PHA 381: Health Informatics Definitions

Health Informatics

All aspects of understanding and promoting the effective organization, analysis, management, and use of information in health care

Health level 7

standards developing organization - mission=improve care delivery, optimize workflow, reduce ambiguity and enhance knowledge transfer among all of our stakeholders, including healthcare providers, government agencies, vendor community, fellow SDOS and patients

Which of the following is an example of patient-specific information? A. Evidence-based guidelines B. Drug metabolism C. Human anatomy D. Medication history

D

Which of the following organizations have identified important pharmacy informatics competencies? A. AACP/CAPE B. AMIA C. ACPE D. All of the above

D

Network

an interconnected group of systems or devices, remote from one another

Barriers to HIE

1. limited demand for HIE 2. sustainability 3. clinician workflow 4. lack of universal adoption of standards base EHR systems 5. impact on providers D2D workflow 6. complex privacy and security challenges 7. need for synchronous collective action among multiple stakeholders 8. weak or misaligned incentives

Medication Use Process:

1. prescribing 2. transcribing/documenting 3. dispensing 4. administering 5. monitoring

Meaningful Use Stage 1 and 2

1 = 90 days 2 = 1 year

3 Ways IT can reduce errors: (Bates & Gawande - "Improving Safety with Information Technology")

1. preventing errors and adverse effects 2. facilitating a more rapid response after an adverse event occurs 3. tracking and monitoring feedback about adverse events

Primary uses of an EHR system?

1. pt care delivery 2. pt care management 3. pt care support processes 4. financial and other administrative processes 5. patient self-management

Informatics Competency Statements

1. store, retrieve, and analyze HI 2. optimize the medication prescribing/ordering process 3. aid in clinical decision making 4. automate the medication delivery process 5. facilitate pharmacy management

HIT workforce program

1. CCC - community college consortia 2. Developers - curriculum development centers program 3. HIT PRO examination - competency examination for individuals completing non-degree training program 4. UBT - program of assistance for university-based training

Which of the following organizations is NOT involved in developing interoperability standards? A. eHealth Initiative B. Health Information Technology Standards Panel C. Health Level 7 D. National Institute of Standards and Technology

A

Decision Science

application of mathematical modeling and analysis to the decision-making process

advantages of EHR

1. access to more complete health information 2. timely access 3. improved communication w/other providers and patients 4. doesn't require pulling of paper charts 5. doesn't require extra storage space 6. improves levels of coding

unintended consequences of EHR

1. alert fatigue 2 copy and paste 3. workarounds

5 building blocks of the future of HIE

1. core technical standards and functions 2. certification to support adoption and optimization of HIT products and services 3. privacy and security protections for HI 4. supportive business, clinical, cultural, and regulatory environments 5. rules of engagement and governance

barriers to EHR adoption:

1. de-personilzation of care visits 2. obtaining sponsorship from senior leaders/administrators 3. finding clinician champions 4. ensuring adequate personnel 5. start-up costs 6. maintenance costs 7. questionable ROI 8. different health care providers and specialists have different needs 9. IT infrastructure 10. variation in privacy policy and consent management/strategies 11. no finalized standards for interoperability 12. providers may be using different systems 13. disruption of clinical workflow 14. provider resistance

3 types of HIE

1. directed (send and receive secure info electronically btw care provider to support coordinated care) 2. query-based (providers can search/request info on a patient from another provider, great for unplanned care - ED) "HealthEWay" 3. consumer-mediated (patients can aggregate and control the use of their health information among providers

secondary use of EHR system

1. education 2. regulation 3. research 4. public health and homeland security 5. policy support

Barriers to improvement: (Bates & Gawande - "Improving Safety with Information Technology")

1. financial barriers 2. lack of standards 3. cultural barriers

Levels of interoperability

1. foundational interoperability 2. structural interoperability (called the Message Format" 3. semantic interoperability (adds data comparability)

Basic System EHR

1. health info and data 2. order entry management 3. results management

Comprehensive EHR system

1. health information and data 2. order entry management 3. results management 4. CDSS

IOM core functions of EHR?

1. health information and data (diagnosis, med list, allergies, pt demographics, clinical narratives, labs) 2. result management (computerized results/analytic) 3. order entry/management (CPOE w/ or w/out CDSS) 4. decision support (preventative care, med safety, evidence-based practice) 5. electronic communication and connectivity (telehealth) 6. patient support (education, home monitoring) 7. administrative processes (scheduling, billing, research ) 8. reporting and population health management (clinical dashboards)

Limitations with paper records:

1. illegible handwriting 2. expensive to copy, transport, store 3. easy to destroy 4. difficult to analyze and determine who has seen it 5. data may be missing

Barriers to HIT adoption

1. inadequate time 2. inadequate expertise and workforce 3. high cost of adoption 4. lack of interoperability 5. security and privacy concerns

Why is HIT adoption Important?

