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Curs EHR


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Course for the first year students on medical informatics

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Curs EHR

  1. 1. MEDICAL INFORMATION SYSTEMS Electronic Healthcare Record
  2. 2. 1. MEDICAL INFORMATION <ul><li>1.1. TYPES OF ACTIVITY </li></ul><ul><ul><li>a. MEDICAL ACTIVITIES (CONSULTATIONS, VISITS) </li></ul></ul><ul><ul><li>Different approaches: </li></ul></ul><ul><ul><ul><li>Time oriented </li></ul></ul></ul><ul><ul><ul><li>Patient oriented </li></ul></ul></ul><ul><ul><ul><li>Problems oriented ( S imptoms, O bjective, A ssesment, P lans - SOAP) </li></ul></ul></ul><ul><ul><li>Steps: </li></ul></ul><ul><ul><ul><li>DIAGNOSING </li></ul></ul></ul><ul><ul><ul><ul><li>DATA - MEDICAL OBSERVATION, INVESTIGATIONS </li></ul></ul></ul></ul><ul><ul><ul><ul><li>KNOWLEDGE - EDUCATION, ETC </li></ul></ul></ul></ul><ul><ul><ul><li>THERAPY / FOLLOW-UP </li></ul></ul></ul><ul><ul><ul><li>NURSING </li></ul></ul></ul>
  3. 3. <ul><li>b. LOGISTIC SUPPORTT </li></ul><ul><ul><li>ADMINISTRATION </li></ul></ul><ul><ul><li>ACCOUNTING </li></ul></ul><ul><li>c. SOCIAL CONTEXT FRAME </li></ul><ul><ul><li>MEDICAL DATA CENTRALISATION </li></ul></ul><ul><li>d. MEDICAL EDUCATION (CME) </li></ul><ul><ul><li>STAFF </li></ul></ul><ul><ul><li>PATIENTS </li></ul></ul><ul><li>e. MEDICAL DOCUMENTATION </li></ul><ul><li>f. MEDICAL RESEARCH </li></ul>1. MEDICAL INFORMATION
  5. 5. “ Allied” Professionals in Healthcare
  6. 6. <ul><ul><ul><li>PRIMARY CARE </li></ul></ul></ul><ul><ul><ul><li>SECONDARY (SPECIALISED) CARE </li></ul></ul></ul><ul><ul><ul><li>HOSPITAL - HEALTHCARE UNITS </li></ul></ul></ul><ul><ul><ul><li>CENTRAL LEVELS : </li></ul></ul></ul><ul><ul><ul><ul><li>COUNTY HEALTH DEPARTMENTS </li></ul></ul></ul></ul><ul><ul><ul><ul><li>NATIONAL LEVEL: HEALTH MINISTERY </li></ul></ul></ul></ul><ul><ul><ul><ul><li>INTERNATIONAL BODIES: WHO </li></ul></ul></ul></ul>1.3. Medical activities organisational levels
  7. 7. 1.4. DEFINITIONS <ul><ul><li>a. INFORMATIONAL SYSTEM = ensemble of structural units exchanging information between them </li></ul></ul><ul><ul><li>b. INFORMATION SYSTEM = that part of the informational system which comprises computer use </li></ul></ul>
  8. 8. Fluxul de informaţii în cadrul Sistemului Naţional Informaţional din Sănătate
  9. 9. Terminology <ul><li>CPR (computer-based patient record) </li></ul><ul><li>PCR (patient-carried record) </li></ul><ul><li>CMR (computerized medical record) </li></ul><ul><li>EMR (electronic medical record) </li></ul><ul><li>EPR (electronic patient record) </li></ul><ul><li>EHR (electronic healthcare record) </li></ul>
  10. 10. Integrated Care EHR <ul><li>ISO/DTR 20514 : </li></ul><ul><li>a repository of information regarding the health of a subject of care in computer processable form, stored and transmitted securely , and accessible by multiple authorised users . </li></ul><ul><li>It has a commonly agreed logical information model which is independent of EHR systems. </li></ul><ul><li>Its primary purpose is the support of continuing, efficient and quality integrated health care and it contains information which is retrospective, concurrent and prospective. </li></ul>
  11. 11. Challenges facing today’s health record systems <ul><li>The need to record more data </li></ul><ul><li>The need to analyse more data </li></ul><ul><li>The need to share more data </li></ul>
  12. 12. <ul><li>University Hospital of Heidelberg: </li></ul><ul><li>400000 new medical records per year </li></ul><ul><li>6.3 million pages </li></ul><ul><li>1,7 km of storage </li></ul><ul><li>250000 reports generated </li></ul>
  13. 13. <ul><li>to observe trends and patterns within the historical record of one patient </li></ul><ul><li>to enable the use of clinical guidelines and decision support tools: evidence based health care </li></ul><ul><li>to perform clinical audit </li></ul><ul><li>to inform management and commissioning decisions </li></ul><ul><li>to support epidemiology, research and teaching </li></ul>The need to analyse more data
