Medical Information Structuring: Analysing and Designing Structure of healthcare information systems, Architectures of Information Systems.

1. Health
Informatics
BCA-2020: Semester-V

2. Module 2:
Chapter 2
INFORMATION SYSTEM
ACQUISITION &
LIFECYCLE
MEDICAL INFORMATION
STRUCTURING
SEARCHING AND
RETRIEVAL

3. Module
Content
 Information System Acquisition & Lifecycle: system acquisition
process, phases: Initiation, Planning, Procurement, System
Development, System Implementation, Maintenance &
Operations, and Closeout. development models.
 Medical Information Structuring: Analysing and Designing
Structure of healthcare information systems, Architectures of
Information Systems.
 Searching and Retrieval: locate or retrieve specific information to
meet an information need, information retrieval techniques.

4. LearningObjectives
 To learn System Analysis and Design (Health
Informatics)
 Different Architectures of Information Systems

5. Potential
Problem

6. Systems(softw
are)
Development
LifeCycle
(SDLC)

7. Systems(softw
are)
Development
LifeCycle
(SDLC)

8. SYSTEMS(SO
FTWARE)
DEVELOPME
NT LIFE
CYCLE (SDLC)

9. System
Analysis and
Design (Health
Informatics)
 System Analysis and Design (SAD), deals with the software development
activities. In business, System Analysis and Design refers to the process
of examining a business situation with the intent of improving it through
better procedures and methods.
 System Analysis and Design (SAD) Systems Analysis and Design (SAD) is
a broad term for describing methodologies for developing high quality
Information System which combines InformationTechnology, People
and Data to support business requirement.
 Definition: SAD is the complex organizational process whereby
computer-based information systems are developed and maintained.
 A method of studying a system by examining its component parts and
their interactions. - Understanding and specifying in detail what an
information system should do. -The major objectives of systems analysis
are to find answers for each business process:What is being done, How is
it being done,Who is doing it,When is he doing it,Why is it being done
and How can it be improved? - It attempts to give birth to a new efficient
system that satisfies the current needs of the user and has scope for
future growth. System Analysis

10. Structure of
healthcare
information
systems

11. Architectures
of Information
Systems
 1. FUNCTIONAL REQUIREMENTS
 The system architecture is designed to support all HIS applications
discussed earlier and achieve the following objectives:
 Allow data communications between all applications and users of
the entire system.
 Ensure quick response to requests and completion of transactions
(fast system performance)
 Ensure business continuity (almost 100% up-time through sufficient
redundancy and system back-up)
 Fully recovery from a disaster (system may be re-built from back-up
of data, system configuration and restoration of applications)
 Storage capacity capable of containing migrated previous data and
new data for the next 5 years.
 Scalability server-storage system hardware that is vendor
independent

12. Architectures
of Information
Systems
 2. ARCHITECTURE DESIGN: COMPONENTS
 The information system for a single hospital is best built around a Multi-tiered
Client-Server Local Area Network (LAN) architecture. By this, it is meant that users
enter and retrieve data using clients i.e. computers with display monitors and data
input devices such as keyboard and mouse, obtain various applications software
from the Application server and store the data via the Storage server into Storage
devices (hard disks). All the tiers are linked through a network consisting of cables
joined by switches and routers. Part of the network can also be wireless.
 A sufficiently fast processor
 Sufficient ready access memory (RAM) to retain data temporarily
while being viewed or entered
 A display monitor for viewing both applications and data.
 Data input tools such keyboard, bar-code reader and image
scanners and pointing devices e.g. mouse
 A front end Operating system (OS) that allow all the above hardware
to function and to facilitate interaction with the server
 Video/graphic cards for locations where complex images are used

13. Architecture of
Health IT
 Health IT consists of a complex set of technologies, policies, standards, and
user sets.The text and diagram is intended to help put some of the
"buzzwords" into perspective.
 A general framework for understanding the levels of health IT from a technical
perspective is as follows:
 Application Level
 Computerized Provider Order Entry (CPOE), Clinical Decision Support
(CDS), Electronic Prescribing (e-prescribing), Electronic Medication
Administration Records (eMAR), Results Reporting, Electronic
Documentation, Interface Engines, and so on
 Communication Level
 Messaging Standards
HL7, ADT, NCPDP, X12, DICOM, ASTM, and so on
 Coding Standards
LOINC, ICD-9, CPT, NDC, RxNorm, SNOMED CT, and so on
 Process Level
 Health Information Exchange (HIE), Master Patient Index (MPI), HIPAA
Security/Privacy, and so on
 Device Level
 Tablet PCs, Application Service Provider (ASP) models, Personal Digital Assistants
(PDAs), Bar Coding, and so on

