HEALTH INFORMATION TECHNOLOGY

I. Electronic Health Record (EHR)- is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations. EHRs may include a range of data, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age and weight, and billing information. Implementation, end user and patient considerations 1. 2. 3. 4. 5. Quality Costs Software quality and usability deficiencies Unintended consequences Privacy and confidentiality

Meaningful use: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Use computerized order entry for medication orders. Implement drug-drug, drug-allergy checks. Generate and transmit permissible prescriptions electronically. Record demographics. Maintain an up-to-date problem list of current and active diagnoses. Maintain active medication list. Maintain active medication allergy list. Record and chart changes in vital signs. Record smoking status for patients 13 years old or older. Implement one clinical decision support rule. Report ambulatory quality measures to CMS or the States. Provide patients with an electronic copy of their health information upon request. Provide clinical summaries to patients for each office visit. Capability to exchange key clinical information electronically among providers and patient authorized entities. 15. Protect electronic health information (privacy & security) http://en.wikipedia.org/wiki/Electronic_health_record#Implementation.2C_end_user_and_patient_considerations II. Computerized physician order entry (CPOE)- (also sometimes referred to as Computerized Provider Order Entry) is a process of electronic entry of medical practitioner instructions for the treatment of patients (particularly hospitalized patients) under his or her care. These orders are communicated over a computer network to the medical staff or to the departments (pharmacy, laboratory, or radiology) responsible for fulfilling the order.CPOE decreases delay in order completion, reduces errors related to handwriting or transcription, allows order entry at point-of-care or off-site, provides error-checking for duplicate or incorrect doses or tests, and simplifies inventory and posting of charges. Features of CPOE systems 1. Ordering Physician orders are standardized across the organization, yet may be individualized for each doctor or specialty by using order sets. Orders are communicated to all departments and involved caregivers, improving response time and avoiding scheduling problems and conflict with existing orders. 2. Patient-centered decision support The ordering process includes a display of the patient's medical history and current results and evidencebased clinical guidelines to support treatment decisions. Often uses medical logic module and/or Arden syntax to facilitate fully integrated Clinical Decision Support Systems (CDSS). 3. Patient safety features

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The CPOE system allows real-time patient identification, drug dose recommendations, adverse drug reaction reviews, and checks on allergies and test or treatment conflicts. Physicians and nurses can review orders immediately for confirmation. Intuitive Human interface The order entry workflow corresponds to familiar "paper-based" ordering to allow efficient use by new or infrequent users. Regulatory compliance and security Access is secure, and a permanent record is created, with electronic signature. Portability The system accepts and manages orders for all departments at the point-of-care, from any location in the health system (physician's office, hospital or home) through a variety of devices, including wireless PCs and tablet computers. Management The system delivers statistical reports online so that managers can analyze patient census and make changes in staffing, replace inventory and audit utilization and productivity throughout the organization. Data is collected for training, planning, and root cause analysis for patient safety events. Billing Documentation is improved by linking diagnoses (ICD-9-CM or ICD-10-CM codes) to orders at the time of order entry to support appropriate charges.

