Question

How can electronic health records (EHRs) address gaps in clinical knowledge?

What are advantages and disadvantages to using PowerPoint presentations?

How can Electronic Health Records be beneficial to health care facilities and consumers?

Describe what is meant by the term “interoperable”.

Answer 1

1. How can electronic health records (EHRs) address gaps in clinical knowledge?

Ans:-

Most clinical decisions involve bridging the inferential gap: Clinicians are required to “fill in” where they lack knowledge or where no knowledge yet exists. In this context, we consider how the inferential gap is a product, in part, of how knowledge is created, the limits to gaining access to such knowledge, and the variable ways in which knowledge is translated into decisions. We consider how electronic health records (EHRs) will help narrow this gap by accelerating the creation of evidence relevant to everyday practice needs and facilitating real-time use of knowledge in practice.

TOPICS

• ELECTRONIC MEDICAL RECORDS
• ACCESS TO CARE
• PHARMACEUTICALS
• QUALITY OF CARE
• BLOOD PRESSURE
• COMORBIDITY
• DISEASES
• PATIENT CARE
• OBSERVATIONAL STUDIES
• CLINICAL PRACTICE

EHRS AND CLINICAL EVIDENCE

The creation of evidence using traditional research designs is extremely time-consuming, costly, and, as previously noted, limited. We consider five different scenarios for how EHRs will likely influence the traditional research paradigm. The scenarios are presented in sequence from ones that primarily offer logistical advantages to those directly relevant to clinical practice needs. Together, these scenarios describe the unique features of research enabled by the advent of EHR-based clinical practice. Namely, the process of engaging in practice-based research will motivate improvements in data quality and the specificity of questions that can be answered, which will in turn influence the ability to monitor and improve patient outcomes and vice versa.

What is an electronic health record (EHR)?

An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs are a vital part of health IT and can:

• Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results
• Allow access to evidence-based tools that providers can use to make decisions about a patient’s care
• Automate and streamline provider workflow

One of the key features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization. EHRs are built to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.

What information does an electronic health record (EHR) contain?

Electronic Health Records: The Basics

An electronic health record (EHR) contains patient health information, such as:

• Administrative and billing data
• Patient demographics
• Progress notes
• Vital signs
• Medical histories
• Diagnoses
• Medications
• Immunization dates
• Allergies
• Radiology images
• Lab and test results

An EHR is more than just a computerized version of a paper chart in a provider’s office. It’s a digital record that can provide comprehensive health information about your patients. EHR systems are built to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in a patient’s care.

Benefits of EHRs

An electronic health record (EHR) is more than a digital version of a patient’s paper chart.

EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care. EHRs can:

Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results

Allow access to evidence-based tools that providers can use to make decisions about a patient’s care

Automate and streamline provider workflow

Impact of EHRs on Care

Our world has been radically transformed by digital technology – smartphones, tablets, and web-enabled devices have transformed our daily lives and the way we communicate. Medicine is an information-rich enterprise.

A greater and more seamless flow of information within a digital health care infrastructure, created by electronic health records (EHRs), encompasses and leverages digital progress and can transform the way care is delivered and compensated.

With EHRs, information is available whenever and wherever it is needed.

·   Improved Patient Care

·   Increase Patient Participation

·   Improved Care Coordination

·   Improved Diagnostics & Patient Outcomes

·   Practice Efficiencies and Cost Savings

What are the advantages of electronic health records?

Advantages of Electronic Health Records

EHRs and the ability to exchange health information electronically can help you provide higher quality and safer care for patients while creating tangible enhancements for your organization. EHRs help providers better manage care for patients and provide better health care by:

• Providing accurate, up-to-date, and complete information about patients at the point of care
• Enabling quick access to patient records for more coordinated, efficient care
• Securely sharing electronic information with patients and other clinicians
• Helping providers more effectively diagnose patients, reduce medical errors, and provide safer care
• Improving patient and provider interaction and communication, as well as health care convenience
• Enabling safer, more reliable prescribing
• Helping promote legible, complete documentation and accurate, streamlined coding and billing
• Enhancing privacy and security of patient data
• Helping providers improve productivity and work-life balance
• Enabling providers to improve efficiency and meet their business goals
• Reducing costs through decreased paperwork, improved safety, reduced duplication of testing, and improved health.

