This document provides an overview of electronic medical records and health IT standards presented by Thomas Petry at an AITP meeting on September 10th, 2015. It defines key health IT terms and concepts, describes the differences between EMRs and EHRs, lists the components of an EMR, and discusses the benefits of electronic health records. It also covers topics like structured versus unstructured data, data analysis skills, health IT standards, ICD-10 implementation, and preparing organizations for the ICD-10 transition.
This slide deck was used to provide an introductory tutorial on the HL7 Clinical Document Architecture (CDA) standard. It has shared copyright with Health Level Seven. CDA is an HL7 document exchange standard.
In this slide deck, I present two recently approved FHIR implementation guides: vital records death reporting (VRDR) and chronic disease bi-directional electronic referrals (BSeR). The objective of this presentation is to share insights regarding the processing steps required to go from concept to design, from design to published standard, and published standard into implementation. The VRDR and BSeR FHIR Implementation Guide STUs are used to illustrate and facilitate these learning objectives.
A presentation about the role of informatics standards in facilitating electronic data interchange, and a framework for service-oriented semantic interoperability among data systems.
Part of the "2016 Annual Conference: Big Data, Health Law, and Bioethics" held at Harvard Law School on May 6, 2016.
This conference aimed to: (1) identify the various ways in which law and ethics intersect with the use of big data in health care and health research, particularly in the United States; (2) understand the way U.S. law (and potentially other legal systems) currently promotes or stands as an obstacle to these potential uses; (3) determine what might be learned from the legal and ethical treatment of uses of big data in other sectors and countries; and (4) examine potential solutions (industry best practices, common law, legislative, executive, domestic and international) for better use of big data in health care and health research in the U.S.
The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School 2016 annual conference was organized in collaboration with the Berkman Center for Internet & Society at Harvard University and the Health Ethics and Policy Lab, University of Zurich.
Learn more at http://petrieflom.law.harvard.edu/events/details/2016-annual-conference.
This presentation provides a concise overview of the history, operational framework, and standards of Health Level Seven (HL7). It is intended to be a guide to those seeking to engage in the HL7 standards development effort or to be consumers of HL7 products and services.
This slide deck was used to provide an introductory tutorial on the HL7 Clinical Document Architecture (CDA) standard. It has shared copyright with Health Level Seven. CDA is an HL7 document exchange standard.
In this slide deck, I present two recently approved FHIR implementation guides: vital records death reporting (VRDR) and chronic disease bi-directional electronic referrals (BSeR). The objective of this presentation is to share insights regarding the processing steps required to go from concept to design, from design to published standard, and published standard into implementation. The VRDR and BSeR FHIR Implementation Guide STUs are used to illustrate and facilitate these learning objectives.
A presentation about the role of informatics standards in facilitating electronic data interchange, and a framework for service-oriented semantic interoperability among data systems.
Part of the "2016 Annual Conference: Big Data, Health Law, and Bioethics" held at Harvard Law School on May 6, 2016.
This conference aimed to: (1) identify the various ways in which law and ethics intersect with the use of big data in health care and health research, particularly in the United States; (2) understand the way U.S. law (and potentially other legal systems) currently promotes or stands as an obstacle to these potential uses; (3) determine what might be learned from the legal and ethical treatment of uses of big data in other sectors and countries; and (4) examine potential solutions (industry best practices, common law, legislative, executive, domestic and international) for better use of big data in health care and health research in the U.S.
The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School 2016 annual conference was organized in collaboration with the Berkman Center for Internet & Society at Harvard University and the Health Ethics and Policy Lab, University of Zurich.
Learn more at http://petrieflom.law.harvard.edu/events/details/2016-annual-conference.
This presentation provides a concise overview of the history, operational framework, and standards of Health Level Seven (HL7). It is intended to be a guide to those seeking to engage in the HL7 standards development effort or to be consumers of HL7 products and services.
HIMSS15: Trust in Regional Exchange Supports Patient-Centered ResearchIBM Analytics
Thomas F. Check, MA, and Lorraine M. Fernandes, RHIA, gave this presentation at HIMSS15. Inside you will find info on a number of learning objectives including:
1.Explain how HIE patient-matching technology supports the innovative research infrastructure of NYC-CDRN.
2.Identify privacy issues addressed by HIE participants including how the NYC-CDRN infrastructure supports patient privacy.
3.Describe how consumer, patient consent and other concerns of community stakeholders are addressed.
4.Discuss the value of re-using data from Healthix and the Bronx RHIO including costs and technology infrastructure.
5.Illustrate the information data model’s use within NYC-CDRN and its connection to the PCORnet.
Follow @IBM Healthcare on Twitter: https://twitter.com/IBMHealthcare
Beyond Import/Export – Holistic Data Migration ApproachesJustin Campbell
To the uninformed, getting your data from here to there is a simple proposition, but for those in the know — those who will be responsible for the task — it’s a huge challenge. With interoperability far from where it should be, moving data (especially the unstructured variety) is an exercise fraught with pitfalls leaving the uninitiated in a very precarious position. In this webinar we’ll put you in a stronger state by hearing from those who’ve managed real world, live and significant application-to-application data transitions. You’ll learn not just the technical solutions of how to move data cleanly, but tips around preparation, training and go-live that will ensure your users also brave the journey unscathed.
Achieve Internet VP of Operations Marc Hermsmeyer and Dexcom Inc., Senior Marketing Manager Tom Hall speak about technology solutions for the Healthcare Industry using Open Source software, such as Drupal.
The Government is forcing technology innovation within the Healthcare industry yet there are very few solutions out there that are tailored for the specific requirements and needs of the Healthcare market. In past experiences with Dexcom and other Healthcare clients Achieve has leveraged the power of Drupal to create powerful solutions that drive patient outcomes, improve workflows, and remain compliant with rigorous regulatory requirements.
This presentation shines a light on the technology needs of the Healthcare market and how Drupal can meet those needs.
Part of the "2016 Annual Conference: Big Data, Health Law, and Bioethics" held at Harvard Law School on May 6, 2016.
This conference aimed to: (1) identify the various ways in which law and ethics intersect with the use of big data in health care and health research, particularly in the United States; (2) understand the way U.S. law (and potentially other legal systems) currently promotes or stands as an obstacle to these potential uses; (3) determine what might be learned from the legal and ethical treatment of uses of big data in other sectors and countries; and (4) examine potential solutions (industry best practices, common law, legislative, executive, domestic and international) for better use of big data in health care and health research in the U.S.
The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School 2016 annual conference was organized in collaboration with the Berkman Center for Internet & Society at Harvard University and the Health Ethics and Policy Lab, University of Zurich.
Learn more at http://petrieflom.law.harvard.edu/events/details/2016-annual-conference.
The Clinical Document Architecture (CDA®) is HL7’s
specification for standards-based exchange of clinical
documents. CDA is based on the concept of scalable,
incremental interoperability and uses Extensible Markup
Language (XML), the HL7 Reference Information Model
(RIM), and controlled terminology for structure and
semantics. This tutorial presents the business case for
CDA, its primary design principles, and an overview of the
technical specification.