1. increases health care efficiency 2. improves quality of patient care 3. improves safety of patient care 4. reduces health care costs 5. improves health care access 6. improves communication, coordination, and continuity of care

Missing clinical information

1. likely to adversely affect the patient in 44% visits, 2. result in at least 1 duplicate medical service in 59.8% cases 3. outside the clinicians system in 57.3% cases

Which of the following statements is the most accurate description of pharmacy informaticists? A. They are typically pharmacists who have knowledge of computer systems B. Nearly all pharmacy informaticists have received formal academic training for their jobs C. They are involved primarily in patients care and are not involved in research D. All of the above

A

Active HIOs

221 HIEs 119 operational HIEs (exchange results, patient summary care record, discharge summaries, clinical summaries, ambulatory problem list, med list, inpatient list, etc.) ***primary funding = government

A perceived shift in expertise was identified as a potential barrier to EHR adoption and use. Which of the following best describe this barrier? A. Younger providers have techological expertise that older providers do not B. EHRs are often set-up to support primary care providers compared to specialists C. Providers must now use a computer to enter in patient care information instead of dictating their patient note D. Administrators, not providers, are the ones who decide on EHR adoption

A

All of the following were identified as information that should be included in a personal health record, EXCEPT: A. Insurance information B. Immunizations C. Full medication profile D. Laboratory data

A

How do most pharmacy informaticists learn about informatics as a career choice? A. Work B. Professional conference/meeting C. School D. Job search

A

Pharmacy informatics is defined as, "the use and integration of data, information, knowledge, technology, and automation in the medication-use process for the purpose of" what? A. Improving patient outcomes B. Enhancing patient care C. Facilitating pharmaceutical care D. Demonstrating pharmacists' value in health care

A

The ONC identifies three key forms of information exchange. Which is NOT a form of information exchange identified by the ONC? A. Patient-centered exchange B. Directed exchange C. Consumer-mediated exchange D. Query-based exchange

A

Which of the following best describes the "core objectives" for meaningful use? A. They comprise basic functions that enable EHRs to support improved health care. B. They comprise advanced functions that enable EHRs to support improved health care. C. They comprise a set of functions that are recommended, but not required for meaningful use. D. None of the above.

A

Which of the following is NOT a barrier to the development, testing, and adoption of information technology? A. Inadequate hardware B. Financial barriers C. Cultural barriers D. Lack of standards

A

Which of the following levels of interoperability is sometimes called the "message format" standard? A. Structural interoperability B. Foundational interoperability C. Semantic interoperability D. None of the above

A

All of the following are HIO models, EXCEPT: A. Centralized B. Advanced C. Federated D. Hybrid

B

All of the following were identified as potential pharmacy implications for EHR use, EXCEPT: A. The pharmacist history of medication use is valuable and needs to be integrated into the EHR B. Pharmacists need to work with software vendors to create PHRs for patients to maintain their medication records C. Pharmacists need to understand physicians' and other providers' expectations and views on sharing patient information D. Pharmacist access to patient EHRs is a public safety imperative

B

Stage 3 of meaningful use is expected to focus on all of the following, EXCEPT: A. Enhancing patient access to self-management tools. B. E-prescribing for controlled substances C. Improving population health. D. Use of decision support for high-priority conditions

B

Which of the following best describes a pubic utility business model for an HIO? A. They have a primary purpose of generating a profit. B. They are typically maintained using federal or state funding. C. They are typically maintained using philanthropic funding. D. They are typically maintained using funding from payers and physicians.

B

Which of the following is NOT a drawback to the use of paper records and processes? A. Handwriting is often illegible B. It costs more than the use of electronic records C. Documentation is time-consuming D. It is difficult to transfer information between health care providers

B

Which of the following is NOT a way that information technology can reduce the rates of errors? A. Preventing errors and adverse events B. Identifying the person who committed the error so they can be punished C. Facilitating a more rapid response after an adverse event has occurred D. Tracking and providing feedback about adverse events

B

Which of the following professional health informatics organizations is responsible for the RHIA/RHIT certifications? A. AMIA B. AHIMA C. HIMSS D. IMIA

B

Which of the following statements best describes pharmacists' current use of the EHR and feelings towards information exchange with other providers? A. Pharmacists are not interested in sharing information with other health care providers. B. Pharmacist EHR users work primarily in the hospital setting. C. Most pharmacists currently have access to other providers' EHRs. D. Most pharmacists are current EHR users.

