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Classi&ca(on Systems In Healthcare - 1  Course Descrip(on  This course will help the students to: o Understand the collection, coding and classi6cation of health data under the ICD-10 AM coding system. o Improve and increase eDciency in the...

Classi&ca(on Systems In Healthcare - 1  Course Descrip(on  This course will help the students to: o Understand the collection, coding and classi6cation of health data under the ICD-10 AM coding system. o Improve and increase eDciency in the " health 3ï I care system. o Capture the health information in a standard format, to support management, planning and delivery of health services, research and education. o understand data quality in health care and the ICD-10-AM classi6cation system, the current standard within Saudi  Course Learning Outcome Knowledge and understanding 1.1 Develop strategies for accurate and e3cient Clinical Coding Iden6fy the structure and organiza6on of the three volumes of WHO 1.2 ICD-10 and the Ave volumes of ICD-10 AM, ACHI and ACS Understand the conven6ons and instruc6ons used in WHO ICD-10, 1.3 ICD-10 AM, ACHI and ACS Iden6fy the principal diagnosis and principal procedure for 1.4 admission Select the appropriate condi6ons and procedures for coding from 1.5 medical records generated by an episode of care. 1.6 Assess the quality of coded data  Course Learning Outcome Skills Summarize the principles of coding healthcare data using the three 2.1 volumes of WHO ICD-10, and the Ave volumes of ICD-10 AM, ACHI and ACS Create principal diagnosis and procedure codes for appropriate pa6ent care 2.2 seKng Apply the Instruc6ons in the instruc6onal manual of WHO, ICD 10 and the 2.3 Australian Coding Standards in clinical coding. 2.4 DiLeren6ate conMic6ng clinical informa6on in the medical records.  Course Learning Outcome Values Construct adequate ICD-10-AM codes in a pa6ent encounter for diagnosis and 3.1 procedures independently. Perform update process for ICD-10-AM and other professional prac6ces in 3.2 managing health informa6cs. 3.3 ConAdent to communicate and work as a clinical coder Marks Distribu(on Examina(on Schedule Assignments 10 Marks Presenta6on 10 Marks Quiz 10 Marks Quiz aVer comple6on of Unit: TBD Midterm 20 Marks Final 50 Marks Midterm aVer comple6on of Unit:TBD Minimum 60/100 Final aVer comple6on of all units  Module (1-2)  Understanding the medical terminology language  Brief understanding of anatomy and physiology including the diRerent body systems Anatomy, Physiology and Medical Language OpenStax Anatomy and Physiology  Introduc(on to Medical Terminology Medical terminology is a language that is used in health care seKngs. Medical terms are built from Greek and La6n word parts and in addi6on include acronymns, eponyms, and modern-day language terms. Medical terms are built from word parts. Those word parts are pre&x, word root, suSx, and combining form vowel. When a word root is combined with a combining form vowel the word part is referred to as a combining form.  Pre$x Pre$xes are located at the beginning of a medical term. The pre6x alters the meaning of the medical term. It is important to spell and pronounce pre6xes correctly.  SuSx Su*xes are word parts that are located at the end of words. SuDxes can alter the meaning of medical terms. It is important to spell and pronounce suDxes correctly.  word parts Many medical terms are built from word parts and can be translated literally. building your medical terminology founda6on stay literal when applicable. It should be noted that as with all language rules there are always excep6ons, and we refer to those as rebels  word parts (Osteoarthri(s)  Oste/o/arthr/i(s – InWamma(on of bone and joint. Oste/o is a combining form that means bone arthr/o is a combining form that means joint -i6s is a suSx that means inMamma6on No(ce, when breaking down words that you place slashes between word parts and a slash on each side of a combining form vowel.  word parts (Intravenous) Intra/ven/ous – Pertaining to within a vein. Intra- is a pre&x that means within ven/o – is a combining form that means vein ous is a suSx that means pertaining to  Language Rules for Building Medical Terms  Gastr/o/enter/o/logy – The study of the stomach and the intes6nes Following rule 1, when we join combining form gastr/o (meaning stomach) with the combining form enter/o (meaning intes6nes) we keep the combining form vowel o. Following rule 2, when we join the combining form enter/o (meaning intes6nes) with the su3x -logy (that starts with a su3x and means the study of) we keep the combining form vowel o  Language Rules for Building Medical Terms  Intra/ven/ous – Pertaining to within the vein Following rule 3, no6ce that when combining the combining form ven/o (meaning vein) with the su3x -ous ( that starts with a vowel and means pertaining to) we drop the combining form vowel o. Following rule 4, the preAx intra- (meaning within) is at the beginning of the medical term with no combining form vowel used.  Language Rules for Building Medical Terms Intra/ven/ous – Pertaining to within the vein or Pertaining to within a vein. ◦ Following rule 5, no6ce that I start with the su3x -ous (that means pertaining to) then we work leV to right star6ng with the preAx Intra- (meaning within) and the combining form ven/o (meaning vein).  