Information System
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Transcript Information System
HIMA 4160
Fall 2009
HIS: Health Information Systems
EHR: Electronic Health Records
EMR: Electronic Medical Records
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Level of conception.
Data – factual
Information – meaning of data
Knowledge – model for information
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Data – Body temperature 103
Information – The patient is having a fever
Knowledge -- The knowledge used to
generate the information: if a patient
temperature is > 100 F, he might a fever (or
hyperthermia).
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Concrete
Abstract
Factual
Conceptual
Volatile
Stable
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General term cover all three levels
Database – data level
Information storage and retrieval system –
information level
Knowledge system – knowledge level
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Information System
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In-house – developed and managed in the
health care organization
Shared – developed and managed at the
vendor site
Turnkey system – developed by vendor,
installed and managed by health care
organization
Stand-alone – lack of information sharing.
Legacy system.
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Integration
Continuality
Standards
Consumer oriented
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Clinical information systems – serving clinical
activities
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Hospital information system
Patient monitoring system
Nursing information system
Laboratory information system
Pharmacy information system
Computer based patient record
Others
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Provide communication among health facility
workers and support organizational
information needs for operations, planning,
patient care, and documentation.
Communication, coordination
Various across different hosptials
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HIS should have following functions
Central application
Business and financial function
Communications and Networking
Department management
Medical documentation
Medical decision support
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Patient management
◦ Scheduling
◦ RADT (registration, admission, discharge, and
transfer)
◦ RADT provides basic patient information to other
clinical systems.
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Payroll
General ledger
Accounts receivable
Insurance
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Connect different systems.
Need data standards to communicate.
This is a disadvantage of paper based system.
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Needs of individual department
Pharm, lab, radiology, dietary, pathology, etc
The trend is to integrate these systems while
maintaining their functional independence.
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Medical record
Will be paperless
Provide support to managerial and
administrative decision making
In order to do so, the medical record has to
be digitalized and codified.
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Help clinicians make decision
Not replace clinicians
data from various sources – hard to managed
by human
Often integrated into physician order entry
system
focal role in decreasing medical errors
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Physiological data
Emergency room, operating room, intensive
are, critical care
Can give real time alert
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Support nurse care process
Clinical and managerial
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Associated with lab test
Usually already available in the instrument
Various types of lab tests have different
demands
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Data related to drug usage for patient
Also can help decreasing medication errors
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IOM 1991 report first proposed the concept
Other names include electronic health record
(EHR), electronic medical record (EMR).
It is not a single computer product or
program
Based an changed model of managing patient
data
Computer and information technology is
necessary but not sufficient factor.
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Focus on integration
Government support
◦ http://www.cnn.com/2004/ALLPOLITICS/04/27/b
ush.healthcare.ap/
◦ National Health Information Infrastructure
◦ ARRA
Standardization
◦ HL7
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Financial information system
Accounting information systems
Human recourse management information
systems
Material management information system
Facilities management information system
Management planning and decisin support
system
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Computer based patient record
◦ National health information infrastructure
◦ Medical errors
E-Health and e-HIM
◦ Web based technology
Standards
Privacy and Security
Technology
◦ Wireless
◦ Voice recognition
◦ Data warehouse and data mining
Enterprise information management
Virtual information system – results of integration,
standardization, and personalization.
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Before we answer that, what is a patient record?
• commonly referred to as the patient's chart or
medical record
• amalgam of all the data acquired and created
during a patient's course through the heath care
system
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"to recall observations, to inform others, to
instruct students, to gain knowledge, to monitor
performance, and to justify interventions"
Reiser, S. (1991). The Clinical Record in Medicine. Part 1: Learning from Cases. Annals of
Internal Medicine, 114(10): 902-907
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• create the basis for the historical data
• support communication among providers
• anticipate future health problems
• record standard preventive measures
• identify deviation from expected trends
• provide a legal record
• support clinical research and public health
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Pragmatic and Logistical issues.
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Can I find the data I need when I need them?
Can I find the medical record in which they are recorded?
Can I find the data within the record
Can I find what I need quickly?
