healthcare it systems

7/28/2019 Healthcare It Systems

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F LORIDA STATE UNIVERSITY

The College of Medicine

Healthcare Information

Systems: An OverviewNancy B. Clark, M.Ed.

Director of Medical Informatics EducationFSU College of Medicine


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The College of M edicine

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 tovisualize the progress of a patients conditions.

poor availability- studies have shown that as muchas 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 behand 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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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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Administrative 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


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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


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Sad Facts Medical errors account for more deaths

than breast cancer, AIDs and motorcycleaccidents.

US has highest HC costs per capita inworld

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 MedicineTechnology Supporting

Medical EducationWhat 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 grouppresentation system The Portals: The College Web Site, the

Electronic Library & Blackboard


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The Tablet PC

Lenovo ThinkPadTabletPC

Issue First Day1.88 GHz Processor

3 G MB RAM130 GB Hard DiskExternal DVD-RW

drivesSD card slot

PCM/CIA slot3 USB ports

4.5 lbs


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Software 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


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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 3 rd year


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PDAs Issues Fall 1 st year Used to track all patient encounters Used as extension of library resources,

to find information quickly in clinicalenvironments at the point of care.


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HP iPAQ

Windows Mobile 6 1 GB SD card

Color, backlit, 240-360screen Sound recorder, mp3

player

Wireless - both WiFi &Bluetooth


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The College of M edicine 7/22/2013 Intro to Medical Library Resources 19

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


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iPhone Revolution

Cell phone technologyexpanding to PDAs

Medical reference websitesreformatting

Software versions availabilityexpanding

6 resources: Epocrates, PEPID,Dynamed, ePSS, Pediatric CareOnline, Clinical Evidence

WM cell phones popular


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The College of M edicine 21

PDA Versions Available


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Epocrates Essentials Epocrates

Essentials Most widely used

PDA program bymedical practitioners

Rx, (Drugs &Complementarymeds)

Sx/Dx (Symptom &Disease Reference)

Labs & other tools.


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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 andsigns is available for school related

projects


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Clinical Learning Center


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Sim Center


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The College Portals Our Electronic Library SharePoint Intranet

Internal document sharing Policies, procedures, etc.

Enterprise Exchange e-mail systemwith integrated calendars and contacts

Blackboard Courseware


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Our Library is always open


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24/7 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 educationresources Web-based course materials Medical search engines

200 periodicals databases PDA versions of 7 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

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, HealthAffairs

Nir Menachemi Ph.D., MPH, Director, Center onPatient Safety
http://www.himss.org/2007Survey/healthcareCIO_final.asphttp://www.himss.org/2007Survey/healthcareCIO_final.asp


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Projected IT Priorities

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


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Top Business Issues FacingHealthCare

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


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Most Significant Barriers toBarriers to Implementing IT



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Florida Hospitals

Brooks R, et al. Patient Safety-Related Information Technology Utilization in Urban and RuralHospitals. Journal of Medical Systems, Vol. 29, No. 2, April 2005


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Top Security Concerns of Computerized Medical Information



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Security Tools



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Technology Adoption Curve

50%

25%

75%


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Technology Adoption(Next Two Years)



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2008 Health IT Staffing Needs



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2009 Health IT Staffing Needs



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National Initiatives


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Wiring Healthcare

Hospital

s

Primary carephysician

Specialty

physician

Ambulatorycenter (e.g.

imagingcenters)

Payers

Pharmacy

Laboratory

Publichealth

Current system fragments patient informationand creates redundant, inefficient efforts Future system will consolidate informationand provide a foundation for unifying efforts

Hospital

Datarepository

HealthInformationExchange

Networkapplications

Payers

Labs

Outpatient RX

Physician office

Ambulatory centers Public health


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Sharing Medical Data Increase patient safety Lower Healthcare costs Allow for coordination of care Increase communication between

providers

Banking analogy

Offi f h N i l


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Office of the NationalCoordinator for Health IT

Established by Executive Order 13335 (April 27, 2004) Responsible for realizing the Presidents vision of

Health IT:

Widespread adoption of interoperableEHR 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

f f


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Status of Health InformationExchange (HIE)



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Needed for CCR

Universally agreed-on medical vocabulary Principled and standard formats for

laboratory data, medical images, medicalrecord

Standardization of medical literatureformats--structured abstracts

Health care standards -- treatmentguidelines Standards for health data exchange


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Patient: JohnDoeMRN: 123-0Diagnosis: 410.0WBC: 14,000/cm 3

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 Standards


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Where can you learn more?


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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)
http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.amia.org/http://www.himss.org/ASP/http://www.himss.org/ASP/http://www.healthcareitnews.com/http://www.healthcare-informatics.com/http://en.wikipedia.org/wiki/Health_informaticshttp://www.mgma.com/http://www.informatics-review.com/http://www.nap.edu/books/0309068371/html/http://www.nap.edu/books/0309072808/html/http://www.nap.edu/books/0309087236/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309090776/html/http://www.nap.edu/books/0309087236/html/http://www.nap.edu/books/0309072808/html/http://www.nap.edu/books/0309068371/html/http://www.informatics-review.com/http://www.mgma.com/http://en.wikipedia.org/wiki/Health_informaticshttp://www.healthcare-informatics.com/http://www.healthcareitnews.com/http://www.himss.org/ASP/http://www.himss.org/ASP/http://www.amia.org/


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Web 2.0 http://www.hitsphere.com/
http://www.hitsphere.com/http://www.hitsphere.com/


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Journals

JAMIA J. of the American Medical InformaticsAssoc.

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

Ar t i f ic ia l Inte l l igence in Medic ine (Elsevier) Com puters in Bio logy and Medic ine (PergamonPress)

Com puters in Biom edica l Research (AcademicPress)

Com puter Method s and Programs in Biom edic ine (Elsevier) IEEE Engin eer ing in Medicine and Bio log y Magazine Jo urn al of Medical Systems (Plenum Press) MD Com put ing (Springer-Verlag) Medical Inform at ics & The Internet in Medicine

(Taylor & Francis) Method s o f Inform ation in Medic ine (Schattauer) Yearboo k o f Medical Info rm at ics (Schattauer)


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Conferences

HIMSS: regional and national conferences.3/10/10 Atlanta

AMIA: Annual Symposium (and SpringCongress)

HEALTHCOM: Health CommunicationConference

MEDINFO: (every 3 years, next in 2007), runby the IMIA (International MedicalInformatics Association)

MGMA: 2007 MGMA Health Care InformationTechnology Forums


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Training AMIA/Oregon Health Sciences 10 x 10

programhttp://www.amia.org/10x10/partners/ohsu/
http://www.amia.org/10x10/partners/ohsu/http://www.amia.org/10x10/partners/ohsu/


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Health IT Conclusions

Financial Support for Health IT on-going concern Patient Centric Focus

Customer Satisfaction Patient Safety

High-speed networks, Intranet and wirelessinformation systems currently in use, to beexpanded across regions

Electronic Medical Records (EMR) andComputerized Physician Order Entry (CPOE) mostimportant applications

Interoperability is a must for Health IT

healthcare it systems

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