Topic 1

Health Informatics Careers

 Chief Medical Information Officer

 Clinical Informatics Analysts
 Health Information Technology Project Managers
 Health Informatics Consultants
 Electronic Medical Record Keepers
 Informatics Nurses
Information Hierarchy
Data > Information > Knowledge > Wisdom
What Makes Informatics Difficult? (barriers, challenges)

 subjective factors
 difficult to model all of healthcare
 difficult due to incomplete, imprecise, vague, inconsistent and uncertain information
 Humans can adapt to this dynamic and vague information but computers can not
Why Health IT Fails Sometimes?

 Health IT is an attractive solution to our troubled healthcare system, but is it realistic?

 Other IT fields have experienced serious “ups and downs” such as artificial intelligence
 There is a large gap between healthcare data generated and information (semantic gap)
Five Vs:
Volume , Velocity, Variety, Veracity, Value
Driving Forces Behind Health Information Technology (why hit, benefits, advantages)

 Increase healthcare efficiency and productivity

 Improve healthcare quality (patient outcomes) resulting in improved patient safety
 Reduce healthcare costs
 Improve healthcare access with technologies such as telemedicine and online
scheduling
 Improve coordination and continuity of care
 Improve medical education of clinicians and patients
 Standardize medical care
 Reducing Errors
o Order entry systems
 Reduce medication errors
 Detect potential drug interactions
o Clinical decision support systems
 Improve drug dosing
 Improve preventive care
 Not diagnosis
Barriers to HIT Adopt (disadvantages, why not to, challenges)

 Inadequate time
 Inadequate time
 Inadequate expertise and workforce
 Inadequate cost and return on investment data
 High cost to adopt
 Change in workflow
 Privacy concerns
 Legal issues
 Behavioral change
Informatics Use in Healthcare

 Communication (Telemedicine, Tele-radiology , Patient e-mail ,Presentations)

 Knowledge management (Journals , Consumer Health information , Evidence-based
medical information)
 Decision Support (Reminder systems , Diagnostic Expert Systems , Drug Interaction)
 Information Management (Electronic Medical Records , Billing transactions ,Ordering
System)
Key Users of Health Information Systems
Patient , Provider , Purchaser , Payor , Public health
Categories of healthcare Information Systems

 Administrative Information System (or an administrative application)

o Admission, discharge, transfer (ADT)
o Registration
o Scheduling
o Patient billing or accounts receivable
o Utilization management
o Accounts payable
o General ledger
o Personnel management
o Materials management
o Payroll
o Staff scheduling
o Staff time and attendance
o Revenue cycle management
 Clinical Information System (or clinical application)
o Laboratory information
o Radiology information
o Pharmacy information
o Nursing documentation
o Electronic health record (EHR)
 o Computerized provider order entry (CPOE)
o Telemedicine and telehealth
o Rehabilitation service documentation
o Medication administration
o Monitoring

Advanced features of EHR systems

 Patient portals
 Electronic prescriptions
 Voice-to-text translation
 Reporting

Comparison / differences (EMR, HER, PHR)

EMR : healthcare facility has specific expertise

EHR: medical facility including numerous departments
PHR: healthcare organization puts patients first
Topic 2
Computer Types:

 Microcomputer
 Minicomputer
 Personal computer (PC) (Desktop)
 Supercomputer: mainframe enterprise level
 Laptop
 Server: robust in terms of speed and memory
 Mobile (smartphone ,tablet)

Conversion between bit & byte

RESTful Operations

Service Oriented Architecture (SOA) Web Services

 SOAP
 WSDL
 UDDI
The OSI Model Layers

 Application
 Presentation
 Session
 Transport
 Network
 Data link
 Physical
Topic 3
Why do we need EHRs? (benefits, advantages)

 Paper records are severely limited

 Need for improved efficiency and productivity
 Quality of care and patient safety
 Public expectations
 Governmental expectations
 Financial savings
 Technological advances
 Need for aggregated data
 Need for integrated data
 EHR as a transformational tool
 Need for coordinated care
EHR Key Components

 Clinical decision support

 Secure messaging
 Computerized physician order entry
 Practice management
 Results retrieval
 Remote access from home
 Electronic prescribing
 Integration with images
 Integration with physician and patient education
 Public health reporting
 Quality reports
 Patient reminders
 Preventive medicine tracking
 Privacy/security compliance
 Robust backup systems
 Manage care module
 Referral management
 Prior encounter retrieval
 Electronic encounter notes
 Multiple input methods
 Access via mobile technology
 Problem summary
 Ability to scan in data
 Evaluation and management help
 Ability to graph and track results
 Ability to create patient lists
 Ability to create registries
 Ability to generate summaries of care (CCD)
  Support for client server or application service provider (ASP) modes
Benefits of CPOE

 Overcomes the issue of illegibility

 Fewer errors associated with ordering drugs with similar names
 More easily integrated with decision support systems than paper
 Easily linked to drug-drug interaction warning
 More likely to identify the prescribing physician
 Able to link to adverse drug event (ADE) reporting systems
 Able to avoid medication errors like trailing zeroes
 Creates data that is available for analysis
 Can point out treatment and drugs of choice
 Can reduce under and overprescribing
 Prescriptions reach the pharmacy quicker
Tools to assist in decision making

