Patient Health Record Card (PHRC) Project:

The Illinois State Initiative

MED INFO 403—Spring 2009

Anjana SantosBashar Attar

Cathy WhaleyDawn L. RexImran Khan

Lemuel Dizon

• What is the PHRC?

• Why in healthcare?

• Who uses the PHRC?

Patient Health Record Card(PHRC)

• Simple

• Cost-effective

• Basic medical profile

• Low tech

• Smart card technology

• Portability

• Access

PHRC—Purpose

• Better efficiency

• Improved accuracy

• Response time

Clinicians work smarter, not harder

Effective medical treatment

Accurate medical diagnosis

Quality Patient Care

PHRC—Purpose

• Emergency/Trauma

• Office Visit

• Hospital Admission

PHRC—How is it used?

• Germany: electronische Gesundheitskarte (eGK)

• France: Sesam Vitale• Taiwan: National Health Insurance

PHRC—Global Model

• Regional Focused– NYC: HealthSmart Network– Omaha, NE: Health Data Card– UPMC: Health Care Passport

PHRC—U.S. Initiative

• Significance • Scope

– Challenges/Obstacles– Implementation– Processing

• Technology• Timelines for Illinois PHRC Implementation• Demonstration

PHRC—Project Outline

• Institute of Medicine (IOM) 6 AIMS– Safety

– Timeliness

– Effectiveness

– Efficiency

– Patient-centered

– Equitability

PHRC—What is theSignificance?

Committee on Quality of Health Care in America, Institute of Medicine Washington, DC, USA: National Academies Press; 2001

• Patient Empowerment• Harmonization of Patient Management• Better Satisfaction of Patients and Healthcare

Providers• The card is the logic way for portable clinical data

repository• Health Card will lead to Cost Savings• Ability to maintain confidentiality, HIPAA

Compliance• Life Saver? The card is the future passport to

healthcare

PHRC—Significance

• Health problem list

• Emergency data

• Prior hospitalizations

• Allergy information

• Vaccination

• Pregnancy records

• Laboratory data

• Electronic prescription

• Insurance information

• Current and prior treatments

• Organ donor status

• Power of Attorney for Healthcare

• Emergency contact information

PHRC—What information isstored on the card?

• State Based Implementation of PHRC– Rapid identification of patients; improved

treatment– Convenient way to carry data between

systems or to sites without systems– Reduction of records maintenance costs

PHRC—Scope

• Convenient to patients– Size– Current medical data housed on card

• Access authenticated by provider PIN• Encrypting technology employed to preserve

data integrity• Technology employed for security

– PIN (provider, patient & other pre-designated people)– Lockdown after unsuccessful PIN entry– Audit trails to identify who accessed by tracking PIN,

date/time and location of accesshttp://www.bmj.com/cgi/content/full/314/7080/573

PHRC—Benefits

• Failure rate of the chips in the cards– House each card in a “card enclosure” for

protection.

• Deficiency of standards surrounding the performance & security of smart cards– The Berlin Group, project: ERIDANE

• Develop “functional & security framework for smart card based Point of Interaction equipment”

http://en.wikipedia.org/wiki/Smart_card#Health_care_.28Medical.29 (accessed 4/25/09) http://en.wikipedia.org/wiki/Card_enclosure (accessed 4/25/09)

PHRC—Challenges and Resolutions

• The architecture of electronic clinical data applications required for the smart card depends largely on where they are deployed.

• Generally they can be divided into two groups:– Ambulatory systems – Hospital-based enterprise systems

PHRC—Processing ClinicalData

e-Health: Combining Health Telematics, Telemedicine, Biomedical Engineering and Bioinformatics to the edge.Editors: B. Blobel et al. IOS Press, 2008Implementing an Electronic Health Record System. Editors: J.M.Walker et.al. Springer, 2005

• Electronic data systems intended for use in outpatient settings are usually composed of two major components: – The underlying database: is based on the relational model and

consists of tables organized around common medical records concepts.

– The user interface.

• Typical table groups would be laboratory, diagnosis, medications, demographics, referrals, etc.

• Outpatient electronic data should be stand-alone systems and have relatively simple external interfaces (EKG, clinical laboratory downloads, practice management system). This permits the design of the database component to remain uncomplicated.