Medical Language Within the Context of Anatomy and Physiology Compare and contrast anatomy and physiology, including their specializa6ons and methods of study Discuss the fundamental rela6onship between anatomy and physiology Introduc(on to the Field Anatomy studies structures Gross Anatomy Microscopic Anatomy Regional Anatomy Systemic Anatomy Physiology studies the chemistry Anatomy focuses on structure and physiology focuses on function. Much of the study of physiology centers on the body’s tendency toward homeostasis. Structural Organization of the Human Body: Objectives Describe the structure of the human body in terms of six levels of organization List the eleven organ systems of the human body and identify at least one organ and one major function of each The Levels of Organization Lets discuss each level in brief  Organ Systems Basic functions of each Organ Systems cont.. Basic functions of each  Demonstrate the anatomical posi6on Describe the human body using direc6onal and regional terms Anatomical Terminology: Iden6fy three planes most commonly used in the study of anatomy Objec(ves Dis6nguish between the posterior and anterior body cavi6es, iden6fying their subdivisions and representa6ve organs found in each Describe serous membrane and explain its func6on Anatomical Posi(on Prone Supine Direc(onal Terms Essen6al for describing rela6ve loca6ons. Anatomical Planes Three most commonly used planes. Body Cavities Dorsal and Ventral are largest Representa6ve organs Abdominal Regions and Quadrants Help provide clear communica6on Serous Membranes Covers walls and organs in thoracic cavity. Pleura Pericardium Peritoneum  Growth (increase in size by increase cell number or size) Movement (action cause a change of position) Nutrition (organic substance or mineral ions) Func(ons of Life “Maintaining life Excretion (e.g., removal of toxic substances) in humans”: Reproduction (processes make more from same organism) Sensitivity ( e.g., ability to detect change in the environment stimuli) Respiration (breaking nutrient molecules to release energy)  Homeostasis  Homeostasis refers to a rela6vely stable set of condi6ons within an organism’s internal environment.  Within the human body, maintaining a healthy environment for living cells requires maintaining appropriate condi6ons in the extracellular Wuids – including the inters((al Wuid and blood plasma for each living cell to be able to func6on properly.  The constancy of an internal environment is important in allowing chemical reac6ons to take place at rates necessary to maintain the body. Maintaining homeostasis requires that the body con6nuously monitor its internal condi6ons. From body temperature to blood pressure to levels of certain nutrients, each physiological condi6on has a par6cular set point. Nega(ve Feedback Think of a thermostat Examples in the body. Posi(ve Feedback Childbirth Other examples?  Reference You are required to use this reference to revise and update your knowledge regarding medial terminology, anatomy, and physiology. Anatomy, Physiology and Medical Language h"ps://pressbooks.nscc.ca/medicallanguage/ Pages: (1 to 36) Pages: (91 to 94) Pages: (166-172)  UNIT-4 HEALTHCARE DATA ANALYTICS  2 LEARNING OBJECTIVES After reading this chapter the students should be able to: Define health data analytics. Understand machine learning and big data. Describe Challenges to Data Analytics. Understand Research and Application of Analytics  3 INTRODUCTION ‫ أﺣﺪ وﻋﻮد اﻟﻜﺘﻠﺔ اﻟﺤﺮﺟﺔ اﻟﻤﺘﺰاﯾﺪة ﻣﻦ اﻟﺒﯿﺎﻧﺎت‬- One of the promises of the growing critical mass of clinical ‫اﻟﺴﺮﯾﺮﯾﺔ اﻟﻤﺘﺮاﻛﻤﺔ ﻓﻲ أﻧﻈﻤﺔ اﻟﺴﺠﻼت اﻟﺼﺤﯿﺔ‬ data accumulating in electronic health record (EHR) systems is ‫( ھﻮ اﻻﺳﺘﺨﺪام اﻟﺜﺎﻧﻮي )أو إﻋﺎدة‬EHR) ‫اﻹﻟﻜﺘﺮوﻧﯿﺔ‬ secondary use (or re-use) of the data for other purposes, such as ‫ ﻣﺜﻞ ﺗﺤﺴﯿﻦ‬،‫اﻻﺳﺘﺨﺪام( ﻟﻠﺒﯿﺎﻧﺎت ﻷﻏﺮاض أﺧﺮى‬ quality improvement and clinical research..‫اﻟﺠﻮدة واﻟﺒﺤﻮث اﻟﺴﺮﯾﺮﯾﺔ‬ The growth of such data has increased dramatically in recent ‫ ﻟﻘﺪ زاد ﻧﻤﻮ ھﺬه اﻟﺒﯿﺎﻧﺎت ﺑﺸﻜﻞ ﻛﺒﯿﺮ ﻓﻲ اﻟﺴﻨﻮات‬- years due to incentives for EHR adoption in Saudi Arabia. ‫اﻷﺧﯿﺮة ﺑﺴﺒﺐ اﻟﺤﻮاﻓﺰ ﻻﻋﺘﻤﺎد اﻟﺴﺠﻼت اﻟﺼﺤﯿﺔ‬.‫اﻹﻟﻜﺘﺮوﻧﯿﺔ ﻓﻲ اﻟﻤﻤﻠﻜﺔ اﻟﻌﺮﺑﯿﺔ اﻟﺴﻌﻮدﯾﺔ‬ In the meantime, there has also seen substantial growth in other kinds of health-related data, most notably through efforts ‫ ﺷﮭﺪﻧﺎ أﯾﻀًﺎ ﻧﻤ ًﻮا ﻛﺒﯿﺮًا ﻓﻲ أﻧﻮاع‬،‫ وﻓﻲ ھﺬه اﻷﺛﻨﺎء‬- to sequence genomes and other biological structures and ‫ وﻻ ﺳﯿﻤﺎ ﻣﻦ‬،‫أﺧﺮى ﻣﻦ اﻟﺒﯿﺎﻧﺎت اﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﺼﺤﺔ‬ functions. ‫ﺧﻼل اﻟﺠﮭﻮد اﻟﻤﺒﺬوﻟﺔ ﻟﺘﺴﻠﺴﻞ اﻟﺠﯿﻨﻮم واﻟﮭﯿﺎﻛﻞ‬ The analysis of this data is usually called analytics (or data.‫واﻟﻮظﺎﺋﻒ اﻟﺒﯿﻮﻟﻮﺟﯿﺔ اﻷﺧﺮى‬ analytics). ‫ ﯾُﻄﻠﻖ ﻋﻠﻰ ﺗﺤﻠﯿﻞ ھﺬه اﻟﺒﯿﺎﻧﺎت ﻋﺎدةً اﺳﻢ اﻟﺘﺤﻠﯿﻼت‬-.(‫)أو ﺗﺤﻠﯿﻼت اﻟﺒﯿﺎﻧﺎت‬  4 ‫ﻣﺼﻄﻠﺤﺎت اﻟﺘﺤﻠﯿﻼت‬ TERMINOLOGY OF ANALYTICS ‫ إن اﻟﻤﺼﻄﻠﺤﺎت اﻟﻤﺤﯿﻄﺔ ﺑﺎﺳﺘﺨﺪام أﻧﻮاع‬ The terminology surrounding the use of large and varied ‫ﻛﺒﯿﺮة وﻣﺘﻨﻮﻋﺔ ﻣﻦ اﻟﺒﯿﺎﻧﺎت ﻓﻲ ﻣﺠﺎل‬ types of data in healthcare is evolving, but the term ‫ وﻟﻜﻦ‬،‫اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ آﺧﺬة ﻓﻲ اﻟﺘﻄﻮر‬ ‫ﻣﺼﻄﻠﺢ اﻟﺘﺤﻠﯿﻼت ﯾﺤﻘﻖ اﺳﺘﺨﺪا ًﻣﺎ واﺳﻊ‬ analytics is achieving wide use both in and out of.‫اﻟﻨﻄﺎق داﺧﻞ وﺧﺎرج اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ‬ healthcare. ‫ ﯾﻌﺮّف أﺣﺪ اﻟﺮواد ﻓﻲ ھﺬا اﻟﻤﺠﺎل‬ ‫اﻟﺘﺤﻠﯿﻼت ﺑﺄﻧﮭﺎ "اﻻﺳﺘﺨﺪام اﻟﻤﻜﺜﻒ‬ A longtime leader in the field defines analytics as ،‫ واﻟﺘﺤﻠﯿﻞ اﻹﺣﺼﺎﺋﻲ واﻟﻜﻤﻲ‬،‫ﻟﻠﺒﯿﺎﻧﺎت‬ ‫ واﻹدارة‬،‫واﻟﻨﻤﺎذج اﻟﺘﻮﺿﯿﺤﯿﺔ واﻟﺘﻨﺒﺆﯾﺔ‬ extensive use of data, statistical and quantitative analysis, ‫اﻟﻘﺎﺋﻤﺔ ﻋﻠﻰ اﻟﺤﻘﺎﺋﻖ ﻟﺪﻓﻊ اﻟﻘﺮارات‬.‫واﻹﺟﺮاءات‬ explanatory and predictive models, and fact-based management to drive decisions and actions.  5 CONT ‫ اﻟﺘﺤﻠﯿﻼت ﺑﺄﻧﮭﺎ‬IBM ‫ ﺗُﻌﺮّف ﺷﺮﻛﺔ‬ IBM defines analytics as systematic use of data ‫"اﻻﺳﺘﺨﺪام اﻟﻤﻨﮭﺠﻲ ﻟﻠﺒﯿﺎﻧﺎت ورؤى اﻷﻋﻤﺎل‬ and related business insights developed through applied analytical disciplines (e.g. statistical, ‫ذات اﻟﺼﻠﺔ اﻟﺘﻲ ﺗﻢ ﺗﻄﻮﯾﺮھﺎ ﻣﻦ ﺧﻼل‬ ‫اﻟﺘﺨﺼﺼﺎت اﻟﺘﺤﻠﯿﻠﯿﺔ اﻟﺘﻄﺒﯿﻘﯿﺔ )ﻣﺜﻞ اﻟﻨﻤﺎذج‬ ‫اﻹﺣﺼﺎﺋﯿﺔ واﻟﺴﯿﺎﻗﯿﺔ واﻟﻜﻤﯿﺔ واﻟﺘﻨﺒﺆﯾﺔ‬ contextual, quantitative, predictive, cognitive, other ‫واﻟﻤﻌﺮﻓﯿﺔ وﻏﯿﺮھﺎ ]ﺑﻤﺎ ﻓﻲ ذﻟﻚ اﻟﻨﻤﺎذج‬ [including emerging] models) to drive fact-based ‫اﻟﻨﺎﺷﺌﺔ[( ﻟﺪﻓﻊ ﻋﻤﻠﯿﺔ ﺻﻨﻊ اﻟﻘﺮار اﻟﻘﺎﺋﻤﺔ ﻋﻠﻰ‬ decision making for planning, management,.‫اﻟﺤﻘﺎﺋﻖ ﻟﻠﺘﺨﻄﯿﻂ واﻹدارة واﻟﻘﯿﺎس واﻟﺘﻌﻠﻢ‬ measurement and learning. ‫ ﻗﺪ ﺗﻜﻮن اﻟﺘﺤﻠﯿﻼت وﺻﻔﯿﺔ أو ﺗﻨﺒﺆﯾﺔ أو‬ Analytics may be descriptive, predictive or.‫إرﺷﺎدﯾﺔ‬ prescriptive.  6 CONT ‫ ﻗﺎم آداﻣﺰ وﻛﻼﯾﻦ ﺑﺘﺄﻟﯿﻒ ﻛﺘﺎب ﺗﻤﮭﯿﺪي ﻋﻦ اﻟﺘﺤﻠﯿﻼت‬ ‫ﻓﻲ ﻣﺠﺎل اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ ﯾﺤﺪد اﻟﻤﺴﺘﻮﯾﺎت اﻟﻤﺨﺘﻠﻔﺔ‬ Adams and Klein have authored a primer on analytics in.‫وﺧﺼﺎﺋﺼﮭﺎ ﻟﺘﻄﺒﯿﻖ اﻟﺘﺤﻠﯿﻼت‬ healthcare that defined different levels and their attributes of the application of analytics. ‫ ﻟﻜﻞ ﻣﻨﮭﺎ‬،‫ وأﺷﺎروا إﻟﻰ ﺛﻼﺛﺔ ﻣﺴﺘﻮﯾﺎت ﻣﻦ اﻟﺘﺤﻠﯿﻼت‬ They noted three levels of analytics, each with increasing :‫وظﺎﺋﻒ وﻗﯿﻤﺔ ﻣﺘﺰاﯾﺪة‬ functionality and value: Descriptive standard types of reporting that describe current ‫ وﺻﻔﯿﺔ – أﻧﻮاع ﻗﯿﺎﺳﯿﺔ ﻣﻦ اﻟﺘﻘﺎرﯾﺮ اﻟﺘﻲ ﺗﺼﻒ‬ situations and problems ‫اﻟﻤﻮاﻗﻒ واﻟﻤﺸﺎﻛﻞ اﻟﺤﺎﻟﯿﺔ‬ Predictive simulation and modeling techniques that identify trends and portend outcomes of actions taken ‫ اﻟﺘﻨﺒﺆﯾﺔ – ﺗﻘﻨﯿﺎت اﻟﻤﺤﺎﻛﺎة واﻟﻨﻤﺬﺟﺔ اﻟﺘﻲ ﺗﺤﺪد‬ Prescriptive optimizing clinical, financial, and other outcomes ‫اﻻﺗﺠﺎھﺎت وﺗﻨﺬر ﺑﻨﺘﺎﺋﺞ اﻹﺟﺮاءات اﻟﻤﺘﺨﺬة‬ ‫ ﺗﺤﺴﯿﻦ اﻟﻨﺘﺎﺋﺞ اﻟﺴﺮﯾﺮﯾﺔ واﻟﻤﺎﻟﯿﺔ وﻏﯿﺮھﺎ‬- ‫ ﺗﻮﺟﯿﮭﻲ‬  7 ‫ ﺗﻌﻠﻢ اﻵﻟﺔ‬/ ‫ﺗﺤﻠﯿﻼت اﻟﺒﯿﺎﻧﺎت‬ ‫ ھﻨﺎك ﻋﺪد ﻣﻦ اﻟﻤﺼﻄﻠﺤﺎت اﻟﻤﺘﻌﻠﻘﺔ ﺑﺘﺤﻠﯿﻞ‬ DATA ANALYTICS/ MACHINE LEARNING ‫ اﻟﻤﻨﮭﺠﯿﺔ اﻷﺳﺎﺳﯿﺔ ﻓﻲ ﺗﺤﻠﯿﻞ اﻟﺒﯿﺎﻧﺎت‬.