Chapter 3 - Health Information Systems - Workflow and Functions PDF

Medical Records and HIS/EHR Systems Health Information Systems Workflow and Functions  Health Information Systems Workflow and Functions Learning Objectives ❖ Describe the Types and functions of Health Information Systems (HIS) ❖ Identifying the roles of HIS systems in...

Medical Records and HIS/EHR Systems Health Information Systems Workflow and Functions  Health Information Systems Workflow and Functions Learning Objectives ❖ Describe the Types and functions of Health Information Systems (HIS) ❖ Identifying the roles of HIS systems in generating, managing, and use of EHR data ❖ the common workflows of Health Information Systems HISs ❖ HISs refer to any system that Capturing, storing, managing, analyzing or transmitting information related to the health of individuals Health Information Systems HISs ❖ HISs refer to any system that Administering and managing the activities of organizations that work within the health sector (financial, personnel, payroll, bed census etc.) Health Information Systems HISs ❖ HISs refer to any system that Evaluation of Hospital Performance and Cost , and projection of the long-term forecast Health Information Systems HISs ❖ HIS systems are categorized into four categories: Clinical Information Systems Administrative Information Systems Management Support Information Systems Research and Data Analysis Information Systems ❖ Each category consists of multiple HISs Each HIS system interact with EHR Health Information Systems HISs Patients Oriented HISs  Administrative HIS Support the business functions of the healthcare organization  Administrative HIS ❖ Mainly contains administrative and financial data About patients About healthcare providers (staff members) About healthcare materials, equipment, etc. others  Administrative HIS Patient Registration System (PRS) ❖ PRS allows administration department to capture pertinent information of patients when they enter to the healthcare institute (e.g., hospital)  Administrative HIS Patient Registration System (PRS) ❖ Also, PRS tracking patients encounters among multiple points of data input  Administrative HIS Patient Registration System (PRS) ❖ PRS is the core HIS in any healthcare institution PRS is the starting point of the patients’ trip and provides the required information that identify patients to other HISs  PRS functions  Administrative HIS Patient Registration System (PRS) Search and retrieve patient’s demographic and care data from most recent visit (if exist).  Administrative HIS Patient Registration System (PRS) Registering patient’s identification information (unique identification No, age, name, and contact information, etc.) If a patient not registered.  Administrative HIS Patient Registration System (PRS) Registering detailed information about a patient who needs treatment or admission ❑ Pain symptoms, preliminary diagnosis, admission cause and department, etc.  Administrative HIS Patient Registration System (PRS) Coordination and management of Patients’ admission transfer, and discharge ‫براءة الذمة‬  Administrative HIS Patient Registration System (PRS) Make patients data available to all departments of the healthcare institution PRS and EHR Workflow  Administrative HIS PRS and EHR Workflow healthcare receptionist search for incoming patient via PRS user interface  Administrative HIS PRS and EHR Workflow 1. PRS access EHR Repository search and retrieve data related to incoming patient from most recent visit (if exist)  Administrative HIS PRS and EHR Workflow 2. Healthcare receptionist add identification information (unique identification No, age, name, and contact information, etc.) if a patient not registered via PRS user interface PRS store patient’s data in his/her related EHR  Administrative HIS PRS and EHR Workflow 3. Healthcare receptionist add detailed information about a patient who needs treatment or admission PRS update the patient’s related EHR  Administrative HIS PRS and EHR Workflow 4. Other HISs notify PRS when a transfer or discharge request is recorded by other HISs (i.e., request from other healthcare profession)  Administrative HIS PRS and EHR Workflow 4. Other HISs notify PRS when a transfer or discharge request is recorded by other HISs (i.e., request from other healthcare profession) Healthcare receptionist access EHR for handling the unified transfer or discharge request via PRS user interface. RPS updates the patient’s related HER. PRS notify other HISs. Other HISs can view the status of the transfer/discharge request Clinical HIS  Clinical HIS Clinical ISs are mainly designed to support patients’ care  Clinical HIS healthcare providers can access a timely, complete, and relevant clinical information. Healthcare provider can use clinical information to diagnose, treat, and manage patient care.  Clinical HIS Clinical ISs directly feed the EHR  Computerized Provider Order Entry CPOE  Clinical IS Computerized Provider Order Entry CPOE is designed to replace a clerical's paper-based ordering system.  Clinical IS Computerized Provider Order Entry ❖ CPOE allow healthcare providers to electronically write full range of orders, maintain and review changes made to an order by successive responsible personals.  