
* 5) Measured Service. The cloud provider monitors and reports the customer's use of services<br />
<br />
Because the expense of EHR implementation remains a significant barrier to adoption by many providers, and this expense is largely tied to infrastructure, cloud computing has emerged as an architecture to providers seeking an alternative to on premise infrastructure. NIST supports further promotion of cloud computing due to its potential for significant cost savings and IT agility. One type of cloud service, [http://en.wikipedia.org/wiki/Platform_as_a_service Platform as a Service, or PAAS], has great potential for EHR proliferation. PAAS would not only provide the EHR software in a cloud based environment, it would also provide the customer with tools and access to the base product to allow user customization and additional development. This provision for local customization is of particular interest of EHR customers who have, to date, expressed reluctance to depend on a product over which they have little or no developmental control.<br />
== Federal Security and Privacy Regulation ==<br />
The [[Health Insurance Portability and Accountability Act (HIPAA) | Health Insurance Portability and Accountability Act of 1996 (HIPAA)]] called for regulatory safeguards for electronic [[Protected Health Information (PHI) | protected health information]] (ePHI). In essence, HIPAA established provisions for improving healthcare through efficient health data exchange, and reducing costs, as well as providing patients with enhanced rights over their medical record information including; having access to their own records, controlling access to their records. In 2009, the Health Information Technology for Economic and Clinical Health (HITECH) act added clarity and strength to the privacy and security rules with definitions for responsible parties, expectations and penalties.<br />
== Security Measures, Concerns and Solutions ==<br />
In addition to the standard set of over 40 HIPAA security stipulations, [[The Cloud and it's impact on Health IT|cloud computing]] faces some particular challenges. Of particular concern to a cloud-based EHR service is multi-tenancy characteristic of the shared resource model. Drilling down further, one finds a challenge regarding the dynamic scaling of pooled data storage resources. The mechanism(s) for data isolation are of critical importance. On possible solution would be a "cloud community" that would dedicate sets of shared resources to EHR only, thus allowing the vendor to focus on the applicable challenged of isolation, encryption in a shared environment, and others.<br />
Schweitzer asserts that the requirement for all third parties accessing ePHI enter into a Business Associate Contract is of critical importance with the cloud provider. Considering the central role of the cloud provider in the maintenance of the EHR, Schweitzer suggests that the contract also contain specific obligations for maintaining and monitoring security metrics including periodic audits. He also recommends specific assignment of liability for breaches. As this may be a contentious item in contract negotiations, Schweitzer reminds the reader that the HITECH act specified the business associate as carrying the same responsibility and liability for breach-related penalties as a provider.<br />
<br />
== Conclusions ==<br />
While concerns remain about the value and sufficiency of cloud based computing for EHR, Schweitzer believes that these concerns are on the decline. In addition to technical strategies evolving to address concerns like customer configuration, legal strategies are also needed to address the challenges of regulatory compliance. Schweitzer maintains that specific inclusions in a business associate agreement will be critical to providers for whom adoption of a cloud based EHR is an effective way to overcome the cost barrier of EHR adoption. <br />
==Comment==<br />
According to Rodrigues et al (2013), Cloud service providers can protect privacy and security of patient information through the following steps:<br />
*By setting a Role-based access,<br />
*Through monitoring network security, specially during exchange of information with an outside net work party,<br />
*Using data inscription, digital signature and auditing system logs.<br />
Besides that, Cloud service providers must be compliant with various certifications such as: SAS70 Type II, PCI DSS Level 1, ISO 27001, and the US Federal Information Security Management Act (FISMA). [http://www-ncbi-nlm-nih-gov.ezproxyhost.library.tmc.edu/pmc/articles/PMC3757992/]<br />
<br />
== References ==<br />
<references/><br />
[[Category: Other Technologies]]<br />
[[Category: EHR]]<br />
[[Category: Review]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/%E2%80%9CNot_all_my_friends_need_to_know%E2%80%9D:_a_qualitative_study_of_teenage_patients,_privacy,_and_social_media“Not all my friends need to know”: a qualitative study of teenage patients, privacy, and social media2015-04-16T03:45:23Z<p>Mho2: </p>
<hr />
<div>This is a review of “Not all my friends need to know”: A qualitative study of teenage patients, privacy, and social media. <ref name="Velden, Emam (2013)">Van der Velden, M., & Emam, K. (2013). “Not all my friends need to know”: A qualitative study of teenage patients, privacy, and social media. Journal of the American Medical Informatics Association, 20(1), 16-24. Retrieved April 5, 2015, from http://jamia.oxfordjournals.org/content/20/1/16</ref>.<br />
<br />
==Background==<br />
Teenagers are substantial users of social media and tend to share their personal health information [[PHI]] on-line. This paper studies their on-line behavior and their concern for [http://www.hhs.gov/ocr/privacy/''privacy''].<br />
<br />
==Methods==<br />
The studies consisted of patients with chronic illnesses obtaining treatment from Children’s Hospital of eastern Ontario (CHEO) and a pediatric institute in Ottawa, Canada. A variety of technologies were available to the patients. Consent was given by parents and patients were interviewed on their on-line activity.<br />
<br />
==Results==<br />
The following themes were analyzed: Online information-seeking behavior, Online communication, Applied privacy awareness, Self-protection and Self-definition. Teens often mentioned that they couldn’t spend time in school or with friends due to being in the hospital. They did not go into detail about their prognosis. They were generally concerned about their privacy but didn’t pay attention to their settings. <br />
<br />
==Conclusion==<br />
<br />
Teens don’t identify themselves as patients on-line. Teens allow their friends to view everything they post but don’t associate that with over sharing personal information. To them, they feel in control.<br />
<br />
==Comments==<br />
<br />
I don’t think teens realize the information they share online should stay confidential. Social media is just a way to keep up to date with entertainment and friends. I think teens need to be more selective with what they share and parents need to be more aware as well. <br />
<br />
==References==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: EHR]]<br />
[[Category: Technologies]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Privacy,_Confidentiality,_and_Electronic_Medical_RecordsPrivacy, Confidentiality, and Electronic Medical Records2015-04-16T03:42:44Z<p>Mho2: </p>
<hr />
<div>This is a review on Barrows, R., & Clayton, P. (1996) article, Privacy, Confidentiality, and Electronic Medical Records. <ref name"privacy"> Privacy, Confidentiality, and Electronic Medical Records<br />
Randolph C. Barrows , Paul D. Clayton Journal of the American Medical Informatics Association Mar 1996, 3 (2) 139-148; DOI: 10.1136/jamia.1996.96236282 Retrieved from http://jamia.oxfordjournals.org/content/3/2/139</ref><br />
<br />
<br />
===Goals of Informational Security in Health Care===<br />
<br />
Although health information is becoming more readily available in health care settings to improve quality and save on health care costs, there is concern for privacy and confidentiality. An electronic medical record ([[EMR]]) allows providers and clinicians to access and share a patient's medical health information among authorized individuals. The increase in number of authorized users, including remote access and from multiple sites, to access patient electronic medical records (EMRs) can reduce privacy. Because there is a risk of a potential breach of privacy and confidentiality, healthcare organizations should establish security measures to protect their data. <br />
<br />
To assist organizations, the goals of informational security in health care should be considered.<br />
*Ensure the [[privacy]] of patients and confidentiality of health care data<br />
*Ensure the [[integrity]] of health care data<br />
*Ensure the [[availability]] of health data for authorized persons<br />
<br />
<br />
<br />
=== Security Policy===<br />
A cohesive security policy for securing health data should be in place to reduce vulnerability <ref name='Curran'> Curran WJ, Steams B, Kaplan H. Privacy, confidentiality and other legal considerations in the establishment of a centralized health-data system. N Engl J Med. 1968;281:241-8. </ref>. Organizations should define a policy that will not only protect their patients but also their personnel who are authorized to view data and outside vendors such as insurance companies and managed care organizations.<br />
<br />
Organizations should define their security policy based on the following factors:<br />
*Functional requirements of an information system<br />
*Security requirements for the system<br />
*[https://www.owasp.org/index.php/Application_Threat_Modeling A threat model]<br />
<br />
=== Privacy and Confidentiality in Health Care ===<br />
In addition to a security policy, privacy and confidentiality should also be established between clinicians and patients. When patients "trust" clinicians with their medical data, privacy and confidentiality is established. <br />
There are different measures organizations can implement to protect privacy and confidentiality.<br />
*Establishing data ownership and legal accountability<br />
*Implementing informed consent to disclosure<br />
*Establish primary uses of medical records<br />
*Create user authentication and access control <ref name="Orr"> Orr GA, Brantley BA. Development of a model of information security requirements for enterprise-wide medical information systems. In Frisse ME, ed. Proceedings of the Sixteenth Annual Symposium for Computer Applications in Medical Care. New York: McGraw-Hill, 1992:287-91.</ref><br />
**Password security<br />
**User-specific or role-specific views<br />
*Implement encryption software -- often referred to as cryptography<br />
*Implement protocols and mechanisms that will test and verify data --- referred to as data integrity<br />
*Create firewalls between EMR sites and internal networks<br />
*Recommend implementation of audit trail software<br />
<br />
==Proliferation of Healthcare Regulations==<br />
*HIPAA - The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of an individual’s health information and governs the way health care providers manage and disclose protected health information (PHI). Healthcare providers must introduce appropriate systems and practices to comply with HIPAA.<br />
*ARRA-HITECH – The Health Information Technology for Economic and Clinical Health Act (HITECH) provisions of the American Recovery and Reinvestment Act (ARRA) expand HIPAA privacy requirements and create new challenges for healthcare privacy and security teams. In particular, the act introduces new regulations governing the confidentiality of EHRs.<br />
*FTC Red Flags Rule – The Federal Trade Commission (FTC) Red Flags Rule require healthcare providers to institute new systems and practices to combat identity theft. Providers have until June 1st 2010 to comply with this law.<br />
*State Laws – U.S. healthcare providers must abide by both federal and state regulations. Forty-five states have enacted privacy breach notification laws – many of which are more stringent than federal laws.<br />
*International Regulations – Healthcare privacy rules are not limited to the United States. The European Union and many individual countries and provinces in other parts of the world have implemented patient confidentiality laws.<br />
<br />
==Healthcare Privacy Breach Examples==<br />
Patient privacy is a serious matter for healthcare providers and patients alike. Patients can suffer financial damage if their billing data (credit card number, social security number) is stolen or emotional harm if PHI is disclosed. Healthcare providers can face stiff fines and suffer damage to their reputation if their records or systems are compromised. Examples of privacy breaches include:<br />
*VIP record snooping – disclosing a celebrity’s medical records. One notable case involved a UCLA Medical Center employee leaking Farah Fawcett’s cancer treatment records to the tabloids.<br />
*Financial identity theft – stealing patient data for financial gain. An admissions clerk at the Baptist Health Medical Center in Little Rock, AR was recently accused of using stolen patient information to buy Wal-Mart gift cards. Approximately 1,800 patient records were exposed.<br />
*Medical identity theft – using patient data to initiate bogus or inflated treatment claims, purchase prescription drugs, or obtain free medical treatment. Not long ago a front desk clerk at a Florida medical clinic downloaded information on more than 1,100 Medicare patients and gave it to a cousin who made$2.8 million in false Medicare claims.<br />
*Coworker, family member and neighbor snooping – disclosing a patient’s medical records to an unauthorized person. In a recent investigative report CNN reporter Elizabeth Cohen was able to retrieve 18 month’s worth of medical records for colleague Gary Tuchman and his entire family in minutes – on live television – using only his date of birth and social security number.<br />
<br />
<br />
<br />
===A Comparison of the Paper and Electronic Record Environments===<br />
Electronic records are more secure than paper records if and when the right policies are in place. For instance, with paper records organizations are unable to access audit trails and secure information based on user roles. In a paper record, all data is accessible to all viewers. In addition, paper records can be potentiality be misplaced and altered.<br />
<br />
===Conclusion ===<br />
In conclusion, as EMR adoption increases healthcare organizations need to ensure that although they are allowing users to view and share patient data among one another, security should always be a top priority. Protocols involving electronic security features should be put in place for EMRs safety during the creation of these EMRs applications. There are many barriers organizations will encounter with security but if they follow the recommendations above it will be beneficial to themselves, users and their patients.<br />
<br />
=== Comments ===<br />
As a security analyst in my current employment, I have seen firsthand my organization implement the recommendations mentioned in the article. Privacy and confidentiality is always in question when granting users' access to EMRs. As a security analyst, I find myself asking users when granting access, "What type of access do you need?" "Why do you need access?" Therefore, in my opinion I feel that privacy, confidentiality and security should be considered core fundamental principles in which organizations must define and establish prior to granting users access to their EMRs.<br />
<br />
==Related Article== <br />
[[HIPPA]]<br />
<br />
= References =<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: EHR]]<br />
[[Category: Security]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Duplicate_Orders:_An_Unintended_Consequence_of_Computerized_provider/physician_order_entry_(CPOE)_ImplementationDuplicate Orders: An Unintended Consequence of Computerized provider/physician order entry (CPOE) Implementation2015-04-09T04:50:06Z<p>Mho2: </p>
<hr />
<div>This is a review of Magid, Forrer, and Shaha’s 2012 article, Duplicate Orders: An Unintended Consequence of Computerized provider/physician order entry (CPOE) Implementation: Analysis and Mitigation Strategies <ref name="Magid et al 2012"> Magid, S., Forrer, C., & Shaha, S. (2012). Duplicate Orders: An Unintended Consequence of Computerized provider/physician order entry (CPOE) Implementation: Analysis and Mitigation Strategies. Applied Clinical Informatics, 3(4), 377–391. doi:10.4338/ACI-2012-01-RA-0002.</ref><br />
<br />
== Background ==<br />
<br />
The benefits of [[CPOE| computerized provider/physician order (CPOE)]] entry - particularly with [[CDS| clinical decision support (CDS)]] - has been shown to increase patient safety. [[CPOE]] has also been reported to improve:<ref name="Magid et al 2012"></ref><br />
* The utilization of health care services<br />
* Decrease costs<br />
* Reduce hospital length of stay<br />
* Decrease medical errors<br />
* Improve compliance with guidelines <br />
<br />
[[CPOE]] systems improve legibility and decrease errors relating to look-alike, sound-alike medications. Reductions in [[Medication errors| medication errors]] have been noted for:<ref name="Magid et al 2012"></ref><br />
* Dosing<br />
* Frequency<br />
* Route<br />
* Substitution<br />
* Allergies <br />
<br />
The authors’ objective in this report was to describe the nature of duplicate orders, report their analysis of them and describe the methods used to reduce them.<br />
<br />
== Methods ==<br />
<br />
Duplicate medication orders (“duplicates”) were defined for the study as two or more active orders for the identical medication regardless of dose. The second order entered was labeled as the duplicate order. Certain orders were not considered to be duplicates and were excluded from analysis. These include:<ref name="Magid et al 2012"></ref><br />
<br />
# Dose range ordering (e.g. acetaminophen: one pill for mild pain and two pills for severe pain)<br />
# Combination drug plus component (e.g. losartan/[http://www.drugs.com/hctz.html HCTZ] plus [http://www.drugs.com/hctz.html HCTZ] or [http://www.drugs.com/percocet.html Percocet] plus acetaminophen)<br />
# The same drug prescribed for different indications (e.g. acetaminophen for pain and acetaminophen for fever) <br />
# Large volume parenterals<br />
<br />
== Results ==<br />
<br />
A total of 316,160 orders were captured during the 84 weeks, averaging 3,764 orders per weekly sampling period.<ref name="Magid et al 2012"></ref><br />
* There were 5,442 duplicate orders over this period, an average duplication rate of 1.8%. <br />
* The highest rate was 5.0% (211/4,220) in week 1, and the lowest rate was 0.3% (8/2,667) in week 75. <br />
* The duplication rate was 0.82% (32/3,888) in the last week (84) of the study. <br />
<br />
There was an 84.8% decrease in the duplication rate from week 1 (211 duplicates) to week 84 (32 duplicates), and a 94.6% decrease from the highest (week 1) to the lowest (week 75). <br />
The duplication rate of 3.7% Pre-interventions (780/21,081) was reduced to 0.9% Post-interventions (211/23,444); from nearly one duplicate for every 25 orders to fewer than nine in every 1,000 representing a decrease of 75.7%.<ref name="Magid et al 2012"></ref><br />
<br />
== Discussion ==<br />
<br />
The goals of the study were to identify the drugs, which were being duplicated most frequently and create strategies to reduce them. These strategies included the following interventions: <br />
# Many duplicated drugs were defaulted within order sets; wherever possible they were “un-defaulted”<br />
# Many drugs were removed from order sets altogether (and now require a specific order to prescribe)<br />
# Additional duplicate alerts were activated for high-risk and high frequency drugs<br />
# The pharmacy was asked to discontinue certain duplicate orders.<br />
<br />
== Conclusion ==<br />
<br />
By studying the specific drugs, the type and role of prescribers, the origin of the duplicate orders, and workflow, the authors were able to devise reduction strategies: <br />
* Changes in order sets to avoid overlapping medications<br />
* Changes in work-flow<br />
* Additional training strategies<br />
* Altering pharmacy procedure<br />
* Broadening duplicate warnings. <br />
<br />
It was through implementation of these methods that the authors were able to decrease duplicate orders significantly.<br />
<br />
== Comments ==<br />
<br />
The journal article was an interesting read because it took a different approach than most published papers when looking at duplicate orders. Instead of looking directly at the alert function of the CPOE system, the author’s decided to look at the source and work-flow causes that were creating duplicate orders. <br />
<br />
== Related Article ==<br />
<br />
[[Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care]]<br />
<br />
== References==<br />
<references/><br />
<br />
[[Category:CPOE]]<br />
[[Category:Reviews]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Reduction_in_medication_erros_in_hospitals_due_to_adoption_of_computerized_provider_order_entry_systemsReduction in medication erros in hospitals due to adoption of computerized provider order entry systems2015-04-09T04:46:18Z<p>Mho2: </p>
<hr />
<div>Computerized provider order entry has become one of the standard practices that also provides reimbursement from the government. Aside from this known fact, it is one of the main safety features that is incorporated and a major component in almost all [[EHR|EHR]] systems. This article sets out to "derive a nationally representative estimate of medication error reduction in hospitals attributable to electronic prescribing through computerized physician order entry [[CPOE|(CPOE)]] systems." <ref name= "Radley 2013">Radley DC, Wasserman MR, Olsho LEW, Shoemaker SJ, Spranca MD, Bradshaw B.(2013) Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems, Journal of the American Medical Informatics Association, 20:470-476, http://dx.doi.org/10.1136/amiajnl-2012-001241</ref><br />
<br />
===Background===<br />
Medications and errors have always been a priority for patient safety. There has been discussion as to how effective the use of [[CPOE|(CPOE)]] systems really is and to determine if in-fact there is a reduction in errors is a question that many ask. As it currently stands "Institute of Medicine [http://en.wikipedia.org/wiki/Institute_of_Medicine], estimates that, on average, hospitalized patients are subject to at least one medication error per day"<ref name= "Radley 2013"></ref>, and there are recommendations that take place, one of those being to incorporate [[CPOE|(CPOE)]] systems.<ref name= "Radley 2013"></ref> When conducting studies the main focus is to ascertain the actual effect the system has on patient safety.<ref name= "Radley 2013"></ref><br />
<br />
===Methods===<br />
<br />
This study was conducted in two different phases, the first was determining which hospitals to include in the inclusion criteria. Hospitals that were used in the inclusion criteria were found by using the [http://www.aha.org/ AHA survey]. Once determined if they met inclusion criteria it was found that 4701 hospitals met criteria and were utilized to conduct such study.<ref name= "Radley 2013"></ref>. Of these hospitals approximately 60.3% participated in responding to the actual survey conducted. Unfortunately there is no easy way of conducting such findings thus the researchers "used meta-analytic random effects techniques to estimate three parameters: medication error rates when CPOE is not used, medication error rates when CPOE is used, and the percentage difference between them."<ref name= "Radley 2013"></ref><br />
<br />
===Results===<br />
<br />
The findings determined that nationally there are approximately 17.4million medication errors per year avoided due to [[CPOE|(CPOE)]] implementation which translates into 12.5%.<ref name= "Radley 2013"></ref> This finding alone should encourage other hospitals who have yet to adopt such system to take a look at the lives they maybe saving. Although adopting and implementing may mean spending money, the overall picture would be that the same money they are spending to invest in such key features could possibly be the same money they are spending in reversing the harm that is caused by these same medication errors.<br />
<br />
===Comments===<br />
<br />
As a nurse I take a personal interest in such statistical findings. I along with many other individuals take our families when crisis arise to the hospital in search of medical attention. Having faith in nurses and doctors to care for families and no such harm would ever be brought to them. The reality though still exists though, that errors can occur and it's made me aware that despite having IT and [[CPOE|(CPOE)]] implementation we must still use caution. I firmly believe now that [[CPOE|(CPOE)]] should be used as aid and not become completely dependent on such systems, we should continue to use our knowledge of medicine and despite having computers still rely on our fundamental basics.<br />
<br />
===References===<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: CPOE]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Phased_implementation_of_electronic_health_records_through_an_office_of_clinical_transformationPhased implementation of electronic health records through an office of clinical transformation2015-04-09T04:42:19Z<p>Mho2: </p>
<hr />
<div>This is a review on Banas, C. A., Erskine, A. R., Sun, S., & Retchin, S. M. (2011) article, Phased implementation of electronic health records through an office of clinical transformation <ref name="Phased Implementation"> Banas, C. A., Erskine, A. R., Sun, S., & Retchin, S. M. (2011) . Journal of the American Medical Informatics Association, 20, 749-757. doi: http://dx.doi.org/10.1136/amiajnl-2011-000165</ref>.<br />
<br />
<br />
=Abstract=<br />
The concept of [http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/ health information technologies (HIT)] is introduced and presented in the article as beneficial based on clinical outcomes. The article discusses HIT implementation strategies at an academic health center with an office of clinical transformation. Seven percent of the medical center's information technology budget was dedicated to the Office of Clinical Transformation, and successful conversion of 1491 physicians to electronic-based documentation was accomplished. This paper outlines the process re-design, end-user adoption, and practice transformation strategies that resulted in a 99.7% adoption rate within 6 months of the introduction of digital documentation.<br />
<br />
=Introduction=<br />
With the introduction of new technologies, the medical field is being renovated like it has never before. Incentives to make [[EMR|electronic health records (EHR)]] more efficient are at an all-time high. Despite the evidence of benefits, dissemination of EHRs through the healthcare sector has been limited. The lack of engagement of clinical stakeholders likely accounts for some disappointing results.<br />
<br />
=Background=<br />
The [http://www.vcuhealth.org Virginia Commonwealth University Health System (VCUHS)] has a tradition of initiatives in information technology. In 1999, VCUHS committed to update its clinical information system to a more contemporary product which promised streamlined clinical workflows and more intuitive [http://en.wikipedia.org/wiki/Graphical_user_interface graphical user interface]. Even though VCUHS made significant investments to establish electronic-based clinical automation, clinicians complained that the new system lacked intuitiveness.<br />
<br />
=Design Objectives=<br />
The VCUHS created an Office of Clinical Transformation (OCT) in order to overcome barriers posed by traditional methods of implementing clinical applications. The OCT was established with the goal of converging clinical, educational, financial, and research activities through the application of [[Health informatics| medical informatics]]. Seven percent of its budget was dedicated to the OCT.<br />
<br />
=System Description=<br />
OCT members included the faculty physician informaticists, the [[CMIO|Chief Medical Information Officer (CMIO)]] who served as the [[Physician champion| physician champion]], nurse informaticists led by the [http://www.hl7standards.com/blog/2012/04/03/cnio/ Chief Nursing Information Officer (CNIO)], and analysts.<br />
The OCT is organized into three primary domains which include: diffusion of innovation, impact assessment and interoperability. [http://en.wikipedia.org/wiki/Diffusion_of_innovations Diffusion of innovation] has the purpose of facilitating adoption into the clinical environment; [http://en.wikipedia.org/wiki/Impact_assessment impact assessment] evaluates the integrity of data inputted and finds whether it is capable of supporting the robust hypothesis; and [[Interoperability|interoperability]] seeks to provide efficient communication without any restrictions.<br />
<br />
=Status Report =<br />
There are '''“phases”''' within this process. The '''first phase''' is a six-month preparatory phase and it consists of the learning process, deployment strategies, and the production of documentation tools. '''Following''' this phase is a six-month adoptive period in which physicians are encouraged to adopt the new system and are allowed to proceed with ease by taking it slowly and comfortably. Physicians that adopted the system early found some major benefits to their time and great comfort with handling paper work. The '''final phase''' is a two-week practice transformation that had the purpose of providing aid to those that were identified as still unfamiliar with the system after the mandatory conversion, and provided them with nurses that were very much involved with the system and could explain it thoroughly and efficiently.<br />
<br />
=Discussion and Comments=<br />
The article describes as to what was most prevalent throughout the whole investigation and this is that when led by people within the clinical system of the same institution already, the transformation can be mitigated. The OCT was a vital component that helped ensure provider input and engagement. <br />
There is great value to the system that these individuals have brought forward yet this type of system might be limited to only this institution since they had tremendous help from those already within the hospital. This system, however, does extrapolate the great value of investing time into getting help from within the hospital so that the transition can be done in a much smoother fashion. I believe that the domains used within this realm of research were accurate, and accounted for things that should be significantly valued within the standards that are sought out by these transitions. Once again, this article has proven that the people involved in EMR implementation matter significantly as they become the factor or factors that could make this operation a success or a complete failure and worthless investment.<br />
<br />
= References =<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: EHR implementation project]]<br />
[[Category: EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Views_on_health_information_sharing_and_privacy_from_primary_care_practices_using_electronic_medical_recordsViews on health information sharing and privacy from primary care practices using electronic medical records2015-04-09T04:36:38Z<p>Mho2: </p>
<hr />
<div>=== Abstract ===<br />
The purpose of this article is to explore how physicians and patients balance the potential benefits and dangers of sharing patients’ electronic health information in regards to patient safety as well as miscellaneous secondary purposes <ref name="Privacy">Perera, G., Holbrook, A., Thabane, L., Foster, G., & Willison, D. J. (2011). Views on health information sharing and privacy from primary care practices using electronic medical records. International journal of medical informatics, 80(2), 94-101. http://www.sciencedirect.com.ezproxyhost.library.tmc.edu/science/article/pii/S138650561000225X</ref>.<br />
<br />
=== Methods ===<br />
A Health Information Privacy Questionnaire(s) (HIPQ) which was composed of before and after surveys were filled out by both physicians and patients in practices which had [[EMR|electronic medical records (EMRs)]] implemented and were part of a clinical trial in Ontario, Canada. Thirteen questions were asked in the following four categories<ref name="Privacy"></ref>:<br />
* [[privacy|Privacy]] of EMRs<br />
* Use of patients' health information by someone outside the health care organization<br />
* Sharing patients' information within the health care system<br />
* The overall perception of benefits versus harms of computerization in health care<br />
<br />
=== Results ===<br />
There were a total of 511 patients and 46 physicians who participated in the survey. Over 90% of those surveys had favorable opinions regarding the sharing of electronic health information amongst health care professionals for the purpose of providing clinical advice. Less than 70% agreed health data lacking identification information should be shared with non health care professionals. Approximately 38%-50% believed computerized records could have greater [[Security|security]] than paper records, but 58% of patients and 70% of physicians believed the benefits gained from having electronic health information outweighed the risk towards [[confidentiality]]<ref name="Privacy"></ref>.<br />
=== Conclusions ===<br />
The majority of patients and physicians highly valued the benefits which EMRs can provide, but it is important to note the large percentage of those who had doubts regarding any and all secondary uses of de-identified personal health information. Additional values and beliefs showed that there were no major concerns about academic researchers access to health information.<br />
<br />
=== Comments ===<br />
I agree with the conclusion of the article as 58% of patients believed the good EMRs can provide are worth the risk, and only 38%-50% believed electronic records could be better protected than paper records. These results are concerning because if only approximately half of the patients surveyed were supportive of EMRs then they might be reluctant to allow their information to be entered into an EMR, and lack of patient participation could cause problematic issues towards EMR implementations.<br />
<br />
Related Read: [[The Mobile Technology Era: Potential Benefits and the Challenging Quest to Ensure Patient Privacy and Confidentiality|The Mobile Technology Era: Potential Benefits and the Challenging Quest to Ensure Patient Privacy and Confidentiality]]<br />
<br />
=== Related Article === <br />
<br />
[[Patient Experiences and Attitudes about Access to a Patient Electronic Health Care Record and Linked Web Messaging]]<br />
<br />
= References =<br />
<references/><br />
[[Category: Reviews]]<br />
[[Category: EHR]]<br />
[[Category: PHR]]<br />
[[Category: Privacy]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Patient_Experiences_and_Attitudes_about_Access_to_a_Patient_Electronic_Health_Care_Record_and_Linked_Web_MessagingPatient Experiences and Attitudes about Access to a Patient Electronic Health Care Record and Linked Web Messaging2015-04-09T04:32:01Z<p>Mho2: Created page with "This article studies the patients’ perception regarding Web-based communication with their providers. <ref name="cDDs10"> Hassol, A., Walker, J. M., Kidder, D., Rokita, K., ..."</p>
<hr />
<div>This article studies the patients’ perception regarding Web-based communication with their providers. <ref name="cDDs10"> Hassol, A., Walker, J. M., Kidder, D., Rokita, K., Young, D., Pierdon, S., ... & Ortiz, E. (2004). Patient experiences and attitudes about access to a patient electronic health care record and linked web messaging. Journal of the American Medical Informatics Association, 11(6), 505-513.<br />
http://jamia.oxfordjournals.org/content/11/6/505 </ref><br />
<br />
== Background ==<br />
<br />
Patient access to their electronic health care record [[EHR]] and Web-based communication between patients and providers can potentially improve the quality of health care, but little is known about patients' attitudes toward this combined electronic access record.<br />
<br />
== Objective == <br />
<br />
The objective of this study was to evaluate patients' values and perceptions regarding Web-based communication with their primary care providers in the context of access to their electronic health care.<br />
<br />
== Methods ==<br />
<br />
They conducted an online survey of 4,282 members of the Geisinger Health System who are registered users of an application (MyChart) that allows patients to communicate electronically with their providers and view selected portions of their EHR. To supplement the survey, they also conducted focus groups with 25 patients who were using the system and conducted one-on-one interviews with ten primary care clinicians. They collected and analyzed data on user satisfaction, ease of use, communication preferences, and the completeness and accuracy of the patient EHR.<br />
<br />
== Results ==<br />
<br />
A total of 4,282 registered patient EHR users were invited to participate in the survey; 1,421 users (33%) completed the survey, 60% of them female. The age distribution of users was as follows: 18 to 30 (5%), 31 to 45 (24%), 46 to 64 (54%), 65 and older (16%). Using a continuous scale from 1 to 100, the majority of users indicated that the system was easy to use (mean scores ranged from 78 to 85) and that their medical record information was complete, accurate, and understandable (mean scores ranged from 65 to 85). Only a minority of users was concerned about the confidentiality of their information or about seeing abnormal test results after receiving only an explanatory electronic message from their provider. Patients preferred e-mail communication for some interactions (e.g., requesting prescription renewals, obtaining general medical information), whereas they preferred in-person communication for others (e.g., getting treatment instructions). Telephone or written communication was never their preferred communication channel. In contrast, physicians were more likely to prefer telephone communication and less likely to prefer e-mail communication.<br />
<br />
== Conclusion ==<br />
<br />
Patients' attitudes about the use of Web messaging and online access to their EHR were mostly positive. Patients were satisfied that their medical information was complete and accurate. A minority of patients was mildly concerned about the confidentiality and privacy of their information and about learning of abnormal test results electronically. Clinicians were less positive about using electronic communication than their patients. Patients and clinicians differed substantially regarding their preferred means of communication for different types of interactions.<br />
<br />
== Comments == <br />
<br />
The use of technology in communicating between providers and patients are becoming more and more common. Although it is more efficient, we need to be careful in keeping this data secure to protect the patient’s privacy. <br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category:EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/CookiesCookies2015-04-09T03:39:15Z<p>Mho2: /* Definition */</p>
<hr />
<div>A cookie is data that is generated by a website and saved to a computer by the web browser. The purpose of this information is to remember certain information by the entity accessing the web site. A cookie may store log-in information for a specific site. The cookie may also save information from search engines regarding recently viewed sites. Cookies generated by browsers may be "session" types or "persistent" types. When the system closes, session type cookies are deleted. This would be type of cookie used by a commerce sites to store items in a shopping bag. Persistent cookies store data for a more extended period of time. The expiration date of the persistent cookie may vary from a few days to several years. The cookie is not deleted until that expiration date. Generally, web browsers save cookies in a single file located within the browser's directory, typically within the Privacy or Security tabs. Disallowing cookies increases privacy but some websites will not function without cookies. If a user switches browsers, new cookies are created.<br />
<br />
== Definition == <br />
<br />
A Cookie is a small file or part of a file stored on a World Wide Web user's computer, created and subsequently read by a Web site server, and containing personal information (as a user identification code, customized preferences, or a record of pages visited) <ref name="def"> Cookie [Def. 3]. (n.d.). In Merriam Webster Online http://www.merriam-webster.com/dictionary/cookie</ref><br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category: Definition]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/CookiesCookies2015-04-09T03:38:38Z<p>Mho2: </p>
<hr />
<div>A cookie is data that is generated by a website and saved to a computer by the web browser. The purpose of this information is to remember certain information by the entity accessing the web site. A cookie may store log-in information for a specific site. The cookie may also save information from search engines regarding recently viewed sites. Cookies generated by browsers may be "session" types or "persistent" types. When the system closes, session type cookies are deleted. This would be type of cookie used by a commerce sites to store items in a shopping bag. Persistent cookies store data for a more extended period of time. The expiration date of the persistent cookie may vary from a few days to several years. The cookie is not deleted until that expiration date. Generally, web browsers save cookies in a single file located within the browser's directory, typically within the Privacy or Security tabs. Disallowing cookies increases privacy but some websites will not function without cookies. If a user switches browsers, new cookies are created.<br />
<br />
== Definition == <br />
<br />
A Cookie is a small file or part of a file stored on a World Wide Web user's computer, created and subsequently read by a Web site server, and containing personal information (as a user identification code, customized preferences, or a record of pages visited) <ref name="def"> Cookie [Def. 2]. (n.d.). In Merriam Webster Online http://www.merriam-webster.com/dictionary/cookie</ref><br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category: Definition]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Does_CPOE_support_nurse-physician_communication_in_the_medication_order_processDoes CPOE support nurse-physician communication in the medication order process2015-04-03T03:55:41Z<p>Mho2: </p>
<hr />
<div>The following is a review of the article, “Does CPOE support nurse-physician communication in the medication order process? A nursing perspective" <ref name="Saddik"> Saddik, B. & Al-Mansour, S. (2014). Does CPOE support nurse-physician communication in the medication order process? A nursing perspective. Studies in Health Technology and Informatics, 204, 149-155 http://www.ncbi.nlm.nih.gov/pubmed/25087542 </ref>.<br />
<br />
<br />
== Abstract ==<br />
The authors of this article understand the major role that [[CPOE|computerized physician order entry (CPOE)]] have in the future of health care. There are many journey articles that document the benefits of using CPOE to improve clinician performance. The two major healthcare providers who will be utilizing CPOE will be physicians and nurses. This article will focus on the effects of CPOE on nurse-physician communication as previous studies indicate reduced in-person communication can potentially negatively affect CPOE use <ref name="Ash"> Ash, J. S., Sittig, D. F., Poon, E. G., Guappone, K., Campbell, E., & Dykstra, R. H. (2007). The extent and importance of unintended consequences related to computerized provider order entry. Journal of the American Medical Informatics Association, 14(4), 415-423. </ref> <ref name='Beuscart'> Beuscart-Zéphir, M. C., Pelayo, S., Anceaux, F., Meaux, J. J., Degroisse, M., & Degoulet, P. (2005). Impact of CPOE on doctor–nurse cooperation for the medication ordering and administration process. International journal of medical informatics, 74(7), 629-641. </ref> and hinder future collaboration. <ref name='Pimejad'> Pirnejad, H., Niazkhani, Z., van der Sijs, H., Berg, M., & Bal, R. (2008). Impact of a computerized physician order entry system on nurse–physician collaboration in the medication process. International journal of medical informatics, 77(11), 735-744. </ref><br />
<br />
==Methods==<br />
146 nurses who worked in different inpatient units at a 112 bed hospital in Saudi Arabia were included in the study. A questionnaire was used to gather the data on the nurses’ opinions of CPOE in the medication order process. The first section of the questionnaire included the demographic data such as age, gender, position, and work experience. The second section of the questionnaire included the nurses’ views on the relation between the CPOE and the medication order such as efficiency of the medication order process, drug prescriptions written correctly, and clarity of written drug orders. The third section of the questionnaire included the nurses’ views on the nurse-physician communication such as follow up with physicians, frequency of physician contact, and inaccessibility of physicians. The nurses’ answers were based on a 5-point Likert scale that ranged from strongly agree to strongly disagree.<br />
<br />
== Results ==<br />
The study was able to establish that nurses have a positive attitude towards CPOE. Over half of the nurses agreed with the benefits of CPOE such as clear written drug orders and efficient drug orders that were carried out in a timely manner. The study also showed that CPOE did not help with communication between physicians and nurses. The nurses felt that the implementation of CPOE caused them to increase their communication with physicians. CPOE did not improve physician and nurse cooperation. The nurses frequently needed to follow up with the physicians to clarify the orders that were written ambiguously. <br />
<br />
== Comments ==<br />
This article serves as a good reminder that communication is paramount in providing quality patient care. CPOE has a lot of advantages in aiding physicians and nurses in writing and implementing the order. Understanding the order still requires communication skills that CPOE cannot provide. All health care providers need to realize that communication is still vital in the usage of CPOE. <br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: CPOE]]<br />
[[Category: CDS]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Data_quality_and_clinical_decision-making:_do_we_trust_machines_blindlyData quality and clinical decision-making: do we trust machines blindly2015-04-03T03:53:03Z<p>Mho2: </p>
<hr />
<div>This is a review of a 2009 article by Pesudovs & Applegate entitled; Data quality and clinical decision-making: do we trust machines blindly? <ref name= "Pesudovs2009">Pesudovs, K., & Applegate, R. A. (2009). Data quality and clinical decision-making: do we trust machines blindly? Clinical and Experimental Optometry, 92(3), 173–175. http://onlinelibrary.wiley.com/doi/10.1111/j.1444-0938.2009.00367.x/abstract</ref><br />
<br />
<br />
==Introduction ==<br />
This article touches on an important consideration of clinical decision support systems ([[CDS]]S) - which is the need for the user to be actively engaged in the process as opposed to passively accepting [[CDS]] outputs. The authors discuss CDS in an [http://en.wikipedia.org/wiki/''Optometry''] setting and the increasing reliance on technology particularly in the area of [http://en.wikipedia.org/wiki/Optical_coherence_tomography ocular imaging]. They emphasize the importance of clinicians being able to distinguish when the data is reliable and 'trustworthy' and when to question its quality <ref name = "Pesudovs2009"/><br />
<br />
==Methodology ==<br />
The authors discuss concerns that should be considered by practitioners making clinical decisions on the basis of data generated using ocular imaging machines. Particular concerns expressed are in the area of accuracy and precision of these technologically advanced machines. <ref name = "Pesudovs2009"/><br />
<br />
==Observation==<br />
<br />
===Validity===<br />
*A machine may give valid results in one aspect but this vote of confidence can not be extrapolated to other aspects of the machine's functioning.<br />
*Authors cite the example of the ''Oculus Pentacam'' which accurately measures ''lens opacity, corneal curvature & central corneal thickness'' of the anterior segment of the eye but inaccurately measures pupil size and peripheral corneal thickness resulting in errors in the derived ''Pentacam-derived wavefront aberrations''. As a result a higher number of these aberrations are reported than should be the norm. <br />
*According to the authors ''Face Validity'' should be considered when evaluating data used in [[Clinical Decision Support]] i.e. the data should make sense to the user upon initial review. <ref name = "Pesudovs2009"/><br />
<br />
<br />
===Reliability===<br />
The authors make a distinction between the precision / reliability of the imaging machines to repeatedly produce the same results which does not in turn mean that these results are valid - just because they are consistently produced. They however feel that the issue of inaccuracy can be rectified as long as the machine in question is precise and hence this may be more desirable than a machine that is imprecise but accurate. <br />
This would be an important consideration for clinicians as to the level of confidence they can place in [[Clinical Decision Support]] Data generated by either type of machine described in this scenario. <ref name = "Pesudovs2009"/><br />
<br />
<br />
==Discussion ==<br />
It appears to be a quandary as to what level of imprecision or inaccuracy is acceptable for clinicians when using new technology [[http://clinfowiki.org/wiki/index.php/Category:Technologies]] systems. One part of the dilemma faced is often the lack of comparable standards for accurately evaluating the results obtained with the new technology. Clinicians are encouraged by the authors to stringently consider the quality of data obtained from new technology and not simply accept it ''blindly'' in their eagerness to use it. Data quality is a key consideration and needs to be ensured via empirically based studies and testing in order to facilitate sound clinical decision making and not hinder it. <br />
<br />
<br />
==Conclusion == <br />
The article is an interesting look at clinical decision support systems from the perspective of machine derived information. It is plausible that some clinicians may be trusting of these machines especially if the are not conversant with the technology in use and if there is no precedent for comparison. Scarcity of empirical based studies makes it even more difficult and may lead to reluctance of clinical centers to be 'the first' to pilot validity & reliability studies of the new technology among their patients. Data quality is extremely important to clinical decision support. From the article it is not clear if the data generated by the Optometry devices were integrated into an Electronic Health Record [[http://clinfowiki.org/wiki/index.php/Integrating_Medical_Devices_into_EMRs]]. Other data quality issues could arise if data integration of data generated from devices is not electronically but manually entered. <ref name = "DataQuality_ventilator"> http://clinfowiki.org/wiki/index.php/Assessing_Data_Quality_in_Manual_Entry_of_Ventilator_Settings </ref><br />
<br />
== Related Articles == <br />
<br />
[[Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care]]<br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category:Reviews]]<br />
[[Category:CDS]]<br />
[[Category:HI5313_SP15]]<br />
[[Category:Medical Imaging]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Evaluating_Clinical_Decision_Support_Systems:Monitoring_CPOE_Order_Check_Override_Rates_in_the_Department_of_Veterans_Affairs%E2%80%99_Computerized_Patient_Record_SystemEvaluating Clinical Decision Support Systems:Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs’ Computerized Patient Record System2015-04-03T03:49:24Z<p>Mho2: /* Comments */</p>
<hr />
<div>A review of research article (2008) titled "Evaluating Clinical Decision Support Systems: Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs’ Computerized Patient Record System"<ref name="Lin">Lin, C.P., Payne, T. H., Nichol, W. P., Hoey, P. J., Anderson, C. L., Gennari, J. H. Evaluating Clinical Decision Support Systems: Monitoring CPOE Order Check Override Rates in the Department of Veterans Affairs’ Computerized Patient Record System.2008.Journal of the American Medical Informatics Association Volume 15 (5), 620-626. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2528033/</ref> by Lin et al.<br />
<br />
== First review ==<br />
<br />
===Objectives===<br />
<br />
To reevaluate and compare the VA Veterans Affairs Puget Sound-[http://www.pugetsound.va.gov/ VA Puget Sound] Health Care System’s computerized practitioner order entry [[CPOE]] system generated critical order checks over ride rates in 2001 to that of 2006. A secondary objective was to assess the impact of system changes related to topical medication order checks.<br />
<br />
===Introduction===<br />
<br />
VA Puget Sound Health System health care providers had been using CPOE which has an inbuilt order checking to mitigate the potential medication errors in orders in view of patient safety since 1997. Most of the times the order checks alerts with “high severity” were overridden by healthcare providers in view of clinical irrelevance. A study was conducted in 2001 to analyze the various factors which affect the order checking overrides. A follow up study had been conducted to reassess if the changes in the [[Computerized Patient Record System]] (CPRS) order check rules have an influence on the overridden rates of order checks.<br />
<br />
===Design and Setting===<br />
<br />
The Computerized Patient Record System (CPRS) part of the larger [[Veterans Health Information Systems and Technology Architecture (VistA)]] had been used by VA Puget Sound for note entry, results review and order entry. Critical overridden order checks were analyzed for patients from VA Puget Sound Health Care System Hospitals following VA centrally developed and controlled National Drug File (NDF) and few locally developed Drug files. <br />
VA CPOE also classifies order checks as “critical” or “significant” were high mainly for drug-allergy and drug-drug order checks and also few other types. To be classified as critical, the interaction must be identified in the manufacturer’s black box warning, or be well documented in the literature to cause significant sequelae. Significant drug interactions do not meet the critical [[drug-drug interaction]] criteria but are still thought to have substantial clinical importance.<br />
<br />
===Methods===<br />
<br />
Retrospective analysis by post-hoc logging into system for order activity for two time 3 day periods were Wednesday, January 4, 2006 14:11 to Friday, January 6, 2006 15:46 (Period1) and from Monday, January 9, 2006 08:41 to Wednesday, January 11, 2006 10:30 (Period 2).<br />
*Inclusion criteria: Direct practitioner entry in the ordering package.<br />
*Exclusion criteria: Orders entered through the Pharmacy, Lab or Radiology packages.<br />
Lin et al., defined override rate as the percentage of distinct orders receiving a high severity, critical order check that are signed. <br />
<br />
<br />
<br />
===Results===<br />
<br />
Chi-square contingency table test was applied to compare results from the 2001 and 2006 studies. <br />
Eight different types of critical order checks identified were Drug-Drug Interaction, [[Drug-allergy interaction]], Clozapine appropriateness, Procedure uses intravenous contrast media - abnormal biochemistry result/no creatinine results within 30 days, Metformin - no serum creatinine, Patient has no allergy assessment, Patient allergic to contrast media, Procedure uses intravenous contrast media and patient is taking metformin.<br />
The percentages of overridden high severity order checks had increased from 0.5% in 2001 to 2.5% in 2006. Drug-Drug order checks override rate percentage declined by a percentage in 2006 (87%) than in 2001(88%) with rate being still over 85%. But the percentage of Drug-Allergy Order Checks escalated a difference of 12% from 2001(69%) to 2006(81%).Pearson’s chi-square contingency table test calculated that overall there had been a statistically significant change in the rate of critical order checks from 2001 to 2006. A slight decrease in critical drug-drug overrides on Topical form medications was observed from 29% in 2001 to 25.9% in 2006.<br />
<br />
===Discussion===<br />
<br />
Lin et al., study highlighted that the override rates were due to diverse factors. It strongly agrees with Kuperman et al. who recommended that drug knowledge base designers need to provide the necessary tools to understand, customize and share rule information and that organizations need to create policy and procedure infrastructure to support the use of these tools.<br />
System behavior should also be easily monitored, and ease of evaluation and the development of built-in evaluation tools should be accessible in system design.<br />
Abookire et al. study highlighted that periodic evaluation of system operators to identify the unexpected effects on order checking and particularly after the introduction of new policies, or updates, or changes in the system. Further studies will be interesting in this aspect. <br />
<br />
===Limitations===<br />
<br />
The retrospective analysis applied in this study, sampling the data orders at different times during the year, identifying the factor or combination of factors, both technical and social, may have contributed to new system behaviors including significantly higher drug allergy order check and override rates. So, Lin et al., could not control for many possible changes in the environment and so were not certain about the cause of the overridden rates. <br />
<br />
===Conclusion===<br />
<br />
Lin et al were successful in finding the quantitative data but still need to assume few factors which could have contributed to such high percentages of overridden rates of critically high rates particularly life threatening order checks for drug-allergy orders which might have been due to policy changes and changes in rule bases and drug files.<br />
Simultaneous Analysis of order check systems both qualitatively observational with quantitative order checks monitoring to better understand clinical decision making and the interactions physicians have with information and decision support systems. These outcomes must be clinically relevant for correlation.<br />
<br />
<br />
===Comments===<br />
More studies on overridden rates qualitatively and quantitatively on patient outcomes and educating the physicians about the documented clinically relevant data of the importance of order checks, might decrease the overridden rates in future.<br />
Related study at the VA Puget Sound Healthcare System [[A qualitative cross-site study of physician order entry|A qualitative cross-site study of physician order entry]]<br />
<br />
=Second Review=<br />
==Background==<br />
The purpose of this study was to identify and measure the number of override rates in 2006 for computerized practitioner order entry (CPOE) for the Veteran Affairs Puget Sound Health Care System. Alerts are set in place to reduce errors and provide information over drug-allergies and drug-drug interactions <ref name="van"> van der Sijs H, Aarts J, Vulto A, Berg M. Overriding of Drug Safety Alerts in Computerized Physician Order Entry. J Am Med Inform Assoc. 2006;13(2):138–47. http://www.ncbi.nlm.nih.gov/pubmed/16357358 </ref>. A previous study conducted in 2001 would compare results. <br />
<br />
==Methods==<br />
A post-hoc logging program helped identify and analyze ordering data to then measure the number of orders, order check types, and order check overrides by order check type. Pearson’s chi-square tests were used to compare results from 2006 to previous study in 2001.<br />
<br />
==Results==<br />
The study reviewed 37,040 orders that generated '''908 (2.5%''') critical order checks and identified an '''74/85 (87%)''' override rate for drug-drug critical alerts compared to '''95/108 (88%)''' in the 2001 study '''(X2=0.04, df=1,p=0.85)'''. The study also identified a '''341/420 (81%)''' override rate compared to '''72/105 (69%)''' in 2001 for drug-allergies '''(X2=7.97, df=1,p=0.005)'''. Of these override rates, there were '''420/37040 (1.13%)''' orders generated compared to '''105/42621 (0.25%)''' during a drug-allergy order check in 2001.<br />
<br />
==Conclusion==<br />
The override rates of these orders generated including drug-drug and drug-allergy order checks were high. From the 2001 study to the current 2006 study, there was a significant increase in the frequency of drug-allergy order checks. For purposes of clinical computing systems frequent monitoring of override rates and study further physician action during ordering and decision support.<br />
<br />
==Comments==<br />
I have been interested in the varying VA’s [[EHR]]s as it has provided insight for a wide range of uses. It was an interesting read to look at override rates of the alerts put in place for efficiency and patient safety. There were policy and drug file changes between 2006 and 2001 overrides that would have led to believe the need for less overrides in 2006. It indicates the need for continued monitoring.<br />
<br />
==References==<br />
<references/><br />
<br />
[[Category: CDS]]<br />
[[Category: Reviews]]<br />
[[Category: CPOE]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/EHR_implementation:_one_organization%27s_road_to_successEHR implementation: one organization's road to success2015-04-03T03:41:58Z<p>Mho2: </p>
<hr />
<div>This article is adapted from MacDonald A and Riahi S(2012)'s article " EHR implementation: one organization's road to success" <ref>MacDonald A and Riahi S. EHR implementation: one organization's road to success. ''Nurs Inform. 2012; 2012:'' 258</ref><br />
<br />
= '''INTRODUCTION''' =<br />
The [[electronic health record]]([[EHR]]) is becoming more and more integral to the healthcare.Nationally and provincially, there is a shared vision to transition to an EHR by Canada Health Infoway.<ref>Pynn D. ABC’s of transitioning from paper to electronic documentation. Canadian Journal of Nursing Informatics. 2010;5:3–15</ref> Despite this vision, many healthcare organizations in Canada have been slow to adapt and implement fully integrated EHRs. Management support,financial resource availability,and implementation policies and practices are determined to influence the effectiveness of EHR implementation.<ref> Studer M. The effects of organizational factors on the effectiveness of EMR system implementation – what have we learned? Electronic Healthcare. 2005;4:92–98</ref> <br />
Ontario Shores centre for mental health services(Ontario Shores) is a 325 bed tertiary care mental health centre in Whitby,Ontario,Canada. In late 2007, Ontario Shores began it's successful journey to the implementation of a fully integrated EHR system. This was accomplished through the financial and visionary support of the senior leadership team.<br />
<br />
= '''BACKGROUND''' =<br />
In September 2008, Ontario Shores began work for the implementation of the Meditech 6.0. This readiness work involved process mapping of the current and future state clearly defining the organization's interprofessional standards of practice and care delivery, reviewing policies and procedures,and reviewing documentation practices and process which were organized in various phases.<br />
The project was divided into 3 phases to ensure smoother transition: <br />
# ''Phase 1''(October 2009) included the implementation of the financial,human resources,staffing/scheduling,admissions and pharmacy modules. Prior to implementation, all paper documentation was reviewed and revised by a clinical documentation working group which was committed to ensuring standardization and adherence to best practices in the development of new paper forms that would ease the transition to electronic documentation system in phase 2.This was supported by clinical informaticians and professional practice group.<br />
<br />
# ''Phase 2''(October 2010) included the implementation of electronic documentation and order entry for all clinicians including physicians in the in-patient setting. This encompassed the Meditech 6.0 advanced clinical applications in-patient implementation including Computerized Provider Order Entry([[CPOE]]), Electronic Medication Administration Record([[e-MAR]])/bedside medication verification, Patient care system, Imaging and therapeutic services, lab, and Physician Care Manager. This required intensive training of all disciplines plus support to ensure smooth transition from paper to EHR.<br />
<br />
# ''Phase 3'' was implementation of the clinical modules in the out-patient setting. Pre-work began in January 2011 and involved training of out-patient physicians.<br />
<br />
= '''APPROACH''' =<br />
== Building the team ==<br />
The key theme throughout the design and implementation of clinical modules was to focus on people,process and workflow. Ontario Shores chose to assign the clinical informatics portfolio under the Professional Practice umbrella. The recruitment of the team included the identification of clinical informatics staff that would balance both knowledge of mental health practices along with understanding the complexity of decisions needed to build content of an EHR.<br />
Throughout the process, engagement of key clinical stakeholders was a primary focus. A governance model that include a Clinical system steering committee, Physician Advisory Group(PAG), Safe medication practice committee, and Application design team/working groups added key decisions. The decision team working groups include nursing,allied health staff,physicians and members of the Professional Practice department. Involvement of all the key stakeholders ensured that the design of the system was led by clinicians and not IT professionals.<br />
<br />
== Process mapping ==<br />
A focus of the design team from the pre-work to implementation phase of the project was to document using a consistent process mapping framework. Few organizations are able to recruit staff with the skills and the expertise necessary to effectively map out clinical processes.<ref>Nagle LM, Catford P. Towards a model of successful electronic health record adoption. Healthcare Quarterly. 2008;11:84–91</ref> Early in the process, the organization partnered with a local university to receive process mapping training and utilized a new innovative mapping model. Ontario Shores has also adopted the Lean/Kaizen methodology for evaluating many processes and activities,including out-patient services. The methodology supports involvement in patient satisfaction, financial resources, and greater throughput.<ref>Toussaint J. On the mend. Lean Enterprise Institute, Inc.; 2010</ref><br />
<br />
== Training ==<br />
Training development was lead by a clinical practice leader in the Professional Practice department. The curriculum content was based on "a day in the life of" concept that would walk the clinician through documentation from the beginning to the end of their shift. An e-learning online module, which provided a high overview of the Meditech 6.0 functionality, was utilized for staff as an introduction to the system during training classes,as well as,post-training for review. This training also allowed each clinician to practice in real-time with a "test" patient. The length of face to face training varied amongst disciplines. Nursing received 24 hours of training over three 8-hour sessions. Allied health received 12 hours of training over 1.5 days, and Physicians received 8 hours of training divided into two 4-hour blocks.<br />
In anticipation of training support and go-live,Super users were recruited from each unit/program across the facility.<br />
== Device selection ==<br />
The devices selection process was led by IT with collaboration with clinical informatics and Professional Practice.The selection was based on evaluation provided by frontline staff and clinical managers.<br />
== Implementation process ==<br />
A "big bang" approach was used. The in-patient integration of Meditech consisted of two go-live phases to enable the available resources the ability to complete staff training,chart conversion,and on-unit support. Each phase consisted of two weeks of intense on-unit support with each unit having a minimum of one super user. Chart conversion was done the week before the go-live. The same process was followed for out-patient implementation too.<br />
<br />
There are numerous examples of literature that identify critical factors to ensuring successful EHR implementation, one such work is “[[Best Practices in EMR Implementation: A Systematic Review]].”<br />
<br />
= '''UTILIZATION AND ADOPTION''' =<br />
100% of clinical documentation and orders are now done through the EHR in both the in-patient and out-patient settings. More specifically:<br />
* 96% of orders are ordered into the system directly by the ordering provider<br />
* 99% of the time, patient identification is confirmed through Bar code Medication Administration(BCMA)<br />
[http://en.wikipedia.org/wiki/Bar_Code_Medication_Administration]<br />
* 93% of the medication administrations are scanned<br />
* 45% of the time, physicians use order sets.<br />
<br />
= '''LESSONS LEARNT''' =<br />
Leadership support and physician engagement were key enablers in the success of the project. The senior management team showed unwavering commitment to the success of the project. The project team also strategically selected a physician champion which enabled a highly successful P.A.G for the project. Inclusion of frontline clinicians was integral in the evaluation of various processes and documentation within the system.<br />
One of the major success factors was the ability of the team to work together and adapt to the various challenges encountered throughout the project. This specifically included a strong project manager and team leaders for each of the modules that were implemented in phases 1-3. Also, the collaboration between clinical informatics, PAG, and Professional Practice was key in ensuring that all appropriate decisions were documented and approved in a timely manner. Use of super users for training and on-unit support was also one of the reasons for the success of the implementation of the EHR.<br />
<br />
= '''NEXT STEPS''' =<br />
At this point of EHR evolution, sustainability and optimization are key to ensuring ongoing utilization and adoption by the staff. Informatics personnel need to be active stakeholders in all decisions and committees to ensure seamless integration of new processes to the electronic system. The role of nursing informaticians will continue to evolve to support this. The next phase for the EHR system at Ontario Shores will be the integration of the Resident Assessment Instrument-Mental health into Meditech to continue to support streamlining of documentation and processes.<br />
<br />
= '''COMMENTS''' =<br />
I totally agree with the authors statements that the future of healthcare resides in EHRs and there is the need for multi-step process of building the team, process mapping, training , device selection and finally go-live in both in-patient and out-patient settings to achieve this. Obviously, leadership support and physician engagement are very essential. Also, the super users offer crucial training and on-unit support and are very crucial in gaining the confidence of the clinicians and gaining the vital "buy-in" to improve the healthcare and patient outcomes.<br />
<br />
= '''RELATED ARTICLES''' = <br />
<br />
[[Nursing domain of CI governance: recommendations for health IT adoption and optimization]]<br />
<br />
= REFERENCES =<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: EHR]]<br />
[[Category: Business and Organization]]<br />
[[Category: Methodologies and Frameworks]]<br />
[[Category: Training and User Support]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Nursing_domain_of_CI_governance:_recommendations_for_health_IT_adoption_and_optimizationNursing domain of CI governance: recommendations for health IT adoption and optimization2015-04-03T03:40:09Z<p>Mho2: /* References */</p>
<hr />
<div>This article shows the importance of organizational leaders and how they can make implementation and adoption better. <ref name="cDDs8"> Collins, S. A., Alexander, D., & Moss, J. (2015). Nursing domain of CI governance: recommendations for health IT adoption and optimization. Journal of the American Medical Informatics Association, ocu001. http://jamia.oxfordjournals.org/content/early/2015/02/09/jamia.ocu001 </ref><br />
<br />
== Background ==<br />
<br />
There is a lack of recommended models for [[clinical informatics]] governance that can facilitate successful health information technology implementation. The objective is to understand existing CI governance structures and provide a model with recommended roles, partnerships, and councils based on perspectives of nursing informatics leaders.<br />
<br />
== Methods ==<br />
<br />
They conducted a cross-sectional study through administering a survey via telephone to facilitate semistructured interviews from June 2012 through November 2012. They interviewed 12 nursing informatics leaders, across the United States, currently serving in executive- or director-level CI roles at integrated health care systems that have pioneered electronic health records implementation projects.<br />
<br />
<br />
== Results ==<br />
<br />
They found the following 4 themes emerge: (1) Interprofessional partnerships are essential. (2) Critical role-based levels of practice and competencies need to be defined. (3) Integration into existing clinical infrastructure facilitates success. (4) CI governance is an evolving process. <br />
<br />
== Conclusion ==<br />
<br />
Applied clinical informatics work is highly interprofessional with patient safety implications that heighten the need for best practice models for governance structures, adequate resource allocation, and role-based competencies. Overall, there is a notable lack of a centralized CI group comprised of formally trained informaticians to provide expertise and promote adherence to informatics principles within EHR implementation governance structures.<br />
<br />
== Comments == <br />
<br />
It is very important that organizations that have successfully implemented EHR share their strategies and lessons learned to others who are implementing their own. We should not only learn from our mistakes but also from the mistakes of others. This is the only way we can make our health systems better. <br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category:EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Nursing_domain_of_CI_governance:_recommendations_for_health_IT_adoption_and_optimizationNursing domain of CI governance: recommendations for health IT adoption and optimization2015-04-03T03:36:14Z<p>Mho2: Created page with "This article shows the importance of organizational leaders and how they can make implementation and adoption better. <ref name="cDDs8"> Collins, S. A., Alexander, D., & Moss,..."</p>
<hr />
<div>This article shows the importance of organizational leaders and how they can make implementation and adoption better. <ref name="cDDs8"> Collins, S. A., Alexander, D., & Moss, J. (2015). Nursing domain of CI governance: recommendations for health IT adoption and optimization. Journal of the American Medical Informatics Association, ocu001. http://jamia.oxfordjournals.org/content/early/2015/02/09/jamia.ocu001 </ref><br />
<br />
== Background ==<br />
<br />
There is a lack of recommended models for [[clinical informatics]] governance that can facilitate successful health information technology implementation. The objective is to understand existing CI governance structures and provide a model with recommended roles, partnerships, and councils based on perspectives of nursing informatics leaders.<br />
<br />
== Methods ==<br />
<br />
They conducted a cross-sectional study through administering a survey via telephone to facilitate semistructured interviews from June 2012 through November 2012. They interviewed 12 nursing informatics leaders, across the United States, currently serving in executive- or director-level CI roles at integrated health care systems that have pioneered electronic health records implementation projects.<br />
<br />
<br />
== Results ==<br />
<br />
They found the following 4 themes emerge: (1) Interprofessional partnerships are essential. (2) Critical role-based levels of practice and competencies need to be defined. (3) Integration into existing clinical infrastructure facilitates success. (4) CI governance is an evolving process. <br />
<br />
== Conclusion ==<br />
<br />
Applied clinical informatics work is highly interprofessional with patient safety implications that heighten the need for best practice models for governance structures, adequate resource allocation, and role-based competencies. Overall, there is a notable lack of a centralized CI group comprised of formally trained informaticians to provide expertise and promote adherence to informatics principles within EHR implementation governance structures.<br />
<br />
== Comments == <br />
<br />
It is very important that organizations that have successfully implemented EHR share their strategies and lessons learned to others who are implementing their own. We should not only learn from our mistakes but also from the mistakes of others. This is the only way we can make our health systems better. <br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category:EHR]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Optimization_of_drug%E2%80%93drug_interaction_alert_rules_in_a_pediatric_hospital%27s_electronic_health_record_system_using_a_visual_analytics_dashboardOptimization of drug–drug interaction alert rules in a pediatric hospital's electronic health record system using a visual analytics dashboard2015-03-26T04:34:10Z<p>Mho2: </p>
<hr />
<div>Alert fatigue can become a serious safety issue for hospitalized patients in "deactivating clinically irrelevant drug–drug interaction (DDI) alert rules"<ref name="Simpao 2014">Simpao AF, Ahumada LM, Desai BR, Bonafide CP, Gálvez JA, Rehman MA, Jawad AF, Palma KL, Shelov ED, 2014, Creating Optimization of drug-drug interaction alert rules in pediatric hospital's electronic health record system using a visual analytics dashboard, Journal of the American Medical Informatics Association, 2014,0:1-7(http://dx.doi.org/10.1136/amiajnl-2013-002538)</ref> can assist with decreasing potential alert fatigue and lead to increased patient safety.<br />
<br />
==Background==<br />
<br />
The development of [[EHR|EHR]] and [[CPOE|CPOE]] have assisted with decreasing medication errors and with the implementation of a [[CDS|CDS]] support system we now have alerts for potential drug interactions. This development as well is for patient safety. The downfall has been that perhaps at times CDS support systems can implement many alerts and could potentially cause alert fatigue for providers, including the pharmacy staff. These alerts are at times clinically irrelevant. <ref name="Simpao 2014"></ref><br />
<br />
==Methods==<br />
<br />
This study was conducted over a 3 year span from January 11,2011 to January 26,2014 during which the hospital sought a third party vendor to assist with [[Drug-drug interaction|DDI]] alerts. Due to the number of alerts implemented, the hospital then turned to a visual analytics dashboard in assisting with identifying which alerts were relevant and which were not. This was achieved with the input of pediatrics, providers, and pharmacy staff as well as the hospital stakeholders. <ref name= "Simpao 2014"></ref> During the implementation of turning off alerts, everything was closely monitored and the fears of missing a major DDI did not occur.<ref name= "Simpao 2014"></ref><br />
<br />
==Results==<br />
After the implementation of deactivating alerts there was significant decrease in override of alerts. For both providers and pharmacy staff, noted a decrease in DDI overrides. However they did not see a decrease in override of the actual viewing. There was total of 7.51% with the first intervention. Total of 3 interventions took place and after 3 years there was a significant decrease in overrides.<ref name="Simpao 2014"></ref><br />
<br />
==Conclusion==<br />
It is possible to safely deactivate alerts and still have patient safety as priority. <ref name= "Simpao 2014"></ref><br />
<br />
==Comments==<br />
Patient safety is always a concern in any institution. If ever a situation arises in which alerts become an issue, it is comforting to know that there are other success in deactivating alerts that are clinically irrelevant have a positive impact.<br />
<br />
== Related Articles == <br />
<br />
[[Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care]]<br />
<br />
<br />
==References==<br />
<references/><br />
<br />
<br />
[[Category: Reviews]]<br />
[[Category: CDS]]<br />
[[Category: EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Are_We_Heeding_the_Warning_Signs%3F_Examining_Providers%E2%80%99_Overrides_of_Computerized_Drug-Drug_Interaction_Alerts_in_Primary_CareAre We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care2015-03-26T04:24:22Z<p>Mho2: Created page with "This article studies the downstream effects of CPOE alerts and how critical it really gets. <ref name="cDDs7"> Slight SP, Seger DL, Nanji KC, et al. Are We Heeding the Warni..."</p>
<hr />
<div>This article studies the downstream effects of CPOE alerts and how critical it really gets. <ref name="cDDs7"> Slight SP, Seger DL, Nanji KC, et al. Are We Heeding the Warning Signs? Examining Providers’ Overrides of Computerized Drug-Drug Interaction Alerts in Primary Care. Berthold HK, ed. PLoS ONE. 2013;8(12):e85071. doi:10.1371/journal.pone.0085071. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3873469/ </ref><br />
<br />
== Background ==<br />
<br />
This study talks about how too many [[CDS]] alerts can cause clinicians to ignore them and override critical ones. It evaluates the appropriateness of providers’ overrides and the reason why they chose to do so. <br />
<br />
== Methods ==<br />
<br />
A total of 24,849 DDI alerts were generated in the study period, with 40% accepted. The top 62 providers with the highest override rate were identified and eight overrides randomly selected for each (a total of 496 alert overrides for 438 patients, 3.3% of the sample).<br />
<br />
== Results ==<br />
<br />
