An accessible primer, Electronic Health Record: A Systems Analysis of the Medications Domain introduces the tools and methodology of Structured Systems Analysis as well as the nuances of the Medications domain. The first part of the book provides a top-down decomposition along two main paths: data in motion--workflows, processes, activities, and tasks in parallel to the analysis of data at rest--database structures, conceptual, logical models, and entities relationship diagrams. Structured systems analysis methodology and tools are applied to: electronic prescription, computerized physician order entry, drug dispensation, medication administration, and clinical decision support. Assuming no previous clinical and/or informatics knowledge, the book supplies a comprehensive view of the EHR/EMR with dedicated chapters on: user interface considerations, reporting requirements, and standards and vocabularies for meaningful use. Containing clear language and more than 170 figures and 100 review questions with answers--this book is a great companion for Healthcare IT professionals and an ideal resource for clinical informatics students. Praise for the book: ! a common sense guide to this new world of informatics !
should prove invaluable to the clinician making his/her way past the commercial hype into the realm of true understanding of the systems of medical informatics. ! strongly recommended ! . --William F. Bria MD, CMIO Shriners Hospitals for Children, President of the Board, Association of Medical Directors of Information Systems Finally, here's a textbook that the market and the industry have been looking for. The author has captured the details of the information flows involved in the EHR while processing an order or prescription from inception to completion. --Joseph T. Finn, RPh, MBA ! a thoughtful and well-constructed manual to understanding and incorporating the complex and many-sided aspects of medication concepts ! a clear and accessible entry to this challenging topic. --Don Martin, Managing Consultant ...encompasses high-value, high-volume therapeutic transactions of indescribable complexity that touch nearly every licensed professional in a hospital ! I'm hoping the vendors of my own hospital's systems take its recommendations to heart. --Mr. HIStalk, Healthcare IT Blogger !. a very useful guide ! provides the necessary detail that is often missing in many books! very useful in health informatics education at universities and courses within community colleges.
--Jane M. Brokel, PhD, RN ! a welcome and valuable addition to the toolkit for IT professionals and clinicians participating in the design or implementation of EHR systems. --Christine Greifzu, RN-BC, MBA, MSIS
Short Primer on Structured Systems Analysis What Is a System? Why Systems Analysis? Why Structured Systems Analysis? Processes and Data Dataflow Diagram Entity Relationship Diagram Normalization Data Dictionary Functional Primitives Specification Balancing the Models The Medications Domain Workflows and Data Structures Context Diagram DFD 0 Workflow Responsibility Data Model Conceptual Model Step 1 One Brand--Many Packs One Pack--Many Items One Drug--Many Forms and Many Routes One Drug Item--Many Ingredients and Strengths National Drug Code One Ingredient--Many Brands One Ingredient--Many Classes One Class--Many Ingredients One Class--Many Parents and Many Children Tall Man Letters Conceptual Model Step 2 One Pack--Many Indications One Ingredient--Many Contraindications Dosing Types Intermittent versus Continuous Dose Units Time Units Frequency Duration SIG Precaution Not All Concepts Are Entities Conceptual Model Step 3 The Patient Is Uniquely Identified The Clinician Is Uniquely Identified Medication Life Cycle One Medication Life Cycle--Multiple Statuses One Patient--Many Prescriptions, Orders, Dispensations, and Administrations One Clinician--Many Prescriptions, Orders, Dispensations, and Administrations One Prescription (Order, Dispensation, Administration)--Many Items Not Indicated Is Not Equal to Contraindicated The Actual Dose Has a Quantity Dosing Regimens Actual Dose May Be Different from the Recommended One Drug Name and Other Parameters May Change during Medication Life Cycle Half Tablets Daily Dose versus Maximal Dose Not All Drug Parameters Are Clinically Relevant Prescribe/eRx Processes DFD 1 Prescribe Workflow DFD 