week 5 (exam 1) Flashcards
What are some BIG issues with US healthcare system?
- it is not interconnected (different doctors don’t communicate with each other)
- expensive!!
- not everyone is covered
- inconsistent quality
- medical errors
- takes too long for new research to affect practice
- baby boomers getting older
- Struggling to improve early detection capabilities
why is it important to have interconnected health care systems?
Complete medical record always available
Decision support available
Link between medical care & public health
Consumers can access their medical records
Payment systems streamlined
What’s the problem with paper records in healthcare?
illegible
hard to store
hard to find
hard to share
very individualized
expensive to copy
hard to find information in it
negative environmental impact
pages can fall out
get mixed up
misfiled
What’s missing in a paper chart?
Lab results - 45%
letters/dictations - 39%
Radiology results - 28%
Hx and physical exams - 27%
Pathology results - 15%
What are the 3 types of Health Records?
EMR: Electronic Medical Record
EHR: Electronic Health Record
PHR: Personal Health Record
explain what a EMR is?
EMR: Electronic version of a paper-based health record.
Single organization
Legal record
Might have a patient portal to let patients view certain components, but not interactive
explain what a EHR is?
EHR: Electronic record of health-related information that is created and SHARED across more than one health care organization
More comprehensive
EMR with interoperability
Provides interactive patient access
Advantages of Electronic health records
Increased quality—decreased errors, reminders, reduced duplication
Increased communication between providers
Access to medical history, previous procedures/tests
Decision support tools
Increased data for public health
Cost savings: one estimate $44 billion yearly
Paper reduction
Why is computerized physician order entry a good thing?
Allows for orders for medications, lab tests, x-rays, consults and other diagnostic tests
Thought to reduce medication errors, reduce costs, reduce variation in care
Explain Clinical Decision Support Systems (what is it and types)
Any software that directly aids clinical decision making for patient-specific recommendations
—–Most offer recommendations, clinician makes the decision
Types:
Knowledge support
Medication ordering: allergies, drug-drug
interactions
Reminders: e.g. age 40 and female: mammogram
Order sets and protocols: e.g. pneumonia
Differential diagnosis
Public health alerts
CDSS works best if it’s……
Clinical Decision support system
Part of the regular workflow and provided at the point-of-care
Provides recommendations, not just information
What things need to be considered when creating a CDSS?
Need to have existing guidelines in place, e.g. vaccination schedule
Represent knowledge
- -Tables
- —Each row contains a condition and an action
- -Rules
- —If-then
- -Flowcharts
- -Model-based knowledge: incorporates statistical models
Define the system architecture, including who will use, where they will use, strategies for updating content
Test and evaluate
name some barriers to Electronic Record Use
Cost (Hardware, software, training, obsolescence and upgrades, lowered productivity, data storage, might be running two systems)
Physicians’ attitudes
Loss of productivity
Workflow changes
Usability issues
Lack of standards
Privacy concerns
Practices/hospitals lack IT staff
Inadequate proof of benefit
—E-iatrogenesis: patient harm caused at least in part by the application of health information technology
What are some FACILITATORS to Electronic Record Use?
Financial incentives
Training and technical support
Access to list of certified vendors
Access to information at point-of-care when physician needs it
Evidence of effectiveness
explain the HITECH Act of ARRA (2009)?
The American Recovery and Reinvestment Act provides $19.2 billion to encourage the adoption of EHR systems and their “meaningful use.”
To participate:
- -Eligible Professional
- —Medicare: MDs, dentists, podiatrists, optometrists, chiropractors; not hospital-based
–Register for reimbursement
–Use certified EHRs
–Demonstrate meaningful use
What are some of the meaningful use areas of policy? (what things was considered reimbursable?)
Improve patient care and reduce disparities
Engage patients and families in their care
Improve coordination of care
Improve population and public health
Ensure adequate privacy and security protections for personal health information
Examples of Stage TWO CORE OBJECTIVES (really long)
Computerized order entry for medications, labs, radiology
Generate/transmit prescriptions
Record demographics
Record and chart changes in vital signs
Record smoking status
Use clinical decision support for high-priority health conditions
Give patients online access
Provide pts w/ office visit summaries
Protect privacy and security of patient data
Exchange key clinical information among clinicians or other entities
Generate lists of pts by condition
Determine which pts. should receive reminders
Submit data to immunization registries
Use secure messaging to communicate with patients
List some samples of STAGE 2 MENU Objectives?
Submit surveillance data to public health agencies
Record notes in patient records
Access to imaging results
Record patient family health history as structured data
Report cancer cases to state cancer registry
Report cases to other specialized registries
What are PERSONAL HEALTH RECORDS and what may they contain?
