Doctor's Office Quality Information Technology

HIT Assistance

Resources

Electronic Health Record (EHR): Resources
provided by Lumetra

EHR General

Brailer D. The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care. Framework for Strategic Action. Office of the National Health Information Technology Coordinator (ONCHIT). Washington D.C.: US Dept. of Health and Human Services. July 21, 2004. Available here.

Initial report on the progress and execution of a strategic plan to support nationwide implementation of interoperable HIT in the public and private sectors. 12 strategies are outlined, which meet central goals of President Bush's Executive Order for “widespread adoption of interoperable EHRs within 10 years."

Gordon D, Geiger G, Lowe N, Jickling J. What is an electronic patient record? Sunnybrook Boundaries Taskforce of the Electronic Patient Record Project. Proc AMIA Symp. 1998; 240-4. Available here.

Presents a definition of a patient record system and identifies a model that incorporates both the electronic and paper components. Outlines standards and policies that apply to the electronic patient record.

Kilbridge P. Crossing the chasm with information technology: bridging the quality gap in health care. First Consulting Group. Oakland, CA: California HealthCare Foundation. July 2002. Available here.

Describes and provides case studies of ways in which a representative sample of health care technology applications that support clinical processes in the outpatient setting are being used to support the Institute of Medicine's goals for quality improvement. Concludes that organizational challenges including workflow, cost and culture change must be dealt with to ensure successful implementation of health care IT.

Miller RH, Sim I. Physicians' use of electronic medical records: barriers and solutions. Health Aff. 2004:23; 116-126.

Article available for purchase at: http://content.healthaffairs.org/cgi/content/abstract/23/2/116

Argues that quality improvement and financial benefit in physician practices is heavily influenced by physicians' use of an electronic health record for daily tasks. Identifies major barriers to EHR adoption, and outlines policy suggestions to overcome barriers discussed.

EHR Adoption and Implementation

Brailer D, Terasawa E. Use and Adoption of Computer-Based Patient Records. Oakland, CA: California HealthCare Foundation. October 2003. iHealth Reports Series. Available here.

Discusses barriers and drivers of consumer-based patient record (CPR) adoption, and highlights the need for widespread adoption of interoperability standards. Argues that more rigorous study of CPR across care settings is necessary for public policy, and that reducing physician resistance to EHR may strengthen the business case for CPR adoption. Highlights the growing gap in CPR adoption between small, rural and large, urban organizations.

MacDonald K, Metzger J. Achieving tangible benefits in small physician practices. First Consulting Group. Oakland, CA: California Healthcare Foundation. September 2002. Available here.

Presents case studies to demonstrate the various quantitative and qualitative benefits that small physician offices have gained from use of health IT, and explores how offices have successfully implemented IT products. Includes an overview of health IT tools in the marketplace, and an analysis of how a representative sample of IT vendors support these various functions.

Metzger J. Using Computerized Registries in Chronic Disease Care. First Consulting Group. Oakland, CA: California HealthCare Foundation. February 2004. Available here.

Discusses functions and use of computerized disease registries to improve the care for patients with chronic conditions. Includes a list of considerations to guide physicians in implementing a registry.

Miller R, Sim I, Newman J. Electronic medical records: lessons from small physician practices . University of California, San Francisco. Oakland, CA: California Healthcare Foundation. October 2003. Available here.

Intended to provide practical information on EHR implementation and use to small-group and solo physicians, this report is based on open-ended interviews with 20 physician champions in small/solo physician practices. Discusses lessons learned from EHR implementation and outlines recommendations for small group practices considering EHR implementation.

O'Connell RT, Cho C, Shah N, Brown K, and Shiffman RN. Take note(s): differential EHR satisfaction with two implementations under one roof. J Am Med Inform Assoc. 2004 Jan-Feb; 11:43-9. Available here.

Finds a difference in satisfaction with EHR implementation between internal medicine and pediatric residents. Differences in previous experience with EHR implementation may explain different levels of satisfaction observed.

EHR Selection

Barrett MJ, Holmes BJ, McAulay S. Electronic Medical Records: A Buyer's Guide for Small Physician Practices . Forrester Research. Oakland, CA: California HealthCare Foundation. October 2003. Available here.

Provides a detailed analysis of eight EHR systems, chosen for the quality of their systems and the vendor's commitment to small physician practice. Outlines a 12-step program for physician offices selecting an EHR, and lists a broader set of considerations to be used in selecting an EHR.

Bush J. Looking for a good electronic medical records system? Fam Pract Manag. January 2002; 9: 50-1 [serial online]. Available here.

Presents a brief excerpt from the American Academy of Family Physicians Ad Hoc Committee on Electronic Medical Records criteria for evaluating “family physician friendly” EMR systems.

