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Health Informatics Primer2015
Overview for workshop
What does health
informatics mean for
me?
What does health
informatics mean for
me?
What is health
informatics?
What is health
informatics?
Why is health
informatics important?
Why is health
informatics important? What does
health informatics include?
What does health
informatics include?
• The science and practice behind the convergence of healthcare, information technology and business
• The discipline that deals with the storage, retrieval, sharing, and optimal use of data that relates to human health
• The knowledge for problem solving and decision making using health information
Health Information lifecycle
Collect
Store
Share
Maintain
What does health
informatics mean for
me?
What does health
informatics mean for
me?
What is health
informatics?
What is health
informatics?
Why is health
informatics important?
Why is health
informatics important? What does
health informatics include?
What does health
informatics include?
Triple aim for quality in health
• Health informatics is a set of competencies to support achieving the triple aim as set out by the NZ HQSC– Improved quality, safety and experience of care– Improved health and equity for all populations– Best value for public health system resources
NZ Health Quality and Safety Commission
The National Health IT Plan• First published for 2010-14 with focus on
national and regional initiatives, and integration of IT systems
• Particular commitment to “patient portal”• Update in July 2014 focused on:
– electronic medication management– national clinical solutions – regional information platforms– community-based integrated care initiatives
What does health
informatics mean for
me?
What does health
informatics mean for
me?
What is health
informatics?
What is health
informatics?
Why is health
informatics important?
Why is health
informatics important? What does
health informatics include?
What does health
informatics include?
Six categories for health informatics competencies• Core principles and methods **• Information & Communications Technology• Health and Biomedical Sciences• Information Sciences• Management Sciences• Human and Social Context
Core principles & methods
• Types of information systems in health informatics
• Important concepts for health informatics• Challenges for health informatics• Applying health informatics into practice
Types of information systems
• Electronic Health Records• Decision Support Systems• E-health applications and solutions• Informatics for participatory health – personal
health records and patient portals
Electronic health records• What are EHRs?• Examples of EHRs • Issues with EHR
The Electronic Health Record• “Computer-based systems for input, storage,
display, retrieval, and printing of information contained in a patient's medical record” – Pubmed
• Part of a clinical information system relating to individuals
• Records information about a person:– Results of tests and clinical examinations– Encounters with health professionals– Treatment and plans further management
Electronic Health Record
Laboratory resultsAdministration Systems
Imaging (including PACS)
Clinical users
Government and provider statistics
Other health care providers
Etc.
Advantages of EHRs
• Always available• Legible• Searchable• Sharable• Different views• Audit and decision support• Security
Issues
• Consistency of data • Free text versus coding• Security – who can access and when• Protecting an individual's privacy• Need a computer• “Fishing expeditions”
Some examples…• Orion Health
http://www.orionhealth.com/solutions/packages/electronic-health-record-ehr
• Medtechhttp://www.medtechglobal.com/nz/products/medtech32-nz.html
• Epic Systemshttp://www.epic.com/software-ambulatory.php
• OpenMRShttp://openmrs.org
Technology for decision support• Use data from Electronic Health Record combined
with rules• Reminders – eg high blood pressure, protocols• Decision Analysis – need utility values• Alerts• Linking to resources• Recalls - Cervical Screening, immunisations• Telehealth
VignetteBoth an electronic and a paper medical record was transferred from GP A to GP B for a new patient. A medical incident review noted the electronic record was incomplete, however the review of the paper record by GP B overlooked important information, resulting in the patient’s death.
What concerns would you have for electronic records?What concerns would you have for paper records?
Important concepts for health informatics• Knowledge representation• Interfacing and patient identification• Integration of clinical data and associated risks• Value of information systems and adoption
Computers are dumb…• They don’t learn• They can’t tell what you mean• They don’t get bored
Data• Discrete variables• National Health Index – NHI • Name, date of birth, gender, address• Values collected – blood test results • Clinical data - blood pressure, clinical signs,
diagnosis, medicationsData itself is nothing…
Should provide useful, usable information that makes a difference to patient care
Information• Data in context• 120/80 means something if you know it is
mmHg • However it still doesn’t tell you anything about
whether the patient is sick or well.• Need more data to provide context – , when
taken, other readings, age, medical history, medications
Knowledge• Adds MEANING to information • 120/80 is high blood pressure in an infant• May be high relative to other readings in an adult• Relies on expertise to interpret.• Information to knowledge usually done by
humans, can see clinical diagnosis as this sort of process.
Users of health knowledge• Patients
– Self management and support
• Clinical staff– Support diagnosis and
treatment• Administration and
funders– Cost Estimation– Management
Uses of health information• Supporting clinical intervention
• Clinical governance
• Administration (in all parts of health)
• Strategy and policy development
• Research
• Patient self-management and self care
Consumer self management
Challenges for health informatics
• Clinical safety and information systems• Ethics, privacy and security• New data sources and emerging technologies
Sharing health information
• Communication of information is a key task in health informatics
• Communication must be accurate, reliable and timely– Prescriptions (from hospital or GP to Pharmacy)– Referrals (from GP to hospital)– Discharge Summaries (from hospital to GP)– Lab results
How to share safely…• Potential architectures• Single Clinical Information system
– Everybody accesses own part and gets views of other data.
