Test 1 Flashcards
Health Information Technology (HIT)
The use of computers and communications technology in healthcare and the public health setting.
Computer-based Patient Records
Earliest forms of Electronic Health Records; circa 1990’s.
Clinical Trials
Research projects that involve direct management of patients and are generally aimed at determining optimal modes of therapy, evaluation, or other interventions.
Four Issues Slowing the Building of EHRs
1) Standards for clinical terminology.
2) Data privacy, security, and confidentiality.
3) Physician data entry
4) Integrating record systems with other information resources in a health setting.
Backbone Network
A high-speed communication network that carries major traffic between smaller networks.
Biomedical Informatics
The interdisciplinary field that studies and pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decision making, driven by efforts to improve human health.
Office of the National Coordinator for Health Information Technology (ONC)
An agency within the US Department of Health and Human Services that is charged with supporting the adoption of health information technology and promoting nationwide health information exchange to improve health care.
Meaningful Use
The set of standards defined by the Center for Medicare and Medicaid Services (CMS) Incentive Programs that governs the use of electronic health records and allows eligible providers and hospitals to earn incentive payments by meeting specific criteria.
-Belief that health providers using EHR in an effective way can improve health care quality and efficiency.
Medical Computer Science
The subdivision of computer science that applies the methods of computing to medical topics.
Information Science
The field of study concerned with issues related to the management of both paper-based and electronically stored information.
Cognitive Science
Area of research concerned with studying the processes by which people think and behave.
Information Theory
The theory and mathematics underlying the processes of communication.
Biomedical Computing/Biocomputation
The use of computers in biology or medicine.
Field encompassing the modeling and simulation of tissue, cell, and genetic behavior.
Medical Informatics
The sub-field of clinical informatics that deals with the management of disease and the role of physicians.
-Former term for Biomedical Informatics
Medical Information Science
The field of study concerned with issues related to the management and use of biomedical information.
Health Informatics
Term increasingly used solely to refer to applied research and practice in clinical and public health informatics.
-Synonym for Biomedical Informatics
Bioinformatics
The study of how information is represented and transmitted in biological systems, starting at the molecular level.
Biomedical Information Science and Technology Initiative (BISTI)
An initiative launched by NIH in 2000 to make optimal use of computer science, mathematics, and technology to address problems in biology and medicine.
Hospital Information System (HIS)
Computer system designed to support the comprehensive information requirements of hospitals and medical centers, including: patient, clinical, ancillary, and financial management.
Basic Science
The enterprise of performing basic research.
American Medical Informatics Association (AMIA)
A working group created in the 1980’s to develop a formal definition for the field.
-Responsible for the core competencies for graduate training.
BMI Defined: Scope and Breadth of Discipline
Investigates and supports reasoning, modeling, simulation, experimentation, and translation across the spectrum from molecules to individuals and to populations, from biological to social systems, bridging basic and clinical research and practice and the health care enterprise.
BMI Defined: Theory and Methodology
Develops, studies, and applies theories, methods, and processes for the generation, storage, retrieval, use, management, and sharing of biomedical data, information, and knowledge.
BMI Defined: Technological Approach
Builds on and contributes to computer, telecommunication, and information sciences and technologies, emphasizing their application in biomedicine.
BMI Defined: Human and Social Context
Draws upon the social and behavioral sciences to inform the design and evaluation of technical solutions, policies, and the evolution of economic, ethical, social, educational, and organizational systems.
History of the Punch Card
- Invented by Herman Hollerith
- First used for vital statistics by NYC Board of Health in several states
- Adopted for use in 1890 census
- 1928: Hollerith’s company renamed IBM.
Cards for Computers
- Complex, formatted cards to hold data.
- Printed with a format specific to the needs of programmers.
IBM Calculator Instruction Card
-Printed in the 1950’s for use with the IBM 701, the first general purpose computer.
History of HIT: Burroughs 3rd Generation computer
Provided one of the earliest hospital information systems in Charlotte, NC.
History of HIT: Shared Data-Processing Centers
Provided hospitals with business and financial system processing.
History of HIT: SNOP (1965)
American College of Pathology begins work on systematizing the language of pathology.
-Precursor to SNOMED
History of HIT: Late 1960’s
Some HIT systems include patient diagnoses and other patient information, including care plans based on physician orders and nursing orders.
History of HIT: Late 1960’s-Early 1970’s
Health departments and community health organizations partner with vendors to develop systems to provide the statistical reports required by government agencies.
