Tuesday, June 10, 2008

EHR for Non-Owned clinicians - Coming to terms

Since our community EHR infrastructure is now built we're in an education and communication phase, explaining to clinicians what it does, what it costs, and what they can expect. All our written and verbal communication must be consistent to ensure we set the right expectations. Part of being accurate is a precise definitions of our terms - what is an EMR, EHR, PHR, HIE, RHIO etc. The consensus definition work of NAHIT and AHIMA was presented to AHIC last week. Although not everyone will agree with these definitions, they are starting point. At AHIC one public comment illustrated the problem of legacy definitions - NextGen markets its product as the NextGen EMR. Does that mean it is inferior to the eClinicalWorks EHR, since an EHR is defined as standards-based and interoperable, while an EMR is defined as a single institution's standalone record. At BIDMC, we're providing a community EHR, we have an institutional EHR called webOMR (Online Medical Record), and a PHR called Patientsite. Patientsite is fully interactive with multiple data sources and Google Health, so we can continue to call it a PHR per the definition below. Here's the summary of the NAHIT work:

Electronic Medical Record
An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization.

Electronic Health Record
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff, across more than one health care organization.

Personal Health Record
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared, and controlled by the individual.

Health Information Exchange
The electronic movement of health-related information among organizations according to nationally recognized standards. HIE is a verb describing a process.

Health Information Organization
An organization that oversees and governs the exchange of health-related information among organizations according to nationally recognized standards. HIO is a noun describing an organization.

Regional Health Information Organization
A health information organization that brings together health care stakeholders within a defined geographic area and governs health information exchange among them for the purpose of improving health and care in that community

Next week's entry about our non-owned clinician project will provide an overview of our Health Information Exchange activities.

3 comments:

DanCorwin said...

As a patient, I'd hope that my evolving EHR will contain a clear, useful summary of my overall current clinical condition. By aggregating data on me from multiple (pro) sources, an EHR has enough information to let software assemble this, but your definitions omit this key difference from EMRs.

The EMR data I've seen, by contrast, seems more like a list (or pile?) of disjoint notes on the actions of individuals at one provider. My impression: EMRs are really for billing, not care-giving. They track neither my latest known meds nor my general state of health - summary sections good to have readily at hand if any part of either changes.

I could periodically confirm (or help fix) such a summary, but instead I selectively dump bits of it at each visit from my own fallible memory. It and recent local EMRs give caregivers an inconsistent image of me, which I've seen can add confusion and waste time.

Concise clinical profiles seem another type of "low hanging fruit" one could capture into EHRs, initially by mining discharge summaries. If not there already, please consider adding that design goal to the agenda for your June 17 retreat.

John Halamka said...

I completely agree. At BIDMC, we've created a medication list and problem list which is editable by any clinician or nurse, resulting in a lifetime medical record, not a huge collection of disjointed records for each episode of care. The clinical summary format HITSP has created for care continuity is the kind of summary profile you suggest. Mine is at here

平平 said...

^^Thanks!!

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