Please read the case study about Akron General Medical Center. Then take a look at the Amatayakul text p. 126-127. Figure 6-1 on page 126 is very important. What generation of EHR migration does the Akron example represent? Explain your choice. What about the Akron example made you select that generation? The case study lists some plans for the future. When those plans are implemented, what generation will Akron be at?

From pgs. 126-127

Figure 6.1, Gartner-Group generations of an HER

Collector DocumenterHelperPartnerMentor

Phase 1Phase 2Phase 3Phase 4Phase 5

The collector Generation

In the generation, systems provide a site-specific, encounter-based solution to access clinical data. The industry also has described this functionality as clinical data display or result retrieval. In such environment, there is no work-flow support, no decision support, and no knowledge, and communication basically are unidirectional.

The Documenter Generation

Gartner describes the Documenter generation as the phase in which data capture occurs at the point of care, Simple documentation tools exist with minimal collection of discrete data. Graphic and tabular display capability is included. Computerized physician order entry (CPOE) with drug-drug and drug-allergy alerts is provided in real or near real time. There is minimal access to knowledge sources and simple bidirectional communications. It is interesting to note that this only the second generation because many healthcare organizations are still very much in the early planning stages for even the most rudimentary CPOE system. However, many organizations also have more robust support for each other forms of documentation, such as nursing documentation of encounters in an ambulatory care setting. Actually a major reason for the difficulty in getting CPOE systems adopted is that they lack the robust decision support capability that would return value to the provider using the system.

The Helper Generation

The Helper generation includes more advanced EHR systems that cover episodes and encounters and use decision support to assist clinicians. Gartner qualifies that this system must be able to function in ambulatory and acute settings. The functions of document, data display, work flow decision support, and knowledge management are beginning to be integrated; and communication is more complex, such as with extranet capabilities. Although Gartner indicates that it believes the industry is still in documenter generation, it is possible that many organizations are in the Helper generation, without the CPOE component from the Documenter generation, or are just beginning to implement the CPOE component as described in the Documenter generation.

The Partner Generation

Gartner considers the Partner generation to be an advanced system that provides more complex decision support encompassing evidence-based medicine, with comprehensive links to personal health records (PHRs). This is most likely the type of system needed to fully support a CPOE used directly by physicians. Some organizations with leading-edge EHR implementations have this level of EHR, but often on only limited areas of the organization. Gartner both links the PFR TO THE EHR and places it in its fourth generation.

When the Institute of Medicine (IOM) first conceived of the computer-based patient records (as it was then called), it was envisioned that information also would flow to and from patients. This was never widely recognized, and the concept of the PHR has grown up somewhat disconnected from the EHR. The original IOM patient record study participants would be placed to see the link but would likely hope that it could be earlier in the generations.

The Mentor Generation

The Mentor Generation is the most complex and sophisticated phase. In this phase, the system is fully integrated across the continuum of care and actually guides clinicians through highly advanced knowledge management, decision support, and predictive modeling. A key element of this generation is the notion of data flowing throughout the continuum of care. Many organization that are composed of multiple provider settings, typically called integrated delivery systems. (IDSs) or integrated delivery networks (IDNs), do not even have an enterprise wide master person index, so in some respects the Mentor generation is quite futuristic. However, there also has been significant movement toward sharing information among providers where there is a treatment relationship and with patients via web portals.

CASE STUDY

"Akron General Medical Center (AGMC) is a 511-bed, 26 bassinet, adult, tertiary-care, not-for-profit teaching hospital located in Akron, Ohio. It is a component of the Akron General Health System, which is committed to providing independent locally based health care. AGMC is staffed by more than 1,000 physicians, 3,400 healthcare professionals and support staff and 550 volunteers who serve a population of more than 1.2 million people in a five-county area within Northeast Ohio. It is accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHO). ... As health information demands evolved, it became apparent that the paper medical record could not meet the needs of the users. Health information was needed in a timely, complete, and efficient manner wherever the patient was being treated throughout the organization. AGMC views its document imaging system as an essential building block in the development of a full EHR system. Future goals include the ability to enter and process discrete data for physicians orders, progress notes and so on. ... The document imaging system at AGMC offers many features and functionalities. It offers a suite of integrated, workflow-based applications to automate all chart activities within the medical records department, as well as from a clinician access standpoint. The system includes the ability to electronically review patient information that has been previously scanned. Physicians have the ability to complete their records online. They can also edit records and use an encrypted digital signature. The following health record processes are automated as a result of implementing an EHR system: deficiency analysis, chart completion, release of information, chart access, administrative reports and letters, and workflow customization. ... Scanning workstations are deployed in the medical records department to scan patient record documents that are not interfaced into the system. They are also deployed at all points of registration so that insurance cards, outpatient physician orders, and face sheets can be scanned. Image printers are strategically placed and limited to staff with printing privileges. Such individuals would include release-of-information technicians, nursing coordinators who print nursing assessments for readmitted patients, risk management staff, some care managers and quality improvement nurses and so on."
Source: Heiser, S. and Janus, C. (2004) Studies in EHR Implementation: Document Imaging for Clinician Access. Chicago: American Health Information Management Association