History of HIT: Social Security Act amendment (1965)
Social Security adds Medicaid and Medicare.
- Qualifying for reimbursement is dependent on data provided by nurses regarding care delivered.
- Department of Health and Human Services responsible for reimbursement.
History of HIT: Minicomputers
- Arrived in early 1960’s
- Low cost and small.
- Allowed computer access to individual departments and small organizations, causing a surge in the development of computer applications, particularly in universities and industry.
History of HIT: Microprocessor (1971)
Lay the groundwork for hobbyists to build home computers (microcomputers).
- Personal Computer (PC): Made it possible for individual users, i.e. physicians, to own their own systems.
- aka “Computer on a chip”
Biomedical Engineering (BME)
The application of engineering principles and design concepts to medicine and biology for healthcare purposes.
-Includes: drugs, imaging equipment, prostheses, and regenerative tissue growth.
Medical Information: Low Level Processes
- Receptive to mathematical treatments.
- Computer programs only require numerical programming.
Medical Information: High Level Processes
Human processes raise complex issues to which conventional logic and mathematics are less readily acceptable.
High Level Processes: Artificial Intelligence
Any device that perceives its environment and takes action to maximize its chances of success for a given goal; the mimicking of behaviors that people associate with the human mind.
-aka Machine Intelligence (MI)
Global Forces Affecting Biomedical Computing and its Assimilation
1) New developments in computer hardware and software.
2) A gradual increase in the number of individuals cross-trained in medicine and BMI.
3) Following changes in healthcare financing designed to control the rate of growth in health-related expenditures.
Clinical Datum
Any single observation of a patient
Five Elements of Datum:
1) The Patient in question
2) The Parameter being observed
3) The Value of the parameter
4) The Time of the observations
5) The Method by which the observation is made.
Types of Clinical Data
Narrative, Textual, Numerical, Genetic, Recorded Signals, Drawings/Photographs
Who Collects the Data?
Physicians, Nurses, Admission personnel, Radiologists, Pharmacists, Allied Health Professionals, Technological Devices
Uses of Health Data
- Create basis for historical record.
- Supports communication among providers
- Anticipate future health problems
- Record standard preventative measures
- Identify deviations from expected trends
- Provide a legal record
- Support clinical research
Disadvantages of Paper-Based Records: Storage
Consume too much space; easily lost.
Disadvantages of Paper-Based Records: Accessibility
- Can only be shared by one provider or allied health professional at a time.
- Unavailable approximately 30% of the time in larger facilities.
Disadvantages of Paper-Based Records: Quality
- Ink can fade, becomes illegible
- Susceptible to the elements (e.g. water, fire)
Disadvantages of Paper-Based Records: Fragmentation
Due to disparate documentation and billing systems across multiple providers, the possibility of a comprehensive, longitudinal history is nearly impossible.
- Each provider holds only a limited portion of the health record at any given time
Disadvantages of Paper-Based Records: Security
- Unauthorized access is too easy.
- Paper breaches on the rise in recent history
Disadvantages of Paper-Based Records: Illegible Handwriting
- A leading cause in quality care errors.
- Also poor syntax due to inconsistent medical terminology
The Human Genome Project
International research effort to determine the sequence of the human genome and identify the genes that is contains.
- Unearthed unprecedented amounts of data that need to be sorted and configured for use.
- 1990-2003
Structure of Clinical Data: Classification
A system of grouping similar diseases and procedures and organizing related information for easy retrieval.
Structure of Clinical Data: Nomenclature
A system of terms structured according to pre-established naming rules.
Structure of Clinical Data: Terminology
A set of terms representing the system of concepts in a particular field of study or practice.
International Classification of Diseases (ICD)
An adisagnostic coding scheme created by the WHO
ICD Tenth Revision
- The newest version of the ICD
- US gov’t mandated health care to update to this version in 2009.
Key Issues for Update to ICD-10
- ICD-9 was out-of-date and running out of space for new codes.
- ICD-10 is the international standard to report and monitor disease and mortality.
- ICD Codes are essential to the success of HIT and updating to the latest version is necessary for HIT to reach its full potential.
ICD-10-CM
- Used for diagnosis coding
- Uses 3-7 digits
- Uses the format of code sets but with increased coding complexity
ICD-10-PCS
- Used for inpatient procedure coding
- Uses 7 alphanumerical digits
- Much more specific than its predecessor
Healthcare Terminologies: Human Genome Nomenclature (HUGO)
- Each known gene is assigned a unique gene name and symbol by the Human Genome Nomenclature Committee (HGNC)
- All gene names are stored in the HGNC database.