Patient safety benefits of CPOE In the past, physicians have traditionally hand-written or verbally communicated orders for patient care, which are then transcribed by various individuals (such as unit clerks, nurses, and ancillary staff) before being carried out. Handwritten reports or notes, manual order entry, non-standard abbreviations and poor legibility lead to errors and injuries to patients, according to a 1999 Institute of Medicine (IOM) report. A follow up IOM report in 2001 advised use of electronic medication ordering, with computer- and internet-based information systems to support clinical decisions. Prescribing errors are the largest identified source of preventable hospital medical error. A 2006 report by the Institute of Medicine estimated that a hospitalized patient is exposed to a medication error each day of his or her stay. Studies of computerized physician order entry (CPOE) has yielded evidence that suggests the medication error rate can be reduced by 80%, and errors that have potential for serious harm or death for patients can be reduced by 55%, and other studies have also suggested benefits. Further, in 2005, CMS and CDC released a report that showed only 41 percent of prophylactic antibacterials were correctly stopped within 24 hours of completed surgery. The researchers conducted an analysis over an eight-month period, implementing a CPOE system designed to stop the administration of prophylactic antibacterials. Results showed CPOE significantly improved timely discontinuation of antibacterials from 38.8 percent of surgeries to 55.7 percent in the intervention hospital. CPOE/e-Prescribing systems can provide automatic dosing alerts (for example, letting the user know that the dose is too high and thus dangerous) and interaction checking (for example, telling the user that 2 medicines ordered taken together can cause health problems). In this way, specialists in pharmacy informatics work with the medical and nursing staffs at hospitals to improve the safety and effectiveness of medication use by utilizing CPOE systems. Risks of CPOE CPOE presents several possible dangers by introducing new types of errors. Prescriber and staff inexperience may cause slower entry of orders at first, use more staff time, and is slower than person-to-person communication in an emergency situation. Physician to nurse communication can worsen if each group works alone at their workstations. Automation causes a false sense of security, a misconception that when technology suggests a course of action, errors are avoided. These factors contributed to an increased mortality rate in the Children's Hospital of Pittsburgh's Pediatric ICU when a CPOE systems was introduced. In other settings, shortcut or default selections can override non-standard medication regimens for elderly or underweight patients, resulting in toxic doses. Frequent alerts and warnings can interrupt work flow, causing these messages to be ignored or overridden due to alert fatigue. CPOE and automated drug dispensing was identified as a cause of error by 84% of over 500 health care facilities participating in a surveillance system by the United States Pharmacopoeia. Introducing CPOE to a complex medical environment requires ongoing changes in design to cope with unique patients and care settings, close supervision of overrides caused by automatic systems, and training, testing and re-training all users. http://en.wikipedia.org/wiki/Computerized_physician_order_entry#Features_of_CPOE_systems

III.

Clinical Decision Support System (CDSS)- is a type of expert system (also commonly referred to as a knowledge-based system) used within a clinical setting to support clinical processes. CDSSs are the result

of the research of those within both the medical and computer science fields who had wished to develop artificially intelligent (AI) computer systems that would revolutionize healthcare. Clinical Decision Support Systems are often used with Computerized Physician Order Entry (CPOE) functions in hospitals. Examples: Name DXplain GRIP POEMS Description Internal Medicine Expert System Glucose Regulation for Intensive Care Patients Post-operative Expert Medical System

VisualDX Image-based Clinical Diagnosis Support TheraDoc Expert System Platform

The main purpose of modern CDSS is to assist clinicians at the point of care. This means that a clinician would interact with a CDSS to help determine diagnosis, analysis, etc. of patient data. Previous theories of CDSS were to use the CDSS to literally make decisions for the clinician. The clinician would input the information and wait for the CDSS to output the right choice and the clinician would simply act on that output. The new methodology of using CDSS to assist forces the clinician to interact with the CDSS utilizing both the clinicians knowledge and the CDSS to make a better analysis of the patients data than either human or CDSS could make on their own. Typically the CDSS would make suggestions of outputs or a set of outputs for the clinician to look through and the clinician officially picks useful information and removes erroneous CDSS suggestions. There are two main types of CDSS: Knowledge-Based NonKnowledge-Based

