This document discusses health information technology (IT) in hospital settings. It describes the roles of hospitals, different types and levels of hospitals, and why the context of each hospital is important for IT decision making. The document also outlines some key considerations for successful IT implementation in hospitals, such as system quality, information quality, use, user satisfaction, and individual and organizational impacts. Examples of important hospital IT include infrastructure systems, clinical systems like electronic health records and computerized physician order entry, and decision support systems. Challenges of implementation are also discussed.
Presented at the 9th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on March 4, 2019
A presentation in March 2012 presented at the Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. Presentation partly in English and partly in Thai.
HIS was introduced to solve the complications coming from managing all the paper works of every patient associated with the various departments of hospitalization with confidentiality. HIS provides the ability to manage all the paperwork in one place, reducing the work of staff in arranging and analyzing the paperwork of the patients.
This is a simple presentation about Hospital Information System. The following are the contents.
1) What is Hospital Information System?
2) Problems associated with traditional paper based systems.
3) Purpose of Hospital Management System
4) Functions
5) How it works?
6) System Requirements
7) Advantages
This is my first upload, hope you like it.
Presented at the 9th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on March 4, 2019
A presentation in March 2012 presented at the Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. Presentation partly in English and partly in Thai.
HIS was introduced to solve the complications coming from managing all the paper works of every patient associated with the various departments of hospitalization with confidentiality. HIS provides the ability to manage all the paperwork in one place, reducing the work of staff in arranging and analyzing the paperwork of the patients.
This is a simple presentation about Hospital Information System. The following are the contents.
1) What is Hospital Information System?
2) Problems associated with traditional paper based systems.
3) Purpose of Hospital Management System
4) Functions
5) How it works?
6) System Requirements
7) Advantages
This is my first upload, hope you like it.
CARESOFT an Information technology company offering Computer software, IT services and IT consulting to our clients worldwide.
Health Industry being our prime domain CARESOFT provides Intelligent Healthcare Solutions to healthcare Verticals such as Hospitals, Specialty Clinics, Nursing Homes , Diagnostic Centers and Research Care Institutes among others.
We have 8 + years of domain expertise in healthcare processes & software systems and a huge satisfied client base of 300 + Healthcare organizations who have benefited from our solutions.
SoftClinic Integrated Hospital Management System for Cardiology is worlds first comprehensive hospital information system designed for cardiology clinics. It covers all the requirements like HIS, EMR and PACS for the hospital
Cosmosoft Hospital management system is among the top web based HMS solution which is including more than 12 basic modules and web reporting for top management along with all the financial modules of Hospital management system, For more details visit our website www.cosmosoftsolution.com
You can view the demo of our Hospital management system, for demo plz send us your detail at marketing@cosmosoftsolution.com
Care EMR's Hospital Management Information System (HMIS) software will provide a secure, robust environment for transactions across all departments of the hospital and remote access of patient medical records for physicians and nurses.
Odoo OpenERP 7 Medical Healthcare and Hospital Management Systempragmatic123
We provide implementation service for Medical which is an open source, centralized Health and Hospital Information System that provides the following functionality :
1) Electronic Medical Record (EMR)
2) Hospital Information System (HIS)
3) Health Information System
EMR (Electronic Medical Record) is computerized legal medical record created in an organization that delivers care such as Hospital or doctor’s clinic. EMR will provide to improve the quality of life by reducing costs. The use of the system will help to centralize the medical information.
Pragmatic has launched another new and advanced Product in the field of Health-care Management . This Product comes with many features like
1) Patient Management with full patient details like General Information , Socio-Economic Details , Diet and exercise details etc
2) Appointment Management with Features like Confirmation of Appointment , Related Prescriptions , Pediatric Symptom Checklist.
3) Inpatient Management with features like Diet Details , Nutrition and care plan etc.
4) ICU with details like GCS , ECG , APACHE 2 score etc.
5) Roundings with options like Six P's , Vital signs , Respiratory Details etc
6) Patient Ambulatory Care informations.
