The following is a series of articles about the electronic health that have appeared in Medigram.

• EHR vendor fair to offer hands-on demonstrations and expert advice
• Making sense of alphabet soup
• Overcoming misconceptions about EHRs

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From Medigram March 26, 2009

EHR vendor fair to offer hands-on demonstrations and expert advice

Receive a hands-on introduction to electronic health records (EHR) systems at the Society’s EHR Systems Exhibition Day June 23 at the Holiday Inn of Fond du Lac. A variety of EHR vendors, selected by the Society, will demonstrate how their products work, answer questions and distribute information about their systems’ features.

While the Society is not endorsing any EHR systems, we have questioned potential vendors, and only invited those whose answers show their product meets the functionality, security and interoperability standards necessary. Our goal is to help you choose a system that meets your practice’s needs both in the short term and over the long haul.

In addition to the EHR vendors, Michelle Klagos, the Society’s Quality and Efficiency Analyst, will be on hand to offer tips on EHR selection and implementation. Klagos implemented the Epic EHR system at UW Health’s primary and specialty clinics and worked in a clinical setting for 16 years. Her experience makes her an excellent source of information about what makes EHRs work in day-to-day practice.

The event, which runs from 9 a.m. to 4 p.m., costs $199 for members. However, each registrant receives complimentary access to the Society’s two teleconferences on how to select an EHR system: “Navigating the Electronic Health System World” and “Choose and Use – The Electronic Health System and Beyond.” For more information about the fair or teleconferences, or to register, please contact Stephanie Taylor at 608.442.3796.

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From Medigram February 26, 2009

Making sense of alphabet soup

EHR, EMR, HIT, HIE. Health care acronyms can read like alphabet soup. And as quality improvement efforts and technology evolve, there’s a whole new glossary of acronyms physicians and health care staff should know. It’s important to learn not only what they mean but how they may be applied in a practice environment.

Consider EMR versus EHR. An Electronic Medical Record (EMR) is an electronic version of a paper chart that uses electronic software as a tool to document or view patient information. Information can be entered or retrieved, but EMR programs cannot send it anywhere. An Electronic Health Record (EHR), on the other hand, can actually store the EMR, providing health care professionals the ability to:

• display consistent, accurate information at multiple clinic sites,
• integrate data from outside equipment, such as an EKG tracing or an accuchek reading by synching that information into the EHR,
• offer clinical decision support such as allergy alerts, specific lab tests that require review or an alert indicating that the patient needs a tetanus shot.

To ensure the safe transmission of health records, it is important to select an EHR that is advanced enough to interface with other systems securely. To help physicians work through the EHR selection and implementation process, the Society is offering two teleconferences. Click here for more information. And to futher unscramble the information technology alphabet soup, read below.

Glossary of Information Technology terms
Health Information Exchange (HIE): To transport clinical information across organizations within a community or region using a standard electronic language to preserve the meaning of information being exchanged. Information sharing policies must exist for what information is being shared, with the ultimate goal of having better access to clinical data that will provide safe and efficient patient care.

Health Information Technology (HIT): Technology specifically designed for health care to create, maintain or exchange health information electronically in a secure and confidential manner. This technology includes electronic hardware, software, licensing of products, and related services.

Health Level 7 (HL7): An electronic language protocol created by the Health Level 7 Organization that creates a standard terminology used when messaging between electronic health systems so information can be communicated without altering the information content. This brings a universal understanding to many different electronic languages.

E-prescribing (Electronic prescribing): The practice of electronically creating, storing and transmitting prescriptions. E-prescribing systems should include a complete medication list and the ability to display warnings or alerts on medication interactions. They should also provide alternative or generic information, and formulary information when available. This system should be able to provide two-way communication between a pharmacy and provider as well.

Interoperability: The technical ability to send and receive information across organizational boundaries to improve patient care.