An example of how a CDSS might be used by a clinician comes from the subset of CDSS, DDSS (Diagnosis Decision Support Systems). A DDSS would take the patients data and propose a set of appropriate diagnoses. The doctor then takes the output of the DDSS and figures out which diagnoses are relevant and which are not. Another important classification of a CDSS is based on the timing of its use. Doctors use these systems at point of care to help them as they are dealing with a patient, with the timing of use as either prediagnoses, during diagnoses, or post diagnoses. Pre-diagnoses CDSS systems are used to help the physician prepare the diagnoses. CDSS used during diagnoses help review and filter the physicians preliminary diagnostic choices to improve their final results. And post-diagnoses CDSS systems are used to mine data to derive connections between patients and their past medical history and clinical research to predict future events. http://en.wikipedia.org/wiki/Clinical_decision_support_system IV. Picture archiving and communication system (PACS)- is a medical imaging technology which provides economical storage of, and convenient access to, images from multiple modalities (source machine types). Electronic images and reports are transmitted digitally via PACS; this eliminates the need to manually file, retrieve, or transport film jackets. The universal format for PACS image storage and transfer is DICOM (Digital Imaging and Communications in Medicine). Non-image data, such as scanned documents, may be incorporated using consumer industry standard formats like PDF (Portable Document Format), once encapsulated in DICOM. A PACS consists of four major components: The imaging modalities such as X-ray computed tomography (CT) and magnetic resonance imaging (MRI), a secured network for the transmission of patient information, workstations for interpreting and reviewing images, and archives for the storage and retrieval of images and reports. Combined with available and emerging web technology, PACS has the ability to deliver timely and efficient access to images, interpretations, and related data. PACS breaks down the physical and time barriers associated with traditional film-based image retrieval, distribution, and display.

 Types of images Most PACSs handle images from various medical imaging instruments, including ultrasound (US), magnetic resonance (MR), positron emission tomography (PET), computed tomography (CT), endoscopy (ENDO), mammograms (MG), Digital radiography (DR), computed radiography (CR) ophthalmology, etc. Additional types of image formats are always being added. Clinical areas beyond radiology; cardiology, oncology, gastroenterology and even the laboratory are creating medical images that can be incorporated into PACS. Uses PACS has four main uses: Hard copy replacement: PACS replaces hard-copy based means of managing medical images, such as film archives. With the decreasing price of digital storage, PACSs provide a growing cost and space advantage over film archives in addition to the instant access to prior images at the same institution. Digital copies are referred to as Soft-copy. Remote access: It expands on the possibilities of conventional systems by providing capabilities of off-site viewing and reporting (distance education, telediagnosis). It enables practitioners in different physical locations to access the same information simultaneously for teleradiology. Electronic image integration platform: PACS provides the electronic platform for radiology images interfacing with other medical automation systems such as Hospital Information System (HIS), Electronic Medical Record (EMR), Practice Management Software, and Radiology Information System (RIS). Radiology Workflow Management: PACS is used by radiology personnel to manage the workflow of patient exams.

PACS is offered by virtually all the major medical imaging equipment manufacturers, medical IT companies and many independent software companies. Basic PACS software can be found free on the Internet. http://en.wikipedia.org/wiki/Picture_archiving_and_communication_system V. A barcode system- is a network of hardware and software, consisting primarily of mobile computers, printers, handheld scanners, infrastructure, and supporting software. Barcode systems are used to automate data collection where hand recording is neither timely or cost effective. Barcoding systems are not radio-frequency identification (RFID) systems even though the companies that provide barcode equipment will often also provide RFID equipment and many companies use both technologies as part of larger resource management systems.

Hardware There is a wide range of hardware that is manufactured today for use in Barcode Systems. The best known brand of handheld scanners and mobile computers is Symbol, which is now a division of Motorola. Other manufacturers include Intermec, HHP (Hand Held Products), Microscan Systems, Unitech, Metrologic, PSC and PANMOBIL. Software While there is a range of hardware on the market, software is more difficult to find from the hardware manufacturers. Some ERP, MRP, and other inventory management software have built in support for barcode reading and some even allow the software to run directly on a mobile computer. Besides full management software, there are more than a few software development kits on the market that allow the developer to easily produce custom mobile interfaces and that handle the connect to the database. One such software is RFgen another is PeopleVox. Then there is always the option of developing a custom software solution, using a language such as C++, C#, Java, Visual Basic.NET, and many others. Often developing a custom interface using software such as RFgen or developing new, personalized software is the most effective method since it allows the individual to have a solution that is fitted to their exact needs.

