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HIS: Health Information SystemsEHR: Electronic Health RecordsEMR: Electronic Medical Records

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Level of conception. Data – factual Information – meaning of data Knowledge – model for information

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Data – Body temperature 103 Information – The patient is having a fever Knowledge -- The knowledge used to

generate the information: if a patient temperature is > 100 F, he might a fever (or hyperthermia).

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5

Concrete Abstract

Factual Conceptual

Volatile Stable

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General term cover all three levels Database – data level Information storage and retrieval system –

information level Knowledge system – knowledge level

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Information System

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In-house – developed and managed in the health care organization

Shared – developed and managed at the vendor site

Turnkey system – developed by vendor, installed and managed by health care organization

Stand-alone – lack of information sharing. Legacy system.

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Integration Continuality Standards Consumer oriented

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Clinical information systems – serving clinical activities◦ Hospital information system◦ Patient monitoring system◦ Nursing information system◦ Laboratory information system◦ Pharmacy information system◦ Computer based patient record ◦ Others

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Provide communication among health facility workers and support organizational information needs for operations, planning, patient care, and documentation.

Communication, coordination Various across different hosptials

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HIS should have following functions Central application Business and financial function Communications and Networking Department management Medical documentation Medical decision support

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Patient management◦ Scheduling◦ RADT (registration, admission, discharge, and

transfer)◦ RADT provides basic patient information to other

clinical systems.

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Payroll General ledger Accounts receivable Insurance

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Connect different systems. Need data standards to communicate. This is a disadvantage of paper based

system.

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Needs of individual department Pharm, lab, radiology, dietary, pathology,

etc The trend is to integrate these systems

while maintaining their functional independence.

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Medical record Will be paperless Provide support to managerial and

administrative decision making In order to do so, the medical record has to

be digitalized and codified.

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Help clinicians make decision Not replace clinicians data from various sources – hard to

managed by human Often integrated into physician order entry

system focal role in decreasing medical errors

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Physiological data Emergency room, operating room, intensive

are, critical care Can give real time alert

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Support nurse care process Clinical and managerial

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Associated with lab test Usually already available in the instrument Various types of lab tests have different

demands

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Data related to drug usage for patient Also can help decreasing medication errors

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IOM 1991 report first proposed the concept Other names include electronic health

record (EHR), electronic medical record (EMR).

It is not a single computer product or program

Based an changed model of managing patient data

Computer and information technology is necessary but not sufficient factor.

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Focus on integration Government support

◦ http://www.cnn.com/2004/ALLPOLITICS/04/27/bush.healthcare.ap/

◦ National Health Information Infrastructure◦ ARRA

Standardization◦ HL7

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Financial information system Accounting information systems Human recourse management information

systems Material management information system Facilities management information system Management planning and decisin support

system

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Computer based patient record◦ National health information infrastructure◦ Medical errors

E-Health and e-HIM◦ Web based technology

Standards Privacy and Security Technology

◦ Wireless◦ Voice recognition◦ Data warehouse and data mining

Enterprise information management Virtual information system – results of

integration, standardization, and personalization.

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Before we answer that, what is a patient record? • commonly referred to as the patient's chart or

medical record  • amalgam of all the data acquired and created

during a patient's course through the heath care system

    

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"to recall observations, to inform others, to instruct students, to gain knowledge, to monitor performance, and to justify interventions"

    Reiser, S. (1991). The Clinical Record in Medicine. Part 1: Learning from Cases. Annals of Internal Medicine, 114(10): 902-907

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• create the basis for the historical data

• support communication among providers

• anticipate future health problems

• record standard preventive measures

• identify deviation from expected trends

• provide a legal record

• support clinical research and public health

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• Pragmatic and Logistical issues.• Can I find the data I need when I need them?• Can I find the medical record in which they are recorded?• Can I find the data within the record• Can I find what I need quickly?• Can I read and interpret the data once I find them?• Can I update the data reliably with new observations in a

form consistent with the requirements for future access by me or other people?

