Health Informatics Survey INTD 560 O.R. Zaïane © 2009Health Information Management Knowledge Management, Intro to Electronic Databases, Health Data Analysis

Health Informatics SurveyINTD 560

O.R. Zaïane © 2009Health Information Management

Knowledge Management, Intro to Electronic Databases,

Health Data Analysis

INTD 560

Survey of Health Informatics

Osmar R. Zaïane



Who am I?

UNIVERSITY OFALBERTA

Osmar R. Zaïane, Ph.D.ProfessorDepartment of Computing Science

352 Athabasca HallEdmonton, AlbertaCanada T6G 2E8

Telephone: Office +1 (780) 492 2860Fax +1 (780) 492 1071

E-mail: [email protected]://www.cs.ualberta.ca/~zaiane/

• Computer Scientist• No medical training• Specialize in Data Mining• Many years of sporadic

experience designing

and implementing health

care systems• Not a chronic patient yet



Health Information Management

• What kind of information is collected in health care?

• Who collects it?• Why is it collected?• What is it used for?• By who?• Where is stored• Who does it belong to?• Who is entitled to access it?



Example:• Physicians assess patient status;• Clinicians administer treatment;• Administrators determine appropriate staffing levels;• Administrators manage inventory of supplies;• Administrators negotiate contracts and payment for services;• Pharmacists manage inventory of drugs;

• Administrators and statisticians evaluate clinical outcome, quality and cost of healthcare provided per population;• Politicians make decisions investing in new services or eliminating underutilized services;• Researchers analyze and compare clinical treatment and outcome and devise new treatments





Patient Profile: Mary Smith• Mrs. Mary Smith

– 73 year old female– recently moved to Red Deer– previously lived in Toronto

• Where are her medical records?– Not in Red Deer– Not in Alberta– Spread in Ontario (Toronto

hospitals, health centres, etc.)

• What will happen if she needs them?



• Mrs. Smith visits the Red Deer regional hospital

• She has come for an “Initial Visit” appointment at 10:00am with Dr. Robertson

• Upon arrival, Mrs. Smith checks in with the front desk

• Front desk staff enters her information into the registration system



Ideal Scenario on Information Flow

Red Deer Registration

System

Health System 1

Health System 2

Health System 3

Health System n

Local HIS Interface

1- New Patient message Interface Engine /

Aggregator

Gateway

Federal Aggregator

2- Internal Request 3- External Request

4- External sites identified

5- Request inform

ation for Mrs. S

mith

6- Receive data: Smith’s Medications and Allergies

7- Provide data



• The data exchange occurs automatically and transparently, between registration at Red Deer and the health organization custodian of medical data in Ontario

• When Dr. Robertson walks into the exam room, Mrs. Smith’s known Medications and Allergies are available for review on local health information system

Wish list



Ideal Scenario on Information Flow

Red Deer Registration

System

Health System 1

Health System 2

Health System 3

Health System n

Local HIS Interface

1- New Patient message Interface Engine /

Aggregator

Gateway

Federal Aggregator

2- Internal Request 3- External Request

4- External sites identified

5- Request inform

ation for Mrs. S

mith

6- Receive data: Smith’s Medications and Allergies

7- Provide data

Dr. Robertson examines Mrs. Smith, then writes prescriptions into the Health Information System…

1. Reordering a previous prescription 2. Verification of allergy3. Decision support

• Allergy detection• Drug-Drug Interaction

4. Select pharmacy to receive electronic prescriptions



Reality Check

• Mrs. Smith has 3 months to get an Alberta health card and number

• Dr. Robertson would ask Mrs. Smith about her medical history and her previous medical providers (doctors, hospitals, etc.)

• Dr. Robertson (or hospital) has to contact Mrs. Smith’s previous medical providers for her file.

• They might reply, by mail or fax. E-mail is not considered secure (but fax is ???)

• Her medical record in Alberta has to be created from scratch.