7) Patient Laboratory test Management.
8) Newborn records with details like Neonatal signs and symptoms ,Neonatal Reflex check.
9) Pharmacy with related entries in Warehouse.
10) Pre - configured data according to ICD-10 Standard for Diseases , Medical procedures , Recreational drugs , Medical Specialties , Disease Categories etc.
11) Various Reports like appointments per doctor , appointments per month , Appointments per specialty.
ERP software for Doctor. Complete management software for hospital.Jyotindra Zaveri
View this slideshow to learn more about this affordable ERP software. Includes complete accounting module. Case paper management. Multi user, multiple location system. ERP is a fully comprehensive software for Doctors, Hospitals, and Clinics including prescription writing and storing, Electronic case papers records and medical practice management. ERP for Dr., focuses on helping the doctor and automating tasks. It is very simple to use, customizable to your workflow and suitable for both Specialists and General Practitioners.
A hospital is a complex health care unit where all department needs to function in synchronization to deliver timely and quality patient care. Traditional paper based medical records are bulky and harder to maintain.
CARESOFT an Information technology company offering Computer software, IT services and IT consulting to our clients worldwide.
Health Industry being our prime domain CARESOFT provides Intelligent Healthcare Solutions to healthcare Verticals such as Hospitals, Specialty Clinics, Nursing Homes , Diagnostic Centers and Research Care Institutes among others.
We have 8 + years of domain expertise in healthcare processes & software systems and a huge satisfied client base of 300 + Healthcare organizations who have benefited from our solutions.
SoftClinic Integrated Hospital Management System for Cardiology is worlds first comprehensive hospital information system designed for cardiology clinics. It covers all the requirements like HIS, EMR and PACS for the hospital
Cosmosoft Hospital management system is among the top web based HMS solution which is including more than 12 basic modules and web reporting for top management along with all the financial modules of Hospital management system, For more details visit our website www.cosmosoftsolution.com
You can view the demo of our Hospital management system, for demo plz send us your detail at marketing@cosmosoftsolution.com
Care EMR's Hospital Management Information System (HMIS) software will provide a secure, robust environment for transactions across all departments of the hospital and remote access of patient medical records for physicians and nurses.
Odoo OpenERP 7 Medical Healthcare and Hospital Management Systempragmatic123
We provide implementation service for Medical which is an open source, centralized Health and Hospital Information System that provides the following functionality :
1) Electronic Medical Record (EMR)
2) Hospital Information System (HIS)
3) Health Information System
EMR (Electronic Medical Record) is computerized legal medical record created in an organization that delivers care such as Hospital or doctor’s clinic. EMR will provide to improve the quality of life by reducing costs. The use of the system will help to centralize the medical information.
Pragmatic has launched another new and advanced Product in the field of Health-care Management . This Product comes with many features like
1) Patient Management with full patient details like General Information , Socio-Economic Details , Diet and exercise details etc
2) Appointment Management with Features like Confirmation of Appointment , Related Prescriptions , Pediatric Symptom Checklist.
3) Inpatient Management with features like Diet Details , Nutrition and care plan etc.
4) ICU with details like GCS , ECG , APACHE 2 score etc.
5) Roundings with options like Six P's , Vital signs , Respiratory Details etc
6) Patient Ambulatory Care informations.
7) Patient Laboratory test Management.
8) Newborn records with details like Neonatal signs and symptoms ,Neonatal Reflex check.
9) Pharmacy with related entries in Warehouse.
10) Pre - configured data according to ICD-10 Standard for Diseases , Medical procedures , Recreational drugs , Medical Specialties , Disease Categories etc.
11) Various Reports like appointments per doctor , appointments per month , Appointments per specialty.
