Question

What core functions for EHRs did Institute of Medicine suggested in 2003?

Answer 1

In 2003, the Institute of Medicine identified eight core functions that EHR systems should be capable of performing in order to promote safety, quality and efficiency in health care. These functions include:

• health information and data
• result management
• order management
• decision support
• electronic communication and connectivity
• patient support
• administrative processes and reporting
• reporting and population health

Additional functions common to EHRs include alerts for clinical preventive services, drug-drug interactions and drug allergies. Organizations have taken several approaches to obtaining a system with the needed functionalities. Purchasing a comprehensive system (often referred to as the “single-vendor strategy”) has been the most common approach among U.S. hospitals,242 but some piece together elements from different systems (e.g., scheduling, billing, and EHRs) and there is variation in what information is included in EHRs in different organizations.

EHRs typically include a patient’s demographic information, personal and family medical history, allergies, immunizations, medications, health conditions, contact and insurance information, as well as a record of what has occurred during visits with the provider.243 Information may be collected both at sign in at the registration desk and during the visit with the provider.

Patient-reported data

Basic contact, insurance, and demographic information about patients is collected at the registration desk or in the waiting room. Patients may also be asked for pertinent information about their health. Some providers use iPads or computer kiosks that allow patients to enter information directly into their EHR. Some also have patient portals that allow patients to view their information and to communicate with their health care providers. These can be set up to directly interface with the EHR,244 creating source of information within the EHR. At this stage of EHR use, all patients are not equally likely to use patient portals; minority patients may be less likely to use them and younger patients more likely.

Clinical encounter data

Data collected during office visits and entered by the clinician into patient records during a visit may include reason for the visit, height, weight, vital signs, patient reported symptoms and characteristics (such as behavior and lifestyle), diagnoses, treatments and tests ordered, and medications prescribed. Information the pharmacy, laboratory and radiology are often incorporated into the EHR. This should include test results and imaging from other systems.

Clinical information may be entered in a structured format where the clinician can select from standard, predetermined categories such as diagnosis or procedure codes or medication list. Clinicians may also enter information in free-text notes in their own words or the patient’s words. For a condition such as autism spectrum disorder, relevant information may be entered as a diagnostic code or in free text about symptoms suggest the diagnosis or about patient or parental reports of such a diagnosis in the past. Diagnostic information may also be implied by the clinician’s prescription choices.

Claims/billing information

Many providers have electronic practice management systems that handle functions like scheduling, billing, and collections. Such systems are increasingly being integrated with electronic health records. Although this is being done for practice management purposes, it can make the overall data system more useful for research. Billing systems can have more complete diagnostic and procedure information than do EHRs.