Nurses Exchanging Inform a t i o n : Understanding Electronic Health R e c o rd Standards and I n t e ro p e r a b i l i t y Elizabeth Casey Halley Jane M. Bro k e l Joyce Sensmeier The complexity in adopting health information technology (IT) stan - ealth care inform a t i o n d a rds is not from lack of standard s . R a t h e r, there are a vast nu m b e r systems began in the of standards that overlap and some that are missing.The objective of late 1970s and were this art i cle is to provide nu rses with an understanding of the impor - described as modular tance of the National Health IT Agenda and be empowered to influ - Hdesigned systems with a specific ence the processes to ensure nu rsing is represented. S ev e r a l focus to admit and discharg e aspects include harmonization and adoption of standards necessary patients or order diagnostics tests to ach i eve intero p e r a b i l i t y, and the strategies for nu rsing leaders to (Peterson & Jelger, 1988). Clinical a dvocate for adoption of those standard s . computers were used to calculate c a rdiac outputs or to measure © 2009 Society of Urologic Nurses and Associates rates and pre s s u res within the U rologic Nurs i n g, p p . 3 0 5 - 3 1 4 . h e a rt. The storage of clinical data was not captured except by a nurse documenting data on Key Wo rd s : E l e c t ron ic health record (EHR), EHR intero p e r a b i l i t y, paper re c o rds. Historically, nurs- Health Information Te chnology Standard s , i n t e ro p- es have used a variety of tech- erability specification, National Health IT Age n d a , nologies, but they have used p e rsonal health record (PHR), Use Cases, them more often to support other Te chnology Informatics Guiding Education Refo r m p rofessional departments or (TIGER) Initiative. O b j e c t i v e s Elizabeth Casey Halley, R N , M BA , is the P rincipal Healthcare Consultant, MITRE, 1 . Discuss the importance of interoperability in health care. and a Co-Fa c i l i t a t o r, Technology Info rm a t i c s Guiding Education Refo r m (TIGER) 2 . Explain the difference between an electronic medical record, an Standards and Interoperability Colla - electronic health record, and a personal health record. b o ra t i ve, McLean, VA . 3. Describe the National Health IT Agenda and its implication on J oyce Sensmeier, M S , R N - B C , C P H I M S , for nurses. F H I M S S , is the Vice President, Info rm a t i c s 4. Identify the goals of the TIGER Initiative. Healthcare Info r mation and Management Systems Society, Chicago, IL, and Co- Fa c i l i t a t o r, TIGER Standards and I n t e r o p e rability Collabora t i ve. Jane M. B ro k e l , P h D, R N , is an Assistant P r o fe s s o r, University of Iowa College of Nursing, Iowa City, IA; a member of the State of Iowa Electronic Health Info r m a t i o n E xe c u t i ve Committee and Advisory Council; Statement of Discl o s u r e : The authors reported no actual or potential conflict of interest in relation to this continuing nursing education art i c l e. an Info r matics Researcher, Trinity Health, N ovi, MI; and is the Guest Editor of this N o t e : O b j e c t i ves and CNE Evaluation Fo rm appear on page 314. issue of Urologic Nursing. UROLOGIC NURSING / September-October 2009 / Volume 29 Number 5 305 administrative statistics. These Ta ble 1. basic technical functions were Core Concepts i n t e rmittently used by nurses to communicate with other clinical Core Concept D e s c r i p t i o n d e p a rtments. Early technologies Electronic Health The electronic health record (EHR) is defined as an elec- for the exchange of inform a t i o n Record (EHR) tronic record of health-related info rmation on an individual re q u i red standard codes (often that confo rms to nationally recognized interoperability stan- a c ronyms) that were used to ord e r dards and that can be created, managed, and consulted by the correct diagnostic tests and a u t h o ri zed clinicians and staff across more than one health- care organization (DHHS Office of the National Coordinator procedures. Nurses exchanged for Health Info rmation Te c h n o l o g y, 2008). i n f o rmation using many of these early information systems. Electronic Medical The electronic medical record (EMR) is defined as an elec- To d a y, health inform a t i o n Record (EMR) tronic record of health-related info rmation on an individual technology (IT) is developed to that can be created, gathered, managed, and consulted by i n c reas e the capabilities of a u t h o ri zed clinicians and staff within one health care organ- exchanging protected health ization (DHHS Office of the National Coordinator for Health i n f o rmation beyond the hospital I n fo rmation Te c h n o l o g y, 2008). or clinic. As in the past, there are I n t e r o p e ra b i l i t y I n t e r o p e rability is the essential factor in building the infra- s t a n d a rd clinical terms and steps s t r ucture to create, transmit, store, and manage health- for exchanging this inform a t i o n . related info r mation (DHHS Office of the National These emerging technologies Coordinator for Health Info r mation Te c h n o l o g y, 2008). used in health care settings, I n t e r o p e ra b i l i t y I n t e r o p e rability specifications provide implementation guid- schools, and communities de- S p e c i f i c a t i o n ance for the health IT and harm o n i zed interoperability stan- mand standard methods of use. d a r d s. The purpose of this article, in p a rt, is to inform nurses of how National Health To address the fundamental need for harm o n i zed health IT health IT standards are form u l a t- IT Agenda standards to enable the exchange of health info r m a t i o n , ed within the United States to s eve ral public and public initiatives were enacted. A m o n g p romote interoperability (techni- these effo r ts was the National Health IT Agenda activities i n i t i a t i ve by the President of the United States in 2004. cal exchanging of patient infor- mation, such as allergies and Personal Health The personal health record (PHR) is defined as an electron- health conditions) among sys- Record (PHR) ic record of health-related info rmation on an individual that tems and discuss the active ro l e c o n fo r ms to nationally recognized interoperability standards taken by nurses to support prac- and that can be drawn from multiple sources while being tice, education, and re s e a rc h managed, shared, and controlled by the individual (DHHS using health IT. The overall goal Office of the National Coordinator for Health Info rm a t i o n is to present what nurses must Te c h n o l o g y, 2008). know to use health inform a t i o n Use Case Use Cases would be the first national wo rk to describe the technology to its fullest, which requirements for the interoperability standards that wo u l d will benefit themselves, patients, guide the wo rk of technology vendors for ambu l a t o ry and inpatient systems. Use Cases identified the health info rm a- families, and other disciplines. tion necessary within the wo rk f l ow of all clinical and bu s i- Definitions of the core concepts ness stakeholders as they related to three perspective s : to describe health IT systems are p r ov i d e r, consumer, and population health. p rovided in Table 1. The role of informatics nurs- es as educators, re s e a rchers, and designers was to give clinicians [TIGER] Standards and Inter- ized users (Thede & Sewell, 2009). the informatics tools, principles, operability Wo r k g roup, 2009). Nurses are empowered to make theories, and practices to make i n f o rme d decisions to pro v i d e health care safer, effective, eff i- s a f e r, higher-quality patient and Importance of Interoperability cient, patient-centered, timely, family care when data are cap- and equitable. Informatics nurses Evolving health IT and inter- t u r ed, shared, and reused multi- help nurses to interweave en- operability standards are founda- ple times.