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Health Informatics Course Review
LIS 4776 Advanced Health Informatics
Week 15
Instructor: Dr. Sanghee Oh
Health Informatics Overview
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Health Informatics Basics
Meaningful Use
Data Standards
IT Governance
EMR/EHR
Privacy & Security
PHR
Data Analysis
Telehealth
Consumer Health Informatics
HEALTH INFORMATICS BASICS
What is Health Informatics
Biomedical Informatics in Perspective
Basic Research
Biomedical Informatics Methods,
Techniques, and Theories
Biomedical Informatics ≠ Health Informatics
Health Informatics
Bioinformatics
Imaging
Clinical
Informatics Informatics
Public Health
Informatics
Tissues and
Organs
Populations
And Society
Applied Research
And Practice
Molecular and
Cellular
Processes
Individuals
(Patients)
Key players in HIT
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Patients
Physicians and nurses
Support staff
Public health
Federal and state governments
Medical educators
Insurance companies
Hospitals
Medical researchers
Technology vendors
Benefits of HIT adoption
• Increase the efficiency of health care
(improve physician, nurse and overall
healthcare productivity)
• Improve the quality (patient outcomes) of
healthcare, resulting in improved patient
safety
• Reduce healthcare costs
• Improve healthcare access with
technologies such as telemedicine
• Improve communication, coordination,
and continuity of care
• Improve medical education for clinicians
and patients
• Standardize of medical care
Barriers to HIT adoption
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Inadequate time to adopt
Inadequate information to use
Inadequate expertise and workforce
Inadequate cost and return on investment data
High cost to adopt
Lack of interoperability
Change in workforce
Privacy concerns (HIPPA: Health Insurance Portability and
Accountability Act)
• Legal issues
• Behavioral change
How HIT plays a role
• Provides the tools to generate information from data that humans
(clinicians and researchers) can turn into knowledge and wisdom.
– To improve human decision making with usable information
• Promote data in formats that
can be rapidly transmitted,
shared and analyzed.
– EHRs, HIE, and multiple
hospital electronic
information systems
provide the ability and the
need to collate and
analyze large amounts of
data to improve health
and financial decisions.
EHR
Claims
Data
PHR
Health
Data
Home
Monitoring
Data
Warehouse
HIE
MEANINGFUL USE
American Recovery and Reinvestment Act of
2009 (ARRA)
• Health Information Technology for Economic and Clinical Health
(HITECH) Act
– Part of the ARRA of 2009 to promote the adoption and
meaningful use of health information technology.
• Meaningful Use (3 Stages)
– Stage 1 (2011-2012): The use of a certified EHR in a meaningful
manner by promoting the basic EHR adoption and data gathering
– Stage 2 (2014): The use of certified EHR technology for care
coordination and electronic exchange of health information
– Stage 3 (2016) The use of certified EHR technology to improve
healthcare outcomes
CMS Meaningful Use Regulations
• An effort lead by CMS
(Centers for Medicare
& Medicaid Services)
• CMS: Previously known
as the Health Care
Financing
Administration (HCFA),
is a federal agency
within the United
States Department of
Health and Human
Services (DHHS)
Meaningful Use: 13 Core Objectives
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13.
Computerized provider order entry (CPOE)
Drug-drug and drug-allergy checks
Maintain an up-to-date problem list of current and active
diagnoses
E-Prescribing (eRx)
Maintain active medication list
Maintain active medication allergy list
Record demographics
Record and chart changes in vital signs
Record smoking status for patients 13 years or older
Implement clinical decision support
Provide patients with the ability to view, download, or transmit
their health information online
Provide clinical summaries for patients for each office visit
Protect electronic health information
Computerized Physician Order Entry (CPOE)
• An EHR feature that processes orders for medications, lab tests,
imaging, consults and other diagnostic tests.
Electronic Prescribing (e-prescribing, eRx)
• An electronic system to support a prescriber's ability to
electronically send an accurate, error-free and understandable
prescription directly to a pharmacy from the point-of-care.