After the initial screening, 68.2% (338/496) of the DDI alert overrides were considered appropriate. A detailed review of the medical charts revealed that the desired action was only carried out in 63.3% (214/338) of these cases. One hundred and thirteen different drugs, and 119 different drug-drug interactions, were found to have triggered the 496 DDI alerts.<br />
<br />
== Conclusion ==<br />
<br />
It was found that even though the alerts were modified to be better accepted by the clinicians, a lot of the them still choose to override these alerts. <br />
<br />
== Comments == <br />
<br />
There really is a fine line between helpful alerts and over-alerting. Over alerting can cause alert fatigue and lead to users ignoring critical alerts that could potentially prevent patient harm. There are still a lot of considerations regarding this issue and hoping that it would improve in the future. <br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category:CDS]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Immunization_Prompts_in_EHRsImmunization Prompts in EHRs2015-03-05T04:20:40Z<p>Mho2: </p>
<hr />
<div>Several studies have examined the effectiveness of EHR prompts to remind providers to give immunizations, with mixed success:<br />
<br />
== Immunization Prompts in EHRs ==<br />
<br />
In a cluster-randomized trial,(1) an EHR alert for influenza vaccine appeared on the screen at all visits for patients with asthma aged 5-19 years. The authors found that vaccination opportunities increased from 14.4% to 18.6% at intervention sites and from 12.7% to 16.3% at control sites, which represented a 0.6% greater improvement (not statistically significant). Another study by the same lead author(2) examined the effect of immunization alerts on rates of young children up-to-date for immunization. In that intervention study, rates of children under age 24 months who were up-to-date increased from 81.7% prior to the intervention, to 90.1% after the intervention. <br />
<br />
A few studies have examined the effect of computerized alerts on pneumococcal vaccination for adults in inpatient settings,(3,4) and have found standing orders to be more effective than reminders in increasing immunization rates (51% vs. 31% in the Dexter study, p<0.001). Another prospective study(5) found that a computerized reminder in an emergency department increased rates of pneumococcal vaccination for patients over 65 years old by 5%.<br />
<br />
In a commentary responding to the 2009 Fiks et al. study,(6) Sittig et al. noted that providing clinical decision support (CDS) in the form of alerts to encourage desired health care activities may not be sufficient to make a substantial impact. One must first ensure that the intervention is well accepted. In the cases of influenza vaccination at acute visits, as well as pneumococcal vaccination on inpatient wards, poor patient acceptance as well as physicians' low priority of vaccination in these settings were likely barriers to a greater effect from reminders. Both patients and providers have to be convinced that the immunization is worthwhile for a brief reminder to make substantial differences in immunization rates. In addition, the placement of the reminder in the physician’s workflow was noted to be a critical issue in all of these studies, and should be carefully planned and tested.<br />
<br />
== Related Articles== <br />
<br />
[[Use of Clinical Decision Support to Increase Influenza Vaccination: Multi-year Evolution of the System]]<br />
<br />
== References ==<br />
<br />
# Fiks A. G., Hunter K. F., Localio A. R., Grundmeier R. W., Bryant-Stephens T., Luberti A. A., et al. Impact of electronic health record-based alerts on influenza vaccination for children with asthma. Pediatrics. 2009;124(1):159-169.[http://www.ncbi.nlm.nih.gov/pubmed/19564296]<br />
# Fiks A. G., Grundmeier R. W., Biggs L. M., Localio A. R., Alessandrini E. A. Impact of clinical alerts within an electronic health record on routine childhood immunization in an urban pediatric population. Pediatrics. 2007;120(4):707-714.[http://www.ncbi.nlm.nih.gov/pubmed/17908756]<br />
# Coyle C. M., Currie B. P. Improving the rates of inpatient pneumococcal vaccination: impact of standing orders versus computerized reminders to physicians. Infect Control Hosp Epidemiol. 2004;25(11):904-907.[http://www.ncbi.nlm.nih.gov/pubmed/15566021]<br />
# Dexter P. R., Perkins S. M., Maharry K. S., Jones K., McDonald C. J. Inpatient computer-based standing orders vs physician reminders to increase influenza and pneumococcal vaccination rates: a randomized trial. JAMA. 2004;292(19):2366-2371.[http://www.ncbi.nlm.nih.gov/pubmed/15547164]<br />
# Dexheimer J. W., Jones I., Waitman R., Talbot T., Gregg W., Aronsky D. Prospective evaluation of a closed-loop, computerized reminder system for pneumococcal vaccination in the emergency department. AMIA Annu Symp Proc. 2006:910.[http://www.ncbi.nlm.nih.gov/pubmed/17238529]<br />
# Sittig D. F., Teich J. M., Osheroff J. A., Singh H. Improving clinical quality indicators through electronic health records: it takes more than just a reminder. Pediatrics. 2009;124(1):375-377.[http://www.ncbi.nlm.nih.gov/pubmed/19564321]<br />
<br />
<br />
Submitted by Cynthia Rand<br />
<br />
[[Category:BMI512-FALL-10]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Use_of_Clinical_Decision_Support_to_Increase_Influenza_Vaccination:_Multi-year_Evolution_of_the_SystemUse of Clinical Decision Support to Increase Influenza Vaccination: Multi-year Evolution of the System2015-03-05T04:09:48Z<p>Mho2: /* Methods */</p>
<hr />
<div>This article studies the use of CDS to increase flu vaccinations. <ref name="cDDflu"> Mary N. Gerard , William E. Trick , Krishna Das , Marjorie Charles-Damte , Gregory A. Murphy , Irene M. Benson. Use of Clinical Decision Support to Increase Influenza Vaccination: Multi-year Evolution of the System. Journal of the American Medical Informatics Association Nov 2008, 15 (6) 776-779. http://jamia.oxfordjournals.org/content/15/6/776<br />
</ref><br />
<br />
== Background ==<br />
<br />
This study talks about how [[CDS]] improved compliance with influenza vaccinations over 3 seasons during implementation of an EMR.<br />
<br />
== Methods ==<br />
<br />
Stroger Hospital implemented Cerner and studied how CDS improved influenza vaccination. During Year 1, [[CPOE]] was not yet available for medications so orders were on paper. They used a preselected order set to order the flu vaccine. In Year 2, nurses used an electronic kardex to view their task list. In Year 3, medication CPOE was active and medications were routed to an eMAR.<br />
<br />
== Results ==<br />
<br />
Over the 3 seasons, as CDS functionality improved, there was also a significant increase in patient flu vaccination. Year 1 = 0/36, Year 2 = 8/66, and Year 3 = 286/805.<br />
<br />
== Conclusion ==<br />
<br />
There are several ways of using CDS. Having it for both the physicians and nurses increase compliance significantly. <br />
<br />
== Comments == <br />
<br />
As our technology advances, CDS should be used to help ensure compliance. But at the same time, we should also consider the possibility of alert fatigue.<br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category:CDS]]<br />
[[Category:CPOE]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Use_of_Clinical_Decision_Support_to_Increase_Influenza_Vaccination:_Multi-year_Evolution_of_the_SystemUse of Clinical Decision Support to Increase Influenza Vaccination: Multi-year Evolution of the System2015-03-05T04:09:29Z<p>Mho2: /* Background */</p>
<hr />
<div>This article studies the use of CDS to increase flu vaccinations. <ref name="cDDflu"> Mary N. Gerard , William E. Trick , Krishna Das , Marjorie Charles-Damte , Gregory A. Murphy , Irene M. Benson. Use of Clinical Decision Support to Increase Influenza Vaccination: Multi-year Evolution of the System. Journal of the American Medical Informatics Association Nov 2008, 15 (6) 776-779. http://jamia.oxfordjournals.org/content/15/6/776<br />
</ref><br />
<br />
== Background ==<br />
<br />
This study talks about how [[CDS]] improved compliance with influenza vaccinations over 3 seasons during implementation of an EMR.<br />
<br />
== Methods ==<br />
<br />
Stroger Hospital implemented Cerner and studied how CDS improved influenza vaccination. During Year 1, CPOE was not yet available for medications so orders were on paper. They used a preselected order set to order the flu vaccine. In Year 2, nurses used an electronic kardex to view their task list. In Year 3, medication CPOE was active and medications were routed to an eMAR. <br />
<br />
== Results ==<br />
<br />
Over the 3 seasons, as CDS functionality improved, there was also a significant increase in patient flu vaccination. Year 1 = 0/36, Year 2 = 8/66, and Year 3 = 286/805.<br />
<br />
== Conclusion ==<br />
<br />
There are several ways of using CDS. Having it for both the physicians and nurses increase compliance significantly. <br />
<br />
== Comments == <br />
<br />
As our technology advances, CDS should be used to help ensure compliance. But at the same time, we should also consider the possibility of alert fatigue.<br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category:CDS]]<br />
[[Category:CPOE]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Use_of_Clinical_Decision_Support_to_Increase_Influenza_Vaccination:_Multi-year_Evolution_of_the_SystemUse of Clinical Decision Support to Increase Influenza Vaccination: Multi-year Evolution of the System2015-03-05T04:09:01Z<p>Mho2: Created page with "This article studies the use of CDS to increase flu vaccinations. <ref name="cDDflu"> Mary N. Gerard , William E. Trick , Krishna Das , Marjorie Charles-Damte , Gregory A. M..."</p>
<hr />
<div>This article studies the use of CDS to increase flu vaccinations. <ref name="cDDflu"> Mary N. Gerard , William E. Trick , Krishna Das , Marjorie Charles-Damte , Gregory A. Murphy , Irene M. Benson. Use of Clinical Decision Support to Increase Influenza Vaccination: Multi-year Evolution of the System. Journal of the American Medical Informatics Association Nov 2008, 15 (6) 776-779. http://jamia.oxfordjournals.org/content/15/6/776<br />
</ref><br />
<br />
== Background ==<br />
<br />
This study talks about how CDS improved compliance with influenza vaccinations over 3 seasons during implementation of an EMR. <br />
<br />
== Methods ==<br />
<br />
Stroger Hospital implemented Cerner and studied how CDS improved influenza vaccination. During Year 1, CPOE was not yet available for medications so orders were on paper. They used a preselected order set to order the flu vaccine. In Year 2, nurses used an electronic kardex to view their task list. In Year 3, medication CPOE was active and medications were routed to an eMAR. <br />
<br />
== Results ==<br />
<br />
Over the 3 seasons, as CDS functionality improved, there was also a significant increase in patient flu vaccination. Year 1 = 0/36, Year 2 = 8/66, and Year 3 = 286/805.<br />
<br />
== Conclusion ==<br />
<br />
There are several ways of using CDS. Having it for both the physicians and nurses increase compliance significantly. <br />
<br />
== Comments == <br />
<br />
As our technology advances, CDS should be used to help ensure compliance. But at the same time, we should also consider the possibility of alert fatigue.<br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category:CDS]]<br />
[[Category:CPOE]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Impact_of_Electronic_Health_Record_Clinical_Decision_Support_on_Diabetes_Care:_A_Randomized_TrialImpact of Electronic Health Record Clinical Decision Support on Diabetes Care: A Randomized Trial2015-03-04T22:53:13Z<p>Mho2: /* Discussion */</p>
<hr />
<div>This is a review of the study entitled Impact of Electronic Health Record Clinical Decision Support on Diabetes Care: A Randomized Trial<ref name="oconnor 2011">O’Connor, P. J., Sperl-Hillen, J. M., Rush, W. A., Johnson, P. E., Amundson, G. H., Asche, S. E., Ekstrom, H. L., Gilmer, T. P. (2011). Impact of electronic health record clinical decision support on diabetes care: A randomized trial. Annals of Family Medicine, 9(1), 12–21. doi:10.1370/afm.1196 Retrieved from http://www.annfammed.org/cgi/content/long/9/1/12</ref><br />
==Introduction==<br />
This study was performed to assess the impact of a clinical decision support tool called the Diabetes Wizard on the control of [http://www.emedicinehealth.com/hemoglobin_a1c_hba1c/article_em.htm hemoglobin A1c], blood pressure, and low density lipoprotein (LDL) cholesterol levels of diabetic patients. The study was performed at HealthPartners Medical Group (HPMG) in Minnesota in 2007.<br />
<br />
==Background==<br />
Statistics gathered in 2008 indicate that less than 20% of patients with diabetes maintain hemoglobin A1c levels, blood pressure, and LDL values within recommended guidelines. The high number of patients without optimal control of these parameters is attributed to a lack of timely increase in medications due to short physician visits and also patient noncompliance. The authors of this study suggested that a clinical decision support tool could help improve patients’ diabetic markers. The Diabetes Wizard used the patient’s past and current clinical information to make detailed clinical recommendations. In contrast to previous studies of CDS tools that presented alerts during or at the end of the patient’s visit, the Diabetes Wizard was presented to the physician at the beginning of the patient’s visit. <br />
==Methods==<br />
Physicians participated on a volunteer basis. Diabetic patients, as determined by a search of the EHR for certain prescribed medications and laboratory values, were selected randomly to be in the study arm and the control arm. When a patient in the study presented to the clinic, the nurse clicked the Diabetes Wizard icon within the patient’s electronic health record. The wizard gathered clinical information about the patient and printed a sheet with pertinent data and personalized clinical recommendations using evidence-based guidelines published by the Institute for Clinical Systems Improvement. This sheet was given to the physician just before entering the patient’s exam room. After the patient visit, the physician completed a short visit-resolution form indicating actions taken. Recommendations included specific changes in medication regimen or treatment plan for patients with renal insufficiency or congestive heart failure. Blood tests may have been recommended as well. Finally, shorter followup intervals were recommended based on previous clinical trials that showed more frequent followup visits are associated with better outcomes. <br />
To incentivize the staff, the nurses shared a bonus payment and the physicians were compensated based on the percentage of completed visit resolution forms. <br />
==Results==<br />
Outcomes of the study were based on a comparison of preintervention parameters (hemoglobin A1c, blood pressure, and LDL) compared to postintervention parameters. The data support the hypothesis that an EHR-based clinical decision support system can improve compliance with evidence-based guidelines. The cohort in the study arm showed a modest but significant improvement in glucose control and some aspects of blood pressure control. The monetary incentives ended after 6 months, but physicians were free to continue to use the Diabetes Wizard for an additional 12 months. Some clinicians continued to use it but at a lesser rate than during the compensated period. <br />
==Discussion==<br />
This study of a [[CDS]] took a slightly different approach than other studies in that nurses were a key part of the workflow and the tool was presented to the clinician before seeing the patient. In addition, the clinicians were offered monetary incentives to complete the visit resolution forms. The improved outcomes in the study arm were only slightly better than those in the control arm. This finding suggests that the clinicians learned and applied the recommendations across all patients, not just those in the study arm.<br />
<br />
==Conclusion==<br />
When combined with a modified workflow and sufficient incentives, clinical decision support tools can play a role in improving adherence to guidelines for hemoglobin A1c, LDL cholesterol, and blood pressure control in patients with diabetes. Other studies have looked at using clinical decision support tools to aid in patient specific glucose lowering therapy in Type 2 Diabetic patients.<ref name="A Decision Support Tool for Appropriate Glucose-Lowering Therapy">A Decision Support Tool for Appropriate Glucose-Lowering Therapy in Patients with Type 2 Diabetes.http://online.liebertpub.com.ezproxyhost.library.tmc.edu/doi/full/10.1089/dia.2014.0260</ref><br />
<br />
==Comments==<br />
The authors of this study continued to track the number of completed visit resolution forms for an additional 12 months after the incentive period. The use of this tool dropped by about half when incentives were discontinued. The study did not evaluate the patient’s clinical parameters at the end of those 12 months to see if the improved values were sustained or if the prescribing patterns “learned” during the 6-month course of the study were maintained. Since there was little difference in the improvement between the study arm and the control arm, yet an overall improvement across both cohorts, one might conclude that the CDS served as a learning tool that benefited all patients. <br />
<br />
==References==<br />
<references/><br />
[[Category:HI5313 SP15]]<br />
[[Category:Reviews]]<br />
[[Category:CDS]]<br />
[[Category:EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Overrides_of_medication-related_clinical_decision_support_alerts_in_outpatientsOverrides of medication-related clinical decision support alerts in outpatients2015-03-04T22:49:07Z<p>Mho2: /* References */</p>
<hr />
<div>This is a review of the 2014 article by Nanji et al, ''Overrides of medication-related clinical decision support alerts in outpatients.''<ref name="Nanji 2014"> Nanji, K. C., Slight, S. P., Seger, D. L., Cho, I., Fiskio, J. M., Redden, L. M., . . . Bates, D. W. Overrides of medication-related clinical decision support alerts in outpatients. doi: 10.1136/amiajnl-2013-001813.t</http://jamia.oxfordjournals.org/content/21/3/487.short</ref><br />
<br />
== Background ==<br />
<br />
A large incidence of [[Alert|alert]] overrides in a computerized provider order entry medication [[CDS|clinical decision support]] (CDS) prompted the authors to investigate the reason and appropriateness of the overrides. Both the [[EMR|electronic health record (EHR)]] and CDS were internally developed, and had ordering alerts for: <br />
*Patient allergies<br />
*[[Drug-drug interactions]]<br />
*Age-based recommendations<br />
*Renal recommendations<br />
*[[Formulary decision support|Formulary substitutions]]<br />
*Duplicate drug<br />
*Drug-class interaction<br />
*Class-class interaction<ref name="Nanji 2014"></ref><br />
<br />
== Methods ==<br />
<br />
The incidence of CDS overrides was obtained from the EHR’s audit logs. The appropriateness of the overrides was determined based on criteria created by four clinicians: a physician, nurse, and two pharmacists. A sample of 600 alert overrides from a three-year time period was evaluated. <br />
<br />
<br />
== Results ==<br />
<br />
Over three years, out of 2,004,069 medication orders, 157483 CDS alerts were received and 82,889 (52.6%) of these alerts were overridden. 53% of the overrides were appropriate, and they were in the categories of patient allergy, drug-class, duplicate drug, and drug formulary. The inappropriate overrides were in the categories of renal recommendations, drug-drug interactions, and age-based recommendations. In a different study to check the incidence of delirium in cognitively impaired older adults, alerts were overridden by ICU staff to the point that "[[Alerts|Alert Fatigue]]" occurred. The link to that study is "[[Clinical decision support system and incidence of delirium in cognitively impaired older adults transferred to intensive care]]".<br />
<br />
== Conclusion ==<br />
<br />
The authors concluded that the CDS needed to be evaluated to make it relevant and to decrease alert fatigue. They also surmised that education needed to be given to clinicians on the categories where the alert overrides were inappropriate. Also, a study done by Khan BA et al. contended that the interruptive alerts were best handled if presented to ICU nurses or allied health workers and not to the physicians. They also opined that added human intelligence along with the CDSS alerts would make a difference,rather than the CDSS alerts alone. Please check my article review:<br />
[http://clinfowiki.org/wiki/index.php/Clinical_decision_support_system_and_incidence_of_delirium_in_cognitively_impaired_older_adults_transferred_to_intensive_care]<br />
<br />
== Comments ==<br />
<br />
I found this article to be very informative as it quantified and classified the CDS alert overrides, which would result in a targeted modification of clinical decision support, and at the same time produce basis for intervention in the form of education for clinicians. It highlighted one of the benefits of an EHR: having audit logs that can be mined for research geared towards the improvement of the safety of healthcare delivery. <br />
<br />
== References==<br />
<references/><br />
<br />
<br />
[[Category:Reviews]]<br />
[[Category: CDS]]<br />
[[Category: EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Drug%E2%80%93drug_interactions_that_should_be_non-interruptive_in_order_to_reduce_alert_fatigue_in_electronic_health_recordsDrug–drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records2015-03-04T22:45:51Z<p>Mho2: /* References */</p>
<hr />
<div>This is a review of Phansalkar, S., Van der Sijs, H. , Tucker, A. D., Amrita, D. A., Bell, D. S., Teich, J. M., Middleton, B., Bates, D.W. (2013) article Drug–drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records <ref name="alert fatigue (2013)"> Phansalkar, S., Van der Sijs, H. , Tucker, A. D., Amrita, D. A., Bell, D. S., Teich, J. M., Middleton, B., Bates, D.W. Drug–drug interactions that should be non-interruptive in order to reduce alert fatigue in electronic health records. Journal of the American Medical Informatics Association: JAMIA, 20(3), 489-493. doi:10.1136/amiajnl-2012-001089. Retrieved from http://jamia.oxfordjournals.org/content/20/3/489 </ref><br />
<br />
<br />
==Background==<br />
Medication-related [[CDS|clinical decision support (CDS)]] allows healthcare providers to become aware of potential adverse [[drug-drug interactions]] before any medications are used. The intention of the system is to alert drug prescribers of potential adverse drug-drug interactions (DDI) but [[alerts]] are often ignored and overridden with high rates of up to 96% because system users believe the alerts lack content specificity.<br />
<br />
==Objective==<br />
The purpose of the research study detailed in the article was to determine whether or not it was possible to reduce the number of DDI alerts by classifying alerts as either critical, and thus necessarily interruptive, or non-critical, and thus unnecessarily interruptive. If the occurrence of interruptive alerts could be reduced then it was hoped that patient safety could be increased by decreasing the tendency for the alerts to be ignored by system users. Rather than give an alert for all drug-drug interactions, the researchers proposed that the system only alert the user for the highest priority drug-drug interactions.<br />
In a different study done by Khan BA et al. in Wishard memorial hospital, it was found that adding human intelligence to the CDSS alerts would improve the effectiveness of those alerts. Please check this link:[[Clinical decision support system and incidence of delirium in cognitively impaired older adults transferred to intensive care]] Khan BA et al. found out that interruptive alerts were given to ICU physicians when they added order in GOPHER for inappropriate anticholinergic drugs, order for urinary catheter, or order for physical restraint. They opined that added human intelligence to these alerts would have made a difference by reducing cognitive impairment in older adults in ICU. Please check this article: [http://clinfowiki.org/wiki/index.php/Clinical_decision_support_system_and_incidence_of_delirium_in_cognitively_impaired_older_adults_transferred_to_intensive_care]<br />
<br />
==Methods==<br />
In order to conduct their analysis the researchers obtained logs from an [[EMR|Electronic Health Records (EHR)]] system in use at an academic medical center. A list of DDI alerts were then shown to a panel of 11 experts and each expert was asked to determine whether or not certain types of [[Drug-Drug Interaction Rules|DDI alerts]] could safely be made non interruptive. <br />
<br />
== Results ==<br />
A list of the top 50 most frequently occurring DDI pairs were analyzed in detail by the panel and it was determined that 16 DDI pairs should remain interruptive but that 33 could safely be changed to non-interruptive alerts.<br />
<br />
<br />
== Comments ==<br />
In an attempt to provide patient safety, Electronic Health Records (EHR) systems contain clinical decision support sub component systems that alert users to potentially negative drug-drug interactions. Unfortunately, the system users find that they are alerted too frequently for DDI that are not severe enough to warrant attention but because the alerts interrupt the user workflow and require input in order to circumvent, the alerts cause what is known as [[alerts|alert fatigue]]. Because there are so many interruptions, the alerts cease to signal something that must be attended to but rather are seen as something that should be ignored. This defeats the purpose of the alerts, which is to interrupt a workflow that might potentially cause an [http://en.wikipedia.org/wiki/Adverse_effect adverse effect].Carspecken et al <ref name="Carspecken">http://pediatrics.aappublications.org.ezproxyhost.library.tmc.edu/content/131/6/e1970.full</ref>. conducted a study that observed a patient in the PICU who experienced complications as a result of an extended series of non–evidence-based alerts in the electronic health record.<br />
<br />
In conclusion, the theory behind having a system that alerts users before harm is done is noble but when users are given alerts that are too vague or are not truly serious in nature they become more of a nuisance than a useful tool. When users begin to see the alerts as nothing more than an inconvenient interruption to their workflow they begin to find ways to circumvent the system. Only when interruptive alerts are truly meaningful are they in turn useful. When interruptive alerts are truly meaningful then system users will give them the attention they deserve. In a study done by Khan BA in Wishard memorial hospital, Interruptive alerts were given to the physicians when they type in the CPOE advising use of physical restraints,use of anticholinergics or a urinary catheter. The details are mentioned in this article:[[Clinical decision support system and incidence of delirium in cognitively impaired older adults transferred to intensive care]]<br />
<br />
Lastly, the researchers had the right idea in that a system should only alert when necessary but their methodology could have been better. Their panel of experts only comprised 11 people and no mention of a physician being on the panel was made. Rather than only having pharmacists and pharmacologists on the panel, it would have been nice to have a more diversified panel including the users of the systems as well. In a different study by Khan BA et al., the results showed that diverting the alerts to the ICU nurses and other staff rather than the ICU physicians would have had more impact and the CDSS could have proven effective in cognitively impaired patients and reduced delirium. [http://clinfowiki.org/wiki/index.php/Clinical_decision_support_system_and_incidence_of_delirium_in_cognitively_impaired_older_adults_transferred_to_intensive_care]<br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: CDS]]<br />
[[Category: CPOE]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Design_of_Decision_Support_Interventions_for_Medication_PrescribingDesign of Decision Support Interventions for Medication Prescribing2015-03-04T22:40:37Z<p>Mho2: /* References */</p>
<hr />
<div>This is a review for Horsky, J., Phansalkar, S., Desai, A., Bell, D., & Middleton, B. (2013). Design of decision support interventions for medication prescribing. International Journal of Medical Informatics, 82(6), 492–503. doi:10.1016/j.ijmedinf.2013.02.003<br />
== Introduction ==<br />
Horsky et al.’s stated objective in this study is to describe optimal design attributes of clinical decision support([[CDS]]) interventions for medication prescribing, emphasizing perceptual, cognitive and functional characteristics that improve human–computer interaction([http://en.wikipedia.org/wiki/Human%E2%80%93computer_interaction HCI]) and patient safety.<ref name="Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"> Horsky, J., Phansalkar, S., Desai, A., Bell, D., & Middleton, B. (2013). Design of decision support interventions for medication prescribing. International Journal of Medical Informatics, 82(6), 492–503. doi:10.1016/j.ijmedinf.2013.02.003 http://ca3cx5qj7w.search.serialssolutions.com/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Design+of+decision+support+interventions+for+medication+prescribing&rft.jtitle=International+Journal+of+Medical+Informatics&rft.au=Horsky%2C+Jan&rft.au=Phansalkar%2C+Shobha&rft.au=Desai%2C+Amrita&rft.au=Bell%2C+Douglas&rft.date=2013-06-01&rft.pub=Elsevier+B.V&rft.issn=1386-5056&rft.eissn=1872-8243&rft.volume=82&rft.issue=6&rft.spage=492&rft.externalDBID=n%2Fa&rft.externalDocID=331196429&paramdict=en-US</ref><br />
<br />
Clinical decision support (CDS) systems can safely and effectively support [[CPOE]]. Many contemporary installations, however, have poor user interface design. Horsky et al states this makes the receiving and responding to decision support interventions difficult. Few systems have substantially delivered on the promise to improve healthcare processes and outcomes. The challenges of designing effective but potentially work-disruptive [[alerts]] and notifications are manifold and often require the reconciliation of contradictory goals, such as the need for succinctness with the need to adequately support complex medical decisions. <ref name=" Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"></ref><br />
<br />
Designers and developers of health information technology (HIT) need a cohesive, widely accepted and reliable set of industry standards, recommendations and best practices to substantially increase the [[usability]], effectiveness and safety of electronic health records ([[EHR]]s) and CDS systems. <br />
This report describes design recommendations for CDS interventions that are activated during medication prescribing, such as alerts to drug and allergy interactions, according to Horsky et al. <ref name=" Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"></ref><br />
<br />
== Background ==<br />
<br />
Horsky et al. performed a background investigation with these findings: There is somewhat scant but increasingly more reported evidence of medical errors, adverse drug events, near misses and other patient safety problems that can be at least in part attributed to failures in human interaction with poorly designed EHR and CDS interfaces. Published reports include descriptions of decreased cognitive performance, medication prescribing errors, unsafe workarounds and poor handling of safety alerts. Existing standards do provide an authoritative source of reference but are difficult to apply by designers without usability training. <ref name=" Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"></ref> <br />
<br />
<br />
== Methods ==<br />
Horsky et al. found from published reports on success, failures and lessons learned during implementation of CDS systems were reviewed and interpreted with regard to HCI and software [[usability]] principles. The authors then formulated design recommendations for CDS alerts that would reduce unnecessary workflow interruptions and allow clinicians to make informed decisions quickly, accurately and without extraneous cognitive and interactive effort. <ref name=" Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"></ref> <br />
<br />
Horsky et al. searched PubMed, Web of Science, PsychInfo, Books @ Ovid and ACM Digital library databases for peer-reviewed articles and trade literature and articles published online by private and public healthcare institutions and usability organizations. The search returned 1544 articles of which Horsky et al. reviewed 421 either in brief (abstract only) or in detail for statements about design, software development or lessons learned from implementation that described positive and negative findings related to specific design characteristics of EHR and decision support systems. <ref name=" Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"></ref> <br />
<br />
== Results ==<br />
Excessive alerting that tends to distract clinicians rather than provide effective CDS can be reduced by designing only high severity alerts as interruptive dialog boxes and less severe warnings without explicit response requirement, by curating system knowledge bases to suppress warnings with low clinical utility and by integrating contextual patient data into the decision logic. Recommended design principles include parsimonious and consistent use of color and language, minimalist approach to the layout of information and controls, the use of font attributes to convey hierarchy and visual prominence of important data over supporting information, the inclusion of relevant patient data in the context of the alert and allowing clinicians to respond with one or two clicks. <ref name=" Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"></ref> <br />
<br />
Horsky et al. categorized the research findings with the following headings: reducing excessive alerting, alerts tiered by levels of interaction severity, Interruptive high-severity alerts, non-interruptive alerts for low-severity interactions, filtering of alerts and rule maintenance, alert content, language and typography, visual and perceptual characteristics. <ref name=" Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"></ref> <br />
<br />
== Discussion ==<br />
Healthcare has been incorporating best practices and proven design principles into IT development at a much slower pace than is necessary to maintain a high level of function and safety for increasingly more complex systems and HIT is therefore often considered as having low reliability, states Horsky et al. Basic HCI standards and guidelines that Horsky et al. review in this report need to be complemented by socio-technical, observational and ethnographic methods to give designers realistic insight into the conditions in which care is provided and the complexities of treating patients with a multitude of comorbid conditions. Safety analyses should not look for a single cause of problems but should consider the system as a whole when looking for ways to make a safer system and avoid unintended consequences of poorly designed HIT. The high rate of drug interaction alerting to even minor possibility of personal discomfort or adverse reaction may in practice counteract the primary objective of CDS to safeguard patients from severe drug injuries.<ref name=" Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"></ref> <br />
<br />
==Conclusion==<br />
Horsky et al. highlighted the findings as follows: Alerts should be tiered by severity, have concise text, justification, clear response options, prioritize concurrent alerts, use controlled color sets, consistent terminology, format text to visually associate drug categories, show clinical context data, maintain manageable pick lists, allow multiple entry options and custom order sets.<ref name=" Horsky, Phansalkar, Desai, Bell, & Middleton, 2013"></ref> <br />
<br />
==Reviewer’s Comments==<br />
=== Jonzy’s Comments ===<br />
Horsky et al. succeeds in its objectives. This article was thorough and informative. The findings of this study should impact all CDS systems in a positive way. I highly recommend reading the entire article. The website link can be found in the references.<br />
==Other Comments==<br />
Other studies suggest that use of [[Evaluation of Medication Alerts in Electronic Health Records for Compliance with Human Factors Principles|human factors design principles]] may also improve receptiveness to alerts. The two studies appear to compliment one another. It would be interesting to see a study combining optimized "mechanics" with optimized "fit and feel".<br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category:CDS]]<br />
[[Category:Reviews]]<br />
[[Category:CPOE]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Development_and_evaluation_of_a_comprehensive_clinical_decision_support_taxonomy:_comparison_of_front-end_tools_in_commercial_and_internally_developed_electronic_health_record_systemsDevelopment and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems2015-03-04T22:36:39Z<p>Mho2: </p>
<hr />
<div><br />
=Introduction=<br />
“[http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ Clinical Decision Support CDS] is a valuable tool for improving healthcare quality and lowering costs”. <ref name = " HealthIT.gov"> HealthIT.gov. 2013. Policymaking, Regulation and Strategy. Accessed from http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds . 03/02/2015./</ref> A comprehensive classification of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] across systems will help facilitate efficiency.<br />
<br />
== Objective ==<br />
This study aims “to develop and validate a [http://www.cbd.int/gti/taxonomy.shtml/ Taxonomy] of front-end [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] tools and to assess support for these tools in major commercial and internally developed [http://www.himss.org/library/ehr/ EHRs].” <ref name = " Adam Wright, Dean F Sittig, et. al "> Adam Wright, Dean F Sittig, et. al. Development and evaluation of a comprehensive clinical decision support Taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems.2011. Journal of the American Medical Informatics Assoc. Accessed from http://jamia.oxfordjournals.org/content/18/3/232. 03/02/2015./</ref> Classifications may help standardize and optimize the use of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS].<br />
<br />
== Methods ==<br />
The authors were very creative to use a modified Delphi approach utilizing eleven “decision support experts to develop a [http://www.cbd.int/gti/taxonomy.shtml/ Taxonomy] of 53 front-end CDS tools”. <ref name = " Adam Wright, Dean F Sittig, et. al "> Adam Wright, Dean F Sittig, et. al. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems.2011. Journal of the American Medical Informatics Assoc. Accessed from http://jamia.oxfordjournals.org/content/18/3/232. 03/02/2015./</ref> A [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] Tool survey were sent to 9 Commercial Vendors and 4 state-of-art [http://www.himss.org/library/ehr/ EHRs].<br />
<br />
== Results ==<br />
Responses received were 85% or 7 out of 9 vendors. All 53 CDS types were identified and found in at least one EHR system surveyed and 8 functions were common in all [http://www.himss.org/library/ehr/ EHRs]. Most common were medication dosing and order support were the common classes while diagnostic and ventilator management suggestions were the common systems identified. A subsequent study also reveled that “a small core set of common CDS tools, but identified significant variability in the remainder of clinical decision support content.” <ref name = " Adam Wright, Dean F Sittig, et. al "> Adam Wright, Dean F Sittig, et. al. Development and evaluation of a comprehensive clinical decision support taxonomy: comparison of front-end tools in commercial and internally developed electronic health record systems.2011. Journal of the American Medical Informatics Assoc. Accessed from http://jamia.oxfordjournals.org/content/18/3/232. 03/02/2015./</ref><br />
<br />
== Comments ==<br />
The authors did very well in developing and validating a comprehensive [http://www.cbd.int/gti/taxonomy.shtml/ Taxonomy] of front-end [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] tools. A comprehensive [http://www.cbd.int/gti/taxonomy.shtml/ Taxonomy] of [http://www.healthit.gov/policy-researchers-implementers/clinical-decision-support-cds/ CDS] tools may existing across all [http://www.himss.org/library/ehr/ EHRs], which perhaps are the better and effective systems in place. Thanks to the authors for the brilliant their brilliant ideas and great efforts for this study.<br />
<br />
== Related Articles == <br />
<br />
Guided Medication Dosing for Inpatients With Renal Insufficiency <ref name = "GMD"> Chertow GM, Lee J, Kuperman GJ, et al. Guided Medication Dosing for Inpatients With Renal Insufficiency. JAMA. 2001;286(22):2839-2844. http://jama.jamanetwork.com/article.aspx?articleid=194455 </ref><br />
<br />
== References ==<br />
<references/><br />
[[Category:Reviews]]<br />
[[Category:CDS]]<br />
[[Category:EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Effects_of_Computerized_Physician_Order_Entry_and_Clinical_Decision_Support_Systems_on_Medication_SafetyEffects of Computerized Physician Order Entry and Clinical Decision Support Systems on Medication Safety2015-03-04T22:19:15Z<p>Mho2: /* Background */</p>
<hr />
<div>== Background ==<br />
<br />
[[Clinical Decision Support]] (CDS) and Computerized Physician Order Entry (CPOE) are believed to reduce medication errors and adverse drug events (ADEs) when integrated in EHR systems.<br />
<br />
== Research Questions ==<br />
<br />
One important question from the authors was “whether the currently available data were sufficiently compelling that CPOE should be widely adopted or whether further research was required.”<br />
<br />
== Methods ==<br />
<br />
The authors used the U.S. National Library of Medicine, Medline electronic bibliographic database and the electronic Cochran library for their literature search. They identified and evaluated articles that described computerized systems for performing general order entry or CDS systems for guiding physicians in the order-writing process. All articles identified were grouped into two categories. One category evaluated CPOE with CDS systems while the other evaluated CDS systems alone.<br />
<br />
== Results ==<br />
<br />
The category of articles that evaluated CPOE with CDS systems showed 25 percent improvement in ordering, 55-86 percent decrease in medication errors, 13 percent decrease in inappropriate dose, 24 percent decrease in inappropriate frequency, and improvement in prescribing practices. The category of studies that evaluated isolated CDS systems showed a decrease in ADEs, lower rates of drug toxicity and fewer interventions.<br />
<br />
== Conclusion ==<br />
<br />
The studies evaluated in this systematic review provide some evidence that medication errors and serious medication error rates are significantly decreased with the use of CPOE and CDS systems. Although the effect of ADE rates has not been adequately tested, considering the strong correlation between medication errors and ADEs, the use of CPOE and CDS systems also appears to have the propensity to decrease ADEs.<br />
<br />
== Discussion ==<br />
<br />
A great number of injuries are caused by medication errors and ADEs. The primary driving force behind the adoption of CPOE and CDS systems is patient safety and better clinical outcomes. It has been shown that the use of CPOE and isolated CDS systems significantly decreases medication error rates and provides other important benefits related to medication use.<br />
Many barriers to CPOE adoption exist, and these barriers have made organizational adoption to CPOE very limited. The authors believe that further studies are needed to clarify a few unanswered questions in order to promote the widespread adoption of CPOE. In addition, more investigation is needed with regard to the efficacy of individual CDS elements.<br />
<br />
== References ==<br />
<br />
http://archinte.jamanetwork.com/article.aspx?articleid=215756</div>Mho2http://www.clinfowiki.org/wiki/index.php/Effects_of_clinical_decision-support_systems_on_practitioner_performance_and_patient_outcomes:_a_synthesis_of_high-quality_systematic_review_findingsEffects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings2015-02-25T05:34:42Z<p>Mho2: </p>
<hr />
<div>This is a review of Monique W M Jaspers, Marian Smeulers, Hester Vermeulen, Linda W Peute 2011 article, “Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings”. <ref name="Monique et.al">Monique W M Jaspers, Marian Smeulers, Hester Vermeulen, Linda W Peute. 2011 Effects of clinical decision-support systems on practitioner performance and patient outcomes: a synthesis of high-quality systematic review findings. http://jamia.oxfordjournals.org/content/18/3/327</ref><br />
<br />
== Objective ==<br />
<br />
This article summarized the impact of [[CDS|clinical decision support]] systems on the performance of medical practitioners and how they influence patient outcomes. Additionally, this article attempted to identify areas which would benefit from additional research.<br />
<br />
== Methods ==<br />
<br />
Authors defined a literature search strategy that consist of research on different clinical libraries (Such as Medline, Embase, and Inspec) and performed analysis on the best systematic reviews focused on CDS. In order to implement this strategy, researchers defined a two-stage procedure, publication selection with use of predefined criteria and an independent assessment approach by the measurement tool. They included systematic reviews with AMSTAR score 9 or above and rated them based on their level of evidence by two independent reviewers.<br />
<br />
== Results and Conclusion ==<br />
<br />
The research result showed that 48.57% (17 out of 35) of pre-included reviews were had adequate quality to further investigated. 57.14% (52 out of 91) of cases showed an evidence that CDS has impact on practitioner performance. Finally, only 30% (25 out of 82) studies of the systematic reviews showed a unique evidence that the CDS have a positive impact on patient outcomes. Researchers concluded that among few studies focused on any benefits of CDS on patient outcomes, many had had very small sample size or had a narrow time frame to show any clinically important effects. <br />
The study shows a significant evidence of positive CDS impact on healthcare providers' performance which affects drug ordering and preventive care reminder systems. The explanation behind this finding comes from the fact that these CDS types need a very small amount of patient information that are available before the diagnosis notes prepared. In fact, they are generated at the time clinicians make the decisions.<br />
<br />
== Comments ==<br />
<br />
This important research took a serious important step toward showing tangible effectiveness of clinical decision support systems in practitioner performance and patient outcomes. Different systematic reviews have been analyzed and a brief outcome of the research objectives have been produced. Additionally, one important aspect of this research is that it focused on areas that need more attention to understand the CDS impact more effectively. Although this article present some limitations, and also used materials developed more than a decade ago, when CDS systems were difficult to use and were in their early stages of development, it shows a guide and road-map for future research areas.<br />
<br />
<br />
== Second Review == <br />
<br />
[[Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes|Effects of CDSS 2nd Review]]<br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category:Reviews]]<br />
[[Category:CDS]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Effects_of_Computerized_Clinical_Decision_Support_Systems_on_Practitioner_Performance_and_Patient_OutcomesEffects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes2015-02-25T05:27:57Z<p>Mho2: Created page with "This article studies the downstream effects of CPOE alerts and how critical it really gets. <ref name="cDDs6"> Garg AX, Adhikari NJ, McDonald H, et al. Effects of Computeriz..."</p>
<hr />
<div>This article studies the downstream effects of CPOE alerts and how critical it really gets. <ref name="cDDs6"> Garg AX, Adhikari NJ, McDonald H, et al. Effects of Computerized Clinical Decision Support Systems on Practitioner Performance and Patient Outcomes: A Systematic Review. JAMA.2005;293(10):1223-1238. http://jama.jamanetwork.com/article.aspx?articleid=200503&resultClick=3<br />
</ref><br />
<br />
== Background ==<br />
<br />
This study focuses on reviewing whether [[CDS]] alerts really improve practitioner performance and patient outcomes. <br />
<br />
== Methods ==<br />
<br />
They included English-language randomized and nonrandomized trials with a contemporaneous control group that compared patient care with a CDSS to routine care without a CDSS and evaluated clinical performance (ie, a measure of process of care) or a patient outcome. They stipulated that the CDSS had to provide patient-specific advice that was reviewed by a health care practitioner before any clinical action. Studies were excluded if the system (1) was used solely by medical students, (2) only provided summaries of patient information, (3) provided feedback on groups of patients without individual assessment, (4) only provided computer-aided instruction, or (5) was used for image analysis. Studies assessing CDSS diagnostic performance against a defined gold standard were not included in this review unless clinical use of the diagnostic CDSS was also compared with routine care. Based on these criteria, they reevaluated all studies from their previous reviews for inclusion.<br />
<br />
== Results ==<br />
<br />
Of the 97 controlled trials assessing practitioner performance, the majority (64%) improved diagnosis, preventive care, disease management, drug dosing, or drug prescribing. However, the effects of these systems on patient health remain understudied—and inconsistent when studied. Fifty-two trials assessed patient outcomes, often in a limited capacity without adequate statistical power to detect clinically important differences. Only 7 trials reported improved patient outcomes with the CDSS, and no study reported benefits for major outcomes such as mortality. Surrogate patient outcomes such as blood pressure and glycated hemoglobin were not meaningfully improved in most studies.<br />
<br />
== Conclusion ==<br />
<br />
It showed that CDS alerts do improve practitioner performance however, patient outcomes were still undermined. <br />
<br />
== Comments == <br />
<br />
This study, however, is about 10 years old. The field has rapidly grown since then and it would be interesting to see if there are recent studies measuring if CDS alerts affect patient outcomes. <br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category:CDS]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/A_Framework_for_Evaluating_the_Appropriateness_of_Clinical_Decision_Support_Alerts_and_ResponsesA Framework for Evaluating the Appropriateness of Clinical Decision Support Alerts and Responses2015-02-25T04:59:20Z<p>Mho2: </p>
<hr />
<div>This is a review of McCoy ''et al's'' 2012 article, ''A Framework for Evaluating the Appropriateness of Clinical Decision Support Alerts and Responses.''<ref name="McCoy 2012"> McCoy, A. B., Waitman, L. R., Lewis, J. B., Wright, J. A., Choma, D. P., Miller, R. A., & Peterson, J. F. A framework for evaluating the appropriateness of clinical decision support alerts and responses. ''J Am Med Inform Assoc'', 19(3), 346-352. doi: 10.1136/amiajnl-2011-000185. Retrieved from http://jamia.oxfordjournals.org/content/19/3/346</ref><br />
<br />
== Background ==<br />
<br />
The authors noted that review of literature shows that current methods of analyzing clinician responses to [[CDS|clinical decision support]] (CDS) alerts are not comprehensive. Their goal is to create a framework for evaluating the appropriateness or inappropriateness of alert overrides that could be used to evaluate other clinical decision support systems.<br />
<br />
== Methods ==<br />
<br />
They developed an evaluation framework that considered both alert appropriateness measures and provider response appropriateness measures. The framework's effectiveness was tested by using it to evaluate a CDS for medication management of acute kidney injury (AKI) that the authors had previously launched. Their sample consisted of 300 patients that had AKI CDS alerts from November 2007 to October 2008. Two nephrologists analyzed the alert responses, with another nephrologist to adjudicate any subject matter disagreements.<br />
<br />
== Results ==<br />
<br />
The authors noted that while only 20% of the CDS alerts were inappropriate, 82% of the alerts were overridden. After further review using this evaluation framework, the percentage of inappropriate clinician overrides decreased to 17%. This is because the framework measured clinician alert responses not only during the immediate ordering timeframe; it also tracked modifications for the alerted medication order even after 24 hours. Some physicians performed delayed modification or discontinuation of the orders in response to the CDS alerts, with average delay time being 13 hours. Expanding the timeframe of review for alert overrides gives allowance for the time that clinicians take to verify their final decisions on medication orders with their peers, superiors, or published literature.<br />
<br />
== Conclusion ==<br />
<br />
The authors concluded that their evaluation framework allows comprehensive assessment of CDS effectiveness, and can be modified by other institutions employing it depending on differences in the practice setting.<br />
<br />
== Comments ==<br />
<br />
This article emphasizes the complexity of implementation and evaluation of effective clinical decision support systems. Clinical decision-making is not always linear; data gathering from electronic medical records does not always lend to the provision of the patient’s complete clinical picture, which is necessary for CDS systems to present the most appropriate alerts. Clinical decision supports will always need constant revision, but the use of evaluation frameworks such as the one suggested by the authors should allow for better identification of needed modifications.<br />
<br />
==Related Article Review== <br />
<br />
[[Informatics Interchange - Alert Fatigue]]<br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category:Reviews]]<br />
[[Category: CDS]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Informatics_Interchange_-_Alert_FatigueInformatics Interchange - Alert Fatigue2015-02-25T04:56:05Z<p>Mho2: </p>
<hr />
<div>This is a review of Jared J. Cash's (2009) article, Alert Fatigue published on the American Journal of Health-System Pharmacy. <ref name="Alertfatigue"> Cash, J. J., (2009). Alert Fatigue. http://www.ajhp.org/content/66/23/2098?hw-tma-check=true</ref><br />
<br />
== Summary ==<br />
[[CDS|Clinical Decision Support (CDS)]] enhance the clinicians' workflow and decision making. The authors discuss [[Alerts|Alert Fatigue]], which is one of the unintended consequences of a CDS. Alert Fatigue, as the name implies, is when the end user begins to ignore the numerous pop ups and notification from the system. A lot of times, physicians ignores or overrides the alerts because they are relying on their own judgment or because the alert does not necessarily apply to the situation.<br />
Alert fatigue is the most common complaint about [http://en.wikipedia.org/wiki/Computerized_physician_order_entry CPOE] systems and alerts are overridden 49-96% of the time. <ref name="Alertfatigue"></ref><br />
<br />
<br />
== Study ==<br />
The authors tried to determine the following information:<br />
<br />
*How many alerts occurred per week, per day, per shift, per patient, per pharmacist?<br />
*The most common type of alerts<br />
*The most common triggers<br />
*Most common reasons why alerts are overridden<br />
**Ex: The system will automatically send an alert when two sedatives are ordered, in reality, the operating room uses two or even three sedatives at the same time.<br />
*If the override reasons were mandatory<br />
<br />
<br />
== Results ==<br />
From the data they gathered, the authors were able to determine a few ways to reduce the frequency of the alerts.<br />
<br />
*Change the sensitivity of alerts<br />
**Firing alerts only when the severity is high<br />
*Customizing alerts based on practices<br />
**In a trauma setting, the medication used may require higher dosage while the dosing in an ambulatory setting may not need such high dosage.<br />
*Keeping the patient’s allergies up to date<br />
*Allowing more options on the alerts such as alternative dosing<br />
<br />
<br />
== Comments ==<br />
The authors were successful in determining the type of alerts, which ones were most commonly ignored, how many alerts of each specific types, the number of occurrences of the alerts, and also many other stats. However, in the paper, the authors only recommend ways to reduce the number of alerts and how to make the alerts more effective. Other studies suggest that use of [[Evaluation of Medication Alerts in Electronic Health Records for Compliance with Human Factors Principles|human factors design principles]] may improve receptiveness to alerts. It would have been really nice if the authors were able to actually implement these recommendations to their study and then follow up after a period of time to determine if their recommendations were successful.<br />
<br />
==Related Article Review == <br />
<br />
[[A Framework for Evaluating the Appropriateness of Clinical Decision Support Alerts and Responses]] <br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: CDS]]<br />
[[Category: CPOE]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Development_and_use_of_active_clinical_decision_support_for_preemptive_pharmacogenomicsDevelopment and use of active clinical decision support for preemptive pharmacogenomics2015-02-25T04:47:48Z<p>Mho2: /* Background */</p>
<hr />
<div>Prescribing medication is changing and with the help of [[CDS|CDS]] and EHR there will be more and more "gene-based drug prescribing". <ref name= "Bell 2013">Bell GC, Crews KR, Wilkinson MR, Haidar CE, Hicks JK, Baker DK, Kornegary NM, Wenjian Y, Cross SJ, Howard SC, Freimuth RR, Evans WE, Broeckel U, Relling MV, Hoffman JM, 26 August 2013, Development and use of active clinical decision support for preemptive pharmacogenomics, Journal of the American Medical Informatics Association, 2014,21, 93-99. http://jamia.oxfordjournals.org/content/21/e1/e93</ref><br />
<br />
===Background===<br />
Many institutions have [[CDS]] as part of their EHR however few institutions have patients genetically tested and use this information to prescribe medication. This institution is looking at patients who have been genetically tested and have and CDS within the EHR and alerts that are generated based on the medication prescribed and wether or not the medication is a high risk medication for this patient. If a medication is a high risk medication it alerts the physician prompting the physician to potentially prescribe a medication that would be most beneficial for the patient or even change the dose that would be most beneficial for the patient based on genetics.<br />
<br />
===Methods===<br />
Using the St. Judes PG4KDS protocol, samples were collected and approximately 225 results were placed in the EHR. This is important because it is now important to determine if there are recommendations for the gene-drug pair. These recommendations are from the CPIC guidelines. Once determined they are then placed into the EHR system as such pairs, the CDS is then activated when a physician orders a medication that could potentially be high risk based on the pharmocogentic test results.<ref name="Bell 2013"></ref> This warning can serve different purposes, it can suggest a different medication type all together or perhaps a change in dose medication, where as previously medication was dosed based on weight.<br />
<br />
<br />
===Results===<br />
During an 18month period of information collection and new alerts implemented it was ultimately found that the alerts were not being ignored and the correct medication and dosage was being prescribed. It was found that approximately "95% patients who had a post-test alert at the time of the first prescription received the appropriate change in therapy as guided by the on-screen alert."<ref name= "Bell 2013"></ref><br />
<br />
===Conclusion===<br />
Implementing a CDS system that delivers real time alerts based on the pharmocgenetic testing results in a higher incidence of appropriate mediation administration. This has helped physicians to be proactive when prescribing medication from dosing to perhaps even changing the course of therapy.<br />
<br />
===Comments===<br />
This is new information for me and this is exciting in the way of how medicine is continuously evolving. It is a privilege to see how medicine and modern day technology making advancements in patient therapy and treatment. As always, it makes me wonder where will we be in the next 5-10 years!<br />
<br />
===References===<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: CDS]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Drug-drug_interaction_checking_assisted_by_clinical_decision_support:_a_return_on_investment_analysisDrug-drug interaction checking assisted by clinical decision support: a return on investment analysis2015-02-25T04:45:07Z<p>Mho2: /* References */</p>
<hr />
<div>=Introduction=<br />
The existence of [http://www.himss.org/library/ehr/ Electronic Health Record (EHR)] in the present generation brings us a lot of wonderful features where one of them is [http://medical-dictionary.thefreedictionary.com/drug-drug+interaction/ Drug-drug Interaction (DDI)] Checking. [http://medical-dictionary.thefreedictionary.com/drug-drug+interaction/ DDIs] are set to check and alert users on possible interactions based on orders/entries placed to help prevent possible complications. It is a very common functionality that is part of the [http://www.clinfowiki.org/wiki/index.php/Meaningful_use Meaningful Use] Requirements and available for almost all [http://www.himss.org/library/ehr/ EHRs]. <br />
<br />
== Objective ==<br />
The authors of this study aimed “to determine the number of [http://medical-dictionary.thefreedictionary.com/drug-drug+interaction/ DDI] alerts, time saved, and time invested after suppressing clinically irrelevant alerts and adding clinical-decision support to relevant alerts”. This will help eliminate unnecessary alerts and keep/implement relevant ones. <ref name = "Helmons, Pieter, et.al"> Helmons, Pieter, et.al. Drug-drug interaction checking assisted by clinical decision support: a return on investment analysis. Journal of the American Medical Informatics Assoc. 2014. http://jamia.oxfordjournals.org/content/early/2015/02/09/jamia.ocu010/</ref><br />
<br />
== Methods ==<br />
A multidisciplinary panel evaluated clinical relevance on most frequently occurring [http://medical-dictionary.thefreedictionary.com/drug-drug+interaction/ DDIs]. [http://searchhealthit.techtarget.com/definition/clinical-decision-support-system-CDSS/ Clinical Decision Support System (CDSS)] was utilized by the pharmacists during their evaluation process. Only CDSS-assisted [http://medical-dictionary.thefreedictionary.com/drug-drug+interaction/ DDI] checking exist in phase 1, then kept in phase 2 but suppressed clinically irrelevant [http://medical-dictionary.thefreedictionary.com/drug-drug+interaction/ DDIs]. Conventional DDI Checking was compared to the results from Pharmacists’ CDSS-assisted DDI checking. <ref name = "Helmons, Pieter, et.al"> Helmons, Pieter, et.al. Drug-drug interaction checking assisted by clinical decision support: a return on investment analysis. Journal of the American Medical Informatics Assoc. 2014. http://jamia.oxfordjournals.org/content/early/2015/02/09/jamia.ocu010/</ref><br />
<br />
== Results ==<br />
The study revealed that “[http://searchhealthit.techtarget.com/definition/clinical-decision-support-system-CDSS/ CDSS]-assisted DDI checking resulted in a 55% reduction of the number of alerts and a 45% reduction in time spent on [http://medical-dictionary.thefreedictionary.com/drug-drug+interaction/ DDIs] checking, yielding a return on investment of almost 10 years.” It showed significant benefits and favorable towards the use of [http://searchhealthit.techtarget.com/definition/clinical-decision-support-system-CDSS/ CDSS]. <ref name = "Helmons, Pieter, et.al"> Helmons, Pieter, et.al. Drug-drug interaction checking assisted by clinical decision support: a return on investment analysis. Journal of the American Medical Informatics Assoc. 2014. http://jamia.oxfordjournals.org/content/early/2015/02/09/jamia.ocu010/</ref><br />
<br />
== Comments ==<br />
The authors did a great job on methods used and it turned out that using [http://searchhealthit.techtarget.com/definition/clinical-decision-support-system-CDSS/ CDSS]-assisted [http://medical-dictionary.thefreedictionary.com/drug-drug+interaction/ DDI] is better than using the tradition ones. Once again, investment is needed at the beginning but it showed a promising return on investments and possibly minimizing [[Alerts|alert fatigues]] and ensuring only relevant DDIs are in placed. <ref name = "Helmons, Pieter, et.al"> Helmons, Pieter, et.al. Drug-drug interaction checking assisted by clinical decision support: a return on investment analysis. Journal of the American Medical Informatics Assoc. 2014. http://jamia.oxfordjournals.org/content/early/2015/02/09/jamia.ocu010/</ref><br />
<br />
== References ==<br />
<br />
<references/><br />
[[Category:Reviews]]<br />
[[Category:CDS]]<br />
[[Category:EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Changes_in_end-user_satisfaction_with_Computerized_Provider_Order_Entry_over_time_among_nurses_and_providers_in_intensive_care_unitsChanges in end-user satisfaction with Computerized Provider Order Entry over time among nurses and providers in intensive care units2015-02-19T04:53:32Z<p>Mho2: </p>
<hr />
<div>This is a review of Hoonakker, P.T., Carayon, P., Brown, R. L., Cartmill, R. S., Wetterneck, T.B, Walker, J. M. (2013) article, Changes in end-user satisfaction with Computerized Provider Order Entry over time among nurses and providers in intensive care units<ref name="Hoonakker et al (2013)"> Hoonakker, P.T., Carayon, P. , Brown, R. L., Cartmill, R. S., Wetterneck, T.B, Walker, J. M. Changes in end-user satisfaction with Computerized Provider Order Entry over time among nurses and providers in intensive care units. Journal of the American Medical Informatics Association: JAMIA, 20(2), 252-259. doi:10.1136/amiajnl-2012-001114. http://www.ncbi.nlm.nih.gov/pubmed/23100129</ref>.<br />
<br />
<br />
==Background==<br />
The subject matter of the article under investigation focuses on [[CPOE|Computerized Provider Order Entry (CPOE)]] and CPOE [[user satisfaction]]. Attempts to implement new [[EMR|health information systems]] relying on CPOE have traditionally been met with criticism and a certain degree of resistance among physicians and nurses. The authors of the study assert that previous literature and research efforts have not examined changes in user attitudes towards CPOE and other health information systems over time. <br />
<br />
==Objective==<br />
The purpose of the study was to identify if users’ attitudes and satisfaction levels change towards CPOE systems over time. <br />
<br />
==Methods==<br />
The authors of the article employed a mixed method research strategy using a survey as the primary [http://en.wikipedia.org/wiki/Data_collection data collection] instrument. The survey is comprised of 15 closed-ended questions and contains two additional open-ended questions. The closed-ended questions of the survey represent the quantitative element of a mixed method study whereas the open-ended questions constitute the qualitative component. The research team also incorporated a cross-sectional design element to measure nurse and physician responses at two different points in time, although the nurses and physicians in each group are not necessarily the same participants.<br />
<br />
The [http://clinfowiki.org/wiki/index.php/CPOE Provider Order Entry User Satisfaction & Usage Survey (POESUS)], a validated questionnaire, was distributed to nurses and ordering providers in four ICUs at 3 months (n=177) and 12 months (n=220) after CPOE implementation. Each item was answered based on a scale ranked from 1 (never) to 7 (always) and an overall scale from 0 (lowest) to 100 (highest) was created to measure user-satisfaction.<br />
<br />
== Results ==<br />
Results from the study indicate nurses may become more accepting and satisfied with CPOE systems after a significant period of time passes, whereas [http://www.fiercehealthit.com/story/docs-cpoe-doesnt-improve-care-or-increase-productivity/2012-10-25 providers’ general satisfaction levels] remained almost the same. The additional time afforded to nurses enables them to gain hands-on experience with CPOE systems and seemingly reduces frustrations associated with preliminary CPOE implementation phases. Both the physicians and nurses liked the system because of the ease in reading orders, making orders, and the range of patient data they have access to. The study identified how CPOE systems can accelerate ordering management processes and integrate [[CDS|Clinical Decision Support (CDS)]] to improve safety and quality metrics associated with ordering functions<ref name="Hoonakker et al (2013)"> </ref>. Instead of evaluating CPOE user feedback based on a single interval, the research team collected feedback three months after CPOE system implementation and again 12 months after implementation. The voluntary survey response rate for the first interval was 47% followed by 68% for the second interval.<br />
<br />
At 3 months post CPOE implementation, surveyed nurses (n=121) reported below the scale midpoint (mean=48.6) and providers (n=54) reported mean 57.8 overall user-satisfaction. At the 12 month post CPOE implementation, nurses (n=163) reported and increased satisfaction (mean=56.8); however, providers remained around the same (mean=57.3).<br />
<br />
== Comments ==<br />
Nurses and providers only experienced between six and ten hours of training prior to the implementation of the CPOE system. Whether a new information system is rolled out in a healthcare, business, or educational work environment, logic suggests end users will demonstrate frustrations related to overhauls in work processes; a characteristic likely exacerbated by insufficient training and support. Another criticism of the study pertains to response rates, or lack thereof, at both intervals. It is plausible to suspect nurses and providers who chose to participate in the survey may be individuals who are particularly frustrated by the CPOE system. Conversely, those who opted not to participate may encompass nurses and providers who are pleased or content with the CPOE systems. Such low response rates when dealing with user-experience ratings raises questions about whether the survey results represent the population they purportedly exemplify. Although the data collection instrument is intrinsically valid and reliable, those factors do not eliminate the need for a representative sample. The authors also rightly admit the study’s cross-sectional design render the results less meaningful since it is impossible to identify how many participants in the first survey interval participated in the second survey interval. At best the study results suggest time, as an independent variable, is potentially correlated with improvements in user satisfaction levels connected to newly implemented CPOE systems.<br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: CPOE]]<br />
[[Category: CDS]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/The_Influence_that_Electronic_Prescribing_has_on_Medication_Errors_and_Preventable_Adverse_Drug_Events:_an_Interrupted_Time-Series_StudyThe Influence that Electronic Prescribing has on Medication Errors and Preventable Adverse Drug Events: an Interrupted Time-Series Study2015-02-19T04:49:24Z<p>Mho2: /* Comments */</p>
<hr />
<div>This is a review on an article in which computerized physician order entry [[CPOE|CPOE]]/clinical decision support[[CDS|CDSS]] have been introduced and its effect on hospitals that have been entering orders using a paper system.<ref name="Doormaal 2009">van Doormal JE, van den Bemut PMLA, Zeal RJ, Egberts ACG, Lenderink BW, Kosterink JGW, Haaijer-Rukamp FM, Mol PGM, 1 November 2009, The Influence that Electronic Prescribing has on Medication Errors and Preventable Adverse Drug Events: an Interrupted Time-Series Study,JAMIA 16,6,816-825 http://jamia.oxfordjournals.org/content/16/6/816,/,</ref><br />
<br />
===Introduction===<br />
The authors discuss the effects of the creation and implementation of a CPOE integrated with a CDSS. They believed that CPOE/CDSS systems would be effective in reducing medication errors and adverse drug events [[ADE|ADE]] "thereby improving patient safety."<ref name="Doormaal 2009"></ref><br />
<br />
<br />
===Methods===<br />
<br />
Interestingly the authors chose to perform this study using "an interrupted time series that is characterized by a series of measurements over time interrupted by an intervention"<ref name="Doormaal 2009"></ref> The study was conducted at two different hospitals with a combined number of 1900 beds. If patients met criteria they were then asked to participate in the study. The study began with paper based order entry and data was subsequently gathered for approximately 5 months, the intervention then came when the CPOE was introduced. There was a time gap of approximately 2 months and the data was then collected post implementation of CPOE and CDSS. However, CDSS was not always implemented concurrently with CPOE.<ref name="Doormaal 2009"></ref> <br />
<br />
<br />
<br />
===Discussion===<br />
<br />
Many different factors played a role in the implementation of the CPOE/CDSS as well as impact on the findings. However "physicians and nurses were positive about the way CPOE/CDSS" impacted the safety of the patient. Though data was collected from approximately '''1500 patients''' whom met criteria during the study '''only 1000 consented to release''' of information and participation in the study.<ref name="Doormaal 2009"></ref><br />
<br />
===Conclusion===<br />
Utilization of CPOE/CDSS was a success in reduction medication errors, thus proving increase in patient safety. After initial adjustment to beginning the practice of CPOE then introducing CDSS, there was a significant decrease in medication errors, as well and increase in completeness of medication prescriptions.<ref name="Doormaal 2009"></ref><br />
<br />
===Comments===<br />
There is truth to be told when implementing a CPOE system, as I was present at many go-live instances for when the "swtich" of paper to electronic occurred, that many factors can and do effect the success of the project. I believe the authors captured some however I would also like to have known how much training was done and as well was the learning curve the same and did they implement the same EHR system at both facilities?<br />
<br />
== Related Article Review ==<br />
<br />
1. Related article review: [[Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients|Cost-effectiveness of an electronic medication ordering system (CPOE/CDSS) in hospitalized patients]]<br />
<br />
2. Related Article Review: [[Provider and pharmacist responses to warfarin drug–drug interaction alerts: a study of healthcare downstream of CPOE alerts]]<br />
<br />
===References===<br />
<references/><br />
<br />
<br />
[[Category:Reviews]]<br />
[[Category:CPOE]]<br />
[[Category:CDS]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/The_impact_of_electronic_health_record_implementation_and_use_on_performance_of_the_surgical_care_improvement_project_measuresThe impact of electronic health record implementation and use on performance of the surgical care improvement project measures2015-02-19T04:42:27Z<p>Mho2: /* Literature Review */</p>
<hr />
<div>This is a review for Thirukumaran, C. P., Dolan, J. G., Webster, P. R., Panzer, R. J., & Friedman, B. (2015). The Impact of Electronic Health Record Implementation and Use on Performance of the Surgical Care Improvement Project Measures. Health Services Research, 50(1), 273–289. doi:10.1111/1475-6773.12191.<br />
== Literature Review ==<br />
One study that examined the impact of [[EHR]] use on the composite SCIP found a decline in the composite score when hospitals transitioned to comprehensive EHRs. Studies that examined individual process measures relevant to SCIP have shown mixed results.<ref name="Thirukumaran et al., 2015">Thirukumaran, C. P., Dolan, J. G., Webster, P. R., Panzer, R. J., & Friedman, B. (2015). The Impact of Electronic Health Record Implementation and Use on Performance of the Surgical Care Improvement Project Measures. Health Services Research, 50(1), 273–289. doi:10.1111/1475-6773.12191.http://onlinelibrary.wiley.com.ezproxyhost.library.tmc.edu/doi/10.1111/1475-6773.12191/full</ref> <br />
EHRs can also adversely impact quality of care. Research has demonstrated an unfavorable association between the use of Computerized Physician Order Entry and clinical. The disruption in the workflows associated with EHR deployment can provide an opportunity for errors to occur.<ref name="Thirukumaran et al., 2015"></ref><br />
<br />
== Objective ==<br />
Thirukumaran et al.’s objective was to examine the impact of electronic health record (EHR) deployment on Surgical Care Improvement Project (SCIP) measures in a tertiary-care teaching hospital. These 10 evidence-based process measures and their composite measure aim to increase adherence to processes that reduce postoperative complications. Thirukumaran et al. (2015) hypothesized that EHR deployment may be associated with a short-term unintended decline (worsening) of the SCIP score, followed by an increased probability of achieving a higher (better) SCIP score.<ref name="Thirukumaran et al., 2015"></ref><br />
== Methods ==<br />
One-group pre- and post-EHR logistic regression and difference-in-differences analyses. SCIP Core Measure dataset from the CMS Hospital Inpatient Quality Reporting Program (March 2010 to February 2012).<ref name="Thirukumaran et al., 2015"></ref><br />
== Setting ==<br />
The main setting for the study was Strong Memorial Hospital (SMH), a 792-bed tertiary-care teaching hospital located in Rochester, New York. The hospital deployed an ONC-ATCB-certified EHR2 (ONC HIT 2012) across most of its inpatient areas on March 5, 2011. Highland Hospital (HH), a 261-bed teaching hospital located 1.3 miles from SMH, was selected by the researchers as the comparison hospital. EHRs were deployed at HH on June 11, 2011.<ref name="Thirukumaran et al., 2015"></ref><br />
Study Duration and Design<br />
For the main (short-term) analysis, the preEHR (before) phase extended from October 1, 2010, to March 4, 2011; and the post-EHR (after) phase extended from March 5, 2011, to June 10, 2011. Three sensitivity analyses were conducted using different long-term study periods. The study adopted two statistical methods for the main analysis and each of the sensitivity analyses: (1) one-group pretest-posttest design (prepost) for SMH patients and (2) difference-in-difference (DID) estimation with pre- and post-EHR samples from SMH, utilizing HH as the control group.<ref name="Thirukumaran et al., 2015"></ref><br />
== Variables ==<br />
Statistical models were created for each SCIP measure. The dependent variable for each model was a dichotomous variable. The impact was quantified as the change in the relative odds of achieving success on a particular measure with EHR use. The composite measure represented episodes that had received appropriate care for all qualifying measures.<ref name="Thirukumaran et al., 2015"></ref><br />
== Results ==<br />
Statistically significant short-term declines in scores were observed for the composite, postoperative removal of urinary catheter and post–cardiac surgery glucose control measures, states Thirukumaran et al. A statistically insignificant improvement in scores for these measures was noted 3 months after EHR deployment.<ref name="Thirukumaran et al., 2015"></ref><br />
'''Discussion'''<br />
The findings demonstrated a decline in SCIP scores in the months immediately following EHR deployment, according to Thirukumaren et al. For the composite measure, EHR use was associated with lesser likelihood of success in the first 2 months afterwards.<ref name="Thirukumaran et al., 2015"></ref><br />
'''Limitations'''<br />
First limitation Thirukumaran et al. cited, the choice of hospitals. Second, a concurrent abstraction process for the SCIP measures at SMH as compared to retrospective abstraction at HH. Third, it is difficult to tell from the data whether the fall in quality followed by the rebound that we observed is likely to be an effect directly linked to the EHR or is just random variation. Though, they give evidence to counter the randomness. Fourth, it is possible that changes in scores may be due to changes in documentation. <ref name="Thirukumaran et al., 2015"></ref><br />
<br />
== Conclusion ==<br />
According to Thirukumaran et al., the study identified statistically significant temporary reductions in surgical quality associated with EHR deployment. . Implementation strategies should be developed to preempt or minimize this initial decline While the use of EHRs has the potential to improve quality of care, their deployment may lead to a temporary reduction in quality. Incorporating this awareness in the design of the implementation process should reap rich benefits.<ref name="Thirukumaran et al., 2015"></ref><br />
==Reviewer’s Comments==<br />
=== Jonzy’s Comments ===<br />
This article is a bit dated but confirms what another study already found to be true. Knowing that such a decrease in productivity is probable should motivate mitigating responses during the implementation period.<br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
[[Category:CPOE]]<br />
[[Category:EHR]]<br />
[[Category:Reviews]]<br />
[[Category:Surgical Care Improvement Project Measures]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Provider_and_pharmacist_responses_to_warfarin_drug%E2%80%93drug_interaction_alerts:_a_study_of_healthcare_downstream_of_CPOE_alertsProvider and pharmacist responses to warfarin drug–drug interaction alerts: a study of healthcare downstream of CPOE alerts2015-02-19T04:31:44Z<p>Mho2: Created page with " This article studies the downstream effects of CPOE alerts and how critical it really gets. <ref name="cDDI"> Allison M Miller , Maureen S Boro , Nancy E Korman , J Ben Dav..."</p>
<hr />
<div><br />
