longitudinal collection of electronic health information for and about persons, where health information is defined as information pertaining to the health of an individual or health care provided to an individual
immediate electronic access to person- and population-level information by authorized, and only authorized, users
provision of knowledge and decision-support that enhance the quality, safety, and efficiency of patient care
support of efficient processes for health care delivery. Critical building blocks of an EHR system are the electronic health records (EHR) maintained by providers (e.g., hospitals, nursing homes, ambulatory settings) and by individuals (also called personal health records).
The IOM identified Core Functionalities of the EMR in their Letter Report, as follows:
Health information and data
Results management
Order entry and management
Decision support
Electronic communication and connectivity
Patient support
Administrative processes
Reporting and population health management
The IOM also identified uses of the EMR, as follows:
Primary uses
Patient care delivery
Patient care management
Patient care support processes
Financial and other administrative processes
Patient self-management
Secondary uses
Education
Regulation
Research
Public health and homeland security
Policy support
The EMR must conform to data standards
A major limitation in the evolution of the EMR has been the lack of standards. Momentum for this is now being focussed by initiatives discussed in the PTTF's Data Standards document. The operations on these data also have requirements to assure security and intergrity issues, also discussed elsewhere in the PTTF's Security document. Other data considerations include the ability of the data to readily address the core functionalities and uses just discussed.
The Scope of the EMR
The PTTF concludes that the missions of the Department of Pediatrics requires a full scope of functionality as outlined by the IOM. The PTTF also envisions the full set of uses defined by the IOM. Thus, a very wide scope is necessary in implementing the EMR at CMH and its satellites. While the priority needs to be given to solid clinical records, the PTTF strongly believes that alternate uses require careful consideration throughout the rollout of the EMR.
Leading Vendors and Products
There are various models for EMRs and the companies that produce them. GE Medicals' Centricity (formerly Logician) is a web based EMR that gained substantial market penetration. It was recently acquired by GE Medical who is aggressively marketing it to small practices and larger institutions. Cerner is a mature product that grew up from the in-patient arena; it runs on local hospital servers. Epic is also a mature product that began in the ambulatory venue and evolved to encompass in-patient and other functionalities. GE and Cerner are publically traded companies; Epic is privately held.
The PTTF has followed the internal CMH discussions about EMR vendors. Epic products were those preferred by the PTTF and these opinions convergence with those of CMH IM. The PTTF recommends the rollout of multiple modules of Epic's software, as discussed in the Recommendations document.