Transcript SISTEME INFORMATICE MEDICALE

MEDICAL INFORMATION
SYSTEMS
Electronic Healthcare Record
1. MEDICAL INFORMATION
1.1. TYPES OF ACTIVITY
a. MEDICAL ACTIVITIES (CONSULTATIONS,
VISITS)
Different approaches:
• Time oriented
• Patient oriented
• Problems oriented (Simptoms, Objective, Assesment,
Plans - SOAP)
Steps:
• DIAGNOSING
– DATA - MEDICAL OBSERVATION,
INVESTIGATIONS
– KNOWLEDGE - EDUCATION, ETC
• THERAPY / FOLLOW-UP
• NURSING
1. MEDICAL INFORMATION
b. LOGISTIC SUPPORTT
ADMINISTRATION
ACCOUNTING
c. SOCIAL CONTEXT FRAME
MEDICAL DATA CENTRALISATION
d. MEDICAL EDUCATION (CME)
STAFF
PATIENTS
e. MEDICAL DOCUMENTATION
f. MEDICAL RESEARCH
1.2. CYCLES OF
MEDICAL INFORMATION FLOW
1.3. Medical activities
organisational levels
• PRIMARY CARE
• SECONDARY
(SPECIALISED) CARE
• HOSPITAL HEALTHCARE UNITS
• CENTRAL LEVELS :
– COUNTY HEALTH
DEPARTMENTS
– NATIONAL LEVEL:
HEALTH MINISTERY
– INTERNATIONAL
BODIES: WHO
1.4. DEFINITIONS
a. INFORMATIONAL SYSTEM = ensemble of
structural units exchanging information between
them
b. INFORMATION SYSTEM = that part of the
informational system which comprises computer
use
Fluxul de informaţii în cadrul Sistemului Naţional Informaţional din Sănătate
Terminology
• CPR (computer-based patient record)
What
is
an
EHR?
• PCR (patient-carried record)
• CMR (computerized medical record)
• EMR (electronic medical record)
• EPR (electronic patient record)
• EHR (electronic healthcare record)
Integrated Care EHR
ISO/DTR 20514 :
• a repository of information regarding the health of a subject
of care in computer processable form, stored and
transmitted securely, and accessible by multiple
authorised users.
• It has a commonly agreed logical information model
which is independent of EHR systems.
• Its primary purpose is the support of continuing, efficient
and quality integrated health care and it contains
information which is retrospective, concurrent and
prospective.
Challenges facing today’s
health record systems
 The need to record more data
 The need to analyse more data
 The need to share more data
University Hospital of Heidelberg:
• 400000 new medical records per year
• 6.3 million pages
• 1,7 km of storage
• 250000 reports generated
The need to analyse more data
• to observe trends and patterns within the
historical record of one patient
• to enable the use of clinical guidelines and
decision support tools: evidence based
health care
• to perform clinical audit
• to inform management and commissioning
decisions
• to support epidemiology, research and
teaching
Share more healthcare data
• with other clinicians in the same team
– clinical firms, practice partnerships or nursing shifts
• with other healthcare professions
– doctors, nurses, physiotherapists, midwives, dieticians...
• with other disciplines
– a diabetic patient may also be under: ophthalmology,
nephrology, orthopaedics, chiropody, wheelchair clinic..
• with other institutions
• with patients and their families
The mains advantages of EHR
• Reducing the storing space of the medical data
• Facilitate researches activities
• Standardized environment for medical data
evidence, based on efficient Database Management
Systems
• Great level of data integration between different
segments of information healthcare systems.
• Increasing the quality of healthcare by the
informational support provided to local and central
administrative structures.
