Medical Imaging Informatics

wtf topic

Health Informatics

Study of the “acquisition, storage, retrieval, and use of health care information and resources for the purpose of optimizing patient care”

Health Informatics

Began in the 1950s

D A T A

• Base of hierarchy for understanding informatics

• Represents observations or symbols of differences in nature

• Ex. One number does not have meaning on its own, its just one piece of data
  

I N F O R M A T I O N

• Assigns meaning to data

• Ex. four tires on a car

K N O W L E D G E

• Information that can be justified as being correct or true

• Ex. Three tires on a car suggest a car will not roll evenly

W I S D O M

• The use of knowledge (critical thinking) to make sound, intelligent decisions

• Ex. A car with three tires could be dangerous to drive

Data, Information, Knowledge, Wisdom (DIKW) Hierarchy

Followed by computer software so that wisdom can be gained through the computation of data, information & knowledge

Information Technology

Study of the collection and distribution of information through computers

Level 1 of Data in Medicine

Nonelectric data such as paper forms & handwritten notes

Level 2 of Data in Medicine

Unstructured, viewable electronic data (paper forms that have been scanned into computer)

Level 3 of Data in Medicine

Structured, viewable electronic data electronically entered that cannot be computed by other computers

Level 4 of Data in Medicine

Computable electronic data that can be computed by other computers

GAO

Government Accounting Office

Healthcare relies on Level 4 data

All health information on any patient must be available to caregivers who rely on basic demographics such as name, age, gender, race, and health information such as allergies, existing conditions, history, medication and treatment, etc.

H I P A A (Health Insurance Portability & Accountability Act of 1996)

A legislation providing data privacy & security for medical information (accountability)

H I P A A

Ensures individuals are able to maintain health insurance between jobs (portability)

H I T E C H (Health Information Technology for Economic & Clinical Health Act)

Signed into law on February 17, 2009 as a part of American Recovery and Reinvestment (ARRA) Act of 2009

H I T E C H Act Goal

To promote the adoption & Meaningful Use (MU) of Health Information Technology (HIT)

H I T E C H Act Subtitle A

• Promotion of Health Information

1. Part 1: Improving Healthcare Quality, Safety and Efficiency

2. Part 2: Application and Use of Adopted Health Information Technology Standards; Reports

H I T E C H Act Subtitle B

• Testing of Health Information Technology

H I T E C H Act Subtitle C

• Grants and Loans Funding

H I T E C H Act Subtitle D

• Privacy Part 1

1. Part 1: Improved Privacy Provisions and Security Provisions

2. Part 2: Relationship to Other Laws; Regulatory References; Effective Date; Reports

H I T E C H Act Function

Addresses privacy & security concerns associated with the electronic transmission of health information, partially through provisions that strengthen civil & criminal enforcement of HIPAA rules

H I T E C H Act Primary Purpose

Created primarily to push the adoption of the Electronic Health Record (EHR) & supporting technology

Meaningful Use (MU)

A Medicare program that rewards the use of certified EHRs to improve patient care

Meaningful Use (MU) Reimbursement

Providers who follow the guidelines receive increased Medicare reimbursements, increasing profit

Meaningful Use (MU) Penalties

The guidelines include specific objectives that must be met, if not, the provider will be fined

Meaningful Use (MU) Implementation

Implemented in a phased approach over a series of 3 stages

Stage 1 of Meaningful Use

Promotes basic EHR adoption and data gathering

Stage 2 of Meaningful Use

Emphasizes care coordination and exchange of patient information

Stage 3 of Meaningful Use

Improves healthcare outcomes

Benefit 1 of Informatics

Information is stored in such a way that it can be almost indestructible and can be retrieved over and over again without information loss

Benefit 2 of Informatics

Allows a number of key people to access information from anywhere, anytime, so that vital information is available when needed

Benefit 3 of Informatics

Allows patients some access to their health record with the ability to contact physician offices online for prescriptions, appointments, lab results, etc.

Benefit 4 of Informatics

Patient data can also be shared with disease registries such as the Centers for Disease Control and Preventions (CDC), public health reporting, or from a general practitioner physician to a specialist

Benefit 5 of Informatics

Has led to portable sharing of information, which in turn has reduced the possibility of redundant lab and X-ray testing and has increased consistency in treatment

Barrier 1 to Informatics

Physicians & other clinicians complain there is inadequate time to read, research, or learn new technologies and must rely on IT experts

Barrier 2 to Informatics

There may be plenty of data but not enough information available to health professionals

Barrier 3 to Informatics

Lack of health informatics experts to train and teach those who could best use data to provide more, deeper information

Barrier 4 to Informatics

Cost of technology, because many software program developers and vendors sell basic programs requiring expensive upgrades for add-on programming

