Transcript INTD-560-Knowledge Management

Health Informatics Survey
INTD 560
Knowledge Management,
Intro to Electronic Databases,
Health Data Analysis
INTD 560
Survey of Health Informatics
Osmar R. Zaïane
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Who am I?
UNIVERSITY OF
ALBERTA
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Osmar R. Zaïane, Ph.D.
Professor
Department of Computing Science
352 Athabasca Hall
Edmonton, Alberta
Canada T6G 2E8
Telephone: Office +1 (780) 492 2860
Fax +1 (780) 492 1071
E-mail: [email protected]
http://www.cs.ualberta.ca/~zaiane/
Health Information Management
Computer Scientist
No medical training
Specialize in Data Mining
Many years of sporadic
experience designing
and implementing health
care systems
• Not a chronic patient yet
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Health Information Management
• What kind of information is collected in
health care?
• Who collects it?
• Why is it collected?
• What is it used for?
• By who?
• Where is stored
• Who does it belong to?
• Who is entitled to access it?
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Example:
• Physicians assess
patient status;
• Clinicians administer
treatment;
• Administrators determine
appropriate staffing levels;
• Administrators manage
inventory of supplies;
• Administrators negotiate
contracts and payment for
services;
• Pharmacists manage
inventory of drugs;
• Administrators and statisticians evaluate clinical outcome, quality and cost of
healthcare provided per population;
• Politicians make decisions investing in new services or eliminating underutilized
services;
• Researchers analyze and compare clinical treatment and outcome and devise new
treatments
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Patient Profile: Mary Smith
• Mrs. Mary Smith
– 73 year old female
– recently moved to Red Deer
– previously lived in Toronto
• Where are her medical records?
– Not in Red Deer
– Not in Alberta
– Spread in Ontario (Toronto
hospitals, health centres, etc.)
• What will happen if she needs
them?
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
• Mrs. Smith visits the Red Deer regional hospital
• She has come for an “Initial Visit” appointment at 10:00am
with Dr. Robertson
• Upon arrival, Mrs. Smith checks in with the front desk
• Front desk staff enters her information into the registration
system
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Ideal Scenario on Information Flow
4- External sites identified
Red Deer
Registration
System
6- Receive data: Smith’s
Medications and Allergies
Interface
Engine /
Aggregator
Gateway
Health
System 1
Federal
Aggregator
Health
System 2
2- Internal Request
Health
System 3
7- Provide data
Health
System n
Local HIS Interface
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Wish list
• The data exchange occurs automatically and
transparently, between registration at Red Deer
and the health organization custodian of medical
data in Ontario
• When Dr. Robertson walks into the exam room,
Mrs. Smith’s known Medications and Allergies are
available for review on local health information
system
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Ideal Scenario on Information Flow
4- External sites identified
Red Deer
Registration
System
6- Receive data: Smith’s
Medications and Allergies
Interface
Engine /
Aggregator
Federal
Aggregator
Health
System 2
Gateway
2- Internal Request
Health
System 3
7- Provide data
Dr. Robertson examines
Mrs. Smith, then writes
prescriptions into the 1.
Health Information
2.
3.
System…
Local HIS Interface
Health
System 1
Reordering a previous prescription
Verification of allergy
Decision support
• Allergy detection
• Drug-Drug Interaction
Health
System n
4. Select pharmacy to receive
electronic prescriptions
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Reality Check
• Mrs. Smith has 3 months to get an Alberta health
card and number
• Dr. Robertson would ask Mrs. Smith about her
medical history and her previous medical
providers (doctors, hospitals, etc.)
• Dr. Robertson (or hospital) has to contact Mrs.
Smith’s previous medical providers for her file.
• They might reply, by mail or fax. E-mail is not
considered secure (but fax is ???)
• Her medical record in Alberta has to be created
from scratch.
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Healthcare=Information Intensive
• Healthcare professionals = heterogeneous group with
divers objectives and information requirements
• “The purpose of a HealthCare Information System is to
manage the information that health professionals need to
perform their jobs effectively and efficiently.”
