Health Informatics Survey INTD 560 O.R. Zaïane © 2009 Health Information Knowledge Management, Intro to Electronic Databases, Health Data Analysis INTD 560 Survey of Health Informatics Osmar R. Zaïane
Jan 09, 2016
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Knowledge Management, Intro to Electronic Databases,
Health Data Analysis
INTD 560
Survey of Health Informatics
Osmar R. Zaïane
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Who am I?
UNIVERSITY OFALBERTA
Osmar R. Zaïane, Ph.D.ProfessorDepartment of Computing Science
352 Athabasca HallEdmonton, AlbertaCanada T6G 2E8
Telephone: Office +1 (780) 492 2860Fax +1 (780) 492 1071
E-mail: [email protected]://www.cs.ualberta.ca/~zaiane/
• Computer Scientist• No medical training• Specialize in Data Mining• Many years of sporadic
experience designing
and implementing health
care systems• Not a chronic patient yet
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Health Information Management
• What kind of information is collected in health care?
• Who collects it?• Why is it collected?• What is it used for?• By who?• Where is stored• Who does it belong to?• Who is entitled to access it?
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Example:• Physicians assess patient status;• Clinicians administer treatment;• Administrators determine appropriate staffing levels;• Administrators manage inventory of supplies;• Administrators negotiate contracts and payment for services;• Pharmacists manage inventory of drugs;
• Administrators and statisticians evaluate clinical outcome, quality and cost of healthcare provided per population;• Politicians make decisions investing in new services or eliminating underutilized services;• Researchers analyze and compare clinical treatment and outcome and devise new treatments
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Patient Profile: Mary Smith• Mrs. Mary Smith
– 73 year old female– recently moved to Red Deer– previously lived in Toronto
• Where are her medical records?– Not in Red Deer– Not in Alberta– Spread in Ontario (Toronto
hospitals, health centres, etc.)
• What will happen if she needs them?
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
• Mrs. Smith visits the Red Deer regional hospital
• She has come for an “Initial Visit” appointment at 10:00am with Dr. Robertson
• Upon arrival, Mrs. Smith checks in with the front desk
• Front desk staff enters her information into the registration system
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Ideal Scenario on Information Flow
Red Deer Registration
System
Health System 1
Health System 2
Health System 3
Health System n
Local HIS Interface
1- New Patient message Interface Engine /
Aggregator
Gateway
Federal Aggregator
2- Internal Request 3- External Request
4- External sites identified
5- Request inform
ation for Mrs. S
mith
6- Receive data: Smith’s Medications and Allergies
7- Provide data
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
• The data exchange occurs automatically and transparently, between registration at Red Deer and the health organization custodian of medical data in Ontario
• When Dr. Robertson walks into the exam room, Mrs. Smith’s known Medications and Allergies are available for review on local health information system
Wish list
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Ideal Scenario on Information Flow
Red Deer Registration
System
Health System 1
Health System 2
Health System 3
Health System n
Local HIS Interface
1- New Patient message Interface Engine /
Aggregator
Gateway
Federal Aggregator
2- Internal Request 3- External Request
4- External sites identified
5- Request inform
ation for Mrs. S
mith
6- Receive data: Smith’s Medications and Allergies
7- Provide data
Dr. Robertson examines Mrs. Smith, then writes prescriptions into the Health Information System…
1. Reordering a previous prescription 2. Verification of allergy3. Decision support
• Allergy detection• Drug-Drug Interaction
4. Select pharmacy to receive electronic prescriptions
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Reality Check
• Mrs. Smith has 3 months to get an Alberta health card and number
• Dr. Robertson would ask Mrs. Smith about her medical history and her previous medical providers (doctors, hospitals, etc.)
• Dr. Robertson (or hospital) has to contact Mrs. Smith’s previous medical providers for her file.
• They might reply, by mail or fax. E-mail is not considered secure (but fax is ???)
• Her medical record in Alberta has to be created from scratch.
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Healthcare=Information Intensive• Healthcare professionals = heterogeneous group with
divers objectives and information requirements
• “The purpose of a HealthCare Information System is to manage the information that health professionals need to perform their jobs effectively and efficiently.”
