About EHR

Andrew & Associates Explains EHR Terminology & Background Data As Used On This Site:  

In order to conform to the current activity of various standards development organizations…including HL7…as they develop industry-wide "EHR" standards, we will, hereinafter, use the acronym "EHR" instead of "CPR" or "EMR".(Electronic Medical Record).  While there is still much confusion in the marketplace…by both providers and vendors.  We will use "EHR" within the context of the Institute of Medicine's (IOM) Committee on Improving the Patient Record final study report issued in 1991.  This report, The Computer-based Patient Record: An  Essential Technology for Health Care…revised with minor additions to the original study report in 1997…provides the basis for many of the attributes and criteria presented in this 11th Annual EHR Systems Review: 2005.  Much of this survey is based on the original work of Richard S. Dick, PhD, former study director for the IOM/CPR study, and William F. Andrew, PE Retired, as provided in the initial survey…eleven years ago.

The IOM/CPR "committee defined the CPR as an electronic patient record (i.e., a repository of health care information about a single patient) that resides in a system specifically designed to support users through availability of complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids."

The committee further identified twelve (12) specific attributes that comprehensive, robust CPRs and CPR systems must possess.  All of the twenty-six (26) attributes, including sub-attributes, presented in this survey document have been extrapolated from the IOM/CPR study report. Andrew & Associates has simply adapted those same criteria to the new concept of the EHR. We have presented these survey criteria…as well as supplemental criteria…to the HIT marketplace as the genesis for development of EHR standards with acclaimed acceptance from both the vendor and provider communities.  After eleven consecutive years, most vendors in the EHR system marketplace are familiar with the survey and its value to healthcare providers…physician groups and healthcare facilities. The reader can reference past issues of ADVANCE for Health Information Executives or the IOM/CPR final study report for more information. To the best of our knowledge, no similar in-depth analysis is being provided by any other HIT magazine or other media source.  The criteria presented have been accepted as de facto standards by many of the leading EHR vendors as evidenced by their participation in this annual survey in the previous ten years.

The Institute of Medicine (IOM) Computer-based Patient Record (CPR) "committee defined the CPR as an electronic patient record (i.e., a repository of health care information about a single patient) that resides in a system specifically designed to support users through availability of complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids."  The committee further identified twelve (12) specific attributes that comprehensive, robust CPRs (EHRs) and CPR (EHR) systems must possess.  All of the twenty-six (26) attributes presented in this survey document have been extrapolated from the IOM/CPR final study report The Computer-based Patient Record: An Essential Technology for Health Care. 

This report, first issued in 1991, and revised with minor additions in 1997, was the result of significant effort by the IOM's Committee on Improving the Patient Record.  The recommendations of this report are as valid today as they were when first reported in 1991. 

Regarding HIPAA and EHR Development

With HIPAA impacting all aspects of the Healthcare Information Technology (HIT) marketplace, it is important that EHR systems conform to the mandated HIPAA requirements and regulations. This is especially important when addressing the privacy and security aspects of patient health/medical information during the patient/physician encounter and subsequent encounter-related activities. Support for the criteria in this section has been provided by George Schroeder, J.D., Privault, Inc.

Regarding Workflow Management & Management Systems

The term “workflow” is apparently being used inconsistently in the Healthcare Information Technology (HIT) marketplace…more specifically, in the Electronic Health Record (EHR) system segment.  Last seen in the business process reengineering (BPR) activity of the mid-1990s, it now appears in the promotional materials of various HIT products…from EHRs to ASP (application service provider) vendors, clinical messaging, and document imaging systems.  From our perspective, there is much confusion in the marketplace…both EHR vendors and healthcare providers tend to use the word “workflow” interchangeably with other terms.  As a buzzword, workflow seems to be in a revival of sorts…albeit, as if the buzzword “workflow” is the answer to all of healthcare’s problems.

Specifically, “workflow”, “workflow system”, “workflow management”, and “workflow management system”…as well as other related terms…are used to describe various vendor EHR systems.  All of these terms have different meanings as defined by the Workflow Management Coalition (WfMC)…an international organization of users, suppliers, and developers of workflow-related products.  The most important objective of the WfMC is to develop workflow-related standards.  Information can be obtained at www.wfmc.org or www.aiim.org/wfmc/ to learn more about the WfMC.

Workflow Management: Models, Methods, and Systems, Wil van der Aalst and Kees Max van Hee, The MIT Press, 2002, is often-referenced when one does a literature search on workflow and related workflow terms.  Originally published in the Netherlands as Workflow Management: Modellen, Methoden en Systemen, in 1997 by Academic Service, this reference provides a comprehensive introduction to workflow management…the management of business processes with information technology.  The terminology in this book conforms to that of the WfMC. 

This section of the survey is extensively based on the work of the Workflow Management Coalition and the book Workflow Management: Models, Methods, and Systems…as well as the expertise and experience of the survey collaborators.  By defining, analyzing, and redesigning an organization’s resources and operations, workflow management systems ensure that the right information reaches the right person or computer application at the right time.  The term “workflow” is used as a synonym for “business process.”  Workflow management is about the management of business processes. 

The questions that follow are intended to determine the extent to which your firm's EHR system addresses the extensive workflow-related criteria as referenced above.  These questions are representative of a more extensive list of criteria that were presented in the 2005 Workflow Management Survey: Ambulatory CPR/EHR/EMR Systems conducted in the Fall of 2004.  Results of this survey were presented in the February 2005 issue of ADVANCE for Health Information Executives and in the July 2005 issue as well.  If your firm did not complete this landmark survey and would like to receive a copy of the 2006 version, please email William F. Andrew, Andrew & Associates, at wfandrew@verizon.net or call him at 863/294-5513.