Personal Health Record (PHR): An electronic software application patients may use to enter and view their personal health information. A PHR can send electronic messages for refills, physician callbacks and appointment scheduling. It can also download home-monitoring data such as glucose or blood pressure readings and list the patient’s medications and allergies. Many electronic EHRs systems come with a PHR that the physician owns and allows a patient to access, but patients may also purchase their own PHRS.

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From Medigram February 19, 2009

Overcoming misconceptions about EHRs

When discussing Electronic Health Records (EHR), some physicians initially have a negative reaction, citing various reasons not to make the conversion. But EHRs are not going away. The Wisconsin Medical Society is working to help physicians and other health care professionals navigate what may be “unfamiliar territory,” by developing a series of teleconferences to help prepare physicians to make educated choices when considering EHRs. The first step, however is addressing some common concerns and misconceptions. Society Quality and Efficiency Analyst Michelle Klagos spent over three years implementing an EHR at UW Health before joining the Society staff and offers these insights and experiences to physicians and health care staff considering EHR implementation.

Ten misconceptions about Electronic Health Records
By Michelle Klagos, Wisconsin Medical Society Quality and Efficiency Analyst

1. Patients won’t like it. Actually, patients don’t mind EHRs when they see you have an accurate record; it can make them feel more secure. Patients see computers at banks, pharmacies and grocery stores so this is not new. It just needs to be presented correctly.
2. I won’t get to use paper anymore. Quite the contrary! Paper is frequently used when taking vitals information outside the exam room, or notes to be used later in dictating. That can still be the case.
3. I don’t want my patients to see my weak computer skills. You don’t have to enter information into the system in the exam room right away. Many physicians easily view the basic information they need when talking to patients, then go to their office to order a medication until they feel comfortable with the system.
4. I will spend all my time looking at the computer instead of the patient. Currently you probably spend a lot of time looking at the paper chart – it’s just a different tool to look at.
5. I can’t learn all of this at once, it is too confusing. After assessing your practice and staff, you might decide to implement an EHR in a phased approach, first concentrating on the medications, allergies, problem list and demographics. Many sites find this an easier adjustment for patients and staff.
6. I can’t afford to see fewer patients and slow down my practice to train or implement an EHR. Again, a phased approach with proper planning can minimize this problem. Some phases can be more nursing-focused than physician-focused. It should be a top priority, though, to give staff enough time to feel comfortable with the system. The worst feeling is having an EHR that no one wants to use!
7. I won’t be able to keep patients from seeing other patients’ information. Securing the workstation or turning the workstation away from the patient until only their chart is visible gives quiet indications that you are keeping this information secure. When patients are able to see only their own information during a visit, it validates that their information is protected.
8. It is faster to use paper. There very well could be times when paper seems faster, but does it compromise patient safety? When the patient’s information is stored correctly in an EHR, it is faster and safer to prescribe medications electronically. Basic information entered into the EHR can be carried to the next visit to be verified, saving time of rewriting the same medicine and allergy list. If a system is set up correctly to show the information you need to see frequently (flowsheets, last labs or immunizations), it can take the same time as paper. It all goes back to putting the information in the EHR consistently to retrieve it in an efficient manner. This is accomplished by good investigation, assessment and planning of your EHR before you go live or launch the system.
9. I would rather talk to my staff than send electronic messages. And you should! The EHR has many capabilities, one of them being able to send messages to your staff. Just because the system can send messages does not mean you have to. That is where analysis of your practice and workflows will help with choosing and customizing your system. Implementation can actually improve staff communication.
10. I don’t want to lose my staff. There are two ways to help with this. 1) If staff isn’t receptive to learning the new system, find out what their barriers (or reasons) are and work through them. 2) If staff are worried the EHR system may eliminate jobs, a proper workflow analysis can help ease that concern. Many times job responsibilities are reallocated so everyone can accomplish more–nurses can finish refills faster and have more time on the phones so reception gets fewer call- backs and has more time for administrative duties, etc.

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