HIM 4203 Health Informatics II Strategic Planning PDF

HIM 4203 Health Informatics II Strategic planning of Health Information System (HIS) Strategic Information Systems Planning The process of identifying and assigning priorities to a set of computer applications that will assist an organization in executing its business plans and achieving its strateg...

HIM 4203 Health Informatics II Strategic planning of Health Information System (HIS) Strategic Information Systems Planning The process of identifying and assigning priorities to a set of computer applications that will assist an organization in executing its business plans and achieving its strategic goals and objectives Strategic Information Systems Planning Purpose of Strategic IS Planning To align information systems goals with strategic goals and objectives of the organization To define specific information requirements and priorities To define the information technology infrastructure of the organization To develop a budget for resources allocation Strategic Information Systems Planning Strategic Alignment with Organizational goals and objectives The strategic IS plan should address questions like: How can IT be used to generate new services in response to market demands? How can IT be used to distinguish among services provided by the organization from those of competitors? Which computer applications and supporting technology are needed to make the new strategy work? Strategic Information Systems Planning Information requirements and priorities The IS plan should identify the major types of information required to support strategic objectives and establish priorities for installation of specific computer applications for the time period covered by the plan Strategic Information Systems Planning IT Infrastructure The health services organization must develop blueprints for its IT infrastructure. Hardware architecture, network communications, degree of centralization or decentralization of computing facilities, and types of computer software required to support the network Strategic Information Systems Planning IT Infrastructure The following IT infrastructure priorities were identified: Client/server network architecture Optical disk storage and data warehouse of clinical records Interface engines for linking the information systems of members of integrated delivery systems Wide-area fiber-optic networks Relational databases Multimedia workstations Strategic Information Systems Planning Budgeting and Resources Allocation Provide data for estimating resources required to meet the objectives and priorities established through the planning process Capital budgets Vs. Operational budgets Strategic Information Systems Planning Organizing the planning effort Development of an overall master plan for IS development is an essential first step in the process The CEO should take direct responsibility for organizing the planning effort IS steering committee Consideration should be given to the use of outside consultants Board of management CEO IS Steering Committee 1. Oversee IS planning 2. Link IS planning to strategic plans of the organization 3. Establish priorities of system development Subcommittees Priorities for new Replacement systems Specifications for IT infrastructure Capital and operating Budgeting Strategic Information Systems Planning The following factors should be considered in selecting IS consultants: Independence and objectivity: exclusive focus on interests of the client Healthcare expertise: understanding of healthcare business and clinical issues Resources: sufficient breadth and depth of resources to complete the assignment without “on-the-job training” Effective personality: appropriate mix of character traits and skills Strategic Information Systems Planning Elements of an IS Master Plan 1. Statement of corporate/institutional goals and objectives 2. Statement of information systems goals and objectives 1. Management information needs 2. Critical success factors 3. Information priorities Strategic Information Systems Planning Elements of an IS Master Plan 3. 4. Priorities of the applications portfolio 1. Clinical 2. Administrative 3. Decision support Specification of overall systems architecture and infrastructure 1. Level of distribution (centralized Vs. decentralized) 2. Network architecture 3. Data location (central data warehouse to total distribution) 4. Database security and control requirements Strategic Information Systems Planning Elements of an IS Master Plan 5. Software development plan 6. IS management plan 1. 2. 3. 4. 1. 2. 3. 4. Commercial packages In-house development Tailor-made applications through contracting Combinations of the above Central IS staffing Outsourcing Limited central staffing Combinations of the above Strategic Information Systems Planning Elements of an IS Master Plan 7. Statement of resource requirements 1. Capital budget (hardware, software, network communications equipment) 2. Operating budget (staff, supplies, consultants, training, etc) Strategic Information Systems Planning Goals & Objectives Planning period is usually 2-5 years IS goals and objectives should be aligned with the strategic objectives of the organization The Continuous Quality Improvement example of prioritizingspecial attention paid to medical records; clinical protocols; incident reporting; and measures of patient, physician, and employee satisfaction Critical Success Factors (CSF) Strategic Information Systems Planning Goals & Objectives IS objectives should be as specific as possible and should flow from a review of strategic priorities as well as an analysis of deficiencies and gaps in current information process Examples of specific objectives: ▫ Information systems should be designed such that all records from the master patient index file are available online to all physicians ▫ Information systems should be designed such that all diagnostic test results are available within two hours after the tests have been completed Strategic Information Systems Planning Applications Priority List Documentation of objectives statement will help the steering committee in prioritizing computer applications Priority list and resources Strategic Information Systems Planning System Architecture The plan must specify an overall system architecture and infrastructure to include: 1. The degree to which computing will be centralized or decentralized 2. Network architecture 3. Data storage and security 4. Interfacing different applications Strategic Information Systems Planning Software development plan Employing large number of IT staff Vs. ready made software packages (of-the-shelf) A combination of both ? Strategic Information Systems Planning Information Systems Management Plan Most health services organization still employ an inhouse staff for system operation and management Centralized technical system management staff advantages: ▫ Reduction in the number of technical staff Distributed technical system management staff advantages: ▫ Offers the potential for increased support and user involvement in system development and operation Strategic Information Systems Planning Information Systems Management Plan Outsourcing of IS functions cost might be high and may tend to generate too much distance between users and technical systems specialists Strategic Information Systems Planning Statement of Resource Requirements The final element of the IS plan Capital budget: 5-10 years projections, includes hardware, software, and network and telecommunication equipment Operating budget: includes costs for staff, supplies, and materials, consultants, training, programs, and other recurring expenses Both budgets should be updated annually Strategic Information Systems Planning Review and approval of the plan The strategic plan for IS development must be a dynamic instrument that is reviewed periodically and updated (at least once a year). Strategic Information Systems Planning Organization-wide Information System Standards Data security policies Data security involves two essential elements: 1. Protecting against system failures or external catastrophic events (fire, storms,…etc.) 2. Controlling access to computer files by unauthorized personnel Strategic Information Systems Planning Data security policies Critical data files should be copied to removable disks/tapes and stored in a secure location The CIO should develop a data backup plan for approval by the steering committee Data can also be lost through computer viruses Protecting data confidentiality: 1. Physical security (keys, badges) 2. Technical controls over access (passwords, encryption, audit logs) 3. Management policies enforced in all organizational units (written security policy, employee training, disciplinary actions for violations) Strategic Information Systems Planning Data Standardization System integration is an important element of IS strategic planning Electronic data exchange cannot occur without some level of standardization of data structures used in computer applications Examples of projects to standardize electronic data interchange: ▫ American National Standards Institute (ANSI) ▫ Health Industry Bar Code Supplier Labeling Standard (HIBC) ▫ Health Level-7 (HL7) Standard for Healthcare Electronic Data Transmission ▫ MEDIX, the Institute of Electrical and Electronics Engineers (IEEEE) Committee for medical data interchange Strategic Information Systems Planning The HL7 & MEDIX projects’ objective is to develop a comprehensive set of data standards for sharing clinical information within and across healthcare organizations. HL7 was initiated in 1987 It started with developing standards of interfacing departmental computer applications in hospitals, and more recently expanded efforts to develop standards for exchange among different types of organization HL7 Strategic Information Systems Planning Hardware and Software Standards The IS steering committee should oversee the development of a broad set of policies related to the acquisition of computer hardware, software, and networks communication equipment Reasons for central review and approval of all computer hardware and software purchases: ▫ Helps to ensure compatibility with standards (HL7) ▫ Ensures that data terminals & workstations use common OS ▫ Cost advantages through acquisition of site licenses for multiple users of common packages ▫ Available technical support ▫ Prevent illegal use of unlicensed software Strategic Information Systems Planning Policies on use of the Internet: Policies on creation of home pages Policies related to security of information on the Internet Legal protection of intellectual property on the Internet Policies on controlling employee use and potential abuse of the system Strategic Information Systems Planning Data security policies and procedures