Healthcare=Information Intensive• Healthcare professionals = heterogeneous group with

divers objectives and information requirements

• “The purpose of a HealthCare Information System is to manage the information that health professionals need to perform their jobs effectively and efficiently.”



Automation of Healthcare Systems

• Historically, different units and services within a hospital were automated (introduction of IT) separately;

• Separate in terms of function, hardware, operating system, programming language, vendors;

• Connecting and communicating between the pieces is a challenging obstacle: consistency, updates, etc.

• Locating where the patient is and any given time; Identifying the kind of care provided; recognizing the clinical results, etc. are significant real challenges.




Hospital

Registration Billing Medical Unit Medical Unit Medical Unit Medical Unit Lab Unit

Separate automation of specific functions within the hospital

Integration via Interface Engine or Protocol (HL7)



Separate functional automation

• Significant duplication; for instance registration and demographic data can be entered many times for the same visit.

• Contradictions and missing data

• Integration difficult and prone to error

• Software maintenance and upgrades expensive

• Infrastructure and training expensive



Enterprise Automation

Hospital

Registration

Billing

Medical Unit

Medical Unit

Medical Unit

Medical Unit

Lab Unit

automation within the hospital as a whole enterprise




Healthcare Organization

Integration via Aggregator/Mediator/Protocol (HL7)




“The expertise gained from managing an inpatient driven organization (e.g. a hospital) does not translate easily to the successful management of other organizational activities, nor in some cases, even to other hospitals.”

Idem for automation



Functions and components of HIS

• Patient Management and Billing

• Departmental Management

• Care Delivery and Clinical Documentation

• Clinical Decision Support

• Financial and Resource Management



Benefits

• Cost reduction

• Productivity enhancement

• Quality and service improvement

• Regulatory compliance

• Research enabler

• Competitive advantage



Requirements

• Information requirements– Operational– Planning– Communication– Documentation and Reporting

• Integration requirements

• Security and confidentiality requirements



Personal Information Protection• Alberta: Personal Information Protection Act (PIPA),

2003 (http://pipa.alberta.ca/)– The purpose of this Act is to govern the collection, use and disclosure of personal

information by organizations in a manner that recognizes both the right of an individual to have his or her personal information protected and the need of organizations to collect, use or disclose personal information for purposes that are reasonable.

• Ontario: Personal Health Information Protection Act (PHIPA); outlines privacy regulations for health information custodians

• Saskatchewan: Health Information Protection Act (HIPA), 2005

• Canada: Personal Information Protection and Electronic Documents Act (PIPEDA), 2001 (applies to federally regulated industries)

• USA: Health Insurance Portability and Accountability Act (HIPAA), 1996 http://www.hipaa.org/

Not Health Specific



Privacy of health information

Why protect the privacy of health information?•Do you know who accessed your health information this week?•Do you know what they did with your health information?•Does this concern you?

What increased threats to privacy, if any, does the emerging ‘electronic health record’ pose?

•Privacy incorporates much more than “confidentiality” and “security”.•Privacy is about protecting an individual’s right to have a choice about how their health information is handled.

•Challenge: maximise both the protection of individual privacy AND positive health outcomes.

Identity theft and being impersonated may lead to financial lossesIdentity theft in healthcare and being impersonated may lead to death.



Active Participants

• Physician• Nurse• Lab technician• Pharmacist• Other care providers• Administrators• Insurance• Patient (becomes an active participant)



Patients can be active Participants• The patient is a participant in their care with self-entered data and consent

preferences for this data. Patient in control over what goes into the Personal Health Record and who has access to it.

• Some companies see this as business opportunity

• Let consumers opt-in to share the output from a device measuring their blood sugar or blood pressure or other medical sensors.

• This information is viewable in an aggregated format allowing for a more accurate overall clinical picture

• Clinicians can view self entered data as well as historical prescriptions and conditions from multiple sources electronically

• goals: “To create integrated online environments where you can create and store your personal records, get information, find doctors, make medical appointments, communicate online, manage medications, share information with providers and more.”





Questions?