The Distributed Science Ecosystem, Sean Manion TFECON 2018Sean Manion PhD
"The Distributed Science Ecosystem," is a presentation from Sean Manion, PhD of Science Distributed to the Johns Hopkins Technology & Future Economy 2018 Conference on 07 Apr 2018 looking at the application of blockchain to health science research from a business perspective.
Health Datapalooza IV: June 3rd-4th, 2013
Unlocking Clinical & Claims Data by Giving Consumers Access: Blue Button Plus For Data Holders
Moderator:
Ryan Panchadsaram, Senior Advisor, White House Office of Science and Technology Policy
Speakers:
Kym Martin, Three-time cancer survivor
Jon R. Cohen, Chief Medical Officer, Quest Diagnostics
Craig Lipset, Head of Clinical Innovation, Pfizer
Mark Savage, Director of Health IT Policy and Programs, National Partnership for Women & Families
Consumers can be engaged, active participants in their own health and partners in reducing health care costs. But first, they need access to their own personal health information, and they need tools and services that use this information to help them make better choices. The panel will bring together payers, providers, and other data holders who will discuss the value proposition for sharing data with consumers. They will demonstrate Blue Button Plus, which makes it easy for data holders to share personal health information with consumers and their applications in a standardized, automated format.
Quality of Care Measures Development for Medicaid HCBS: AHRQ Efforts nashp
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: D.E.B. Potter, M.S.
2013 10 utilizing member engagement to improve cahps scoresimagine.GO
The Accountable Care Act means more access to healthcare for more people. But to pay for that access it also means margins for healthcare companies are going to be squeezed. But this does not necessarily imply doom for healthcare companies. The law actually encourages healthcare businesses to build better business models – and is willing to pay for it. By retooling your market approach, and the operations that run your business, you can actually improve your margins and your customer’s happiness at the same time you are helping to create a better and more efficient healthcare ecosystem.
McKesson helps improve health care quality and patient safety while reducing health care costs.
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THE EXPENSE OF QUALITY IS AN INTERACTIVE PROCESS BETWEEN CUSTOMER & PROVIDER. QUALITY ASSURANCE USUALLY FOCUSES ON MATERIAL, GOOD WORK & SERVICE PROVIDED EFFECTIVELY. ANY LACK IN SERVICE PROVIDED CAUSES DECREASE IN QUALITY
Why We Need to Shift Healthcare Quality Measures from Volume to ValueHealth Catalyst
Healthcare quality reporting is integral to achieving the Triple Aim and improving outcomes. But the sheer volume of quality measures has become as much a part of healthcare as healing and prevention. Recently, CMS and AHIP took the unprecedented step of aligning and consolidating measures in seven care categories. This will go a long way toward reducing the amount of time physicians and staff spend every week on quality reporting, but it’s only a beginning. Healthcare’s focus needs to shift from volume to value of quality measures, such as those that concentrate on quality of life and patient-reported outcomes. The International Consortium for Health Outcomes Measurement is setting the right example for quality measures designed to actually improve outcomes rather than just processes.
HETT Conference Olympic Central 2014 Integrating Healthcare DeliveryElmar Flamme
Integrating Healthcare Delivery through the Innovative Use of Information & Technology - A user story from behind the CONTENT covered mountains and the deep
BIG DATA forest
An overview of clinical healthcare data analytics from the perspective of an interventional cardiology registry. This was initially presented as part of a workshop at the University of Illinois College of Computer Science on April 20, 2017.
Late-Binding Data Warehouse - An Update on the Fastest Growing Trend in Healt...Health Catalyst
Now that the industry has had some time to study, react, and apply the concepts, Dale Sanders is going to provide an update on the topic. As a CIO in the Air Force and healthcare, consistently specializing in decision support and analytics for the past 30 years, Dale will share the stories of the failures and successes that led him to the unconventional approach of late binding in the design of data warehouses— a design pattern that is now implemented in over a dozen leading healthcare organizations and serving over 35 million patients. Dale will talk about:
The basic approach to a late-binding data warehouse.
Pros and cons of early- versus late-binding.
The historical volatility in vocabulary and business rules.
How to predict the rate and specifics of volatility in the future.
New learnings and helpful advice based on numerous discussions, forums, and Interactions with many of you.
A robust, interactive question and answer period with attendees.
HIMSS15: Trust in Regional Exchange Supports Patient-Centered ResearchIBM Analytics
Thomas F. Check, MA, and Lorraine M. Fernandes, RHIA, gave this presentation at HIMSS15. Inside you will find info on a number of learning objectives including:
1.Explain how HIE patient-matching technology supports the innovative research infrastructure of NYC-CDRN.
2.Identify privacy issues addressed by HIE participants including how the NYC-CDRN infrastructure supports patient privacy.
3.Describe how consumer, patient consent and other concerns of community stakeholders are addressed.
4.Discuss the value of re-using data from Healthix and the Bronx RHIO including costs and technology infrastructure.
5.Illustrate the information data model’s use within NYC-CDRN and its connection to the PCORnet.
Follow @IBM Healthcare on Twitter: https://twitter.com/IBMHealthcare
Beyond Import/Export – Holistic Data Migration ApproachesJustin Campbell
To the uninformed, getting your data from here to there is a simple proposition, but for those in the know — those who will be responsible for the task — it’s a huge challenge. With interoperability far from where it should be, moving data (especially the unstructured variety) is an exercise fraught with pitfalls leaving the uninitiated in a very precarious position. In this webinar we’ll put you in a stronger state by hearing from those who’ve managed real world, live and significant application-to-application data transitions. You’ll learn not just the technical solutions of how to move data cleanly, but tips around preparation, training and go-live that will ensure your users also brave the journey unscathed.
Achieve Internet VP of Operations Marc Hermsmeyer and Dexcom Inc., Senior Marketing Manager Tom Hall speak about technology solutions for the Healthcare Industry using Open Source software, such as Drupal.
The Government is forcing technology innovation within the Healthcare industry yet there are very few solutions out there that are tailored for the specific requirements and needs of the Healthcare market. In past experiences with Dexcom and other Healthcare clients Achieve has leveraged the power of Drupal to create powerful solutions that drive patient outcomes, improve workflows, and remain compliant with rigorous regulatory requirements.
This presentation shines a light on the technology needs of the Healthcare market and how Drupal can meet those needs.
Part of the "2016 Annual Conference: Big Data, Health Law, and Bioethics" held at Harvard Law School on May 6, 2016.
This conference aimed to: (1) identify the various ways in which law and ethics intersect with the use of big data in health care and health research, particularly in the United States; (2) understand the way U.S. law (and potentially other legal systems) currently promotes or stands as an obstacle to these potential uses; (3) determine what might be learned from the legal and ethical treatment of uses of big data in other sectors and countries; and (4) examine potential solutions (industry best practices, common law, legislative, executive, domestic and international) for better use of big data in health care and health research in the U.S.
The Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School 2016 annual conference was organized in collaboration with the Berkman Center for Internet & Society at Harvard University and the Health Ethics and Policy Lab, University of Zurich.
Learn more at http://petrieflom.law.harvard.edu/events/details/2016-annual-conference.
