Lecture 2: Overview of Health Informatics PDF

Lecture 2: Overview of Health Informatics Presented By Dr. Ali Buabbas Faculty of Medicine Learning Objectives After reviewing these slides, the student should be able to:       State the definition and origin of informatics in health care Identify the Information Hierarchy Sources of Healt...

Lecture 2: Overview of Health Informatics Presented By Dr. Ali Buabbas Faculty of Medicine Learning Objectives After reviewing these slides, the student should be able to:       State the definition and origin of informatics in health care Identify the Information Hierarchy Sources of Healthcare Data Identify the forces behind health informatics Describe the key players involved in health informatics List the barriers to health information technology (HIT) adoption Introduction High speed computers, voice recognition, mobile technology are technologies emerged with the advent of the internet in early 1990s. Healthcare professionals today have many more tools at their disposal, utilizing the functionalities offered by technology. Technology is advancing faster than healthcare professionals can integrate it into practice. Therefore, there is a new need for education and translation of emerging technologies and the data/information they generate into healthcare Definitions  Health informatics (HI) is the field of information science concerned with management of healthcare data and information through the application of computers and other technologies  Its an intersection of three sciences: information science, computer science, and medicine/health care.  It is more about applying information in the healthcare field than it is about technology  Technology can generate, transport and analyze useful healthcare data  “Technology is the transportation, not the destination”  HI as a term appeared in 1970s. Dr. Safran Definitions  Health informatics is also known as clinical informatics when informatics applied in clinical medicine, and medical informatics when informatics applied in medical practice.  The same thing when we apply informatics in dentistry, nursing, public health, pharmacy, medical imaging and veterinary.  Informatics is a term that describe the process of collecting data, analyzing it, using computer applications.  Bioinformatics is concerned with biological data, particularly DNA and genomic information How is informatics distinguished from related terms?  Information technology (IT) – computer and related technology.  Computer science is academic discipline that underlies IT and is concerned about programing .  Management information systems is another field underlying IT (usually in business schools)  Health information technology (HIT or health IT) – health-related application of IT. 6 What are clinical data?  A datum is a single observation  Clinical data are the collection of observations about a patient  Example from John Halamka of Geek Doctor blog fame (https://dmice.ohsu.edu/hersh/halamka-record.pdf), part of Personal Genomes Project (https://www.personalgenomes.org/us)  Each datum about a patient has a minimum of four elements:     the patient (Bill Hersh) the attribute (heart rate) the value of the attribute (50 beats per minute) the time of the observation (1:00 pm on 7/1/1990 – many ways to record dates!) 7 Information Hierarchy  Data is meaningless facts  Information is data with meaning, e.g. the number 10 could be anything but a prostate specific antigen (PSA) of 10 is important information, which means the patient is more likely to develop a prostate cancer and needs more investigation, this is knowledge.  Knowledge is the stage of making actions  Humans provide knowledge and wisdom  There are lots of data but less information, knowledge and wisdom. Types of clinical data  Narrative – recording by clinician  Numerical measurements – blood pressure, temperature, lab values  Coded data – selection from a controlled terminology system  Textual data – other results reported as text  Recorded signals – EKG, EEG  Pictures – radiographs, photographs, and other images 9 Different Levels of Data  There are different levels of data and data can be structured or unstructured  The goal is ultimately to have all healthcare data as computable data so it can be shared and analyzed by humans and computers Electronic Health Records (EHRs)  There is no topic in health informatics as important, yet controversial, as the electronic health record (EHR)  Electronic Health Record: “An electronic record of healthrelated information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed and consulted by authorized clinicians and staff across more than one healthcare organization”  Computer technologies and early EHRs appeared in 1970s at the Massachusetts General Hospital Why do we need EHRs?  Paper records are severely limited: less legible, more difficult to retrieve, store and share and unstructured data. Also, electronic records less likely to be missing and available 24/7 from multiple locations. Paper records do not permit clinical decision support  Need for improved efficiency and productivity: clinicians are more productive if charts are available and retrieval of results is faster. EHR access from home while on call helps productivity  Quality of care and patient safety: the factors already described in last two bullets plus patient reminders, quality reports and secure messaging as part of an EHR Why do we need EHRs?  Public expectations: EHRs may increase patient satisfaction through faster results, messaging, patient portals, electronic patient education, e-prescribing and online scheduling  Governmental expectations: government considers EHR to be transformational and hence why they support reimbursement for use.  Need for integrated data: electronic data permits integration with health information organizations, data analytics, public health reporting, artificial intelligence and genomic information Why do we need EHRs?  