Computers in Healthcare Admin. Final Exam
ehealth, mhealth, social media, and telemedicine and telehealth offer new opportunities in health care and public health, capitalizing on technological advancements in other avenues of our lives. the growth of HIS provides opportunities for ehealth, and mhealth to be productively used in the informatics, research, policy, and public health spheres as represented in the HIS model.
4. eHealth, mHealth, social media, and telemedicine are overlapping but useful labels for capabilities slightly unique from one another. Dicuss the scope and impact of each, and challenges in their use in health care and public health.
1. human work being augmented by technology, such as a healthcare professional using an automatic sign-on computer access device. 2. machines replacing the work of humans, such as a virtual assistant providing automated services to assist a person finding a needed health service in a new community 3. humans and machines working together, such as a mobile robot used by a surgeon while performing a surgical procedure. These increasingly refined interactions between people and computers will continue to be applied in ways that improve productivity, transform the customer or patient experience, and improve outcomes from clinical, cost, and competitive perspectives.
7. Emerging technologies and human-machine relationships go hand in hand. In what ways do improvements in human-machine relationships help the advancement and application of emerging technologies to health care and public health?
Healthcare has an inordinate number of moving parts and an incredible plethora of raw and uncoordinated data. In lay terms, bringing all those data into a single location, harmonizing them, and making the results available to the masses of potential users is a very good thing. Medical Group Management Supply-chain managers?
Chapter 10 Who might use and benefit from healthcare BI/CI?
Relationship to Research: - HIS create & capture data, data can then be aggregated and combined for researchers to use. Through the use of data originating from core HIS, health services clinical researchers, policy analysts, and public health professionals are able to analyze, evaluate, and identify associations between variables and themes reflected in the data. - Results from research then communicated to healthcare provider communities through conferences, lectures, etc - based on new research, an informatics may design a check-off confirmation within an EHR for identifying whether a patient's medication has been cross-referenced against a newly understood conditions or drug therapy. Relationship to Policy: - policy influences business and clinical activities carried on in healthcare organizations, establishes regulations to protect the public, and preserves and protects the public's health. - policy work needs data from HIS just as research does, but for policy analysis, program evaluation, white papers, reports, and recommendations. Relationship to Public Health: - public health functions as surveillance, reporting, analysis, and intervention <-- need data emanating from HIS.
Chapter 11 Describe the relationship of foundational HIS to the research, policy, and public health layer in the HIS model. In which ways are these two reliant on each other? List at least three ways.
CER includes: 1. studies of collections of evidence about benefits and risks of various approaches to healthcare, treatments, processes, and clinical services for different conditions, groups, and populations based on currently available published literature, clinical trials, and research studies. 2. studies that produce new evidence about the effectiveness of treatments, processes, tests, or services. GOAL of CER is to provide the best possible synthesis of research results to clinicians and others in healthcare organizations so that these findings can be put to use. Helpful to policy makers who build these results into recommendations (meaningful use criteria, other guidelines). BASED ON comparative effectiveness; the comparative effectiveness of various treatments, processes, and approaches to care is based on assessment of the benefits and risks of one method relative to other methods.
Comparative effectiveness research (CER) is the compilation and meta-analysis of multiple pieces of research in particular areas of study. Do you think it is a good idea to look at all research results and identify the relative effectiveness of various treatments and approaches to care? Why or why not?
Data Definition Variability - occurs when the actual values of a data element with the same name vary between systems (ex. time to medication in an emergency situation might be defined as time from registration to time of medication administration versus time from triage to time of medication administration. -- comparing these two times, given the values represent different metrics but are called the same thing, would lead to inaccurate conclusions regarding this quality measure for emergency care. Data Inaccuracy - EHR data are no better than the care with which they are entered by busy clinicians and the ways the EHR system features and functions interface with these knowledge workers. Data accuracy depends on the clinician's time, attention to data completeness, accuracy, understandability, consistency, and accessibility. Data Incompleteness - EHR systems do not consistently have data elements recorded or entered by end users into every available data field. --clinician time constraints, urgent situations, and varying interest in data entry tasks, many data fields in a given EHR are likely to be left empty or incomplete. Other - data are often coded for purposes of billing, not to reflect purely clinical activities; therefore, it may not be valid to use these billing data for clinical research.
