Standards of dental informatics, security issues


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Standards of dental informatics, security issues

  1. 1. Standards of dentalinformatics, security issues,privacy and costs Dr Ebtissam Al-Madi
  2. 2. • Why are standards important inmedical informatics? – Promote consistent naming of individuals, events, objects, etc. – Allow better use of data for patient care, quality assurance, research, etc. – Enhance ability to transfer data among applications, allowing better system integration
  3. 3. Benefits and limitations of standardsBenefits – Interoperability – May allow innovation based on common foundationLimitations – Dominance by one segment of industry: Microsoft “standards,” e.g., Windows, Office, etc. – May stifle innovation
  4. 4. The standards development process• Groups agree to informal specifications• Single vendor controls industry• Government agency creates standard and mandates its use.• Interested parties work in open process
  5. 5. International standards bodies• International Organization for Standardization (ISO)• ADA Standards Committee on Dental Informatics (ADA SCDI) ards/informatics_reports.asp#a1031
  6. 6. Medical informatics standards1. Identifiers2. Transactions3. Message exchange4. Terminology
  7. 7. 1. Identifiers• Various approaches have been proposed for – Patients – Providers – Employers – Health Plans
  8. 8. Patient identifiers• Unique – only one person has a particular identifier• Non-disclosing – discloses no personal information• Permanent – will never be re-used• Ubiquitous – everyone has one• Canonical – each person has only one• Invariable – will not change over time
  9. 9. Patient identifiersBenefits – Easy linkage of records – Facilitate health information exchange – Reduce errors and costs arising from duplicate records – Medical record identifier errors compromise quality of care and can be costly – Cost increases with length of time error not identifiedRisks – Easy linkage of records – Potentially compromise privacy and confidentiality
  10. 10. 2. Transactions• Transaction standards are designed to encourage electronic commerce for health claims.• HIPAA (Health Insurance and privacy act) mandates use of these standards for health care business electronic data exchange “Administrative simplification”
  11. 11. Transactions standards cover – Health claims and equivalent encounter information – Enrollment and disenrollment in a health plan – Eligibility for a health plan – Health care payment and remittance advice – Health plan premium payments – Health claim status – Referral certification and authorization – Coordination of benefits
  12. 12. 3. Message exchange standardsAllow data and application interoperability• Major standards include – Health Level 7 (HL7) – Digital Imaging and Communications (DICOM) – IEEE – NCPDP and SCRIPT – ELINCS – Continuity of Care Record (CCR)
  13. 13. 4. Terminology standards Benefits of computerization of clinical information depends upon its “normalization”• Clinical language is inherently vague, which is at odds with the precision of computers• Computers have no intelligence• Computers can only do what programmers and users tell them to do• Computers process numbers and symbols very fast and accurately• Computers have extraordinarily great memory• It is up to humans to define the meaning or semantics of information represented in a compute
  14. 14. Standardized terminology• Information capture – documenting findings, conditions, and outcomes• Communication – transferring information• Knowledge organization – classification of diseases, treatments, etc.• Information retrieval – accessing knowledge based information• Decision support – implementing decision support rules
  16. 16. Personal privacy vs. the common good• Personal privacy is important.• Common good of society is more important. Where do your views fit?
  17. 17. • Privacy – right to keep things to yourself• Confidentiality – right to keep things about you from being disclosed to others• Security – protection of your personal information
  18. 18. Security Issues• Who owns information?• How is informed consent implemented?• When does public good exceed personal privacy?• What conflicts are there with business interests?
  19. 19. Problems of Poor security• Patients avoid health care• Patients lie• Providers avoid entering sensitive data• Providers devise work-arounds• Disclosure problems continue
  20. 20. Security for paper records• Difficult to audit trail of paper chart• Fax machines are easily accessible• Records frequently copied for many reasons – New providers, insurance purposes• Records abstracted for variety of purposes – Research – Quality assurance – Insurance
  21. 21. Technologies to secureinformationDeterrents Obstacles – Alerts – Authentication – Audit trails – AuthorizationSystem management – Integrity precautions management – Software – Digital signatures management – Encryption – Analysis of – Firewalls vulnerability – Rights management
  22. 22. Protected health information (PHI)• Name • Social security number• Address (street address, city, • Internet protocol (IP) addresscounty, zip code) • Any vehicle or device serial• Names of relatives number• Names of employers • Medical record number• E-mail address • Health plan beneficiary• Fax number number• Telephone number • Account number• Birth date • Certificate/license number• Finger or voice prints • Web URL• Photographic images • Any other unique identifying number, characteristic, or code
  23. 23. Costs of Informatics• Health IT costs and return on investment (ROI) – “What do I get back („return‟) for the money Im being asked to spend („investment‟)?”• Cost-benefit defined – “Ratio of money value of benefit divided by cost”• Cost-benefit in the outpatient setting – Increased time for first 4 months but thereafter saved time that was either spent seeing more patients or reducing work hours – Only a few practices implemented comprehensive quality improvement efforts, usually when insurers paid explicitly for it – System payback achieved at average of 2.5 years. – Factors associated with success included • Near complete use of system functions • Having local EHR champion and supportive practice culture
  24. 24. • Cost-benefit in integrated delivery setting – Laboratory and radiology order entry • Reduction of time spent processing orders – Pharmacy order entry • Reduced adverse drug events • Improved cost savings through better formulary compliance – Documentation • Reduction in cost due to use of structured documentation in outpatient setting
  25. 25. • Overcoming the economic obstacles – Centrally funded. – Grants – Financial incentives – Tie into quality of care initiatives
  26. 26. This weeks assignments1. View this lecture online for review.2. Read article: How to write a term paper3. Participate in discussion: Personal privacy vs Common good of society- which is more important. View Read Discuss
  27. 27. • Thank you – Dr Ebtissam Al-Madi –
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