Fourth Regional Conference on e-health: Building the Electronic Health Record

Fourth+regional+conference+on+e-health%3a+building+the+electronic+health+record%0d%0aTehran%2c+7-9+September+2004%0d%0a%0d%0a%0cElectronic+health+record%3a+a+cornerstone+in+e-health+and+telemedicine+services+by+Dr.+N.+Al-Shorbaji%2c+WHO%2fEMRO%0d%0a%0d%0a%0cLack+of+IT+leads+to+death%0d%0a%ef%81%8e+Medical+records+are+still+handwritten%3b+%ef%81%8e+Lack+of+widespread+use+of+Computer+Physician+Order+Entry+(CPOE)+Systems+%e2%80%95Kill+People%e2%80%96%3b+%ef%81%8e+CPOE+Systems+would+eliminate+half+a+million+medical+errors+a+year.%0d%0aComputerworld%2c+April+22%2c+2002%2c+P.+8%0d%0a%0d%0a%0ce-Health%0d%0a%e2%80%a2+is+the+use%2c+in+the+health+sector%2c+of+digital+data%e2%80%94transmitted%2c+stored+and+retrieved+electronically%e2%80%94for+clinical%2c+educational+and+administrative+purposes%2c+both+at+the+local+site+and+at+a+distance%0d%0a%0d%0a%0cWhat+does+e-Health%0d%0a%0d%0aencompass%3f%0d%0a%e2%80%a2+Electronic+processing+and+telecommunication+of%3a%0d%0a%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+Management+Information%3b+Clinical+Information%3b+Surveillance+and+epidemiological+information%3b+Health+Literature+and+Documentation%3b+Medical+knowledge%3b+Personal+and+Community+Health+related+Information%3b%0d%0a%0d%0a%0cTelemedicine%0d%0a%e2%80%a2+Definition%3a%0d%0a%e2%80%93+%e2%80%9cmedicine+at+distance%e2%80%9d+%e2%80%93+%e2%80%9cpractice+of+medical+care+using+interactive+audio%2c+visual+and+data+communications%3b+this+includes+medical+care+delivery%2c+consultation%2c+diagnosis+and+treatment%2c+as+well+as+education+and+the+transfer+of+medical+data%e2%80%9d%0d%0a%0d%0a%0cTelemedicine+-+Why%3f%0d%0a%e2%80%a2+Telemedicine+and+developing+countries+(ITU+study)%3a%0d%0a%e2%80%93+distance+consultations%2c+diagnosis+and+treatment+by+medical+specialists%3b+%e2%80%93+availability+of+quality+health+care+in+remote+areas+of+the+country%3b+%e2%80%93+improvement+in+the+qualifications+of+national+specialists+and+health+technicians%3b%0d%0a%0d%0a%0cTelemedicine+-+Why%3f+(cont%e2%80%99d)%0d%0a%e2%80%a2+Telemedicine+and+developing+countries+(ITU+study)%0d%0a%e2%80%93+overall+improvement+of+service+by+centralisation+of+resources%3b+%e2%80%93+effectiveness+and+efficiency+in+management+of+action%3b+%e2%80%93+Cost+reduction%3a%0d%0a%e2%80%a2+For+the+patient%2c+and+%e2%80%a2+For+providers+of+health+services.%0d%0a%0d%0a%0cElectronic+Health+Record%0d%0a%0d%0a%0cHealth+Records%0d%0a%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+%e2%80%a2+From+paper+to+electronic%3b+From+fragmented+to+integrated%3b+From+staged+to+life-long%3b+From+textual+to+multimedia%3b+From+centralized+to+decentralized%3b+From+passive+to+interactive%3b+From+dead+to+alive.%0d%0a%0d%0a%0c%0cPurposes+of+the+health+record%0d%0a%e2%80%a2+Primary+purpose%0d%0a%e2%80%93to+benefit+the+patient+through+support+of+current+and+future+healthcare+needs.