HAN 364 Final Study Guide: EHR, Telehealth, Privacy, and Informatics

Request for Proposal (RFP)

Formal detailed document that should include information about organization, requirements for proposed system, request for information from vendor, including company profile, sample contracts, system testing and training requirements, and process for evaluating responses.

Request for Information (RFI)

May start with a Request for Information to obtain basic information about products and narrow to whom RFP is sent.

Key Components of Security Design

Access Controls, Device Security, Software Updates, Cloud or Local, Antivirus/Firewalls, Security Training for Staff, Threat Detection/Awareness, How to Handle Breaches, Regulatory Compliance.

Unit Testing

Directed at EHR modules or subunits.

Integration Testing

Information flow between the EHR and external systems such as lab.

Regression Testing

Fixing one thing that didn't break another.

Performance Testing

Speed is within expected boundaries.

Hardware, Software, and Interface Testing

Testing of the hardware, software, and interfaces involved.

Application-Meets-Requirements Testing

All subunits working together.

Volume Testing

Many numbers & types of users.

'At the Elbow' User Support

Someone physically nearby to help.

SuperUsers & Clinical Champions

People from a clinical unit given more training and charged with helping colleagues through the transition.

Parallel Go-Live Model

Keep new and old systems running; very expensive.

Phased Go-Live Model

Add modules sequentially across organization.

Pilot Go-Live Model

Install full system in one unit at a time; may overlap.

Big Bang Go-Live Model

All at once; has risks but has been used successfully with proper planning.

Post-Implementation Considerations

How is it working? Did it cause other issues? Is the workflow being followed? What happens in a downtime situation? Any metrics being tracked? Collect Feedback from Users? Define Check Points? Lessons Learned and Handoff?

Reasons Telemedicine has become popular

Rising cost of healthcare worldwide, shortages of specialists in rural areas, rise in chronic disease, improved collaboration among physicians, raising patient satisfaction.

Store-and-Forward Transmission Mode

Images/videos saved and sent later; asynchronous communication.

Real-Time Transmission Mode

A specialist views video images transmitted from a remote site and discusses the case with another physician.

Remote Monitoring

Monitor patients at home or in nursing homes; usually part of disease management.

Goal of Teleconsultations

Improving access to services in rural/underserved areas.

Teleradiology

Radiologists can be home at night, read an image, dictate a report via voice recognition and host it all in the cloud for others to view.

Teleneurology

Remote neurologist can read the CAT scan of the brain and see the neurological exam being conducted on the patient.

Telemental Health/Telepsychiatry

Remote/virtual sessions with therapists/psychiatrists.

Teledermatology

Practical as images of skin conditions are diagnostic.

Teleophthalmology

Practical as retinal images can now be obtained without pupil dilation.

Barriers to Telemedicine

Limited reimbursement, limited research showing reasonable benefit, high initial cost, limited availability of high speed telecommunications, bandwidth issues, need for high resolution images, licensure laws, lack of standards, fear of malpractice, ethical and legal challenges.

Telemedicine & COVID-19

CMS allowed telemedicine for all Medicare visits, rapid update/increase of patients, improved communications with some patients.

Three Pillars of Data Security

Confidentiality, Availability, Integrity.

Administrative Safeguards of HIPAA

Security management processes, security personnel, information access management, workforce training, background checks, evaluation of security policies.

Physical Safeguards of HIPAA

Limit physical access to facilities, workstation and device security policies.

Technical Safeguards of HIPAA

Access control, audit controls, integrity controls, transmission security, unique usernames and passwords.

Consumer Rights under HIPAA

Ask to see and get a copy of their health records

Organizations That Do Not Need to follow HIPAA Privacy Rule

Life insurers

Threat Actors

Insiders, Hackivists, Organized Crime, Nation States

Social Engineering

Phishing: attackers deceive people into revealing sensitive information or installing malware (via email or text messaging)

Denial of Service (DOS)

Website is flooded with traffic, shutting it down

Brute Force

Random credentials are rapidly thrown at website hoping to gain access

Doxing

Gathers info about a victim and publishes that to harass or embarrass the individual

Clinical Research Informatics (CRI)

Application of informatics principles and techniques to support the spectrum of activities and business processes that instantiate clinical research

Challenges in Clinical Research Informatics

Patient Matching & Recruitment

US Common Rules

Guide the protection of research subject

Bioinformatics

Computational biology or the field of science in which biology, computer science, and information technology merge to form a single discipline

Transformational Bioinformatics

Specialization of bioinformatics for human health

Genomics

Field that analyzes genetic material from a species

Proteomics

Study at the level of proteins (through gene expression)

Pharmacogenomics

Study of genetic material in relationship with drug targets

Metabolomics

Study of genes, proteins, or metabolites

Metagenomics

Analysis of genetic material derived from complete microbial communities harvested from natural environments

Phenotype

Observable characteristic, structure, function, behavior of living organism

Genotype

Based on the genetic information associated with a phenotype or regulation of biological function

Genome

Total of genotypic traits

Challenges of Translational Informatics

Consent; Specimen/Protocol Tracking; Standards/Interoperability; Data Provenance; Optimal EHR Use; Precision Medicine Knowledge Capture & Application; Patient/Consumer Engagement

Precision Medicine

Diagnosis & treatment targeted to individual patients on basis of genetic/biomarker/phenotypic/psychosocial characteristics that distinguish them from other patients with similar clinical presentations.

