The Electronic Medical Record EMR

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The Electronic Medical RecordEMR
EMR

• Ken Geoly, M.D.
• Clinical Informatics Consultant
• Inova Health System
• BIO IT Coalition
• May 4, 2006

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Multiple Definitions of the EMR

• Macro Definition
• Composite Record of all data pertaining to a
  patient - The Clinical Data Repository
• Micro Definition(s)
• Electronic Storage of some or all patient data by
  a health care entity

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EMRs by Health Care Entity

• Hospitals - Free Standing (transaction systems)
• All transactions (nursing, pharmacy,
  radiological, medical staff, administrative and
  support staff, etc.) stored in a patient centric
  fashion to effect delivery of health care and
  insure efficient charge capture

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Definitions by Health Care Entity

• Physicians Offices - Free Standing (Transaction)
• All transactions by physicians, other health care
  givers, administrative staff to insure an
  accurate health care record and provide efficient
  pass-through of patients in the office

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Definitions by Health Care Entity

• Integrated Delivery Networks
• Combination of the two previous environments
• Sometimes easier to deal with
• Sometimes harder

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Commonalties of Transaction Systems - Regardless
of Site

• Clinical Data
• Need for accurate storage
• Need for ease of use
• Need for ease of entry (preferably automated) of
  universal data elements
• Conceivably Problem Oriented Approach

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Differences in Transaction Systems

• Physician Offices
• Physician Encounter is the driver
• Scheduling is important
• Billing emanates from the encounter and is part
  of the program
• Pharmacy is usually not on site
• Prescription Functionality and Archiving are
  essential
• Medication Lists are long standing
• Office note creation is essential
• Clinical Data is usually from external sources

• Hospitals
• Usually have separate billing and scheduling
  systems
• Pharmacy and Nursing activity is much more
  intense
• In-Hosp Meds may not be continued as OPs
• Storage Capacity is usually much greater
• Physician encounter is usually quite different
  than in the office
• Clinical data is usually from internal sources

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Retrospective EMRs

• Designed not for day to day transactions but to
  study large populations and encounters over time
• Usually require very large storage capacity
• Extract Data from transaction systems
  (conceivably from either or both systems we just
  discussed)

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All are called EMRs!
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Office Based EMRsWhat to Look For...

• Essentials
• Electronic Claims Submission (goes without
  saying)
• Combined PMS with EMR
• Bill emanates from the clinical encounter
• Clinical Information Management
• Radiology Reports (? PACS)
• Lab Reports
• Pharmacy Management
• Electronic Prescriptions
• Prescription Pad
• Medication Management

Rx
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Office Based EMRsWhat to Look For...

• Nice to Haves
• Clinical Note Builder (Free text vs Structured
  Text vs Voice Recognition)
• Preferably tying the note to the bill
• PDA Support
• Secure Wireless Internet Access
• Connection to PMS/EMR for access to office based
  info and for billing from other areas - e.g.
  hospital rounds (ever see 24)
• Internal Wireless LAN
• Portable Tablet Computers for Walk Around Access

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Office Based EMRsWhat to Look For...

• Nice To Haves (contd)
• Retrospective Data Analysis
• Disease Management
• Pharmacy Management
• Practice Management
• Guideline Adherence

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Security / Administrative Issues

• Data Sharing usually not an issue in large
  practices
• Remote access over the Internet will have to be
  secure
• Pharmacy Laws w/ Electronic Prescription
• Split Data for
• Chart Completeness
• Medico-Legal Purposes