Case Study Telehealth and Electronic Medical Records in Marshfield Wisconsin

TeleHealth and EMRs: Talking the TeleHealth Language Nina M. Antoniotti, RN, MBA, PhD Marshfield Clinic TeleHealth Marshfield, Wisconsin American Telemedicine Annual Meeting Nashville, Tennessee May 2007 The Health Care World Patient Provider Diagnostics Imaging Archiving/Retrieval TeleHealth/Telemedicine EMR Infrastructure/Human Doctors Nurses Care Managers Allied Providers Providers Patients Patient Family Care Giver Custodian Payers Patient Family Self-Insured Employers Health Plans Government Regulators State Federal Licensing Accrediting TeleHealth/Telemedicine Telemedicine The use of medical information exchanged from one site to another via electronic communications to improve patients’ health status. “telehealth,” which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers. (Retrieved 04-23-07 www.americantelemed.org) Information Technology "any equipment or interconnected system or subsystem of equipment, that is used in the automatic acquisition, storage, manipulation, management, movement, control, display, switching, interchange, transmission, or reception of data or information. The term 'information technology' includes computers, ancillary equipment, software, firmware and similar procedures, services (including support services), and related resources." (Office of the Federal Register 2000, p. 80499) "any technology, including the computer hardware, software, and telecommunications networks that enable the transmission, processing, storage, organization, and retrieval of information for the purpose of understanding, decision making, and action taking. Penn State Un IST Institute "The application of technology in computers and communication systems to the storage, processing and transmission of information with the objective of improving communication in the workplace and the efficiency and effectiveness of human endeavor." Univ of Canberra, Australia Health Information Technology Health Information Technology Health information technology (Health IT) allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of health IT will: • Improve health care quality; • Prevent medical errors; • Reduce health care costs; • Increase administrative efficiencies; • Decrease paperwork; and • Expand access to affordable care. • Interoperable health IT will improve individual patient care, but it will also bring many public health benefits including: – Early detection of infectious disease outbreaks around the country; – Improved tracking of chronic disease management; and – Evaluation of health care based on value enabled by the collection of de-identified price and quality information that can be compared. Nina’s Definition “any technology, including the computer hardware, software, and telecommunications networks used in the health care environment that enable the transmission, processing, storage, organization, and retrieval of health related information for the purpose of understanding, decision making, and action” 5-07-07 Electronic Medical/Health Records (EMR/EHRs) Computer-based patient record and/or electronic health record; often used in the US to refer to an electronic health record in a physician office setting or a computerized system of files (often scanned via a document imaging system) rather than individual data elements. library.ahima.org/xpedio/groups/public/documents/ahima/pub_bok1_025042.html Technology, when fully developed, that meets provider needs for real-time data access and evaluation in medical care. Together with clinical workstations and clinical data repository technologies, provides the mechanism for longitudinal data storage and access, meeting the need for medical outcome studies, more efficient care, speedier communication among providers and management of health plans. www.plexisweb.com/glossary/words/e.html An electronic medical record (EMR) is a term used to describe computer-based patient medical records. An EMR facilitates* easy look up of patient data by clinical staff at any given location* accurate and complete claims processing by insurance companies* building automated checks for drug and allergy interactions* clinical notes* prescriptions* scheduling* sending and viewing labs en.wikipedia.org/wiki/Electronic_medical_record There is a lack of consensus on what constitutes an EHR, and thus multiple definitions and names exist for EHRs, depending on the functions included. An EHR generally includes: (1) a longitudinal collection of electronic health information about the health of an individual or the care provided, (2) immediate electronic access to patient- and population-level information by authorized users, (3) decision support to enhance the quality, safety, and efficiency of patient care, and (4) support of efficient processes for health care delivery. GAO-05-628, a report to the Chairman, Comm on the Budget, House of Representatives Definition of EMR/EHR TeleHealth and their networks are uniquely positioned for the assessment, evaluation, implementation, and deployment of electronic medical records. TeleHealth and EMRs • Use common platform • Use common network • The right information at the right time for the right provider and the right patient for the right diagnosis and treatment. Health Information Technology Standards Benefits to Providers • Basic appropriate requirements for health care settings, i.e. ambulatory care • Helps with judging product suitability, quality, interoperability and data portability, and security • Designation sets the bar for EHR products • Has the potential to reduce buying risk for purchasers while opening up the flow of HIT incentives from payers and purchasers • Prepare for changing reimbursement • 88 EMR products already certified Certification Commission for Healthcare Information Technology CCHIT is a recognized certification body (RCB) for electronic health records and their networks, and an independent, voluntary, private-sector initiative. CCHIT’s mission is to accelerate the adoption of health information technology by creating an efficient, credible and sustainable product certification program. Marshfield Clinic EMR The Certification Commission for Healthcare Information Technology (CCHIT) confirms that CattailsMD Version 5 from Marshfield Clinic is a CCHIT Certified Ambulatory EHR product for 2006 CCHIT asserts that CattailsMD Version 5 has met a comprehensive set of criteria for: Functionality – setting features and functions to meet a basic set of requirements. Interoperability – enabling standards-based data exchange with other sources of healthcare information. (For additional details, see the Security – ensuring data privacy and robustness to prevent data loss. Tablet Technology Fully Integrated Functions All Applications Available EHR at Marshfield All work starts and is completed around Dashboard All work is stored in the Combined Medical Record (CMR) Dashboard Verify allergies/adverse reactions Verify medications Access Practice Guidelines Review preventive services Growth Chart Clinical Code Acquisition Launch Documentation Manger Electronic Medical Record View lab results View Images Marshfield Clinic TeleHealth Provider Workstation Strategic Planning for TH - HIT- EMR • Develop networks with all applications in mind – TeleHealth, HIT, and EMRs • Collaborate between sites on the purchase of EMRs as well as TH equipment • Integrate the two from the beginning – one doesn’t come without the other • Work with state-wide initiatives to see the value of linking both initiatives Benefits of TH + EMRs • Increased privacy of patient data • Increased productivity of provider and presenter • Increased communication between consultant and referring providers • Decreased chance for omissions/errors • E-prescribing • Improved quality of IOM indicators • Nina M. Antoniotti, RN, MBA, Ph.D. – Program Manager, Marshfield TeleHealth – Email: antoniotti.nina@marshfieldclinic.org – 715-389-3694 • Paul Olinsky Contacts – General Manager Commercial IS – 715-221-8164 – Email: olinski.paul@marshfieldclinic.org