B

Which of the following statements best describes the current environment related to health information exchange? A. Critical patient information is routinely shared whenever a patient experiences a transition of care. B. Information exchange is costly because of the lack of widely-used technical standards. C. While it is desired, public trust is not essential for sustainble health information exchange. D. Information exchange only occurs through local, state, or regional nonprofit or government-sponsored exchange networks.

B

Which of the following was NOT a major goal of the Decade of Health Information Technology report? A. Inform clinical practice B. Educate health care providers C. Personalize care D. Improve population health

B

Which type of health record is defined as, "An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one health care organization"? A. Personal health record B. Electronic medical record C. Electronic health record D. Continuity of care record

B

Centralized v. federated models;

Centralized = simple, uniform data appearance, fast access, easy to create (bad = high hardware costs, high operating costs, more difficult with large HIOs) Federated model = greater privacy, good examples exist, buy-in may be easier if data is local, (bad=data display not uniform, data retrieval delays from others, potential for node downtime)

In the context of health care, the term "information brokerage" refers to which of the following: A. The selling of health care data to third-parties B. The development of standards to promote interoperability C. The sharing of health information between providers and health care organizations D. None of the above

C

Pharmacy informaticists should have expertise in which of the following skills? A. Computer programming B. Database architecture C. Risk analysis D. Technology development

C

Regional Extension Centers were designed to which of the following: A. Design EHRs for rural providers to use B. Provide financial assistance to providers in adopting EHRs C. Assist health care providers in meeting meaningful use criteria D. Assist ONC in developing the meaningful use criteria

C

The Roadmap for Pharmacy HIT Integration in U.S. Health Care report was developed and released by which organization? A. AACP B. AMIA Pharmacoinformatics Working Group C. Pharmacy e-HIT Collaborative D. National Pharmacy Informatics Organization

C

What health informatics organization developed their own model for EHR/EMR adoption? A. AMIA B. AHIMA C. HIMSS D. IMIA

C

Which Institute of Medicine report identified health information technology use as a strategy to address problems with patient safety? A. To Err is Human B. Key Capabilities of an Electronic Health Record C. System Crossing the Quality Chasm D. Health Professions Education: A Bridge to Quality

C

Which of the following is NOT a future challenge to health information exchange that was identified in the paper? A. Matching patients and their records. B. Tracking where patients' health information is coming from. C. Developing a business model for health information exchange networks. D. Determining the best way to integrate information exchange into provider workflow.

C

Which of the following was NOT an EHR Core Function identified by the Institute of Medicine? A. Order entry/management B. Patient support C. Medication administration record D. Decision support

C

AHIMA certifications:

CCA -- certified coder associate CCS - certified coder specialist CCS-P - certified coders specialist RHIA - registered health information administrator (BS required) RHIT - registered health information technician (AS required)

Which of the following disciplines are involved in health informatics? A. Genetics B. Library Sciences C. Public Health D. All of the above

D

All of the following are typical changes in meaningful use objectives from Stage 1 to Stage 2, EXCEPT: A. Increase in requirement threshold to meet an objective (e.g. 30% of patients to 50% of patients). B. Integration of measures into larger more comprehensive measures. C. Elimination of objectives that may have been technically difficult or infeasible. D. Having to demonstrate actual improvements in clinical outcomes.

D

All of the following were identified by Kaiser Permanente as ways they can realize improved health care efficiency through EHR use, except: A. Virtual consultation or e-visits B. Previsit questionnaire completion C. Decreased emergency department visits D. Savings from paper costs

D

How do most pharmacy informaticists acquire the skills and knowledge needed in their position? A. Learned it during their Pharm.D. program B. Training through a certification program C. Training through a degree program (e.g. Ph.D. program) D. On-the-job training

D

In the article, it is noted that "one of the main benefits of using computers for clinical tasks that is often overlooked is that it makes it possible to implement 'forcing functions'." What are "forcing functions"? A. Offering a limited number of functions B. Allowing users to turn functions on and off as needed C. Not allowing users to turn functions on and off as needed D. Features that restrict the way in which tasks can be performed

D

The Classen and Bates article identified four organizations (Brigham and Women's Hospital, LDS Hospital, Vanderbilt University Medical Center, and the Regenstrief Institute) that have used internally-developed EHRs to improve quality and safety. All of the following were characteristics crucial to their success, except: A. The EHRs were highly customized. B. The informatics culture of the organization supported continuous quality improvement. C. The organizations used rapid improvement cycles to modify their EHRs. D. The organizations partnered with the federal government to obtain funding to develop their EHR systems.