• Centralised model– Requires very large investment– Issues with who “owns” data– Connectivity always needed
Health information safety= legal and ethical practice • Professional codes of conduct• Privacy Act & Health Information Privacy Code• Technological solutions:
– Audit trails – who looked at the data– Industry-standard security and authentication– Rules for data preservation– Data consistency and cross-checking– Sealed envelopes
Privacy principles• Rule 1: Purpose of collection of health information• Rule 2: Source of health information• Rule 3: Collection of health information from individual• Rule 4: Manner of collection of health information• Rule 5: Storage and security of health information• Rule 6: Access to personal health information• Rule 7: Correction of health information• Rule 8: Accuracy etc of health information to be checked
before use• Rule 9: Retention of health information• Rule 10: Limits on use of health information• Rule 11: Limits on disclosure of health information• Rule 12: Unique identifiers
Keep hardware secure
Keep data secure
What is HIGEAG?• HIGEAG is the Health Information Governance
Expert Advisory Group
• It reports to and advises the National Health IT Board
• It was established to develop a Health Information Governance Framework for the New Zealand Health sector
The Health Information Governance Framework will cover:Maintaining Quality and Trust• support information sharing so that health practitioners have all relevant
information at point of care and consumers feel confident that their personal health information is held securely and treated confidentially
Upholding Consumer Rights and Maintaining Transparency• consumers’ privacy rights in regard to their personal health information and
health agency obligations around maintaining transparency in their use of that personal health information
Appropriate Disclosure and Sharing• rules around information sharing and disclosureEnsuring Security and Protection of Personal Health Information• link to Health Information Security Framework which sets out the technical
and procedural requirements for protecting personal health information
Future trends
• Genomics• Global Information Systems (GIS)• Smartphone Apps• Sensors and wearable devices• Predictive Analytics• The digital divide
VignetteOctober 2012“The Herald understands staff allegedly accessed the man's medical file and emailed the x-rays. It is understood the incident could lead to court action against those involved.”
What technology is involved and is this a technological issue?
Applying health informatics in practice• Standards and interoperability• Architectures of health information systems• Informatics in support of education and research
Making best use of data• Data to record diagnoses, observations,
outcomes• Coding - Diagnostic related groups (DRGS)
• ICD 10 codes• Read codes• Snomed CT
• Vocabularies – to standardise terms, shared meanings• Pre-eclampsia, PE, Toxaemia, PET, Gestational Proteinuric
Hypertension GPH
Examples of codes• International Classification of disease (ICD) currently version 10.• http://www.who.int/classifications/icd/en/• World Health Organisation standard• http://www.cdc.gov/nchs/about/otheract/icd9/icd10cm.htm
ICD10 Code Description
O104.11 Pre-existing secondary hypertension complicating pregnancy, first trimester
O104.12 Pre-existing secondary hypertension complicating pregnancy, second trimester
O104.13 Pre-existing secondary hypertension complicating pregnancy, third trimester
O104.19 Pre-existing secondary hypertension complicating pregnancy, unspecified trimester
Systematized Nomenclature of Medicine-Clinical Terms - SNOMED CT• Hierarchical• Concepts - also link concepts• Synonyms and different languages• >600,000K Concepts• clinical vocabulary administered by international
health terminology standards development organisation (IHTSDO) http://www.ihtsdo.org/.
• Member countries; Australia, Canada, Denmark, Lithuania, Netherlands, NZ, Sweden, UK & USA
General model
Unstructured text
Extract SNOMED terms
EHR
Map to ICD 10 Send/receive messages
Cliniclue http://www.clinical-info.co.uk
What does health
informatics mean for
me?
What does health
informatics mean for
me?
What is health
informatics?
What is health
informatics?
Why is health
informatics important?
Why is health
informatics important? What does
health informatics include?
What does health
informatics include?
What do HI professionals do?
• Ensure patient records are complete, accurate and easily available to medical professionals
• Devise, implement and maintain systems to capture, store and organise medical data
• Compile and analyse medical data for better quality care, research and cost control
• Troubleshoot and improve all the technologies and workflows that are used in the delivery of healthcare
How computer literate should health professionals be?• What basic information literacy skills should
health professionals possess?• Where and how should they get the education
for this? • To what extent should health professionals be
trained in IT to enable them to work with health information systems?
Health informatics skills provide for:• lifelong learning • career development • critical thinking ability• communication skills• information literacy
Follow Up:Personal assessment and plan International Computer Driving License
Useful information sources• HINZ www.hinz.org.nz• National Health IT Board www.ithealthboard.health.nz• Ministry of Health www.health.govt.nz• IMIA www.imia.org• Health IT cluster www.healthit.org.nz• Health Quality & Safety Commission www.hqsc.govt.nz
Questions?
What does health
informatics mean for
me?
What does health
informatics mean for
me?
What is health
informatics?
What is health
informatics?
Why is health
informatics important?
Why is health
informatics important? What does
health informatics include?
What does health
informatics include?