are particularly important if the Internet is to be used for internal communications (intranet) or sharing of information among organizational units. Polices to regulate employee use of the Internet and e-mail. Strategic Information Systems Planning Strategic IS Planning for Integrated Delivery Systems Vertically integrated organizations IS must be patient-centered in order to aggregate data from the various medical care units, and skilled nursing home facilities. Provision of comparative data Standardization HIM 4203 Health Informatics II DevOps LO.1-3 DevOps vs SDLC Objective: 1. Define DevOps and explain the key principles and practices of the DevOps methodology 2. Identify challenges and issues with legacy SDLC approaches in modern software environments 3. Discuss how adopting DevOps culture, automation practices, and tools can help accelerate delivery, improve quality, and enhance IT productivity DevOps vs SDLC DevOps vs SDLC DevOps is a set of practices combining software development (Dev) and IT operations (Ops). It aims to shorten systems development life cycles and provide continuous delivery of highquality software. Emphasizes: - Collaboration between Dev and Ops teams - Tight integration of their workflows and tools - Extensive automation across the development pipeline DevOps vs SDLC Key Goals: - Increase the speed of delivering features and updates - Improve the quality and reliability of software releases - Quickly diagnose and resolve defects or production issues - Enable faster innovation by reducing time to market Core Principles: - Communication and collaboration - Continuous integration and testing - Automated deployments - Infrastructure as code - Monitoring and observability - A culture that values flexibility and adaptation to change DevOps vs SDLC Definition: - SDLC stands for Software Development Life Cycle. It is a structured, linear method of building software that moves the process through several defined phases. Phases: 1. Requirements - Gather and define features and functions for the application 2. Design - Outline application structure, interfaces, data, architecture 3. Build/Develop - Code and program the software based on the design 4. Test - Systematically test for defects and validate against requirements 5. Deploy - Deliver the product to production environments 6. Maintain - Provide ongoing support/maintenance, updates, fixes DevOps vs SDLC Linear Process: - SDLC follows a sequential waterfall model. Each phase has to fully complete before moving to next phase in a linear order. Waterfall Model: - Strictly sequential phases for gathering requirements, software design, implementation, testing, installation, maintenance - Output of one phase becomes the input for the next - No overlapping phases, movement flows linearly downward DevOps vs SDLC Challenges of SDLC Slow Process: - Significant lags and delays between phases since they are run sequentially - If issues found during testing, need to cycle back through previous phases - Lengthy development cycles stretching 6 months to 1+ year Lack of Communication: - Teams operate independently during different phases - Developers throw requirements "over the wall" with limited collaboration - Testers get code drops to test without understanding code or design DevOps vs SDLC Challenges of SDLC Manual Processes: - Many tasks like builds, deployments, testing done manually - No automation across pipeline leads to errors, delays - Time wasted on repeating mundane tasks vs innovating Other Challenges: - Changing requirements not accommodated well after design phase - Risk of finding critical issues late in testing - Disconnect between technical teams and business needs - Budget/timeline overruns due to lack of visibility DevOps vs SDLC What Makes DevOps Different? Continuous Development: - Developers work in small batches committing code frequently - Emphasizes constant cycles of coding, building, testing - Enables rapid feedback if issues are found Continuous Testing: - Testing automated at every stage including unit, integration, UI, performance - Shifts testing left rather than just end of cycle - Provides safety nets for regular code commits DevOps vs SDLC What Makes DevOps Different? Continuous Integration: - Use of integrated tools to automate compiling, building, packaging code - Developers merge code into shared branches extremely often - Detect integration issues early when easier to diagnose Continuous Deployment: - Automate steps of infrastructure config, deploying builds to all envs - Single click deployments enable high release rates - Pipelines model flow from commit to production DevOps vs SDLC What Makes DevOps Different? Automated Workflows: - Automate manual tasks like deployments, testing, infrastructure builds - Treats infrastructure as code for consistency across environments Focus on Collaboration: - Break down silos through collaboration across teams - Shared goals and vision ties together distributed teams - Culture focused on open communication and tearing down barriers DevOps vs SDLC Key Differences between SDLD and DevOps Linear vs. Continuous: - SDLC: Sequential phase-based waterfall methodology - DevOps: Constant iteration through integrated development, testing, deployment Manual vs. Automated: - SDLC: Manual handoffs, testing, deployments - DevOps: End-to-end automation of steps from code to production Lack of Communication vs. Collaboration: - SDLC: Silos between teams, "Throw over wall" mentality - DevOps: Breaks down barriers between teams. Promotes open channels DevOps vs SDLC Key Differences between SDLD and DevOps Requirements-Driven vs. Value-Driven: - SDLC: Driven by upfront requirements gathering - DevOps: Focus on rapid experimentation and learning Quality Assurance vs. Quality Culture - SDLC: Test quality in at end - DevOps: Builds in quality at each stage Slow Feedback vs. Rapid Feedback Loops - SDLC: Long dev cycles delays customer feedback - DevOps: Fast iterations and feature experimentation What is DevOps? - Definition of DevOps as an integration of development and operations. - Focus on collaborative, agile methodologies. - Aim to improve software delivery speed and quality. - Combines cultural philosophies, practices, and tools. Benefits of Adopting DevOps - Faster delivery of features and improved efficiency. - More stable operating environments. - Improved communication and collaboration. - Enhanced innovation and competitiveness. Key Principles of DevOps - Automation of software development processes. - Continuous integration and delivery. - Emphasis on team collaboration. - Strong focus on customer feedback and experience. Overview of the DevOps Lifecycle - Iterative and collaborative process. - Key stages: Plan, Code, Build, Test, Release, Deploy, Operate, Monitor. - Continuous improvement and agility. - Integration of development and operations teams. DevOps Planning Phase - Collaboration with stakeholders to define requirements. - Creation of a roadmap and setting project goals. - Use of tools like Jira for task management. - Emphasis on understanding stakeholders' needs. DevOps Coding Phase - Development of application code. - Focus on maintainable and testable code. - Use of version control systems like Git. - Implementing coding best practices. DevOps Build Phase - Compilation of code into binaries or packages. - Running unit tests and packaging applications. - Tools like Jenkins for automating the build process. - Ensuring code changes are regularly integrated and tested. Jenkins Tool: Open-source automation server used to build, test, deploy software projects continuously. Enables implement DevOps pipelines. DevOps Testing Phase - Ensuring application meets quality standards. - Various levels of testing: unit, integration, acceptance. - Automated testing using tools like Selenium. - Continuous testing throughout development. Selenium Tool: Selenium is an automated testing framework used to validate functionality and behavior of web apps efficiently. DevOps Releasing Phase - Final checks for production readiness. - Resolving identified issues before deployment. - Using tools like Jenkins for automating release processes. - Ensuring application meets all quality standards. Jenkins Tool: Open-source automation server used to build, test, deploy software projects continuously. Enables implement DevOps pipelines. DevOps Deployment Phase - Application deployment to environments (staging, production). - Infrastructure setup and application code deployment. - Tools like Ansible for deployment automation. Ansible Tool: - Automating provisioning & configuration of infrastructure – setting up servers, cloud resources, networks - Application deployment automation - deploying apps to production environments DevOps Operation Phase - Monitoring and maintaining application in production. - Focus on performance, availability, and security. - Using monitoring tools like Nagios, Prometheus. - Responding to incidents and issues. Prometheus Tool: - Open-source monitoring and alerting toolkit originally built at SoundCloud - Provides metrics aggregation, visualization, alerting for infrastructure and apps Importance of Continuous Monitoring in DevOps - Early detection of problems. - Maintaining high system performance. - Insights into user behavior and system usage. - Essential for proactive maintenance and improvement. Integration in DevOps Integration in DevOps refers to the close alignment and collaboration between cross-functional teams across the software delivery lifecycle including development, testing, operations, security, and business teams in order to enable continuous development and deployment of applications. It Breaks down silos between teams through close communication and shared ownership Continuous Integration in DevOps - Integration of code changes into a shared repository. - Automated build and test processes. - Detecting problems early. - Reducing integration issues. Integration Tools in DevOps - Automated tools for build and test. - Examples: Jenkins, Travis CI. - Streamlining code integration. - Enhancing software quality. Travis Tool: - It is used for automatically building and testing projects hosted on GitHub whenever code is pushed - Deploying applications to staging/production environments after passing tests Automation in Testing in DevOps - Reducing manual testing efforts. - Faster feedback on new changes. - Increasing test coverage. - Tools for automation: TestNG, Cucumber. TestNG Tool: - It is a popular open-source automated testing framework used for testing Java applications. - It is used for Functional, integration, and end-to-end testing of Java code Role of Testing in DevOps - Ensuring software meets quality standards. - Continuous testing throughout the lifecycle. - Automated and integrated testing