Lesson 01 - Introduction of Health Informatics and Its Importance PDF

Lesson 1 Introduction of Health Informatics and Its Importance Health Informatics Course NUR 351 Dr. Sally M.Farghaly 1 ‫شريحة‬ Objectives By the end of this lesson, students will be able to: Define health informatics related concepts. Determine the Nursing Informatics Framework. Recognize the Application of Health Informatics in Nursing. Identify the benefits of health informatics in nursing. Determine role of nurse informatics according to ANA. Introduction of Health Informatics and Its Importance “ Computers are incredibly fast, accurate, and stupid. Human beings are incredibly slow, inaccurate, and brilliant. Together they are powerful beyond “ imagination Introduction of Health Informatics and Its Importance Introduction Over the past four decades, the field of informatics has become the focus of a large body of research, theory development. In order to address both the visible and hidden aspects of informatics in nursing. Introduction of Health Informatics and Its Importance Informatics – science that combines: Domain science Computer science Information science Cognitive science It denotes an application of computer science and information science to the management and processing of data, information, and knowledge in the named discipline. Introduction of Health Informatics and Its Importance Nursing Informatics defined as: Nursing Knowledge & Information “is a specialty that integrates nursing science, computer science, and information science to Nursing manage and communicate data, information, Informatics knowledge and wisdom in nursing practice. Nursing Information & Communication Practice Technologies Introduction of Health Informatics and Its Importance Nursing Informatics supports consumers, patients, nurses, and other providers in their decision-making in all roles and settings. This support is accomplished through the use of information structures, information processes, and information technology. Introduction of Health Informatics and Its Importance Health informatics: It is use of information technology (software) in combination with information management concept methods to support delivery of health care. Umbrella term encompassing medical, nursing dental and pharmacy informatics among others. Introduction of Health Informatics and Its Importance A healthcare information system (or HIS) Define a Healthcare Information System (HIS) as a system for holding and updating patient-related information and records, clinically as well as administratively oriented. refers to any system that stores and manages information related to the health of individuals from different sources, such as hospitals, clinics, doctors, and all other organizations that work in the health sector. Introduction of Health Informatics and Its Importance A healthcare information system (or HIS) So a HIS creates, sends, receives, processes, and stores information about patients. This is done by taking data as input from the healthcare worker, then processing it and generating useful information as output to help improving the quality and effectiveness of medical services. Introduction of Health Informatics and Its Importance A healthcare information system (or HIS) Nowadays, it seems inevitable that we exploit the Internet in all aspects of our modem life, and in particular, the applications in the health sector, where all local networks in hospitals, clinics, etc. are interconnected to enable each healthcare organization to have access to the same medical records stored in one central place. Introduction of Health Informatics and Its Importance A healthcare information system (or HIS) The management of HIS is based on cataloging, maintaining, transmitting, and comparing a significant amount of data and information. HIS requires effective storing and efficient retrieval of electronic medical records, which is the best way to guarantee secure access to a central database full of all the medical data. Introduction of Health Informatics and Its Importance Nursing Informatics Conceptual Framework The main concepts in nursing informatics theory are: A. Data is a single observation or discrete entities that are described objectively without interpretation" and would include some value assigned to a variable. Introduction of Health Informatics and Its Importance Measures to insure data integrity include Education of personnel who collect and enter data System checks to ensure accurate data entry and data completeness Data verification techniques. Measures to minimize the entry of fraudulent information Introduction of Health Informatics and Its Importance Nursing Informatics Conceptual Framework B. Information: Is data that have been organized and interpreted. It reflects interpretation, organization, or structuring of data. Information is the result of processing data. For example, if a child's height and weight are recorded on a standardized growth chart during each well child visit, you can interpret whether the growth pattern is normal or abnormal Introduction of Health Informatics and Its Importance Introduction of Health Informatics and Its Importance Characteristics of quality information are: 1. complete and clear in its descriptions 2. accurate 3. measurable, preferably by objective means such as numbers 4. verifiable by independent observers 5. promptly entered 6. rapidly and easily available when needed… Introduction of Health Informatics and Its Importance Nursing Informatics Conceptual Framework C. Knowledge: is the synthesis of information derived from several sources to produce a single concept or idea. Knowledge provides a basis for logical decision-making. D. Wisdom: is defined as the appropriate use of knowledge to manage and solve human problems. It is knowing when and how to apply knowledge to deal with complex problems or specific human need Introduction of Health Informatics and Its Importance Nursing Informatics Conceptual Framework E. Data Management: involves control, retrieval and use of data. Key issues related to data management include organization-of data to maximize its usefulness, insuring accuracy and safeguarding integrity F. Processing: It is transformation of data from one form to another, usually at a more complex level of meaning or organization. Information processing includes gathering, interpreting and synthesizing data to produce knowledge and/or make decisions. This occurs when data are transformed into information and information to knowledge. Introduction of Health Informatics and Its Importance Relationship of data, information, knowledge, and wisdom Introduction of Health Informatics and Its Importance Applied: I’d better stop the car Context: The traffic light I am driving towards has turned red Context: South facing traffic light on corner of Pitt and George streets has turned red Raw: Red Introduction of Health Informatics and Its Importance An example, an instance of vital signs for an individual can be considered a set of data. A serial set of vital sign taken over time, placed into a context, and used for longitudinal comparisons is considered information. That is, a dropping blood pressure, increasing heart rate, respiratory rate, and fever in an elderly, catheterized person. Recognition that the person may be septic and, therefore may need certain nursing interventions reflects information synthesis (knowledge) based on nursing knowledge and experience Introduction of Health Informatics and Its Importance Goal of nursing informatics It is important that nurses should understand technology benefits and problem, and how it will affect their practice. Why informatics important to nursing? 1. Make nursing practice visible in local, national and international health care sets. 2. Empowering nurses with informatics to influence policy. 3. Information is a critical component of effective decision making and high quality of nursing practice. Introduction of Health Informatics and Its Importance Why informatics important to nursing? 4. Information gained through nursing informatics increase awareness& understanding of nursing& health care issues. 5. It is committed to maintain a clinical perspective. 6. It is promoting research that would be directly on improving patient care. Application of nursing informatics Practice. Education. Administration. Research. Introduction of Health Informatics and Its Importance Nursing informatics can be applied to all area of nursing practice include; Clinical practice Recording of patient assessment data in an electronic health record. Computer - generated nursing care plans Automatic billing for supplies or procedures Clinical practice Automated staff scheduling E-mail for improved communication Cost analysis and finding trends for budget purposes Quality assurance and outcomes analysis Introduction of Health Informatics and Its Importance Education Computerized record-keeping Computerized-assisted instruction Interactive video technology Distance Learning-Web based courses and degree programs Presentation software for preparing slides and handouts-PowerPoint and MS Word Research The ability to find trends in aggregate data, that is data derived from large population groups-Statistical Software, SPSS. Introduction of Health Informatics and Its Importance Benefits of nursing informatics 1. Improve access to the medical record. 2. Decreased redundancy of data entry. 3. Decreased time spent in documentation. 4. Facilitation of data collection for research. 5. Improved communication between all health care providers 6. Improve patient care outcome by creating and using aggregated data prevent errors, easing working condition and better healthcare records 7. Making the storage and retrieval of health care records much easier, quicker retrieval Introduction of Health Informatics and Its Importance Roles of a Nurse Informatics according to American Nurses Association: 1. The nurse begins to make design for stored information. 