healthcare it systems
TRANSCRIPT
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F LORIDA STATE UNIVERSITY
The College of Medicine
Healthcare Information
Systems: An OverviewNancy B. Clark, M.Ed.
Director of Medical Informatics EducationFSU College of Medicine
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F LORIDA STATE UNIVERSITY
The College of M edicine
What is wrong with this picture?
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The College of M edicine
What is wrong with this picture? illegible handwriting, ambiguous and incomplete data, data fragmentation- each lab report is a separate
piece of paper which does not allow a physician tovisualize the progress of a patients conditions.
poor availability- studies have shown that as muchas 40% of the time the paper record can not be
found.
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What is wrong with this picture? Insecure in open, unguarded shelving in a clinic In addition, paper records often become bulky with
time, which leads to lack of overview. When it comes time to share the record with another
clinician, each individual piece of paper has to behand copied, then mailed. It can cost a clinic up to$35 just to do this.
Employee cost of moving all this paper around
estimates it costs $5 just to pull one chart. Space most medical office space rents for $18-
22/sq ft/yr 240 sq ft
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Outline
What kinds of HIT systems are there? What are we using here at FSU CoM?
What major trends are emerging? What are the benefits to adoption? What are the barriers to adoption?
What is the current state of adoption? How can you learn more?
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Elements of IT Infrastructure
Hardware/Software Support Issues Workflow/Mindset Issues Training Issues
Budgeting Issues
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Basic Technology High speed
networks Wireless Networks
PDAs Tablets
Internet access Web server Intranets
(SharePoint)
Video conferencing Bar-code readers Voice over internet
Speech recognition
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Administrative Applications Security (virus protection, firewalls, retinal
scans, thumb prints) System wide e-mail with external access via
web System wide calendaring Single sign-on active user directory Website Intranet Shared file systems Personnel systems
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HIT Applications Patient registration/
demographics Insurance validation Billing systems Appointment systems Computerized
Physician Order Entry(CPOE)
EMR/EHR/CPR Pharmacy systems
Lab systems Imaging systems Telemedicine Patient education Decision Support Library resources Sensors
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Sad Facts Medical errors account for more deaths
than breast cancer, AIDs and motorcycleaccidents.
US has highest HC costs per capita inworld
US has worst outcomes of industrialized
nations. (infant mortality, lifespan, etc.) Healthcare is 10-15 yrs behind business in
adoption of IT
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F LORIDA STATE UNIVERSITY
The College of Medicine
FSU College of MedicineTechnology Supporting
Medical EducationWhat our graduates will expect to have in
their residencies, practices, and hospitals.
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Technology Highlights Tablet PCs PDAs for Medical Reference IT Enchanced Environment printing,
scanner, classroom & small grouppresentation system The Portals: The College Web Site, the
Electronic Library & Blackboard
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The Tablet PC
Lenovo ThinkPadTabletPC
Issue First Day1.88 GHz Processor
3 G MB RAM130 GB Hard DiskExternal DVD-RW
drivesSD card slot
PCM/CIA slot3 USB ports
4.5 lbs
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The College of M edicine
Software Installed
Windows Vista (7) Tablet Edition Office 2007, including Word, Excel,
PowerPoint, Publisher, Access, Outlook,Internet Explorer Adobe Acrobat Reader, Microsoft Digital
Image Suite, WinZip, Sonic Record Now,
medical spell checker, and EndNote Anti-virus, anti-spyware, & other security
software
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Interesting Tablet Software Microsoft Office
OneNote Windows Journal Microsoft Educational
Pack for Tablet PC Microsoft Experience
Pack for Tablet PC Sticky Notes Snipping Tool
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EMR SOAPware Use 3 rd year
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PDAs Issues Fall 1 st year Used to track all patient encounters Used as extension of library resources,
to find information quickly in clinicalenvironments at the point of care.
