Part I Flashcards
Introduction
What is the definition of biomedical informatics?
The interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for sci. inquiry, problem solving, decision making, motivated by efforts to improve human health
Describe the spectrum of informatics?
BMI - biomedical informatics Bioinformatics Translational informatics - TBI, clinical research informatics (CRI) Health informatics
What is Hersh’s definition of BMI?
- Biomedical and health informatics (BMHI) is the field concerned with the optimal use of information, often aided by technology, to improve individual health, healthcare, public health, and biomedical research
- Informatics applied in a more focused domain is {X} informatics, e.g., nursing, dental, pathology, primary care, etc.
- Can be classified by “level” of domain but also has some overarching areas, e.g., imaging and research
What is the “fundamental theorem?”
a human brain + computer > human brain
What informatics is / isn’t?
- Is: cross-training where basic informational science meets biomed. application domain; tower of achevement: model formulate, system dev, system implement, study of effects
- Isn’t: tinkering with computers, work with large datasets, circumscribed roles, profession of health info manage, anything with a computer
History of informatics
- Informatics - Dreyfus 1962
- “Medical informatics” - 1974 (Collen)
- France - informatique > Russia > rest of europe
What are early EHRs?
- COSTAR,
- HELP,
- TMR,
- Regenstrief,
- El Camino,
- VistA,
- MYCIN,
- Internist-1,
- ELHILL,
- Problem-knowledge coupler
Who are the administrative leaders and exec positions in IT and informatics?
- CIO - chief info officer
- CCIO - chief clin. informatics officer
- CMIO - chief med. info officer
- CHIO - chief health info officer
- CXO - other
- HIM - health information officer
What is the Chief Medical Informatics Officer?
Serves as
- (1) liaison between clinicians and IT
- (2) executive informatician
- (3) director of clinical IT systems;
- leadership, communication, concensus building most important
What did the AMDIS CMIO Survey find?
95 respondents - priorities are:
- EHR optimization,
- data analytics,
- population health
- Challenges -
- competing priorities,
- org. culture,
- clinician disconnect,
- shortage of resources and talent;
- 68% still practice,
report to CMO, CIO, CEO, COO
Describe informatics organizations
HIMSS - Healthcare information and Management Systems Society
AMDIS - Assn Med. Directors of Information Systems
AHIMA - American Health Information Management Association
ANI - Alliance for Nursing Informatics
PHII - Public Health Informatics Institute
Society for Imaging Informatics in Medicine - SIIM
ISCD - Int. society for comp bio.
What is Homer Warner’s Summarization of informatics?
10% med
10% tech
80% sociology
What are some Informatics Challenges
Evidence-based informatics:
- Appropriate outcome measures may be indirect from system intervention
- Unit of analysis - beyond person, include clinic, hospital unit, etc.
List international ethical codes relevant to informatics
- Article 12 - Univ. Declaration Human Rights
- Hippocratic Oath
- European Convention on Human Rights
What are the US ethical codes?
- Code of Fair information practice
- Belmont report
- common rule
- AMIA Conflict of interest
What is the ethically relevant part of the Universal Declaration of Human Rights?
Article 12 - “No one shall be subjected to arbitrary interference with his privacy, family, home or correspondence, nor to attacks upon his honour and reputation. Everyone has the right to the protection of the law against such interference or attacks.” - mentions PRIVACY
How is the Hippocratic oath ethically relevant?
Privacy - “Whatever I see or hear in the lives of my patients, whether in connection with my professional practice or not, which ought not to be spoken of outside, I will keep secret, as considering all such things to be private.”
What is the Code of Fair Information Practice?
- No personal data record-keeping system whose existence is secret
- Must be a way for person to find out what info about the person is in record and how it’s used
- Must be a way to prevent info about person from being used without consent
- Must be a way to amend or correct a record
- Organization - must assure reliability of data for intended use and take precautions to prevent misuse
Describe the Belmont Report
Belmont Report on ethical principles and guidelines for protection of Human Subjects of Research
- Respect for persons
- Beneficence (1) no harm (2) max benefits, minimize harms
Common Rule
1991 - outlines basic provisions of
- IRBs
- informed consent
- assurances of compliance
Describe the AMIA Conflict of Interest Policy
- REAL or APPARENT divided loyalty
- There is no monetary threshold for a COI
What does the US Bill of Rights say about privacy?
Fourth amendment - protection from unreasonable search, seizure
Describe the American Recovery and Reinvestment Act
Title XIII - health information technology
Title IV - medicare and medicaid health information technology
What is the model and context for security?
- Threat assessment
- Asset list
- Policy
- Education
- Technical measures
What are privacy protections with EMRs?
Most US hospitals use policy and audits against access to records
How do computing systems ensure legal compliance?
- Authenticate / authorize
- Non-repudiation
- Billing based on codes, based on
- Med Record docs
- Audit trails,
- doc. version hx
- Compliance and general counsel
Considerations for macros / templates / cut and paste
Should avoid this, since you’re billing and guiding patient care, can cause errors
HIPAA Security Rule
Defines confidentiality, integrity and availability
The HIPAA Security Rule requires physicians to protect patients’ electronically stored, protected health information (known as “ePHI”) by using appropriate administrative, physical and technical safeguards to ensure the confidentiality, integrity and security of this information.
TJC JCAHO IM Standards
Patient-Specific information –
- 1 The hospital has a complete and accurate medical record for every individual assessed, cared for, treated or served. –
- 2 Records contain patient-specific information, as appropriate, to the care, treatment, and services provided. –
- 3 The medical record thoroughly documents operative or other high risk procedures and the use of moderate or deep sedation or anesthesia.
TJC IM Standards
Information Management Planning
1.1 The hospital plans and designs information management processes to meet internal and external information needs.
• Confidentiality and Security
- 1 Information privacy and confidentiality are maintained.
- 2 Information security, including data integrity, is maintained.
- 3 The hospital has a process for maintaining continuity of information.
What is the role of a Medical Records Committee?
Oversight to meet goals of info management
Oversight for implementation of regs
Oversight for meeting accreditation standards
Policy / Procedure review
Understanding of record and systems functionality and impact on flow
Advisory / direction in area of system fn / work flow, appropriate entries, chart completion, forms management, audits and quality
What is involved in HIM?
Hospital Bylaws, Rules and regulations
estab. Medical Records Committee, and professional staff record responsibilities
Hospital policy and procedures guide hospital operations
- regulatory bodies - state and federal (state: division of health) => state: division of health; federal: CMS, medicare, HIPAA; accreditation
- Joint Commission
Describe key coding standards
ICD-10, CPTL HIPAA standards
HIM Key Operators
Release of Information
Master Patient Index and Encounters HIM
Credentials and certifications
coding cert, privacy cert, health information credentials: RHIA, RHIT
What is a capital budget?
Planning process for expenditure of relatively large sums on long-term assets such as replacing worn out assets with new ones and developing new business opportunities.
What is an operating budget?
A detailed projection of all estimated income and expenses based on forecasted revenue during a given period (usually one year). a complete operating budget consists of not only a projected profit and loss statement but also a supporting cash flow statement, as well as a balance sheet.