- Unique names allow for ease of query and conversation about specific genes.
Healthcare Terminologies: Universal Medical Device Nomenclature System (UMDNS)
Standard international nomenclature and computer coding system.
-Used in applications ranging from hospital inventory and work-order controls, to national agency medical device regulatory systems, to e-commerce and procurement.
Healthcare Terminologies: Systematized Nomenclature of Medicine - Clinical Technology (SNOMED-CT)
- Enables providers and EMRs to communicate in a common language, increasing quality care across many different providers.
- Used in the US and internationally.
Healthcare Terminologies: Systematized Nomenclature of Dentistry (SNODENT)
Official subset of SNOMED-CT used in EMRs for dental disease.
Unified Medical Language System (UMLS)
Integrates and distributes key terminology, classification and coding standards, and associated resources to promote the creation of more effective and interoperable biomedical information systems and services.(e.g. EHRs)
-Created by the National Library of Medicine
UMLS Metathesaurus
- Large, multi-purpose and multi-lingual vocabulary database that contains information about biomedical and health-related concepts, their various names, and the relationship among them.
- Built from electronic records of various thesauri, classifications, code sets, and lists of controlled terms used in patient care, health services billing, public health statistics, indexing and cataloging biomedical literature, and/or basic, clinical, and health services research.
- Organized by concept and meaning.
- Designed for system developers.
UMLS Semantic Network
Provides consistent categorization of all concepts in the Metathesaurus at the relatively general level.
-All terms in the Metathesaurus are assigned at least one Semantic type from this Network.
UMLS SPECIALIST Lexicon
Provides the lexical information needed for the SPECIALIST Natural Language Processing (NLP) system
-Includes commonly occurring English words and biomedical vocabulary.
Medical Subject Headings (MeSH)
The National Library of Medicine’s controlled vocabulary thesaurus used for indexing articles in PubMed.
Heuristic
Enabling a person to discover or learn something by themselves.
Database
A collection of individual observations without any summarizing analysis.
Hypothetico-Deductive Approach
Procedure for the construction of a scientific theory that will account for results obtained through direct observation and experimentation and that will, through inference, predict further effects that can be verified or disproved by empirical evidence derived from other experiments.
Differential Diagnosis
Set of active hypotheses that a physician develops when determining the source of a patient’s problem.
Sensitivity
The likelihood that a given datum will be observed in a patient with a given disease or condition.
Pathognomonic
Distinctively characteristic and uniquely identifying a condition or object.
Specificity
The probability of a negative result (of a test), given that the condition under consideration is absent.
Bayes’ theorem
An algebraic expression, often used in clinical diagnosis, for calculating post-test probability of a condition if the pre-test probability of the condition, as well as the sensitivity and specificity of the test are known.
Prevalence
The frequency of the condition under consideration within the population.
Baseline Rate
The prevalence in the population from which the patient was selected.
Predictive Value (PV)
The post-test probability that a disease is present based on the results of a test.
Genome
The entire set of hereditary instructions for building, running, and maintaining an organism, and passing life on to the next generation
-All genetic material of a living thing.
Sequence Information
Information from a database that captures the sequence of component elements in a biological structure.
Proteomics
The study of the protein products produced by genes in the genome.
Gene Expression Microarray
Study the expression of large numbers of genes with one another and create multiple variations on a genetic theme to explore the implications of changes in genome function on human disease.
Gene
Sections of DNA within the genome that carries information to make a molecule, usually a protein.
- Contains instructions for individual characteristics
- Genes are split into coding (exons) and non-coding sequences (introns)
Transcription
The first step during protein synthesis when the DNA in a gene is copied to produce an RNA transcript called messenger RNA (mRNA).
Single Nucleotide Polymorphism (SNP)
A DNA sequence variation, occurring when a single nucleotide in the genome is altered.
-A variation must be present in at least 1% of the population to be considered an SNP.
Genotype
The genetic makeup, as distinguished from physical appearance, of an organism or group of organisms.
Phenotype
The observable physical characteristics of an organism, produced by the interaction of the genotype with the environment.
Open Consent Model
A legal mechanism by which an individual can disclose their own private health information or genetic information for research use.
GenBank
A centralized repository of protein, RNA, and DNA sequences in all species, currently maintained by the National Institutes of Health.
Protein Data Bank (PDB)
A centralized repository of experimentally determined 3-D protein and nucleic acid structures.