approaches. - Role in feedback and improvement. Deployment in DevOps - Automated and Consistent Across Environments - Infrastructure-as-code templates ensure standard – config - Minimizes configuration drift and errors Key focus is on extensive automation, progressive monitoring, and self-service access to minimize friction between development and production environments enabling continuous delivery at high velocity. Tools for Continuous Deployment in DevOps - Automating deployment processes. - Tools: Docker, Kubernetes. - Ensuring consistent and reliable deployments. - Scalability and management of application deployment. Kubernetes Tool: - Open-source system for automating deployment, scaling, and management of containerized applications - Provides tools for managing container lifecycles and services across clusters of hosts Challenges in Continuous Deployment in DevOps - Managing deployment risks. - Balancing speed with stability. - Handling complex deployment scenarios. - Ensuring security and compliance. Continuous Deployment in DevOps Real-World Examples - Automated testing and validation. - Incremental deployment strategies. - Monitoring and rollback capabilities. - Collaboration between development and operations. Best Practices in Continuous Deployment in DevOps Case Studies Case Study 1: Etsy - Implemented continuous deployment in 2016 across web and mobile apps - New code changes deployed to production over 150 times a day - Led to measurable improvements in key business metrics: * 20% increase in checkout conversion rates * 110% more page views per browser session Best Practices in Continuous Deployment in DevOps Case Studies Case Study 2: Amazon - Continuous delivery ingrained within Amazon DNA since early days - New code deployed every 11.6 seconds on average - Culture focused on automation, small single-purpose services Best Practices in Continuous Deployment in DevOps Case Studies Case Study 3: Netflix - Pioneered continuous delivery at scale with microservices - Early adopter of containerization with custom scaffolding - Failed deploys are automatically rolled back thanks to canary process Containerization: Containerization refers to packaging application code with its runtime dependencies into standardized units that can run in isolation on any infrastructure. Canary Process: Canary process means rolling out a new software version to a subset users first before making it available to everyone. Benefits of Coinerization in DevOps - Portability - Can deploy on any OS (Linux, Windows, Mac) - Ensure Consistency - Container is exactly the same regardless of where it runs - Isolation - Applications run in independent containers, avoids conflicts - Scalability - Easily scale by running multiple instances of a container Benefits of the Canary Process in DevOps - Minimizes risk - issues only impact a small group of users - Get early warning indicators by monitoring key metrics - Easy to do automated or manual rollback - Builds confidence before wider release Objectives - Understand the process involved in conducting a thorough system evaluation and procurement/acquisition process alongside the implementation of the solution. - Understand the formal mechanisms such as RFI and RFP to enable structured vendor engagement - Select and integrate the best technology partner in stages to create a cohesive, efficient platform. - Utilize standard interfaces such as HL7 to ensure maximum compatibility between different systems. - Rely on detailed analytical methods for making informed decisions. - Manage the process through formal contracts to maintain clarity and responsibility throughout all phases. The Entire Process in a Nutshell ▫ Business Requirements Analysis ▫ System Design ▫ Vendor Selection ▫ Custom Development & Integration ▫ Testing ▫ Deployment / Implementation ▫ Maintenance / Support ▫ Closure Business Requirements Analysis ▫ In this phase, we identify business drivers and issues with current state workflows through stakeholder interviews. Document findings in a Business Requirements Document (BRD). Create detailed functional requirements specifications including process flows, use cases, integrations required using tools like process mapping and user stories. Describe non-functional requirements around performance, availability, security etc. Specify measurable metrics. Business Requirements Analysis cont.… ▫ Model core entities and attributes in data dictionary. Diagram data flows to/from planned system using data flow diagrams. Call out HL7/FHIR integration touchpoints. Define infrastructure environment requirements like server hardware, network diagrams etc. in a technical specification document. Build Cost/Benefit models factoring system development, training, support costs and expected efficiency or revenue gains for justification. RFI drafted to assess potential vendor solutions to meet requirements. The RFI (Request for Information) Stage ▫ Identify Project Goals & Must Haves: Clearly determine core project objectives, key functional requirements or problem set that new system aims to fulfill. Research Market & Capability Sets: Research the general vendor landscape and systems in the problem domain. Identify top players to target via RFI. Draft Initial RFI: List all information required about potential solutions including functionality, configurations, delivery models and company expertise/experience to gauge fits and gaps. The RFI (Request for Information) Stage Cont.. ▫ Refine & Finalize RFI: Workshop the draft RFI internally to include all aspects through multi lens view before finalizing to issue to market. Issue the RFI: Publish or directly send the comprehensive RFI to profiled list of target vendors for responses. Include clear guidelines and timeframe. Gather & Evaluate Responses: Assess returned RFIs using a pre-defined rating criteria on dimensions like functional match, implementation services, customer case studies etc. Shortlist Solutions: Based on total weighted scores (qual + quant factors), filter down prospective platforms and companies that strongly align with needs identified. Discard ill fits for next phase evaluation The RFP (Request for Proposal) Stage After the RFI (Request for Information) stage, the next key steps in the systems procurement process are typically: With the shortlisted vendors from the RFI stage, publish a detailed Request for Proposal (RFP) document outlining all functional, technical and project delivery requirements, pricing framework, terms and qualification criteria expected from potential suppliers. Hold a joint conference meeting with all participating RFP vendors to provide transparency on priorities, address common queries and clarify position on certain decision factors. Sets expectations. The RFP (Request for Proposal) Stage Cont.… ▫ As submitted proposals come in from vendors, review responses rigorously by cross-functional team on how well they meet set criteria along technology fit, services capability, company viability parameters and costs. Conduct Technical Demos with the top 2-3 vendors post proposal reviews, arrange exhaustive technical demonstrations focused on interoperability, use cases and integration flows to deeply evaluate system capabilities firsthand before finalizing choice. Enter into contract negotiations around pricing, license agreements, SLAs, customization rates, support models etc. based on insights gained from the selection cycle. Lock preferences. The Design Phase Prepare the Technical Specifications: - Analyze the current state infrastructure including servers, storage, network diagrams, data flows, integration touchpoints etc. - Define specifications of hardware components required for the new system like compute capacity, redundancy levels etc. - Outline relevant performance metrics like peak concurrent users, response times sought, future capacity growth outlooks. The Design Phase cont.… Prepare the Technical Specifications: - Describe compatibility prerequisites spanning databases, OS, browsers, security layers etc. - Specify integration & interfacing needs with existing enterprise systems and standards followed. Explain data retention policies. - Articulate non-functional expectations on dimensions like availability, DR needs, encryption algorithms used etc. - Describe customization constraints and product roadmap transparency requirements post implementation. The Design Phase cont.… Prepare the Technical Specifications: - Describe compatibility prerequisites spanning databases, OS, browsers, security layers etc. - Specify integration & interfacing needs with existing enterprise systems and standards followed. Explain data retention policies. - Articulate non-functional expectations on dimensions like availability, DR needs, encryption algorithms used etc. The Design Phase cont.… Defining Vendor Qualification & Services Criteria: - Outline related project experience prerequisites especially around similar integrations delivered - Specify exact composition of implementation teams requested with qualification criteria - Make training and support expectations explicit in terms of model, response times etc. - Request transition plans for knowledge transfer to internal teams for sustainability - Require tools and methodologies to be used for design, configuration management, issue tracking etc. - Mandate product development processes followed for transparency and IP protection - Quantify types and number of customer references to be submitted. Vendor Selection Evaluating Vendor Systems: - Compile completed RFP responses and score objectively against each criteria finalized in RFP around functionality match, technology platform attributes, company viability, customer evidence and services approach - Attend product demonstrations to review first hand against use cases called out in requirements specifications and evaluate the fitness. Review integration capability. - Request and verify customer references submitted by conducting independent outreach for direct feedback on vendor project delivery success, product stability etc. Vendor Selection Cont.… Selection and Contract Negotiations: - Develop a comparative analysis highlighting relative strengths and weaknesses per critical factors stated in RFP to facilitate discussions. - Thoroughly review contracts including SLA commitments, payment & customization terms, scope inclusions/exclusions, knowledge transfer expectations etc. - Ensure technical specifications compliance and exception handling methods confirmed in contracts Vendor Selection Cont.… Selection and Contract Negotiations: - Establish clear measures and checkpoints for success criteria demonstration by vendor. - Finalize all terms indicating timelines, rates for additional services requests beyond contract scope. - Ensure technical specifications compliance and exception handling methods confirmed in contracts. - Use market intelligence through advisors to negotiated favorable concessions in flexible areas Vendor Selection Cont.