This article studies the downstream effects of CPOE alerts and how critical it really gets. <ref name="cDDI"> Allison M Miller , Maureen S Boro , Nancy E Korman , J Ben Davoren<br />
DOI Provider and pharmacist responses to warfarin drug–drug interaction alerts: a study of healthcare downstream of CPOE alerts http://dx.doi.org/10.1136/amiajnl-2011-000262 i45-i50 First published online: 1 December 2011<br />
</ref><br />
<br />
<br />
== Background ==<br />
<br />
Department of Veterans Affairs (VA) medical centers have had a [[CPOE]] system implemented for more than 10 years in 150 hospital environments. At the San Francisco VA Medical Center (SFVAMC), CPOE with basic decision support is utilized throughout the institution, bar code recognition technology is in place for verification and documentation of inpatient medication administration, and the patient medical record is fully integrated and available online. Providers are prompted when an ordered medication interacts with medications already included on the patient's active inpatient and outpatient medication profile. At the time of this study, these interaction alerts provide only information about interaction severity. When the interaction is categorized as a potentially critical drug–drug interaction (cDDI), providers are required to either cancel the order or enter an explanation as free text before over-riding the alert. Providers have a single text box to enter the reason for over-ride for all order checks being over-ridden at that time. When a pharmacist subsequently processes the order with a cDDI alert, they view the provider's over-ride response and are prompted to document their own intervention before processing the order; however, pharmacists are able to bypass this last step. Studies focused on CPOE alerts and warfarin management to date have shown mixed results on provider actions. A study of alerts in the long term care setting found that 12% of the DDI alerts seen by providers were for warfarin interactions and that providers were only slightly more likely to take appropriate action if they were alerted versus a non-alerted control. The objective of this study was to investigate the utility of cDDI alert processes by categorizing provider and pharmacist responses to warfarin cDDI alerts as clinically appropriate, tracking providers' actions after cDDI alerts, and determining the occurrence of warfarin ADE following the alerts.<br />
<br />
<br />
<br />
<br />
== Methods ==<br />
<br />
The VA Veterans Health Information Systems and Technology Architecture (VISTA) database was queried for patients who had at least one cDDI alert to warfarin over-ridden during an acute care hospital stay. Admissions were included if the patient received warfarin and the interacting medication during their admission, were admitted from January 1, 2007 to June 30, 2008, and had an admission lasting at least 72 h. Admissions were excluded if the patient was on both warfarin and the interacting medication before admission or no INR was calculated during admission before warfarin was started. The alert of interest (AOI) was the first cDDI alert with warfarin that met all inclusion criteria. Provider and pharmacist responses when over-riding the cDDI alerts were categorized as clinically appropriate (hereafter referred to as appropriate), inappropriate, or absent based on criteria published by Grizzle <ref name="grizzle"> Grizzle AJ, Mahmood MH, Ko Y, et al. Reasons provided by prescribers when overriding drug-drug interaction alerts. Am J Manag Care 2007;13:573–8. http://www.ncbi.nlm.nih.gov/pubmed/17927462?access_num=17927462&link_type=MED&dopt=Abstract </ref><br />
<br />
<br />
<br />
== Results ==<br />
<br />
During the study period, there were 555 acute care admissions with a cDDI alert to warfarin over-ridden during the hospital stay. After chart review, 137 admissions were included in this study, accounted for by 133 unique patients. A total of 418 admissions were excluded, some due to multiple reasons. Grounds for exclusion included being on both medications prior to admission (294), failure to receive both medications together during the admission (171), admission lasting less than 72 h (109), or other miscellaneous reasons. The most common categories for responses are listed. For providers, the most common responses were ‘OK’ or ‘MD aware’ which were categorized as ‘Provider aware but no additional reason.’ Due to the set up of the system, providers were not allowed to have an absent response. For pharmacists, no response was most common, categorized as absent. The only variable found to be associated with inappropriate provider response was an increased number of non-critical alerts at the time of the AOI (p=0.01). Alerts with an inappropriate response had an average of four simultaneous non-critical alerts versus 2.4 simultaneous non-critical alerts for over-rides with appropriate responses. On multivariate analysis as well, the only factor associated with an inappropriate response was the number of simultaneous non-critical alerts. Providers were no more likely to have an appropriate response to amiodarone than to vitamin E, the two most common medications involved in the cDDI. Analysis was not completed on factors associated with a inappropriate or absent pharmacist response due to the small number of text responses. In 42% of admissions, providers decreased, held, or stopped warfarin within 72 h of the AOI. Providers adjusted or stopped the interacting medication in 11% of admissions.<br />
There were 50 ADE related to warfarin documented in this study, representing 36.6% of admissions. <br />
<br />
<br />
== Conclusion ==<br />
<br />
The large number of CPOE alerts that providers and pharmacists must respond to in the VA CPOE system is associated with inappropriate responses to cDDI alerts, even with high risk medications such as warfarin. This decision support tool is not being fully utilized by providers at the point of care and review by pharmacists does not improve documentation of over-ride rationale. While most of the patients in this study had appropriate follow-up, the high rate of ADE suggests a need to improve the quality of appropriate medication management following cDDI alerts. Although the rationale for DDI alerts is reasonable, improvements in design are needed to overcome the prevalence of inappropriate responses to alert over-rides. This study provides additional support for the necessity of improving alert utility in existing and future CPOE systems.<br />
<br />
== Comments == <br />
<br />
We must be very careful about crossing the line between helping with clinical decisions and causing alert fatigue. Having too many popups causes the end users to stop reading them and it could lead to major events when it matters. <br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category:CPOE]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Novel_user_interface_design_for_medication_reconciliation:_an_evaluation_of_TwinlistNovel user interface design for medication reconciliation: an evaluation of Twinlist2015-02-12T05:41:08Z<p>Mho2: Created page with "This article compares the effectiveness between Twinlist and Control Interface in performing medication reconciliation. <ref name="Plaisant"> Catherine Plaisant , Johnny Wu ,..."</p>
<hr />
<div>This article compares the effectiveness between Twinlist and Control Interface in performing medication reconciliation. <ref name="Plaisant"> Catherine Plaisant , Johnny Wu , A. Zach Hettinger , Seth Powsner , Ben Shneiderman<br />
DOI: http://dx.doi.org/10.1093/jamia/ocu021 First published online: 9 February 2015. </ref><br />
<br />
<br />
== Background ==<br />
<br />
[[Medication Reconciliation]] is a very important part of meaningful use. It is a multistep process that is frequently complicated by the involvement of multiple providers in the patient’s care over the course of a hospital stay. During the discharge process, clinicians must obtain a list of home medications (usually created during the admission process) and one of current medications used during the hospital stay. Getting this information as accurate as possible is vital in patient care and a simple mistake could lead to medication errors that could cause death. This study is looking at the effectiveness of Twinlist compared to a Control Interface.<br />
<br />
== Methods ==<br />
<br />
Twenty participants, both emergency and Internal Medicine residents and attending physicians, with no experience with Twinlist were used in this study. They used both Control Interface and Twinlist. <br />
<br />
== Results ==<br />
<br />
Participants completed both reconciliation tasks significantly faster (P = 0.006) using Twinlist (M = 211.4 s, SD = 54.5 s) compared to using Control (M = 293.2 s, SD = 133.3 s). The mean improvement was 81.8 s, an 18% improvement.<br />
<br />
== Conclusion ==<br />
<br />
This study evaluated the effectiveness of a novel interface (Twinlist), which uses a spatial layout to reveal similarities and differences, staged animation, and carefully designed interaction to facilitate medication reconciliation in a medical provider population. Twinlist reduced reconciliation time by 18% and the number of clicks and scrolls by 40% and 60%, respectively. Overall, three times as many errors were made with the Control interface than with Twinlist, driven by dramatic improvements observed for three participants. These results suggest that cognitive support through interface design can have a significant impact on patient safety.<br />
<br />
== Comments == <br />
<br />
Due to the constant issues that we encounter with medication reconciliation, this article was very interesting. I believe that making the user experience better is one very important step in making this process as accurate as possible to prevent medication errors and better patient care.<br />
<br />
== References ==<br />
<references/><br />
<br />
[[Category: Reviews]]<br />
[[Category: Interface, Usability and Accessibility]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Category:Interface,_Usability_and_AccessibilityCategory:Interface, Usability and Accessibility2015-02-12T04:53:47Z<p>Mho2: </p>
<hr />
<div>This is a core category for Clinfowiki. It belongs to Clinfowiki > Applications.<br />
<br />
[[Category:Applications]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Category:Interface,_Usability_and_AccessibilityCategory:Interface, Usability and Accessibility2015-02-12T04:52:50Z<p>Mho2: </p>
<hr />
<div>This is a core category for Clinfowiki. It belongs to Clinfowiki > Applications.<br />
<br />
[[Category:Applications]]<br />
<br />
<br />
[[Novel user interface design for medication reconciliation: an evaluation of Twinlist]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Vendor_Selection_CriteriaVendor Selection Criteria2015-02-04T05:05:26Z<p>Mho2: </p>
<hr />
<div>Choosing an [[EMR|electronic medical record (EMR)]] vendor is an important task, with many aspects to consider. An EMR can completely redesign a hospital's practice, but can also optimize it in ways a [[Removing Paper|paper-based system]] could not. With over 400 EMR vendors in the market, selecting the best option could be overwhelming. After clearly defining the needs of the company, the next step is to evaluate which vendors more closely match your list of priorities.<ref name="Selecting a vendor">Selecting the right EMR vendor. http://www.himss.org/files/HIMSSorg/content/files/selectingemr_flyer2.pdf </ref><br />
Here is a list of some of the important considerations when choosing, installing, implementing and upgrading an EMR system. <ref name="factors selecting vendor"></ref><br />
<br />
== Basic EHR Criteria ==<br />
<br />
* ONC‐ATCB certification (Six certifying bodies ) [http://www.healthit.gov/policy-researchers-implementers/certification-bodies-testing-laboratories]<br />
* HIPAA privacy and security compliant [http://www.hhs.gov/ocr/privacy/hipaa/understanding/srsummary.html]<br />
* Meaningful use reporting<br />
* Ability to generate county, state, and federal reports<br />
* Support HL7 messaging standard [http://www.hl7.org/implement/standards/product_brief.cfm?product_id=146]<br />
* Support Secure Sockets (SSL) digital certificate<br />
* Audit trail capabilities<ref name="EHR-Selection">HITECLA.Org Selecting the Right EHR.<br />
http://www.hitecla.org/ehr_selection_tips</ref><br />
<br />
== Core Clinical Features ==<br />
<br />
In 2003, the DHHS [http://www.hhs.gov/] asked the IOM [http://www.iom.edu/] to provide guidance on the basic functionalities of electronic health records systems. The committee concluded that the core functionalities should address the following areas:<br />
* Improvement of patient safety<br />
* Support delivery of effective patient care<br />
* Facilitate management of chronic conditions<br />
* Improve efficiency<br />
* Feasibility of implementation and <br />
* Integration of hospital services<br />
In the Journal of Healthcare Information Management Kranny et. al discussed the importance of an application in the EHR which will promote continuity of care. During the selection of a vendor it is imperative for the decision committee to find out if there is an integration of inpatient, clinical and outpatient interface systems. <ref name="Find-EHR-Vendor">Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23 (42), 1-4.</ref> The patient's progress in house and discharge summary should be accessible by his primary care provider upon discharge. Medications that were discontinued during hospitalization should be updated in the patient's outpatient medication profile so wrong medications are not refilled by the patient. In addition, when new medications are added to the patient medication regimen it should be accessible by the primary care provider and outpatient pharmacist.<br />
<br />
The IOM committee decided that the core functionalities of EHR system should cover the following areas: <ref name="Johnson-Ahima-2006">Johnson 2006: Selecting an electronic medical record system for the physician practice. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035390.hcsp?dDocName=bok1_035390g</ref><br />
<br />
* Improvement of patient safety<br />
* Support delivery of effective patient care<br />
* Facilitate management of chronic conditions<br />
* Improve efficiency<br />
* Feasibility of implementation<br />
<br />
Jain et al. (2010), in the article Evaluating EHR Systems, describes a few criteria to look for in EHR selection. Considerations for EHR selection should include privacy of patient data, interoperability, ease of use( for physicians and support staff) and efficiency of the integrated systems. Management support during implementation is crucial. <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/747986471?accountid=7034</ref><br />
<br />
Based on these areas, the they identified eight categories of core functionalities, including: <ref name="Johnson-Ahima-2006">Johnson 2006: Selecting an electronic medical record system for the physician practice. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_035390.hcsp?dDocName=bok1_035390g</ref><br />
<br />
* Health information and data<br />
* Results management<br />
* [[CPOE|Order entry/management]]<br />
* [[CDS|Decision support]]<br />
* Electronic communication and connectivity<br />
* Patient support; administrative processes<br />
* Reporting and population health management<br />
<br />
== Analyzing EHR Business Requirements ==<br />
<br />
The evaluation team or decision team should consist of clinical healthcare professionals including house staff, technical support professionals, administrators, and finance department team from all areas of the institution. Each person brings to the table a different perspective of usage from their daily job responsibilities. Institution-wide involvement creates awareness and knowledge of EMRs and their benefits, as well as an understanding of the upcoming modifications in the workflows. In summary, the following tasks must be followed before starting EHR business requirements analysis:<br />
<br />
* Assemble an Evaluation Team<br />
* Define the Product, Material or Service<br />
* Define the Technical and Business Requirements<br />
* Define the Vendor Requirements<br />
* Publish a Requirements Document for Approval<br />
<br />
== Meeting Organizational Needs == <br />
<br />
*Understand if and how a vendor's product will accomplish the key goals of the practice. Essentially, a test drive of your specific needs with the vendor’s product. Provide the vendor with patient and office scenarios that they may use to customize their product demonstration. <ref name="HoVS"> Selecting EHR http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
<br />
== System Integration ==<br />
<br />
*Ability to integrate with other products (e.g., practice management software, billing systems, and public health interfaces, ADT). One of the biggest headaches with systems are the inability to exchange information between third party applications. These could cause a lot of issues down the road.<ref name="HoVS"></ref><br />
<br />
== Go Live Support == <br />
<br />
*Define implementation support (amount, schedule, information on trainer(s) such as their communication efficiency and experience with product and company). Will vendor provide go live support? It is very important to have vendor support during go live to help address the hundreds of issues that come up. <ref name="HoVS"></ref><br />
<br />
=== EHR System Feature List ===<br />
<br />
* Information to be considered to store in the system:<br />
** Demographics details<br />
** Patient specific problem or CC (Chief Complaint) with [[ICD|ICD-9 or ICD-10]] numbering<br />
*** Acute/Chronic Indicator<br />
*** Worsening/Resolving Indicator<br />
*** Injuries List<br />
*** Present Illness Description<br />
** Procedures<br />
** Diagnoses <br />
** Medications<br />
** Allergies<br />
** Family medical history <br />
** Consultations<br />
** Signs & Symptoms<br />
** Vitals<br />
** Progress Notes<br />
** Discharge Summaries<br />
** Appointments/Admissions/Visits<br />
** Advance Directives<br />
** Clinical Reminders [Immunizations, Screenings, Risks]<br />
* Result Management (lab, imaging, other diagnostic measurements, pictures, multimedia)<br />
** Review and search results easily by sorting test types, test time, test administers, test results and so on<br />
** Choose one or several test types, such as HGB, and/or WBC, and/or blood sugar and chart on their results for showing trends<br />
* Is the software configuration flexible to customize for future needs? How much customization to the EMR can the vendor offer to meet the institution’s needs? Will there be a surplus of unusable or insufficient components to the EMR? <ref name"himss-ama-pms">American Medical Association. 15 questions to ask before signing an EMR/EHR agreement. http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* Is this EHR system compatible with any other systems such as adverse drug reaction system, case based reasoning system and rule based reasoning systems?<br />
* The proposed EHR software should bring minimal to no new limitations to the existing workflows of the institution <ref name"himss-ama-pms">American Medical Association. 15 questions to ask before signing an EMR/EHR agreement. http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* Does the system meet all existing required operational tasks?<br />
* Does the EHR tested in any other provider sites?<br />
* Does the EHR allow for expandability to mobile devices, mobile medical applications and upcoming mobile technologies?<br />
* Does the EHR have integrated practice management to avoid having to interface with a 3rd party practice management system?<ref name"himss-ama-pms">American Medical Association. 15 questions to ask before signing an EMR/EHR agreement. http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* Does the software provide a tool for workflow mapping/charting?<br />
* Is it possible to migrate existing legacy EMR system institute use to the new EMR database schema?<br />
* Can the software be easily configured/adapted to changing workflows?<br />
* Does the EHR provide on-screen flags to indicate patient visit status? <br />
* Does the EHR allow customization of work flows by the provider, clinician, or other health care professional?<br />
* Does the EHR documentation method support error checking for vital sign data entry? <br />
* Does the EHR/EMR system allow multiple terminals (physician, nurses' station, X-ray, labs, etc.) to log in to the same patient's record simultaneously? Certain systems only allow one terminal to access a patient record at a time - they must log out before any other terminal can access patient EHR/EMR. (For example, if a nurse forgets to log out at their station, the lab cannot access that patient's record.)<br />
<br />
== Vendor Assessment ==<br />
<br />
* Asking about product experiences and user experiences are crucial before selecting a vendor. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
* An EHR evaluation tool should be utilized before selecting a vendor. EHR evaluation tools can be obtained from medical societies. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
* Requesting a demo from the vendor keeps a potential buyer informed on prospective features an EHR possesses. <ref name=" Vendor Selection"> - Vendor Assessment http://www.healthit.gov/providers-professionals/faqs/how-do-i-select-vendor</ref><br />
<br />
* Asking if the vendor is committed to training the institution's in house staff. <ref name="train">Weber, M. Selecting an EHR, now what???? [PDF document]. Retrieved from Lecture Notes Online Web site: https://moodle.sbmi.uth.tmc.edu/pluginfile.php/43545/mod_resource/content/1/Selecting_an_EHR_Vendor.pdf</ref><br />
<br />
* Is there capability to tailor current features of EMRs to enable a smoother changeover from paper to electronic records and to facilitate meeting the criteria for meaningful use. <ref> https://medicalmastermind.com/blog/emr-checklist-ten-product-questions-to-ask-the-vendor/ ‘’Medical Mastermind’’, EMR Vendor Checklist: Ten Important Product Questions to Ask the Vendor, July 31, 2012 </ref><br />
<br />
* Will the EHR meet present and future requirements? How user friendly is the EHR? <ref> [http://www.practicefusion.com/blog/4-questions-ask-selecting-ehr/ ‘’Practice Fusion Blog”, 4 questions to ask when selecting an EHR, July 7, 2014] </ref><br />
<br />
== Vendor Proposal (Request) ==<br />
<br />
* A clear list of specific needs (EHR system requirement) should be written<br />
* Prepare a clear criterion of the system that will be used to make the selection<br />
* Make request to selected vendors <br />
<br />
<br />
=== Privacy and Security ===<br />
* Does the system provide roadmaps for adherence to organizational policies (such as HIPAA)?<br />
* Does the vendor’s EMR source code comply with the Patient Safety & Quality Improvement Act of 2005 (PSQIA)?<br />
* The system shall allow an authorized administrator to enable or disable auditing for events or groups of related events to properly collect evidence of compliance with implementation-specific policies. Note: In response to a [[Health Insurance Portability and Accountability Act (HIPAA)|HIPAA-mandated risk analysis]] and management, there will be a variety of implementation- specific organizational policies and operational limits.<br />
* Internet Connectivity and Redundancy Contract - There are three main types of connections for clinical data connections: business class digital subscriber line (DSL), business class cable, and T1 connection. Redundant back up systems and procedures to ensure your data will be backed up in multiple locations and securely stored off-site. <br />
* Will the system allow staff administrators to create and manage users and [[Data security|user security profiles]]?<br />
* The system restore functionality shall result in a fully operational and secure state. This state shall include the restoration of the application data, [[Security|security credentials]], and log/audit files to their previous state.<br />
* If the system includes hardware, the system shall include documentation that covers the expected physical environment necessary for proper secure and reliable operation of the system including: electrical, HVAC, sterilization, and work area.<br />
* How well does the EMR work with antivirus, antispyware and other security software?<br />
* What is the vendor’s history with cyber attacks? <ref name="mit cybersecurity">MIT Geospactial Data Center: Protecting EMR Data (1 of 2) http://cybersecurity.mit.edu/2012/11/protecting-emr-data-1-of-2/</ref><br />
* Does the system allow for off-site access to files/data and how does the technology protect against external breech or diversion of patient information?<br />
* Does the system have role based permission and access? Different job roles should only be able to access what is required of their job.<br />
* Are all messaging capabilities within the EMR encrypted?<br />
* Does the system have the ability to audit / monitor user activity if needed?<br />
* Does the system have time-stamp functionality (name, date, & time)?<br />
* Is the system in compliance with the organization’s HIPPA policy?<br />
* How will the decrease the unauthorized disclosure of information?<br />
* Does the vendor offer policy and procedures in regards to disposal of Protected Health Information?<ref name="FAQs About the Disposal of PHI">http://www.hhs.gov/ocr/privacy/hipaa/enforcement/examples/disposalfaqs.pdf</ref><br />
* How often do users have to update password information and credentials?<br />
* What does the vendor offer in regards to data backup procedures to ensure privacy and security integrity?<br />
* How often are user ID’s audits performed for inactive users?<ref name="information security">Information security policy template. (2011). Retrieved from http://www.healthit.gov/sites/default/files/info_security_policy_template_v1_0.docx.</ref><br />
<br />
=== CPOE ===<br />
<br />
* [[CPOE| Computerized Physician Order Entry (CPOE)]], [[Electronic prescribing| e-Prescribing]]<br />
* Computerized Physician Order Entry system that integrates and provides for two-way communication with the Pharmacy, Laboratory, Registration systems, and that allows for scanning and downloading of health information as needed. The EHR system should have a completely understood interface and provide for [[HIE|interoperability]] with all current and future systems and between clinics and providers.<br />
* CPOE will generally allow for the organization to specify a default dose for a medication order. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
* The CPOE team will need to review what happens when non-formulary items are entered. The workflow for non-formulary items will also need to be determined. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
* The EHR should have the capabilities to interface with the various labs the hospital or physician uses to order and receive patient lab work automatically.<br />
* Does the EHR have a referral management system so that within large organizations, specialty and primary care departments can easily communication with each other and have similar information on a patient that is using both offices to treat their illness?<ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
<br />
=== Clinical decision support (CDS) ===<br />
* [[Earlier Clinical Decision Support (CDS) Tools]]<br />
* [[Historical Challenges of Clinical Decision Support (CDS) Tools]]<br />
* [[Benefits of Various types of Clinical Decision Support(CDS) Tools]]<br />
* [[CDS|Decision Support]] (Drug Interaction, Drug information and other Prescription Supports, Clinical Guidelines [Plans & Protocols] and disease information, Diagnosis and differential diagnosis Support, Risk Assessments, Clinical Checklists, Medical References, etc)<br />
* Formulary Database Support<br />
* Electronic Communication (Provider-Provider & Patient-Provider Direct Communication, Health Data Exchange, Interface to Medical Devices, Notifications, Clinical Documentation such as Nursing Notes)<br />
* Patient Administration (ADT [Admit, Transfer, Discharge], Reservation & Scheduling, Billing, Waiting List Management, Records of Patient Activity, Master Patient Index across the Healthcare Organization)<br />
* Querying & Reporting (Research & Analysis, Statistics [Vital Statistics, National Statistics], External Accountability Reporting)<br />
* Telecare, Telehealth, and Telemedicine functionality. Home Monitoring device input/linking.<br />
* [[PHR|Patient Portal for online personal health record access]]<br />
* Clinical policies and procedures guidelines<br />
* Produce visit summary and complete medical record printout and data export on demand for patient use.<br />
* Electronic Health Record (EHR) systems should be capable of accommodating multiple users working concurrently within the system and within the same patient file or document. EHR systems should also be capable of protecting the integrity of data in the system so that no data loss occurs when multiple users are working concurrently with the same patient file or document.<br />
** Provide direct decision support explanation link to [[EBM|evidence based knowledge]] (through such as "infobutton",etc) about needed test information, such as purpose and methods of conducting that test, normal range of that test, clinical indications when abnormal results occurred and suggestions what to do, etc.<br />
** Provide abnormal alerts to providers and/or patients through various ways, such as online display, cell phone text messages, etc if the patients/doctors register for this service.<br />
* The organization will need to strike a balance between displaying so many alerts that it causes clinical care to slow. <ref name="HIMSS CPOE Wiki">HIMSS Computerized Provider Order Entry (CPOE) Wiki. https://himsscpoewiki.pbworks.com/w/page/26349065/Clinical%20Content </ref>.<br />
*Does the EHR have an aspect of the CPOE that can manage patient protocols and treatment plans? <ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the software have “Clinical/Business Intelligence” capability based on local clinic medical trends, e.g. if there is above normal upper respiratory infection clinic visits, perhaps a flu season is imminent and may warrant stocking of flu vaccine in the clinic?<br />
<br />
=== Data Storage and Retrieval ===<br />
<br />
* EHR systems should be capable of capturing, storing, indexing, retrieving and displaying externally created documents. Indexing of captured documents should include not only patient identifiers and descriptive information, but also date/time stamps and document type.<br />
* EHR systems should be capable of retaining all system data until such data is archived or intentionally purged from the system.<br />
* The system should load patient records in a timely manner to not interrupt workflow. <br />
* This system should present chronological data of patients like medicine history, progress of diseases. <br />
* Also, system provides gene information or drug allergies of patients to avoid [[Adverse drug event|ADE]].<br />
* System should be compatible with old system to reduce re-entry time.<br />
* System should update regularly.<br />
* system should be able to have Patient prescription plan eligibility, prescription product formulary and external medication history.<br />
* System should be able to have insurance retrieval capabilities (i.e. insurance firms, sum insured, premium dues, etc.).[11]<br />
* Capability to integrate with other products such as practice management software, billing systems and public health interfaces.<br />
<br />
=== Functional Requirements ===<br />
<br />
Functional requirements are those processes that you want a system to perform <ref name="stratishealth"> Requirements Analysis. http://www.stratishealth.org/documents/HITToolkitHospital/1.Adopt/1.3Select/1.3Requirements_Analysis.doc. </ref>.<br />
The electronic health record’s architecture, or its relationship across any existing or future systems at the organization’s practice, directly influences what functions the EHR can support <ref name="ehrchecklist"> EHR Checklist: Functional and Technical Essentials. http://www.poweryourpractice.com/electronic-health-records/ehr-checklist-functional-and-technical-essentials/. </ref>.<br />
The following functional requirements have been broken into the following areas that correspond to EHR functional categories:<br />
==== Clinical Documentation Requirements ====<br />
Clinical documentation is used throughout healthcare to describe care provided to a patient,communicate essential information between healthcare providers and to maintain a patient medical record <ref name="clindoc"> Boone,K.W. Clinical Documentation. 2011. http://www.springer.com/cda/content/document/cda_downloaddocument/9780857293350-c1.pdf?SGWID=0-0-45-1140144-p174097770. </ref>.<br />
* Document and View Medication History<br />
** Will the EHR have the ability to perform basic clinical documentation, including medication history?<br />
** Will the current, active medications be viewable on demand?<br />
** Will the system have the ability to display a complete medication history from information available within the EHR? <ref name="functional"> EHR Functional Requirements. http://www.nyehealth.org/images/files/File_Repository16/pdf/Version_2_2_EHR_Functional_Requirements-16_Nov_09.pdf. </ref><br />
* Treatment plan<br />
** Will the system be able to document a treatment plan and create any new orders?<br />
** As part of that treatment plan, will clinician have the ability to confirm previous medications and prescribe any potential new medications or make dose changes, and the ability to electronically submit orders such as labs, radiology, physical therapy, and other supportive services?<br />
** Will the EHR be able to create structured treatment plan as part of patient encounter? <ref name="functional"></ref><br />
* Consult Note<br />
** Will the system be able to document a consult note with appropriate clinical information from the medical record, including a clinical recommendation, and surgical clearance? <ref name="functional"></ref><br />
*Chief Complaint, Problems, Vital Sign, History, Visits, Medication List, Allergies<br />
** Will the appropriate clinical staff be able to electronically document chief complaint, vital signs, reason for visit, new history, MD visits, problem list, and medication lists?<br />
** Will the system permit appropriate clinical staff to document, review and update patient problems, medications, and allergies or adverse drug reactions in the EHR?<ref name="functional"></ref><br />
*History of Present Illness/Review of Systems/Family History/Medical History/Surgical History/Social History and Physical Exam<br />
** Will the system allow the complete physical assessment, including all necessary examinations based on the current standards of care for the applicable condition, to be documented in a standardized manner with consistent nomenclature? <ref name="functional"></ref><br />
*Patient Educational Materials<br />
** Will the system have patient education material available within the application either from the application itself or from a third party solution? <ref name="functional"></ref><br />
<br />
==== Results Management Requirements ====<br />
Results management is an important clinical activity that requires a structured approach in order to be effective. Results management is in accord with the precepts of Meaningful Use. Incorporation of clinical lab results into the EHR as structured data is an ongoing MU objective. <ref name="results Mgt"> Carter, J. A New Look at Results Management. 2012. http://www.americanehr.com/blog/2012/07/a-new-look-at-results-management/ </ref><br />
* Lab Results<br />
** Will the system send the lab request electronically?<br />
** Will lab results populate electronically into the EHR with flags for abnormal result?<br />
* LOINC Codes<br />
** Will the EHR accept LOINC-mapped electronic lab results if available from the source lab <ref name="functional"></ref>?<br />
*Radiology Results<br />
** Will the system accept radiology results and reports electronically from imaging centers or through the HIE? <ref name="functional"></ref><br />
* Reminder of next test due<br />
** Will the system set a reminder for recommended time frame for next lab test <ref name="functional"></ref>?<br />
<br />
=== Specialty Needs (OBGYN) ===<br />
There are unique requirements from electronic medical records systems for obstetrics and gynecology, and rooting out vendors that provide the ability to support those requirements can be challenging.Unfortunately, until CCHIT adds OB/GYN as a specialty endorsement (not slated until 2012),there are no externally validated organizations that assure the prospective purchaser that the product meets all of the required needs. Of course, should one be in a sub-specialty practice (MFM, REI), there are even fewer assurances offered on suitability; it will be up to the individual/organization to sift through the vendors and product capabilities to match with the stipulated needs.<ref>http://www.acog.org/About-ACOG/ACOG-Departments/Health-Information-Technology/EMR-Vendor-Selection-Process</ref><br />
<br />
=== Other Clinical Functionality ===<br />
<br />
* Does the system promote delivery of safe care?<br />
* The system shall require documentation of the audit support functionality in the vendor provided user guides and other support documentation, including how to identify and retrospectively reconstruct all data elements in the audit log including date, time.<br />
* Can the system identify the chronic disease management subgroups?<br />
* Is the EHR scalable to different medical specialties and practice demographics (i.e., Neurology vs. Cardiology, small satellite practice vs. intensive care unit) <br />
* Can the system support future clinical models (i.e., Medical Home)?<br />
* Does the EHR system support accurate, consistent and effective clinical documentation by appropriately balancing data auto-population, structured data entry, and unrestricted physician entry of natural-language narrative?<br />
* Does the EMR have the capability to display data over time graphically, such as growth charts?<br />
* The system shall provide the ability to query for a patient by more than one form of identification<br />
* Can it integrate with external knowledge sources such as links to journal references or other knowledge base systems (such as [http://www.hopkinsguides.com/ John Hopkins Guidelines System]) to provide more academic information and update on particular patient problem?<br />
* Does the EHR store the identity of the user and associate the ID with the additions or changes made to the system?<br />
* Can the EHR system be used to capture clinical trial data? How the clinical trial specific data is managed?<br />
* Does the EHR system have the ability to import and export data (interact) in a standard format to EHR systems from other vendors?<br />
*In outpatient departments, does the EHR have a patient-to-physician email and/or web access abilities for the outpatient department to communicate directly with the patient in case more information is needed or the office needs the patient to take some action?<ref name="KDHE 2008">Kansas Department of Health and Environment 2008: Selecting an EHR, Now What??? http://krhis.kdhe.state.ks.us/olrh/Notices.nsf/bf25ab0f47ba5dd785256499006b15a4/720f6f7bfa876f0a862573c600595a2f/$FILE/EHR%20System%20Selection%20Process.pdf</ref>.<br />
* Does the vendor’s product provide the key functionality needed to achieve the organization vision?<br />
* Does the EHR provide outcomes data in terms of key metrics (cost savings, medication error reduction, disease management) in line with the vision of the organization?<br />
* How does the system import data from personal health devices?<br />
* Can patient data be directly imported from patient portals or [[PHR|personal health records]]?<br />
* Does the vendor provide an EHR system that can be integrated with and is interoperable with other systems?<br />
* Can the vendor provide an EHR system with standard terminology that is cross platform with other EHR systems?<br />
* Does the vendor provide safe log in for patients and clients?<br />
* Does the EMR could provide appropriate information on screen without cramming too much information?<br />
* If the EMR/EHR system allows users to access through mobile devices (through the web or an app), is the mobile version similar to the computer-based version? Is it user-friendly? Will mobile access require additional training, or will user feel comfortable with it after training on the computer-based version?<br />
* What type of system is built into the EHR for clinicians, staff and any other users to provide feedback?<br />
* Does the EMR/EHR integrate with off the shelf software currently in use? (i.e. Microsoft products, adobe, etc.) and will new software/upgrades need to be purchased to enable inter-operability?<br />
* Is the EMR capable of sending a Virtual Consultation Summary to another Physician via HIE?<br />
<br />
==== Continuity of Care: Outpatient vs Inpatient EMR ====<br />
If there is no communication between the ambulatory (outpatient) and the inpatient (hospital admissions) EMR services, the clinical information does not get accurately or completely transmitted between transitions of care. This need for continuity of care must be addressed by the EMR vendors by looking at the integration between their outpatient and inpatient clinical systems. The level of integration can be-<br />
#at the user interface level (for example, separate inpatient and outpatient applications, minimal data sharing with separate databases, viewable in same shell)<br />
#at the database level (such as having two separate applications and one database, with the ability to manually transfer data between applications)<br />
#at the workflow level (with one application and one database, with data displays in the context of care setting and full accommodation for workflow) <br />
A discharge note writer is needed to generate a transition of care document (discharge summary) so that the patient can be handed off from one setting of care to another. According to JCAHO (Joint Commission) ''medication reconciliation'' must be done at every transition of care. There is very little literature that addresses the direct financial ROI for an ambulatory EMR, as opposed to the inpatient arena, where more evidence exists.<ref name="Continuity of Care">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref><br />
#Cerner Ambulatory and Cerner Inpatient<br />
Cerner has recently deployed their “Cerner Integrated” platform that does “speak” to inpatient Cerner. Cerner deployed this to "improve the quality and accessibility of clinical documentation across the inpatient and outpatient venues of care while reducing costs of transcription and document scanning." Jim Shave, President of Cerner in Canada, stated “This integration between inpatient and outpatient systems will provide a seamless experience for patients and clinicians, particularly with the large volume of Ontario residents who use outpatient hospital care.” It is still fairly new and not a lot of hospitals and outpatient clinics have had the opportunity to experience the flow of this integrated platform but this is a step in the right direction for continuity of care. <ref name="Cerner">Cerner Hospital Information System in Extended to Ambulatory Clinics in Three Ontario Hospitals. http://www.cerner.com/Cerner_Hospital_Information_System_is_Extended_to_Ambulatory_Clinics_in_Three_Ontario_Hospitals/</ref><br />
<br />
== References ==<br />
<references/><br />
<br />
=== Nursing Functionality ===<br />
# Supporting eMAR: supporting real-time electronic medication administration record and [http://www.ncbi.nlm.nih.gov/pubmed/20445181 bar code medication administration technology].<br />
## Does the system track refusal of medications?<br />
## Does the eMar have the ability to send encrypted messages directly to the pharmacy? <br />
# Supporting bedside automation in medication delivery: Support data interface and real-time monitoring of [http://www.ncbi.nlm.nih.gov/pubmed/15753744 smart infusion pumps] and home infusion pumps <br />
# Ease of use of Nursing flow sheets: Rows in the EHR to be filled by nurses for consistent patient care processes.<ref name="ICU Accept">Carayon, P. Cartmill, R. Blosky, M. Brown, R. Hackenberg, M. Hoonakker, P. Hundt, A. Norfolk, E. Wetterneck, T. Walker, J. (2011).ICU nurses’ acceptance of electronic health records. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3197984/pdf/amiajnl-2010-000018.pdf </ref><br />
# Ease of access and usability of EHR for nursing administration and clinical documentation for nurses. <ref name="Disputes Risks">Raasikh, . What the others haven't told you: lessons learned to avoid disputes and risks in EHR implementation.http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?action=interpret&id=GALE%7CA365889941&v=2.1&u=txshracd2509&it=r&p=HRCA&sw=w&authCount=1</ref><br />
# Clinical decision support and risk assessment tools for issues related to nurse care delivery, such as falls, medication delivery, skin ulcers etc. <ref name="Impact Nurse">Dowding,D. Turley, M. and Garrido, T. (2012). The impact of an electronic health record on nurse<br />
sensitive patient outcomes: an interrupted time<br />
series analysis. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3384108/pdf/amiajnl-2011-000504.pdf</ref><br />
<br />
=== Pharmacy Operation ===<br />
Hospitals and physician practices need to keep their patients safe and well managed by using a pharmacy information system also called a medication management system. The system must have several core functions including in and outpatient order entry, dispensing, and inventory and purchasing management. The system must also be able to connect to other systems within the enterprise, including an EMR, computerized physician order entry (CPOE), barcode technology, and smart IV infusion pumps.<ref name="Pharmacy Information Systems">10 Popular Pharmacy Information Systems".http://www.informationweek.com/healthcare/clinical-information-systems/10-popular-pharmacy-information-systems/d/d-id/1104805?</ref><br />
<br />
==== Formulary Management ====<br />
<br />
# Data repository for formulary information, maintain real time update of medication information with national drug information database<br />
# Support periodic update of formulary, restricted formulary, and nonformulary medications<br />
# Cross reference patient’s insurance formulary list to allow for generic medications to be selected when e-prescribing.<br />
<br />
==== Drug dispense and delivery ====<br />
<br />
# Support outpatient pharmacy operation functionality: <br />
## Maintain outpatient prescription data<br />
## Management of prescription fill, refill and dispense activities<br />
## Support billing protocols with governmental and private insurance<br />
# Support inpatient pharmacy operation functionality<br />
## Maintain inpatient medication ordering data<br />
## Real-time monitoring of IV and oral medication compounding and delivery<br />
## Support real-time data interface with automatic dispensing cabinet<br />
<br />
== References ==<br />
<references/><br />
<br />
== Research Functionality ==<br />
<br />
* Does the vendor bid include the product's ability to be used as a tool for research. If "no", is an add-on solution for research capability needed and will it entail extra cost. <ref name="kannry 2006">Kannry J 2006: Using an Evidence-based Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref><br />
* Does the EMR have informed consent alerts and documentation systems for clinical research?<br />
* If the proposed installation site is a research hospital, what are the research capabilities of the EMR?<br />
* How is research achieved?<br />
* How are reports produced?<br />
* How is data exported from the production system?<br />
* Which database is used for reporting? For research? Vendor or other?<br />
* Does the vendor provide [[Natural language processing (NLP)|natural language processing for entry data]] or document?<br />
* Support for research billing including research orders (6)<br />
* Does the EHR system provide data mining capabilities to support clinical research?<br />
** Are there limits on the fields that researchers can use?<br />
** How difficult is it to interface with the database?<br />
** Does the EMR have smart search abilities to search through physician notes for specific keywords while extracting research data.<br />
** Does the vendor assist in research endeavors, or is it left up to the institution?<br />
* Does the EMR have the flexibility to capture documents necessary for specific clinical trials like adverse events, enrollments, and etc? <ref name="Jain-V-2010">Jain, V. (2010). Evaluating EHR systems. Health Management Technology, 31(8), 22-24</ref><br />
* If research involves use of pathological/histological samples, does the EMR system tie into the laboratory management systems and database to allow for retrieval and processing of samples?<br />
* Does the EMR system provide functionality to identify clinical related concepts?<br />
* Does the EMR provide the flexibility to normalize the clinical concepts found in the document?<br />
* Does the EMR provide the assistance to automatically generate the de-identified document for research purpose? <br />
* Does EMR system provide functionality to implement study-screening parameter into patients’ registration, scheduling, medication lists, diagnostic codes (ICD) and clinical notes? <ref name="sixteen"> Integrating Electronic Health Records and Clinical Trials http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf <br />
.</ref><br />
<br />
* Does EMR system provide functionality to contact potential candidates and notify the patient’s providers of potential study eligibility? <ref name="sixteen"></ref><br />
* Does EMR system provide capability to systematically captured study specific data and electronically exports deidentified study data to clinical trial electronic data capture system? <ref name="sixteen"></ref><br />
*Vendor's ability to support research is especially important for large academic hospitals. In academic settings, research productivity is evaluated on publication and funding. To assess the ability of each vendor’s EMR to support research, the same two criteria for assessing productivity can be used— 1) publications that were the result of or 2) funded research made possible through EMR use or data analysis from the EMR’s data warehouse. <ref name="Vendor support for research">Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. http://www.ncbi.nlm.nih.gov/pubmed/16669592</ref> To assess this one can follow Mt. Sinai's example in selecting a vendor as follows:<br />
#After a rigorous investigation of vendor statements and industry statements, a ''standardized questionnaire'' was used to consistently ask about items specific to the site contacted. Sites suggested by vendors, as well as community listservs, were contacted; the user community was engaged. <br />
#Literature search:<br />
** [[PubMed]] was used to search [[MEDLINE]] covering the fields of medicine, nursing, dentistry, veterinary medicine, the health care system, and the preclinical sciences.<br />
** Also queried was CRISP (Computer Retrieval of Information on Scientific Projects), a searchable database of federally-funded biomedical research projects.<br />
<br />
=== Patient Quality Improvement ===<br />
* Link to patient education materials database or service and the ability to load practice specific documents for patient handouts. Must be able to access and print these from visit encounter interface.<br />
* Does EHR system provide better integration among providers by improved information sharing, viewable and up-to-date medication and allergy lists and order entry at point of care or off-site ?<br />
* Will the EHR system provide standardization of data, order sets, and care plans helping to implement common treatment of patients using evidence-based medicine ?<br />
* Are vendor-provided and supported order sets available?<br />
* Does EHR system provide access to experts for rural health care providers by sharing best practices and allowing for specialized care through telemedicine ?<br />
* Can EHR system manipulate and provide feedback on population management trended data and treatment and outcome studies for more convenient, faster, and simpler disease management?<br />
* Can the system pull from clinical documentation for billing, quality reporting and patient safety reporting?<br />
* How does the vendor use certified EHR technology in ways that can be measured significantly in quality and in quantity?<br />
* Will the system support utilization review with the Milliman and Interqual clinical criteria for Quality Management and discharge planning.<br />
* Does EMR system provide capability to aggregates data on the impact of specific evidence based/cost effectiveness intervention as compared to current population in management practice?<br />
<br />
=== Public Health Research ===<br />
* Does the vendor support the ability to send de-identified bio-surveillance data to population health agencies to support epidemiologic research?<br />
* Does the vendor have the ability to send patient specific public health disease report(s) to a disease registry, as a part of a Public Health Information Network (PHIN)?<br />
* Does the vendor have the ability to report on Quality Improvement, such as infection control measures (i.e., Hospital Acquired Infection rates) or patient safety measures?<br />
* Does the vendor have the ability to report to the State, CDC Registry and external sources<br />
<br />
== IT and Technical Requirements ==<br />
<br />
* For already existing software functionality, does the vendor employ reliable and trustworthy software like an open-source MySQL or Apache server? Or do they develop their own system, or do we have to license a proprietary one (extra cost)?<br />
* How the vendor estimates the total amount of users and licenses needed? Will they be concurrent user licenses or asynchronic?<br />
* Will technical support remain active even if the Hospital is running a non-upgraded system? For how long?<br />
* Does the system use [http://medical.nema.org/ DICOM] standards for the transmission of image data?<br />
* Does the system provide an imaging database or allow customized program attachments of imaging needs of specific departments in the hospital?<br />
* What are the hardware requirements?<br />
* How frequently does the vendor provide patch upgrades for the product?<br />
*Do the upgrades come with a fee?<br />
*Is the vendor’s application (system) platform independent? <br />
*Is the system using standards such as Snomed, [http://www.who.int/classifications/icd/en/ ICD 10]; [http://hl7book.net/index.php?title=HL7_version_2 HL7 Version 2] or [http://hl7book.net/index.php?title=HL7_version_3 3]; HL7 infobutton…)<br />
*How does the system handle multiple logins of the same user at different locations/instances?<br />
*How does the system handle user inactivity? (auto-logout, discarding\saving changes, draft creation)<br />
* Is the software capable of using biometric data for rapid login by providers who are mobile between patients/sites?<br />
* How does the system lend itself to automated back-ups? Does the vendor provide IT support team to implement specific back-up plans that will work with the hospital's IT team? <br />
* Can the system allow login remotely – off site transcription or home or other clinic?<br />
* Does the system provide the ability to identify all users who have accessed an individual's chart over a given time period, including date and time of access?<br />
* Does the vendor offer a Software as a Service (SaaS) solution, also know as an Application Service Provider (ASP), or a client-server solution?<br />
* With existing systems, how tightly integrated will the new EHR system be and what prep work is required to make the integration possible?<br />
* Does the system have modules for automatic update of knowledge sets at regular intervals, more like automatic update of antivirus definitions?<br />
* How often does the software need to be upgraded?<br />
* Does the software allow generation of customized reports such that desired information can be extracted periodically for performance improvement projects or performance monitoring.<br />
* Does the vendor utilize the desired technology?<br />
* Is remote access available for mobile devices?<br />
** Is this web-access or a dedicated app?<br />
** In what way is this mobile access limited? Does it have access to all functionality?<br />
** What devices can access the mobile apps? (e.g. iPad, iPhone, Android, etc.)<br />
* Is remote access cross platform? The use of open standards (e.g. HTML5, [[Extensible Markup Language (XML)|XML)]] allows users on any platform, including smartphones and tablets, to have equivocal access to the system.<br />
* Does the system support web-based working environment?<br />
* Does the system provide extension package or software for IT engineers or users? <br />
* Does the system comply with HIMMS standard?<br />
* Can the system be installed on Windows or IOS operating systems?<br />
* How does the system’s IT infrastructure requirement align with the institution’s current infrastructure and the institution’s infrastructure five-year strategic road map?<br />
* What hardware technology (Server) does the database support? And does the supported hardware provide built-in high availability?<br />
* Does the system’s application (not database) support virtual environments? Will it run on a virtual server? <br />
* Is your ticketing system capable of interfacing with [name of ITSM software utilized by your institution]?<br />
* Negotiate the terms and prices of the interface system: to/from PM system, scanner, fax machine, laboratory, health information exchange partners such as hospitals, ambulatory surgical centers, radiology, ePrescribing.<br />
* Can the system be hosted and supported remotely by the vendor? <br />
* How scalable is the IT infrastructure? Is there a peak limit on the number of concurrent users utilizing the system? (this comes in handy during mergers & acquisitions in which you may exponentially increase in size of user base) <br />
* Does the system support dictation function?<br />
* Does the system support speech recognition?<br />
* Does the system have a spell check tool for notes (progress notes, letters, and H&P notes)? <br />
* What are the data back up options available in case of natural calamity? <br />
* Is the EHR system compatible with other systems in the event of termination or vendor's insolvency? <ref name="obsolete technology">Neal, D. (2011). Choosing an Electronic Health Records System: Professional Liability Considerations. Innovations in Clinical Neuroscience, 8(6), pg. 45.</ref><br />
* Are scanning capabilities available and if so, is there a particular scanner make and model required?<br />
* Are scanning licenses needed? How much are the scanning licenses and are they needed per user or per pc?<br />
<br />
=== Legacy systems ===<br />
<br />
* How does the vendor compare in [http://www.klasresearch.com/ KLAS] rankings of similar systems and applications?<br />
* How will legacy patient record data be integrated into the new system?<br />
* Does the vendor provide services to convert and transfer data from legacy systems into the new system, and if so, what is the cost?<ref name="himss-ama-legacy">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* How does a legacy Practice Management System integrate with the EHR system? Is there a list of successful PM vendor integrations? <br />
*Make sure the vendors give accurate information for the Request for Proposal. So the stakeholders can make informed decisions on the comparison of vendors.<br />
-Zoker 9/17/2011<br />
* What is the legacy Practice Management System conversion process for legacy data import into the EHR system? Time/cost and loose-ends? What reference clients are there for particular legacy PM systems?<br />
* Does the vendor have a List of Lessons Learned from previous implementations?<br />
* Does the vendor have a legal license to essential code sets, such as the [http://www.ama-assn.org/ama/pub/physician-resources/solutions-managing-your-practice/coding-billing-insurance/cpt.page? AMA Current Procedural Terminology] (CPT®) file? Will the vendor maintain this license annually as part of your service or maintenance agreement?[http://www.ama-assn.org American Medical Association]<br />
* How does the vendor manage diagnosis documentation and coding? Does the system require specific coding terminology or does it allow provider synonyms for coding terms? How is that updated and maintained? <br />
* Does the vendor offer a “test environment” in which upgrades are loaded to allow you time to test and learn their functionality without affecting your live system? [http://www.ama-assn.org American Medical Association]<br />
* What is the vendor's rate for on time & under budget implementations?<br />
* Are other consulting firms certified to implent the vendor's product? If so will the vendor provide system updates and customer service if system issues (not related to implementation) arise?<br />
* Check whether the vendors EMR products are certified Health IT products through the [http://oncchpl.force.com/ehrcert/ehrproductsearch Office of the National Coordinator (ONC) for HIT.] Previously [http://www.cchit.org/ CCHIT] provided a list of certified EMR but as of late 2014 is no longer in operation.<br />
* What services does the EHR vendor offers for post-implementation optimization of the system with respect to training and system customization? <br />
* What is the company policy regarding data ownership for the ASP EHR? <br />
* The EHR product should be certified for the standards and certification criteria issued by the Office of the National Coordinator for Health Information Technology (ONC-HIT)? How many criteria does it satisfy?<br />
* How is documentation managed and preserved over time? How is documentation protected from being altered, in all parts of the system including the underlying databases?<ref name="Legal EHR">The Legal Electronic Health Record.www.himss.org/files/HIMSSorg/content/files/LegalEMR_Flyer3.pdf</ref><br />
*Does the vendor retain, ensure availability, and destroy health record information according to organizational standards? For instance, retaining all EHR data and clinical documents for the time period designated by policy or legal requirement; retaining inbound documents as originally received (unaltered); ensuring availability of information for the legally prescribed period of time; and provide the ability to destroy EHR data/records in a systematic way according to policy and after the legally prescribed retention period.<ref name="EHR Functions">Understanding Features & Functions of an EHR.http://www.aafp.org/practice-management/health-it/product/features-functions.html</ref><br />
<br />
=== Troubleshooting ===<br />
<br />
* Immediate trouble shooting ability<br />
* Once the problem is identified, the first step is to ascertain the scope<ref name="Kevin MD"></ref><br />
* If the scope of outage is large and the root cause is unknown, raise alarm bells early<ref name="Kevin MD"></ref><br />
* Bring visibility to the process by having hourly updates,and multiple eyes on the problem<ref name="Kevin MD"></ref><br />
* Over communicate with the users<ref name="Kevin MD">http://www.kevinmd.com/blog/2010/09/10-tips-troubleshooting-complex-ehr-infrastructure-problems.html</ref><br />
* Do not let pride get in the way<ref name="Kevin MD"></ref><br />
* It is important to set deadlines in the response plan<ref name="Kevin MD"></ref><br />
* The simplest explanation is usually the correct one<ref name="Kevin MD"></ref><br />
* Regular connect with customers about their problems<br />
* The system shall include documentation that describes the patch (hot-fix) handling process the vendor will use for EHR, operating system and underlying tools (e.g. a specific web site for notification of new patches, an approved patch list, special instructions for installation, and post-installation test).<br />
* The system shall include documented procedures for product installation, start-up and/or connection.<br />
* What options does the EMR have for upfront abstraction and scanning? Are these costs included in the purchase of the EMR?<br />
* Can the vendor support the organization desired implementation strategy?<br />
* How can the [http://en.wikipedia.org/wiki/Electronic_health_record#Quality quality of EHR] technology be useful for electronic exchange of clinical health information among providers and patient authorized entities?<br />
<br />
=== EHR Disaster Recovery ===<br />
<br />
Either internal hardware problems or external sources (especially in EHR systems that store data in the cloud) may cause unexpected EHR system failures. The EHR may be unavailable for a few hours or for a week or more. Disaster recovery must always be considered when selecting a vendor to ensure that data is secure in these emergency situations. Questions to consider include:<br />
<br />
* Does the EHR use internal hosting or an ASP model? <ref name="himssdisaster">EHR and Disaster Recovery. http://www.himss.org/News/NewsDetail.aspx?ItemNumber=6469</ref><br />
* Is the EHR system adherent to the HIPAA Security Rule and provides both a contingency plan and secure data back-up reserves in case of system failure? <br />
* Has the EHR provided users with a detailed disaster plan during implementation of the EHR that includes how to cope with unexpected system failure?<br />
* Has the EHR provided training packets and educational materials for end users to study to prepare for unscheduled downtime of the EHR?<br />
* Will the EHR notify users immediately when system failure occurs and provide information about the breadth of the failure and the time anticipated before the EHR will be restored?<br />
* What happens when small private EHR vendors go out of business for any reason? Will you have a backup of the source code when that happens? Are we able to access that source code for our use?<br />
* Is off-site back-up and recovery supported in the event of a natural disaster or other catastrophic event?<br />
* Is training available for catastrophic event recovery?<br />
* What safeguards does the software have to warn users/administrator of an impending major failure?<br />
* Does the software monitor the hardware that it runs on? <br />
* Is there a technical relationship between the EHR/EMR vendor and hardware vendors?<br />
<br />
Some of the criteria I will like to see in an EHR system in the event that it crashes or during downtime*****<br />
<br />
1. What backup system does it have in place during such an event so that patient care continues without reverting to a paper system? <br />
<br />
2. How is data updated into the system when it is back up and running again?<br />
<br />
3. Where is the data stored so that in the event of a catastrophic crash historical data is not lost?<br />
<br />
=== Health information exchange, connectivity, and standards ===<br />
Because healthcare providers rarely use the same EHR system integration between providers in a state or region is being addressed by healthcare information exchange (HIEs). Patients will often see different providers from different groups. An exchange that provides one of more standards methods for integrating with it means that a provider needs to integrate just once, to the exchange, rather than dozens of times.<ref name="Healthcare Electronic REcords TEchnology and Government Funding">Healthcare Electronic Records Technology and Government Funding:Improving Patient Care.http://www.myemrstimulus.com/tag/ehr-application/</ref><br />
<br />
* Does it meet the following connectivity standards: [[HL7]], HL7 CDA, CCR, HL7 CCD, ELINCS and Vendor software specifications? <ref name="whitepaper emr connectivity">What is Your EHR Connectivity Strategy? http://www.corepointhealth.com/sites/default/files/whitepapers/emr-connectivity-strategy-healthcare-interoperability.pdf </ref><br />
* How flexible is there connection framework? Can it negotiate multiple standards?<br />
* How quickly can you build and implement an interface within the interface engine?<br />
* Can our facility support the space needed for the installation and implementation of an EHR? <br />
* Make sure wireless connection is accessible in all parts of the hospital is your facility is planning to use portable devices (tablets, computers on wheels, etc.) to access the system.<br />
* Is there a cost to connecting the EMR/EHR to an HIE? <ref name="HIE"> How to implement EHRs? http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr</ref><br />
<br />
==References==<br />
<reference/><br />
<br />
== Cost and Budget ==<br />
There are also long-term costs associated with EHRs that need to be considered. Certain systems require specific hardware, interfaces, networking, training and support resources that all add on to the price. Practices should take these additional services into account to get a comprehensive picture of what the technology will cost.<br />
<ref name="nuemd"> McCarthy, K. 5 important considerations when choosing EHR. 2014. http://www.nuemd.com/news/2014/10/28/5-important-considerations-when-choosing-ehr-systems </ref> <br />
<br />
Associated Costs – in addition to EHR licensing and maintenance, studies report expenses can be expected for; over 130 hrs./physician for system training, reduction in patient volume by as much as 50% during initial implementation, and significant expenses for additional IT infrastructure (e.g. approx. $10,000 for primary care practice). <ref name=”True Cost of HER Implementation”> Understanding the True Costs of an EHR implementation http://go.galegroup.com.ezproxyhost.library.tmc.edu/ps/i.do?ty=as&v=2.1&u=txshracd2509&it=search&s=RELEVANCE&p=HRCA&st=T002&dblist=HRCA&qt=TI~Understanding+the+true+costs+of+an+EHR+implementation~~SP~52~~IU~14~~SN~00257206~~VO~89&sw=w&asid=a842cc467e789e3bde4b58ab9e5d0fab </ref><br />
<br />
'''Vendor Financing'''<br />
<br />
A 2010 Health management Technology article states, a number of healthcare technology vendors are now offering free financing for electronic health record (EHR) purchases, in an effort to increase adoption of electronic records. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
Cost is physicians' top concern when considering EHRs, according to a recent Ingenix survey of 1 ,000 physicians and physician-practice administrators. More than 80 percent ranked cost as one of the greatest risks to deploying technology in their practice. <ref name="Anon (2010)”>EHR financing offered. (2010). Health Management Technology, 31(2), 10. Retrieved from http://ezproxyhost.library.tmc.edu/login?url=http://search.proquest.com/docview/622031107?accountid=7034</ref><br />
<br />
=== Hardware ===<br />
Most physician practices will need to upgrade existing hardware (computers and servers) in order to run the EHR. Typically the vendor will give the organization a “shopping list” for hardware so that the organization will purchase equipment that is compatible with the EHR. <ref name="Selecting a vendor"></ref><br />
*Will the new hardware include tablets, laptops, desktops, servers, routers, printers, and scanners? <ref name=”hadware”> How do I plan for hardware purchases? http://www.healthit.gov/providers-professionals/faqs/EHR-infrastructure-investment. </ref><br />
==== Desktops ====<br />
Advantages:<ref name="Hardware">www.aafp.org/practice-management/health-it/product/hardware.html</ref><br />
* Desktops are low-cost and available from a wide variety of vendors.<br />
* Because desktop PCs are standardized, it is relatively easy and inexpensive to find spare parts and support, or to replace a machine.<br />
* Desktops will run just about any software you need.<br />
* Additional devices such as microphones, speakers, and headsets are readily available at low cost.<br />
<br />
Disadvantages:<ref name="Hardware"></ref><br />
* Because it's stationary, you need to buy a desktop PC for each room in which you need access to your EHR software.<br />
* Desktops typically take up more space than a laptop or tablet PC. While flat screen monitors and tower units save actual desktop space, the standard desktop computer requires more room than either a laptop or tablet PC.<br />
* You must purchase additional equipment to take full advantage of voice recognition and/or handwriting recognition programs.<br />
==== Laptops ====<br />
Advantages:<ref name="Hardware"></ref><br />
* A laptop has a smaller footprint and can easily be turned to allow patients to view information on the screen.<br />
* A laptop is less obtrusive during patient interviews.<br />
* Most have fairly long battery life and/or an A/C adaptor.<br />
* Laptops use standard PC inputs such as keyboard and mouse and/or touchpad.<br />
Disadvantages:<ref name="Hardware"></ref><br />
* Although laptops are portable, they can be heavy to carry, typically weighing five to eight pounds.<br />
* Repairs and maintenance tend to be more expensive because laptops use non-standard or proprietary parts. You may have to send a laptop off-site for diagnosis and repair.<br />
<br />
==== Tablet PCs ====<br />
Advantages:<ref name="Hardware"></ref><br />
* Tablets are truly portable and lightweight, typically weighing three to four pounds.<br />
* It is as powerful as a PC, but it doesn't require a keyboard. Instead, you add information by writing on the screen with a digital pen or stylus, much like you do in a paper chart.<br />
* Handwriting recognition software developed for tablet PCs is excellent, even for very poor handwriting.<br />
* Tablet PCs have integrated dictation capability with voice recognition software that transcribes directly into the patient record.<br />
Disadvantages:<ref name="Hardware"></ref><br />
* Writing with a stylus takes getting used to; there is a longer learning curve in adapting to a new way of using a computer.<br />
* Handwriting recognition dictionaries have not yet fully integrated medical terminology and acronyms, requiring more correction.<br />
* There is not as much standardized software yet available for tablets.<br />
* Screens are easily scratched and can become unusable without screen protectors purchased at additional cost.<br />
* Some EHRs/EMRs require a higher/lower resolution than others and won't work on a tablet. ex: Amazing Charts (AC) will not work on the Surface Pro 2 but will work on a Surface Pro 3.<br />
* Some EHRs/EMRs can work on a tablet but licenses/support will cost more. ex: To use Amazing Charts on an iPad will require the clinic to purchase their "Cloud Based" package. It is slightly more expensive since AC will host the data vs hosting the EMR on a server built by the clinic or hospital. Amazing charts charges $39 a month in addition to license and support fees, per user for their "cloud." When a clinic or hospital hosts AC on their own server, they only pay the license and annual support fees. <ref name="AC">No Servers to set up. No software to install. http://amazingcharts.com/products/web-based-ehr/ref><br />
<br />
<br />
== References ==<br />
<references/><br />
<br />
=== Software ===<br />
*Identify and budget for required systems changes<br />
** Software changes<br />
** Increased system storage capacity<br />
*Know if the necessary upgrades are covered by current vendor contracts<br />
*Identify for what upgrade costs the practice will be responsible <ref name="mgma"> Is your practice ready? 5010 and ICD-10 vendor questions and guidelines. 20143. http://www.mgma.com/government-affairs/issues-overview/health-information-technology/icd-10/5010-and-icd-10-vendor-questions-and-guidelines </ref><br />
<br />
=== Professional Support ===<br />
*What kind of support is included in the initial purchase price of the EHR system?<br />
*How long will support be provided (e.g, on site, by telephone, or email)?<br />
*Will the vendor work with contractors to install the system or just be providing with a set of network, telecommunications and electrical specifications?<br />
*Will the vendor be working with the organization to customize software features such as the templates that will be used? <ref name=”aaft”> How Much Will That EMR System Really Cost? http://www.aafp.org/fpm/2002/0400/p57.html. </ref><br />
*Will the travel expenses of the vendor be included in the implementation estimate? Are the travel expenses fixed or a percentage of the implementation fees?<ref name=”Travel”> Kannry, J., Mukani S., Myers K. Using an Evidence-based Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital. Journal of Healthcare Information Management. Vol. 20, No.2 pg.94</ref><br />
<br />
== Extensive Testing of EMR Software Prior to Implementation == <br />
<br />
Vendors should be able to demonstrate the conduction of rigorous testing of their EMR, such as: <ref name="Valacich">Valacich, J. S., George, J. F., & Hoffer, J. A. (2012). Essentials of systems analysis and design (5th ed.)</ref><br />
<br />
*Unit Testing – testing of software codes and algorithm to detect errors which might lead to inaccuracies in patients’ medical records i.e., transposition of patient information, omission of diagnostic test results <ref name="Valacich"></ref><br />
*Regression Testing – Testing “end to end” functionality after the introduction of an additional ‘unit’ of functionality or a “bug fix” to confirm that the newly introduced change does not “break” related processes. <ref name=”Regulatory-Driven Testing”> Proposing Regulatory-Driven Automated Test Suites http://ieeexplore.ieee.org.ezproxyhost.library.tmc.edu/stamp/stamp.jsp?tp=&arnumber=6612874 </ref><br />
*Integration Testing – testing for integration and interface between different vendor modules i.e., faulty integration of CPOE and Pharmacy modules could result in physicians orders not being forwarded to the pharmacy department <ref name="Valacich"></ref><br />
*Systems Testing – testing of the EMR system’s ability to run on a multiple user environment, have optimal runtime availability, have an interface that is highly usable and intuitive, with strict adherence to information security regulations such as HIPAA <ref name="Valacich"></ref><br />
*User Acceptance Testing – testing by end users (physicians, nurses, administrative personnel) that validates whether all specified requirements and functionalities for the EMR have been met <ref name="Valacich"></ref><br />
<br />
== Implementation ==<br />
<br />
* Implementation Project Manager – A project manager is necessary to bring vendor experience and guidance to the implementation process and should hand off the implementation to your internal team within 12 to 15 months.<br />
* While vendors often assign resources designated as “project managers”, and this may be important for vendor-side work, it is in the best interest of the customer to obtain a project manager accountable to the executive sponsor for the success of the overall implementation (which often has a scope beyond that of the EHR itself).<br />
* Will the vendor be readily available to conduct training for all shift and service line?<br />
* Service Agreement - A service agreement identifies what the EMR vendor will do to maintain the software, including software maintenance, technical support, and upgrades. <br />
* IT Support Agreement - Hardware installations are your responsibility, not the EHR vendor. However, if you do not have onsite IT support, request an estimate for the following: <br />
** Installation charges for electrical requirements, cable and phone connections for the system<br />
** Monthly fees to provide access to patient data on a remote server<br />
** Networking design and administration charges related to the set-up and service of client's network<br />
** Hardware onsite installation and maintenance<br />
** Third-party software maintenance for products not provided by the vendor<br />
** Correcting errors that result from changes you or a third-party made to the software. This applies primarily to client-server agreements<br />
** Backup capabilities. This applies primarily to client-server agreements.<br />
* Terms and Conditions - Irrespective of the contract length, ask about penalties for withdrawing your data. Any vendor interested in preserving its reputation will provide you with data in a common format able to be transitioned to another system, but there is a withdrawal fee. [13]<br />
* How long is does it take for a typical install, troubleshooting and go-live of the EHR?<br />
<br />
=== Configuration ===<br />
* Does the vendor factor the number of users as part of their implementation cost? <br />
* Does the vendor provide their own hardware or use a third-party company for their hardware needs? Based on the practice size and niche, is a well-established vendor with all software and hardware in-house preferable?<br />
* If you have an existing system, what kind of difficulties will the vendor encounter? Will it be possible to transfer existing data to the new system? <br />
*In calculating the Total Cost of Ownership (TCO), the break out costs should include who pays for the additional costs due to delays in implementation, especially those due to the Vendor. In fairness, the Vendor's rate for successful, on-time and under-budget implementation should be discussed as well.<br />
•Does the TCO include lifecycle costs that include milestone payment scheduling to back up promises made by EHR implementation? <ref name="ADB-Mag-2011">Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23(42), 1-4.</ref><br />
* Does the system minimize or ease the data input, so that doctors spend more time with their patient?<br />
* Does the vendor qualify under the organization acquisition policies?<br />
* How will current policies and procedures change once implementation takes place?<br />
* Is there a dedicated support team?<br />
* If implementation of the system fails, what steps is the EHR willing to take to make it successful?<br />
* Will the license cost for updated versions of the EHR be borne solely by the purchasing institution or will there be cost sharing between the institution and the vendor for updates?<br />
* How often the possibility of system break out?<br />
* Does the fee include pre-training and post-training?<br />
* How long and including of the warranty of infrastructure and system? Do we pay for accident damage for system or hardware?<br />
* What system configurations are available? How does the vendor involve the client in the configuration of the system?<br />
<br />
==== Face the Interfaces ==== <br />
<br />
One of an EHR’s most valuable assets is its potential to share information with other IT systems such as lab and diagnostic services. Interfaces allow the EHR system to communicate with other applications. These applications can reside outside the practice, such as lab applications, or can be another system within the practice, such as a billing system.<ref name="AHIMA"></ref><br />
<br />
