Handbook of Informatics for Nurses & Healthcare Professionals                                          Fifth Edition      ...
Learning Outcomes1. Recognize the importance of system   integration and interoperability for   healthcare delivery.2. Exp...
Learning Outcomes4. Discuss the relevance to system   integration efforts of the data   dictionary, master patient index, ...
Learning Outcomes6. Review the benefits of successful   information system integration for   healthcare providers and heal...
Learning Outcomes8. Understand how Web-based tools can   provide an alternative method for   obtaining patient information...
System Integration• Health and financial data are collected  at multiple points within the healthcare  delivery system.• R...
System Integration• Process by which different information  systems are able to exchange data in a  fashion that is seamle...
Interface• Software that tells different systems  “how” to exchange data• Point-to-point: Directly connects 2  systems  – ...
Interface Engine• Allows data exchange between sending  and receiving systems• Uses translation tables to move data  from ...
Clinical Data Repository• Provides data definition consistency  through mapping• May also be referred to as the clinical  ...
Real-Time vs. Batch Processing• Real-time processing occurs  immediately or almost immediately;  used when speed is import...
Interoperability• Ability of two entities to exchange and  predictably use data or information  while retaining the origin...
Types of Interoperability• Syntactic (functional)—ability to  exchange the structure of the data, but  not the meaning• Se...
Interoperability Efforts• Health Level Seven (HL7) Clinical  Document Architecture (CDA)• European Committee for  Standard...
Integration Issues•   Massive undertaking•   Vendors failure to deliver on promises•   Lack of agreement on standards•   P...
NHIN• National Healthcare Information  Network (NHIN) proposed as a means  to advance healthcare information  technology a...
Status of the NHIN• No nationwide health information now  exists.• There is some limited data exchange  within smaller geo...
Benefits of Interoperability• Improved access to information• Improved physician workflow,  productivity, and patient care...
Drivers•   Consumer demands for improved care•   Demands from managed care•   The move toward the EHR•   Improved trending...
Integration Requirements• May require enhancements to  – Data dictionary—defines terminology to    ensure consistent under...
Uniform Language• Provides uniform definition of terms• Facilitates communication and ability to  exchange data with a sha...
Uniform Language Efforts• Unified Medical Language System  (UMLS)  – Uniform Nursing Language• Congress of Nursing Practic...
Data Exchange Standards• HL7  – Health Level 7  – Major standard for the exchange of    clinical data• DICOMM  – Digital I...
Role of the Nurse• Must be involved in:  – Identifying and defining data elements    that an interface can supply  – Deter...
Web Tools• Web applications have been used to  present data from different systems in  an easy-to-use format.     Handbook...
Emerging Solutions• Refined data exchange standards• National priorities set• Work has started on building the  framework ...
Future Directions• Improved technical standards eliminate  some of the obstacles.• A large financial investment is require...
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Issues and Trends in HBI Ch13 pp

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Issues and Trends in HBI Ch13 pp