… Last Step in the Vendor Selection Process: - The selection process moves from stated plans to validated capability demonstration to gain full project clarity supported by contracts structured to drive accountability through service levels and statements of work.. Implementation & Integration HL7 Integration: - Set up a dedicated integration environment for building HL7 interfaces. - Install HL7 parser software (Integration Engine) and middleware needed for message handling. - Define interface specifications for all key HL7 messaging touchpoints identifying trigger events. - Build workflows to generate and route HL7 messages to external systems based on specifications Implementation & Integration Cont.… HL7 Integration: - Develop parsing logic to extract data elements from inbound HL7 interfacing systems. - Implement handling logic to process messages and derive internal system actions required. - Test end-to-end HL7 workflows simulating transactions, handle errors/retries/logs automatically. - Use HL7 testing tools to validate against standard conformance requirements. Implementation & Integration Cont.… Data Migration Implementation & Testing: - Analyze legacy databases to create extraction logic per entities and data model mappings. - Develop ETL scripts for necessary transformations required to migrate each data set identified including cleansing. - Build routines to load staging area database used for import into new system database. - Define mock test data sets across systems to validate migration programs end-to-end. Implementation & Integration Cont.… Data Migration Implementation & Testing: - Execute migration routines in controlled manner in staging environments iterating until quality benchmarks achieved. - Establish checkpoints per methodology finalized (phased, parallel etc) to freeze programs during rollout. - Tight integration workflows and robust data migration capabilities are pivotal for new system adoption demonstrating development rigor. Testing Integration Testing: - Set up dedicated test environment with test tooling as per the test plan. - Identify all integration touchpoints - HL7 and other systems. - Develop test scenarios covering end-to-end business flows across systems. - Simulate transactions triggering integration events per specifications. Testing Cont.… Integration Testing: - Monitor and validate data transitions through systems per expectations. - Perform negative testing by injecting invalid data, logical failures etc. - Measure overall defects and track to closure through multiple test cycles. - Retest integrations thoroughly post fixes until stability achieved. Testing Cont.… Vendor Support: - Form cross-functional team across vendor/client for collaborative testing. - Provide comprehensive requirements traceability matrix mapping covered functionality. - Submit detailed test case specifications that vendor assists executing. - Log issues in ticketing tool requiring code fixes, configuration changes, data updates. Testing Cont.… Vendor Support: - Vendor allocates experts resources to diagnose root causes. - New builds deployed to test environment upon resolution of prioritized defects. - Verify and close issues in ticketing tool to document resolutions. Deployment / Implementation Phased Rollout Planning: - Define workstreams spanning hardware, software, testing, data migration etc. - Break down implementation into logical phases targeting functionality sets, business units or regions. - Analyze dependencies between workstreams and phases to derive optimal sequencing. - Develop phase wise rollout schedule highlighting tasks, timelines and resource allocation. Deployment / Implementation cont.… Phased Rollout Planning: - Plan training, migration and support at phase level accounting for complexity. - Determine achievable milestones pre and post go-live for each phase to baseline. Deployment / Implementation Execution: - Simulate disaster recovery tests for high availability validation. - Load test and scale infrastructure components in pre -production for capacity planning. - Deliver focused training for pilot users including hands -on process walkthroughs. - Activate software services per phase activation plan and monitor health indicators. Deployment / Implementation cont.… Execution: - Manage legacy data and system transitions in alignment with platform onboarding. - Provide on-site specialist vendor assistance for transition troubleshooting. - Measure phase acceptance criteria demonstrating process and technology stability. - Incorporate feedback into next phase deployment strategies and plans. System Maintenance Vendor Support: - Contractually agree on stabilization period from vendor post go-live (typically 3-6 months). - Monitor system availability SLAs covering uptime, response times as per contract. - Allocate consultant resources to work closely with vendor for diagnosis, testing and signoffs. - Log tickets for bugs, issues requiring fixes that vendor is committed to resolving while onsite. System Maintenance Cont.… Vendor Support: - Verify implemented solutions before closing tickets postresolution. - Conduct periodic reviews of open issues by priority, ageing and actions planned. - Provide granular system usage data to size capacity and stability needs. System Maintenance Cont.… Enhancements Planning: - Gather new or advanced business functionality requirements from key stakeholders. - Prioritize enhancement backlog based on resources, costs vs business value. - Release roadmap for planning major and minor release upgrade cycles. - Detail out specifications for each item scheduled in release pipeline. System Maintenance Cont.… Enhancements Planning: - Assign internal owners to coordinate requirements clarification. - Estimate level of effort, breaking functional scope into development stories. - Plan staging of releases accounting for capability dependencies. - Proactive maintenance governance ensures continuity of committed service levels while delivering upgrades catering to evolving needs. Project Review & Closure Project Evaluation: - Evaluate project delivery as per contracted scope using metrics like budget variance, timeline adherence and quality benchmarks. - Conduct user satisfaction surveys to gauge productivity or workflow improvements after stabilization. - Highlight achievements vs goals across dimensions like adoption, ROI realization, user reported issues etc. - Identify areas of over/under performance relative to original projections. Project Review & Closure Cont. Project Evaluation: - Quantify total cost of ownership reduction through optimization efforts. - Estimate ongoing operational costs for steady state maintenance needs. Project Review & Closure Documenting Key Learnings: - Catalog all challenges faced during implementation and how resolved. - List process or technology innovations implemented for benefit recognition. - Describe mitigation strategies found effective when goals threatened. - Articulate enhancements desired for greater efficiency gains. - Quantify all custom tools, accelerators developed for leverage in future rollouts. Project Review & Closure Securing Vendor Commitments: - Lock-in all contract renewals options under support and warranty agreements. - Outline roadmap commitments for next gen upgrades, licensing needs etc. - Explore additional services like packaged custom capabilities for licensed reuse. - Negotiate preferential rates for add-on professional services. - Broad project reviews set the foundation for downstream success by confirming return realization, securing vendor partnerships and creating playbooks for repeating wins. HIM 4023 Health Informatics II Managing Information Resources LO3: Managing System Implementation Managing Information Resources Managing System Implementation Information Systems implementation may include: 1. 2. 3. 4. 5. 6. Acquisition of hardware Computer programming Training Database preparation System testing Final documentation Managing Information Resources 1. Equipment acquisition Whatever the magnitude of hardware requirements, hardware ordering and installation must be carefully planned Space planning must accompany all new equipment orders Managing Information Resources 2. Computer Programming Most systems in healthcare organization use applications software acquired from vendors Some in-house programming may still be required for building interfaces to other applications or changing network configurations to accommodate the new software Managing Information Resources 3. Training: The vendor usually include initial training as part of the contract Vendor  orientation for top management  more specific training for managers and first-line supervisorsmanagers & supervisors are responsible for training staff in their area The contract with the vendor should specify training responsibilities and costs The healthcare facility should designate a training director Managing Information Resources 4. Database preparation: Data files conversion (manual  computerized) Managing Information Resources 5.System testing: Testing should determine whether specific goals and objectives for the information system have been met Testing data collection and input procedures Errors detecting and correction procedures Testing personnel training Software & Hardware testing Test of completeness of system documentation, including procedures manuals, computer programs, and machine operating manuals Parallel testing Managing Information Resources 6.Final Documentation Completion of all system documentation System documentation should be adequate for effective maintenance of the new system Managing Information Resources System Operation and Maintenance Scheduled Vs. unanticipated maintenance Adequate technical staffing If system maintenance is to be provided by outside contractors or software suppliers, contracts must be negotiated to ensure timely response to requests of emergency maintenance Emergency backup procedures Managing Information Resources Continuous Q.I. Information system QI evaluations should include: 1. Functionality: meeting organizational objectives 2. User satisfaction: meeting or exceeding expectations 3. Costs 4. Benefits 5. Errors and Exceptions: determining if error rates are within tolerance levels Managing Information Resources Organizing for information Management: Role of Chief Information Officer (CIO) The CIO serves two important functions: 1. Assisting the executive team and governing board in using information effectively in support of strategic planning and management 2. Providing management oversight and coordination of information processing and telecommunications systems throughout the organization Managing Information Resources Attributes needed for success CEO: 1. Leadership ability 2. Vision / Imagination 3. Business acumen Thus, a CIO should: Be a leader of information utilization, not a controller of data and technology Focus on long-term strategy and not on day-to-day operations Champion the development and constant monitoring of a strategic information plan Participate as full member of the executive team Managing Information Resources Staffing CIO Management Engineering Department System Development Division Programming Systems Analysis Information Systems Department Software Evaluation & User Support System Maintenance Data Preparation Telecom Department Operations Division Network Maintenance Computer Operations Managing Information Resources Outsourcing Potential benefits of outsourcing include: 1. Reduction of in-house staffing requirements 2. Smaller investment in capital equipment 3. More flexibility in meeting changing requirements and adopting new technology 4. Reduction in the time required to implement new applications 5. More predictable cost structure Managing Information Resources Outsourcing Risks: 1. Too much dependence on vendors. Bankruptcy? 