Lincoln University College

MASTERS IN PUBLIC HEALTH

HEALTH INFORMATION
TECHNOLOGY
LECTURE BY

MR. ABDULWAKIL DAUDI (Msc., BED (Sc)

 MODULES AND UNITS
MODULE Units
1 Overview of the Health Information 1. Introduction to the concepts of terms
Technology 2. Describe a brief history of health Information technology
3. Roles and Skills of Health IT
4. Emerging Trends in Health Information Technology

2 Electronic Health Records 1. Limitations of paper-based health records vs benefits of EHR

2. Key components of an electronic health record
3. The obstacles to purchasing, adopting and implementing an EHR
4. The steps to adopt and implement an HER

3 Telemedicine and e-health 1. Difference between telehealth and telemedicine

2. Types of telemedicine consultations, such as teleradiology and teleneurology and Benefits.
3. Different means of transferring information with telemedicine, such as store and forward
Health Information Exchange (HIE) 1. Identify the need for and benefits of HIE and interoperability
2. Describe the concept of health information organizations (HIOs)
3. Compare and contrast the differences between Direct and eHealth Exchange
4. Enumerate the basic and advanced features offered by HIOs
5. Detail the obstacles facing HIOs
6. Understand the future direction of HIOs and the impact of Meaningful Use
2 Clinical Decision Support Systems 1. Introduction to Clinical Decision Support
2. Perspectives on Clinical Decision Support
3 Consumer Health Informatics (CHI) 1. Introduction to Consumer Health Informatics
2. Personal Health Records and Consumerism
4 Administrative, Billing, Financial Systems 1. Introduction Administrative, Billing, and Financial Systems and Health Care Information Systems Integration
and HIT Governance 2. Master Patient Index and the Unique Patient Identifier
6 Health Information Privacy and Security 1. Privacy and security measures as part of HIPAA, HITECH Act,
2. The importance of data security and privacy as related to public perception
3. Benefits and pitfalls of local vs. Software-as-a-Service (SaaS) technical security solutions
4. Ways to ensure authentication
5. Compare and contrast digital signature and certificate based encryption
6. Types of security breaches and their causes
7. Security standards and the laws intended to protect health data

5 Final Assessment Examination

 Module 2
ELECTRONIC HEALTH
RECORDS (EHR)
Mode: Evening
Programme
 UNIT2: ENVIRONMENT
OBJECTIVES OF UNIT 2
By the end of this unit, the students should be able to:
1.State the definition of electronic health records (EHRs)
2.Limitations of paper-based health records vs benefits of EHR
3.Key components of an electronic health record
4.The obstacles to purchasing, adopting and implementing an EHR
5.The steps to adopt and implement an HER
Introduction to EHR
• An EHR is a digital version of a patient's medical history, combining information from
various healthcare encounters.
• It often replaces terms like Electronic Medical Record (EMR) and Computer-based Patient
Record (CPR).
• Information on EHR includes: A comprehensive set of patient data, including
demographics, diagnoses, medications, medical history, allergies, lab results, and more.
• EHRs automates complex processes, streamlining workflows for clinicians.
• It is a comprehensive patient record that provides a complete picture of a patient's
health for better-informed care decisions.
• To enhance care delivery EHR supports evidence-based practices, quality management,
and outcomes reporting.
• It enables various stakeholders (administrators, doctors, nurses, researchers) to utilize
data for different needs.
• Overall, EHRs play a crucial role in modern healthcare by offering a centralized, digital
platform for managing patient information, improving care coordination, and
supporting various healthcare activities.
Definition of EHR, EMR and PHR
• Electronic Health Record: “An electronic record of
health-related information on an individual that
conforms to nationally recognized interoperability
standards and that can be created, managed and
consulted by authorized clinicians and staff across
more than one healthcare organization”
• Electronic Medical Record: “An electronic record of
health-related information on an individual that can be
created, gathered, managed and consulted by
authorized clinicians and staff within one healthcare
organization.”
• Personal Health Record: “An electronic record of
health-related information on an individual that
conforms to nationally recognized interoperability
standards and that can be drawn from multiple
sources while being managed, shared and
controlled by the individual.”
 Comparing EHR, EMR and PHR
Feature EHR EMR PHR
Function Comprehensive digital Digital record of Patient-controlled
record of all healthcare healthcare encounters platform for managing
encounters within a specific personal health
organization information