D

The Classen and Bates article identified the need for EHR evaluation strategies post-implementation. Examples of these strategies included all of the following, except: A. Examining the organization's procedures for when an EHR is taken offline. B. Identification of patient safety events or hazards that have affected EHR users or patients. C. Identification of the top 25 most common actions that an EHR user should be capable of performing. D. Engaging external evaluators to identify why certain functions are not being used effectively.

D

Which of the following are unintended consequences of EHR use? A. Copy-and-paste B. Alert fatigue C. Workarounds D. All of the above

D

Which of the following best describes query-based exchange? A. It is facilitated through the Direct protocol. B. It uses the Blue Button functionality. C. It automates the transfer of patient information during care transitions. D. It is often used during unplanned care.

D

HI challenge grant program

Develop innovative/scalable solutions in 5 areas: 1. achieving health goals through HIE 2. improving long-term and post-acute care transitions 3. Consumer mediated information exchange 4. enabling enhanced query for patient care 5. fostering distributed population level analytics

Four major health records?

EMR, CCR, PHR, EHR

AACP/CAPE Educational Outcome Domain 2.2:

Essentials for practice and care: Medication Use Systems Management * manage patient healthcare needs using human, financial, technological, and physical resources to optimize the safety and efficacy of medication use systems

Beacon Community Cooperative Agreement Program

Focus: 1. building and strengthening the HIT infrastructure and exchange capabilities within communities, positioning each community to pursue a new level of sustainable health care quality and efficiency 2. translating investments in health IT to measurable improvements in cost, quality, and population health 3. developing innovative approaches to performance measurement, technology and care delivery to accelerate evidence generation for new approaches

Opt-in vs. Opt-out

Opt-in = exclusion Opt-out = inclusion

Stages of Meaningful Use:

Stage 1 (2011-2012) data capture and sharing Stage 2 (2014) advance clinical processes Stage 3 (2016) improved outcomes

Information Silo

a situation in which health care providers often maintain their own health records without obtaining or exchanging information with other providers, resulting in patients being asked the same questions at each encounter, poor use of time management, minimal data being collected and an unstructured approach to care

PCMH coordinated ccare

care that is coordinated across all elements of the broader healthcare system (specialty care, hospital, home health, community services)

ONC HIT certification program

certifies EHR systems to ensure they can achieve meaningful use criteria Bodies: Drummond Group, Infogard Labs, ICSA Labs, NTS, SLI Global Solutions

EHR 5 rights:

clinical data presentation decision work processes outcomes

PCMH quality and safety

commitment to safe, high-quality care through engagement in quality improvement activities and safe monitoring

Stage 7 of HIMSS EMR adoption model

complete EMR, CCD, transaction to share data, Data warehousing, data continuity with ED, ambulatory and OP (only 4.2%)

Information Systems

computer and communications hardware, software, networks, and other components that supply information. In health care, these systems typically support clinical activities as well as scheduling and reimbursement

relational databases

creates a single repository of data - can be used same time as multiple applications, managed with software

Software

data and instructions that control a computer

PCMH accessible services

enhanced to primary care through a variety of means including expanded hours, email, and telephone communication

database normalizaiton

ensure there is no redundancy of information (e.g. birthdate, birthday, date of birth)

Interoperability?

extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exhange data, and subsequently present that data such that it can be understood by a user *seamlessly exchange HI electronically connectivity = communicate with

Meaningful Use Stage 3

focus on: 1. improving quality, safety, and efficiency leading to improved health outcomes 2. decision support for high-priority conditions 3. patient access to self-monitoring tools 4. access to comprehensive patient data through patient-centered HIE 5. improving population health

DHHS Report: The Decade of HIT: Delivering consumer-centric and information-rich health care

four goals: 1. inform clinical practice (1-incentivize EHR adoption, 2-reduce risk of EHR investment, 3-promote EHR diffusion in rural and underserved areas) 2. interconnect clinicians (1-foster regional collaborations, 2-develop national HIN, 3-coordinate federal HIS) 3. personalize care (encourage use of PHR, 2-enhance informed consumer choice, 3-promote use of telehealth) 4. improve population health (1-unify public health surveillance architecture, 2-streamline quality and status monitoring, 3-accelerate research and dissemination of evidence)

