Transcript Introduction to Health Care Informatics HS 6300 Health Information Systems

Introduction to
Health Care Informatics
HS 6300
Health Information Systems
François Sainfort, Ph.D.
David Cowan
Healthcare Information &
Technology Systems
• Healthcare
– one of America’s largest industries
• Information
– not data but information
• Technology
– computers, sensors, imaging, robotics, etc.
• Systems
– a way to organize, think, solve problems,
build
Information
• Not just data
• Clinical data, Scientific data, Manpower
data, Facility data, Utilization data,
Demographic data, Operational Data,
• My data, your data, our data
• concurrent, retrospective, forecasts
• Turning data into information
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statistical analysis
benchmarks
relevance
presentation
inference
Technology
• Diagnostic Devices
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Imaging
Chemistry
Flow /Pressure
Electronics
• Monitoring Devices
– Telemetry
– Imbedded
• Theraputic
– Angiography
– Prosthetics
Systems
• Systems Thinking
– Break it up into its component parts, fix the parts
and put it back together
• Complexity made simple
• Logic, Algorithms
• The System Design, Selection,
Implementation, Management
• Integrating disparate systems to develop
synergy
• Functionality, value, elegant
• Understanding the user.
• Hospitals
Terms
– patient days,
discharges, occupancy,
Outpatient, Inpatient,
Length of Stay
– obstetrics,orthopedics,
neuro, pediatrics,
cardiology,
– medical record, vital
signs, ICD9 codes, CPT,
diagnosis, mortality,
nosocomial,
abstracting,
– Radiology, Pharmacy,
Respitory Therapy,
Laboratory, ER, OR,
PACU,
– DRGs, Medicare,
Medicaid, Third Party
Payer,
• Organizations
– HHS, CMS, HCFA,
AHRQ, IOM, WHO,
DCH, CDC, PHS, IHI
– HIMSS, CHIME
– AHA, GHA, AMA,
MGMA, APHA
• HIPAA
– Security, Privacy,
Transaction Standard
• HIS
– CPOE, EMR, HL7,
PACS, EBM
Topics for Discussion
• Applications
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Hospital IS
Physician IS
Public Health
Health Planning
Patient Consumer IS
Medical Records
Disease Coding
Evidence Based Medicine
Medical Devices
• Monitors, Imaging,
Testing
• Robotics, Surgery
• HIS Vendor
– Cerner, IDX, Seimans,
Philips, McKesson,
Solucient, Meditech, GE,
EPIC
• Techniques
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HCI
Systems Planning
Implementation Mngt
Benefits Realization /
ROI
Systems Design
Systems Support
Systems Interfaces
Process Reenginneering
Database Design
Computer Methods
• Infrastructure
– Organizations
– Vendors
– Public Policy
The Past and Future of Care:
Defining Attributes
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Acute, episodic
Patient passive
Culture of deference
Personal memorybased
• No systems
awareness
• Acute and Chronic
• Patient empowered
• Accountability &
evidence driven
• Protocol supported
• IT & Team-based
• Person & Population
WHAT: Medical Informatics
• “the field concerned with the cognitive,
information processing, and
communication tasks of medical
practice, education, and research,
including the information science and
technology to support these tasks.”
Robert Greenes
WHAT: Medical Informatics
• “the rapidly developing scientific field
that deals with resources, devices and
formalized methods for optimizing the
storage, retrieval, and management of
biomedical information for problem
solving and decision making.
Edward Shortliffe
WHAT: Healthcare
Informatics
• “Union of computer science, information
science, and health sciences in service
of health care delivery and
management.”
Judith Ozbolt
WHAT/WHY:
Health Informatics
• “A scientific field that draws upon the
information sciences and related
technology to enhance the use and
discovery of health sciences’ knowledge
in order to improve health care,
biomedical and clinical research,
education, management, and policy.”
Don Detmer
Many Disciplines
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Health Systems Engineering
Clinical and basic medical knowledge
Health policy and management
Knowledge Management
– Decision support, Expert systems, etc.
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Human computer interaction
Computer Science
Library Science
Health values and ethics
Taxonomy:
Health Informatics
• Bioinformatics (biomedical informatics)
• Clinical Informatics
• Computer Methods for Health
Applications
• Consumer Health (E-health) Informatics
• Health Information Policy
• Knowledge Management
Bionic Convergence
• Convergence of the biological revolution
with the information revolution, of
biology with electronics
W.T. Anderson, “Evolution Isn’t What It Used
To Be”, 1996
1997 - A year to remember
with no looking back
• Deep Blue ( IBM computer) beat Gary
Kasparov, reigning chess champion. Kasparov
resigned in last of six-game match after 19
moves. First time a human was defeated by a
machine in head-to-head match.
• Blue Gene ready in 2004
– Million billion operations per second
– Over 500 x Deep Blue
– Use: determine folding of proteins
Computing Architectures
Now and into the Future:
• Discrete - devices, e.g. PC, PA, cellular
phones
• Pervasive (ubiquitous) - imbedded
computers, e.g. autos, ultimately in us
too
• Virtual - “We imbed ourselves into the
computer’s artificial reality.”
The future just isn’t what it
used to be.
Will Rogers
The New Medicine
• Driven by Computing
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semiconductors
software
fiber optic networks
automation
robotics
telemetry
• Driven by Molecular Biology
– Genetics
– Genomics
– Proteomics
Areas of Biotechnology /
Biomedicine to watch
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Nanotechnology
Fiber optics - Video cameras
Sensors
Tissue engineering
Robotics
Modeling and simulations, e.g.,virtual
clinical trials
• Genomics; genetics databases
• Etc.