 Typical Systems A typical barcode system consist of some infrastructure, either wired or wireless that connects some number of mobile computers, handheld scanners, and printers to one or many databases that store and analyze the data collected by the system. At some level there must be some software to manage the system. The software may be as simple as code that manages the connection between the hardware and the database or as complex as an ERP, MRP, or some other inventory management software. Simple example Assume ABC Inc. manufactures widgets and they want to offer online shopping for their customers and they only want their customers to order widgets they have in stock. ABC already uses an ERP system to help manage their inventory and day-to-day operations at their manufacturing plant but for information to get into the ERP database an employee must enter the data manually using a desktop computer terminal. This method does not work well with ABC's plans because the inventory data is nowhere close to real time; in fact in most cases it is at least 24 hours old and sometimes as much as a week old if the data entry person is on vacation. A solution to ABC's problem may be the installation of a barcode system. By installing a barcode system to help track inventory in real time ABC would be able to offer their customers online ordering and the customers could see which widgets were available and could in turn only be allowed to place orders for those widgets which were in stock. To install this barcode system ABC would need to first install a wireless network to cover most if not all of their manufacturing plant and warehouse, unless they planned on using wired barcode scanners. For this example, assume ABC chose to go with wireless scanners that communicate on a IEEE 802.11g frequency because ABC does not want their employees to be restricted to the limited range of wired scanners. Next ABC would need to either purchase an out of the box software package or have custom software developed to allow the hardware of the barcode system to communicate with their current ERP system. This is assuming ABC's ERP system does not have the ability to directly communicate with the wireless devices. Assume that the out of the box software vendor or the software developer whichever is chosen will take care of the setup and testing of the software. We are assuming this because the development and/or setup of this software is usually rather complicated and also because the process is different for almost all types of software. Next ABC will have to purchase and set up the hardware (scanners, printers, etc.) that the employees will use on a daily basis to help track ABC's inventory in real time. After the wireless network is set up and the software and hardware is in place ABC will have to start labeling its products with labels containing bar-coded information so the labels can be read by the new barcode system. The final step for ABC is to train its employees on the procedures of use for the barcode system. http://en.wikipedia.org/wiki/Barcode_system VI. Radio-frequency identification (RFID)- is the use of a wireless non-contact system that uses radiofrequency electromagnetic fields to transfer data from a tag attached to an object, for the purposes of automatic identification and tracking. Some tags require no battery and are powered by the electromagnetic fields used to read them. Others use a local power source and emit radio waves (electromagnetic radiation at radio frequencies). The tag contains electronically stored information which can be read from up to several metres (yards) away. Unlike a bar code, the tag does not need to be within line of sight of the reader and may be embedded in the tracked object.

RFID tags are used in many industries. An RFID tag attached to an automobile during production can be used to track its progress through the assembly line. Pharmaceuticals can be tracked through warehouses. Livestock and pets may have tags injected, allowing positive identification of the animal. RFID identity cards can give employees access to locked areas of a building, and RF transponders mounted in automobiles can be used to bill motorists for access to toll roads or parking. Since RFID tags can be attached to clothing, possessions, or even implanted within people, the possibility of reading personally-linked information without consent has raised privacy concerns. Applications The RFID tag can be affixed to an object and used to track and manage inventory, assets, people, etc. For example, it can be affixed to cars, computer equipment, books, mobile phones, etc. In social media, RFID is being used to tie the physical world with the virtual world. RFID in Social Media first came to light in 2010 with Facebook's annual conference.