Interface development is completed during the implementation phase; however, interface functions and costs must be a consideration during system selection. One cannot assume that a given EHR product will automatically communicate with other electronic functions such as appointment scheduling or billing. Vendors should be asked to address the issue of integrating lab and radiology results into the electronic record.<ref name="AHIMA"></ref><br />
<br />
Many vendors offer ancillary services such as automatic statement processing, billing services, consulting services, additional coding enhancements, and claim scrubbing. One may want to take advantage of these services later. These items are considered third-party or add-on applications.<ref name="AHIMA"></ref><br />
<br />
Many practices are considering the implementation of portals that offer patients a secure Internet connection to the practice. The portal allows patients to schedule appointments, complete paperwork, and access test results (or even their medical record), depending on the services the practice offers. These portals have the potential for increased practice production, increased revenues, and increased patient satisfaction. <ref name="AHIMA"></ref><br />
<br />
Interfaces can be a tricky piece of system selection and the implementation that follows. Red flags during the selection process include:<br />
<br />
* One-way or bidirectional interface not specified. The system may only accept demographic or appointment data from the practice management system but not feed data back to it.<br />
* Data format not specified. Data can be entered into EHRs in one of two formats--as free text (unstructured data) or as defined elements (structured data) such as forms and pick lists. Each practice must weigh the pros and cons for itself.1 However, ask vendors if their products support standard vocabularies such as SNOMED, Medcin, and LOINC.<br />
* Additional license costs not specified. Additional fees for third-party applications could apply, such as plug-ins for a drug database or CPT and ICD-9 coding, code scrubbing, database user seats, and anti-virus software.<br />
* Interface promised but not available. A vendor may say it can interface with your billing application or a lab system, but after the contract is signed it may advise you that the interface is not available. That can place a serious strain on the practice and require you to enter data twice.<ref name="AHIMA"></ref><br />
<br />
===== Interface History ===== <br />
<br />
One of the more efficient methods of determining a particular EMR's ability to handle interfaces is by reviewing the history of interfaces which have already been built and established. <ref name="History of Interfaces"> How to Select an Electronic Health Record System. http://www.aafp.org/fpm/2005/0200/p55.html</ref> The following questions should be answered in order to establish if the EMR being considered meets your organization's needs:<br />
<br />
*Which vendors (and which of their applications) have they interfaced with?<br />
<br />
*What type of information (patient demographics, order entry, laboratory results, billing, radiology findings, etc.) was interfaced?<br />
<br />
*How many interfaces were built, and what is the maximum the system can support?<br />
<br />
*What is the capacity of the interface; how many messages where sent and/or received per day; and what is the theoretical maximum amount allowed?<br />
<br />
*What, if any, additional costs were involved in creating, operating, and maintaining the interface?<br />
**Where there additional fees depending on the amount of data being sent/received?<br />
**Were there any costs to expand and/or modify the capabilities of the interface in the event the organization grows and requires additional functionality?<br />
<br />
=== User Training ===<br />
A significant predictor or implementation difficulty is lack of adequate end-user training and support. Depending on your organization and its staff, training may need to address the entire spectrum of computer usage from basic use of a mouse to specific use of that mouse to navigate your EHR.<ref name="Planning Your EHR System">Planning Your EHR System:guidelines for Executive Management.http://www.satva.org/white-papers/MHCA-SATVA-PlanningYourEHRSystem.pdf</ref><br />
* How many hours of initial training is provided for administrators? For users?<br />
* When is the initial training provided, during or after implementation?<br />
* How large a virtual environment will be required to provide training for staff, and how much time should be allocated. <br />
* What are the time requirements to train the trainers?<br />
* Is the initial training included in the costs of the tool?<br />
* If additional training is required post-implementation, how is it priced – lump sum or hourly rate?<br />
* How many hours of post-implementation support is included?* Will the vendor provide technical training to the IT Department of the purchasing institution to handle minor non-critical hardware problems?<br />
* How long is the training that is required for each subgroup to fully implement the system?<br />
* What are the training requirements for the vendor? For the clinic/hospital?<br />
* What is the vendor's track record for successfully training a new system for your clinic/hospital size?<br />
* What training manuals, user guides, on-line training assets, and any other training materials will be made available to the clinic/hospital?<br />
* What training mechanisms are used by the EHR Vendor? (http://www.americanehr.com/Home.aspx) <br />
* Does the vendor provides training instructors at beginning?<br />
* Are the training staff familiar with both the technical aspects of the product and the clinical needs of the department of interest? (i.e. subject matter specialist, clinical informatics specialist)<br />
* Does the vendor has well-organized and reliable training courses?<br />
* Training Contract - Training should be included in the licensing and service agreement, but some vendors provide separate online and onsite training contracts.<br />
* Does the EHR vendor provide a test version of EHR product for training and quality assurance (QA) purposes as well as the full production environment that is installed in the clinic? (The test version is a segmented area where users can make changes to templates or forms without it affecting the live environment) [http://www.americanehr.com/Home.aspx]<br />
* Are training materials provided by the vendor or is the organization responsible for producing in-house? If the training material will be developed in-house, does the vendor stipulate specific training requirements (i.e. classroom-based vs. web-based, mandatory competency examinations)?<br />
* What kind of on-going training and support will be provided after implementation? Is the cost of post-implementation training and support clearly specified?<br />
* If there are major updates to the system, will the vendor provide ample support and training for the users? And how much will this additional training cost?<br />
* Does the EHR/EMR vendor offer the option to have their staff available to be present at the hospital/clinic/facility during training and then "go-live" implementation? This would allow the EHR/EMR staff to offer hands-on support for any obstacles that come up during training and "go live" implementation. <br />
'''* Spell out pricing before selecting and Electronic Medical Record (EMR/Electronic Health Record (EHR) system such as hardware, software, maintenance, upgrade costs, lab and pharmacies interfaces, customized quality reports, expenditure to connect to health information exchange (HIE)'''<br />
<br />
==References==<br />
<reference/><br />
<br />
=== User Satisfaction : ''User-Centric Selection'' ===<br />
<br />
* User satisfaction of the clinical staff plays a key role in vendor selection and can predict the success or failure of the EMR system implementation <ref name="Kannry"> Kannry, J., Mukani, S., & Myers, K. (2006). Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. Journal of Healthcare Information Management: JHIM, 20(2), 84–99. </ref><br />
* Since users may have varied experiences according to Kannry, Mukani, and Myers (2006, p. 89) it is important to include a multidisciplinary team from clinical, administrative and IT personnel as part of the vetting and selection process.<br />
*The creation and use of ''Scripted Scenarios'' representative of user workflow was helpful even when users had little technical knowledge of EMR systems. <ref name="Kannry"> Kannry, J., Mukani, S., & Myers, K. (2006). Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. Journal of Healthcare Information Management: JHIM, 20(2), 84–99. </ref><br />
<br />
<br />
== Future Relationships: Vendor Partnership ==<br />
<br />
* Talk to vendor's existing customers, making sure to also contact some vendor customers independently, as the vendors tend to only provide contacts to their most satisfied customers.<br />
*Research available EMR systems and vendors: determine if your jurisdiction has a "pre-approved" vendor list; develop checklists & questionnaires to assist with product comparison; and prepare a Request for Proposals (RFP). <br />
*Composing the RFP can be a daunting task. AHIMA has created a guidelines for a template that may be used to write the RFP. The guidelines are extensive and include several particular components that must be included. It can be found [http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=bok1_047959 here]. <ref name="RFI/RFP Template (Updated)">AHIMA http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047959.hcsp?dDocName=bok1_047959</ref><br />
*An important consideration is whether the vendor or any of its industry partners have done an analysis of processes in healthcare<br />
*Ensure there will be well-laid out contractual agreement regards the 'source code' that will satisfy/cover necessary conditions: "When does the company get the 'source code?, How does the company get the source code?"<br />
*If there are workflow changes within the organization, after the product is implemented, is the product flexible enough to allow for changes without major outages or disruptions to daily activity?<br />
*What are the vendors’ contingency plans if technical glitches occur, post implementation?<br />
*Is technical support offered by the vendor 24 hours per day/ 7 days a week?<br />
*In the event of need for support from the vendor, what is the approximate response time to calls that vendor the projects?<br />
* What is the cost of providing this technical support per hour?<br />
* What size, in terms of employees, is the EHR vendor? Do they have the staff to fully address the support needs of their current client base and, can they accommodate the added support load of your institution?<br />
*In terms of clinical decision support, how often are drug list and drug interaction list updated? Once updated, how long will it take for the changes to be accessible by the end users?<br />
* When code sets and medical vocabularies, ontologies, etc. are updated, how long after will the tool be updated?<br />
*In "EMR Vendor Selection" on [http://www.healthtechnologyreview.com/emr-vendor-selection.php Health Technology Review website], it states an old adage in the Software industry that consumers will buy a product based on features, but will leave the vendor based on a lack of support. Therefore, it is important to check references for the vendor related to post-implementation technical support satisfaction.<br />
* Aside from providing source code in the event the company undergoes changes, how and when can the organization acquire the "raw" data?<br />
* Will the source code be placed in escrow so that the system could be maintained and modified by internal IT staff in the event that the vendor ceases operation.<br />
* Does the vendor have local support personnel or will all issues be handled by a distant team?<br />
* What is an average time for installing and testing upgrades to the system? If an upgrade is missed or skipped, does the subsequent upgrade(s) have all prior changes included or just the current fix or feature for that version?<br />
* Is there going to be a vendor-institution confidentiality agreement or can the vendor share institutional information and dealings with other establishments?<br />
<br />
'''* Does the vendor's produce meet our needs and goals for our practice? Carryout a test drive of our specific needs with the vendor's product and provide the vendor with patient and office scenarios or mock trial that they may use to customize their produce demonstration.'''<br />
<br />
=== Upgrades ===<br />
<br />
* Does the vendor share the organization's '''vision''' for the EHR?<br />
* Does the product provided by the vendor has all the '''key functions''' needed to fulfill the vision of the organization?<br />
* Is the vendor utilizing the desired technology?<br />
* Compare retail broker workstation alternatives, including proprietary and third party packages, based on user requirements and technology/operational considerations. Project included EMR development and response evaluation<br />
* Does the vendor plan to offer interoperability options in the event of a nationally implemented CIS?<br />
* Upon the termination of a license or agreement, is there an orderly process for you to extract your data? This is applicable if you access the vendor’s software within an application service provider (ASP) model.[http://www.ama-assn.org American Medical Association]<br />
* Ability to have HIE compatibility<br />
* Improved billing accuracy and charge capture<br />
* Electronic replacement for traditional reportable disease notifications to health departments, may become part of biosurveillance in the future.<br />
* Is it possible to virtualize or [http://en.wikipedia.org/wiki/Sandbox_(software_development) sandbox] the system to test updates? This functionality would allow site specific testing of new features and systems with less risk of corruption of the current system. It would also allow testing of new features functionality and allow easy rollback if features end up being unwanted.<br />
* Does the system allow outreach/growth to affiliates as a "subset" of the existing clinical provider group? Does that outreach include full or limited functionality? How does that data interface with the existing clinical record?<br />
*How does the system scale? Is the vendor able to provide support and functionality as a practice grows or can they provide functionality to a small, regional branch?<br />
* Provision of EHR systems that support the capture of public health data from Clinical Information Systems.<br />
* Does the system can combine with EHR in long term health care area as a reminder of senior people?<br />
* Ensure that your vendor will be around when you need help. While specific vendor qualifications vary, generally information to be considered in the vendor vetting process, besides functional and technical details, includes vendor reputation, staff experience and qualifications, and financial solvency. (Chao, C., & Goldbort, J. (2012). Lessons Learned from Implementation of a Perinatal Documentation System. JOGNN: Journal Of Obstetric, Gynecologic & Neonatal Nursing, 41(5), 599-608. doi:10.1111/j.1552-6909.2012.01378.x)<br />
*Does the vendor allow discrete data capture and easy reporting of critical data that needs to be submitted for reimbursement by the national and state policies on healthcare?<br />
*Is the vendor at the forefront of research in healthcare and does the software offer clinical dashboards and predictive models for easy tracking and analysis of patient data and efficient decision making by clinicians.<br />
*Does the vendor require hiring of outside consultants for training?<br />
* Does the vendor, as part of their 18-24 month roadmap, include Direct-Trust (commonly referred to as Blue Button) to facilitate a more automated Provider to Provider data exchange as a replacement for FAX machine?<br />
* Does the vendor, as part of their 18-24 month roadmap, include Fast Healthcare Interoperability Resource (FHIR) protocol as well as Human APIs implementation to facilitate bi-directional data exchange between Provider and Patient?<br />
* Does the vendor, as part of their 18-24 month roadmap, include not only Member Eligibility data but History data, Formulary data as well as Drug Utilization Review (DUR) data in their ePrescription Hub?<br />
<br />
== Contracts ==<br />
<br />
Contracts are as much a business tool as they are a purchasing agreement. <ref name="ehr contract">Carolyn Hartley - signing an EHR contract http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx </ref><br />
<br />
* Project Payments<br />
* Contract Terms [http://calhipso.org/documents/ehr_contracting_terms_final_508_compliant.pdf]<br />
* All costs, current and future, associated with the implementation<br />
Details of the total cost incurred by the institution also called total cost of ownership (TCO) is an important consideration in the selection process. It helps to predict the longevity of the program. The request for proposal to vendors should include a request for information about vendor license and implementation costs. Vendors should deliniate the assumptions made when preparing the TCO so the decision committee is able to verify that they are parallel to the goals and objectives of the insitutions. If the same assumptions are encorporated in all request for proposals one can better compare the applications. <ref name="Find-EHR-Vendor">Finding an EHR vendor: Mistakes are costly, and questions about confidentiality linger. (2011). Alcoholism & Drug Abuse Weekly, 23 (42), 1-4.</ref><br />
Institutions must also consider the intangible return on their investments such as reduced adverse events, decreased hospital stay, accurate and timely billing and improved management of supplies.<br />
* Does the vendor have any hidden fees?<br />
* Time commitment from vendor with regard to implementation and training<br />
* Penalties for delays in implementation<br />
* Code escrow - be sure code will be available if vendor goes out of business<br />
* Indemnification and hold harmless clauses <br />
* Confidentiality and nondisclosure agreements <br />
* Warranties and disclaimers <br />
* Limits on liability <br />
* Dispute resolution <br />
* Termination and wind down<br />
* Intellectual property disputes <br />
* IT support agreement<br />
* Training Contract<br />
* Applied area contract<br />
* User and vender liability<br />
* Disputation judgment <br />
* Attorney of vender and clients<br />
* User License - The person who has access to data using a user ID and password. Pricing structures vary according to the definition of user.<br />
* Consider variation of user licenses according to the needs: one price per MD, tiered price (MD, nurse or administrator), site license (25+ providers in the same facility), and enterprise license (multiple users in multiple departments). <ref name="user license">Signing an EHR contract. Tips to control costs. http://physiciansehr.org/signing-an-ehr-contract-25-tips-to-control-costs.aspx </ref><br />
* Interface - The EHR vendor's contract includes the cost of interfaces. These include interfaces such as those with your scanner or fax machine; and more complex interfaces such <br />
* Hardware Contract - Review the EHR vendor's hardware quote, but research may lower costs. Check the vendor's website for hardware specifications the vendor supports. Hardware includes servers, high-speed scanners, computers, handhelds, computer on wheels (COW), wall mounts, etc. Hardware installation to a wholesaler means assembling the server and software to make it work at their location prior to delivering it to you. It usually does NOT mean the installation at your location, a difference that will create a significant budget surprise. Clarify the term "installation" with any hardware wholesaler before making the purchase.<br />
* Third Party Software Contracts – Software includes encryption, speech-recognition, password management, Microsoft™ suite, anti-virus, golden image, bar-coding or webcams.<br />
* Business Associate Agreement - To be HIPAA-compliant you will need a business associate agreement with the vendor, and must ensure the vendor meets HIPAA security and privacy requirements.<ref name="HIMSS-AMA-BAA">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
<br />
=== Check Vendor References ===<br />
<br />
*Each vendor being considered should provide minimal of three (3) references, to include a) physician users, b) IT person, and c) senior manager of the facility or practice.<br />
* Vendor provided references may be considered 'happy customers' with biased viewpoints.<br />
* Check several references on your own, outside of the provided references from the proposed vendor. <br />
* The chosen reference should be of a comparable size and structure <br />
* Have a prepared list of questions to ask.<br />
* Compare vendor satisfaction with current customers. <br />
* Ask supplied list of references how they acquired the EHR system, eg did they purchase the system or was it provided by the vendor?<br />
* Ask each reference to rate the vendor on a scale from 1 (very dissatisfied/strongly disagree) to 5 (very satisfied/strongly agree) for each criterion<br />
* Each vendor reference should provide reference on background information such as version of system currently being used, duration using current system, length of implementation, number of interfaces practice currently installed and estimated time to install, training provided on-site or remote.<br />
* Each vendor reference should provide reference on current system overview such as system reliability, satisfaction with vendor, and overall satisfaction with system.<br />
* Research references the vendor did not mention, visit facility to get an unbiased viewpoint<br />
* Must use listservs, internet searches and networking to identify other users to interview to get more objective viewpoint.<br />
* All interviewers should utilize the same questionnaire approved by the project manager or steering team.<br />
* Notes must be recorded by each interviewer for each customer interviewed.<br />
* These notes should be made part of the overall evaluation process, ideally kept by the project manager. <ref name="Murphy-EMR-Interface">Murphy E., et. al. An Electronic Medical Records System for Clinical Research and the EMR–EDC Interface http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2361387/</ref><br />
* Is the vendor currently involved in or have a history of any litigation with customers?<br />
*Does the vendor have a track record?<br />
*Has the vendor been in business for long?<br />
*Perform site visits to similar organizations that are currently implementing the vendor’s product and ask plenty of questions to all end users (physicians, administrative staff, nurses, etc.) <ref name="himss-ama-litigation">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref> <ref name="weber 2008">Selecting An EHR, Now What? ftp://ftp.hrsa.gov/ruralhealth/jan082008tacall.pdf</ref><br />
<br />
=== Site Visits ===<br />
Once you have narrowed down your search to two vendors, you’ll want to visit a practice where the system has already been implemented. Ask the vendors for a client list and contact the references yourself. If there is no local client base, keep in mind that you won’t have the support of a local colleague, and that can be challenging. Only visit practices that are similar in size and specialty to yours; if they use different templates you may not get the full idea of how the system can be applied to your specialty.<ref name="AHIMA">http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_031357.hcsp?dDocName=bok1_031357</ref> During site visits, ask how engaged the vendor was in the implementation. For a truly successful implementation, you’ll need a close relationship with your vendor. Be sure that the vendor’s project manager provides face-to-face interaction with your staff. The project manager should also attend staff meetings and produce regular project updates as the implementation progresses.<ref name="AHIMA"></ref> Conducting site visits at other institutions that have already implemented the vendor’s system may provide additional and practical insight. Below is a list of criteria that should be observed on site visits. The following are criteria established by MetaStar and can be found [https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc here]. <ref name="Site Visiting Tips">MetaStar https://www.metastar.com/web/professional/docs/DOQ-IT/Vendor/Tools/SiteVisitingTips.doc</ref><br />
<br />
* Bring a diversity of positions from your committee.<br />
** At minimum bring a physician, IT specialist, and senior management person.<br />
* Observe during actual patient encounters.<br />
* Observe other departments such as billing and labs using the vendor.<br />
* Choose a site to visit based on your own research rather than one provided by the vendor.<br />
<br />
=== Transparency ===<br />
<br />
EHR vendors may enter contracts with confidentiality or non-disclosure terms that can prevent transparency. Examples include:<br />
<br />
* Disclosures required by law or regulation, sometimes with an obligation to give the other party advance notice and the opportunity to oppose the disclosure or seek confidential treatment.<br />
<br />
*Disclosure of information that has been independently developed by the disclosing party<br />
<br />
*Disclosure of information that is available to the general public or has been provided separately to the disclosing party without violation of an agreement. <br />
<br />
*Are there any hidden fees associated with training, support, consultant costs?<br />
<br />
The definition of confidential information may be broad and could restrict your ability to share access to the EHR technology developer’s software in order to compare different EHR technology developer systems, provide access to researchers, or even address possible patient safety concerns. You should review the confidentiality and non-disclosure language carefully to make certain it does not inhibit your ability to conduct activities you value. <ref name="westatterms">EHR Contracts: Key Contract Terms for Users to Understand. http://www.healthit.gov/sites/default/files/ehr_contracting_terms_final_508_compliant.pdf </ref><br />
<br />
== Misc considerations ==<br />
<br />
* It is not uncommon for developers or implementers to impose lock-in features in order to protect their IP rights. How mature is the support community for the particular vendor and is there a marketplace for support and services to their product or is support limited to their own team?<br />
* A multidisciplinary team, usually a subset of the decision team consisting of a physician, IT personnel and a senior management must conduct a site visit to one of the vendor customer sites and vendor headquarters. Informal discussions at this level were quite informative as they bridged the gap between theory and practice for actual software implementation and usage.<br />
* An unstructured “drive-by” demonstration of the system must be arranged for, wherein the vendors conduct product demos, demonstrate product futures and distribute promotional materials for a majority of the employees to get the feel of the new systems. It facilitates building a comfort level and relationship with the vendor and the product offered.<br />
* Can the company demonstrate tangible ways that use of the product can increase hospital revenue? If yes, can you validate this/these claims?<br />
* Is the vendor willing to contract to go "at risk" for any part(s) of the contract?<br />
* What other services does the company offer (especially useful for rural or small hospitals or practices)? e.g. consultants to do special projects, data transmission/claims, billing<br />
*Can the record be accessed at home by clinicians and patients, or do they have to be on-site at the facility?<br />
* Is the vendor capable of adapting to emerging technology such as open source programming, cloud computing, "tablet" PCs/Macs, demand for smartphones (e.g. iPhone), and Web 2.0 technology?<br />
* Is the vendor capable of integrating its system with a personal health record and allowing more patient control?<br />
* Can the company provide return on investment analysis?<br />
* Vendors may not be chosen if the current managers have been convicted of or have had a civil judgment for the following: fraud, antitrust violations, embezzlement, theft, etc.<br />
* Reduced pharmaceutical costs derived from having information available at the time it is needed<br />
* How can this EHR be an asset for the solo practitioner who sees this technology primarily as a financial drain?<br />
* How much extra financial cost will it be to train outpatient clinics that are a subset of the system?<br />
* Does the vendor return loss money if their system can not complete established goal in scheduled time?<br />
* Can the company provide a multi-background consult team from doctors, nurses, IT engineer, to attorney?<br />
* Does the vendor qualify the organization's acquisition policies? Is the vendor '''CCHIT certified'''?<br />
* Certification can be verified at the Certified Health IT Product List (CHPL) <ref name="onc ehrcert">Certified Health IT Product List (CHPL) list of EMRs. http://oncchpl.force.com/ehrcert </ref><br />
* Is the vendor active in national EMR leadership task forces, such as the Electronic Health Records Vendors Association <ref name="HIMSSEHRA">HIMSS Electronic Health Record Association http://www.himssehra.org/ASP/index.asp </ref><br />
* Will the vendor be supporting the organization's desired implementation strategy?<br />
* Check the track record of vendor for operations and maintenance support?<br />
* Will the vendor sell or monetize of our clinical data for research or any other purposes? <br />
* Is Application Support provided by on-shore resources? <br />
* Clarify the roles, responsibilities and costs for data migration if desired. <ref name="factors selecting vendor"></ref><br />
* Does the Vendor demonstrate financial and management stability?<br />
* Does the vendor have experience with implementing the product in a similar type of organizations? How many?<br />
* Conduct a site visit <ref name="factors selecting vendor">What factors should I consider when selecting a vendor? http://www.healthit.gov/providers-professionals/faqs/what-factors-should-i-consider-when-selecting-vendor </ref><br />
* Ensure that the site is similar to you - similar number of beds, acuity, rural/urban setting<br />
*'''Flexibility that allows for significant changes in product or order lines'''. Thus, this enables for businesses to modify orders, if necessary, without having to face a penalty from the vendor. Not always do things go as planned and if any modifications are needed, there should not be any consequences that inhibit this from occurring. <br />
* '''The ability to provide all the products/services required and/or the complete solution.''' This in turn can provide the whole picture in allowing for the consumer more transparency in terms of being able to distinguish between the products/services that a particular vendor is offering. As a result, this can save time and money in terms of a consumer being able to choose a certain business that can provide everything that is needed instead of wasting time and effort in purchasing products/services from individual vendors that have a small selection available.<br />
* '''The ability to have a consistent supply of products or services readily available for the business to purchase at all times.''' There is always a need for products and services to be provided on a regular basis; thus a business does not want to have a vendor that has supply issues. If a vendor is not reliable, then it can affect the business’s ability to in turn supply and provide for its customers, which can have a dramatic effect on the reputation and finances of the business.<br />
* Does vendor volunteering disclose adverse events or near misses data involving vendor’s EMR system to potential buyers? Are there protocol designed to notify federally designated patient safety organizations of IT related adverse events or near misses? <ref name="seventeen"> Better Patient Safety is Goal of Confidential EHR Error Reports http://www.amednews.com/article/20130724/profession/130729986/8/ .</ref><br />
*Does the EHR have the ability to link payments and incentive rewards to the implementation of milestones and performance goals, as well as conduct data queries for support of quality improvement? <ref name="HRSA">Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html </ref><br />
<br />
=== Dr. Sittig's Overview of EMR Vendor Selection ===<br />
#Make The Plan <br />
##Identify Decision makers<br />
#Set Goals<br />
##Make a Checklist of what should the EMR accomplish<br />
##Map your Workflow<br />
##Do a thorough Scan of your environment <br />
#Prioritize needs<br />
##Make EHR Functionality Checklist<br />
#Develop a Request For Proposal (RFP)<br />
#Select RFP recipients <br />
##For example up to 5 vendors<br />
#Narrow the field<br />
##EHR Evaluation Form<br />
#EHR Vendor Demonstrations<br />
#Narrow the field <br />
##For example up to 3 vendors<br />
##Ask additional questions to vendors<br />
#Check references <br />
##Examples: consulting KLAS, Gartner etc<br />
#Rank the vendors<br />
##Functionality vs cost vs vendor characteristics<br />
###functionality can be the institution's most important function<br />
###cost can include the total amount from hardware, software, training, and support<br />
###vendor characteristics can be important traits that are aligned with the institution's core values<br />
##Vendor selection tools<br />
#Site visits<br />
#Select a finalist (between the last 2 competitors)<br />
#Verify Commitment<br />
##Determine approval of selection committees and discuss choice will all the key stakeholders.<br />
##If possible repeat the Demo to all the staffs <br />
##For uncovered concerns, verify all the references and repeat verification steps if necessary <br />
#Formal Contract Negotiation<br />
##Ask vendors to spell out all the current as well as the future costs including the vendor time commitments for training and implementation<br />
##Ask vendor to put source code in escrow just in case Vendor go out of business<br />
##Before signing the software contracts,make sure you have familiar attorney to review<br />
#Follow all the above process<br />
##Know that the process takes time and do not rush because the end result can be expensive.<br />
##Follow the process without skipping any steps.<br />
<br />
== Regulatory Compliance ==<br />
<br />
Selecting an EMR is like buying a house where it needs thorough inspection/evaluation and making sure that every component is functional and meeting all the related requirements prior to approval and signing of contract. Based on experience, some of the significant criteria that must be considered during the selection process are the following:<br />
<br />
=== Meaningful Use (MU) === <br />
<br />
Meaningful use is using certified electronic health record (EHR) technology to: Improve quality, safety, efficiency, and reduce health disparities. Engage patients and family. Improve care coordination, and population and public health. <ref name="HIT.gov">Meaningful Use Definition and Objectives http://www.healthit.gov/providers-professionals/meaningful-use-definition-objectives</ref> A gap analysis can be performed:<br />
<br />
==== Meaningful Use Gap Analysis ====<br />
<br />
* Is it ONC Certified? [http://oncchpl.force.com/ehrcert?q=chpl]<br />
* Does it meet all Meaningful Use objectives?<br />
* Does it provide automated MU & Clinical Quality Measure Reports?<br />
* Does the vendor provide MU Training Guides/Resources?<br />
* Does the system facilitate easy MU Data capture such as required data fields?<br />
* Does it provide audit logs, usage monitoring, etc?<br />
* Does it allow/include data migration from previous EMR?<br />
* Does it contain CDS Rules to improve performance on high priority health conditions?<br />
* Does it have capability to electronically submit Clinical Quality Measures to CMS?<br />
* Does it have Public/Cancer Registry Reporting Capabilities? <br />
* Does it provide 24/7 technical support?<br />
* Does it include Pt Portal, CCD Transmission & Direct Messaging with no extra/minimal cost? <ref name="CMS.gov">http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html</ref><br />
<br />
=== Hospital Inpatient Quality Reporting Program (IQR)===<br />
<br />
The Hospital Inpatient Quality Reporting (Hospital IQR) program was originally mandated by Section 501(b) of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003. This section of the MMA authorized CMS to pay hospitals that successfully report designated quality measures a higher annual update to their payment rates. Initially, the MMA provided for a 0.4 percentage point reduction in the annual market basket (the measure of inflation in costs of goods and services used by hospitals in treating Medicare patients) update for hospitals that did not successfully report. The Deficit Reduction Act of 2005 increased that reduction to 2.0 percentage points.<br />
<br />
In addition to giving hospitals a financial incentive to report the quality of their services, the hospital reporting program provides CMS with data to help consumers make more informed decisions about their health care. Some of the hospital quality of care information gathered through the program is available to consumers on the [http://www.hospitalcompare.hhs.gov Hospital Compare Website]. <ref name=“CMS.gov”> Hospital Inpatient Quality Reporting Program. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/HospitalQualityInits/HospitalRHQDAPU.html/</ref> It is important that the EMR supports the capability to capture all required elements for different Core Measure Conditions to help facilitate compliance.<br />
<br />
=== Physician Quality Reporting System (PQRS) ===<br />
<br />
PQRS is a reporting program that uses a combination of incentive payments and negative payment adjustments to promote reporting of quality information by eligible professionals (EPs). The program provides an incentive payment to practices with EPs (identified on claims by their individual National Provider Identifier [NPI] and Tax Identification Number [TIN]). EPs satisfactorily report data on quality measures for covered Physician Fee Schedule (PFS) services furnished to Medicare Part B Fee-for-Service (FFS) beneficiaries (including Railroad Retirement Board and Medicare Secondary Payer). <br />
<br />
Beginning in 2015, the program also applies a negative payment adjustment to EPs who do not satisfactorily report data on quality measures for covered professional services. This website serves as the primary and authoritative source for all publicly available information and CMS-supported educational and implementation support materials for PQRS. Stay informed for latest updates by subscribing to the [PQRS Listserv] <ref name=“CMS.gov”> Physician Quality Reporting System http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/PQRS/</ref><br />
EMR should have PQRS data capture and reporting capability in order to meet PQRS and avoid related payment adjustments.<br />
<br />
The measures CMS has selected for PQRS are developed and approved by organizations such as the National Quality Form (NQF). Some measures represent undesirable outcomes, while others represent desirable outcomes. New measures are added each year and measures from previous years can be updated or deleted. A list of the 267 measures for 2012 can be found [http://www.cms.gov/PQRS/15_MeasuresCodes.asp#TopOfPage here]. The PQRS measures include both process quality measures and outcome measures, such as the patient’s blood pressure and HbA1c level. Examples include:<br />
<br />
<Li>Diabetes Mellitus: Hemoglobin A1c Poor Control in Diabetes Mellitus. Developed by the NCQA. A patient aged 18 through 75 years with diabetes mellitus whose most recent hemoglobin A1c was greater than nine percent.</Li><br />
<Li>Coronary Artery Disease (CAD): Oral Antiplatelet Therapy Prescribed for Patients with CAD. Developed by the American Medical Association-sponsored Physician Consortium on Performance Improvement. A patient aged 18 years and older with a diagnosis of CAD who was prescribed oral antiplatelet therapy.</Li><br />
<br />
Participation in PQRS is voluntary, but there are rewards and penalties associated with participation. Currently, providers earn an incentive payment simply for reporting PQRS measures <ref name="Dowd">Bryan Dowd, Chia-hsuan Li, Tami Swenson, Robert Coulam, and Jesse Levy. Medicare’s Physician Quality Reporting System (PQRS): Quality Measurement and Beneficiary Attribution. Medicare Medicaid Res Rev. 2014; 4(2): mmrr2014.004.02.a04</ref>.<br />
<br />
== EHR Evaluation Resources ==<br />
<br />
* American Academy of Family Physicians [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrvendorrating.Par.0001.File.tmp/ehrvendorrating.pdf Vendor Rating Tool]<br />
* American Academy Of Family Physicians HR Demonstration Rating Form EHR Demonstration Rating Form [http://www.aafp.org/online/etc/medialib/aafp_org/documents/news_pubs/fpm/pcmhtools/ehrdemorateform.Par.0001.File.tmp/ehrdemorating.pdf]<br />
* American Academy of Family Physicians vendor's references verification form [http://www.aafp.org/fpm/2005/0200/p55.html#fpm20050200p55-bt4]<br />
* American College of Physicians [http://www.acponline.org/acp_press/electronic_health_records/checklist.pdf EHR Feature Checklist]<br />
* Bureau of Primary Health Care. BPHC Electronic Medical Record Resources page. [http://bphc.hrsa.gov/chc/CHCInitiatives/emr.htm]<br />
* Doctor's Office Quality - Information Technology [http://www.healthinsight.org/Internal/REC_Event_Resources/MU_Boot_Camp_Materials_Resources/Guidelines%20for%20Evaluating%20Systems.pdf Guidelines for Evaluating EHR Vendors]<br />
* www.purchasing-procurement-center.com/selecting-a-vendor.html<br />
* The National Learning Consortium Vendor Evaluation Matrix Tool. <ref name="NLCmatrix">The National Learning Consortium Vendor Evaluation Matrix Tool. http://www.healthit.gov/providers-professionals/implementation-resources/vendor-evaluation-matrix-tool</ref><br />
*California Health Care Foundation, EMR Evaluation Tool and User Guide - A Guide for Small Physician Practices: [http://www.chcf.org/publications/2003/10/emr-evaluation-tool-and-user-guide]<br />
*American Medical Association - 15 questions to ask before signing an EMR/EHR agreement<ref name"AMA-HIMSS-15Questions">http://www.himss.org/files/HIMSSorg/content/files/Code%2093_15%20questions%20to%20ask%20before%20signing%20an%20EMR-EHR%20agreement_AMA.pdf</ref><br />
* Health Resources and Services Administration [http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html How to Select a Certified EHR] <ref name="HRSA"> Health Resources and Services Administration http://www.hrsa.gov/healthit/toolbox/healthitimplementation/implementationtopics/selectcertifiedehr/selectacertifiedehr_7.html</ref><br />
* Select or upgrade to a certified electronic health record vendor [http://www.healthit.gov/providers-professionals/ehr-implementation-steps/step-3-select-or-upgrade-certified-ehr]<br />
<br />
== References ==<br />
<references/><br />
# [Kannry, J., Mukani, S., & Myers, K. (2006). Using an evidence-based approach for system selection at a large academic medical center: lessons learned in selecting an ambulatory EMR at Mount Sinai Hospital. Journal of Healthcare Information Management: JHIM, 20(2), 84–99.]<br />
64. www.hrsa.gov</div>Mho2http://www.clinfowiki.org/wiki/index.php/EMR_Benefits_and_Return_on_Investment_CategoriesEMR Benefits and Return on Investment Categories2015-01-29T05:23:25Z<p>Mho2: </p>
<hr />
<div>The [[EMR|Electronic Medical Record]] may consist of computer order entry, decision support, electronic medication administration, documentation, and so much more. <ref name="what is an emr">What Is an Electronic Medical Record (EMR)? http://www.healthit.gov/providers-professionals/electronic-medical-records-emr</ref><br />
<br />
The sections below detail the benefits, costs, and barriers in evaluating EMR implementations.<br />
<br />
== Informational ==<br />
<br />
Commonly cited benefits of EMRs include:<br />
<br />
* Lower number of doctor visits (from the payer's perspective)<br />
* Communication, coding, efficiency, safety improvements<br />
* Transformation of healthcare delivery<br />
* Better Coordination of care<br />
* Improved management of chronic conditions<br />
* Increased revenue and decreased costs for healthcare organizations <br />
* Increased use of preventive care <ref name="EMR Benefits">EMR Benefits, https://www.longwoods.com/articles/images/ABC_&_HIMSS_research-1.pdf</ref><br />
* Nursing staff time savings <ref name="EMR Benefits"></ref><br />
* Length of stay reduction <ref name="EMR Benefits"></ref><br />
* Clinical cost reduction <ref name="EMR Benefits"></ref><br />
* Pharmacist time savings <ref name="EMR Benefits"></ref><br />
* Reduced payment denials <ref name="EMR Benefits"></ref><br />
* Improved reimbursement inpatient or outpatient<ref name="EMR Benefits"></ref><br />
* HIM/Medical Records staffing reductions<ref name="EMR Benefits"></ref><br />
* Reduction in duplicate lab testing<ref name="EMR Benefits"></ref><br />
* Decreased cost of paper forms<ref name="EMR Benefits"></ref><br />
* Improved drug order to administration times<ref name="EMR Benefits"></ref><br />
* Reduction in order turnaround times<ref name="EMR Benefits"></ref><br />
* Data accessibility by multiple users <ref name="practical guide">Benefits of Switching to an Electronic Health Record. http://www.practicefusion.com/health-informatics-practical-guide/ </ref><br />
* Retrieval of prior encounters and medication history <ref name="practical guide"></ref><br />
* Improve legal and regulatory compliance <ref name="benefits & drawbacks"> Benefits and Drawbacks of Electronic Health Record System. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3270933/#b55-rmhp-4-047. </ref><br />
* Up to date information about patient at point of care <ref name="benefits">Benefits of Electronic Medical Records (EMR), 2011 Physician Survey. http://blog.softwareadvice.com/articles/medical/benefits-of-emr-software-survey-1081611/ </ref><br />
* Improve Public Health Outcomes <ref name="Diagnostics and Outcomes">Improved Diagnostics & Patient Outcomes http://www.healthit.gov/providers-professionals/improved-diagnostics-patient-outcomes</ref><br />
* Healthcare Quality and Convenience <ref name="Patient Participation">Health Care Quality & Convenience http://www.healthit.gov/providers-professionals/health-care-quality-convenience</ref><br />
* Increased Accuracy in Medication Administration <ref name="Electronic Mediation Administration">Electronic Mediation Administration. http://www.fdbhealth.com/solutions/emar/ </ref><br />
* Improvement to patient appointment management<br />
* Improved integration with pharmacy (e-prescribing)<br />
* Advances in medical research <ref name="Enormous Benefits">How Epic EMR Implementations Bring Enormous Benefits to Human Health<br />
. http://www.knowledgeanywhere.com/blog/news-and-events/post/how-epic-emr-implementations-bring-enormous-benefits-to-human-health </ref><br />
* Improved utilization of radiology tests <ref name="wang 2003"></ref> <br />
* [http://clinfowiki.org/wiki/index.php/Department_of_Veterans_Affairs_Initiatives Special VA Benefits]<br />
Veterans Transportation Service (VTS) provides Veterans with transportation to and from their VA health care appointments, which avails the service to care and continuity of care for many who would otherwise be limited in mobility.<br />
Many other distinguished services such as VA Dental Insurance Program (VADIP),Minority Veterans Program (National Call Center for Homeless Veterans), Military Sexual Trauma, Family Caregivers Program,and many more.[http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf]<br />
Further elaborate information is available at [[www.va.gov/healthbenefits]]<br />
<br />
<br />
However, quantifying these benefits is not a simple task. Issues that have hampered Return on Investment (ROI) studies and affected their validity include:<br />
<br />
* Pressure to justify expense<br />
* Shoddy collection of "before" comparison data after the implementation<br />
* Application of multiple simple statistical tests (the more statistical tests you run, the more likely you are to find something significant)<br />
<br />
----<br />
<br />
=== Storage and retrieval ===<br />
<br />
EMRs improve the storage and retrieval of patient information in the following ways:<br />
<br />
# Reduces the amount of physical storage space required to house charts.<br />
# Protected from fire, natural disaster, or theft.<br />
# Records can be backed up to off-site facilities<br />
# Instant access to records.<br />
# More controlled access, including a record of who accessed the record.<br />
# Eliminates “lost” or incomplete charts.<br />
# More than one provider can access the record at one time. Ability to identify who modified the record.<br />
# Ensures business continuity and uninterrupted medical service.<br />
# EMRs store patient data, including but not limited to, patient medical history, medication history, vital signs, lab tests results, as well as other pertinent information in a single location, and is readily available to anyone directly involved in the patient’s care, regardless of location. It eliminates time and cost from paper chart pulls and transcription and re-file of paper charts <ref name="wang 2003"></ref> <br />
# They reduce the likelihood that tests will be unnecessarily duplicated. <br />
# Coordination of care is easier to achieve and eliminates steps that may lead to discrepancies in the sharing of data. <br />
# EMRs can promote early intervention in disease processes because all the health data- vital signs, lab results, imaging, physician notes, nursing notes, etc.- of a patient are accessible in the same record (6). <br />
# They are vital to improved quality of care at the bedside or point of care because less time is spent doing non-caring activities and more time spent actually caring for the patient (6). <br />
# EMRs reduce the number of lost or missing reports. <br />
# They reduce variability of care.<br />
# Timely delivery of critical services <br />
# Ensures business continuity and uninterrupted medical service.<br />
# Facilitates patient self-service and increases patient's engagement with the help of Patient portal which is a secure online website that patients can access anywhere and anytime to view their medications, immunizations, lab reports, request prescription refills, schedule appointments, make payments and much more.<br />
# Enforces data confidentiality and improves compliance.<br />
# Ensures accurate patient identification: For example, there can be multiple Jon Does in the hospital even with same age. EMR ensure that they are uniquely identified with medical record numbers and also additional features like photograph etc.<br />
# Increased ability to sanitize data for use in research studies<br />
# Increased access for researchers both in-house and external<br />
# The records provide proof to insurance companies that a patient was seen[http://www.insight.com/insighton/healthcare/emr-benefits-challenges-and-tips-for-integration/]<br />
<br />
Respondents from the 2011 U.S. Physician Workflow study of office-based physicians reported that the Electronic Health Record (EHR) helped them access patient records remotely (81%) and enhanced patient care overall (78%).<br />
<br />
=== Workflow ===<br />
<br />
EMR has tremendous effects on changing workflow by several ways such as reducing time spent in getting medical histories, ease of data retrieval, greater remote access, and providing auto-produced sign-out documents to support handoff workflow.<br />
According to a study performed by Julia Driessen and ects. They estimated EMR assist an employee to reduce about 17 min per working day (28%) in transcription time. Although the volume of work initially required to achieve the goal of digitizing a healthcare office may seem overwhelming, the end result is well worth the effort.<br />
<br />
Every medical office has its own "system" for organizing patient data, the majority of these facilities could use a little help in improving their processes. Searching through physical file folders for a specific patient's medical record and then being required to sift through paperwork to find the document(s) necessary for a certain task are time-consuming tasks that could be eliminated through the implementation of electronic medical records. A digitized records database can solve problems associated with human filing errors and misplaced documentation. Instead, all authorized medical staff will have immediate and accurate access to the exact information needed through just a few clicks of a mouse.<br />
<br />
An EMR service that fully analyzes and streamlines the patient workflow, and works to support a lean practice operation, can actually improve efficiency, such as integrated billing. Providers can be more productive, spend more time with patients, and even enjoy increased patient visits.<br />
<br />
=== Care coordination ===<br />
<br />
EMRs can decrease the fragmentation of care by improving care co-ordination among clinical and administrative staff. Better care coordination can improve transparency among overall processes. EMRs have the potential to integrate and organize patient health information and communicate this information accurately among everyone that is involved in a patient's care. Better availability of patient information can reduce medical errors and redundancy in health care.<br />
<br />
Improved care coordination increases with EHRs. Care coordination can be seen when every provider has the same access to a patients health information. This is important with patients who are receiving emergency setting treatment, seeing a few or many specialists and when transitioning care settings. EHRs can even provide the ability to set off alerts in a patients charts when they have been in the hospital. This allows providers to proactively follow up. <ref name="care coordination">Health IT: Improved Care Coordination http://www.healthit.gov/providers-professionals/improved-care-coordination</ref><br />
<br />
=== Integrated View of Patient Data ===<br />
<br />
EHR systems can provide integrated access to all data about a patient from many visits and facilities such as laboratory tests, problems, diagnoses, medications, etc. from the database. This retrieval is made easy by data standards like HL7, LOINC, and SNOMED. Practitioners can also have multiple views of data through links provided in the user interfaces.<br />
<br />
The capacity to integrate the way patient data can be viewed is one of the most important benefits of the EMR to healthcare providers. Being able to see flowcharts of a patients vital signs, lab results, intake and output, and medication administration, provide physicians a faster and better way to visualize and make decisions on the patient’s current condition without spending a considerable amount of time leafing through a patient’s paper chart searching for disjointed documentation. <ref name="MD satisfaction">Sittig, D. F., Kuperman, G. J., & Fiskio, J. (1999) .Evaluating physician satisfaction regarding user interactions with an electronic medical record system (1999). Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2232602/</ref> <br />
<br />
=== Tracking Patients’ Medical Data ===<br />
<br />
By having the EMR save patient data (such as heart rate, blood pressure, eating habits, etc.) over, healthcare providers – or even the patients – can check parameters during a specific time frame when certain symptoms occur and correlate any relation. Having the constant patient data, allows the healthcare professional to go back in time and see any relationship to specific parameters and patient illness symptoms. [5]<br />
<br />
=== Data Accessibility by Multiple Users ===<br />
<br />
Electronic health records are accessible to multiple healthcare workers at the same time <ref name="paper chart">Benefits of EMR or EHR Over Paper Chart. http://www.emrandhipaa.com/benefits-of-emr-or-ehr-over-paper-charts/ </ref>, at multiple locations such as remote access from the office, hospital or home. <ref name="practical guide"></ref>. While a billing clerk is looking at the electronic chart, the primary care physician and a specialist can be analyzing clinical information simultaneously <ref name="practical guide"></ref>.<br />
<br />
Electronic Health Records (EHRs) can improve health care quality. As opposed to paper record, it can also make health care more convenient for providers and patients. Below are some instances showing improved Health Care Quality and Convenience:<br />
<br />
* For Providers <br />
Quick access to patient records from inpatient and remote locations for more coordinated, efficient care, enhanced decision support, clinical alerts, reminders, and medical information performance-improving tools, real-time quality reporting. Legible, complete documentation that facilitates accurate coding and billing Interfaces with labs, registries, and other EHRs safer, more reliable prescribing.<br />
<br />
* For Patients<br />
Reduced need to fill out the same forms at each office visit, reliable point-of-care information and reminders notifying providers of important health interventions, convenience of e-prescriptions electronically sent to pharmacy, patient portals with online interaction for providers and electronic referrals allowing easier access to follow-up care with specialists <ref name="Health Care Quality & Convenience">http://www.healthit.gov/providers-professionals/health-care-quality-convenience</ref><br />
<br />
=== Retrieval of Prior Encounters and Medication History ===<br />
<br />
One of the most attractive features of EMR is the ability to create and store a patient encounter electronically. In seconds one can view the last encounter and determine what treatment was rendered <ref name="practical guide"></ref>.<br />
<br />
=== Improvement to Patient Appointment Management ===<br />
<br />
EHRs improve the process of scheduling, changing, and cancelling patient appointments. Occasionally, patients will forget their appointment which may cause a delay in their care. EHR systems have the ability to reduce the number of missed appointments by sending out reminders to the patient via email, or even a text message. Alternatively, the system can also remind the staff to call the patient to follow up a missed appointment. EHR systems that also provide patient portals allow patients to directly schedule their appointments online and when the appointment reminder is received, they have the ability to confirm the appointment online or reschedule the appointment without having to pick up the phone.<ref>EHR Patient Portals. http://www.hbma.org/news/public-news/n_patient-portals-ehrs-and-third-party-billing</ref> Reducing the number of missed appointments can also help the organization see more patients.<br />
<br />
=== Improved Integration with Pharmacy ===<br />
<br />
EHRs are able to instantly look up the patient's pharmacy and send refill requests reducing the chances of a patient losing a paper prescription. Clinicians can also search for a patient's past and current medication, communicate with the pharmacy staff, and determine if there are any contraindications.<br />
<br />
Records such as in-pharmacy immunizations in the past were sent to physicians by fax or traditional mail. By using EHRs, pharmacists and pharmacy healthcare providers contribute to the compilation of more complete medical histories for their patients. <ref name="immunizations">The impact of electronic health records on pharmacy practice.http://drugtopics.modernmedicine.com/drug-topics/news/clinical/community-pharmacy/impact-electronic-health-records-pharmacy-practice?id=&sk=&date=&&pageID=1</ref><br />
<br />
=== Data Legibility ===<br />
<br />
Legibility is very important to reduce medical errors. For instance, patient information presented as typed text is much easier to read compared to human writings. They are also unified in structures and standards to prevent confusion. Misspelled words can be corrected with spell checks or autocorrect function. Clinicians will be required by computers to enter complete patient notes to avoid missing information.<br />
<br />
When physicians use Computer Provider Order Entry (CPOE) systems within the EMR, fewer medication errors also occur because there are fewer legibility issues. Proper dosages are clearly entered into the computer by the ordering physician, thus reducing the need for nurses or other staff to “second guess” or question the order. [7]<br />
<br />
In addition, with the use of electronic prescribing, the hand-written prescription is no longer applicable as a physician can electronically send a prescription directly to the pharmacy of the patient’s choice. This means there’s no question regarding which medication/dosage the provider prescribed and there are no complications with the physical prescription potentially being lost in transition [73].<br />
<br />
=== Facilitated referral for multidisciplinary care ===<br />
<br />
Electronic medical record (EMR) systems have the potential to facilitate referral of patients from one physician to another physician for provision of well-integrated multidisciplinary care [17]. Such an advantage of EMRs is best served when the referring physician and the physician(s) to whom the patient is referred have direct and full access to the EMR system containing the patient’s file. In such a scenario, viewing and modification of the patient’s EMR file by the physician to whom the patient is referred is immediate and secure [17]. In the absence of direct and full access, referral to other physicians can still be facilitated by EMRs if the relevant data contained within the patient’s EMR file can be transferred electronically, securely, and rapidly between physicians [17]. <br />
<br />
=== Better Integrated Care by Hospitals and Long-Term Facilities/Rehabilitation Centers ===<br />
<br />
EHR plays an important role in improving the health care quality and safety; thus reducing the costs of providing care in long-term care facilities. <ref name="ford e 2010">Ford E. Electronic Health Records Hold Great Promise for Long-Term Care Facilities. http://www.ihealthbeat.org/perspectives/2010/electronic-health-records-hold-great-promise-for-longterm-care-facilities </ref> The relationship-building between the hospitals and long-term facilities is essential in reducing readmissions and improving patient satisfaction. EHR helps in '''improving the transition''' from one care setting to next and hence prevents any gaps in care provided to the patient. <br />
<br />
According to Jenq (Program Director for the Greater New Haven Coalition for Safe Transitions and Readmission Reductions, or GNH CoSTARR)"Nursing facilities frequently do not receive the information they need to properly care for patients discharged from the hospital. From the hospital side, we presume that our paperwork makes it to the skilled-nursing facility and that they have all the material necessary," Jenq says. "But we're finding that our paperwork actually doesn't make it in a timely, efficient manner." Hospital clerical workers often do not recognize all the components of the discharge paperwork; historically, there has been no protocol for laboratory results, such as urine cultures, to be sent to nursing facilities. <ref name="hhnmag">Hospitals strengthen bonds with post-acute providers. http://www.hhnmag.com/display/HHN-news-article.dhtml?dcrPath=/templatedata/HF_Common/NewsArticle/data/HHN/Magazine/2013/Jan/0113HHN_Feature_strategy&domain=HHNMAG</ref><br />
<br />
Skilled nursing facilities (SNF) nurses do not know how to get information from the hospital. "Sometimes the nursing facility will call back to the hospital, but the hospital RN they reach will say, 'I don't know the patient,' and essentially end the conversation there," Jenq says. "We are going to have to lay out roles and responsibilities for all the people involved in the transition of care to make sure they are held accountable for this type of communication." When a problem arises, nursing facilities may not share the hospital's goal of keeping patients out of the hospital. "Right now, the skilled-nursing facilities don't get penalized for the readmission, so they are not affected if the patient goes to the emergency department and gets admitted," Jenq says. "In the future, when penalties apply to them as well, both the SNF and the emergency department will be forced to develop care plans that can work at an SNF." <ref name="hhnmag"></ref><br />
<br />
EHR also helps in Improving the communication between the hospital staff and assisted living or the long-term care facility staff when the patient is transferred from one setting to other. <ref name="hhnmag"></ref><br />
<br />
=== Minimize Repeating Diagnostic Imaging Studies ===<br />
<br />
HIE can potentially eliminate unnecessary repetition of diagnostic testing, especially in the Emergency Department. Indeed as study found that HIE reduced imaging studies order by Emergency Department physicians for patients presenting with back pain, this is not only decrease the cost of expensive imaging studies but also decrease risk of unnecessary patients exposure to radiation[1]. This illustrate the importance of HIE and the potentially huge impact it will have on reducing cost and delivery an optimal health care. <br />
<br />
<br />
=== Administrative and Management Benefits ===<br />
<br />
By moving beyond the paper records, EMR can help Heath Care Providers do a better job at managing patient care. A vast amount of information can be easily used and shared. When fully functional and interoperable, EMRs can provide far more benefits than paper records such as "help providers improve productivity and work life balance." [68] At a higher level of EMR implementation and functionality, Computerized Provider Order Entry (CPOE) can help standardize the clinical practice and eliminate variation. Some benefits of CPOE are:<br />
<br />
* The records can be used in court in the event of a malpractice claim[http://www.insight.com/insighton/healthcare/emr-benefits-challenges-and-tips-for-integration/]<br />
* Help improve communication amongst care givers<br />
* Expedite patient transfer to other levels of care<br />
* Capture data for quality assurance and administrative purposes<br />
* Aid practice and care in a complex care environment through the use of alerts and reminders<br />
* Provides some level of assurance to patients that technology is being applied to their safety [38].<br />
* Better strategic planning - The data generated from using electronic medical records can be used for strategic management by the administration. EMRs can help identify trends in utilization, identify bottlenecks in productivity for staff, and monitor patient needs and satisfaction. This would allow the management team to make better decisions on capital investments, staffing levels and workforce redeployment. They can use this data to implement process improvement projects. EMRs have the potential to help medical facilities design and reach their strategic vision.<br />
<br />
=== Establishing a learning chance to improve healthcare system === <br />
<br />
EMR can assist people to review the outcomes of populations under care. Managers can find a more Meaningful Use criteria applied on quality improvement, research, outreach, and reduction of disparities.<br />
<br />
=== Improved Documentation and Coding ===<br />
<br />
With an EHR system a record can be captured within 12 to 24 after discharge, which can provide an accurate coding in a decreasing amount of time. Healthcare organizations are no longer limited to local coding resources and now healthcare facilities can provide coders with better expertise. <br />
<br />
=== Improved Diagnostics and Patient Outcomes ===<br />
<br />
According to a national survey, physicians who were ready for meaningful use found 95% of clinical providers reported that their EHR system made records available to them at the point of care. The survey also found that 88% of the clinical produced benefits their practices. And there was a 75% improvement in patient care providers reported. <br />
<br />
=== Improved Risk Management ===<br />
<br />
• Prevention of adverse drug events<br />
• Public health outcome improvements<br />
• Prevention of liability actions<br />
• Improvement with complete and legible health records<br />
<br />
=== Customer Support ===<br />
<br />
Some EHR provide help and support in the form of a medical billing specialist. This specialist gives both practices and patients customer support. The specialist also has access to medical codes (ICD-9), CPT code books and practice-related HIPAA information. Other EHRs provide onsite training and on-the-phone consulting for software and billing questions. http://www.advancedmd.com/medical-billing-services<br />
<br />
== Security ==<br />
<br />
Security is an advantageous attribute which comes with EMR systems. Centers for Medicare and Medicaid Services (CMS) published a privacy, security & [[Meaningful Use|meaningful use]] guidelines which computer systems that store patient information need to conform to imply to [[Health Insurance Portability and Accountability Act (HIPAA)|HIPAA]] privacy guidelines. <ref name="Privacy-Standards-CMS">Centers for Medicare & Medicaid Services. Privacy and Security Standards. http://www.cms.gov/Regulations-and-Guidance/HIPAA-Administrative-Simplification/HIPAAGenInfo/PrivacyandSecurityStandards.html</ref><br />
<br />
=== Confidentiality and Secrecy ===<br />
<br />
Publicizing confidential medical records can be overwhelming and the outcomes may have a tremendous impact on a patient's personal life. "Victims could seek litigation against the healthcare practice in which the breach occurred. If the breach affected multiple patients, the practice is headed down a long road of legal tribulations." <ref name="EHR-Security-Concerns">Electronic Health Records Security and Privacy Concerns. http://www.ironmountain.com/Knowledge-Center/Reference-Library/View-by-Document-Type/General-Articles/E/Electronic-Health-Records-Security-and-Privacy-Concerns.aspx</ref><br />
<br />
Confidentiality of patient medical records can be better protected from misuse by the use of well-designed EMRs. The reason for this claim is that monitoring and securing patient medical records in electronic forms is more achievable than any paper-based structure. Although different potential threats exist for any EMR system, a well-designed EMR system has a great potential to facilitate medical record confidentiality. For instance, EMR software developers have the option of using biometric data or multi-factor authentication to ensure that only authorized personnel have access to such data. Further, this method would allow for a data-trail to monitor this access. Installing and enabling encryption is another way to protect and secure patient health information. Encryption is the conversion of data into a form that cannot be read without the decryption key or password. While achieving data encryption is a hard complex mission for any paper-based medical record structure, it is easily possible to implement it for any EMR solution. <ref name="Mendoza-Security-Considerations">Mendoza, E. Security considerations when choosing an EMR system. http://search.proquest.com.ezproxyhost.library.tmc.edu/docview/195651099/fulltextPDF</ref><br />
<br />
Sophisticated e-prescribing capabilities can ensure secure communication of prescriptions from clinicians to any pharmacy the consumer requests. <ref> Phillips, J.L., Shea, J.M., Leung, V. & MacDonald, D. (2015). Impact of Early Electronic Prescribing on Pharmacists’ Clarification Calls in Four Community Pharmacies Located in St John’s, Newfoundland. JMIR Medical Informatics; 3(1):e2. http://www.ncbi.nlm.nih.gov/pubmed/25595165 </ref><br />
<br />
=== Data Consistency and Integrity ===<br />
<br />
Data consistency refers to the level in which the recorded data in the storage medium can be matched with the original and valid state of information which has initially stored. A consistent data with high level of integrity must be always identical with the original state it has stored. In any paper-based medical record, there is a chance that different sort of inconsistencies occur. Maintainability of data integrity in electronic forms of medical records has a significant impact on patient medical record security.<br />
<ref name="Rode-Integrity">Rode, D. Data Integrity in an Era of EHRs, HIEs, and HIPAA: A Health Information Management Perspective. http://csrc.nist.gov/news_events/hiipaa_june2012/day1/day1-b2_drode_integrity-protections.pdf</ref><br />
<br />
=== Access Control and Auditing ===<br />
<br />
In general, access control refers to an act of controlling the access of individuals to any resources of the organization. The term "access" might have different meanings which may refers to "view", "modification", "deletion", or "creation" of records. Auditing is simply the act of monitoring user activities based on their privileges to the resources. In the field of medical records, these two paradigms refer to the act of giving permission to the authorized person and monitor their activities based on their permissions.<br />
<br />
Maintaining access control and auditing in traditional paper-based medical records is hard to implement and achieve. The reason for this complexity comes from the fact that data segmentation in paper-based records is not easily achievable as most of data resides on a series of related documents. Therefore, restricting a person from accessing part of a document (E.g. symptoms or prescriptions) and also monitoring that person activities is nearly impossible or extremely costly. By using an electronic medical record system, it is possible to implement a proper way to provide access control and data auditing.<br />
<br />
== Mobile EMRs ==<br />
<br />
Ease of access to EMRs using mobile technologies such as iPad and smartphones has decreased resistance to EMR use and implementation in busy settings such as Emergency Departments (EDs). A recent study has shown that use of iPads in EDs presents the following advantages in addition to those observed for EMRs in general (29).<br />
<br />
# Enhanced patient education and satisfaction<br />
# Increased mobility of the device provides a better fit of technology to the application setting <br />
# The iPad touch screen enables easy use even without excessive knowledge of computers<br />
# Mobile devices was similar to paper charts in that they are extremely portable allowing physicians to carry it around in EDs easily<br />
# Remote patient monitoring and diagnosis<br />
# Remote ordering capability for physicians [78]<br />
# Ability to cross-reference medical terminology and provide multi-language support.<br />
# Supports globalization of medical care.<br />
# Ability to send health data directly from wearable devices to medical records [1]<br />
# Link daily activities of living (e.g. fitness, nutrition data) to health data [1]<br />
# Dictate on the iOS device, e-Prescribe, and perform real-time eligibility checks [74]. <br />
<br />
The March 16, 2012, Letter to Us at Kaiser Permanente reported that Kaiser Permanente members can use mobile smartphones (Android, iPhones, or Blackberrys) to access their medical records, lab results, and all other aspects of kp.org. Kaiser Permanente members accessed the smartphone application over 1,000,000 times during the first month of use. In 2011, KP patients participated in more than 12,000,000 e-visits with their health care providers.<br />
<br />
Another form of mobile technology that can ease access to EMRs are wearables such as Google Glass, Moto 360, and the Apple Watch <ref name="Wearable extend data">Davies, Michael A.M. "Wearable Tech Can Extend Clinical Analytics." InformationWeek. N.p., 12 Aug. 2014. Web. 19 Sept. 2014 http://www.informationweek.com/healthcare/mobile-and-wireless/wearable-tech-can-extend-clinical-analytics/a/d-id/1297924</ref>. <ref name="apple watch">Will Apple Watch revolutionize health care? Three reasons to be cautious. http://www.advisory.com/daily-briefing/blog/2014/09/will-apple-iwatch-revolutionize-health-care</ref>There also other wearables on the market such as BodyMedia Fit system that is FDA approved. These products can collect basic biometrics such as number of steps taken, hours slept, calories burned, etc., and when synced to a smartphone or computer, track your progress over time <ref name="BodyMedia FitBit Official Website">BodyMedia FitBit Official Website http://www.fitbit.com/story </ref>. Patients with chronic illnesses can wear these devices that can collect continuous data that can be automatically be updated to an EMR. This will allow clinicians to see more accurate trends of a patient's vitals that could not be achieved with regular appointment visits<ref name="Wearable extend data"></ref>. <br />
<br />
=== Architecture of Mobile EMRs ===<br />
<br />
Severence Hospital started developing mobile EMR applications in 2005. In 2010, a mobile solutions for healthcare professionals for IOS based iPhones. In 2012, this application was redesinged to be platform independent, encryption policy was added to ensure data security and provided integrated management of Legacy EMR and a mobile solution. The patient list was organized by themes and its main feature was EMR history retrieval. The new architecture design process had four steps: Server and its architecture, Screen layout and story board making, Screen UI design and development, Pilot test and step by step by step deployment.<br />
<br />
The Mobile architecture: consists of Mobile server and Mobile device.The server receives information from the EMR system matched with search parameters which is then converted into information to be displayed on specific mobile device.<br />
This mobiles solution was first pilot tested for two month and later deployed in four Severence Hospitals[69]<br />
<br />
Cloud Based EHRs: Cloud based EHRs are on the rise in todays health care world. Even though there is still uncertainty and resistance towards cloud services, many small physician practices are leaning towards the cloud. Some important considerations to note when moving towards a cloud based EHR are hardware, usability and cost of ownership. This type of EHR is easier to update than onsite EHRs. [http://www.ihealthbeat.org/insight/2013/physicians-divided-on-cloudbased-ehrs]<br />
<br />
In January 2015, due to a recent KLAS study, ZH Healthcare (ZH), a leading provider of open source Health IT solutions, announced the release of BlueEHS, the first Electronic Health Solution (EHS). BlueEHS will provide a “customizable on the cloud” design that allows users to enable or disable modules that may not fit the provider’s need. The basic system will be offered to providers at no cost.<ref name="BlueEHS">ZH Healthcare (ZH) Releases New Electronic Health Solution (EHS), Becomes Provider’s Answer to Health IT. http://www.prweb.com/releases/2015/01/prweb12444585.htm</ref><br />
<br />
=== drchrono ===<br />
<br />
With technology pushing us into a new era of healthcare, it appears that many hospitals and privately owned physician institutions are switching to EHRs. This has been a breakthrough from previous years, but the change is still happening. Now, programs such as drchrono take the EHR and make it accessible through a mobile device such as iPhone or iPad through a specific tailored app. The remarkable functionality of drchrono is that it provides benefits not only for physicians, but also for patients. <ref name="drchrono">drchrono https://www.drchrono.com/about_us/</ref><br />
<br />
==== Physician Benefits ====<br />
<br />
In present time, it seems as if physicians always give the five-minute consultation when evaluating a patient. They come in, introduce themselves, go over the patient's problem briefly, give a diagnosis and prescription if necessary, and then move on to the next patient. It can be concluded that time is a very key aspect of a physician's daily practice. Therefore, it is logical to hypothesize that a physician needs to find ways to cut time in any scenario so that he/she may spend more time with a patient. This is where the benefits of drchrono play a key role.<br />
<br />
The first benefit implemented by drchrono is the ability to have speech-to-text support. Essentially, a physician is able to tap on the screen and begin to speak; the program will then analyze the audio sample and turn it into text. <ref name="drchrono products">drchrono products https://www.drchrono.com/products/ehr/</ref><br />
With specific M*Modal technology implemented into the application, medical language is easily turned into accurate text. <ref name="mmodal">mmodal http://mmodal.com/products-and-services/speech/</ref> A functional tool like this eliminates the barrier between older physicians who struggle with using physical or electronic keyboards.<br />
<br />
Another benefit directly derived from drchrono is the ability of customizing templates on the system. <ref name="drchrono clinical forms">drchrono clinical forms https://www.drchrono.com/features/clinical-forms/</ref> Many traditional EHRs used in hospital settings are inundated with extra material which is irrelevant to many physicians. With template customization, a physician who specializes in neurology can specifically set forms that are only relevant to his practice. Other material such as cardiovascular, pulmonary, etc. can be removed completely from the application in order to have better user-interface functionality.<br />
<br />
==== Patient Benefits ====<br />
One of the most frustrating things for a physician can be when a patient either arrives late or completely misses a scheduled consultation. One of the main reasons this tends to happen is simply because the patient forgot. With the drchrono application, patients can also benefit from the software. The application has the capability of allowing a patient to receive automated patient reminders. <ref name="drchrono patient benefits">drchrono patient benefits https://www.drchrono.com/</ref><br />
<br />
When a patient arrives at the clinic, logging on to their personal drchrono account will speed up the visit. Once logged in, a patient is able to check-in and fill out any necessary forms online. These forms will then be stored directly on the patient’s account for future use. <ref name="drchrono onpatient ">drchrono onpatient https://www.drchrono.com/products/onpatient/</ref> Tools like this make a patient’s visit more friendly and provide a reason for greater patient satisfaction.<br />
<br />
== Health Information Exchange (HIE) ==<br />
<br />
