MEDICAL INFORMATIONSYSTEMS

Electronic Healthcare RecordElectronic Healthcare Record

1. MEDICAL INFORMATION1. MEDICAL INFORMATION

1.1. TYPES OF ACTIVITY1.1. TYPES OF ACTIVITY a. MEDICAL ACTIVITIES (CONSULTATIONS, a. MEDICAL ACTIVITIES (CONSULTATIONS,

VISITS)VISITS)Different approaches:Different approaches:

• Time orientedTime oriented• Patient orientedPatient oriented• Problems oriented (Problems oriented (SSimptoms, imptoms, OObjective, bjective, AAssesment, ssesment,

PPlans - lans - SOAP)SOAP)

Steps:Steps:• DIAGNOSINGDIAGNOSING

– DATA - MEDICAL OBSERVATION, DATA - MEDICAL OBSERVATION, INVESTIGATIONSINVESTIGATIONS

– KNOWLEDGE - EDUCATION, ETCKNOWLEDGE - EDUCATION, ETC• THERAPY / FOLLOW-UPTHERAPY / FOLLOW-UP• NURSING NURSING

b. LOGISTIC SUPPORTTb. LOGISTIC SUPPORTTADMINISTRATIONADMINISTRATIONACCOUNTINGACCOUNTING

c. SOCIAL CONTEXT FRAMEc. SOCIAL CONTEXT FRAMEMEDICAL DATA CENTRALISATIONMEDICAL DATA CENTRALISATION

d. MEDICAL EDUCATION (CME)d. MEDICAL EDUCATION (CME)STAFFSTAFFPATIENTSPATIENTS

e. MEDICAL DOCUMENTATIONe. MEDICAL DOCUMENTATIONf. MEDICAL RESEARCHf. MEDICAL RESEARCH

1. MEDICAL INFORMATION1. MEDICAL INFORMATION

1.2. 1.2. CYCLES OF CYCLES OF MEDICAL INFORMATION FLOWMEDICAL INFORMATION FLOW

• PRIMARY CAREPRIMARY CARE

• SECONDARY SECONDARY (SPECIALISED) CARE(SPECIALISED) CARE

• HOSPITAL - HOSPITAL - HEALTHCARE UNITSHEALTHCARE UNITS

• CENTRAL LEVELS :CENTRAL LEVELS :– COUNTY HEALTH COUNTY HEALTH

DEPARTMENTS DEPARTMENTS – NATIONAL LEVEL: NATIONAL LEVEL:

HEALTH MINISTERYHEALTH MINISTERY– INTERNATIONAL INTERNATIONAL

BODIES: WHOBODIES: WHO

1.3. Medical activities 1.3. Medical activities organisational levelsorganisational levels

1.4. DEFINITIONS1.4. DEFINITIONS

a. a. INFORMATIONAL SYSTEMINFORMATIONAL SYSTEM = ensemble of = ensemble of structural units exchanging information between structural units exchanging information between themthem

b. b. INFORMATION SYSTEMINFORMATION SYSTEM = that part of the = that part of the informational system which comprises computer informational system which comprises computer use use

Fluxul de informaţii în cadrul Sistemului Naţional Informaţional din Sănătate

Terminology

• CPR (computer-based patient record)

• PCR (patient-carried record)

• CMR (computerized medical record)

• EMR (electronic medical record)

• EPR (electronic patient record)

• EHR (electronic healthcare record)

What is an EHR?

Slide kindly provided by S¿ren Vingtoft

What is an EHR?

Slide kindly provided by S¿ren Vingtoft

Integrated Care EHR

ISO/DTR 20514 : • a repository of information regarding the health of a subject

of care in computer processable form, stored and transmitted securely, and accessible by multiple authorised users.

• It has a commonly agreed logical information model which is independent of EHR systems.

• Its primary purpose is the support of continuing, efficient and quality integrated health care and it contains information which is retrospective, concurrent and prospective.

Challenges facing today’s health record systems

The need to record more data

The need to analyse more data

The need to share more data

University Hospital of Heidelberg:• 400000 new medical records per year• 6.3 million pages• 1,7 km of storage • 250000 reports generated

• to observe trends and patterns within the historical record of one patient

• to enable the use of clinical guidelines and decision support tools: evidence based health care

• to perform clinical audit• to inform management and commissioning

decisions• to support epidemiology, research and

teaching

The need to analyse more data

Share more healthcare data

• with other clinicians in the same team– clinical firms, practice partnerships or nursing shifts

• with other healthcare professions– doctors, nurses, physiotherapists, midwives, dieticians...

• with other disciplines– a diabetic patient may also be under: ophthalmology,

nephrology, orthopaedics, chiropody, wheelchair clinic..

• with other institutions

• with patients and their families

The mains advantages of EHR

• Reducing the storing space of the medical data• Facilitate Facilitate researchesresearches activities activities• Standardized environment Standardized environment for medical data for medical data

evidence, based on efficient Database Management evidence, based on efficient Database Management SystemsSystems

• Great level of Great level of data integration data integration between different between different segments of information healthcare systems.segments of information healthcare systems.

• Increasing the quality of healthcare by the informational support provided to local and central administrative structures.