ERP software for Doctor. Complete management software for hospital.Jyotindra Zaveri
View this slideshow to learn more about this affordable ERP software. Includes complete accounting module. Case paper management. Multi user, multiple location system. ERP is a fully comprehensive software for Doctors, Hospitals, and Clinics including prescription writing and storing, Electronic case papers records and medical practice management. ERP for Dr., focuses on helping the doctor and automating tasks. It is very simple to use, customizable to your workflow and suitable for both Specialists and General Practitioners.
A hospital is a complex health care unit where all department needs to function in synchronization to deliver timely and quality patient care. Traditional paper based medical records are bulky and harder to maintain.
Presented at the Thai Medical Informatics Association Annual Conference and The National Conference on Medical Informatics (TMI-NCMedInfo 2016) on November 25, 2016.
Presented at the Thai Medical Informatics Association Annual Conference and The National Conference on Medical Informatics (TMI-NCMedInfo 2016) on November 25, 2016.
Presented at the Health Informatics and Health Information Technology Course, Doctor of Philosophy and Master of Science Programs in Data Science for Health Care (International Program), Faculty of Medicine Ramathibodi Hospital, Mahidol University on October 10, 2017
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 12, 2020
Presented at the 11th Healthcare CIO Certificate Program, School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 16, 2021
Data Science for Healthcare Graduate Programs, Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 15, 2019
Clinical Information Systems and Electronic Health Records (October 18, 2021)Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on October 18, 2021
Presented at the 7th Healthcare CIO Program, Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand on July 8, 2016
Presented at the 8th Healthcare CIO Certificate Program, Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University on March 12, 2018
Introduction to Health Informatics and Health IT in Clinical Settings (Part 3...Nawanan Theera-Ampornpunt
Presented at the 10th Healthcare CIO Certificate Program, Ramathibodi School of Hospital Management, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on February 19, 2020
Presented at the BDMS Golden Jubilee Scientific Conference 2022 "BDMS Beyond 50 years: Looking towards the centennial," Bangkok Dusit Medical Services Public Company Limited (BDMS), Bangkok, Thailand on October 19, 2022
Presented at The Thai Medical Informatics Association Annual Conference and The National Conference on Medical Informatics (TMI-NCMedInfo) 2021, Bangkok, Thailand on November 26, 2021
Presented at the Master of Science Program in Medical Epidemiology and the Doctor of Philosophy Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 25, 2021
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 15, 2021
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...
Health IT in Hospital Settings
1. Health IT in Hospital Settings
Nawanan Theera-Ampornpunt, MD, PhD
Healthcare CIO Program, Ramathibodi Hospital Administration School
Aug. 10, 2012 SlideShare.net/Nawanan
Except where
citing other works
2. Health Care System
Home Emergency
Responders Hospital Nursing Home/
Long-Term Care
Facility
Ministry of
Public Health The Payers
Clinic/
Physician’s Office Pharmacy Community
Lab Health Center (PCU)
3. Hospital’s Roles
• Provider of Secondary & Tertiary Care
– Acute Care
– Chronic Care
– Emergency
• Facilitator of Primary Care
• Sometimes Teaching & Research
4. Levels of Hospitals
• Community Hospitals
• General/Provincial Hospitals
• Tertiary/Regional Hospitals
• University Medical Centers
• Specialty Hospitals
5. Types of Hospitals
• Public
• Private For-Profit
• Private Not-For-Profit
• Stand-Alone
• Part of Multi-Hospital System
• Teaching vs. Non-Teaching Hospitals
6. Why They Matter: The Importance of “Context”
• $$$ (Purchasing Power)
• Bureaucracies & regulations
• Organizational cultures & management styles
• Level of organizational/workflow complexity
• Facilities & level of information needs
• Service volume, resources, priorities
• Internal IT capabilities & environments
7. IT Decision Making in Hospitals: Key Points
• Depends on local context
• IT is not alone -> Business-IT alignment/integration
• “Know your organization”
• View IT as a tool for something else, not the
end goal by itself
• Focus on the real goals (what define “success”)
9. CLASS EXERCISE #3
Suggest 2-3 examples of “success”
of IT implementation in hospitals
for each of DeLone & McLean’s
Model (1992)
10. Success of IT Implementation
System Quality
• System performance (response time, reliability)
• Accuracy, error rate
• Flexibility
• Ease of use
• Accessibility
11. Success of IT Implementation
Information Quality
• Accuracy
• Currency, timeliness
• Reliability
• Completeness
• Relevance
• Usefulness
12. Success of IT Implementation
Use
• Subjective (e.g. asks a user “How often do you use the
system?”)