2. High costs associated with vendor fees and profit structure 3. Employment of contractors who do not understand the operation and culture of healthcare organizations Managing Information Resources Executive Management Responsibilities 1. Management must insist on a careful planning process 2. Management should employ a user-driven focus throughout the IS development process 3. Management must take the responsibility for recruiting competent personnel for the design and operation of IS 4. Establish policies and procedures to ensure integration of data files or interfacing among individual IS Managing Information Resources 5. Ethical obligation to maintain security and confidentiality of IS 6. Management should be involved in all major design projects to ensure congruence with organizational goals and objectives 7. Careful system analysis should precede any implementation decision 8. Preliminary design specifications should comply with the master plan for IS Managing Information Resources 9. Detailed system specifications should always be required before any implementation activities take place 10.During analysis and design and implementation phases management should require careful scheduling of all activities and should receive periodic progress reports 11. During the implementation phase, thorough training of all personnel to be involved in the new system should be carried out Managing Information Resources 12. Testing should cover all phases of system operation 13. Provision should always be made for adequate maintenance after an IS is operational 14. Management must ensure that information systems are periodically audited and that all systems are formally evaluated once they are installed and operating normally The Electronic Health Record Existing Hospital Records....... Paper Charts of Patient Health Records are the norm worldwide for recording patient information. All relevant patient information is documented in one file for reference - including Lab. results, test results and progress notes. Existing Hospital Records.......  These charts are easy to use.  The same file is used on subsequent admission to the same institution.  And as source of reference for medicolegal cases and research studies. Almost all large health care institutions have a computer database of patients which matches : * Patient’s Hospital I.D. Number * Name * Date of Birth * Address.... This provides a rapid search to match a patient name with a chart no. when retrieving a record from storage. The source of the Electronic Health Record is simply expanding on this database creating an “on-line” record for each Patient. The Health The Electronic Electronic Health RecordRecord. (EHR) is the future of patient record documentation. There is very wide scope for applications and additions around a centralized record. The EHR can be accessed conveniently by appropriate health professionals to ensure ultimate maximum and optimal patient care. This tutorial discusses the following : Description of a typical EHR. Potential applications. Problems associated with its use. There are many aspects contributing to a typical EHR. PATIENT HOSPITAL ADMISSION GENERAL PRACTITIONER DIAGNOSIS LABORATORY RESULTS DECISIONS TREATMENTS PROGRESS NOTES At Hospital Admission... Admission Details : Patient History Physical Exam. Observations - weight - b.p. - temp. - pulse are easily updated and reviewed at subsequent hospital admissions. LABORATORY RESULTS GRAPH Different variables at different dates can be seen at a glance. Variations from the normal values are also easily seen. 350 Glucose Cholesterol 300 250 200 150 100 Glucose Normal 50 0 1/8/1995 2/15/1995 5/31/1995 9/28/1995 Lab. results can be received directly from the laboratory and are entered directly, available for the doctor to review. A S.M.A.C. result may look like.... 8 7 6 Creatinine Glucose urea Calcium 3 2 1 0 250 200 5 4 300 Phosphate Cholesterol 150 100 Uric Acid umol/l Alk phos u/l LDH u/l AST u/l 50 ALT u/l 0 GGT u/l A Centralized Record can be accessed easily by various hospital departments as illustrated below. Care/Treatment Unit Hospital Ward Patient Location Laboratory Pathology Bacteriology Radiology Physiotherapy Unit Pharmacy PHARMACY ACCESS A Medication Guide such as the one in the next slide gives a comprehensive overview of : Patient Drug History Drug Allergies PHARMACY ACCESS Reasons for prescription Dose Through inclusion of an on-line guide such as BNF or MIMS, warning of impending drug interactions and contraindications may be given MEDICATION MANAGER Patient Name : I.D. No. : Consultant CURRENT : DRUG HISTPORT CURRENT DRUG HISTORY DIAGNOSIS : Urinary Tract Infection Include : All current and expired drugs. OTHER ACTIVE PROBLEMS ASTHMA Drugs Available for Diagnostic Profile : CODE AMPICILLIN AMPICILLIN-SODIUM SELECT CANCEL DRUG Becotide 250 DOSE 2/day Drug Allergies : NONE KNOWN PRESCRIBE RESULTS.... Processing results CT Scan and X-ray results such as this (see next slide) can be processed, reviewed and entered directly into the patient file. The results may be sent to other specialists by the Internet network for consultation. Display Graphics... The index of an Electronic Health Record may look like..... Applications of the E.H.R. COMMUNICATION... One of the advantages of a central record is the ease of communication between - Hospital Departments e.g. for booking of diagnostic tests. -G.P. and hospital physician by email. Standardized, structured messages may be sent from one person to another both of whom are familiar with the format, by the Edifact system (Electronic Data Interchange For Administration, Commerce and Transport). Communication can be made easier via email services Hospital Physician Patient Specialist Surgeon Anaesthetist Other health care personnel General Practitioner Referee TELEMEDICINE... This is the practice of medicine using any data transfer linked with the process of care, in which some aspects of the care are assisted by remotely located professionals. Specialist communications may be made by Video-link. Components of Telemedicine PATIENT SITE PATIENT DATA COMMUNICATION NETWORK TREATMENTS PHYSICIAN IN-CHARGE EXPERT SITE SPECIALIST CONSULTATION EXPERT DATA “Net To The Rescue”..... It was recently reported that two Chinese students at Peking University sent an appeal for help to find a diagnosis for their Chemistry student colleague who had developed a severe illness to which the doctors at Peking Union Medical College hospital had no cure. The medical information was sent to Sci.med newsgroups and within 24hrs was read by a doctor in Washington who recognized the girls serious condition could be due to thallium poisoning. Phoning the hospital in Beijing he advised to check for thallium poisoning. To the initial annoyance of the physicians over 600 email messages were received in reply to this appeal and the general consensus pointed to the same and correct diagnosis. An Internet page is established to monitor the patient - Zhu Ling’s recovery. This can be accessed at http://www.radsci.ucla.edu/telemed/zhuling. THE EHR AS AN INFORMATION SOURCE FOR STATISTICAL RESEARCH. Specific information gathered from a large number of patients for a certain disease with regard to Severity, Duration of symptoms, can be represented graphically or scored. This can be used as a reference for aids to diagnosis. A “Relational Database “ would be of this form and could be incorporated into the EHR. QUESTIONNAIRE ON LIVER DISEASE General ScreenAnorexia liver definitely enlarged Yellow Sclerae Nausea/vomiting liver hard Symptoms preceded.....Age in years liver tender jaundice Male sex Haemetamesis liver irregular Weight loss obvious mass pale stool Other diarrhoea Jaundice Fatigue urine dark....Duration (days) Charts such as the sample in the previous slide are completed and the information is coded into computers. From these standard form findings, accumulated from thousands of patients, it is possible to set up a data base. Through the use of Artificial Intelligence and applying statisitcal rules, the condition of a given patient - on which the same findings are available, can be predicted. In the I.C.U. this type of correlation, analysis of Laboratory results and biochemical readings from monitors may be incorporated to predict a patient’s progress and forecast how long a patient may have to stay in intensive care. This is important to hospital staff and management as to how many places will be available at a given time. APPLICATIONS FOR HOSPITAL MANAGEMENT. CENTRAL RECORDING OF : number of bed days procedures and tests obtained by the patient, units of treatment given in addition to CODING OF DIAGNOSIS, PROCEDURES AND MEDICATIONS will make auditing of patient accounts easier and also more accurate. TRANSMISSIBLE RESULTS MAY CUT DOWN ON THE NEED TO REPEAT TESTS. Conclusion The aim of the EHR is to encompass all underlying structures of paper record in a structured user-friendly format. Good history and physical exam. and clinical observation skills are the key to achieving information which is managed to support clinical decisions and actions taken in patient care. A Centralized record including lab. and procedure results and medication records will enhance patient record interpretation. Coding of Diagnoses, Procedures and Medications will benefit ~ Research ~ Auditing 164 Chapter 1 Introduction to Digital Radiography and PACS Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. 165 Objectives Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Define the term digital imaging. Explain latent image formation for conventional radiography. Describe the latent image formation process for computed radiography. 