With better information integration capability, it allows for healthcare institutions to facilitate better quality care, contain costs, and better manage risks. Thus, by having healthcare organizations that incorporate an EMR, it enables for both clinical and business advantages by in turn creating a clinical healthcare system that helps to unite crucial patient information with various departments. As a result, this helps to create a central clinical information repository and resource used throughout the integrated delivery network of the institution. This in the long run allows for the different information of patients to be coalesced together in a timelier manner, which can reduce errors in diagnosis. EMRs allow for interoperability such that multiple clinicians and facilities may use or add to a patient’s record, even at the same time.<br />
<br />
The advent of the [[HIE|Health Information Exchange (HIE)]] allows for sharing of patient information electronically within an organization, system, community, region or state. This helps in monitoring not just a patient's health but health in certain subsets of populations, whether for a certain diagnosis group or within a social demographic or a geographic region. Stratifying the data to look for trends over areas, ethnicities or over time has helped in development of software models which help in predicting the health of not only a patient but also patient populations over time.<br />
Metrics such as 30 day readmission are used commonly in healthcare to gauge the quality of care of a patient and is an example of where predictive modeling is being used. EMR has allowed for transparency, and the analysis of data has helped to establish trends and patterns. Big Data is another commonly used term in healthcare and refers to the availability of large amounts of data available from the collection of patient EMR records.<br />
<br />
[[HIE|Health information exchange (HIE)]] is the electronic transfer of healthcare information between various organizations. This has become an important topic because it improves the quality, safety and efficiency of healthcare. Electronic health records (EHR) helps to facilitate the electronic exchange between hospitals, clinics, and patients much more possible. According to the Department of Health and Human Services, 84% of hospitals that adopted EHR and participated in regional HIO exchanged information w/ providers outside organization. HIEs also assist with provider/patient interactions regarding chronic disease management. One example of this looks at Western New York (WNY) Beacon Community and the regional health information exchange (HIE) HealtheLink. The two organizations teamed up to help diabetic patients in upstate New York with disease management. The cost of diabetes management has risen from $174 billion in 2007 to $245 billion in 2012; that is a 41% increase over five years (American Diabetes Association, 2014). These figures address an increased in financial burden, use of health resources and lost productivity associated with diabetes (American Diabetes Association, 2014). In response to this rise in cost, WNY Beacon has shared strategies not only improving the health of diabetic patients, but cutting costs for such management as well. Their strategies cover three primary topics: 1) expanding research for better analytics, 2) improving real-time care coordination and communication and 3) patient education, telehealth and population management. <br />
<br />
Aside from the Kaiser HMO and the VA system, considered the nation's best examples of Health Information Exchange (HIE), there are two other such HIEs, Indiana Health Information Exchange (IHIE) and Rhode Island Quality Institute (riqi.orrg) worth mentioning. They're mentioned here to introduce the idea of federated data management (as against the traditional centralized data management approach) by keeping ownership of data at source (Physician Practices) and introducing data lockers to get access to data for Analytics & Reporting purposes, thus minimizing data aggregation, normalization and security expenses. (Source: [60] Excerpts from Interviews with John Kansky Interim President, CEO, IHIE, Laura Adams, CEO of Rhode Island Quality Institute, August 2014 by Georgia Tech's Mark Braunstein).<br />
<br />
Virtual Lifetime Electronic Record (VLER), a program initiated in April 2009 by President Obama designed for the VA and DoD to lead the efforts in creating VLER (Virtual Lifetime Electronic Record), which would “ultimately contain administrative and medical information from the day an individual enters military service throughout their military career and after they leave the military.” VLER avails the eHealth Exchange to share prescribed patient information via this protected network environment with participating private health care providers, with exception of ‘scanned’ patient information.[[http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf]]<br />
<br />
<br />
=== The Direct Project ===<br />
<br />
Standards of information exchange are beginning to take hold for purposes of summarizing a patient record or event or allowing a provider to query for records across a community. The Direct Project aims to utilize these standards as well to replace methods of information exchange such as fax, courier, postal mail, and patients themselves that continue to slow down and predominate the health care field for transferring lab results, x-ray results, reminders for Dr. visits, etc. [61]<br />
<br />
The project is sponsored by the Office of the National Coordinator for Health IT (ONC) but led by volunteers in the industry. The Direct Project offers a simple, non-proprietary solution for direct information exchange between two healthcare entities. [51]<br />
<br />
It is important to note here another emerging standard called Fast Healthcare Interoperability Resource (FHIR), also referred to as fire, that is expected to meet the standards of the market needs in the areas of Mobile HC apps, Medical devices and Custom workflows and also drive new efficiencies in terms of care coordination, cost of care optimization, patient engagement and behavior influence of both care delivery folks as well as patients. (source: Blog - interfaceware.com, 3/3/2013.)<br />
<br />
== Environmental ==<br />
<br />
Electronic Health Records have the potential to improve the environmental footprint left by the health care industry. <ref name="turley 2011">Turley, M., Porter, C., Garrido, T., Gerwig, K., Young, S., Radler, L., & Shaber, R. (2011). Use of electronic health records can improve the health care industry’s environmental footprint. Health affairs, 30(5), 938-946.</ref><br />
<br />
=== Decreased Paper Consumption ===<br />
<br />
Using EHRs can greatly reduce the need for paper in an office setting. Instead of throwing away and shredding old paper records or documents and destroying trees, digital documents can be erased without another tree being cut down to make another sheet of paper. <ref name="emr and hippa paper">Benefits of EMR or EHR Over Paper Charts http://www.emrandhipaa.com/benefits-of-emr-or-ehr-over-paper-charts/</ref> As an eco-friendly software application, it reduces need for reams of paper and the environmental costs associated with it. <ref name="healthy numbers">Electronic Medical Records and the Environment http://www.healthynumbers.co.za/index.php?page=electronic_medical_records_environment</ref><br />
<br />
=== Avoided Transportation ===<br />
<br />
EHRs also reduce the gasoline consumption by patients by avoiding non-urgent medical office visits and instead using it’s services to securely message requests for prescription refills, ask clinicians questions, and conduct other virtual activities. <ref name="turley 2011"></ref><br />
<br />
===Avoided Plastic Waste From X-Rays===<br />
<br />
X-ray film is composed of at least 57 percent plastic. EHRs ability to digitize and archive x-ray images avoids the waste of printing x-rays on plastic film. <ref name="turley 2011"></ref><br />
<br />
== Medical Education ==<br />
<br />
While clinical and operational benefits of EMRs are obvious, their effect on medical education and trainees are not well documented. The few studies that have analyzed such effects have shown that there are advantages inherent in EMRs that can be leveraged and disadvantages in the current EMRs to education that need to be addressed in the future [22]. Implementation of EMRs in academic environments can benefit education of trainees by:<br />
<br />
# Increased accessibility to relevant and up-to-date literature for diagnosis and management plans via clinical decision support (CDS) systems within the EMR<br />
# Training the students to follow accepted clinical guidelines (best practices) using CDS<br />
# Monitoring clinical experience of trainees more efficiently in real time to optimize workflow for trainees and training programs. Use of EMRs to track patient care milestones achieved by trainees will identify that can be then addressed more efficiently in a prospective manner.<br />
# EMRs have been used to help physicians improve the quality of their clinical skills. An example of this has been in Radiology. Radiologists do not routinely receive information on clinical outcomes of patients for whom they provide radio-diagnoses. Alkasab et.al created an automated outcome tracking system for radiologists which allows them to review clinical outcomes of the patients whose images they reported on. Such a system can allow radiologists to improve self-assessment, accuracy and relevance of their reporting, and study interventions in their processes to improve outcomes [47].<br />
<br />
The disadvantages of EMRs to education were noted by the following issues:<br />
<br />
# Problems with student access into the facilities systems such as obtaining log-ins and passwords<br />
# Concern that students will not learn skills of independently recognizing items that need to be documented, but rather the students would only choose from drop down boxes and pick lists.<br />
# Instructor's concern that EMRs allow portions or entire sections of notes to be copied and pasted, which in turn leads to ethical concerns with plagiarism and documenting procedures that were never performed.<br />
# Trainees overly attentive to patient’s EMR data versus gaining information from physical examination and patient interactions<br />
# Focus on engagement with computer terminal disrupts patient-physician relationship in exam room<br />
# Automation bias - too much trust in decision support systems without consideration of their limitations<br />
<br />
As EMR use becomes standard fare in medical practice, the benefits of using EMR need to be harnessed by adapting the training curriculum of medical students and graduate medical education trainees to incorporate EMR-related sub-competencies <ref name="tierney 2013">Medical Education in the Electronic Medical Record (EMR) Era: Benefits, Challenges, and Future DirectionsMichael J. Tierney, MD, Natalie M. Pageler, MD, Madelyn Kahana, MD, Julie L. Pantaleoni, MD, and Christopher A. Longhurst, MD, MS Acad Med. 2013 Jun;88(6):748-52. http://www.ncbi.nlm.nih.gov/pubmed/23619078</ref> <ref name="pageler 2013">Refocusing Medical Education in the EMR Era. Natalie M. Pageler; Charles P. Friedman; Christopher A. Longhurst. JAMA. 2013;310(21):2249-2250. http://jama.jamanetwork.com/article.aspx?articleid=1787416</ref><br />
<br />
=== Improving interpersonal and communication skills ===<br />
<br />
EMR can reduce time of getting information and trainees can spend more time on synthesizing and demonstrating clinical reasoning in real time.<br />
<br />
=== Enhancing professionalism ===<br />
<br />
Detailed data provided by EMR can help doctors or other medical workers to convince patients more easily.<br />
EMR documentation can enhance professionalism among medical personnel by increasing accountability on the part of the healthcare provider to offer quality healthcare to patients.<br />
<br />
=== Access to knowledge resource ===<br />
<br />
Today, clinicians can get access to medical literature on the internet while making clinical decisions or reviewing patient charts. EHRs can provide links in a patient record to internet resources like PubMed, NLM, and OVID to show clinicians the most up-to-dated information and knowledge in medicine.<br />
<br />
== Financial ==<br />
<br />
By consolidating information across the entire spectrum of clinical operations, from admission to treatment to labs and beyond, EMR allows for: <br />
<br />
# Increase in the pace of information flow including service delivery.<br />
# Coding/billing accuracy.<br />
# Better capture of charges. <br />
# Better documentation of patient encounters.<br />
# Reduction in overall administrative and maintenance costs of healthcare institutions.<br />
# Reduction in costs for the patient. <br />
# Reduction in transcription costs [http://jamia.bmj.com/content/18/2/169.full.pdf+html].<br />
# Decrease in malpractice insurance premiums.<br />
# Decrease in paper consumption has the potential to lead to yearly estimated savings of $1.3 billion in the U.S. <ref name="kumar 2010">Overcoming barriers to electronic medical record (EMR) implementation in the US healthcare system: A comparative study. Sameer Kumar, Krista Aldrich. http://jhi.sagepub.com/content/16/4/306.full.pdf+html</ref><br />
# Reduction in overtime expenses.<br />
<br />
The efficiency of increased information flow and documentation allow for measurable time and cost savings. The amount of time support staff save during patient encounters has been directly demonstrated in a clinical setting [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513660/pdf/261.pdf].<br />
Furthermore, the integration of EMR systems enables for a more consistent application of medical protocols, such as those that provide guidance on the use of specific or expensive drugs. As a result, the availability of information 24 hours a day, 7 days a week, helps to contribute significantly to reduced errors, better decision-making, improved outcomes, and lower malpractice risk. In a study done by Harvard researchers, 6.1% of physicians with electronic records had malpractice settlements, compared to 10.8% without electronic records <ref name="malpractice 2008">Electronic health records may lower malpractice settlements. Nov 2008. http://www.eurekalert.org/pub_releases/2008-11/hms-ehr112508.php</ref><br />
<br />
Another feature of EMR is the capability to eliminate paper-based informed consents. Paper consents get lost or misplaced very easily and this problem contributes $3.3 billion to the cost of health care in the U.S. due to resulting operating room delays for example. Electronic informed consents also help better reducing liability risk [57]. <br />
<br />
One financial benefit of improving care through the use of Health IT might be to lower malpractice insurance costs for providers. A number of firms that sell liability insurance for physicians are offering discounted premiums to practices that use EHRs.(Congress of the United States Congressional Budget Office. (2008). Evidence on the costs & benefits of health information technology (). Washington, DC: Government Printing Office.) P. 13<br />
<br />
Financial benefits include averted costs and increased revenues, which can be divided into three categories: payer-independent benefits, benefits under capitated reimbursement, and benefits under fee-for-service reimbursement [58].<br />
<br />
=== Meaningful Use === <br />
<br />
Certified EMRs significantly aid healthcare professionals and hospitals in achieving Meaningful Use measures by means including:<br />
* Pop up alerts to providers reminding them to ask the patient for smoking status, medical history, ect.<br />
* Allowing providers to proactively see how they are doing and compare themselves to their peers<br />
Several EMRs also dramatically increase the chance of hospitals and physicians collecting Meaningful Use money by providing reports to submit proof that those measures were met. When Meaningful Use measures are met and submitted, a Physician can earn up to $44,000 a year for 5 years and avoid paying penalties for not meeting the requirements <ref>CMS EHR Incentive Programs. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms</ref><br />
<br />
<br />
<br />
=== Quantitative Benefits === <br />
<br />
These are financial benefits that are clearly measurable and are attributable to the use of a particular technology. E.g. the use of EMR technology to submit claims has resulted in widely quantified cost savings for provider and payer organizations.<br />
<br />
In 2009, the Medical Group Management Association(MGMA) reported the results from surveying 1,324 primary care and specialty practice members. These results found that independent practices reported a median of $49,916 more revenue per full-time physician than paper-based practices. In addition, hospital-owned multi-specialty facilities reported a median of $42,042 more than their paper-based counterparts.[36]<br />
<br />
One of the most widely touted financial benefits for physician offices is elimination of transcription services, which can save several thousand dollars per physician, per year. A 2010 article published by the American Health Information Management Association urges practices to realistically gauge their probability of eliminating transcription altogether. Many practices instead opt to retain some transcription, or implement voice recognition software in its place, mitigating the effect of this factor on actual vs expected ROI (10). Voice recognition saves physicians time in their clinical practices by allowing them to dictate notes for transcription either by software or by a human transcriber. In this manner, physicians are able to document accurately in free-text, individual descriptions of clinical conditions, histories, physical exams and plans. Additionally, the traditional discrete text fields of SOAP can be filled out with a greater level of efficiency while maintaining, if not improving, noting quality. <ref name="Rhoades, Charles E">The more you use EMR, the more you benefit. http://www.aaos.org/news/aaosnow/feb09/managing6.asp</ref><br />
<br />
The net benefit from using an EHR for a 5 year period was $86,400 per provider. <ref name="wang 2003"></ref><br />
<br />
=== Reducing cost ===<br />
<br />
EMR can help hospitals or patients to reduce some redundant tests. For example, EMR could reduce the number of tests conducted at KCH by 7% according estimate by Julia Driessen’s report. A 1998 study at Brigham and Women's Hospital concluded that 8.6% of the tests sampled were redundant, and if those tests were not performed, charges would be reduced by $930,000 annually. (30) A review of studies looking at possible benefits of CPOE found significant evidence of reduced laboratory test ordering in multiples studies [38]. The use of EMRs improved the utilization of radiology tests, which also reduced costs for organizations in the study. <ref name="wang 2003"></ref><br />
<br />
Also, by SWOT analysis performed by Sameer Kumar. He said that nationally applied EMR can reduce paper to maintain medical records about 1.3 billion with a cumulative savings over 15 years of $19.9 billion.<br />
<br />
Kuperman et al. (2003) upon reviewing the benefits of CPOE said that a reduction in medication errors would increase hospital savings. They found two studies showing that half of all of medication errors were due to ordering of a drug for which the patient had an allergy and the other half were because of incorrect drug and incorrect dose. (11) During physician order entries standardized computer order sets can assist physicians to select disease-sensitive drug and patient-specific dosing. Computer applications can also send alerts about patient allergies, drug interactions and monitoring of drug levels.<br />
In addition to reducing medication errors, EMR can help hospital savings on total drug costs annually by 15% just by recommending alternative drugs in the EMR reminders.<ref name="wang 2003"></ref> <br />
<br />
Clinical support alerts and reminders can also assist with offering alternatives to expensive medications and updates on drug dosage recommendations. A clinical decision to utilize a generic drug substitution or decrease a drug dosage frequency from twice a day to once a day can offer additional savings to a healthcare institution, estimated at $16,400 annually per provider <ref name="wang 2003"></ref>Interventions to switch the twice-daily dosing of ceftriaxone to once-d<br />
*Provide users with real time knowledge<br />
*Reduce non-clinical time<br />
*Increase patient doctor time<br />
*Investment Motivationaily dosing at Brigham and Women's Hospital (BWH)resulted in $320,000 in annual cost savings (Kaushal at al, 2006).<br />
<br />
Over a 5-year period and determined by the overall size of the particular health system and scope of the EMR implementation, large hospitals can potentially save between $37M and $59M. <ref>Bell, B, Thornton, K. (2011). From promise to reality achieving the value of an EHR. Healthcare Financial Management, 65(2),51-56.</ref><br />
<br />
In 2012, at the Children’s Hospital in Boston, medical waste in general was reduced by 30% resulting in approximately $1.6 M savings per year [78].<br />
<br />
=== Investment Flexibility ===<br />
<br />
Another potential benefit from an EMR implementation is the increase in available operating budget. Reduce in staff expenses or lower drug and maintenance costs, for example, could significantly impact a hospital or clinic operating budget (Kaushal at al, 2006).<br />
<br />
The meaningful use of certified EHR technology is a core requirement for healthcare providers looking to qualify for the incentive payments. In July 2010, the CMS issued the final rules, setting criteria that providers need to meet, and the schedule to meet them, to qualify for the subsidies. (15)<br />
<br />
=== Management Risk Disposition ===<br />
<br />
The following tenets are the willingness to invest in experimental efforts.<br />
* Provide users with real time knowledge<br />
* Reduce non-clinical time<br />
* Increase patient doctor time<br />
* Investment Motivation<br />
To reduce cost, position for capitation/managed care, and gain market share.<br />
To enable providers to take advantage of financial incentives, the Health Information Technology for Economic and Clinical Health Act (HITECH) lists related criteria related to "Meaningful Use of EHR technology". [8] In addition, the Centers for Medicare & Medicaid Services, along with the Office of the National Coordinator for Health IT requires that an EHR technology are constituted of the following five pillars as health outcome policy priorities (67):<br />
* Improving quality, safety, efficiency, and reducing health disparities.<br />
* Engaging patients and families in their health.<br />
* Improving care coordination.<br />
* Improving population and public health.<br />
* Ensuring adequate privacy and security protection for personal health information.<br />
<br />
===Inflow===<br />
<br />
Total benefits per year are known as the annual inflow (or cash-in). If Anytown Hospital can save $2,500 from chart pull and $2,000 from transportation in the year after implementation, inflow will be $4,500 in the first year. An EHR will bring more benefits to the healthcare organization as the staff becomes familiar with the system and eliminates the initial productivity loss in the following years.<br />
<br />
The sum of the annual outflow and inflow is the net cash flow per year.<br />
<br />
For example, Anytown Hospital will not realize a financial benefit in the initial year of implementation. The net cash flow in the initial year is -$12,500 ($0 inflow + -$12,500 outflow).<br />
<ref name= "wang 2010">Wang, Tiankai; Biedermann, Sue. "Running the Numbers on an EHR: Applying Cost-Benefit Analysis in EHR Adoption." Journal of AHIMA 81, no.8 (August 2010): 32-36. http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_047866.hcsp?dDocName=bok1_047866</ref><br />
<br />
==Drug Surveillance==<br />
EMRs make it possible to monitor and correlate the side effects of drugs and treatment outcomes. For example, Kaiser Permanente had noted a correlation between Vioxx and increased risk of heart attack before the FDA announced their findings. <ref>http://www.practicefusion.com/health-informatics-practical-guide/ </ref><br />
<br />
EHRs also improve drug surveillance as there is a vast amount of literature published on features that are offered by an EHR to catch adverse drug reactions and adverse drug events. Features can include alert notification systems linked to physician portable devices to alert the patient of their health status. Adverse event reporting system have also been under-utilized and the reports the FDA receives greatly under-represent the true experience with medications in clinical practice. Institutions (e.g. hospitals) have used the AERS system more systematically, but now that EHRs are more widely in place in smaller independent community practices, the potential to build-in adverse event reporting becomes something feasible. <ref name="Drug Safety Is Aided by EHR Use">http://www.practicefusion.com/blog/drug-safety-is-aided-by-ehr-use/</ref>With these strides drug surveillance is increased and increase patient safety when drugs are prescribed and administered in the clinical setting.<br />
<br />
== Personal Health Records ==<br />
<br />
[[PHR|Personal Health Records]] - A personal health record, or PHR, is an electronic application used by patients to maintain and manage their own health information (or that of others for whom they are authorized to do so). Patients can use a PHR to keep track of information from doctor visits, record other health-related information, and link to health-related resources. PHRs can increase patient participation in their own care. They can also help families become more engaged in the health care of family members.<br />
<br />
With standalone PHRs, patients fill in the information from their own records and memories, and the information is stored on patients' computers or the Internet. Tethered or connected PHRs are linked to a specific health care organization's EHR system or to a health plan's information system. The patient accesses the information through a secure portal. With tethered/connected PHRs, patients can log on to their own records and see, for example, the trend of their lab results over the last year. That kind of information can motivate patients to take medications and keep up with lifestyle changes that have improved their health. Products such as FitBit allow consumers to record changes and sync the data to a smartphone to track changes. <ref name="Wearable extend data"></ref><ref name="BodyMedia FitBit Official Website"></ref><br />
<br />
Ideally, patients will be able to link their PHRs with their doctors' EHRs, creating their own health care "hubs." Most doctors are not ready for that kind of change quite yet, but it is a worthy goal. A study has show that allowing patients to see their medical record, called OpenNotes, showed that patients 77 to 87 percent of patients felt they were more in control of their health when they could see their medical records. <ref name="OpenNotes">Delbanco T, Walker J, Bell SK, Darer JD, Elmore JG, Farag N, et al. Inviting Patients to Read Their Doctors' Notes: A Quasi-experimental Study and a Look Ahead. Ann Intern Med. 2012;157:461-470. <br />
http://annals.org/article.aspx?articleid=1363511</ref><br />
<br />
Although expectations for EMRs in the areas of data exchange typically span Provider to Provider data exchange for better care coordination at transitions of care, it is important to point out here emergence of another standard called, "Human API" which enables users (patients) to share their personal health records (PHR) with the EMR systems bi-directionally, regardless of how they're recorded, processed or stored. <br />
<br />
Over a decade, VA has emphasized patient-centered innovations including MyHealtheVet (www.myhealth.va.gov), an e-portal suite of tools for Veterans and Caregivers that provides a secure web-based Personal Health Record (PHR), patient access to personal health information from the VA Electronic Health Record, the ability to download and share personal health information using the VA Blue Button, online services such as e-prescription refills, trusted health education resources, and Secure Messaging between patients and their VA health care teams.<br />
A VA patient with an upgraded account has following benefits <br />
• Engage in Secure Messaging with your participating VA health care team members <br />
• Request prescription refills <br />
• Access to key portions of your Department of Defense (DOD) Military Service Information , VA Wellness Reminders ,VA Appointments, VA Lab Results, VA Allergies and Adverse Reactions and other key portions of their VA electronic record ,VA Comprehensive Care Document (CCD) and involve in future features as they become available<br />
[[http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf]]<br />
<br />
<br />
<br />
=== Patient Participation ===<br />
<br />
Providers and patients who share access to electronic health information can collaborate in informed decision making. Patient participation is especially important in managing and treating chronic conditions such as asthma, diabetes, and obesity.<br />
<br />
Electronic health records (EHRs) can help providers:<br />
<br />
* Ensure high-quality care. With EHRs, providers can give patients full and accurate information about all of their medical evaluations. Providers can also offer follow-up information after an office visit or a hospital stay, such as self-care instructions, reminders for other follow-up care, and links to web resources.<br />
* Create an avenue for communication with their patients. With EHRs, providers can manage appointment schedules electronically and exchange e-mail with their patients. Quick and easy communication between patients and providers may help providers identify symptoms earlier. And it can position providers to be more proactive by reaching out to patients. <ref name="Patient Participation"></ref> <ref name="about ehrs">About: The Benefits of Electronic Health Records (EHRs) http://patients.about.com/od/electronicpatientrecords/a/EMRbenefits.htm</ref><br />
<br />
As patient participation increases with EHR usage. The participants are able to increase their knowledge and become more proactive with their medical record. This will intern improve the service of care when a patient is admitted to a facility with an installed EHR and PHR integration. "Patients indicated they were interested in EHRs as a means of gaining more one-to-one physician access: 55% said they would like to use EHRs to ask doctors questions, 56% wanted to use them for refill requests, and 36% said it would be a valuable way to request referrals."<ref name= "patient survey">Weinstein, D. P''atient survey indicates promise of EHR'' (2015)http://www.mmm-online.com/patient-survey-indicates-promise-of-ehr/article/391473/</ref> EHRs empower the patient increasing patient participation and improved overall health of the patient.<br />
<br />
Snapshot of Improved Health Care Quality and Convenience for Patients<br />
<br />
*Reduced need to fill out the same forms at each office visit<br />
*Reliable point-of-care information and reminders notifying providers of important health interventions<br />
*Convenience of e-prescriptions electronically sent to pharmacy<br />
*Patient portals with online interaction for providers<br />
*Electronic referrals allowing easier access to follow-up care with specialists<br />
http://www.healthit.gov/providers-professionals/health-care-quality-convenience<br />
<br />
== Patient Safety Outcomes ==<br />
<br />
EMRs increase patient safety and improve patient quality care by:<br />
<br />
# Insuring practice of better evidence-based medicine<br />
# Allowing flawless health information exchange between health care providers<br />
# Decreasing cost due to changes in drug frequency, dose or route administration <ref name="wang 2003">Wang, S. J., Middleton, B., A. Prosser, L., G. Bardon, C., D. Spurr, C., J. Carchidi, P. A cost-benefit analysis of electronic medical records in primary care. http://www.ncbi.nlm.nih.gov/pubmed/12714130 </ref><br />
# Improving communication and engagement with patients and their health care providers<br />
# Increasing patient medication compliance leading to improved overall health outcomes<br />
# Promoting higher rates of reporting incidents and near incidents, ensuring greater numbers of completed reports and resulting in a more diverse pool of healthcare staff who report. <ref> Elliott, P., Martin, D. & Neville, D. (2014). Electronic Clinical Safety Reporting System: A Benefits Evaluation. JMIR MEDICAL INFORMATICS; 2(1):e12. http://www.ncbi.nlm.nih.gov/pubmed/25600569 </ref> <br />
<br />
EMRs insure the practice of better evidence-based medicine by developing evidence-based clinical and Good Clinical Practice guideline reminders that are prompted to health care providers during patient encounters. <br />
<br />
The exchange of health information is greatly improved with EMRs because it can be delivered instantly and securely. Since the health care provider is entering the data into an EMR, medical errors are reduced from illegible handwriting. <br />
<br />
The impact of computerized provider order entry (CPOE) on medication errors with the use of a basic CPOE system in an ambulatory setting was associated with a significant reduction in medication errors of most types and severity levels. <ref name="devine 2010"></ref><br />
<br />
EMRs help health care providers by alerting them to potential adverse drug events when entering new prescribed medications in the computerized provider entry forms (CPOE) for patients with allergies, incompatible medication interactions, and delivering medications to verified patients. CPOE systems address these problems, ensure patient safety and save associated costs and injuries. CPOE features that help to achieve this are patient-specific dosage suggestions, reminder to monitor drug levels, reminders to choose an appropriate drugs, checking for drug allergy and drug-drug interactions, standardized order sets, increased legibility, automated communication to ancillary departments and ease of access to patient data.[17] <br />
<br />
EMRs allow pharmacists access to patient histories, past medication therapies, and current lab values. Clinical pharmacists have the responsibility of medication reconciliation, medication dose adjustments due to changes in liver/kidney function, transition of IV to oral therapies (in order to discharge the patient) and establishment of outpatient therapies. These areas of focus have shown to dramatically decrease length of hospital stay, increase beneficial patient outcomes, and decrease overall healthcare cost.<br />
<br />
Use of traditional peer-reviewed approaches as a model for developing standardizations could serve as models for a foundation for new CPOE tools and as a benchmark for existing CPOE tools. For practically all major disease states, there are publicly accessible treatment guidelines that have been established by experts, undergone peer review, and are updated on a periodic basis. Using these review standards for development of protocols for drug-drug interactions, etc. improved accuracy and up-to-date information would be available and utilized to assist in protecting patients. [54]<br />
<br />
Participants in the U.S. 2011 Physician Workflow study of office-based physicians responded that use of the EHR alerted them to potential medication errors (65%) and critical lab values (75%). This type of notification is a clinical decision support tool that many hospitals and providers use in their EHR. Clinical Decision Support is not limited to just alerts but can also inform a physician of immunizations needed for a certain age group or clinical guidelines. <ref name="CDS">Clinical Decision Support more than just alerts tipsheet. http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/ClinicalDecisionSupport_Tipsheet-.pdf </ref><br />
<br />
In other words, EMRs allow for Decision Support Systems (DSS) to be utilized. DSS detect critical values or errors in care and notify the clinician immediately. DSS may provide knowledge-based information and/or reminders to support or aid in finding a solution to a clinical problem (7). <ref name="devine 2010">The impact of computerized provider order entry on medication errors in a multispecialty group practice. http://www.ncbi.nlm.nih.gov/pubmed/20064806/</ref>.<br />
<br />
=== Improving patient care ===<br />
<br />
EMR can optimize workflow for trainees and training programs by reviewing reports of trainees’ clinical activity and notes. We can more easily and efficiency identify deficiencies of trainees and training program compared to paper-based system. Thus, EMR can provide a safer environment for patient. <br />
According to a study performed by Julia Driessen and ects. They said about 10.5% reduction in length of stay of inpatients in USA because EMR provides a better mechanism for analyzing and reviewing patient outcomes. Its flexible output formats could be customized to meet the needs of patients, payers, referral sources, and other parties who use health information.<br />
<br />
Healthcare quality is plagued by overuse, underuse, and misuse of Healthcare services. Reducing these plagues will invariably improve the quality of care. Kuperman and Gibson indicate that EMR such as Computer Physician Order Entry have been found to:<br />
i)reduce overuse of health care services<br />
ii)reduce underuse of health care services<br />
iii)reduce misuse of health care services [17] <br />
Furthermore, CPOE has been continuously shown to reduce the overuse of diagnostic procedures and antibiotics.<ref name="Kuperman CPOE"></ref><br />
<br />
When it comes to patient care, the more information that a doctor has at his or her fingertips, the better the results will be for everyone involved. If a notation made from a previous visit regarding a patient's drug allergies or condition cannot be read or goes missing from their paper medical file, a physician could be in the dark and make a grave decision with regards to treatment. With electronic medical records, a patient's entire healthcare history can be viewed with ease in order to help doctors make the best judgment calls.<br />
<br />
In the 2014 HIMSS study, "EMR Effectiveness: The Positive Benefit Electronic Medical Record Adoption has on Mortality Rates", it was noted that a relationship exists between the level of EMR adoption as measured by the EMRAM score, and a hospital’s performance as measured by predicted, actual rates of mortality and associated z-scores. This study implications include that hospitals with advanced EMR capabilities are able to capture more information about the patient. This improved data capture involving the patient’s co-morbidities and other risks allow clinicians to better manage patients seen in the hospital, resulting in more positive predicted clinical outcomes. [63]<br />
<br />
=== Improved quality and convenience of patient care ===<br />
<br />
With the implementation of EMRs, patients' health information is available in one place and can be accessed when and where it is needed. Complete access to health information is essential for safe and effective care of patients which can lead to better patient outcomes and high quality care. In addition, it serves in achieving a higher form of personalized medicine and continuity of care, which are really important in the quality of patient care. Health care providers with busy practices and patients with busy lives can conveniently manage their health care transactions with EMRs. Besides, the 'clinical information distribution framework' (paper processes) is antiquated and does not support the modern practice of medicine as it migrates increasingly to evidence-based practice. Four signs that these outmoded processes need to change:<br />
* Paper based systems are not viable - patient care should be driven by point of care information available to clinicians when and where they need it. This is typically not available in paper based processes but is in the EHR.<br />
* Human memory is unreliable: so much research is being published that clinicians do not have time to read it all and the unaided mind is hard-pressed to recall all the detailed knowledge that current studies can impart. Computer based alerts, reminders and similar tools are needed! <br />
* Capturing clinical data is a new business imperative - clinically based information needs to be utilized for better responsiveness to unaffordable high costs of care and for use in disease management; EHRs are better adapted at these tasks than are paper based processes.<br />
* Rising consumer expectations - increasing numbers of consumers have high expectations of IT in various facets of their lives and this includes healthcare where they are increasingly responsible for managing their care [39]. Paper charts controlled by the provider do not meet consumer expectations for control of their information and convenient access.<br />
<br />
=== Enhanced Decision Support === <br />
<br />
Clinical decision support (CDS) provides clinicians, staff, patients or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and better health care. CDS encompasses a variety of tools to enhance decision-making in the clinical workflow. These tools include:<br />
<br />
*Computerized alerts and reminders to care providers and patients based on patient specific data elements, including diagnosis, medication, and gender/age information as well as lab test results<br />
*Clinical guidelines/established best practices for managing patients with specific disease states<br />
*Condition-specific order sets<br />
*Focused patient data reports and summaries<br />
*Documentation templates<br />
*Diagnostic support<br />
<br />
<ref name="EnhancedDecisionSupport"> Enhanced Decision Support http://www.healthit.gov/providers-professionals/frequently-asked-questions/455#id124</ref><br />
<br />
=== Improved Care Coordination === <br />
<br />
The Need for Better Improved Care Coordination<br />
As medical practices and technologies have advanced, the delivery of sophisticated, high-quality medical care has come to require teams of health care providers—primary care physicians, specialists, nurses, technicians, and other clinicians.<br />
<br />
Each member of the team tends to have specific, limited interactions with the patient and, depending on the team member's area of expertise, a somewhat different view of the patient. In effect, the health care team's view of the patient can become fragmented into disconnected facts and clusters of symptoms. Health care providers need less fragmented views of patients.<br />
<br />
<ref name="ImprovedCareCoordination"> Improved Care Coordination http://www.healthit.gov/providers-professionals/improved-care-coordination</ref><br />
<br />
=== Medical Practice Efficiencies & Cost Savings ===<br />
<br />
Many health care providers have found that electronic health records (EHRs) help improve medical practice management by increasing practice efficiencies and cost savings.<br />
<br />
A national survey of doctors1 who are ready for meaningful use offers important evidence:<br />
<br />
*79% of providers report that with an EHR, their practice functions more efficiently<br />
*82% report that sending prescriptions electronically (e-prescribing) saves time<br />
*68% of providers see their EHR as an asset with recruiting physicians<br />
*75% receive lab results faster<br />
*70% report enhances in data confidentiality<br />
<br />
Based on the size of a health system and the scope of their implementation, benefits for large hospitals can range from $37M to $59M over a five-year period in addition to incentive payments.<br />
<br />
<ref name="Efficiencies"> Medical Practice Efficiencies and Cost Savings http://www.healthit.gov/providers-professionals/medical-practice-efficiencies-cost-savings</ref><br />
<br />
== Research ==<br />
<br />
Researchers can use EHRs to retrieve up-to-date data from various sources around the country to advance their studies. EHRs can compute a report to show researchers certain trends in the population or common side effects of medications. <ref name="Enormous Benefits"></ref><br />
<br />
The EMR allows researchers to efficiently search patient medical information by medical condition, date of treatment, physician name and test category. Researchers can quickly focus their attention on medical information that will support their research efforts, develop databases to study patient outcomes, and cross-check complex medical information.<br />
<br />
Researchers can use the EMR to analyze large amounts of patient data more efficiently, quickening the use of new research findings to improve patient care [5].<br />
<br />
* EMR's increase the quality of medical data by recording coded rather than textual data. This, alongside the application of UMLS coding, will facilitate processes like data mining, data warehousing, ''in silico'' clinical trials, predictive modeling and any other mainstream research which requires data analysis. Also, by paving the way for automating data acquisition from other systems (like lab machines, imaging devices, barcode/RFID readers, bio-data sensors) error resulting from duplicate data entry procedures, manual file search and patient identification will decrease. <br />
* While EMRs have shown an increase in the quality of medical data, research is still conflicting on the cost benefits and efficiency gains of EHRs. A study of HIMSS Analytics Database data from California medical-surgical units showed a decrease in cost efficiency for Stage 1 and Stage 2 EMR implementation, and no efficiency correlation for State 3 EMR implementations (http://www.ncbi.nlm.nih.gov/pubmed/20812460). <br />
*EMRs contain large amounts of structured and free-text data which can be de-identified and used for research without disclosing patient information. Pantazos, K., Lauesen, S., Lippert, S. 2011. [http://www.ncbi.nlm.nih.gov.ezproxyhost.library.tmc.edu/pubmed/21893869 De-identifying an EHR Database - Anonymity, Correctness and Readability of the Medical Record]. Stud Health Technol Inform. 2011, 169, 862-866. <br />
* In addition to structured vocabulary searches of EMR databases, free-text search algorithms within and EMR can generate additional information critical to the identification of epidemics. Often, critical information is omitted by the clinical team when only structured vocabulary is analyzed. <ref name="delisle 2010">DeLisle S, South B, Anthony JA, Kalp E, Gundlapalli A, Curriero FC, Glass GE, Samore M, Perl TM. Combining Free Text and Structured Electronic Medical Record Entries to Detect Acute Respiratory Infections. PLoS One''. 2010 Oct 14, 5(10):e13377. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954790</ref><br />
<br />
=== Bioinformatics ===<br />
<br />
* Genome-wide association studies have become commonplace for the identification of risk and causative genetic variants. The power of these studies is highly dependent on accurate phenotypic classification of both control and test populations. Application of natural language processing algorithms to free-text clinical narrative, in addition to structured data, can significantly benefit these studies. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2995686/?tool=pmcentrez Kullo IJ, Fan J, Pathak J, Savova GK, Ali Z, Chute CG. Leveraging informatics for genetic studies: use of the electronic medical record to enable a genome-wide association study of peripheral arterial disease. ''J Am Med Inform Assoc.'' 2010 September, 17(5): 568-574.]<br />
<br />
=== Translational Research Informatics (TRI) ===<br />
<br />
Translational Research Informatics (TRI) is a sub-domain of biomedical informatics concerned with the application of informatics theory and methods to translational research (Translational research is the science is the project of bringing new knowledge from “bench to bedside.”) TRI mediates between and interoperates with the following: [http://en.wikipedia.org/wiki/Translational_research_informatics]<br />
#Health Information Technology/ Electronic Medical Record systems<br />
#Clinical Trial Management System /Clinical Research Informatics<br />
#Statistical analysis and Data mining<br />
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=== Enhance public health surveillance ===<br />
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In addition to improving patient hospital outcomes, electronic health records can also improve public and population health outcomes as well. EHRs can accomplish this by improving reporting capabilities, ease the exchange of information across organizations, and improve communication between healthcare providers and public health officials. According to The Advisory Board Company, there are three key elements for successful population health management (The Advisory Board Company, 2014):<br />
# Information-powered clinical decision making (e.g. robust patient data sets and integrated data networks)<br />
# Primary care-led clinical workforce (e.g. PCP care team leaders and mobilization of community workforces)<br />
# Patient engagement and community integration (e.g. map services to population need and overcoming non-clinical barriers to maximize health outcomes).<br />
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EHRs in conjunction with organizational improvement practices can help to address all three of these key elements. Incorporating electronic health records into public health practice not only improves public health surveillance, but also expands the communication between health care providers and public health professionals. In addition, organizations will be better able to track and prevent disease before an epidemic occurs. Through current government legislation, EHRs will assist public health research in achieving meaningful use(68). Many programs have already been implemented to begin this integration. <br />
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An example of successful EMR surveillance is displayed in a 2012 article of the American Journal of Preventive Medicine, where the study focused on a model EMR-based public health surveillance platform, Electronic Medical Record Support for Public Health (ESP). It was noted to enable clinicians to provide high-quality surveillance data on notifiable diseases, influenza-like illness, and diabetes to public health agencies. This surveillance data can help health departments acquire rich and timely data on broader populations and wider sets of health indicators than is routinely possible with current surveillance systems. [64]<br />
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In 2013, New York City Public Health Department is set to launch a project to aggregate EHR data into a surveillance tool to improve public health in the city [24]. This project will monitor the prevalence of conditions such as obesity, hypertension, smoking rates, and flu vaccinations.<br />
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=== Tracking Epidemics ===<br />
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Electronic Medical records have the potential to help patients get better care and hospitals leverage best practices on a large scale. But the ability to quickly and efficiently compile and analyze vast amounts of patient data is also of critical importance when it comes to spotting patterns in a health emergency or in fast spreading outbreaks, such as a flu pandemic or salmonella. The [[Centers for Disease Control and Prevention (CDC)|U.S. Centers for Disease Control and Prevention (CDC)]] and GE Healthcare are working on just that — with the official start of a project to evaluate putting EMR data to use in public health alerts. <ref name="emr cdc outbreak">http://www.gereports.com/using-emrs-to-help-the-cdc-track-outbreaks-faster/ </ref><br />
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=== Improve Public Health Outcomes ===<br />
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EHRs can be very useful in managing health on groups of patients. Providers who have electronic health information about the entire population of patients, can look more meaningfully at the needs of patients who suffer from a specific condition and determine who are eligible for specific preventive measures and or currently taking specific medications This EHR capability helps providers identify and work with patients to manage specific risk factors or combinations of risk factors to improve patient outcomes. <br />
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<ref name="Improve Public Health Outcomes">http://www.healthit.gov/providers-professionals/improved-diagnostics-patient-outcomes</ref><br />
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EHRs are beneficial to the Public Health and preventive sectors of healthcare. As they are able to perform syndomic surveillance data submission, immunization registries and electronic laboratory reporting.<ref name="Improve Public Health and population Outcomes">http://www.healthit.gov/providers-professionals/faqs/how-can-electronic-health-records-improve-public-and-population-health-</ref>Public health officials can monitor, manage and prevent disease easier and faster without headaches. Patients will be more compliant with immunizations as reminders will be used when a patient has missed an immunization or is in need of one. Patient follow up percentage rates will also increase which is very important in the public health and preventive sector of care as follow ups are hard to maintain through paper based record keeping. EHRs will aid an organization in need of maintaining compliance with state and national regulation of meaningful use standards.<br />
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=== Better Evidence Based Practices ===<br />
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The patient data stored electronically increases the availability of data, which may in turn lead to more quantitative analyses to identify evidence-based best practices more easily. With availability of the aggregated electronic clinic data, more public health researchers are using it for the research purposes to benefit the society. The availability of clinical data is limited, but as providers continue to implement EHRs, this pool of data will grow. By combining aggregated clinical data with other sources, such as over-the-counter medication purchases and school absenteeism rates, public health organizations and researchers will be able to better monitor disease outbreaks and improve surveillance of potential biological threats. [44]<br />
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EHR's use of clinical decision support systems could also decrease the time elapsed between acceptance of evidence-based research and actual practice of evidence-based medicine. A report from the Institute of Medicine, ''To Err is Human'', states that 15 years was the time frame that elapsed between acceptance of the evidence and practice. This time frame could be drastically reduced with electronic health resources. [52]<br />
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=== Pharmacogenetic Research ===<br />
Patients' responses to drug treatment differ due to their genetic backgrounds. Such information is important to provide patient with optimized drug treatment. <br />
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EHR can improve the quality and efficiency of pharmacogenetic research works by providing the link between pharmacoepidemiology and pharmacogenetics. EHR also supporting the pharmacogenetic research with access to health record database. [http://www.ncbi.nlm.nih.gov/pubmed/24581153]<br />
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=== Clinical Research ===<br />
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'''How EMR’s Could Accelerate Clinical Trials (Front-end)''' [69]<br />
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#Study setup<br />
##Query EMR database to establish number of potential study candidates.<br />
##Incorporate study manual or special instructions into EMR “clinical content” for study encounters.<br />
#Study enrollment<br />
##An EMR can enable an organization to set up alerts so that a provider and/or study coordinator would receive an alert when a new patient is seen that qualifies for the study and prompt the provider to enroll that patient.<ref>EHR. http://www.sibley.org/epic/</ref><br />
#Implement study screening parameters into patient registration and scheduling. <br />
##Query EHR database to contact/recruit potential candidates and notify the patient’s providers of potential study eligibility.<br />
#Study execution<br />
##Incorporate study specific data capture as part of routine clinical care/documentation workflows. <br />
##Auto-populate study data elements into care report forms from other parts of the EMR database.<br />
##Embed study specific data requirement as special tabs/documentation templates using structured data entry.<br />
##Implement rules/alerts to ensure compliance with study data collection requirements.<br />
##Create range checks and structured documentation checks to ensure valid data entry.<br />
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'''How EMR’s Could Accelerate Clinical Trials (Back-end)''' [69]<br />
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# Submission & Reporting<br />
##Provide data extraction formats that support data exchange standards<br />
##Document and report adverse events<br />
#Evidence-based review<br />
##Assess congruence of new findings and existing evidence with current practice and outcomes (incorporate into meta-analyses)<br />
##Submit findings to electronic trial banks using published standards.<br />
#Evidence-based clinical care<br />
##Implement study findings as clinical documentation, order sets, point of care rules/alerts<br />
##Monitor changes in care and outcomes in response to evidence base clinical decision support.<br />
##Provide easy access to detailed clinical care data for motivating new clinical trial hypotheses.<br />
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=== The n-of-1 Clinical Trial ===<br />
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N-of-1 or single subject clinical trials consider an individual patient as the sole unit of observation in a study investigating the efficacy or side-effect profiles of different interventions. The ultimate goal of an n-of-1 trial is to determine the optimal or best intervention for an individual patient using objective data-driven criteria. The availability of electronically accessible data provides opportunities for learning from experience in clinical care; this can also referred to as evidence farming or using evidence macrosystem. Evidence farming can be characterized as a “bottom up” paradigm for clinical practices to incorporate practice data systematically as source of evidence, or and articulated form of clinical experience. <ref name="n-of-1">Lillie, Elizabeth O., et al. "The n-of-1 clinical trial: the ultimate strategy for individualizing medicine?" http://www.ncbi.nlm.nih.gov/pubmed/21695041 </ref><br />
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=== Clinical Data Research Networks ===<br />
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Since electronic medical records systems allow for the capture and storage of records in a discrete data format many secondary uses of the data is made possible. By utilizing health information exchange communities can share and aggregate their data for research to improve population health. The compiled data can be used to improve patient engagement, improve regulatory oversight, share the results of studies across health systems, and increase the use of research to improve outcomes at member institutions. In New York City this very concept has been proven successful through a project funded by the Patient-Centered Outcomes Research Institute (PCORI), and with the future adoption and utilization of HIEs more populations will be able to take advantage of these benefits. <ref name="CDRN">Kaushal, R., Hripcsak, G., Ascheim, DD., et al. (2014, March 25). Changing the research landscape: the New York City Clinical Data Research Network. J Am Med Inform Assoc. doi:10.1136/amiajnl-2014-002764</ref><br />
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=== Improved Reporting Capabilities ===<br />
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An EMR has the capability of providing a more robust reporting environment with integrated clinical and administrative data, standardized clinical assessments and calculation of outcome measures[http://ptjournal.apta.org/content/86/3/434.full.pdf+html].<br />
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Facing more and more complicated situation in clinical areas, doctors and other people need more up-to date data and knowledge to help them make decision. Thus, they use clinical decision support system (CDSS) to help them getting up-to-date information and selecting more appropriate remedy. EMR and facilitate this process by providing just-in-time data. In the end, practitioners can apply evidence-based medicine by EMR and CDSS.<br />
For example, surveys performed in resources-constrained areas like Kenya about HIV show that EMR based CDSS by many ways like Increasing Guideline adherence, reducing data errors, decreasing patient visit time, and ects. Researchers from King Saud University in Saudi Arabia also found the usefulness of incorporating EHR techniques in their clinical decision support systems. The team created a four-module knowledge-based system that incorporated algorithmic guidelines and EHR data mining (66). Guidelines used in the proposed system are the International Classification of Disease (IDC), SNOMED CT, LOINIC, and the Unified Medical Language System (UMLS). The sophisticated system is projected to not only increase workflow, but also serve as a system for various entities to use as a consulting tool.<br />
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=== More effective preventive care ===<br />
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EMR systems have the potential to enhance preventive care through integration of an automated alert system that reminds physicians and/or patients when preventive care procedures such as vaccinations, screening tests, or wellness/follow up visits are recommended [18].<br />
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Kuperman et al. (2003) conducted a review of studies discussing the benefits of CPOE. A randomized control trial of 6731 patients and 200 physicians in a General Medicine teaching institution where the computer application sent a reminder that the patient was eligible for preventive care yielded an increase number of orders for the flu and pneumococcal vaccine as well as aspirin for coronary artery disease.<br />
Another 4 week study conducted in medical and surgical units showed increased number of orders for H2 blockers and prophylactic Heparin when the EHR prompted physicians during CPOE. [11]<br />
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The use of EMRs has been shown to reduce ED visits and hospitalizations among diabetic patients in an integrated delivery network [37].<br />
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=== More effective urgent care ===<br />
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EMR systems have the potential to facilitate and enhance urgent care when the emergency room or urgent care physician has access to the patient’s EMR file as would occur when a patient seeks urgent care within the healthcare system where the patient receives routine care or when the patient’s EMR file is available in a ilocal, regional, national EMR system [19]. In such a scenario, the emergency room or urgent care physician could consult the patient’s EMR file to view the patient’s current medications, diagnoses, recent surgeries or procedures, and medical history, allowing the emergency physician to be better informed about the patient’s status and urgent needs [19]. In terms of specific chronic illnesses such as heart failure, an EHR may have the potential to be a valuable adjunct in the care of heart failure patients [28]. Information security and privacy concerns will have to be addressed, however, in order for shared EMRs to gain widespread public acceptance [19]<br />
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=== Improved Coordination of Care ===<br />
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The use of electronic medical records has allowed multiple healthcare providers across different specialties to access the patient's complete medical record. This more complete picture into the patient's medical history allows better collaborative medical treatment.<br />
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=== Increased patient participation in their care === <br />
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EMRs can give full and accurate information to patients about all of their medical evaluations and follow up information such as an office visit or a hospital stay, self-care instructions, reminders and other helpful information. Patients are able to obtain medication refill reminders, insert lab values (i.e. glucose levels or warfarin levels) for review by a clinician, and request refills. The pharmacist at a distant location is able to review this information and make the appropriate changes in therapy. This electronic process allows patients to be more involved in their medication therapies and this involvement may increase compliance and overall outcomes.<br />
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EMRs also provide patient online scheduling and patient preparatory instructions for specific interventions such as blood and other laboratory testing (Kaushal at al, 2006). Effective communication with patients can enhance informed decision making and high quality care.<br />
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The use of Personal Health Records (PHRs) is allowing patients to be more educated and involved with their care. PHRs are often integrated directly with the EMR so that information flows seamlessly between the two systems. Patients can easily monitor their own health and learn more about how their condition is cared for [55].<br />
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=== Improved accuracy of diagnoses and health outcomes === <br />
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EMRs provide reliable access to a patient's comprehensive health information which in turn helps diagnose patients' problems efficiently. EMRs can improve the ability to diagnose diseases, improve patient safety, support better patient outcomes and reduce or even prevent medical errors. Of the latter problem, medication errors are the most common cause of clinically induced injuries and CPOE has been shown to reduce these errors, by as much as 55% according to one study. Evidence shows that when combined with Clinical Decision Support, CPOE is particularly effective in reducing medication errors and also helps improve laboratory and imaging test utilization, among other benefits [42]. One study showed a 48% decrease in the likelihood of medication errors in an inpatient hospital setting. <ref name="Radley"></ref> Although it is unclear that CPOE can reduce the harm for patients from medication, the increasing amounts of data acquired such as particular medication for certain diseases and outcomes, may play a vital role in the efforts for improving public health.<br />
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===Preventing Adverse Events===<br />
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Physician surveys have attributed EMRs to alerting to allergic drug reactions and drug interactions that might have been missed. In addition, they reported more timely reporting of critical laboratory values.[60] <br />
A systematic review of the effectiveness of safety alerts in EMRs showed a reduction in medication errors in patients with renal insufficiency, pregnant women, elderly patients, drug-drug interactions and ADEs related to hyperkalemia.[61]<br />
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This is an important benefit, since medication related adverse events, will not only cause patients harm but will increase the cost <ref name="bates 1997">Bates DW, Spell N, Cullen DJ, Burdick E, Laird N, Petersen LA, et al. The costs of adverse drug events in hospitalized patients. Adverse Drug Events Prevention Study Group. JAMA 1997 Jan 22;277(4):307-11. http://www.ncbi.nlm.nih.gov/pubmed/9002493</ref> and the use CPOE will eventually help to reduce the cost of medication related adverse events [3]. Although, some study suggested that is less likely to occur during the early implantation phase[4].EHRs act as a multilevel feedback system to report adverse events. Reporting can be facilitated at multiple levels such as physicians, nursing staff, patients , thus capturing adverse event related data more quickly and efficiently<br />
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Although many studies have shown CPOE can reduce the frequency of medication errors, there is no distinct association between CPOE and reduced harm for patients from medication. <ref name="Radley"> Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. (2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association : Jamia, 20, 3, 470-6 </ref> For instance, there are certain antibiotics that work well with certain disease pathways, and selecting the wrong one may have null effects that may cause further harm for the patient. Developing EHR systems will provide additional data on the usage of certain medications with diseases and outcomes, which will expand our knowledge on selecting efficient medication for improving quality in patient care.<br />
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=== Improve patient safety at the point of pharmacy order entry ===<br />
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EHRs with alerts at the point of pharmacy order entry can help reduce medication errors and prevent potential clinical hazards. <br />
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EHR alerts has been beneficialin reduce medication errors in elder patient, pregenant patient and patient with compromised renal or liver functions. EHR alerts can help reduce drug-drug interactions and allergic and adverse events. [http://www.ncbi.nlm.nih.gov/pubmed/23816138]<br />
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===Structure to Clinical Environment===<br />
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Clinical care outcomes may be improved by promoting the use of electronic checklists in clinical settings. A study from John Hopkins demonstrates a 0% bloodstream infection rate from intravenous lines after checklists were adopted as procedure. In addition, this lowered infection rate and also reduced medical costs that may have otherwise been associated with bloodstream infections. Another study showed reduced errors in positioning by surgeons for laparoscopic procedures. <br />
Major goals of checklists: <br />
*To educate<br />
*To serve as action reminders <br />
*To promote teamwork for best practices<br />
*To capture clinical data for reporting purposes <br />
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Electronic checklists are able to accommodate for any supplementary photos, images and documents with consistent formatting and can be found in a single and readily accessible location. <ref name="EHRI 2013">Improving Patient Care with Structured Clinical Care. http://www.youtube.com/watch?v=PMv7kKoGir8#t=419</ref><br />
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=== Improved Medication Prescription ===<br />
EMR systems allow for improved methods of prescription for patients and result in several benefits for patients, physicians and pharmacies alike. EMR provides a network by which prescriptions may be prescribed bypassing the traditional paper route, but instead utilizing facsimile or emailing prescription with digital signature. The electronic method allows for a record of any medications sent, while maintaining legibility. With this implementation, an accurate and up to date record is always on file, there is an increased ease of prescribing refills along with greater convenience to patients who may otherwise be handling paper prescriptions. <br />
<ref name="Rhoades, Charles E">The more you use EMR, the more you benefit. http://www.aaos.org/news/aaosnow/feb09/managing6.asp</ref><br />
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=== Qualitative Benefits === <br />
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The EMR will improve patient care by reducing medication error and wait time. Clinical processes will be standardized and there will be less variation in clinical care provided at one place from another. Records would be easily shared among the providers, which will reduce the process time and over all improve disease management. It will also improve the communication among the care providers and the administrative staff and administrative activities. The EMR can help the provider deliver the best quality of care because the EMR contains the complete patient‘s health history. In a crisis, the EMR provides immediate access to a patient's medical history, allergies, and medications. The retrieved information enables providers to make decisions sooner which otherwise they would have to wait for, like information from test results or other resources. This feature is very critical when a patient has a serious or chronic medical condition, such as diabetes. Also, the EMR information can be shared with patients and their family, so they can more fully take part in decisions about their health care. In addition, using decision support tools in EMRs help the provider to make efficient and effective decisions about patient care through clinical alerts and reminders.<br />
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These are directly and indirectly attributed to the technology but are more difficult to quantify. E.g. implementation of a clinical nursing system may lead to increased case in recruiting efforts, better nurse retention, more rapid access to clinical nursing data, and decreased charting time. Quantification and measurement – of benefits usually is difficult because of the task complexity of the nursing function.<br />
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Pinsonneault and associates found that data from before and after EHR integration, from a matched set of 15,626 patients with electronic integration and 15, 626 patients in a control group, who visited over 95 physicians in a large North American health network, show that patients treated through the electronically integrated system had better quality of care in the follow-up period and a higher continuity of care, compared to the control group [29].<br />
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Another overview of an attempt to quantify quality outcomes and cost reporting measures benefits of EHRs was published by the Healthcare Information and Management Systems Society in 2010 and can be found here: http://www.himss.org/content/files/QPRWhitePaper.pdf<br />
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=== Improve Legal and Regulatory Compliance ===<br />
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EMRs can facilitate and improve legal and regulatory compliance in terms of increased security of data and enhanced patient confidentiality through controlled and auditable provider access<br />
<ref name="benefits & drawbacks"></ref>. In a study by Bhattacherjee et al, Florida hospitals with a greater adoption of health information technology had higher operational performance, as measured by outcomes of Joint Commission on Accreditation of Healthcare Organizations (JCAHO) site visits <ref name="benefits & drawbacks"></ref><br />
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=== Up To Date Information About Patient at Point of Care ===<br />
EMR can provide health information that is up-to-date with clinical information <ref name="health news">The Era of Electronic Medical Records. http://health.usnews.com/health-news/most-connected-hospitals/articles/2011/07/18/most-connected-hospitals </ref>. With an EMR, lab or radiology results can be retrieved much more rapidly. Test results and medical history are recorded directly into the EMR <ref name="practical guide"></ref>.<br />
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=== Increased Accuracy in Medication Administration ===<br />
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EMAR can help increase accuracy in Medication Administration. There are about 700,000 reasons annually—the estimated U.S. number of adverse drug events—for the increasing use of the electronic medication administration record (EMAR) to support inpatient care. With paper and other non-digital records prone to being incomplete, misread, or even misplaced, nurses need a way to help ensure that medications are properly administered and tracked. With the help of EMAR functionality and bar coding/electronic verification during medication administration along with real-time alerts, there is very little room for errors thus accuracy in Medication Administration most like happen at all times.<br />
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<ref name="Electronic Mediation Administration">Electronic Mediation Administration. http://www.fdbhealth.com/solutions/emar/ </ref><br />
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== Personalizing Healthcare ==<br />
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===After Visit summaries (AVS)===<br />
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Stage 3 meaningful use recommends that patients or their authorized representative receive a clinical summary after each visit that is not just an abstract from the medical records, Most EHRs enable clinicians to supply patients with such information in the form of an After Visit Summary (AVS) that is generated from data entered into their medical records. The AVS should have relevant clinical information and instructions pertinent to the office visit. It should also be provided in a language other than English, when needed, within 3 business days of the clinic visit, and should contain more than 50% of the office visit clinical summary. Provision of the AVS is important, as physicians usually overestimate patient understanding of the treatment plan. Therefore, the AVS has the potential to improve patient engagement in their care and contribute to more personalized healthcare and share medical decisions.<br />
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===Improved Documentation of Advanced Care Planning=== <br />
EMR can be utilized to screen patients in an outpatient setting and prompt the physician to have a discussion about Advanced Directives. A study conducted as a QI improvement project showed that EMR-based reminders on counseling were effective in improving documentation rates of Advanced Directives.[59]<br />
=== Targeted cancer therapy ===<br />
EHR with clinical decision support help process the genomic data in the context of individual patient and provide dosing recommendation in a timely manner. <br />
EHR when intergrated into work flow can help realize personalized cancer treatment at the point of care. [www.ncbi.nlm.nih.gov/pubmed/21568680]<br />
=== Enhanced Patient Access ===<br />
Some EHR systems provide functionality e.g. MyChart [10] for patients to access portions of their medical record, view test results, renew prescriptions, schedule appointments etc. These convenience features enable patients to engage in and take ownership of their own health care.<br />
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[http://my.clevelandclinic.org/online-services/mychart.aspx]<br />
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===Integrated Imaging===<br />
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With an EHR imaging can be integrated into the patient's chart electronically allowing for quick access to multiple imaging studies in high definition native formats rather than having to view them from film or on a printout. Having the studies in the EHR allows the provider to pull up the imaging with the patient quickly and easily. This improves patient communication and understanding.<ref name="iimaging">Berdy, Gregg J. "EHR brings tangible benefits: how it's possible to operate an ophthalmology practice electronically and efficiently." Ophthalmology Times 1 Oct. 2013: 48. Health Reference Center Academic. Web. 12 Sept. 2014. Accessed at: http://go.galegroup.com/ps/i.do?id=GALE%7CA350575449&v=2.1&u=txshracd2509&it=r&p=HRCA&sw=w&asid=4392d00f96857d4f275dd1ab337a1958</ref> On top of improved efficiency and communication from having the right information at the right time almost instantly, integrating imaging in EHRs can reduce costs as well. By no longer needed to store and archive imaging there are no more expenses for labels, jackets, or storage. It also reduces the workload of the staff since filing and retrieval is no longer necessary. <ref name="imagingbenefits">http://srssoft.com/srs-pacs</ref><br />
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==Telehealth==<br />
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Integrating EMRs with telehealth can improve the scope of telehealth and boost its benefits. Some benefits are:<br />
#It can increase the access of healthcare to remote, underserved and rural areas<br />
#It can address the shortage of healthcare providers. Primary care physicians and specialist consultants can serve patients remotely <br />
#It can ensure continuity of care without increasing number of hospital visits.<br />
For example, Texas prison system successfully combined a statewide EMR system with Telemedicine system of UTMB, which resulted in improved healthcare delivery for the inmates as well as huge savings for the state. [http://www.healthcareitnews.com/news/emr-telemedicine-saves-texas-1b?single-page=true]<br />
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Telehealth has become very popular due to the rural patients that can start receiving specialty services at their local communities. Some of the services rural hospitals can provide are trauma, stroke and intensive care. The adoption of Telehealth also supports clinical education programs. It allows easy communication between rural clinicians and specialists. Continuing education will also be easily accessed by rural healthcare providers. [http://www.setrc.us/index.php/what-is-telehealth/benefits-of-telehealth-telemedicine/]<br />
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In one paper Telehealthcare showed to improve blood glucose checking by individuals with diabetes and resulted in the study participants to have tighter glycemic control, this may result in more widespread adoption of such technology for diabetes management. <ref> Chen, L., Chuang, L.M., Chang, C.H., Wang, C.S., Wang, I.C., Chung, Y., Peng, H.Y., Chen, H.C., Hsu, Y.L., Lin, Y.S., Chen, H.J., Chang, T.C., Jiang, Y.D., Lee, H.C., Tan, C.T., Chang, H.L. & Lai, F. (2013). Evaluating Self-Management Behaviors of Diabetic Patients in a Telehealthcare Program: Longitudinal Study Over 18 Months. Journal of Medical Internet Research; 15(12):e266. http://www.jmir.org/2013/12/e266/ </ref><br />