Can I read and interpret the data once I find them?
Can I update the data reliably with new observations in a
form consistent with the requirements for future access by
me or other people?
• Redundancy and Inefficiency
• Influence on Clinical Research
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Accessibility
Legibility
Adaptive
Structure
Reusability
Flexibility
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Comprehensiveness of information
Duration of use and retention of data
Degree of structure of data
Ubiquity of access
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Disease Pattern Change
Health Care Delivery System Change
Specialization of Medicine
Advances of Computer and Information
Technology
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Primary Uses
Second Uses
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Patient Care Delivery
Patient Care Management
Patient Care Support Processes
Financial and Other Administrative Processes
Patient Self-Management
Education
Regulation
Research
Public Health and Homeland Security
Policy Support
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Health Information and Data
Results management
Order entry/management
Decision support
Electronic communication and connectivity
Patient support
Administrative processes
Reporting and population health
management
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Key Data
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Problem list
Procedures
Diagnoses
Medication list
Allergies
Demographics
Diagnostic test results
Radiology results
Health maintenance
Advance directives
Dispositions
Level of service
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Minimum Data Set (MDS) for nursing homes
◦ From CMS
◦ Support Long Term Care
◦ Current Version 3.0
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Narrative (clinical and patient narrative)
◦ Free text
◦ Template based
◦ Deriving structures from unstructured text
NLP
◦ Structured and coded
Signs and symptoms
Diagnoses
Procedures
Level of service
◦ Treatment plan
Single discipline
interdiscipline
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Patient Acuity/Severity of Illness/ Risk
Adjustment
◦ Nursing workload
◦ Severity adjustment
Capture of identifiers
◦ People and roles
◦ Products/devices
◦ Places (including directions)
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Results Reporting
Results notification
Multiple views of data/presentations
Multimedia support
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Laboratory
Microbiology
Pathology
Radiology
Consult
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Computerized provider order entry
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Electronic prescribing
Laboratory
Microbiology
Pathology
Radiology
Ancillary
Nursing
Supplies
Consults
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Access to knowledge sources
Drug alert
◦ Domain knowledge
◦ Patient education
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Drug dose defaults
Drug dose checking
Allergy checking
Drug interaction checking
Drug-lab checking
Drug-condition checking
Drug-diet checking
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Other rule-based alert (e.g., significant lab
trends, lab test)
Reminders
◦ Preventive services
Clinical guidelines and pathways
◦ Passive
◦ Context-sensitive passive
◦ Integrated
Chronic Disease Management
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Clinician work list
Incorporation of patient and/or family
preference
Diagnostic decision support
Use of epidemiologic data
Automated real-time surveillance
◦ Detect adverse vents and near misses
◦ Detect disease outbreaks
◦ Detect bioterrorism
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Provider to provider
Team coordination
Patient-provider
◦ Email
◦ Secure web messaging
Medical Devices
Trading partners
(external)
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Integrated medical
record
◦ Within setting
◦ Cross-setting
Inpatient-outpatient
Other cross-setting
◦ Cross-organizational
Outside pharmacy
Insurer
Laboratory
Radiology
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Patient education
◦ Access to patient
education materials
◦ Custom patient
education
◦ Tracking
Family and informal
caregiver education
Data entered by
patient, family,
and/or informal
caregiver
◦ Home monitoring
◦ Questionnaires
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Scheduling management
◦ Appointments
◦ Admissions
◦ Surgery/procedure schedule
Eligibility determination
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Insurance eligibility
Clinical trial recruitment
Drug recall
Chronic disease management
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Patient safety and quality reporting
◦ Clinical dashboard
◦ External accountability reporting
◦ Ad hoc reporting
Public health reporting
◦ Reportable diseases
◦ Immunizations
De-identifying data
Disease registry
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Ambulatory (NEJM 2008)
◦ 4% fully functional EHR
◦ 13% basic system
◦ Small and solo practices struggle
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Standardization of Clinical Information
Cost of implementation and maintenance
Physicians' readiness to adopt the EHR
Privacy issues and patients’ concerns with
information sharing.
Legal liability
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