REFLECTIVE DIARY H E A LT H I N F O R M AT I C S I N T R O D U C T I O N T O H E A LT H I N F O R M AT I C S • Health Informatics an umbrella term referring to the application of the methodologies and techniques of information science, computing, networking and communications to support health and health related disciplines such as medicine, nursing, pharmacy, dentistry etc. • Health informatics tools include not only computers but also clinical guidelines, formal medical terminologies, and information and communication systems. • eHealth is a broad term for healthcare practice which is supported by electronic processes and communication. • Also Health Informatics deals with the resources, devices and methods required to optimize the acquisition, storage, retrieval and use of information in health. • Key Elements of Informatics are Acquisition, Storage, Communication, Manipulation and Display. • Applications of Health Informatics are - For recording accurate data to have data available in a timely manner, Support and inform managers to make better decisions ,Resource allocation and planning ,Email therapy ,Risk management and Training etc. • Telehealth is the delivery of health-related services and information via telecommunications technologies. • Medical informatics is a scientific/systematic field of study that deals with the acquiring, storage, and processing of medical, biological and associated data, information and knowledge for the purpose of problem solving and decision making • Medical Informatics Solutions are Databases ,Information Retrieval Internet and Computer programs H E A LT H I N F O R M AT I O N SYSTEM • Health Information System is a system that provides specific information support to the decisionmaking process at each level of the health system • The Health Information System Supports Decision Making at All Levels i.e. At patient/client management level, At health-unit management level and At system management level (district/regional/national) • Six Functions of health System are Service delivery, Information, human resources, commodities infrastructure, Financing and Stewardship. • The Different Health Challenges are-Aging population, urbanization, unhealthy lifestyles, chronic diseases brings on heavy healthcare costs, Shortage of healthcare workers and specialized caregivers and Financial crisis • A routine health information system produces information through routine data collection. • Sources of Health Information are Hospitals, health centers, community-based institutions/service delivery mechanisms • Types of Routine Data Collection Methods are Health unit data collection and Community data collection. • Community data collection is to monitor activities performed in the community by health unit staff or by community health workers. • Different Issues with Routine Data Collection Instruments are Content (comprehensive) ,Record filing, Layout ,Production form and Electronic patient record. • The Universe of Routine Health Information Systems are Individual record systems , Service record systems, Resource record systems and Health facility surveys CLINICAL DECISION SUPPORT • A clinical decision support system (CDSS) is a health information technology system that is designed to provide physicians and other health professionals with clinical decision support (CDS), that is, assistance with clinical decision-making tasks. • Main purpose of CDSS is to assist in problem solving with semi structured problems improve the effectiveness of the decision making process. • Various Clinical decision support drivers are Demand Pull ,Technology Push and Regulatory Push. • Technology Drivers is used to Reduced barriers to facilitated and customized information access • Approach used In CDSS System are Provide background data ,Support analytic work ,structure repetitive decisions ,automate , planning processes and structure control processes. • Benefits of CDSS is to Reduce the risk of medication errors ,Reduce misdiagnoses ,Provide the entire care team with consistent' reliable information and Improve efficiency and patient throughput. • Various Challenges in CDSS System are Understanding human decision making ,Understanding the technology environment. • Common errors in healthcare are medical errors ,missing abnormal lab findings, clinical practice guidelines and Bias in Judgement and Decision Making. 7 THINGS ABOUT INDIA HI SECTOR • Fragmented health information systems • Irrational use and spiralling cost of drugs • A weak primary healthcare sector • Unequally distributed skilled human resources sector • Large unregulated private sector • Low public spending on health • Weak governance and accountability ELECTRONIC HEALTH RECORDS • BioMedical Informatics Seeks knowledge from computer analysis of data, results, stats This includes the development of storage, retrieval, and data analysis methods, cellular / molecular system modeling and simulation. • Health Informatics At the point of treatment, specific focus is placed on programs and growing importance is placed on informatics for patients and carers as well as for professionals. • Paper Records: Pros: Portable, Familiar, Natural Cons: Can only be used for one task at a time, Records can get lost , Consume space, Large individual records are hard to use, Fragile and susceptible to damage, Environmental cost • Electronic Records .Pros: Compact, Concurrent use, Easily copied/archived, Portable (handheld and wireless devices), Secure, Supports many other services Cons: High capital investment, Training requirements, Continuing security debate, Power outs – the whole system goes down. • Traditional Perspective This includes Electronic medical records technologies and other health information systems used for billing, scheduling and analysis Standards (e.g. DICOM, HL7) Controlled vocabularies Software for specialist services and devices Contemporary multidisciplinary view Traditional “engineering” topics Human and organisational factors in quality and safety Formal representation of data and knowledge HIS GOVERNANCE • Health information system always refers to as the system which provide information support in decision making at each level in organization. • Good management is required to increase the efficiency which requires all policymaker, health care and community health worker to make decision as center. • RHIS is the inclusion of statistical approach of data collection, administration data, drugs prescription to patients, surveillance data and all