  14. 14. Share more healthcare data <ul><li>with other clinicians in the same team </li></ul><ul><ul><li>clinical firms, practice partnerships or nursing shifts </li></ul></ul><ul><li>with other healthcare professions </li></ul><ul><ul><li>doctors, nurses, physiotherapists, midwives, dieticians... </li></ul></ul><ul><li>with other disciplines </li></ul><ul><ul><li>a diabetic patient may also be under: ophthalmology, nephrology, orthopaedics, chiropody, wheelchair clinic.. </li></ul></ul><ul><li>with other institutions </li></ul><ul><li>with patients and their families </li></ul>
  15. 15. The mains advantages of EHR <ul><li>Reducing the storing space of the medical data </li></ul><ul><li>Facilitate researches activities </li></ul><ul><li>Standardized environment for medical data evidence, based on efficient Database Management Systems </li></ul><ul><li>Great level of data integration between different segments of information healthcare systems. </li></ul><ul><li>Increasing the quality of healthcare by the informational support provided to local and central administrative structures. </li></ul>
  16. 16. EHR adoption barriers <ul><li>Technical limitation for assuring the security, integrity and accesibility of stored data </li></ul><ul><li>Concerning about the records ownership </li></ul><ul><li>Big initial costs for implementation </li></ul><ul><li>The lack of operate abilities and trust in computerized systems from the medical stuff and the resistance to change </li></ul><ul><li>Low diversity of the quality EHR systems </li></ul><ul><li>Lack of universal recognized quality standards and adequate legal framework </li></ul>
  17. 17. Core Functionalities for an Electronic Health Record System <ul><li>Repository of health related data </li></ul><ul><li>Health information and data management </li></ul><ul><li>Results management </li></ul><ul><li>Order entry/management </li></ul><ul><li>Decision support management </li></ul><ul><li>Electronic communication and connectivity </li></ul><ul><li>Patient support </li></ul><ul><li>Reporting and Population Health Management </li></ul><ul><li>Administrative processes </li></ul>
  18. 18. EHR ARHITECTURE <ul><li>Object oriented, relational DBMS </li></ul><ul><li>Interoperability - transport of information over: </li></ul><ul><ul><li>Time </li></ul></ul><ul><ul><li>Space </li></ul></ul><ul><ul><li>Context, Communities, and Cultures </li></ul></ul>
  19. 20. <ul><li>Logical building blocks of the EHR: </li></ul><ul><li>FOLDER </li></ul><ul><li>COMPOSITION </li></ul><ul><ul><li>Tranzactional unit </li></ul></ul><ul><ul><li>Contribution – all compositions created/modified during a session </li></ul></ul><ul><li>HEADED SECTIONS - data segments for navigation purposes </li></ul><ul><li>ITEM – single clinical &quot;statement&quot; </li></ul>
  20. 22. The Record attributes <ul><li>Pacient identification </li></ul><ul><li>Medical stuff identification </li></ul><ul><li>Utilized standards identification </li></ul><ul><li>The Name of the parameter measured/observed </li></ul><ul><li>The value of the parameter </li></ul><ul><ul><li>[measure unit] </li></ul></ul><ul><ul><li>value [measured] </li></ul></ul><ul><ul><li>[normal value] </li></ul></ul><ul><li>data / time stamp </li></ul><ul><li>Observation circumstances </li></ul>
  21. 23. The “Core” EHR <ul><li>Key characteristics: </li></ul><ul><li>Concerns a single subject of care </li></ul><ul><li>Primary purpose is the support of present and future healthcare of the subject </li></ul><ul><li>Principally concerned with clinical information </li></ul><ul><li>Simplifies standardization of the EHR </li></ul><ul><ul><li>has a clear, limited scope enabling a manageable set of requirements to be specified and a manageable standardized model to be defined </li></ul></ul><ul><li>Fits more closely with the distributed systems or “system-of-systems” paradigm </li></ul><ul><ul><li>Allows more modular health information systems to be built </li></ul></ul>