166 Objectives Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Compare and contrast the latent image formation process for indirect capture digital radiography and direct capture digital radiography. Explain what a PACS (picture archiving and communication system) is and how it is used. Define digital imaging and communications in medicine. 167 Computed Key Termsradiography Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. DICOM (digital imaging and communications in medicine) Digital imaging Digital radiography Direct capture DR Indirect capture DR PACS Teleradiology 168 Conventional Radiography Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Method is film-based. Method uses intensifying screens. Film is placed between two screens. Screens emit light when x-rays strike them. Film is processed chemically. Processed film is viewed on lightbox. 169 Digital Imaging Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Digital imaging is a broad term. Term was first used medically in 1970s in computed tomography (CT). Digital imaging is defined as any image acquisition process that produces an electronic image that can be viewed and manipulated on a computer. In radiology, images can be sent via computer networks to a variety of locations. 170 Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Historical Development CT coupled imaging devices and the computer. of Digital Imaging Early CT scanners required hours to produce a single slice. Reconstruction images took several days to produce. First CT scanners imaged the head only. First scanner was developed by Siemens. 171 Historical Development of Digital Imaging Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Magnetic resonance imaging (MRI) became available in the early 1980s. Lauterbur paper in 1973 sparked companies to research MRI. Many scientists and researchers were involved. Advancements in fluoroscopy occurred in the 1970s as well. Analog-to-digital converters allowed real-time images to be viewed on TV monitors. 172 Historical Development of Digital Imaging Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Fluoroscopic images could also be stored on a computer. Ultrasound and nuclear medicine used screen capture to grab the image and convert it digitally. Eventually, mammography converted to digital format. Digital Radiography Development 173 Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Concept began with Albert Jutras in Canada in the 1950s. Early PACS systems were developed by the military to send images between Veterans Administration hospitals in the 1980s. Development was encouraged and supported by the U.S. government. Digital Radiography Development 174 Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Early process involved scanning radiographs into the computer and sending them from computer to computer. Images were then stored in PACS. Computed and digital radiography followed. 175 Uses storage phosphor plates Computed Radiography Uses existing equipment Requires special cassettes Requires a special cassette reader Uses a computer workstation and viewing station and a printer Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. 176 Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Storage phosphor plates are similar to intensifying Computed screens. Radiography Imaging plate stores x-ray energy for an extended time. Process was first introduced in the United States by Fuji Medical Systems of Japan in 1983. First system used a phosphor storage plate, a reader, and a laser printer. 177 Computed Radiography Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Method was slow to be accepted by radiologists. Installation increased in the early 1990s. More and more hospitals are replacing film/screen technology with digital systems. 178 Digital Radiography Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Cassetteless system Uses a flat panel detector or charge-coupled device (CCD) hard-wired to computer Requires new installation of room or retrofit 179 Digital Radiography Two types of digital radiography Indirect capture DR Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Machine absorbs x-rays and converts them to light. CCD or thin-film transistor (TFT) converts light to electric signals. Computer processes electric signals. Images are viewed on computer monitor. 180 Digital Radiography Direct capture DR Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Photoconductor absorbs x-rays. TFT collects signal. Electrical signal is sent to computer for processing. Image is viewed on computer screen. 181 Digital Radiography Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. First clinical application was in 1970s in digital subtraction. University of Arizona scientists applied the technique. Several companies began developing large field detectors. 182 Digital Radiography Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. DR used CCD technology developed by the military and then used TFT arrays shortly after. CCD and TFT technology developed and continues to develop in parallel. No one technology has proved to be better than the other. Comparison of Film to CR and DR 183 Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. For conventional x-ray film and computed radiography (CR), a traditional x-ray room with a table and wall Bucky is required. For DR, a detector replaces the Bucky apparatus in the table and wall stand. Conventional and CR efficiency ratings are about the same. DR is much more efficient, and image is available immediately. Comparison of Film to CR and DR 184 Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Latent image formation is different in CR and DR. Conventional film/screen Film is placed inside of a cassette that contains an intensifying screen. X-rays strike the intensifying screen, and light is produced. The light and x-ray photons interact with the silver halide grains in the film emulsion. Comparison of Film to CR and DR 185 Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. An electron is ejected from the halide. Ejected electron is attracted to the sensitivity speck. Speck now has a negative charge, and silver ions will be attracted to equal out the charge. Process happens many times within the emulsion to form the latent image. After chemical processing, the sensitivity specks will be processed into black metallic silver and the manifest image is formed. Comparison of Film to CR and DR 186 CR A storage phosphor plate is placed inside of CR cassette. Most storage phosphor plates are made of a barium fluorohalide. When x-rays strike the photosensitive phosphor, some light is given off. Some of the photon energy is deposited within the phosphor particles to create the latent image. The phosphor plate is then fed through the CR reader. Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Comparison of Film to CR and DR 187 CR, continued Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Focused laser light is scanned over the plate, causing the electrons to return to their original state, emitting light in the process. This light is picked up by a photomultiplier tube and converted into an electrical signal. The electrical signal is then sent through an analog-to-digital converter to produce a digital image that can then be sent to the technologist review station. Comparison of Film to CR and DR 188 DR Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. No cassettes are required. The image acquisition device is built into the table and/or wall stand or is enclosed in a portable device. Two distinct image acquisition methods are indirect capture and direct capture. Comparison of Film to CR and DR 189 DR, continued Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Indirect capture is similar to CR in that the x-ray energy stimulates a scintillator, which gives off light that is detected and turned into an electrical signal. With direct capture, the x-ray energy is detected by a photoconductor that converts it directly to a digital electrical signal. 190 Image Processing Conventional radiography Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Image is determined by the film itself and the chemicals. CR and DR Image processing takes place in a computer. For CR, the computer is located near the readers. For DR, the computer is located next to x-ray console, or it may be integrated within the console, and the image is processed before moving on to the next exposure. 191 Exposure Latitude or Dynamic Range Conventional radiography Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Based on the characteristic response of the film, which is nonlinear. Radiographic contrast is primarily controlled by kilovoltage peak. Optical density on film is primarily controlled by milliamperesecond setting. 192 Exposure Latitude CR and DR Range or Dynamic Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Contain a detector that can respond in a linear manner. Exposure latitude is wide, allowing the single detector to be sensitive to a wide range of exposures. Kilovoltage peak still influences subject contrast, but radiographic contrast is primarily controlled by an image processing look-up table. Milliampere-second setting has more control over image noise, whereas density is controlled by image-processing algorithms. 193 Scatter Sensitivity Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. It is important to minimize scattered radiation with all three acquisition systems. CR and DR can be more sensitive to scatter than screen/film. Materials used in the many CR and DR image acquisition devices are more sensitive to low-energy photons. 194 Picture Archival and Networked group of computers, Communication Systems servers, and archives to store digital images Can accept any image that is in DICOM format Serves as the file room, reading room, duplicator, and courier Provides image access to multiple users at the same time, ondemand images, electronic annotations of images, and specialty image processing Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. 195 Picture Archival and Custom designed Systems for each facility Communication Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Components/features can vary based on the following: Volume of patients Number of interpretation areas Viewing locations Funding 196 Picture Archival and Communication Systems Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Early systems did not have standardized image formats. Matching up systems was difficult. Vendors kept systems proprietary and did not share information. DICOM standards helped change this by allowing communication between vendors’ products. 