Healthcare Information
Systems: An Overview
Nancy B. Clark, M.Ed.
Director of Medical Informatics Education
FSU College of Medicine
FLORIDA STATE UNIVERSITY
The College of Medicine
What is wrong with this picture?
FLORIDA STATE UNIVERSITY
The College of Medicine
What is wrong with this picture?
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illegible handwriting,
ambiguous and
incomplete data,
data fragmentation- each lab report is a separate
piece of paper which does not allow a physician to
visualize the progress of a patient’s conditions.
• poor availability- studies have shown that as much
as 40% of the time the paper record can not be
found.
FLORIDA STATE UNIVERSITY
The College of Medicine
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 be
hand 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 $1822/sq ft/yr 240 sq ft
FLORIDA STATE UNIVERSITY
The College of Medicine
Outline
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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?
FLORIDA STATE UNIVERSITY
The College of Medicine
Elements of IT Infrastructure
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Hardware/Software
Support Issues
Workflow/Mindset Issues
Training Issues
Budgeting Issues
FLORIDA STATE UNIVERSITY
The College of Medicine
Basic Technology
• High speed
networks
• Wireless Networks
– PDAs
– Tablets
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Video conferencing
Bar-code readers
Voice over internet
Speech recognition
• Internet access
• Web server
• Intranets
(SharePoint)
FLORIDA STATE UNIVERSITY
The College of Medicine
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
FLORIDA STATE UNIVERSITY
The College of Medicine
HIT Applications
• Patient registration/
demographics
• Insurance validation
• Billing systems
• Appointment systems
• Computerized
Physician Order Entry
(CPOE)
• EMR/EHR/CPR
• Pharmacy systems
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Lab systems
Imaging systems
Telemedicine
Patient education
Decision Support
Library resources
Sensors
FLORIDA STATE UNIVERSITY
The College of Medicine
Sad Facts
• Medical errors account for more deaths
than breast cancer, AIDs and motorcycle
accidents.
• US has highest HC costs per capita in
world
• US has worst outcomes of industrialized
nations. (infant mortality, lifespan, etc.)
• Healthcare is 10-15 yrs behind business in
adoption of IT
FLORIDA STATE UNIVERSITY
The College of Medicine
FSU College of Medicine
Technology Supporting
Medical Education
What our graduates will expect to have in
their residencies, practices, and hospitals.
FLORIDA STATE UNIVERSITY
The College of Medicine
Technology Highlights
• Tablet PCs
• PDAs for Medical Reference
• IT Enchanced Environment – printing,
scanner, classroom & small group
presentation system
• The Portals: The College Web Site, the
Electronic Library & Blackboard
FLORIDA STATE UNIVERSITY
The College of Medicine
The Tablet PC
Issue First Day
Lenovo ThinkPad
TabletPC
1.88 GHz Processor
3 G MB RAM
130 GB Hard Disk
External DVD-RW
drives
SD card slot
PCM/CIA slot
3 USB ports
4.5 lbs FLORIDA STATE UNIVERSITY
The College of Medicine
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
FLORIDA STATE UNIVERSITY
The College of Medicine
Interesting Tablet Software
• Microsoft Office
OneNote
• Windows Journal
• Microsoft Educational
Pack for Tablet PC
• Microsoft Experience
Pack for Tablet PC
• Sticky Notes
• Snipping Tool
FLORIDA STATE UNIVERSITY
The College of Medicine
EMR
• SOAPware
• Use 3rd year
FLORIDA STATE UNIVERSITY
The College of Medicine
PDAs
• Issues Fall 1st year
• Used to track all patient encounters
• Used as extension of library resources,
to find information quickly in clinical
environments at the point of care.
