Health Informatics Chapter 4

four main uses of GIS in health informatics

disease surveillance, health risk analysis, health access and planning and community health profiling

Electronic Medical Record

"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 healthcare organization."

EHR

"An electronic record of 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."

PHR

"An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be drawn from multiple sources while being managed, shared and controlled by the individual."

What is Born Digital Data

"Born" digital data is data that began its existence already digitalized and is therefore more readily collectable and analyzable. Think digital electronic medical records, implanted medical devices such as insulin pumps and neurostimulators, diagnostic imaging technology, and physiologic monitoring devices of every kind...

Clinical decision

"any electronic or non-electronic system designed to aid directly in clinical decision making, in which characteristics of individual patients are used to generate patient-specific assessments or recommendations that are then presented to clinicians for consideration."

Key Components of EHR's

-Clinical Decision support systems (CDSS) -Secure messaging for communication between patients and office staff -Referral Management system -Retrieval of lab results and xray results -Retrieval of prior encounters and medical history -Computerized Physician Order Entry -Remote access from anywhere

Qualitative Data

-Descriptive -Collected through observation, field work, focus groups, interviews, recording or filming conversations -Open ended

What are the benefits of using big data?

-Expanding diagnostic service -Reducing prescription errors -Reducing costs

How is Healthcare Big Data is now starting to catch up with Big Data in the business world

-Faster and cheaper technology and data storage -Widespread sensing devices -An increase in "born" digital data -Greater availability of data via repositories -Data sharing mandates

Data collected from a PM is used to:

-Generate claims to seek reimbursement from healthcare payers -Apply payments and denials -Generate patient statements for any balance that is the patient's responsibility -Generate business correspondence -Build databases for practice and referring physicians, payers, etc. -Offer patient scheduling system

Goals of Meaningful Use

-Improve quality safety, efficiency, and reduce health disparities -Engage patients and families -Improve care coordination -Ensure adequate privacy and security of personal health information -Improve population and public health

How does an EHR improve patient safety?

-Improved legibility of clinical notes -Improved access anytime and anywhere -Reduced duplication -Reminders and Clinical Alerts -Clinical Decision support that reminds physicians about drug interactions -Electronic problem summary lists which provide diagnoses, allergies etc.

quantitative data

-Measurable -Collected through measuring things that have a fixed reality -Close ended

How is big data currently being used in our everyday lives?

-Mobile maps and GPS. -Online Shopping. -Urban Planning. Big Data is constantly being used in the context of smart cities to plan urban centers. ... -Grading Systems -Wearable Technology -Mobile Banking

What are some ethical considerations around the use of big data for comparative effectiveness research (or other health-related applications)?

-Protection of individuals data -Security precaution in terms of unique identifiers for users

Potential Benefits of CPOE:

-Reduce Medication Errors -Reduce Costs -Reduce Variation of Care

What are some legal considerations around the use of big data for comparative effectiveness research (or other health-related applications)?

-Security of individuals data -Billing systems are fragmented and dated

Function of patient registries

-natural history of disease -effectiveness of treatments -safety -quality

Steps to Big Data Mining

1. Collect Big Data or obtain access to a repository. 2. Perform data analysis to explore patterns (pattern recognition, predictive analytics). 3. Identify potential correlations.

What are the benefits and challenges of computerized physician order entry?

A benefit of CPOE is, the potential to reduce medication errors through a variety of mechanisms. Another benefit with the use of a CPOE is the reduction of the average length of stay for patients as well as a reduction in overall costs with the decreased medication costs with the use of a CPOE. Lastly, a benefit of the use of a CPOE is, the ability of clinicians to reduce variations in care by using a CPOE. Challenges of CPOE's are associated with, the complexity and inability to learn a new software. CPOE's have also been shown to lead to a decrease in work production thus leading to there being a negative effect of the workflow.

What are the benefits and challenges of clinical decision support systems?

A benefit of a clinical decision support system could be the offering of alternatives for treatment and next steps to clinicians. Another benefit of CDSS is that they can improve imaging study ordering and they may decrease the amount of duplicate ordering that occurs. A challenge of using a clinical decision support system could include a lack of skills in terms of using the system on the clinical staff's part due to them lacking the proper training for these systems. Another challenge could be that clinicians may begin to rely too much on the computer systems which could lead to overlooked errors. Lastly, a challenge of clinical decision support systems may be the bias that humans inputting the information possess possibly having a negative effect on the patient diagnosis and treatment.

What are some of the key benefits of electronic health records?