• Objective (e.g. number of orders done electronically)
User Satisfaction
• Satisfaction toward system/information
• Satisfaction toward use
13. Success of IT Implementation
Individual Impacts
• Efficiency/productivity of the user
• Quality of clinical operations/decision-making
Organizational Impacts
• Faster operations, cost & time savings
• Better quality of care, better aggregate outcomes
• Reputation, increased market share
• Increased service volume or patient retention
16. Examples of Hospital IT
Departmental Applications
• Pharmacy applications
• LIS, PACS, RIS
• Specialized applications (ER, OR, LR, Anesthesia,
Critical Care, Dietary Services, Blood Bank)
• Incident management & reporting system
• E-Learning
• Clinical research informatics
17. 4 Quadrants of Hospital IT
Strategic
Business
Intelligence HIE
PHRs
CDSS
Social
Media CPOE
Administrative Clinical
VMI EHRs
ERP PACS
LIS
ADT
Word
Processor MPI
Operational
22. Master Patient Index (MPI)
• A hospital’s list of all patients
• Functions
– Registration/identification of patients (HN/MRN)
– Captures/updates patient demographics
– Used in virtually all other hospital service applications
• Issues
– A large database
– Interface with other systems
– Duplicate resolutions
– Accuracy & currency of patient information
– Language issues
23. Admit-Discharge-Transfer (ADT)
• Functions
– Supports Admit, Discharge & Transfer of patients
(“patient management”)
– Provides status/location of admitted patients
– Used in assessing bed occupancy
– Linked to billing, claims & reimbursements
• Issues
– Accuracy & currency of patient status/location
– Handling of exceptions (e.g. patient overflows, escaped
patients, home leaves, discharged but not yet departed,
missing discharge information)
– Input of important information (diagnoses, D/C summary)
– Links between OPD, IPD, ER & OR
24. EHRs & HIS
The Challenge - Knowing What It Means
Electronic Health
Records (EHRs)
Hospital
Information
Electronic Medical System (HIS)
Records (EMRs)
Electronic Patient
Records (EPRs)
Clinical
Information
Personal Health
Computer-Based System (CIS)
Records (PHRs)
Patient Records
(CPRs)
25. EHRs
Commonly Accepted Definitions
• Electronic documentation of patient care by providers
• Provider has direct control of information in EHRs
• Synonymous with EMRs, EPRs, CPRs
• Sometimes defined as a patient’s longitudinal records over
several “episodes of care” & “encounters” (visits)
26. EHR Systems
Are they just a system that allows electronic documentation of
clinical care?
History Diag- Treat-
...
& PE nosis ments
Or do they have other values?
