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Healthcare Information Systems: An Overview

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... M.Ed. Director of Medical ... 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions Most ... et al. Patient Safety-Related Information ... – PowerPoint PPT presentation

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Title: Healthcare Information Systems: An Overview


1
Healthcare Information Systems An Overview
  • Nancy B. Clark, M.Ed.
  • Director of Medical Informatics Education
  • FSU College of Medicine

2
What is wrong with this picture?
3
What is wrong with this picture?
  • illegible handwriting,
  • ambiguous and
  • incomplete data,
  • data fragmentation- each lab report is a separate
    piece of paper which does not allow a physician
    to visualize the progress of a patients
    conditions.
  • poor availability- studies have shown that as
    much as 40 of the time the paper record can not
    be found.

4
What is wrong with this picture?
  • Insecure in open, unguarded shelving in a clinic
  • In addition, paper records often become bulky
    with time, which leads to lack of overview.
  • When it comes time to share the record with
    another clinician, each individual piece of paper
    has to be hand copied, then mailed. It can cost
    a clinic up to 35 just to do this.
  • Employee cost of moving all this paper around
    estimates it costs 5 just to pull one chart.
  • Space most medical office space rents for
    18-22/sq ft/yr 240 sq ft

5
Outline
  • What kinds of HIT systems are there?
  • What are we using here at FSU CoM?
  • What major trends are emerging?
  • What are the benefits to adoption?
  • What are the barriers to adoption?
  • What is the current state of adoption?
  • How can you learn more?

6
Elements of IT Infrastructure
  • Hardware/Software
  • Support Issues
  • Workflow/Mindset Issues
  • Training Issues
  • Budgeting Issues

7
Basic Technology
  • High speed networks
  • Wireless Networks
  • PDAs
  • Tablets
  • Internet access
  • Web server
  • Intranets (SharePoint)
  • Video conferencing
  • Bar-code readers
  • Voice over internet
  • Speech recognition

8
Administrative Applications
  • Security (virus protection, firewalls, retinal
    scans, thumb prints)
  • System wide e-mail with external access via web
  • System wide calendaring
  • Single sign-on active user directory
  • Website
  • Intranet
  • Shared file systems
  • Personnel systems

9
HIT Applications
  • Patient registration/ demographics
  • Insurance validation
  • Billing systems
  • Appointment systems
  • Computerized Physician Order Entry (CPOE)
  • EMR/EHR/CPR
  • Pharmacy systems
  • Lab systems
  • Imaging systems
  • Telemedicine
  • Patient education
  • Decision Support
  • Library resources
  • Sensors

10
Sad Facts
  • Medical errors account for more deaths than
    breast cancer, AIDs and motorcycle accidents.
  • US has highest HC costs per capita in world
  • US has worst outcomes of industrialized nations.
    (infant mortality, lifespan, etc.)
  • Healthcare is 10-15 yrs behind business in
    adoption of IT

11
FSU College of Medicine Technology Supporting
Medical Education
  • What our graduates will expect to have in their
    residencies, practices, and hospitals.

12
Technology Highlights
  • Tablet PCs
  • PDAs for Medical Reference
  • IT Enchanced Environment printing, scanner,
    classroom small group presentation system
  • The Portals The College Web Site, the Electronic
    Library Blackboard

13
The Tablet PC
  • Lenovo ThinkPad TabletPC

Issue First Day 1.88 GHz Processor 3 G MB
RAM 130 GB Hard Disk External DVD-RW drives SD
card slot PCM/CIA slot 3 USB ports 4.5 lbs
14
Software Installed
  • Windows Vista (7) Tablet Edition
  • Office 2007, including Word, Excel, PowerPoint,
    Publisher, Access, Outlook, Internet Explorer
  • Adobe Acrobat Reader, Microsoft Digital Image
    Suite, WinZip, Sonic Record Now, medical spell
    checker, and EndNote
  • Anti-virus, anti-spyware, other security
    software

15
Interesting Tablet Software
  • Microsoft Office OneNote
  • Windows Journal
  • Microsoft Educational Pack for Tablet PC
  • Microsoft Experience Pack for Tablet PC
  • Sticky Notes
  • Snipping Tool

16
EMR
  • SOAPware
  • Use 3rd year

17
PDAs
  • Issues Fall 1st year
  • Used to track all patient encounters
  • Used as extension of library resources, to find
    information quickly in clinical environments at
    the point of care.