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HP iPAQ
Windows Mobile 6 1 GB SD card
Color, backlit, 240-360screen Sound recorder, mp3
player
Wireless - both WiFi &Bluetooth
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The College of M edicine 7/22/2013 Intro to Medical Library Resources 19
FSU Licensed PDA Software
Epocrates Essentials ($149/yr) Essential Evidence Plus ($249/yr) DynaMed ($200/yr)
PEPID ($199/yr) Pediatric Care Online ($289/yr) Clinical Evidence ($99/yr) Harrisons Practice ($325/yr) Geriatrics at Your Fingertips ($30) Savings to each faculty and student > $1,500/yr
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iPhone Revolution
Cell phone technologyexpanding to PDAs
Medical reference websitesreformatting
Software versions availabilityexpanding
6 resources: Epocrates, PEPID,Dynamed, ePSS, Pediatric CareOnline, Clinical Evidence
WM cell phones popular
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The College of M edicine 21
PDA Versions Available
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Epocrates Essentials Epocrates
Essentials Most widely used
PDA program bymedical practitioners
Rx, (Drugs &Complementarymeds)
Sx/Dx (Symptom &Disease Reference)
Labs & other tools.
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IT Enhanced Environment Wireless networking Classroom Presentation Systems Multi-function copier, printer, scanner
- machines A/V equipment in small group rooms
and community learning centers Large format printing for posters andsigns is available for school related
projects
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Clinical Learning Center
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The College of M edicine
Sim Center
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The College Portals Our Electronic Library SharePoint Intranet
Internal document sharing Policies, procedures, etc.
Enterprise Exchange e-mail systemwith integrated calendars and contacts
Blackboard Courseware
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Our Library is always open
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The College of M edicine
24/7 Access to Resources
>1900 medical eJournals (3.5 M articles) Hundreds of clinical eBooks Evidence-based medicine resources and
Guidelines
Disease, drug, images and patient educationresources Web-based course materials Medical search engines
200 periodicals databases PDA versions of 7 web resources
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Blackboard - Course Websites
All Course Materials Syllabus & Assignments PowerPoints & Lecture notes Discussion board & Grades Posting
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Overview of Current State of
Healthcare IT Adoption
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Source of Stats
2009 HIMSS Leadership Survey 304 IT HealthCare Executives representing 700
hospitals
http://www.himss.org/2009Survey/healthcareCIO_final.asp FSU CoM - Center on Patient Safety
Robert Brooks, MD, Associate Dean, HealthAffairs
Nir Menachemi Ph.D., MPH, Director, Center onPatient Safety
http://www.himss.org/2007Survey/healthcareCIO_final.asphttp://www.himss.org/2007Survey/healthcareCIO_final.asp -
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Projected IT Priorities
Source: 20 th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
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Top Business Issues FacingHealthCare
Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
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Most Significant Barriers toBarriers to Implementing IT
Source: 19 th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
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Florida Hospitals
Brooks R, et al. Patient Safety-Related Information Technology Utilization in Urban and RuralHospitals. Journal of Medical Systems, Vol. 29, No. 2, April 2005
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Top Security Concerns of Computerized Medical Information
Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
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Security Tools
Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
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Technology Adoption Curve
50%
25%
75%
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Technology Adoption(Next Two Years)
Source: 19 th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
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2008 Health IT Staffing Needs
Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
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2009 Health IT Staffing Needs
Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
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National Initiatives
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Wiring Healthcare
Hospital
s
Primary carephysician
Specialty
physician
Ambulatorycenter (e.g.
imagingcenters)
Payers
Pharmacy
Laboratory
Publichealth
Current system fragments patient informationand creates redundant, inefficient efforts Future system will consolidate informationand provide a foundation for unifying efforts
Hospital
Datarepository
HealthInformationExchange
Networkapplications
Payers
Labs
Outpatient RX
Physician office
Ambulatory centers Public health
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Sharing Medical Data Increase patient safety Lower Healthcare costs Allow for coordination of care Increase communication between
providers
Banking analogy
Offi f h N i l
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The College of M edicine
Office of the NationalCoordinator for Health IT
Established by Executive Order 13335 (April 27, 2004) Responsible for realizing the Presidents vision of
Health IT:
Widespread adoption of interoperableEHR within 10 years Medical information follows consumer Clinicians have complete, computerized patient information Quality initiatives measure performance and drive
quality-based competition Public health and bioterrorism surveillance are seamlessly
integrated into care
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Goals Develop a nationwide health
information network (NHIN) Establish standards for data transfer
and storage: Continuity of care records
Develop Regional Healthcare
Information Organizations (RHIOs) See article: Burton, et al. Using electronic health records to
help coordinate care. Milbank Quarterly. V(82);457-81. 2004
f f
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Status of Health InformationExchange (HIE)
Source: 20 th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
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Needed for CCR
Universally agreed-on medical vocabulary Principled and standard formats for
laboratory data, medical images, medicalrecord
Standardization of medical literatureformats--structured abstracts
Health care standards -- treatmentguidelines Standards for health data exchange
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Patient: JohnDoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm 3
Current HL7 messages for most lab data DICOM messages for images LOINC for laboratory results content CPT-4 for procedures content ICD-9 for diagnoses content (10 coming) NDC RxNorm for medication content
Anticipated medical vocabulary SNOMED/UMLS Concept Unique Identifiers for
microbiology content
Clinical Data Standards
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Where can you learn more?