The Clinical Document Architecture (CDA®) is HL7’s
specification for standards-based exchange of clinical
documents. CDA is based on the concept of scalable,
incremental interoperability and uses Extensible Markup
Language (XML), the HL7 Reference Information Model
(RIM), and controlled terminology for structure and
semantics. This tutorial presents the business case for
CDA, its primary design principles, and an overview of the
technical specification.
The Distributed Science Ecosystem, Sean Manion TFECON 2018Sean Manion PhD
"The Distributed Science Ecosystem," is a presentation from Sean Manion, PhD of Science Distributed to the Johns Hopkins Technology & Future Economy 2018 Conference on 07 Apr 2018 looking at the application of blockchain to health science research from a business perspective.
Health Datapalooza IV: June 3rd-4th, 2013
Unlocking Clinical & Claims Data by Giving Consumers Access: Blue Button Plus For Data Holders
Moderator:
Ryan Panchadsaram, Senior Advisor, White House Office of Science and Technology Policy
Speakers:
Kym Martin, Three-time cancer survivor
Jon R. Cohen, Chief Medical Officer, Quest Diagnostics
Craig Lipset, Head of Clinical Innovation, Pfizer
Mark Savage, Director of Health IT Policy and Programs, National Partnership for Women & Families
Consumers can be engaged, active participants in their own health and partners in reducing health care costs. But first, they need access to their own personal health information, and they need tools and services that use this information to help them make better choices. The panel will bring together payers, providers, and other data holders who will discuss the value proposition for sharing data with consumers. They will demonstrate Blue Button Plus, which makes it easy for data holders to share personal health information with consumers and their applications in a standardized, automated format.
Quality of Care Measures Development for Medicaid HCBS: AHRQ Efforts nashp
Presented at the National Academy for State Health Policy's 20th Annual State Health Policy Conference in Denver, Colorado. Author: D.E.B. Potter, M.S.
2013 10 utilizing member engagement to improve cahps scoresimagine.GO
The Accountable Care Act means more access to healthcare for more people. But to pay for that access it also means margins for healthcare companies are going to be squeezed. But this does not necessarily imply doom for healthcare companies. The law actually encourages healthcare businesses to build better business models – and is willing to pay for it. By retooling your market approach, and the operations that run your business, you can actually improve your margins and your customer’s happiness at the same time you are helping to create a better and more efficient healthcare ecosystem.
McKesson helps improve health care quality and patient safety while reducing health care costs.
Task Actions
Task Not Started ( 00:00:00 )
*
*
*
*
*
*
*
*
THE EXPENSE OF QUALITY IS AN INTERACTIVE PROCESS BETWEEN CUSTOMER & PROVIDER. QUALITY ASSURANCE USUALLY FOCUSES ON MATERIAL, GOOD WORK & SERVICE PROVIDED EFFECTIVELY. ANY LACK IN SERVICE PROVIDED CAUSES DECREASE IN QUALITY
Why We Need to Shift Healthcare Quality Measures from Volume to ValueHealth Catalyst
Healthcare quality reporting is integral to achieving the Triple Aim and improving outcomes. But the sheer volume of quality measures has become as much a part of healthcare as healing and prevention. Recently, CMS and AHIP took the unprecedented step of aligning and consolidating measures in seven care categories. This will go a long way toward reducing the amount of time physicians and staff spend every week on quality reporting, but it’s only a beginning. Healthcare’s focus needs to shift from volume to value of quality measures, such as those that concentrate on quality of life and patient-reported outcomes. The International Consortium for Health Outcomes Measurement is setting the right example for quality measures designed to actually improve outcomes rather than just processes.
HETT Conference Olympic Central 2014 Integrating Healthcare DeliveryElmar Flamme
Integrating Healthcare Delivery through the Innovative Use of Information & Technology - A user story from behind the CONTENT covered mountains and the deep
BIG DATA forest
An overview of clinical healthcare data analytics from the perspective of an interventional cardiology registry. This was initially presented as part of a workshop at the University of Illinois College of Computer Science on April 20, 2017.
Late-Binding Data Warehouse - An Update on the Fastest Growing Trend in Healt...Health Catalyst
Now that the industry has had some time to study, react, and apply the concepts, Dale Sanders is going to provide an update on the topic. As a CIO in the Air Force and healthcare, consistently specializing in decision support and analytics for the past 30 years, Dale will share the stories of the failures and successes that led him to the unconventional approach of late binding in the design of data warehouses— a design pattern that is now implemented in over a dozen leading healthcare organizations and serving over 35 million patients. Dale will talk about:
The basic approach to a late-binding data warehouse.
Pros and cons of early- versus late-binding.
The historical volatility in vocabulary and business rules.
How to predict the rate and specifics of volatility in the future.
New learnings and helpful advice based on numerous discussions, forums, and Interactions with many of you.
A robust, interactive question and answer period with attendees.
Health IT has a Big Data opportunity with HL7 analytics. Learn about what is possible from Wes Wright, CIO at Seattle Children's Hospital, and Erik Giesa, SVP of Marketing and Business Development at ExtraHop.
Galen healthcare solutions Healthcare Information Technology 2017 Year in Rev...Justin Campbell
In the ever-changing and fast-paced world of healthcare IT, there can be a lot to keep up with. As 2017 wraps up and we look towards 2018, we take the opportunity to review the major happenings in the industry this past year, and explore key focal areas for the next. We’ve compiled insights gleaned from our market research conducted through attending industry conferences, gathering healthcare executive perspectives, and observing what is occurring in practice, to distill the key areas of focus for 2018. We’ll examine topics critical to the success of Healthcare Delivery Organizations (HDOs) including:
Application Portfolio Rationalization – Data Migration & Archival
Patient Engagement through Telehealth & Telemedicine
Clinician Engagement, Satisfaction, and Data-Driven Clinical Optimization
Clinical Decision Support – Syndromic Surveillance, Sepsis Prevention
Quality Payment Programs – Medicare Advantage, HCC & PCMH
Interoperability – HIE, APIs, Patient Identity & Matching
This webinar will provide a blueprint to assist healthcare information technology stakeholders in understanding key issues affecting the healthcare industry. Attendees will gain insightful resources and analysis of the healthcare information technology landscape in 2018. Register now to learn how these key trends could affect your organization and what you can do to prepare.
Explains about Evolution of IT in Healthcare, how analytics can make a difference and evolution of IT in healtcare. For more information visit: http://www.transformhealth-it.org/
Since the HITECH Act was passed in 2009, healthcare executives have felt the pressure to implement the electronic health record and achieve Meaningful Use status resulting in the flow of incentive dollars over the next five years.
Splunking HL7 Healthcare Data for Business Value Splunk
Healthcare data is time-oriented and diverse. HL7 (Health Level Seven International) is a set of interoperability standards, formats and definitions for exchanging data between software applications used by healthcare providers. In this session, learn how to leverage HL7 data for business value. Through a presentation and demo’s, we will discuss a variety of HL7 use cases from exploring HL7 data within Splunk, addressing missing orders investigations, queuing up integrations, and others. Also, you can learn about the health of the system that is providing these services by using Splunk ITSI.
Pfizer's HR division runs a massive data warehouse that
averages over 1 million queries per day from over 3,000 users. They needed to cut data costs and mitigate regulatory and audit risks and decrease costs.
