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Loading for Bear

February 1, 2006
by Michael Cassarino
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By itself, the electronic health record (EHR) is an extremely powerful tool for all types of clinicians and their support staff. But what makes an EHR truly indispensable is its ability to incorporate clinical content from disparate data sources. In fact, incorporation of this data is integral to the success of the EHR as a clinical tool. There are four primary means of loading clinical content into an EHR system to make it more efficient and a better fit for physicians.

Conversion of existing data
Some practices have existing electronic data systems for storage of clinical information. These systems may range from custom-built programs for managing diabetes care plans from legacy computerized physician order entry systems to programs for storing digital images and transcribed documents. Whichever the system or electronic format, existing clinical data can potentially be imported into the EHR. However, the integrity of the source data must be reviewed to ensure that incorporation of the data into the new system is viable from both human and financial resources perspectives.

Data conversion automates importation of the data into the EHR. The amount and types of data to be converted are considerations. For example, it may make sense to import your transcribed patient-visit notes even though six months of historical lab data is sufficient for the practice.

Data capture
Patient data clearinghouses such as RxHub, St. Paul, Minn. (which electronically routes current patient medication history and pharmacy benefit information) can provide data to EHR systems to improve patient safety. The data allows physicians to access a patient's medication history before writing a prescription.

Manual data entry strategies
Of all the mechanisms for loading clinical content into the EHR, data entry is both the most time consuming and the most crucial. From doctors' perspectives, pertinent patient information must be available in the EHR.

A number of different manual strategies for entering patient data can be used. For current patients, populate patients' charts with their problems lists and medications lists before converting the paper chart to digital format. Whenever possible, enter the data before the patient's next appointment. In early phases of live use, increase appointment-time intervals to allow nurses to enter patient data during the triage period and before the physician enters the examination room. Finally, have clinically trained staff enter the clinical data to ensure its quality and accuracy.

Interface connections between your EHR, administrative, financial and external clinical systems are an excellent way to keep the electronic chart updated with patients' most recent data. These external interfaces may begin with the billing system. A practice management system interface provides patient appointments, insurance information, and demographic data to the EHR. Unidirectional and bidirectional communication links with laboratory information systems at reference labs, hospitals or in-house enable order entry and results reporting directly to the EHR.

Through software interfaces, medical devices can also communicate directly with the EHR. Commonly interfaced medical devices include those for capturing vital signs and spirometry readings. Transcription interfaces can process digital voice files from clinicians' dictation files and return them to the EHR as transcribed notes.

Interfaces with image-rich systems such as picture archiving and communications systems provide great benefit to clinicians. Secure Internet connections allow patients to interact with their EHR through Web-based systems which, for example, support scheduling, medication refill requests and updates to their personal information. From their homes, patients can schedule appointments, conduct online visits, request prescription refills, update insurance and demographic data, and interact with providers via e-mail.

Depending on its strategy, each organization can find its own best approach to loading clinical content into the EHR.

Michael Cassarino, MBA, MCSE, is an implementation project manager for electronic health record and practice management system implementations.

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