Which of the following terms is best described by a system that allows physicians to order prescriptions and diagnostics in a computer system?

Electronic health information exchange (HIE) allows doctors, nurses, pharmacists, other health care providers and patients to appropriately access and securely share a patient’s vital medical information electronically—improving the speed, quality, safety and cost of patient care.

Despite the widespread availability of secure electronic data transfer, most Americans’ medical information is stored on paper—in filing cabinets at various medical offices, or in boxes and folders in patients’ homes. When that medical information is shared between providers, it happens by mail, fax or—most likely—by patients themselves, who frequently carry their records from appointment to appointment. While electronic health information exchange cannot replace provider-patient communication, it can greatly improve the completeness of patient’s records, (which can have a big effect on care), as past history, current medications and other information is jointly reviewed during visits.

Appropriate, timely sharing of vital patient information can better inform decision making at the point of care and allow providers to

Avoid readmissions
Avoid medication errors
Improve diagnoses
Decrease duplicate testing

If a practice has successfully incorporated faxing patient information into their business process flow, they might question why they should transition to electronic health information exchange. Many benefits exist with information exchange regardless of the means of which is it transferred. However, the value of electronically exchanging is the standardization of data. Once standardized, the data transferred can seamlessly integrate into the recipients' Electronic Health Record (EHR), further improving patient care. For example:

If laboratory results are received electronically and incorporated into a provider’s EHR , a list of patients with diabetes can be generated. The provider can then determine which of these patients have uncontrolled blood sugar and schedule necessary follow-up appointments.1

There are currently three key forms of health information exchange:

Directed Exchange – ability to send and receive secure information electronically between care providers to support coordinated care
Query-based Exchange – ability for providers to find and/or request information on a patient from other providers, often used for unplanned care
Consumer Mediated Exchange – ability for patients to aggregate and control the use of their health information among providers

The foundation of standards, policies and technology required to initiate all three forms of health information exchange are complete, tested, and available today. The subsequent sections provide detailed information and example scenarios for each of the three forms.

Learn more about ONC standards, policies and technology.

DIRECTED EXCHANGE

Directed exchange is used by providers to easily and securely send patient information—such as laboratory orders and results, patient referrals, or discharge summaries—directly to another health care professional. This information is sent over the internet in an encrypted, secure, and reliable way amongst health care professionals who already know and trust each other, and is commonly compared to sending a secured email. This form of information exchange enables coordinated care, benefitting both providers and patients. For example:

A primary care provider can directly send electronic care summaries that include medications, problems, and lab results to a specialist when referring their patients. This information helps to inform the visit and prevents the duplication of tests, redundant collection of information from the patient, wasted visits, and medication errors.

Directed exchange is also being used for sending immunization data to public health organizations or to report quality measures to The Centers for Medicare & Medicaid Services (CMS).

Got questions about Direct and how to use it? Read the Direct Basics: Q&A for Providers [PDF - 312 KB].

Learn more about the technology supporting directed exchange.

QUERY-BASED EXCHANGE

Query-based exchange is used by providers to search and discover accessible clinical sources on a patient. This type of exchange is often used when delivering unplanned care. For example:

Emergency room physicians who can utilize query-based exchange to access patient information—such as medications, recent radiology images, and problem lists—might adjust treatment plans to avoid adverse medication reactions or duplicative testing.
If a pregnant patient goes to the hospital, query-based exchange can assist a provider in obtaining her pregnancy care record, allowing them to make safer decisions about the care of the patient and her unborn baby.

Learn more about the technology supporting query-based exchange.Web Site Disclaimers

Consumer-mediated exchange provides patients with access to their health information, allowing them to manage their health care online in a similar fashion to how they might manage their finances through online banking. When in control of their own health information, patients can actively participate in their care coordination by:

Providing other providers with their health information
Identifying and correcting wrong or missing health information
Identifying and correcting incorrect billing information
Tracking and monitoring their own health1

Learn more about the benefits of consumer-mediated exchange.

YouTube embedded video: http://www.youtube-nocookie.com/embed/UMiPW831b1o

Claudia Williams, Farzad Mostashari, Kory Mertz, Emily Hogin and Parmeeth Atwal. From The Office Of The National Coordinator: The Strategy For Advancing The Exchange Of Health Information. Health Affairs, 31, no.3 (2012):527-536.

Computerized provider order entry (CPOE) refers to the process of providers entering and sending treatment instructions – including medication, laboratory, and radiology orders – via a computer application rather than paper, fax, or telephone.

Why It Matters

CPOE has several benefits. CPOE can help your organization:

Reduce errors and improve patient safety: At a minimum, CPOE can help your organization reduce errors by ensuring providers produce standardized, legible, and complete orders. In addition, CPOE technology often includes built-in clinical decision support tools that can automatically check for drug interactions, medication allergies, and other potential problems.
Improve efficiency: By enabling providers to submit orders electronically, CPOE can help your organization get medication, laboratory, and radiology orders to pharmacies, laboratories, and radiology facilities faster, saving time and improving efficiency.
Improve reimbursements: Some orders require pre-approvals from insurance plans. CPOE, when integrated with an electronic practice management system, can flag orders that require pre-approval, helping you reduce denied insurance claims.

In short, CPOE is safer and more efficient for providers and patients.

Achieving Meaningful Use

CPOE is a core meaningful use objective for Stage 1 and Stage 2 meaningful use. Learn more:

For More Information

For more information about CPOE, see the following resources.

