Transcript Survey of Medical Informatics

Survey of Medical
Informatics
CS 493 – Fall 2004
October 4, 2004
Health Care Data Standards
Chapter 4: Patient Safety - Achieving a
New Standard of Care.
IOM Report
Knowledge Representation
Clinical Guideline Representation Model
Clinical Guidelines

National Guideline Clearinghouse  contains
1,000 publicly accessible guidelines



http://www.guideline.gov/
Box 4-2 pg. 159
Comparison of these representative schemes


http://www.openclinical.org/gmmcomparison.html
http://www.pubmedcentral.nih.gov/articlerender.fc
gi?artid=150359
Guideline Interchange Format


Developed by InterMed Collaboratory –
Harvard, Stanford and Columbia
Goals of GLIF




Encode clinicians requirements for decision
making
Support verification and validation of guidelines
Support guideline dissemination and local
adaptation
Support integration with clinical information
systems
Guide-line Expression Language, Object
Oriented (GELLO)



Based on HL7 RIM model
Developed for GLIF
Syntax for querying EHR for relevant patient
information
Representation of Medical Literature






Need tools that will interface clinical decision
support applications with published literature
NLM provides access to a large array of literature in
medicine
MEDLINEplus  provides access to consumer
friendly information sources
Cochrane Collaborations – to develop practice
guidelines
Disease-specific registries
DailyMed database from NLM tracks medication
information for consumers
Establishing Comprehensive
Patient Safety Programs
Part II – Chapter 5: Patient Safety Achieving a New Standard of Care.
IOM Report
A culture of patient safety



Delivery process designed to prevent failures
Organization commitment to detecting and
analyzing patient injuries and near misses
Process that balances the need for reporting
adverse events and the need to take
disciplinary action
Culture of patient safety



Shared beliefs and values
Recruitment and training with patient safety in mind
Organizational commitment to detecting patient
injuries and near misses





Active surveillance based on real-time, interventional, databased clinical triggers
Passive surveillance based on retrospective chart review
Making it easy for front-line workers and family members to
report ADE and near misses
Appropriate protections and rewards for reporting near
misses and injuries
Box 5-1 page 176
Organizational commitment to analyzing
errors




Management structure that is geared towards
tracking, analyzing and fixing patient safety
issues
Process in place to determine the efficacy of
the actions taken to prevent errors
Open communication
A Just Culture
Safety

A model for introducing safer care




Pg 179 – Figure 5-1
Retrospective reviews based on ICD-9 CM
discharge codes and External Causes of Injury
Codes (E-Codes)
Pg 182 – Figure 5-2
Pg 183 –Table 5-1
ADE – Case Study


Table 5-2, page 187
Figure 5-3, page 187
Case Study – Postoperative Deep Wound
and Organ Space Infections


Table 5-3, page 189
Figure 5-4, page 190
Tools

Tools needed for:


Early detection
Prevention







Physician order system
Drug interactions verifications
Verifying adverse events
Data mining for large patient safety databases
NLP
Knowledge dissemination
Audit procedures
Source: http://www.dec.org/pdf_docs/PNACN715.pdf