Simon J, Powers M. Chronic Disease Registries: A Product Review . NAS Consulting Services. Oakland, CA: California HealthCare Foundation. May 2004. iHealth Reports Series. Available here.

Intended to serve as a guide for providers in selecting a registry product. Includes an evaluation of 16 public domain and commercial software computer registry applications along eight criteria. Certain products are recommended, depending on which criteria are most important to the organization.

Continuity of Care Record

ASTM International (formerly known as the American Society for Testing and Materials). Continuity of Care Record (CCR). The Concept Paper of the CCR. Version 2.1 b . ASTM E31 Committee on Health Informatics. Available here.

Describes the goals, content and use of a CCR, a joint development of ASTM International, the Massachusetts Medical Society, the Health Information Management Systems Society (HIMSS) and the American Academy of Family Physicians (AAFP). States that the CCR is intended to a provide minimum set of basic, timely and relevant facts about the patient and their condition, and differs fundamentally from other documents such as the EHR.

Waegemann PC. EHR vs. CCR: What is the difference between the electronic health record and the continuity of care record? Medical Record Institute. Available here.

Presents definition, functions and standards for an EHR, and suggests the Continuity of Care Record (CCR) as an alternative in light of the difficulties in achieving EHR interoperability. States that the CCR is a dataset of the most relevant information about a patient to inform health care provider decisions.

EHR Standards

Handler T, Holtmeier R, Metzger J, Overhage M, Taylor S, Underwood C. EHR Definition, Attributes and Essential Requirements: Definitional model. Version 1.1 . Chicago, IL: HIMSS Electronic Health Record Committee. Sept. 24, 2003. Available here.

Includes a working definition of an EHR, attributes, key requirements to meet attributes, and measures or “evidence” to assess the degree to which essential requirements have been met once EHR is implemented.

Tang P. Key Capabilities of an Electronic Health Record System Letter Report. Institute of Medicine Committee on Data Standards for Patient Safety. Board on Health Care Services. Washington D.C.: National Academies Press. July 31, 2003. Available here. .

Outlines important “care delivery-related” functions of an electronic health record system. Identifies eight core functionalities for an EHR system, and for each of these capabilities, provides details on the care setting (hospital; ambulatory care; nursing home; community) of the function, and time frame for implementation.

EHR Security

Prepared by the National Institute of Standards and Technology (NIST) for use by federal agencies, this guide summarizes the HIPAA Security Rule, which focuses on protection of electronic protected health information (EPHI), and is applicable only to certain federal agencies and contractors based on use of EPHI. Intended as a guide to educate readers about concepts discussed in the Security Rule.

Pacific Health Policy Group. HIPAA Administrative Simplification: Tool Kit for Small Group and Safety-Net Providers. Oakland, CA: California HealthCare Foundation. November 2001. Available here .

Intended to help solo and small group providers understand HIPAA requirements and provide training materials for these organizations to use in educating their staff to meet compliance requirements.

EHR Business Case

Khoury AT. Support of quality and business goals by an ambulatory automated medical record system in Kaiser Permanente of Ohio. Eff Clin Pract. 1998; 1: 73-82. Available here.

Describes the medical record system implemented (Medical Automated Record System — MARS) and demonstrates how implementation of this system resulted in clinical improvements and financial benefits to the organization.

Nelson R. Computerized patient records improve practice efficiency and patient care. Healthcare Finance Management . 1998; 52:86, 88. Available here.

Concise article discussing benefits of EHR and key challenges to implementation. Implementation recommendations are put forth and savings from a study of six group practices are presented.

Valancy, J. How much will that EMR system really cost? Family Practice Management [serial online]. 2002: 9; 57-8. Available here.

Brief article including a spreadsheet that physicians can use to compare initial purchase price and long-term costs associated with electronic health record systems.

Practice assessment

Godfrey MM, Nelson EC, Batalden PB. Assessing your Practice: The Green Book. Dartmouth College, Institute for Healthcare Improvement. 2004. Available here.

A workbook to help physicians collect information on patients, practices and staff. A locally adaptable tool to identify opportunities for quality improvements in patient care, outcomes and staff experience.

Nelson EC, Batalden PB, Huber TP, Mohr, JJ, Godfrey MM, Headrick, LA, Wasson, JH: Microsystems in health care: part 1. Learning from high-performing front-line clinical units. Jt Comm J Qual Improv 2002; 28:472-493. Available here.

Best practices are identified among 20 high performing “clincal microsystems,” the “front-line units where health care is delivered.” Outlines nine qualities associated with success, and concludes that improving the health care systems must involve “transformation of the essential building blocks of the system.”