EHR adoption barriers

• Technical limitation Technical limitation for assuring the the security, integrity and accesibility of stored datadata

• Concerning about the records Concerning about the records ownershipownership• Big initial costs for implementation• The lack of operate abilities and trust in computerized

systems from the medical stuff and the changing resistance

• Low diversity of the quality EHR systems• Lack of universal recognized quality standards and

adequate legal framework

Core Functionalities for an Electronic Health Record System

• Health information and data management

• Results management

• Order entry/management

• Decision support management

• Electronic communication and connectivity

• Patient support

• Reporting and Population Health Management

• Administrative processes

EHR ARHITECTURE

• Object oriented, relational DBMS• Interoperability - transport of information

over:

– Time

– Space

– Context, Communities, and Cultures

Logical building blocks of the EHR:• FOLDER • COMPOSITION

– Tranzactional unit– Contribution –all

compositions created/modified during a session

• HEADED SECTIONS - data segments for navigation purposes

• ITEM – single clinical "statement"

ONTOLOGY

BloodPressure

Systolic

Diastolic

Body Position

Pressure

Intra-vascularPressure

ArterialPressure

Systemic

Applies to

Whole body

Systolic ArterialPressure

Has phase

Heart cyclephase

Has phase

Systolicphase

Diastolic ArterialPressure

Part of

Has phase

Diastolicphase

BloodPressure

Has units

ISO pressureunits

Has units

Mm[Hg]

Has positionBody

Position

Mm[Hg]

Mm[Hg]

Cuff Size

BP Cuff

Taken with

Has size

Cuff Size

BP Cuff

ARCHETYPE

The Record attributes

• PacientPacient identification• Medical stuff identification• Utilized standards identification• The Name of the parameter measured/observedThe Name of the parameter measured/observed• The value of the parameterThe value of the parameter

– [measure unit]– value [measured] – [normal value]

• data / time stamp• Observation circumstancesObservation circumstances

The “Core” EHR

• Key characteristics:• Concerns a single subject of care• Primary purpose is the support of present and

future healthcare of the subject• Principally concerned with clinical information• Simplifies standardization of the EHR

has a clear, limited scope enabling a manageable set of requirements to be specified and a manageable standardized model to be defined

• Fits more closely with the distributed systems or “system-of-systems” paradigm

Allows more modular health information systems to be built

The “Extended EHR”

• Includes not only clinical information but essentiallythe whole health information landscape.

• It is a superset of the Core EHR• Extended EHR functions beyond the scope of the

Core EHR include:– Patient administration– Scheduling and resource allocation– Billing– Decision support– Access control and policy management– Demographics– Order management– Population health recording, querying, and analysis– Health professional recording, querying, and analysis– Business operations recording, querying, and analysis

User view: functional grouping of data

• Demographic and general data– Name, gender, date of birth, picture ..– Residence and contact data– Current job, education– Insurance condition

• Alerts – allergies, special conditions (pregnancies)• Current medication• Vaccines • Consultations

– SOAP– Schedule

• Surgical interventions• Reports• Healthcare costs

OMS 1623/2004 Setul minim de date la nivel de pacient (SMDP)

Standard definition

ISO/IEC

defines a standard as a document, established by consensus and approved by a recognized body, that provides, for common and repeated use, rules, guidelines or characteristics for activities or their results, aimed at the achievement of the optimum degree of order in a given context

STANDARDSSTANDARDS

SStandard Attributes (SMART):tandard Attributes (SMART):S = specificS = specificM = measurable M = measurable A = acceptableA = acceptableR = realisticR = realisticT = time relatedT = time related

Standard OrganizationsStandard Organizations– ASRO ASRO – – Romanian Association for Standardisation (TC 319)Romanian Association for Standardisation (TC 319)– CENCEN - - Comité Européen de NormalisationComité Européen de Normalisation– CEN/TC251CEN/TC251 – Medical informatics Technical Committee– Medical informatics Technical Committee– ANSI ANSI - - American National Standards Institute – ISOISO - - International Organization for Standardization..

Standard OrganizationsStandard Organizations

ASRO

• ISO DTR 20514 - EHR definition and scopeISO DTR 20514 - EHR definition and scope• ISO TS 18308 - EHR RequirementsISO TS 18308 - EHR Requirements

• CEN TS 14796 - Data TypesCEN TS 14796 - Data Types• CEN/TC 251 EN 13606 - EHR CommunicationsCEN/TC 251 EN 13606 - EHR Communications

• HL7 - EHR Functional SpecificationHL7 - EHR Functional Specification• HL7 - Templates specificationHL7 - Templates specification• HL7 - Clinical Document ArchitectureHL7 - Clinical Document Architecture

• DICOM – Digital Imaging and Communications in MedicineDICOM – Digital Imaging and Communications in Medicine• EDIFACT , XML – Messaging standardsEDIFACT , XML – Messaging standards

DATA PROTECTIONDATA PROTECTION

a) CONFIDENTIALITY - a) CONFIDENTIALITY - limited, leveledlimited, leveled

accessibilityaccessibility

b) PROTECTION -b) PROTECTION - against accidental against accidental

deterioration / access / lossdeterioration / access / loss

c) SECURITY - c) SECURITY - intendedintended d/ad/a

EHR exemples

• OfficeMed ver 1.60– Integrated system for family physicians (GP)

• Conform to CoCa 2003

• FoxPro / MSDOS

• “Programul este agreat de Direcţia de  sănătate publică Bistriţa Năsăud”

• Medins – GP

– MEDINETMEDINET

INFO WORLD

“... soluţiile oferite au fost dezvoltate conform celor mai noi standarde în domeniu, precum HL7HL7 şi DICOMDICOM”

• Hospital Manager SuiteHospital Manager Suite

• CabiMed CabiMed – GP – GP

• Cabinet Manager Cabinet Manager – ambulatory healthcare – ambulatory healthcare

systemsystem.

• ePractice – ePractice – EPR system EPR system