community-based health actions. • RHIS worked on some guiding principles like requirement of data for the decision making,, collecting data for analysis and utilize it for health worker, processing and collection starts from very beginning, integrate all routine information along with simplicity to operate and maintain • Coordination and partnership should be exercised together for maintaining sustainability in health care system with some leadership quality. • Current RHIS has problems like insignificance of gathered information, poor quality data, lack of feedback and reporting time, duplication of data and difference in culture of data people and decision makers. • HIS involved components into three categories: Inputs, Processes & Outputs • In input we focus on resources, in processes we focus on indicators, data sources, data management and in output we set on information products and distribution & use H I D ATA C O L L E C T I O N • An indicator is objectively calculating the changing value for program and services • It involved indicator as input and processes as broad deal, focusing on specific sector in output components and under the impact, it shows slower respond to program and practice change. • Outcomes and impacts are calculated using individual and house-hold level data whereas certain inputs & processes are suitable for national level calculation. • Indicators have the domain of health status, risk factors, service coverage and health system • Rationale data helps to identify problems and assess trends using performance index, accountability and achievement for success completion • Characteristics of good indicators are specific, measurable, relevant and time bounded • Indicators are insensitive to change, restricted measuring on outcomes and not collected realistically as these are common pitfall for indicators. • Good indicators should have information for decision making, independent, use of definite terms, shows consistency with international standards and have values to explain. • RHIS data are collected for Management level, Health system and Health determinants • Routine data collection are done continuously and have facility and community-based subsystems whereas nonroutine data collections are done periodically. • They discuss the content and common data elements using tally sheet, register and patient/client record charts. • It runs through channel of paper-based records and electronic medical record • We even focus on data aggregation and it’s reporting since it is performed manually or electronically using software • Data aggregation is a process in which data from clinical or individuals gathered and summarized. HIS_DW_ E H E A LT H • It is difficult to automate human decision on nature of business they run and their standard of care • These are poorly-coordinated system and have high volume with less resources. • To treat patient with complete care, one must have ability to give time & resources • Safe, timely, effective, patient-centered , efficiency and equitable are considered as High-quality care • Governance, information, financing, service delivery, human resources, medicines& technologies are the components of health system • Drug allergies inappropriate treatment , redundant order are the common errors • Needs of ICT in Healthcare: Availability of information everywhere, it is error-prone area and technology can help into it, access to high quality patient information and it demands process improvement at all levels in healthcare. C A R E E R I N H E A LT H I N F O R M AT I C S • Way back before HI, medical records were hand- written consisting of X-ray & laboratory report. When all documented files put together, they became big mess of files and creates difficulties to manage when required. • To resolve this, US introduced Electronic medical record system with proper Healthcare Training SPECIFICALLY WHAT IS HI? It is the application of information processing involving • Computer hardware & software • Storage, Retrieval, Sharing & use • Healthcare information, data and knowledge • Information communication • Decision-making For instance, when we visit doctor, they usually take down our height, weight and blood pressure which helps in diagnostic of patient. • EHR( Electronic Health Record) is the real-time patient health record chart used n decision making as per available current knowledge. WHAT KIND OF ROLE DO HI WORKERS FILL? Basic entry level Intermediate level Advanced level Data clerk Department manager Quality director Data coordinator Office manager EHR auditor HIM clerk Data analyst Chief information officer Medical record specialist EHR trainer Chief Medical information officer Unit clerk Patient advocate Chief medical officer Medical assistant Clinical quality specialist Chief Technology officer CAREER STARTS WITH QUESTIONING • What is Health Informatic? • Where do HI employees work? • What kind of roles do HI workers fill? • What skills do you need? • How is HI improving the job market? WHAT DO HI EMPLOYEES WORK? They work in variety of places such as • Hospital • Ambulatory care clinics • Private physician practices • Skilled nurses' facilities • Military & veteran affairs • EHR vendors • Higher education as researcher or innovator WHAT SKILLS NEEDED? Technical Workplace Academic Personal effectiveness skill Medical terminology Collaboration Reading comprehension Teamwork Ability to use the EHR Planning & organizing Critical & Analytical thinking Communication Computer skills Innovative thinking Healthcare knowledge Integrity Information management Knowledge of HI products Basic IT terminology Dependability Software development Data management Writing, mathematics Adaptability Privacy & Confidentiality of HI Problem solving & decision-making Privacy, Security & Safety skills Reliability • ICT includes treating patients, conducting researches, allocating & tracking diseases and monitoring of public health • eHealth is equivalent to Health IT • eHealth have leadership & governance, strategy & investment, services & applications, infrastructure, policy & compliance and workforce as the components according to WHO-ITU model • Requirement of Data repository system with common search engines • Expert system based on AI, Machine learning and statistics like CDSS • Data warehouse is the subject-oriented, integrated, non-volatile and time variant. • Data staging involves extraction, transformation and loading the data into the warehouse. 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