State HIE cooperative agreement program

funding provided to rapidly build capacity for exchanging HI across the health care system both within and across states (focus on governing, policies, tech. services, business operations, financing mechanisms)

Office of the National Coordinator for HIT

principal entity charged with coordination of nationwide efforts to implement and use the most advanced HIT and the electronic exchange of health information

Information Science

how information is created, used, and managed

Management Science

how organizations plan and make decisions

Cognitive Science

how people think and learn

IOM (2003) health professions education: A bride to quality

identify a need for HIT education, emphasized effective use of communication and information technologies (CDSS)

Executive Order 13335

incentives for the use of health information technology and establishing the position of the national health information technology coordinator

Knowledge

information that is justifiably considered to be true (i.e. if the humidity is very high and the temperature drops substantially, the atmosphere is often unable to hold the moisture, so it rains)

Information

meaningful data or facts from which conclusions can be drawn by humans or computers (i.e. the temperature dropped 15 degrees and then it started raining)

ASHP pharmacy informatics survey

most informatics pharmacists hold a MS in science, business, health administration, public health, informatics, etc. *self-learning/OTJ training is most common communication skill most essential attribute!

HIO business models

not for profit public utility physician and payer collaborative for profit

advanced exchange

novel data exchange functionalities - alerts triggered by an ED visit are sent to the PCP and disease-specific care plans are shared among the clinical team

regional extension centers (REC)

offer assistance to providers for meeting meaningful use criteria

stage 7 of HIMSS ambulator EMR adoption model

only 7.79%

Patient specific vs. knowledge based information

patient-specific: created and applied in the process of caring for individual patients (med history, labs, etc) knowledge-based: forms the scientific basis of health care (understanding how drugs work in the body, clinical practice guidelines)

Pharmacy informatics vs. health informatics

pharmacy informatics is a subset of health informatics - focuses on the use of information technology and drug information to optimize medication use

PCMH comprehensive care (patient centered medical home)

primary care providers are accountable for meeting the large majority of each patient's physical and mental health needs (physicians, nurses, pharmacists, nutritionists, social workers, educators, care coordinators)

Health IT Policy committee

recommendations to the national coordinator on a policy framework for the development and adoption of a nationwide health information infrastructure, including standards for the exchange of patient medical information 1. API task force 2. certified technology task force 3. clinical, technical, organizational and financial barriers to interoperability task force 4. Quality measurement task force

Health IT standards committee

recommendations to the national coordinator on standards implementation specifications and certification criteria for the electronic exchange and use of Health information 1. Interoperability Standards Advisory Task Force 2. Precision Medicine Task Force 3. Transitional Vocabulary Task Force

PCMH patient-centered care

relationship-based primary care that meets the individual patient and family's needs, preferences and priorities *understanding and respecting each patient's unique needs, culture, values, and preferences **patients and families are core members of the care team

EHealth initiative

seeks to identify best practices, monitor trends and developments in the field and convene multi-stakeholder groups to guide health IT progress across three areas: 1. using data and analytics to improve care 2. IT infrastructure to support accountable communities and value-based care initiatives 3. connecting communities through interoperable data exchange

Roadmap for Pharmacy HIT Integration in US Health Care

strategic plan for pharmacy providing guidance to stakeholders on how to integrate pharmacy HIT into the national HIT infrastructure Goals: 1. ensure HIT supports pharmacists in health care service delivery 2. achieve integration of clinical data with e-prescribing 3. advocate pharmacist recognition in existing programs and policies 4. ensure HIT infrastructure includes and supports MTM services 5. integrate pharmacist-delivered immunizations into the EHR 6. achieve recognition of pharmacists as meaningful users of EHR quality measures 7. advance system vendor EHR certification 8. promote pharmacist adoption and use of HIT and EHRS 9. achieve integration of pharmacies and pharmacists into HIE 10. establish the value and effective use of HIT solutions by pharmacists (barriers = time, workload)

structured v. unstructured data

structured = computable (lab tests) unstructured = narrative (clinical note)

Data

symbols or observations reflecting differences in the world (i.e. it is raining)

Wisdom

the critical use of knowledge to make intelligent decisions (i.e. it rains because it rains. This statement encompasses an understanding of all the interactions that happen between raining, evaporation, air current, temperature gradients, etc.)

Hardware

the physical, mechanical, and tangible parts of a computer system

Computer Science

theories, methods, design issues, and implementation of computing systems

Meaningful Use

using certified electronic health record technology to: 1. improve safety, quality, efficiency, and reduce health disparities 2. engage patients and family 3. improve care coordination, and population and public health 4. maintain privacy and security of PHI