Healthcare information technology

Healthcare information technology

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  HEALTHCARE INFORMATION TECHNOLOGY Dr.Vijay bhushanam MD
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  CPOE HL7 EMR HIS EHR RIS HIPAA PACS DICOM
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  Objectives • Evolution ofHealthcare IT and its advantages • Terminology • Components of Hospital Information System • Standards Organizations
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  Medication errors: inthe US 80,000 people died in 2004. (=8th cause of death)
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  In Malaysia.. (Source:Hosp_AT_Terendak)
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  Computerized Physician Order Entry(CPOE) Reduces • Serious medication errors--55% • Prescribing errors-- 19% • Transcription errors-- 84% • Dispensing errors-- 68% • Administration errors--- 59% • Preventable ADE’s-- 17% • Non-intercepted potential ADE’s-- 84% (According to a study conducted in Malaysia)Source: Hosp_AT_Terendak.
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  Evolution of Healthcareand HIT (Changing concepts) Today Tomorrow Location Hospital Decentralized, at home Time Symptomatic, curative Preventive, lifetime Focus On the process and provider On the patient Scope Cure Patients Care for Citizens Methods Invasive Less invasive
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  Order Process ManualAutomated Experience Individual Best Practices The Process Fragmented, isolated disease mgt. Clinical Decisions Personal preferences Guide lines / evidence based Information Fragmented, isolated Consolidated / complete Today Tomorrow
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  Data completeness Fragmented Consolidated Data integrityManual/error prone Systematic mgt. and control Data access Limited, Difficult Any time, any place Technology Isolated systems Integrated systems Data availability Slow Real time Today Tomorrow
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  Ultimate objective • Decreasecost • Increase quality • Easy to use
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  Some terms associatedwith Healthcare IT • Electronic Medical Record (EMR) • Electronic Health Record (EHR) • Computerized physician order entry (CPOE) • Hospital information system (HIS) • Radiology information system (RIS) • HL7 • DICOM • PACS • HIPAA
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  Evolution of Electronicrecords • In the beginning there was the hand written chart • Next came Transcription • PC-based word processors (MS Word, etc.)
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  Ideal recording systemshould be • Easy, legible chart generation • Reduced burden • “Real time" Chart generation • Improved billing • Expert computer & typing skills not required • Consistent quality charts • True database record keeping, • The ability to automatically bring in past history, saving time & reducing errors • Storage of digital multimedia data
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  EMR • EMR isthe digital equivalent of the paper patient chart within a specific provider organization. It is a comprehensive record of tests, prescriptions, diagnostic images and the entire patient history • An EMR system manages patient medical information created within an individual provider organization • It is an application environment composed of the clinical data repository, clinical decision support, controlled medical vocabulary, order entry, computerized provider order entry, pharmacy, and clinical documentation applications. • This environment support the patient’s electronic medical record across inpatient and outpatient environments, and is used by healthcare practitioners • The data in the EMR is the legal record of what happened to the patient during their encounter at the CDO and is owned by the CDO.
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  EHR • Is asubset of each care delivery organization’s EMR. • Is owned by the patient and has patient input and access that spans episodes of care across multiple CDOs with a community, region, or state. • The EHR in the US will ride on the proposed National Health Information Network (NHIN).
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  EMR Vs EHR
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  Example • Patient “A”,smoker, comes with pneumonia to a hospital in Feb.----- EMR • “A” gets admitted in another hospital with Bronchial cancer in Sep.----EMR • Record of information on both the episodes along with other information related to overall health of “A” ----EHR
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  Advantages of Electronicrecords • Saves lives and reduces costs. • Computer physician order entry (CPOE) systems can effectively reduce preventable adverse drug events. • Computerized reminders and prompts on disease management and preventive health guidelines are very effective. • Clinical IT tools can improve drug prescribing and administration. • Potential to transform care delivery, offering greater quality, safety, and efficiency • Many clinical IT benefits such as provider convenience, patient satisfaction, and improved
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  Hospital information system(HIS) A hospital information system (HIS), variously also called clinical information system (CIS) is a comprehensive, integrated information system designed to manage the administrative, financial and clinical aspects of a Hospital
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  Medical Ward GeneralWard ICCU CTICU ROOMS ROOMS Post OP Pre OP OT OT ADMINISTRATOR ED DOCTOR’S ROOM NURSE’S ROOM PHARMACY SC US LAB X-RAY RECEPTION MED OP SURG OP ORTH O OP CARDIAC OP
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  HIS (cont.) EMR Lab Data LIS RIS Patient Bedside Monitoring Pharmacy solutions Administrative HIS Diagnostic Imaging
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  Clinical Systems Overview EnterpriseApplications  Scheduling,  Case Management Users  Clinical Reporting  Management EIS  Regulatory Agencies  Performance Report Card Location Specific and Distributed Transaction Systems I N T E G R A T I O N T O O L S U S E R S Order Entry / Results Pharmacy Clinical Documentation ADT/Registration Radiology STOR Surgical Scheduling Clinical Data Repository M E T A D A T A Data Warehouse  Archived  Lightly summarized  Highly summarized Archive Archive Clinical Decision Support Clinical Decision Support EMPI Interface Engine
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  HIS (Cont.) • Supportof Clinical and Medical Patient Care Activities in the Hospital • Administration of the Hospital’s Daily Business transactions (financial, personnel, payroll, bed census etc.) • Evaluation of Hospital performance and Cost , and projection of the long-term forecast
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  HIS Business & Administration Components •Material Services • Accumulate payments • Recharge • Budgeting • General ledger • Patient ADT/Billing/Account receivable • Payroll • Cost accounting Operation Components • OR scheduling • Nursing management • Clinical appointment • Dietary • Doctor ID system • Employee health system • Medical record system • Pathology system • Patient ADT Pathology system • Patient ADT • Pharmacy system • Radiology system • Referring doctor system • Cancer registry system