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Special Care Access Network - Extension for Community Healthcare Outcomes (SCAN-ECHO):Through VA’s SCAN-ECHO initiative, Veterans and their primary care team can videoconference to seek expertise advice from specialists within 100-500 miles away. In 2013, SCAN ECHO spread to 46 rural sites of care with more than 100 participating rural primary care physicians, nurse practitioners, and physician assistants.[[http://www.va.gov/healthbenefits/resources/publications/IB10185_Health_Care_Overview_2014_Eng_V6_web.pdf]]<br />
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===Increased practice efficiencies, cost savings, and reimbursement===<br />
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EMRs help improve medical practice management by increasing practice efficiencies and cost savings. A practice can be made more efficient by using integrated EMR systems that can be used for scheduling, automated coding, and managing claims which save time as well. As one example, a clinic or physician practice can expect to increase revenue and decrease costs by converting the encounter form to digital format to reduce billing errors and revenue loss. Prompts for fields that need to be completed will reduce errors by an average of 78% according to one study [40]. Communication is enhanced among clinicians, labs and health plans as information can be accessed from anywhere. EMRs save money by reducing redundancies in medical care, by eliminating costly tasks of creating paper charts and labor intensive management of paper charts. Very simply, the EHR eliminates paper chart pulls and staffing expenses can be reduced as a result. One study estimated that an average of $5 per pull would be saved considering the time and cost of medical records staff to retrieve and then re-file the paper chart. The clinic studied expected it would reduce paper chart pulls by approximately 600 annually and transcription costs would be reduced by 28% [41]. <br />
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There is significant evidence to show that while initial costs remain an issue, switching from paper records to EHR systems will ultimately reduce overall health care expenses. Documenting electronically is much less time consuming than documenting on paper allowing physicians more time with their patients and the ability to see more patients. <ref name="see more patients">5 simple ways to realize ROI from your EHR.http://www.healthcareitnews.com/news/5-simple-ways-realize-roi-your-ehr/ </ref> Historically, it has been difficult to identify and achieve a solid, measurable Return on Investment (ROI) following Electronic Health Records (EHR) or other clinical system implementation initiatives. The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 has motivated system implementations, and the associated incentive dollars have offered a simple measure of ROI on the revenue side of the ledger, but this represents only one aspect of the substantial benefits clinical systems can yield. A proper optimization program, with broader consideration for the projects comprising it, can bring a truly positive ROI to healthcare organizations over a 10-15 year period if properly considered and executed. (Cumberland Consulting Group, 2013) Research indicates that Medicare and private payers could save tens of billions of dollars every year. To incentivize EMR adoption, the federal government has established a plan to provide $44.7 billion during 2010-2019 to financially assist health care providers in the EMR implementation process [4]. However according to Himmelstein, Wright & Woolhandler, as currently implemented, the use of Electronic Medical Records could moderately advance metrics related to quality measures, it does however not reduce the cost of administration of ‘overall’ costs. “Hospitals on the ‘Most Wired’ list performed no better than others on quality, costs, or administrative costs” (Himmelstein, Wright & Woolhandler, 2009). Forecasts of potential improvements in efficiency and cost-savings from implementation of computerized health care and the use of Electronic Medical Records seem premature at the time the authors published their data in 2009 [12]. According to DRCRHONO, physicians qualify to get $24,000 or more as part of the economic stimulus incentive offered by the HITECH act if they adopt a certified EMR. Incentives are given to providers who qualify. The stimulus includes $24,000 in Medicare Incentives or $63,750 in Medicaid Incentives. The government is putting in $19.2 billion dollars to help move all doctors off paper records onto electronic systems [62].<br />
<br />
EMR implementations could affect physician and health system reimbursement in a number of ways. Some have argued that increased clinical documentation as a result of using an EMR will lead to increased billing and therefore reimbursement. Having an electronic health record can mean less time with filing claims or searching for documentation. If a physician works in many different locations accessing a patients electronic record from a different location is very easy. <ref name="see more patients"></ref> An increase in emergency department billing among Medicare patients has been attributed to more complete documentation that allows for higher levels of billing [43]. However, given the pay-for-service model present in many facets of the American healthcare system, some of the cost savings possibly generated by the introduction of an EMR – such as eliminating unnecessary and duplicated tests and ineffective procedures – could lead to decreased reimbursement for the physicians and health systems.<br />
<br />
According to a survey performed by the National Center for Health Statistics, in collaboration with the Office of the National Coordinator for HIT, it was found that 82% of providers report time savings when sending prescriptions electronically and that 79% of providers see increased efficiency when using an electronic health record. <ref name="Jamoom">Jamoom, E., Patel, V., King, J., & Furukawa, M. (2012, August). National perceptions of ehr adoption: Barriers, impacts, and federal policies. National conference on health statistics.</ref><br />
<br />
=== EMRs Help Manage Transactions ===<br />
EMRs help better manage the “large number of transactions and handoffs” which can include: billing, physicians’ orders, prescriptions, nurses’ orders insurance information, and more. Having this information all in one place makes it easier for any staff member – from administrators/front office to pharmacists to physical therapists – to gain access to the patient’s records and read and notes that may apply to them. [6]<br />
<br />
=== Physician Recruitment === <br />
<br />
68% of physicians surveyed by the National Center for Health Statistics report that the implementation and use of electronic health records is seen as an asset when recruiting physicians to their practice.<ref name="Jamoom"></ref><br />
<br />
=== Physician Satisfaction ===<br />
An association has been shown to exist between EMR use and physician satisfaction with their current practice[76], as well as with their career satisfaction [77].<br />
<br />
=== Patient Handoff ===<br />
<br />
Patients can be safely handed off from one caregiver to the other. Especially CPOE reduces errors due to bad handwriting, verbal miscommunication etc.<br />
Implementing standardized, electronic patient hand off communication tools is known to have a positive effect on provider satisfaction and potentially patient safety. <ref name="Dyches, 2004">Implementation of a Standardized, Electronic Patient Hand Off Communication Tool in a Level III NICU. Source: OJNI Volume 18, Number 2 June 1, 2014</ref> Also, integrating sign off notes into EHR was found to improve physician workflow and improve physician satisfaction. <ref name="Bernstein 2010">Bernstein, Jonathan A.; Imler, Daniel L.; Sharek, Paul; Longhurst, Christopher A. Improved Physician Work Flow After Integrating Sign-out Notes into the Electronic Medical Record Source: Joint Commission Journal on Quality and Patient Safety, Volume 36, Number 2, February 2010, pp. 72-78(7) </ref><br />
<br />
== Patient portals ==<br />
<br />
Electronic health records can improve the relationship between healthcare providers and their patients. EHR systems make it easier for patients to access their medical records as opposed to the time consuming and expensive way of copying stacks of paper health records. Patients appreciated the ability to review their patient files which allowed them to be more comfortable and knowledgeable about their own health [25].<br />
<br />
With the increase in use of patient portals, more patients and physicians are communicating via secure online messaging. Patients can request appointments, refills, review lab results, pay bills or ask general questions about their health via online portals. Online appointment scheduling is one of the most desired features of the patient portal followed by reviewing test results. In fact, Kaiser Permanente experienced a jump from 9% to 27% in patient registration once they added the feature to review test results [72]. <br />
<br />
Patients are more likely to ask questions via the portal because it offers private and direct communication with the physician. This enables the patient to feel comfortable to ask difficult -- and sometimes embarrassing -- questions, whereas the patient may refrain if he or she has to go through a nurse first. These candid questions offer better insight into the patient’s concerns, allowing the provider to be more responsive to the patient’s individual needs.<ref name="patient portal"> J.Morrow How a patient portal can benefit your practice.http://www.medicalpracticeinsider.com/best-practices/how-patient-portal-can-benefit-your-practice </ref> <br />
<br />
Engagement of patients with their care is a benefit of these portals and the education they receive due to this engagement is also profound [55].<br />
<br />
But first we must look at changing the behavior of both the physician and patient. Patients have always relied on their physicians as having all their healthcare information. Patients need to be educated on the importance of their involvement in their own healthcare. Physicians need to be shown how this will improve their quality of care to the care and what it will mean to their workflow. <ref name= "patient engagement">Patient engagement means attitude adjustments on both sides. http://www.healthcareitnews.com/news/patient-engagement-means-attitude-adjustments-both-sides </ref><br />
<br />
==Patient Education Through PHRs==<br />
PHRs and patient portals can provide patients with vetted, high-quality information specific to their disease, condition, or health. Patient education, improved health literacy, and more patient engagement are seen as key factors in improving healthcare outcomes.<ref>http://www.healthit.gov/providers-professionals/faqs/what-are-advantages-electronic-health-records</ref><br />
<br />
== Healthcare quality ==<br />
<br />
[[CDS|Clinical Decision Support (CDS)] can be used as an additional tool for performing potentially more accurate diagnoses in challenging situations, thus improving the quality of provided care. It has been shown to increase healthcare quality and patient safety, improve adherence to guidelines for prevention and treatment, avoid medication errors and reduce cost of care.<br />
<br />
Monitors attached to the patient in a hospital bed emit a plethora of real-time physiological data, i.e. EKG signals, blood-oxygen saturation, etc. A CDSS driven by computer algorithms capable of pattern recognition by interpreting the data, ideally in real-time, will aid the physician in providing prompt, better quality care.<br />
<br />
=== Improved patient safety ===<br />
<br />
CDSS affect patient safety by substantially reducing medication error rates, reducing risk of overdose or medication abuse, decreasing the occurrence of adverse drug reactions, and increasing adequate follow-up of critical test results such as abnormal biopsies, radiological studies, and laboratory tests Further, these systems utilize a variety of tools to enhance decision-making in clinical workflow, including computerized alerting systems, reminders, advice, critiques, and suggestions which can notify physicians about problems occurring asynchronously (clinical guidelines, condition-specific order sets, focused patient data report, summaries, etc.).<br />
<br />
Furthermore, the system can reduce unnecessary prescription of antibiotics. There has been an increased prevalence of antibiotic resistant bacteria due to the widespread abuse of broad spectrum antibiotics. A study reported 73% of adults received antibiotic therapy from their primary care physicians when in reality only 5-17% of the cases warranted antibiotics.<ref name="Hoffman Cure"></ref>. CDSS can help prevent the unnecessary use of antibiotics in addition to providing support regarding prescription medication. <ref name="Hoffman Cure"></ref><br />
<br />
=== Reduce Diagnostic Errors ===<br />
Diagnostic errors are defined as missed, delayed, or wrong diagnosis can lead to missed opportunity in patient care and increased cost [6].Diagnostic error has received comparatively less attention, despite the fact that landmark patient safety studies have consistently found that diagnostic error is common. In the Harvard Medical Practice Study, diagnostic error accounted for 17% of preventable errors in hospitalized patients, and a systematic review of autopsy studies covering four decades found that approximately 9% of patients experienced a major diagnostic error that went undetected while the patient was alive. Taken together, these studies imply that thousands of hospitalized patients die every year due to diagnostic errors.<ref name=”Dignostic errors”>AHRQ Daignostic errors”http://psnet.ahrq.gov/primer.aspx?primerID=12 </ref>.The widespread adoption of EHRs and other technology will hopefully reduce diagnostic errors. CDS have the potential to improve the diagnostic process[7] The news source cited the use of one clinical decision support tool called UpToDate that has been featured in many studies for its ability to help reduce errors. One study conducted by researchers from Harvard University found that using UpToDate over the course of three years shortened the average length of hospital stay and lowered mortality rates. While this study was conducted at a hospital, smaller practices can benefit from technology that reduces diagnostic errors, as well.<ref name=”Dignostic errors”>EHRS and other technology can reduce diagnostic errors http://www.exscribe.com/orthopedic-e-news/ehremr/ehrs-and-other-technology-can-reduce-diagnostic-errors</ref>.Moreover, systematic reviews found that CDS can improve health care professional performance [8]. Therefore, there is increase evidence that CDS can be helpful in many ways. It is clear that CDSS will have significant effect on improving patient safety strategies [9] <br />
<br />
===Reduced Cost ===<br />
<br />
EHRs can reduce the cost associated with "defensive medicine." By using CDS support and integrated reference materials if available, physicians can reduce cost by determining if a treatment or procedure is truly needed.<ref name="Hoffman Cure">Hoffman, S. & Podgurski, A. Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems.http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1122426</ref> <br />
<br />
Incorporating decision support within a CPOE not only assists a physician in practicing evidence-based medicine, it has also been demonstrated to reduce cost. Specifically, renal dosing guidance, specific drug guidance and adverse drug prevention have contributed to a net operating budget savings of $9.5 million at Brigham and Women's Hospital [21]. The average savings computed from the study indicated a 6-month savings of $3,450 per clinician. This is just one example of a study result measuring the impact of a specific CDSS in a specific EHR system in a singular clinic setting.Another example is use of antibiotic utilization cost. Many hospitals utilize antimicrobial management teams(AMTs) To improve patient care.However most function with minimal computer support. A randomized control trial was done to evaluate the effectiveness and costeffectiveness of computerized clinical decision support sysyem for the management of antimicrobial utilization. Antimicrobial utilization was managed by an existing AMT using the system in the intervention arm and without the system in the control arm.Result of the study suggested that Hospital antimicrobial expenditures were $285,812 in the intervention arm and $370,006 in the control arm, for a savings of $84,194 (23%), or $37.64 per patient.Thus, Use of the system facilitated the management of antimicrobial utilization by allowing the AMT to intervene on more patients receiving inadequate antimicrobial therapy and to achieve substantial time and cost savings for the hospital.<ref name=”Jessina C.McGregogor”> McGregor JC, Weekes E, Forrest GN, et al. Impact of a Computerized Clinical Decision Support System on Reducing Inappropriate Antimicrobial Use: A Randomized Controlled Trial. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513678/</ref><br />
<br />
CDSS can also reduce healthcare costs through the presence of alerts regarding the compliance with prescription of formulary medications.<ref name="Kuperman CPOE"> Kuperman, G. J., & Gibson, R. F. (2003). Computer Physician Order Entry: Benefits, Costs and Issues. Annals of Internal Medicine, 139, 31-39. Retrieved from http://annals.org/article.aspx?articleid=716518</ref> The process of drug substitution has been reported to be time-intensive and prone to inaccuracies . CDSS linked to pharmacy and insurance formularies can result in error free substitutions resulting in improved patient outcomes through the prevention of ADEs. <ref name="Pruszydlo develop">Pruszydlo, M. G., Walk-Fritz, S. U., Hoppe-Tichy, T., Kaltschmidt, J., & Haefeli, W. E. (2012). Development and evaluation of a computerised clinical decision support system for switching drugs at the interface between primary and tertiary care. BMC Med Inform Decis Mak, 12, 137. doi: 10.1186/1472-6947-12-137</ref><br />
<br />
<br />
===Improve efficiency and patient throughput===<br />
<br />
The Institute of Medicine estimates that $17-29 billion is spent annually on unnecessary or inaccurate patient care due to misdiagnosis. If clinicians can rapidly determine the correct dose, calculation or diagnosis, they can order relevant tests and make appropriate referrals, saving time and eliminating unnecessary costs for the patients and the ED. Of course, CDS is most effective when it is built into the clinician’s workflow, which minimizes interruptions and dangerous distractions. It is also important for CDS to be incorporated into providers’ workflow in such a way that minimizes alert fatigue.<ref name=”Robert Hitchcock”> Top 5 Benefits of Clinical Decision Support in the ED http://www.govhealthit.com/blog/top-5-benefits-clinical-decision-support-ed</ref>.<br />
<br />
===Standardization of Practice===<br />
<br />
Although publication of evidence-based medicine abounds, it has been noted that physicians do not practice according to proven guidelines.<ref name="Morris develop"> Morris, A. H. (2000). Developing and implementing computerized protocols for standardization of clinical decisions. Retrieved from http://www.sciencedirect.com/science/article/pii/S1532046407001049</ref> The reasons are numerous. One of them is that busy physicians do not have the time to read publications that have increased exponentially. <ref name="Sackett need"> Sackett, D. L., & Rosenberg, W. M. (1995). The need for evidence-based medicine. J R Soc Med, 88(11), 620-624. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1295384/?tool=pmcentrez</ref> Another is the innate human limitation in the capacity to integrate information during decision-making.<ref name="Morris develop"></ref> This has led to a decline in patient care standards.<ref name="Sackett need"></ref> <br />
CDDS can increase compliance with evidence-based practice by presenting the needed information to the clinician at the point of care.<ref name="Morris develop"></ref> And while there is resistance to its use from physicians who view CDSS as an out of the box practice that is not tailored to their clinical workflow, it has been noted that incorporating factors such as patient-specific information, consideration of comorbid conditions, and organized and explicit presentation, might result in increased CDSS utilization. <ref name="Sittig Grand"> Sittig, D. F., Wright, A., Osheroff, J. A., Middleton, B., Teich, J. M., Ash, J. S., . . . Bates, D. W. (2008). Grand challenges in clinical decision support. J Biomed Inform, 41(2), 387-392. doi: 10.1016/j.jbi.2007.09.003. Retrieved from http://www.sciencedirect.com/science/article/pii/S1532046407001049</ref><br />
<br />
=== Universal Protocol ===<br />
CDSS ensures that caregivers follow universal protocols for patient diagnosis and treatment. This ensures the same standard of care everywhere.<br />
<br />
== National and international effects ==<br />
<br />
=== Growth, Job creation, and enhancement in the Commercial Clinical IT sector ===<br />
<br />
The commercial marketplace for clinical IT products has evolved dramatically<br />
in recent years through corporate mergers, acquisitions, and other challenges to fledgling startup companies. Cerner Corporation and Eclipsys Corporation, two vendors of clinical IT solutions, have acquired the greatest share of the market. Other major participants include Epic Systems Corporation (Madison, WI), IDX (Burlington, VT), McKesson (San Francisco, CA), Siemens Medical Solutions (Erlangen, Germany), and Meditech (Westwood, MA).2,3 Industry analysts estimate that only 5% of the health care IT market has been penetrated, and this estimate has led to optimistic growth forecasts for vendors of clinically focused IT products as the market continues to mature.<br />
<br />
=== Adapt to governmental regulatory changes and requirements ===<br />
<br />
HIPAA and other legislative bodies often require specific requirements. Compiling information from thousands of documents could be needed to complete the government’s requirements, a feat that would be inefficiently labor and time intensive if done with paper records. Digital patient records helps administration and upper management to meet requirements and regulatory changes to satisfy legislative demands. With digital records, auditors can quickly see if physicians and hospital systems are government compliant and can easily point out if they are not, allowing the non-compliant party to correct their inadequacy. <ref name="msdc benefits of emr">Benefits of EMR. Advanced Point-of-Care Clinical Information Solutions and Services. http://www.msdc.com/EMR_Benefits.htm</ref><br />
<br />
<br />
== Barriers to EMR Implementation ==<br />
<br />
=== System Selection ===<br />
<br />
Based on the application the type of system selected will vary based on current research, size of practice, institution, academic affiliation, vendors and their ability to demonstrate compliance with current research “by identifying funded and published research(Kannry Mukani& Myers , 2006)” and ultimately the assessment and analysis of the total cost of ownership.<br />
<br />
According to Kannry Mukani& Myers in their 2006 article Using an Evidence-based Approach for System Selection at a Large Academic Medical Center: Lessons Learned in Selecting an Ambulatory EMR at Mount Sinai Hospital . The authors note the technology requirements of educational institutions vary greatly from the needs of the private sector. Although both the private sector and academia have concerns with accurate documentation, patient safety and patient care, educational institutions focus on “education, training and research, (Kannry Mukani& Myers, 2006). The need of residents and compliance with regulatory requirements is significant and cannot be minimized. [13] According to Ajami and Chadegani, despite of the potential benefits of electronic health records, implement of this project facing with barriers and restriction, that the most of these limitations are cost constraints, technical limitations, standardization limits, attitudinal constraints–behavior of individuals and organizational constraints.[71]<br />
The most frequent adoption factors common to all user groups were design and technical concerns, ease of use, interoperability, privacy and security, costs, productivity, familiarity and ability with EHR, motivation to use EHR, patient and health professional interaction, and lack of time and workload. Each user group also identified factors specific to their professional and individual priorities [30].<br />
<br />
* In order for an EMR to be truly successful, proper and timely training must be administered to all who will interact with the system. <br />
* Conflicting research findings on the cost and efficiency benefits of EMR implementations will make it difficult, if not impossible, for administration staff to be confident in choosing an EMR for their facility. Until there is adequate research on multitudes of EMR systems that shows causal relationships between facility characteristics and the related EMR components there will not be a sufficient method of EMR selection and implantation. <br />
* If it is true that implementations of EMRs cause a decrease in efficiency and an increase in quality of medical care then further research must take both of these repercussions into account and determine if there is an overall net benefit of EMR implementation. <br />
*The use of EMR and the afforded efficiencies may not provide immediate cost savings to some office-based physicians. These physicians may not be able to reduce their office expenses sufficiently to offset the revenue decreases they may see as a result of increasing efficiency. For example, a physician who is paid, as many laboratory or treatment centers are, per service rendered would see a direct decrease in revenue were they to reduce the number of duplicated diagnostic tests.[http://www.cbo.gov/sites/default/files/cbofiles/ftpdocs/91xx/doc9168/05-20-healthit.pdf ]<br />
* The reported barriers to adoption and MU of EHRs were not associated with serving a predominately Medicaid-insured population, and were consistent with barriers that health care professionals in other studies had previously reported. In fact, barriers to adopting and using EHRs that could be associated with Medicaid providers were issues specific to provider types who were eligible for the Medicaid EHR Incentive Program but not the Medicare EHR Incentive Program, specifically, dentists and pediatricians. However, all findings were useful in generating a set of recommendations that are specific to promoting MU of EHRs among health care professionals eligible for the Medicaid EHR Incentive Program. [http://healthit.ahrq.gov/portal/server.pt/document/958478/barriers_to_meaningful_use_in_medicaid_final_report_pdf?qid=82968838&rank=5]<br />
* The variability of results of similar studies on the monetary and efficiency benefits of EHRs indicates that there is no single approach to EMR implementation that will fit all settings. Variables such as hospital size, setting, specialty, prior computer integration, etc will determine the effectiveness of an EMR dramatically and must be considered in all cases. <br />
*The high cost of basic infrastructure of clinical information technology is a substantial hurdle for many health care organizations, many of whose income margins have deteriorated after years of decreasing reimbursement (from Medicare and other sources) and whose access to capital for new medical technology is extremely scarce. Financial instability and scarce capital resources for IT infrastructure similarly affect small to mid-sized independent practice associations (IPAs) and independent physician offices, the practice venues for most physicians in the United States.<br />
*Diversity of products as well as lack of standards for common architecture of basic infrastructure of clinical information technology constitutes a barrier and further complicates EMR Implementation.<br />
<br />
=== Costs ===<br />
<br />
Cost benefit analysis is categorized into 3 fields [70]:<br />
# Direct, one-time costs<br />
## Hardware & Peripherals<br />
## Packaged and customized software<br />
## Network, peripherals, supplies, equipment<br />
## Initial data collection and conversion of archival data<br />
## Facilities upgrades, including site preparation and renovation<br />
## End-user project management<br />
## Project planning, contract negotiation, procurement<br />
## Application development and deployment<br />
## Configuration management<br />
## Office accommodations, furniture, related items<br />
## Initial user training<br />
## Workforce adjustment for affected employees<br />
## Transition costs (parallel systems, converting legacy systems)<br />
## Quality assurance and post implementation reviews<br />
<br />
# Direct, ongoing costs<br />
## Salaries for IT and assigned end user staff<br />
## Software maintenance, subscriptions, upgrades,<br />
## Equipment leases<br />
## Facilities rental and utilities<br />
## Professional services, Ongoing training and<br />
## Reviews and audits<br />
<br />
# Indirect, ongoing costs. <br />
## Data integrity<br />
## Security<br />
## Privacy<br />
## IT policy management<br />
## Help Desk<br />
<br />
The financial commitment of implementing a CPOE system varies amongst facilities and depends on the facility's current hardware and software systems. The institution's current system needs to have a strong infrastructure in order to be able to enhance it's capabilities. The license for the software is but a small portion of the total cost. The larger expenses incurred will be a result of training healthcare professionals and support activities. Customer service and technical support should be available everyday 24 hours a day. <br />
<br />
For more information, see [[EMR Cost Categories]].<br />
<br />
=== Challenges to Identifying a Return on Investment (ROI) ===<br />
<br />
Evidence of a strong ROI business case for EHR implementation is confounded by anecdotal evidence in peer reviewed research and trade journals. Furthermore, environmental differences across provider settings make it challenging to replicate information system strategies and dependence on disparate legacy applications [48]. For organizational stakeholders to embrace EHR adoption, they need assurance that adopting an EHR system would positively impact business performance [58]. <br />
<br />
Additional barriers include:<br />
<br />
*Vendor supplied benefits data may not be objective <br />
*Few vendors maintain a structured database of benefits information<br />
*Peer reviewed studies are difficult to compare due to the complexity of health services delivery and variety of provider settings. <br />
*Differences in system architecture <br />
*Trade journals tend to focus on anecdotal evidence rather then empirical evidence<br />
*No standardized domain method exists to measure the ROI of electronic health records <br />
*Lack of information regarding maintenance and optimization costs [48]<br />
<br />
Consequently, providers frequently lack the necessary information to make sound financial decisions regarding Health IT capital investments. Uncovering the true cost and benefit of EHR adoption will require a national effort to standardize and centralize evidence in a national database. [48]<br />
<br />
=== EMR and Providers’ Productivity ===<br />
<br />
Health care providers are adopting electronic medical records, but some doctors report a disturbing side effect. Instead of becoming more efficient, some practices, especially smaller ones are becoming less. As with all new systems, there will be a temporary reduction in productivity as the healthcare staff become familiar with the new system. A study by Menachemi and Brooks (2006) estimated a 20% loss of productivity for the first month, 10% loss in the second month, and 5% loss in the third month and finally productivity returning to baseline in the subsequent months. <ref name="Brooks 2006">Menachemi, N. & Brooksm R. (2006). Reviewing the Benefits and Costs of Electronic Health Records and Associated Patient Safety Technologies.http://download.springer.com.ezproxyhost.library.tmc.edu/static/pdf/470/art%253A10.1007%252Fs10916-005-7988-x.pdf?auth66=1411967145_1fbceb4fa2c5cea1c67867e88dd78695&ext=.pdf</ref>. Several studies indicated that when physicians spent extra time entering data themselves, it cut down time spent with patients and stretched out their workday. [70] <br />
<br />
In a study by Bhargava et al. which examines productivity impacts of electronic medical records (EMR) implementation in a large academic hospital in California. Bhargava et al. also investigate the dynamics through which EMRs may impact productivity. The study employ random effects model on panel data comprising 3,189 physician-month observations for productivity data collected on 87 physicians specializing in internal medicine, pediatrics and family practice. The total duration of data collection was 39 months. Bhargava et al. find that the productivity of physicians dropped immediately after EMR implementation, but began to recover in a few months and finally leveled-off. Additionally, Bhargava et al. find that productivity impacts of EMR are contingent upon physician specialty. Bhargava et al postulate that the fit provided by an EMR to the task requirements of physicians of various specialties is key to entangling the productivity dynamics. [71]<br />
<br />
== Return on Investment (ROI) Estimates ==<br />
<br />
While barriers of determining actual ROI for EMR implementations exist, companies such as Dr. Cloud EMR are providing EMR and EHR ROI estimates based on each practice's details. This however does not suggest that it is entirely accurate and is only an estimate. DrCloudEMR is built by DrCloud Healthcare Solutions Inc, a wholly owned EnSoftek, Inc. subsidiary. [65]<br />
There are 2 main postulates for ROI which KOSH’s postulate and Sir Austin Bradford Hill’s criteria for Causation. <br />
Kosh’s postulate for CIS is <br />
i. The system or feature must be present in every case in which the benefit is observed.<br />
ii. The system must be isolated from the organization. <br />
iii. The benefit must be reproduced when the system is implemented in a new organization.<br />
iv. We must demonstrate that the system was used in the new organization.<br />
Hill’s Criteria for Causation includes (a) Strength of Association (b) Consistency of findings (c) Specificity of Association (d) Temporality (e) Dose-response (f) Plausibility (g) Coherence (h) Experimental Evidence and Analogy.<br />
<br />
(a) Strength of Association tells us that the greater the change observed, the more likely the association is to be causal (e.g. If a EHR system is implemented and the CPOE feature greatly reduces medication errors, we could say that the implementation of the system had a causal effect on the reduction of medication errors and the strength of association is great). <br />
<br />
(b) Consistency of Findings explains that if a change has been observed by different groups in different places with different circumstances and systems, the change is valid, so to speak. For example, if Company A (London, England, UK) implements System A , Company B (Houston, TX, USA) implements System B, and Company C (Guadalajara, Jalisco, Mexico) implements System C, and all three companies reduce medication errors using their respective systems, we can, again say that the CPOE feature of EHR systems can help reduce medication errors. It is important to note that the more consistent findings amongst different groups in different places, the better. <br />
<br />
(c) Specificity of Association requires us to ask if there are any other factors which may have affected the change that we've observed. In regards to medication errors being reduced, one would have to ask if CPOE was the only factor involved. If errors could have been reduced due to other mechanisms in place besides CPOE alerts (e.g. better workflow in departments, new policies, etc.), the specificity of association could be considered weak. Weak does not imply wrong, but it does mean that more research has to be initiated. <br />
<br />
(d) Temporality addresses the evaluation after an EHR system is implemented. Temporality asks us "were there any changes AFTER the system was implemented?" Usually this is harder to prove due to lack of data prior to EHR implementation, however, Sittig rates temporality as "strong." <br />
<br />
(e) Dose-Response asks if the size of changes are directly correlated with the increase of system use (e.g. were medication errors greatly reduced due to the use of many medication alerts in the EHR system?). Usually, there is a strong and direct correlation between system use and the reduction of medication errors, as one example of a dose response in an EHR system. <br />
<br />
(f) Plausibility must be shown; There must be some way to demonstrate that the EHR system was used the way it was intended to deliver certain results (e.g. Physicians must have used clinical support decisions the way the EHR system intended to reduce medication errors, in order to demonstrate plausibility.)<br />
<br />
(g) Coherence simply states that changes caused by EHR systems should be caused by other EHR systems elsewhere. So, if medication errors are reduced by the use of one EHR system and that happens with the use of many other EHR systems, coherence exists. <br />
<br />
(h) Experimental Evidence and Analogy is proving that when the system is not used properly or at all, that certain changes stop. So, if an EHR system is not being used properly or at all (after initial proper use), does a rise in medication errors resume? Experimental evidence is hard to obtain after EHR implementation because it requires not using the system for quite some time (which many would view as wasted money). <br />
<br />
=== Sittig's Postulates ===<br />
<br />
Dean Sittig, professor at UT Houston's School of Biomedical Informatics, has suggested a new set of criteria for determining ROI for an EMR implementation. Based on Koch's Postulates and Hill's criteria for causation, these criteria are designed specifically for EMR evaluation.<br />
<br />
* Must have the hardware and software available before the effect is identified.<br />
** Need to at least estimate state of affairs before system is implemented…manual review<br />
* Show that clinicians are actually using the system that could produce the effect.<br />
* Show that the effect increases with increasing availability and usage of the system.<br />
* Show that all obvious “alternative explanations” for the effect are false.<br />
* Show the effect goes away when the system goes away.<br />
* Show that a similar effect occurs when a similar system is installed and used at a similar facility.<br />
<br />
=== Quality Care ===<br />
<br />
One could approach the ROI from the perspective of the Institute of Medicine Report, ''Crossing the Quality Chasm''<br />
# Safe: Reducing adverse drug events, inappropriate testing<br />
# Effective: Reducing drug costs through appropriate prescribing<br />
# Efficient: Reducing drug, laborotory, or radiologic utilization<br />
# Timely: Reducing wait times<br />
# Patient-centered: Reducing length-of-stay while hospitalized<br />
# Equitable: Provides data to demonstrate equal delivery<br />
<br />
=== Achieving ROI from EHRs: The value of various approaches ===<br />
<br />
==== Modest ROI ====<br />
<br />
Organizations implement the electronic health records(EHRs),then optimize.<br />
The chief medical information officer (CMIO) is charged with making the EHR work.<br />
Success is measured by whether the project is "on-time" and "on-budget"<br />
Lean Six Sigma Is the silver bullet<br />
ROIs difficult to calculate and too time-consuming to determine.<br />
<br />
==== Next-Generation Value Realization ====<br />
<br />
Organizations seek to optimize business and clinical result through value realization.<br />
Physician leader, such as the chief medical officer and the chief transormation officer, work with the CMIO to be accountable for value.<br />
"On-value" and "speed-to-value" will be critical measures of success.<br />
Lean will be combined with other methodologies to drive breakthrough innovation, performance improvement, and change.<br />
Financial, clinical, business strategy, and IT leaders will work together to create an organization value<br />
management strategy and approach.<ref name="Arlotto 2015">Arlotto P. accelerating the ROI of EHRs. (cover story). Hfm (Healthcare Financial Management) [serial online]. February 2014;68(2):72-79. Available from: Health Source - Consumer Edition, Ipswich, MA. Accessed January 25, 2015.</ref><br />
<br />
=== Strategic Benefits === <br />
<br />
These offer substantial benefits to the organization, but at some future date. E.g. investments in networking and telecommunications offer significant future strategic benefits, positioning organizations to utilize enterprise-wide patient indexing and EMR or distributed case management technologies as they emerge.<br />
<br />
If EMR is fully implemented and functional, the benefits they offer are substantially than a paper records. Some of these benefits are:<br />
* Improvement in quality of patient care<br />
* An increase patient participation in their care (making appoints, refill of prescriptions, limited access to their records.<br />
* There will be an improvement in the accuracy of diagnoses and health outcomes-decrease of some types of medical errors<br />
* Improve care coordination<br />
* Increase practice efficiencies and cost savings <ref name="healthIT.gov"> http://www.healthit.gov/providers-professionals/benefits-electronic-health-records-ehrs </ref><br />
<br />
Arlotto (2014) defends the right that EHRs are able to provide organizations the greatest value in the future of healthcare. She argues that this can be accomplished through the involvement of business, clinical, and financial platforms within an organization. As the healthcare industry is transitioning from volume to value based payment, organizations are increasingly depending on IT applications to facilitate the progress. She explains that our current healthcare practices use EHRs as an entity that simply automates the paper record and measure value based on direct cost-benefit analysis, rather than ensuring value realized over the lifetime of the investment.<ref name="ArlottoAccelROI"></ref> Five commonly mistaken truths are further discussed in order to facilitate the transition for more efficient use of EHR. <ref name="ArlottoAccelROI"> Arlotto, P. (2014). Accelerating the ROI of EHRs. Healthcare Financial Management : Journal of the Healthcare Financial Management Association, 68, 2, 72-9. </ref><br />
<br />
=== Achieving a Positive ROI ===<br />
<br />
A key to achieving a positive return on investment (ROI) when implementing an EHR system is using it for more than meeting meaningful use requirements. A 2013 study conducted by Harvard University researchers showed that many practices that implemented EHRs showed a negative 5 year ROI. Citing only 27 percent of practices which adopted EHRs would show a positive ROI. The reason for this according to their research was that many practices were not using their EHR systems effectively. The practices which showed a positive ROI were able to use their EHR in a way that increased the number of patients they were able to see in a day as well as improving their billing to reduce rejected claims. The practices which showed a negative ROI were mostly still using paper charts heavily even after implementing the EHR system. This resulted in decreased productivity on top of the expense of the system. The most important step practices must take to see a positive ROI on EHRs is to take the time to optimize their use so they can improve efficiency and reduce costs.<ref name="posroi">Harvard University Reports Findings in Electronic Medical Records. (2013, June 7). Health & Medicine Week, 1809. Retrieved from http://go.galegroup.com/ps/i.do?id=GALE%7CA332414959&v=2.1&u=txshracd2509&it=r&p=HRCA&sw=w&asid=f6372a5c3f33b3956c1739aae9c7d466</ref><br />
Since the roll out of meaningful use many organizations and providers are still asking themselves if the use of this technology has improved the delivery and quality of patient care. Value can be defined in many ways and be difficult to measure. With that said organizations need to be fully committed to implementing the technology and follow up with post implementation optimization. <ref name= "Value of Health IT"> How to measures the value of health IT. http://www.healthcareitnews.com/news/how-measure-value-health-it/ </ref><br />
<br />
== Incentive Programs ==<br />
<br />
In recent years, many providers have factored government incentive payments into the cost analysis and final decision to purchase an EHR. The Medicare EHR Incentive Program provides incentive payments of $44,000 over five years to eligible professionals, eligible hospitals, and CAHs that demonstrate meaningful use of certified EHR technology. There's an additional incentive for eligible professionals who provide services in a Health Professional Shortage Area (HPSA). Medicare eligible professionals who predominantly furnish services in an area designated as a Health Professional Shortage Area (HPSA) will receive a 10% increase in their annual EHR incentive payments.(29)<br />
<br />
The Medicaid EHR Incentive Program provides incentive payments to eligible professionals, eligible hospitals, and CAHs as they adopt, implement, upgrade, or demonstrate meaningful use of certified EHR technology in their first year of participation and demonstrate meaningful use for up to five remaining participation years. Eligible professionals can receive up to $63,750 over the six years that they choose to participate in the program. (11)<br />
<br />
Beginning in 2015, Medicare eligible professionals who do not successfully demonstrate meaningful use will be subject to a payment adjustment. The payment reduction starts at 1% and increases each year that a Medicare eligible professional does not demonstrate meaningful use, to a maximum of 5%.(29)<br />
<br />
The American Reinvestment and Recovery Act law creates two key concepts to determine whether providers qualify for the health IT incentives: they must make "meaningful use" of IT and use a "qualified or certified EHR" (electronic health record). Besides incentives to providers and hospitals, the law also creates $2 billion in health IT funding administered by the Office of the [[Office of the National Coordinator for Health Information Technology (ONC)|National Coordinator for Health Information Technology (ONC)]]. A significant amount of this $2 billion should lay important groundwork to help providers use health IT meaningfully toward the goals of improving the nation's health. (14)<br />
<br />
== Reference Laboratories ==<br />
<br />
Reference Labs benefit greatly from interfacing with the various EMR's of the Hospitals, Clinics, and Physician Practices which utilize their services. Benefits include, but are not limited to: <ref name="Reference Lab Benefits">Making Reference Labs More Competitive and Profitable with an HL7 Interface Engine, http://www.corepointhealth.com/sites/default/files/whitepapers/reference-labs-hl7-engine-advantages.pdf</ref><br />
<br />
* Decreased costs as a result of transitioning to a paperless system.<br />
* Decreased order entry time.<br />
* Decreased lab result response time. <br />
<br />
Through the use of EMRs a physician is able to place a lab order for their patients in their EMR and have that information be conveyed electronically through the use of Health Level 7 (HL7)<ref name="HL7">Health Level 7, http://www.hl7.org/about/index.cfm?ref=nav</ref> messages to the system utilized by the reference lab. This saves time as the order will automatically populate within the reference lab's system and will not have to be manually entered. <br />
<br />
Once the lab work is complete the results can be transmitted in a similar manner as the initial order to have the results populate in the ordering provider's EMR. This increases the precision of the results, and decreases the time required for the patient and physician to receive the results as the result would no longer require to wait until someone in the physician's office manually enters the results into the EMR (risking the possibility of errors).<br />
<br />
<br />
== Misc, to sort later ==<br />
<br />
* [[E-prescribing]] will reduce number of physician office visit and phone call. phone calls and visits, Test results and appointments alert will be implemented and patients are automatically notified of test results and appointment times. [http://www.cms.hhs.gov/PQRI/Downloads/PQRIEPrescribingFactSheet.pdf] [http://www.drfirst.com/e-prescribing.jsp] [http://www.emrconsultant.com/education/e-prescribing]<br />
* Updates are done faster and files can be synchronized.<br />
* Duplicate orders and illegible handwriting will no longer be an issue is less of a problem <ref name="iom ehr key">IOM Key Capabilities of an Electronic Health Record System http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf</ref><br />
* Hard drives take up less space. Shared databases reduces the need for paper [http://www.allscripts.com/casestudies/nffm.pdf]<br />
* Billing is easier as the formatted documentation may improve the accuracy of charge capture.<br />
* Billing edits, including National and Local Coverage Determinations, can be alerted in real-time. <br />
* Patients arecan be informed of generic drugs, doctors can know if insurances do not cover patients, and formulary requirements can be identified.<br />
* Insurance and malpractice premiums can also be lowered. [http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm]) [http://www.msdc.com/EMR_Benefits.htm]<br />
* Different drugs can save hospitals money Hospitals will save money over various drugs [http://www.kpinstituteforhealthpolicy.org/kpihp/CMS/Files/fulfilling_potential.pdf].<br />
* Dictation is automatic<br />
* HIM staff may be reduced or staffing requirements changed [http://library.ahima.org]<br />
* Nurses will be more productive and more efficient [http://www.cbo.gov/ftpdocs/91xx/doc9168/HealthITTOC.2.1.htm]<br />
* Reduces medication errors and checks for [[adverse drug event|drug-drug interactions]]Adverse drug event (ADE), drug-drug interactions(DDI)will be detected thereby reducing errors in medication. [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf] [http://www.chcf.org/publications/2004/04/patient-safety-in-the-physicians-office--assessing-the-value-of-ambulatory-cpoe] [http://www.himss.org/content/files/davies_2002_maimonides.pdf] [http://www.ncbi.nlm.nih.gov/pubmed/19590335]<br />
* Reduces redundant lab tests [http://www.providersedge.com/ehdocs/ehr_articles/Key_Capabilities_of_an_EHR_System.pdf] [http://www.cbo.gov/ftpdocs/91xx/doc9168/MainText.3.1.shtml]<br />
* Reminders increase underused preventative measures [http://www.nejm.org/doi/full/10.1056/NEJMsa010181]<br />
* deduce infections from a list of symptoms and help make doctors make good clinical decisions. [http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2954790/] [http://www.annals.org/content/139/1/31.abstract] [http://www.ncbi.nlm.nih.gov/pubmed/18999073] [http://www.ncbi.nlm.nih.gov/pubmed/11025783] The patient internet portal allows patients to know the most up to date information about healthcare. [http://www.pubmedcentral.nih.gov/articlerender.fcgi?pmid=16236699]<br />
* [[Telemedicine]]<br />
* Large scale data exchange and [[HIE|information integration]] [http://xnet.kp.org/permanentejournal/winter03/cis.html] [http://content.healthaffairs.org/content/24/5/1103.abstract]<br />
* Surveillance and reporting of diseases [http://www.bt.cdc.gov/episurv/]<br />
* Research information in the database [http://www.cbo.gov/ftpdocs/91xx/doc9168/05-20-HealthIT.pdf]<br />
Academic EHRs are functional systems that makes training for nursing staff more efficient. Student nurses apply their learnt skills to plan patient care in a simulated setup. This allows student nurses to develop their acquired knowledge in a practical setting and transition into a familiar working environment after their academic careers.(<ref name="Gardner 2012">Gardner, C. and Jones, S. (June 2012). Utilization of academic electronic medical records in undergraduate nursing education. Online Journal of Nursing Informatics (OJNI), vol. 16 (2) </ref>.<br />
<br />
=== Sources of Funding === <br />
<br />
# Organizational Reserves – provider organization make investments in affiliated organizations<br />
# Bank and other financial service – short term loans<br />
# Capital leases – used for large equipment acquisitions but can be negotiated for a major IT investment<br />
# Vendor discounts and incentives – requires something in return<br />
# Joint venture or partnership – tighter relationship <br />
# Health plans and plan sponsors – contractual arrangement<br />
# Private philanthropy – fellowships or university chairs<br />
# Pharmaceutical companies – willing to conduct clinical trials<br />
# Public grants – government initiatives<br />
# State legislative initiatives – local and state initiatives<br />
<br />
== References ==<br />
<references/><br />
<br />
60. Interviews with John Kansky, Laura Adams (2014, 8) by Mark Braunstein, GA Tech.<br />
61. What is the DIRECT project (2010, 10) by The Direct Project. http://wiki.directproject.org/file/view/DirectProjectOverview.pdf<br />
<br />
== References (old, to edit) ==<br />
<br />
Committee on Quality of Health Care in America, Institute of Medicine. "Front Matter." ''Crossing the Quality Chasm: A New Health System for the 21st Century''. Washington, DC: The National Academies Press, 2001. [http://www.nap.edu/openbook.php?isbn=0309072808 Full text]<br />
<br />
# msdc benefits of emr<br />
# about ehrs<br />
# malpractice 2008<br />
# http://www.cdc.gov/about/grand-rounds/archives/2011/july2011.htm<br />
# http://www.mayoclinic.org/emr/benefits.html<br />
# Integrated Centre for Care Advancement through Research (iCARE); Canada Health Infoway (Infoway); Canadian Patient Safety Institute (CPSI). (2007). The Relationship Between Electronic Health Records and Patient Safety: A Joint Report On Future Directions For Canada. 1-31.<br />
# Crane, R. M., Raymond, B., (Winter 2003). Fulfilling the Potential of Clinical Information Systems. The Permanente Journal. 7 (1), pp.62-67<br />
# Hersh, W. R., (2002). Medical Informatics: Improving Health Care Through Information. Journal of American Medical Association. 288 (16), pp.1955-1958<br />
# http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_046429.hcsp?dDocName=bok1_046429 <br />
# http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/EHRIncentivePrograms/56_DataAndReports.asp<br />
# http://www.ischool.drexel.edu/faculty/ssilverstein/AJM-Himmelstein-Hospital-Computing.pdf<br />
# http://www.himss.org/content/files/jhim/20-2/16_original_evidence.pdf<br />
# http://www.markle.org/publications/403-achieving-health-it-objectives-american-recovery-and-reinvestment-act<br />
# http://www.cdc.gov/ehrmeaningfuluse/<br />
# http://healthit.ahrq.gov/portal/server.pt/document/958478/barriers_to_meaningful_use_in_medicaid_final_report_pdf?qid=82968838&rank=5<br />
# Evidence on the Costs and Benefits of Health Information Technology. A Congressional Budget Office Paper. Congress of the United States. Congressional Budget Office. Available at: http://www.cbo.gov/publication/41690. Acessed September 30, 2013.<br />
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# http://www.practicefusion.com/ehrbloggers/2010/10/return-on-investment-for-emrs.html<br />
# http://jama.jamanetwork.com/article.aspx?articleid=1737043#ArticleInformation<br />
# Kuperman, G.J. and Gibson, R.F. (2003) “Computer Physician Order Entry: Benefits, Costs & Issues” Am Intern Med 2003; 139:31-39<br />
# Crane, R.M. and Raymond, B. (2003) “Fulfilling the Potential of Clinical Information Systems: The Permanente Journal Winter/2003/Vol.7No1<br />
# Kaushal, R.; Jha, A.K.; Franz, C. et al. (2006) J Am Med Inform Assoc 2006;13:261-266 doi 10.1197/jamia.J1984<br />
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# Menachemi N, Collum H.T. Benefits and drawbacks of electronic health record systems.Risk Manag Healthc Policy. 2011; 4: 47–55.<br />
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# Butcher L. Hospitals strengthen bonds with post-acute providers. http://www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/01JAN2013/0113HHN_Feature_strategy&domain=HHNMAG<br />
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# Otte-Trojel, T., de Bont, A., Rundall, T. G., & van de Klundert, J. (2014). How outcomes are achieved through patient portals: a realist review. Journal of the American Medical Informatics Association, amiajnl-2013.<br />
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# https://www.drchrono.com/meaningful-use-ehr/<br />
# EMR Effectiveness: The Positive Benefit Electronic Medical Record Adoption has on Mortality Rates. http://apps.himss.org/content/files/HAHealthgradesEMRStudyWhitePaper.pdf<br />
# Integrating Clinical Practice and Public Health Surveillance Using Electronic Medical Record Systems. http://www.ajpmonline.org/article/S0749-3797(12)00249-8/fulltext<br />
# EMR ROI / EHR ROI Calculator. http://www.drcloudemr.com/roi/<br />
# http://www.academia.edu/4083826/An_Adaptive_Evidence_Based_Medicine_System_Based_on_a_Clinical_Decision_Support_System<br />
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# http://www.healthit.gov/providers-professionals/faqs/how-can-electronic-health-records-improve-public-and-population-health-<br />
# http://www.esi-bethesda.com/ncrrworkshops/clinicalresearch/pdf/MichaelKahnPaper.pdf<br />
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# http://hitconsultant.net/2014/08/19/patient-portal-features-which-is-the-most-beneficial-frustrating/<br />
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<br />
== References ==<br />
# Bailey JE, Pope RA, Elliott EC, Wan JY, Waters TM, Frisse ME. Health Information Exchange Reduces Repeated Diagnostic Imaging for Back Pain. Annals of Emergency Medicine 2013 Jul;62(1):16-24.<br />
# bates 1997<br />
# Johnston D, Pan E, Walker J. The value of CPOE in ambulatory settings. J Healthc Inf Manag 2004;18(1):5-8.<br />
# Berger RG, Kichak JP. Computerized physician order entry: helpful or harmful? J Am Med Inform Assoc 2004 Mar;11(2):100-3.<br />
# Stage DRMU. 3; Meaningful Use Work Group; Paul Tang, chair and George Hripcsak, co-chair. 2013. August. <br />
# Singh H. Editorial: Helping Health Care Organizations to Define Diagnostic Errors as Missed Opportunities in Diagnosis. Joint Commission Journal on Quality and Patient Safety 2014 Mar;40(3):99-101.<br />
# Bogua¡eviaius A, Maleckas A, Pundzius J, Skaudickas D. Prospective randomised trial of computerâ€aided diagnosis and contrast radiography in acute small bowel obstruction. European Journal of Surgery 2002;168(2):78-83.<br />
# Garg AX, Adhikari NK, McDonald H, Rosas-Arellano MP, Devereaux PJ, Beyene J, et al. Effects of computerized clinical decision support systems on practitioner performance and patient outcomes: a systematic review. JAMA 2005;293(10):1223-38.<br />
# McDonald KM, Matesic B, Contopoulos-Ioannidis DG, Lonhart J, Schmidt E, Pineda N, et al. Patient safety strategies targeted at diagnostic errors: a systematic review. Ann Intern Med 2013 Mar 5;158(5 Pt 2):381-9.<br />
# Radley, D. C., Wasserman, M. R., Olsho, L. E., Shoemaker, S. J., Spranca, M. D., & Bradshaw, B. ( 2013). Reduction in medication errors in hospitals due to adoption of computerized provider order entry systems. Journal of the American Medical Informatics Association : Jamia, 20, 3, 470-6.<br />
11. Kuperman,G.J.,Gibson,R.F. (2003)Computer Order Physician Entry: Benefits, Costs, and Issues. ''Annals of Internal Medicine,139,31-19'' <br />
# Sittig, D. (2014, September). Return on Investment Calculations. Lecture conducted from University of Texas Health Science Center at Houston, Houston, TX.<br />
#The American Journal of Medicine , Volume 114 , Issue 5 , 397 - 403<br />
#Jamoom E, Beatty P, Bercovitz A, et al. (2012) Physician adoption of electronic health record systems: United States, 2011. NCHS data brief, no 98. Hyattsville, MD: National Center for Health Statistics.<br />
<br />
# http://www.healthit.gov/providers-professionals/patient-participation<br />
# AHRQ Daignostic errors”http://psnet.ahrq.gov/primer.aspx?primerID=12.<br />
# EHRS and other technology can reduce diagnostic errors http://www.exscribe.com/orthopedic-e-news/ehremr/ehrs-and-other-technology-can-reduce-diagnostic-errors.<br />
# McGregor JC, Weekes E, Forrest GN, et al. Impact of a Computerized Clinical Decision Support System on Reducing Inappropriate Antimicrobial Use: A Randomized Controlled Trial.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1513678/.<br />
# Top 5 Benefits of Clinical Decision Support in the ED http://www.govhealthit.com/blog/top-5-benefits-clinical-decision-support-ed.<br />
<br />
<br />
[[Category:EHR]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/CernerCerner2015-01-29T04:49:26Z<p>Mho2: </p>
<hr />
<div>Cerner’s mission: to contribute to the systemic improvement of health care delivery and the health of communities. <ref name="Cerner Form 10k">Cerner Corp, Form 10-K, Annual Report, Filing Date Feb 5, 2014. http://pdf.secdatabase.com/2355/0000804753-14-000006.pdf</ref> <br />
<br />
'''Cerner''' Corporation is a supplier of healthcare information technology (HCIT) solutions, services, devices and hardware. Cerner solutions optimize processes for healthcare organizations. <ref name="Cern.O">Cerner Corporation Company Profile. http://www.reuters.com/finance/stocks/companyProfile?rpc=66&symbol=CERN. </ref> Cerner solutions are licensed by approximately 14,000 facilities around the world, including more than 3,000 hospitals; 4,900 physician practices; 60,000 physicians; 590 ambulatory facilities, such as laboratories, ambulatory centers, behavioral health centers, cardiac facilities, radiology clinics and surgery centers; 3,500 extended care facilities; 150 employer sites and 1,790 retail pharmacies. <ref name="Cerner Form 10k"></ref> <br />
<br />
== Introduction ==<br />
<br />
In1979, inspired by a short consulting project for a medical lab, former Arthur Andersen information systems consultants Neal Patterson, Clifford Illig, and Paul Gorup broke away from Arthur Andersen to form Cerner. Cerner’s name stems from the Latin word cernere, translated as “to sift or understand.” <ref name="Strategic Report">Strategic Report for Cerner Corporation. http://economics-files.pomona.edu/jlikens/SeniorSeminars/oasis/reports/CERN.pdf </ref> <br />
<br />
Cerner is one of the leading global suppliers of healthcare information technology solutions. Around the world, health organizations ranging from single-doctor practices to entire countries turn to Cerner for our powerful yet intuitive solutions. Cerner offers clients a dedicated focus on healthcare, an end-to-end solution and service portfolio, and proven market leadership. <ref name="Corporate Profile">Corporate Profile. http://www.cerner.com/About_Cerner/Corporate_Profile/?LangType=3081 </ref> <br />
<br />
<br />
=== Locations ===<br />
<br />
Cerner is headquartered in Kansas City, Mo., neighbor of North Kansas City Hospital, Cerner's second hospital client. <ref name="Rand Study">Rand Study helps Cerner makes its case. http://www.bizjournals.com/kansascity/stories/2005/09/19/story1.html?page=all </ref> <br />
* 2005: Cerner acquired the Riverport Campus complex on the site of what was formerly the Sam's Town Casino above the Missouri River in North Kansas City, Missouri. <ref name="riverport">Riverport Campus Cerner Corporation. http://www.emporis.com/building/riverport-campus-cerner-corporation-inc-world-headquarters-in-north-kansas-city-mo-kansas-city-mo-usa </ref> <br />
* 2006: it also acquired the former Marion Laboratories complex in southeast Kansas City, Missouri, renaming the campus the Innovation Campus. <ref name="southcampus">Cerner Corporation South Campus Bldg. http://www.emporis.com/building/cerner-corporation-south-campus-bldg-i-kansas-city-mo-usa </ref><br />
* 2013: the company opened the first building in a new campus development located in Kansas City, Kan. The company calls this the Continuous Campus. <ref name="continuous campus">Cerner Continuous Campus. https://foursquare.com/v/cerner-continuous-campus/4f96d3b8e4b0ba85ae7a81c5 </ref><br />
* 2014: the company announced that it had begun a $4.45 billion campus construction project on the site of the former Bannister Mall in South Kansas City near the Innovation Campus. <ref name="bannister mall">Cerner breaks ground for its Trail Campus in South Texas. http://www.kansascity.com/news/business/development/article3845781.html </ref>The Kansas City Star reports, that the campus will have enough room to house up to 16,000 employees. <ref name="break ground"> Cerner breaks ground on planned Kansas City site. http://www.cerner.com/Cerner_breaks_ground_on_planned_Kansas_City_site/</ref><br />
<br />
Cerner maintains a handful of additional offices in the United States, as well as offices in the UK, Australia, UAE, Saudi Arabia, Egypt, Germany, France and several other countries outside the United States.<br />
<br />
=== Mission statement ===<br />
<br />
Cerner's Vision has 4 pillars:<br />
<br />
# Automate the Care Process to Eliminate Paper<br />
# Connect the Person by Providing Virtual Personal Health Systems<br />
# Structure, Store and Study the Evidence to Create New Knowledge<br />
# Close the Loop by Implementing Evidence-Based Care" <ref name="cerner annual report 2001">“Cerner Annual Report 2001” (March 2002) https://www.cerner.com/uploadedFiles/2001_Annual_Report.pdf</ref><br />
<br />
== From 1980s into the 90s ==<br />
<br />
By 1984, Cerner was ready to roll out its first application, the PathNet laboratory information system. PathNet provided a comprehensive information system for laboratory clinicians, allowing laboratories to automate their processes. PathNet, which grew to combine applications for general laboratory information, microbiology, blood bank transfusion and blood bank donation, and anatomic pathology, broke away not only from the traditional paper-based sharing of information, but also from the prevailing financial focus of data gathering systems. <ref name="history">Cerner Corporation History. http://www.fundinguniverse.com/company-histories/cerner-corporation-history/ </ref> <br />
<br />
In 1988, Cerner added the next component of its clinical management systems, RadNet, which focused on automating radiology department functions. The following year, pharmacy support was added with the PharmNet application. As with PathNet, each new component was based on the same application architecture, allowing applications to be seamlessly combined to share information across applications. <ref name="history"></ref> <br />
<br />
By 1990, more than 200 PathNet sites had been installed, solidifying Cerner's position as the leading maker of laboratory information systems. Cerner next moved to expand its product family beyond clinical management systems and into care management systems, with the introduction of its ProNet and CareNet products. ProNet provided automated support for patient management and registration, ordering, scheduling, and tracking processes. CareNet gave patient care planning, management, and measurement tools to nurses and other direct care providers. Care management was meant to play a central role in gathering information needed for the care process. With Cerner's care management tools, providers could more easily manage the many pieces of patient information, including demographic and financial data, health status, operations data such as treatment procedures and protocols, while linking this information to ordering, tracking, scheduling, and patient, case, and health records management. <ref name="history"></ref> <br />
<br />
By the end of 1993, Cerner had completed the largest part of its product family, with the 1992 introduction of its SurgiNet and Open Management Foundation (OMF) products, and the 1993 introduction of its MRNet product. SurgiNet, part of Cerner's clinical management product line, offered information management support for operating room teams. OMF extended Cerner's repository line with tools for supporting management analysis and decision-making based on process-related information. MRNet functioned to link the OCF and OMF products in automating the chart management process for the medical records department. <ref name="history"></ref> <br />
<br />
== Cerner EHR ==<br />
<br />
The founders created '''Cerner Millennium''', the industry's first person-centric integrated architecture. <ref name"cerner millennium">HP & Cerner http://h20338.www2.hp.com/enterprise/us/en/partners/cerner-millennium.html</ref> Cerner Millennium is a partnership of Cerner and HP. The architecture of Millennium allows caregivers and supporting providers the ability to view results, problems, diagnosis, medications, and other pertinent information in real-time as well as share clinical and management data across multiple disciplines and facilities. This architecture has been referred to as Health Network Architecture (HNA), providing 12 major system applications operating by this means, fitting into 4 interrelated groups <ref name="history"></ref>.<br />
<br />
In a continued effort to reduce waste and friction in healthcare, Cerner has developed many solutions including employee health, life sciences, medical devices, clinical trial management, and biosurveillance. In 2012, Cerner announced its acquisition of Anasazi Software Inc. to support continuity of mental health care through the combination of Anasazi’s established community behavioral health functionality with the in-patient behavioral health capabilities of Cerner Millennium. <ref name="cerner acquires Anasazi">Cerner to Acquire Anasazi Software, Inc. http://www.cerner.com/about_cerner/newsroom/Cerner_to_Acquire_Anasazi_Software_Inc/</ref> Also in 2012, Cerner announced the launch of Millennium + which combines the enterprise platform with the secure Cerner Cloud. <ref name="cerner millennium 2012">Cerner Announces Next Evolution of Cerner Millennium 2012 http://www.cerner.com/about_cerner/newsroom/cerner_announces_next_evolution_of_cerner_millennium/</ref><br />
<br />
=== Millenium+ ===<br />
<br />
In 2012, Cerner launched Millennium+, which uses the Cerner Cloud to provide a user experience that is “fast, smart and easy”, enabling caregivers to have personalized, intuitive and moment relevant clinical work flows via desktop, tablet or smartphone with minimal orientation to begin usage. <ref name="cerner millennium 2012"></ref> <br />
<br />
One of the solutions that was launched as part of the Millennium+ platform was PowerChart+Touch™. PowerChart+Touch as a mobile solution allows physicians to complete workflows directly from their mobile devices and was created specifically for the iPad. <ref name="powerchart touch">PowerChart Touch Wins National Acclaim for User Experience. http://www.cerner.com/PowerChart_Touch_Wins_National_Acclaim_for_User_Experience/</ref><br />
<br />
=== PowerChart ===<br />
<br />
Built upon the scalable, unified, person-centric Cerner Millennium® architecture, PowerChart® delivers the benefits of a clinical database, with functionality allowing you to view clinical data, complete orders and optimise clinician documentation in one powerful solution.<br />
<br />
The universal PowerChart framework can be leveraged across multiple roles, venues and disciplines, thereby driving efficiencies and user adoption. The solution provides a foundation for a multitude of Cerner point-of-care solutions, including those for home care, physician offices, clinics, acute patient care, critical care, and long-term and rehabilitation services.<br />
<br />
'''Key Benefits<br />
'''<br />
* Improve coordination and identification of patients<br />
* Positively impact cash flow<br />
* Access records at any time from any location<br />
* Optimize workflow efficiency and performance<br />
<br />
<ref name"PowerChart"> Cerner PowerChart. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/PowerChart/?LangType=3081</ref><br />
<br />
== FirstNet==<br />
<br />
FirstNet is Cerners emergency department documentation system. FirstNet tracking board allows physicians and staff to see their patient population and their location. The FirstNet tracking board is also customizable so you can see the information you need. FirstNet has a coding functionality that allows ERs to capturing all their physician charges correctly and for reimbursement. Patient education is also part of the FirstNet application so when a patient is discharge they can also receive education material related to their diagnosis or issue. <ref name="FirstNet">Cerner Emergency Department. https://store.cerner.com/hospitals_and_health_systems/emergency_department </ref><br />
<br />
== RadNet ==<br />
<br />
The RadNet® Radiology Information System (RIS) enables radiology practitioners to work more efficiently and provide patients with a positive experience and superior care.<br />
<br />
Advanced technology and access to vital clinical information enables you to do more than automate basic radiology processes. You can deliver more effective, more personal care while expanding and optimizing performance.<br />
<br />
RadNet RIS helps you streamline departmental operations, from registration and order entry, to worklist management and image interpretation, to image and result distribution, to business analysis. When you need critical allergy data, lab values or current medications, you can access them quickly. RadNet also allows your department to efficiently perform exam coding and procedural documentation, as well as streamline documentation. With only a few key strokes, you can optimize revenue and profitability.<br />
<br />
Key Benefits:<br />
<br />
Streamline and automate workflow processes<br />
Collect, display, manage and instantly deliver vital patient information<br />
Increase clinical and operational performance<br />
Improve patient safety and reduce error<br />
<br />
<ref name"RadNet"> Cerner RadNet https://store.cerner.com/items/265</ref><br />
<br />
== Finances ==<br />
<br />
With a total revenue $2.8B including $391M globally (Cerner Corporation 2013 Annual Report), organizations ranging from single-doctor practices to hospitals to corporations to local, regional, national and global government agencies and organizations use Cerner solutions. As of 2012, Cerner works with more than 9,300 facilities worldwide, including 2,650 hospitals, 3,750 physician practices and 500 ambulatory clinics <ref name"cerner excite"> Cerner EMR Solutions - An Overview. (May, 2012) Excite Health Partners</ref>. Associates span 7,300 worldwide with business in Argentina, Aruba, Canada, Cayman Islands, Chile, Puerto Rico, Saudi Arabia, Singapore, Spain and the United Arab Emirates. <ref name"cerner nyt"> Cerner Corporation" (September, 2013) New York Times Business Day</ref><br />
<br />
=== Siemens acquisition ===<br />
<br />
In a press release on August 5, 2014, Cerner Corporation announced that they would be acquiring Siemens Health Services for $1.3 billion. This acquisition will allow Cerner to provide health IT to 20,000 associates in more than 30 countries and 18,000 client facilities, greatly expanding their global presence. <ref name"cerner siemens"> Cerner to Acquire Siemens Health Services for $1.3 Billion” (August, 2014) Cerner News Release http://www.cerner.com/About_Cerner/Investor_Relations/News_Releases/</ref> This deal will increase Cerner's annual revenue form about 3 billion last year to more than 4.5 billion on annual revenue in 2014. <br />
<br />
Based on 2014 estimates, Cerner and Siemens Health Services have combined totals of more than: <ref name="cerner forbes siemens">Cerner To Buy Siemens Health IT Business For $1.3 Billion http://www.forbes.com/sites/matthewherper/2014/08/05/cerner-to-buy-siemens-health-it-business-for-1-3-billion/</ref><br />
<br />
* 20,000 associates in more than 30 countries<br />
* 18,000 client facilities, including some of the largest health care organizations in their respective countries<br />
* $4.5 billion of annual revenue<br />
* $650 million of annual R&D investment<br />
<br />
== Powerchart ECG == <br />
<br />
The Cerner PowerChart ECG™ solution powered by Mortara provides cardiologists a comprehensive ability to capture, manage, display, interpret and report on ECGs anywhere from within Cerner’s electronic health record (PowerChart®) and other affiliated Cerner solutions, such as PathNet® (pathology) and RadNet® (radiology).<br />
<br />
Cerner is the first company to provide full capabilities for the ECG from within an electronic health record (EHR). The PowerChart ECG solution includes communication integration and clinical worklist functionality. The solution presents a consolidated view of ECG information, visually incorporating prior encounters, critical results and observations.<br />
<br />
Key Benefits<br />
<br />
ECG viewing of full fidelity (DICOM) ECG data<br />
Ability to analyze, measure, and manipulate presentation of ECG anywhere and anytime in PowerChart<br />
Enterprise distribution of ECG images with automated interpretation for attending and primary doctors, ED staff and cardiologists<br />
Access to ECGs at any workstation with PowerChart<br />
<br />
<ref name="PowerchartECG"> Cerner Powerchart ECG https://store.cerner.com/items/224</ref><br />
<br />
== Oracle ==<br />
<br />
The partnership between Cerner and Oracle helps to provide a number benefits to Cerner customers such as: <ref name="cerner oracle">http://www.cerner.com/About_Cerner/Partnerships/Oracle/, 2014)</ref><br />
<br />
* industry-leading scalability and reliability in both clustered and single system configurations<br />
* high performance<br />
* fault tolerance<br />
* heavy online processing loads<br />
* the ability to handle a large number of users<br />
<br />
Cerner Millennium applications use an Oracle database and provide a common data model to enable data sharing between applications and to eliminate redundant data, while maximizing reliability and performance. This implementation runs on a variety of networks, processors and operating systems, including Windows XP Professional and any Internet browser.[8] <br />
All Millennium installs take advantage of the full Oracle database stack (9iEE, RAC, and the Management Packs). Oracle’s Real Application Clustering (RAC) enables both reliability and scalability by allowing the addition of servers to the host cluster.<br />
<br />
Cerner also uses Oracle’s Tuning Pack, Diagnostic Pack, and Change Management Pack to help protect the integrity, confidentiality, and availability of its Millennium healthcare data. Oracle’s EAL 4 (Evaluation Assurance Level 4) rating also attests to its robust security. Additionally, Cerner's Remote Hosting Facility uses the full Oracle database stack (9iEE, RAC, and the Management Packs) as well and in an exclusive manner <ref name="cerner oracle">Oracle 2014 http://www.cerner.com/About_Cerner/Partnerships/Oracle/</ref><br />
<br />
[[Certification Commission for Health Information Technology (CCHIT)|Certification Commission for Health Information Technology (CCHIT)]] performs rigorous inspection of EHR's integrated functionality, interoperability, security and is intended to serve health care providers looking for maximum assurance that a product will meet their complex needs. These listed products have CCHIT Certification but have not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the [[ARRA|American Recovery and Reinvestment Act of 2009 (ARRA)]]: <br />
<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart 2007 (Expired January 22, 2011)<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart/PowerWorks EMR 2007.19 (Expired April 22, 2011). <ref name="history"></ref> <br />
<br />
=== Millennium Objects ===<br />
<br />
Clients can create custom applications on the Cerner Millennium architecture with MillenniumObjects. <ref name="cerner millennium objects"> MillenniumObjects http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/?LangType=3081</ref> MillenniumObjects utilizes Java and XML services for Application Programming Interfaces (API) development by client developers. MillenniumObjects can be used to create custom applications and additional features on existing processes. This allows the user to create a unique application tailored to their specific needs using data already present within Cerner Millennium. Third-party extensions are available to create new workflows.<br />
<br />
Benefits of Millennium Objects include:<br />
<br />
* Quickly create custom applications for your organization<br />
* Build upon the processes already in place for the maintenance of users, passwords, administration, etc. of the new application<br />
* Leverage the capabilities of third-party built extensions to create new workflows across applications<br />
<br />
<ref name="Benefits of Millennium Objects"> Benefits of Millennium Objects. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/</ref><br />
<br />
== St. John Sepsis Agent==<br />
<br />
Sepsis affects 750,000 patients per year in the United States alone. <ref name="st john sepsis">http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/st_john_sepsis_agent/</ref> It also states, nearly $17 billion annual healthcare expenditures in the U.S. goes to health problems associated with sepsis. <br />
<br />
However, studies show sepsis can be handled better if it is diagnosed in the first six hours after contracting germs. In order to make this detection as early as possible, Cerner now has come with a solution. St. John Sepsis Agent, created in co-operation with Methodist health care in Memphis, Tennessee speeds up early detection and diagnosis of sepsis.<br />
How the system works?<br />
<br />
It gathers information from different sources such as: physician practices, ambulances, emergency department ,lab results and patient electronic health record’s vital signs.The integrated system analyzes all the information gathered from the above sources which includes Glucose level, Respiratory rate, Temperature, Heat rate, and Lab results. An alert fires when the system finds three out of range criteria. Then the agent sends a message to the hospital’s clinical team which reviews the data and begins the appropriate treatment.<br />
<br />