  1. 1. Handbook of Informatics for Nurses & Healthcare Professionals Fifth Edition CHAPTER 13 System Integration and Interoperability Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  2. 2. Learning Outcomes1. Recognize the importance of system integration and interoperability for healthcare delivery.2. Explain what an interface engine is and how it works.3. Identify several integration issues, including factors that impede the process. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  3. 3. Learning Outcomes4. Discuss the relevance to system integration efforts of the data dictionary, master patient index, uniform language efforts, and clinical data repository.5. Consider how standards for the exchange of clinical data affect integration efforts. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  4. 4. Learning Outcomes6. Review the benefits of successful information system integration for healthcare providers and healthcare professionals.7. Define the role of the nurse in system integration efforts. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  5. 5. Learning Outcomes8. Understand how Web-based tools can provide an alternative method for obtaining patient information from diverse information systems. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  6. 6. System Integration• Health and financial data are collected at multiple points within the healthcare delivery system.• Redundant efforts are expensive, frustrating, waste time, and result in different “versions” with none being complete or error free. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  7. 7. System Integration• Process by which different information systems are able to exchange data in a fashion that is seamless to the end user• This exchange occurs across an “interface” Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  8. 8. Interface• Software that tells different systems “how” to exchange data• Point-to-point: Directly connects 2 systems – Requires custom programming – Expensive• Interface engine: Allows data exchange between sending and receiving systems Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  9. 9. Interface Engine• Allows data exchange between sending and receiving systems• Uses translation tables to move data from each system to the clinical data repository, a database where collective data from all information systems are stored and managed Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  10. 10. Clinical Data Repository• Provides data definition consistency through mapping• May also be referred to as the clinical data warehouse (CDW)• Mapping—terms defined in one system are associated with comparable terms in another system Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  11. 11. Real-Time vs. Batch Processing• Real-time processing occurs immediately or almost immediately; used when speed is important.• Batch processing usually occurs once daily at the end of the day (traditionally when there are fewer demands on the processor). Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  12. 12. Interoperability• Ability of two entities to exchange and predictably use data or information while retaining the original meaning of data• Used interchangeably with term “interface” but interface engine routes information from system to system without enabling understanding/use Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  13. 13. Types of Interoperability• Syntactic (functional)—ability to exchange the structure of the data, but not the meaning• Semantic—guarantees meaning of the exchanged data on both ends of the transaction – Critical for clinical data Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  14. 14. Interoperability Efforts• Health Level Seven (HL7) Clinical Document Architecture (CDA)• European Committee for Standardization (CEN) EN 13606-1 (EHRcom)• OpenEHR• Service-oriented architecture (SOA) Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  15. 15. Integration Issues• Massive undertaking• Vendors failure to deliver on promises• Lack of agreement on standards• Politics and power – Lack of agreement on data dictionary, data mapping, and clinical data repository – Fear of change – Competition Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  16. 16. NHIN• National Healthcare Information Network (NHIN) proposed as a means to advance healthcare information technology and realize the benefits that HIT.• 2004 directive by President Bush for interoperable electronic health records by 2014 Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  17. 17. Status of the NHIN• No nationwide health information now exists.• There is some limited data exchange within smaller geographic regions.• There is no single exchange standard at present that provides complete interoperability. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  18. 18. Benefits of Interoperability• Improved access to information• Improved physician workflow, productivity, and patient care• Improved safety• Fully standardized healthcare information exchange• Estimated savings = 5% annual U.S. healthcare expenditures Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  19. 19. Drivers• Consumer demands for improved care• Demands from managed care• The move toward the EHR• Improved trending• Easier data collection for accreditation purposes, research Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  20. 20. Integration Requirements• May require enhancements to – Data dictionary—defines terminology to ensure consistent understanding and use – Master patient index (MPI)—database that lists all identifiers assigned to a client in all the information systems within an enterprise – Clinical data repository Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  21. 21. Uniform Language• Provides uniform definition of terms• Facilitates communication and ability to exchange data with a shared meaning• Facilitates ability to replicate research Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  22. 22. Uniform Language Efforts• Unified Medical Language System (UMLS) – Uniform Nursing Language• Congress of Nursing Practice Steering Committee on Databases – NANDA, NIC, NOC, ICNP• Systemized Nomenclature of Human and Veterinary Medicine Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  23. 23. Data Exchange Standards• HL7 – Health Level 7 – Major standard for the exchange of clinical data• DICOMM – Digital Imaging and Communications In Medicine – Production, display, storage, retrieval, and printing of medical images Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  24. 24. Role of the Nurse• Must be involved in: – Identifying and defining data elements that an interface can supply – Determining measures to ensure the quality of data exchanged among individual systems – Formation and maintenance of the electronic health record Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  25. 25. Web Tools• Web applications have been used to present data from different systems in an easy-to-use format. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  26. 26. Emerging Solutions• Refined data exchange standards• National priorities set• Work has started on building the framework Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar
  27. 27. Future Directions• Improved technical standards eliminate some of the obstacles.• A large financial investment is required to achieve interoperability before the promised return on investment can begin to be realized. Handbook of Informatics for Nurses & Healthcare Professionals, Fifth Edition Toni Hebda • Patricia Czar

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