Take the First Step:

1. Contact your local REC to find out if you are eligible for free or reduced-price support. Your local Regional Extension Center (REC) can help you realize the benefits of electronic health records. RECs are located in every region of the country to help health care providers select, implement, and become adept and meaningful users of EHRs.
2. Download Health IT Implementation Resources
3. Review the 6 Implementation Steps

Other Advantages

Transformed Health Care

Electronic Health Records (EHRs) are the first step to transformed health care. The benefits of electronic health records include:

• Better health care by improving all aspects of patient care, including safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency, and equity.
• Better health by encouraging healthier lifestyles in the entire population, including increased physical activity, better nutrition, avoidance of behavioral risks, and wider use of preventative care.
• Improved efficiencies and lower health care costs by promoting preventative medicine and improved coordination of health care services, as well as by reducing waste and redundant tests.
• Better clinical decision making by integrating patient information from multiple sources.

Meaningful Use

One of the best ways to ensure you take full advantage of the benefits of electronic health records is to achieve meaningful use. By achieving meaningful use, you can reap benefits beyond financial incentives.

ELECTRONIC HEALTH RECORD (EHR) IMPLEMENTATION

Implementing an Electronic Health Record (EHR) is a multi-step process that will impact all staff members. As with any new process, a learning curve is involved. Having a solid plan can save hours of stress for everyone on your team.

Here are ten essential steps to take for a successful EHR implementation.

1) BUILD YOUR ELECTRONIC HEALTH RECORD (EHR) IMPLEMENTATION, TEAM

As you implement your EHR, you’ll need a strong team to help the process go as smoothly as possible. The team can include staff members such as physicians, nurses, medical assistants, and administrative staff. Team members will assist the process by teaching colleagues EHR skills and serving as messengers to the implementation team to identify challenges along the way.

A lead superuser, lead physician, and project manager are three essential roles to consider while building your team.

Lead Super User

The lead superuser is the resident in-house EHR expert. A few duties may include template creation and developing workflows. This position may also be responsible for creating standard operating procedures to address problems users come across as they use the system.

Lead Physician

The lead physician’s role is to guide the organization through EHR implementation by serving as a link between the front line users of the system and the technical staff. Consider utilizing a tech-savvy physician who welcomes the new process as the lead physician.

Project Manager

The project manager will become the main point of contact with the EHR vendor and staff. This position will also help everyone keep focused on implementation timelines, track progress, and deal with user issues.

2) PREPARE THE SOFTWARE  

When implementing your EHR, ensure security measures are met to not violate HIPPA. Your organization may need to conduct a HIPPA risk assessment. You can work with your health IT vendor to make sure the software is compliant.

3) DETERMINE YOUR HARDWARE NEEDS  

Your hardware choices will have a significant impact on the time and money your practice uses. For example, having a printer in every room can save physicians up to 30 minutes a day. Some practices provide each staff member with their own tablet or laptop to save time logging in and out between each patient interaction.

If the idea of doing all this seems overwhelming, IT service companies can help practices with system hardware needs by helping find the correct equipment at the best price. Many companies will also install and troubleshoot the devices, taking the burden off your office staff.

4) CONSIDER THE PATIENT TREATMENT ROOM LAYOUT  

As the EHR program requires electronic data entry, the room layout can have a substantial impact on patient engagement and satisfaction. If the staff and physician face away from the patient while entering data, patients may feel like they are not being heard.

One way to solve this is by using the “triangle of trust.” This is a room configuration where the patient, physician, and computer to form a virtual triangle, allowing the patient and physician to see each other. This layout helps because the staff member or physician only has to turn slightly while entering data, helping the patient feel they are being seen. Consider placing semi-circular shaped desks in patient rooms or use moveable carts to help the patient feel at ease during their appointment.

5) TRANSFER DATA

Once your hardware and software are ready to go, the next step in EHR implementation is to transfer the data. To begin, you’ll need to determine how to migrate data from your former record system to your new EHR.

There are a couple of ways to do this step. You can assign existing staff, or hire additional or temporary staff to upload information into the new EHR.

To make this process as smooth as possible, you’ll want to prepare a checklist of information to be entered into the EHR. Having a process in place will help ensure no critical information is missed.

6) CREATE WORKFLOWS

Speaking of process, now is the time to get solid workflows in place. It is vital to establish workflows prior to EHR implementation to decrease the amount of stress your team will face.

Having inefficient workflows, including an insufficient number of staff members who are trained and ready to use the EHR will exacerbate issues during the implementation process.

Consider these questions as you create workflows:

• Is this necessary?
• Does this add value for the patient?
• Does this increase efficiency for the staff?
• Is this the right order?
• Is the right person doing this step?