‫اﻟﺒﯿﺎﻧﺎت‬ ‫ وھﻮ ﻣﺠﺎل ﻋﻠﻮم اﻟﻜﻤﺒﯿﻮﺗﺮ اﻟﺬي‬،‫ھﻲ اﻟﺘﻌﻠﻢ اﻵﻟﻲ‬ There are a number of terms related to data analytics. A core ‫ﯾﮭﺪف إﻟﻰ ﺑﻨﺎء أﻧﻈﻤﺔ وﺧﻮارزﻣﯿﺎت ﺗﺘﻌﻠﻢ ﻣﻦ‬ methodology in data analytics is machine learning, which is the area of.‫اﻟﺒﯿﺎﻧﺎت‬ computer science that aims to build systems and algorithms that learn from data. ‫ اﻟﻤﺼﻄﻠﺢ اﻷﺣﺪث ﻓﻲ اﻟﻠﻐﺔ اﻟﻌﺎﻣﯿﺔ ھﻮ اﻟﺒﯿﺎﻧﺎت‬ More recent term in the vernacular is big data, which describes large and ‫ واﻟﺬي ﯾﺼﻒ اﻟﻜﻤﯿﺎت اﻟﻜﺒﯿﺮة‬،‫اﻟﻀﺨﻤﺔ‬ ever-increasing volumes of data that adhere to the following attributes. ‫واﻟﻤﺘﺰاﯾﺪة ﺑﺎﺳﺘﻤﺮار ﻣﻦ اﻟﺒﯿﺎﻧﺎت اﻟﺘﻲ ﺗﻠﺘﺰم‬ Volume ever-increasing amounts.‫ﺑﺎﻟﺴﻤﺎت اﻟﺘﺎﻟﯿﺔ‬ Velocity quickly generated Variety many different types ‫ اﻟﺤﺠﻢ – ﻛﻤﯿﺎت ﻣﺘﺰاﯾﺪة ﺑﺎﺳﺘﻤﺮار‬ ‫ اﻟﺴﺮﻋﺔ – ﺗﻢ إﻧﺸﺎؤھﺎ ﺑﺴﺮﻋﺔ‬ Veracity from trustable sources ‫ اﻟﺘﻨﻮع – اﻟﻌﺪﯾﺪ ﻣﻦ اﻷﻧﻮاع اﻟﻤﺨﺘﻠﻔﺔ‬ ‫ اﻟﺼﺪق – ﻣﻦ ﻣﺼﺎدر ﻣﻮﺛﻮﻗﺔ‬  8 ‫ ﺗﻘﻮم اﻟﻤﺴﺘﺸﻔﯿﺎت‬،‫ ﻣﻊ رﻗﻤﻨﺔ اﻟﺒﯿﺎﻧﺎت اﻟﺴﺮﯾﺮﯾﺔ‬ ‫وﻣﻨﻈﻤﺎت اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ اﻷﺧﺮى ﺑﺘﻮﻟﯿﺪ ﻛﻤﯿﺔ‬ CONT ‫ ﻓﻲ ﺟﻤﯿﻊ ﻣﺆﺳﺴﺎت‬.‫ﻣﺘﺰاﯾﺪة ﺑﺎﺳﺘﻤﺮار ﻣﻦ اﻟﺒﯿﺎﻧﺎت‬ ‫ ﺗﺘﺨﺬ اﻟﺒﯿﺎﻧﺎت اﻟﺴﺮﯾﺮﯾﺔ ﻣﺠﻤﻮﻋﺔ‬،‫اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ‬ ‫ ﺑﺪ ًءا ﻣﻦ اﻟﺒﯿﺎﻧﺎت اﻟﻤﻨﻈﻤﺔ )ﻣﺜﻞ‬،‫ﻣﺘﻨﻮﻋﺔ ﻣﻦ اﻷﺷﻜﺎل‬ With the digitization of clinical data, hospitals and other ‫اﻟﺼﻮر وﻧﺘﺎﺋﺞ اﻟﻤﺨﺘﺒﺮات وﻣﺎ إﻟﻰ ذﻟﻚ( إﻟﻰ ﻏﯿﺮ‬ healthcare organizations are generating an ever-increasing ‫ اﻟﻤﻼﺣﻈﺎت اﻟﻨﺼﯿﺔ ﺑﻤﺎ‬،‫اﻟﻤﻨﻈﻤﺔ )ﻋﻠﻰ ﺳﺒﯿﻞ اﻟﻤﺜﺎل‬ amount of data. In all healthcare organizations, clinical data ‫ﻓﻲ ذﻟﻚ اﻟﺮواﯾﺎت اﻟﺴﺮﯾﺮﯾﺔ واﻟﺘﻘﺎرﯾﺮ وأﻧﻮاع أﺧﺮى‬ takes a variety of forms, from structured (e.g., images, lab.(‫ﻣﻦ اﻟﻤﺴﺘﻨﺪات‬ results, etc.) to unstructured (e.g., textual notes including clinical narratives, reports, and other types of documents). ‫ وﻛﻤﺜﺎل ﻋﻠﻰ ذﻟﻚ اﻟﺠﻤﻌﯿﺔ اﻷﻣﺮﯾﻜﯿﺔ ﻟﻌﻠﻢ اﻷورام‬ As an example American Society for Clinical Oncology ‫( اﻟﺘﻲ ﺗﻌﻤﻞ ﻋﻠﻰ ﺗﻄﻮﯾﺮ ﺷﺒﻜﺔ‬ASCO) ‫اﻟﺴﺮﯾﺮﯾﺔ‬ (ASCO) that is developing its Cancer Learning Intelligence ‫ذﻛﺎء ﺗﻌﻠﻢ اﻟﺴﺮطﺎن ﻣﻦ أﺟﻞ اﻟﺠﻮدة‬ Network for Quality (CancerLinQ). CancerLinQ will provide a comprehensive system for clinicians and researchers consisting ‫ ﻧﻈﺎ ًﻣﺎ‬CancerLinQ ‫ ﺳﯿﻮﻓﺮ‬.(CancerLinQ) of EHR data collection, application of clinical decision support, ‫ﺷﺎﻣﻼً ﻟﻸطﺒﺎء واﻟﺒﺎﺣﺜﯿﻦ ﯾﺘﻜﻮن ﻣﻦ ﺟﻤﻊ ﺑﯿﺎﻧﺎت‬ data mining and visualization, and quality feedback. ‫ وﺗﻄﺒﯿﻖ دﻋﻢ اﻟﻘﺮار‬،‫اﻟﺴﺠﻞ اﻟﺼﺤﻲ اﻹﻟﻜﺘﺮوﻧﻲ‬ ‫ وﺗﻌﻠﯿﻘﺎت‬،‫ واﺳﺘﺨﺮاج اﻟﺒﯿﺎﻧﺎت وﺗﺼﻮرھﺎ‬،‫اﻟﺴﺮﯾﺮي‬  9 ‫ﺧﻂ اﻧﺎﺑﯿﺐ‬ ،‫ ﻻﺣﻈﻮا أن ﻋﻤﻠﯿﺔ ﺗﺤﻠﯿﻼت اﻟﺒﯿﺎﻧﺎت اﻟﻀﺨﻤﺔ ﺗﺸﺒﮫ ﺧﻂ اﻷﻧﺎﺑﯿﺐ‬.‫ ﻛﻮﻣﺎر وآﺧﺮون‬ ‫ واﻟﺘﻲ ﯾﻤﻜﻦ ﻟﻠﻤﺮء أن ﯾﻀﻊ‬،‫وطﻮروا ﻧﮭﺠًﺎ ﯾﺤﺪد أرﺑﻊ ﺧﻄﻮات رﺋﯿﺴﯿﺔ ﻓﻲ ھﺬا اﻟﺨﻂ‬ PIPELINE.‫ﻋﻠﯿﮭﺎ ﻣﺼﺎدر اﻟﺒﯿﺎﻧﺎت واﻹﺟﺮاءات اﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ واﻟﻄﺐ اﻟﺤﯿﻮي‬ ‫ واﻟﺘﻲ ﻗﺪ ﺗﺸﻤﻞ ﻓﻲ‬،‫ ﯾﺒﺪأ اﻟﻤﺴﺎر ﺑﻤﺼﺎدر ﺑﯿﺎﻧﺎت اﻟﻤﺪﺧﻼت‬ Kumar et al. have noted that the process of big data analytics resembles a ،‫ﻣﺠﺎل اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ واﻟﻄﺐ اﻟﺤﯿﻮي اﻟﺴﺠﻼت اﻟﺴﺮﯾﺮﯾﺔ‬ pipeline, and have developed an approach that specifies four major steps ،‫ وﻋﻠﻢ اﻟﺠﯿﻨﻮم واﻟﺒﯿﺎﻧﺎت ذات اﻟﺼﻠﺔ‬،‫واﻟﺴﺠﻼت اﻟﻤﺎﻟﯿﺔ‬ in this pipeline, to which one can place data sources and actions on it ‫ ﺣﺘﻰ ﺗﻠﻚ اﻟﻮاردة ﻣﻦ ﺧﺎرج ﺑﯿﺌﺔ اﻟﺮﻋﺎﯾﺔ‬،‫وأﻧﻮاع أﺧﺮى‬ pertinent to healthcare and biomedicine. ‫ اﻟﺨﻄﻮة‬.(‫ ﺑﯿﺎﻧﺎت اﻟﺘﻌﺪاد اﻟﺴﻜﺎﻧﻲ‬،‫اﻟﺼﺤﯿﺔ )ﻋﻠﻰ ﺳﺒﯿﻞ اﻟﻤﺜﺎل‬ The pipeline begins with input data sources, which in healthcare and ‫ ﺣﯿﺚ ﯾﺘﻢ اﺳﺘﺨﺪام ﺗﻘﻨﯿﺎت‬،‫اﻟﺘﺎﻟﯿﺔ ھﻲ اﺳﺘﺨﺮاج اﻟﻤﯿﺰات‬ biomedicine may include clinical records, financial records, genomics and related data, and other types, even those from outside the healthcare setting ‫ ﻣﺜﻞ رﺑﻂ‬،‫ﺣﺴﺎﺑﯿﺔ ﻣﺨﺘﻠﻔﺔ ﻟﺘﻨﻈﯿﻢ واﺳﺘﺨﺮاج ﻋﻨﺎﺻﺮ اﻟﺒﯿﺎﻧﺎت‬ (e.g., census data). The next step is feature extraction, where various ‫ واﺳﺘﺨﺪام ﻣﻌﺎﻟﺠﺔ اﻟﻠﻐﺔ اﻟﻄﺒﯿﻌﯿﺔ‬،‫اﻟﺴﺠﻼت ﻋﺒﺮ اﻟﻤﺼﺎدر‬ computational techniques are used to organize and extract elements of the ‫ وﻣﻄﺎﺑﻘﺔ اﻷﻧﻤﺎط‬،‫( ﻻﺳﺘﺨﺮاج اﻟﻤﻔﺎھﯿﻢ وﺗﻄﺒﯿﻌﮭﺎ‬NLP) data, such as linking records across sources, using natural language processing (NLP) to extract and normalize concepts, and matching of other patterns. ‫ ﺣﯿﺚ ﯾﺘﻢ اﺳﺘﺨﺪام‬،‫ وﯾﻠﻲ ذﻟﻚ اﻟﻤﻌﺎﻟﺠﺔ اﻹﺣﺼﺎﺋﯿﺔ‬.‫اﻷﺧﺮى‬ This is followed by statistical processing, where machine learning and related ‫اﻟﺘﻌﻠﻢ اﻵﻟﻲ وﺗﻘﻨﯿﺎت اﻻﺳﺘﺪﻻل اﻹﺣﺼﺎﺋﻲ ذات اﻟﺼﻠﺔ‬ statistical inference techniques are used to make conclusions from the data..‫ﻻﺳﺘﺨﻼص اﺳﺘﻨﺘﺎﺟﺎت ﻣﻦ اﻟﺒﯿﺎﻧﺎت‬ The final step is the output of predictions, often with probabilistic measures of confidence in the results. ‫ وﻏﺎﻟﺒًﺎ ﻣﺎ ﺗﻜﻮن‬،‫واﻟﺨﻄﻮة اﻷﺧﯿﺮة ھﻲ إﺧﺮاج اﻟﺘﻨﺒﺆات‬.‫ﻣﺼﺤﻮﺑﺔ ﺑﻤﻘﺎﯾﯿﺲ اﺣﺘﻤﺎﻟﯿﺔ ﻟﻠﺜﻘﺔ ﻓﻲ اﻟﻨﺘﺎﺋﺞ‬  ‫ ﺗﺤﺪﯾﺎت أﻣﺎم ﺗﺤﻠﯿﻼت‬،‫ ﺑﻄﺒﯿﻌﺔ اﻟﺤﺎل‬،‫ ھﻨﺎك‬ ‫ أﺣﺪ اﻟﻤﺨﺎوف ھﻮ أن اﻟﺒﯿﺎﻧﺎت اﻟﻨﺎﺗﺠﺔ ﻋﻦ‬.‫اﻟﺒﯿﺎﻧﺎت‬ 10 ‫اﻟﺘﺤﺪﯾﺎت اﻟﺘﻲ ﺗﻮاﺟﮫ ﺗﺤﻠﯿﻼت اﻟﺒﯿﺎﻧﺎت‬ ‫اﻟﺮﻋﺎﯾﺔ اﻟﺮوﺗﯿﻨﯿﺔ ﻟﻠﻤﺮﺿﻰ ﻗﺪ ﺗﻜﻮن ﻣﺤﺪودة ﻓﻲ‬ ،‫ ﻋﻠﻰ ﺳﺒﯿﻞ اﻟﻤﺜﺎل‬.‫اﺳﺘﺨﺪاﻣﮭﺎ ﻟﻸﻏﺮاض اﻟﺘﺤﻠﯿﻠﯿﺔ‬ CHALLENGES TO DATA ‫ وﻗﺪ‬.‫ﻗﺪ ﺗﻜﻮن ھﺬه اﻟﺒﯿﺎﻧﺎت ﻏﯿﺮ دﻗﯿﻘﺔ أو ﻏﯿﺮ ﻛﺎﻣﻠﺔ‬ ‫ﯾﺘﻢ ﺗﺤﻮﯾﻠﮭﺎ ﺑﻄﺮق ﺗﻘﻮض ﻣﻌﻨﺎھﺎ )ﻋﻠﻰ ﺳﺒﯿﻞ‬ ANALYTICS.(‫ ﺗﺮﻣﯿﺰ أوﻟﻮﯾﺎت إﻋﺪاد اﻟﻔﻮاﺗﯿﺮ‬،‫اﻟﻤﺜﺎل‬ There are, of course, challenges to data analytics. One concern is that data generated in the routine care of patients may be limited in its use for ‫ أي‬،‫ ﻗﺪ ﺗﻈﮭﺮ ظﺎھﺮة اﻟﺮﻗﺎﺑﺔ اﻹﺣﺼﺎﺋﯿﺔ اﻟﻤﻌﺮوﻓﺔ‬ analytical purposes. For example, such data may be inaccurate or incomplete. It may be transformed in ways that undermine its meaning (e.g., coding for ‫أن اﻟﺤﺎﻟﺔ اﻷوﻟﻰ ﻟﻠﻤﺮض ﻓﻲ اﻟﺴﺠﻞ ﻗﺪ ﻻ ﺗﻜﻮن‬ billing priorities). ‫ﻋﻨﺪﻣﺎ ظﮭﺮ ﻷول ﻣﺮة )اﻟﺮﻗﺎﺑﺔ اﻟﯿﺴﺮى( أو ﻗﺪ ﻻ‬ It may exhibit the well-known statistical phenomenon of censoring, i.e., the ‫ﯾﻐﻄﻲ ﻣﺼﺪر اﻟﺒﯿﺎﻧﺎت ﻓﺘﺮة زﻣﻨﯿﺔ طﻮﯾﻠﺔ ﺑﻤﺎ ﻓﯿﮫ‬ first instance of disease in record may not be when it was first manifested. (‫اﻟﻜﻔﺎﯾﺔ )اﻟﺮﻗﺎﺑﺔ اﻟﯿﻤﻨﻰ‬ (left censoring) or the data source may not cover a sufficiently long time interval (right censoring). Data may also incompletely adhere to well-known standards, which makes ‫ ﻗﺪ ﺗﻠﺘﺰم اﻟﺒﯿﺎﻧﺎت أﯾﻀًﺎ ﺑﺸﻜﻞ ﻏﯿﺮ ﻛﺎﻣﻞ ﺑﺎﻟﻤﻌﺎﯾﯿﺮ‬ combining it from different sources more difficult. Finally, clinical data ‫ ﻣﻤﺎ ﯾﺠﻌﻞ ﺟﻤﻌﮭﺎ ﻣﻦ ﻣﺼﺎدر ﻣﺨﺘﻠﻔﺔ‬،‫اﻟﻤﻌﺮوﻓﺔ‬ mostly only allows observational and not experimental studies, thus raising issues of cause-and-effect of findings discovered. ‫ ﺗﺴﻤﺢ اﻟﺒﯿﺎﻧﺎت اﻟﺴﺮﯾﺮﯾﺔ ﻓﻲ‬،‫ أﺧﯿﺮًا‬.