Healthcare Information Systems: An Overview

FFLORIDALORIDA SSTATE TATE UUNIVERSITYNIVERSITY

The College of MedicineThe College of MedicineFFLORIDALORIDA SSTATE TATE UUNIVERSITYNIVERSITY

The College of MedicineThe College of Medicine

Healthcare Information Healthcare Information Systems: An OverviewSystems: An Overview

Nancy B. Clark, M.Ed.Nancy B. Clark, M.Ed.Director of Medical Informatics EducationDirector of Medical Informatics Education

FSU College of MedicineFSU College of Medicine

FFLORIDALORIDA SSTATETATE UUNIVERSITYNIVERSITY

The College of MedicineThe College of MedicineFFLORIDALORIDA SSTATETATE UUNIVERSITYNIVERSITY


What is wrong with this picture?What is wrong with this picture?




What is wrong with this picture?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 patient’s conditions.

• poor availability- studies have shown that as much as 40% of the time the paper record can not be found.




What is wrong with this picture?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




Outline 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?




Elements of IT InfrastructureElements of IT Infrastructure

• Hardware/Software

• Support Issues

• Workflow/Mindset Issues

• Training Issues

• Budgeting Issues




Basic TechnologyBasic Technology• High speed

networks• Wireless Networks

– PDAs– Tablets

• Internet access• Web server • Intranets

(SharePoint)

• Video conferencing • Bar-code readers • Voice over internet• Speech recognition




Administrative ApplicationsAdministrative 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




HIT ApplicationsHIT 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




Sad FactsSad 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




FSU College of Medicine FSU College of Medicine

Technology Supporting Technology Supporting Medical EducationMedical Education

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




Technology HighlightsTechnology 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




The Tablet PCThe Tablet PC

Lenovo ThinkPad TabletPC

Issue First Day

1.88 GHz Processor3 G MB RAM

130 GB Hard DiskExternal DVD-RW

drivesSD card slotPCM/CIA slot3 USB ports

4.5 lbs




Software InstalledSoftware 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




Interesting Tablet SoftwareInteresting Tablet Software• Microsoft Office

OneNote• Windows Journal• Microsoft Educational

Pack for Tablet PC• Microsoft Experience

Pack for Tablet PC• Sticky Notes• Snipping Tool




EMREMR

• SOAPware

• Use 3rd year




PDAsPDAs

• 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.




HP iPAQHP iPAQ

• Windows Mobile 6 • 1 GB SD card• Color, backlit, 240-360

screen• Sound recorder, mp3

player• Wireless - both WiFi &

Bluetooth



The College of MedicineThe College of Medicine04/19/23 Intro to Medical Library Resources

19

FSU Licensed PDA SoftwareFSU 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)• Harrison’s Practice ($325/yr)• Geriatrics at Your Fingertips ($30)

• Savings to each faculty and student > $1,500/yr




iPhone RevolutioniPhone 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



The College of MedicineThe College of Medicine 21

PDA Versions AvailablePDA Versions Available




Epocrates EssentialsEpocrates Essentials• Epocrates

Essentials– Most widely used

PDA program by medical practitioners

– Rx, (Drugs & Complementary meds)

– Sx/Dx (Symptom & Disease Reference)

– Labs & other tools.




IT Enhanced EnvironmentIT 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




Clinical Learning Center Clinical Learning Center




Sim CenterSim Center




The College PortalsThe 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




www.med.fsu.eduwww.med.fsu.edu




Our Library is always openOur Library is always open




24/7 Access to Resources24/7 Access to Resources• >1900 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




Blackboard - Course WebsitesBlackboard - Course Websites

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




Overview of Current State of Overview of Current State of Healthcare IT AdoptionHealthcare IT Adoption




Source of StatsSource of Stats

• 2009 HIMSS Leadership Survey– 304 IT HealthCare Executives representing 700

hospitals– http://www.himss.org/2009Survey/healthcareCIO_final.asp

• FSU CoM - Center on Patient Safety– Robert Brooks, MD, Associate Dean, Health Affairs– Nir Menachemi Ph.D., MPH, Director, Center on

Patient Safety




Projected IT PrioritiesProjected IT Priorities

Source: 20th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions




Top Business Issues Facing Top Business Issues Facing HealthCareHealthCare

Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions




Most Significant Barriers to Most Significant Barriers to Barriers to Implementing ITBarriers to Implementing IT





Status of Electronic Medical Status of Electronic Medical Record ImplementationRecord Implementation





Florida HospitalsFlorida 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




Top Security Concerns of Top Security Concerns of Computerized Medical InformationComputerized Medical Information





Security ToolsSecurity Tools





Technology Adoption CurveTechnology Adoption Curve

50%

25%

75%




Technology Adoption Technology Adoption (Next Two Years)(Next Two Years)





2008 Health IT Staffing Needs2008 Health IT Staffing Needs





2009 Health IT Staffing Needs2009 Health IT Staffing Needs





National InitiativesNational Initiatives




““Wiring” HealthcareWiring” Healthcare

Hospitals

Primary care physician

Specialty physician

Ambulatory center (e.g.

imaging centers)

Payers

Pharmacy

Laboratory

Public health

Current system fragments patient information and creates redundant, inefficient efforts

Future system will consolidate information and provide a foundation for unifying efforts

Hospital

Data repository

Health Information Exchange

Network applications

Server

Payers

Labs

Outpatient RX

Physician office

Ambulatory centers Public health




Sharing Medical DataSharing Medical Data

• Increase patient safety

• Lower Healthcare costs

• Allow for coordination of care

• Increase communication between providers

• Banking analogy




Office of the National Office of the National Coordinator for Health ITCoordinator for Health IT

Established by Executive Order 13335 (April 27, 2004)

• Responsible for realizing the President’s 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




GoalsGoals

• 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




Status of Health Information Status of Health Information Exchange (HIE)Exchange (HIE)





Needed for CCRNeeded 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




Patient: John DoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm3

Patient: John DoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm3

• 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

Clinical Data StandardsClinical Data Standards




Where can you learn more?Where can you learn more?




Web Sites/Organizations 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)




Web 2.0Web 2.0

• http://www.hitsphere.com/




Journals 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




More Journals 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)




Conferences 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




TrainingTraining

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




Health IT ConclusionsHealth 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

Documents

Healthcare Information Systems: An Overview