In addition to the alert, there are enhancements that complement St John’s Sepsis Agent. One of such is The Millennium Light house. This program includes sepsis management power plan with orders for intravenous fluid, diagnostic tests and an empiric therapy adviser. This adviser guide clinicians to a variety of treatment option based on the source of infection.The agent offering also includes Significant Events mpage component which provides up front view of the patient’s most recent lab results, vital signs and significant treatment event. <ref name="cerner youtube sepsis">Youtube: Cerner Sepsis Program https://www.youtube.com/watch?v=_-P6DZos9UU</ref><br />
<br />
Finally, to follow up cases of sepsis, Cerner offers the Sepsis Confirmation Power form which is designed to use by organization’s quality officers during case review and quality reporting. <ref name="st john sepsis"></ref> Reports show using the St. John Sepsis Agent can improve healthcare organizations in the following ways:<br />
<br />
* 24 percent reduction in in-hospital patient mortality rate.<br />
* 21 percent reduction in length of stay.<br />
* $5,882 medical savings per treated patient.<br />
<br />
== Acute care Electronic Medical Record==<br />
<br />
The Cerner electronic medical record (EMR) is an integrated database that provides a comprehensive set of capabilities with the following key benefits:<br />
1.Improve patient care as clinicians can focus on the patient’s overall health and not just the encounter<br />
2. Increase efficiency by placing real-time, updated information with the care team in time to make fast and effective decisions<br />
3. Increase access to information from multiple venues in the health system. <ref name="acute care">Acute Care Electronic Medical Record. https://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/</ref> <br />
<br />
The EMR was created to allow healthcare professionals to electronically store, capture and access patient health information in both the acute and ambulatory care setting. It allows the users to provide real-time access to patient results and clinical information across care disciplines, enable that healthcare organizations meet The Joint Commission requirements for patient confidentiality, access patient information securely from wherever and whenever it is most convenient for the care team. <ref name="acute care"></ref> <br />
<br />
<br />
== Cerner Laboratory solution==<br />
<br />
The PathNet laboratory information system delivers to clinicians a comprehensive and fully integrated technology that covers both the managerial and the operational sides of the laboratory. <ref name="cerner laboratory">Laboratory http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Laboratory/</ref> The system operates on the unified Cerner Millennium architecture. As a result, information links seamlessly with the patient's electronic medical record. PathNet serves the needs of different sections under pathology departments umbrella such as Blood Science, Microbiology, Cellular Pathology and Blood Transfusion functions. The technology has a capability to store, retrieved and disseminated patient specific information to and from health care system. Aside from that, the system is continually updated based on national standards and guidelines. Reports enumerates the different kinds of benefits PathNet® laboratory information system provides. Some are: it has a capability to process large quantities of specimens efficiently with minimal error possible. It integrates lab results with patent's EMR which allows the availability of full patient records on the EMR. Finally it ensures the rapid availability of patent results to care providers. <br />
<br />
== Device Connectivity==<br />
<br />
Medical devices contain critical health information reports a Cerner’s website, However, it can be a challenge to get that information into the care giver’s hand. As a result Cerner come up with medical device connectivity solution which alleviate this challenge. The company implemented the CareAware iBus, a core component of the CareAware connectivity architecture which acts as a USB for health care devices. In doing so, the solution connects medical devices with EMR enabling two-way communication between the two systems. This solution improves care by allowing care providers to focus on patients rather than paper work and data entry associated with it. <br />
<ref name="cerner solutions">Healthcare Devices http://www.cerner.com/solutions/Healthcare_Devices/?langtype=3081&WT.mc_id=audevice</ref><br />
<br />
== Integrating medical calculators into the EHR==<br />
<br />
Medical calculators integrated in EHR are invaluable assists for care providers, reports a Cerner website. In order to address this need, a group of physicians at Cerner started to work on integrated medical calculator solutions. In order, to accomplish that they partnered with MedCalc300. As a result, this new solution provides all Cerner clients access to more than 600 calculators, clinical criteria and decision trees. To name one example of such clinical calculator is Apgar score for determining the well being of a new born. <br />
<ref name="cerner med calculators">Integrating medical calculators into the EHR http://www.cerner.com/blog/integrating_medical_calculators_into_the_ehr/?langtype=1033</ref><br />
<br />
==HealthLife==<br />
<br />
Cerners patient portal was designed to help patients become more actively involved in their healthcare. Individuals will have greater access to their health information than ever before using a variety of access tools including laptops, tablets and other mobile devices. This new design will enable patients to: <ref name=" HealtheLife">Cerner HealtheLife. http://www.cerner.com/solutions/individuals_and_families/cerner_patient_services/ </ref><br />
<br />
* Schedule or reschedule or cancel appointments<br />
* Make payments or view their medical fees<br />
* View their health information and download their data<br />
* Send information to their healthcare team thru secure messaging<br />
* Fill prescriptions<br />
<br />
Providers will be able to:<br />
<br />
* send their patients reminders<br />
* share the patients lab or diagnostic results<br />
* attach documents concerning education or patient care<br />
* send registration forms for patient to complete<br />
<br />
== LearningLive == <br />
<br />
LearningLIVE is a new eLearning solution designed to deliver training closer to the point-of-care and support continuous learning in the healthcare environment. Available within PowerChart, FirstNet, and INet, LearningLIVE offers clinicians relevant learning resources in the context of their workflow.<br />
<br />
The simple and flexible design facilitates dynamic delivery and real-time updates. A reporting dashboard allows your organization to track learning activity and user performance, and leverage the data to target training and drive user adoption.<br />
<br />
In addition to the creation of customized learning assets, LearningLIVE comes with twenty two standard assets that support Meaningful Use requirements. The pre-built assets are categorized according to the requirement they support and facilitate training for Meaningful Use.<br />
<br />
Client Benefits:<br />
<br />
Allows clinicians to access learning resources and apply knowledge at the point-of-need.<br />
Enables educators to deliver dynamic learning content and communications.<br />
Provides hospital administrators key learning and performance metrics.<br />
Key Features<br />
<br />
The LearningLIVE solution offers:<br />
<br />
Relevant, on-demand learning resources in the context of clinical workflow.<br />
Reporting dashboard with a comprehensive view of learning activity and user performance.<br />
Simple and flexible design to facilitate dynamic delivery and real-time updates.<br />
Pre-built assets targeted towards meeting Meaningful Use objectives<br />
<br />
<ref name="LearningLive">Cerner LearningLive. https://store.cerner.com/items/319</ref><br />
<br />
==HealtheIntent==<br />
This is one of Cerners newest cloud based platforms to address the needs of population health while looking at the health outcomes of an individual. This cloud-based platform enables health care systems to aggregate, transform and reconcile data across the continuum of care. A longitudinal record is established, through that process, for individual members of the population that the organization is held accountable for; helping to improve outcomes and lower costs for health and care. <ref name= "HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent/ Cerner HealtheIntent </ref><br />
<br />
[http://www.cerner.com/solutions/population_health/ Population Health Management] solution is enabled with the HealtheIntent platform. Physicians will be able to use the tools and programs to address individual patients or a group. This solution will allow physicians to know their population, engage their patients and evaluate patient and population outcomes.<br />
<br />
[http://www.cerner.com/solutions/member_engagement/cerner_wellness/ Cerner Wellness] solution is designed to assist patients through their continuity of care with resources and tools to engage and motivate them towards healthy lifestyle improvements, managing their medical conditions and enhance their knowledge base.<br />
<ref name="HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent</ref><br />
<br />
== CareAware AlertLink ==<br />
<br />
In today's health care environment, devices sound many alarms, some of which are informational, some of which are life critical. Nurses often have to rely on proximity to a nurse's station or a patient’s room to ensure an alarm is heard. This can result in delays in responding to life-critical alerts. The problem is amplified when there are high volumes of alarms and only a small number of them requiring life-critical immediate response.<br />
<br />
AlertLink provides an alternative. Patient monitors are connected to a network and every alarm they produce is captured by AlertLink. A small percentage of those alarms are considered life critical and can be forwarded to a caregiver’s mobile device, such as a phone.<br />
<br />
At the beginning of a shift, a nurse uses the solution to create a connection with his or her phone by scanning an ID badge and phone. Once the nurse connects the phone to the network, he or she can receive alerts, accept notifications and take action. If the nurse is unable to respond to the event, he or she can press “decline” on the phone to immediately forward the alert to the next caregiver, a feature that ultimately improves response times for patients.<br />
<br />
CareAware AlertLink system saves time for nurses through improved alert escalation. It also gives administrators better insight into nurse workload by capturing the acceptance and rejection of alerts. The improved ability to monitor facilities and staff gives your organization the opportunity to lower costs.<br />
<br />
<ref name="CareAwareAlertLink">Cerner CareAware AlertLink. https://store.cerner.com/items/154</ref><br />
<br />
==Partnerships==<br />
<br />
Every potential partnership is evaluated for the opportunity for collaboration and innovation in order to serve clients’ health care needs. Cerner has partners in the following areas:<br />
<br />
* Medical Device Integration and Connectivity<br />
* Business Continuity<br />
* Caregiver Experience<br />
* Document Management and Imaging<br />
* HotSpot Dictation<br />
* Operational and System Management<br />
* Preferred Suppliers<br />
* Security and Administration<br />
<br />
<ref name="Cerner Partnerships">Cerner Partnerships. http://www.cerner.com/About_Cerner/Partnerships/</ref><br />
<br />
Cerner has also partnered with CommonWell and will provide it to their clients for free until January 1, 2018. CommonWell will work with Cerner to exchange patient records safely and securely at the right time with any of the CommonWell parnters. <br />
<br />
<ref name="CommonWell">Cerner Blog. http://www.cerner.com/blog/Cerner_is_Providing_CommonWell_Services_Free_for_Three_Years/?langtype=1033/</ref><br />
<br />
==Virtual Community==<br />
<br />
=== Cerner and Second Life ===<br />
<br />
Cerner has established a virtual healthcare environment to represent its 25-year vision. The environment includes numerous venues, such as a hospital, clinic, pharmacy, and more. Within the venues are areas where individuals can interact to learn about Cerner’s solutions. The virtual environment acknowledges education and affiliation among clients and supports Cerner’s vision for the future of healthcare. Virtual characters, known as avatars, will guide you through the environment where you can participate in the following:<br />
<br />
* View and interact with Smart Room technologies such as myStation and iAware, to learn about them in real life<br />
* Experience how clinicians view real-time data from the care team and medical devices in the medical intensive care unit<br />
* Witness how Cerner’s solutions enable patients to connect with the care team<br />
* Collaborate and share knowledge with other individuals in Second Life<br />
<br />
=== What is Second Life? ===<br />
<br />
Launched in 2003, Second Life is a virtual world that creates a user-defined environment where people can interact, conduct business and exchange ideas. Second Life is used in many large corporations such as IBM, Intel and Microsoft to collaborate, share product knowledge and network. Additionally, many leading universities and school systems use Second Life in their educational programs to familiarize students with benefits of virtual worlds, connect them with others and provide instructional simulations. <ref name="Cerner Virtual Community">Cerner Virtual Community. http://www.cerner.com/About_Cerner/Cerner_Virtual_Community/</ref><br />
<br />
== Awards ==<br />
<br />
• UX Award, 2013, Best Clinical Health Care Experience, Powerchart Touch <ref name="powertouch">2013 UX Awards. http://userexperienceawards.com/ux-awards-2013-winners/#powerchart/ </ref><br />
<br />
• Information Week Elite100, 2014, <ref name="infoweek">Cerner clients recognized as elite and innovative users of IT. http://www.cerner.com/blog/cerner_clients_recognized_as_elite_innovative_users_of_it/?langtype=1033 </ref> <br />
<br />
• Most Innovative Companies, 2014 <ref name="forbes">The World’s Most Innovative Companies List. http://www.forbes.com/innovative-companies/list/ </ref><br />
<br />
• Best in KLAS award for Application Hosting (CIS/ERP/HIS) 2013 <ref name="klas">Cerner : Best in KLAS Awards: Software and Services. http://www.4-traders.com/CERNER-CORPORATION-8744/news/Cerner--Best-in-KLAS-Awards-Software-and-Services-18576417/ </ref><br />
<br />
• One of The 10 Most Competitive Technology Companies of 2013 <ref name="competitive">10 Most Competitive Tech Companies in the World. http://outthinker.com/outthinkerblog/?p=59/ </ref><br />
<br />
• Healthcare Informatics 100 Ranking <ref name= "Healthcare Informatics">Cerner recognized as No. 2 for 2014.http://www.healthcare-informatics.com/hci100/2014-hci-100-list/ </ref><br />
<br />
== References ==<br />
<references/><br />
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[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/CernerCerner2015-01-29T04:45:49Z<p>Mho2: </p>
<hr />
<div>Cerner’s mission: to contribute to the systemic improvement of health care delivery and the health of communities. <ref name="Cerner Form 10k">Cerner Corp, Form 10-K, Annual Report, Filing Date Feb 5, 2014. http://pdf.secdatabase.com/2355/0000804753-14-000006.pdf</ref> <br />
<br />
'''Cerner''' Corporation is a supplier of healthcare information technology (HCIT) solutions, services, devices and hardware. Cerner solutions optimize processes for healthcare organizations. <ref name="Cern.O">Cerner Corporation Company Profile. http://www.reuters.com/finance/stocks/companyProfile?rpc=66&symbol=CERN. </ref> Cerner solutions are licensed by approximately 14,000 facilities around the world, including more than 3,000 hospitals; 4,900 physician practices; 60,000 physicians; 590 ambulatory facilities, such as laboratories, ambulatory centers, behavioral health centers, cardiac facilities, radiology clinics and surgery centers; 3,500 extended care facilities; 150 employer sites and 1,790 retail pharmacies. <ref name="Cerner Form 10k"></ref> <br />
<br />
== Introduction ==<br />
<br />
In1979, inspired by a short consulting project for a medical lab, former Arthur Andersen information systems consultants Neal Patterson, Clifford Illig, and Paul Gorup broke away from Arthur Andersen to form Cerner. Cerner’s name stems from the Latin word cernere, translated as “to sift or understand.” <ref name="Strategic Report">Strategic Report for Cerner Corporation. http://economics-files.pomona.edu/jlikens/SeniorSeminars/oasis/reports/CERN.pdf </ref> <br />
<br />
Cerner is one of the leading global suppliers of healthcare information technology solutions. Around the world, health organizations ranging from single-doctor practices to entire countries turn to Cerner for our powerful yet intuitive solutions. Cerner offers clients a dedicated focus on healthcare, an end-to-end solution and service portfolio, and proven market leadership. <ref name="Corporate Profile">Corporate Profile. http://www.cerner.com/About_Cerner/Corporate_Profile/?LangType=3081 </ref> <br />
<br />
<br />
=== Locations ===<br />
<br />
Cerner is headquartered in Kansas City, Mo., neighbor of North Kansas City Hospital, Cerner's second hospital client. <ref name="Rand Study">Rand Study helps Cerner makes its case. http://www.bizjournals.com/kansascity/stories/2005/09/19/story1.html?page=all </ref> <br />
* 2005: Cerner acquired the Riverport Campus complex on the site of what was formerly the Sam's Town Casino above the Missouri River in North Kansas City, Missouri. <ref name="riverport">Riverport Campus Cerner Corporation. http://www.emporis.com/building/riverport-campus-cerner-corporation-inc-world-headquarters-in-north-kansas-city-mo-kansas-city-mo-usa </ref> <br />
* 2006: it also acquired the former Marion Laboratories complex in southeast Kansas City, Missouri, renaming the campus the Innovation Campus. <ref name="southcampus">Cerner Corporation South Campus Bldg. http://www.emporis.com/building/cerner-corporation-south-campus-bldg-i-kansas-city-mo-usa </ref><br />
* 2013: the company opened the first building in a new campus development located in Kansas City, Kan. The company calls this the Continuous Campus. <ref name="continuous campus">Cerner Continuous Campus. https://foursquare.com/v/cerner-continuous-campus/4f96d3b8e4b0ba85ae7a81c5 </ref><br />
* 2014: the company announced that it had begun a $4.45 billion campus construction project on the site of the former Bannister Mall in South Kansas City near the Innovation Campus. <ref name="bannister mall">Cerner breaks ground for its Trail Campus in South Texas. http://www.kansascity.com/news/business/development/article3845781.html </ref>The Kansas City Star reports, that the campus will have enough room to house up to 16,000 employees. <ref name="break ground"> Cerner breaks ground on planned Kansas City site. http://www.cerner.com/Cerner_breaks_ground_on_planned_Kansas_City_site/</ref><br />
<br />
Cerner maintains a handful of additional offices in the United States, as well as offices in the UK, Australia, UAE, Saudi Arabia, Egypt, Germany, France and several other countries outside the United States.<br />
<br />
=== Mission statement ===<br />
<br />
Cerner's Vision has 4 pillars:<br />
<br />
# Automate the Care Process to Eliminate Paper<br />
# Connect the Person by Providing Virtual Personal Health Systems<br />
# Structure, Store and Study the Evidence to Create New Knowledge<br />
# Close the Loop by Implementing Evidence-Based Care" <ref name="cerner annual report 2001">“Cerner Annual Report 2001” (March 2002) https://www.cerner.com/uploadedFiles/2001_Annual_Report.pdf</ref><br />
<br />
== From 1980s into the 90s ==<br />
<br />
By 1984, Cerner was ready to roll out its first application, the PathNet laboratory information system. PathNet provided a comprehensive information system for laboratory clinicians, allowing laboratories to automate their processes. PathNet, which grew to combine applications for general laboratory information, microbiology, blood bank transfusion and blood bank donation, and anatomic pathology, broke away not only from the traditional paper-based sharing of information, but also from the prevailing financial focus of data gathering systems. <ref name="history">Cerner Corporation History. http://www.fundinguniverse.com/company-histories/cerner-corporation-history/ </ref> <br />
<br />
In 1988, Cerner added the next component of its clinical management systems, RadNet, which focused on automating radiology department functions. The following year, pharmacy support was added with the PharmNet application. As with PathNet, each new component was based on the same application architecture, allowing applications to be seamlessly combined to share information across applications. <ref name="history"></ref> <br />
<br />
By 1990, more than 200 PathNet sites had been installed, solidifying Cerner's position as the leading maker of laboratory information systems. Cerner next moved to expand its product family beyond clinical management systems and into care management systems, with the introduction of its ProNet and CareNet products. ProNet provided automated support for patient management and registration, ordering, scheduling, and tracking processes. CareNet gave patient care planning, management, and measurement tools to nurses and other direct care providers. Care management was meant to play a central role in gathering information needed for the care process. With Cerner's care management tools, providers could more easily manage the many pieces of patient information, including demographic and financial data, health status, operations data such as treatment procedures and protocols, while linking this information to ordering, tracking, scheduling, and patient, case, and health records management. <ref name="history"></ref> <br />
<br />
By the end of 1993, Cerner had completed the largest part of its product family, with the 1992 introduction of its SurgiNet and Open Management Foundation (OMF) products, and the 1993 introduction of its MRNet product. SurgiNet, part of Cerner's clinical management product line, offered information management support for operating room teams. OMF extended Cerner's repository line with tools for supporting management analysis and decision-making based on process-related information. MRNet functioned to link the OCF and OMF products in automating the chart management process for the medical records department. <ref name="history"></ref> <br />
<br />
== Cerner EHR ==<br />
<br />
The founders created '''Cerner Millennium''', the industry's first person-centric integrated architecture. <ref name"cerner millennium">HP & Cerner http://h20338.www2.hp.com/enterprise/us/en/partners/cerner-millennium.html</ref> Cerner Millennium is a partnership of Cerner and HP. The architecture of Millennium allows caregivers and supporting providers the ability to view results, problems, diagnosis, medications, and other pertinent information in real-time as well as share clinical and management data across multiple disciplines and facilities. This architecture has been referred to as Health Network Architecture (HNA), providing 12 major system applications operating by this means, fitting into 4 interrelated groups <ref name="history"></ref>.<br />
<br />
In a continued effort to reduce waste and friction in healthcare, Cerner has developed many solutions including employee health, life sciences, medical devices, clinical trial management, and biosurveillance. In 2012, Cerner announced its acquisition of Anasazi Software Inc. to support continuity of mental health care through the combination of Anasazi’s established community behavioral health functionality with the in-patient behavioral health capabilities of Cerner Millennium. <ref name="cerner acquires Anasazi">Cerner to Acquire Anasazi Software, Inc. http://www.cerner.com/about_cerner/newsroom/Cerner_to_Acquire_Anasazi_Software_Inc/</ref> Also in 2012, Cerner announced the launch of Millennium + which combines the enterprise platform with the secure Cerner Cloud. <ref name="cerner millennium 2012">Cerner Announces Next Evolution of Cerner Millennium 2012 http://www.cerner.com/about_cerner/newsroom/cerner_announces_next_evolution_of_cerner_millennium/</ref><br />
<br />
=== Millenium+ ===<br />
<br />
In 2012, Cerner launched Millennium+, which uses the Cerner Cloud to provide a user experience that is “fast, smart and easy”, enabling caregivers to have personalized, intuitive and moment relevant clinical work flows via desktop, tablet or smartphone with minimal orientation to begin usage. <ref name="cerner millennium 2012"></ref> <br />
<br />
One of the solutions that was launched as part of the Millennium+ platform was PowerChart+Touch™. PowerChart+Touch as a mobile solution allows physicians to complete workflows directly from their mobile devices and was created specifically for the iPad. <ref name="powerchart touch">PowerChart Touch Wins National Acclaim for User Experience. http://www.cerner.com/PowerChart_Touch_Wins_National_Acclaim_for_User_Experience/</ref><br />
<br />
=== PowerChart ===<br />
<br />
Built upon the scalable, unified, person-centric Cerner Millennium® architecture, PowerChart® delivers the benefits of a clinical database, with functionality allowing you to view clinical data, complete orders and optimise clinician documentation in one powerful solution.<br />
<br />
The universal PowerChart framework can be leveraged across multiple roles, venues and disciplines, thereby driving efficiencies and user adoption. The solution provides a foundation for a multitude of Cerner point-of-care solutions, including those for home care, physician offices, clinics, acute patient care, critical care, and long-term and rehabilitation services.<br />
<br />
'''Key Benefits<br />
'''<br />
* Improve coordination and identification of patients<br />
* Positively impact cash flow<br />
* Access records at any time from any location<br />
* Optimize workflow efficiency and performance<br />
<br />
<ref name"PowerChart"> Cerner PowerChart. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/PowerChart/?LangType=3081</ref><br />
<br />
== FirstNet==<br />
<br />
FirstNet is Cerners emergency department documentation system. FirstNet tracking board allows physicians and staff to see their patient population and their location. The FirstNet tracking board is also customizable so you can see the information you need. FirstNet has a coding functionality that allows ERs to capturing all their physician charges correctly and for reimbursement. Patient education is also part of the FirstNet application so when a patient is discharge they can also receive education material related to their diagnosis or issue. <ref name="FirstNet">Cerner Emergency Department. https://store.cerner.com/hospitals_and_health_systems/emergency_department </ref><br />
<br />
== RadNet ==<br />
<br />
The RadNet® Radiology Information System (RIS) enables radiology practitioners to work more efficiently and provide patients with a positive experience and superior care.<br />
<br />
Advanced technology and access to vital clinical information enables you to do more than automate basic radiology processes. You can deliver more effective, more personal care while expanding and optimizing performance.<br />
<br />
RadNet RIS helps you streamline departmental operations, from registration and order entry, to worklist management and image interpretation, to image and result distribution, to business analysis. When you need critical allergy data, lab values or current medications, you can access them quickly. RadNet also allows your department to efficiently perform exam coding and procedural documentation, as well as streamline documentation. With only a few key strokes, you can optimize revenue and profitability.<br />
<br />
Key Benefits:<br />
<br />
Streamline and automate workflow processes<br />
Collect, display, manage and instantly deliver vital patient information<br />
Increase clinical and operational performance<br />
Improve patient safety and reduce error<br />
<br />
<ref name"RadNet"> Cerner RadNet https://store.cerner.com/items/265</ref><br />
<br />
== Finances ==<br />
<br />
With a total revenue $2.8B including $391M globally (Cerner Corporation 2013 Annual Report), organizations ranging from single-doctor practices to hospitals to corporations to local, regional, national and global government agencies and organizations use Cerner solutions. As of 2012, Cerner works with more than 9,300 facilities worldwide, including 2,650 hospitals, 3,750 physician practices and 500 ambulatory clinics <ref name"cerner excite"> Cerner EMR Solutions - An Overview. (May, 2012) Excite Health Partners</ref>. Associates span 7,300 worldwide with business in Argentina, Aruba, Canada, Cayman Islands, Chile, Puerto Rico, Saudi Arabia, Singapore, Spain and the United Arab Emirates. <ref name"cerner nyt"> Cerner Corporation" (September, 2013) New York Times Business Day</ref><br />
<br />
=== Siemens acquisition ===<br />
<br />
In a press release on August 5, 2014, Cerner Corporation announced that they would be acquiring Siemens Health Services for $1.3 billion. This acquisition will allow Cerner to provide health IT to 20,000 associates in more than 30 countries and 18,000 client facilities, greatly expanding their global presence. <ref name"cerner siemens"> Cerner to Acquire Siemens Health Services for $1.3 Billion” (August, 2014) Cerner News Release http://www.cerner.com/About_Cerner/Investor_Relations/News_Releases/</ref> This deal will increase Cerner's annual revenue form about 3 billion last year to more than 4.5 billion on annual revenue in 2014. <br />
<br />
Based on 2014 estimates, Cerner and Siemens Health Services have combined totals of more than: <ref name="cerner forbes siemens">Cerner To Buy Siemens Health IT Business For $1.3 Billion http://www.forbes.com/sites/matthewherper/2014/08/05/cerner-to-buy-siemens-health-it-business-for-1-3-billion/</ref><br />
<br />
* 20,000 associates in more than 30 countries<br />
* 18,000 client facilities, including some of the largest health care organizations in their respective countries<br />
* $4.5 billion of annual revenue<br />
* $650 million of annual R&D investment<br />
<br />
== Oracle ==<br />
<br />
The partnership between Cerner and Oracle helps to provide a number benefits to Cerner customers such as: <ref name="cerner oracle">http://www.cerner.com/About_Cerner/Partnerships/Oracle/, 2014)</ref><br />
<br />
* industry-leading scalability and reliability in both clustered and single system configurations<br />
* high performance<br />
* fault tolerance<br />
* heavy online processing loads<br />
* the ability to handle a large number of users<br />
<br />
Cerner Millennium applications use an Oracle database and provide a common data model to enable data sharing between applications and to eliminate redundant data, while maximizing reliability and performance. This implementation runs on a variety of networks, processors and operating systems, including Windows XP Professional and any Internet browser.[8] <br />
All Millennium installs take advantage of the full Oracle database stack (9iEE, RAC, and the Management Packs). Oracle’s Real Application Clustering (RAC) enables both reliability and scalability by allowing the addition of servers to the host cluster.<br />
<br />
Cerner also uses Oracle’s Tuning Pack, Diagnostic Pack, and Change Management Pack to help protect the integrity, confidentiality, and availability of its Millennium healthcare data. Oracle’s EAL 4 (Evaluation Assurance Level 4) rating also attests to its robust security. Additionally, Cerner's Remote Hosting Facility uses the full Oracle database stack (9iEE, RAC, and the Management Packs) as well and in an exclusive manner <ref name="cerner oracle">Oracle 2014 http://www.cerner.com/About_Cerner/Partnerships/Oracle/</ref><br />
<br />
[[Certification Commission for Health Information Technology (CCHIT)|Certification Commission for Health Information Technology (CCHIT)]] performs rigorous inspection of EHR's integrated functionality, interoperability, security and is intended to serve health care providers looking for maximum assurance that a product will meet their complex needs. These listed products have CCHIT Certification but have not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the [[ARRA|American Recovery and Reinvestment Act of 2009 (ARRA)]]: <br />
<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart 2007 (Expired January 22, 2011)<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart/PowerWorks EMR 2007.19 (Expired April 22, 2011). <ref name="history"></ref> <br />
<br />
=== Millennium Objects ===<br />
<br />
Clients can create custom applications on the Cerner Millennium architecture with MillenniumObjects. <ref name="cerner millennium objects"> MillenniumObjects http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/?LangType=3081</ref> MillenniumObjects utilizes Java and XML services for Application Programming Interfaces (API) development by client developers. MillenniumObjects can be used to create custom applications and additional features on existing processes. This allows the user to create a unique application tailored to their specific needs using data already present within Cerner Millennium. Third-party extensions are available to create new workflows.<br />
<br />
Benefits of Millennium Objects include:<br />
<br />
* Quickly create custom applications for your organization<br />
* Build upon the processes already in place for the maintenance of users, passwords, administration, etc. of the new application<br />
* Leverage the capabilities of third-party built extensions to create new workflows across applications<br />
<br />
<ref name="Benefits of Millennium Objects"> Benefits of Millennium Objects. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/</ref><br />
<br />
== St. John Sepsis Agent==<br />
<br />
Sepsis affects 750,000 patients per year in the United States alone. <ref name="st john sepsis">http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/st_john_sepsis_agent/</ref> It also states, nearly $17 billion annual healthcare expenditures in the U.S. goes to health problems associated with sepsis. <br />
<br />
However, studies show sepsis can be handled better if it is diagnosed in the first six hours after contracting germs. In order to make this detection as early as possible, Cerner now has come with a solution. St. John Sepsis Agent, created in co-operation with Methodist health care in Memphis, Tennessee speeds up early detection and diagnosis of sepsis.<br />
How the system works?<br />
<br />
It gathers information from different sources such as: physician practices, ambulances, emergency department ,lab results and patient electronic health record’s vital signs.The integrated system analyzes all the information gathered from the above sources which includes Glucose level, Respiratory rate, Temperature, Heat rate, and Lab results. An alert fires when the system finds three out of range criteria. Then the agent sends a message to the hospital’s clinical team which reviews the data and begins the appropriate treatment.<br />
<br />
In addition to the alert, there are enhancements that complement St John’s Sepsis Agent. One of such is The Millennium Light house. This program includes sepsis management power plan with orders for intravenous fluid, diagnostic tests and an empiric therapy adviser. This adviser guide clinicians to a variety of treatment option based on the source of infection.The agent offering also includes Significant Events mpage component which provides up front view of the patient’s most recent lab results, vital signs and significant treatment event. <ref name="cerner youtube sepsis">Youtube: Cerner Sepsis Program https://www.youtube.com/watch?v=_-P6DZos9UU</ref><br />
<br />
Finally, to follow up cases of sepsis, Cerner offers the Sepsis Confirmation Power form which is designed to use by organization’s quality officers during case review and quality reporting. <ref name="st john sepsis"></ref> Reports show using the St. John Sepsis Agent can improve healthcare organizations in the following ways:<br />
<br />
* 24 percent reduction in in-hospital patient mortality rate.<br />
* 21 percent reduction in length of stay.<br />
* $5,882 medical savings per treated patient.<br />
<br />
== Acute care Electronic Medical Record==<br />
<br />
The Cerner electronic medical record (EMR) is an integrated database that provides a comprehensive set of capabilities with the following key benefits:<br />
1.Improve patient care as clinicians can focus on the patient’s overall health and not just the encounter<br />
2. Increase efficiency by placing real-time, updated information with the care team in time to make fast and effective decisions<br />
3. Increase access to information from multiple venues in the health system. <ref name="acute care">Acute Care Electronic Medical Record. https://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/</ref> <br />
<br />
The EMR was created to allow healthcare professionals to electronically store, capture and access patient health information in both the acute and ambulatory care setting. It allows the users to provide real-time access to patient results and clinical information across care disciplines, enable that healthcare organizations meet The Joint Commission requirements for patient confidentiality, access patient information securely from wherever and whenever it is most convenient for the care team. <ref name="acute care"></ref> <br />
<br />
<br />
== Cerner Laboratory solution==<br />
<br />
The PathNet laboratory information system delivers to clinicians a comprehensive and fully integrated technology that covers both the managerial and the operational sides of the laboratory. <ref name="cerner laboratory">Laboratory http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Laboratory/</ref> The system operates on the unified Cerner Millennium architecture. As a result, information links seamlessly with the patient's electronic medical record. PathNet serves the needs of different sections under pathology departments umbrella such as Blood Science, Microbiology, Cellular Pathology and Blood Transfusion functions. The technology has a capability to store, retrieved and disseminated patient specific information to and from health care system. Aside from that, the system is continually updated based on national standards and guidelines. Reports enumerates the different kinds of benefits PathNet® laboratory information system provides. Some are: it has a capability to process large quantities of specimens efficiently with minimal error possible. It integrates lab results with patent's EMR which allows the availability of full patient records on the EMR. Finally it ensures the rapid availability of patent results to care providers. <br />
<br />
== Device Connectivity==<br />
<br />
Medical devices contain critical health information reports a Cerner’s website, However, it can be a challenge to get that information into the care giver’s hand. As a result Cerner come up with medical device connectivity solution which alleviate this challenge. The company implemented the CareAware iBus, a core component of the CareAware connectivity architecture which acts as a USB for health care devices. In doing so, the solution connects medical devices with EMR enabling two-way communication between the two systems. This solution improves care by allowing care providers to focus on patients rather than paper work and data entry associated with it. <br />
<ref name="cerner solutions">Healthcare Devices http://www.cerner.com/solutions/Healthcare_Devices/?langtype=3081&WT.mc_id=audevice</ref><br />
<br />
== Integrating medical calculators into the EHR==<br />
<br />
Medical calculators integrated in EHR are invaluable assists for care providers, reports a Cerner website. In order to address this need, a group of physicians at Cerner started to work on integrated medical calculator solutions. In order, to accomplish that they partnered with MedCalc300. As a result, this new solution provides all Cerner clients access to more than 600 calculators, clinical criteria and decision trees. To name one example of such clinical calculator is Apgar score for determining the well being of a new born. <br />
<ref name="cerner med calculators">Integrating medical calculators into the EHR http://www.cerner.com/blog/integrating_medical_calculators_into_the_ehr/?langtype=1033</ref><br />
<br />
==HealthLife==<br />
<br />
Cerners patient portal was designed to help patients become more actively involved in their healthcare. Individuals will have greater access to their health information than ever before using a variety of access tools including laptops, tablets and other mobile devices. This new design will enable patients to: <ref name=" HealtheLife">Cerner HealtheLife. http://www.cerner.com/solutions/individuals_and_families/cerner_patient_services/ </ref><br />
<br />
* Schedule or reschedule or cancel appointments<br />
* Make payments or view their medical fees<br />
* View their health information and download their data<br />
* Send information to their healthcare team thru secure messaging<br />
* Fill prescriptions<br />
<br />
Providers will be able to:<br />
<br />
* send their patients reminders<br />
* share the patients lab or diagnostic results<br />
* attach documents concerning education or patient care<br />
* send registration forms for patient to complete<br />
<br />
== LearningLive == <br />
<br />
LearningLIVE is a new eLearning solution designed to deliver training closer to the point-of-care and support continuous learning in the healthcare environment. Available within PowerChart, FirstNet, and INet, LearningLIVE offers clinicians relevant learning resources in the context of their workflow.<br />
<br />
The simple and flexible design facilitates dynamic delivery and real-time updates. A reporting dashboard allows your organization to track learning activity and user performance, and leverage the data to target training and drive user adoption.<br />
<br />
In addition to the creation of customized learning assets, LearningLIVE comes with twenty two standard assets that support Meaningful Use requirements. The pre-built assets are categorized according to the requirement they support and facilitate training for Meaningful Use.<br />
<br />
Client Benefits:<br />
<br />
Allows clinicians to access learning resources and apply knowledge at the point-of-need.<br />
Enables educators to deliver dynamic learning content and communications.<br />
Provides hospital administrators key learning and performance metrics.<br />
Key Features<br />
<br />
The LearningLIVE solution offers:<br />
<br />
Relevant, on-demand learning resources in the context of clinical workflow.<br />
Reporting dashboard with a comprehensive view of learning activity and user performance.<br />
Simple and flexible design to facilitate dynamic delivery and real-time updates.<br />
Pre-built assets targeted towards meeting Meaningful Use objectives<br />
<br />
<ref name="LearningLive">Cerner LearningLive. https://store.cerner.com/items/319</ref><br />
<br />
==HealtheIntent==<br />
This is one of Cerners newest cloud based platforms to address the needs of population health while looking at the health outcomes of an individual. This cloud-based platform enables health care systems to aggregate, transform and reconcile data across the continuum of care. A longitudinal record is established, through that process, for individual members of the population that the organization is held accountable for; helping to improve outcomes and lower costs for health and care. <ref name= "HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent/ Cerner HealtheIntent </ref><br />
<br />
[http://www.cerner.com/solutions/population_health/ Population Health Management] solution is enabled with the HealtheIntent platform. Physicians will be able to use the tools and programs to address individual patients or a group. This solution will allow physicians to know their population, engage their patients and evaluate patient and population outcomes.<br />
<br />
[http://www.cerner.com/solutions/member_engagement/cerner_wellness/ Cerner Wellness] solution is designed to assist patients through their continuity of care with resources and tools to engage and motivate them towards healthy lifestyle improvements, managing their medical conditions and enhance their knowledge base.<br />
<ref name="HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent</ref><br />
<br />
== CareAware AlertLink ==<br />
<br />
In today's health care environment, devices sound many alarms, some of which are informational, some of which are life critical. Nurses often have to rely on proximity to a nurse's station or a patient’s room to ensure an alarm is heard. This can result in delays in responding to life-critical alerts. The problem is amplified when there are high volumes of alarms and only a small number of them requiring life-critical immediate response.<br />
<br />
AlertLink provides an alternative. Patient monitors are connected to a network and every alarm they produce is captured by AlertLink. A small percentage of those alarms are considered life critical and can be forwarded to a caregiver’s mobile device, such as a phone.<br />
<br />
At the beginning of a shift, a nurse uses the solution to create a connection with his or her phone by scanning an ID badge and phone. Once the nurse connects the phone to the network, he or she can receive alerts, accept notifications and take action. If the nurse is unable to respond to the event, he or she can press “decline” on the phone to immediately forward the alert to the next caregiver, a feature that ultimately improves response times for patients.<br />
<br />
CareAware AlertLink system saves time for nurses through improved alert escalation. It also gives administrators better insight into nurse workload by capturing the acceptance and rejection of alerts. The improved ability to monitor facilities and staff gives your organization the opportunity to lower costs.<br />
<br />
<ref name="CareAwareAlertLink">Cerner CareAware AlertLink. https://store.cerner.com/items/154</ref><br />
<br />
==Partnerships==<br />
<br />
Every potential partnership is evaluated for the opportunity for collaboration and innovation in order to serve clients’ health care needs. Cerner has partners in the following areas:<br />
<br />
* Medical Device Integration and Connectivity<br />
* Business Continuity<br />
* Caregiver Experience<br />
* Document Management and Imaging<br />
* HotSpot Dictation<br />
* Operational and System Management<br />
* Preferred Suppliers<br />
* Security and Administration<br />
<br />
<ref name="Cerner Partnerships">Cerner Partnerships. http://www.cerner.com/About_Cerner/Partnerships/</ref><br />
<br />
Cerner has also partnered with CommonWell and will provide it to their clients for free until January 1, 2018. CommonWell will work with Cerner to exchange patient records safely and securely at the right time with any of the CommonWell parnters. <br />
<br />
<ref name="CommonWell">Cerner Blog. http://www.cerner.com/blog/Cerner_is_Providing_CommonWell_Services_Free_for_Three_Years/?langtype=1033/</ref><br />
<br />
==Virtual Community==<br />
<br />
=== Cerner and Second Life ===<br />
<br />
Cerner has established a virtual healthcare environment to represent its 25-year vision. The environment includes numerous venues, such as a hospital, clinic, pharmacy, and more. Within the venues are areas where individuals can interact to learn about Cerner’s solutions. The virtual environment acknowledges education and affiliation among clients and supports Cerner’s vision for the future of healthcare. Virtual characters, known as avatars, will guide you through the environment where you can participate in the following:<br />
<br />
* View and interact with Smart Room technologies such as myStation and iAware, to learn about them in real life<br />
* Experience how clinicians view real-time data from the care team and medical devices in the medical intensive care unit<br />
* Witness how Cerner’s solutions enable patients to connect with the care team<br />
* Collaborate and share knowledge with other individuals in Second Life<br />
<br />
=== What is Second Life? ===<br />
<br />
Launched in 2003, Second Life is a virtual world that creates a user-defined environment where people can interact, conduct business and exchange ideas. Second Life is used in many large corporations such as IBM, Intel and Microsoft to collaborate, share product knowledge and network. Additionally, many leading universities and school systems use Second Life in their educational programs to familiarize students with benefits of virtual worlds, connect them with others and provide instructional simulations. <ref name="Cerner Virtual Community">Cerner Virtual Community. http://www.cerner.com/About_Cerner/Cerner_Virtual_Community/</ref><br />
<br />
== Awards ==<br />
<br />
• UX Award, 2013, Best Clinical Health Care Experience, Powerchart Touch <ref name="powertouch">2013 UX Awards. http://userexperienceawards.com/ux-awards-2013-winners/#powerchart/ </ref><br />
<br />
• Information Week Elite100, 2014, <ref name="infoweek">Cerner clients recognized as elite and innovative users of IT. http://www.cerner.com/blog/cerner_clients_recognized_as_elite_innovative_users_of_it/?langtype=1033 </ref> <br />
<br />
• Most Innovative Companies, 2014 <ref name="forbes">The World’s Most Innovative Companies List. http://www.forbes.com/innovative-companies/list/ </ref><br />
<br />
• Best in KLAS award for Application Hosting (CIS/ERP/HIS) 2013 <ref name="klas">Cerner : Best in KLAS Awards: Software and Services. http://www.4-traders.com/CERNER-CORPORATION-8744/news/Cerner--Best-in-KLAS-Awards-Software-and-Services-18576417/ </ref><br />
<br />
• One of The 10 Most Competitive Technology Companies of 2013 <ref name="competitive">10 Most Competitive Tech Companies in the World. http://outthinker.com/outthinkerblog/?p=59/ </ref><br />
<br />
• Healthcare Informatics 100 Ranking <ref name= "Healthcare Informatics">Cerner recognized as No. 2 for 2014.http://www.healthcare-informatics.com/hci100/2014-hci-100-list/ </ref><br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
<br />
<br />
<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Centricity_EMRCentricity EMR2015-01-29T04:42:28Z<p>Mho2: /* Centricity Perinatal */</p>
<hr />
<div>'''Centricity EMR''' is a patient centered [[EMR|electronic medical record (EMR) system]] designed for use in clinical and ambulatory care practices (1). Centricity EMR allows clinicians to electronically document patient encounters, enter patient data into research databases, and ensure the secure exchange of clinical knowledge (1). <br />
<br />
Centricity was introduced in 2003 with two applications, Centricity EMR and Centricity Physician Office - Practice Management. The products were acquired by what was then GE Medical Systems in 2002 and 2003 respectively, and released future versions of both products under the Centricity name.(3)<br />
<br />
<br />
== Introduction ==<br />
<br />
The GE Centricity EMR features a robust user interface which supports the accurate and consistent documentation for a wide range of clinical and demographic patient information (1). The Centricity EMR tracks medical information for patients over time and allows clinicians to compare clinical outcomes against their peers (1).<br />
<br />
Information stored in the Centricity EMR includes:<br />
*medical setting<br />
*diagnosis<br />
*patient complaints/reason for visit<br />
*medications<br />
*laboratory tests/results (3)<br />
The Centricity EMR is easily combined with other Centricity software packages to allow clinicians to further optimize the management of information (1). <br />
<br />
==The Centricity EMR Research Database==<br />
<br />
Approximately 5,000 clinicians provide data to the medical quality improvement consortium (MQIC) which in turn uses the data for a research database (3).This database is quickly becoming a powerful tool as it allows investigators to:<br />
*examine large patient populations<br />
*de-identify patient data <br />
*perform retrospective cohort studies <br />
*determine the primary reason for the visit <br />
*determine clinical outcomes (5)<br />
*use of electronic medical records for clinical research in the management of type 2 diabetes <ref>name="Chopra">Kamal KM, Chopra I, Elliott JP, Mattei T. Use of electronic medical records for clinical research in the management of type 2 diabetes. 2014. 10(6): 877–884. http://www.ncbi.nlm.nih.gov/pubmed/24556384</ref>.<br />
<br />
By 2008, there had been 12 journal publications and 31 poster presentations using data collected by clinicians using the GE Centricity database (3).<br />
<br />
== Centricity Advance ==<br />
<br />
'''Centricity Advance''' is GE Healthcare’s integrated [[EMR|electronic medical record (EMR)]], practice management and patient portal system delivered through the web. Specifically designed for use by primary care providers and other physicians in smaller offices, Centricity Advance helps streamline office management, enhance delivery of patient care, and enable expanded communication with secure online exchange between physicians and patients.<br />
<br />
Unlike many other healthcare IT systems, Centricity Advance is delivered in a true Software-as-a-Service (SaaS) model. With this web-based system, practices can get up and running quickly, with minimal disruption, at a modest startup cost. Technology upgrades and maintenance are delivered automatically, with virtually no practice involvement.<br />
<br />
== Centricity Advance ==<br />
<br />
On August 8, 2011, GE Healthcare announced the release of Centricity Advance – Mobile, a native Apple iPad® application designed for primary care physicians in small practices.<br />
<br />
EMR Features:<br />
* Integrated EMR<br />
* Practice Management Software<br />
* Self-Service Patient Portal<br />
* Secure Medical Management Software<br />
* Web Based EMR Software<br />
<br />
Centricity EMR offers a broad range of embedded clinical content, plus the flexibility to design your own encounter forms, add content, and adapt the program to suit the way you work best:<br />
<br />
• Intelligent decision support tools built into your workflow bring critical information right to the point of care, facilitating informed treatment decisions<br />
• Automatic reminders alert you to needed tests or procedures to proactively manage care and avoid potential medical problems<br />
• ePrescribing can alert you to potential drug interactions and lets you offer added convenience to your patients<br />
• Powerful evaluation and management (E&M) advisor assists with coding accuracy<br />
• Robust tools for communicating with patients and giving them access to care information to increase patient satisfaction<br />
• Automated workflows and rapid documentation streamline repetitive tasks and instantly update patient charts<br />
<br />
== Centricity Practice Solution ==<br />
Centricity Practice Solution is one of the original two Centricity products.. It is a fully integrated electronic medical record (EMR) and practice management (PM) system for practices of all sizes. It is designed to enhance the clinical and financial productivity of ambulatory practices, is a certified complete and modular EHR under the 2014 edition criteria, and attests to Meaningful Use. It also has intuitive ICD-9 to ICD-10 mapping. It is prevalidated for Patient Centered Medical Homes (PCMHs)<br />
#EMR module<br />
#PM module<br />
<br />
== Centricity Perinatal == <br />
<br />
Centricity Perinatal is a clinical information system that integrates documentation and fetal surveillance to help healthcare organizations deliver their best care to every mother and baby. From Labor & Delivery to the nursery or NICU, our perinatal software interfaces with multiple devices and systems, including all major EMRs. In an environment where every second counts, it is important to use an established product. Centricity Perinatal is an intuitive system that has been used to deliver over 39 million babies.<br />
<br />
== References ==<br />
<br />
# GE Healthcare: Centricity Advance. https://www2.gehealthcare.com/portal/site/usen/ProductDetail/?vgnextoid=23738fdab5219210VgnVCM10000024dd1403RCRD&productid=03738fdab5219210VgnVCM10000024dd1403____<br />
# EMR, EHR, and Practice Management Software - Centricity Advance - GE Healthcare. http://www.gehealthcare.com/centricityadvance/<br />
# GE Healthcare Releases Centricity Advance - Mobile. http://www.genewscenter.com/content/detail.aspx?ReleaseID=12968&NewsAreaID=2<br />
# GE Healthcare Centricity Perinatal - http://www3.gehealthcare.com/en/Products/Categories/Healthcare_IT/Departmentals/Centricity_Perinatal<br />
<br />
== External links ==<br />
<br />
# GE Healthcare Newsroom http://newsroom.gehealthcare.com<br />
# GE Healthcare Centricity Perinatal - http://www3.gehealthcare.com/en/Products/Categories/Healthcare_IT/Departmentals/Centricity_Perinatal<br />
<br />
== References ==<br />
<br />
# GE Healthcare: Centricity Electronic Medical Record (EMR). [https://www2.gehealthcare.com/portal/site/usen/ProductDetail/?vgnextoid=5bb454fbded30210VgnVCM10000024dd1403RCRD&productid=4bb454fbded30210VgnVCM10000024dd1403____]<br />
# Centricity - Wikipedia. [http://en.wikipedia.org/wiki/Centricity]<br />
# Crawford, A.G., et al. [http://ca3cx5qj7w.search.serialssolutions.com/OpenURL_local?sid=Entrez:PubMed&id=pmid:20568974 Comparison of GE Centricity Electronic Medical Record<br />
# Database and National Ambulatory Medical Care Survey Findings on the Prevalence of Major Conditions in the United States].Population Health Management. 2010. 13: 139-150. <br />
# Brixner, D., Ghate, S. R., McAdam-Marx, C., Ben-Joseph, R., Said, Q. [http://onlinelibrary.wiley.com.ezproxyhost.library.tmc.edu/doi/10.1111/j.1463-1326.2007.00758.x/pdf Association Between Cardiometabolic Risk Factors and Body Mass Index Based on Diagnosis and Treatment Codesin an Electronic Medical Record Database]. Journal of Managed Care Pharmacy. 2008. 14: 756-767. <br />
# Asche, C. V., McAdam-Marx, C., Shane-McWhorter, L., Sheng, X., and Plauschinat, C. [http://www.amcp.org/data/jmcp/756-767.pdf Association between oral antidiabetic use, adverse events and outcomes in patients with type 2 diabetes]. Diabetes, Obesity and Metabolism 2007. 10: 638-645.</div>Mho2http://www.clinfowiki.org/wiki/index.php/CernerCerner2015-01-29T04:40:23Z<p>Mho2: </p>
<hr />
<div>Cerner’s mission: to contribute to the systemic improvement of health care delivery and the health of communities. <ref name="Cerner Form 10k">Cerner Corp, Form 10-K, Annual Report, Filing Date Feb 5, 2014. http://pdf.secdatabase.com/2355/0000804753-14-000006.pdf</ref> <br />
<br />
'''Cerner''' Corporation is a supplier of healthcare information technology (HCIT) solutions, services, devices and hardware. Cerner solutions optimize processes for healthcare organizations. <ref name="Cern.O">Cerner Corporation Company Profile. http://www.reuters.com/finance/stocks/companyProfile?rpc=66&symbol=CERN. </ref> Cerner solutions are licensed by approximately 14,000 facilities around the world, including more than 3,000 hospitals; 4,900 physician practices; 60,000 physicians; 590 ambulatory facilities, such as laboratories, ambulatory centers, behavioral health centers, cardiac facilities, radiology clinics and surgery centers; 3,500 extended care facilities; 150 employer sites and 1,790 retail pharmacies. <ref name="Cerner Form 10k"></ref> <br />
<br />
== Introduction ==<br />
<br />
In1979, inspired by a short consulting project for a medical lab, former Arthur Andersen information systems consultants Neal Patterson, Clifford Illig, and Paul Gorup broke away from Arthur Andersen to form Cerner. Cerner’s name stems from the Latin word cernere, translated as “to sift or understand.” <ref name="Strategic Report">Strategic Report for Cerner Corporation. http://economics-files.pomona.edu/jlikens/SeniorSeminars/oasis/reports/CERN.pdf </ref> <br />
<br />
Cerner is one of the leading global suppliers of healthcare information technology solutions. Around the world, health organizations ranging from single-doctor practices to entire countries turn to Cerner for our powerful yet intuitive solutions. Cerner offers clients a dedicated focus on healthcare, an end-to-end solution and service portfolio, and proven market leadership. <ref name="Corporate Profile">Corporate Profile. http://www.cerner.com/About_Cerner/Corporate_Profile/?LangType=3081 </ref> <br />
<br />
<br />
=== Locations ===<br />
<br />
Cerner is headquartered in Kansas City, Mo., neighbor of North Kansas City Hospital, Cerner's second hospital client. <ref name="Rand Study">Rand Study helps Cerner makes its case. http://www.bizjournals.com/kansascity/stories/2005/09/19/story1.html?page=all </ref> <br />
* 2005: Cerner acquired the Riverport Campus complex on the site of what was formerly the Sam's Town Casino above the Missouri River in North Kansas City, Missouri. <ref name="riverport">Riverport Campus Cerner Corporation. http://www.emporis.com/building/riverport-campus-cerner-corporation-inc-world-headquarters-in-north-kansas-city-mo-kansas-city-mo-usa </ref> <br />
* 2006: it also acquired the former Marion Laboratories complex in southeast Kansas City, Missouri, renaming the campus the Innovation Campus. <ref name="southcampus">Cerner Corporation South Campus Bldg. http://www.emporis.com/building/cerner-corporation-south-campus-bldg-i-kansas-city-mo-usa </ref><br />
* 2013: the company opened the first building in a new campus development located in Kansas City, Kan. The company calls this the Continuous Campus. <ref name="continuous campus">Cerner Continuous Campus. https://foursquare.com/v/cerner-continuous-campus/4f96d3b8e4b0ba85ae7a81c5 </ref><br />
* 2014: the company announced that it had begun a $4.45 billion campus construction project on the site of the former Bannister Mall in South Kansas City near the Innovation Campus. <ref name="bannister mall">Cerner breaks ground for its Trail Campus in South Texas. http://www.kansascity.com/news/business/development/article3845781.html </ref>The Kansas City Star reports, that the campus will have enough room to house up to 16,000 employees. <ref name="break ground"> Cerner breaks ground on planned Kansas City site. http://www.cerner.com/Cerner_breaks_ground_on_planned_Kansas_City_site/</ref><br />
<br />
Cerner maintains a handful of additional offices in the United States, as well as offices in the UK, Australia, UAE, Saudi Arabia, Egypt, Germany, France and several other countries outside the United States.<br />
<br />
=== Mission statement ===<br />
<br />
Cerner's Vision has 4 pillars:<br />
<br />
# Automate the Care Process to Eliminate Paper<br />
# Connect the Person by Providing Virtual Personal Health Systems<br />
# Structure, Store and Study the Evidence to Create New Knowledge<br />
# Close the Loop by Implementing Evidence-Based Care" <ref name="cerner annual report 2001">“Cerner Annual Report 2001” (March 2002) https://www.cerner.com/uploadedFiles/2001_Annual_Report.pdf</ref><br />
<br />
== From 1980s into the 90s ==<br />
<br />
By 1984, Cerner was ready to roll out its first application, the PathNet laboratory information system. PathNet provided a comprehensive information system for laboratory clinicians, allowing laboratories to automate their processes. PathNet, which grew to combine applications for general laboratory information, microbiology, blood bank transfusion and blood bank donation, and anatomic pathology, broke away not only from the traditional paper-based sharing of information, but also from the prevailing financial focus of data gathering systems. <ref name="history">Cerner Corporation History. http://www.fundinguniverse.com/company-histories/cerner-corporation-history/ </ref> <br />
<br />
In 1988, Cerner added the next component of its clinical management systems, RadNet, which focused on automating radiology department functions. The following year, pharmacy support was added with the PharmNet application. As with PathNet, each new component was based on the same application architecture, allowing applications to be seamlessly combined to share information across applications. <ref name="history"></ref> <br />
<br />
By 1990, more than 200 PathNet sites had been installed, solidifying Cerner's position as the leading maker of laboratory information systems. Cerner next moved to expand its product family beyond clinical management systems and into care management systems, with the introduction of its ProNet and CareNet products. ProNet provided automated support for patient management and registration, ordering, scheduling, and tracking processes. CareNet gave patient care planning, management, and measurement tools to nurses and other direct care providers. Care management was meant to play a central role in gathering information needed for the care process. With Cerner's care management tools, providers could more easily manage the many pieces of patient information, including demographic and financial data, health status, operations data such as treatment procedures and protocols, while linking this information to ordering, tracking, scheduling, and patient, case, and health records management. <ref name="history"></ref> <br />
<br />
By the end of 1993, Cerner had completed the largest part of its product family, with the 1992 introduction of its SurgiNet and Open Management Foundation (OMF) products, and the 1993 introduction of its MRNet product. SurgiNet, part of Cerner's clinical management product line, offered information management support for operating room teams. OMF extended Cerner's repository line with tools for supporting management analysis and decision-making based on process-related information. MRNet functioned to link the OCF and OMF products in automating the chart management process for the medical records department. <ref name="history"></ref> <br />
<br />
== Cerner EHR ==<br />
<br />
The founders created '''Cerner Millennium''', the industry's first person-centric integrated architecture. <ref name"cerner millennium">HP & Cerner http://h20338.www2.hp.com/enterprise/us/en/partners/cerner-millennium.html</ref> Cerner Millennium is a partnership of Cerner and HP. The architecture of Millennium allows caregivers and supporting providers the ability to view results, problems, diagnosis, medications, and other pertinent information in real-time as well as share clinical and management data across multiple disciplines and facilities. This architecture has been referred to as Health Network Architecture (HNA), providing 12 major system applications operating by this means, fitting into 4 interrelated groups <ref name="history"></ref>.<br />
<br />
In a continued effort to reduce waste and friction in healthcare, Cerner has developed many solutions including employee health, life sciences, medical devices, clinical trial management, and biosurveillance. In 2012, Cerner announced its acquisition of Anasazi Software Inc. to support continuity of mental health care through the combination of Anasazi’s established community behavioral health functionality with the in-patient behavioral health capabilities of Cerner Millennium. <ref name="cerner acquires Anasazi">Cerner to Acquire Anasazi Software, Inc. http://www.cerner.com/about_cerner/newsroom/Cerner_to_Acquire_Anasazi_Software_Inc/</ref> Also in 2012, Cerner announced the launch of Millennium + which combines the enterprise platform with the secure Cerner Cloud. <ref name="cerner millennium 2012">Cerner Announces Next Evolution of Cerner Millennium 2012 http://www.cerner.com/about_cerner/newsroom/cerner_announces_next_evolution_of_cerner_millennium/</ref><br />
<br />
=== Millenium+ ===<br />
<br />
In 2012, Cerner launched Millennium+, which uses the Cerner Cloud to provide a user experience that is “fast, smart and easy”, enabling caregivers to have personalized, intuitive and moment relevant clinical work flows via desktop, tablet or smartphone with minimal orientation to begin usage. <ref name="cerner millennium 2012"></ref> <br />
<br />
One of the solutions that was launched as part of the Millennium+ platform was PowerChart+Touch™. PowerChart+Touch as a mobile solution allows physicians to complete workflows directly from their mobile devices and was created specifically for the iPad. <ref name="powerchart touch">PowerChart Touch Wins National Acclaim for User Experience. http://www.cerner.com/PowerChart_Touch_Wins_National_Acclaim_for_User_Experience/</ref><br />
<br />
=== PowerChart ===<br />
<br />
Built upon the scalable, unified, person-centric Cerner Millennium® architecture, PowerChart® delivers the benefits of a clinical database, with functionality allowing you to view clinical data, complete orders and optimise clinician documentation in one powerful solution.<br />
<br />
The universal PowerChart framework can be leveraged across multiple roles, venues and disciplines, thereby driving efficiencies and user adoption. The solution provides a foundation for a multitude of Cerner point-of-care solutions, including those for home care, physician offices, clinics, acute patient care, critical care, and long-term and rehabilitation services.<br />
<br />
'''Key Benefits<br />
'''<br />
* Improve coordination and identification of patients<br />
* Positively impact cash flow<br />
* Access records at any time from any location<br />
* Optimize workflow efficiency and performance<br />
<br />
<ref name"PowerChart"> Cerner PowerChart. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/PowerChart/?LangType=3081</ref><br />
<br />
== FirstNet==<br />
<br />
FirstNet is Cerners emergency department documentation system. FirstNet tracking board allows physicians and staff to see their patient population and their location. The FirstNet tracking board is also customizable so you can see the information you need. FirstNet has a coding functionality that allows ERs to capturing all their physician charges correctly and for reimbursement. Patient education is also part of the FirstNet application so when a patient is discharge they can also receive education material related to their diagnosis or issue. <ref name="FirstNet">Cerner Emergency Department. https://store.cerner.com/hospitals_and_health_systems/emergency_department </ref><br />
<br />
== Finances ==<br />
<br />
With a total revenue $2.8B including $391M globally (Cerner Corporation 2013 Annual Report), organizations ranging from single-doctor practices to hospitals to corporations to local, regional, national and global government agencies and organizations use Cerner solutions. As of 2012, Cerner works with more than 9,300 facilities worldwide, including 2,650 hospitals, 3,750 physician practices and 500 ambulatory clinics <ref name"cerner excite"> Cerner EMR Solutions - An Overview. (May, 2012) Excite Health Partners</ref>. Associates span 7,300 worldwide with business in Argentina, Aruba, Canada, Cayman Islands, Chile, Puerto Rico, Saudi Arabia, Singapore, Spain and the United Arab Emirates. <ref name"cerner nyt"> Cerner Corporation" (September, 2013) New York Times Business Day</ref><br />
<br />
=== Siemens acquisition ===<br />
<br />
In a press release on August 5, 2014, Cerner Corporation announced that they would be acquiring Siemens Health Services for $1.3 billion. This acquisition will allow Cerner to provide health IT to 20,000 associates in more than 30 countries and 18,000 client facilities, greatly expanding their global presence. <ref name"cerner siemens"> Cerner to Acquire Siemens Health Services for $1.3 Billion” (August, 2014) Cerner News Release http://www.cerner.com/About_Cerner/Investor_Relations/News_Releases/</ref> This deal will increase Cerner's annual revenue form about 3 billion last year to more than 4.5 billion on annual revenue in 2014. <br />
<br />
Based on 2014 estimates, Cerner and Siemens Health Services have combined totals of more than: <ref name="cerner forbes siemens">Cerner To Buy Siemens Health IT Business For $1.3 Billion http://www.forbes.com/sites/matthewherper/2014/08/05/cerner-to-buy-siemens-health-it-business-for-1-3-billion/</ref><br />
<br />
* 20,000 associates in more than 30 countries<br />
* 18,000 client facilities, including some of the largest health care organizations in their respective countries<br />
* $4.5 billion of annual revenue<br />
* $650 million of annual R&D investment<br />
<br />
== Oracle ==<br />
<br />
The partnership between Cerner and Oracle helps to provide a number benefits to Cerner customers such as: <ref name="cerner oracle">http://www.cerner.com/About_Cerner/Partnerships/Oracle/, 2014)</ref><br />
<br />
* industry-leading scalability and reliability in both clustered and single system configurations<br />
* high performance<br />
* fault tolerance<br />
* heavy online processing loads<br />
* the ability to handle a large number of users<br />
<br />
Cerner Millennium applications use an Oracle database and provide a common data model to enable data sharing between applications and to eliminate redundant data, while maximizing reliability and performance. This implementation runs on a variety of networks, processors and operating systems, including Windows XP Professional and any Internet browser.[8] <br />
All Millennium installs take advantage of the full Oracle database stack (9iEE, RAC, and the Management Packs). Oracle’s Real Application Clustering (RAC) enables both reliability and scalability by allowing the addition of servers to the host cluster.<br />
<br />
Cerner also uses Oracle’s Tuning Pack, Diagnostic Pack, and Change Management Pack to help protect the integrity, confidentiality, and availability of its Millennium healthcare data. Oracle’s EAL 4 (Evaluation Assurance Level 4) rating also attests to its robust security. Additionally, Cerner's Remote Hosting Facility uses the full Oracle database stack (9iEE, RAC, and the Management Packs) as well and in an exclusive manner <ref name="cerner oracle">Oracle 2014 http://www.cerner.com/About_Cerner/Partnerships/Oracle/</ref><br />
<br />
[[Certification Commission for Health Information Technology (CCHIT)|Certification Commission for Health Information Technology (CCHIT)]] performs rigorous inspection of EHR's integrated functionality, interoperability, security and is intended to serve health care providers looking for maximum assurance that a product will meet their complex needs. These listed products have CCHIT Certification but have not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the [[ARRA|American Recovery and Reinvestment Act of 2009 (ARRA)]]: <br />
<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart 2007 (Expired January 22, 2011)<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart/PowerWorks EMR 2007.19 (Expired April 22, 2011). <ref name="history"></ref> <br />
<br />
=== Millennium Objects ===<br />
<br />
Clients can create custom applications on the Cerner Millennium architecture with MillenniumObjects. <ref name="cerner millennium objects"> MillenniumObjects http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/?LangType=3081</ref> MillenniumObjects utilizes Java and XML services for Application Programming Interfaces (API) development by client developers. MillenniumObjects can be used to create custom applications and additional features on existing processes. This allows the user to create a unique application tailored to their specific needs using data already present within Cerner Millennium. Third-party extensions are available to create new workflows.<br />
<br />
Benefits of Millennium Objects include:<br />
<br />
* Quickly create custom applications for your organization<br />
* Build upon the processes already in place for the maintenance of users, passwords, administration, etc. of the new application<br />
* Leverage the capabilities of third-party built extensions to create new workflows across applications<br />
<br />
<ref name="Benefits of Millennium Objects"> Benefits of Millennium Objects. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/</ref><br />
<br />
== St. John Sepsis Agent==<br />
<br />
Sepsis affects 750,000 patients per year in the United States alone. <ref name="st john sepsis">http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/st_john_sepsis_agent/</ref> It also states, nearly $17 billion annual healthcare expenditures in the U.S. goes to health problems associated with sepsis. <br />
<br />
However, studies show sepsis can be handled better if it is diagnosed in the first six hours after contracting germs. In order to make this detection as early as possible, Cerner now has come with a solution. St. John Sepsis Agent, created in co-operation with Methodist health care in Memphis, Tennessee speeds up early detection and diagnosis of sepsis.<br />
How the system works?<br />
<br />
It gathers information from different sources such as: physician practices, ambulances, emergency department ,lab results and patient electronic health record’s vital signs.The integrated system analyzes all the information gathered from the above sources which includes Glucose level, Respiratory rate, Temperature, Heat rate, and Lab results. An alert fires when the system finds three out of range criteria. Then the agent sends a message to the hospital’s clinical team which reviews the data and begins the appropriate treatment.<br />
<br />
In addition to the alert, there are enhancements that complement St John’s Sepsis Agent. One of such is The Millennium Light house. This program includes sepsis management power plan with orders for intravenous fluid, diagnostic tests and an empiric therapy adviser. This adviser guide clinicians to a variety of treatment option based on the source of infection.The agent offering also includes Significant Events mpage component which provides up front view of the patient’s most recent lab results, vital signs and significant treatment event. <ref name="cerner youtube sepsis">Youtube: Cerner Sepsis Program https://www.youtube.com/watch?v=_-P6DZos9UU</ref><br />
<br />
Finally, to follow up cases of sepsis, Cerner offers the Sepsis Confirmation Power form which is designed to use by organization’s quality officers during case review and quality reporting. <ref name="st john sepsis"></ref> Reports show using the St. John Sepsis Agent can improve healthcare organizations in the following ways:<br />
<br />
* 24 percent reduction in in-hospital patient mortality rate.<br />
* 21 percent reduction in length of stay.<br />
* $5,882 medical savings per treated patient.<br />
<br />
== Acute care Electronic Medical Record==<br />
<br />
The Cerner electronic medical record (EMR) is an integrated database that provides a comprehensive set of capabilities with the following key benefits:<br />
1.Improve patient care as clinicians can focus on the patient’s overall health and not just the encounter<br />
2. Increase efficiency by placing real-time, updated information with the care team in time to make fast and effective decisions<br />
3. Increase access to information from multiple venues in the health system. <ref name="acute care">Acute Care Electronic Medical Record. https://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/</ref> <br />
<br />
The EMR was created to allow healthcare professionals to electronically store, capture and access patient health information in both the acute and ambulatory care setting. It allows the users to provide real-time access to patient results and clinical information across care disciplines, enable that healthcare organizations meet The Joint Commission requirements for patient confidentiality, access patient information securely from wherever and whenever it is most convenient for the care team. <ref name="acute care"></ref> <br />
<br />
<br />
== Cerner Laboratory solution==<br />
<br />
The PathNet laboratory information system delivers to clinicians a comprehensive and fully integrated technology that covers both the managerial and the operational sides of the laboratory. <ref name="cerner laboratory">Laboratory http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Laboratory/</ref> The system operates on the unified Cerner Millennium architecture. As a result, information links seamlessly with the patient's electronic medical record. PathNet serves the needs of different sections under pathology departments umbrella such as Blood Science, Microbiology, Cellular Pathology and Blood Transfusion functions. The technology has a capability to store, retrieved and disseminated patient specific information to and from health care system. Aside from that, the system is continually updated based on national standards and guidelines. Reports enumerates the different kinds of benefits PathNet® laboratory information system provides. Some are: it has a capability to process large quantities of specimens efficiently with minimal error possible. It integrates lab results with patent's EMR which allows the availability of full patient records on the EMR. Finally it ensures the rapid availability of patent results to care providers. <br />
<br />
== Device Connectivity==<br />
<br />
Medical devices contain critical health information reports a Cerner’s website, However, it can be a challenge to get that information into the care giver’s hand. As a result Cerner come up with medical device connectivity solution which alleviate this challenge. The company implemented the CareAware iBus, a core component of the CareAware connectivity architecture which acts as a USB for health care devices. In doing so, the solution connects medical devices with EMR enabling two-way communication between the two systems. This solution improves care by allowing care providers to focus on patients rather than paper work and data entry associated with it. <br />
<ref name="cerner solutions">Healthcare Devices http://www.cerner.com/solutions/Healthcare_Devices/?langtype=3081&WT.mc_id=audevice</ref><br />
<br />
== Integrating medical calculators into the EHR==<br />
<br />
Medical calculators integrated in EHR are invaluable assists for care providers, reports a Cerner website. In order to address this need, a group of physicians at Cerner started to work on integrated medical calculator solutions. In order, to accomplish that they partnered with MedCalc300. As a result, this new solution provides all Cerner clients access to more than 600 calculators, clinical criteria and decision trees. To name one example of such clinical calculator is Apgar score for determining the well being of a new born. <br />
<ref name="cerner med calculators">Integrating medical calculators into the EHR http://www.cerner.com/blog/integrating_medical_calculators_into_the_ehr/?langtype=1033</ref><br />
<br />
==HealthLife==<br />
<br />
Cerners patient portal was designed to help patients become more actively involved in their healthcare. Individuals will have greater access to their health information than ever before using a variety of access tools including laptops, tablets and other mobile devices. This new design will enable patients to: <ref name=" HealtheLife">Cerner HealtheLife. http://www.cerner.com/solutions/individuals_and_families/cerner_patient_services/ </ref><br />