The Institute of Medicine has identified eight core functions of Electronic Health Records (EHRs). These core EHR functions include the following: Here is what you need to know about these eight core functions of EHRs. EHRs replace paper medical records with electronic clinical and demographic information on patients. With an EHR, you get rapid access to patient data like medical history, diagnoses, allergies, medications, and test results. Because EHRs can hold more data than paper records, medical histories can be more complete, improving care. But EHR usability must be of utmost concern with a well-designed user interface to avoid distracting clinicians with extraneous information. Customize your EHR to meet your practice’s business and workflow needs. Filing lab results in the appropriate paper medical record can be time-consuming, cause errors, or lead to misplaced results. A core function of EHRs is to simplify results management, making testing more efficient, and improving patient care. EHRs, like NextGen Healthcare Information Systems, give you faster access to lab results, allowing your practice to recognize and address abnormal results faster. An EHR will also reduce redundant testing by automatically displaying previous lab results. An EHR also lets you share test results with patients and other providers and import them into your EHR. This automated results sharing improves patient engagement and care coordination. Computerized physician order entry (CPOE) is another core function of EHRs. Within an EHR system, you can order lab tests, prescription drugs, radiology, and even consults. Studies have shown that computerized provider order entry can improve workflow and reduce errors. For example, electronic orders can end lost orders and confusion from illegible handwriting. An EHR can also flag suspected duplicate orders, and it can generate related orders automatically. This reduces the time to fill orders, thereby increasing patient satisfaction and care quality. Electronic orders can also save money by eliminating the costs of producing and filing paper forms for orders and results. Filing electronic prescription drug orders through your EHR can also improve your practice. EHRs with e-prescribing reduce medication errors. Your EHR will flag medication doses or frequencies outside of the recommended range. An EHR will also check the proposed medication against the patient’s record. This automated check flags potential allergies or interactions with existing medications. You EHR can even check prescriptions against insurance formularies to ensure coverage. And, an EHR can store pharmacy information, helping you easily get prescriptions to each patient’s preferred pharmacy. EHRs provide two major types of decision support: Reminders and alerts and computer-assisted diagnosis and treatment. Reminders and alerts include the following:

Flags for potentially inappropriate medication doses or frequencies
Alerts about potential drug interactions
Reminders to clinicians to provide appropriate preventive care screenings

These clinical quality measure tools can reduce errors and improve prevention in your practice. For example, your EHR will remind clinicians to provide vaccines, cancer screenings, and cardiovascular screenings at the appropriate intervals. Computer-assisted diagnosis, treatment, and disease management tools are more sophisticated. Diagnostic tools can help guide clinicians through the diagnosis of complex conditions. Using these tools, your practice can reduce the time it takes for a patient to receive a diagnosis and reduce the frequency of misdiagnosis. Decision support tools can also help busy clinicians provide guidelines-based care. For example, your EHR can find and display clinical guidelines based on diagnosis entry. Also, EHR decision support tools can flag treatment plans and orders that may not adhere to the latest clinical guidelines. By adhering to guidelines, your practice can improve care quality and reduce claims denials. Clinical decision support can help your practice improve care quality, reduce errors, and get to diagnosis and treatment faster. These tools can increase your quality scores, patient satisfaction, and practice efficiency. EHRs promise faster, easier access to patient medical records and sharable data. EHRs allow you to share data with other providers, improving care coordination. You can also share data with patients to increase their engagement in their care. EHRs can facilitate patient education and encourage self-management. EHRs also have built-in electronic messaging, patient portal, and email connectivity. This allows for quick communication both among providers and between providers and patients. Providers can easily share lab results, request referrals, direct messaging, and email questions. This rapid communication among providers improves care coordination and reduces duplicative testing. EHRs also enhance patient-provider communication, making patients more engaged in their care. Through an EHR Patient Portal, your patients can message their provider, see lab results, and schedule appointments. Patient education and support are essential for managing chronic conditions. Your EHR can help you provide appropriate and timely patient education. EHRs can host a library of educational materials for easy access. They can also generate follow-up instructions and treatment plans, so patients know their next steps. EHR Patient Portals can also help patients access electronic education materials and treatment plans. Finally, EHR systems can also integrate with telehealth and telemonitoring programs. These programs can help your practice track patient progress between office visits. An EHR can help your practice improve scheduling, billing, and claims management. For example, Patient Portals let patients make appointments electronically, without calling your office. You can also customize your EHR to allow electronic patient registration, reducing patient wait times. Electronic registration also reduces your data entry time by requiring patients to enter their own data. An EHR can also help your practice streamline billing and claims management practices. For example, your EHR can validate a patient’s insurance coverage for tests and medications, reducing coverage denials. EHRs can also help you request prior approval and authorizations, reducing wait times. Finally, EHR clinical decision support tools can improve your practice’s adherence to guidelines-based care. This can reduce claims denials and improve quality scores. If your practice accepts multiple insurance types, you likely face many reporting requirements. For example, under Medicare, many practices participate in the Quality Payment Program (QPP). The QPP requires annual reporting of a variety of quality measures. An EHR can help you fulfill your reporting requirements more easily. EHRs can draw data from across your system without the need for manual data entry or pulling from paper charts. An EHR can also help you manage your patient population's health by giving your practice simple access to key quality indicators. For example, TempDev’s NextGen EHR Dashboards can help you track population health metrics of interest to your practice. Through regular monitoring, you can identify problem areas and address them quickly. In this way, Dashboards can help you improve your efficiency and the quality of care you provide. TempDev’s consultants offer best in class NextGen EHR support. For practices new to NextGen, TempDev offers implementation support and training. Take advantage of TempDev's customized reporting solutions, templates, and workflow optimization. TempDev’s NextGen consultants also support data conversions and data cleaning. Call us at 888.TEMP.DEV, or contact us here to get started with improving your NextGen EHR.