Ownership Healthcare organizations Healthcare Individual patients

organizations
Content Demographics, diagnoses, Similar to EHR, but Information entered by
medications, labs, may be less patient or imported
imaging, treatment plans comprehensive and with permission (e.g.,
(across organizations) specific to the medical history,
organization allergies, medications)
Relationship Between EHR, EMR
and PHR
Relationship Between EHR, EMR and PHR
Why we Need EHR
• Paper records are severely limited.
• Need for improved efficiency and productivity
• Quality of care and patient safety
• Public expectations
• Financial savings
• Technological advances
• Need for aggregated data
• EHR as a transformational tool
• Need for coordinated care
Advantages of EHR over Paper Records
1. Improved Accuracy and Completeness: Minimize transcription errors
through automated data entry and reminders for missing data.
2. Enhanced Accessibility and Sharing: Different authorized healthcare
institutions can access patient records from anywhere, facilitating
coordinated care and communication.
3. Increased Efficiency and Productivity: Reduced Time Spent
Searching through automated tasks, frees up clinician time for
patient interaction.
4. Enhanced Quality of Care: EHR systems can provide evidence-based
recommendations and clinical guidelines to support informed
decisions. EHRs facilitate tracking chronic conditions and
preventative care measures.
Advantages of HER over Paper Records
5. Cost Savings: Over time, reduced duplication of efforts and improved
efficiency can lead to cost savings.
6. Disaster Recovery: Electronic backups ensure data security and
minimize risk of loss during disasters.
7. Research and Public Health: EHR data can be used for research
purposes and public health initiatives.
8. Patient Engagement: Some EHR systems offer patient portals,
allowing patients to access their health information and participate in
their care more actively.
Purpose/Functions of EHR
• The main purpose of EHR is to support clinical care and billing.
• Other EHR functionalities include:
Improving the quality and convenience of patient care,
Improving the accuracy of diagnoses and health outcomes,
Improving care coordination and patient participation,
Improving cost savings,
Improving the general health of the population.
• To perform these functions, it must integrate to different
components
Components/
Elements of EHR
Different components of
HER includes:
Administrative,
Nursing,
Pharmacy,
Laboratory,
Radiology,
Physician’ entries/
Clinical etc.
1. Administrative System Component
• Captures information like patient demographics, insurance details, and
contact information.
• Includes social history data (marital status, family history).
• Assigns a unique identifier medical record number or master patient index
(MPI) for linking data across different platforms.
• Allows aggregation of a person's health information for analysis and
research.
2. Laboratory System Component and Vital Signs:
• Stores lab test data in a structured format using standard terminology
Logical Observation Identifiers Names and Codes (LOINC).
• Crucial for diagnosis, treatment, and health management.
• Enables comparison with previous test results for better insights.
• Records vital signs like pulse, temperature, blood pressure, body mass
index (BMI), etc. .
 3. Radiology System Component:
• Uses RIS (Radiology Information System) to manage medical imagery and
data.
• Employs Procedural Terminology (CPT) or International Classification of
Diseases (ICD) coding to identify procedures and resources.
• Offers functionalities like patient tracking, scheduling, and image storage
as picture archiving communications system (PACS).
• Generates complete patient imagery history and statistical reports.
4. Pharmacy System Components:
• Maintains medication history (drug name, dosage, allergies, etc.).
• Documents and shares immunization data with public health
organizations.
• Uses NDC, SNOMED, and RxNorm coding systems for medication data.
• May be independent of central EHRs but strives for secure and
effective medication management.
5. Computerized Physician Order Entry (CPOE):
• Allows electronic ordering of services like lab tests, medication, and
radiology studies.
• Reduces medication errors through automated alerts for allergies,
contradictions, etc.
• Improves patient-centered clinical decision support.
Benefits of CPOE include:
• Reduced errors due to illegibility and transcription
• Streamlined workflow and faster order completion
• Error checking for dose and test accuracy
• Improved inventory management
 CPOE continues:
Risks of CPOE: Advantages:
• Slower communication • Overcomes illegibility issues
in emergencies • Reduces errors with similar drug names
• Ambiguity in • Integrates with decision support systems
instructions due to
separate workstations
• Provides drug-drug interaction warnings
• Increased mortality rate • Links prescriptions to specific physicians
(reported in some • Enables Adverse Drug Event (ADE) reporting
studies) • Reduces medication errors (trailing zeros)
• Workflow disruption • Creates data for analysis and research
due to frequent alerts • Suggests treatment and drug options
• Slow adaptation rate • Helps prevent under- and overprescribing
due to physician
skepticism • Speeds up prescription delivery to pharmacies
Clinical Documentation
• Overall, clinical documents are essential components of EHRs, providing
