Healthcare Information Systems: An Overview

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Healthcare Information Systems An Overview

• Nancy B. Clark, M.Ed.
• Director of Medical Informatics Education
• FSU College of Medicine

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What is wrong with this picture?
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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.

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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

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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?

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Elements of IT Infrastructure

• Hardware/Software
• Support Issues
• Workflow/Mindset Issues
• Training Issues
• Budgeting Issues

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Administrative Applications

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

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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

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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
• Integrated Clinical Information Systems

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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

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FSU College of Medicine Technology Supporting
Medical Education

• What our graduates will expect to have in their
  residencies, practices, and hospitals.

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Technology Highlights

• Tablet PCs
• PDAs for Medical Reference
• IT Enchanced Environment printing, scanner,
  classroom small group presentation system,
  audience response system, wireless single sign
  on,
• The Portals The College Web Site, the Electronic
  Library Blackboard

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The Tablet PC

• Dell XT

Issue First Day 1.88 GHz Processor 2 G MB RAM 80
GB Hard Disk DVD-RW drives SD card slot PCM/CIA
slot 4 USB ports 4.5 lbs
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Software Installed

• Windows Vista
• Office 2007, including Word, Excel, PowerPoint,
  Publisher, Access, Outlook, Internet Explorer
• Adobe Acrobat Reader, Microsoft Digital Image
  Suite, medical spell checker, and EndNote
• Anti-virus, anti-spyware, other security
  software

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Turning Point

• Audience Response Systems
• Incorporated into classroom teaching to provide
  instant feedback
• Software is installed on the tablets

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Interesting Tablet Software

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

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EMR

• SOAPware
• Use 3rd year

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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.
• Replaced 3rd yr

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The HP iPAQ

• Windows Mobile 5
• 1 GB SD card
• Color, backlit, 240-360 screen
• Sound recorder, mp3 player
• Wireless - both WiFi Bluetooth

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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)

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iPhone Revolution

• Cell phone technology expanding to PDAs
• Medical reference websites reformatting
• Software versions availability expanding
• WM cell phones popular

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Epocrates Essentials

• Epocrates Essentials
• Most widely used PDA program by medical
  practitioners
• Rx, (Drugs Complementary meds)
• Sx/Dx (Symptom Disease Reference)
• Labs other tools.
• iPhone version released Jan 09

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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

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Clinical Learning Center
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Simulation Center
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The College Portals

• Our Electronic Library
• SharePoint Intranet
• Internal document sharing
• Wikis, blogs, webcasts
• Policies, procedures, etc.
• Enterprise Exchange e-mail system with integrated
  calendars and contacts
• Blackboard Courseware

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www.med.fsu.edu
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Our Library is always open
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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 8 web resources

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Blackboard - Course Websites

• All Course Materials
• Syllabus Assignments
• PowerPoints Lecture notes
• Discussion board Grades Posting

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Overview of Current State of Healthcare IT
Adoption
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Source of Stats

• 2008 HIMSS Leadership Survey
• 360 IT HealthCare Executives representing 700
  hospitals
• http//www.himss.org/2008Survey/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

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Projected IT Priorities
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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Top Business Issues Facing HealthCare
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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Most Significant Barriers to Barriers to
Implementing IT
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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Most Important Applications
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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Status of Electronic Medical Record Implementation
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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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
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Hikmet N, et al. The role of organizational
factors in the adoption of healthcare information
technology in Florida hospitals. Health Care
Manag Sci. 2008 Mar11(1)1-9.
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Top Security Concerns of Computerized Medical
Information
Source 17th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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Security Tools
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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Technology Adoption Curve
75
50
25
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Technology Adoption (Next Two Years)
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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2008 Health IT Staffing Needs
Source 19th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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National Initiatives
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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)
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Sharing Medical Data

• Increase patient safety
• Lower Healthcare costs
• Allow for coordination of care
• Increase communication between providers
• Banking analogy

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Health IT Activities Over the Years

• Selected activities to drive interoperability and
  standardization of health information technology
  
• 1996 The Health Insurance Portability and
  Accountability Act (HIPAA) enacted
• 1998 The National Committee on Vital and Health
  Statistics (NCVHS) espoused a national health
  information infrastructure to promote American
  health
• 2002 Markle Foundation forms the Connecting For
  Health initiative that assembled public/private
  leadership in healthcare to promote common
  electronic standards

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Health IT Activities Over the Years

• Selected activities to drive interoperability and
  standardization of health information technology
  
• 2003 The Federal Health Architecture (FHA) is
  established in the HHS Office of the Chief
  Information Officer and is tasked with defining a
  framework and methodology for establishing the
  target architecture and standards for
  interoperability and communication throughout the
  federal health community
• 2003 President Bush signs the Medicare
  Prescription Drug Improvement and Modernization
  Act (MMA) allowing CMS to establish key
  infrastructure for health information technology
  such as e-prescribing

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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

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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

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Status of Regional Health Information
Organization (RHIO)
Source 17th Annual HIMSS Leadership Survey
Sponsored by ACS HealthCare Solutions
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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

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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

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Where can you learn more?
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Web Sites/Organizations

• American Medical Informatics Association (AMIA)
• Healthcare Informatics
• Healthcare Information and Management Systems
  Society (HIMSS)
• 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)

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Resources - Books
Medical Informatics Practical Guide for the
Healthcare Professional, 2007 by Robert Hoyt
MD, Melanie Sutton PhD, Ann Yoshihashi MD
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Resources - Books

• Healthcare Information Systems Ed. By K. Beaver
  (Auerbach) 2002.

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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

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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)

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Conferences

• HIMSS regional and national conferences
• 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

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Training

• FSU College of Information
• CoM Faculty Development
• AMIA/Oregon Health Sciences 10 x 10 program
  http//www.amia.org/10x10/partners/ohsu/

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Health IT Conclusions

• Health care and education rapidly adopting
  technology
• Patient Centric Focus
• Customer Satisfaction
• Patient Safety
• Financial Support for Health IT on-going concern
• Sharing information cost effective and safer
• Clinical Information Systems, Electronic Medical
  Records (EMR) and Computerized Physician Order
  Entry (CPOE) most important applications
• Interoperability is a must for Health IT