See how they met their goals, and reduced extract, transform and load (ETL) times, using Appfluent!
ICD-10 Is Really Here: What Does That Mean To Compliance Officers?PYA, P.C.
PYA Principal Denise Hall presented “ICD-10 Is REALLY Here: What Does that Mean to Compliance Officers?” at the THA 2015 Fall Compliance Conference. The presentation helps providers get “in tune” with the latest in ICD-10 compliance:
* A brief discussion of ICD-10 and its impact on healthcare.
* Compliance risks with the transition to the ICD-10 system.
* Mitigation of compliance risk and denial activities during and post-implementation.
* ICD-10’s impact on value-based purchasing and quality-based payment models.
Splunking HL7 Healthcare Data for Business Value Splunk
Healthcare data is time-oriented and diverse. HL7 (Health Level Seven International) is a set of interoperability standards, formats and definitions for exchanging data between software applications used by healthcare providers. In this session, learn how to leverage HL7 data for business value. Through a presentation and demo’s, we will discuss a variety of HL7 use cases from exploring HL7 data within Splunk, addressing missing orders investigations, queuing up integrations, and others. Also, you can learn about the health of the system that is providing these services by using Splunk ITSI.
My presentation on Healthcare Information Exchange technical infrastructure given as a skills building session at the eHealth Conference in Kenya (http://www.e-healthconference.or.ke/)
Similar to Your electronic medical record - Structure versus Non-Structure - Order verus Chaos (20)
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
The Importance of Community Nursing Care.pdfAD Healthcare
NDIS and Community 24/7 Nursing Care is a specific type of support that may be provided under the NDIS for individuals with complex medical needs who require ongoing nursing care in a community setting, such as their home or a supported accommodation facility.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
Deep Leg Vein Thrombosis (DVT): Meaning, Causes, Symptoms, Treatment, and Mor...The Lifesciences Magazine
Deep Leg Vein Thrombosis occurs when a blood clot forms in one or more of the deep veins in the legs. These clots can impede blood flow, leading to severe complications.
2. WHO IS THIS GUY
Thomas J. Petry - DC
Chapter Association of
IT Professionals
ALFIO'S - SEPTEMBER 10TH 2015 2
3. • Electronic Medical Record (EMR)
• Electronic Health Record (EHR)
• Clinical Health Repository (CHR)
• Virtual Health Record (VHR)
• Personal Health Record (PHR)
• Patient Portal
• Regional Health Information
Organization (RHIO)
• Continuity of Care Document (CCD)
• CDA, CDR, Green CDA
• Enterprise Data Warehouse (EDW)
• Certified EHR Technology (CEHRT)
• Meaningful Use (MU)
• Regional
• Health Information Exchange (HIE)
• Health Information Service Provider
(HISP)
• Nationwide Health Information
Network (NHIN/NwHIN)
• eHealth Exchange
• Fast Healthcare Interoperability
Resources (FHIR)
DEFINITIONS
Thomas J. Petry - DC
Chapter Association of
IT Professionals
ALFIO'S - SEPTEMBER 10TH 2015 3
4. EMR/EHR WHAT’S THE DIFFERENCE
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Chapter Association of
IT Professionals
ALFIO'S - SEPTEMBER 10TH 2015 4
• Electronic Medical Record:
• Digital version of the paper charts in the clinician’s office.
• Contains Medical and treatment history of the patients in a single practice
• Tracks patients progress over time
• Doesn’t travel easily outside the practice
• Electronic Health Record:
• Goes beyond standard clinical/medical information
• Moves with patient to specialists, hospitals, nursing homes, across state/country
boundaries
• Built to share information across the entire care continuum
5. COMPONENTS OF AN EMR
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6. • Registration/Pre-Registration/Quick
Registration
• CPOE/CDSS/Alerts
• Billing ICD-9/ICD-10
• Interfaces
• Registries
• Patient Chart (Progress Note)
• Demographics
• Medical Summaries/Discharge
Instructions/problem lists/differential
diagnosis
• Scheduling/Administrative
• Patient Communications and
Engagement
• Referrals
• Patient Documentation/Education
• Rx/eRx
• Circle/Plan of Care
• Consultations and Referrals (Care
Transition)
• Patient Histories (Family, Medical,
GYN/OB, Sexual/Behavior, Surgical,
Social
• Clinical Document (CD)
PARTIAL LIST OF EHR COMPONENTS
Thomas J. Petry - DC
Chapter Association of
IT Professionals
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7. BENEFITS OF ELECTRONIC HEALTH RECORDS
Thomas J. Petry - DC
Chapter Association of
IT Professionals
ALFIO'S - SEPTEMBER 10TH 2015 7
• The information gathered by the PCP informs ED clinician about patient’s life-threatening
allergy so that care can be adjusted appropriately even if patient is unconscious.
• A patient can log on to his own PHR to see the trend of lab results over the past year which can
help motivate medication compliance and appropriate life-style changes.
• Lab results run last week are already in the record to tell the specialist what she needs to know
without running duplicate tests.
• The Clinician’s notes from the patient’s hospital stay can help inform the discharge instructions
and follow-up care and enable the patient to move from one care setting to another more
smoothly.
***Just one word “medical” vs “health” – Subtle distinction – World of difference***
8. STRUCTURED DATA
Thomas J. Petry - DC
Chapter Association of
IT Professionals
ALFIO'S - SEPTEMBER 10TH 2015 8
• Data that resides in a fixed field within a record or file
• Includes data contained in relational databases and spreadsheets
• Depends on creating a data model
• Data type (Numeric, currency, alphabetic, name, date, address, etc.)
• Data restrictions/Validation (Mr., Ms., or Dr.; M or F; etc.)
• Can be easily entered, stored, queried, and analyzed
• Structured data is often managed using Structured Query Language (SQL)
9. UNSTRUCTURED DATA
Thomas J. Petry - DC
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ALFIO'S - SEPTEMBER 10TH 2015 9
• Doesn’t fit into a neat box (photos, graphics, images, videos, streaming instrument data,
webpages, PDF files, PowerPoint Presentations, emails, blog entries, wikis and word
processing documents)
10. SEMI-STRUCTURED DATA
Thomas J. Petry - DC
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• Cross between structured and unstructured data
• Type of structure but lacks the strict data model structure
• Tags or other types of markers are used to identify certain elements within the data but
the date does not have a rigid structure.
• Examples: word processing software can now include metadata showing the author’s
name and date created with the bulk of the document just being unstructured text.
• Emails have a sender, recipient, date, time and other fixed fields added to the
unstructured data of the email message content and any attachments.
