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