FLORIDA STATE UNIVERSITY
The College of Medicine
HP iPAQ
• Windows Mobile 6
• 1 GB SD card
• Color, backlit, 240-360
screen
• Sound recorder, mp3
player
• Wireless - both WiFi &
Bluetooth
FLORIDA STATE UNIVERSITY
The College of Medicine
FSU Licensed PDA Software
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Epocrates Essentials ($149/yr)
Essential Evidence Plus ($249/yr)
DynaMed ($200/yr)
PEPID ($199/yr)
Pediatric Care Online ($289/yr)
Clinical Evidence ($99/yr)
Harrison’s Practice ($325/yr)
Geriatrics at Your Fingertips ($30)
• Savings to each faculty and student > $1,500/yr
FLORIDA STATE UNIVERSITY
3/14/2016
Intro to Medical Library Resources
The
College of Medicine
19
iPhone Revolution
• Cell phone technology
expanding to PDAs
• Medical reference websites
reformatting
• Software versions availability
expanding
– 6 resources: Epocrates, PEPID,
Dynamed, ePSS, Pediatric Care
Online, Clinical Evidence
• WM cell phones
popular
FLORIDA
STATE UNIVERSITY
The College of Medicine
PDA Versions Available
FLORIDA STATE UNIVERSITY
The College of Medicine
21
Epocrates Essentials
• Epocrates
Essentials
– Most widely used
PDA program by
medical practitioners
– Rx, (Drugs &
Complementary
meds)
– Sx/Dx (Symptom &
Disease Reference)
– Labs & other tools.
FLORIDA STATE UNIVERSITY
The College of Medicine
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 and
signs is available for school related
projects
FLORIDA STATE UNIVERSITY
The College of Medicine
Clinical Learning Center
FLORIDA STATE UNIVERSITY
The College of Medicine
Sim Center
FLORIDA STATE UNIVERSITY
The College of Medicine
The College Portals
• Our Electronic Library
• SharePoint Intranet
– Internal document sharing
– Policies, procedures, etc.
• Enterprise Exchange e-mail system
with integrated calendars and contacts
• Blackboard Courseware
FLORIDA STATE UNIVERSITY
The College of Medicine
www.med.fsu.edu
FLORIDA STATE UNIVERSITY
The College of Medicine
Our Library is always open
FLORIDA STATE UNIVERSITY
The College of Medicine
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 education
resources
• Web-based course materials
• Medical search engines
• 200 periodicals databases
• PDA versions of 7 web resources
FLORIDA STATE UNIVERSITY
The College of Medicine
Blackboard - Course Websites
• All Course Materials
– Syllabus & Assignments
– PowerPoints & Lecture notes
FLORIDA STATE UNIVERSITY
– Discussion board
& Grades Posting
The College of Medicine
Overview of Current State of
Healthcare IT Adoption
FLORIDA STATE UNIVERSITY
The College of Medicine
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, Health
Affairs
– Nir Menachemi Ph.D., MPH, Director, Center on
Patient Safety
FLORIDA STATE UNIVERSITY
The College of Medicine
Projected IT Priorities
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 20th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
Top Business Issues Facing
HealthCare
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
Most Significant Barriers to
Barriers to Implementing IT
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 19th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
Status of Electronic Medical
Record Implementation
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
Florida Hospitals
Brooks R, et al. Patient Safety-Related
Information
FLORIDA
STATE UTechnology
NIVERSITY Utilization in Urban and Rural
Hospitals. Journal of Medical Systems, Vol. 29, No. 2, April 2005
The College of Medicine
Top Security Concerns of
Computerized Medical Information
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
Security Tools
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
Technology Adoption Curve
75%
50%
25%
FLORIDA STATE UNIVERSITY
The College of Medicine
Technology Adoption
(Next Two Years)
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 19th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
2008 Health IT Staffing Needs
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
2009 Health IT Staffing Needs
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
National Initiatives
FLORIDA STATE UNIVERSITY
The College of Medicine
“Wiring” Healthcare
Current system fragments patient information
and creates redundant, inefficient efforts
Future system will consolidate information
and provide a foundation for unifying efforts
Payers
Hospital
Hospital
s
Public
health
Health
Information
Exchange
Primary care
physician
Laboratory
Labs
Pharmacy
Data
repository
Specialty
physician
Server
Network
applications
Outpatient RX
Payers
Ambulatory
center (e.g.