‫أﻛﺜﺮ ﺻﻌﻮﺑﺔ‬ ،‫اﻟﻐﺎﻟﺐ ﻓﻘﻂ ﺑﺎﻟﺪراﺳﺎت اﻟﺮﺻﺪﯾﺔ وﻟﯿﺲ اﻟﺘﺠﺮﯾﺒﯿﺔ‬ ‫ﻣﻤﺎ ﯾﺜﯿﺮ ﻗﻀﺎﯾﺎ ﺣﻮل اﻟﺴﺒﺐ واﻟﻨﺘﯿﺠﺔ ﻟﻠﻨﺘﺎﺋﺞ‬.‫اﻟﻤﻜﺘﺸﻔﺔ‬  ‫ ﻻ ﺗﺰال ﻗﺎﻋﺪة اﻷﺑﺤﺎث ﺣﻮل ﺗﻄﺒﯿﻖ اﻟﺘﺤﻠﯿﻼت‬ ‫اﻟﺒﺤﺚ وﺗﻄﺒﯿﻖ اﻟﺘﺤﻠﯿﻼت‬ 11.‫ﻟﺘﺤﺴﯿﻦ ﺗﻘﺪﯾﻢ اﻟﺮﻋﺎﯾﺔ اﻟﺼﺤﯿﺔ ﻓﻲ ﻣﺮاﺣﻠﮭﺎ اﻷوﻟﻰ‬ ‫ھﻨﺎك ﻗﺎﻋﺪة ﺑﺤﺜﯿﺔ ﻧﺎﺷﺌﺔ ﺗﻮﺿﺢ ﻛﯿﻒ ﯾﻤﻜﻦ اﺳﺘﺨﺪام‬ ‫اﻟﺒﯿﺎﻧﺎت اﻟﻤﺴﺘﻤﺪة ﻣﻦ اﻷﻧﻈﻤﺔ اﻟﺴﺮﯾﺮﯾﺔ اﻟﺘﺸﻐﯿﻠﯿﺔ‬ RESEARCH AND APPLICATION ‫ﻟﺘﺤﺪﯾﺪ اﻟﺤﺎﻻت اﻟﺤﺮﺟﺔ أو اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﺗﻜﻮن‬.‫ﺗﻜﺎﻟﯿﻔﮭﻢ ﻣﺘﻄﺮﻓﺔ‬ OF ANALYTICS The research base around applying analytics to improve healthcare ‫ ھﻨﺎك ﻋﺪد أﻗﻞ ﻣﻦ اﻷﺑﺤﺎث اﻟﺘﻲ ﺗﻮﺿﺢ‬،‫ وﻣﻊ ذﻟﻚ‬ delivery is still in its early stages. There is an emerging base of research ‫ﻛﯿﻔﯿﺔ اﺳﺘﺨﺪام ھﺬه اﻟﺒﯿﺎﻧﺎت ﻟﺘﺤﺴﯿﻦ اﻟﻨﺘﺎﺋﺞ اﻟﺴﺮﯾﺮﯾﺔ‬ that demonstrates how data from operational clinical systems can be used ‫ ﻟﻘﺪ اﻧﺘﺸﺮت اﻟﺪراﺳﺎت اﻟﺘﻲ‬.‫ﻓﻌﻠﯿًﺎ أو ﺗﻘﻠﯿﻞ اﻟﺘﻜﺎﻟﯿﻒ‬ to identify critical situations or patients whose costs are outliers. ‫ﺗﺴﺘﺨﺪم ﺑﯿﺎﻧﺎت اﻟﺴﺠﻞ اﻟﺼﺤﻲ اﻹﻟﻜﺘﺮوﻧﻲ ﻟﻠﺘﻨﺒﺆ‬ There is less research, however, demonstrating how this data can be put.‫اﻟﺴﺮﯾﺮي‬ to use to actually improve clinical outcomes or reduce costs. Studies using EHR data for clinical prediction have been proliferating. ‫ ﻛﺎن أﺣﺪ ﻣﺠﺎﻻت اﻟﺘﺮﻛﯿﺰ اﻟﻤﺸﺘﺮﻛﺔ ھﻮ اﺳﺘﺨﺪام‬ ‫ﺗﺤﻠﯿﻼت اﻟﺒﯿﺎﻧﺎت ﻟﺘﺤﺪﯾﺪ اﻟﻤﺮﺿﻰ اﻟﻤﻌﺮﺿﯿﻦ ﻟﺨﻄﺮ‬ One common area of focus has been the use of data analytics to identify ‫ ﯾﻮ ًﻣﺎ ﻣﻦ‬30 ‫إﻋﺎدة اﻹدﺧﺎل إﻟﻰ اﻟﻤﺴﺘﺸﻔﻰ ﺧﻼل‬ patients at risk for hospital readmission within 30 days of discharge. The importance of this factor comes from the US Centers for Medicare and ‫ وﺗﺄﺗﻲ أھﻤﯿﺔ ھﺬا اﻟﻌﺎﻣﻞ ﻣﻦ‬.‫اﻟﺨﺮوج ﻣﻦ اﻟﻤﺴﺘﺸﻔﻰ‬ Medicaid Services (CMS) Readmissions Reduction Program that ‫ﺑﺮﻧﺎﻣﺞ اﻟﺤﺪ ﻣﻦ ﻋﻤﻠﯿﺎت إﻋﺎدة اﻟﻘﺒﻮل اﻟﺘﺎﺑﻊ ﻟﻠﻤﺮاﻛﺰ‬ penalizes hospitals for excessive numbers of readmissions. ،(CMS) ‫اﻷﻣﺮﯾﻜﯿﺔ ﻟﻠﺮﻋﺎﯾﺔ اﻟﻄﺒﯿﺔ واﻟﺨﺪﻣﺎت اﻟﻄﺒﯿﺔ‬ ‫واﻟﺬي ﯾﻌﺎﻗﺐ اﻟﻤﺴﺘﺸﻔﯿﺎت ﻋﻠﻰ اﻷﻋﺪاد اﻟﻤﻔﺮطﺔ ﻣﻦ‬.‫ﻋﻤﻠﯿﺎت إﻋﺎدة اﻟﻘﺒﻮل‬  12 ‫ ھﻨﺎك ﻋﺪد ﻣﻦ اﻟﺤﺎﻻت اﻟﺴﺮﯾﺮﯾﺔ اﻟﺤﺮﺟﺔ اﻷﺧﺮى اﻟﺘﻲ‬ CONT ‫ﻛﺎﻧﺖ ﻗﺎﺑﻠﺔ ﻟﻼﻛﺘﺸﺎف ﻣﻦ ﺧﻼل اﻟﺘﺤﻠﯿﻼت اﻟﻤﻄﺒﻘﺔ ﻋﻠﻰ‬ : ‫اﻟﺴﺠﻼت اﻟﺼﺤﯿﺔ اﻹﻟﻜﺘﺮوﻧﯿﺔ واﻟﺒﯿﺎﻧﺎت اﻟﺴﺮﯾﺮﯾﺔ اﻻﺧﺮى‬ A number of other critical clinical situations have been amenable to detection by analytics applied to EHR and other clinical data: ‫ ﯾﻮ ًﻣﺎ ﺑﯿﻦ‬30 ‫ اﻟﺘﻨﺒﺆ ﺑﺨﻄﺮ إﻋﺎدة اﻟﻘﺒﻮل واﻟﻮﻓﺎة ﻟﻤﺪة‬ Predicting 30-day risk of readmission and death among HIV-infected inpatients ‫اﻟﻤﺮﺿﻰ اﻟﺪاﺧﻠﯿﯿﻦ اﻟﻤﺼﺎﺑﯿﻦ ﺑﻔﯿﺮوس ﻧﻘﺺ اﻟﻤﻨﺎﻋﺔ اﻟﺒﺸﺮﯾﺔ‬ Identification of children with asthma ‫ اﻟﺘﻌﺮف ﻋﻠﻰ اﻷطﻔﺎل اﻟﻤﺼﺎﺑﯿﻦ ﺑﺎﻟﺮﺑﻮ‬ Risk-adjusting hospital mortality rates ‫ ﺗﻌﺪﯾﻞ ﻣﻌﺪﻻت اﻟﻮﻓﯿﺎت ﻓﻲ اﻟﻤﺴﺘﺸﻔﯿﺎت‬ Detecting postoperative complications ‫ اﻟﻜﺸﻒ ﻋﻦ ﻣﻀﺎﻋﻔﺎت ﻣﺎ ﺑﻌﺪ اﻟﺠﺮاﺣﺔ‬ Measuring processes of care ‫ ﻗﯿﺎس ﻋﻤﻠﯿﺎت اﻟﺮﻋﺎﯾﺔ‬ ‫ ﺗﺤﺪﯾﺪ اﻟﻌﻤﺮ اﻟﻤﺘﻮﻗﻊ ﻟﻤﺪة ﺧﻤﺲ ﺳﻨﻮات‬ Determining five-year life expectancy ‫ اﻟﻜﺸﻒ ﻋﻦ اﻟﺘﺄﺧﯿﺮ اﻟﻤﺤﺘﻤﻞ ﻓﻲ ﺗﺸﺨﯿﺺ اﻟﺴﺮطﺎن‬ Detecting potential delays in cancer diagnosis ‫ ﺗﺤﺪﯾﺪ اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ ﺗﻠﯿﻒ اﻟﻜﺒﺪ اﻟﻤﻌﺮﺿﯿﻦ‬ Identifying patients with cirrhosis at high risk for readmission ‫ﻟﺨﻄﺮ ﻛﺒﯿﺮ ﻹﻋﺎدة اﻟﻘﺒﻮل‬ Predicting out of intensive care unit cardiopulmonary arrest or death ‫ اﻟﺘﻨﺒﺆ ﺑﺎﻟﺴﻜﺘﺔ اﻟﻘﻠﺒﯿﺔ أو اﻟﻮﻓﺎة ﺧﺎرج وﺣﺪة اﻟﻌﻨﺎﯾﺔ اﻟﻤﺮﻛﺰة‬  13 CONT ‫ رﻛﺰت اﻟﺠﮭﻮد اﻹﺿﺎﻓﯿﺔ ﻋﻠﻰ اﻟﻤﺴﺎﻋﺪة ﻓﻲ ﺗﺤﺪﯾﺪ‬ Additional efforts have focused on helping to identify patients for ‫اﻟﻤﺮﺿﻰ ﻟﻠﻤﺸﺎرﻛﺔ ﻓﻲ ﺑﺮوﺗﻮﻛﻮﻻت اﻟﺒﺤﺚ أو‬ participation in research protocols or improve diagnosis of disease: :‫ﺗﺤﺴﯿﻦ ﺗﺸﺨﯿﺺ اﻟﻤﺮض‬ Identifying patients who might be eligible for participation in clinical studies ‫ ﺗﺤﺪﯾﺪ اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﻗﺪ ﯾﻜﻮﻧﻮن ﻣﺆھﻠﯿﻦ ﻟﻠﻤﺸﺎرﻛﺔ‬ Determining eligibility for clinical trials ‫اﻟﺴﺮﯾﺮﯾﺔ‬ ‫اﻟﺪراﺳﺎت‬ Identifying patients with diabetes and the earliest date of diagnosis ‫ ﺗﺤﺪﯾﺪ اﻷھﻠﯿﺔ ﻟﻠﺘﺠﺎرب اﻟﺴﺮﯾﺮﯾﺔ‬ Predicting diagnosis in new patients ‫ ﺗﺤﺪﯾﺪ اﻟﻤﺮﺿﻰ اﻟﺬﯾﻦ ﯾﻌﺎﻧﻮن ﻣﻦ ﻣﺮض اﻟﺴﻜﺮي‬ ‫وأﻗﺮب ﺗﺎرﯾﺦ ﻟﻠﺘﺸﺨﯿﺺ‬ ‫ اﻟﺘﻨﺒﺆ ﺑﺎﻟﺘﺸﺨﯿﺺ ﻟﺪى اﻟﻤﺮﺿﻰ اﻟﺠﺪد‬  14 ‫ وھﻲ‬،(UKGPRD) ‫ ﻗﺎﻋﺪة ﺑﯿﺎﻧﺎت اﻷﺑﺤﺎث‬ CONT.‫ﻣﺴﺘﻮدع ﻟﻠﺴﺠﻼت اﻟﻄﻮﻟﯿﺔ ﻟﻠﻤﻤﺎرﺳﯿﻦ اﻟﻌﺎﻣﯿﻦ‬ ‫ ﻛﺎﻧﻮا‬.‫ ﺗﺎﻧﯿﻦ وآﺧﺮون‬،‫ﺑﺎﺳﺘﺨﺪام ھﺬه اﻟﺒﯿﺎﻧﺎت‬ Research Database (UKGPRD), a repository of longitudinal records of ‫ﻗﺎدرﯾﻦ ﻋﻠﻰ إﺛﺒﺎت اﻟﻘﺪرة ﻋﻠﻰ ﺗﻜﺮار ﻧﺘﺎﺋﺞ‬ general practitioners. Using this data, Tannen et al. were able to demonstrate ‫ﻣﺒﺎدرة ﺻﺤﺔ اﻟﻤﺮأة واﻟﺘﺠﺎرب اﻟﻤﻌﺸﺎة ذات‬ the ability to replicate the findings of the Health Initiative and ‫اﻟﺸﻮاھﺪ ﻷﻣﺮاض اﻟﻘﻠﺐ واﻷوﻋﯿﺔ اﻟﺪﻣﻮﯾﺔ‬ RCTs of other cardiovascular diseases..‫اﻷﺧﺮى‬ Likewise, Danaei et al. were able to combine subject matter expertise, complete data, and statistical methods emulating clinical trials to replicate ‫ ﻛﺎﻧﻮا ﻗﺎدرﯾﻦ ﻋﻠﻰ‬.‫ داﻧﺎي وآﺧﺮون‬،‫ وﺑﺎﻟﻤﺜﻞ‬ RCTs demonstrating the value of statin drugs in primary prevention of coronary heart disease. ‫اﻟﺠﻤﻊ ﺑﯿﻦ اﻟﺨﺒﺮة اﻟﻤﻮﺿﻮﻋﯿﺔ واﻟﺒﯿﺎﻧﺎت اﻟﻜﺎﻣﻠﺔ‬ ‫واﻷﺳﺎﻟﯿﺐ اﻹﺣﺼﺎﺋﯿﺔ اﻟﺘﻲ ﺗﺤﺎﻛﻲ اﻟﺘﺠﺎرب‬ ‫اﻟﺴﺮﯾﺮﯾﺔ ﻟﺘﻜﺮار اﻟﺘﺠﺎرب اﻟﻤﻌﺸﺎة ذات اﻟﺸﻮاھﺪ‬ ‫اﻟﺘﻲ ﺗﻮﺿﺢ ﻗﯿﻤﺔ أدوﯾﺔ اﻟﺴﺘﺎﺗﯿﻦ ﻓﻲ اﻟﻮﻗﺎﯾﺔ‬.‫اﻷوﻟﯿﺔ ﻣﻦ أﻣﺮاض اﻟﻘﻠﺐ اﻟﺘﺎﺟﯿﺔ‬  15 ‫ ﺗﻢ اﺳﺘﺨﺪام ھﺬه اﻟﻤﺴﺘﻮدﻋﺎت اﻟﻜﺒﯿﺮة ﻷﻏﺮاض‬ ‫ ﺗﻢ اﺳﺘﺨﺪام‬،‫ ﻋﻠﻰ ﺳﺒﯿﻞ اﻟﻤﺜﺎل‬.‫ﺑﺤﺜﯿﺔ أﺧﺮى‬ ‫ ﻟﺘﺤﺪﯾﺪ ﻋﻮاﻣﻞ اﻟﺨﻄﺮ ﻟﺴﺮطﺎن‬UKGPRD CONT.‫اﻟﺒﻨﻜﺮﯾﺎس وﺳﺮطﺎن اﻟﻤﻌﺪة واﻷﻣﻌﺎء‬ These large repositories have been used for other research purposes. For example, the UKGPRD has been used for determining risk factors for ‫ ھﻨﺎك ﻣﺴﺘﻮدع ﻛﺒﯿﺮ آﺧﺮ ﻟﻠﺒﯿﺎﻧﺎت ﻓﻲ اﻟﻮﻻﯾﺎت‬ pancreatic cancer and gastroesophogeal cancer. ‫اﻟﻤﺘﺤﺪة ﯾﺴﻤﺢ ﺑﺘﻜﺮار اﻟﺪراﺳﺎت اﻷﺗﺮاﺑﯿﺔ‬ Another large data repository in the US allowed replication of ‫اﻻﺳﺘﺒﺎﻗﯿﺔ ﻟﻤﺨﺎطﺮ أﺣﺪاث اﻻﻧﺼﻤﺎم اﻟﺨﺜﺎري‬ prospective cohort studies for risks of venous thromboembolic events in ‫اﻟﻮرﯾﺪي ﺑﻄﺮﯾﻘﺔ أﻛﺜﺮ ﻛﻔﺎءة ﺑﻜﺜﯿﺮ ﻣﻦ اﻟﺘﺤﻠﯿﻼت‬ a manner much more efficient that historical retrospective analyses..‫اﻟﺘﺎرﯾﺨﯿﺔ اﻻﺳﺘﺮﺟﺎﻋﯿﺔ‬ In addition, the Observational Medical Outcomes Partnership (OMOP) was to apply risk-identification methods to records from ten different ‫ ﻛﺎن ﻣﻦ اﻟﻤﻘﺮر أن ﺗﻘﻮم‬،‫ﺑﺎﻹﺿﺎﻓﺔ إﻟﻰ ذﻟﻚ‬ large healthcare institutions in the US. (OMOP) ‫ﺷﺮاﻛﺔ اﻟﻨﺘﺎﺋﺞ اﻟﻄﺒﯿﺔ اﻟﺮﺻﺪﯾﺔ‬ ‫ﺑﺘﻄﺒﯿﻖ أﺳﺎﻟﯿﺐ ﺗﺤﺪﯾﺪ اﻟﻤﺨﺎطﺮ ﻋﻠﻰ اﻟﺴﺠﻼت‬ ‫ﻣﻦ ﻋﺸﺮ ﻣﺆﺳﺴﺎت ﻛﺒﯿﺮة ﻣﺨﺘﻠﻔﺔ ﻟﻠﺮﻋﺎﯾﺔ‬.