EHR adoption barriers
• Technical limitation for assuring the security, integrity
and accesibility of stored data
• Concerning about the records ownership
• Big initial costs for implementation
• The lack of operate abilities and trust in computerized
systems from the medical stuff and the changing
resistance
• Low diversity of the quality EHR systems
• Lack of universal recognized quality standards and
adequate legal framework
Core Functionalities for an
Electronic Health Record System
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Health information and data management
Results management
Order entry/management
Decision support management
Electronic communication and connectivity
Patient support
Reporting and Population Health Management
Administrative processes
EHR ARHITECTURE
• Object oriented, relational DBMS
• Interoperability - transport of information
over:
– Time
– Space
– Context, Communities, and Cultures
Logical building blocks of the EHR:
• FOLDER
• COMPOSITION
– Tranzactional unit
– Contribution –all
compositions
created/modified during a
session
• HEADED SECTIONS - data
segments for navigation
purposes
• ITEM – single clinical
"statement"
ONTOLOGY
ISO pressure
units
Whole body
Has position
Has units
Body
Position
Pressure
Mm[Hg]
Cuff Size
Applies to
Intra-vascular
Pressure
Heart cycle
phase
Has units
Arterial
Pressure
Has phase
Taken with
ARCHETYPE
Systolic
phase
Blood
Pressure
Diastolic
phase
Part of
Has phase
Has phase
Systolic Arterial
Pressure
Has size
BP Cuff
Systemic
Blood
Pressure
Systolic
Mm[Hg]
Diastolic
Mm[Hg]
Body Position
Diastolic Arterial
Pressure
BP Cuff
Cuff Size
The Record attributes
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Pacient identification
Medical stuff identification
Utilized standards identification
The Name of the parameter measured/observed
The value of the parameter
– [measure unit]
– value [measured]
– [normal value]
• data / time stamp
• Observation circumstances
The “Core” EHR
• Key characteristics:
• Concerns a single subject of care
• Primary purpose is the support of present and
future healthcare of the subject
• Principally concerned with clinical information
• Simplifies standardization of the EHR
has a clear, limited scope enabling a manageable set of
requirements to be specified and a manageable
standardized model to be defined
• Fits more closely with the distributed systems or
“system-of-systems” paradigm
Allows more modular health information systems to be
built
The “Extended EHR”
• Includes not only clinical information but essentially
the whole health information landscape.
• It is a superset of the Core EHR
• Extended EHR functions beyond the scope of the
Core EHR include:
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Patient administration
Scheduling and resource allocation
Billing
Decision support
Access control and policy management
Demographics
Order management
Population health recording, querying, and analysis
Health professional recording, querying, and analysis
Business operations recording, querying, and analysis
User view:
functional grouping of data
• Demographic and general data
– Name, gender, date of birth, picture ..
– Residence and contact data
– Current job, education
– Insurance condition
• Alerts – allergies, special conditions (pregnancies)
• Current medication
• Vaccines
• Consultations
– SOAP
– Schedule
• Surgical interventions
• Reports
• Healthcare costs
OMS 1623/2004
Setul minim de date
la nivel de pacient
(SMDP)
Standard definition
ISO/IEC
defines a standard as a document, established by
consensus and approved by a recognized body, that
provides, for common and repeated use, rules,
guidelines or characteristics for activities or their
results, aimed at the achievement of the optimum
degree of order in a given context
STANDARDS
Standard Attributes (SMART):
S = specific
M = measurable
A = acceptable
R = realistic
T = time related
Standard Organizations
– ASRO – Romanian Association for Standardisation (TC 319)
– CEN - Comité Européen de Normalisation
– CEN/TC251 – Medical informatics Technical Committee
– ANSI - American National Standards Institute
– ISO - International Organization for Standardization.
Standard Organizations
28
ASRO
• ISO DTR 20514 - EHR definition and scope
• ISO TS 18308 - EHR Requirements
• CEN TS 14796 - Data Types
• CEN/TC 251 EN 13606 - EHR Communications
• HL7 - EHR Functional Specification
• HL7 - Templates specification
• HL7 - Clinical Document Architecture
• DICOM – Digital Imaging and Communications in Medicine
• EDIFACT , XML – Messaging standards
DATA PROTECTION
a) CONFIDENTIALITY - limited, leveled
accessibility
b) PROTECTION - against accidental
deterioration / access / loss
c) SECURITY - intended d/a
EHR exemples
• OfficeMed ver 1.60
– Integrated system for family physicians (GP)
• Conform to CoCa 2003
• FoxPro / MSDOS
• “Programul este agreat de Direcţia de sănătate publică
Bistriţa Năsăud”
• Medins
– GP
– MEDINET
INFO WORLD
“... soluţiile oferite au fost dezvoltate conform celor
mai noi standarde în domeniu, precum HL7 şi
DICOM”
• Hospital Manager Suite
• CabiMed – GP
• Cabinet Manager – ambulatory healthcare
system.
• ePractice – EPR system