Financial savings: EHRs may save money by eliminating transcription and improving coding. Decreased file room storage and faster chart pulls and information retrieval may result in cost savings.  Technological advances: computers are much faster, the Internet is more prevalent, wireless and mobile technologies are ubiquitous; all supporting EHRs  Need for aggregated data: healthcare data must be electronic to be shared, stored and analyzed. Research depends on large study populations and data sets which EHRs can provide Electronic Health Record Key Functions  Clinical decision support  Secure messaging  Computerized physician order entry  Practice management  Manage care module  Referral management  Results retrieval  Prior encounter retrieval  Patient reminders        Electronic encounter notes Multiple input methods Access via mobile technology Remote access from home Electronic prescribing Integration with images Integration with physician and patient education  Public health reporting  Quality reports  Problem summary lists Electronic Health Record Key Functions  Ability to scan in data  Evaluation and management help  Ability to graph and track results  Ability to create patient lists  Ability to create registries  Preventive medicine tracking  Privacy/security compliance  Robust backup systems  Ability to generate summaries of care (CCD)  Support for client server or application service provider (ASP) modes Many sources, users, and uses of clinical data Mining the Data  All large healthcare organizations will collect and analyze a variety of clinical, financial and administrative data to make wise clinical and business decisions  Therefore, data analytics is very important Driving Forces Behind Using Electronic Health Records System  Increase healthcare efficiency and productivity  Improve healthcare quality (patient outcomes) resulting in improved patient safety  Reduce healthcare costs  Improve healthcare access with technologies such as telemedicine and online scheduling  Improve coordination and continuity of care  Improve medical education of clinicians and patients  Standardize medical care Avalanche of Healthcare Data  Being working in an e-hospital, datasets will be available to healthcare professionals, developers and researchers  Datasets are available in categories: raw data, special tools and a geodata catalog  Users can use filters: data type, subject, agency, date updated, coverage period, collection frequency, geographic area, release date and output format Key Players Involved with HIT  Physicians and nurses  Patients  Hospitals and healthcare organizations  Support staff  Medical educators     Public health HIT vendors Insurance companies Federal and state governments  Medical research Organizations Involved with HIT  Institute of Medicine  Department of Health and Human Services (HHS)  Office of the National Coordinator (ONC)  Agency for Healthcare Research and Quality (AHRQ) * Academic * Federal government  HHS (cont.)  Centers for Medicare and Medicaid (CMS)  Centers for Disease Control and Prevention (CDC)  Health Resources and Services Administration (HRSA)  National Institute of Standards and Technology (NIST) Institute of Medicine (IOM) IOM Evaluates policy relevant to healthcare and provides feedback to the Federal Government and the public In their two pioneering books To Err is Human (1999) and Crossing the Quality Chasm (2001), they reported approximately 98,000 deaths occur yearly in the US due to medical errors. It is their belief that adopting health information technology will help promote “safe, effective, patient centered, timely, efficient and equitable medical care” They recommended 12 types of HIT that would help move healthcare into the 21st Century IOM reports laid out vision for better healthcare system For high-quality 21st century healthcare (2001) Aims included in a health care system should be: • Safe – avoid injuries from care intended to help • Effective – provide service based on scientific knowledge and avoid care unlikely to benefit • Patient-centered – care respectful of patients’ preferences, needs, and values • Timely – reduce waits and delays in care • Efficient – avoid waste of equipment, supplies, and energy • Equitable – provide care that does not vary based on personal characteristics Barriers to HIT Adoption Not enough time Not enough expertise, as few have formal training in informatics Not enough financial resources Lack of interoperability between technologies Privacy concerns New legal concerns: who owns the electronic data? Need for behavioral changes: about 50% of staff will be slow to adopt any new changes Change in workflow means new habits Barriers to HIT Adoption Hype versus Fact: there have been many overly optimistic predictions by vendors, academicians, the government and early adopters that HIT will revolutionize healthcare While we are still early in the game, the reviews are mixed whether adoption today has improved quality, safety or reduced medical costs There is a need for  Informatics training must be expansive to include IT knowledge about networks and systems, usability, process re-engineering, workflow analysis and redesign, quality improvement, project management, leadership, teamwork, implementation and training  Many of the newest technologies are interrelated systems such as EHRs, patient portals, mobile technology, telemedicine, etc. Conclusions  Health Informatics is an exciting field with many new educational and job opportunities.  Health sciences students must be prepared to be an independent learners, information seekers, and proficient users of computer technologies.  The changing role of physicians in a new health environment that requires health care professionals equipped with informatics knowledge and skills.  Teaching HI in medical education becomes an essential requirement