Electronic Health Records

Foundation of Clinical Informatics (INLS 725)


Dr. Javed Mostafa

Tuesday & Thursday, 11:00-12:15PM

117 Manning Hall

School of Information and Library Science

University of North Carolina at Chapel Hill



Course Description


Due to recent government regulations in the USA, the prevalence of Electronic Health Record (EHR) systems in care settings has increased dramatically. They are the primary source of data that care providers rely on to diagnose, treat, and track patients. They are also used by health care administrators and managers of clinical environments to monitor and assess quality of care and ensure that care delivery meets stringent standards set by accreditation bodies and government organizations.


Accumulated EHR data, collected for a specific population (e.g., immune records of children), over a long period of time, often called health registries are mandatory in certain cases and often are the primary resources used for public health systems and services. EHR systems are also used for ongoing public health surveillance and for assessing outbreaks of community-wide diseases and other threats to public health. Finally, EHR systems have increasingly become critical in supporting medical research, particularly for recruitments and supporting both prospective and retroactive trials.


In this class we will focus on EHR data standards with a strong emphasis on associated data management requirements, applications, and services. Along with a close examination of the standards criteria being developed by the Office of the National Coordinator (ONC), the course will also focus on a set of widely adopted standards such as the Health Level 7, SNOMED, ICD9/10, CPT, and MeSH. The course is aimed at data management specialists, data management administrators, and students interested in health data analytics.




Objectives include learning about the following areas and engaging in related activities:


o   Standards that ensure EHR systems are both secure and interoperable with other systems

o   Data management, architecture and information exchange platforms

o   Informatics principles that support quality of care and evidence-based practice

o   Data governance and regulations associated with securing health data

o   EHR future and evolution: Next generation technologies being shaped by the Federal Government through financial incentives/penalties (meaningful use)

o   Practical experience with EHR tools and applications









Course Requirements



*  Project (Group Effort)

- 5%           Topic Selection and Overview Presentation

- 5%           Abstract and Outline

- 10%          Draft of project report submission (emphasizing usability data), DUE ON APRIL 12th.

- 25%          Final Project Report


*  15%         Field Report DUE ON APRIL 14th.


*  25%         Take-home final exam DUE ON APRIL 19th.


*  15%         Class participation: Activities in class, regular attendance, and contributions to class list





Based on current UNC grading scales, the following grades and corresponding numeric ranges are applicable:


Graduate Students


Grad Grade









69 or below









Honor Code


All students are expected to follow general classroom decorum and respect the rights of everyone to have a safe and collegial environment for learning. Violations of general academic practices and norms will not be tolerated. Please refer to the Carolina Honor system to learn more about basic academic expectations at UNC at Chapel Hill: https://studentconduct.unc.edu/honor-system.


Do not hesitate to contact the instructor at any time if you have any questions about the honor system and related matters.



Required Text-book



The previous edition of the book is adequate to fulfill most of the requirements of this course.



Additional Recommended Books



Additional readings will be assigned and shared as needed.


















Course Outline & Calendar



Class 1 - Jan 12


Introduction to the class and distribution of the syllabus. Important dates, exam, and assignments described.

Class project requirements discussed.




Class 2 - Jan 14


Overview of EHR; platform, standards, applications, and evolution


Readings: Chapter 1





Class 3 - Jan 19


EHR as a gateway and integration hub. Applications contd.


Readings: Chapter 1



Class 4 - Jan 21

EHR in action from the perspectives of patients & clinicians


Reading: Trotter, F., & Uhlman (additional suggested text-book)





Class 5 - Jan 26


Health data architectures, standards, and protocols I.


Readings: Chapters 6



Readings: Payne et al., 2010 (Current Case Study); Fernandopulle & Patel, 2010 (Current Case Study)





Class 6 - Jan 28


Health data architectures, standards, and protocols II.


Readings: Chapter 2, Payne, T. (2008). In Practical Guide to Clinical Computing Systems (Thomas Payne, Ed.). Architecture of Clinical Computing Systems (Chapter 2)





Class 7 - Feb 2


Data management I.


Readings: Chapter 4




Class 8 - Feb 4


Data management II. Architecture and information exchange platforms.





Class 9 - Feb 9


Health vocabularies, taxonomies, and ontologies I.


Readings: Cimino, J. (2000). From Data to Knowledge through Concept-Oriented Terminologies: Experience with Medical Entities Dictionary. J. Am Med Inform Assoc (7): 288-297.





Class 10 - Feb 11


Health vocabularies, taxonomies, and ontologies II.



Readings: Chapter 4







Class 11 - Feb 16


Data modelling in basic and data warehousing contexts. Usabilty.


Readings: Chapter 4.





Class 12 - Feb 18


Usability & Testing Methodology I


  Readings: Health Information Tech Usability






Class 13 - Feb 23


Usability & Testing Methodology II







Class 14 - Feb 25


Implementing EHR: coding, vocabularies, interfaces, XML, and APIs.



Readings: Chapter 6.






Class 15 - March 1


Coding and interfacing (contd.). Clinical workflows and clinical processes.



Readings: Chapter 8








Class 16 - March 3



Guest Speaker.







Class 17 - March 8


Evidence-based care and quality improvement I


Readings: Chapter 10.






Class 18 - March 10


Evidence-based care and quality improvement II.


Reading: Buntin, et. al. (2011).


Clinical decision support


Reading: Chapter 9





Class 19 - March 22



Implementing EHR and evaluating systems. Data Governance. Meaningful use I.


Reading: Chapters 16 and 17





Class 20 - March 24



Meaningful Use II contd.


Reading: Caleen, J.L., Braithwaite, J. & Westbrook, J.A. (2008). Hamalka, J.D. (2010).





Class 21 - March 29


Guest Lecture: Clinical data warehouse and integration of data.






Class 22 - March 31


EHR regulations, privacy, and security I


Reading: Chapters 12 and 13





Class 23 - April 5


EHR regulations, privacy, and security contd.


Consumer-centric Health Information I


Reading: Chapters 12 and 13







Class 24 - April 7



Field Trip: 11A with Dr. Carlton Moore.







Class 25 - April 12


Consumer-centric Health Information II


Draft Project Report Due.






Class 26 - April 14


Advanced Topics: Consumer-centric Health Information III


Field Report Due.





Class 27 - April 19



Advanced topics: Mobilie Health & EHR


Take-home Final Due.



Class 28 - April 21


Guest Lecture: UNC Hospital IT Environment and Governance




Class 29 - April 26


Class presentations.  Wrap-up.


Contact Information


Instructor Office hours: Thursday 2P-3PM. The instructor will be in Room 300A, Manning Hall.

TA Office hours: Thursday 1P-2PM. The TA will be in Room 300, Manning Hall.

Please do not hesitate to contact the instructor or the TA to schedule other meeting times.


Ph:          (919) 610-6230

Email:     jm@unc.edu (instructor) and vcarrasc@live.unc.edu) (TA)