1.1 Communicate Prescription DFD 1.2 Review Patient Data DFD 1.3 Select Drug DFD 1.4 Select Dose DFD 1.5 Consider Formulary DFD 1.6 Sign Rx Controlled Substances Data Elements Prescription-Related Communications Patient Medications Patient Non-Drug-Related Parameters CDS PBM Patient's Preferred Pharmacies Order/CPOE Processes DFD 2 Order Workflow DFD 2.1 Communicate Order DFD 2.2 Review Patient Data DFD 2.3 Select Drug DFD 2.4 Select Dose DFD 2.5 Consider Formulary DFD 2.6 Sign Order Reuse Considerations DFD 2.7 Use Order Set DFD 2.8 Reconcile Meds Data Elements Internal Data Store External Actors Multiple Destinations for One Drug Communication Multiple Physical Measurements BMI and BSA Conditional and Sequential Complex Orders Patient A/D/T Settings Location and Time Frames Data Exchange with External Actors Dispense/ePharmacy Dispense Workflow Automated Dispensing Cabinet Processes DFD 3 Dispense Workflow DFD 3.1 Communicate Dispensation DFD 3.2 Review Patient Data DFD 3.3 Select Drug DFD 3.4 Select Dose/Prepare DFD 3.5 Consider Formulary DFD 3.6 Dispense/Deliver Data Elements Administer/eMAR 5 Rights Processes DFD 4 Administer Workflow Bar Code Medication Administration Smart Pumps Drug Storage DFD 4.1 Communicate Administration DFD 4.2 Review Patient Data DFD 4.3 Select Drug DFD 4.4 Select Dose/Prepare DFD 4.5 Interact with Storage DFD 4.6 Administer/Sign Data Elements Calculation of Dosing Parameters for a Continuous Drip User Interface Usability Cognitive Load Principles of Graphic Excellence Characteristics of a Clinical Story Cause and Effect Titrate to Effect Parallel Channels of Information UI Main Elements Time Axis Caution: The Direction of Time Axis Parameters Axis Caution: Hidden Information Tabular Versus Graphical Display of Data Number of Clicks and Data Density Trends Are Nice, but Where Are the Numbers? Layers of Information Review Patient Data: Ambulatory UI Refill a Medication Modify a Medication Prescribe a New Medication Order Set Medication Administration Medication Reconciliation Clinical Decision Support What Is CDS? Types of CDS Why Is CDS Needed? Clinical Decision Characteristics Trustworthy Medical Information CDS Configuration CDS Adaptability CDS--A Binary Classification System False-Positive versus False-Negative Alerts Medication Errors Medication CDS Dialog Paradigm Automated CDS Algorithm Outline Processes DFD 5 CDS Workflow DFD 5.1 Filter Drug DFD 5.2 Adjust Dose DFD 5.3 Consider Demographics 5.3.1 Consider Age 5.3.2 Consider Gender 5.3.3 Consider Weight, Height 5.3.4 Consider Ethnicity DFD 5.4 Consider Patient Condition 5.4.1 Consider Indication & EBM 5.4.2 Consider Allergy and C/I 5.4.3 Consider Adverse Reaction & Side Effect 5.4.4 Consider Pregnancy and Lactation 5.4.5 Consider Drug-Lifestyle 5.4.6 Consider Drug-Vital 5.4.7 Consider Drug-Procedure DFD 5.5 Consider Patient Drugs 5.5.1 Consider Interaction 5.5.2 Consider Duplicate Therapy 5.5.3 Consider Alternative 5.5.4 Consider Setting 5.5.5 Consider IV Admixture DFD 5.6 Consider Lab 5.6.1 Lab Affect Drug & Dose 5.6.2 Monitor Lab 5.6.3 Drug Interfere with Lab DFD 5.7 Educate Data Elements Temp CDS Drug Temp CDS Dose Precaution Drug Interaction IV Admixture Dose Adjustment Monitor Drug Lab Drug Interfere Lab Barriers to CDS Adoption Recommendations CDS and Genomics: Personalized Medicine Report Motivation Types of Reports Measuring Healthcare Quality Goals for the Healthcare System Dimensions of Quality Measures Evaluating Quality Measures Organizations Involved in Quality Reports PQRS and MU Measures Anatomy of a Quality Measure Reporting Methods Medications Reports Data Warehouse Data Mining CDS versus Reports Processes DFD 6 Report Workflow DFD 6.1 Report on Single Patient DFD 6.2 Report on Multiple Patients Data Elements Interoperability Standards and Vocabularies Interoperability Open Systems Interconnection Model Language and Ontologies Interfaces Rocket Science Standards U.S. Government and MU Qualities of a Modern Clinical Terminology Healthcare Standards Organizations EHR Standards and Vocabularies Medications Standards and Vocabularies Processes DFD 7 Update/Sync Workflow HIE/Regional Health Information Organization/HUB Data Elements Discrete Data Elements Semistructured Documents Appendix Acronyms List Answers to Review Questions Index Each chapter includes a Summary, References, and Review Questions