U.S. Organizations Involved with HIT
• Office of the National Coordinator for Health Information
Technology (ONC) (HealthIT.gov)
• American Recovery and Reinvestment Act (ARRA)
– 5 goals
• Improve medical quality, patient safety, health care
efficiency and reduce health disparities
– Health Information Technology for Economic and Clinical
Health (HITECH)
• eHealth Initiative
– Non-profit organization promoting the use of IT to improve
quality and patient safety (http://www.ehidc.org/)
U.S. Department of Health & Human Services
(HHS)
• Agency for Healthcare Research and Quality (AHRQ)
– Support health service research that will improve the quality
of health care and promote evidence based decision making
– In 2014, invested $166 million in grant to research HIT
• Center for Medicare & Medicaid Services (CMS)
• Center for Disease Control and Prevention (CDC)
• Health Resources & Services Administration (HRSA)
• National Institutes of Health (NIH)
• Food and Drug Administration (FDA)
• Administration on Aging (AOA)
• Indian Health Service (HIS)
DATA STANDARDS
Why Do We Need Data Standards?
• “The healthcare delivery system today employs many different
information systems from different vendors, both within a single
organization and across multiple organizations.
For example, a hospital may have a laboratory
system from one vendor, a pharmacy system
from another vendor, and a patient care
documentation system from a third vendor.
Physicians affiliated with the hospital also have
different systems in their offices, yet need
access to data from the hospital on their
patients.” (Source: 2000 NCVHS Report)
• Standards provide a common language and set of expectations that
enable interoperability between systems and/or devices.
• Ideally, data exchange schema and standards should permit data to be
shared between clinician, lab, hospital, pharmacy, and patient
regardless of applications or application vendors in order to improve
healthcare delivery.
Terminology Standards
• Logical Observations, Identifiers, Names, and Codes (LOINC)
– A standard for electronic exchange of lab results transmitted
to hospitals, clinics, and payers.
– The database has more than 72,000 terms (as of 2013) used
for lab results.
– LOINC is divided into lab, clinical, and HIPPA portions.
– Widely accepted in the U.S. and internationally.
– Have been cross referenced to SNOMED
2951-2: The LOINC code for serum sodium
SODIUM: SCNC: PT: SER/PLAS:QN
(component:property:timing:specimen:scale)
International Statistical Classification of
Diseases and Related Health Problems (ICD)
• Published by World Health Organization (WHO) to collect data
worldwide on the causes of morbidity and mortality.
• Widely used for both billing and statistical analyses and used to
code and classify mortality data from death certificates.
• Updated every year, but major revisions in every 10 years.
The Systemized Nomenclature of Medicine
(SNOMED)
• The clinical terminology or
medical vocabulary commonly
used in software applications,
including EHRs.
• Covers diseases, findings,
procedures, drugs, etc.
• Provide more clinically usable
data than ICD-9.
• Include 1,000,000 clinical
descriptions.
• Terms are divided into 19
hierarchical categories.
• SNOMED links (maps) to LOINC
and ICD codes.
CPT (Current Procedural Terminology) Codes
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Numbers assigned to every task and service a
medical practitioner may provide to a patient
including medical, surgical and diagnostic
services.
They are then used by insurers to determine
the amount of reimbursement that a
practitioner will receive by an insurer when
he or she performs that service.
CPT codes are developed, maintained and
copyrighted by the AMA (American Medical
Association)
Examples
– 99214: an office visit
– 99397: a preventive exam if you are over
65
– 90658: a flu shot
Medicare uses HCPCS codes (Healthcare
Common Procedure Coding System) which
are an adjusted form of CPT code.
EVIDENCE BASED-MEDICINE
Evidence-based Medicine
• Evidence-based medicine (EBM) is the process of systematically
reviewing, appraising and using clinical research findings to aid
the delivery of optimum clinical care to patients.
• “The conscientious, explicit and judicious use of current best
evidence in making decisions about the care of individual
patients” (Sackett et al., 1996).
• The practice of EBM is the integration of individual clinical
expertise with the best available external clinical evidence from
systematic research (Sackett et al., 1996).
Clinical Decision Support System (CDSS)
• Computer software that presents uses with a knowledge base,
patient-specific data, and related information at the point of care
to enhance healthcare provision and management
• Providing clinicians, staff, patients or other individuals with
knowledge and person-specific information, intelligently filtered
or presented at appropriate times, to enhance health and health
care.
• Clinical decision making is based on good scientific evidence,
which is derived from closed clinical trials and sound statistical
analysis.
