Neehr Perfect Activity: Evaluation of an EHR

Neehr Perfect Activity: Evaluation of an EHR

Overview

This activity is intended for Intermediate EHR student users. Students will work in groups of 2 to 4 to complete a thorough evaluation of the EHR. Students will use their own portfolios for this activity.

Prerequisites

1. Completion of Scavenger Hunts I, II, and III.

Objectives

1. Demonstrate the technical skills necessary to access an EHR system.

2. Demonstrate knowledge of EHR functionality.

3. Demonstrate analysis of EHR capabilities.

Activity

Dr. Carter is head of a family outpatient clinic. He has switched to using an EHR, and you are tasked with evaluating the EHR. In this activity, you will assess the system’s functionality and usability, decision support, reporting capabilities and health record manageability. You will analyze your findings and make suggestions for improvement in a written report.

Evaluating functionality/usability

Analyze charting

1. Log into the EHR and select your portfolio. Go to the Notes section of the EHR and select New Note. Test different notes in the EHR.

a. In the search box, type in “Vitals” and select the note NURS: VITALS ASSESSMENT. Select your instructor as the cosigner. Complete the note based on the following information. Sign the note when completed.

Temp: 96.4 F

HR: 88

BP: 140/60

RR: 18, spontaneous breathing

Pain: 5/10, dull, aching,

Wt: 170

Ht: 66 inches

O2 Sat: 98% on room air

Intake: 600ml since admit, this shift

Output: 420ml since admit, this shift

b. In the search box, type “Untemplated” and select the note NURS: PROGRESS NOTE UNTEMPLATED. Select your instructor as the cosigner. Type a simple statement of your choice in the note. Right click in the note and choose Save without Signature. Now edit the note using the Action tab on the tool bar or right clicking in the middle of the note and choosing Edit Progress Note. Type another statement of your choice. Click Save without Signature. Go to File > Refresh. What happens?

c. In the search box, type “EST” and select MED: EST PT H&P. Select your instructor as the cosigner. Click the white buttons to examine the template, filling out some of the fields and checking some of the check boxes. Sign the note when you are finished.

d. In the search box type “CODE” and select CODE STATUS. Click on “FULL CODE” and then save and sign the note. File and Refresh patient chart. Go to the cover sheet. What, if anything, has changed?

e. Click on the first note you completed. Add an addendum by choosing Action > Make Addendum Type in anything you’d like.

f. Click on Options on the tool bar and select Create New Template. Use your name as the title of the template. Create a template using the edit button and inserting template fields. Preview your template. Select Apply when you are finished.

g. Explore other areas of the notes section using New Note and the Actions menu.

Charting analysis questions

1. Does the system offer a variety of notes? Both structured and unstructured? Is it easy to build and/or customize “off-the-shelf” templates? Does the system alert regarding unfinished portions of the clinical documentation and can you bypass it if necessary? Does the system ensure that only authorized clinicians can sign clinical documentation? Does documented information flow to other areas in the chart?

2. Consider improvements or changes to the charting aspects of this EHR.

3. Write a report on your findings.

Analyze prescriptions

1. Go to the Orders tab of the chart and select Inpatient Unit Dose Meds. Note the medications on the medication selection screen. Choose Order any INPT Med. Scroll down and review the number of medications in the formulary.

2. Type in “Tylenol” and select the Acetaminophen tab. Complete the order by selecting dose, route and schedule. Select Accept Order. Note any Order checks. Repeat the above steps and order the following drugs:

i. Fluoxetine cap oral 20mg PO qAM

ii. Ranitidine tab 150mg PO BID

iii. Codeine 1 tab PO daily

Exit the medication order set by selecting Done.

3. Go to File > Refresh Patient Information. Note the alert message. Sign orders by typing in your username. Note any order checks and cancel the order by highlighting and selecting Cancel Order.

4. Go to the Tools section on the toolbar. Select Drug Information Portal. Find and review information on Ranitidine. Return to the chart by locating the icon in your task bar.

