TeleHealth and EMRs: Talking the TeleHealth Language

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TeleHealth and EMRsTalking the TeleHealth
Language

• Nina M. Antoniotti, RN, MBA, PhD
• Marshfield Clinic TeleHealth
• Marshfield, Wisconsin
• American Telemedicine Annual Meeting
• Nashville, Tennessee
• May 2007

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The Health Care World
Patient
Provider
Diagnostics
TeleHealth/Telemedicine
Imaging

• EMR

Archiving/Retrieval
Infrastructure/Human
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• Doctors Patient
• Nurses Family
• Care Managers Care Giver
• Allied Providers Custodian
• Patient State
• Family Federal
• Self-Insured Licensing
• Employers Accrediting
• Health Plans
• Government

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TeleHealth/Telemedicine

• Telemedicine
• The use of medical information exchanged from one
  site to another via electronic communications to
  improve patients health status.
• telehealth, which is often used to encompass a
  broader definition of remote healthcare that does
  not always involve clinical services.
• Videoconferencing, transmission of still images,
  e-health including patient portals, remote
  monitoring of vital signs, continuing medical
  education and nursing call centers.
  (Retrieved 04-23-07 www.americantelemed.org)

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Information Technology

• "any equipment or interconnected system or
  subsystem of equipment, that is used in the
  automatic acquisition, storage, manipulation,
  management, movement, control, display,
  switching, interchange, transmission, or
  reception of data or information. The term
  'information technology' includes computers,
  ancillary equipment, software, firmware and
  similar procedures, services (including support
  services), and related resources."
• (Office of the Federal Register 2000, p.
  80499) 

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• "any technology, including the computer hardware,
  software, and telecommunications networks that
  enable the transmission, processing, storage,
  organization, and retrieval of information for
  the purpose of understanding, decision making,
  and action taking. Penn State Un IST Institute
•  
• "The application of technology in computers and
  communication systems to the storage, processing
  and transmission of information with the
  objective of improving communication in the
  workplace and the efficiency and effectiveness of
  human endeavor." Univ of Canberra, Australia

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Health Information Technology
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Health Information Technology

• Health information technology (Health IT) allows
  comprehensive management of medical information
  and its secure exchange between health care
  consumers and providers. Broad use of health IT
  will
• Improve health care quality
• Prevent medical errors
• Reduce health care costs
• Increase administrative efficiencies
• Decrease paperwork and
• Expand access to affordable care.

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• Interoperable health IT will improve individual
  patient care, but it will also bring many public
  health benefits including
• Early detection of infectious disease outbreaks
  around the country
• Improved tracking of chronic disease management
  and
• Evaluation of health care based on value enabled
  by the collection of de-identified price and
  quality information that can be compared.

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Ninas Definition

• any technology, including the computer hardware,
  software, and telecommunications networks used in
  the health care environment that enable the
  transmission, processing, storage, organization,
  and retrieval of health related information for
  the purpose of understanding, decision making,
  and action 5-07-07

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Electronic Medical/Health Records (EMR/EHRs)

• Computer-based patient record and/or electronic
  health record often used in the US to refer to
  an electronic health record in a physician office
  setting or a computerized system of files (often
  scanned via a document imaging system) rather
  than individual data elements.library.ahima.org/x
  pedio/groups/public/documents/ahima/pub_bok1_02504
  2.html

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• Technology, when fully developed, that meets
  provider needs for real-time data access and
  evaluation in medical care. Together with
  clinical workstations and clinical data
  repository technologies, provides the mechanism
  for longitudinal data storage and access, meeting
  the need for medical outcome studies, more
  efficient care, speedier communication among
  providers and management of health plans.
  www.plexisweb.com/glossary/words/e.html