‫اﻟﺼﺤﯿﺔ ﻓﻲ اﻟﻮﻻﯾﺎت اﻟﻤﺘﺤﺪة‬  16 RECOMMENDED READING THE FOLLOWING ARE INTERESTING REFERENCES TO EXPAND YOUR HEALTHCARE DATA ANALYTICS KNOWLEDGE: Mining Electronic Health Analytics in Healthcare and the Records in the Genomics Life Sciences: Strategies, Era.https://pubmed.ncbi.nlm.ni Implementation Methods, and h.gov/23300414/ Best Practices. THANK YOU Reference Text Book: HEALTH INFORMATICS Practical Guide for Healthcare and Information Technology Professionals SIXTH EDITION Robert E Hoyt Editor Ann Yoshihashi Associate Editor ‫تنفيذ النظام والدعم‬ ‫‪Unit 7‬‬  To be able to discuss the process that a health care organization typically goes through in implementing a health care information system. To be able to appreciate the organizational factors that can affect system acceptance and strategies for managing change. To be able to develop a sample system implementation plan. Gain insight into the things that can go wrong during implementation & strategies managers can employ to alleviate problems. To be able to discuss factors important to system support and evaluation.  System Implementation Process  Organize the Team and Identify a Champion  Determine Project Scope and Expectations  Establish and Institute a Project Plan  Typical Components of an Implementation Plan  Manging the Organizational Aspects  Manage Unintended Consequences  System Support and Evaluation  Case study  Summary  Learning activities  Implementation team  System champion  System implementation  Train the trainer  Unintended consequences  User resistance  Workflow and process analysis  ‫تنفيذ النظام‬  Once a health care organization has finalized its contract with the vendor to acquire an information system, the system implementation ‫بمجرد أن تنهي منظمة الرعاية الصحية عقدها مع البائع‬ process begins. ‫ تبدأ عملية تنفيذ النظام‬،‫للحصول على نظام معلومات‬  This chapter focuses on the two final stages of the system development life cycle, implementation and then support and evaluation ‫يركز هذا الفصل على املرحلتني األخيرتني من دورة‬ ‫ التنفيذ ثم الدعم والتقييم‬،‫حياة تطوير النظام‬  System implementation begins once the organization has acquired the system and continues through the early stages following the go-live date (the date when the system is put into general use for everyone). ‫يبدأ تنفيذ النظام بمجرد حصول املنظمة على النظام ويستمر خالل‬ ‫املراحل املبكرة التي تلي تاريخ التشغيل املباشر )التاريخ الذي يتم‬.(‫فيه وضع النظام لالستخدام العام للجميع‬ Some fundamental activities that should occur during any system implementation ‫بعض األنشطة األساسية التي يجب أن‬ ‫تحدث أثناء تنفيذ أي نظام‬ ‫تنظيم فريق التنفيذ وتحديد بطل النظام‬ Organize implementation team 1 and identify system champion ‫تحديد نطاق املشروع‬ Determine the scope of the 2 project ‫وضع وتنفيذ خطة املشروع‬ Develop and implement a 3 project plan  ‫تنظيم الفريق وتحديد البطل‬ 1. Organize the Team and Identify a Champion ‫إن إحدى الخطوات‬ ‫األولى في التخطيط‬  One of the first steps in planning for the ‫لتنفيذ نظام جديد هي‬.‫تنظيم فريق التنفيذ‬ implementation of a new system is to organize an implementation team.  Implementation teams often include some ‫غالبًا ما تتضمن فرق التنفيذ‬ ‫بعض األشخاص املشاركني في‬ of the same people involved in selecting ‫ قد‬،‫اختيار النظام؛ ومع ذلك‬ ً ‫تتضمن‬ ‫أيضا أفرا ًدا آخرين‬ the system; however, they may also ‫يتمتعون باملعرفة واملهارات املهمة‬ ‫للنشر الناجح للنظام الجديد‬ include other individuals with knowledge ‫يجب أن يتضمن فريق التنفيذ‬ and skills important to the successful ً ‫أيضا بطل نظام واحد على‬ deployment of the new system ‫األقل‬  The implementation team should also include at least one system champion.  ‫إن بطل النظام هو شخص‬ ،‫يحظى باالحترام في املنظمة‬ ‫ويرى أن النظام الجديد‬ ‫ضروري لتحقيق املنظمة‬  A system champion is someone who is well ‫ وهو‬،‫ألهدافها االستراتيجية‬.‫متحمس لتطبيقه‬ respected in the organization, sees the new system as necessary to the organization’s achievement of its strategic goals, and is passionate about implementing it. Chief Information Officers  ‫تحديد نطاق املشروع والتوقعات‬.‫أحد البنود األولى لعمل فريق التنفيذ هو تحديد نطاق املشروع وما تأمل املنظمة أن يحققه املشروع‬ 2. Determine project scope and expectations  One of the implementation team’s first items of business is to determine the scope of the project and what the organization hopes the project will achieve.  What are the goals of the project?  What is the project’s scope?  What does the organization hope to achieve as a result of the new system?  How will it measure its success?  What are the risks of failing to define project goals and scope? ‫ما هي أهداف املشروع؟‬ ‫ما هو نطاق املشروع؟‬ ‫ما الذي تأمل املنظمة تحقيقه نتيجة للنظام الجديد ؟‬ ‫كيف ستقيس نجاحها؟‬ ‫ما هي مخاطر الفشل في تحديد أهداف ونطاق املشروع؟‬ ‫بمجرد أن يتفق فريق التنفيذ على‬ ‫ فإن الخطوة‬،‫أهدافه وأغراضه‬ ‫الرئيسية التالية هي تطوير وتنفيذ‬ ‫ يجب أن تتضمن‬.‫خطة املشروع‬ ‫إنشاء وتأسيس خطة املشروع‬ ‫خطة املشروع‬  Once the implementation team has agreed on its goals and objectives, the next major step is to develop and implement a project plan. The project plan should include (‫أيضا املهام‬ ً ‫ األنشطة الرئيسية )وتسمى‬.1 Major 1.Once activities (also called tasks) the implementation team has agreed on‫الرئيسية‬ its‫ املعالم‬.2 2. Major milestones ‫ املدة املقدرة لكل نشاط‬.3 goals and objectives, the next major ،‫سبيل املثال‬step is to ‫ على‬،‫األنشطة )بحيث‬ ‫ أي تبعيات بني‬.4 3. Estimated duration of each activity (‫يجب إكمال مهمة واحدة قبل أن تبدأ مهمة أخرى‬ develop and implement a project plan. 4. Any dependencies among activities (so that, for What one example, is the project task must be plan shouldbefore completed include? another can begin) (‫ املوارد وامليزانية املتاحة )بما في ذلك املوظفني الذين سيتم تخصيص وقتهم للمشروع‬.5 5. Resources and budget available (including staff whose time will be allocated to the project) 6. Individuals or team members responsible for ‫ األفراد أو أعضاء الفريق املسئولني‬.6 completing each activity ‫عن إكمال كل نشاط‬ ‫ تواريخ الهدف‬.7 7. Target dates ‫ مقاييس تقييم اإلنجاز والنجاح‬.8 8. Measures for evaluating completion and success  The health care IT vendor may have a suggested implementation plan; the team must make sure, however, that this plan is tailored to suit the unique needs of the organization in which the new system is to be introduced ‫ يجب على الفريق التأكد من‬،‫قد يكون لدى بائع تكنولوجيا املعلومات للرعاية الصحية خطة تنفيذ مقترحة؛ ومع ذلك‬ ‫أن هذه الخطة مصممة لتناسب االحتياجات الفريدة للمنظمة التي سيتم تقديم النظام الجديد فيها‬ Typical Components of an Implementation Plan 1. Workflow and process analysis 2. System installation ‫املكونات النموذجية لخطة التنفيذ‬ ‫ تحليل سير العمل والعمليات‬.1 3. Staff training ‫ تثبيت النظام‬.2 ‫ تدريب املوظفني‬.3 4. Conversion ‫ التحويل‬.4 ‫ االتصاالت‬.5 5. Communications ‫ التحضير لتاريخ بدء التشغيل‬.6 6. Preparation for go-live date  ‫املكونات النموذجية لخطة التنفيذ‬ ‫تحليل سير العمل والعملية‬ ‫تحليل أو تقييم العملية واإلجراءات الحالية‬ ‫تحديد فرص التحسني‪ ،‬وتنفيذ هذه التغييرات حسب االقتضاء‪.