14. Architecture of
Health IT
 The various health IT Applications include the following:
 Computerized Provider Order Entry (CPOE)
 Clinical Decision Support (CDS)
 Electronic Prescribing (e-prescribing)
 Electronic Medication Administration Record (eMAR)
 Results Reporting
 Clinical Documentation
 Interface Engines
 These are the applications (that run stand-alone or as modules) on the
client or server devices.
 One flow of data within health care organizations begins with multiple
specialized systems that efficiently collect and store specific data
within hospital information systems. For instance, a patient may have
blood drawn and analyzed by the hospital laboratory. Specialized
laboratory information systems have been developed to collect all the
data about processed specimens. Similar systems have been
developed for radiology, billing, pharmacy, and other services. These
hospital information systems are designed to serve narrow functions
with great efficiency, but this situation results in multiple silos of
information.

15. Coding
Standards
 The LogicalObservation Identifier Names and Codes (LOINC)
database provides a universal code system for reporting
laboratory and other clinical observations.
 Its purpose is to identify observations in electronic messages, so
that when hospitals, health maintenance organizations,
pharmaceutical manufacturers, researchers, and public health
departments receive such messages from multiple sources, they
can automatically file the results in the right slots of their medical
records, research, and/or public health systems.
 For each observation, the database includes a code (of which
25,000 are laboratory test observations), a long formal name, a
"short" 30-character name, and synonyms. LOINC codes are being
used by large reference laboratories and federal agencies, and are
part of the Health Insurance Portability andAccountabilityAct
(HIPAA) attachment proposal.
 Laboratories should include LOINC codes in their system
messages so that clinical and research clients can easily integrate
these results into their clinical and research repositories.

16. Coding
Standards
 The International Classification of Diseases (ICD) is an international
standard for classifying diseases and other health problems (clinical
diagnoses).
 It is used for all general epidemiological and many health
management purposes.These uses include the analysis of the general
health situation of population groups and monitoring of the incidence
and prevalence of diseases and other health problems in relation to
other variables, such as the characteristics and circumstances of the
individuals affected.
 TheWorld Health Organization (WHO) is responsible for the
continued maintenance and development of the ICD standard.
 ICD-10-CM will include the addition of the following:
 Information relevant to ambulatory and managed care encounters.
 Expanded injury codes.
 Combination diagnosis/symptom codes to reduce the number of codes
needed to fully describe a condition.
 Sixth and seventh characters.
 Common fourth and fifth digit subclassifications, laterality, and greater
specificity in code assignment.

17. Coding
Standards
 Current ProceduralTerminology (CPT) is a vocabulary used to describe
common procedures performed by medical professionals.The CPT
standard consists of three categories:
 Category I - codes that describe common medical, surgical, radiology,
laboratory, anesthesiology, and evaluation/management services of
physicians, hospitals, and other health care providers.
 Category II - codes that describe performance measurement variables
designed to facilitate data collection about the quality of care rendered.
 Category III - temporary codes that describe emerging technology,
services, and procedures.
 CPT codes are used in electronic transaction messages and electronic
medical records (EMRs) to accurately identify the procedures
performed during a clinical encounter.The American Medical
Association (AMA) developed CPT in 1996 and is responsible for the
continued maintenance of the CPT standard.The 2007 version of CPT
contains 8,611 codes and descriptors.The standard is updated
annually. AMA provides several additional informational resources,
including the monthly newsletter CPT Assistant and an annual
publication called CPT Changes: An Insider'sView. For more
information, visit the AMA's CPTWeb site.The 2009 CPT became
available in October 2008.

18. Coding
Standards
 The National Drug Codes (NDCs) are standards for reporting drugs and
biological products. Originally established to serve as a critical part of an out-
of-hospital drug reimbursement program under Medicare, they are now
maintained by the Food and DrugAdministration (FDA) and are used for
many purposes, including reporting prescription drugs in pharmacy
transactions, coding drug information within clinical information systems and
for prescription drug claims processing. NDC numbers are also reported in the
Physicians Desk Reference(PDR).The Drug Listing Act of 1972 requires that all
drug-producing establishments report to the FDA all drugs "manufactured,
prepared, propagated, compounded, or processed by it for commercial
distribution." Only selected non-prescription drugs are included in the NDC
database.
 NDCs consist of a 10-digit number broken into three segments:
 The labeler code - identifies the firm that produces, repackages, or
distributes the drug
 The product code - identifies the strength, dosage form, and formulation
of the particular drug
 The trade package size - identifies the size and type of the packaging in
which the drug is sold or distributed
 An NDC will take one of three possible configurations: 4-4-2, 5-3-2, or 5-4-1.
The product and package codes are assigned by the manufacturer. In some
places, an asterisk may appear as a placeholder. HIPAA transactions require an
11-digit NDC, so a leading 0 may be placed in those circumstances.

19. ThankYou!