“Sniff” TechnologyBiosensors
• Bacteria and viruses give off an odor
• Odor can be sensitively evaluated
against its “signature” smell
• Offers major help on prompt decision
regarding need for antibiotic and if so,
which one
Or, since the Europeans love their
dogs, take a biological approach and
teach your dog to “sniff” out
melanomas.
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In 1989, the British Journal Lancet published a case report from London.
A female half Border collie, half Doberman, had alerted a 44 year old woman to
a lesion on her thigh. The woman reported that the dog kept sniffing at this
lesion, but it ignored other moles. In fact, the dog even attempted to bite off the
offending mole when she was wearing shorts. The woman consulted her doctor
and the mole was excised.
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The diagnosis? Malignant melanoma.
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Dr. Armand Cognetta, dermatologist in Florida got a friend to help train a retired
“bomb-sniffing” dog to sniff out melanomas.
Pace of new drugs will
quicken, by 2008:
• 65% increase in number of potential
medicines entering clinical development
• Success rate from 1:10 to 3:10
• Time for development
– Discovery/preclinical - down 46%
– Phase I/Iia – down 40%
– Phase IIa/III down 27 %
Source: Sir R.D. Sykes (UK)
Diffusion of Technology
• Telephone : 40 years to reach 10 million
customers
• Internet: 4-5 years to reach 100 million users
• Today: The daily volume of electronic
messages equals traditional telephonic
messages
Simon Says…
(Herbert A. Simon)
What information consumes is rather
obvious: it consumes the attention of
its recipients. Hence a wealth of
information creates a poverty of
attention, and a need to allocate that
attention efficiently among the
overabundance of information sources
that might consume it.
The Truth about Knowledge
• Today it is as much a river as a
mountain.
• One can drown in information
so many choose to stay on land.
• We need all the help we can get
because we must swim.
Evidence-based Medicine
• The plural of anecdotes is not data.
Randomized Clinical Trials:
Looking at last 30 years of growth
• First 5 years - 1% of all articles
• Last 5 years - 49% of all articles
• From just over 100 per year to nearly
10,000 annually
Chassin - Milbank Quarterly 1998
Assured Process Improves
Outcomes and Reduces Costs
• Prevention is preferred to detection
• The patient is central
• Focus on the system and not the
individual
• Variation in clinical practices is endemic
• Quality can be constantly improved
Reed Gardner, 1995
Quality & IT R&D
• Multiple IT quality systems are needed.
Among them, they should:
– assure safety and monitor where lapses can
still occur
– shift the mean performance upward
– diligently assess errors and ‘near misses’
that occur so systems are improved
– audit for “rotten apples”
Coming: A global health
information infrastructure?
Elements of a Global Health
Information Infrastructure
• Computer-based health records
• International collaboration – digital divide
• Knowledge-management/decision support for
practice and education based upon evidence
• Privacy, confidentiality, & security
• Research, education, & development
• Standards development
• Telemedicine & Tele-education
• Universal access
The Digital Divide:
The 3 billion person question
• Half of the world’s people have never
used a telephone.
• How many will use the Internet?
• In Winter 2001 total volume of e-mail
communications exceeded telephone
messages
Needed… High Tech - Low
Touch Technologies
• Hand-powered websurfer/telephone/fax
• Touch-button spoken English for
Medline abstracts
• Touch-button translations of Medline
articles into multiple languages
• Your choices
Computer-based Patient
Records (C3PRs)
• Personal - the person’s health record
for own uses
• Patient - the care delivery record
itself
• Population - without personal
identifiers, aggregated records for
planning and management
Patient access to information
• Data about their care system and its
value
• Health information for wellness, general
health promotion, or specific conditions
• Access to same data professionals
utilize for best practices in diagnosis
and treatment
• Access to data relating to their own
care
IT Staging in Organizations
(Hebert 1998)
• I - Substituting IT for past existing
discrete tasks - direct automation of
past
• II - Proceduralization - re-design with
new procedures; separate tasks
grouped together
• III -Totally new activities occur,
including some that in the past were
simply impossible
Predictions for 2001-2020 –
• Hospitals
• Primary care office
• Home & Community
Implications for 2001-2020
• Hospitals - from places for cure
to quality improvement for chronic illness
Predictions for 2001-2020
• Primary care office - from quality
improvement to cure
Implications for 2001-2020
• Home – more
prevention, primary
care, and cure
• Community - illness
prevention and
health assurance
Taxonomy: Health
Informatics and YOU
• Bioinformatics (biomedical informatics)
– IT dimensions of Genomics research
• Clinical Informatics
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Computer-based Patient Records
Database Design and Management
Decision-support systems
Telemedicine (distant Dx &/or Rx)
Taxonomy: Health
Informatics And YOU
• Computer Methods for Health
Applications
– Care, Education, Evaluation, & Research
– Authentication, security, etc.
• Consumer Health (E-health) Informatics
– Computer-based Personal Health Records
– Telehealth (health education)
Taxonomy: Health
Informatics And YOU
• Health Information Policy
– National Information Infrastructure
– Privacy, Confidentiality, and Security Policy
• Knowledge Management
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Language, Terminology, and Messaging
Standards
Digital Libraries
(Evaluating the Evidence)