Babak Mohit for SAPHIR - Feb 26, 2013 1 An introduction to health information technology systems Babak Mohit MPH, MBA. DrPH candidate Department of Health

Babak Mohit for SAPHIR - Feb 26, 2013

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An introduction to health information technology systems

Babak Mohit MPH, MBA.DrPH candidate

Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public Health


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Highlights

• Comparison of levels of observation in public health and information technology (IT).

• Overlapping domains of public health and health information technology (HIT).

• Functions of IT in public health with practical examples.

• Theoretical frameworks of IT in public health.


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Level of observation

• WHO definition of health recognizes various levels of influence on health:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; Official Records of the World Health Organization, no. 2, p. 100


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Levels of observation in information technology (IT)

• Data: symbols• Information: data that are processed to be useful;

provides answers to "who", "what", "where", and "when" questions

• Knowledge: application of data and information; answers "how" questions

• Understanding: appreciation of "why"• Wisdom: evaluated understanding

Ackoff, R. L., (1989) "From Data to Wisdom", Journal of Applied Systems Analysis, (16) 3-9.


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Example levels of observation in information technology

• Data represents a fact or statement of event without relation to other things.Ex: It is raining.

• Information embodies the understanding of a relationship of some sort, possibly cause and effect or as we say in epidemiology an association.

Ex: The temperature dropped 15 degrees and then it started raining.

• Knowledge represents a pattern that connects and generally provides a high level of predictability as to what is described or what will happen next.

Ex: If the humidity is very high and the temperature drops substantially the atmosphere is often unlikely to be able to hold the moisture so it rains.

• Wisdom embodies more of an understanding of fundamental principles embodied within the knowledge that are essentially the basis for the knowledge being what it is. Wisdom is essentially systemic.

Ex: When it rains, it pours.


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Domains• A. Biomedical/biological sciences (e.g.,

genetics, neurosciences)• B. Clinical sciences (evidence based

medicine)• C. Informatics and analytic sciences

(e.g., decision sciences, computer sciences, statistical)

• 1. A and C: Bio-informatics (aka, computational biology)

• 2. B and C: Clinical/medical informatics

• 3. B and D: Population based medicine and “care management” within clinical settings (not informatics)

• 4. B, C and D: HIT support of care management and population based medicine in clinical settings

• 5. C and D: Public health/population health informatics


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What HIT systems cannot do!• Replace physicians with computers Doctors are trained to make diagnoses They don't desire or use software that purports to do this for them• Create “superdoctors” through the use of computer toolsThe practice of medicine is learned through personal experiencesDoctors do not need simulations of reality• Vastly improve upon books and traditional teaching strategiesBooks are an adequate method of conveying knowledge. Computers can provide some

improvements to book learning, but there is no reason to think that a system of learning based on printed literature, which works well, can be vastly improved.

• Solve subtle or complex problems via the use of medical ontologyComplex systems are inherently chaotic hence inferences reached through a logical ontology

modeling a complex system are likely to be misleading• Create, within the next decade, comprehensive medical records for all U.S. citizens

that can be accessed and annotated by all authorized caregiversThis “Holy Grail” of U.S. medical informatics is a worthy long-term pursuit, but there is no

reason to expect that it can be achieved within a decade or even two decades


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Why do public health professionals need to know health IT?


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Functions of an IT system

1. Collect data (input)2. Manage data (verify, store, upload, etc.)3. Integrate data4. Analyze data (SAS, SPSS, STRATA, GIS)5. Generate reports (output, e.g., summary, reminders,

notification, alert, update, etc.)


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Requirements Elicitation Includes:

• Specifying goals (SMART)• Specifying actors (business and technical)• Specifying functional and nonfunctional requirements• Specifying use cases• Developing models/diagrams (Use case, workflow, and

dataflow)• Specifying high-level system architecture• Specifying hardware and software requirements• Specifying system evaluation plan• Specifying project timeline and documentation


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Example: Immunization System


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Unified Modeling Language (UML)


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Workflow & Dataflow


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The stack framework

Lehmann, H. P. (2011). The stack framework. Introduction to bio-medical and public health informatics (315.707.81) Topic 5- Frameworks for health IT and informatics. Class lecture notes. Johns Hopkins University. Baltimore, MD.

What?

How?


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Prism Framework

Aqil, A., Lippeveld, T., & Hozumi, D. (2009). PRISM framework: a paradigm shift for designing, strengthening and evaluating routine health information systems. Health Policy Plan, 24(3), 217-228.


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Questions? Comments?

Babak Mohit, MPH, MBA

[email protected]


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The evolution of the electronic health record (EHR) in the US.

Babak Mohit MPH, MBA.DrPH candidate

Department of Health Policy and ManagementJohns Hopkins Bloomberg School of Public Health


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Highlights

• The necessity of an Electronic Health Record (EHR)

• History and current efforts towards an EHR.

• Meaningful Use• Architecture• Steps towards a future public health grid• Wrap-up with ways to get involved.


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The Aday Andersen model of healthcare utilization

Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974 Fall;9(3):208-20.


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Decision making in healthcare

Genetics

History of comorbidities

Current Symptoms

Lab results

Radiology

Family History

Socio Economic Status

Education, Current residence, etc

Perception of Disease

Decision towards treatment

Mostly self reported


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Building a HIT infrastructure…


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$20 billion in context

• Medical care = $2.4 trillion per year (U.S.)• Budget of Centers for Disease Control and

Prevention: $6 billion• Mean per capita spending for public health in

2004-05 was $149, compared to $6,423 for overall health care

• Most industries spend 3% on IT = $72 billion• Hollywood worldwide revenue: $40 billion• Practitioners spend about 30% of their time on

informationSource: FSU study draws attention to U.S. public health spending. Available at:

http://www.fsu.edu/news/2006/07/19/health.spending/


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Presumed benefits

• Ambulatory computerized provider order entry: $44 bil per year

• Healthcare information exchange and interoperability: $33.5 bil per year

• Interoperable personal health records: $19 bil per year

• Provider-to-provider telehealth technologies: $3.6 billion per year

Source: Center for Information Technology Leadership (CITL). Clinical Informatics Research and Development (CIRD), Partners Healthcare System (http://www.partners.org/cird/).


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History


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Meaningful Use


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Meaningful Use


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ArchitectureBest of Breed EHR Integrated EHR


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EPIC


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EHR runs at the application level


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Conceptual representation of a Public Health Grid

Savel T, Hall K, Lee B, McMullin V, Miles M, Stinn J, White P, Washington D, Boyd T, Lenert L., A Public Health Grid (PHGrid): Architecture and value proposition for 21st century public health. Int J Med Inform. 2010 Jul;79(7):523-9.


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It all boils down to standards…

Lopez DM, Blobel BG., A development framework for semantically interoperable health information systems. Int J Med Inform. 2009 Feb;78(2):83-103


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How to get involved…

• American Medical Informatics Association (AMIA):

http://www.amia.orghttp://jamia.bmj.com/• Healthcare Information and

Management Systems Society (HiMSS)

http://www.himss.org• Public Health Data Standards

Consortium (PHDSC) http://www.phdsc.org/


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Thank you.Questions? Comments?

Babak Mohit, MPH, MBA

[email protected]

Documents

Babak Mohit for SAPHIR - Feb 26, 2013 1 An introduction to health information technology systems Babak Mohit MPH, MBA. DrPH candidate Department of Health