EHR systems provide much-needed clinical data for research, policy, and public health activities. Name several concerns about data provided from EHR systems. Are these concerns well founded? Why or why not? What will improve these problems with this very important source of data for research, policy, and public health questions, analyses, and programs?
"The complexity of modern medicine exceeds the inherent limitations of the unaided human mind" -too much new info for physicians and nurses working in health to keep up with using traditional methods (reading peer-reviewed journals and other publications)...theres not enough time in the day/capacity in the human mind to hold/process all of the information. The 5 Rights of Clinical Decision Support The 5 Rights of Health Information Management
Explain how the practice of medicine is becoming increasingly complex. What does this mean for the amount of information people working in clinical settings are expected to know, remember, and make use of in their clinical practices? How can computers help this situation?
- informatics involves the efforts of multidisciplinary groups of knowledge workers and researchers applying expertise in their respective clinical, public health, research, and business disciplines. - creates synergies by combining expertise from the distinct disciplines of computer science, information science, clinical medicine, nursing, biology, social systems and organizational culture, and health care. - Because health and healthcare are ideally integrated around the person and the patient, the expertise of many disciplines is called upon to understand the essentials of what is happening in any particular situation. - A variety of disciplines offer their perspectives to the collective to determine new and better ways to work, or create the collective intelligence needed to understand any situation. - the different masteries come together in ways that no single discipline could to understand a situation and interpret new information.
Identify and explain synergies between clinical disciplines, informatics, and health outcomes as depicted in Figure 8.1. Which two areas of informatics do you think have the most impact on each other? Defend your answer by providing its rationale.
- HIS and technology consist of the foundational layer of systems and management of the wide array of technology infrastructure, hardware, software systems, databases, interoperability, and communications capabilities used by clinical, administrative, and public health professionals and organizations. Informatics is the understanding, shaping, and use of these HIS capabilities, systems, and the data they house and transport - all with the aims of improving workflows, processes, outcomes, and health status. - Informatics is practiced to help physicians, nurses, and other clinicians be more productive and effective; to enhance access to data and information and integrate multiple, additional forms of data relevant to each situation; to create meaningful, accessible information from data; and to gain insights by traversing the informatics continuum from data to information to knowledge that improve healthcare and provider efficiency, effectiveness, and outcomes. -informatics involves the structure of data & information and HIS and technology, particularly EHR systems - provide data standards and documentation and methodologies that will result in consistent and safe data for patient care purposes, as well as quality data and information for population health management, research, clinical and business intelligence, external reporting, and other secondary uses of the data. - patient portal information capabilities - connections in remote areas using texting, smartphones, and crowd-sourcing - ability to exchange/connect data b/w systems, organizations, devices, and people.
What role does health informatics play in the design, development, and implementation of new HIS and technology, especially EHR systems?
data must be kept secure, private, and confidential.
What strikes you as the three biggest data challenges in healthcare?
IOM warns that a growing body of evidence displays the unintended consequences of implementation of EHR systems and other HIS and technology. - warnings lead us to question why some of these unintended consequences occur: reasons such as incomplete data in the EHRs; persistent "silos" of info telling an unfinished story about patients or health issues; data codified first for billing and claims, then for patient care, public health informatics, or research; difficulties capturing data contained within narrative documentation and free-form notes; lack of granularity in EHR data needed for public health informatics and research; and different data needs for patient care versus public health analyses.
What warnings does the IOM's report Health IT and Patient Safety: Building Safer Systems for Better Care provide regarding EHR systems data that are used for secondary uses? Which types of flaws potentially exist in EHR data?
mHealth - mobile health; the use of mobile technologies for purposes of health care, public health, and health related activities at the individual level. mHealth technologies include smartphones, mobile applications using tablets, internet, machine-to-machine wireless capabilities, sensors and patient monitoring devices, and more. The growth of HIS provides opportunities for eHealth and mHealth to be productively used in the informatics, research, policy, and public health spheres as represented in the HIS model.
