Foundational knowledge LP 5: Advancing EHR knowledge and education in the present day

Educational: EHR Core competencies

The American health information management association and the American medical informatics association developed core competencies for individuals working with electronic health records. The core competencies are intended to be used for educational purposes by educators, trainees and or any healthcare worker creating, accessing, or using EHR. The competencies are divided into four domains, within each domain there are a set of skills/abilities that as user of EHR should be cable of.

1. Health information literacy and skills

1. Differentiate data versus information.
2. Describe the principles of structure, design, and use of health information (such as individual, comparative reports, and trended data).
3. Use health record data collection tools (such as input screens, document templates).
4. Apply standard data definitions, vocabularies, terminologies, and/or relevant healthcare data sets (such as OASIS, HEDIS, UHDDS) as used in the organization’s health information systems.
5. Differentiate between the types and content of patient health records (such as paper-based, electronic health records, and personal health records).
6. Adhere to health record documentation requirements of external agencies and organizations (such as those specified by the Joint Commission, regulatory bodies, professional review organizations, licensure, reimbursement, discipline-specific “good practice”).
7. Adhere to internal organizational health record documentation requirements, policies, and procedures.
8. Ensure that documentation in the health record reflects timeliness, completeness, accuracy, appropriateness, quality, integrity, and authenticity as required.
9. Adhere to information systems policies and procedures as required by national health information initiatives from national, state, local, and organizational levels.
10. Write or update policies and procedures related to health data and information in daily work.
11. Identify incorrect data and take corrective action.
12. Identify methods and types of data collected in health care.
13. Maintain professional standards in all documentation activities Health information skills using the EHR 
14. Create and update documents within the electronic health record (EHR) and the personal health record (PHR).
15. Locate and retrieve information in the electronic health record for various purposes.
16. Perform data entry of narrative information.
17. Locate and retrieve information from a variety of electronic sources.
18. Differentiate between primary and secondary health data sources and databases.
19. Know the architecture and data standards of health information systems.
20. Identify classification and systematic health-related terminologies for coding and information retrieval.
21. Know the policies and procedures related to populating and using the health data content within primary and secondary health data sources and databases.
22. Apply appropriate documentation management principles to ensure data quality and integrity.
23. Use software applications to generate reports.
24. Know and apply appropriate methods to ensure the authenticity of health data entries in electronic information systems.
25. Use electronic tools and applications for scheduling patients

2.  Privacy and confidentiality of health information

1. Explain legal responsibility, limitations, and implications of actions.
2. Apply the fundamentals of privacy and confidentiality policies and procedures.
3. Follow legal aspects and regulations of documentation in requests for information.
4. Identify legal and regulatory requirements related to the use of personal health information.
5. Identify and apply policies and procedures for access and disclosure of personal health information
6. Identify policies and procedures regarding release of any patient-specific data to authorized users.
7. Identify what constitutes authorized use of personal health data.
8. Participate in privacy and confidentiality training programs.
9. Follow security and privacy policies and procedures to the use of networks, including intranet and Internet.
10. Follow confidentiality and security measures to protect electronic health information.
11. Maintain data integrity and validity within an information system.
12. Report any possible breaches of confidentiality in accordance with organizational policies.
13. Describe the possible consequences of inappropriate use of health data in terms of disciplinary action.
14. Describe monetary and prison penalties for breaches.
15. Document profession-specific information in an electronic health record.
16. Know appropriate methods to correct inaccurate information/errors personally entered in an electronic health record.
17. Authenticate information entered in an electronic health record.
18. Access reference material available through an electronic health record.
19. Identify the source of information entered in an electronic health record.
20. Identify, evaluate, select, and appropriately use computer systems for patient information documentation.
21. Teach others health record concepts, laws, documentation requirements and organizational policies and procedures as it applies to your work.

3. Health information/data technical security

1. Implement administrative, physical, and technical safeguards.
2. Develop security policies and procedures.
3. Resolve minor technology problems associated with using an electronic health record.
4. Follow access protocols for entry to an electronic health record.
5. Enforce access and security measures to protect electronic health information.
6. Recommend elements that must be included in the design of audit trials and data quality monitoring programs.
7. Implement policies, procedures, and training for health data security.
8. Apply departmental and organizational data and information system security policies.

