Electronic Medical Records (EMR)

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Electronic Medical Records (EMR)

• Computerized Patient Record (CPR)
• Electronic Health Record (EHR)

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Work-out Problem 1

• Assume that disease D1 has a prevalence of 10 in
  Milwaukee (population 600,000)
• Test T1 has a sensitivity of 80 and a
  specificity of 90 for D1
• Calculate
• The positive predictive value of T1
• The negative predictive value of T1

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Work-out Problem 2

• Assume that disease D2 has a prevalence of 0.01
  in Milwaukee (population 600,000)
• Test T2 has a sensitivity of 80 and a
  specificity of 90 for D2
• Calculate
• The positive predictive value of T2
• The negative predictive value of T2

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Patient Record

• The patient record is a representation of all the
  data acquired and created when the patient
  navigates through the health care system

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Use of a Patient Record

• To recall observations
• To inform others
• To instruct students
• Gain knowledge
• Monitor performance
• Justify interventions
• In short, to improve health care delivery

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EMR

• A repository of electronically maintained
  information about an individuals lifetime health
  status and health care. It should be accessible
  to multiple legitimate users.

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EMR

• Adds information management tools
• Clinical reminders and alerts
• Links to literature
• Health care decision support
• Analysis of aggregate data

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How EMR Differs from a Paper Record

• EMR flexible and adaptable
• Care for a single patient or groups of patients
  (guidelines)
• All authorized persons can access data
  immediately based on need
• Possible remote access
• Better documentation and legibility

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Factors Influencing EMR Usefulness

• Comprehensiveness of information
• Duration of use and data retention
• Structure of data
• Ubiquity of access

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Disadvantages of EMR

• Initial cost
• Hardware
• Software
• Training
• Support
• Failures
• Data input issues

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Functional Components of EMR

• Integrated view of patient data
• Providers need many views
• Clinical decision support
• Clinician order entry
• Access to knowledge resources

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EMR Input and Output
Order Entry
Data Entry Results Review
Event Monitor
Medical Logic Modules
Laboratory
Database Interface
Billing Finance
Pharmacy
Medical Entities Dictionary
Radiology
Patient Database
Research Databases
Modified from Shortliffe etal. 01
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Clinical Decision Support

• Most effective when the physician is assessing
  the patients condition and is making ordering
  decisions
• Override option required
• Rationale for suggestion helpful
• Anti-microbial assistance has resulted in
  significantly improved clinical and financial
  outcomes for patients

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Access to Knowledge Resources

• The most effective time to provide access to
  knowledge resources is at the time decisions or
  orders are being contemplated by the physician

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Fundamental Issues for EMR

• Data capture
• Data input
• Error prevention
• Data display
• Flow sheet
• Summaries and abstracts

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Questions?? Comments!!