a comprehensive and centralized record of a patient's healthcare journey.
What information does a clinical document include?
• Patient care details: Physician notes, nurse notes, other clinician notes.
• Timeline: Relevant dates and times associated with the document.
• Care providers: Individuals involved in the patient's care.
• Monitoring data: Flow sheets for vital signs, input/output, and problem
lists.
• Procedural reports: Perioperative notes and discharge summaries.
• Legal documents: Advance directives, durable powers of attorney, and
consents.
• Administrative details: Medical record tracking, information release
authorizations, and staff credentials.
Major Coding Systems:
• International Classification of Diseases (ICD):
• Developed by the World Health Organization (WHO).
• Classifies diseases, diagnoses, health management, and clinical purposes.
• Provides a standardized system of codes for various conditions, symptoms,
and procedures.
• Used for data exchange, statistical reporting, and reimbursement
purposes.
• Two main versions: ICD-10 (current) and ICD-11 (future implementation)
• Current Procedural Terminology (CPT):
• Developed by the American Medical Association (AMA).
• Provides standardized codes for medical, surgical, and diagnostic services.
• Used for billing purposes and tracking healthcare resource utilization.
• Distinct from ICD, focusing on procedures and services rather than
diseases.
 Major Coding Systems:
• Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT):
• Comprehensive, computer-processible terminology for clinical and healthcare
concepts.
• Facilitates data capture and standardization.
• Enables consistent recording, retrieval, and analysis of clinical data across diverse
systems.
• Offers a broader scope than ICD and CPT, encompassing findings, symptoms,
diagnoses, procedures, and medications.
• Logical Observation Identifiers Names and Codes (LOINC):
• Universal code system for identifying laboratory observations and clinical test
results.
• Ensures standardized communication of test results across different systems.
• Each LOINC record specifies the component measured, type of property, time of
observation, specimen used, and measurement scale.
 Major Coding Systems:
• RxNorm:
• Drug vocabulary maintained by the National Library of Medicine (NLM) in
the US.
• Groups drugs by concept for accurate medication identification and
dispensing.
• Distinguishes similar drugs from different providers using standardized
concepts.
• Provides a comprehensive framework for medication coding in EHRs.
• International Classification of Functioning, Disability, and Health (ICF):
• Developed by WHO.
• Classifies functioning, disability, and health-related components.
• Focuses on functionality and body structure rather than diagnoses.
• Used for comprehensive patient assessment, rehabilitation planning, and
outcome measurement.
Major Coding Systems:
• Diagnosis-Related Groups (DRGs):
• Patient classification scheme used for grouping related patients with similar
costs.
• Based on principal diagnosis, additional diagnoses, procedures, and other
factors.
• Serves as a tool for hospital resource allocation, reimbursement, and quality
improvement.
• The Unified Medical Language System (UMLS):
• Collection of biomedical concepts and ontologies.
• Facilitates the development of computer systems that understand and
process biomedical information.
• Supports knowledge representation, reasoning, and interoperability in
healthcare applications.
Major Coding Systems:
• The Digital Imaging and Communications in Medicine (DICOM):
• Medical imaging standard for data exchange, image format, and file
structure.
• Enables seamless integration of scanners, servers, workstations, and printers
within healthcare institutions.
• Promotes interoperability among radiology and imaging systems.
 Benefits of Electronic Health Records (EHRs)
• Improved Financial Performance:
• Reduced billing errors and improved documentation for accurate
reimbursement.
• Enhanced revenue collection through service alerts and virtual care
options.
• Reduced costs associated with:
• Paper and supplies.
• Unnecessary tests due to improved organization of results.
• Transcription through structured documentation.
• Improved workflow efficiency leading to increased productivity.
 Benefits of Electronic Health Records (EHRs)
• Enhanced Quality of Care and Patient Safety:
• Improved accuracy of diagnosis and treatment planning:
• Through better access to comprehensive patient information.
• Utilizing clinical decision support systems (CDSS) for suggestions and
comparisons.
• Reduced medication errors through computerized physician order entry
(CPOE).
• Improved patient education and engagement:
• Through access to information and follow-up care reminders.
 Benefits of Electronic Health Records (EHRs)
• Increased Efficiency and Productivity:
• Improved availability of patient information due to digital records,
eliminating the need for physical chart pulls.
• Reduced time spent on paperwork and administrative tasks.
• Improved data aggregation and interoperability for better insights and
informed decision-making.
• Additional Benefits:
• Enhanced care coordination through secure information sharing.
• Improved legal and regulatory compliance with standardized records and secure data
storage.
• Increased research and surveillance potential through anonymized data analysis.