‬‬ ‫تحديد مصادر البيانات‪ ،‬بما في ذلك الواجهات مع األنظمة األخرى‪.‬‬ ‫تحديد موقع وعدد محطات العمل املطلوبة‪.‬‬ ‫إعادة تصميم املوقع املادي حسب الحاجة‪.‬‬ ‫تركيب النظام‬ ‫تحديد تكوين النظام‪.‬‬ ‫طلب األجهزة وتثبيتها‪.‬‬ ‫إعداد غرفة الكمبيوتر‪.‬‬ ‫ترقية البنية األساسية لتكنولوجيا املعلومات أو تنفيذها‪.‬‬ ‫تثبيت البرامج والواجهات‪.‬‬ ‫تدريب املوظفني‬ ‫تخصيص البرامج‪.‬‬ ‫تدريب املوظفني‪.‬‬ ‫االختبار وإعادة االختبار واالختبار مرة أخرى‪...‬‬ ‫تحديث أدلة اإلجراءات‪.‬‬  ‫‪.4‬التحويل‬ ‫تحويل البيانات‪.‬‬ ‫اختبار النظام‪.‬‬ ‫االتصاالت‬ ‫إنشاء آليات اتصال لتحديد املشكالت واملخاوف ومعالجتها‪.‬‬ ‫التواصل بانتظام مع مختلف املجموعات املكونة‪.‬‬ ‫التحضير لتاريخ بدء التشغيل‬ ‫ً‬ ‫منخفضا‬ ‫تحديد التاريخ الذي يكون فيه عدد املرضى‬ ‫نسب ًيا‪.‬‬ ‫ٍ‬ ‫كاف من املوظفني في متناول‬ ‫التأكد من وجود عدد‬ ‫اليد‪.‬‬ ‫إنشاء آلية لإلبالغ عن املشكالت والقضايا‬ ‫وتصحيحها‪.‬‬ ‫مراجعة وتنفيذ إعادة هندسة العملية‪.‬‬  ‫إدارة الجوانب التنظيمية‬ ‫إن تنفيذ نظام معلومات في منشأة للرعاية الصحية يمكن أن يكون له تأثير عميق على املنظمة‬.‫واألشخاص الذين يعملون هناك واملرضى الذين يخدمونهم‬  Implementing an information system in a health care facility can have a profound impact on the organization, the people who work there, and the patients they serve. Individuals may have concerns and ‫مخاوف‬ ‫قد يكون لدى األفراد‬ ‫وقلق بشأن النظام الجديد‬ apprehensions about the new system.  They may wonder: How will the new system affect my job responsibilities or productivity? How will my workload change? Will the new system cause me more or less ‫ كيف سيؤثر النظام الجديد على مسؤولياتي الوظيفية أو إنتاجيتي؟ كيف‬:‫قد يتساءلون‬ stress? ‫سيتغير عبء العمل لدي؟ هل سيسبب لي النظام الجديد ضغوطًا أكثر أم أقل؟‬  :‫ ويرون قيمته املحتملة قد يشعرون بالقلق‬،‫ ويرون الحاجة إليه‬،‫حتى األفراد الذين يرحبون بالنظام الجديد‬  Even individuals who welcome the new system, see the need for it, and see its potential ‫ماذا سأفعل إذا تعطل النظام؟‬ value may worry: ‫هل سيعيق النظام عالقتي بمرضاي؟‬  What will I do if the system is down?  Will the system impede my relationship with my patients? ‫من سأتوجه إليه إذا كانت لدي مشاكل أو أسئلة؟‬  Who will I turn to if I have problems or questions? ‫هل سيُطلب مني كتابة مالحظاتي في النظام؟‬  Will I be expected to type my notes into the system?.‫ والتغيير قد يكون صعبا ً إذا لم تتم إدارته بشكل فعال‬،‫مع النظام الجديد يأتي التغيير‬  With the new system comes change, and change can be difficult if not managed effectively.  ‫االستراتيجيات التي قد‬ ‫تؤدي إلى قبول املنظمة‬ ‫واستخدامها لنظام جديد‬ ‫إنشاء بيئة مناسبة‬ Create an appropriate environment strategies that ‫ال تقلل من شأن مقاومة املستخدم‬ may lead Do not underestimate user resistance organizational ‫تخصيص املوارد الكافية‬ Allocate Sufficient Resources acceptance and ‫توفير التدريب املناسب‬ use of a new Provide Adequate Training system ‫إدارة العواقب غير املقصودة‬ Manage Unintended Consequences  ‫االستراتيجيات التي قد تؤدي إلى قبول أكبر من جانب املنظمة واستخدام نظام جديد‬ ‫إنشاء بيئة حيث يتم تحديد التوقعات وتلبيتها وإدارتها‬  Create an environment where expectations are defined, met and managed ‫ال تقلل من أهمية مقاومة االستخدام‬ What  Do areunderestimate not the strategies that usemay lead to greater resistance organizational  Allocate sufficient acceptance resources, and use of a new including system? technical support staff and IT infrastructure  Provide adequate initial and ongoing training ‫توفير التدريب األولي واملستمر املناسب‬ ‫ بما في ذلك‬،‫تخصيص املوارد الكافية‬ ‫موظفي الدعم الفني والبنية األساسية‬ ‫لتكنولوجيا املعلومات‬  Manage unintended consequences. especially those known to affect implementations.‫إدارة العواقب غير املقصودة‬ such as CPOE ‫خاصة تلك املعروفة بتأثيرها على التنفيذات‬ CPOE ‫مثل‬  ‫إدارة العواقب غير املقصودة‬ ‫الخبرة اإلدارية والقيادة هي عناصر مهمة لنجاح تنفيذ أي نظام‬  Management expertise and leadership are important elements to the success of any system implementation..‫يساعد القادة الفعالون على بناء مجتمع من التعاون والثقة‬  Effective leaders help build a community of ً ‫ فإن القيادة الفعالة تستلزم‬،‫ومع ذلك‬ ‫أيضا فهم العواقب غير‬ collaboration and trust..‫املقصودة التي يمكن أن تحدث أثناء تنفيذ األنظمة املعقدة وإدارتها‬  However, effective leadership also entails understanding the unintended consequences that can occur during complex system implementations and managing them.  Unintended consequences can be positive, negative, or both, depending on one’s ،‫ أو سلبية‬،‫يمكن أن تكون العواقب غير املقصودة إيجابية‬ perspective..‫ وذلك حسب وجهة نظر الشخص‬،‫أو كليهما‬  ‫إدارة العواقب غير املقصودة‬  Eight types of unintended consequences that implementation teams should plan for and consider when implementing computerized provider order entry CPOE: ‫ثمانية أنواع من العواقب غير املقصودة التي‬ ‫يجب على فرق التنفيذ التخطيط لها والنظر‬ ‫فيها عند تنفيذ إدخال طلبات مقدم الخدمة‬ :CPOE ‫املحوسب‬ Eightwork More types or of newunintended work consequences ‫مزيد من العمل أو عمل جديد‬ Workflow ‫سير العمل‬ System demands ‫مطالب النظام‬ Communication ‫تواصل‬ Emotions ‫العواطف‬ New kinds of errors ‫أنواع جديدة من األخطاء‬ ‫تحوالت القوة‬ Power shifts Dependence on the system ‫االعتماد على النظام‬  ‫مزيد من العمل أو عمل جديد‪.‬‬ ‫يمكن أن تزيد عمليات ‪CPOE‬‬ ‫نظرا لحقيقة مفادها‬ ‫‪1.‬‬ ‫من العمل ً‬ ‫‪More work or new work. CPOEs can increase work‬‬ ‫أن األنظمة قد تكون بطيئة‪ ،‬وقد‬ ‫تتطلب الحاالت غير القياسية‬ ‫‪due to the fact that systems may be slow,‬‬ ‫املزيد من الخطوات في الطلب‪،‬‬ ‫وقد يظل التدريب مشكلة‪ ،‬وقد‬ ‫‪nonstandard cases may call for more steps in‬‬ ‫تصبح بعض املهام أكثر‬ ‫صعوبة‪ ،‬ويجبر الكمبيوتر‬ ‫‪ordering, training may remain an issue, some tasks‬‬ ‫املستخدم على إكمال "جميع‬ ‫الخطوات"‪ ،‬وغالبًا ما يتولى‬ ‫األطباء مهام كان يقوم بها‬ ‫‪may become more difficult, the computer forces the‬‬ ‫آخرون في السابق‪.‬‬ ‫‪user to complete “all steps,” and physicians often‬‬ ‫‪take on tasks that were formerly done by others.