Clinical Practice Guidelines (CPGs)
• Systematically developed
statements to assist practitioners
and patient decisions about health
care for specific clinical
circumstances
• The very best evidence based
medical information and formulate
an approach to treat a specific
disease or condition.
• CPGs represent the logical step in
which evidence is transformed into
a recommendation at the point of
care.
• Many medical organizations use
CPGs with the intent to improve
quality of care, patient safety and
or reduce costs.
CPG Example: Post-Traumatic Stress Disorder
(PTSD) Evaluation
Point-of-Care Tools
• A synthesized resource that can easily provide evidence-based
answers to questions during the patient visit
• UpToDate (hosted by Ebsco)
• eMedicine (Integrated to Medscape)
(http://www.medscape.com/)
• DynaMed (hosted by Ebsco)
• ACP Smart Medicine (used to be ACP-PIER): Accessible through
FSU Library (http://smartmedicine.acponline.org/index.aspx)
• FirstConsult (http://www.firstconsult.com/php/4653442277/home.html)
Medical Subject Headings (MeSH)
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http://www.nlm.nih.gov/mesh/meshhome.html
The National Library of Medicine's controlled vocabulary thesaurus. It
consists of sets of terms naming descriptors in a hierarchical structure
that permits searching at various levels of specificity.
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MeSH descriptors are arranged in both an alphabetic and a
hierarchical structure.
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The MeSH thesaurus is used by NLM for indexing articles from 5,400
of the world's leading biomedical journals for the
MEDLINE®/PubMED® database.
It is also used for the NLM-produced database that includes
cataloging of books, documents, and audiovisuals acquired by the
Library. Each bibliographic reference is associated with a set of MeSH
terms that describe the content of the item.
Similarly, search queries use MeSH vocabulary to find items on a
desired topic.
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MeSH Example
IT GOVERNANCE IN HEALTHCARE
IT Governance
• All organizations have IT governance but few are effective
• Effective IT governance means
• An actively designed set of IT governance mechanisms that
encourage behaviors consistent with the organization’s mission,
strategy, values, norms, and culture
• Effective IT governance does not mean…IT governance by default
(tactical governance)
• Good governance design allows enterprises to deliver superior results
on their IT investments
Strategic Planning Overview
Guiding Principles
• Vision
• Mission
• Goals/Objectives
Current Goals
Outcome Measures
• Objective
measurements of
Goal performance
• Key areas of focus for
next 1 – 5 years
• Identify the top 3
Action Plans
• Programs to achieve
Goals
• 6–12 mnth timeframe
Records Management
• Record Policy must include:
– Policy
– Standards
– Management
• The policy must be broad enough
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to meet standards for compliance
to be legal admissibility
to be secure and private
AND must be capable of demonstrating this compliance.
EHR/EMR
What are EHRs?
• The simplest definition:
– Digital (computerized) versions of patients' paper charts
• Real-time, patient-centered records, which makes information
available instantly, "whenever and wherever it is needed".
• Contain information about a patient's medical history, diagnoses,
medications, immunization dates, allergies, radiology images, and
lab and test results
• Offer access to evidence-based tools that providers can use in
making decisions about a patient's care
• Automate and streamline providers' workflow
• Increase organization and accuracy of patient information
• Support key market changes in payer requirements and consumer
expectations
EHR Benefits
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Cost
Access
Quality
Safety
Efficiency
EHR Barriers
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Cost
Ownership
Data integrity
Privacy and confidentiality
Standards
Organizational culture
Human factors
The Current EMR Market
• Incentives (what are they?)
• Meaningful use (is this important?)
• Interoperability (how important is this?)
User Needs Assessment Process
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0. DEFINE GOALS
1. Create a process
2. Start with a project plan
3. Needs Analysis
4. Methods of Analysis – what are
the goals?
• 5. Key Success Factors
• 6. Look at ALL options
• 7. What about the Vendor
What to Consider for EMR
1. Workflow Efficiency:
2. Specialty Content:
3. User Flexibility:
4. Implementation Flexibility:
5. Clinically-Driven Product Design:
6. Return On Investment:
7. Product Integration:
8. Installation, Training and Support:
9. Vendor Stability:
10. Commitment to Product
Development:
Clinical workflow
How to Implement EHRs (from HealthIT.gov)
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Step 1: Assess your practice readiness
Step 2: Plan your approach
Step 3: Select or Upgrade to a Certified EHR
Step 4: Conduct Training & Implement an EHR System
Step 5: Achieve Meaningful Use
Step 6: Continue Quality Improvement
User Training Process
1. Assess training needs.
2. Determine your training
resources.