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• An electronic medical record (EMR) is a term used
  to describe computer-based patient medical
  records. An EMR facilitates easy look up of
  patient data by clinical staff at any given
  location accurate and complete claims processing
  by insurance companies building automated checks
  for drug and allergy interactions clinical
  notes prescriptions scheduling sending and
  viewing labs
  en.wikipedia.org/wiki/Electronic_medical_record

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Definition of EMR/EHR

• There is a lack of consensus on what constitutes
  an EHR, and thus multiple definitions and names
  exist for EHRs, depending on the functions
  included. An EHR generally includes
• (1) a longitudinal collection of electronic
  health
• information about the health of an individual
• or the care provided,
• (2) immediate electronic access to patient- and
• population-level information by authorized
  users,
• (3) decision support to enhance the quality,
  safety,
• and efficiency of patient care, and
  (4) support of efficient processes for
  health care delivery. GAO-05-628, a report to
  the Chairman, Comm on the Budget, House of
  Representatives

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TeleHealth and their networks are uniquely
positioned for the assessment, evaluation,
implementation, and deployment of electronic
medical records.
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TeleHealth and EMRs

• Use common platform
• Use common network
• The right information at the right time for the
  right provider and the right patient for the
  right diagnosis and treatment.

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Health Information Technology Standards
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Benefits to Providers

• Basic appropriate requirements for health care
  settings, i.e. ambulatory care
• Helps with judging product suitability, quality,
  interoperability and data portability, and
  security
• Designation sets the bar for EHR products
• Has the potential to reduce buying risk for
  purchasers while opening up the flow of HIT
  incentives from payers and purchasers
• Prepare for changing reimbursement
• 88 EMR products already certified

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• Certification Commission for Healthcare
  Information Technology
• CCHIT is a recognized certification body (RCB)
  for electronic health records and their networks,
  and an independent, voluntary, private-sector
  initiative.
• CCHITs mission is to accelerate the adoption of
  health information technology by creating an
  efficient, credible and sustainable product
  certification program.

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Marshfield Clinic EMR

• The Certification Commission for Healthcare
  Information Technology (CCHIT) confirms
  that CattailsMD Version 5 from Marshfield
  Clinic is a CCHIT Certified Ambulatory EHR
  product for 2006 CCHIT asserts that CattailsMD
  Version 5 has met a comprehensive set of criteria
  for
• Functionality setting features and functions to
  meet a basic set of requirements.
• Interoperability enabling standards-based data
  exchange with other sources of healthcare
  information. (For additional details, see the
• Security ensuring data privacy and robustness
  to prevent data loss. 

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• Tablet Technology
• Fully Integrated
  Functions
• All Applications
  Available

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EHR at Marshfield
All work starts and is completed around Dashboard
All work is stored in the Combined Medical
Record (CMR)
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Dashboard
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Verify allergies/adverse reactions
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Verify medications
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Access Practice Guidelines
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Review preventive services
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Growth Chart
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Clinical Code Acquisition
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Launch Documentation Manger
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Electronic Medical Record
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View lab results
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View Images
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Marshfield Clinic TeleHealth Provider
Workstation
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Strategic Planning for TH - HIT- EMR

• Develop networks with all applications in mind
  TeleHealth, HIT, and EMRs
• Collaborate between sites on the purchase of EMRs
  as well as TH equipment
• Integrate the two from the beginning one
  doesnt come without the other
• Work with state-wide initiatives to see the value
  of linking both initiatives

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Benefits of TH EMRs

• Increased privacy of patient data
• Increased productivity of provider and presenter
• Increased communication between consultant and
  referring providers
• Decreased chance for omissions/errors
• E-prescribing
• Improved quality of IOM indicators

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Contacts

• Nina M. Antoniotti, RN, MBA, Ph.D.
• Program Manager, Marshfield TeleHealth
• Email antoniotti.nina_at_marshfieldclinic.org
• 715-389-3694
• Paul Olinsky
• General Manager Commercial IS
• 715-221-8164
• Email olinski.paul_at_marshfieldclinic.org