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CAHIMS Review Course
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Learning ObjectivesIdentify basic clinical vocabulary/terms frequently represented in healthcare informatics (e.g., dosage frequency, dosage routes, body systems)Identify basic healthcare IT vocabulary/terms frequently represented in healthcare informatics (e.g., LAN, SMS, VPN)Identify basic clinical metrics frequently represented in informatics (e.g., average daily census, turnaround time, adherence, barcode medication administration)Identify and support opportunities to optimize clinical effectiveness and efficiencies
Understand various data visualization techniques (e.g., tables, graphs, charts)
Maintain clinical content and decision-support tools
CAHIMS Review Course
What is Clinical Informatics?
HIMSS definition:
“activities that promote the understanding, integration and application of information technology in healthcare settings.”
AMIA differentiates:
by explicitly noting that it is the use of information by clinicians
ANIA definition:
“explicitly addressing improvements for the health of populations, communities, families and individuals by optimizing information management and communication.”
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CAHIMS Review Course
Who are Clinical Informaticists?
Translators in the interprofessional team, as a professional that speaks both informatics and healthcare
To be able to speak the same language,
and understand each other,
common ground must be found.
Need to understand the basic
underpinnings of computers and how
they work to manage healthcare
information
Practice the expansive scope of clinical informatics, subset of informatics within the healthcare domain
Clinical informatics increasingly impactful to healthcare world
Clinical Decision Support (CDS) provides guidance clinicians
Artificial intelligence (AI) and machine learning on the rise
Social determinants of health, patient-driven care
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CAHIMS Review Course
Basic Vocabulary• At the root of clinical language is the use of prefixes, suffixes, letters, words or
numbers which may form medical terms
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Prefix Meaning Prefix Meaning
Brachi/o Arm Lapar/o Abdomen, loin, or flank
Cardi/o Heart My/o Muscle
Cyt/o Cell Neur/o Nerve
Derm/a, derm/o, dermat/o Skin Ocul/o Eye
Encephal/o Brain Ophthalm/o Eyes
Gastr/o Stomach Or/o Mouth
Hemat/o Blood Ot/o Ear
Intestin/o Intestine Pulmon/o Lungs
CAHIMS Review Course
Basic Clinical Abbreviations
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Abbreviation Definition Abbreviation Definition
AM Morning BP Blood pressure
AC Before meals BS Blood sugar
AD Right ear CC Chief complaint
Ad lib Freely Cap Capsule
Amp Ampule CM Centimeter
Ante Before CXR Chest x-ray
AS Left ear DC Discontinue
ASA Aspirin Disp Dispense
AU Both ears ER/EC/ED Emergency Room
BID Twice a day G Gram
BMI Body mass index Gr Grain
*Accepted form of abbreviations may be institution-specific
Caution:Duplicatedefinition?
CAHIMS Review Course
Basic Clinical Abbreviations (Continued)
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Abbreviation Definition Abbreviation Definition
HR Hour MCG microgram
H/O History of mEq/L Milliequivalent per liter
HR Heart rate mL Milliliter
HS At bedtime mm Millimeter
Hx History N/V Nausea and vomiting
ID Intradermal NKDA No known drug allergies
IM Intramuscular NPO Nothing by mouth
IN Intranasal OD Right eye
INJ Injection OS Left eye
L Liter OU Both eyes
LMP Last menstrual period oz Ounce
CAHIMS Review Course
Basic Clinical Abbreviations (Continued)
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Abbreviation Definition Abbreviation Definition
PM Evening Rx Prescription
PMH Past medical history SL Sublingual
Q Every SQ Subcutaneous
Q2h Every two hours STAT Immediately
Q6h Every six hours Supp Suppository
Qam Every morning T Temperature
Qpm Every night TID Three times a day
QID Four times a day w/o Without
QOD Every other day WNL Within normal limits
*Abbreviations may hold multiple meanings• ”D/C” – discharge or discontinue• “SSRI” – sliding scale regular insulin or selective-serotonin reuptake inhibitor• “MS” – morphine sulphate or multiple sclerosis
CAHIMS Review Course
National Standards for Health Information Technology
Developed and maintained by a number of global organizations.
Critical to capturing and transmitting data effectively across institutions,
states, nationally and internationally.
Have evolved over time and continue to evolve.
Standards support certification of
electronic health records and the ability to capture and report data with consistency.