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Automation of Healthcare Systems
• Historically, different units and services within a hospital were automated (introduction of IT) separately;
• Separate in terms of function, hardware, operating system, programming language, vendors;
• Connecting and communicating between the pieces is a challenging obstacle: consistency, updates, etc.
• Locating where the patient is and any given time; Identifying the kind of care provided; recognizing the clinical results, etc. are significant real challenges.
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Automation of Healthcare Systems
Hospital
Registration Billing Medical Unit Medical Unit Medical Unit Medical Unit Lab Unit
Separate automation of specific functions within the hospital
Integration via Interface Engine or Protocol (HL7)
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Separate functional automation
• Significant duplication; for instance registration and demographic data can be entered many times for the same visit.
• Contradictions and missing data
• Integration difficult and prone to error
• Software maintenance and upgrades expensive
• Infrastructure and training expensive
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Enterprise Automation
Hospital
Registration
Billing
Medical Unit
Medical Unit
Medical Unit
Medical Unit
Lab Unit
automation within the hospital as a whole enterprise
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Automation of Healthcare Systems
Healthcare Organization
Integration via Aggregator/Mediator/Protocol (HL7)
Healthcare Organization
Healthcare Organization
Healthcare Organization
“The expertise gained from managing an inpatient driven organization (e.g. a hospital) does not translate easily to the successful management of other organizational activities, nor in some cases, even to other hospitals.”
Idem for automation
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Functions and components of HIS
• Patient Management and Billing
• Departmental Management
• Care Delivery and Clinical Documentation
• Clinical Decision Support
• Financial and Resource Management
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Benefits
• Cost reduction
• Productivity enhancement
• Quality and service improvement
• Regulatory compliance
• Research enabler
• Competitive advantage
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Requirements
• Information requirements– Operational– Planning– Communication– Documentation and Reporting
• Integration requirements
• Security and confidentiality requirements
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Personal Information Protection• Alberta: Personal Information Protection Act (PIPA),
2003 (http://pipa.alberta.ca/)– The purpose of this Act is to govern the collection, use and disclosure of personal
information by organizations in a manner that recognizes both the right of an individual to have his or her personal information protected and the need of organizations to collect, use or disclose personal information for purposes that are reasonable.
• Ontario: Personal Health Information Protection Act (PHIPA); outlines privacy regulations for health information custodians
• Saskatchewan: Health Information Protection Act (HIPA), 2005
• Canada: Personal Information Protection and Electronic Documents Act (PIPEDA), 2001 (applies to federally regulated industries)
• USA: Health Insurance Portability and Accountability Act (HIPAA), 1996 http://www.hipaa.org/
Not Health Specific
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Privacy of health information
Why protect the privacy of health information?•Do you know who accessed your health information this week?•Do you know what they did with your health information?•Does this concern you?
What increased threats to privacy, if any, does the emerging ‘electronic health record’ pose?
•Privacy incorporates much more than “confidentiality” and “security”.•Privacy is about protecting an individual’s right to have a choice about how their health information is handled.
•Challenge: maximise both the protection of individual privacy AND positive health outcomes.
Identity theft and being impersonated may lead to financial lossesIdentity theft in healthcare and being impersonated may lead to death.
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Active Participants
• Physician• Nurse• Lab technician• Pharmacist• Other care providers• Administrators• Insurance• Patient (becomes an active participant)
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Patients can be active Participants• The patient is a participant in their care with self-entered data and consent
preferences for this data. Patient in control over what goes into the Personal Health Record and who has access to it.
• Some companies see this as business opportunity
• Let consumers opt-in to share the output from a device measuring their blood sugar or blood pressure or other medical sensors.
• This information is viewable in an aggregated format allowing for a more accurate overall clinical picture
• Clinicians can view self entered data as well as historical prescriptions and conditions from multiple sources electronically
• goals: “To create integrated online environments where you can create and store your personal records, get information, find doctors, make medical appointments, communicate online, manage medications, share information with providers and more.”
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Health Informatics SurveyINTD 560
O.R. Zaïane © 2009Health Information Management
Questions?