• Improved business relationships with insurers and payers due to efficient data
management.
• Increased data reliability and security through digital storage and backups.
Barriers to Adopting EHRs
• Despite of having great potential of EHRs in medical practice, the
adoption rate is quite slow and faces a range of various obstacles.
• Financial barriers: High initial and ongoing costs (hardware,
software, maintenance, upgrades, data storage)
• Physician resistance: Concerns about limited training, support,
technical issues, capability limitations, and workflow disruption
during implementation
• Usability issues: Complex interfaces and difficulty achieving user-
friendly design (simplicity, efficiency, etc.)
Barriers to Adopting EHRs
• Interoperability challenges: Lack of standardized systems across
vendors hinders data exchange and integration (different
languages, databases)
• Privacy and security concerns: Vulnerability to attacks, potential
for unauthorized access, and importance of robust safeguards for
sensitive patient information
• Legal considerations: Maintaining data confidentiality, potential
for increased legal responsibility for physicians due to detailed
EHR documentation
Challenges of Using EHR Data
1. Data Quality Issues:
• Incompleteness: Missing data due to various reasons like lack of
collection, documentation, knowledge, or negligence.
• Errors: Data inaccuracies arising from human mistakes, faulty
equipment, or inconsistencies in coding practices.
• Uninterpretability: Difficulty in interpreting data due to missing
elements, unclear context, or lack of quality/quantity information.
• Inconsistency: Variations in data collection methods, coding rules,
and standards across institutions and over time.
Challenges of Using EHR Data
2. Data Processing Challenges:
• Unstructured Text: Difficulty for automated analysis methods to extract
meaningful information from free-text clinical notes.
• Selection Bias: Non-representative patient samples from specific
practices, regions, or demographics, limiting generalizability of findings.
3. Data Integration and Sharing Challenges:
• Interoperability: Lack of compatibility between different EHR systems
hinders data exchange and analysis.
• Privacy and Security: Concerns regarding patient privacy and data
security with regulations like HIPAA adding complexity.
The Steps to Adopt and
Implement an EHR
The Steps to Adopt and Implement an EHR
• Implementation of an EHR can be divided into three separate, yet intertwined
phases: Pre-implementation, implementation and post-implementation.
• Pre-implementation:
• Decide to purchase and choose a vendor.
• Conduct workflow mapping to understand current processes.
• Implementation:
• Form an implementation team with key roles (project manager, sponsor, clinical
champion).
• Migrate patient and practice data.
• Develop user training programs.
• Define go-live activities and schedules.
• Post-implementation:
• Maintain, reassess, and improve the EHR system, workflows, and staff training.
• Adapt to software upgrades and new functionalities.
The Steps to Adopt and Implement an EHR
• Roadmap:
• Build Roadmap:
• Outline tasks, budget, and timeline.
• Include data transfer, training program, go-live plan, and evaluation strategies.
• Build Implementation Team:
• Recruit staff from various departments (administrative, medical, IT).
• Consider roles like project manager, application developer, testers, analysts, advocates
(nurses, physicians, billing), and super-users for training.
• Budget: Estimate costs for:
• Staff time and potential productivity loss.
• Hardware and network upgrades.
• Customization, training, data storage, and consultancy.
• Schedule: Develop a timeline based on project scope, team, and budget.
The Steps to Adopt and Implement an EHR
• Data Migration:
• Convert paper records to electronic format.
• Cleanse and verify data.
• Set up EHR database and map legacy data.
• Transfer data and test functionality.
• Training:
• Design an interactive program with advocates, communication channels, vendor
support, role-based training, and feedback mechanisms.
• Go-Live Activities:
• Plan system testing, patient communication, staffing, appointment management,
reporting, communication plans, network checks, and data backup procedures.
The Steps to Adopt and Implement an EHR
• Evaluation: Assess success through:
• Return on investment (ROI) calculations;
• Patient and physician satisfaction surveys;
• Data error rate analysis;
• Efficiency and quality of care measurements
• Continuously monitor and improve based on evaluation results.
• C. Post-implementation or maintenance/sustainment/optimization.
• This phase involves maintaining, reassessing and improving the EHR’s content
and capabilities, facility workflows/processes, and staff training with a focus on
continuous improvement and patient safety.
• As the EHR software is periodically upgraded, new functionality is added that
increases efficiencies or opens up new possibilities.
END OF UNIT 2- SELF-
EVALUATION
1. State the definition of the terms
(a) electronic health records (EHRs)
(b) medical health records (MHRs)
(c) patient health records (PHRs)
2. (a) State the limitations of paper-based health records over EHR
(b) State the benefits of EHR
3. Describe the key components of an electronic health record
4. What are the obstacles to purchasing, adopting and implementing
an EHR
5. Explain briefly the steps to adopt and implement an HER