08 - Installation and Maintenance of Health IT Systems - Unit 1 - Elements of A Typical Electronic Health Record System - Lecture A

Installation and Maintenance of
Health IT Systems
Elements of a Typical Electronic
Health Record System
Lecture a
This material Comp8 _Unit1a was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.
Elements of a Typical Electronic Health
Record System
Learning Objectives
1. Identify the core elements that comprise an EHR
system (Lecture a)
2. Describe the use of client and server hardware for
access to and storage of EHRs (Lecture a, b)
3. Describe network needs for access to and storage of
EHRs (Lecture b)
4. Identify the application software and back-end data
storage software needed for a comprehensive, effective
health IT system (Lecture a, b)
2
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Installation and Maintenance of Health IT Systems
Elements of a Typical Electronic Health Record System
Lecture a
Why Implement an EHR?
3
Lecture a
Information technology holds enormous
potential for transforming the health care
delivery system

- Institute of Medicine (IOM), Crossing the Quality Chasm, 2001

4
Lecture a
A New Health System for
the 21st Century
IOM (2001): Six aims for improving health
care quality
1. Safe
2. Effective
3. Patient-centered
4. Timely
5. Efficient
6. Equitable

(IOM, 2001)

Patient Record System
IOM (1991): Any patient record system
includes:
People
Data
Rules and procedures
Processing and storage devices
Communication and support facilities

(Dickinson et al, 2003)
5
Lecture a
Core EHR Functions: US
Government
Orders for therapies (e.g. medications)
Orders for tests
Reporting of test results
Physician notes

(Torrey, 2011)

6
Lecture a
Core EHR Functions: IOM
Provides longitudinal health data on
individuals
Provides immediate, yet secure, electronic
access
Provides knowledge to enhance quality,
safety, and efficiency of care
Supports efficient processes of care

(Dickinson et al, 2003)
7
Lecture a
EHR Systems: Then and Now
The early years
Earlier EHR systems required extremely
expensive computer hardware.
Core components usually ran on UNIX and often
incurred high training costs.
Rapid progression of technology meant
technology was outdated almost as soon as it
was installed.

(Pawola, 2011; Medical Software Associates)
8
Lecture a
(contd)
The 1990s
Improvements in computing power and
connectivity spurred progress.
EMRs began to be adopted by some practices.
Rapid progression of technology meant
technology was outdated almost as soon as it
was installed.

9
Lecture a
(contd)
Now
Fast, low-cost PC systems permeate the
workplace, often less than $500 each.
Improved network protocols make updating
and maintenance easier and more cost-
effective.
Ubiquitous, easy to use graphical systems
reduce training costs.

10
Lecture a
CPR vs. EMR vs. EHR
CPR: Electronic record with full
interoperability within an enterprise (hospital,
clinic, practice)
EMR: Commonly found in ambulatory care
and physicians practices
EHR: Designed for interoperability and
accessibility across disparate organizations

(Pawola, 2011; Garrett & Seidman, 2011)

11
Lecture a
Potential Advantages of
EHR Systems
"Legacy" EHR systems have often fallen
short for a variety of reasons, but overall
potential benefits include:
Better, more accurate documentation
More efficient storage & retrieval of records
Higher quality of care, fewer errors
Lower insurance premiums and operating costs

(Dickinson et al, 2003; Gurley, 2004; Steele, 2009; Greenhalgh et al, 2009)

12
Lecture a
13
Lecture a

Hardware and Software
Hardware
Physical devices or components that make up
a computer system.
Software
Computer programs and accompanying data
needed to tell the computer what to do and
how to behave.
Software Elements Pre-EHR
14
Lecture a
1.1 Figure: (MITRE, 2006)

Software Elements Post-EHR
15
Lecture a
1.2 Figure: (MITRE, 2006)

Client-Server Model
Most of todays EHR systems are based on the clientserver
model.
Software: the collection of programs and related data that
contain the instructions for what the computer should do
Servers: service providers
Servers run server application software designed to meet client
requests.
Clients: service requesters
Client software is designed to request information from a server
and then present it to the user in an efficient manner.
A server and client may reside on the same box but is
generally not recommended..

