HAN364 Informatics midterm (ch 1,3,4,5,6,7,9,10)

biomedical and health informatics (BMHI)

field concerned with the optimal use of information, often aided by technology, to improve individual health, healthcare, public health, and biomedical research

the main goal is _____

improved pt care

most inclusive term is

biomedical informatics

biomedical informatics

encompasses bioinformatics as well as medical, dental, nursing, public health, pharmacy, medical imaging and veterinary informatics

bioinformatics

concerned with biological data, particularly DNA and genomic information

data

characters, numbers, or facts gathered for analysis and possibly later action
ex: 140/110

information

interpreted data

ex: BP reading

knowledge

synthesis of information from several sources to produce a single concept

ex: pt’s BP is high!

wisdom

Occurs when knowledge is used appropriately to manage and solve problems

ex: give medication

information hierarchy

data → information → knowledge → wisdom

driving forces for health informatics

- increase healthcare efficiency and productivity

- improve healthcare quality (pt outcomes) resulting in improved pt safety

- reduce healthcare costs

- improve healthcare access with technologies such as telemedicine and online scheduling

- improve coordination and continuity of care

- improve medical education if clinicians and pts

ARRA (american recovery and reinvestment act) 5 broad goals

- improve medical quality, pt safety, healthcare efficiency and reduce health disparities

- engage pts and families

- improve care coordination

- ensure adequate privacy and security of personal health information

- improve population and public health

barriers to HIT (health information technology) adoption- not enough

- time to learn new systems

- useful information

- skilled workers to manage and design systems

- financial benefits

- interoperability data (data structure and interface standardization)

• sharing data from different places/interfaces

barriers to HIT (health information technology) adoption- too much

- changes in office workflow and business processes

- security required for HIPAA compliance

- legal red tape between hospitals and referring doctors

- behavior changes

- hype (?) - expectations (kinda like exponential, so like implement a system, at first, 50% then 75 then 100 and get very used to it)

Moore’s law

everything from speed to size to cost per unit of power doubles every 18 months

computer hardware

central processing unit (CPU)

memory

auxiliary storage

input and output devices

speed is measured in

hertz

hertz =

1 CPU clock cycle per second

computer software

software

operating systems

application programming interfaces (APIs)

open source software

it is software with source code that is free and shareable

database

collection of data that is organized

all physical data

database management system (DBMS)

application that houses database

communication with data

wide area networks WAN

telecommunications network that extends over a large geographic area for the primary purpose of computer networking

like SBM

local area networks LAN

generally refer to linked computers in an office, hospital, home or a situation where facilities are in proximity

like computer lab

personal area networks PAN

close proximity network designed to link phones, computers, PDAs, etc

like ur phone

global area networks GAN

networks that connect other networks and have unlimited geographic area

like world wide

electronic health record EHR

electronic record oh health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization

components of EHRs

- EMR access system

• VPN (allows remote access to EHR)

- practice management software

• pt registration → pt scheduling → pt check-in….

- clinical software

- emergency department software

- laboratory information system

- radiology information system

- administration systems software

- pharmacy system

- ancillary department systems

computerized physician order entry CPOE

EHR feature that processes orders for medications, lab tests, imaging, consults and other diagnostic tests, it is not the same as electronic prescribing

clinical decision support systems CDSS

variety of tools to assist in decision making

ex: a message that pops up as a warning to confirm smth

electronic prescribing eRx

send prescription from EMR to pharmacy

EHR benefits

- improved pt care

- personal health records

- data science and artificial intelligence

- clinical decision support

- quality measurement and improvement

- health information exchange

- clinical research

- improved nursing care

- public health

EHR challenges

- implementation

• workflow changes: everyone must adapt to doing business differently

- data quality/usability

• data incomplete, inaccurate, inaccessible, etc

- standards and interoperability

- data entry

- privacy, confidentiality, and security

personal health record PHR

record controlled by the individual and may include health information from a variety of sources