CPOE functions  Clinical IS Computerized Provider Order Entry Order entry ❑ CPOE allows healthcare providers (i.e., physician) to enter testing and treatment orders for a patient  Clinical IS Computerized Provider Order Entry Order entry ❑ CPOE electronically transmitting the orders to the correct department(s) for fulfillment (i.e., pharmacy, laboratory, radiology, etc.)  Clinical IS Computerized Provider Order Entry Decision support ❑ CPOE utilizes alerts and reminders to assist healthcare provider during ordering process such as: ▪ Alert to laboratory technician when he/she withdraw a blood from a patient who has high blood fluidity. ▪ The patient is allergic or has other health problem with the ordered medication. ▪ The physician should order lab tests to monitor the blood level of a particular medication. Etc. CPOE and EHRs Workflow  Clinical IS CPOE and EHRs Workflow ❖ Physician or other authorized healthcare provider enters order data via CPOE user interface  Clinical IS CPOE and EHRs Workflow ❖ Physician or other authorized healthcare provider enters order data via CPOE user interface: 1. CPEO check the order data against patient data and medication contradiction data ▪ If required, CPEO notify reminder or alert ▪ OR Order data is stored in EHR related to the patient  Clinical IS CPOE and EHRs Workflow ❖ Physician or other authorized healthcare provider enters order data via CPOE user interface 2. CPOE send a notification to the relevant IS responsible to handle the order (i.e., Laboratory, pharmacy, or radiology ISs).  Nursing Information System (NIS) Nursing Information System (NIS) ❖ Nurse profession to help nurses provide better patient care Facilitate nursing activities and provides tools for managing the delivery of nursing care  Nursing Information System Functions Nursing Information System (NIS) ❖ NIS Functions 1. Register, view, and update patient’s vital signs Vital signs includes : body temperature, blood pressure, heart beats, Oxygen percentage, etc. Nursing Information System (NIS) ❖ NIS Functions 2. Register, view, and update patient care’s plan Patient care plan include: admission and nursing assessments, required treatment tests, nursing notes Nursing Information System (NIS) ❖ NIS Functions 3. Register, view, and update patient’s condition Patient’s condition could be: Undetermined, Good, fair, serious, critical, treated and released, or confirming patient’s death Nursing Information System (NIS) ❖ NIS Functions 4. Access order information Drug order, lab order, radiology order, etc. Nursing Information System (NIS) ❖ NIS Functions 5. Access procedure guidelines Systematic statements that help Nurses to make decisions about care in specific clinical circumstances NIS and EHR Workflow  NIS and EHR Workflow 1. Nurse profession record/view/update patient’s plan via NIS user interface EHRs stores/updates patient’s plan  NIS and EHR Workflow 2. Nurse profession periodically record/view/ update patient’s vital signs via NIS user interface EHRs periodically stores multiple copies of vital signs  NIS and EHR Workflow 3. Nurse profession record/view/update patient’s condition via NIS user interface EHRs retrieve/updates patient’s plan  NIS and EHR Workflow 4. CPOE or other HIS send notification alert to the NIS: Medication order, lab order Patient's serious or critical condition alert Nurse profession view notification alert and handle patient’s situation EHR retrieve/update patient info  NIS and EHR Workflow 5. Nurse profession view procedure guidelines EHRs retrieve procedure guidelines  Laboratory Information System (LIS) Laboratory Information System (LIS) LIS is an IS that effectively manage lab samples and associated data, and integrate lab instruments to improve lab efficiency  Laboratory Information System (LIS) Functions Laboratory Information System (LIS) 1. Patients and sample management ❑ Patient management, including admission date, admitting physician, ordering department, specimen ‫ عينه‬type, etc. ❑ Specimen & specimen container registration (e.g., generate of a barcode identifier) ❑ Tracking chain of custody ‫ عهدة\رعاية‬sample & sample location Laboratory Information System (LIS) - cont. 2. Instrument and application integration ❑ Accept input from bedside devices or other devices ❑ Control the operations of some physical instruments such as tube sample test ❑ Extract, store, and report results generated by some instruments Laboratory Information System (LIS) - cont. 3. Decision Support ❑ Notify alert or reminder when the lab test contradict with patient situation or contradict with current patient’s medication. ❑ Notify alert when the requested test is done soon ❑ Notify alert when the result of such lab test is serious or critical. Laboratory Information System (LIS) - cont. 4. Electronic data exchange ❑ Management of instruments’ input and output data ❑ Importing of remote data and exporting of test result to remote system or to EHR ❑ Send test results to other clinical systems Other secondary functions LIS and EHR Workflow  LIS and EHR Workflow ❖ Lab test could be requested manually or electronically by other HISs such as CPOE 1. Laboratory profession receive lab test