Electronic Health Records (EHR)

Presented by: Dr. R. Tapera (PhD, MMedSc, MPH, B.Sc.)

Dr R. Tapera
 Learning outcomes
• Describe the origins of EHRs.
• Illustrate the key capabilities of an EHR
• Discuss the advantages of EHRs over the
paper.
• Categorise some of the disadvantages of EHRs

Dr R. Tapera
 We all use principles of informatics in our day-
to-day practice of medicine

• Informatics is the “science” of information

• Data Information Knowledge

…..and ultimately for Decision Making

Dr R. Tapera
 Informatics principles in clinical
medicine (without computers)
• Data Information Decisions
Malnutrition
05/10/2005 = 13.0 kg
08/11/2005 = 13.2 kg
04/06/2006 = 14 kg
11/01/2007 = 18.1 kg
21/03/2008 = 17.9 kg

Dr R. Tapera
 Informatics principles in Clinical
Medicine (with computers)
• Data Information Decisions

The same principles apply with computers. . .

and the main tool we use for data collection,
analysis, decision support to provide clinical care
and to perform outcomes research is the

Electronic Health Record (EHR)

Dr R. Tapera
What is an EHR? (refresher from last week)
The Electronic Health Record (EHR) is:
• A longitudinal electronic record of patient health information generated
by one or more encounters in any care delivery setting.

• Included in this information are patient demographics, progress notes,

problems, medications, vital signs, past medical history, immunizations,
laboratory data and radiology reports.

• The EHR automates and streamlines the clinician's workflow. The EHR
has the ability to generate a complete record of a clinical patient
encounter - as well as supporting other care-related activities directly or
indirectly via interface - including evidence-based decision support,
quality management, and outcomes reporting.
Dr R. Tapera
 Key features of electronic health
records applications 1
1. Patient Demographics: Stores basic patient
information such as name, age, gender, and contact
details.
2. Medical History: Records past medical conditions,
surgeries, allergies, and family medical history.
3. Medication Tracking: Tracks current and past
medications, including dosages and prescribing
physicians.
4. Lab Results: Integrates with laboratory systems to
store and display test results.
Dr R. Tapera
 Key features of electronic health
records applications 2
1.Clinical Notes: Allows healthcare providers to
document patient encounters, including
symptoms, diagnoses, and treatment plans.
2.Imaging Integration: Links to radiology and
other imaging systems to store and display
images and reports.
3.E-Prescribing: Enables electronic prescribing
of medications, reducing errors and improving
efficiency.
Dr R. Tapera
 Key features of electronic health
records applications 3
1.Decision Support: Provides alerts and
reminders for preventive care, drug
interactions, and evidence-based treatment
options.
2.Interoperability: Facilitates the exchange of
patient information between different
healthcare systems and providers.
3.Security and Privacy: Implements robust
security measures to protect patient data and
ensure compliance with regulations.
Dr R. Tapera
 Systems within EHR
• Decision support systems:
• An electronic system that provides structured
guidance based on patient-specific input.
- Expert systems
- Conditional alerts

Dr R. Tapera
 Functions of Clinical Decisions
Support Systems
Function Example
Alerting Highlighting out of range laboratory
values.
Reminding Reminding the clinician to schedule a
mammogram
Critiquing Rejecting an electronic order
Interpreting Interpreting the echocardiogram
Predicting Predicting risk of mortality from a severity
of illness score
Diagnosing Listing different diagnosis for a patient
with chest pain
Assisting Tailoring the antibiotic choices for liver
transportation and renal failure

Dr R. Tapera
 Cognitive Bias: Availability Bias
• In this bias, clinicians overestimate the
likelihood of unusual conditions due to recent
experiences.
• Results in poor use of resources.
• Might distract clinician from correct diagnosis.

Dr R. Tapera
The Medical Record Beginnings
• Created by Ed Hammond and
William Stead at Duke
University in 1969.
• Began with a 19-page
medical history entered into
a PDP-12 minicomputer.
• Data entered by clinicians
included medications and lab
data.

