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Letter Report
Pages 1-19

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From page 1...
... Critical building blocks of an EHR system are the electronic health records (EHR) maintained by providers (e.g., hospitals, nursing homes, ambulatory settings)
From page 2...
... A handful of co~n~nunities and systems have established secure platforms for the exchange of (1ata among providers; suppliers; patients; and other authorized users, such as the Veterans Health Act~ninistration, the New England Healthcare Electronic Data Interchange Network, the Indiana Network for Patient Care, the Santa Barbara County Care Data Exchange, the Patient Safety Institute's National Benefit Trust Network, arid the Markle Foundation's Healthcare Collaborative Network (CareScience, 2003; Koloclner and Douglas, 1997; Markle Foundation, 2003b; New Englancl Healthcare EDI Network, 2002; Overhage, 2003; Patient Safety Institute, 2002~. But these examples are the exception, not the
From page 3...
... In addition, a number of employers, health plans, and physicians have recently formed a coalition called Bridges to Excellence, which will provicle financial bonuses to providers to encourage improved patient care management systems, including EHR systems (Briciges to Excellence, 2003~. Another option is to provide grant funding or access to "low-cost" capital to enable providers, especially those with a safety net role, to invest in acquiring EHR systems (Health Technology Center and Manatt, Phelps and Phillips, LLP, 20034.
From page 4...
... PROJECT OVERVIEW In response to the request from DHHS in May 2003, the charge to the IOM Committee on Data Standards for Patient Safety was expander! as follows: Provide guidance to DHHS on a set of"basic functionalities" that an electronic health record system should possess to promote patient safety.
From page 5...
... Box 1. Primary and Secondary Uses of an Electronic Health Record System Primarv Uses , Patient Care Delivery Patient Care Management · Patient Care Support Processes Financial and Other Administrative Processes Patient Self-Management SOURCE: Adapted from Institute of Medicine (1997)
From page 6...
... More than half of those with chronic conditions have three or snore different providers and report that they often receive conflicting information frown those providers; moreover, many undergo duplicate tests and procedures, but still do not receive reco~n~nendeci care (Leatherman and McCarthy, 2002; Partnership for Solutions, 20023. Physicians also report clifficulty in coordinating care for their patients with chronic conditions, and believe that this lack of coordination produces poor outcomes (Partnership for Solutions, 2002~.
From page 7...
... ~ : :: : :: :: :: Box 2. Core Functionalities for:~an-~Electronic Health Record System · Health: information and~:data:~: ~ I: ·~ Patient support .
From page 8...
... Finally, access to electronic consults and patient consents can establish critical linkages and improve care coordination among multiple providers, as well as between provider and patient (Bates et al., 2003~. Order Entry/Order Management The benefits of computerized provider order entry (CPOE)
From page 9...
... Other studies on the use of decision support tools have not found i~nprove~nents, however (Eccles et al., 2002; RolIman et al., 2002~. More sophisticated tools, such as artificial neural networks, have also demonstrated their effectiveness in detecting acute myocardial infarction, breast cancer, and cervical cancer (Bates and Gawande, 2003; Heden et al., 1997; Kok ant!
From page 10...
... and artificial neural networks that can assist in identifying candidates for chronic disease nanagement programs (Heden et al., 1997; Kok and Boon, 1996; Petrick et al., 20021. Reporting and Population Health Management Institutions currently have multiple public and private sector reporting requirements at the federal, state, and local levels for patient safety and quality, as well as for public health.
From page 11...
... the capture of essential patient data already found frequently in electronic for~n, such as laboratory and radiology results; (2) the acquisition of limited decision support capabilities for which software is readily available in the marketplace (e.g., order entry, electronic prescribing)
From page 12...
... . In identifying core functionalities for specific provider settings, the IOM Co~n~nittee also considered the current level of information technology capabilities within a sector.
From page 13...
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From page 14...
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From page 15...
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From page 16...
... 16 s . ~ s a Electronic Health Record Functional Model.
From page 17...
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From page 18...
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From page 19...
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