(Wikipedia, 2010)
16
Lecture a
Client-Server Model
17
Lecture a
1.3 Figure: (Neal, 2011)
Advantages:
Data resides on the server, which
generally has safer controls
Easier to manage and update
Less resource-intensive for the client
18
Lecture a

Summary Lecture a
EHRs offer potential long-term benefits
over traditional methods.
EHRs require both hardware and software
components.
Client-server model is predominant in EHR
software models.
References Lecture a
References
DesRoches, C.M., et al. (2008). Electronic health records in ambulatory care: a national survey of physicians. N
Engl J Med; 359:50-6. http://www.nejm.org/doi/full/10.1056/NEJMsa0802005
Dickinson, G., Fischetti, L., & Heard, S. (Eds.). (2003). HL7 EHR System Functional Model and Standard.
Retrieved July, 2010, from HIMSS.org: http://www.himss.org/Content/Files/EHR_Functional_Model_Ballot.pdf
Garrett, P., & Seidman, J. (2011, January 4). EMR vs EHR: What is the difference. Heath IT Buzz. Retrieved
December, 2011, from http://www.healthit.gov/buzz-blog/electronic-health-and-medical-records/emr-vs-ehr-
difference/
Greenhalgh, T., et al. (2009). Tensions and paradoxes in electronic patient record research: a systematic literature
review using the meta-narrative method. Milbank Quarterly. Retrieved June 2011 from
http://www.milbank.org/quarterly/8704feat.html
Gurley, L. (2004). Advantages and disadvantages of electronic medical records. Retrieved from
http://www.aameda.org/MemberServices/Exec/Articles/spg04/Gurley%20article.pdf
Institute of Medicine (2001, March 1). Crossing the quality chasm: a new health system for the 21st century.
Retrieved June 30, 2010, from http://www.nap.edu/catalog/10027.html
Maons, D. (2011, November11). EHRs are inevitable, experts say. Heathcare IT News. Retrieved from
http://www.healthcareitnews.com/news/ehrs-are-inevitable-experts-say
Medical Associates. Electronic Medical Record. Retrieved September 2011 from http://www.medical-
software.org/electronic-medical-record.html
Pawola, L. (2011, February 22). The history of the electronic health record. Health Informatics and Health
Information Management. Retrieved December 2011 from http://healthinformatics.uic.edu/the-history-of-the-
electronic-health-record/
19
Lecture a
References Lecture a
References (contd)
Steele, E. (2009, December 16). Research explains why EHRs wont achieve Meaningful Use. Retrieved Nov
2011 from http://blog.srssoft.com/2009/12/research-explains-why-ehrs-won%e2%80%99t-achieve-
%e2%80%9cmeaningful-use%e2%80%9d/
Torrey, T. (2011, April 11). What is an EMR (Electronic Medical Record) or EHR (Electronic Health Record)?
Retrieved June, 2011, from patients.about.com: http://patients.about.com/od/electronicpatientrecords/a/emr.htm
Torrieri, M. (2011, August 23). EHR adoption grows slowly, steadily at small practices. Retrieved from
http://www.searchmedica.com/resource.html?rurl=http%3A%2F%2Fwww.physicianspractice.com%2Fblog%2Fcon
tent%2Farticle%2F1462168%2F1933985%3FCID%3Drss&q=Kleaveland&c=pm&ss=physiciansPractice&p=Conve
ra&fr=true&ds=0&srid=3
Wikipedia. (2011, August). Client server model. Retrieved June 2011 from Wikipedia.com:
http://en.wikipedia.org/wiki/Client%E2%80%93server
Charts, Tables, Figures
1.1 Figure: Electronic Health Data Pre-EHR. MITRE. (2006). Electronic Health Records Overview. Available from
http://www.ncrr.nih.gov/publications/informatics/EHR.pdf Used with permission.
1.2 Figure: Electronic Health Data Post-EHR. MITRE. (2006). Electronic Health Records Overview. Available from
http://www.ncrr.nih.gov/publications/informatics/EHR.pdf. Used with permission.
1.3 Figure: Client Server Model. Neal, Scott. (2011). Used with permission.

20
Lecture a

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