%0d%0a%0d%0a%0cPurpose+of+the+health+record%0d%0a%e2%80%a2+Secondary+purpose%0d%0a%e2%80%93to+provide+a+medico-legal+record+of+the+care+provided+and+hence+support+and+demonstrate+the+competence+of+clinicians.%0d%0a%0d%0a%0cPurpose+of+the+health+record%0d%0a%e2%80%a2+Tertiary+purpose%0d%0a%e2%80%93education%2c+research%2c+public+health%2c+health+service+management+%e2%80%a2+NB%3a+must+be+legitimate+(involve+consent)+and+can+never+be+allowed+to+compromise+the+primary+or+secondary+purpose.%0d%0a%0d%0a%0cBenefits+of+an+EHR%0d%0a%0d%0a%0c1.+A+greater+consumer+focus+in+health+care%3b+2.+Improved+health+outcomes%3b%0d%0a3.+Improved+%26+appropriate+access+to+health+records+for+health+providers%3b+4.+Improved+quality+and+safety+data%3b%0d%0a%0d%0a%0c5.+Improved+efficiency+and+quality+of+healthcare%3b+6.+Improved+management+and+utilisation+of+health+information%3b+7.+Simultaneous+access+to+its+contents+from+multiple+locations%3b+8.+Legibility+of+content+as+data+is+machine+coded+or+typewritten%3b%0d%0a%0d%0a%0c9.+Variety+of+views+on+data%3b+10.Support+of+structured+data+entry+as+data+elements+are+well-defined%3b+11.Support+data+analysis%2c+medical+research%2c+epidemiological+surveillance+and+disease+trend+analysis%3b+12.Decision+support%3b+13.Electronic+data+exchange+and+sharing+care+support.%0d%0a%0d%0a%0cThe+eight+core+capabilities+of+an+EHR+system%0d%0a%0d%0a%0cHealth+information+and+data%0d%0a%e2%80%a2+Immediate+access+to+key+information.+This+would+improve%0d%0acaregivers%e2%80%99+ability+to+make+sound+clinical+decisions+in+a+timely+manner.%0d%0a%0d%0a%0cResult+management%0d%0a%e2%80%a2+Ability+of+all+providers+participating+in+the+care+of+the+patient+across+multiple+settings+to+quickly+access+new+and+past+test+results.%0d%0aThis+would+increase+patient+safety+and+effectiveness+of+care.%0d%0a%0d%0a%0cOrder+management%0d%0a%e2%80%a2+Ability+to+enter+and+store+orders+for+prescriptions%2c+tests%2c+and+other+services+in+a+computer-based+system.%0d%0a%0d%0aThis%0d%0a%0d%0ashould+enhance+legibility%2c+reduce+duplication%2c+and+improve+the+speed+with+which+orders+are+executed.%0d%0a%0d%0a%0cDecision+support%0d%0a%e2%80%a2+Using+reminders%2c+prompts%2c+and+alerts.+This+would+help+improve+the%0d%0aspeed+which+would+help+improve+compliance+with+best+clinical+practices%2c+ensure+regular+screenings+and+other+preventive+practices%2c+identify+possible+drug+interactions%2c+and+facilitate+diagnoses+and+treatments.%0d%0a%0d%0a%0cElectronic+communication+and+connectivity%0d%0a%0d%0a%e2%80%a2+Efficient%2c+secure%2c+and+readily+accessible+communication+among+providers+and+patients.+This+would+improve+continuity+of%0d%0acare%2c+increase+timeliness+of+diagnoses+and+treatments%2c+and+reduce+the+frequency+of+adverse+events.%0d%0a%0d%0a%0cPatient+support%0d%0a%e2%80%a2+Tools+that+give+patients+access+to+their+health+records.