ch 2 - hti

data

observations reflecting difference in the world

domain of computer scientists

data

domain of informaticians

information

information

processed data, data with meaning

clinical data warehouse (CDW)

helps convert medical info to knowledge

- collection of aggregated data
- meta data - data that describes data
- took power away to do analytics from day-to-day pt EHRs
- do a better job than EHRs of analyzing and reporting aggregate healthcare data

natural language processing (NLP)

the ability of a computer system to understand spoken human language
- developed to extract concepts from free text in EHRs or CDWS

knowledge

information justifiably believed to be true

primary data sources

patient (symptoms, reasons for seeking care) and health record (clinicians and other healthcare providers documenting)

secondary data sources

derived from the primary data sources
- registries, indices, databases

structured data

data that are organized and easily retrievable and interpreted by tradition databases and data models
- data that a computer system can act upon

unstructured data

data that doesn't have a predefined data model or are not stored in a traditional database structure
- free form, doesn't follow a structure
- narrative + free text notes
- 80% of the data in the EHRs

document

handwritten notes, hand signed patient consent forms

audio data

voice recordings, heart sounds

video data

ultrasound, cardiac catheterization exams

vector graph data

EKG, EEG, fetal signal tracings

i2b2 (integrating biology and the bedside)

popular CDW by harvard
- database consists of facts queried by users and dimensions that describe the facts
- data model is organized around facts rather than individual patients, as would be the case for an EHR

concept extraction

problem of identifying concepts within unstructured data

semantics

the meaning of a word, phrase sentence, or text
- makes health informatics difficult
- large semantic gap, "i feel sick" varies for each patient

we are data rich but

we are information poor but

true

there's a gap between healthcare data and information (semantic (meaning) gap)

data quality

the reliability and effectiveness of data for its intended uses in operations, decision making, and planning
- focuses on the usability of data

data accuracy

the extent to which the data are free of identifiable errors

data accessibility

the level of ease and efficiency at which data are legally obtainable, within a well protected and controlled environment

data comprehensiveness

the extent to which all required data within the entire scope are collected, documenting intended exclusions

data consistency

the extent to which the healthcare data are reliable, identical, and reproducible by different users across applications

data currency

the extent to which data are up-to-date; a datum value is up-to-date if it's current for a specific point in time, and it's outdated if it was current at a preceding time but incorrect later

data defintion

the specific meaning of a healthcare-related data element

data granularity

the level of detail at which the attributes and values of healthcare data are defined

data precision

the degree to which measures support their purpose, closeness of 2+ measures to each other

data relevancy

the extent to which healthcare-related data are useful for the purposes for which they were collected

data timeliness

the availability of up-to-date data within the useful, operative, or indicated time

data dictionary

a descriptive list of the names, definitions, and attributes of data elements to be collected in an EHR or information system

required fields

a data capture field in which data must be entered before the EHR of information system will allow the user to proceed

edit check

preprogrammed definition for a data field
help us with consistency and accuracy, if illogical data/format entered, wouldn't allow you to advance forward

data integrity

can be used to describe a state, a process or function
- goes beyond quality, about the trustworthiness of the data

data integrity is a...

process - verifies that data has remained unaltered
measure - of the validity and fidelity
function - maintains info exactly as entered

amendments

changing previously established information
- as soon as the information is amended, you have to leave a note so other members of the care team can see the consistency

integrity and authorship

- clinical signature signifies authorship
- authorship identifies origin of creation and info to a specific individual
- EHR needs to allow multiple clinicians to document and sign to verify actual services provided

copying and pasting

- some EHR systems are designed to facilitating cloning using smart phrases
- can create redundancy
- can result in inaccurate info in the EHR

smart phrases

you can build your words and the system plans out what's next

dictation errors

-important that information is accurate
- organizations need processes to ensure providers review, edit, and approve dictated information in a timely manner

patient matching

- documentation integrity is at risk when wrong info is document on wrong PHR

receiving complaints

frequent complaints about issues with specific data entry formats, or for specific data elements, should be investigated

observing use

watching the use of a new system, new users or when workaround are suspected

auditing

evaluate potential issues

evaluating output

evaluates quality of the output of a process to identify issues that may reveal data entry problems

key to sharing data

data quality, integrity and provenance

- policies and procedures are critical

data provenance

a type of administrative data that represents the historical record of data and its origins, including where the data originated and where data may have moved between databases

who owns your health data?

- patient owns their information
- patient has the right to access that information
- provider is the custodian of the healthcare record, they're responsible for it
- HCP can only use information with patient's permission