Health record that is initiated & maintained by an individual
May contain
–Medical history, vaccination record
–Self-reported health information: weight, blood pressure, blood glucose
–May contain reports from labs or healthcare providers
What are some of the PHR formats?
PAPER
TETHERED: Linked to one platform and not interoperable, usually through insurers or healthcare organizations
UNTETHERED: More interoperability potential
Web-based
Mobile technology: USB drives, smart phones, smart cards
ADVANTAGES of PHR?
Empowerment
Improved patient-provider communication
Improved patient safety
Track need for well-visits, immunizations
DISADVANTAGES of PHR?
Need to gather information
Privacy concerns
Accuracy
What is needed for interconnectivity?
Functionality
Interoperability
Security
What are the functions of EHR?
review chart, add visit notes, e-prescribe, order tests, review results, provide patient education materials, alert to needed tests, share information with other providers
What are the functions of GIS?
incorporate and link maps and health data, allow queries
What are the functions of Syndromic surveillance systems?
collect data from many sources, allow visualization of data, algorithms to detect incidents
What is Interoperability?
Ability to share and use electronic health information between systems
Name some barriers to interoperability?
Different definitions
Different formats
Different protocols for message exchange
define Standards
Uniform use of common terms and methods for sharing data
define Harmonization
process of reaching agreement between different standards
What do Standard ALLOW?
Interoperability
Improved data quality
Comparability
Better patient care and improved outcomes
Name some TYPES of standards
Vocabulary Standards: to describe clinical problems, procedures, medications, etc.
Transport Standards: for sharing information
Privacy and Security Standards
What is SNOMED CT?
Systematically-organized computer-processable collection of health and healthcare terminology
VOCABULARY STANDARD FOR CLINICAL TERMS
Contains over a million medical concepts, strings of 6-18 digits, divided into 19 categories
22298006 means myocardial infarction
SNOMED concepts are used in HL7
What is HEALTH LEVEL 7 OR HL7?
(1) International standards-developing organization
(2) Standard for exchanging information for all healthcare flows
- -EHR
- -Practice management systems
- -Lab systems
- -Pharmacy
CHALLENGES TO STANDARDS? (HL7)
Working to create templated documents to standardize patient notes, such as Continuity of Care documents using Clinical Document Architecture, an HL-7 standard
examples of other standards in medicine?
LOINC: used for laboratory codes
ICD-9 or 10: alphanumeric code to represent clinical diagnoses or procedures typically for billing
CPT-4: 5 digit code to represent medical, surgical, and diagnostic services and procedures, also used for billing
WHY haven’t standards been adopted?
Lack of agreement on which to use
Voluntary
Cost
Standard code sets may not meet all your needs
define PRIVACY
right of individuals to hold information about themselves in secret
define CONFIDENTIALITY
assurance that information about identifiable persons will not be disclosed without consent, except as allowed by law
define SECURITY
the mechanisms through which privacy and confidentiality policies are implemented in computer systems
What is the HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT (HIPAA)
Title II:
–Contains privacy rules that govern how patient’s health care information can be released
–Requires covered entities to protect privacy
—-Covered entities: health plans, doctors, health care clearinghouses, some public health agencies
(Not covered: schools, employers, most state agencies)
—-Protected HI: individually identifiable
HITECH Act include more on electronic security
Meaningful Use standards
List some disclosures that DO NOT NEED authorization.
Public health agencies
Child abuse/neglect
Quality, safety, or effectiveness of a product/service regulated by the FDA
Workplace medical surveillance
De-identified data can be shared…one method is the SAFE HARBOR METHOD - please explain this method
Safe harbor method: strip out 18 types of information: name, street address, age, phone number, fax number, email address, SSN, medical record numbers, beneficiary numbers, acc’t numbers, certificate numbers, vehicle ID numbers, medical device identifiers, URLs, IP addresses, biometric identifiers, photos, any other unique identifiers
What are some of the things that need to be considered for SECURITY purposes?
PHYSICAL SAFEGUARDS: alarm systems, locked offices, screen shields
ADMINISTRATIVE SAFEGUARDS: staff training, confidentiality agreements, monthly review of user activities/audit trails, policy enforcement
TECHNICAL SAFEGUARDS: “AUTHENTICATION” secure passwords, data back-ups, virus checks, data encryption during transport
–Need-to-know: information only available to those who need it
ORGANIZATIONAL REQUIREMENTS: Breach notification and associated policies, business associate agreements, policies and procedures (e.g. protocols on authorizing users)
PENALTIES