Barrier 5 to Informatics

Lack of data sharing standards across the nation

Barrier 6 to Informatics

Changes in workflow, transition from traditional to digital imaging

Barrier 7 to Informatics

Resistance to newer technology by older users may be problematic

Barrier 8 to Informatics

Privacy, becomes more concerning as computer hacking & privacy breaches become more common

H I P A A Update

HIPAA of 1996 was updated in 2013, undergoes smaller changes every year to better address access and privacy violations

HIPAA Privacy Rule and Security Rule

Enacted in 2003

HIPAA Enforcement Rule

Enacted in 2006

HITECH Act Requirements

Incorporation into HIPAA occurred in 2009

HIPAA Omnibus Final Rule

Enacted in 2013

Informatics

More interested in information & knowledge where the focus is on manipulating digitized data

Information Technology

Deals mostly with data and focus on technology associated with the handling of data such as hardware, software, data algorithms, and the searching & sorting of data

INFORMATICS

Involves meaningful data (information) & the relationships between data (mortality & a certain drug)

IT/Computer Science Focus

Concerns isolated data

E H R (Electronic Health Records)

Also known as (three other names)

1. Computerized Medical Record (CMR)

2. Electronic Clinical Information System (ECIS)

3. Computerized Patient Record (CPR)

E H R Definition

A compilation of health-related information concerning one individual "that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization"

E H R Benefit

Removes some limitations of handwritten record such as readability, efficiency, productivity, quality of care, and patient safety

EHR Elimination of Issues

1. Interpreting multiple handwriting styles

2. Offers immediate availability of entered information

3. Easy navigation through the patient’s record

4. Needs no staff to pull the record

5. Reduces duplication of orders

6. Can provide reminders for tests or preventive services

E H R Elimination of Issues 1

Interpreting multiple handwriting styles

E H R Elimination of Issues 2

Offers immediate availability of entered information

E H R Elimination of Issues 3

Easy navigation through the patient’s record

E H R Elimination of Issues 4

Needs no staff to pull the record

E H R Elimination of Issues 5

Reduces duplication of orders

E H R Elimination of Issues 6

Can provide reminders for tests or preventive services

Major components of an EHR

1. Clinical Decision Support System (CDSS)

2. Patient List & Registries

3. Electronic Calculations

Clinical Decision Support System (CDSS)

Software designed to help clinicians make decisions by drawing from a large database to generate patient assessments

Example:
SOB with wheezing

CDSS databases provide extensive information on:

(PMPRDRLP)

1. Patient Tracking

2. Medications

3. Patient Order Protocols

4. Reminders

5. Differential Diagnoses

6. Radiology Exam

7. Laboratory Tests

8. Public Health Alerts

Patient List & Registries

CDSS tracking patient information

Particularly important for patients who have progressive diseases such as heart disease, cancer & diabetes

Patient List & Registries

Electronic Tracking of Vital Signs

Gives more accurate, consistent, comparative information

Electronic Calculations

Calculation of Potential Risks

Electronic Calculation Point 1 (Cardiovascular)

Cardiovascular Disease risk calculation using DEFINED PARAMETERS such as cholesterol, blood pressure, diabetes, smoking, & hypertension, is much faster using predefined calculator integrated into the EHR

Electronic Calculation Point 2 (Kidney Function)

Calculators are also available for determining creatinine clearance for kidney function before administering contrast media or medications harmful to compromised kidneys

Database for Electronic Calculations 1

Elder Risk Assessment (ERA)

Database for Electronic Calculations 2

Hierarchical Condition Category (HCC)

Patient Risk can be determined by entering

Diagnosis, Patient Age and Associated Risks

Data Entry Importance

It is critical that patient information is entered accurately every time

Disadvantage of an EHR

The reduction of one-on-one interactions

Disadvantage of an EHR

Often the caregiver does not look at the patient because much more time is spent looking at an input device

Physician-Patient Interaction Necessity

It is important to maintain eye contact with the patient so they are reassured their treatment and care is personal and valued

INFORMATICS

a field of study encompassing the gathering,

analysis, & distribution of data, information and knowledge

electronically

ELECTRONIC HEALTH RECORD

1, Contains information compiled from multiple clinical entry

areas (radiology, laboratory, respiratory care, physical

therapy)

2. From databases for determining diagnoses, testing, disease

comparison, medication

3. patient tracking, risk determination & treatment

Software Calculators

are available to determine patient risk for disease & medication compatibility

Patient Registries

are streamlining disease statistics & transplant protocols

Legislation such as HIPAA, ARRA, & HITECH

and programs such as MU

govern the appropriate application of electronic information in medicine.