7) WHAT TO DO WHEN YOUR EHR IS DOWN

As with any type of technology, you must be prepared for the occasional glitch. Start by brainstorming issues and come up with a solid game plan for how to handle potential problems.

For example, what will you do when the power goes out? What if there is a system-wide malfunction that requires the help of IT to fix? You will want to develop procedures that give clear instructions to physicians and staff on what to do when the EHR is unavailable.

Consider these questions when developing your procedures:

• How will physicians and staff be notified of downtime?
• How will the patient care flow continue?
• How will patient check-in occur?
• How will physicians and staff document the visit?

Having electronic and paper procedures available to staff will increase their confidence on how to handle EHR downtime. Some medical practices compile the instructions in three-ring binders and store copies both in-house and offsite. Also, consider storing PDF copies on a secure cloud, so staff members have multiple options to get the instructions quickly.  

8) HAVE A TRAINING PROGRAM IN PLACE

Extensive training is imperative to ensure success with EHR implementation. Create a training plan so that all physicians and staff, current and future, can gain the knowledge and skills to use the EHR successfully when you are ready to launch.

Here are a few principles to consider:

Start slow

Provide physicians and staff with basic skills before launching. It can be difficult for users to fully understand the system until they are able to use the program. Once users are able to “drive” for at least a week, additional training can be introduced to increase skills, learn time-saving tricks and get more comfortable with the technology.

Let colleagues teach colleagues

Consider training super users in each specialty and for each role. For example, nurses teach nurses best and surgeons teach surgeons best. Besides, if you have a super user in each specialty, they can become an ongoing resource for their colleagues.

Map out ongoing training needs

Have a plan for ongoing training. As time passes, users will find shortcuts and new ways to use the tools, and will want to share these findings with their colleagues. In addition, the EHR will need to be updated with new and/or improved functionality that will require extra training.

Ways to effectively handle these situations include:

· Develop a system for users to submit EHR recommendations so changes can be made.

· Encourage active EHR users to share input and offer solutions for enhancing usability, either by a formal tracking system or through an online discussion that encourages the sharing of ideas.

· Create a system for continuous EHR customization. Once physicians and staff have a handle on the new EHR, they will identify modifications that can improve workflow.

· Preserve the EHR vendor relationship and utilize IT support to:

Develop or customize data entry templates

Revise EHR generated forms and letters

Enable new clinical decision support rules (if available)

Modify order sets

· Look for integration opportunities with other commonly used systems in the practice

· Plan group training in advance. Training will take time from seeing patients, so advanced planning decreases disruption to the practice workflow.

9) DECIDE ON LAUNCH APPROACH – “BIG BANG” OR INCREMENTAL?

Once your EHR implementation plan is ready to go, it’s time to decide how to launch. There are typically two ways to do this, all at once, the “Big Bang” or slowly, in an incremental approach.

Some practices use the “big bang” approach and roll out the EHR system for all patients and functions on the same day. This approach minimizes time spent managing paper records as well as the new EHR system at the same time. The disadvantage is it can be very disruptive and small problems can seem monumental.

Some practices take a slower approach and implement the EHR incrementally. By introducing EHR functions one at a time, such as e-prescribing to begin and then introducing other features later, some practices find the disruption easier to manage. Larger practices and organizations may implement slowly by rolling out the EHR in specific sites or departments first and introducing the program to the rest of the organization later.

Once the launch approach is decided, physicians and staff can get ready for the new EHR system.

On the actual “Go Live” day it is recommended to lower the patient volume which will ensure a smooth transition for both patients and staff. It is also recommended that the front desk staff informs the patients either pre-appointment or the day of that the practice is transitioning software and that the process may be slightly interrupted. They will appreciate the insight and have more patience should there be a delay during their visit.

10) GATHER FEEDBACK FOR CONTINUAL IMPROVEMENT

Now that you’ve successfully implemented the EHR, be sure to gather feedback from the users to continually improve the process. Be sure to keep the lines of communication open so staff members and physicians feel comfortable providing feedback. If everyone works together, the EHR system will be an improvement to your practice.

Implementing an EHR is a multi-step process that requires advanced planning. Use these steps to help make the transition as smooth as possible.

2. What are advantages and disadvantages to using PowerPoint presentations?

Ans:-

PowerPoint is the most popular presentation software. It is regarded by many as the most useful and accessible way to create and present visual aids to the audience.