6. Use the HIS model to describe ways in what HIS and management support mHealth
Plateau of productivity
8. Where do new technologies used in health care fall today on the Hype Cycle? Which do you think have the most promise?
Ubiquitous Availability - always accessible, at any place or time. In terms of HIS and technology, this term refers to how increasingly more people and organizations have and use various technologies and hardware, such as mobile phones. When something is so pervasive that there is no clear line regarding where, when, by whom, and for what purpose it is used, it is said to have become ubiquitous.
Chapter 12 What does ubiquitous availability of HIS technologies systems mean?
- Health informatics is the second layer of the HIS model. Health informatics is both an art and a science: It is aimed at improving, redesigning, and informing health and clinical care, organizations, processes, and research capabilities through the use of HIS and technology. - Informatics is the science of collecting, organizing, and using data to solve problems, innovate, and improve. - Informatics = data + meaning - Health and biomedical informatics is informatics applied to healthcare and biomedical research. - involves understanding, designing, and improving clinical and business workflows and processes through automation.
Chapter 8 Describe health informatics and identify its place among the other layers of the HIS and technology model.
Interests of healthcare organizations and agencies of public health are converging in their mutual focus on health status and prevention of disease. <-- HIS emphasizing EHR systems, CER, and business intelligence/clinical intelligence are being implemented across the United States to provide essential data, info, and analytics along with hope for improved quality and cost performance, all while changing our approach to health and healthcare from reactive to proactive and preventive.
In which ways are the interests and goals of healthcare organizations and public health converging? How does HIS play a role in supporting these mutual interests and goals?
Policy research derives its source data from an equally diverse set of data sources, and public health research relies on data sources from many settings, including healthcare organizations, individual occurrences of reportable events, and population-level views of health and health status. Six S's of Sources of Public Health Data: data sources that inform public health; they include single case or small series, statistics, surveys and sampling, self-reporting, sentinel monitoring, and syndromic surveillance.
Source systems providing data for the domains of research, policy, and public health are found in a variety of settings. What do these settings have in common, and how do they differ? Describe source systems for each area.
Clinical Decision Support: 1. the right information 2. to the right person 3. in the right format 4. through the right medium or channel 5. at the right time Health Information Management: 1. Right Time 2. Right Route 3. Right Person 4. Right Data 5. Right Use
The 5 Rights of Clinical Decision Support The 5 Rights of Health Information Management
- Clinical Decision Support Systems provide end users with prompts and alerts about specific patient, and other information such as lab results or medication data contained in the EHR system. - deliver info support to physicians, nurses, professionals from labs and other clinical areas. - commonly used capabilities = alerts for allergies, drug-drug interactions, drug-allergy interactions. - Nurses are responsibly for the care of the "whole" person, through assessments and constant monitoring to keep track of all the elements of that person's care. Aim is to bring to bear all perspectives, including any medical-, pharmacy-, and nursing-related info such as the social and emotional consideration of the patient. - Physicians come and go throughout the day/night on their rounds and to check in on patients, perform surgeries, deliver therapies, but nurses are present 24/7. -the work of physicians is frequently based on the medical interventions and workflow, with a focus on access to results, placing orders, performance of procedures, and other medically oriented objectives.
What are clinical decision support systems? How are they used by physicians? By nurses? In what ways do the clinical decision support needs of physicians and nurses differ? In what ways are they the same?
Clinical & Public Health Clinical - includes the sub disciplines of medical informatics, nursing informatics, and informatics for other clinical disciplines such as therapies. Public Health - deals with detecting, monitoring, analyzing, preventing disease, and promoting health. The use of informatics will gradually free us from our current condition of inadequate levels of quality, excessive costs, and waste of resources and lead to a more efficient and effective U.S> health system, thereby improving the health status of each individual and the population overall.
Which types of professionals participate in the work of health informatics? What do they do in their health informatics work? What do practicing physicians and nurses contribute and what do they gain from the work of clinical informatics?
Health informatics is the effort to transform health and clinical care, organizations, processes, and research capabilities through the use of HIS and technology. As a result of the evolution of HIS and technology, and in particular the massive introduction of EHR systems globally, informatics is now going through its own evolutionary phase. Tasks of informatics include process improvements, workflow redesign, and outcomes analysis.
Why is health informatics important in today's healthcare and public health environment in the United States? In the world? What type of transition is health care going through in the way it handles and processes information, and why is health informatics essential to that transition?