• Photos or other graphics can be tagged with keywords such as the creator, date, location
and keywords,
• XML and other markup languages are often used to manage semi-structured data
11. THE SQUARE PEG IN THE ROUND HOLE
Thomas J. Petry - DC
Chapter Association of
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12. BIG DATA
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Chapter Association of
IT Professionals
ALFIO'S - SEPTEMBER 10TH 2015 12
• Volume – Velocity – Variety (3Vs)
• EMR’s collect huge volumes of data
• Large Patient Populations generate large volumes of data with great velocity
• Diverse Healthcare Organizations generate great volume and velocity with great variety
• Most healthcare organizations don’t need big data to meet most of their analytics and reporting
needs
• We’ve not come close to stretching the limits of what healthcare analytics can accomplish
• Regulatory reporting and operational dashboards
• More suited to regional/national/statewide population health management and policy
• Most healthcare organizations not prepared to use big data
• Requires Technical Expertise
• May involve complex machine learning and data mining
• Requires more robust and integrated security surrounding it
13. MIGRATING SKILL SETS
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• Analysts
• Reporting Analysts
• Configuration Specialists
• Support Specialists
• Medical Informaticists
• Nursing/Physician Informatics
• IT People with clinical backgrounds/Clinicians with IT skills
• Data Scientists
• Hard to come by
• Expensive
• Ph.D level thinkers
• Significant Expertise
14. ESSENTIAL DATA ANALYST SKILLS
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Chapter Association of
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• Structured Query Language (SQL)
• Export – Transform – Load (ETL)
• Data modeling
• Data analysis
• Business Intelligence (BI) Reporting
• Story Telling
15. EHR/EMR INTEROPERABILITY PROBLEMS
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• Interoperability not specifically incentivized through Meaningful Use
• EHR vendors not satisfying interoperability gap
• Privacy and Security Issues
• All lack free and easy sharing in some aspect
• Impacts to industry workflows
• Errors in Documentation
• Structured/Unstructured Data Representation and Quality
• Stepwise, Rushed and Incremental Lifecycle Development
• Interruption of the doctor-patient relationship
16. TRIPLE AIM OF HEALTHCARE
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ALFIO'S - SEPTEMBER 10TH 2015 16
• Better outcomes
• Improved quality of experience
• Lower cost
17. POPULATION HEALTH
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ALFIO'S - SEPTEMBER 10TH 2015 17
• Children’s Health & Obesity Prevention
• Family income/education/neighborhood safety
• Disease Management
• Health coaching
• Wave or reduce cost(s) associated with preventative medicine and routine office
visits
• Incentivizing care coordination/improvement on patient outcomes
• Prevention and Wellness
• 80% of healthcare costs consumed by 5 top chronic conditions
• Interagency Collaboration
• 60% of your health impacts occur outside physician offices and hospitals
18. PERSONALIZED MEDICINE
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• Mutation of the MET gene and MET inhibitors
• We now have the ability to manufacture antibodies/vaccines using genomics
19. HEALTH POLICY ISSUES
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• Entitlement Programs
• Health Insurance Exchanges
• Integration of Mental, Dental, Vision Care
• Health Workforce Adequacy
• US Aging Population
• Framework for Multiple Chronic Conditions (MCC)
20. • Healthcare-Associated Infections
• Human Immunodeficiency Virus
• CDC Vital Signs
• Public Health Grand Rounds
• Million Hearts ™
• Helping Smokers Quit
• Newborn Screenings
• Heads-Up Program
• Food Safety
• Children’s Mental Health
• Clinical Preventive Services for
Children/Adolescents
• Preventing Parasitic Diseases
• Global Efforts to Prevent Violence
Against Children
CDC 13 PUBLIC HEALTH ISSUES OF 2013
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21. HEALTH DISPARITIES
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22. • Race
• Ethnicity
• Preferred Language vs Language
Competencies
• Sexual Orientation
• Sexual Identity
• Sexual History
• Social-Economical Status
• Geographic Location
• Trans Status (MTF/FTM related health
issues
• Culture
• Religion
• Age
• Disability Status
• Citizenship
• Immigration Status
• Length of time in Country
• Primary Language (ESL)
• Not mutually exclusive.
• Often interacting in important ways
• Impacts sub-groups differentially
HEALTHCARE DISPARITIES
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23. RISK FACTORS FOR TYPE 2 DIABETES
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• Non-modifiable
• Family History of type 2 diabetes
• Genetic Factors
• Age
• Ethnicity (African-American, Hispanic, Native-Americans, Asian-Americans, Pacific Islanders/Micronesia)
• Modifiable
• Obesity/Weight
• Physical Activity/Inactivity
• Diet/Nutrition
• Co-morbidity
• Previously identified IFG or IGT
• History of gestational diabetes
• Delivering a baby weighing > 9 pounds
• Polycystic ovary syndrome
• Alzheimer’s
24. Thomas J. Petry - DC
Chapter Association of
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25. • Level of Exercise
• Diet
• Language Proficience
• Health Literacy
• Blood Glucose Level
• Glasgow Coma Scale
• Pulse Oximetry
• End-tidal CO2
• Functional Status
• Shortness of Breath
• Gate Speed
• Temperature
• Pulse
• Respiratory Rate
• Blood Pressure
• I/O
• Pain Level (AKA: Sixth VS)
VITAL SIGNS EVOLUTION
Existing Vital Signs New or Proposed
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26. SECURITY AND PRIVACY
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• Health Exchange
• Referrals
• Continuity of Care
• Care Transitions
• Circle of Care
• BYOD
• FIDO-compliant authentication
• Federated Identification Management
• Trusted Relationships
27. BYOD
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• Bring your own device (BYOD)
• Unrestricted Supported
• Restricted Supported
• Unrestricted Unsupported
• Strategy:
• Corporate-Owned Personally Enabled (COPE)
• Choose Your Own Device (CYOD)
• Corporate-Owned Business Only (COBO)
• Mobility-as-a-service (MAAS)
• For the first time, a large amount of iOS malware has made it past Apple's App Store security
controls, potentially affecting hundreds of millions of users
• Mobile Malware: The Hackers’ New Playground!
28. STANDARDS AND CODE SETS
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IT Professionals
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• Systematized Nomenclature of Medicine – Clinical Terms (SNOWMED-CT)
• International Classification of Diseases (ICD-9, ICD-10, etc.)
• NATIONAL COUNCIL FOR PRESCRIPTION DRUG PROGRAMS (NCPDP) SCRIPTS
• Logical Observation Identifiers Names and Codes) LOINC
• ANSI X12.N Healthcare Transactions and Code Sets
• ASTM E31 – HEALTHCARE INFORMATICS COMMITTEE OF ASTM INTERNATIONAL –
CONTIUITY OF CARE DOCUMENT (CCD)
• Current Procedural Terminology (CPT)
• Healthcare Common Procedure Coding System (HCPCS) Level II coding
• Evaluation and Management (E&M) Codes and calculatons (CPT: 99201 through 99499)
• Health Level 7 (HL7)
• Digital Imaging and Communications In Medicine (DICOM)
• UMLS, IEEE,
29. • HIT/Messaging
• HL7
• IEEE
• NCPDP
• ANSI X12
• CCOW
• Imaging
• DICOM
• Billing
• ICD
• CPT
• HCPCS
• Clinical Terminology
• SNOMED
• LOINC
• UMLS
CATEGORIES OF STANDARDS
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30. Thomas J. Petry - DC
Chapter Association of
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31. INTERNATIONAL CLASSIFICATION OF DISEASES
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• Currently the most widely used statistical classification system for diseases in the world.
• Dates back to an 1860 proposal submitted by Florence Nightingale
• ICD-6 published in 1949
• ICD-9 – Proposals adopted by WHO in Geneva in 1978.
• Coded for approximately 17,000 codes.