• Redundancy and Inefficiency

• Influence on Clinical Research

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Accessibility Legibility Adaptive Structure Reusability Flexibility

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Comprehensiveness of information Duration of use and retention of data Degree of structure of data Ubiquity of access

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Disease Pattern Change Health Care Delivery System Change Specialization of Medicine Advances of Computer and Information

Technology

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Primary Uses◦Patient Care Delivery◦Patient Care Management◦Patient Care Support Processes◦Financial and Other Administrative Processes◦Patient Self-Management

Second Uses◦Education◦Regulation◦Research ◦Public Health and Homeland Security◦Policy Support

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Health Information and Data Results management Order entry/management Decision support Electronic communication and connectivity Patient support Administrative processes Reporting and population health

management

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Key Data◦ Problem list◦ Procedures◦ Diagnoses◦ Medication list◦ Allergies ◦ Demographics◦ Diagnostic test results◦ Radiology results◦ Health maintenance◦ Advance directives◦ Dispositions◦ Level of service

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Minimum Data Set (MDS) for nursing homes◦ From CMS◦ Support Long Term Care◦ Current Version 3.0

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Narrative (clinical and patient narrative)◦Free text◦Template based◦Deriving structures from unstructured text

NLP◦Structured and coded

Signs and symptoms Diagnoses Procedures Level of service

◦Treatment plan Single discipline interdiscipline

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Patient Acuity/Severity of Illness/ Risk Adjustment◦ Nursing workload◦ Severity adjustment

Capture of identifiers◦ People and roles◦ Products/devices◦ Places (including directions)

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Results Reporting◦ Laboratory◦ Microbiology◦ Pathology◦ Radiology ◦ Consult

Results notification

Multiple views of data/presentations

Multimedia support

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Computerized provider order entry◦Electronic prescribing◦Laboratory◦Microbiology◦Pathology◦Radiology◦Ancillary◦Nursing◦Supplies◦Consults

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Access to knowledge sources◦Domain knowledge◦Patient education

Drug alert◦Drug dose defaults◦Drug dose checking◦Allergy checking◦Drug interaction checking◦Drug-lab checking◦Drug-condition checking◦Drug-diet checking

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Other rule-based alert (e.g., significant lab trends, lab test)

Reminders◦ Preventive services

Clinical guidelines and pathways◦ Passive ◦ Context-sensitive passive◦ Integrated

Chronic Disease Management

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Clinician work list Incorporation of patient and/or family

preference Diagnostic decision support Use of epidemiologic data Automated real-time surveillance

◦Detect adverse vents and near misses◦Detect disease outbreaks◦Detect bioterrorism

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Provider to provider Team coordination Patient-provider

◦ Email◦ Secure web

messaging Medical Devices Trading partners

(external)◦ Outside pharmacy◦ Insurer◦ Laboratory◦ Radiology

Integrated medical record◦ Within setting◦ Cross-setting

Inpatient-outpatient Other cross-setting

◦ Cross-organizational

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Patient education◦Access to patient

education materials◦Custom patient

education◦Tracking

Family and informal caregiver education

Data entered by patient, family, and/or informal caregiver◦Home monitoring◦Questionnaires

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Scheduling management◦ Appointments◦ Admissions◦ Surgery/procedure schedule

Eligibility determination◦ Insurance eligibility◦ Clinical trial recruitment◦ Drug recall◦ Chronic disease management

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Patient safety and quality reporting◦ Clinical dashboard◦ External accountability reporting◦ Ad hoc reporting

Public health reporting◦ Reportable diseases◦ Immunizations

De-identifying data Disease registry

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Ambulatory (NEJM 2008)◦ 4% fully functional EHR◦ 13% basic system◦ Small and solo practices struggle

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Standardization of Clinical Information Cost of implementation and maintenance Physicians' readiness to adopt the EHR Privacy issues and patients’ concerns with

information sharing. Legal liability

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