PHRC—Processing Outpatient Data

Health Information Management. Principles and Organization for Health Information Services. Editor: M.A.Skurka. Jossey-Bass, 2003

• Inpatient clinical data are more complex in design and have at their core clinical data repositories (CDR).

• These electronic data systems consolidate data from a variety of clinical sources to present a unified view of a single patient.

• It is optimized to allow clinicians to retrieve data for a single patient rather than to identify a population of patients with common characteristics or to facilitate the management of a specific clinical department.

PHRC—Processing Inpatient Data

Electronic Health Records. Editor J.H. Carter. ACP Press, 2008Health Information Management. Principles and Organization for Health Information Services. Editor: M.A.Skurka. Jossey-Bass, 2003

• Typical data types that are often found within core clinical data repositories (CDR) include: – clinical laboratory test results– patient demographics– pharmacy information– radiology reports and images– pathology reports– hospital admissions/discharges/transfers – ICD-9 codes, discharge summaries– For the smart card purposes, progress notes,

radiology images will be excluded.

PHRC—ProcessingInpatient Data

e-Health: Combining Health Telematics, Telemedicine, Biomedical Engineering and Bioinformatics to the edge. Editors: B. Blobel et al. IOS Press, 2008Implementing an Electronic Health Record System. Editors: J.M.Walker et.al. Springer, 2005

• Dictation and transcription of clinical notes– Uploading these documents require indexing by the transcriptionist

based on a unique patient identifier, the date of dictation, and type of report.

• Scanning – Should be reserved as an adjunct for entry of clinical data that is

deemed of value to the longitudinal patient record (e.g., discharge summary, results of tests or procedures, operation reports).

• Indexing of documents – Requires hiring competent staff who will be

responsible for indexing, proofreading and editing the OCR’d documents to avoid content errors.

PHRC—How clinical data iscaptured?

Electronic Health Records. Editor J.H. Carter. ACP Press, 2008

• There is growing number of modalities to support data entry.

• Interfaces with systems such as laboratories, pharmacy, diagnostic imaging, and point –of-care equipment can result more efficient, less manual data entry.

• The most common message standards are HL7, ASTM, and DICOM. Electronic forms can be customized to display and capture required data such as problem list documentation.

• Smart cards may not only be used to describe important clinical conditions but also can be proactive in nature, initiating clinical alerts and health maintenance reminders.

PHRC—Data Entry

Health Information Management. Principles and Organization for Health Information Services. Editor: M.A.Skurka. Jossey-Bass, 2003

• Digital World– CCHIT Certified EMR having CCR/CCD

functionality – Central Server – Health Smart Card Reader with USB cable– Barcode Scanner?

• Analog World– Optical Character Recognition

Technology (OCR) for scanning

paper charts

PHRC—TechnologyEmployed

 

PHRC

• Existing standard that packages summary documents that may include:– Allergies, Medications, Problems List, Immunizations– Procedures, Results, Health Care Providers, Plans – Demographics, Insurance information etc

PHRC—Continuity of CareRecord/Document (CCR/CCD)

Patient Sensitive Information:

• Addiction Medicine

• HIV Testing

• Psychological Treatment

PHRC—Break Glass

• Doctor’s Office• Hospitals

• EMS (Ambulances)• Home Health

PHRC—Syncing and EditingHealth Records

•Scan paper forms, and digitally parse data

–Process called “Optical Character Recognition” (OCR)

–Store data as text, with image data archived

•Analog workflow with digital data capability

Paper World—Using OCRTechnology

Form IDIdentifies form:Discharge Summary from CCR / CCD

Form NumberUniquely identifies the document, incl. page, i.e. “Page 2 of

Discharge form for MRN # 983345443.”

Sample Form Excerpt—Form Identification

 

Sample Form Excerpt—Document Scanned

Sample Form Excerpt—Fields and Data Identified

PHRC—Illinois Initiative

1. Go to Secretary of State’s office, bring with:– Driver’s License, State ID, other photo ID– Proof of residency – two forms– Insurance card, Medicare/Medicaid information

2. Residency will be verified3. Photograph will be taken4. PHRC created5. Card activated6. Demographic and insurance/payor information

downloaded to card7. Secure PIN established8. Resident leaves with card in hand

PHRC—Process for ILResidents Obtaining PHRC

Demonstration of the PHRC in action

Link to Demonstration