• Work on ICD-10 began in 1983 (ICD-11 is planned for 2017)
• The United States of America is the last industrialized country to adopt ICD-10
• New ICD-10 allows for more than 155,000 different codes and codes greater
specificity
WARNING: The US HHS ICD-10 compliance date is: October 1st, 2014
32. ICD-9 VERSUS ICD-10
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• ICD-9 (Compare to VCR technology – old school)
• 5,000 diagnostic categories (Numeric only)
• 14,000 diagnosis codes
• 4,000 procedure codes
• Causes confusion requiring additional authorizations and certificates of medical necessity
• ICD-10 (Compare to DVR technology – new kid on the block)
• 8,000 diagnostic categories (Alpha-numeric coding)
• 68,000 diagnosis codes (clinical modifications)
• 72,000 procedure codes
• Much more detailed with sub-classifications and sub-categories
• Codes for greater specificity, laterality, chronic versus acute, etc.
33. PREPARING FOR ICD-10
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• Three areas lacking in provider preparedness for Oct 1 deadline
• Internal Testing
• External Compatibility Testing
• Health Exchabges
• Registries
• Labs, Imaging, Pharmacy
• Employee Education
• Huge drop in revenue anticipated during the transition
• Four State Medicare Programs implementing backward crosswalks to ICD-9 adjudication rules
• HHS CMS (Medicare/Medicaid) implementing 1-year grace period on misuse of ICD-10
specificity
34. • Templates
• Order Sets
• ICD Groups
• Superbills
• Diagnostic alerts
• Claims
• Adjudication
• Rejection
• Follow up
• Appeals
• ICD-CPT Combinations
• Reporting
• Compliance Reporting
• Forecasting
• Trend Analysis (US Cause of
Death Statistics)
• ICD Manifestation Codes (Specialists)
• ICD Categories
• Future Lab Orders
• Revenue Cycle
• Charge Bills
SCOPE OF ICD-10 IMPLEMENTATION
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35. HEALTHCARE FINANCE REFORM
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• Employer-based Healthcare System
• Kaiser Permanente
• Blue-Cross/Blue-Shield
• Bottom-Line versus Patients First
• Emergency Medical Treatment & Labor Act (EMTALA)
• Fee-for-Service
• Single Payer, tax payer subsidized, free healthcare for all???
• Value-based reimbursements
• Improved Patient Outcomes
• Increased Patient Safety
• Lower Cost
• Better Population Management
36. RACE – ETHNICITY – LANGUAGE
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• Language Preference
• First Language
• Language Competency
• Constructed Languages (CONLANG) – ARTIFICIAL OR INVENTED ALANGUAGE
• Braille
• Sign Language (not necessarily ASL)
37. TYPING SPANISH ACCENTS
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• More than just a “Spanish” version of the software
• Impacts who the clinician is communicating too, not who is doing the documentation
• Two Options
• Type in cryptic codes – Cumbersome and frustrating!
• Re-map your computer keyboard
• Workstation Specific
• Sounds too ominous for the average user
• Use the U.S. International Keyboard
• Impacts apostrophe and quotes (i.e.: Impacts more than just Spanish Accent Characters)
• Impacts patient communications in multiple ways
• Email
• Patient Portal
• SMS/Text Messaging
38. IMPACT OF SPANISH ACCENTS
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• Multiple Modalities
• Patient Education Pamphlets
• Drug Information Sheets
• Email, Snail Mail and related communications
• Impacted by Technology
• Not consistently supported between MAC, PC, Linux/Unix and/or Mobile Devices
• May require a Windows CD or other product activation
• Not consistently supported by vendors (even within their own applications)
• http: Accept-Charset Accept-Language
• Minority Languages of Spain
• Basque/Euskara (EU)
• Aragonese (AN)
• Asturian/Leon (AU)
• Catalan (CA)
• Valencian (CA-Valencia)
• Galician (GL)
• Ladino/Judeo-Spanish (LY)
• Leísmo
39. SEX – ORIENTATION – IDENTIFICATION –
HISTORY
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• Sexual Orientation (SO), Sexual Identification (SI) and Past Sexual Behavior (Sexual
History - SrX) all have significant clinical implications:
• Access to healthcare
• Healthcare Disparities
• Variable Risk Factors
• HHS is only beginning to standardize structured collection and reporting regulatory
requirements
• Similar to Race, Ethnicity and Language
• Meanwhile individual healthcare providers and the vendors that support them are adding
in these requirements in a stepwise pattern
40. RACE
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41. ETHNICITY
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42. HOW ARE THEY EVOLVING
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• Medical care is getting more and more complex …
• New information is already overwhelming physician’s
• Physicians need new technologies to help them cope
• Continued growth in digital record generation and dissemination (But: Who has time to read it)?
• From sole-source provider to multiple provider care team(s) …
• From clinical data repositories to sharing and coordination of data across the entire care continuum …
• From fee-for-service to value based payment models …
• Shift from individual care to population health …
• From transactional health records to relational health records …
• From recent clinical significance to significance of the entire longitudinal health record …
• Personalized medicine, genomics and epi-genomics driving this need across generations …
• Shift from targeting individual major disease categories to Multiple Chronic Disease Conditions (MCC)
• Greater emphasis on evidence based medicine and CDDS …
43. MULTIPLE CHRONIC CONDITIONS (MCC)
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• A strategic framework proposed by HHS to improve health status for individuals with MCC
• Enhanced focus on prevention and public health
• Shifts emphasis from individual chronic disease (ICD/CPT) to using a relational MCC approach
• One in 4 Americans have multiple (two or more) concurrent chronic conditions
• Condtions that last a year or more and require ongoing medical attention and/or limit
activities of daily living
• Also includes: substance abuse, addiction disorders, mental illness, dementia, other
cognitive imparement disorders, developmental disabilities
• Increases with age (substantial in older adults)
• Direct correlation (number of MCCs – Elevation of Risk and Poor Outcomes)
• Mortality, functional status, unessisary hospitalization, adverse drug events, duplicative
tests, conflicting medical advise, non-meds compliance
• Substantial out-of-pocket expenses under current delivery of care
44. MCC FRAMEWORK GOALS
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IT Professionals
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• Foster healthcare and public health system changes to improve the health of individuals with
MCC
• Heightened coordination of complex medical and longitudinal psychosocial care (including
coordination across acute- and long-term care systems
• Maximize the use of proven self-care management and other services by individuals with MCC
• Home based physical activity training, family caregiving, evidence-based care models
• Provide better tools and information to healthcare, public health and social services workers
who deliver care to individuals with MCC
• Most management of MCC happens outside of a health care setting
• Facilitate research to fill knowledge gaps about, and interventions and systems to benefit,
individuals with MCC
• Individuals with MCC typically excluded from clinical trials
45. DRIVERS OF INNOVATION
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• Evidence based medicine
• Complexity of Data Dictionary
• Regulatory Environment
• Interoperability
• Usability
• Longitudinally
• Volume, data retention and clinical significance
• Reporting
46. HEALTHCARE REGULATORY ENVIRONMENT
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• Health Insurance Portability and Accountability Act (HIPAA)
• The American Recover and Reinvestment Act of 2009 (ARRA)
• HEALTH INFORMATION TECHNOLOGY FOR ECONOMIC AND CLINICAL HEALTH ACT
(HITECH)
• EHR certification programs
• Entitlement Programs (Medicare, Medicaid and CHIPS)
• Indian Health Services
• Veteran’s Health
47. MEANINGFUL USE (MU)
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• Highly successful in some regards
• Miserable failure in other regards
• Successes
• Incentivized the adoption of EMR systems
• Resulted in widespread investment in electronic health records (EHR) endeavors.