Prescription analysis questions

1. Can you complete prescription orders in a few clicks? Can you look up medication information from the EHR? Does the system use an order check system? How extensive and sensitive is the systems interaction checking capability? Can the system refill medications and send prescriptions to local pharmacies? (Remember this is an Educational EHR!!). Consider why you would want to assess this capability in a REAL EHR.

2. Consider what improvements or changes you make to the Prescription aspects of the EHR.

3. Write a report on your findings.

Analyze lab results management

1. Go to the Orders tab of the chart and select IN PT Laboratory.

2. On the Lab menu below, place an order for a CHEM 7 and CBC. Go to File Refresh Patient Information and sign off the lab orders using your username.

3. Repeat the steps above. Note any order checks, if any.

4. Go to File Select New Patient. Type in “Olson, Warren”. On his cover sheet, review the lab section. Left click on one of the labs. What are the results?

5. Go to the Labs section of the chart. Select cumulative and all results to review labs.

6. Use the Graphing function to view lab trends.

Lab management analysis questions

1. Can you complete a lab order with a few clicks? Can you pull up and review lab results with a few clicks? Does the system notify you of abnormal lab results and provide normal lab ranges? Can the system show you trending of results over time?

2. Consider what improvements or changes you would make to the lab aspects of the EHR.

3. Write a report on your findings.

Analyze decision support and reporting

1. Go to the Reports tab in the EHR.

2. Use the CLINICAL REPORT function and expand each section by clicking on the “plus” sign.

3. Open the Lab section and review the last set of lab values.

4. Open the Health Summary section and select Adhoc Report

1. Create an Adhoc report containing

a.) Adverse Reactions/Allegies [ADR];

b.) Lab Chemistry &Hematology;

c.) Vital Signs Detailed Display[VSD];

d.) Progress Note [PN]

5. Go to File > Select New Patient. Note any pending notifications on the patient selection screen. Select your portfolio, by typing in your name.

6. Go to the Problems tab and type in “Diabetes”. Select Diabetes (250.00). Complete the problems form by selecting Chronic and OK.

7. Return to the cover sheet. Note any changes.

8. Click on any clinical Reminders. Right click to view references.

9. Go to Tools on the tool bar and select Health Information. Research diabetes on the web page. Return to the chart by locating the icon in your task bar.

10. Go to the Allergy box and right click to add a new allergy. Type in “Penicillin” and select it from the list. On the allergy form, choose Allergy as the nature of the reaction and select a few symptoms. Select OK.

11. Return to the cover sheet. Note any changes.

Decision support and reporting analysis questions

1. Does the system utilize clinical information from all parts of the chart to provide decision support? Does the system alert you when patient data indicates intervention is recommended? Can you access medical literature, clinical guidelines, etc.? Can reports on patient information be created? Are these ad-hoc reports or is it limited to ones provided?

2. Consider what improvements or changes you make to the decision and reporting aspects of the EHR.

3. Write a report on your findings.

Analyze health record management and clinical tasking

Think about what you have learned about this EHR and consider the following:

Health record management and clinical tasking analysis questions

1. Can you look up a patient by a number of different criteria, e.g., name, MRN, SSN, etc.? Does the system provide a summary view of a patient’s health status? Does the system handle other such clinical documents as x-rays, reports, etc.? Does the system allow you to maintain patient lists, e.g., problems, allergies, medications, etc.? Can you access and manage various tasks, e.g., sign progress notes, review labs, etc. within a few clicks? Does the system alert of overdue tasks and urgent lab results? Can you manage tasks and messages from a computer other than your own?

2. Consider what improvements or changes you make to the EHR.

3. Write a report on your findings.

Analyze financial consideration

1. Research the cost of EHR systems. Consider the following questions.

a. Roughly how much could the system cost your clinic?

b. Roughly how much do the software licenses cost?

c. About how much will on-going maintenance and upgrades cost?

d. How often will a support person(s) be available once the system goes “live” in case of any system difficulty?

2. Consider all of your findings carefully. In a two page paper, compile a detailed report. Include recommendations, with rationales.