Electronic Health Information Systems

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Electronic Health Information Systems Agency
Collaborative Workgroup OVERVIEW OF ELECTRONIC
HEALTH RECORDS, STANDARDS AND RESOURCES
May 8, 2008
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KEY BENEFITS OF AN ELECTRONIC HEALTH RECORD

• The American Health Information Management
  Association (AHIMA), defines the three essential
  capabilities of an electronic health record as
  follows
• To capture data at the point of care,
• To integrate data from multiple internal and
  external sources, and
• To support caregiver decision making.

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ESSENTIAL CAPABILITIES OF AN ELECTRONIC HEALTH
RECORD SYSTEM1
Health information and data. Having immediate
access to key information - such as patients'
diagnoses, allergies, lab test results, and
medications - would improve caregivers' ability
to make sound clinical decisions in a timely
manner. Result management. The ability for all
providers participating in the care of a patient
in multiple settings to quickly access new and
past test results would increase patient safety
and the effectiveness of care. Order management.
The ability to enter and store orders for
prescriptions, tests, and other services in a
computer-based system should enhance legibility,
reduce duplication, and improve the speed with
which orders are executed. Decision support.
Using reminders, prompts, and alerts,
computerized decision-support systems would help
improve compliance with best clinical practices,
ensure regular screenings and other preventive
practices, identify possible drug interactions,
and facilitate diagnoses and treatments.
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ESSENTIAL CAPABILITIES OF AN ELECTRONIC HEALTH
RECORD SYSTEM1
Electronic communication and connectivity.
Efficient, secure, and readily accessible
communication among providers and patients would
improve the continuity of care, increase the
timeliness of diagnoses and treatments, and
reduce the frequency of adverse events. Patient
support. Tools that give patients access to their
health records, provide interactive patient
education, and help them carry out
home-monitoring and self-testing can improve
control of chronic conditions, such as diabetes.
Administrative processes. Computerized
administrative tools, such as scheduling systems,
would greatly improve hospitals' and clinics'
efficiency and provide more timely service to
patients. Reporting. Electronic data storage
that employs uniform data standards will enable
health care organizations to respond more quickly
to federal, state, and private reporting
requirements, including those that support
patient safety and disease surveillance."
1. US IOM report, Key Capabilities of an
Electronic Health Record System (Tang 2003)
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INTEROPERABILITY

• Data transfer and sharing on much more than a
  local or enterprise wide scale,
• Knowledge transfer and integration,
• Medical terminology transfer, mapping and
  integration,
• Image transfer, and
• Integration with clinical and non-clinical
  applications.

The Value Of Health Care Information Exchange And
Interoperability1 defines four levels for
interoperability between health information
systems
Level 1 Non-electronic data (e.g. mail,
telephone), Level 2 Machine-transportable data
(e.g. faxed or scanned documents), Level 3
Machine-organizable data (e.g. e-mail,
proprietary file formats), and Level 4
Machine-interpretable data (e.g. structured data
within standardized messages, XML, etc.).
1. Walker et al 2005
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HL7 RIM 2.20 (NORMATIVE)
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A VIEW ON STANDARDS
ISO 18308 Clinical and technical requirements for
an Electronic Health Record Reference
Architecture "that supports using, sharing, and
exchanging electronic health records across
different health sectors, different countries,
and different models of healthcare delivery."
(2004) ASTM Committee Standards on Electronic
Health Record Content and E31.19 Structure CEN
13606 The European electronic healthcare record
interoperability standard (2004). Includes EHR
reference model, archetype interchange
specification, reference archetypes and term
lists, security functions, exchange models to
support communication. HL7 v3 Messaging standard
for communications .. between EMR systems and
practice management systems." (2003).
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A VIEW ON STANDARDS
HL7 Clinical An XML-based generic model for the
representation and Document transfer of clinical
documents. CDA is being used also in
Architecture (CDA) electronic health records
projects to provide a standard format for entry,
retrieval and storage of health information. The
CDA release 2.0 was approved as an ANSI standard
in May 2005. ASTM Continuity of XML-based
document standard for a summary of personal Care
Record (CCR) health information (data set) to
help achieve interoperability between medical
records and to ensure "a minimum standard of
health information transportability when a
patient is referred or transferred to, or is
otherwise seen by, another provider."  
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A VIEW ON STANDARDS
HL7 Reference The RIM is a single,
all-encompassing model of the data Information
Model structures that healthcare applications can
exchange. It is (RIM) an essential part of the
HL7 Version 3 development methodology, as it
provides an explicit representation of the
semantic and lexical connections that exist
between the information carried in the fields of
HL7 messages.
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HELPFUL REFERENCES
Health Level 7 (HL7) Reference Information Model
(RIM) / RIM Critique An Incoherent
Standard HL7 Clinical Document Architecture
(CDA) HL7 Message Development Framework ISO
18308 Health Informatics - Requirements for an
EMR Architecture ISO 12967 Health Informatics
- Service Architecture Part 1 (Enterprise
View) ASTM E1384-07 Standard Practice for
Content and Structure of the Electronic Health
Record The Certification Commission for
Healthcare Information Technology
(CCIT) Healthcare Information Technology (HIT)
Standards Panel Healthcare Information
Technology Leadership Panel - Final Report (March
2005) Medicaid Information Technology
Architecture American Health Information
Community
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