3. Design the training.
4. Write the training plan.
5. Maintain skills and
certifications among staff
6. Evaluate user training
HEALTH INSURANCE PORTABILITY
AND ACCOUNTABILITY ACT (HIPAA)
History
HIPAA
Health Insurance Portability
and Accountability Act (1996)
HITECH
American Recovery and
Reinvestment Act - Health
Information Technology for
Economic and Clinical Health
(2009)
Meaningful
Use
Guidelines for EHR
(2010)
HIPAA Privacy Rule
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The HIPAA Privacy Rule establishes national
standards to protect individuals’ medical records
and other personal health information and
applies to health plans, health care
clearinghouses, and those health care providers
that conduct certain health care transactions
electronically.
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Health plan
– An individual or group plan that provides, or
pays the cost of, medical care.
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Healthcare clearinghouses
– A public or private entity, including a billing
service, repricing company, community health
management information system or
community health information system, and
“value-added” networks and switches
Notice of Privacy Practices
• A statement that an authorization
may be revoked
• A statement of individuals’ rights
• A statement of the covered
entities’ duties
• A statement describing how
complaints can be made and that
no retaliation will occur
• Reserve the right to amend the
notice and retroactively apply the
new standards
• Effective date
A PATIENT’S RIGHTS
• HIPAA stipulates the following patient’s right under its privacy
rule:
– Patients have a right to receive a Notice of the Privacy
Practices of any health care provider, health clearing house,
or health plan.
– Patients have a right to access and receive a copy of their PHI
(paper or electronic formats).
– Patients have a right to request amendments to information,
that changes be made to correct errors in their records or to
add information that ha been omitted.
– Patients have a right to request restriction of PHI uses and
disclosures.
– Patients have a right to request that you give special
treatment to their PHI.
– Patients have a right to request confidential communications.
– Patients have a right to complain.
Consent vs. Authorization
• Consent for Treatment, Payment, and health care Operations
• Authorization for any other use or disclosure
Minimum Necessary
• Minimum Necessary applies:
– When using or disclosing PHI or when requesting PHI from
another covered entity or business associate, a covered entity
or business associate must make reasonable efforts to limit
protected health information to the minimum necessary to
accomplish the intended purpose of the use, disclosure, or
request.
HIPAA Security Rule
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The Security Rule requires appropriate administrative, physical and
technical safeguards to ensure the confidentiality, integrity, and security
of ePHI.
Confidentiality
e-PHI
Integrity
Security
– Confidentiality
• a set of rules or a promise that limits access or places restrictions
on certain types of information
– Integrity
• the state of being whole and undivided
– Security
• the state of being free from danger or threat
HIPAA Audit Program Protocol
Determine the
activities that will
be tracked or
audited
Select the tools
that will be
deployed for
auditing and
system activity
reviews
Develop and
deploy the
information
system activity
review/audit
policy
Develop
appropriate
standard
operating
procedures
PHR
PHRs
• An electronic application used by patients to maintain and
manage their health information in a private, secure, and
confidential environment. PHRs:
– Are managed by patients
– Can include information from a variety of sources, including
health care providers and patients themselves
– Can help patients securely and confidentially store and
monitor health information, such as diet plans or data from
home monitoring systems, as well as patient contact
information, diagnosis lists, medication lists, allergy lists,
immunization histories, and much more
– Are separate from, and do not replace, the legal record of any
health care provider
– Are distinct from portals that simply allow patients to view
provider information or communicate with providers
PHR Functionality
PH.1 Account Holder Profile
PH.2 Manage Historical Clinical Data And
Current State Data
Personal
Health
PH.3 Wellness, Preventive Medicine, and Self
Care
PH.4 Manage Health Education
PH.5 Account Holder Decision Support
PH.6 Manage Encounters with Providers
Supportive
Information
Infrastructure
S.1
Provider Management
S.2
Financial Management
S.3
Administrative Management
S.4
Other Resource Management
IN.1
Health Record Information Management
IN.2
Standards Based Interoperability
IN.3
Security
IN.4
Auditable Records
HL7 Functional Model
Functions are categorized
and listed hierarchically.