• Greatly accelerated e-Prescribing in America
• Failures
• Caused costly upgrades
• Slowed down the evolution and maturity of EMRs
• Made EMR vendors “reactive” rather than “proactive”
48. IMPACT OF EMR ADOPTION
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• Improved outcomes
• Decreased cost
• Improved Care Coordination
• Increased Quality of Data
• Increased Integrity of Data
49. RISKS OF EMR ADOPTION
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• System design flaws
• Poor Usability
• Improper Use
• Inappropriate documentation
• CDSS introduced errors
50. • Healthcare-Associated
Infections
• Antibiotic Resistance
• Personal Protective
Equipment Protocols
• Hand Hygiene
• Health IT Issues
• Medical Errors
• Workforce Safety
• Transitions of Care
• Diagnostic Errors
• Patient Engagement
TOP TEN PATIENT SAFETY ISSUES
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51. • Healthcare-Associated
Infections
• Antibiotic Resistance
• Personal Protective
Equipment Protocols
• Hand Hygiene
• Health IT Issues
• Medical Errors
• Workforce Safety
• Transitions of Care
• Diagnostic Errors
• Patient Engagement
TOP TEN PATIENT SAFETY ISSUES
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52. • Meaningful Use
• Health Information Exchange
• Healthcare Reform
• HIPAA Compliance
• Mobile health and BYOD
• Wireless Networking
• Telemedicine
• Patient Engagement
• Clinical Data Analysis
• Storage Infrastructure
• The Healthcare Cloud
• ICD-10 implementation
TOP 12 HEALTH IT ISSUES
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53. POLITICS
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• Congress trying to squelsh ICD-10 implementation.
• Senator Lamar Alexander (R Tennessee) and chairman of the Senate Health, Education,
Labor and Pensions Committee calls for delaying implementation of Meaningful Use
Stage 3.
• Republicans always looking for ways to defund and/or overturn “Obamacare”
54. UNINTENDED CONSEQUENCES
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IT Professionals
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• Poor EMR design and improper use
• Increased Fraud and Abuse
• Forced or Rushed Adoption driven by Regulatory Compliance
• HIT-induced medical errors significantly increased
• Patient Identification Errors
• Patient Merging, Matching and Segregation
• Lack of case studies leading to successful implementations working one place that fail or
don’t work well in others
• Impacts workflow of clinicians adding excessive steps to treating patients
55. SCOPE OF IMPACT
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• Sheer volume of Data Dictionary
• Additional layers of complexity to an already complex delivery system
• Potential unintended consequences of EMR adoption growing
• Lack of proper training and use
• Delays in treatment
• No way to systematically measure HIT induced errors
• Dosing errors
• Failure to detect specific conditions
56. INTEROPERABILITY
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• Electronic Health Exchange (eHx)
• RHIO/HiE
• Registries
• ePrescribing
• Peer to peer referral networks
• Billing
• LIS, RIS/PACS, Radiological/Referral reports/readings
• Telemedicine
57. MATCHING PAIRS
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58. PATIENT MATCHING
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• Unmatched Patient Records
• Mismatched Patient Records
• Overlaid Patient Records
• Internal Patient Matching
• Matching Across the Continuum
• Merging Patient Records
• Unmerging Patient Records
59. E-PRESCRIPTIONS
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• NEW Rx
• Refill Requests
• Refill Response
• CanRx Requests
• CanRx Response
• Denials
• Medication History
• Currently no way to discontinue medcations electronically
• Most doctors use comments field in new prescrption asking pharmacist to
discontinue prior meds.
60. MEDICAL DATA BREACHES
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• Data Breaches and Cyber Security Attacks at an all-time high
• Health plans are top targets for cyber attacks
• Criminal attacks cited as the number one cause of data breaches in healthcare
• More than 90% of healthcare organizations and almost 60% of their business associates have
experienced a data breach.
• Virtually 80% of healthcare organizations have experienced multiple breaches since 2010.
• Theft accounts for almost ½ of all cybercrime in healthcare.
• Credit card records are worth $1 on the black market
• Healthcare records command 10 times as much, because the rich data provides fertile ground
for fraud.
• US Healthcare is a $3 trillion/year industry
• 2014 Chinese hackers compromised 4.5 million patients
• Large payer breaches can yield millions of records and data points instantaneously.
61. MEDICAL RECORDS RETENTION
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• Full time job!
• Policy Issues
• HIPAA privacy and security regulations
• EHR system upgrades
• Release of Information Request
• Who manages the record when Physician is out dies or retires?
• ½ of all current active doctors will reach traditional retirement age by 2020
• Deloitte’s 2013 survey of over 20,000 physicians notes 62% say “it’s likely that many physicians
will retire earlier than planned in the next one to three years.
• Higher operating costs and lower reimbursements are driving many physicians out of private
practice.
• Only one-in-three doctors will remain independent by the end of 2016.
• Patients, payers, employees and lawyers may still have a vested interest
62. • Financial
• Insurance
• Medical
• Criminal
• Driver’s License
• Social Security
• Synthetic
• Child
TYPES OF IDENTITY THEFT
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63. WHAT IS MEDICAL IDENTITY THEFT
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• Use’s a person’s identity without the person’s knowledge or consent to obtain goods or
services
• Uses a person’s identity to make false claims
• Not a victimless crime
• This type of identity theft can actually kill you
64. MEDICAL IDENTITY THEFT
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• Frequently results in erroneous entries being put into existing medical records
• Can involve the creation of fictitious medical records in the victim’s name
• Not a victimless crime and in fact can KILL YOU!
• Despite the profound risk it carries, is the least studied and most poorly documented
identity theft crime.
• Most difficult to fix after the fact.
• Victims have limited rights are recourses.
• Leaves a trail of falsified information in medical records that can plague victim’ medical
and financial lives for years
65. • Names
• All geographical subdivisions smaller
than a state (including street address,
city, county, precinct and zip code)
• All elements of dates (except year)
directly related to an individual (including
birth, admission, discharge and death)
• Phone Numbers
• Fax Numbers
• Email Addresses
• Social Security Numbers
• Medical Record Numbers
• Health Plan Beneficiary Numbers
• Account Numbers
• Certificates and License Numbers
• Vehicle Identifiers and Serial Numbers
• Device Identifiers and Serial Numbers
• Web URLs
• IP Address Numbers
• Biometric identifiers including
fingerprints and voice prints
• Full face photographic images and any
comparable image
• Any other unique ID number,
characteristic or code
HIPAA LIST OF 18 IDENTIFIERS
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66. • Account Numbers
• Certificates and License Numbers
• Vehicle Identifiers and Serial Numbers
• Device Identifiers and Serial Numbers
• Web URLs
• IP Address Numbers
• Biometric identifiers including fingerprints and
voice prints
• Full face photographic images and any
comparable image
• Any other unique ID number, characteristic or
code
• Names
• All geographical subdivisions smaller than a
state (including street address, city, county,
precinct and zip code)
• All elements of dates (except year) directly
related to an individual (including birth,
admission, discharge and death)
• Phone Numbers
• Fax Numbers
• Email Addresses
• Social Security Numbers
• Medical Record Numbers
• Health Plan Beneficiary Numbers
PROTECTED HEALTH INFORMATION
“Any information about health status, provision of health care, or payment for health care
that can be linked to a specific individual.”