18
HP iPAQ
  • Windows Mobile 6
  • 1 GB SD card
  • Color, backlit, 240-360 screen
  • Sound recorder, mp3 player
  • Wireless - both WiFi Bluetooth

19
FSU Licensed PDA Software
  • Epocrates Essentials (149/yr)
  • Essential Evidence Plus (249/yr)
  • DynaMed (200/yr)
  • PEPID (199/yr)
  • Pediatric Care Online (289/yr)
  • Clinical Evidence (99/yr)
  • Harrisons Practice (325/yr)
  • Geriatrics at Your Fingertips (30)
  • Savings to each faculty and student gt 1,500/yr

20
iPhone Revolution
  • Cell phone technology expanding to PDAs
  • Medical reference websites reformatting
  • Software versions availability expanding
  • 6 resources Epocrates, PEPID, Dynamed, ePSS,
    Pediatric Care Online, Clinical Evidence
  • WM cell phones popular

21
PDA Versions Available
22
Epocrates Essentials
  • Epocrates Essentials
  • Most widely used PDA program by medical
    practitioners
  • Rx, (Drugs Complementary meds)
  • Sx/Dx (Symptom Disease Reference)
  • Labs other tools.

23
IT Enhanced Environment
  • Wireless networking
  • Classroom Presentation Systems
  • Multi-function copier, printer, scanner -
    machines
  • A/V equipment in small group rooms and community
    learning centers
  • Large format printing for posters and signs is
    available for school related projects

24
Clinical Learning Center
25
Sim Center
26
The College Portals
  • Our Electronic Library
  • SharePoint Intranet
  • Internal document sharing
  • Policies, procedures, etc.
  • Enterprise Exchange e-mail system with integrated
    calendars and contacts
  • Blackboard Courseware

27
www.med.fsu.edu
28
Our Library is always open
29
24/7 Access to Resources
  • gt1900 medical eJournals (3.5 M articles)
  • Hundreds of clinical eBooks
  • Evidence-based medicine resources and Guidelines
  • Disease, drug, images and patient education
    resources
  • Web-based course materials
  • Medical search engines
  • 200 periodicals databases
  • PDA versions of 7 web resources

30
Blackboard - Course Websites
  • All Course Materials
  • Syllabus Assignments
  • PowerPoints Lecture notes
  • Discussion board Grades Posting

31
Overview of Current State of Healthcare IT
Adoption
32
Source of Stats
  • 2009 HIMSS Leadership Survey
  • 304 IT HealthCare Executives representing 700
    hospitals
  • http//www.himss.org/2009Survey/healthcareCIO_fina
    l.asp
  • FSU CoM - Center on Patient Safety
  • Robert Brooks, MD, Associate Dean, Health Affairs
  • Nir Menachemi Ph.D., MPH, Director, Center on
    Patient Safety

33
Projected IT Priorities
Source 20th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
34
Top Business Issues Facing HealthCare
Source 20h Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
35
Most Significant Barriers to Barriers to
Implementing IT
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
36
Status of Electronic Medical Record Implementation
Source 20h Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
37
Florida Hospitals
Brooks R, et al. Patient Safety-Related
Information Technology Utilization in Urban and
Rural Hospitals. Journal of Medical Systems, Vol.
29, No. 2, April 2005
38
Top Security Concerns of Computerized Medical
Information
Source 20h Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
39
Security Tools
Source 20h Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
40
Technology Adoption Curve
75
50
25
41
Technology Adoption (Next Two Years)
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
42
2008 Health IT Staffing Needs
Source 20h Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
43
2009 Health IT Staffing Needs
Source 20h Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
44
National Initiatives
45
Wiring Healthcare
Current system fragments patient information and
creates redundant, inefficient efforts
Future system will consolidate information and
provide a foundation for unifying efforts
Hospitals
Public health
Primary care physician
Laboratory
Pharmacy
Specialty physician
Payers
Ambulatory center (e.g. imaging centers)
46
Sharing Medical Data
  • Increase patient safety
  • Lower Healthcare costs
  • Allow for coordination of care
  • Increase communication between providers
  • Banking analogy