Dr R. Tapera
 Capabilities of Electronic Medical
Records
• To Err is Human (1999)
• Close to 100 000 death a year due to hospital
medical errors.
• Suggested use of EHRs
• Crossing the quality Chasm (2001)
• Care should be: Safe, Effective, and Equitable
• The EHRs should support this.

Dr R. Tapera
 Key Capabilities of EHR 1
1. Improved Patient Care: Provides healthcare
providers with comprehensive and accurate
information, leading to better diagnosis and
treatment.
2. Enhanced Coordination: Facilitates communication
and coordination among different healthcare
providers involved in a patient's care.
3. Increased Efficiency: Reduces paperwork,
streamlines workflows, and minimizes administrative
tasks.
Dr R. Tapera
 Key Capabilities of EHRs 2
1.Patient Engagement: Allows patients to access
their health records, schedule appointments,
and communicate with their providers
through patient portals.
2.Data Analytics: Enables the analysis of large
datasets to identify trends, improve
outcomes, and support research.
3.Regulatory Compliance: Helps healthcare
organizations comply with legal and regulatory
requirements related to patient data.
Dr R. Tapera
Data standards: Why data
standards

Dr R. Tapera
 Key Data standards
• International Classification of Diseases, or ICD-
10,
• Current Procedural Terminology (CPT ),
• Logical Observation Identifiers Names and
Codes(LOINC),
• Systematized Nomenclature for Medicine
(SNOMED).

Dr R. Tapera
International Classification of
Diseases

Dr R. Tapera
Example

Dr R. Tapera
 Going deeper—the EHR and Data

“Unstructured” (free text)

vs
“Structured” (or discrete) data
1. What Microsoft Office product uses
1. What Microsoft Office product uses
“unstructured” data (or free text)? Word (docs)
“unstructured” data (or free text)?
2. Which Office product uses “structured” data?
2. Which Office product uses “structured” data?
Excel (spreadsheets)
 Structured Data
Unstructured Data
• …patient pulse is ninety-two…
• Blood pressure is 120/80
• ….currently taking cetirizine for her allergies
• He was born on 2/3/14
Structured Data
• Pulse: 92
• Systolic BP: 120: Diastolic BP: 80
• Medication: 63629-3708 (Cetirizine)
• Diagnosis: J30.9 (Allergic Rhinitis)
• Date of Birth: March 2, 1914Dr R. Tapera
 Structured Data
• Structured data is stored in an organized
manner so it can be processed by computers.
❑ Discrete or fixed data
❑ Opposite of free text
• Without structured data we couldn’t:
❑ Share data across computer systems.
❑ Run queries or reports
• When recording structured data, you must tell
the computer both the type of data and the
value. Dr R. Tapera
 Types of data
• Integer • String
- Heart rate -Free text
• Floating point • Categorical
- Weight, height - Sex
• Date • Standards
- Birthday - Diagnoses
• Boolean
-True or False

Dr R. Tapera
Unstructured or “free text” data in EHR

Dr R. Tapera
Structured or “discrete” data in EHR

Dr R. Tapera
 Advantages of “Structured” Data Collection
Data Validity
We’ve already seen some:
•Decreases data entry errors—spelling
•Improves data entry consistency

Let’s look at other examples and see if you can

define other “advantages” of using structured
data entry
Data Validity
Data Validity
 The challenges of EHRs 1
1.Implementation Costs: High initial costs for
software, hardware, and training.
2.Usability Issues: Some systems may have
complex interfaces that can lead to user
frustration and errors.
3.Data Migration: Transferring data from paper
records or legacy systems can be challenging
and time-consuming.

Dr R. Tapera
 The challenges of EHRs 2
1.Interoperability: Despite advancements,
achieving seamless data exchange between
different EHR systems remains a challenge.
2.Privacy Concerns: Ensuring the security and
privacy of patient data is critical and requires
ongoing vigilance.

Dr R. Tapera