Question

CASE STUDY An integrated delivery network (IDN) serving a large urban fed with high-value data from each of the clinical systems. and rural demographic area is using separate EHR systems The outpatient EHR's MPI already was being used as the mas- ts inpatient and outpatient settings. Some of the specialty ter unique identifier for most of the IDN's systems, so it can be departments have also purchased their own systems for doc incorporated with the new CDR. A robust IE isimplemented to tation. Unfortunately, this means that information col umen lected in the inpatient setting is not available when patients are seen in the IDN's outpatient clinics (and vice versa). The clinicians need this information to be better informed about their patients and to provide optimal care. In addition, .supply data from the clinical systems to the CDR. To normalize the different terminologies used on their various systems, the IDN engages a terminology-services vendor to provide a cen- he concepts from the current systems to the central standard terminology. The IE tral data dictionary for the CDR and map t leaningful Use requirements for problems, medications, and uses the terminology services to normalize inbound data to allergies, as well as new chronic disease care initiatives that the the CDR from the other systems. IDN is implementing for its patient population, are being hin dered by the separate systems. The clinicians have been given system on top of the CDR to develop and maintain enter accounts on both EHRs, but this is cumbersome for the users prise patient-care rules. As rules are executed, their results because they must be trained on multiple systems, they use will be both sent through the IE to the existing EHRs and valuable time logging into different systems and navigating stored in the CDR; storing the decision support results in for information, and there is a potential safety issue if the user the CDR provides a link to supporting data from all clinical selects different patients on the two EHRs. A coordinated decision support environment has also been difficult to Another effort in this phase is to provide clinician views into implement because the two EHRs use different coding sys the CDR. The IDN plans to build data services, possibly tems and do not share most of their information. This means, based on FHIR resources, that can be called by third-party The second phase of the strategic plan is to build a CDS systems, which can help with rule triage and maintenance example, that admission rules for congestive heart failure patients cannot be linked to the ambulatory medication list and recent vital signs measurements to run the IDN's stan- EHRs to display longitudinal, enterprise-wide patient dat from within the EHRs. Several simple web- and mobile- based viewing applications using the data services will also be developed and will be available in a stand-alone mode or as callable modules within the current EHRs. The IDN will use SMART to provide the user and patient context from the EHR to these viewing apps so that the clinicians will not have to log in twice and find the patient. dard care process models. The IDN realizes that it will not be able to replace either EHR in the near future and that, even if it could, there will still be issues with integrating information from the specialty care systems. It decides on a strategic plan to create a CDR that is The organization receives a $3 million gift from an info matics benefactor. You are an informatician in the organi zation. What would your technical priorities be to remedy the issues in the case study? Discussion Questions 1. Describe the advantages and disadvantages of the situation in the case study 2. You are the chief medical informatics officer for the orga- u are asked to comment about how the tech nical plans will affect clinicians. Based on the case study how do you respon

Answer 1

1. Some of the advantages in the case study situation is that , it reveals that there is a use of integrated technology in IDN .Also as they are maintaining two seperate EHR , the confidentiality of information can be assured. It also tells about the various mobile apps or systems that they are going to implement which will have a high positive impact.

The disadvantages of the scenario in the case study are :

First of all because of the two different EHR it's very difficult to integrate the details about one patient. Also it is making the clinicians job quiet difficult and confusing because they will have to cross verify the details of the patient to understand what treatment he was taking , when the follow up was requested and any allergic reactions to any medicines and all. To implement the integrated records , SMART System and FHIR is not an easy task because the current system is just EHR and to change the protocols and policies it would be highly difficult.

2. The technical plan will actually affect the clinicians in both positive and negative ways. If they can implement the plan , the clinicians will be able to get the detail about the patient without logging in for 2 times and the health care delivery can be made more effective. Also the past informations can be retained and used for the present consultation. But when they implement more technology , they will have to spend more time on technical things and the direct interaction between the clinician and patient reduces.

3. Being an informatician , the $3million will be used for the implementation of the new systems that can rectify the current problems . The EHR system can be integrated with the outpatient and inpatient settings and also the speciality . If it an be made as a common record with various domain , one main hurdle of the clinicians can be solved. So the money can be utilized to do it and also hire a person who can coordinate the various domains under one roof. Also SMART system has to be implemented as soon as possible which will help the clinicians and users to get their details in the fingertips. Buy new software to help the users to make it more user-friendly and effective .