medical informatics lecture 1 electronic patient records
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Medical informaticsLecture 1
electronic patient records
The big picture
Understanding
diseases and their
treatment
Understanding
diseases and their
treatment
Ensure rightPatients receiveright
intervention
Ensure rightPatients receiveright
intervention
Service delivery,
performance
assessment
Service delivery,
performance
assessment
Develop and test
treatments
Develop and test
treatments
Clinical engagement, post-
marketing surveillance, data
mining
Manage safe workflow, professional
communication, security
Patient-specificDecision-making to
optimise and personalise treatment
Standards basedformalisation of clinical data and research results
Course objectives
• Provide an overview of the main development areas in health informatics.
• Understand the role of informatics in translating medical research into clinical practice
• Look at Electronic patient records topics in more depth.
Biomedical informatics (1): Bio-informatics
• Rapidly developing branch of biology: highly interdisciplinary, using techniques and concepts from IT, statistics, mathematics, chemistry, biochemistry, physics, and linguistics!
• Seeks knowledge from computer analysis of – biological data (e.g. genomics, proteomics)– experimental results – patient statistics – scientific literature.
• Research in bioinformatics includes development of methods for storage, retrieval, and analysis of data, modeling and simulation of cellular/molecular systems.
Biomedical informatics (2): Health-informatics
• Also known as medical or clinical informatics• It is applied to primary and specialist patient
care, nursing, dentistry, pharmacy, public health etc.
• Deals with the resources, devices, and methods required to optimize the acquisition, storage, retrieval, and use of information in delivery of healthcare services
• A particular focus is on services at the point of care and emphasis is increasingly being placed on informatics for patients and carers as well as professionals.
Topics in health informatics (1): traditional perspective
• Architectures for electronic medical records and other health information systems used for billing, scheduling, and research
• Standards (e.g. DICOM, HL7) … to facilitate the exchange of information between healthcare information systems - these specifically define the means to exchange data, not the content
• Controlled vocabularies … used to allow a standard, accurate exchange of data content between systems and providers
• Software for specialist services and devices
Topics in health informatics (2):
new drivers• Quality and safety
– US Institute of Medicine•“To err is human” •“Crossing the quality chasm”•McGlynn data on service delivery•Fineberg lecture on YouTube
– NHS • Emergence of clinical decision support
and workflow management systems
Topics in health informatics (3):Contemporary multidisciplinary
view• Traditional “engineering” topics
– Hardware and software service architectures– Specialist technical services– Digital signal processing
• Human and organisational factors in quality and safety– User interface design (Tang lecture on YouTube)– Organisational memory– Learning from experience– Change management
• Formal representation of data and knowledge– Controlled vocabularies, “ontologies”– Applying knowledge to data: logic and description logics,
decision theory, guidelines and workflows
The key challenges (adapted from Coiera p 104)
• How do we apply knowledge to achieve a particular clinical objective?
• How do we decide how to achieve a particular clinical objective?
• How do we improve our ability to deliver clinical services?
Medical research, clinical practice
Understanding
diseases and their
treatment
Understanding
diseases and their
treatment
Ensure rightPatients receiveright
intervention
Ensure rightPatients receiveright
intervention
Service delivery,
performance
assessment
Service delivery,
performance
assessment
Develop and test
treatments
Develop and test
treatments
HealthRecords
First …
• Capture your data, accurately, completely
• Make the data readily accessible
The paper record, pros
• Portable• Familiar and easy to use
– Exploits everyday skills of visual search, browsing etc
• Natural: “direct” access to clinical data – Handwriting– Charts, graphs– Drawings, images…
The paper record: cons
• Can only be used for one task at a time– If 2 people need notes one must wait– Can lead to long waits (unavailable up to 30%
of time in some studies)
• Records can get lost • Consume space• Large individual records are hard to use• Fragile and susceptible to damage• Environmental cost
Electronic health records• An electronic health record
is a repository of information about a single person in a medical setting, including clinical, demographic and other data.
• The repository resides in a system specifically designed to support users by – providing accessibility to
complete and accurate data – may include services to
provide alerts, reminders, links to medical knowledge and other aids to clinical practice.
The electronic medical record
Examples
Driving Factor to Adopt an EMR
• Different charting methods in different offices
• Growing practice – adding new docs• Rising transcription costs -
$250k/year in 1998 and going up• Need to enhance quality of care • Reduce practice overhead
Goals of Using the EMR
• Provide a single, uniform medical record.
• Ability to access medical records from any location.
• Improve documentation and coding. • Improve research / clinical trials data /
enhance quality.• Reduce transcription and other rising
costs.
Functions of the EHR (1)
1. Supports structured data collection using a defined vocabulary.
2. Accessible at any or all times by authorized individuals.
3. Contains a problem list - patient’s clinical problems and current status
4. Supports systematic measurement and recording of data to promote precise and routine assessment of the outcomes of patient care
5. States the logical basis for all diagnoses or conclusions as a means of documenting the clinical rationale for decisions about the management of the patient’s care.
Functions of the EHR (2)
1. Can be linked with other clinical records of a patient—from various settings and time periods—to provide a longitudinal (i.e. lifelong) record of events that may have influenced a person’s health.
2. Can assist the process of clinical problem solving by providing clinicians with decision analysis tools, clinical reminders, prognostic risk assessment and other clinical aids.
3. Can be linked to both local and remote databases of knowledge, literature and bibliography or administrative databases and systems so that such information is readily available to assist practitioners in decision making.
4. Addresses patient data confidentiality.
5. Can help practitioners and health care institutions manage the quality and costs of care.
Benefits Realized
• Staff to physician ratio decreased below
national ratio average.
• Practice overhead costs will be reduced.
• Patient perception of practice improved.
• Better patient coverage during off hours
since information was more consistent,
complete and accessible.
Benefits continued…• e-Prescribing improves patient safety
(instructions, warnings and legibility)
• Sharing data efficiently outside the practice.
• improves quality of care at other provider
organizations
• Rewards (financial) for documenting clinical
performance
• Improved quality of life for physicians
Electronic health records: pros
• Compact• Concurrent use• Easily copied/archived• Portable (handheld and wireless devices)• Secure• Supports many other services
– Decision support– Workflow management– Performance audits– Research
Electronic health records: cons
• High capital investment– Hardware, software, operational costs– Transition from paper to computer
• Training requirements• Continuing security debate
– Stealing one paper record is easy, 20 is harder, 10,000 effectively impossible – the security risks are very different for electronic data.
• Power outs – the whole system goes down!
Ad hoc view
User view
Service architecture view
TerminologiesOntologies
Clinical guidelinerepository
Clinicaltrials
repository
Acuteservices
PrimaryCare
services
Point of care
services
FederatedEHR
Search andanalysisservices
Clinical data“Organisational
Memory”
Chroniccare
services
Communication & Coordination
services
Functional view
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