2. The nurse analyzes this information to identify progress of patient or help in decision making. 3. Nurse become informatics nurse specialist and found many opportunities to work in this field. 4. Become responsible for center computer or informatics system in hospital that guides all staff through connection with all computer of hospital. 5. Support nursing work processes using technology. 6. Re-engineer clinical work flow and facilitate change management. 7. Analyze clinical and financial data. Introduction of Health Informatics and Its Importance Roles of a Nurse Informatics according to American Nurses Association: 6. Promote and facilitate access to resources and references. 7. Provide nursing content to standardized languages. 8. Enhance continuity of care. 9. Improve relationship between providers and recipients of health care. 10. Enable cost savings and productivity goals. 11. Monitor their patient outcomes by using automated clinical pathways. 12. Nurse researchers can access decision support systems such as knowledge about diabetic care or maintain information using database management tools. 13. Use of technology to prevent medication errors by having the ordering provider directly enters an order into the computer system. References 1. Susan A, Karen H, and Frith H: Applied Clinical Informatics for nurses, (2019) 2nd ed. 9781284129250 128412925X. 2. Altarum Institute (2017). Health sector economic indicators: Insights from monthly national health spending data through December 2016. Retrieved from http://altarum.org/sites/default/files/uploaded-related-files/CSHS- Spending-Brief_February_2017.pdf 3. International Council of Nurses. (2015). International classification for nursing practice (ICNP) informationsheet. Retrieved from http://www.icn.ch/images/stories /documents/pillars/Practice/icnp/ICNP_FAQs.pdf 4. Mary Jo Bowie, Essentials of Health Information Management: Principles and Practices, (2021) 4th Edition. ISBN-13: 978-1337553674/ ISBN-10: 1337553670 References 5. Dana C. McWay, Legal and Ethical Aspects of Health Information Management, 5th Edition, (2020), ISBN-10 : 0357361547/ ISBN-13 : 978-0357361542 (newer version added) 6. Susan M. Houston, Tina Dieckhaus, Bob Kirchner, and Renee Rook wood; An Introduction to Nursing Informatics Evolution and Innovation, (2015) ISBN: 978-1-4987-5751-5 Thank You Lesson 2 Development of The Health Informatics and Theoretical Framework in Nursing Profession Health Informatics Course NUR 351 Dr. Sally M.Farghaly Objectives By the end of this lesson, students will be able to: Review the history of the development of clinical informatics in the Nursing Profession. Determine the key concepts relating to clinical informatics. Discuss the key concepts relating to clinical informatics and information science. Recognize the Theoretical Framework of clinical informatics in healthcare. Discuss the need for Health Information Management. Development of The Health Informatics and Theoretical Framework in Nursing Profession Informatics in Nursing Practice Role of 21st century nurses is complex – Requires interaction with multiple medical devices and health IT – Increasingly likely to be involved in the design of new clinical systems Technology is integral to all parts of healthcare delivery for healthcare providers (HCPs), patients, and healthcare settings. Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics Florence Nightingale has been recognized as an early informatics nurse because of her use of data to inform knowledge and change nursing practices. In 1863, Nightingale was clear in her desire to collect, retrieve and analyze data to be able to recognize trends in illnesses and treatments to improve the quality of care. It would take another century before nurses would begin to realize the benefits of integrating computer systems into their practice. Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics 1950s and 1960s During the 1950s and 1960s the image of nurses was improving, nursing practices were growing in scope and complexity and nurses were expanding in number. Health care facilities increased in number and the nurses’ station started to be considered the center of communication activities and information exchange. As computer technologies advanced with the development of real-time processing and desktop terminals, research was conducted to determine how computers could be used most effectively in health care. During this time period, computers were used primarily in health care facilities for basic business, financial and accounting operations. Progress in developing clinically-based applications continued to be slow. Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Prototypes Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Transistors Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Integrated circuits Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Microcomputer; Windows Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Internet; Web Development of The Health Informatics and Theoretical Framework in Nursing Profession Computers 1950 1960 1970 1980 1990 2000 Google Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics 1970s Nursing staff began to recognize the value of integrating computer applications into their practices and processes, particularly for documenting care and the evaluation of the care delivered; as well as automating specific functions such as staff scheduling or statistics collection. Nurses became instrumental in the development of nursing applications for hospital information systems. Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics 1980s The advent of the PCs with significantly improved computing power made computers more accessible and user-friendly for nursing and other health care professionals. Hospital information systems were increasing in functionality and use. The system documented several aspect of patient record, namely order entry evaluating the kardex, vital signs, narrative nursing notes , and discharge planning system used as referral to community health care facilities. Nursing informatics became a recognized specialty in the US and experts in the field were beginning to emerge – with job titles such as informatics nurse or nurse informatician. Development of The Health Informatics and Theoretical Framework in Nursing Profession History of Nursing Informatics 1990s and beyond The technology revolution that was impacting all aspects of life did not leave health care untouched. Computers became smaller, faster and easier to use. The internet became a tool for web-based clinical applications, communication and access to evidence-based resources. Wireless technologies made it simpler for nursing and other health care professionals to access applications at the point-of-care – where the patient was. Computer technology becomes integral part of health care setting, nursing practice, and nursing profession. Policies and legislation were adopted and promoting computer in health care including nursing. Nursing informatics becomes approved by American Health Association (ANA) as a new nursing specialty. Development of The Health Informatics and Theoretical Framework in Nursing Profession Clinical Informatics Concepts Data o Collected information used to answer questions Information o Created by assembling data in a clinical context Knowledge o Concerns how data and information are used Wisdom o Use of knowledge to solve real-world problems Development of The Health Informatics and Theoretical Framework in Nursing Profession Clinical Informatics Concepts Systems o Information systems Support the transfer from data to information. o Decision-support systems Support the transition from information to knowledge. o Expert systems Apply knowledge through wisdom. Informatics tools o Clinical guidelines, formal medical terminologies, computers, and information and communication systems Used to capture and present information. Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics There are several theories that related to nursing informatics, which come from a variety of disciplines, and they are: 1. Change theories: A-Lewins change theories (planned change) Kurt Lewin's theorized a three-stage of change that requires prior learning to be rejected and replaced. Development of The Health Informatics and Theoretical Framework in Nursing Profession Unfreeze Refreeze Ensures that Ensures that the Execute the employees are ready change becomes intended change for change permanent Change Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Unfreezing: Unfreezing is the process which involves finding a method of making it possible for people to let go of an old pattern that was counterproductive in some way. An example is moving from a paper-based documentation system to an electronic system. Moving stage: During this stage, the plan change is implemented the change target groups are convinced that the new way is better than the old. This stage involves a process of change in thoughts, feeling, behavior, or all three, that is in some way more liberating or more productive. Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Refreezing stage: Refreezing is establishing the change as a new habit, so that it now becomes the “standard operating procedure.” However, keep in mind that if the change is too strongly reinforced it is easy to backslide into the old ways of doing things. Rewards, support, and champion leadership continue to be important through this stage Lesson 2: Development of The Health Informatics and Theoretical Framework in Nursing Profession Bar-coded medication administration Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Rogers 'Diffusion of Innovation (unplanned change): Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Rogers 'Diffusion of Innovation (unplanned change): Rogers classified people into five groups based on their responses to change to view how innovations are accepted by general population: Innovators: These are the risk-takers who are the first to use the innovation. About 2.5% of the population falls into this group. Early adopters: This group tried to be influential because others look to them for opinion leadership and they serve as role models for others in the organization. They comprise about 13.5% of the population. Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics Rogers 'Diffusion of Innovation (unplanned change): Early majority: Makes 34% of the population. They adopt an innovation after a varying degree of time that is significantly longer than the innovators and early adopters. They may adopt to innovation not because they see a use for it, but because of peer pressure. Late majority: makes 34% they adopt an innovation after the average participant. These individuals approach an innovation with a high degree of skepticism and after the majority of society has adopted the innovation. Laggards: The last groups compromising 16% they are suspicious of innovation and change and are quite resistant. Laggards must be certain to adopt the change. Development of The Health Informatics and Theoretical Framework in Nursing Profession Theories in Nursing Informatics 2. Systems Theory: This theory is built upon the following ideas : Change in one part of the system affects the entire system. In system theory the focus is the interaction among the various parts of the system instead of regarding each individual part as standing alone. Input into the system from the environment is processed within the system and becomes output back into the environment. There must be a built -in feedback mechanism. Development of The Health Informatics and Theoretical Framework in Nursing Profession The Need for Health Information Management Impact of fragmentation – Fragmentation of care places patients at greater risk for poor outcomes, especially in regard to: Patients with multiple or chronic conditions Childhood immunizations Inaccurate or incomplete transfer of information related to patients transitions from inpatient to home care Development of The Health Informatics and Theoretical Framework in Nursing Profession The Need for Health Information Management The promises of clinical informatics systems – Improved efficiency – Improving the health care of older adults Challenges in clinical informatics – Lack of system interoperability – Poor usability of health IT – Failure to design health IT for human factors to prevent errors Development of The Health Informatics and Theoretical Framework in Nursing Profession Challenges in clinical informatics Lack of system interoperability True healthcare interoperability involves people, processes, systems, information, communications, and more — all supported by a drive to deliver better healthcare. “A child got a duplicate chemotherapy dose due to fragmented recordkeeping systems.” Poor usability of health IT Inaccessible information led to inappropriate drug administration “Orders to hold a drug dose were inaccessible to nurses” Development of The Health Informatics and Theoretical Framework in Nursing Profession Challenges in clinical informatics Failure to design health IT for human factors to prevent errors The patient had been started on a heparin infusion on one unit and then transferred to an other one. The order set for the heparin infusion was not entered properly, leaving out the automatic order for blood tests every 6 hours. During the handoff report, the nurses forgot to discuss this. Patient had been complaining of a headache for several hours. CT scan showed intracerebral hemorrhage. Development of The Health Informatics and Theoretical Framework in Nursing Profession Health Informatics / Best Practice in 2005 Denmark 85% of health sector integrated within single system 2 million messages a month Central database of all prescriptions and all lab tests New Zealand 75% of health sector integrated 3 million messages a month Veterans Administration $21 billion, covering 25 million servicemen & families Highest score in every category of quality assessment in 2003 Care based on VISTA, enabling Continuous Quality Control Cost per patient static over last decade (all other US providers 50%) Summary Objectives Review the history of the development of clinical informatics in the Nursing Profession. Define and discuss key concepts relating to clinical informatics and information science. Recognize the Theoretical Framework of clinical informatics in healthcare. Discuss the need for Health Information Management. Why is nursing informatics (NI) vital to effective nursing practice in the 21st century? References 1. 1-Susan A, Karen H, and Frith H: Applied Clinical Informatics for nurses, (2019) 2nd ed. 9781284129250 128412925X. 2. 2- Altarum Institute (2017). Health sector economic indicators: Insights from monthly national health spending data through December 2016. Retrieved from http://altarum.org/sites/default/files/uploaded-related-files/CSHS-Spending- Brief_February_2017.pdf 3. 3- International Council of Nurses. (2015). International classification for nursing practice (ICNP) informationsheet. Retrieved from http://www.icn.ch/images/stories /documents/pillars/Practice/icnp/ICNP_FAQs.pdf References 4. Kaminski, J. (2015). Computer science and the foundation of knowledge model. In D. McGonigle & K. G. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (2nd ed., pp. 33–56). Burlington, MA: Jones & Bartlett Learning. 5. 4- Karamali, M., Heidarzadeh, Z., Seifati, S. M., Samimi, M., Tabassi, Z., Hajijafari, M.,... Esmaillzadeh, A. (2015). Zinc supplementation and the effects of metabolic status in gestational diabetes: A randomized, double-blind placebo- controlled trial. Journal of Diabetes Complications, 29(3), 1314–1319 Thank You Lesson 3 Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Health Informatics Course NUR 351 Dr. Sally M.Farghaly 2 ‫شريحة‬ Objectives By the end of this lesson, students will be able to: Determine the key features of a Health Information System(HIS). Recognize the aims of utilizing the hospital information system. Discuss the components of hospital information system. Explain the HIS modules. Discuss the benefits of using the HIS. Determine the obstacles of using HIS. Describe the healthcare worker's responsibilities in relation to patient confidentiality within a HIS. Objectives By the end of this lesson, students will be able to: Determine the patient's right of(implied or explicit) issues such as sensitivity in dealing with patient data in relation to family members and others appreciate patients right-not-to-know issues. Determine that local legalization gives patients the right to review and amend their own records. Recognize the distinction that system access does not imply authorization to view or use. Objectives By the end of this lesson, students will be able to: Determine national requirements in terms of public reporting and management of patient specific data/rules and constraints, public health, notifiable diseases. Determine that there are certain confidentiality risks associated with HIS such as patient specific printed materials, e-mail risks. Determine measures to protect patient confidentiality. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Introduction Ethics – A branch of philosophy concerned with the values of human behavior. Law – An objective rule based on Act. The ethical standards for nurses are defined in the American Nurses Association Code of Ethics for Nurses. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Hospital Information System It is a comprehensive, integrated information system designed to manage all the aspects of a hospital's operation, such as medical, administrative, financial, and legal issues and the corresponding processing of services. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Aims of Hospital Information System Improve Improve Cost Increased data Patient Care Control Security Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Components of Hospital Information System 1. Hardware: computer-based information systems use computer hardware, such as processors, monitors, keyboard, and printers. 2. Software: These are the programs used to organize process and analyze data as excel, power point and access. 3. Data: Information systems work with data, organized into tables and files. Telecommunication technology: Different elements need to be connected to each other, especially if many different people in an organization use the same information system. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Components of Hospital Information System_ 4. Procedures: these describe how specific data are processed and analyzed in order to get the answers for which the information system is designed. 5. People: (individuals, groups, or organizations). Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Modules of HIS Client Registration Payroll amd Human Quality Assurance Scheduling Administrative Systems Resource Systems Systems Systems Information Systems Financial Risk Management Contract Management Systems Systems Systems Health Information System Monitoring Laboratory Pharmacy Clinical Systems Systems Systems Information Systems Nursing Information Order Entry Radoplogy Other Ancillary Systems Systems Systems Systems Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy A) Clinical information systems 1. Nursing information system:- Documentation of nursing admission assessment and discharge instruction. Generation of nursing work list that indicates routine scheduled activities related to the care of each client. Documentation of routine aspect of client care such as bathing, positioning, blood glucose measurement and\or wound care in flow sheet format. Documentation of medication administration. Documentation of nursing care in progress note format. Standardized care plans that the nurse can individualize for clients as needed. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy A) Clinical information systems__ 2. Monitoring System: Are devices that automatically monitor biometric measurements in critical care and specialty areas, such as cardiology, these devices may send information to the nursing Documentation system. 3. Computerized Physician Order Entry (CPOE): Computerized physician order entry systems are automated systems for physicians to enter orders and access decision support. CPOE systems reduce errors, improve efficiency, and protect patients. Order for medication and treatment are entered into computer and directly transmitted to appropriate areas as laboratory, radiology or another area. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy A) Clinical information systems. 4. Laboratory system: Laboratory system may allow provider to enter orders. In addition, microbiology culture and sensitivity testing can provide treatment suggestions for physician. 5. Radiology Information System (RIS): Provide scheduling of diagnostic test, communication of clinical information, generation of client instructions and preparation procedure, transcription of result and impressions and file room management such as tracking of film location. By using Picture Archiving And Communication System (PACS). Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy A) Clinical information systems 6. Pharmacy Information Systems (PIS): Designed to address the demands of a pharmacy department, PIS helps pharmacists monitor how medication is used in hospitals. PIS helps users supervise drug allergies and other medication-related complications. The system allows users to detect drug interactions and also helps administer the proper drugs based on the patient’s physiologic factors. Pharmacy system check patient history and alert physician to any drug interaction, and physician can change order at this time if indicated. 7. Dietary Module: The dietary module in the hospital management system software is designed to assist the hospital kitchen in providing meals to inpatients as per the instructions of the dietician. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy A) Clinical information systems 8. Electronic Medical Record (EMR): The system supports medical professionals of various departments of the hospital with relevant information like medical examinations, diagnoses, treatment histories, test results and so on. The module provides access to critical and complete patient data that leads to high quality cost effective and efficient patient care. 9. Blood bank information system: This module maintaining all information regarding the blood donation. Details about the donors and recipient (blood group and types of investigations). Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy B) Administrative information system Administrative system may be used in health care organization to support the process of providing client care 1. Registration System: The system used to collect and store client identification and demographic data that are varied and updated at time of each visit, for reason these may also be known as admission\discharge\transfer (ADT) System. 2. Financial system: Provide the facility with accounting functions. Accurate tracking data is critical for enabling the organization to receive reimbursement for services. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy B) Administrative information system 3. Payroll and human resource system: Track employee time and attendance, credentials, performance evaluation and payroll compensation information. 4. Risk management system: Track and plan prevention of unusual occurrence or incidents as outbreak of infection, disaster). 5. Quality assurance system: Monitor outcomes and produce reports that are used to guide quality improvement initiative. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy B) Administrative information system 6. Scheduling system: Schedule patient appointments, it must contain information regarding available resources, which include department, equipment, date and time, room, staff, referral land authorization by patient insurance. That system increase patient satisfaction and cost saving to organization. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Benefits of hospital information system Increase patient safety Facilitate clinical research Used for medico legal purpose Improve patient satisfaction Enhances information integrity Reduces transcription errors Reduces duplication of information entries HIS provide internal and external communication among health care providers. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Benefits of hospital information system The system have to keep data in secure place and controls who can reach the data in certain circumstances. The HIS may protect organizations, handwriting error, overstock problems, conflict of scheduling personnel, official documentation errors like tax preparations errors. Continuity of care through the current and status documentation is available on the system for the nursing professionals. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Obstacles of using HIS: Initial cost of acquisition: the high cost of basic infrastructure of clinical information technology can be a stumbling block to many healthcare organizations. Privacy and Security: There are still huge concerns in the healthcare industry about the privacy of patient data on computer systems and how to keep such information secure. Change Resistance Time to learn Problems with faulty systems 1. HIS Confidentiality Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy 1- Describe the healthcare worker's responsibilities in relation to patient confidentiality within a HIS Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Healthcare worker's responsibilities in relation to patient confidentiality : 1. access only to patient information when necessary 2. access only to items that are need-to-know 3. access only to information that patients have the right to know 4. awareness of concept of personal accountability Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Confidentiality is an essential issue in many different aspects of healthcare control. So, healthcare organizations should take measures to protect patient confidentiality anywhere, whether in a hospital, clinic, institution, etc. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Measures to protect patient confidentiality Confirm the patient's identity' before taking any information from them, or exposing any information to them. Access only to patient information when necessary. Access only to items that they need to know. Only persons directly involved in the patient care or public health activities should have access to patient information. Conduct patient interviews and discussions in private rooms or areas. Never discuss the patient's case with anyone without their permission (including family and friends during off- duty hours). Note that they could be held legally responsible for disclosing any patient information without their consent. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Measures to protect patient confidentiality Never use the patients' names in public areas. Never leave hard copies of forms or records where unauthorized persons may access them. Use only secure methods to send patient information (for example, official mail) and always mark that information as confidential. When using an interpreter, ensure that they determine the importance of patient confidentiality. If a staff member or another healthcare worker requests patient information, ensure they have right to do so before disclosing anything to them. Keep records that contain patient names and other identifying information in closed, locked files; and printouts that are no longer needed should be destroyed. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Measures to protect patient confidentiality Restrict access to electronic databases to designated staff. Carefully protect computer passwords; and never give them to unauthorized persons. Keep computers in a locked or restricted area; and physically or electronically lock the hard disk. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy 2- Determine the patient's right of(implied or explicit) issues such as sensitivity in dealing with patient data in relation to family members and others appreciate patients right-not-to-know issues. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Trust is the key to a successfully relationship between the patient and the healthcare worker in which the rights and responsibilities of both the patient and the healthcare worker are respected. Patients have certain rights about their own personal data. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Patients rights about their own personal data. The right to get a copy of their medical records, and the right to keep them private. The right of informed consent. This means that if the patient needs a treatment, the healthcare provider must give them accurate and easy-to-understand information to make a sound decision. The right to ask questions if they do not determine information or instructions. The right to talk privately with the healthcare provider, and have their medical information protected from all other people, including family members and work colleagues. The right to seek an alternate doctor or ask for a second opinion. The right to know the names and roles of those caring for them (such as doctors and nurses). Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy So, the health information cannot be used or shared without the written permission of the patient, unless allows it. For example, without the patient authorization, the healthcare provider cannot: Give the information to the patient's employer. Use, share, or sell the information for marketing or advertising purposes. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy 3- Determine that local legalization gives patients the right to review and amend their own records. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy if patients find that their medical information is not correct or not accurate, the law gives them the right to submit a request for correcting their records. If the request is rejected, the healthcare provider should explain the reason for the rejection (for example, the healthcare provider did not create that record, or the information is accurate with clarifying reasons). Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy 4- Recognize the distinction that system access does not imply authorization to view or use. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy A HIS must comply with the minimum safety requirements regarding access to electronic medical records of the patients, to ensure that the information is only accessed by people who are authorized to view or use them. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy In this sense, it is essential that the computers are equipped with a system of personal authentication (for access to the system), a system of authentication to the health information and the relevant authorizations to control the type of access to the database of patients to the minimum necessary. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy 5- Determine national requirements in terms of public reporting and management of patient specific data/rules and constraints, public health, notifiable diseases. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Many countries have identified the need to set national requirements in healthcare sector in order to provide high quality, reliable, and safe medical care to the population in the most effective, efficient, and accessible way within the resources available. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Public reporting can be broadly defined as the disclosure of information about an organization or individual to the public, in order to: Give patients a chance to choose higher quality providers Motivate healthcare providers to provide better quality care when they realize the information about their performance is publicly available to patients and the media. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Notifiable diseases are diseases considered to be of great public health importance, such as malaria and plague. So, national requirements also demand that these diseases be reported when they are diagnosed by doctors or laboratories. This allows for the collection of statistics that show how often the disease occurs, which helps researchers identify disease trends and track disease outbreaks, to help control future outbreaks. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy 6- Determine that there are certain confidentiality risks associated with HIS such as patient specific printed materials, e-mail risks. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy As with paper records, information from a patient records can be electronically transmitted to an external party by e-mail Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Although the risk of confidentiality breaches and security has always existed with conventional paper-based healthcare system, the automation and speed of electronic communication have increased this risk. As healthcare organizations do their best efforts to protect the confidentiality of the patient medical information, they may overlook some minor points that may increase the risk of violating patient privacy. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy 7- Appreciate some of the national requirements in terms of patient control of data; opt-in, opt out. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Opt in versus opt out Participation in HIS is optional. The patient has the right to opt in (participate) or opt out (not participate) from having their" personal health information available to their healthcare providers. Opt out opting out means that the healthcare providers will not be able to get any information about the medical history of the patient. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Benefits of opt in The health information will be available quickly in case of a medical emergency, even if the patient was unconscious. The laboratory test results (such as blood tests and radiology reports) will get to the doctor faster. The medical records immediately follow the patient when they see a new specialist or change doctors. The healthcare providers can avoid duplicating any treatments already ordered by other providers, saving the patient time and unnecessary expenses. The healthcare providers can more easily coordinate the medical care tor the patient as a team. 2. HIPAA Privacy Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Health Insurance Portability and Accountability Act of 1996 (HIPAA) Established minimum national standards for protecting health information Privacy and security regulations – Privacy rules focused on the rights of the patient – Standards established to protect health information communicated in any manner – Penalties for failure to protect health information – Security requirements became effective in 2005. Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Health Insurance Portability and Accountability Act of 1996 (HIPAA) (cont.) Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Health Insurance Portability and Accountability Act of 1996 (HIPAA) (cont.). Security – HIPAA: Establishes national standards for protection of health information held or transferred electronically Requires covered entities to protect against hazards that might affect the integrity of electronic PHI, protect against inappropriate disclosures of PHI, and ensure compliance by employees Requires administrative, physical, and technical security safeguards Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Health Insurance Portability and Accountability Act of 1996 (HIPAA) (cont.) – Administrative safeguards Conduct a risk analysis Develop a security management process Conduct workforce training and management Conduct periodic evaluations – Technical safeguards Implement controls for access, audits, integrity, and transmission Hospital Information System (HIS) Confidentiality of Information and HIPAA Privacy Use of PHI in Marketing, Fundraising, and Research Authorization must be given before PHI can be used in marketing. HIPAA allows using PHI for research if: – The research is reviewed by an institutional review board (IRB) – Informed consent forms are provided to the research participants Care cannot be contingent on signing an authorization for research purposes. References 1. Susan A, Karen H, and Frith H: Applied Clinical Informatics for nurses, (2019) 2nd ed. 9781284129250 128412925X. 2. Altarum Institute (2017). Health sector economic indicators: Insights from monthly national health spending data through December 2016. Retrieved from http://altarum.org/sites/default/files/uploaded-related-files/CSHS-Spending- Brief_February_2017.pdf 3. International Council of Nurses. (2015). International classification for nursing practice (ICNP) informationsheet. Retrieved from http://www.icn.ch/images/stories /documents/pillars/Practice/icnp/ICNP_FAQs.pdf References 4. Kaminski, J. (2015). Computer science and the foundation of knowledge model. In D. McGonigle & K. G. Mastrian (Eds.), Nursing informatics and the foundation of knowledge (2nd ed., pp. 33–56). Burlington, MA: Jones & Bartlett Learning. 5. Karamali, M., Heidarzadeh, Z., Seifati, S. M., Samimi, M., Tabassi, Z., Hajijafari, M.,... Esmaillzadeh, A. (2015). Zinc supplementation and the effects of metabolic status in gestational diabetes: A randomized, double-blind placebo- controlled trial. Journal of Diabetes Complications, 29(3), 1314–1319 Thank You Lesson 4 Hospital Information System (HIS) Accessibility of Information and Security Provisions Health Informatics Course NUR 351 Dr. Sally M.Farghaly Objectives By the end of this lesson, students will be able to: Determine access control & security when using a HIS. Interpret electronically recorded data, data storage and backup. Hospital Information System (HIS) Accessibility of Information and Security Provisions Access Control Vast amounts of information is stored in the course of treatment process, and controlling access to that information is important in the continuing care for the patients. Access control is an essential part of HIS, and it is about making sure information is accessible only to authorized workers and protecting its confidentiality by checking if the user has the necessary rights to access the resources he requested. Protecting patient privacy is important, but the most important goal is to provide the best possible care for patients, which depends on the healthcare workers having suitable access to information, Hence, access control is a balance between confidentiality and availability based on each healthcare worker's role and his/her duties and responsivities. Hospital Information System (HIS) Accessibility of Information and Security Provisions 1- Determine that access control in a HIS is intended to protect patient data and access to HIS is often based on: healthcare worker roles, duties and responsibilities. Hospital Information System (HIS) Accessibility of Information and Security Provisions Access control is Patient privacy vs confidentiality vs an essential part of best possible care availability HIS for patients Hospital Information System (HIS) Accessibility of Information and Security Provisions access control is a balance between confidentiality and availability based on each healthcare worker's role and his/her duties and responsibilities. Hospital Information System (HIS) Accessibility of Information and Security Provisions Access may be based on or what they are (e.g.; a what the user has (e.g.; a what the user may know biometric scan fingerprints, card or token) (e.g.; a PIN); eye retinas, etc.). Hospital Information System (HIS) Accessibility of Information and Security Provisions Methods used for controlling access to HIS data PIN code A personal identification number (PIN) is a numeric password used to authenticate the user to a system in order to gain access. Hospital Information System (HIS) Accessibility of Information and Security Provisions Methods / techniques used for controlling access to HIS data Biometric Scans Refers to technologies for analyzing human body characteristics such as fingerprints, eye retinas and irises, voice patterns, facial patterns, and hand measurements. Stronger authentication method. Hospital Information System (HIS) Accessibility of Information and Security Provisions A biometric device, such as fingerprint seamier, consists of: 1. A reader or scanning device. 2. Software that converts the scanned information into digital form. and compares match points. 3. A database that stores the biometric data for comparison. Hospital Information System (HIS) Accessibility of Information and Security Provisions Methods / techniques used for controlling access to HIS data Text Text access control consists of a username and a password. The username can be any name the user chooses on their own. and the password can consist of a simple "secret word" containing both letters and numbers. Hospital Information System (HIS) Accessibility of Information and Security Provisions Methods / techniques used for controlling access to HIS data Tokens Small device (such as a key fob) that provides a different number every time. The user enters his PIN code, which authorizes them as the owner of that particular device: then the device displays a number which uniquely identifies the user to the HIS, allowing them to log in. Hospital Information System (HIS) Accessibility of Information and Security Provisions Methods / techniques used for controlling access to HIS data Smart card The smart card is the size and shape of a credit card, and it contains a microchip with the potential for storage and processing of large amounts of data at high security, so you can store a variety of information about patients. The smart card is inserted into a reader who reads the information stored on the microchip. Hospital Information System (HIS) Accessibility of Information and Security Provisions Methods / techniques used for controlling access to HIS data Barcode is the special identification code printed as a set of vertical bars of differing widths and used as an access code for quick log-in to the HIS. The barcode represents binary information that can be read by an optical scanner that uses a laser beam. the coding can include numbers, letters, or a combination of the two. Hospital Information System (HIS) Accessibility of Information and Security Provisions Recognize the need to change passwords regularly. Hospital Information System (HIS) Accessibility of Information and Security Provisions Changing your password regularly is a good idea. You should change your HIS password regularly (normally every few months). Hospital Information System (HIS) Accessibility of Information and Security Provisions Determine why it is important to choose an appropriate password and other mechanisms of authentication Hospital Information System (HIS) Accessibility of Information and Security Provisions Strong password is extremely important to prevent unauthorized access to your accounts and devices. It is advised that you choose a 20+ character pulse as a password. example, any normal sentence. Passwords shorter than 20 characters must be very complex (and therefore hard to remember). Guidelines for choosing a strong password: 1. Must be tit least 8 characters iii length, but not more than 50 characters. 2. Contains both uppercase letters (A-Z) and lowercase letters (a-z). 3. Includes at least one number and or punctuation mark. like: ! @ # $ 4. Do not choose a password made up of personal data information that one could easily discover about you from searching the internet. Hospital Information System (HIS) Accessibility of Information and Security Provisions Determine that passwords / authentication details should not be shared, and that tokens and passwords need to be safeguarded. Hospital Information System (HIS) Accessibility of Information and Security Provisions Never store your password on your computer except in an encrypted form. Never accept Windows offer to save the password. Do not tell anyone your password, not even a close friend or your system administrator. Never send your password via e-mail or other unsecured method. Do not write down your password, but rather a hint that would allow you and nobody else to reconstruct it. Be careful when entering your password and there is someone else near you. If you believe your password has been compromised or that it is no longer a secret, change it immediately. Hospital Information System (HIS) Accessibility of Information and Security Provisions Recognize the need to observe the password policies of an organization Maximum Password Age. Minimum Password Length. Password History. Minimum Consecutive Failures. Lockout Time. Security Hospital Information System (HIS) Accessibility of Information and Security Provisions Describe some of the key principles of security within a HIS Hospital Information System (HIS) Accessibility of Information and Security Provisions key principles of security within a HIS 01 02 Requirement for formal agreement Awareness of system's vulnerability to organizational security policy. Hospital Information System (HIS) Accessibility of Information and Security Provisions the main functions of the security in HIS are to protect three major issue Confidentiality Integrity Availability Hospital Information System (HIS) Accessibility of Information and Security Provisions The main functions of the security in HIS are to protect three major issues: Confidentiality. This means ensuring that information is only being seen or used by people who are authorized to access it. Integrity. This means preventing any unauthorized user from changing the information, and tracking the changes made by authorized users. Availability. This means making sure the information will be available when authorized users need it. Hospital Information System (HIS) Accessibility of Information and Security Provisions Key principles of security within a HIS Awareness of system vulnerabilities, to try and correct them, and deny any unauthorized user from logging into the system. Formal commitment from healthcare users to HIS organization security policies, so they do not jeopardize the privacy and confidentiality of patient medical data. Tracking who accessed the HIS system and what operations he performed during a given period of time, This can help in detecting security violations, performance problems, and improper modifications of data. Hospital Information System (HIS) Accessibility of Information and Security Provisions Determine that an organizational security policy has personal, professional, and organizational impacts. Hospital Information System (HIS) Accessibility of Information and Security Provisions A security policy is a document that specifies how a healthcare organization plans to protect their physical devices and medical records. financial burden to buy and install all the necessary equipment and software. The security policy may include: description of how the healthcare organization plans to educate the employees about protecting the patients' medical data. explanation of how security measurements will be carried out and enforced. procedure for evaluating the effectiveness of the security policy to ensure that necessary corrections will be made. Hospital Information System (HIS) Accessibility of Information and Security Provisions Describe some of the threats to a HIS such as accidental viewing, unauthorized inquiry, malicious damage, uncontrolled access, risk of transfer of data to external media. Hospital Information System (HIS) Accessibility of Information and Security Provisions Security threats Natural disasters, such as earthquakes, floods, …etc. Inside attacks by malicious employees, and outside attacks by hackers or viruses. Equipment failure (computer or printer). Software failure leads to inaccurate results. Accidental viewing from an unauthorized person to some confidential or sensitive patient data. Unauthorized or uncontrolled access to HIS from outside hackers who seek to steal private medical records. Malicious damage to private medical records or HIS equipment. Risk of transferring patient data to external media, such as CDs or USB flash drives. Hospital Information System (HIS) Accessibility of Information and Security Provisions List some of the defenses against security threats to a HIS. Hospital Information System (HIS) Accessibility of Information and Security Provisions Defenses security threats Employ strategies and procedures for protecting all their computer systems from security threats. defenses should be adjusted according to: 1. the type of network. 2. the way data is shared between users. 