‬‬ ‫سير العمل‪.‬يمكن أن‬ ‫‪2.‬‬ ‫التحسني ‪Workflow. CPOEs can greatly alter workflow,‬‬ ‫تعمل عمليات‬ ‫املستمر على تغيير سير‬ ‫العمل بشكل كبير‪sometimes improving workflow for some and ،‬‬ ‫وفي بعض األحيان تعمل‬ ‫متطلبات النظام‪.‬يمكن أن‬ ‫‪slowing or complicating it for others.‬‬ ‫على تحسني سير العمل‬ ‫بالنسبة للبعض وفي‬ ‫تكون جهود الصيانة‬ ‫‪3.‬‬ ‫والتدريب والدعم مهمة‬ ‫بعض األحيان تبطئه أو ‪System demands. Maintenance, training, and‬‬ ‫تزيد من تعقيده بالنسبة‬ ‫بالنسبة للمنظمة‪ ،‬ليس فقط‬ ‫في بناء النظام ولكن ً‬ ‫أيضا‬ ‫‪support efforts can be significant for an‬‬ ‫لآلخرين‪.‬‬ ‫في إجراء التحسينات‬ ‫والتحسينات عليه‪.‬‬ ‫‪organization, not only in building the system but also‬‬ ‫‪in making improvements and enhancements to it.‬‬  CPOE ‫ تؤثر أنظمة‬.‫التواصل‬ 4. ‫على التواصل داخل املنظمة؛‬ Communication. CPOE systems affect ‫فهي يمكن أن تقلل من الحاجة‬ ‫إلى توضيح األوامر ولكنها‬ communication within the organization; they ‫أيضا إلى فشل‬ً ‫تؤدي‬ ‫األشخاص في التواصل بشكل‬ can reduce the need to clarify orders but also ‫كاف مع بعضهم البعض في‬ ٍ lead to people failing to adequately ‫املواقف املناسبة‬ communicate with each other in appropriate situations..‫ من اإليجابية إلى السلبية‬CPOE ‫ يمكن أن تتراوح ردود أفعال األطباء تجاه‬.‫العواطف‬ 5. Emotions. Clinician reactions to CPOE can run the gamut from positive to negative. ‫ على‬.‫أنواع جديدة من األخطاء‬ CPOE ‫الرغم من أن أنظمة‬ 6. New kinds of errors. Although CPOE systems ‫مصممة عمو ًما للكشف عن‬ are generally designed to detect and prevent ‫ إال أنها قد‬،‫األخطاء ومنعها‬ ‫تؤدي إلى أنواع جديدة من‬ errors, they can lead to new types of errors ‫األخطاء‬ ‫ حيث ينقر‬،‫مثل أخطاء التجاور‬ ‫األطباء على اسم املريض‬ such as juxtaposition errors, in which clinicians click on the adjacent patient name or ‫املجاور أو الدواء من القائمة‬ ‫ويدخلون عن غير قصد ترتيبًا‬ medication from a list and inadvertently enter.‫خاطئ ًا‬ the wrong order.  ‫ قد ال يُنظر إلى‬.‫تحوالت السلطة‬ ‫تحوالت السلطة على أنها مشكلة‬ 7. Power shifts. Shifts in power may not be ‫كبيرة مثل بعض العواقب غير‬ ‫ ولكن يمكن‬،‫املقصودة األخرى‬ ‫ ملراقبة سلوك‬CPOE ‫استخدام‬ viewed as much of a problem as some of the.‫الطبيب‬ other unintended consequences, but CPOE can be used to monitor physician behavior. 8. Dependence on the system. Clinicians become dependent on the CPOE system, so managing downtime procedures is critical. Even then, while the system is down, CPOE users view the situation as managed chaos (adapted from Ash et al., 2007). ‫ أصبح األطباء معتمدين على‬.‫االعتماد على النظام‬ ‫ لذا فإن إدارة إجراءات التوقف عن‬،CPOE ‫نظام‬ ،‫ وحتى في هذه الحالة‬.‫العمل أمر بالغ األهمية‬ ‫ ينظر مستخدمو‬،ً‫بينما يكون النظام معطال‬ ‫ إلى املوقف باعتباره فوضى ُمدارة‬CPOE  System Support and Evaluation Fixing of Errors and Continues Grow and Change Monitoring and Problems Improvement evaluation Information Many opportunities Like any other Evaluations must be systems using for enhancing and device, viewed as an integral improving the information component of every in the daily system’s major health operation performance and systems have a information system functionality will life cycle and project and not an occur well after the eventually need afterthought. go-live date to be replaced ‫املراقبة والتقييم‬ ‫إصالح األخطاء واملشاكل‬ ‫التحسني املستمر ستتاح العديد‬ ،‫ مثل أي جهاز آخر‬:‫النمو والتغيير‬ ‫يجب النظر إلى التقييمات‬ ‫نظم املعلومات املستخدمة في‬ ‫من الفرص لتعزيز وتحسني أداء‬ ‫فإن أنظمة املعلومات لها دورة حياة‬ ‫باعتبارها جز ًءا ال يتجزأ من كل‬ ‫العمليات اليومية‬ ‫النظام ووظائفه بعد تاريخ التشغيل‬ ‫وتحتاج في النهاية إلى االستبدال‬ ‫مشروع رئيسي لنظام املعلومات‬ ‫املباشر‬.‫الصحية وليس مجرد فكرة ثانوية‬  ‫دعم النظام والتقييم‬ ‫تتطور أنظمة املعلومات مع استمرار نمو املنظمة وتغيرها‬  Information systems evolve as an organization ‫يتولى موظفو‬ continues to grow and change. ‫تكنولوجيا املعلومات‬  IT staff generally assume a major role in ‫دورا‬ ً ‫بشكل عام‬ ‫رئيس ًيا في صيانة‬ maintaining and supporting the information‫املعلومات‬ ‫ودعم أنظمة‬ ‫في مؤسسة الرعاية‬ systems in the health care organization..‫الصحية‬  When errors or problems are detected, IT staff correct the problem or work with the vendor to ‫ يقوم موظفو تكنولوجيا املعلومات‬،‫عند اكتشاف أخطاء أو مشكالت‬ see that the problem is fixed. ‫بتصحيح املشكلة أو العمل مع البائع للتأكد من حل املشكلة‬  Moreover, the vendor may detect glitches and develop upgrades or patches that will need to be installed. ‫ قد يكتشف البائع الخلل ويقوم بتطوير الترقيات أو‬،‫عالوة على ذلك‬.‫التصحيحات التي قد تحتاج إلى التثبيت‬.‫ستتاح العديد من الفرص لتعزيز وتحسني أداء النظام ووظائفه بعد تاريخ التشغيل املباشر‬  Many opportunities for enhancing and improving the system’s performance and functionality will ‫تريد املنظمة التأكد من أن النظام يتم صيانته بشكل‬ occur well after the go-live date..‫ وتطويره بشكل أكبر بمرور الوقت‬،‫ ودعمه‬،‫مناسب‬  The organization will want to ensure that the system is adequately maintained, supported, and.ً‫استثمارا هائال‬ ‫يعد اختيار نظام معلومات الرعاية الصحية وتنفيذه‬ further developed over time. ً  Selecting and implementing a health care information system is an enormous investment.  This investment must be maintained, just as one would maintain one’s home..‫ كما نحافظ على منزلنا‬،‫ويجب الحفاظ على هذا االستثمار‬.‫ وفي نهاية املطاف تحتاج إلى االستبدال‬،‫ فإن أنظمة املعلومات لها دورة حياة‬،‫مثل أي جهاز آخر‬  Like any other device, information systems have a life cycle and eventually need to be replaced. ‫تمر مؤسسات الرعاية‬ ‫الصحية عادةً بعملية‬  Health care organizations typically go through a ‫تخطيط وتصميم وتنفيذ‬ ‫وتقييم أنظمة معلومات‬ process whereby they plan, design, implement, ‫الرعاية الصحية الخاصة‬.‫بها‬ and evaluate their health care information ٍ systems..‫منته بمجرد تشغيل النظام‬ ‫ كان يُنظر إلى عمل املنظمة على أنه‬،‫في كثير من األحيان في املاضي‬  Too often in the past the organization’s work was viewed as done once the system went live.  It has since been discovered how vital system maintenance and support resources are and how important it is to evaluate the extent to which the system goals are being achieved. ‫لقد تم منذ ذلك الحني اكتشاف مدى أهمية صيانة‬ ‫النظام وموارد الدعم ومدى أهمية تقييم مدى تحقيق‬.‫أهداف النظام‬.