Standards of dental informatics, security issues, privacy and costs Dr Ebtissam Al-Madi
Transcript
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Standards of dental informatics, security issues, privacy and
costs Dr Ebtissam Al-Madi
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Why are standards important in medical informatics? Promote
consistent naming of individuals, events, objects, etc. Allow
better use of data for patient care, quality assurance, research,
etc. Enhance ability to transfer data among applications, allowing
better system integration
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Benefits and limitations of standards Benefits Interoperability
May allow innovation based on common foundation Limitations
Dominance by one segment of industry: Microsoft standards, e.g.,
Windows, Office, etc. May stifle innovation
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The standards development process Groups agree to informal
specifications Single vendor controls industry Government agency
creates standard and mandates its use. Interested parties work in
open process
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International Organization for Standardization (ISO)
http://www.iso.org/iso/home.html http://www.iso.org/iso/home.html
ADA Standards Committee on Dental Informatics (ADA SCDI)
http://www.ada.org/prof/resources/stand
ards/informatics_reports.asp#a1031
http://www.ada.org/prof/resources/stand
ards/informatics_reports.asp#a1031 International standards
bodies
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Medical informatics standards 1.Identifiers 2.Transactions
3.Message exchange 4.Terminology
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1. Identifiers Various approaches have been proposed for
Patients Providers Employers Health Plans
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Patient identifiers Unique only one person has a particular
identifier Non-disclosing discloses no personal information
Permanent will never be re-used Ubiquitous everyone has one
Canonical each person has only one Invariable will not change over
time
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Patient identifiers Benefits Easy linkage of records Facilitate
health information exchange Reduce errors and costs arising from
duplicate records Medical record identifier errors compromise
quality of care and can be costly Cost increases with length of
time error not identified Risks Easy linkage of records Potentially
compromise privacy and confidentiality
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2. Transactions Transaction standards are designed to encourage
electronic commerce for health claims. HIPAA (Health Insurance and
privacy act) mandates use of these standards for health care
business electronic data exchange Administrative
simplification
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Transactions standards cover Health claims and equivalent
encounter information Enrollment and disenrollment in a health plan
Eligibility for a health plan Health care payment and remittance
advice Health plan premium payments Health claim status Referral
certification and authorization Coordination of benefits
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3. Message exchange standards Allow data and application
interoperability Major standards include Health Level 7 (HL7)
Digital Imaging and Communications (DICOM) IEEE NCPDP and SCRIPT
ELINCS Continuity of Care Record (CCR)
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4. Terminology standards Benefits of computerization of
clinical information depends upon its normalization Clinical
language is inherently vague, which is at odds with the precision
of computers Computers have no intelligence Computers can only do
what programmers and users tell them to do Computers process
numbers and symbols very fast and accurately Computers have
extraordinarily great memory It is up to humans to define the
meaning or semantics of information represented in a compute
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Standardized terminology Information capture documenting
findings, conditions, and outcomes Communication transferring
information Knowledge organization classification of diseases,
treatments, etc. Information retrieval accessing knowledge based
information Decision support implementing decision support
rules
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PRIVACY, CONFIDENTIALITY, AND SECURITY: BASIC CONCEPTS
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Personal privacy vs. the common good Personal privacy is
important. Common good of society is more important. Where do your
views fit?
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Privacy right to keep things to yourself Confidentiality right
to keep things about you from being disclosed to others Security
protection of your personal information
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Security Issues Who owns information? How is informed consent
implemented? When does public good exceed personal privacy? What
conflicts are there with business interests?
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Problems of Poor security Patients avoid health care Patients
lie Providers avoid entering sensitive data Providers devise
work-arounds Disclosure problems continue
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Security for paper records Difficult to audit trail of paper
chart Fax machines are easily accessible Records frequently copied
for many reasons New providers, insurance purposes Records
abstracted for variety of purposes Research Quality assurance
Insurance
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Technologies to secure information Deterrents Alerts Audit
trails System management precautions Software management Analysis
of vulnerability Obstacles Authentication Authorization Integrity
management Digital signatures Encryption Firewalls Rights
management
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Protected health information (PHI) Name Address (street
address, city, county, zip code) Names of relatives Names of
employers E-mail address Fax number Telephone number Birth date
Finger or voice prints Photographic images Social security number
Internet protocol (IP) address Any vehicle or device serial number
Medical record number Health plan beneficiary number Account number
Certificate/license number Web URL Any other unique identifying
number, characteristic, or code
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Costs of Informatics Health IT costs and return on investment
(ROI) What do I get back (return) for the money I'm being asked to
spend (investment)? Cost-benefit defined Ratio of money value of
benefit divided by cost Cost-benefit in the outpatient setting
Increased time for first 4 months but thereafter saved time that
was either spent seeing more patients or reducing work hours Only a
few practices implemented comprehensive quality improvement
efforts, usually when insurers paid explicitly for it System
payback achieved at average of 2.5 years. Factors associated with
success included Near complete use of system functions Having local
EHR champion and supportive practice culture
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Cost-benefit in integrated delivery setting Laboratory and
radiology order entry Reduction of time spent processing orders
Pharmacy order entry Reduced adverse drug events Improved cost
savings through better formulary compliance Documentation Reduction
in cost due to use of structured documentation in outpatient
setting
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Overcoming the economic obstacles Centrally funded. Grants
Financial incentives Tie into quality of care initiatives
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This weeks assignments Log on to
http://faculty.ksu.edu.sa/ealmadi/182DEN/default.as px
http://faculty.ksu.edu.sa/ealmadi/182DEN/default.as px 1.View this
lecture online for review. 2.Read article 3.Participate in
discussion. 4.Submit Homework 5.Answer Quiz.
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