  22. 24. The “Extended EHR” <ul><li>Includes not only clinical information but essentially the whole health information landscape . </li></ul><ul><li>It is a superset of the Core EHR </li></ul><ul><li>Extended EHR functions beyond the scope of the Core EHR include: </li></ul><ul><ul><li>Patient administration </li></ul></ul><ul><ul><li>Scheduling and resource allocation </li></ul></ul><ul><ul><li>Billing </li></ul></ul><ul><ul><li>Decision support </li></ul></ul><ul><ul><li>Access control and policy management </li></ul></ul><ul><ul><li>Demographics </li></ul></ul><ul><ul><li>Order management </li></ul></ul><ul><ul><li>Population health recording, querying, and analysis </li></ul></ul><ul><ul><li>Health professional recording, querying, and analysis </li></ul></ul><ul><ul><li>Business operations recording, querying, and analysis </li></ul></ul>
  23. 25. User view: functional grouping of data <ul><li>Demographic and general data </li></ul><ul><ul><li>Name, gender, date of birth, picture .. </li></ul></ul><ul><ul><li>Residence and contact data </li></ul></ul><ul><ul><li>Current job, education </li></ul></ul><ul><ul><li>Insurance condition </li></ul></ul><ul><li>Alerts – allergies, special conditions (pregnancies) </li></ul><ul><li>Current medication </li></ul><ul><li>Vaccines </li></ul><ul><li>Consultations </li></ul><ul><ul><li>SOAP </li></ul></ul><ul><ul><li>Schedule </li></ul></ul><ul><li>Surgical interventions </li></ul><ul><li>Reports </li></ul><ul><li>Healthcare costs </li></ul>
  24. 27. Standard definition <ul><ul><li>ISO/IEC defines a standard as a document, established by consensus and approved by a recognized body, that provides, for common and repeated use, rules, guidelines or characteristics for activities or their results, aimed at the achievement of the optimum degree of order in a given context </li></ul></ul>
  25. 28. STANDARDS <ul><ul><li>S tandard Attributes (SMART): </li></ul></ul><ul><ul><li>S = specific </li></ul></ul><ul><ul><li>M = measurable </li></ul></ul><ul><ul><li>A = acceptable </li></ul></ul><ul><ul><li>R = realistic </li></ul></ul><ul><ul><li>T = time related </li></ul></ul><ul><ul><li>Standard Organizations </li></ul></ul><ul><ul><li>ASRO – Romanian Association for Standardisation (TC 319) </li></ul></ul><ul><ul><li>CEN - Comité Européen de Normalisation </li></ul></ul><ul><ul><li>CEN/TC251 – Medical informatics Technical Committee </li></ul></ul><ul><ul><li>ANSI - American National Standards Institute </li></ul></ul><ul><ul><li>ISO - International Organization for Standardization . </li></ul></ul>
  26. 29. Standard Organizations ASRO
  27. 30. <ul><li>ISO DTR 20514 - EHR definition and scope </li></ul><ul><li>ISO TS 18308 - EHR Requirements </li></ul><ul><li>CEN TS 14796 - Data Types </li></ul><ul><li>CEN/TC 251 EN 13606 - EHR Communications </li></ul><ul><li>HL7 - EHR Functional Specification </li></ul><ul><li>HL7 - Templates specification </li></ul><ul><li>HL7 - Clinical Document Architecture </li></ul><ul><li>DICOM – Digital Imaging and Communications in Medicine </li></ul><ul><li>EDIFACT , XML – Messaging standards </li></ul>
  28. 31. <ul><li>DATA PROTECTION </li></ul><ul><ul><li>a) CONFIDENTIALITY - limited, leveled accessibility </li></ul></ul><ul><ul><li>b) PROTECTION - against accidental deterioration / access / loss </li></ul></ul><ul><ul><li>c) SECURITY - intended d/a </li></ul></ul>
  29. 32. EHR exemples <ul><li>OfficeMed ver 1.60 </li></ul><ul><ul><li>Integrated system for family physicians (GP) </li></ul></ul><ul><ul><ul><li>Conform to CoCa 2003 </li></ul></ul></ul><ul><ul><ul><li>FoxPro / MSDOS </li></ul></ul></ul><ul><ul><ul><li>“ Programul este agreat de Direcţia de  sănătate publică Bistriţa Năsăud” </li></ul></ul></ul><ul><li>Medins </li></ul><ul><ul><li>GP </li></ul></ul><ul><ul><li>MEDINET </li></ul></ul>
  30. 33. INFO WORLD <ul><li>“ ... soluţiile oferite au fost dezvoltate conform celor mai noi standarde în domeniu, precum HL7 şi DICOM ” </li></ul><ul><li>Hospital Manager Suite </li></ul><ul><li>CabiMed – GP </li></ul><ul><li>Cabinet Manager – ambulatory healthcare system . </li></ul><ul><li>ePractice – EPR system </li></ul>