 Knowledge support
 Calculators
 Flow charts and graphs
 Order sets
 Reminders
 Differential diagnosis
 Lab and Imaging decision support
 Public health alerts
eRx Benefits

 Legible and complete prescriptions

 Abbreviations+ unclear decimal points are avoided
 The wait to pick up scripts shorter
 Fewer duplicated prescriptions
 Better compliance with fewer drugs not filled or picked up
 Potential to reduce workload for pharmacists
 Timely notification of drug alerts and updates
 Ability to check formulary status and copays
 Can interface with practice and drug management software
 The process is secure and HIPAA compliant
 Associated with CDDSs
 Digital records improve data analysis of prescribing habits
 Batch refills can save time
 Better use of generic or preferred drugs
eRx Clinical Decision Support (related)

 Details about drug allergies

 Drug-drug interaction alerts
 Formulary alerts to tell you drug is either not recommended or not reimbursed
 Alerts can exist to ask about pregnancy, kidney or liver function and safety in the elderly
 Dosing alerts can arise based on age or size of patient
eRx Challenges (barriers, difficulties)

 Alert fatigue
 wrong drug or wrong dose
 issues at the pharmacist’s end
 Still not clear how many adverse drug events are prevented with eRx
EHR Challenges (barriers, difficulties)

 Financial
 Physician resistance
 Loss of productivity
EHR and Meaningful Use Challenges

 Workflow changes
 Reduced physician-patient interaction
 Usability issues
 Integration with other systems
 Lack of interoperability
 Privacy concerns
 Legal Inadequate proof of benefit
 Patient safety and unintended consequences
Clinicians had to: (according to HITECH ACT)
(1) be eligible
(2) register for reimbursement
(3) use a certified HER
(4) demonstrate and prove Meaningful Use
(5) receive reimbursement

Meaningful Use Goals (same as the national goals for HIT)

 improve quality, safety, efficiency and reduce health disparities
 engage patients and families
 improve care coordination
 ensure adequate privacy and security of personal health information
 improve population and public health

EHR Steps
 Develop an office strategy
 Do Research
 List features
 Analyze and re-engineer workflow
 Use project management tools
 Choose client versus ASP model
 Practice management system needs
 Survey your hardware and network needs
 Develop a vendor strategy
 Select a vendor
 Develop a paper to EHR conversion strategy
 Training
 Implementation
Topic 4
** Levels of interoperability
• Level 1 – no interoperability
• Level 2 – machine-transportable (structural)
• Level 3 – machine-organizable (syntactic)
• Level 4 – machine-interpretable (semantic)
Types of Standards
• Identifier standards
o Patient Identifiers
o Other Identifiers (National Provider Identifier (NPI), Employer Identifier Number
(EIN))
• Transaction standards
• Messaging standards
• Imaging standards
• Terminology standards
Patient identifier key attributes
• Unique – only one person has an identifier
• Non-disclosing – discloses no personal information
• Permanent – will never be re-used
• Ubiquitous – everyone has one
• Canonical – each person has only one
• Invariable – will not change over time
Major transactions in 5010 (ASC X12)
• Health claims and equivalent encounter information
• Enrollment and disenrollment in a health plan
• Eligibility for a health plan
• Health care payment and remittance advice
• Health plan premium payments
• Health claim status
Elements of the message (Messaging Standards)
• Entity – things in world
• Role – capability or capacity
• Participation – role in context of an act
• Act – clinical or administrative definitions
• Act relationship – links between acts
Types of resources in FHIR
• Clinical: The content of a clinical record
• Identification: Supporting entities involved in the care process
• Workflow: Manage the healthcare process
 • Financial: Resources that support the billing and payment parts of FHIR
• Conformance: Resources use to manage specification, development and testing of FHIR
solutions
• Infrastructure: General functionality, and resources for internal FHIR requirements
** Interoperability Levels

 Foundational
 Syntactic
 Semantic
Shared Healthcare Data

 Clinical results
 Images
 Documents
 Clinical summaries
 Financial information
 Medication data
 Performance data
 Case management
 Public health data
 Referral management
HIO Functions

 Results delivery
 Quality reporting
 Connectivity with EHRs Results distribution
 Clinical documentation
 Electronic health record (EHR) hosting
 Alerts to clinicians
 Assist data loads into EHRs
 Electronic prescribing
 EHR interfaces
 Health summaries
 Drug-drug alerts
 Electronic referral processing
 Drug-allergy alerts Consultation/referrals
 Drug-food allergy alerts Credentialing Billing
HIO Facts
• Can be centralized or decentralized (federated)
• Can be for profit or not-for-profit
• Can be government, private or community based
HIE Barriers

 Lack of successful business models

 Environment is highly competitive
 Federal support monies are gone
 HIOs seem to work better in high population areas
 Return on investment (ROI) is unclear
 Proof of benefit is weak
 Privacy/Security issues
Newer HIE Models
• FHIR
• Blockchain
• OpenHIE
• EHR Vendor-based HIE