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67. CERTIFICATION VS USABILITY
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• CERT program includes rigorous functionality standards
• Does not address usability testing standards
• HHS Office of the National Coordinator for Health Information Technology (ONC) now
addressing this via UCD requirements:
• User-Centered Design (UCD)
• A process that places the needs of the frontline user at the forefront of development
• EHR vendors now required to provide written statements naming the UCD process they
used and the results of their usability tests
• Needs to include at least 15 representative end-user participants
• Reports must be made public once the produce is certified
68. WHAT’S IN THE FUTURE
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• Fee-for-service business models being changed to value based models
• Technology shifts from transactional based to relational based
• Clinical significance expands from recent encounters/assessments to the longitudinal
history of the population throughout the life of generations.
• Framework for treating Multiple Disease Conditions (MCC)
• More rushing forward blindly running to implement flawed systems in order to meet
arbitrary government deadlines.
• Wearable Devices
• Personalized Medicine, Genomics, Robotics and Nano-Technology
• The Internet of Things (IoT)
• Time to step back and evaluate the good, the bad and the ugly.
69. GLOBAL HEALTH
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• Ebola
• HIV/AIDS
• Global Warming
• Immunizations
70. CONCLUSIONS
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• “Meaningful Use” cannot be achieved using a carrot and stick approach
• Technology is only as valuable as its ability to server and support our collective well being
and most importantly the patients we serve.
• Solving complex business problems through the use of technology can often cause
technologically-induced opportunities for more problems.
• Disintegrated healthcare delivery system.
71. DIRECT TRUSTED AGENT ACCREDITATION
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• The Direct Trusted Agent Accreditation Program (DTAAP)
• Collaborative Program Initiative co-sponsored by EHNAC and Direct Trust
• Validates the technical, security, trust and business practice conformance of Trust Agents
involved in Direct.
• Assures HISP-to-HISP interoperability among accredited Trust Agents and other Direct
participants.
• Facilitates security, interoperability and trust among Direct exchange participants and fosters
public confidence.
• Reduces risk to PHI and operations through the demonstration of a risk management program
with effective controls that appropriately minimize threats.
• Prepares your organization for implementing secure communications in support of Meaningful
Use requirements by the ONC.
72. CAN YOU REALLY AUTOMATE EVERYTHING
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73. QUESTIONS
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“Knowing is not enough; we must apply.
Willing is not enough; we must do.” – Goethe
Editor's Notes
What’s the Difference?
Electronic medical records (EMRs) are a digital version of the paper charts in the clinician’s office. An EMR contains the medical and treatment history of the patients in one practice. EMRs have advantages over paper records. For example, EMRs allow clinicians to:
Track data over time
Easily identify which patients are due for preventive screenings or checkups
Check how their patients are doing on certain parameters—such as blood pressure readings or vaccinations
Monitor and improve overall quality of care within the practice
But the information in EMRs doesn’t travel easily out of the practice. In fact, the patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. In that regard, EMRs are not much better than a paper record.
Electronic health records (EHRs) do all those things—and more. EHRs focus on the total health of the patient—going beyond standard clinical data collected in the provider’s office and inclusive of a broader view on a patient’s care. EHRs are designed to reach out beyond the health organization that originally collects and compiles the information. They are built to share information with other health care providers, such as laboratories and specialists, so they contain information from all the clinicians involved in the patient’s care. The National Alliance for Health Information Technology stated that EHR data “can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.”
The information moves with the patient—to the specialist, the hospital, the nursing home, the next state or even across the country. In comparing the differences between record types, HIMSS Analytics stated that, “The EHR represents the ability to easily share medical information among stakeholders and to have a patient’s information follow him or her through the various modalities of care engaged by that individual.” EHRs are designed to be accessed by all people involved in the patients care—including the patients themselves. Indeed, that is an explicit expectation in the Stage 1 definition of “meaningful use” of EHRs.
And that makes all the difference. Because when information is shared in a secure way, it becomes more powerful. Health care is a team effort, and shared information supports that effort. After all, much of the value derived from the health care delivery system results from the effective communication of information from one party to another and, ultimately, the ability of multiple parties to engage in interactive communication of information.
As I have mentioned in a previous blog, we must take great care not to allow the computer to come between doctor and patient. We must continue to practice the art of medicine which requires that we actually talk and listen to our patients. We must not forget the value of interacting with patients, looking them in the eye, and providing them undivided attention. Computers, laptops, and iPads in exam rooms foster distractions–I make it a point to leave my laptop at the workstation and put my notes in the EMR after the patient has left the exam room. This often leads to finishing notes after hours.
From sports fields to schools across the country, CDC’s Heads Up program works to get information on how to spot and respond to concussions to every coach, teacher and athlete. Already CDC has disseminated over 6 million copies of Heads Up materials and has trained more than 800,000 coaches through its Heads Up online concussion trainings. In 2013, CDC will launch the Heads Up to Parents initiative, with tools designed to help parents keep kids safe from concussion on and off the sports field.
– National Center for Transgender Equality – 2015 US Trans Survey follow-up to the National Transgender Discrimination Survey: Injustice At Every Turn
The FIDO ("Fast Identity Online") Alliance is an industry consortium launched in February 2013 to address the lack of interoperability among strong authentication devices and the problems users face creating and remembering multiple usernames and passwords. PayPal and Lenovo were among the founders.[1]
Contents [hide]
1 Members
2 Specifications
3 References
4 External links
Members[edit]
By the end of June 2015, FIDO members totaled more than 200, including a Board made up of the Alibaba Group, ARM, Bank of America, CrucialTec, Discover Financial Services, Google, Daon, Inc., Egis Technology, Intel, ING, Lenovo, MasterCard, Microsoft, Nok Nok Labs, NTT DoCoMo, NXP Semiconductors, Oberthur Technologies, PayPal, Qualcomm, RSA, Samsung, Synaptics, USAA, Visa and Yubico.[2] A full list of members is available here.
The Electronic Healthcare Network Accreditation Commission (EHNAC) a voluntary, self-governing SDO established to develop standard criteria and accredit organizations that electronically exchange healthcare data. (Electronic Health Networks, Payers, Financial Services, Health Information Exchanges
Direct Trust is a collaborative non-profit association of 150 health IT and health care provider organizations to support secure, interoperable health information exchange via the Direct message protocols. Direct Trust has created a “trust framework” that extends use of Direct exchange to over 40,000 health care organizations and 760,000 Direct addresses/accounts. This trust framework supports both provider-to-provider Direct exchange and bi-directional exchange between consumers/patients and their providers.