‫إن تقييم نظام معلومات الرعاية الصحية أو الوصول إلى قيمته أصبح أمرا مهما بشكل متزايد‬  Evaluating or accessing the value of the health care information system is increasingly important.  Acquiring and implementing systems requires large investments, and stakeholders, including boards of directors, are demanding to know both the actual and future value of these projects.  Evaluations must be viewed as an integral component of every major health information system project and not an afterthought..‫ بمعرفة القيمة الفعلية واملستقبلية لهذه املشاريع‬،‫ بما في ذلك مجالس اإلدارة‬،‫ ويطالب أصحاب املصلحة‬،‫يتطلب الحصول على األنظمة وتنفيذها استثمارات ضخمة‬.‫يجب النظر إلى التقييمات باعتبارها جز ًءا ال يتجزأ من كل مشروع رئيسي لنظام املعلومات الصحية وليس مجرد فكرة ثانوية‬  Important to adequately plan for system implementation—need right set of people, skills, and resources  Things can and do go wrong, so it’s also important to address organizational aspects of implementing new system  Process doesn’t end when new system is installed; critical that system continually updated, supported and maintained  Implementing a new information system in a health care organization requires a significant amount of planning and preparation.  The health care organization should begin by appointing an implementation team comprising experienced individuals, including representatives from key areas in the organization, particularly areas that will be affected by or responsible for using the new system.  Key users should be involved in analyzing existing processes and procedures and making recommendations for changes.  A system champion should be part of the implementation team and serve as an advocate in soliciting input, representing user views, and spearheading the project.  When implementing a clinical application, it is important that the system champion be a physician or clinician, someone who is able to represent the views of the care providers.  Under the direction of a highly competent implementation team, a number of important activities should occur during the system rollout.  This team should assume a leadership role in ensuring that the system is effectively incorporated into the day-to-day operations of the facility. This generally requires the organization to  (1) analyze workflow and processes and perform any necessary process reengineering,  (2) install and configure the system,  (3) train staff,  (4) convert data,  (5) adequately test the system, and  (6) communicate project progress using appropriate forums at all levels throughout the organization.  Attention should be given to the countless details associated with ensuring that backup procedures are in place, security plans have been developed, and the organization is ready for the go-live date.  During the days immediately following system implementation, the organization should have sufficient staff on hand to assist users and provide individual assistance as needed.  A stable and secure IT infrastructure should be in place to ensure minimal, ideally zero, downtime and adequate response time.  The IT department or other appropriate unit or representative should have a formal mechanism in place for reporting and correcting errors, bugs, and glitches in the system.  Once the system has gone live, it is critical for the organization to have in place the plans and resources needed to adequately maintain and support the new system.  Technical staff and resources should be available to the users. Ongoing training should be an integral part of the organization’s plans to support and further develop the new system.  In addition, the leadership team should have in place a thoughtful plan for evaluating the implementation process and assessing the value of the health care information system.  Beyond taking ultimate responsibility for completion of the activities needed to implement and to support and evaluate the new system, the health care executive should assume a leadership role in managing the organizational and human aspects of the new system.  Information systems can have a profound impact on health care organizations, the people who work there, and the patients they serve.  Acquiring a good product and having the right technical equipment and expertise is not enough to ensure system success.  Health care executives must also be attuned to the human aspects of introducing new IT into the care delivery process.  Mason Hospital implement a CPOE system 1. Visit a health care organization that has recently implemented a health care information system. What process did it use to implement the system? How does that process compare with the one described in this chapter? How successful was the organization in implementing the new system? To what do staff attribute this success? 2. Search the literature for a recent article on a system implementation project. Briefly describe the process used to implement the system and the lessons learned. How might this particular facility’s experiences be useful to others? Explain. 3. Physician acceptance and use of clinical information systems is often cited as a challenge. What do you think the health care leadership team can or should do to foster acceptance by physicians? Assume a handful of physicians in your organization are actively resisting a new clinical information system. How would you approach and address their resistance and concerns? 4. Assume you are working with an implementation team in installing a new nursing documentation system for a home health agency. Historically, all its nursing documentation was recorded in paper form. The home health agency has little computerization beyond basic registration information and has no IT staff. What recommendations might you offer to the implementation team as it begins the work of installing the new nursing documentation system? 5. Discuss the risks to a health care organization in failing to allocate sufficient support and resources to a newly implemented health care information system. 6. Assume you are the CEO of a large group practice (seventy-five physicians) that implemented an EMR system two years ago. The physicians are asking for an evaluation of the system and its impact on quality, costs, and patient satisfaction. Devise a plan for evaluating the EMR system’s impact on the organization in these three areas.  o u k Y a n T h