27. Documented Benefits of Health IT
• Literature suggests improvement through
– Guideline adherence (Shiffman et al, 1999;Chaudhry et al, 2006)
– Better documentation (Shiffman et al, 1999)
– Practitioner decision making or process of care
(Balas et al, 1996;Kaushal et al, 2003;Garg et al, 2005)
– Medication safety
(Kaushal et al, 2003;Chaudhry et al, 2006;van Rosse et al, 2009)
– Patient surveillance & monitoring (Chaudhry et al, 2006)
– Patient education/reminder (Balas et al, 1996)
– Cost savings and better financial performance
(Parente & Dunbar, 2001;Chaudhry et al, 2006;Amarasingham et al, 2009;
Borzekowski, 2009)
28. Functions that Should Be Part of EHR Systems
• Computerized Medication Order Entry (IOM, 2003; Blumenthal et al, 2006)
• Computerized Laboratory Order Entry (IOM, 2003)
• Computerized Laboratory Results (IOM, 2003)
• Physician Notes (IOM, 2003)
• Patient Demographics (Blumenthal et al, 2006)
• Problem Lists (Blumenthal et al, 2006)
• Medication Lists (Blumenthal et al, 2006)
• Discharge Summaries (Blumenthal et al, 2006)
• Diagnostic Test Results (Blumenthal et al, 2006)
• Radiologic Reports (Blumenthal et al, 2006)
29. EHR Systems/HIS: Issues
• Functionality & workflow considerations
• Structure & format of data entry
– Free text vs structured data forms
– Usability
– Use of standards & vocabularies (e.g. ICD-10, SNOMED CT)
– Templates (e.g. standard narratives, order sets)
– Level of customization per hospital, specialty, location, group, clinician
– Reduced clinical value due to over-documentation (e.g. medico-legal, HA)
– Special documents (e.g. operative notes, anesthetic notes)
– Integration with paper systems (e.g. scanned MRs, legal documents)
• Reliability & contingency/business continuity planning
• Roll-out strategies & change management
• Interfaces
30. Computerized (Physician/Provider) Order Entry
Functions
• Physician directly enters medication/lab/diagnostic/imaging
orders online
• Nurse & pharmacy process orders accordingly
• Maybe considered part of an EHR/HIS system
Values
• No handwriting!!!
• Structured data entry (completeness, clarity, fewer mistakes)
• No transcription!
• Entry point for CDSSs
• Streamlines workflow, increases efficiency
31. Computerized (Physician/Provider) Order Entry
Issues
• “Physician as a clerk” frustration
• Usability -> Reduced physician productivity?
• Unclear value proposition for physician?
• Complexity of medication data structure
• Integration of medication, lab, diagnostic, imaging &other orders
• Roll-out strategies & change management
Washington Post (March 21, 2005)
“One of the most important lessons learned to date is that the complexity
of human change management may be easily underestimated”
Langberg ML (2003) in “Challenges to implementing CPOE: a case study of a work in progress at Cedars-Sinai”
32. Clinical Decision Support Systems (CDSSs)
• The real place where most of the values of health IT can be
achieved
• A variety of forms and nature of CDSSs
– Expert systems
• Based on artificial intelligence, machine learning, rules, or statistics
• Examples: differential diagnoses, treatment options
– Alerts & reminders
• Based on specified logical conditions
• Examples: drug-allergy checks, drug-drug interaction checks, drug-lab
interaction checks, drug-formulary checks, reminders for preventive
services or certain actions (e.g. smoking cessation), clinical practice
guideline integration
– Evidence-based knowledge sources e.g. drug database, literature
– Simple UI designed to help clinical decision making
33. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception
CLINICIAN
Attention
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
From a teaching slide by Don Connelly, 2006 DECISION
34. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception
CLINICIAN
Abnormal lab
Attention highlights
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
DECISION
35. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception
CLINICIAN
Order Sets
Attention
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
DECISION
36. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception
CLINICIAN
Drug-Allergy
Attention Checks
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
DECISION
37. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception Drug-Drug
CLINICIAN Interaction
Attention Checks
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
DECISION
38. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception Clinical
CLINICIAN
Practice
Attention Guideline
Reminders
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
DECISION
39. Clinical Decision Support Systems (CDSSs)
PATIENT
Integration of
Evidence-Based
Perception Resources (e.g.
CLINICIAN drug databases,
literature)
Attention
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference
DECISION
40. Clinical Decision Support Systems (CDSSs)
PATIENT
Perception
CLINICIAN
Attention
Long Term Memory External Memory
Working
Memory
Knowledge Data Knowledge Data
Inference Diagnostic/Treatment
Expert Systems
DECISION
42. Clinical Decision Support Systems (CDSSs)
Issues
• CDSS as a supplement or replacement of clinicians?
– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
The “Greek Oracle” Model
The “Fundamental Theorem”
(Friedman, 2009)
43. Clinical Decision Support Systems (CDSSs)
Issues
• Features with improved clinical practice (Kawamoto et al., 2005)
– Automatic provision of decision support as part of clinician workflow
– Provision of recommendations rather than just assessments
– Provision of decision support at the time and location of decision making
– Computer based decision support
• Usability & impact on productivity
45. Clinical Decision Support Systems (CDSSs)
Issues
• Ethical-legal issues
– Liabilities: Clinicians as “learned intermediaries”
– Prohibition of certain transactions vs. Professional autonomy
(see Strom et al., 2010)
• Unintended Consequences (e.g. workarounds)
– See Koppel et al. (2005), Campbell et al. (2006) & Harrison et al. (2007)
47. Clinical Decision Support Systems (CDSSs)
Issues
• Choosing the right CDSS strategies
• Expertise required for proper CDSS design & implementation
• Integration into the point of care with minimal productivity/
workflow impacts
• Everybody agreeing on the “rules” to be enforced
• Maintenance of the knowledge base
• Evaluation of effectiveness
48. “Ten Commandmends” for Effective CDSSs
• Speed is Everything
• Anticipate Needs and Deliver in Real Time
• Fit into the User’s Workflow
• Little Things (like Usability) Can Make a Big Difference
• Recognize that Physicians Will Strongly Resist Stopping
• Changing Direction Is Easier than Stopping
• Simple Interventions Work Best
• Ask for Additional Information Only When You Really Need
It
• Monitor Impact, Get Feedback, and Respond
• Manage and Maintain Your Knowledge-based Systems
(Bates et al., 2003)
49. Nursing Applications
Functions
• Documents nursing assessments, interventions & outcomes
• Facilitates charting & vital sign recording
• Utilizes standards in nursing informatics
• Populates and documents care-planning
• Risk/incident management
• etc.
Issues
• Minimizing workflow/productivity impacts
• Goal: Better documentation vs. better care?
• Evolving standards in nursing practice
• Change management
50. Pharmacy Applications
Functions
• Streamlines workflow from medication orders to dispensing and
billing
• Reduces medication errors, improves medication safety
• Improves inventory management
51. Stages of Medication Process
Ordering Transcription Dispensing Administration
Automatic Electronic
CPOE
Medication Medication
Dispensing Administration
Records
(e-MAR)
Barcoded
Medication Barcoded
Dispensing Medication
Administration
52. Pharmacy Applications
Issues
• Who enters medication orders into electronic format at which
stage?
• Unintended consequences
• “Power shifts”
• Handling exceptions (e.g. countersigns, verbal orders,
emergencies, formulary replacements, drug shortages)
• Choosing the right technology for the hospital
• Goal: Workflow facilitation vs. medication safety?
53. Imaging Applications
Picture Archiving and Communication System (PACS)
• Captures, archives, and displays electronic images captured from
imaging modalities (DICOM format)
• Often refers to radiologic images but sometimes used in other
settings as well (e.g. cardiology, endoscopy, pathology,
ophthalmology)
• Values: reduces space, costs of films, loss of films, parallel
viewing, remote access, image processing & manipulation,
referrals
Radiology Information System (RIS) or Workflow Management
• Supports workflow of the radiology department, including patient
registration, appointments & scheduling, consultations, imaging
reports, etc.
54. Take-Away Messages
• Health IT in hospitals comes in various forms
• Local contexts are important considerations
• Hospital IT is a very complex environment
• Health IT has much potential to improve quality & efficiency of care
• But it is also risky...
– Costs
– Change resistance
– Poor design
– Alert fatigue
– Workarounds and unintended consequences
– Use of wrong technology to fix the wrong process for the wrong goal
• We need to have an informatician’s mind (not just
a technologist’s mind) to help us navigate through the complexities
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