5. Medical Informatics Flashcards
study of the acquisition, storage, retrieval, and use of health care information and resources for the purposes of optimizing patient care
Health Informatics
Health Informatics began in _____ as the amount of data for each patient got more difficult to track
1950s
In the ____, health informatics a field of study that included subject areas such as the study of DNA and biological data.
1970s
are the base of the hierarchy and represent observations or symbols of differences in nature
Data
DIKW
Data, Information, Knowledge, and Wisdom
each step up the pyramid answers questions about and adds value to the initial data and add values to it
DIKW
is a collection of facts in a raw or unorganized form such as numbers or characters
Data
base building block
Raw Data
this is data that has been “cleaned” of errors and further processed in a way that makes it easier to measure, visualize and analyze for a specific purpose
Information
assigns meaning to data
Information
second building block
Derived Information
combining different sets of data
aggregation
ensuring that the collected data is relevant and accurate
validation
information that can be justified as being correct or true
Knowledge
connected to other pieces help us understand how to apply information to achieve our goal
Knowledge
the use of knowledge (critical thinking) to make sound, intelligent decisions
Wisdom
third building block
Relevant Knowledge
The DIKW is followed by _____ so that wisdom can be gained through the computation of data, information, and knowledge
computer software
is knowledge applied in action
Wisdom
top of the heirarchy
Guiding Wisdom
study of the collection and distribution of information through computers
Information Technology
GAO
Government Accounting Office
According to GAO, there are 4 levels of data in medicine
1: nonelectric data such as paper forms and handwritten notes
2: unstructured, viewable electronic data (paper forms that have been scanned into computer)
3: structured, viewable electronic data electronically entered that cannot be computed by other computers
4: computable electronic data that can be computed by other computers
Health care relies on level __ data
4
level of data in which all health information on any patient must be available to caregivers who rely on basic demographics such as name, race, age, and gender, and health information such as allergies, existing conditions, and history to determine diagnoses, medication needs, treatment, etc.
4
HIPAA
Health Insurance Portability and Accountability Act of 1996
a legislation providing data privacy and security for medical information
HIPAA (Health Insurance Portability and Accountability Act of 1996)
ensures individuals are able to maintain health insurance between jobs
HIPAA (Health Insurance Portability and Accountability Act of 1996)
is adherence to the physical, administrative, and technical safeguards outlined in HIPAA, which covered entities and business associates must uphold to protect the integrity of protected health information (PHI)
HIPAA Compliance
PHI
Protected Health Information
Info protected by HIPAA includes
- Names
- Birth, death or treatment dates
- Contact information
- Social security numbers
- medical record numbers
- photographs
- finger and voice prints
- any other unique identifiers
Common HIPAA violations
- posting PHI on social media
- equipment theft that stores PHI
- cyberattacks/breaches
- office break-ins
- wrongly sending PHI
- discussion PHI in public
HITECH
Health Information Technology for Economic and Clinical Health Act
HITECH was signed into law on ____, as a part of American Recovery and Reinvestment (ARRA) Act of 2009
Feb. 17, 2009
the purpose of this act was to promote the adoption and meaningful use (MU) of health information technology (IT)
HITECH
ARRA
American Recovery and Reinvestment Act of 2009
addresses privacy and security concerns associated with the electronic transmission of health information, partially through provisions that strengthen civil and criminal enforcement of HIPAA rules
Health Information Technology for Economic and Clinical Health Act
created primarily to push the adoption of the Electronic Health Record (EHR) and supporting technology
Health Information Technology for Economic and Clinical Health Act
The HITECH Act contains four subtitles:
A: Promotion of Health Information Technology
B: Testing of Health Information Technology
C: Grants and Loans Funding
D: Privacy
2 Parts of Promotion of Health Information Technology
Part 1: Improving Health Quality, Safety and Efficiency
Part 2: Application and Use of Adopted Health Information Technology Standards; Reports
2 Parts of Privacy
Part 1: Improved Privacy Provisions and Security Provisions
Part 2: Relationship to other laws; regulatory references; effective date; reports
MU
Meaningful Use
Medicare/ Medicaid program that rewards the use of certified EHRs to improve patient care
Meaningful Use (MU)
providers who follow the guidelines receive increases Medicare/Medicaid reimbursements, increasing profit
Meaningful Use (MU)
the guidelines include specific objectives that must be met, if not, the provider will be fined
Meaningful Use (MU)
Meaningful Use is implemented in a phased approach over a series of 3 stages
Stage 1: Promotes basic EHR adoption and data gathering
Stage 2: Emphasizes care coordination and exchange of patient information
Stage 3: Improves healthcare outcomes
Meaningful Use (MU) now called
Promoting Interoperability
Benefits of Health Informatics
- Information is stored in such a way that it can be almost indestructible and can be retrieved over and over again without information loss
- This also allows a number of key people to access information from anywhere, anytime, so that vital information is available when needed
- It allows patients some access to their health record wih the ability to contact to physician offices online for prescriptions, appointments, lab results, etc.
- Patient data can also be shared with disease registries such as the Centers for Disease Control and Preventions (CDC), public health reporting, or from a general practitioner physician to a specialist
- Informatics has led to portable sharing of information, which in turn has reduced the possibility of redundant lab and x-ray testing and has increased consistency in treatment
CDC
Centers for Disease Control and Preventions
Barriers of Health Informatics
- Physicians and other clinicians complain there is inadequate time to read, research, or learn new technologist and must rely on IT experts.
- There may be plenty of data but not enough information available to health professionals
- Lack of health informatics experts to train and teach those who could best use data to provide more, deeper information
- Cost of technology, because many software program developers and vendors sell basic programs requiring expensive upgrades for add-on programming
- Lack of data sharing standards across the nation
- Changes in workflow, transition from traditional to digital imaging
HIPAA of 1996 was updated in _____, undergoes smaller changes every year to better address access and privacy violations
2013
HIPAA Privacy Rule and Security Rule in ____
2003
HIPAA Enforcement Rule in ____
2006
Incorporation of HITECH Act requirements in ___
2009
HIPAA Omnibus Final Rule in ____
2013
more interested in information knowledge where the focus is on manipulating digitized data
Informatics Professionals
deal mostly with data and focus on technology associated with the handling of data such as hardware, software, data
IT Professionals
its problems are those involving meaningful data (information) and the relationships between data (mortality and a certain drug)
Informatics
its problem are those concerning isolated data (a drug search string)
IT or computer science
Both areas of expertise involve retrieval of information, but both focus on different problems
Informatics, IT or computer science
EHR
Electronic Health Record
should result in something that represent reality
Data Conversion
the outcome from data conversion is designed in a _______ where only relevant information is represented
Conceptual Model
the relevant information is used to make comparisons
Computational Model
might contain data such as temperature, blood pressure, pulse, and weight
Conceptual Model
would look at the relationships between those data and how the computer manipulates the data
Computational Model
how the number can be given meaning
Vocabulary
ICD-10-CM
International Classification of Diseases Tenth Clinical Modification code
to describe the transmission of information and it must be consistent
Interoperability
CDWs
Clinical Data Warehouses
emerges as storage solutions for data mined from EHRs
Clinical Data Warehouses (CDWs)
EHR also known as
Computerized Medical Record (CMR), Electronic Clinical Information System (ECIS), Computerized Patient Record (CPR)
CMR
Computerized Medical Record
ECIS
Electronic Clinical Information System
CPR
Computerized Patient Record
is a compilation of health-related information concerning one individual “that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization” (National Alliance for Health Information Technology, 2008)
EHR (Electronic Health Record)
removes some limitations of handwritten record such as readability, efficiency, productivity quality of care, and patient safety
EHR (Electronic Health Record)
EHR ELIMINATES THE ISSUE OF:
- Interpreting multiple handwriting styles
- Offers immediate availability of entered information
- Easy navigation through the patient’s record
- Needs no staff to pull the record
- Reduces duplication of orders
- Can provide reminders for tests or preventive services
Major Components of an EHR
- Clinical Decision Support System (CDSS)
- Patient list and registries
- Electronic calculations
software designed to help clinicians make decisions by drawing from a large database to generate patient assessments
Clinical Decision Support System (CDSS)
Example: Shortness of Breath (SOB) with wheezing
Clinical Decision Support System (CDSS)
CDSS databases provide extensive information:
- Patient Tracking
- Medications
- Patient Order Protocols
- Reminders
- Differential Diagnoses
- Radiology Exam
- Laboratory tests
- Public Health Alerts
tracking patient information can be particularly important for patients who have progressively diseases such as heart disease, cancer and diabetes
Patient list and registries
tracking vital signs electronically gives more accurate, consistent, comparative information
Patient list and registries
calculation of potential risks, such as cardiovascular disease using defined parameters such as cholesterol, blood pressure, diabetes, smoking and hypertension, is much faster using predefines calculator integrated into the EHR
Electronic calculations
are also available for determining creatinine clearance for kidney function before administering contrast media or medications harmful to compromised kidneys
Calculators (Electronic calculations)
ERA
Elder Risk Assessment
HCC
Hierarchical Condition Category
Patient risk can determined by entering:
diagnosis, patient age and associated risks
Patient risk can determined by entering:
- diagnosis, patient age and associated risks.
Then choosing a large database such as:
- Elder Risk Assessment (ERA)
2. Hierarchical Condition Category (HCC)
it is critical that patient information is entered accurately every time
Electronic calculations
Risk Stratification Methods
- Adjusted Clinical Groups (ACG)
- Charlson Comorbidity Measure
- Chronic Comorbidity Count (CCC)
- Elder Risk Assessment (ERA)
- Heirarchical Condition Categories (HCC)
- Minnesota Tiering (MN)
Disadvantage of an EHR is
the reduction of one-on-one interactions
Often the caregiver does not look at the patient because much more time is spent looking at an input device
Disadvantage of EHR
is a field of study encompassing the gathering, analysis and distribution of data, information and knowledge electronically
Informatics
In medicine, this may encompass patient registration and admission, billing, discharge and the EHR
Informatics
contains information compiled from multiple clinical entry areas (radiology, laboratory, respiratory care, physical therapy, etc.)
EHR
are available to determine patient risk for disease and medication compatibility and patient registries are streamlining disease statistics and transplant protocols
Software calculators
Legislation such as ____, ____ and ____ and programs such as ___ govern the appropriate application of electronic information in medicine.
HIPAA,
ARRA,
HITECH,
MU
developed at Johns Hopkins University, It uses both inpatient and outpatient diagnoses, commonly used to predict hospital utilization
Adjusted Clinical Groups (ACG)
predicts the risk of one-year mortality for patient with arrange of comorbid illnesses
Charlson Comorbidity Measure
selected comorbid conditions grouped into six categories
Chronic Comorbidity Count (CCC)
for adults over 60, it uses age, gender, marital status, number of hospital days over the prior two years and selected comorbid medical illness
Elder Risk Assessment (ERA)
contains 70 condition categories selected from ICD codes and includes expected health expenditures
Hierarchical Condition Categories
based on major extended diagnostic groups (MEDCs); groups patients into one of five tiers: Tier 0 (Low: 0 conditions), Tier 1 (Basic: 1 to 3), Tier 2 (Intermediate: 4 to 6), Tier 3 (Extended; 7 to 9), and Tier 4 (Complex: 10+ conditions)
Minnesota Tiering (MN)