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Web Sites/Organizations American Medical Informatics Association (AMIA) Healthcare Information and Management Systems
Society (HIMSS) Healthcare IT News
Healthcare Informatics Health Informatics at Wikipedia Medical Group Management Association (MGMA) The Informatics Review To Err Is Human: Building a Safer Health System (IOM) Crossing the Quality Chasm (IOM) Health Professions Education (IOM) Patient Safety: Achieving a New Standard for Care (IOM)
http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.amia.org/http://www.himss.org/ASP/http://www.himss.org/ASP/http://www.healthcareitnews.com/http://www.healthcare-informatics.com/http://en.wikipedia.org/wiki/Health_informaticshttp://www.mgma.com/http://www.informatics-review.com/http://www.nap.edu/books/0309068371/html/http://www.nap.edu/books/0309072808/html/http://www.nap.edu/books/0309087236/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309087236/html/http://www.nap.edu/books/0309072808/html/http://www.nap.edu/books/0309068371/html/http://www.informatics-review.com/http://www.mgma.com/http://en.wikipedia.org/wiki/Health_informaticshttp://www.healthcare-informatics.com/http://www.healthcareitnews.com/http://www.himss.org/ASP/http://www.himss.org/ASP/http://www.amia.org/ -
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Web 2.0 http://www.hitsphere.com/
http://www.hitsphere.com/http://www.hitsphere.com/ -
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Journals
JAMIA J. of the American Medical InformaticsAssoc.
Telemedicine and e-Health IEEE Trans. on Information Technology in
Biomedicine Health Informatics Studies in Health Technology and Informatics Biosensors and Bioelectronics Healthcare Informatics Online (Magazine) IEEE Technology and Society British Computer Society
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More Journals
Ar t i f ic ia l Inte l l igence in Medic ine (Elsevier) Com puters in Bio logy and Medic ine (PergamonPress)
Com puters in Biom edica l Research (AcademicPress)
Com puter Method s and Programs in Biom edic ine (Elsevier) IEEE Engin eer ing in Medicine and Bio log y Magazine Jo urn al of Medical Systems (Plenum Press) MD Com put ing (Springer-Verlag) Medical Inform at ics & The Internet in Medicine
(Taylor & Francis) Method s o f Inform ation in Medic ine (Schattauer) Yearboo k o f Medical Info rm at ics (Schattauer)
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Conferences
HIMSS: regional and national conferences.3/10/10 Atlanta
AMIA: Annual Symposium (and SpringCongress)
HEALTHCOM: Health CommunicationConference
MEDINFO: (every 3 years, next in 2007), runby the IMIA (International MedicalInformatics Association)
MGMA: 2007 MGMA Health Care InformationTechnology Forums
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Training AMIA/Oregon Health Sciences 10 x 10
programhttp://www.amia.org/10x10/partners/ohsu/
http://www.amia.org/10x10/partners/ohsu/http://www.amia.org/10x10/partners/ohsu/ -
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Health IT Conclusions
Financial Support for Health IT on-going concern Patient Centric Focus
Customer Satisfaction Patient Safety
High-speed networks, Intranet and wirelessinformation systems currently in use, to beexpanded across regions
Electronic Medical Records (EMR) andComputerized Physician Order Entry (CPOE) mostimportant applications
Interoperability is a must for Health IT