Electronic Medical Record
A longitudinal record, birth to death. Also called: Automated Medical Record, Computerized Medical Record, Electronic Medical Record
A principal repository for data concerning a patient's health care that affects virtually everyone associated with providing, receiving, auditing, regulating or reimbursing health care services.
The IOM definition defines a computer-based patient record as an electronic patient record that resides in a system specifically designed to support users by providing accessibility to complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids.
ISO TR 20514
Provides some simple concepts about what an EHR might be. ISO TR 20514 is a technical report published in 2007. It is very general, simply defined, and its purpose is only to provide information about the EHR. (TR is informational not a standard)
ISO TS 18308
Defines the Requirements for an Electronic Health Record Reference Architecture, and provides some suggestions for an EHR architecture that would support interoperability and data sharing. (A Technical Specification) Does not define functional requirements. A technical specification is somewhere between an information document and a standard.
ISO IS 13606
addresses multiple aspects of an EHR_
Goals of 13606
1) Define architecture for communicating the EHR_ 2) Preserve clinical meaning 3) Confidentiality of data
ASTM Standard (E 1769)
Defines Functions, reminders & alerts, authorized use of EHR_, protection of data (most valuable of ASTM standards)
The EHR generally refers to just the storage of the data and maybe a few related functions associated with collecting and presenting the data. The EHR system expands to include all functions related to the EHR. These functions will be such things as billing and claims support, decision support, various reporting functions, queries, etc. These functionalities provide the value behind an EHR.
HL7 EHR-S FM
This standard evolved into a normative standard and was approved by ANSI in 2007. Work continues on this standard, and release two of the standard has been published. This standard was also recently approved as an ISO standard. (FM=functional model) Used for certification
Sections of HL7 EHR-S FM
The standard is divided into three sections: Direct care, support, and information infrastructure.
Direct Care Section
Care management, CDS, operations management & communications (Direct care includes the day to day direct delivery of care to patients in various settings)
Clinical support, administrative & financial processes
Security, Privacy, safety, as well as operational efficiencies and minimum standards for interoperability.
Functional profiles identify a set of functionalities to enable an EHR in a specific setting. The profiles currently registered with HL7 include: Behavioral health, child health, long term care, legal EHR, regulated clinical research (Clinical Trials), vital statistics reporting, and the list is growing rapidly.
HL7 Personal Health Record Functional Model
Specifically, the HL7 Personal Health Record Functional Model does not define PHR but does assume certain characteristics. The PHR-FM assumes a "pull-push" or "push-pull" model. It assumes many sources of data, and it assumes control by an individual, usually to the person whose data is included in the PHR.
There are currently five models or approaches to the PHR. 1) Provider-based- provider portal 2) Health record bank- maintained by a trust 3) Payer-based- primarily claims data 4) Free standing- web based, purchased and maintained by patient 5) Employer-based.
Provider Based Model
The Provider-Linked model largely means that the a healthcare organization designs a portal by which a patient can see their clinical, administrative and financial data, which is clinician-controlled, and is derived from the institutional EHR.
Released 2008. The functional outline for the PHR is divided into three sections, similar to the EHR-FM. These sections are: Personal Health, Supportive, and Information Infrastructure. A core set of functions is identified in each.
Certification of EHR's
Certification is to provide confidence that electronic health information technology products and systems are secure; can maintain data confidentiality; can work with other systems to share information; and can perform a set of well-defined functions. Certification is designed to assure health care providers that the EHR technology that they acquire can perform the functions they need to participate in the Medicare and Medicaid EHR incentive program.
Certification Commission for Healthcare Information Technology (CCHIT)
CCHIT is authorized to offer certification for complete EHRs that meet Stage 1 Meaningful Use requirements.