On the other hand, others believe it has created its own mind-set which forces presenters to spend countless hours thinking in PowerPoint and developing slides. A political party has even formed to ban PowerPoint in Switzerland. Depending on one's perspective, it seems that many advantages could easily be viewed as disadvantages.

Look over the list below to see where you stand— with or against PowerPoint.

TERM TO KNOW

PowerPoint

An electronic slide presentation created and presented using the program (verb) to communicate to (an audience) by electronic slides.

Advantages

Design:

Quick and easy: The basic features are easy to master and can make you appear to be organized, even if you are not.

Simple bullet points: It can reduce complicated messages to simple bullet points. Bullet points are a good basis for a presentation and remind the speaker of main points and the organization of the message.

Easy to create a colorful, attractive design: Using the standard templates and themes, you can create something visually appealing, even if you do not have much knowledge of basic graphic design principles.

Easy to modify: When compared to other visual aids such as charts, posters, or objects, it is easy to modify.

Easily re-order presentation: with a simple drag and drop or using key strokes, you can move slides to re-order the presentation.

Finally, PowerPoint is integrated with other products that allow you to include parts of documents, spread sheets, and graphics.

Delivery:

Audience size: PowerPoint slides are generally easier to see by a large audience when projected than other visual aids.

Easy to present: You can easily advance the slides in the presentation one after another with a simple key stroke while still maintaining eye contact with the audience.

No need for handouts: They look good visually and can be easily read if you have a projector and screen that is large enough for the entire room.

TERM TO KNOW

Bullet Points

Bulleted items – known as bullet points – may be short phrases, single sentences, or of paragraph length; used to introduce items in a list.

In all professional spheres, we use technology to communicate, teach and a lead. Our language is increasingly digital, and more often than not, that means visual. Here's why having a smartly designed slide can and should be more than just text and color on a screen.

Advantages of using visual aids in a presentation

• They tell a compelling story — A presentation should ultimately complement the presenter’s story by providing structure, allowing the presenter to delve deeper by providing additional verbal details. The use of images help the audience gain a fuller understanding of the verbal content.
• Helps audience connect to the content — Since many people are visual learners, a visual presentations can help the audience better connect to the content.
• Keeps the audience engaged — When the audience has visual content to look at during an oral presentation, it can help keep the audience engaged versus losing focus.

Disadvantages

Design:

Design power pointless: Gives the illusion of content and coherence, when in fact there is really not much substance or connection between the different points on the slides.

PowerPoint excess: Some speakers create presentations so they have slides to present rather than outlining, organizing, and focusing on the message.

Replaces planning and preparation: PowerPoint is a convenient prop for poor speakers, as it can reduce complicated messages to simple bullet points and elevates style over substance.

Oversimplification of topic: The linear nature of PowerPoint forces the presenter to reduce complex subjects to a set of bullet items that are too weak to support decision-making or show the complexity of an issue.

Feature abundance: While the basic features are easy to use and apply, a speaker can get carried away and try to use all the features at once rather than simply supporting a message. Too many flying letters, animations, and sound effects without seeing much original thought or analysis can be a real issue. In many cases, the medium shoves the message aside.

Delivery:

Basic equipment required: You will need to have a computer and projection equipment in place to display the slides to the audience.

Focus on medium, not message: Too many people forget that they are making a presentation first and that PowerPoint is just a tool.

While there are advantages to using visual presentations such as PowerPoint, there are also setbacks and traps even the most seasoned presenters can easily fall into. Though making a PowerPoint or Google Slide often seems like the obvious next step in sharing information with a group at work, you may want to consider why and if you really need one to tell your story. Before you create one out of habit, think about these potential drawbacks:

• Poorly created presentations detract from the content — It does not matter how many different software programs exist, a poorly created visual presentation, and by that I mean, ones with distracting or confusing themes, inconsistent font usage, too much text per page and not enough white space, pixilated images, and so forth, serve to pull down the content, and they look unprofessional.
• Presentations can distract the audience — Poorly created presentations or presentations that are too busy or have too many bells and whistles can distract the audience. When the audience focuses too much on the visual component of the presentation, they lose portions of the oral content.
• Presenters can become lazy and rely too heavily on presentations versus telling the story — Too often presenters create their slides and merely read off the slides instead of using the slides as a guide. This makes for a boring presentation. Ultimately, the presenter wants to add verbal content to the visual presentation such as examples and anecdotes to round out the presentation.
• Technical difficulties can get in the way of success — When a presenter relies too heavily on visual presentations to communicate their message, panic can set in when there is an audio-visual glitch. This can leave the presenter feeling overwhelmed and incapable to make their presentation, which again makes the presenter look ill-prepared, and ultimately, unprofessional.