<br />
* Schedule or reschedule or cancel appointments<br />
* Make payments or view their medical fees<br />
* View their health information and download their data<br />
* Send information to their healthcare team thru secure messaging<br />
* Fill prescriptions<br />
<br />
Providers will be able to:<br />
<br />
* send their patients reminders<br />
* share the patients lab or diagnostic results<br />
* attach documents concerning education or patient care<br />
* send registration forms for patient to complete<br />
<br />
== LearningLive == <br />
<br />
LearningLIVE is a new eLearning solution designed to deliver training closer to the point-of-care and support continuous learning in the healthcare environment. Available within PowerChart, FirstNet, and INet, LearningLIVE offers clinicians relevant learning resources in the context of their workflow.<br />
<br />
The simple and flexible design facilitates dynamic delivery and real-time updates. A reporting dashboard allows your organization to track learning activity and user performance, and leverage the data to target training and drive user adoption.<br />
<br />
In addition to the creation of customized learning assets, LearningLIVE comes with twenty two standard assets that support Meaningful Use requirements. The pre-built assets are categorized according to the requirement they support and facilitate training for Meaningful Use.<br />
<br />
Client Benefits:<br />
<br />
Allows clinicians to access learning resources and apply knowledge at the point-of-need.<br />
Enables educators to deliver dynamic learning content and communications.<br />
Provides hospital administrators key learning and performance metrics.<br />
Key Features<br />
<br />
The LearningLIVE solution offers:<br />
<br />
Relevant, on-demand learning resources in the context of clinical workflow.<br />
Reporting dashboard with a comprehensive view of learning activity and user performance.<br />
Simple and flexible design to facilitate dynamic delivery and real-time updates.<br />
Pre-built assets targeted towards meeting Meaningful Use objectives<br />
<br />
<ref name="LearningLive">Cerner LearningLive. https://store.cerner.com/items/319</ref><br />
<br />
==HealtheIntent==<br />
This is one of Cerners newest cloud based platforms to address the needs of population health while looking at the health outcomes of an individual. This cloud-based platform enables health care systems to aggregate, transform and reconcile data across the continuum of care. A longitudinal record is established, through that process, for individual members of the population that the organization is held accountable for; helping to improve outcomes and lower costs for health and care. <ref name= "HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent/ Cerner HealtheIntent </ref><br />
<br />
[http://www.cerner.com/solutions/population_health/ Population Health Management] solution is enabled with the HealtheIntent platform. Physicians will be able to use the tools and programs to address individual patients or a group. This solution will allow physicians to know their population, engage their patients and evaluate patient and population outcomes.<br />
<br />
[http://www.cerner.com/solutions/member_engagement/cerner_wellness/ Cerner Wellness] solution is designed to assist patients through their continuity of care with resources and tools to engage and motivate them towards healthy lifestyle improvements, managing their medical conditions and enhance their knowledge base.<br />
<ref name="HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent</ref><br />
<br />
== CareAware AlertLink ==<br />
<br />
In today's health care environment, devices sound many alarms, some of which are informational, some of which are life critical. Nurses often have to rely on proximity to a nurse's station or a patient’s room to ensure an alarm is heard. This can result in delays in responding to life-critical alerts. The problem is amplified when there are high volumes of alarms and only a small number of them requiring life-critical immediate response.<br />
<br />
AlertLink provides an alternative. Patient monitors are connected to a network and every alarm they produce is captured by AlertLink. A small percentage of those alarms are considered life critical and can be forwarded to a caregiver’s mobile device, such as a phone.<br />
<br />
At the beginning of a shift, a nurse uses the solution to create a connection with his or her phone by scanning an ID badge and phone. Once the nurse connects the phone to the network, he or she can receive alerts, accept notifications and take action. If the nurse is unable to respond to the event, he or she can press “decline” on the phone to immediately forward the alert to the next caregiver, a feature that ultimately improves response times for patients.<br />
<br />
CareAware AlertLink system saves time for nurses through improved alert escalation. It also gives administrators better insight into nurse workload by capturing the acceptance and rejection of alerts. The improved ability to monitor facilities and staff gives your organization the opportunity to lower costs.<br />
<br />
<ref name="CareAwareAlertLink">Cerner CareAware AlertLink. https://store.cerner.com/items/154</ref><br />
<br />
==Partnerships==<br />
<br />
Every potential partnership is evaluated for the opportunity for collaboration and innovation in order to serve clients’ health care needs. Cerner has partners in the following areas:<br />
<br />
* Medical Device Integration and Connectivity<br />
* Business Continuity<br />
* Caregiver Experience<br />
* Document Management and Imaging<br />
* HotSpot Dictation<br />
* Operational and System Management<br />
* Preferred Suppliers<br />
* Security and Administration<br />
<br />
<ref name="Cerner Partnerships">Cerner Partnerships. http://www.cerner.com/About_Cerner/Partnerships/</ref><br />
<br />
Cerner has also partnered with CommonWell and will provide it to their clients for free until January 1, 2018. CommonWell will work with Cerner to exchange patient records safely and securely at the right time with any of the CommonWell parnters. <br />
<br />
<ref name="CommonWell">Cerner Blog. http://www.cerner.com/blog/Cerner_is_Providing_CommonWell_Services_Free_for_Three_Years/?langtype=1033/</ref><br />
<br />
==Virtual Community==<br />
<br />
=== Cerner and Second Life ===<br />
<br />
Cerner has established a virtual healthcare environment to represent its 25-year vision. The environment includes numerous venues, such as a hospital, clinic, pharmacy, and more. Within the venues are areas where individuals can interact to learn about Cerner’s solutions. The virtual environment acknowledges education and affiliation among clients and supports Cerner’s vision for the future of healthcare. Virtual characters, known as avatars, will guide you through the environment where you can participate in the following:<br />
<br />
* View and interact with Smart Room technologies such as myStation and iAware, to learn about them in real life<br />
* Experience how clinicians view real-time data from the care team and medical devices in the medical intensive care unit<br />
* Witness how Cerner’s solutions enable patients to connect with the care team<br />
* Collaborate and share knowledge with other individuals in Second Life<br />
<br />
=== What is Second Life? ===<br />
<br />
Launched in 2003, Second Life is a virtual world that creates a user-defined environment where people can interact, conduct business and exchange ideas. Second Life is used in many large corporations such as IBM, Intel and Microsoft to collaborate, share product knowledge and network. Additionally, many leading universities and school systems use Second Life in their educational programs to familiarize students with benefits of virtual worlds, connect them with others and provide instructional simulations. <ref name="Cerner Virtual Community">Cerner Virtual Community. http://www.cerner.com/About_Cerner/Cerner_Virtual_Community/</ref><br />
<br />
== Awards ==<br />
<br />
• UX Award, 2013, Best Clinical Health Care Experience, Powerchart Touch <ref name="powertouch">2013 UX Awards. http://userexperienceawards.com/ux-awards-2013-winners/#powerchart/ </ref><br />
<br />
• Information Week Elite100, 2014, <ref name="infoweek">Cerner clients recognized as elite and innovative users of IT. http://www.cerner.com/blog/cerner_clients_recognized_as_elite_innovative_users_of_it/?langtype=1033 </ref> <br />
<br />
• Most Innovative Companies, 2014 <ref name="forbes">The World’s Most Innovative Companies List. http://www.forbes.com/innovative-companies/list/ </ref><br />
<br />
• Best in KLAS award for Application Hosting (CIS/ERP/HIS) 2013 <ref name="klas">Cerner : Best in KLAS Awards: Software and Services. http://www.4-traders.com/CERNER-CORPORATION-8744/news/Cerner--Best-in-KLAS-Awards-Software-and-Services-18576417/ </ref><br />
<br />
• One of The 10 Most Competitive Technology Companies of 2013 <ref name="competitive">10 Most Competitive Tech Companies in the World. http://outthinker.com/outthinkerblog/?p=59/ </ref><br />
<br />
• Healthcare Informatics 100 Ranking <ref name= "Healthcare Informatics">Cerner recognized as No. 2 for 2014.http://www.healthcare-informatics.com/hci100/2014-hci-100-list/ </ref><br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
<br />
<br />
<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/CernerCerner2015-01-29T04:33:57Z<p>Mho2: /* LearningLive */</p>
<hr />
<div>Cerner’s mission: to contribute to the systemic improvement of health care delivery and the health of communities. <ref name="Cerner Form 10k">Cerner Corp, Form 10-K, Annual Report, Filing Date Feb 5, 2014. http://pdf.secdatabase.com/2355/0000804753-14-000006.pdf</ref> <br />
<br />
'''Cerner''' Corporation is a supplier of healthcare information technology (HCIT) solutions, services, devices and hardware. Cerner solutions optimize processes for healthcare organizations. <ref name="Cern.O">Cerner Corporation Company Profile. http://www.reuters.com/finance/stocks/companyProfile?rpc=66&symbol=CERN. </ref> Cerner solutions are licensed by approximately 14,000 facilities around the world, including more than 3,000 hospitals; 4,900 physician practices; 60,000 physicians; 590 ambulatory facilities, such as laboratories, ambulatory centers, behavioral health centers, cardiac facilities, radiology clinics and surgery centers; 3,500 extended care facilities; 150 employer sites and 1,790 retail pharmacies. <ref name="Cerner Form 10k"></ref> <br />
<br />
== Introduction ==<br />
<br />
In1979, inspired by a short consulting project for a medical lab, former Arthur Andersen information systems consultants Neal Patterson, Clifford Illig, and Paul Gorup broke away from Arthur Andersen to form Cerner. Cerner’s name stems from the Latin word cernere, translated as “to sift or understand.” <ref name="Strategic Report">Strategic Report for Cerner Corporation. http://economics-files.pomona.edu/jlikens/SeniorSeminars/oasis/reports/CERN.pdf </ref> <br />
<br />
Cerner is one of the leading global suppliers of healthcare information technology solutions. Around the world, health organizations ranging from single-doctor practices to entire countries turn to Cerner for our powerful yet intuitive solutions. Cerner offers clients a dedicated focus on healthcare, an end-to-end solution and service portfolio, and proven market leadership. <ref name="Corporate Profile">Corporate Profile. http://www.cerner.com/About_Cerner/Corporate_Profile/?LangType=3081 </ref> <br />
<br />
<br />
=== Locations ===<br />
<br />
Cerner is headquartered in Kansas City, Mo., neighbor of North Kansas City Hospital, Cerner's second hospital client. <ref name="Rand Study">Rand Study helps Cerner makes its case. http://www.bizjournals.com/kansascity/stories/2005/09/19/story1.html?page=all </ref> <br />
* 2005: Cerner acquired the Riverport Campus complex on the site of what was formerly the Sam's Town Casino above the Missouri River in North Kansas City, Missouri. <ref name="riverport">Riverport Campus Cerner Corporation. http://www.emporis.com/building/riverport-campus-cerner-corporation-inc-world-headquarters-in-north-kansas-city-mo-kansas-city-mo-usa </ref> <br />
* 2006: it also acquired the former Marion Laboratories complex in southeast Kansas City, Missouri, renaming the campus the Innovation Campus. <ref name="southcampus">Cerner Corporation South Campus Bldg. http://www.emporis.com/building/cerner-corporation-south-campus-bldg-i-kansas-city-mo-usa </ref><br />
* 2013: the company opened the first building in a new campus development located in Kansas City, Kan. The company calls this the Continuous Campus. <ref name="continuous campus">Cerner Continuous Campus. https://foursquare.com/v/cerner-continuous-campus/4f96d3b8e4b0ba85ae7a81c5 </ref><br />
* 2014: the company announced that it had begun a $4.45 billion campus construction project on the site of the former Bannister Mall in South Kansas City near the Innovation Campus. <ref name="bannister mall">Cerner breaks ground for its Trail Campus in South Texas. http://www.kansascity.com/news/business/development/article3845781.html </ref>The Kansas City Star reports, that the campus will have enough room to house up to 16,000 employees. <ref name="break ground"> Cerner breaks ground on planned Kansas City site. http://www.cerner.com/Cerner_breaks_ground_on_planned_Kansas_City_site/</ref><br />
<br />
Cerner maintains a handful of additional offices in the United States, as well as offices in the UK, Australia, UAE, Saudi Arabia, Egypt, Germany, France and several other countries outside the United States.<br />
<br />
=== Mission statement ===<br />
<br />
Cerner's Vision has 4 pillars:<br />
<br />
# Automate the Care Process to Eliminate Paper<br />
# Connect the Person by Providing Virtual Personal Health Systems<br />
# Structure, Store and Study the Evidence to Create New Knowledge<br />
# Close the Loop by Implementing Evidence-Based Care" <ref name="cerner annual report 2001">“Cerner Annual Report 2001” (March 2002) https://www.cerner.com/uploadedFiles/2001_Annual_Report.pdf</ref><br />
<br />
== From 1980s into the 90s ==<br />
<br />
By 1984, Cerner was ready to roll out its first application, the PathNet laboratory information system. PathNet provided a comprehensive information system for laboratory clinicians, allowing laboratories to automate their processes. PathNet, which grew to combine applications for general laboratory information, microbiology, blood bank transfusion and blood bank donation, and anatomic pathology, broke away not only from the traditional paper-based sharing of information, but also from the prevailing financial focus of data gathering systems. <ref name="history">Cerner Corporation History. http://www.fundinguniverse.com/company-histories/cerner-corporation-history/ </ref> <br />
<br />
In 1988, Cerner added the next component of its clinical management systems, RadNet, which focused on automating radiology department functions. The following year, pharmacy support was added with the PharmNet application. As with PathNet, each new component was based on the same application architecture, allowing applications to be seamlessly combined to share information across applications. <ref name="history"></ref> <br />
<br />
By 1990, more than 200 PathNet sites had been installed, solidifying Cerner's position as the leading maker of laboratory information systems. Cerner next moved to expand its product family beyond clinical management systems and into care management systems, with the introduction of its ProNet and CareNet products. ProNet provided automated support for patient management and registration, ordering, scheduling, and tracking processes. CareNet gave patient care planning, management, and measurement tools to nurses and other direct care providers. Care management was meant to play a central role in gathering information needed for the care process. With Cerner's care management tools, providers could more easily manage the many pieces of patient information, including demographic and financial data, health status, operations data such as treatment procedures and protocols, while linking this information to ordering, tracking, scheduling, and patient, case, and health records management. <ref name="history"></ref> <br />
<br />
By the end of 1993, Cerner had completed the largest part of its product family, with the 1992 introduction of its SurgiNet and Open Management Foundation (OMF) products, and the 1993 introduction of its MRNet product. SurgiNet, part of Cerner's clinical management product line, offered information management support for operating room teams. OMF extended Cerner's repository line with tools for supporting management analysis and decision-making based on process-related information. MRNet functioned to link the OCF and OMF products in automating the chart management process for the medical records department. <ref name="history"></ref> <br />
<br />
== Cerner EHR ==<br />
<br />
The founders created '''Cerner Millennium''', the industry's first person-centric integrated architecture. <ref name"cerner millennium">HP & Cerner http://h20338.www2.hp.com/enterprise/us/en/partners/cerner-millennium.html</ref> Cerner Millennium is a partnership of Cerner and HP. The architecture of Millennium allows caregivers and supporting providers the ability to view results, problems, diagnosis, medications, and other pertinent information in real-time as well as share clinical and management data across multiple disciplines and facilities. This architecture has been referred to as Health Network Architecture (HNA), providing 12 major system applications operating by this means, fitting into 4 interrelated groups <ref name="history"></ref>.<br />
<br />
In a continued effort to reduce waste and friction in healthcare, Cerner has developed many solutions including employee health, life sciences, medical devices, clinical trial management, and biosurveillance. In 2012, Cerner announced its acquisition of Anasazi Software Inc. to support continuity of mental health care through the combination of Anasazi’s established community behavioral health functionality with the in-patient behavioral health capabilities of Cerner Millennium. <ref name="cerner acquires Anasazi">Cerner to Acquire Anasazi Software, Inc. http://www.cerner.com/about_cerner/newsroom/Cerner_to_Acquire_Anasazi_Software_Inc/</ref> Also in 2012, Cerner announced the launch of Millennium + which combines the enterprise platform with the secure Cerner Cloud. <ref name="cerner millennium 2012">Cerner Announces Next Evolution of Cerner Millennium 2012 http://www.cerner.com/about_cerner/newsroom/cerner_announces_next_evolution_of_cerner_millennium/</ref><br />
<br />
=== Millenium+ ===<br />
<br />
In 2012, Cerner launched Millennium+, which uses the Cerner Cloud to provide a user experience that is “fast, smart and easy”, enabling caregivers to have personalized, intuitive and moment relevant clinical work flows via desktop, tablet or smartphone with minimal orientation to begin usage. <ref name="cerner millennium 2012"></ref> <br />
<br />
One of the solutions that was launched as part of the Millennium+ platform was PowerChart+Touch™. PowerChart+Touch as a mobile solution allows physicians to complete workflows directly from their mobile devices and was created specifically for the iPad. <ref name="powerchart touch">PowerChart Touch Wins National Acclaim for User Experience. http://www.cerner.com/PowerChart_Touch_Wins_National_Acclaim_for_User_Experience/</ref><br />
<br />
=== PowerChart ===<br />
<br />
Built upon the scalable, unified, person-centric Cerner Millennium® architecture, PowerChart® delivers the benefits of a clinical database, with functionality allowing you to view clinical data, complete orders and optimise clinician documentation in one powerful solution.<br />
<br />
The universal PowerChart framework can be leveraged across multiple roles, venues and disciplines, thereby driving efficiencies and user adoption. The solution provides a foundation for a multitude of Cerner point-of-care solutions, including those for home care, physician offices, clinics, acute patient care, critical care, and long-term and rehabilitation services.<br />
<br />
'''Key Benefits<br />
'''<br />
* Improve coordination and identification of patients<br />
* Positively impact cash flow<br />
* Access records at any time from any location<br />
* Optimize workflow efficiency and performance<br />
<br />
<ref name"PowerChart"> Cerner PowerChart. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/PowerChart/?LangType=3081</ref><br />
<br />
== FirstNet==<br />
<br />
FirstNet is Cerners emergency department documentation system. FirstNet tracking board allows physicians and staff to see their patient population and their location. The FirstNet tracking board is also customizable so you can see the information you need. FirstNet has a coding functionality that allows ERs to capturing all their physician charges correctly and for reimbursement. Patient education is also part of the FirstNet application so when a patient is discharge they can also receive education material related to their diagnosis or issue. <ref name="FirstNet">Cerner Emergency Department. https://store.cerner.com/hospitals_and_health_systems/emergency_department </ref><br />
<br />
== Finances ==<br />
<br />
With a total revenue $2.8B including $391M globally (Cerner Corporation 2013 Annual Report), organizations ranging from single-doctor practices to hospitals to corporations to local, regional, national and global government agencies and organizations use Cerner solutions. As of 2012, Cerner works with more than 9,300 facilities worldwide, including 2,650 hospitals, 3,750 physician practices and 500 ambulatory clinics <ref name"cerner excite"> Cerner EMR Solutions - An Overview. (May, 2012) Excite Health Partners</ref>. Associates span 7,300 worldwide with business in Argentina, Aruba, Canada, Cayman Islands, Chile, Puerto Rico, Saudi Arabia, Singapore, Spain and the United Arab Emirates. <ref name"cerner nyt"> Cerner Corporation" (September, 2013) New York Times Business Day</ref><br />
<br />
=== Siemens acquisition ===<br />
<br />
In a press release on August 5, 2014, Cerner Corporation announced that they would be acquiring Siemens Health Services for $1.3 billion. This acquisition will allow Cerner to provide health IT to 20,000 associates in more than 30 countries and 18,000 client facilities, greatly expanding their global presence. <ref name"cerner siemens"> Cerner to Acquire Siemens Health Services for $1.3 Billion” (August, 2014) Cerner News Release http://www.cerner.com/About_Cerner/Investor_Relations/News_Releases/</ref> This deal will increase Cerner's annual revenue form about 3 billion last year to more than 4.5 billion on annual revenue in 2014. <br />
<br />
Based on 2014 estimates, Cerner and Siemens Health Services have combined totals of more than: <ref name="cerner forbes siemens">Cerner To Buy Siemens Health IT Business For $1.3 Billion http://www.forbes.com/sites/matthewherper/2014/08/05/cerner-to-buy-siemens-health-it-business-for-1-3-billion/</ref><br />
<br />
* 20,000 associates in more than 30 countries<br />
* 18,000 client facilities, including some of the largest health care organizations in their respective countries<br />
* $4.5 billion of annual revenue<br />
* $650 million of annual R&D investment<br />
<br />
== Oracle ==<br />
<br />
The partnership between Cerner and Oracle helps to provide a number benefits to Cerner customers such as: <ref name="cerner oracle">http://www.cerner.com/About_Cerner/Partnerships/Oracle/, 2014)</ref><br />
<br />
* industry-leading scalability and reliability in both clustered and single system configurations<br />
* high performance<br />
* fault tolerance<br />
* heavy online processing loads<br />
* the ability to handle a large number of users<br />
<br />
Cerner Millennium applications use an Oracle database and provide a common data model to enable data sharing between applications and to eliminate redundant data, while maximizing reliability and performance. This implementation runs on a variety of networks, processors and operating systems, including Windows XP Professional and any Internet browser.[8] <br />
All Millennium installs take advantage of the full Oracle database stack (9iEE, RAC, and the Management Packs). Oracle’s Real Application Clustering (RAC) enables both reliability and scalability by allowing the addition of servers to the host cluster.<br />
<br />
Cerner also uses Oracle’s Tuning Pack, Diagnostic Pack, and Change Management Pack to help protect the integrity, confidentiality, and availability of its Millennium healthcare data. Oracle’s EAL 4 (Evaluation Assurance Level 4) rating also attests to its robust security. Additionally, Cerner's Remote Hosting Facility uses the full Oracle database stack (9iEE, RAC, and the Management Packs) as well and in an exclusive manner <ref name="cerner oracle">Oracle 2014 http://www.cerner.com/About_Cerner/Partnerships/Oracle/</ref><br />
<br />
[[Certification Commission for Health Information Technology (CCHIT)|Certification Commission for Health Information Technology (CCHIT)]] performs rigorous inspection of EHR's integrated functionality, interoperability, security and is intended to serve health care providers looking for maximum assurance that a product will meet their complex needs. These listed products have CCHIT Certification but have not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the [[ARRA|American Recovery and Reinvestment Act of 2009 (ARRA)]]: <br />
<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart 2007 (Expired January 22, 2011)<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart/PowerWorks EMR 2007.19 (Expired April 22, 2011). <ref name="history"></ref> <br />
<br />
=== Millennium Objects ===<br />
<br />
Clients can create custom applications on the Cerner Millennium architecture with MillenniumObjects. <ref name="cerner millennium objects"> MillenniumObjects http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/?LangType=3081</ref> MillenniumObjects utilizes Java and XML services for Application Programming Interfaces (API) development by client developers. MillenniumObjects can be used to create custom applications and additional features on existing processes. This allows the user to create a unique application tailored to their specific needs using data already present within Cerner Millennium. Third-party extensions are available to create new workflows.<br />
<br />
Benefits of Millennium Objects include:<br />
<br />
* Quickly create custom applications for your organization<br />
* Build upon the processes already in place for the maintenance of users, passwords, administration, etc. of the new application<br />
* Leverage the capabilities of third-party built extensions to create new workflows across applications<br />
<br />
<ref name="Benefits of Millennium Objects"> Benefits of Millennium Objects. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/</ref><br />
<br />
== St. John Sepsis Agent==<br />
<br />
Sepsis affects 750,000 patients per year in the United States alone. <ref name="st john sepsis">http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/st_john_sepsis_agent/</ref> It also states, nearly $17 billion annual healthcare expenditures in the U.S. goes to health problems associated with sepsis. <br />
<br />
However, studies show sepsis can be handled better if it is diagnosed in the first six hours after contracting germs. In order to make this detection as early as possible, Cerner now has come with a solution. St. John Sepsis Agent, created in co-operation with Methodist health care in Memphis, Tennessee speeds up early detection and diagnosis of sepsis.<br />
How the system works?<br />
<br />
It gathers information from different sources such as: physician practices, ambulances, emergency department ,lab results and patient electronic health record’s vital signs.The integrated system analyzes all the information gathered from the above sources which includes Glucose level, Respiratory rate, Temperature, Heat rate, and Lab results. An alert fires when the system finds three out of range criteria. Then the agent sends a message to the hospital’s clinical team which reviews the data and begins the appropriate treatment.<br />
<br />
In addition to the alert, there are enhancements that complement St John’s Sepsis Agent. One of such is The Millennium Light house. This program includes sepsis management power plan with orders for intravenous fluid, diagnostic tests and an empiric therapy adviser. This adviser guide clinicians to a variety of treatment option based on the source of infection.The agent offering also includes Significant Events mpage component which provides up front view of the patient’s most recent lab results, vital signs and significant treatment event. <ref name="cerner youtube sepsis">Youtube: Cerner Sepsis Program https://www.youtube.com/watch?v=_-P6DZos9UU</ref><br />
<br />
Finally, to follow up cases of sepsis, Cerner offers the Sepsis Confirmation Power form which is designed to use by organization’s quality officers during case review and quality reporting. <ref name="st john sepsis"></ref> Reports show using the St. John Sepsis Agent can improve healthcare organizations in the following ways:<br />
<br />
* 24 percent reduction in in-hospital patient mortality rate.<br />
* 21 percent reduction in length of stay.<br />
* $5,882 medical savings per treated patient.<br />
<br />
== Acute care Electronic Medical Record==<br />
<br />
The Cerner electronic medical record (EMR) is an integrated database that provides a comprehensive set of capabilities with the following key benefits:<br />
1.Improve patient care as clinicians can focus on the patient’s overall health and not just the encounter<br />
2. Increase efficiency by placing real-time, updated information with the care team in time to make fast and effective decisions<br />
3. Increase access to information from multiple venues in the health system. <ref name="acute care">Acute Care Electronic Medical Record. https://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/</ref> <br />
<br />
The EMR was created to allow healthcare professionals to electronically store, capture and access patient health information in both the acute and ambulatory care setting. It allows the users to provide real-time access to patient results and clinical information across care disciplines, enable that healthcare organizations meet The Joint Commission requirements for patient confidentiality, access patient information securely from wherever and whenever it is most convenient for the care team. <ref name="acute care"></ref> <br />
<br />
<br />
== Cerner Laboratory solution==<br />
<br />
The PathNet laboratory information system delivers to clinicians a comprehensive and fully integrated technology that covers both the managerial and the operational sides of the laboratory. <ref name="cerner laboratory">Laboratory http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Laboratory/</ref> The system operates on the unified Cerner Millennium architecture. As a result, information links seamlessly with the patient's electronic medical record. PathNet serves the needs of different sections under pathology departments umbrella such as Blood Science, Microbiology, Cellular Pathology and Blood Transfusion functions. The technology has a capability to store, retrieved and disseminated patient specific information to and from health care system. Aside from that, the system is continually updated based on national standards and guidelines. Reports enumerates the different kinds of benefits PathNet® laboratory information system provides. Some are: it has a capability to process large quantities of specimens efficiently with minimal error possible. It integrates lab results with patent's EMR which allows the availability of full patient records on the EMR. Finally it ensures the rapid availability of patent results to care providers. <br />
<br />
== Device Connectivity==<br />
<br />
Medical devices contain critical health information reports a Cerner’s website, However, it can be a challenge to get that information into the care giver’s hand. As a result Cerner come up with medical device connectivity solution which alleviate this challenge. The company implemented the CareAware iBus, a core component of the CareAware connectivity architecture which acts as a USB for health care devices. In doing so, the solution connects medical devices with EMR enabling two-way communication between the two systems. This solution improves care by allowing care providers to focus on patients rather than paper work and data entry associated with it. <br />
<ref name="cerner solutions">Healthcare Devices http://www.cerner.com/solutions/Healthcare_Devices/?langtype=3081&WT.mc_id=audevice</ref><br />
<br />
== Integrating medical calculators into the EHR==<br />
<br />
Medical calculators integrated in EHR are invaluable assists for care providers, reports a Cerner website. In order to address this need, a group of physicians at Cerner started to work on integrated medical calculator solutions. In order, to accomplish that they partnered with MedCalc300. As a result, this new solution provides all Cerner clients access to more than 600 calculators, clinical criteria and decision trees. To name one example of such clinical calculator is Apgar score for determining the well being of a new born. <br />
<ref name="cerner med calculators">Integrating medical calculators into the EHR http://www.cerner.com/blog/integrating_medical_calculators_into_the_ehr/?langtype=1033</ref><br />
<br />
==HealthLife==<br />
<br />
Cerners patient portal was designed to help patients become more actively involved in their healthcare. Individuals will have greater access to their health information than ever before using a variety of access tools including laptops, tablets and other mobile devices. This new design will enable patients to: <ref name=" HealtheLife">Cerner HealtheLife. http://www.cerner.com/solutions/individuals_and_families/cerner_patient_services/ </ref><br />
<br />
* Schedule or reschedule or cancel appointments<br />
* Make payments or view their medical fees<br />
* View their health information and download their data<br />
* Send information to their healthcare team thru secure messaging<br />
* Fill prescriptions<br />
<br />
Providers will be able to:<br />
<br />
* send their patients reminders<br />
* share the patients lab or diagnostic results<br />
* attach documents concerning education or patient care<br />
* send registration forms for patient to complete<br />
<br />
== LearningLive == <br />
<br />
LearningLIVE is a new eLearning solution designed to deliver training closer to the point-of-care and support continuous learning in the healthcare environment. Available within PowerChart, FirstNet, and INet, LearningLIVE offers clinicians relevant learning resources in the context of their workflow.<br />
<br />
The simple and flexible design facilitates dynamic delivery and real-time updates. A reporting dashboard allows your organization to track learning activity and user performance, and leverage the data to target training and drive user adoption.<br />
<br />
In addition to the creation of customized learning assets, LearningLIVE comes with twenty two standard assets that support Meaningful Use requirements. The pre-built assets are categorized according to the requirement they support and facilitate training for Meaningful Use.<br />
<br />
Client Benefits:<br />
<br />
Allows clinicians to access learning resources and apply knowledge at the point-of-need.<br />
Enables educators to deliver dynamic learning content and communications.<br />
Provides hospital administrators key learning and performance metrics.<br />
Key Features<br />
<br />
The LearningLIVE solution offers:<br />
<br />
Relevant, on-demand learning resources in the context of clinical workflow.<br />
Reporting dashboard with a comprehensive view of learning activity and user performance.<br />
Simple and flexible design to facilitate dynamic delivery and real-time updates.<br />
Pre-built assets targeted towards meeting Meaningful Use objectives<br />
<br />
<ref name="LearningLive">Cerner LearningLive. https://store.cerner.com/items/319</ref><br />
<br />
==HealtheIntent==<br />
This is one of Cerners newest cloud based platforms to address the needs of population health while looking at the health outcomes of an individual. This cloud-based platform enables health care systems to aggregate, transform and reconcile data across the continuum of care. A longitudinal record is established, through that process, for individual members of the population that the organization is held accountable for; helping to improve outcomes and lower costs for health and care. <ref name= "HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent/ Cerner HealtheIntent </ref><br />
<br />
[http://www.cerner.com/solutions/population_health/ Population Health Management] solution is enabled with the HealtheIntent platform. Physicians will be able to use the tools and programs to address individual patients or a group. This solution will allow physicians to know their population, engage their patients and evaluate patient and population outcomes.<br />
<br />
[http://www.cerner.com/solutions/member_engagement/cerner_wellness/ Cerner Wellness] solution is designed to assist patients through their continuity of care with resources and tools to engage and motivate them towards healthy lifestyle improvements, managing their medical conditions and enhance their knowledge base.<br />
<ref name="HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent</ref><br />
<br />
==Partnerships==<br />
<br />
Every potential partnership is evaluated for the opportunity for collaboration and innovation in order to serve clients’ health care needs. Cerner has partners in the following areas:<br />
<br />
* Medical Device Integration and Connectivity<br />
* Business Continuity<br />
* Caregiver Experience<br />
* Document Management and Imaging<br />
* HotSpot Dictation<br />
* Operational and System Management<br />
* Preferred Suppliers<br />
* Security and Administration<br />
<br />
<ref name="Cerner Partnerships">Cerner Partnerships. http://www.cerner.com/About_Cerner/Partnerships/</ref><br />
<br />
Cerner has also partnered with CommonWell and will provide it to their clients for free until January 1, 2018. CommonWell will work with Cerner to exchange patient records safely and securely at the right time with any of the CommonWell parnters. <br />
<br />
<ref name="CommonWell">Cerner Blog. http://www.cerner.com/blog/Cerner_is_Providing_CommonWell_Services_Free_for_Three_Years/?langtype=1033/</ref><br />
<br />
==Virtual Community==<br />
<br />
=== Cerner and Second Life ===<br />
<br />
Cerner has established a virtual healthcare environment to represent its 25-year vision. The environment includes numerous venues, such as a hospital, clinic, pharmacy, and more. Within the venues are areas where individuals can interact to learn about Cerner’s solutions. The virtual environment acknowledges education and affiliation among clients and supports Cerner’s vision for the future of healthcare. Virtual characters, known as avatars, will guide you through the environment where you can participate in the following:<br />
<br />
* View and interact with Smart Room technologies such as myStation and iAware, to learn about them in real life<br />
* Experience how clinicians view real-time data from the care team and medical devices in the medical intensive care unit<br />
* Witness how Cerner’s solutions enable patients to connect with the care team<br />
* Collaborate and share knowledge with other individuals in Second Life<br />
<br />
=== What is Second Life? ===<br />
<br />
Launched in 2003, Second Life is a virtual world that creates a user-defined environment where people can interact, conduct business and exchange ideas. Second Life is used in many large corporations such as IBM, Intel and Microsoft to collaborate, share product knowledge and network. Additionally, many leading universities and school systems use Second Life in their educational programs to familiarize students with benefits of virtual worlds, connect them with others and provide instructional simulations. <ref name="Cerner Virtual Community">Cerner Virtual Community. http://www.cerner.com/About_Cerner/Cerner_Virtual_Community/</ref><br />
<br />
== Awards ==<br />
<br />
• UX Award, 2013, Best Clinical Health Care Experience, Powerchart Touch <ref name="powertouch">2013 UX Awards. http://userexperienceawards.com/ux-awards-2013-winners/#powerchart/ </ref><br />
<br />
• Information Week Elite100, 2014, <ref name="infoweek">Cerner clients recognized as elite and innovative users of IT. http://www.cerner.com/blog/cerner_clients_recognized_as_elite_innovative_users_of_it/?langtype=1033 </ref> <br />
<br />
• Most Innovative Companies, 2014 <ref name="forbes">The World’s Most Innovative Companies List. http://www.forbes.com/innovative-companies/list/ </ref><br />
<br />
• Best in KLAS award for Application Hosting (CIS/ERP/HIS) 2013 <ref name="klas">Cerner : Best in KLAS Awards: Software and Services. http://www.4-traders.com/CERNER-CORPORATION-8744/news/Cerner--Best-in-KLAS-Awards-Software-and-Services-18576417/ </ref><br />
<br />
• One of The 10 Most Competitive Technology Companies of 2013 <ref name="competitive">10 Most Competitive Tech Companies in the World. http://outthinker.com/outthinkerblog/?p=59/ </ref><br />
<br />
• Healthcare Informatics 100 Ranking <ref name= "Healthcare Informatics">Cerner recognized as No. 2 for 2014.http://www.healthcare-informatics.com/hci100/2014-hci-100-list/ </ref><br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
<br />
<br />
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<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/CernerCerner2015-01-29T04:30:50Z<p>Mho2: </p>
<hr />
<div>Cerner’s mission: to contribute to the systemic improvement of health care delivery and the health of communities. <ref name="Cerner Form 10k">Cerner Corp, Form 10-K, Annual Report, Filing Date Feb 5, 2014. http://pdf.secdatabase.com/2355/0000804753-14-000006.pdf</ref> <br />
<br />
'''Cerner''' Corporation is a supplier of healthcare information technology (HCIT) solutions, services, devices and hardware. Cerner solutions optimize processes for healthcare organizations. <ref name="Cern.O">Cerner Corporation Company Profile. http://www.reuters.com/finance/stocks/companyProfile?rpc=66&symbol=CERN. </ref> Cerner solutions are licensed by approximately 14,000 facilities around the world, including more than 3,000 hospitals; 4,900 physician practices; 60,000 physicians; 590 ambulatory facilities, such as laboratories, ambulatory centers, behavioral health centers, cardiac facilities, radiology clinics and surgery centers; 3,500 extended care facilities; 150 employer sites and 1,790 retail pharmacies. <ref name="Cerner Form 10k"></ref> <br />
<br />
== Introduction ==<br />
<br />
In1979, inspired by a short consulting project for a medical lab, former Arthur Andersen information systems consultants Neal Patterson, Clifford Illig, and Paul Gorup broke away from Arthur Andersen to form Cerner. Cerner’s name stems from the Latin word cernere, translated as “to sift or understand.” <ref name="Strategic Report">Strategic Report for Cerner Corporation. http://economics-files.pomona.edu/jlikens/SeniorSeminars/oasis/reports/CERN.pdf </ref> <br />
<br />
Cerner is one of the leading global suppliers of healthcare information technology solutions. Around the world, health organizations ranging from single-doctor practices to entire countries turn to Cerner for our powerful yet intuitive solutions. Cerner offers clients a dedicated focus on healthcare, an end-to-end solution and service portfolio, and proven market leadership. <ref name="Corporate Profile">Corporate Profile. http://www.cerner.com/About_Cerner/Corporate_Profile/?LangType=3081 </ref> <br />
<br />
<br />
=== Locations ===<br />
<br />
Cerner is headquartered in Kansas City, Mo., neighbor of North Kansas City Hospital, Cerner's second hospital client. <ref name="Rand Study">Rand Study helps Cerner makes its case. http://www.bizjournals.com/kansascity/stories/2005/09/19/story1.html?page=all </ref> <br />
* 2005: Cerner acquired the Riverport Campus complex on the site of what was formerly the Sam's Town Casino above the Missouri River in North Kansas City, Missouri. <ref name="riverport">Riverport Campus Cerner Corporation. http://www.emporis.com/building/riverport-campus-cerner-corporation-inc-world-headquarters-in-north-kansas-city-mo-kansas-city-mo-usa </ref> <br />
* 2006: it also acquired the former Marion Laboratories complex in southeast Kansas City, Missouri, renaming the campus the Innovation Campus. <ref name="southcampus">Cerner Corporation South Campus Bldg. http://www.emporis.com/building/cerner-corporation-south-campus-bldg-i-kansas-city-mo-usa </ref><br />
* 2013: the company opened the first building in a new campus development located in Kansas City, Kan. The company calls this the Continuous Campus. <ref name="continuous campus">Cerner Continuous Campus. https://foursquare.com/v/cerner-continuous-campus/4f96d3b8e4b0ba85ae7a81c5 </ref><br />
* 2014: the company announced that it had begun a $4.45 billion campus construction project on the site of the former Bannister Mall in South Kansas City near the Innovation Campus. <ref name="bannister mall">Cerner breaks ground for its Trail Campus in South Texas. http://www.kansascity.com/news/business/development/article3845781.html </ref>The Kansas City Star reports, that the campus will have enough room to house up to 16,000 employees. <ref name="break ground"> Cerner breaks ground on planned Kansas City site. http://www.cerner.com/Cerner_breaks_ground_on_planned_Kansas_City_site/</ref><br />
<br />
Cerner maintains a handful of additional offices in the United States, as well as offices in the UK, Australia, UAE, Saudi Arabia, Egypt, Germany, France and several other countries outside the United States.<br />
<br />
=== Mission statement ===<br />
<br />
Cerner's Vision has 4 pillars:<br />
<br />
# Automate the Care Process to Eliminate Paper<br />
# Connect the Person by Providing Virtual Personal Health Systems<br />
# Structure, Store and Study the Evidence to Create New Knowledge<br />
# Close the Loop by Implementing Evidence-Based Care" <ref name="cerner annual report 2001">“Cerner Annual Report 2001” (March 2002) https://www.cerner.com/uploadedFiles/2001_Annual_Report.pdf</ref><br />
<br />
== From 1980s into the 90s ==<br />
<br />
By 1984, Cerner was ready to roll out its first application, the PathNet laboratory information system. PathNet provided a comprehensive information system for laboratory clinicians, allowing laboratories to automate their processes. PathNet, which grew to combine applications for general laboratory information, microbiology, blood bank transfusion and blood bank donation, and anatomic pathology, broke away not only from the traditional paper-based sharing of information, but also from the prevailing financial focus of data gathering systems. <ref name="history">Cerner Corporation History. http://www.fundinguniverse.com/company-histories/cerner-corporation-history/ </ref> <br />
<br />
In 1988, Cerner added the next component of its clinical management systems, RadNet, which focused on automating radiology department functions. The following year, pharmacy support was added with the PharmNet application. As with PathNet, each new component was based on the same application architecture, allowing applications to be seamlessly combined to share information across applications. <ref name="history"></ref> <br />
<br />
By 1990, more than 200 PathNet sites had been installed, solidifying Cerner's position as the leading maker of laboratory information systems. Cerner next moved to expand its product family beyond clinical management systems and into care management systems, with the introduction of its ProNet and CareNet products. ProNet provided automated support for patient management and registration, ordering, scheduling, and tracking processes. CareNet gave patient care planning, management, and measurement tools to nurses and other direct care providers. Care management was meant to play a central role in gathering information needed for the care process. With Cerner's care management tools, providers could more easily manage the many pieces of patient information, including demographic and financial data, health status, operations data such as treatment procedures and protocols, while linking this information to ordering, tracking, scheduling, and patient, case, and health records management. <ref name="history"></ref> <br />
<br />
By the end of 1993, Cerner had completed the largest part of its product family, with the 1992 introduction of its SurgiNet and Open Management Foundation (OMF) products, and the 1993 introduction of its MRNet product. SurgiNet, part of Cerner's clinical management product line, offered information management support for operating room teams. OMF extended Cerner's repository line with tools for supporting management analysis and decision-making based on process-related information. MRNet functioned to link the OCF and OMF products in automating the chart management process for the medical records department. <ref name="history"></ref> <br />
<br />
== Cerner EHR ==<br />
<br />
The founders created '''Cerner Millennium''', the industry's first person-centric integrated architecture. <ref name"cerner millennium">HP & Cerner http://h20338.www2.hp.com/enterprise/us/en/partners/cerner-millennium.html</ref> Cerner Millennium is a partnership of Cerner and HP. The architecture of Millennium allows caregivers and supporting providers the ability to view results, problems, diagnosis, medications, and other pertinent information in real-time as well as share clinical and management data across multiple disciplines and facilities. This architecture has been referred to as Health Network Architecture (HNA), providing 12 major system applications operating by this means, fitting into 4 interrelated groups <ref name="history"></ref>.<br />
<br />
In a continued effort to reduce waste and friction in healthcare, Cerner has developed many solutions including employee health, life sciences, medical devices, clinical trial management, and biosurveillance. In 2012, Cerner announced its acquisition of Anasazi Software Inc. to support continuity of mental health care through the combination of Anasazi’s established community behavioral health functionality with the in-patient behavioral health capabilities of Cerner Millennium. <ref name="cerner acquires Anasazi">Cerner to Acquire Anasazi Software, Inc. http://www.cerner.com/about_cerner/newsroom/Cerner_to_Acquire_Anasazi_Software_Inc/</ref> Also in 2012, Cerner announced the launch of Millennium + which combines the enterprise platform with the secure Cerner Cloud. <ref name="cerner millennium 2012">Cerner Announces Next Evolution of Cerner Millennium 2012 http://www.cerner.com/about_cerner/newsroom/cerner_announces_next_evolution_of_cerner_millennium/</ref><br />
<br />
=== Millenium+ ===<br />
<br />
In 2012, Cerner launched Millennium+, which uses the Cerner Cloud to provide a user experience that is “fast, smart and easy”, enabling caregivers to have personalized, intuitive and moment relevant clinical work flows via desktop, tablet or smartphone with minimal orientation to begin usage. <ref name="cerner millennium 2012"></ref> <br />
<br />
One of the solutions that was launched as part of the Millennium+ platform was PowerChart+Touch™. PowerChart+Touch as a mobile solution allows physicians to complete workflows directly from their mobile devices and was created specifically for the iPad. <ref name="powerchart touch">PowerChart Touch Wins National Acclaim for User Experience. http://www.cerner.com/PowerChart_Touch_Wins_National_Acclaim_for_User_Experience/</ref><br />
<br />
=== PowerChart ===<br />
<br />
Built upon the scalable, unified, person-centric Cerner Millennium® architecture, PowerChart® delivers the benefits of a clinical database, with functionality allowing you to view clinical data, complete orders and optimise clinician documentation in one powerful solution.<br />
<br />
The universal PowerChart framework can be leveraged across multiple roles, venues and disciplines, thereby driving efficiencies and user adoption. The solution provides a foundation for a multitude of Cerner point-of-care solutions, including those for home care, physician offices, clinics, acute patient care, critical care, and long-term and rehabilitation services.<br />
<br />
'''Key Benefits<br />
'''<br />
* Improve coordination and identification of patients<br />
* Positively impact cash flow<br />
* Access records at any time from any location<br />
* Optimize workflow efficiency and performance<br />
<br />
<ref name"PowerChart"> Cerner PowerChart. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/PowerChart/?LangType=3081</ref><br />
<br />
== FirstNet==<br />
<br />
FirstNet is Cerners emergency department documentation system. FirstNet tracking board allows physicians and staff to see their patient population and their location. The FirstNet tracking board is also customizable so you can see the information you need. FirstNet has a coding functionality that allows ERs to capturing all their physician charges correctly and for reimbursement. Patient education is also part of the FirstNet application so when a patient is discharge they can also receive education material related to their diagnosis or issue. <ref name="FirstNet">Cerner Emergency Department. https://store.cerner.com/hospitals_and_health_systems/emergency_department </ref><br />
<br />
== Finances ==<br />
<br />
With a total revenue $2.8B including $391M globally (Cerner Corporation 2013 Annual Report), organizations ranging from single-doctor practices to hospitals to corporations to local, regional, national and global government agencies and organizations use Cerner solutions. As of 2012, Cerner works with more than 9,300 facilities worldwide, including 2,650 hospitals, 3,750 physician practices and 500 ambulatory clinics <ref name"cerner excite"> Cerner EMR Solutions - An Overview. (May, 2012) Excite Health Partners</ref>. Associates span 7,300 worldwide with business in Argentina, Aruba, Canada, Cayman Islands, Chile, Puerto Rico, Saudi Arabia, Singapore, Spain and the United Arab Emirates. <ref name"cerner nyt"> Cerner Corporation" (September, 2013) New York Times Business Day</ref><br />
<br />
=== Siemens acquisition ===<br />
<br />
In a press release on August 5, 2014, Cerner Corporation announced that they would be acquiring Siemens Health Services for $1.3 billion. This acquisition will allow Cerner to provide health IT to 20,000 associates in more than 30 countries and 18,000 client facilities, greatly expanding their global presence. <ref name"cerner siemens"> Cerner to Acquire Siemens Health Services for $1.3 Billion” (August, 2014) Cerner News Release http://www.cerner.com/About_Cerner/Investor_Relations/News_Releases/</ref> This deal will increase Cerner's annual revenue form about 3 billion last year to more than 4.5 billion on annual revenue in 2014. <br />
<br />
Based on 2014 estimates, Cerner and Siemens Health Services have combined totals of more than: <ref name="cerner forbes siemens">Cerner To Buy Siemens Health IT Business For $1.3 Billion http://www.forbes.com/sites/matthewherper/2014/08/05/cerner-to-buy-siemens-health-it-business-for-1-3-billion/</ref><br />
<br />
* 20,000 associates in more than 30 countries<br />
* 18,000 client facilities, including some of the largest health care organizations in their respective countries<br />
* $4.5 billion of annual revenue<br />
* $650 million of annual R&D investment<br />
<br />
== Oracle ==<br />
<br />
The partnership between Cerner and Oracle helps to provide a number benefits to Cerner customers such as: <ref name="cerner oracle">http://www.cerner.com/About_Cerner/Partnerships/Oracle/, 2014)</ref><br />
<br />
* industry-leading scalability and reliability in both clustered and single system configurations<br />
* high performance<br />
* fault tolerance<br />
* heavy online processing loads<br />
* the ability to handle a large number of users<br />
<br />
Cerner Millennium applications use an Oracle database and provide a common data model to enable data sharing between applications and to eliminate redundant data, while maximizing reliability and performance. This implementation runs on a variety of networks, processors and operating systems, including Windows XP Professional and any Internet browser.[8] <br />
All Millennium installs take advantage of the full Oracle database stack (9iEE, RAC, and the Management Packs). Oracle’s Real Application Clustering (RAC) enables both reliability and scalability by allowing the addition of servers to the host cluster.<br />
<br />
Cerner also uses Oracle’s Tuning Pack, Diagnostic Pack, and Change Management Pack to help protect the integrity, confidentiality, and availability of its Millennium healthcare data. Oracle’s EAL 4 (Evaluation Assurance Level 4) rating also attests to its robust security. Additionally, Cerner's Remote Hosting Facility uses the full Oracle database stack (9iEE, RAC, and the Management Packs) as well and in an exclusive manner <ref name="cerner oracle">Oracle 2014 http://www.cerner.com/About_Cerner/Partnerships/Oracle/</ref><br />
<br />
[[Certification Commission for Health Information Technology (CCHIT)|Certification Commission for Health Information Technology (CCHIT)]] performs rigorous inspection of EHR's integrated functionality, interoperability, security and is intended to serve health care providers looking for maximum assurance that a product will meet their complex needs. These listed products have CCHIT Certification but have not been tested against the applicable proposed Federal standards in existence on the date of certification for certified EHR technology of its type under the [[ARRA|American Recovery and Reinvestment Act of 2009 (ARRA)]]: <br />
<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart 2007 (Expired January 22, 2011)<br />
# Cerner Millennium FirstNet 2007.19 (Expired April 22, 2011)<br />
# Cerner Millennium PowerChart/PowerWorks EMR 2007.19 (Expired April 22, 2011). <ref name="history"></ref> <br />
<br />
=== Millennium Objects ===<br />
<br />
Clients can create custom applications on the Cerner Millennium architecture with MillenniumObjects. <ref name="cerner millennium objects"> MillenniumObjects http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/?LangType=3081</ref> MillenniumObjects utilizes Java and XML services for Application Programming Interfaces (API) development by client developers. MillenniumObjects can be used to create custom applications and additional features on existing processes. This allows the user to create a unique application tailored to their specific needs using data already present within Cerner Millennium. Third-party extensions are available to create new workflows.<br />
<br />
Benefits of Millennium Objects include:<br />
<br />
* Quickly create custom applications for your organization<br />
* Build upon the processes already in place for the maintenance of users, passwords, administration, etc. of the new application<br />
* Leverage the capabilities of third-party built extensions to create new workflows across applications<br />
<br />
<ref name="Benefits of Millennium Objects"> Benefits of Millennium Objects. http://www.cerner.com/solutions/Hospitals_and_Health_Systems/MillenniumObjects/</ref><br />
<br />
== St. John Sepsis Agent==<br />
<br />
Sepsis affects 750,000 patients per year in the United States alone. <ref name="st john sepsis">http://www.cerner.com/solutions/hospitals_and_health_systems/acute_care_emr/st_john_sepsis_agent/</ref> It also states, nearly $17 billion annual healthcare expenditures in the U.S. goes to health problems associated with sepsis. <br />
<br />
However, studies show sepsis can be handled better if it is diagnosed in the first six hours after contracting germs. In order to make this detection as early as possible, Cerner now has come with a solution. St. John Sepsis Agent, created in co-operation with Methodist health care in Memphis, Tennessee speeds up early detection and diagnosis of sepsis.<br />
How the system works?<br />
<br />
It gathers information from different sources such as: physician practices, ambulances, emergency department ,lab results and patient electronic health record’s vital signs.The integrated system analyzes all the information gathered from the above sources which includes Glucose level, Respiratory rate, Temperature, Heat rate, and Lab results. An alert fires when the system finds three out of range criteria. Then the agent sends a message to the hospital’s clinical team which reviews the data and begins the appropriate treatment.<br />
<br />
In addition to the alert, there are enhancements that complement St John’s Sepsis Agent. One of such is The Millennium Light house. This program includes sepsis management power plan with orders for intravenous fluid, diagnostic tests and an empiric therapy adviser. This adviser guide clinicians to a variety of treatment option based on the source of infection.The agent offering also includes Significant Events mpage component which provides up front view of the patient’s most recent lab results, vital signs and significant treatment event. <ref name="cerner youtube sepsis">Youtube: Cerner Sepsis Program https://www.youtube.com/watch?v=_-P6DZos9UU</ref><br />
<br />
Finally, to follow up cases of sepsis, Cerner offers the Sepsis Confirmation Power form which is designed to use by organization’s quality officers during case review and quality reporting. <ref name="st john sepsis"></ref> Reports show using the St. John Sepsis Agent can improve healthcare organizations in the following ways:<br />
<br />
* 24 percent reduction in in-hospital patient mortality rate.<br />
* 21 percent reduction in length of stay.<br />
* $5,882 medical savings per treated patient.<br />
<br />
== Acute care Electronic Medical Record==<br />
<br />
The Cerner electronic medical record (EMR) is an integrated database that provides a comprehensive set of capabilities with the following key benefits:<br />
1.Improve patient care as clinicians can focus on the patient’s overall health and not just the encounter<br />
2. Increase efficiency by placing real-time, updated information with the care team in time to make fast and effective decisions<br />
3. Increase access to information from multiple venues in the health system. <ref name="acute care">Acute Care Electronic Medical Record. https://www.cerner.com/solutions/Hospitals_and_Health_Systems/Acute_Care_EMR/</ref> <br />
<br />
The EMR was created to allow healthcare professionals to electronically store, capture and access patient health information in both the acute and ambulatory care setting. It allows the users to provide real-time access to patient results and clinical information across care disciplines, enable that healthcare organizations meet The Joint Commission requirements for patient confidentiality, access patient information securely from wherever and whenever it is most convenient for the care team. <ref name="acute care"></ref> <br />
<br />
<br />
== Cerner Laboratory solution==<br />
<br />
The PathNet laboratory information system delivers to clinicians a comprehensive and fully integrated technology that covers both the managerial and the operational sides of the laboratory. <ref name="cerner laboratory">Laboratory http://www.cerner.com/solutions/Hospitals_and_Health_Systems/Laboratory/</ref> The system operates on the unified Cerner Millennium architecture. As a result, information links seamlessly with the patient's electronic medical record. PathNet serves the needs of different sections under pathology departments umbrella such as Blood Science, Microbiology, Cellular Pathology and Blood Transfusion functions. The technology has a capability to store, retrieved and disseminated patient specific information to and from health care system. Aside from that, the system is continually updated based on national standards and guidelines. Reports enumerates the different kinds of benefits PathNet® laboratory information system provides. Some are: it has a capability to process large quantities of specimens efficiently with minimal error possible. It integrates lab results with patent's EMR which allows the availability of full patient records on the EMR. Finally it ensures the rapid availability of patent results to care providers. <br />
<br />
== Device Connectivity==<br />
<br />
Medical devices contain critical health information reports a Cerner’s website, However, it can be a challenge to get that information into the care giver’s hand. As a result Cerner come up with medical device connectivity solution which alleviate this challenge. The company implemented the CareAware iBus, a core component of the CareAware connectivity architecture which acts as a USB for health care devices. In doing so, the solution connects medical devices with EMR enabling two-way communication between the two systems. This solution improves care by allowing care providers to focus on patients rather than paper work and data entry associated with it. <br />
<ref name="cerner solutions">Healthcare Devices http://www.cerner.com/solutions/Healthcare_Devices/?langtype=3081&WT.mc_id=audevice</ref><br />
<br />
== Integrating medical calculators into the EHR==<br />
<br />
Medical calculators integrated in EHR are invaluable assists for care providers, reports a Cerner website. In order to address this need, a group of physicians at Cerner started to work on integrated medical calculator solutions. In order, to accomplish that they partnered with MedCalc300. As a result, this new solution provides all Cerner clients access to more than 600 calculators, clinical criteria and decision trees. To name one example of such clinical calculator is Apgar score for determining the well being of a new born. <br />
<ref name="cerner med calculators">Integrating medical calculators into the EHR http://www.cerner.com/blog/integrating_medical_calculators_into_the_ehr/?langtype=1033</ref><br />
<br />
==HealthLife==<br />
<br />
Cerners patient portal was designed to help patients become more actively involved in their healthcare. Individuals will have greater access to their health information than ever before using a variety of access tools including laptops, tablets and other mobile devices. This new design will enable patients to: <ref name=" HealtheLife">Cerner HealtheLife. http://www.cerner.com/solutions/individuals_and_families/cerner_patient_services/ </ref><br />
<br />
* Schedule or reschedule or cancel appointments<br />
* Make payments or view their medical fees<br />
* View their health information and download their data<br />
* Send information to their healthcare team thru secure messaging<br />
* Fill prescriptions<br />
<br />
Providers will be able to:<br />
<br />
* send their patients reminders<br />
* share the patients lab or diagnostic results<br />
* attach documents concerning education or patient care<br />
* send registration forms for patient to complete<br />
<br />
== LearningLive == <br />
<br />
LearningLIVE<br />
<br />
LearningLIVE is a new eLearning solution designed to deliver training closer to the point-of-care and support continuous learning in the healthcare environment. Available within PowerChart, FirstNet, and INet, LearningLIVE offers clinicians relevant learning resources in the context of their workflow.<br />
<br />
The simple and flexible design facilitates dynamic delivery and real-time updates. A reporting dashboard allows your organization to track learning activity and user performance, and leverage the data to target training and drive user adoption.<br />
<br />
In addition to the creation of customized learning assets, LearningLIVE comes with twenty two standard assets that support Meaningful Use requirements. The pre-built assets are categorized according to the requirement they support and facilitate training for Meaningful Use.<br />
<br />
Client Benefits<br />
<br />
Allows clinicians to access learning resources and apply knowledge at the point-of-need.<br />
Enables educators to deliver dynamic learning content and communications.<br />
Provides hospital administrators key learning and performance metrics.<br />
Key Features<br />
<br />
The LearningLIVE solution offers:<br />
<br />
Relevant, on-demand learning resources in the context of clinical workflow.<br />
Reporting dashboard with a comprehensive view of learning activity and user performance.<br />
Simple and flexible design to facilitate dynamic delivery and real-time updates.<br />
Pre-built assets targeted towards meeting Meaningful Use objectives<br />
<br />
<ref name="LearningLive">Cerner LearningLive. https://store.cerner.com/items/319</ref><br />
<br />
==HealtheIntent==<br />
This is one of Cerners newest cloud based platforms to address the needs of population health while looking at the health outcomes of an individual. This cloud-based platform enables health care systems to aggregate, transform and reconcile data across the continuum of care. A longitudinal record is established, through that process, for individual members of the population that the organization is held accountable for; helping to improve outcomes and lower costs for health and care. <ref name= "HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent/ Cerner HealtheIntent </ref><br />
<br />
[http://www.cerner.com/solutions/population_health/ Population Health Management] solution is enabled with the HealtheIntent platform. Physicians will be able to use the tools and programs to address individual patients or a group. This solution will allow physicians to know their population, engage their patients and evaluate patient and population outcomes.<br />
<br />
[http://www.cerner.com/solutions/member_engagement/cerner_wellness/ Cerner Wellness] solution is designed to assist patients through their continuity of care with resources and tools to engage and motivate them towards healthy lifestyle improvements, managing their medical conditions and enhance their knowledge base.<br />
<ref name="HealtheIntent">Cerner HealtheIntent. http://www.cerner.com/solutions/population_health/healthe_intent</ref><br />
<br />
==Partnerships==<br />
<br />
Every potential partnership is evaluated for the opportunity for collaboration and innovation in order to serve clients’ health care needs. Cerner has partners in the following areas:<br />
<br />
* Medical Device Integration and Connectivity<br />
* Business Continuity<br />
* Caregiver Experience<br />
* Document Management and Imaging<br />
* HotSpot Dictation<br />
* Operational and System Management<br />
* Preferred Suppliers<br />
* Security and Administration<br />
<br />
<ref name="Cerner Partnerships">Cerner Partnerships. http://www.cerner.com/About_Cerner/Partnerships/</ref><br />
<br />
Cerner has also partnered with CommonWell and will provide it to their clients for free until January 1, 2018. CommonWell will work with Cerner to exchange patient records safely and securely at the right time with any of the CommonWell parnters. <br />
<br />
<ref name="CommonWell">Cerner Blog. http://www.cerner.com/blog/Cerner_is_Providing_CommonWell_Services_Free_for_Three_Years/?langtype=1033/</ref><br />
<br />
==Virtual Community==<br />
<br />
=== Cerner and Second Life ===<br />
<br />
Cerner has established a virtual healthcare environment to represent its 25-year vision. The environment includes numerous venues, such as a hospital, clinic, pharmacy, and more. Within the venues are areas where individuals can interact to learn about Cerner’s solutions. The virtual environment acknowledges education and affiliation among clients and supports Cerner’s vision for the future of healthcare. Virtual characters, known as avatars, will guide you through the environment where you can participate in the following:<br />
<br />
* View and interact with Smart Room technologies such as myStation and iAware, to learn about them in real life<br />
* Experience how clinicians view real-time data from the care team and medical devices in the medical intensive care unit<br />
* Witness how Cerner’s solutions enable patients to connect with the care team<br />
* Collaborate and share knowledge with other individuals in Second Life<br />
<br />
=== What is Second Life? ===<br />
<br />
Launched in 2003, Second Life is a virtual world that creates a user-defined environment where people can interact, conduct business and exchange ideas. Second Life is used in many large corporations such as IBM, Intel and Microsoft to collaborate, share product knowledge and network. Additionally, many leading universities and school systems use Second Life in their educational programs to familiarize students with benefits of virtual worlds, connect them with others and provide instructional simulations. <ref name="Cerner Virtual Community">Cerner Virtual Community. http://www.cerner.com/About_Cerner/Cerner_Virtual_Community/</ref><br />
<br />
== Awards ==<br />
<br />
• UX Award, 2013, Best Clinical Health Care Experience, Powerchart Touch <ref name="powertouch">2013 UX Awards. http://userexperienceawards.com/ux-awards-2013-winners/#powerchart/ </ref><br />
<br />
• Information Week Elite100, 2014, <ref name="infoweek">Cerner clients recognized as elite and innovative users of IT. http://www.cerner.com/blog/cerner_clients_recognized_as_elite_innovative_users_of_it/?langtype=1033 </ref> <br />
<br />
• Most Innovative Companies, 2014 <ref name="forbes">The World’s Most Innovative Companies List. http://www.forbes.com/innovative-companies/list/ </ref><br />
<br />
• Best in KLAS award for Application Hosting (CIS/ERP/HIS) 2013 <ref name="klas">Cerner : Best in KLAS Awards: Software and Services. http://www.4-traders.com/CERNER-CORPORATION-8744/news/Cerner--Best-in-KLAS-Awards-Software-and-Services-18576417/ </ref><br />
<br />
• One of The 10 Most Competitive Technology Companies of 2013 <ref name="competitive">10 Most Competitive Tech Companies in the World. http://outthinker.com/outthinkerblog/?p=59/ </ref><br />
<br />
• Healthcare Informatics 100 Ranking <ref name= "Healthcare Informatics">Cerner recognized as No. 2 for 2014.http://www.healthcare-informatics.com/hci100/2014-hci-100-list/ </ref><br />
<br />
== References ==<br />
<references/><br />
<br />
<br />
<br />
<br />
<br />
<br />
[[Category: EHR]]<br />
[[Category: UT-SHIS SP09]]</div>Mho2http://www.clinfowiki.org/wiki/index.php/Centricity_EMRCentricity EMR2015-01-29T04:23:11Z<p>Mho2: /* Centricity Perinatal */</p>
<hr />
<div>'''Centricity EMR''' is a patient centered [[EMR|electronic medical record (EMR) system]] designed for use in clinical and ambulatory care practices (1). Centricity EMR allows clinicians to electronically document patient encounters, enter patient data into research databases, and ensure the secure exchange of clinical knowledge (1). <br />
<br />
Centricity was introduced in 2003 with two applications, Centricity EMR and Centricity Physician Office - Practice Management. The products were acquired by what was then GE Medical Systems in 2002 and 2003 respectively, and released future versions of both products under the Centricity name.(3)<br />
<br />
<br />
== Introduction ==<br />
<br />
The GE Centricity EMR features a robust user interface which supports the accurate and consistent documentation for a wide range of clinical and demographic patient information (1). The Centricity EMR tracks medical information for patients over time and allows clinicians to compare clinical outcomes against their peers (1).<br />
<br />
Information stored in the Centricity EMR includes:<br />
*medical setting<br />
*diagnosis<br />
*patient complaints/reason for visit<br />
*medications<br />
*laboratory tests/results (3)<br />
The Centricity EMR is easily combined with other Centricity software packages to allow clinicians to further optimize the management of information (1). <br />
<br />
==The Centricity EMR Research Database==<br />
<br />
Approximately 5,000 clinicians provide data to the medical quality improvement consortium (MQIC) which in turn uses the data for a research database (3).This database is quickly becoming a powerful tool as it allows investigators to:<br />
*examine large patient populations<br />
*de-identify patient data <br />
*perform retrospective cohort studies <br />
*determine the primary reason for the visit <br />
*determine clinical outcomes (5)<br />
*use of electronic medical records for clinical research in the management of type 2 diabetes <ref>name="Chopra">Kamal KM, Chopra I, Elliott JP, Mattei T. Use of electronic medical records for clinical research in the management of type 2 diabetes. 2014. 10(6): 877–884. http://www.ncbi.nlm.nih.gov/pubmed/24556384</ref>.<br />
<br />
By 2008, there had been 12 journal publications and 31 poster presentations using data collected by clinicians using the GE Centricity database (3).<br />
<br />
== Centricity Advance ==<br />
<br />
'''Centricity Advance''' is GE Healthcare’s integrated [[EMR|electronic medical record (EMR)]], practice management and patient portal system delivered through the web. Specifically designed for use by primary care providers and other physicians in smaller offices, Centricity Advance helps streamline office management, enhance delivery of patient care, and enable expanded communication with secure online exchange between physicians and patients.<br />
<br />
Unlike many other healthcare IT systems, Centricity Advance is delivered in a true Software-as-a-Service (SaaS) model. With this web-based system, practices can get up and running quickly, with minimal disruption, at a modest startup cost. Technology upgrades and maintenance are delivered automatically, with virtually no practice involvement.<br />
<br />
== Centricity Advance ==<br />
<br />
On August 8, 2011, GE Healthcare announced the release of Centricity Advance – Mobile, a native Apple iPad® application designed for primary care physicians in small practices.<br />
<br />
EMR Features:<br />
* Integrated EMR<br />
* Practice Management Software<br />
* Self-Service Patient Portal<br />
* Secure Medical Management Software<br />
* Web Based EMR Software<br />
<br />
Centricity EMR offers a broad range of embedded clinical content, plus the flexibility to design your own encounter forms, add content, and adapt the program to suit the way you work best:<br />
<br />
• Intelligent decision support tools built into your workflow bring critical information right to the point of care, facilitating informed treatment decisions<br />
• Automatic reminders alert you to needed tests or procedures to proactively manage care and avoid potential medical problems<br />
• ePrescribing can alert you to potential drug interactions and lets you offer added convenience to your patients<br />
• Powerful evaluation and management (E&M) advisor assists with coding accuracy<br />
• Robust tools for communicating with patients and giving them access to care information to increase patient satisfaction<br />
• Automated workflows and rapid documentation streamline repetitive tasks and instantly update patient charts<br />
<br />
== Centricity Practice Solution ==<br />
Centricity Practice Solution is one of the original two Centricity products.. It is a fully integrated electronic medical record (EMR) and practice management (PM) system for practices of all sizes. It is designed to enhance the clinical and financial productivity of ambulatory practices, is a certified complete and modular EHR under the 2014 edition criteria, and attests to Meaningful Use. It also has intuitive ICD-9 to ICD-10 mapping. It is prevalidated for Patient Centered Medical Homes (PCMHs)<br />
#EMR module<br />
#PM module<br />
<br />
== Centricity Perinatal == <br />
<br />
Centricity Perinatal is a clinical information system that integrates documentation and fetal surveillance to help healthcare organizations deliver their best care to every mother and baby. From Labor & Delivery to the nursery or NICU, our perinatal software interfaces with multiple devices and systems, including all major EMRs. In an environment where every second counts, it is important to use an established product. Centricity Perinatal is an intuitive system that has been used to deliver over 39 million babies. <ref name="Centricity_Perinatal">GE Healthcare Centricity Perinatal - http://www3.gehealthcare.com/en/Products/Categories/Healthcare_IT/Departmentals/Centricity_Perinatal</ref>.<br />
<br />
== References ==<br />
<br />
# GE Healthcare: Centricity Advance. https://www2.gehealthcare.com/portal/site/usen/ProductDetail/?vgnextoid=23738fdab5219210VgnVCM10000024dd1403RCRD&productid=03738fdab5219210VgnVCM10000024dd1403____<br />
# EMR, EHR, and Practice Management Software - Centricity Advance - GE Healthcare. http://www.gehealthcare.com/centricityadvance/<br />
# GE Healthcare Releases Centricity Advance - Mobile. http://www.genewscenter.com/content/detail.aspx?ReleaseID=12968&NewsAreaID=2<br />
# GE Healthcare Centricity Perinatal - http://www3.gehealthcare.com/en/Products/Categories/Healthcare_IT/Departmentals/Centricity_Perinatal<br />
<br />
== External links ==<br />
<br />
# GE Healthcare Newsroom http://newsroom.gehealthcare.com<br />
# GE Healthcare Centricity Perinatal - http://www3.gehealthcare.com/en/Products/Categories/Healthcare_IT/Departmentals/Centricity_Perinatal<br />
<br />
== References ==<br />
<br />
# GE Healthcare: Centricity Electronic Medical Record (EMR). [https://www2.gehealthcare.com/portal/site/usen/ProductDetail/?vgnextoid=5bb454fbded30210VgnVCM10000024dd1403RCRD&productid=4bb454fbded30210VgnVCM10000024dd1403____]<br />
# Centricity - Wikipedia. [http://en.wikipedia.org/wiki/Centricity]<br />
# Crawford, A.G., et al. [http://ca3cx5qj7w.search.serialssolutions.com/OpenURL_local?sid=Entrez:PubMed&id=pmid:20568974 Comparison of GE Centricity Electronic Medical Record<br />
# Database and National Ambulatory Medical Care Survey Findings on the Prevalence of Major Conditions in the United States].Population Health Management. 2010. 13: 139-150. <br />
# Brixner, D., Ghate, S. R., McAdam-Marx, C., Ben-Joseph, R., Said, Q. [http://onlinelibrary.wiley.com.ezproxyhost.library.tmc.edu/doi/10.1111/j.1463-1326.2007.00758.x/pdf Association Between Cardiometabolic Risk Factors and Body Mass Index Based on Diagnosis and Treatment Codesin an Electronic Medical Record Database]. Journal of Managed Care Pharmacy. 2008. 14: 756-767. <br />
# Asche, C. V., McAdam-Marx, C., Shane-McWhorter, L., Sheng, X., and Plauschinat, C. [http://www.amcp.org/data/jmcp/756-767.pdf Association between oral antidiabetic use, adverse events and outcomes in patients with type 2 diabetes]. Diabetes, Obesity and Metabolism 2007. 10: 638-645.</div>Mho2