RFID offers advantages over manual systems or use of bar codes. The tag can be read if passed near a reader, even if it is covered by the object or not visible. The tag can be read inside a case, carton, box or other container, and unlike barcodes RFID tags can be read hundreds at a time. Bar codes can only be read one at a time. In 2011, the cost of passive tags started at US$0.05 each; special tags, meant to be mounted on metal or withstand gamma sterilization, can go up to US$5. Active tags for tracking containers, medical assets, or monitoring environmental conditions in data centers start at US$50 and can go up over US$100 each. Battery Assisted Passive (BAP) tags are in the US$310 range and also have sensor capability like temperature and humidity. RFID can be used in a variety of applications,
[2][3]

such as:

Access management Tracking of goods Tracking of persons and animals Toll collection and contactless payment Machine readable travel documents Smartdust (for massively distributed sensor networks) Tracking sports memorabilia to verify authenticity [4] Airport baggage tracking logistics

Current uses Hospitals and healthcare

Adoption of RFID in the medical industry has been widespread and very effective. Hospitals are among the first users to combine both active and passive RFID technology. Many successful deployments in the healthcare industry have been cited where active technology tracks high-value, or frequently moved items, where passive technology tracks smaller, lower cost items that only need room-level identification. The trend is toward using ISO 18000-6c as the tag of choice and combining an active tagging system that relies on existing 802.11X wireless infrastructure for active tags. Since 2004 a number of U.S. hospitals have begun implanting patients with RFID tags and using RFID systems, [47] usually for workflow and inventory management. The use of RFID to prevent mixups between sperm and ova in [48] IVF clinics is also being considered. In October 2004, the FDA approved USA's first RFID chips that can be implanted in humans. The 134 kHz RFID chips, from VeriChip Corp. can incorporate personal medical information and could save lives and limit injuries from errors in medical treatments, according to the company. Anti-RFID activists Katherine Albrecht and Liz [49] McIntyre discovered an FDA Warning Letter that spelled out health risks. According to the FDA, these include "adverse tissue reaction", "migration of the implanted transponder", "failure of implanted transponder", "electrical hazards" and "magnetic resonance imaging [MRI] incompatibility." http://en.wikipedia.org/wiki/Radio-frequency_identification

VII.

Automatic dispensing machines (ADM) or (automated drug cabinets) are a computerized drug storage and dispensing device used in the health care settings like hospitals and nursing homes, and are located at the point of care (the ward, ICU, ED) rather than in the central pharmacy. Advantages

ADM have several major advantages over traditional pharmacy delivery systems. First, the most commonly needed pharmaceuticals are already present at the point of care and do not need to be sent or transported from main pharmacy stores, a time and labor intensive process. This can save considerable time in the daily workflow of nurses. Second, controlled substances remain in a secure lockbox until needed and access to the vault is secured by multi-factor authentication and audit trails to prevent waste and drug diversion. Third, patient charges and inventory control tasks are simplified in an automated dispensing system and "lost charges" are much reduced. Finally, the ADM can provide clinical decision support to improve patient safety---providing drug-allergy alerts, drug-drug interactions, advise on high risk medication (heparin, insulin) and avoid confusion with "sound alike" medications.

 Disadvantages The ADM does not prevent all drug dispensing and administration errors, and is not a panacea for ending all adverse drug administration errors. Precise adherence to standard protocols for administering medication must be followed by clinical personnel and are the final fail safe for preventing errors. Pharmacy can still stock the wrong medication in a given drug cabinet, and a clinician can still pick a "look-alike" medication from an adjacent drug drawer. In addition, the ADM should ideally be used as part of an eMAR system using barcodes on both the medication and the actual patient bracelet to insure the right patient is getting the right medication. In addition, the ADM is an electronic device, takes some time to access and dispense medication, and could malfunction at a critical time in a patient's care; for this reason, a separate supply of most resuscitation/critical care drugs ( e.g. epinephrine, atropine) are kept in traditional resuscitation kits (code carts) for immediate use during an emergency. Future Uses Automatic dispensing devices, in simplified format, are already being used in the home environment to assist in the correct administration of complicated medical regimens to elderly patients and those with memory impairments. This may improve compliance and safety in this population at high risk for medication errors. As clinical decision support improves, ADM will become more sophisticated and provide more useful assistance to patients and clinicians alike. http://en.wikipedia.org/wiki/Automated_dispensing_cabinet

VIII.