197 Picture Archival and Communication Systems First full-scale PACS Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Veterans Administration Medical Center in Baltimore used PACS in 1993. PACS covered all modalities except mammography. Shortly after, PACS was interfaced with radiology information systems, hospital information systems, and electronic medical records. 198 PACS Uses Made up of different components Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Reading stations Physician review stations Web access Technologist quality control stations Administrative stations Archive systems Multiple interfaces to other hospital and radiology systems 199 Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. PACS EarlyUses PACS seen only in radiology and some cardiology departments. PACS now can be used in multiple departments. Archive space can be shared among departments. PACS reading stations may also have image processing capabilities. PACS allows radiologists to reconstruct and stitch images in their offices. 200 PACS Uses Elsevier items and derived items © 2008 by Mosby, Inc., an affiliate of Elsevier Inc. Orthopedic workstations are available for the following: Surgeons can plan joint replacement surgery. Specialized software allows matching of best replacement for patient with patient anatomy. System saves time and provides better fit. HIM 4203 Health Informatics II Administrative Applications Administrative Applications Medical Records Management Information System Requirements for computerized Master Patient Index (MPI) What is the purpose of the MPI? What is the value of computerizing the MPI ? Who should control the data in the MPI? Administrative Applications Requirements for computerized Master Patient Index (MPI) What are the features required when computerizing the MPI? Administrative Applications Requirements for an automated recordtracking system What is the purpose of a record-tracking system? What are the two basic tools in a manual record-tracking system? What are the main features you would want in an automated record-tracking system? What are the type of reports you would want the system to produce? 1) Management reports 2) Statistical reports Administrative Applications Requirements for a physicians incomplete record system What is the purpose of a physicians’incomplete record system? What are the most important features of computerizing this system? Administrative Applications Encoders A computer program (software) that allows a coder to enter a diagnosis or procedure and be prompted by the computer to provide additional information from the medical record so that the correct codes are assigned Administrative Applications Advantages of encoder software Consistency Accuracy (rules and guidelines are built into the system) Speed (not everyone agrees that encoder increase coding speed) Adaptability (e.g. training for new versions; updates) Administrative Applications Features of encoder software Adaptable to users (e.g. language is that used by your physicians) Points out possible significant complications and conditions pertinent to the disease at the time the record is being coded Links to an abstracting Administrative Applications Financial Information Systems The purposes of a financial management program: 1. Providing management with quantitative data 2. Developing operational financial sub-systems 3. Providing management information for controlling and evaluating operations 4. Analyzing historical and current financial activity 5. Projecting future financial needs Administrative Applications Individual financial subsystems include: Payroll preparation and accounting, linked to personnel information system Processing of accounts payable Patient accounting Cost accounting General ledger accounting Budgeting Internal and external auditing Financial forecasting Financial statement preparation Financial reporting for operating supervisors, executive management …etc. Administrative Applications Human Resource Information Systems (HRIS) The functions of HRIS include: Maintaining, updating, and retrieving information from the employee permanent record file Providing automatic position control linked to budget Producing labor analysis Producing reports for analyzing personnel problems Maintaining an inventory of special skills Producing labor cost allocations Providing information on employee productivity Administrative Applications The functions of HRIS include: Providing an analysis of compensation and benefit packages Helping Management in labor relations negotiations Providing access and training Providing assessment of staff needs and strategic HR planning Producing job applicant reviews and profiles Providing scheduling and assignment reports to management Administrative Applications Human Resources Information System Employee Records Payroll Benefits Information Budget HRIS Government Reports Management Reports Strategic Decision Support systems Using organization’s data to help in management decisions and efficient operations. The key is organizing information and using it intelligently. Strategic Decision Support systems Attributes Easy interaction with the system Executives can retrieve data themselves Data are displayed in a meaningful format System has modeling capability System generates clear reports Strategic Decision Support systems Components of DSS User Interface: Allows executives to communicate easily with DSS Model Manager: Software designed to coordinate the creation, storage, and retrieval of the models that comprise the model library. Model Library: Consists of analytical capabilities. Statistical, graphical, financial and what-if models Databases: Essential for the DSS is a collection of databases. Include clinical repository, financial databases and external databases Strategic Decision Support systems Components of DSS Database Management System (DBMS): Enables access to databases in the DSS. Report Writer: Provides the user with clear and meaningful reports containing decision problem solution. Strategic Decision Support systems Characteristics of Useful Management Information Information not raw data Relevant Sensitive Unbiased Comprehensive Timely Action oriented Performance targeted Cost-effective Strategic Decision Support systems Expert Systems Simulate human problem-solving techniques Use artificial intelligence Components: User interface, inference engine, knowledge base, database, workspace Strategic Decision Support systems User User Interface Inference engine Workspace Knowledge base Database Expert System Model 224 Learning Objectives 1. Introduction to HIT 2. Information Systems in Organization 3. Selection of various types of information systems used within healthcare. 4. Ethical issues in HIT 5. Functions/features of some Clinical Information Systems. 6. Understanding basic functions of common software used in HIS. 225 Information Data (facts, numbers, characters) Information (what) Knowledge (concept / idea) Wisdom (why, when, how, what-next…) Roles of Healthcare Professionals in HIS Data gatherer Information user Knowledge user Knowledge builder 226 227 “Good” Information Right content Right format Right time Right user 228 Information Quality Is there any incorrect value in the information? Is there any value missing from the information? Is aggregate or summary information in agreement with detailed information? Is the information current with respect to the needs? Is each transaction and event represented only once in the information? 229 Difficulties in Managing Data Amount of data increases exponentially. Data are scattered and collected by many individuals using various methods and devices. Data come from many sources. Data security, quality and integrity are critical. An ever-increasing amount of data needs to be considered in making organizational decisions. Solution: network database 230 Information Technology Computer equipment ▫ ▫ ▫ Hardware Software Telecommunication network to collect / store, process, and display data 231 Information Systems Use of computer hardware and software to process data into information for operation management and decision making 232 Information Combination of : Systems ▫ Hardware ▫ Software ▫ Telecommunications networks ▫ Data ▫ People ▫ Procedures (business rules /practices) Decision-Making Levels of an Organization Organizational Levels 233 Information Systems across Organizational Boundaries 234 235 Healthcare Information System Healthcare Information System (Hospital Information System HIS)—a group of systems used to support and enhance healthcare business functions Types of Healthcare Information Systems Clinical information systems ▫ Directly support care ▫ Individual systems may be standalone ▫ Goal: data exchange among systems Administrative systems 236 ▫ Indirectly support patient care ▫ Individual systems may stand alone ▫ Goal: data exchange among systems 237 Types of Healthcare Information Systems 238 1. Clinical Information Systems Nursing Monitoring Order entry Laboratory Radiology Pharmacy Other Ancillary Systems ( Physician Practice, Ambulatory, Long-term, Home-care …) 1.1. Nursing Information Systems Supports the use and documentation of nursing activities and provides tools for managing the delivery of nursing care: ▫ view/ update vital data /patient condition ▫ access to online drug info, procedure guidelines databases ▫ provide quality patient care ▫… 239 240 Nursing Information System Advantages Improve access to information Better documentation Improve quality of care Improve productivity and communications Tracking capability Enhanced regulatory compliance 241 1.2 Monitoring Systems Monitor patient vitals and other findings, or automatically feeding the input into a clinical information system. Immediately alert the caregivers “abnormal” findings, real-time patient conditions 242 1.3. Order Entry Systems Direct entry of orders for medications and treatments by the physician, nurse practitioner, physical therapist, or other providers. Transmitted online orders to the appropriate areas (pharmacy, laboratory, radiology, social services and others …) 243 Computerized Provider Order Entry - CPOE Improve the quality of care and reduce medication errors ▫ Eliminates transcription error ▫ Expedites treatment ▫ Encourages more accurate, complete orders 244 1.4. Laboratory Systems Alert providers when new or stat tests results are back or values are critical Send results to clinical system for view Accept input from bedside devices Generate labels for specimen collection Use rules to order additional tests when indicated Address issues such as turnaround time, duplicate testing, errors 245 1.5. Radiology Systems Allows direct order entry or accepts orders from other systems Provide scheduling of diagnostic tests Generate client instructions Permit transcription of results Provide picture archiving and transmission