Gene Expression Omnibus (GEO)
A centralized database of gene expression microarray data sets.
Object-Oriented Database
A database structured around individual objects (concepts) that generally include relationships among those objects and, in some cases, executable code that is relevant to the management and/or understanding of the object.
Next Generation Sequencing Methods
Technologies for performing high throughput sequencing of large quantities of DNA and RNA.
-These typically determine sequences for many millions of short segments of DNA that need to be reassembled and interpreted using bioinformatics.
Metagenomics
Using DNA sequencing technology to characterize complex samples derived from an environmental sample.
Epigenetics
Heritable phenotypes that are not encoded in DNA sequence.
Systems Biology
Research on biological networks or biochemical pathways.
-A comprehensive approach to model biological function by taking the interactions of a set of genes as a whole.
Sequence Alignment
An arrangement of two or more sequences, highlighting their similarity.
Basic Local Alignment Search Tool (BLAST)
An algorithm for determining optimal genetic sequence alignments based on the observations that sections of proteins are often conserved without gaps and that there are statistical analyses of the occurrence of small subsequences within large sequences that can be used to prune the search for matching sequences in a large database.
Markup Language
A document specification language that identifies and labels the components of the document’s contents.
Postegenomic Database
A database that combines molecular and genetic information with data of clinical importance or relevance.
Exome
The entire sequence of all genes within a genome.
-Approximately 1-3% of the entire genome.
Gene Ontology (GO)
A structured controlled vocabulary used for annotating genes and proteins with molecular function.
Electronic Health Record (EHR)
System to achieve the goals of structured and standardized data collection that benefits patients wherever they may be treated.
Paper Records: Inaccessibility
The inability to access the record by more than one person at a time or by more than one place at a time.
Qualified EHR: Defined
Electronic record of health-related information on an individual that includes:
- Patient demographic and clinical health information, medical history, problem list and;
- Has the capacity to:
- Provide clinical decision support
- Support physician order entry
- Capture and query information relevant to health care quality
- Exchange health information with and from the EHR
EHR: Component Composition
Composed of components that meet the following criteria:
- Integrates data from multiple sources
- Captures date at the point of care
- Supports clinical decision making
EHR as a System: Components
Hardware -> Software -> People -> Policy -> Process
Factors Affecting the Success of EHR
- Comprehensiveness
- Duration of use and retention of data.
- Degree of the structure of data
- Ubiquity of access
History of Flexner Report
- Created by an educator/researcher with the Carnegie Foundation
- Two year study surveying 155 medical and osteopathic educational institutions
Flexner Conclusions
- Creation of the Medical Education substandard
- Schools should have minimum standards or HS education and two years of colleges.
- Medical schools should be 4 years; 2 of science, 2 of clinical.
- Proprietary schools should be closed or incorporated into universities.
- Physicians to keep a patient-oriented medical record.
Problem-Oriented Medical Record (POMR)
- Initially defined by Dr. Weed in 1968
- Official method of record keeping
- Used at Foster G McGaw Hospital and its affiliates.
- Automated the system in 1969.
Basic Components of POMR
1) Data Base- History, Physical, and Lab Data
2) Complete Problem List
3) Initial Plans
4) Daily Progress Notes
5) Final Progress Note and Discharge Summary
Functional Components of EHR
1) Integrated view of patient
2) Clinician Order Entry
3) Clinician decision support
4) Access to knowledge resources
5) Integrated Communication and reporting support
DELETE
Deleted
Stages of Meaningful Use
1) Data Capture and Sharing
2) Advanced Clinical Processes
3) Improved Outcomes
Computerized Provider Order Entry (CPOE)
Medication orders (as well as tests and procedures) are entered into a computer system by a physician or qualified providers.
- Medication orders transmitted directly to pharmacy.
- Ensures standardized, legible, and complete orders.
- Potentially reduces errors at the ordering and transcribing stages.
Clinical Decision Support
A process for enhancing health-related decisions and actions with pertinent, organized clinical knowledge and patient information to improve healthcare and health outcomes.
EHR Data Capture: Electronic
Electronic interfaces from systems, such as laboratory systems, that are fully automated.
EHR Data Capture: Manual
- Narrative free text
- Codes
- Combination of the two.
EHR Data Capture: Physician Notes
1) Transcription of dictated or written notes
2) Clincial staff transfer a recording of some or all of the data by clinicians on a paper encounter form
3) Direct data entry by the physician into the EHR.