4.  Basic computer literacy skills

1. Apply basic computer concepts and terminology in order to use computers and peripheral devices, computer communications systems, general purpose and organization-specific system applications, and patient care/health-related software applications.
2. Demonstrate use of the essential aspects of file organization, information storage (such as disk or flash drive), protection from data loss, and basic computer skills.
3. Use basic word processing, spreadsheet, database, and desktop presentation applications as applicable to your work.
4. Identify, evaluate, and use Web-based literature resources, CD-ROMs, and Internet resources.
5. Conduct basic file organization and management for routine storage and protection from data loss.
6. Use statistical analysis packages.
7. Use portable computing devices to facilitate data input and management.
8. Demonstrate basic computer operating procedures such as login the computer and logoff, opening, closure and saving files.
9. Demonstrate proficiency in the Windows operating environment.
10. Resolve minor technical problems associated with use of computers.
11. Demonstrate Internet/intranet communication skills.
12. Access and use a Web browsing application.
13. Demonstrate use of email, addressing, forwarding, attachments, and netiquette.
14. Identify and use icons, windows, and menus.
15. Create and name or rename subdirectories and folders.
16. Open and work with more than one application at a time.
17. Demonstrate how to save work to a computer file, and printing and copy a file.
18. Create and edit a formatted document using tables and graphs.

Educational: AGME Core Competencies:

The ACGME’s core competences are a set of guidelines used in medical schools to assess the educational progression of residents during clinical training (Habboush et al., 2018). When teaching EHR, educators can cross reference these six core competencies with the activities a trainee performs in the EHR to evaluate the trainees EHR learning progress. This can also help with  identifying gaps in knowledge, problem solving and skills which can be targeted and remediated (Habboush et al., 2018). Below is a list of the six core competencies as well as examples of activities an individual can do in EHR, as it relates to the core competencies Habboush et al., 2018).

1. Patient Care

2.  Medical Knowledge

3. Practice-Based learning and improvement

4.  Interpersonal and communication skills

5.  Professionalism

6.   System-based practices

Educational: Frameworks, related concepts and tools

Habboush et al., 2018 developed a conceptual CCM framework for using EHR as an educational tool in residency programs. The purpose of this framework is to a provide a “visual guide for accessing resident progression during training from an EHR perspective” The CCM framework combines different educational concepts and tools to enhance the learning experience of medical students. For instance, the framework incorporates the ACGME’s core competences and the Reporter-Interpreter-Manager-Educator (RIME) framework. RIME is an assessment framework used to evaluate a medical student’s progression through four stages: reporter, interpreter, manager, and educator. “The EHR can provide educators with a feedback tool to monitor a trainees progression.” As a trainee progresses though stages of RIME, the way in which they use and document in the EHR will also progress. For example, at the reporter stage, a trainee will use the EHR to gather and document clinical facts. At an an educator level, the “trainee” would be able to document and seek answer to medical questions based on evidence-based medicine (as an EBM tool is available in the EHR.) “This framework places a high importance on quality notes as a foundational means to assess trainees’ activities in the EHR and correlate these activates to their level of training (Habboush et al., 2018, p.1).”  Essentially, the educator can track the progression of a trainee within the RIME framework by observing how the trainee is documenting notes in the EHR.  The QNOTE tool is also incorporated in this conceptual framework. “QNOTE uses a spreadsheet form to assess medical documentation notes for quality, completeness and efficiency. QNOTE can generate a quantitative score for clinical notes and assists with identifying the gaps in documentation skills (Habboush et al., 2018, p.3).” 

The conceptual CCM framework follows a 36-month timeline. The timeline outlines the educational milestones that a resident should be accomplishing every 3 months. The framework also highlights what competencies the trainees will be working on and what tools will be available to them. Additionally, the tasks and skills are outline with the RIME and indicates what level the trainee should be at any given point in the timeline. Further, the framework highlights the tools that the educator will need to track the trainee’s progression.

Educational: Terminology

Clinical Decision Support (CDS): a set of patient-centered tools embedded within EHR software that can be used to improve patient safety, ensure that care conforms to published protocol for specific conditions and reduce duplicate of unnecessary care and its associated cost.

Computerized provider order entry (CPOE): An EHR function that allows fa physician or other prescribers to order medications and test using an automated format; CPOE can reduce prescribing errors, delays and duplication and simplify inventory and billing processes

Practice management software (PMS): software used in a medical office to accomplish administrative task, including entry of patient demographics, record-keeping for insurance and other billing transactions, appointment scheduling and advance accounting functions

Patient information form (PIF): A form used to gather data about the patient, including basic demographic information, medical insurance data and emergency contact

Documentation: process of recording data about a patient’s health history and status, including clinical observations and progress notes, diagnoses of illnesses and injuries, plans of care, patient education and self-care instructions given, vital signs taken, physical assessment findings, lab and imaging test results, medical treatments prescribed or administered, surgeries preformed, and outcomes

Documenter: A person who contributes to a medical record is called a documenter

Structured data entry: documentation using controlled vocabulary via preloaded data drop-down options, radio buttons and sentence builders

Interoperability: ability of sperate EHR systems to share information in a compatible format

Single source: all systems within the EHR were purchased from the same vendor

Unified database: systems that share a single underlying database

Interface: software programs that move data between systems.