separate from and does not replace the legal record of any health care provider

3 types of PHR- tethered

PHR type, online interface tied to an EHR with which pts may view and sometimes interact with their health data

standalone PHR

PHR type, an isolated application

interconnected or integrated PHR

PHR type, can interact with one or possibly more provider EHRs

levels of interoperability

level 1 to 4 (no operability to max operability)

level 1 of interoperability

no interoperability, e.g., mail, fax, phone, etc

level 2 of interoperability

information cannot be manipulated, e.g., bits, bytes of data transmitted

patient identifiers

reduce the problems of both duplicate and overlaid records

duplicate record

occurs when more than one record exists for a pt

overlaid record

takes place when more than one pt is mapped to the same record

health level 7 HL7

international standards development organization (SDO)

messaging that is standardized

HL7 clinical document architecture CDA

defines XML-based standard structure and metadata for clinical documents

extensive markup language (XML) is a data packaging standard useful for sharing

XML example

<students>

<students>

<name>Rick Stevens<name>

<students> is the root element; each student is the child element; each student has attributes (like age) to describe it

medical coding

process of aligning alphanumeric characters to standardize the descriptions of the reasons for encounters (pt visits) between pts and healthcare providers and the descriptions of all services and procedures performed

just for billing

physician practice billing

physician uses a “superbill” which is a list of the most common codes used in that practice

each provider/clinic has different codes

machine learning ML

field of study that gives computers the ability to learn without being explicitly programmed

the use of computer to optimize a performance

big data 4Vs

volume- ever-increasing amounts

velocity- quickly generated

variety- many different types

variability- from trustable sources

data mining

processing and modeling of data to discover previously unknown patterns or relationships

data visualization

applying visual methods to “tell the story” about the data

data wrangling

processing data into format suitable for analytics, learning, visualization etc

amount of data in record varies across pts and conditions

- pt get care at different places

- sicker pts have more data

- data completeness varies by pts

supervised ML

learn to predict a known output

unsupervised ML

find naturally occurring patterns

not told what to do

clinical decision support CDS

provides clinicians, staff, pts, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times

CDC is applies during

data-entry tasks, data-review tasks, assessment and understanding tasks

expert system ES

computer program that mimics human expertise

approaches to ES

clinical algorithms, Bayesian statistics, production rules, scoring and heuristics

production rules (approaches to ES)

if-then rules

if covid test shows positive, then give treatment

alert fatigue

providers believe many alerts for abnormal test results unnecessary so try to reduce ___ by providing alerts based on severity and clinical relevance

arden syntax specifies

event (if take vitals)

condition (BP high)

action (give medication)

10 commandments of CDS

speed is everything

anticipate needs and deliver in real-time

fit into workflow

classification of error in medicine- adverse events AE

unintended harm caused by medical management

preventable and nonpreventable

near miss (error)

error made but did not reach pt

preventable AEs

adverse outcome errors

what we can learn from aviation industry

use of checklists

pay for performance (P4P)

based on quality: higher quality care, pt doesn’t get sick, get $

health information exchange HIE

electronic sharing of data among hospitals, physicians, clinical laboratories, radiology centers, pharmacies, health plans (insurers), and public health departments (some may add “patients”)

types of HIE

directed, query-based, consumer-mediated

directed HIE

direct sending and receiving of information to support planned care, “push”, e.g., referral, transfer, etc

query-based HIE

finding information to support unplanned care, “pull”, e.g., emergency care

consumer-mediated HIE

consumers aggregating and using their own info, e.g., aggregate and share

trusted exchange framework and common agreement TEFCA

mandated ONC to develop or support a trusted exchange framework, including a common agreement among health information networks nationally

if sending info, needs to be secure

SHIN-NY

statewide health information network- secure network for sharing electronic clinical records, clinical records are accessed and exchanged securely between healthcare providers with appropriate consent

NYS is opt-in state