Standards of dental
informatics, security issues,
privacy and costs
Dr Ebtissam Al-Madi
• 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
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
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
International standards bodies
• International Organization for
Standardization (ISO)
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
Medical informatics standards
1.
2.
3.
4.
Identifiers
Transactions
Message exchange
Terminology
1. Identifiers
• Various approaches have been
proposed for
– Patients
– Providers
– Employers
– Health Plans
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
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
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”
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
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)
4. Terminology standards
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•
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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
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
PRIVACY, CONFIDENTIALITY,
AND SECURITY: BASIC
CONCEPTS
Personal privacy vs. the common
good
• Personal privacy is important.
• Common good of society is more
important.
Where do your views fit?
• 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
Security Issues
• Who owns information?
• How is informed consent implemented?
• When does public good exceed
personal privacy?
• What conflicts are there with business
interests?
Problems of Poor security
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•
•
•
•
Patients avoid health care
Patients lie
Providers avoid entering sensitive data
Providers devise work-arounds
Disclosure problems continue
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
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
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
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
• 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
• Overcoming the economic obstacles
– Centrally funded.
– Grants
– Financial incentives
– Tie into quality of care initiatives
This weeks assignments
Log on to
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.
View
Read
Discuss
Homework
Quiz
• Thank you
– Dr Ebtissam Al-Madi
– ealmadi@ksu.edu.sa