Challenges for the EHR
- User information needs
- Usability
- Standards
- Privacy/Security
- Cost/Benefits
- Leadership
Nationwide Health Information Network (NwHIN)
A set of standard, services, and policies that have been shepherded by the ONC to enable secure HIE over the Internet.
Optimal Character Recognition (OCR)
The conversion of typed text within scanned documents to computer understandable text.
Data Validation: Validity Checks
A set of procedures applied to data entered into an EHR intended to detect or prevent the entry of erroneous data.
Data Validation: Range Checks
A procedure applied to entered data that detects or prevents entry of values out of range.
Data Validation: Pattern Checks
A procedure applied to entered data to verify that the entered data have a required pattern.
Data Validation: Computed Checks
A procedure applied to entered data that detects errors based on whether values have the correct mathematical relationship.
Data Validation: Consistency Check
Detects errors based on internal inconsistencies
Data Validation: Delta Checks
Detects large and unlikely difference between the values of a new result and of previous observations.
Data Validation: Spelling Checks
Checks spelling of entered words.
Standards
Any norm, convention, or requirement.
-Provides the conventional way to solve a given problem.
Standards Development Organization (SDO)
An organization charged with developing a standard that is accepted by the community of affected individuals.
-Designated by ANSI
Health Level Seven (HL7)
An ad hoc standards group formed to develop standards for exchange of health data between independent computer applications.
Why the Need for Standards in Biomedical Informatics?
Interoperability
Implications for Standards in Biomedical Informatics
1) Life or death matters
2) Many, various stakeholders
3) Strong professional values and ethics
4) Many different specialties
5) Evolving knowledge, technology, and standards
6) Fragmented, poorly coordinated systems
7) High volume, low resources, sense of urgency
Standards Development Process: Ad Hoc method
A group of interested parties or organizations agree on a standard.
- Informal
- Exist due to mutual agreement
Standards Development Process: De Facto method
A single vendor controls a large enough portion of the market to make its product the market standard.
Standards Development Process: Gov’t Mandate method
A government agency creates a standard and legislates its use.
Standards Development Process: Consensus method
A group of volunteers representing interested parties work in an open process to create a standard.
Terminology
A set of terms representing the system of concepts of a particular field of study
Vocabulary
A dictionary containing terminology of a subject field.
Purposes of Encoding Standards
1) Prevent the reinvention of the wheel
2) Using commonly accepted standards can facilitate exchange of data between systems
Controlled Vocabulary
A set of terms used in a specific area where the use of the each term is predefined and the set is maintained by the responsible party.
Taxonomy
Hierarchical system to classify objects in a specific area.
Ontology
A formal representation of knowledge is a set of concepts without a domain and the relationship between those concepts.
Coding System
A system to identify how to represent an object or concept.
Control Terminology: Medical Subject Headings(MeSH)
The terminology used to index medical literature.
- Arranges terms in a structure that differs from the strict hierarchy used by most other coding systems.
- Maintained by NLM
Control Terminology: Unified Medical Language System (UMLS)
A resource that pools together and disseminates controlled medical terminology.
- Contains over 1 million terms collected from 100 different sources.
- Attempts to relate synonymous and similar terms from across different sources.
Data-Interchange Standards
To permit one system to transmit to another system, all the data required to accomplish a specific communication, or transaction set, in a precise, unambiguous fashion.
-Both systems must know what format and content is to be transmitted, the words for terminology, and the delivery method.
Medical Data Encoding: Abstraction and Classification
Examination of the recorded data and then the selection of items from a terminology with which to label the data.
Medical Data Encoding: Representation
The process by which as much detail as possible is coded.
Open Systems Interconnection (OSI)
A communication model defined by seven levels of requirements or specifications for an exchange:
1) Physical
2) Data Link
3) Network
4) Transport
5) Session
6) Presentation
7) Application
Health Level 7 of the OSI: Application
Deals primarily with the semantics of data content specification of the transaction set or message.
-Requires the definition of all data elements to be sent in response to a specific task.
Health Level 6 of the OSI: Presentation
Deals with what the syntax of the message is, or how the data is formatted.
Health Levels 1-5 of the OSI
Govern communications and networking protocols and the physical connection made to the system.
-Some understanding of these lower levels is necessary for successful linking of two systems.
American Society for Testing and Materials (ASTM)
Largest non-government source of standards in the U.S.
Institute of Electrical and Electronic Engineering (IEEE)
Responsible for many worldwide standards in telecommunications, electronics, electrical applications, and computers.