request (paper or electronic) and manage this request as follows: Record/view patient’s info and the type of requested lab Generate and store a barcode identifier for the test samples and test containers  LIS and EHR Workflow 2. Laboratory profession Handle the requested test as follows: Manually/automatically prepare test instruments Execute and control the test Extract and report the test’s result Store the test’s result in the patient’s EHR  LIS and EHR Workflow 3. LIS notify alert or reminder to lab profession and to other HISs Lab profession and other healthcare providers handle the LIS notification or reminder  Radiology Information System (RIS)  Radiology Information System (RIS) RIS is used for managing medical images and associated data, and tracking radiology imaging orders Other common name Picture archiving and communication systems (PACSs)  Radiology Information System (RIS) Functions  Radiology Information System (RIS) ❖ RIS Functions Allows direct order entry or accepts orders from other HIS systems Generate, analyze, and manage medical images Allow health provider reporting of image results Provide picture archiving and transmission of images and tracking of film RIS and EHR Workflow  RIS and EHR Workflow 2. Radiology profession handles the requested radiology image as follows: Manually/automatically prepare imaging instruments and machines Execute and control the image Extract and report the image result Store the image result in the patient’s EHR  Pharmacy Information System (PIS) Pharmacy Information System (PIS) ❖ PIS is simplify and streamline the: ▪ dispensing‫ وصف‬of medications, ▪ control inventory ‫ جرد‬, ▪ automatically compare drug orders with dosages ‫ جرعات‬appropriate for the patient  Pharmacy Information System (PIS) Functions Pharmacy Information System (PIS) ❖ PIS Functions Receiving medication order from other HISs such as CPOE and NIS Monitoring of drug interactions, drug allergies and other possible medication-related complications Managing prescription ‫ وصفة طبيه‬for patients Tracking all prescriptions passed through the system from who prescribed the drug, when it was prescribed to when it was dispensed ‫وصفت‬ Clinical Decision Support System (CDSS) Clinical Decision Support System (CDSS) ❖ CDSS assist healthcare providers in the actual diagnosis and treatment of patients CDSS integrate data from a number of systems to assist with charting, CPOE, and identifying drug contraindications Towards Shareable EHR-based HISs Towards Shareable EHR-based HISs Today, not all healthcare institutions (i.e., doctors’ clinics, healthcare and radiology centers, medical labs, hospitals, etc.) adopt sharable EHR Towards Shareable EHR-based HISs BUT The meaningful use of EHR requires healthcare institutions to share information that generated and managed Towards Shareable EHR-based HISs ❖ Sharing of HISs information must be at multiple levels: At institution level ❑ A healthcare institution must be able to share patients’ information generated by its HISs Towards Shareable EHR-based HISs ❖ Sharing of HISs information must be at multiple levels: At national level ❑ A healthcare institution must be able to share patients’ information generated by other national healthcare institutions (i.e., Hospitals, Medical Lab centers, Doctors’ clinics) Towards Shareable EHR-based HISs ❖ Sharing of HISs information must be at multiple levels: At international level ❑ A healthcare institution must be able to share patients’ information generated by other international healthcare institutions Towards Shareable EHR-based HISs The Healthcare Information and Management Systems Society (HiMSS) identify an EHR adoption model Towards Shareable EHR-based HISs EHR adoption model This model consists of eight level stages (0 - 7) that measures the adoption and utilization of shared EHR Functions The purpose of this model is to promote and support healthcare institutions to adopt EHR and HISs ❑ Improve their healthcare delivery Shareable EHR Adoption Model  Shareable EHR Adoption Model ❖ Level (0) The organization has not installed all of the three key ancillary ‫ ملحق‬clinical information systems ❑ Laboratory IS ❑ Pharmacy IS ❑ Radiology IS Paper-based records are the only means of storing and accessing clinical information Shareable EHR Adoption Model  Shareable EHR Adoption Model… ❖ Level (1) The organization has installed all of the three key ancillary clinical information systems ❑ Laboratory IS ❑ Pharmacy IS ❑ Radiology IS Electronic storage of healthcare notes – normally as free text - are stored in patient record Shareable EHR Adoption Model  Shareable EHR Adoption Model… ❖ Level (2) Major ancillary‫ ملحق‬clinical systems feed data to a clinical data repository (CDR) ❑ The CDR provides physician access for reviewing all orders and results. ❑ The CDR contains a controlled medical vocabulary, and the clinical decision support/rules engine (CDS) for rudimentary ‫ بدائي‬conflict checking. (cdc level 1) ❑ Information from document imaging systems may be linked to the CDR at this stage.  