Goals of Precision Medicine

Diagnosing hereditary diseases

Clinical Care Provided by Nurses

Monitoring; Maintenance; Prevention; Comfort; Instruction in ADLs; Patient Education & Self-management; Family Care; Delivery of Medical Plan; Case Management & Care Coordination

Indirect Care Provided by Nurses

Teaching students; Attending staff/committee meetings; Continuing education; Informatics/Quality/Safety

Nursing Workflow Includes

Patient care responsibilities; Planning; Supervision; Patient scheduling; Medications & treatment; Teaching; Admission, transfer, & discharge

Nursing workflows task relevance

Most time devoted to nursing practice, with three areas most promising for improving efficiency: Documentation (35.3%), Care coordination (20.6%), Medication administration (17.2%)

Consumer Health Informatics

The field devoted to informatics from a consumer view, often with a focus on mobile health

Mobile Health (mHealth)

Digital practice of medicine and public health supported by the use of smartphones and other mobile devices

Digital Health

Digital aspects of health & healthcare; technologies that empower consumers to make better-informed decisions about their health and provide new options for prevention/treatment/management of diseases

Participatory Medicine

A movement in which patients & health professionals actively collaborate and encourage one another as full partners in healthcare

Clinician Electronic Communication Challenges

Patient unwillingness to receive email notifications of test results

Patient Portals

Personal health records (PHRs) tethered to institutional EHRs, often providing additional functionality for engagement.

Additional functionality of Patient Portals

Securely message physician and others

Consumer Health Bill of Rights

Look at your health information and/or get a paper or electronic copy of it

Guidelines for Patient-Clinician Email

Establish turnaround time

Public Health

Science of protecting and improving the health of people and their communities.

Public Health Core Functions

Assessment, Policy Development, Assurance.

Assessment

Public health agencies investigate potential threats to the public's health.

Policy Development

Public health agencies create policies and regulations to protect health.

Assurance

Public health agencies ensure compliance with health laws and regulations.

Public Health Achievements in the 20th Century

Vaccination, motor-vehicle safety, safer workplaces, control of infectious diseases.

Geographic Information Systems (GIS)

System of hardware, software, and data used for mapping and analysis of geographical data.

Evidence-Based Medicine

Approach to medicine where decisions are based on well-conducted research.

PICO(T) Method

Framework for formulating clinical questions: Patient, Intervention, Comparison, Outcome, Type of Study.

Internal Validity

Believability of a study.

External Validity

Generalizability of study results to the population of interest.

Randomized Controlled Trials (RCT)

Subjects are randomly assigned to treatment or control groups.

Double-Blind

Both investigators and subjects do not know who received active medication or placebo.

Number Needed to Treat (NNT)

How many people must be treated for one individual to benefit.

Clinical Practice Guidelines

Systematically developed statements to assist decisions about health care.

Medical Imaging Informatics

Study and application of information technology for medical image data.

Picture Archiving and Communication Systems (PACS)

Medical imaging technology for storage and access to images from multiple modalities.

Digital Imaging

Transitioned to PACS starting in the 1970s, with the first filmless hospital in 1999.

PACS Advantages

Allows remote viewing, expedites incorporation into electronic health records.

Nuremberg Code

Established voluntary consent and right to withdraw from experiments.

World Medical Association Declaration of Helsinki

Added right to privacy and confidentiality for research subjects.

Pertinent Ethical Principles

Right to privacy, security of data, informed consent, sharing data appropriately.

Electronic Communications with Patients

Guidelines for communicating with patients via email.

Experimental Event Rate (EER)

Risk for people in the experimental group.

Control Event Risk

Risk for people in the control group.

Relative Risk (RR)

Rate of risk relative to the control: EER/CER.

Relative Risk Reduction (RRR)

Indicates how much the risk is reduced in the treatment group compared to control.

Absolute Risk Reduction (ARR)

Calculated as EER-CER.

Clinical Practice Guidelines Steps

Involves expert panel evaluation, evidence review, and local applicability assessment.

Zoom-in Feature in PACS

Allows close-up detail viewing of medical images.

Mark-up Tool in PACS

Adds text, measures size, angles, and areas on images.