HEALTHCARE INFORMATIONTECHNOLOGY

Dr.Vijay bhushanam MD

CPOE

HL7

EMR

HIS

EHR

RIS

HIPAA

PACS

DICOM

Objectives

• Evolution of Healthcare IT and its advantages

• Terminology

• Components of Hospital Information System

• Standards Organizations

Medication errors: in the US 80,000 people died in 2004. (=8th cause of death)

In Malaysia.. (Source: Hosp_AT_Terendak)

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.

Evolution of Healthcare and 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

Order Process Manual Automated

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

Data completeness

Fragmented Consolidated

Data integrity Manual/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

Ultimate objective

• Decrease cost• Increase quality• Easy to use

Some terms associated with 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

Evolution of Electronic records

• In the beginning there was the hand written chart

• Next came Transcription

• PC-based word processors (MS Word, etc.)

Ideal recording system should 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

EMR

• EMR is the 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.

EHR

• Is a subset 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).

EMR Vs EHR

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

Advantages of Electronic records

• 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 communication

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

Medical Ward General Ward

ICCU CTICU

ROOMS ROOMS

Post OP

Pre OP

OT

OT

ADMINISTRATOR EDDOCTOR’S ROOM

NURSE’S ROOM

PHARMACY SC

US

LAB

X-RAY

RECEPTIONMED OP

SURG OP

ORTHO OP

CARDIAC OP

HIS (cont.)

EMR

Lab DataLIS

RISPatientBedsideMonitoring

Pharmacy solutions

Administrative HIS

DiagnosticImaging

Clinical Systems Overview

Enterprise Applications Scheduling, Case Management

Users Clinical Reporting Management EIS Regulatory Agencies Performance Report Card

Users Clinical Reporting Management EIS Regulatory Agencies Performance Report Card

Location Specific and Distributed Transaction Systems

INTEGRATION TOOLS

USERS

Order Entry / Results

Pharmacy

Clinical Documentation

ADT/Registration

Radiology

STOR

SurgicalScheduling

ClinicalDataRepository

METADATA

DataWarehouse

Archived

Lightlysummarized

Highlysummarized

Archive

Archive

Clinical Decision Support

Clinical Decision Support

Clinical Decision Support

Clinical Decision Support

EMPI Interface Engine

EMPI Interface Engine

HIS (Cont.)

• Support of 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

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

What the system can 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, referralsFinal Bill generation,scheduling booking online

Auto Billing. Auto calculation from registration, Auto calculation upon order execution, interim bill etc

7. AppointmentOnline diet order: Normal, Therapeutic, Patient diet, Referral to dietitian, catering activities

Online appointmentManage appointment scheduling

Advantages of Hospital Information 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

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,... )

Organizations

• CHI (Consolidated Health 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

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

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.

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

HL7

• Health Level Seven (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

DICOM

• Digital Imaging and 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).

PACS

• In medical imaging 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

HIPAA

• The Health Insurance 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.

Summary

• Healthcare transformation is 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

THANK YOU