of images and tracking of film Generate charges once procedures are done 246 1.6. Pharmacy Systems Provide checks in order and administration process using evidence-based guidelines Reduce errors when used with bar code technology Use lab results, allergy, and interaction information from clinical systems Track medication use, costs, and billing information 247 Pharmacy May include: ▫ ▫ In pharmacy dispensing systems (robots) Unit-based dispensing cabinets in care areas ▫ Barcode and RFID Medication Administration 248 Barcode and RFID Medication Administration Use barcode on the unit-dose medication package and patient bracelet to ensure right patient, right drug, right dose, right time, right route Use radio frequency identification (RFID) tags on medication package 249 E-prescribing Provide a longitudinal prescription record Check formulary compliance and reimbursement Provide alerts about drug interactions Generate reminders to order home meds for the discharged client Eliminate phone authorization for refills 250 1.5. Physician Practice Management Systems Capture of demographic and insurance data, scheduling, billing, outcome tracking, and report capability May connect to hospital electronic patient records or maintain separate patient records 251 Long-Term Healthcare Systems For the improved quality of care and efficiency Integration with other systems needed to best serve patients Can include all features seen in other clinical information systems 252 Home Healthcare May communicate with hospital systems to exchange data Support demands for excessive documentation Improve payment for services because it is easier and quicker to find information needed for billing 253 2. Administrative Systems Client Registration Financial Payroll and Human Resource Risk management Quality assurance Contract management Materials management Scheduling Other Administrative Systems … 254 2.1 Registration Systems Admission/discharge/transfer systems Collect and store demographic and insurance data that are verified and updated at the time of each visit Critical to operations to ensure correct patient identification and reimbursement for charges 255 2.2. Financial Systems Charge for service and receive reimbursement Access patient demographic data and insurance information from registration system 256 2.3. Risk Management Enhance ability to identify potential risks and develop appropriate strategies Track back to the point of origin to address specific liabilities 257 2.4. Contract Management Provide visibility and control to negotiate better contracts with the third parties (vendors, suppliers …) Ensure contractual obligations, compliances, deliveries 258 2.5. Scheduling Systems Schedule client appointments and facilities/resources Dates and times, Department, Room, Staff, Equipment, Insurance approval and charging information 2.6. Decision Support and Expert Systems Use organization’s historical data of to facilitate decision making and overall efficiency. What-if analysis, scenario analysis, casebased analysis to select of viable options 259 260 Large-scale Database in HIS Able the location, abstraction, comparison of patient information in many format came from many sources, stored in many places Real-time information Network database Knowledge Representation (Dashboard Display) Display all real-time data/ indicators/ trends from many sources on one screen for overview Allow to go to details of each area (drilldown) 261 262 Mobile Devices in HIS Mobile devices to improve the functionality of HIS ▫ ▫ ▫ personal digital assistants (PDA), tablet computers, iPhones / iPads 263 Impact of Mobile Computing Allow access to data at the point of care to facilitate treatment decisions ▫ ▫ Test results Evidence-based practice guidelines Facilitate documentation at the point of care for improved accuracy HIM 4203 Health Informatics II Patient Care Applications Patient Care Applications Development of clinical information systems has become a top priority for healthcare organizations. Why? Quality of care Cost Control Patient Care Applications According to HP Leadership Survey, the three most important application priorities for healthcare organizations: 1. Implement a clinical data repository 2. Implement new clinical systems 3. Implement an electronic medical record Patient Care Applications Computer-Based Patient/Medical Records - (CPR/MR) The MR is central to all patient care activities. MR is used for : ▫ ▫ ▫ ▫ ▫ ▫ ▫ Continuous record of treatment Archival record Medical audit Utilization review Quality improvement Cost control Database for research studies Patient Care Applications Key attributes of the CPR: 1. The CPR includes a problem list that clearly delineates the patient’s clinical problems and current status of each 2. It encourages and supports the systematic measurement and recording of he patient health status and functional levels 3. It documents the clinical rationale for all diagnosis 4. It links to clinical records from various settings and time periods to provide a longitudinal record of events that have influenced a person’s health Patient Care Applications The current status of computerizing patient records: 1. Many healthcare organizations have partially automated records that include items such as laboratory results, summaries of radiology procedures…etc 2. Integrated delivery systems are moving to develop master patient indexes that provide common patient identifiers for all patients in the system and facilitate electronic exchange of information among all providers in the network Patient Care Applications The current status of computerizing patient records: 3. An increasing number of physician offices and group practices are installing practice management systems and ambulatory/outpatient care records systems 4. A small number of organizations, often university medical centers, are working on the development of complete electronic medical record systems, including the storage and retrieval of medical images as well as digital information Patient Care Applications Major Barriers 1. Legal issues (Laws prohibiting paperless medical records) 2. The need for universal standards on record content and coding 3. Technological limitations 4. The need to convince users of the importance of such systems 5. Users resistance Patient Care Applications City of Hope Medical Center (Case Study) Developed EMR serving users across its campus of 50 buildings First step: installation of fiber-optic communication network with more than 40 file servers supporting 1000 users The medical center selected Oacis Healthcare Network and related clinical applications as the major software The repository collects data from ancillary systems using HL7 standard interfaces The CPR included lab information, doctors’ transcriptions, and encounter data (inpatient & outpatient) Radiology and cardiology data soon to be added… Patient Care Applications Order entry and results reporting systems: These systems provide computerized telecommunication of information throughout the various service areas of a health services organization. System must be fast and easy to use Consistent behavior of interface Commitment by clinicians Top management commitment to the project Patient Care Applications Clinical Service Applications Laboratory Information Systems: One of the most common clinical computer applications in health services organizations Phases to computerizing lab IS: A lab data processing system would include recording of test requisitions, scheduling specimen collection and test processing, recording of the results of completed tests, generating test reports, summary reports, statistical reports, and record keeping for quality control and administrative control of laboratory operations Use of bar-coding (How do is this applicable?) ▫ ▫ Automating test processes Processing lab Data by linking lab instruments to IS Patient Care Applications Clinical Service Applications Pharmacy Information Systems: Pharmacy is one of the most informationally complex departments Accurate records are very essential…Why? Patient Care Applications Clinical Service Applications Two basic approaches to computerizing the pharmacy Information System: ▫ Development of a stand-alone pharmacy IS for control of dangerous drugs (narcotics), drug ordering inventory control, control of drug distribution to patients, storage and retrieval of drug information, construction of patient drug profiles, and generation of charges for patient billing ▫ Integrating pharmacy IS into enterprise-wide information system will typically involve the entering medication orders through workstations ▫ MENTOR clinical pharmacy system Patient Care Applications Clinical Service Applications Radiology IS: Two categories: Radiology data processing systems that include recording test requisitions, scheduling procedures, recording and reporting test results, reporting charges, and preparing management reports fort the department. Picture-archiving and communication systems (PACS) involve online storage and rapid retrieval of images transmitted over communication networks to user workstations. Benefits? Patient Care Applications Ambulatory Care Information Systems A typical ambulatory care/ outpatient systems would include: 1. Patient scheduling and appointment system 2. Electronic medical records and medical management systems 3. Patient and third-party billing 4. Managed care contract management 5. Electronic communications with other providers in an integrated delivery system Patient Care Applications Clinical Decision-Support Systems (CDSS) CDSS are computer-based information systems designed to assist physicians in diagnosis and treatment planning Two categories of CDSS: ▫ Passive CDSS that collect, organize, and communicate patient health and medical data to the physician ▫ Active CDSS that utilize medical data stored in the computer to suggest diagnoses and treatment protocols Patient Care Applications Clinical Decision-Support Systems (CDSS) ▫ Categories of active CDSS  Expert systems: Knowledge base matched against patientspecific information and a rule-based inference engine that generates conclusions for consideration by physician  Probabilistic algorithms use statistical information. They employ statistical probability rather than knowledge collected from expert human beings  Clinical reminders and alerts are incorporated into clinical computer applications to alert the caregiver to potential medical conditions or other problems. (e.g. drug interaction alerts, allergy alerts…etc) Patient Care Applications Other clinical Applications Telemedicine: The application of computer and communications technologies to support healthcare delivery to patients at remote locations ▫ Long-Term Care: ▫ Home health care: ▫ Clinical research and education: