Chapter 1 Clinical Informatics Flashcards
Flexner Report
-Released in 1910
-Chastised American medical education for having lax admission and graduation criteria and for not adhering to established principles of science
-Had tremendous impact on medical education
-Small medical schools closed, clinical teaching in hospitals now under control of medical schools, requirements for medical licensure became stricter
International Classification of Causes of Sickness and Death
-1910
-Published in US
-Became shortened to International Classification of Disease
MUMPS
-Massachusetts General Hospital Utility Multi-Programming System
-AKA M
-1970
-Specialized health care programming language that was dominant platform for hospitalized-based application development
-Hospital Information System (HIS) was huge application run on 1 mainframe computer with many terminals for time-shared access
CPT
-Current Procedural Technology
-First released by American Medical Association (AMA)
-1966
Personal Computers
-Came into market in 1980s
HITECH Act
-Health Information Technology for Economic and Clinical Health Act
-2009
-Part of American Recovery and Reinvestment Act
-Established “meaningful use” of electronic health records
-Listed total of 25 capabilities EHRs were expected to have
-Offered cash awards for implementing certified EHR technology (certified by Office of the National Coordinator ONC)
-Managed by the Center for Medicare and Medicaid Services (CMS)
-First stage 2011-2012: data capture and sharing, divided into core requirements and menu options (e.g., Computerized Provider Order Entry, medication lists, drug-drug or drug-allergy checks, clinical decision support, provide patient copies of medical record and discharge instructions)
-Second stage 2012-2014: improve clinical processes (upgraded thresholds from Stage 1, track medication orders like bedside barcode scanning, electronic transmission of medical record in Consolidated Clinical Document Architecture, eRx, and recording progress notes)
-Third stage 2016: improve outcomes, will be replaced by Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act (known as MACRA) with 8 requirements
=PHI (risk analysis to identify vulnerabilities that lead to breaches of PHI), eRX, CDS, CPEO, Patient Portal, Patient Engagement, HIE, Public Health
Clinical informatics (definition)
-application of informatics to delivery of health care services
Clinical research informatics (definition)
-management of information related to clinical trials or secondary research use of clinical data
Consumer health informatics (definition)
-analyzes information from perspective of health care consumes (health literacy, patient education, access to personal records)
Public health informatics (definition)
-health of communities (surveillance, prevention, preparedness, health promotion)
Translational bioinformatics
-translation of large amounts of data into smaller chunks
American Health Information Management Association (AHIMA)
-Primary goal is to provide the knowledge, resources and tools to advance health information professional practice and standards for the delivery of quality healthcare
Healthcare Information and Management System Society (HIMSS)
-Global, cause-based, not-for-profit organization focused on better health through information technology
American Medical Informatics Association (AMIA)
-Represents healthcare providers
-Was driving force in creating the ACGME certified fellowships and board exams in Clinical Informatics
American Nursing Informatics Association (ANIA)
-Represents nurses
Health Level Seven International (HL7)
-Not-for-profit, American National Standards Institute (ANSI)-accredited standards developing organization
-Dedicated to providing a comprehensive framework and related standards for teh exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery, and evaluation of health services
DIWK framework
Data-Knowledge-Information-Wisdom framework
-Data: single measurement in time
-Information: series of data points, data with context, answers who what when and where questions
-Knowledge: analysis of information, answers why or how
-Wisdom: appropriate use of knowledge to manage and solve human problems, implies ethical considerations
Technology Informatics Guiding Education Reform (TIGER) Summit
-Competencies in informatics
-Computer competency: how to use computer technology to accomplish task
-Information literacy: recognize hat information is needed and how to obtain it
-Informatics management: process of collecting, process, presenting/communicating data
Nursing Informatics Pyramid
-After Schwirian model
-Raw data -> Technology -> Users -> Goal
Primum non nocere
-Latin phrase means “first, do no harm”
-In clinical informatics: the cardinal sin is inappropriate disclosure of personal information
Privacy
Right of an individual to control disclosure of his personal information
Confidentiality
Responsibility to protect information
Security
set of policies and procedures which safeguard the integrity of information systems
Broad categories of inappropriate disclosures
(in decreasing order of occurrence): Insider accidental disclosure, insider curiosity, insider criminality, outsider criminality
Non-malfeasance
Do no harm
Autonomy
patient’s right to make his own decisions
Beneficence
Provider should only act in best interest of the patient
Justice/equality
fair distribution of limited resources
Dignity
Patients have a right to be treated respectfully
Honesty
Providers must be completely truthful with their patients at all times
Integrity
Person should fulfill their obligations to the best of their ability
Integrity
Person should fulfill their obligations to the best of their ability
Patient Protection and Affordable Care Act
-PPACA, also known as Obamacare
-2010
-Intent to decrease number of Americans without health insurance
-By creating state-wide insurance exchanges, and increase eligibility for Medicaid
-Encouraged formations of Accountable Care Organizations (ACOs) which would be reimbursed based on achieving certain benchmarks in patient care
Patient Protection and Affordable Care Act
-PPACA, also known as Obamacare
-2010
-Intent to decrease number of Americans without health insurance
-By creating state-wide insurance exchanges, and increase eligibility for Medicaid
-Encouraged formations of Accountable Care Organizations (ACOs) which would be reimbursed based on achieving certain benchmarks in patient care
Merit-Based Incentive Payment System (MIPS)
-new payment mechanism that started in 2019
-Reimbursement is defined by grades for providers based on quality, resource use, clinical practice improvement, and meaningful use
Health Insurance Portability and Accountability Act (HIPAA)
-1996
-Provides data privacy and security provisions for safeguarding medical information