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Automation of Healthcare Systems
• Historically, different units and services within a
hospital were automated (introduction of IT)
separately;
• Separate in terms of function, hardware, operating
system, programming language, vendors;
• Connecting and communicating between the
pieces is a challenging obstacle: consistency,
updates, etc.
• Locating where the patient is and any
given time; Identifying the kind of care
provided; recognizing the clinical
results, etc. are significant real
challenges.
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Automation of Healthcare Systems
Hospital
Registration
Billing
Medical Unit
Medical Unit
Medical Unit
Medical Unit
Lab Unit
Separate automation of specific functions within the hospital
Integration via Interface Engine or Protocol (HL7)
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Separate functional automation
• Significant duplication; for instance
registration and demographic data can be
entered many times for the same visit.
• Contradictions and missing data
• Integration difficult and prone to error
• Software maintenance and upgrades
expensive
• Infrastructure and training expensive
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Enterprise Automation
automation within the
hospital as a whole
enterprise
Medical Unit
Medical Unit
Medical Unit
Hospital
Medical Unit
Billing
Registration
Lab Unit
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Automation of Healthcare Systems
Healthcare
Organization
Healthcare
Organization
Integration via Aggregator/Mediator/Protocol (HL7)
Healthcare
Organization
Healthcare
Organization
“The expertise gained from managing an inpatient driven organization (e.g. a hospital)
does not translate easily to the successful management of other organizational
activities, nor in some cases, even to other hospitals.”
Idem for automation
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Functions and components of HIS
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Patient Management and Billing
Departmental Management
Care Delivery and Clinical Documentation
Clinical Decision Support
Financial and Resource Management
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Benefits
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Cost reduction
Productivity enhancement
Quality and service improvement
Regulatory compliance
Research enabler
Competitive advantage
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Requirements
• Information requirements
– Operational
– Planning
– Communication
– Documentation and Reporting
• Integration requirements
• Security and confidentiality requirements
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Personal Information Protection
• Alberta: Personal Information Protection Act (PIPA),
2003 (http://pipa.alberta.ca/)
– The purpose of this Act is to govern the collection, use and disclosure of personal
information by organizations in a manner that recognizes both the right of an
individual to have his or her personal information protected and the need of
organizations to collect, use or disclose personal information for purposes that
are reasonable.
Not Health Specific
• Ontario: Personal Health Information Protection Act
(PHIPA); outlines privacy regulations for health
information custodians
• Saskatchewan: Health Information Protection Act (HIPA),
2005
• Canada: Personal Information Protection and Electronic
Documents Act (PIPEDA), 2001 (applies to federally
regulated industries)
• USA: Health Insurance Portability and Accountability Act
(HIPAA), 1996 http://www.hipaa.org/
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Privacy of health information
Why protect the privacy of health information?
• Do you know who accessed your health information this week?
• Do you know what they did with your health information?
• Does this concern you?
Identity theft and being impersonated may lead to financial losses
Identity theft in healthcare and being impersonated may lead to death.
What increased threats to privacy, if any, does the
emerging ‘electronic health record’ pose?
• Privacy incorporates much more than “confidentiality” and “security”.
• Privacy is about protecting an individual’s right to have a choice
about how their health information is handled.
• Challenge: maximise both the protection of individual privacy AND
positive health outcomes.
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Active Participants
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Physician
Nurse
Lab technician
Pharmacist
Other care providers
Administrators
Insurance
Patient (becomes an active participant)
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Patients can be active Participants
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The patient is a participant in their care with self-entered data and consent
preferences for this data. Patient in control over what goes into the Personal
Health Record and who has access to it.
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Some companies see this as business opportunity
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Let consumers opt-in to share the output from a device measuring their blood
sugar or blood pressure or other medical sensors.
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This information is viewable in an aggregated format allowing for a more
accurate overall clinical picture
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Clinicians can view self entered data as well as historical prescriptions and
conditions from multiple sources electronically
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goals: “To create integrated online environments where you can create and
store your personal records, get information, find doctors, make medical
appointments, communicate online, manage medications, share information
with providers and more.”
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Health Information Management
O.R. Zaïane © 2009
Health Informatics Survey
INTD 560
Health Information Management
O.R. Zaïane © 2009