+This+would+provide%0d%0ainteractive+patient+education+and+help+them+carry+out+home+monitoring+and+selftesting%2c+which+can+improve+control+of+chronic+conditions.%0d%0a%0d%0a%0cAdministrative+process%0d%0a%e2%80%a2+Computerized+administrative+tools+such+as+scheduling+systems.+This+would+improve+hospital%0d%0aand+clinic+efficiency+and+provide+more+timely+service+to+patients.%0d%0a%0d%0a%0cReporting%0d%0a%e2%80%a2+Electronic+data+storage+that+employs+uniform+data+standards.+This+will+enable%0d%0ahealthcare+organizations+to+respond+more+quickly+to+federal%2c+state%2c+and+private+reporting+requirements.%0d%0a%0d%0a%0cThe+current+situation%0d%0a%ef%83%bcRival+medical+software%0d%0a%0d%0aprograms%3b%0d%0a%ef%83%bcClosed+systems%3b+%ef%83%bcLittle+or+no+interoperability%3b+%ef%83%bcFragmented+data.%0d%0a%0d%0a%0cRequirements+for+an+EHR+architecture%0d%0a%e2%80%a2+Interoperability%0d%0a%e2%80%93+Semantic+level+sharing+%26+exchange+of+data%0d%0a%0d%0a%e2%80%a2+Safety+and+security%0d%0a%e2%80%93+faithfulness%2c+auditability%2c+ID%2c+version+%26+access+control%0d%0a%0d%0a%e2%80%a2+Comprehensiveness%0d%0a%e2%80%93+multi-discipline+%26+sector%3b+structured+%26+free+text+entry%0d%0a%0d%0a%0cRequirements+for+an+EHR+architecture%0d%0a%e2%80%a2+Portability%0d%0a%e2%80%93+moveable+%26+mergeable+independent+of+hardware%2c+O%2fS%2c+software%2c+natural+%26+coded+languages%0d%0a%0d%0a%e2%80%a2+Evolution%0d%0a%e2%80%93+technology+independent+and+%e2%80%95future+proof%e2%80%96+(%3d%ef%82%af+costs)%0d%0a%0d%0a%0cDifficulties+associated+with+EHRs%0d%0a%e2%80%a2+Moral%2c+legal%2c+and+ethical%0d%0a%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+Consumer+concerns+about+privacy+%26+confidentiality+Access+to+and+ownership+of+EHRs+Balancing+access+and+security+needs+Control+of+processing+of+information+Accuracy+of+data+in+the+EHR%0d%0a%0d%0a%e2%80%a2+Access+and+equity%0d%0a%e2%80%93+Rural%2c+indigenous%2c+aged%2c+disabled%2c+illiterate%2c+etc+should+not+be+disadvantaged%0d%0a%0d%0a%0cDifficulties+associated+with+EHRs%0d%0a%e2%80%a2+Implementation+%26+technical%0d%0a%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+%e2%80%93+Needs+to+be+incremental+Acceptance+by+clinicians+-+user+involvement+essential+EHR+systems+significantly+alter+work+practices+Application+interface+-+data+entry+%26+retrieval+Complexity+of+health+information+%e2%80%93+structured+vs.+free+text+Patient+identification+System+security+Education+%26+training%2c+training%2c+training%0d%0a%0d%0a%0cSuccessful+EHR+Project%0d%0a%0d%0a%0cThe+building+blocks%0d%0a1.+Privacy+and+confidentiality+Privacy+legislation+plus+privacy+charter%3b+2.+Security%3b+3.+Unique+patient+identifier%3b+4.+Standards%3a+EHR%2c%0d%0a%0d%0aBack%0d%0a%0d%0aterminologies%2c+messaging%3b%0d%0a%0d%0a%0cThe+building+blocks%0d%0a5.+Event+summaries%3b+6.+Telecommunications+infrastructure%3b+7.+Education%2c+training%2c+and+promotion%3b%0d%0a%0d%0aBack%0d%0a%0d%0a%0cThank+you%0d%0aDiscussion%0d%0a%0d%0a%0c