Collage of Applied Medical Sciences

Department of Health Information Management and Technology

ELECTRONIC HEALTH RECORDS (EHR)

WEEK 5: FUNDAMENTAL ISSUES FOR ELECTRONIC
HEALTH RECORD SYSTEMS
Collage of Applied Medical Sciences
Department of Health Information Management and Technology

STUDENTS RESOURCES:
Shortliffe, Chapter 12: Electronic Health Record Systems
Collage of Applied Medical Sciences
Department of Health Information Management and Technology

FUNDAMENTAL ISSUES FOR ELECTRONIC HEALTH

RECORD SYSTEMS
• All health record systems must serve the same functions,
whether they are automated or manual.
• From a user’s perspective, the major difference is the way data
are entered into, and delivered from, the record system.
These Issues of EHR may raised in these domain:
1- Data Capture.
2- Data Display.
3- Query and Surveillance Systems.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(A) DATA CAPTURE

EHRs use two general methods for data capture :

(1) Electronic interfaces from systems, such as laboratory

systems that are already fully automated.

(1) Direct manual data entry, when no such electronic source

exists or it cannot be accessed.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(A) DATA CAPTURE . 1- ELECTRONIC INTERFACES

- The preferred method of capturing EHR data is to implement

an electronic interface between the EHR and the existing
electronic data sources such as laboratory systems, pharmacy
systems, home monitoring devices, registration systems, etc.
- The creation of interfaces requires effort to implement, but,
once implemented they provide near-instant availability of the
clinical data without the labor costs and error potential of
manual transcription.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

A) DATA CAPTURE . 1- ELECTRONIC INTERFACES

- Interfacing is usually easier when the organization that owns the
EHR system also owns the source system. Efforts to interface with
systems outside the organizational boundary can be more difficult.
- However, interfaces between office practice systems and major
referral laboratories for exchanging laboratory test orders and
results, and between hospitals and office practices to pharmacies
for e-prescribing, are now relatively easy and quite common.
- The above discussion about interfacing concerns data
produced, or ordered, by a home organization.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(A) DATA CAPTURE. 2- MANUAL DATA ENTRY

- Data may be entered as narrative free-text, as codes, or as a combination
of codes and free text.
- The major advantage of coding is that it makes the data “understandable” to
the computer and thus enables selective retrieval, clinical research, quality
improvement, and clinical operations management.
- Natural-language processing (NLP) offers hope for automatic encoding of
narrative text.
- ((The adoption of natural language processing (NLP) is soaring
because of its undisputed potential in interpreting complex,
unstructured datasets, and in generating actionable intelligence. This
data can be in any form such as text, speech, visuals, etc. Harnessing
this power can unlock the doors to unprecedented opportunities and
maximize the organization’s collective investment in terms of capital,
human efforts, and time.)) 7
Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(A) DATA CAPTURE. 2- MANUAL DATA ENTRY

- The coding of diagnoses, allergies, problems, orders, and

medications using a process called auto complete, clinicians
can code such items by typing in a few letters of an item name,
then choosing the item they need from the modest list of items
that match the string they have entered.
- This process can be fast and efficient when the computer
includes a full range of synonyms for the items of interest, and
has frequency statistics for each item.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(A) DATA CAPTURE. 3- PHYSICIAN-ENTERED DATA

- Physicians spend about 20 % of their time documenting the

clinical encounter and the documentation burden has risen
over time.
- Direct entry by clinicians may not be as important for visit
notes because the time cost of physician input is high and
the information is not a pre-requisite to the check-out
process.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(A) DATA CAPTURE. 3- PHYSICIAN-ENTERED DATA

Physicians’ notes can be entered into the EHR via one of three
general mechanisms:
(1) Transcription of dictated or written notes.
(2) Clinic staff transfer or coding of some or all of the data by
clinicians on a paper encounter form.
(3) Direct data entry by physicians into the EHR (which may be
facilitated by electronic templates or macros).
- Speech recognition software offers an approach to “dictating”
without the cost or delay of transcription. The computer translates
the clinician’s speech to text automatically

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(A) DATA CAPTURE - WHAT TO DO ABOUT DATA RECORDED ON

PAPER BEFORE THE INSTALLATION OF THE EHR

- One approach is to interface the EHR to available electronic

sources and load data from these sources for 6–12 months
before going live with the EHR.
- A second approach is to abstract selected data, e.g., key
laboratory results, the problem lists, and active medications from
the paper record and hand enter those data into the EHR prior
to each patient’s visit when the EHR is first installed.
- Third approach is to scan and store 1–2 years of the old paper
records.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(A) DATA CAPTURE - DATA VALIDATION

- Because of the chance of transcription errors with the hand

entry of data, EHR systems must apply validity checks.
Number of different kinds of checks apply to clinical data:
1- Range checks can detect or prevent entry of values that are
out of range. The computer can ask the users to verify results
beyond the absolute range.
2- Pattern checks can verify that the entered data have a
required pattern.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(A) DATA CAPTURE - DATA VALIDATION

Number of different kinds of checks apply to clinical data:
3- Computed checks can verify that values have the correct
mathematical relationship.
4- Consistency checks can detect errors by comparing entered
data.
5- Delta checks warn of large and unlikely differences between
the values of a new result and of the previous observations.
6- Spelling checks verify the spelling of individual words.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(B) DATA DISPLAY

- Once stored in the computer, data can be presented in
numerous formats for different purposes without further entry
work.
- Increasingly, EHRs are implemented on web browser
technology because of the ease of deployment to any PC or
smart device (including smart phone and tablets).
- Timeline Graphs: A graphical presentation can help the
physician to assimilate the information quickly and draw
conclusions.
- Timeline Flow sheets: can be applied in different domain
such as radiology, ICU, ECG and etc.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(B) DATA DISPLAY

- Summaries and Snapshots: EHRs can highlight important
components (e.g., active allergies, active problems, active
treatments, and recent observations) in clinical summaries or
snapshots.
- Dynamic Search: Anyone who has reviewed a patient’s chart
knows how hard it can be to find a particular piece of
information. Search tools help the physician to locate relevant
data. The EHR can then display these data as specialized
presentation formats (e.g., flow sheets or graphics) to make it
easier for them to draw conclusions from the data.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

(C) QUERY AND SURVEILLANCE SYSTEMS

- The query and surveillance capabilities of computer- stored
records have no counterpart in manual systems.
- Public health professionals can use the reporting functions of
computer-stored records for surveillance, looking for emergence
of new diseases or other health threats for medical attention.
- Although these functions of decision support on the one hand,
and query surveillance systems, on the other, are different, their
internal logic is similar.
- Query and surveillance systems can be used for: clinical care,
quality reporting, clinical research, retrospective studies,
and administration.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

CHALLENGES AHEAD
- The future of EHR systems depends on both technical and
nontechnical considerations.
A. Users’ Information Needs.
B. Usability.
C. Standards.
D. Privacy & Security.
E. Cost & benefits.
F. Leadership.

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Collage of Applied Medical Sciences
Department of Health Information Management and Technology

THANK YOU
ANY QUESTIONS?