A key benefit of EHR's is the fact that with using EHR's it makes it much easier to retrieve and track patient data and patient registries. EHR's also allow for a quicker retrieval of lab or x-ray results and it is likely that these records will also have outlined a patient's family and medical history. Having access to this outline of information easily thus allows for easy navigation through the entire medical history of a patient. Lastly, a benefit of EHR's is that they allow for patients records to be accessed 24hours a day seven days a week and clinicians don't have to wait until another staff member is present to access patient data.

Describe some key limitations of paper-based health records.

A key limitation of paper-based health records may include, the possibility of the clinicians handwriting being illegible making it hard for anyone to extract and use information from the document. Another limitation may be, the fact that the documents cannot be electronically shared or stored. Other limitations of paper-based health records include, they are expensive to copy, transport and store; they are easy to destroy; and they are difficult to analyze and determine who has had access to them.

Clinical Decision Support System (CDSS)

A special subcategory of clinical information systems that is designed to help healthcare providers make knowledge-based clinical decisions

What are some of the obstacles to purchasing, adopting and implementing an electronic health record?

An obstacle related to purchasing, adopting and implementing an electronic health record is the financial barrier that comes with using these systems. Especially for smaller, solo practices, the reality is, many businesses cannot afford the financial burden that comes with attempting to implement an EHR system. Another obstacle related to purchasing, adopting and implementing an electronic health record is, the change in workflow. EHR users and clinicians delivering patient care have to make adjustments to the flow of their workday when an EHR is implemented. Specifically, adjustments must be made in terms of the manner of documentation that is used, the way patient information is shared between physicians and support staff as well as new procedures must be implemented for electronic data privacy and security. Depending on how easily staff members are able to adjust to these changes it could possibly slow things down. Lastly, an obstacle related to purchasing, adopting and implementing an electronic health record is, the concern of the legal aspects that come with the use of an EHR and how that violates legal guidelines. In terms of the legal aspects a potential area for great risks is, clinical documentation and clinical decision support. The automated manner that EHR's transfer information may promote errors. Also, with the clinical decision support that physicians will receive, and the improved access to information physicians may be more likely to become overwhelmed by the amount of information that they are receiving. This overwhelmed feeling may possibly lead to them overlooking vital information regarding patient's health.

What do Data Repositories do?

Data repositories help to ensure that data is findable, accessible, interoperable, and re-usable.

Practice Management Integration System (PM)

Designed to capture all the data from a patient encounter necessary to obtain reimbursement for the services provided.

Benefits of EHR:

Ease of storage, allows lab results to be retrieved rapidly, access 24/7, simultaneous review of the chart, allows easy navigation through patient health history, allows for reduction in duplication of tests, can improve the level of coding, can provide clinical support such as alerts and reminders, and facilitating clinical research

CPOE (Computerized Physician Order Entry)

Feature where physicians can order lab tests, imaging, consulting and other diagnostic tests

Who owns medical records in Georgia?

Hospital and/or physician

Types of CDSS

Knowledge, calculators, flow sheet, CPOE, drug alerts, order set, ddx, radiology, lab, public health alerts

Difference between EHR's and Registries

Registries focus on populations

Sensing Devices

Smartwatches Smart jewelry Fitness trackers Sport watches Smart glasses Smart clothing...

What are some unintended adverse consequences related to EHRs?

Some unintended adverse consequences related to EHRs may include, more work for clinicians, unfavorable workflow changes, never ending demands for system changes and conflicts between electronic and paper-based-systems.

What are the key components of an electronic health record?

The key components of any EHR which are crucial to those records are, Demographics, Insurance Information, Lab results, Vital signs, Clinical reminders, Future and Past appointments, Medical Problems, Allergies and Medications.

True or False EHRs don't just contain or transmit information; they "compute" it.

True

True or False, EHRs can expose potential safety problems when they occur, helping providers avoid more serious consequences for patients and leading to better patient outcomes.

True

True or False, EHRs can help providers quickly and systematically identify and correct operational problems. In a paper-based setting, identifying such problems is much more difficult, and correcting them can take years.

True

True or False: A qualified EHR checks for problems whenever a new medication is prescribed and alerts the clinician to potential conflicts.

True

Patient registries

an organized system that uses observational study methods to collect uniform data to evaluate specified outcomes for a population defined by a particular diseases, condition, or exposure, and that serves one or more predetermined scientific, clinical or policy purposes.

What is big data?

extremely large data sets that may be analyzed computationally to reveal patterns, trends, and associations, especially relating to human behavior and interactions. "Big data in healthcare" refers to the abundant health data amassed from numerous sources including electronic health records (EHRs), medical imaging, genomic sequencing, payor records, pharmaceutical research, wearables, and medical devices, to name a few.

SOAP

subjective, Objective, Assessment and Plan