3. How can Electronic Health Records be beneficial to health care facilities and consumers?

Ans:-

The benefits of electronic health records include:

Better health care by improving all aspects of patient care, including safety, effectiveness, patient-centeredness, communication, education, timeliness, efficiency, and equity

Electronic Health Records (EHR) mandates had an added benefit of significantly improving access for all responsible healthcare workers at a patient’s bedside. The nurse will use a medical cart on wheels with drawers and a laptop, enters the data, and the patient’s doctor has instant access.

However, what about the patient? In today’s digital age, everyone accesses information from anywhere on the planet. Why can’t a patient access information on his or her own healthcare?

Allowing patient access to electronic medical records has several advantages and disadvantages.

Background

One of the stated purposes of the 2009 American Recovery and Reinvestment Act that required public and private healthcare facilities to institute electronic patient records was engaging patients in his or her own healthcare.

Engagement in today’s information age means the ability to access, review, and discuss a patient’s own records and results.

Many hospitals have included a patient portal to permit patients to access information related to their care.

Those clinics that do not have patient portals deliberate about what to include and worry if the disadvantages of a patient portal outweigh the advantages.

Legal Requirements

Currently there is no mandate requiring care facilities to permit patient access to their records.

There are, however, some senators and congressmen who have strongly indicated the desire to legislate a patient records access right under federal law.

Most countries have laws or regulations, giving citizens the right to certain types of medical information related to his or her own care.

Advantage: Improving Patient Engagement Allowing patient access allows patients to take ownership of his or her own care management. The patient feels connected to the clinic and will likely continue to patronize the facility.

Patients can more easily send and receive messages, make appointments, and get questions answered quicker. Patients can use their own electronic devices to access their records whenever they need or want to do so.

Checking on prescriptions and requesting refills is also more straightforward with a patient portal.

Disadvantage:Increased Risk of Data Breeches Opening a patient portal also increases the risk of data breeches. Administrators can mitigate this risk by installing secure firewalls and other IT security measures to keep patient portals from becoming entryways into the electronic health records system for all patients.

The patient portal must require strong passwords and have robust encryption.

Advantage:Eliminates Patient Intake Angst One of the biggest inconveniencies of visiting a clinic or hospital is filling out the intake forms. Allowing access to the system permits patients to enter his or her data securely rather than filling out seemingly endless forms before seeing a doctor.

This also means patients don’t have to fill out the same medical history forms each time they visit or fill out a shot record more than once.

Disadvantage: Doctor Comments and Medical Jargon With patient access to medical records, all comments are visible, including negative ones.

Patients may misconstrue comments that only appear negative but, in reality, are not.

Most patients too will not know the various terminologies and shorthand used by medical professionals. The patient may get confused and this can lead to misunderstandings.

Advantage: Lab Results Patients find getting lab results immediately when posted a very positive feature of patient portals. The patient does not have to wait days for the results to be mailed or wait for the hospital or lab to call.

Disadvantage: Computer Luddites

An electronic health record (EHR) is more than a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. While an EHR does contain the medical and treatment histories of patients, an EHR system is built to go beyond standard clinical data collected in a provider’s office and can be inclusive of a broader view of a patient’s care.

EHRs can: Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test results

Allow access to evidence-based tools that providers can use to make decisions about a patient’s care Automate and streamline provider workflow

4. Describe what is meant by the term “interoperable”.

Ans:-

Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.”

Medical device interoperability is the ability to safely, securely, and effectively exchange and use information among one or more devices, products, technologies, or systems.

How do you achieve interoperability in healthcare?

To achieve interoperability, we must adopt and optimize electronic health records (EHRs) and health information exchange (HIE) services. Paper-based health records, which most doctors and hospitals used until recently, are usable only by one person at a time at a particular location.

What facilitates interoperability with an electronic medical record?

Interoperable electronic health records (EHR) allow the electronic sharing of patient information between different EHR systems and healthcare providers, improving the ease with which doctors can provide care to their patients and patients can move in and out of different care facilities.

Examples of structural interoperability are HL7 interfaces and the transmission of patient data from connected devices like Fitbits. Examples of semantic interoperability are Health Information Exchanges and data collection methods for population health.

Interoperability is so important because it ensures that doctors, surgeons, and other medical providers have the information that they need in order to provide sufficient care. Studies have shown that plenty of healthcare facilities are able to send and receive the data.