Application service provider(ASP)
ASP model involves having a practice‘s clinical data/information stored off site. Data is managed most via World Wide Web (internet)
Locally hosted
Locally hosted model has the data stored within a computer server
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Table 2 : ASP Vs Locally Hosted model
Application service provider(ASP) model Locally hosted model
Advantage:
-System is maintained by IT professionals remotely, reducing the cost of maintenance
Advantage:
- Faster overall operational speed - Practice has control over its data
Project work by K Vijay| Bharathidasan Institute Of Management| Bangalore Campus Page 41 -Online backup service
- Accessible anywhere in the world from any computer with an internet connection
- Low initial cost of ownership
- No dependency on internet connection - Better integration with imaging
devices (scanners, printers) and on-site resources
Disadvantage:
- Higher upfront cost of ownership as a server and software must be purchased upfront
- Manual product updates are usually required (not in all cases) - Online backup must be purchased as add-on 3rd party software
- Remote access to EMR is limited in functionality and is more complex
1.11 Components of EHR
Once an organization has determined that an EHR system is worth implementing, it must decide which components to implement. There are multiple components to the EHR system including:
Clinical Data Repository (CDR)
Clinical Decision Support System (CDSS)
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Clinical Documentation Module
Computerized Point of Entry (CPOE) module
Controlled Medical Vocabulary (CMV)
Clinical Data Repository(CDR)
The CDR functions as the single, comprehensive storage facility for all clinical information generated by Hospitals. It receives data from a variety of ancillary IT systems, as well as direct data entry by caregivers of information such as clinical documentation and medication administration. CDRs are quite mature in current EHR products. They can handle a variety of data types and can retrieve information rapidly for a given patient. In recent years, the breadth and depth of information in the CDR has expanded to include virtually any type of clinical information. Because the CDR represents a comprehensive and authoritative source of clinical information, it forms a critical starting point for automation support of the clinical care process
Clinical Decision Support System (CDSS)
A critical component of the EHR system is the CDSS, or technology that aids the clinician with the decision-making process. Specifically, a CDSS provides context-sensitive advice for clinical-care situations by permitting the CDO to specify and revise the rules that define a significant event. The CDSS obtains the information it needs from the CDR; a CDR is thus a prerequisite for a CDSS. The CDSS monitors information within a CDO and produces an alert when noteworthy events occur. CDSS activities include:
Detection of possible adverse-drug interactions Notification of severely abnormal laboratory values
Reminders of alternate therapies (such as switching from an intravenous to an oral medication) Notice of overdue events
Assistance in differential diagnosis Detection of potentially dangerous trends
Project work by K Vijay| Bharathidasan Institute Of Management| Bangalore Campus Page 43 Suggestion of generic alternatives to brand-name drugs
The benefits of a CDSS are twofold:
Reduction in medical errors and improvement in quality
Potentially dangerous situations are detected quickly and brought to the attention of the caregiver, thus avoiding undesirable patient outcomes.
Potential reduction in long term costs
As quality improves, complications that could result in greater costs down the road are avoided.
Also the risk of malpractice suits is reduced.
Clinical Documentation Module
The Clinical Documentation Module involves the recording of various steps in the process of caring for patients. These steps might include: obtaining patients histories, performing physical examinations, ordering tests and evaluating their results, establishing diagnoses, instituting therapies, and monitoring the course of treatment. An EHR system must be capable of recording every type of significant event that a patient had with his or her caregiver. Ideally it should permit caregivers to document data according to her or his preference (for example, speech recognition, partial or full discrete data, charting by exclusion, or patient-entered data) and should enable the creation of various types of clinician notes (such as history and physical information, procedure reports, nursing notes, admission/progress notes). There also must be a way to import data from clinical systems within the organization including pathology, radiology, laboratory, intensive care unit (ICU) monitoring systems or patient/physician Web messaging systems. The ultimate objective is to integrate clinical information from outside the care delivery organization, because it is unlikely that all of a patient‘s clinical encounters will take place within a given CDO. In this sense, clinical data is instrumental in nearly all healthcare processes
Project work by K Vijay| Bharathidasan Institute Of Management| Bangalore Campus Page 44 such as clinical decision support, billing/billing compliance, and health maintenance and outcomes analysis.
Computerized Point of Entry Module (CPOE)
The CPOE module handles the process of entering an order by a physician or caretaker. This order-management component of an EHR captures new orders, verifies them using a rules engine, communicates them to appropriate recipients and monitors order fulfillment. Often times, the CPOE works hand-in-hand with the CDSS. For example, if a caregiver prescribes a medication that conflicts with another that the patient is taking; the CDSS sends an alert through the CPOE system
Controlled Medical Vocabulary
A controlled medical vocabulary (CMV) supports medically relevant concepts, terms, codes and relationships. The role of a CMV is to provide a linguistic and semantic infrastructure representing a consistent framework to support the exchange of information between humans, between automation systems and across the human/machine interface. In this manner, a CMV is instrumental in enabling humans and automation systems to more-effectively use medical text to support the processes of healthcare. CMV services are delivered using a vocabulary server, which then exposes a set of CMV functions as a series of application programming interfaces (APIs). This approach makes the CMV accessible to any software component in the EHR or its environment that requires such services.
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