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  What the systemcan do 1. Patient registration 2. Ward Booking 3. Tests and treatment 4. Diet and Catering 5. Patient Discharge 6. Billing Registration counter, ED, Labour room, Specialist Clinic etc Done from registration counter, patient transfer, transfer in/out, nurse assignments Online order & result (Lab, Radiology), Interface with other system, Reduce repeat tests & documentation Discharge summary, referrals Final Bill generation, scheduling booking online Auto Billing. Auto calculation from registration, Auto calculation upon order execution, interim bill etc 7. Appointment Online diet order: Normal, Therapeutic, Patient diet, Referral to dietitian, catering activities Online appointment Manage appointment scheduling
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  Advantages of HospitalInformation Systems • Increased time nurses spend with patients • Access to information • Improved quality of documentation • Improved quality of patient care • Increased nursing productivity • Improved communications Reduced medication errors • Reduced hospital costs • Increased nurse job satisfaction • Development of a common clinical database • Improved patient's perception of care • Enhanced ability to track patient's record • Enhanced ability to recruit and retain staff • Improved hospital image
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  Standards Developing Organizations (SDO’s)operating in the HIT Several models of standardization for electronic medical records and electronic medical record exchange have been proposed and multiple organizations formed to help evaluate and implement them. Standards and Reference models are important for interoperability and help to improve Information Quality (accuracy, completeness, timeliness, relevancy, accessibility,... )
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  Organizations • CHI (ConsolidatedHealth Informatics Initiative) - recommends nationwide federal adoption of EHR standards in the US • CCHIT (Certification Commission for Healthcare Information Technology) - a private, not-for-profit organization that evaluates and develops the certification for EHRs and interoperable EHR networks (USA) • IHE (Integrating the Healthcare Enterprise) - a consortium, sponsored by the HIMSS, that recommends integration of EHR data communicated using the HL7 and DICOM protocols • ANSI (American National Standards Institute) - accredits standards in the United States and co-ordinates US standards with international standards
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  Organizations (cont.) • HIMSS(Healthcare Information and Management Systems Society)- an international trade organization of health informatics technology providers • American Society for Testing and Materials - a consortium of scientists and engineers that recommends international standards • Open EHR - promotes open source EHR guidelines • Canada Health Infoway - a private, not-for-profit organization that promotes the development and adoption of EHRs in Canada • World Wide Web Consortium (W3C) - promotes Internet-wide communications standards to prevent market fragmentation • Clinical Data Interchange Standards Consortium (CDISC) - a non-profit organization that develops platform-independent healthcare data standards
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  Standards • HL7 -a standardized messaging and text communications protocol between hospital and physician record systems, and between practice management systems • DICOM - an international communications protocol standard for representing and transmitting radiology (and other) image-based data, sponsored by NEMA (National Electrical Manufacturers Association) • ANSI X12 (EDI) - transaction protocols used for transmitting patient data. Popular in the United States for transmission of billing data.
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  Standards (cont.) • CEN- CONTSYS (EN 13940), supports continuity of care record standardization. • CEN - HISA (EN 12967), a services standard for inter-system communication in a clinical information environment. • ISO - ISO TC 215 provides international technical specifications for EHRs. ISO 18308 describes EHR architectures • CEN's TC/251 provides EHR standards in Europe. Focuses on EHR communication and distributed access • CEN - EHRcom (EN 13606), communication standards for EHR information in Europe
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  HL7 • Health LevelSeven (HL7), is an all-volunteer, not- for-profit organization involved in development of international healthcare standards. “HL7” is also used to refer to some of the specific standards created by the organization (i.e. HL7 v2.x, v3.0, HL7 etc.). • It is one of several American National Standards Institute (ANSI) –accredited Standards Developing Organizations (SDOs) operating in the healthcare arena • Domain is clinical and administrative data • It provides a framework (and related standards) for the exchange, integration, sharing and retrieval of electronic health information
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  DICOM • Digital Imagingand Communications in Medicine • It is a standard for handling, storing, printing, and transmitting information in medical imaging • Developed by American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA). • DICOM files can be exchanged between two entities that are capable of receiving image and patient data in DICOM format • DICOM enables the integration of scanners, servers, workstations, printers, and network hardware from multiple manufacturers into a picture archiving and communication system (PACS).
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  PACS • In medicalimaging picture archiving and communication systems (PACS) are computers or networks dedicated to the storage, retrieval, distribution and presentation of images. The medical images are stored in an independent format. The most common format for image storage is DICOM • Most PACSs handle images from various medical imaging instruments, including ultrasound, magnetic resonance, PET, computed tomography, endoscopy, mammograms, etc
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  HIPAA • The HealthInsurance Portability and Accountability Act (HIPAA) • Title I of HIPAA protects health insurance coverage • Title II of HIPAA, known as the Administrative Simplification (AS) provisions, requires the establishment of national standards for electronic health care transactions • It also address the security and privacy of health data • The standards are meant to improve the efficiency and effectiveness of the nation's health care system by encouraging the widespread use of electronic data interchange in the US health care system.
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  Summary • Healthcare transformationis to increase quality, decrease cost. • Common terms EMR, HER,HIS, HL7, DICOM,PACS, HIPAA,, RIS etc. • HIS is very effective • Standards organizations develop the frame work and integration guidelines for HIT tools
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  THANK YOU