47
Office of the National Coordinator for Health IT
  • Established by Executive Order 13335 (April 27,
    2004)
  • Responsible for realizing the Presidents vision
    of Health IT
  • Widespread adoption of interoperable EHR within
    10 years
  • Medical information follows consumer
  • Clinicians have complete, computerized patient
    information
  • Quality initiatives measure performance and drive
    quality-based competition
  • Public health and bioterrorism surveillance are
    seamlessly integrated into care

48
Goals
  • Develop a nationwide health information network
    (NHIN)
  • Establish standards for data transfer and
    storage
  • Continuity of care records
  • Develop Regional Healthcare Information
    Organizations (RHIOs)
  • See article Burton, et al. Using electronic
    health records to help coordinate care. Milbank
    Quarterly. V(82)457-81. 2004

49
Status of Health Information Exchange (HIE)
Source 20th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
50
Needed for CCR
  • Universally agreed-on medical vocabulary
  • Principled and standard formats for laboratory
    data, medical images, medical record
  • Standardization of medical literature
    formats--structured abstracts
  • Health care standards -- treatment guidelines
  • Standards for health data exchange

51
Clinical Data Standards
  • Current
  • HL7 messages for most lab data
  • DICOM messages for images
  • LOINC for laboratory results content
  • CPT-4 for procedures content
  • ICD-9 for diagnoses content (10 coming)
  • NDC ?? RxNorm for medication content
  • Anticipated medical vocabulary
  • SNOMED/UMLS Concept Unique Identifiers for
    microbiology content

52
Where can you learn more?
53
Web Sites/Organizations
  • American Medical Informatics Association (AMIA)
  • Healthcare Information and Management Systems
    Society (HIMSS)
  • Healthcare IT News
  • Healthcare Informatics
  • Health Informatics at Wikipedia
  • Medical Group Management Association (MGMA)
  • The Informatics Review
  • To Err Is Human Building a Safer Health System
    (IOM)
  • Crossing the Quality Chasm (IOM)
  • Health Professions Education (IOM)
  • Patient Safety Achieving a New Standard for Care
    (IOM)

54
Web 2.0
  • http//www.hitsphere.com/

55
Journals
  • JAMIA J. of the American Medical Informatics
    Assoc.
  • Telemedicine and e-Health
  • IEEE Trans. on Information Technology in
    Biomedicine
  • Health Informatics
  • Studies in Health Technology and Informatics
  • Biosensors and Bioelectronics
  • Healthcare Informatics Online (Magazine)
  • IEEE Technology and Society
  • British Computer Society

56
More Journals
  • Artificial Intelligence in Medicine (Elsevier)
  • Computers in Biology and Medicine (Pergamon
    Press)
  • Computers in Biomedical Research (Academic Press)
  • Computer Methods and Programs in Biomedicine
    (Elsevier)
  • IEEE Engineering in Medicine and Biology Magazine
  • Journal of Medical Systems (Plenum Press)
  • MD Computing (Springer-Verlag)
  • Medical Informatics The Internet in Medicine
    (Taylor Francis)
  • Methods of Information in Medicine (Schattauer)
  • Yearbook of Medical Informatics (Schattauer)

57
Conferences
  • HIMSS regional and national conferences.
    3/10/10 Atlanta
  • AMIA Annual Symposium (and Spring Congress)
  • HEALTHCOM Health Communication Conference
  • MEDINFO (every 3 years, next in 2007), run by
    the IMIA (International Medical Informatics
    Association)
  • MGMA 2007 MGMA Health Care Information
    Technology Forums

58
Training
  • AMIA/Oregon Health Sciences 10 x 10 program
    http//www.amia.org/10x10/partners/ohsu/

59
Health IT Conclusions
  • Financial Support for Health IT on-going concern
  • Patient Centric Focus
  • Customer Satisfaction
  • Patient Safety
  • High-speed networks, Intranet and wireless
    information systems currently in use, to be
    expanded across regions
  • Electronic Medical Records (EMR) and Computerized
    Physician Order Entry (CPOE) most important
    applications
  • Interoperability is a must for Health IT
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