3. the number of users connected to the network from inside and outside and the existence or not of a connection to the Internet, etc. Proper password and authentication policies. An anti-virus software, should be regularly updated. An anti-spam software, should be regularly updated. Hospital Information System (HIS) Accessibility of Information and Security Provisions Defenses security threats A hardware or software that fulfills the functions of a firewall. Physically locking the server room and all other infrastructure. Periodically backing up the medical data. Limiting the employees rights to access the network and applications to match their business needs. Reviewing activity logs to identify if user accounts and access are being misused and when. Locking the screen in case of prolonged absence. logging off at the end of the operations. Hospital Information System (HIS) Accessibility of Information and Security Provisions Determine the obligation to report security breaches and threats such as user impersonation, malicious attack, viruses, worms, etc. Hospital Information System (HIS) Accessibility of Information and Security Provisions User Impersonation or Identity theft It is the illegal use of someone else's personal identifying information (such as username and password) in order to log into someone's HIS account. Ways to steal an identity Searching your trash for documents that contain your personal information. Shoulder surfing. Social engineering. Hospital Information System (HIS) Accessibility of Information and Security Provisions Malware Malware, or malicious software, is any computer program designed to infiltrate and damage computers without the user's consent, or gathering information about the computer users without permission. Malware includes computer : Viruses. Worms. Trojan horses. key loggers. and also, spyware. Hospital Information System (HIS) Accessibility of Information and Security Provisions Viruses Is a program that spread by attaching itself to a legitimate software, document, or e-mail attachments. They can be transmitted though e-mails or downloaded files, and they can be present on CDs, DVDs, USB- drives, and any other soil of digital media. Worms Is a program that propagates across computers, usually by creating copies of itself in each computer without being activated by the user, to the extent it causes the computer to crash. Hospital Information System (HIS) Accessibility of Information and Security Provisions Trojan Horses Is a destructive program disguised as a game, utility, or application. When run, a Trojan horse does something harmful to the computer system while appearing to do something useful, such as deleting files or formatting the hard disk. Key loggers Is a small program that monitors every keystroke you enter on your keyboard, and its purpose is to steal private information such as usernames and passwords. Hospital Information System (HIS) Accessibility of Information and Security Provisions Spywares Is any program that gathers information about a person or organization without their knowledge, and sends it to advertisers, competitors, or other interested parties. Hospital Information System (HIS) Accessibility of Information and Security Provisions Determine the concept of data storage and backup and why it is important. Hospital Information System (HIS) Accessibility of Information and Security Provisions Data storage simply means saving the HIS data either on the main network used daily by the healthcare workers, or on backup disks, such as an external hard disk, USB flash drive, CD, DVD, etc. The goal of backing up data is to ensure that when a system dies, there will be an available, recent copy you can use to restore the system. You could simply back up the complete system at the end of each day. Hospital Information System (HIS) Accessibility of Information and Security Provisions Back up Methods Full Backup. Incremental Backup. Differential Backup. Hospital Information System (HIS) Accessibility of Information and Security Provisions Full Backup Complete, comprehensive. system should not be in use. Once a full backup is made, you have a complete archive of the system. full backup can be a time-consuming process on a large system. Hospital Information System (HIS) Accessibility of Information and Security Provisions Incremental Backup Partial backup that stores only the information that has been changed since the last full or the last incremental backup. smaller than a full backup. the fastest backups to preform on most systems. Restoring data using incremental backups takes longer. Differential Backup Similar in function to an incremental backup. nearly as large as a full backup. Restoring data using differential backups can be faster than the incremental. References 1. Susan A, Karen H, and Frith H: Applied Clinical Informatics for nurses, (2019) 2nd ed. 9781284129250 128412925X. 2. Altarum Institute (2017). Health sector economic indicators: Insights from monthly national health spending data through December 2016. Retrieved from http://altarum.org/sites/default/files/uploaded-related-files/CSHS-Spending- Brief_February_2017.pdf 3. International Council of Nurses. (2015). International classification for nursing practice (ICNP) informationsheet. Retrieved from http://www.icn.ch/images/stories /documents/pillars/Practice/icnp/ICNP_FAQs.pdf References 4. Mary Jo Bowie, Essentials of Health Information Management: Principles and Practices, (2021) 4th Edition. ISBN-13: 978-1337553674/ ISBN-10: 1337553670 5. Dana C. McWay, Legal and Ethical Aspects of Health Information Management, 5th Edition, (2020), ISBN-10 : 0357361547/ ISBN-13 : 978-0357361542 (newer version added) 6. Susan M. Houston, Tina Dieckhaus, Bob Kirchner, and Renee Rook wood; An Introduction to Nursing Informatics Evolution and Innovation, (2015) ISBN: 978-1-4987-5751-5 Thank You Lesson 5 Electronic Health Record Health Informatics Course NUR 351 Dr. Sally M.Farghaly Objectives By the end of this lesson, students will be able to: Define the electronic health record. Determine Types of electronic medical records. List the elements of HIS. Describe the key qualities of a HIS. Enumerate the functions or tools of HIS. Discuss the potential constraints / challenges of using a HIS/ electronic health records. Determine the benefits and Limitations of HIS. Describe the security methods to safeguard the personal medical information. Electronic Health Record Definition of the Electronic Health Record An electronic health record (EHR) is a digital version of a patient’s paper chart. EHRs are real-time, patient-centered records that make information available rapidly and securely to authorized users. EHR contains the personal, medical and treatment histories of patients. EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.” Electronic Health Record Understand that a HIS may be made up of personal, patient, or population records Electronic Health Record Types of electronic medical records(EMR) or electronic health record(EHR) Electronic Medical Records(EMR) Patient records Personal records Population records Electronic Health Record 1) Personal record Each personal record contains information such as: Patient ID (a unique key for each patient) Title (Mr., Mrs., etc.) Height Full Name (first and last name) Weight Date of birth Home and work address Marital status E-mail address Gender Phone number (mobile, home, work, etc.) Electronic Health Record Electronic Health Record 2) Patient record Each patient record contains information such as: Patient ID (a unique key for each patient). Care providers for each medical case (physicians, hospitals, pharmacists, physical therapists, nurses, etc.) Medical condition in each case, such as asthma, heart disease, cancer, broken bones, etc. Treatment provided for each case, such as surgery. Assessment and risk management for the individual case. Electronic Health Record 2) Patient record Each patient record contains information such as: Notes specific to each case made by the hospital, doctor, or nurse, etc. Any specific allergies or chronic diseases the patient suffers from. Imaging reports and laboratory test results. Surgeries and other procedures. Vaccinations. Emergency contacts. Electronic Health Record Electronic Health Record 3) Population record A population record is defined as a repository of statistics, measures, and indicators regarding the state of and influences on the health of a defined population, which is all the inhabitants of a given country, city region, or local area considered together. The primary purpose of the population record is the support of continuing, efficient, and effective public health practice, in order to control: The level and distribution of infectious diseases Number of births and deaths Functional status Wellbeing of a population Electronic Health Record 3) Population record It contains information that is historical, current, and predictive of future trends. Electronic Health Record Electronic Health Records(EHR) The purpose of the integration of the electronic health records contained in the HIS database is to: Produce meaningful information for the healthcare professionals. Organizations about the medical history of each patient (diseases, prescriptions, X-rays, images, etc.), in order to make confident diagnoses and to facilitate the management of the health plan of each patient. Electronic Health Record So the HIS database records helps in producing a model of analysis of the information that allows healthcare workers to identify changes, solutions, and actions so as to reach decisions as safer and reasoned as possible on the basis of the data collected. Examples of HIS database records History of health problems of the patient (illnesses, diseases, etc.) Forms of nursing care and therapy the patient has undergone. List of diagnostic tests (blood tests, MRIs, X-rays, etc.) Allergies. Billing invoices. Electronic Health Record This information also allows the healthcare organization to obtain some statistics about the number of particular surgeries they have performed, for example, or to get an idea about the costs, and some rough forecast of the trend of their business in the future. Electronic Health Record The relationship between population records and personal health records Electronic Health Record The data from the patient records can be aggregated to give some statistics of various diseases, diagnoses, and treatments. This aggregation can be done automatically by a computer counting the incidents of interest over a given time period - this might provide early evidence of emerging (or re-emerging) diseases. Given condition, 1990-2000, Number of cases, females/ males, area of residence 2020 reappeared Preventive planning, Early detection, evaluation of implemented plans. Electronic Health Record Some crucial statistics derived from the aggregation of patient data are: Which regions or areas need more medical attention, so that proper human resources and materials get allocated. For example, some regions might need more healthcare for asthma, while others might need more healthcare for skin cancer. The number of illness cases, injury, pregnancy, or death to get an important feedback on the effectiveness of the health programs which in turn can be shared with national and international donors. Electronic Health Record Electronic Health Record Benefits of healthcare delivery through EMR in the HIS such as more reliable, timely information leading to better patient care. Electronic Health Record The benefits include: Increase in immunization rates. Improved data collection. Increased health staff productivity. Increased patient satisfaction with medical services. improved communication between the patient and the healthcare organization. Reduced medical errors. The limitations include: Time-consuming data entry. Decreased quality of patient-doctor interaction Slow access of data connection. 23 ‫شريحة‬ Electronic Health Record Electronic Health Record Electronic Health Record Determine that HIS are made up of different parts Electronic Health Record HIS refers to any system that captures, stores ,manages, or transmits information related to the health of individuals or the activities of organizations that work within the health sector, in order to influence policy and decision-making, individual and public health outcomes, and research. HIS can be used by several parties each of which is given different type of access depending on their need Doctors Nurses Pharmacy workers Physical therapists Health consultants Private and public laboratories Radiologists Electronic Health Record The elements of HIS 1. Electronic health records o Patient records o Personal records o Population records 2. Ordering medicines, lab tests, etc. 3. Prescribing and laboratory systems. 4. Electronic prescription of medicines or treatments, and electronically storing laboratory test results. Electronic Health Record Picture Archiving & Communication Systems (PACS) Which is a medical imaging technology that provides convenient electronic storage and access to images from multiple sources, such as ultrasound, magnetic resonance imaging (MRI), positron emission tomography (PET), computed tomography (CT), endoscopy (ES), mammogram (MG), digital radiography (DR), computed radiography (CR), ophthalmology, etc. 29 ‫شريحة‬ Electronic Health Record Picture Archiving & Communication Systems (PACS) Electronic Health Record Multimedia and billing Producing electronic medical invoices Electronic Health Record Describe some of the key qualities of a HIS Electronic Health Record The key qualities of a HIS Easy access to the medical information of the patient from any location in the world. The medical information is accurate and reliable. Rapid access to the medical information of the patient, without the hustle of paging through hundreds of papers, or the risk of losing some important test results. Rapid access, minimum time, full details Easy sharing of the medical information with other healthcare workers, when a more professional advice or a second opinion is needed. Easy updating of the medical information. Preventing medical errors and increasing healthcare accuracy and procedural correctness. Reducing healthcare costs. Improving healthcare quality or effectiveness. Electronic Health Record The key qualities of a HIS Decreasing paperwork and unproductive work time. Early detection of infectious disease outbreaks around the country. Secure access to private medical records, in order to prevent unauthorized people from viewing the history of the patient. Low-cost technologies for clinical video case. Use of technologies such as touch-screen tablets to improve the efficiency and timeliness of the system. Electronic Health Record Identify or know about some of the functions or tools of HIS Electronic Health Record Functions or tools of HIS 1 2 3 Booking Transmission of Scheduling appointments outputs/results 4 5 6 Updating of Giving Home healthcare patient records prescriptions via the Internet Electronic Health Record The key Functions of a HIS 1. Booking appointments Appointments are booked electronically online, which allows better management of the busy schedule healthcare organizations. 2. Electronic transfer of laboratory test results This ensures a secure transfer of the test results to the doctor who ordered them and also to other interested parties. This faster and more reliable availability of test results reduces the duplication of tests and avoid unnecessary tests. Electronic Health Record The key Functions of a HIS 3. Updating of patient records Web-based entry and updating of health information. This eliminates duplicate entry of data and provides much more timely availability of meaningful statistical reports. 4. Electronic prescriptions of medicines Prescriptions entered electronically and sent to the pharmacy system and possibly the drug administration tracking system. This provides immediate electronic advice to prescriber on alternatives and potential interactions and side effects. 5. Home healthcare via the internet Mobile phones can be used to quickly notify the public of occurrence of some diseases. Electronic Health Record Potential constraints of using a HIS Electronic Health Record Potential constraints / Challenges of using a HIS/ electronic health records A change in the healthcare professional/patient relationship. Loss of subtlety in language and data entry. loss of context of the data capture. Data capture forms often use boxes or a set amount of spaces and occasionally provide examples too. This is to make sure each field is completed correctly. Ease of use of the patient record. Concerns about the privacy and confidentiality of patient medical data. High initial and maintenance cost of HIS. Electronic Health Record Acknowledge that a HIS supports but does not replace clinical judgment. Electronic Health Record Clinical judgment is : The process by which the healthcare provider (doctor, for example) uses his/her skills provided by long experience of similar cases to make a correct interpretation of the medical data collected about the patient in order to reach an accurate medical diagnosis of his case, and to identify the appropriate medical actions to help cure them. Electronic Health Record Since the HIS data just describes the medical history of the patient and the previous treatments he/she had, it cannot by itself prescribe the proper treatment for his current case, and the healthcare provider should only use the HIS data as a supporting source of information when he decides on the proper way to treat the patient. Electronic Health Record Different kinds of HIS Internationally Nationally Regionally Local Facility Office / Department Electronic Health Record Office/Department based HIS When a doctor or other private health provider installs a HIS in his office to monitor the health state of his patients, the HIS is office/department-based. Local Facility based HIS When a group of doctors or other private health providers operating together in a private clinic install a HIS in the clinic to monitor the health state of their patients using a central computer server, the HIS is local facility-based. Electronic Health Record Regionally based HIS When all healthcare providers (hospitals, doctors, clinics, etc.) in a city (or town) are connected together in a central HIS to use the same health database of patients under the control of the health department, the HIS is regionally-based. Nationally based HIS When all healthcare providers (hospitals, doctors, clinics, etc.) in a country are connected together in a central HIS to use the same health database of patients under the control of the government health department, the HIS is nationally-based. Electronic Health Record Internationally based When all healthcare providers (hospitals, doctors, clinics, etc.) in all participating countries are connected together in a central HIS to use the same global health database of patients under the control of an international health agency, the HIS is internationally-based. Electronic Health Record Information security and privacy in the healthcare sector is an issue of great importance. Threat to patients' privacy could be categorized into 2 broad areas Organizational threats Systemic threats Electronic Health Record Organizational threats That arise from inappropriate access of patient data by either internal staff abusing their privileges, or external persons exploiting security vulnerabilities in the information network. Systemic threats That arise from a person in the information flow chain exploiting the disclosed data beyond its intended use. For example an employer having access to employees' medical records may deny promotion, or worse, terminate employment. Electronic Health Record Security methods to safeguard the personal medical information of patients from any misuse Security methods Administrative safeg

Lesson 01 - Introduction of Health Informatics and Its Importance PDF

Document Details

Tags

Related

Summary

Full Transcript

Upgrade to continue