(The highest level functions
are shown.)
Each function has an ID,
Name, Statement,
Description, Examples, and
Conformance Criteria.
Source: http://www.hl7.org/documentcenter/public_temp_B6505E3B-1C23-BA170CF26E1F1FB8AE71/calendarofevents/himss/2013/Personal%20Health%20Record%20System%20Functional%20Model.pd
f
PHR Evaluation
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Availability/Access
Completeness
Privacy
Security
Usability
Portability
Vendor reliability
HEALTH DATA ANALYSIS
4 Characteristics of Big Data
• Big data is described as high in;
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Volume: ever-increasing amounts
Velocity: quickly generated
Variety: many different types
Veracity: from trustable sources
Big Data Challenges in Healthcare
• Understanding free-text clinical
notes in the right context (Natural
Language Processing)
• Deriving knowledge from
heterogeneous patient data sources
• Electronic health records
• Patient registries
• Claims data
• Health survey data
• Social media data
• Capturing the patients’ behavior from
sensors (Fitbit, Apple Watch, etc.) and
social interaction
3 Levels of Data Analytics
• Descriptive
– Standard types of report
that describe current
situations and problems
• Predictive
– Simulation and modeling
techniques that identify
trends and portend
outcomes of action taken
• Prescriptive
– Optimizing clinical,
financial, and other
outcomes
TELEHEALTH
What is telehealth?
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Telehealth is simply using digital
information and communication
technologies, such as computers and
mobile devices, to manage your health
and well-being.
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Telehealth is the use of electronic
information and telecommunications
technologies to support long-distance 1)
clinical health care, 2) patient and
professional health-related education,
3) public health and health
administration.
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Technologies include videoconferencing,
the internet, store-and-forward imaging,
streaming media, and terrestrial and
wireless communications.
Telehealth vs. Telemedicine
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Telehealth:
– The use of electronic information and
telecommunications technologies to
support long-distance 1) clinical health
care, 2) patient and professional
health-related education, 3) public
health and health administration.
– A broader scope of remote healthcare
services
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Telemedicine:
– The use of medical information
exchanged from one site to another via
electronic communications to improve
patients’ health status
– Limited to remote transmission or
exchange of clinical information only
Telehealth vs. mHealth
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Telehealth:
– The use of electronic information
and telecommunications
technologies to support longdistance 1) clinical health care, 2)
patient and professional healthrelated education, 3) public health
and health administration.
– A broader scope of remote
healthcare services
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mHealth:
– The delivery of healthcare services
via mobile communication devices,
such as cell phones, smartphones,
and tablets
Home health monitoring
• Devices such as blood pressure monitors can be connected to the
Internet or to video equipment that allows real-time, face-to-face
interaction with health care providers.
• Home health monitoring can be particularly useful for people
with chronic diseases, such as heart disease, as well as those who
live in rural or remote areas.
• The benefits are greater convenience, fewer office visits, and
easier access to medical care and advice.
Wearable monitoring systems
• These devices can assess
sounds, images, body
motion, and vital signs
such as blood pressure,
body temperature, heart
rate and pulse, body
weight, and blood
oxygenation.
• Devices can also monitor
sleep patterns and
physical activity.
• These devices are
connected through
networks to a clinic or
monitoring center.
CONSUMER HEALTH INFORMATICS
Consumer Health Informatics
• The area of health informatics that focuses on the
implementation and evaluation of system design to ensure that it
interacts directly with the consumer, with or without the
involvement of healthcare providers.
• The analysis and modeling of consumer preferences and
information needs, the design of applications that support
consumers obtaining high-quality information, and the
development of a methodology that allows for the integration of
consumer needs in clinical information management
E-health
• The use of telecommunication platforms, mobile and ubiquitous
hardware and software and advanced information systems to
support and facilitate healthcare delivery and education
• Support patient empowerment – namely, the transition from a
passive role where the patient is the recipient of care service to
an active role where the patient is informed and involved in or
even leads the decision-making processes