Shareable EHR Adoption Model… ❖ Level (2) The hospital may be health information exchange (HIE) capable at this stage and can share (part of) information it has in the CDR with other healthcare providers. Shareable EHR Adoption Model  Shareable EHR Adoption Model… ❖ Level (3) Nursing/clinical documentation (e.g. vital signs, flow sheets, nursing notes, etc.) is required, implemented and integrated with the CDR. ❑ Care plan charting is scored with extra points  Shareable EHR Adoption Model… ❖ Level (3) The electronic Patient Registration System (PRS) or Patient Master Index system is implemented.  Shareable EHR Adoption Model… ❖ Level (3) Medical image access from Radiology information system (RIS) is available for access by physicians outside the Radiology department via the organization’s intranet.‫شبكة داخلية‬ Shareable EHR Adoption Model  Shareable EHR Adoption Model… ❖ Level (4) Computerized Practitioner Order Entry (CPOE) for use by any clinician licensed to create orders is added to the nursing, laboratory, radiology, and CDR environment  Shareable EHR Adoption Model… ❖ Level (4) The capabilities relatesecond level of clinical decision support(level 2) to evidence based medicine protocols. This stage has been achieved if one inpatient service area has implemented CPOE with physicians entering orders and completed the previous levels (i.e., 1, 2, and 3) Shareable EHR Adoption Model  Shareable EHR Adoption Model… ❖ Level (5) A full complement of RIS(Radiology Information System) systems provides medical images to physicians via an intranet ‫ شبكة داخليه‬and displaces all film based images. Cardiology ‫ قسم القلب‬RIS and document imaging are scored with extra points. Shareable EHR Adoption Model  Shareable EHR Adoption Model… ❖ Level (6) Full physician documentation with structured templates and discrete data is implemented for progress notes, consult ‫ تشاور‬notes, discharge summaries or problem list & diagnosis list maintenance.  Shareable EHR Adoption Model… ❖ Level (6) Level three of clinical decision support(level 3 of CDS) provides guidance for all clinician activities related to protocols and outcomes in the form of variance & compliance‫ التزام‬alerts.  Shareable EHR Adoption Model… ❖ Level (6) The closed loop of medication administration with bar coded unit dose medications environment is fully implemented  Shareable EHR Adoption Model… ❖ Level (6) – cont. The PRS and bar coding or other auto identification technology - such as radio frequency identification (RFID) - are implemented and integrated with CPOE and pharmacy to maximize point of care patient safety processes for medication administration.  Shareable EHR Adoption Model… ❖ Level (6) – cont. The “five rights” of medication administration are verified at the bedside with scanning of the bar code on the unit does medication and the patient ID. Shareable EHR Adoption Model… Shareable EHR Adoption Model…  Shareable EHR Adoption Model… ❖ Level (7) The hospital no longer uses paper-based patient record to deliver and manage patient care  Shareable EHR Adoption Model… ❖ Level (7) Also, it has a mixture of discrete data, document images, and medical images within its EMR environment.  Shareable EHR Adoption Model… ❖ Level (7) Data warehousing‫ تخزين‬is being used to analyze patterns of clinical data to improve quality of care, patient safety, and care delivery efficiency.  Shareable EHR Adoption Model… ❖ Level (7) Clinical information can be readily shared with all entities that are authorized to treat the patient, or a health information exchange (coding system) (i.e., other non-associated hospitals, ambulatory‫ االسعاف‬clinics, employers, Payers Patients in a data sharing environment.  Shareable EHR Adoption Model… ❖ Level (7) – cont. The hospital demonstrates summary data continuity for all hospital services (e.g., inpatient, outpatient, ED, and with any owned or managed ambulatory ‫ االسعاف‬clinics).  Shareable EHR Adoption Model… ❖ Level (7) – cont. Blood products and human milk are included in the closed-loop medication administration process. Shared EHR taken from: http://www.openehr.org – 05/02/2017  EHR data interoperability To achieve level (7) of shareable EHR adoption model, EHR data must be interoperable.  EHR data interoperability ❖ EHR data interoperability refers to: the ability of HISs that create, exchange and consume EHR data to have clear, shared expectations about the contents (at syntax and structure level), context & meaning of that data.  EHR data interoperability ❖ A number of standard coding systems (SCS) are practically developed and used to achieve EHR data interoperability ‫شرط‬ SCS is represented in machine readable form SCS is also represented in human readable form  Standard Coding Systems ❖ Rationale of Machine readable form of SCS HISs will have a common database HISs can communicate using a common language & terminologies.  Standard Coding Systems ❖ Most common standard coding systems developed in the healthcare fields: ICD-X codes SNOMED codes HL7 terminology EHR communication standard (CEN 13606) SCS will be discussed in the next chapters  References 1. Nanette B. Sayles, EdD, RHIA,CHPS, CCS, CPHIMS, FAHIMA. Health Information Management Technology: An Applied Approach, 4th Edition, 2013 2. https://www.healthit.gov, last accessed 01/02/2017 3. http://www.himss.org/ehr-adoption, last access 01/02/2017 143