Electronic Health Records Implantation PDF

Electronic Health Records Implantation A national Electronic Health Record (EHR) has the potential to improve the quality, safety, and efficiency of health care. Moving from scattered information systems environment to fully integrated EHR systems a...

Electronic Health Records Implantation A national Electronic Health Record (EHR) has the potential to improve the quality, safety, and efficiency of health care. Moving from scattered information systems environment to fully integrated EHR systems across any administrative healthcare system will increase the ability of clinicians to have timely, appropriate and secured access to patient information. Patients can better manage their condition and communicate with their care providers, anytime and anywhere. Importance of national EHR: → Ensure the right consumer health information is electronically made available to the right person at the right place and time → Enable the health sector to more effectively operate as an inter-connected system overcoming the current fragmentation and duplication of service delivery → Enable multi-disciplinary teams to electronically communicate and exchange information and provide better coordinated health care across the continuum of care → Improve the quality, safety and efficiency of clinical practices by giving care providers better access to consumer health information, clinical evidence and clinical decision support tools → Provide consumers with electronic access to the information needed to better manage and control their personal health outcomes One key to successful implementation is strong leadership from a variety of roles such as: → Health informaticians, → Physicians, → Nurses, → Health information managers ‫العديد من االيدي العاملة التي تشترك من اجل هدف موحد‬ It requires a multitude of personnel with different talents and skills all working toward the same goal. There are six themes for EHR implantation best practice: ‫ثمان مواضيع لضمان افضل تطبيق للسجالت الصحية‬ → Effective communication ‫التواصل الفعال بين جميع مقدمي الخدمة‬ → Successful system migration ‫ترحيل النظام القديم للجديد بشكل ناجح‬ → Technical equipment, support and training ‫توافر المعدات التقنية والدعم والتدريب الالزم‬ → Safeguards for patient privacy ‫وجود انظمة حماية لضمان خصوصية المرضى‬ → A focus on improved efficiency ‫التركيز دائما على تحسين الكفاءة‬ → A sustainable business plan ‫خطة عمل مستدامه وطويلة االمد‬  The system development life cycle (SDLC): ‫دورة حياة تطوير البرمجيات واالنظمة‬ → Model used in project management that describes the stages involved in an information system development project → Ensures the implementation of different components will be managed with a well-developed project plan. → SDLC includes four primary phases: Planning and analysis, design, implementation and maintenance and evaluation. There are five major architecture requirements to build a national EHR: → Identification and authentication, ‫تحديد هويات المستخدمين والمصادقة على اعطاءهم الوصول‬ → Information standards, ‫معايير المعلومات المستخدمة في النظام‬ → Information protection, ‫حماية المعلومات المستخدمة في النظام‬ → Computing infrastructure, ‫البنية التحتيه الجهزة الكمبيوتر‬ → Networking. ‫توافر الشبكات‬ Identification and authentication ‫توفير الخصائص في النظام‬ → Identification is the provision of functions to uniquely identify patients, care providers and care provider organizations to ensure that information about the right person is going to be sent to the right care provider. → Authentication is the provision of functions to securely address, authenticate and transfer messages from one care provider to another to ensure that the information gets to the right provider in a secure manner. Information Standards ‫توافقيه وقابلية االجهزة‬ → Standardized health information is achieved through interoperability. → It refers to electronic communication among organizations so that the data in one IT system can be incorporated into another. → Elements of semantic interoperability: ‫عناصر التوافق الي الزم تكون بين االنظمة‬ 1. Language 2. Terminology and clinical coding 3. Information structures 4. Clinical protocols 5. Processes ‫يسيطر‬ → Standards facilitate use of common terminology, govern the way health information dataset are stored, secure messaging infrastructure and transmission, and define the message acknowledgements standards. Information Protection → A cross-organizational platform (EHR) communication could be used to share sensitive information so we need mechanism to ensure secure information transaction ‫نظام تشريعي وطني موحد لحماية المعلومات‬ → Design and implement a consistent national legislative framework for information protection, privacy and consent.  → The cross platform integrates regional and national security domains with the help of an inter- domain zone → Inter-domain platform integrates two or more security domains. → The main task of the platform is to offer centrally managed security services for cross- organisational pre-defined communication. → Basic security services of the cross-platform are security policy bridging, cross-domain identification and authentication, certification services, static privilege management and auditing services → Examples of information Security tools: Router/IP addressing Firewall Patches Anti-Virus, Spam, Spyware Passwords / Passphrases Unprotected Shares Web-based e-mail/file sharing Physical Access Backups Public Key Infrastructure (PKI) Audit trail Computing Infrastructure → Encourage care providers to invest in the implementation and maintenance of an acceptable baseline of computing infrastructure such as; desktop, laptop, handheld technology and tablet computers; servers and networks; wireless networks; voice recognition systems for transcription, physician orders and medical records; bar-coding technology for drugs, medical devices, and inventory control; information security systems.  Networking → Broadband connectivity is one of the key foundations for sharing electronic information between care providers. → Optical Ethernet could be used throughout this national network of cities → In order to have a connection between facilities in different CITYs: 1. Each facility has to have an EMR. 2. The hospitals already have EMRs, 3. Primary care providers and other community care provider will be provided with EMRs. 4. Then in each city hospitals will be connected with those primary and community care providers via LAN and WAN architectures. 5. Facilities from one city will be connected with facilities in another city via a national central Hub Infrastructure. (Optical Ethernet) → Virtual private network (VPN) is also used: It reduces networking costs significantly because much of the maintenance is performed by an Internet service provider (ISP) → A gateway is employed to link two different network types together and this way, each CITY network will be linked with other CITY networks. → It is also important to apply security devices such as routers and firewalls at every level in the network. The big picture ‫الصورة الشاملة‬ Facilities: ‫المؤوسسات‬ → In each CITY, applications such as hospital EMR, physician office EMR, pharmacy system, and public health services, will have their own data storage. → Those applications work like Point of Service (POS). ‫شبكة تقديم الرعاية الصحية‬ Repositories: ‫مستودعات البيانات‬ → The received data will be stored in (databases) repositories for health records, drugs, diagnostic images, laboratory, etc. → Each containing a significant subset of the overall EHR data available for sharing with other domain repositories. → All exchange of information is done using standards-based interfaces.  → They are made up of messages using standard message definitions, such as DICOM and HL7. Those messages are further supported by data standards, including reference terminologies such as SNOMED and classification systems. Health Information Access Layer (HIAL): ‫طبقة الحماية‬ → Middleware software is needed to make different applications communicate with each other and with system-level services. → Health Information Access Layer (HIAL) is where information will be verified for correct patient identity and appropriately anonymised depending on the intended use, the location and provider identification added where appropriate, and the identity of the requester checked for authorised use. Registries: ‫السجالت‬ ‫تحديد صفات المستخدمين بشكل مخصص‬ → Registries use unique identifiers of key attributes, in particular the patient, provider, location, user and clinical terminologies. → To ensure that the right clinician or user accesses and provides the right information on the right person in relation to the right location. Longitudinal Record Service: → It is important for collecting and bringing together information from registries, repositories and other sources. → A single comprehensive patient record comprised of data from numerous data sources across the healthcare continuum (EHR) Electronic Health Records will improve health care in governmental health organisations. How? → Consumers will be supported to stay healthy through access to reliable health information sources, tailored care plans and automated care provider monitoring of personal health status. → Care Providers will deliver care more efficiently and be able to more easily share information and coordinate care delivery with other providers. Cloud Computing → It is the practice of using a network of remote servers hosted on the Internet to store, manage, and process data, rather than a local server or a personal computer. → Cloud-based applications can easily scale up or down as demand changes; they’re flexible and accessible. → They can be updated centrally and rolled out from their test environment easily. → Big companies can partner with smaller innovators or third-party developers to execute on business and customer engagement strategies in a secure, agile, and cost-efficient environment. The main advantage of cloud computing is its low cost. → All kinds of IT measures, such as in hardware, software, human resources, and management, are cheaper when implemented on a large scale. → Cloud users, such as smaller hospitals and medical practices, can easily get a cost-effective and on-premise IT solution through cloud computing without the need to purchase or evaluate hardware or software, or to hire internal IT staff  The result of cloud computing: → The user (care provider) can focus on critical tasks without having to incur additional costs with regard to IT staffing and training. Electronic health records are created and stored digitally → implementing solutions designed to take advantage of digital file format have tremendous value → better management of health information and records leads to more accurate records and decrease human errors Big Data Big data in healthcare: electronic health data sets so large and complex that they are difficult (or impossible) to manage with traditional software or hardware; and can't they be easily managed with traditional or common data management tools and methods. Big data in healthcare is overwhelming ‫مهلك‬, why? → Volume → The diversity of data types → The speed at which it must be managed What makes up "big data" in healthcare? → The totality of data related to patient healthcare and wellbeing, it includes: 1. Clinical data from CPOE and clinical decision support systems 2. Physician’s written notes and prescriptions 3. Medical imaging, laboratory, pharmacy, insurance, and other administrative data 4. Patient data in electronic patient records (EPRs) 5. Machine generated/sensor data, such as from monitoring vital signs 6. Social media posts, and web pages 7. Less patient-specific information, including emergency care data, news feeds, and articles in medical journals. → Health informatics applications are known to generate datasets that are complicated to store, untangle, organize, process, and, interpret. Mobile Health: → The data generated by the use of smart phones provides highly descriptive and continuous information anytime and anywhere. → The penetration of smartphones, which has reached over 200% of the total population in some cities such as Hong Kong, makes it logical to use it as a personal logging device of health information. → The new generation of smartphones has a wide range of health apps with standardized protocol to connect to sensors provided by different companies. → They can potentially serve as a platform to centralize health data; from which additional new information that was previously untraceable by individual sensors can now be mined.  → The newer models are packed with sophisticated sensors that facilitate the extraction of different types of vital signs, even without the need for external devices. → These sensors, when properly used, can provide valuable health information for the management of many long-term illnesses. → When connected to health providers, a closer level of interaction in healthcare can be maintained toward greater personalization and responsiveness. Social Health: → One-fourth of patients with chronic diseases, such as diabetes, cancer, and heart conditions, are now using social network to share experiences with other patients with similar conditions, thereby providing another potential source of big data. → In addition to biological information, geolocation and social apps provide an additional feature to understand the behaviours and social demographics of patients, while avoiding resource intensive and expensive studies of large statistical sampling. → This advantage has already been exploited by several epidemiological studies in areas, such as influenza outbreaks, collective dynamics of smoking, and the misuse of antibiotics. → Text messages and posts on online social networks are also a valuable source of health information. → Compared to traditional methods, such as surveys, fluctuations and regulation of emotions, thoughts and behaviours analysed over social network platforms, such as Twitter, offer new opportunities for the real-time analysis of expressed mood and its context. Health Data Challenges: → In today’s era of Big Data: frivolous, meaningless, and unstructured data is collected and stored next to meaningful data. o While computers and hard drives are exceptional at sorting through mounds of structured data, humans are not. o Computers cannot distinguish good data from bad data and unstructured data is more difficult to parse → Human interaction is required to interpret the data. → It is essential to balance usability with functionality. → Healthcare professionals lack background and understanding of data science. → Health informatics should be able to sort through volumes of data for health intelligence purposes. → Potential benefits of big data include detecting diseases at earlier stages when they can be treated more easily and effectively; managing specific individual and population health and detecting health care fraud more quickly and efficiently. Big data analysis → How does big data analytics fit into healthcare? By collecting, maintaining and analysing more information about an individual’s health, doctors can diagnose more holistically ‫بصورة شاملة اكثر‬, and even proactively ‫بشكل استباقي‬. → The two big uses cases for big data analytics in healthcare are: 1. Predictive risk modelling 2. Proactive intervention → Numerous questions can be addressed with big data analytics. → McKinsey estimates that big data analytics can enable more than $300 billion in savings per year in U.S. healthcare, two thirds of that through reductions of approximately 8% in national healthcare expenditures.