imaging
centers)
FLORIDA STATE UNIVERSITY
Physician office
The College of Medicine Ambulatory centers
Public health
Sharing Medical Data
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Increase patient safety
Lower Healthcare costs
Allow for coordination of care
Increase communication between
providers
• Banking analogy
FLORIDA STATE UNIVERSITY
The College of Medicine
Office of the National
Coordinator for Health IT
Established by Executive Order 13335 (April 27, 2004)
• Responsible for realizing the President’s vision of
Health IT:
– Widespread adoption of interoperable
EHR 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
FLORIDA STATE UNIVERSITY
The College of Medicine
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
FLORIDA STATE UNIVERSITY
The College of Medicine
Status of Health Information
Exchange (HIE)
FLORIDA STATE UNIVERSITY
The College of Medicine
Source: 20th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
Needed for CCR
• Universally agreed-on medical vocabulary
• Principled and standard formats for
laboratory data, medical images, medical
record…
• Standardization of medical literature
formats--structured abstracts
• Health care standards -- treatment
guidelines
• Standards for health data exchange
FLORIDA STATE UNIVERSITY
The College of Medicine
Clinical Data Standards
• Current
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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
Patient: John
Doe
MRN: 123-0
Diagnosis: 410.0
WBC: 14,000/cm3
– SNOMED/UMLS Concept Unique Identifiers for
microbiology content
FLORIDA STATE UNIVERSITY
The College of Medicine
Where can you learn more?
FLORIDA STATE UNIVERSITY
The College of Medicine
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)
FLORIDA STATE UNIVERSITY
• Patient Safety: Achieving a New Standard for Care (IOM)
The College of Medicine
Web 2.0
• http://www.hitsphere.com/
FLORIDA STATE UNIVERSITY
The College of Medicine
Journals
• JAMIA – J. of the American Medical Informatics
Assoc.
• 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 ComputerFLORIDA
Society
STATE UNIVERSITY
The College of Medicine
More Journals
• Artificial Intelligence in Medicine (Elsevier)
• Computers in Biology and Medicine (Pergamon
Press)
• Computers in Biomedical Research (Academic
Press)
• Computer Methods and Programs in Biomedicine
(Elsevier)
• IEEE Engineering in Medicine and Biology Magazine
• Journal of Medical Systems (Plenum Press)
• MD Computing (Springer-Verlag)
• Medical Informatics & The Internet in Medicine
(Taylor & Francis)
• Methods of Information in Medicine (Schattauer)
• Yearbook of Medical
Informatics
(Schattauer)
FLORIDA
STATE UNIVERSITY
The College of Medicine
Conferences
• HIMSS: regional and national conferences.
3/10/10 Atlanta
• AMIA: Annual Symposium (and Spring
Congress)
• HEALTHCOM: Health Communication
Conference
• MEDINFO: (every 3 years, next in 2007), run
by the IMIA (International Medical
Informatics Association)
• MGMA: 2007 MGMA Health Care Information
FLORIDA STATE UNIVERSITY
Technology Forums
The College of Medicine
Training
• AMIA/Oregon Health Sciences 10 x 10
program
http://www.amia.org/10x10/partners/ohsu/
FLORIDA STATE UNIVERSITY
The College of Medicine
Health IT Conclusions
• Financial Support for Health IT on-going concern
• Patient Centric Focus
– Customer Satisfaction
– Patient Safety
• High-speed networks, Intranet and wireless
information systems currently in use, to be
expanded across regions
• Electronic Medical Records (EMR) and
Computerized Physician Order Entry (CPOE) most
important applications
• Interoperability is a must for Health IT
FLORIDA STATE UNIVERSITY
The College of Medicine