Electronic Materials Management (EMM) Electronic Materials Management can be defined as - the electronic management and control of goods from acquisition to delivery at point of use. EMM is a system which we developed with our customers and introduced into wards/departments to make best use of space and simplify and automate re-ordering of goods by product bar-coding scanning. EMM utilizes a two bin system to control stock and simplify replenishment with Procurement and Logistics Service staff ordering goods on behalf of nursing staff thus reducing their time to nurse patients.

Benefits of EMM? To our customers Better use of limited storage space Ensures stock rotation which helps minimize wastage due to out of date products Paperless ordering Shorter lead time from order to delivery of goods Automatic authorisation due to pre-agreed re-orders quantity levels Product bar-code labelling removes the possibility of ordering the wrong items Less money tied up stock held at department/ward level Releasing nurses time to nurse

(Procurement and Logistics Service) Smoother product demand patterns which helps stock holding quantities and improve service levels Less returns to store for product incorrectly ordered No time required checking requisitions for approval and product code queries

http://www.hscbusiness.hscni.net/services/2229.htm

IX.

Interoperability -is the ability of diverse systems and organizations to work together (inter-operate). The term is often used in a technical systems engineering sense, or alternatively in a broad sense, taking into account social, political, and organizational factors that impact system to system performance.

While interoperability was initially defined for IT systems or services and only allows for information to be exchanged (see definition below), a more generic definition could be this one: Interoperability is a property of a product or system, whose interfaces are completely understood, to work with other products or systems, present or future, without any restricted access or implementation. This generalized definition can then be used on any system, not only information technology system. It defines several criteria that can be used to discriminate between systems that are "really" inter-operable and systems that are sold as such but are not because they don't respect one of the aforementioned criteria, namely: non-disclosure of one or several interfaces implementation or access restriction built in the product/system/service

The IEEE Glossary defines interoperability as: the ability of two or more systems or components to exchange information and to use the information that has . been exchanged James A. O'Brien and George M. Marakas define interoperability as: Being able to accomplish end-user applications using different types of computer systems, operating systems, and application software, interconnected by different types of local and wide area networks. Medical industry New technologies are being introduced in hospitals and labs at an ever-increasing rate, and many of these innovations have the potential to interact synergistically if they can be integrated effectively. The need for plugand-play interoperability the ability to take a medical device out of its box and easily make it work with ones other devices has attracted great attention from both healthcare providers and industry. Interoperability helps patients get the most out of technology, and it also encourages innovation in the industrial sphere. When different products can be combined without complicated and expensive interfaces, small companies can enter a field and make specialized products. Without interoperability, hospitals are forced to turn to large vendors that provide suites of compatible devices but that do not specialize in any one area. Interoperability promotes competition, and competition encourages innovation and quality. From the perspective of Intel, a major producer of consumer healthcare devices, there are six major factors that affect an industrys ability to achieve interoperability. First there needs to be a demand for interoperable products. Second, there must be standards, or rules, defining what interoperability means in the field. Third, business conditions must encourage manufacturers to make their products interoperable. Fourth, guidelines must exist that make the often-complicated standards easier for companies to interpret. Fifth, compliance must be verified by independent testing; and finally, interoperability must be actively promoted. The rapid rise of wireless technology illustrates that interoperability is attainable. Conditions in the biomedical industry are still in the process of becoming conducive to the development of interoperable systems. A potential market of interested hospitals exists, and standards for interoperability are being developed. Nevertheless, it seems that current business conditions do not encourage manufacturers to pursue interoperability. Only sixteen to twenty percent of hospitals, for example, use electronic medical records (EMR). With such a low rate of EMR adoption, most manufacturers can get away with not investing in interoperability. In fact, not pursuing interoperability allows some of them to tout the inter-compatibility of their own products while excluding competitors. By promoting EMR adoption, companies such as Intel hope to create an environment in which hospitals will have the collective leverage to demand interoperable products. http://en.wikipedia.org/wiki/Interoperability