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CAHIMS Review Course
Technology Standards for Healthcare
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Messaging Standards Used for
HL7 Clinical data (Health Level Seven)
X12N Financial data, HIPAA-mandated transactions, transport of data
DICOM Images (Digital Imaging and Communications in Medicine)
NCPDP Standards for pharmacy business functions, HIPAA-mandated transactions(National Council for Prescription Drug Programs)
IEEE Bedside instruments, medical information (Institute of Electrical and Electronics Engineers)
Terminology Standards Used for
LOINC Lab interoperability/data exchange (Logical Observation Identifiers Names and Codes)
Drugs NLM/FDA/VA collaboration on RxNorm, NDF-RT (National Drug File - Reference Terminology)
Billing CPT (Current Procedural Terminology), ICD-10-CM
(International Statistical Classification of Diseases and Related Health Problems)
Clinical UMLS (Unified Medical Language), SNOMED, and others
CAHIMS Review Course
Computers in Healthcare
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Not a new phenomenon
• Decades of legacy systems (billing, lab, pharmacy, supplies)
Widespread adoption in the U.S. since the American Recovery and Reinvestment Act (ARRA) of 2009
• Health Information for Economic and Clinical Health Act (HITECH)• Created to motivate the implementation of electronic health records (EHRs) and supporting
technology• Created an economic stimulus effect• New jobs/roles created to support the expansion of EHRs, the clinicians who use these systems,
and far beyond
CAHIMS Review Course
Computer Technology Basics
Fundamental building blocks
Bits
Bytes (kb, mb, gb, tb)
Hardware
Software
Connectivity considerations
Clinical informatics
professionals
Understand these foundational concepts
Often fill a role to manage these
components for the clinical teams alongside
IT colleagues
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CAHIMS Review Course
Computer Technology Basics – Internal Components
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Component Definition Function
Motherboard The backbone of the computer Connects the computer parts
Central processing unit (CPU)
Often thought of as “the brains” of the computer
Responsible for interpreting and executing most of the commands from the computer’s hardware and software
Random-access memory (RAM)
The working memory of the computer Allows a computer to work with more information at the same time in active memory processing
Power supply A converter that supplies the power to the machine
Used to convert the power provided from the outlet into usable power for the many parts inside the computer case
Video card Graphics adapter or expansion card Allows the computer to send graphical information to a video display device such as a monitor, TV, or projector
Hard disc drive (HDD) Data storage device and an electromechanical magnetic disk drive
The HDD is the main, and usually largest, data storage hardware device in a computer where the operating system, software, and most files are stored
Solid-state drive (SSD) Data storage device; no moving (mechanical) components
Storage device that is typically more resistant to physical shock, runs silently, and has lower access time and less latency, but more expensive than HDD
Optical drive (Disc) Optical storage devices Optical drives retrieve and/or store data on optical discs like CDs, DVDs, and Blu-ray discs (BDs)
CAHIMS Review Course
Hardware Specifications
Processing Speeds
Memory Requirements
Interface Requirements
Operating Systems
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CAHIMS Review Course
Sample Recommended Specification for a Clinical Information Server
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Processor 2 × Six Core Intel Xeon Platinum Series
Memory 128 GB RAM
Network interface card 1 Gbit
Primary hard drive(s) 2 × 300 GB SAS in RAID 1
Repository hard drives 6 × 300 GB SAS or more in RAID 5 (SAN Preferred)
Operating system Microsoft Windows Server 2019
Database software Microsoft SQL Server 2019
See vendor for recommendations
Recommendations subject to change over time
CAHIMS Review Course
Software Considerations
System software•Used to start and run the computer•Related to what the software does within the computer system to support the use of the computer
•e.g. device-driver software operates and manages all devices attached to the computer
Application software•Generally has a function or purpose specific to its use
•e.g. accounting/financial applications
Programming tools•Used to compile programs and link, or translate, computer program source code and libraries that
belong to either the system software of the application
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CAHIMS Review Course
Types of Internal Components of Computer Software
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Type Description
Operating System The software that is responsible for the direct control and management of the hardware and running application software
Open-source software Free source code access licensed for use by an open community of developers and end-users; proprietary software is owned and distributed for commercial use
Boot loader or bootstrap The small program that loads and executes the command to “boot up” the computer; the program is stored in the RAM
Device drivers A program that operates the various devices on the computer, such as printers and peripherals; the driver provides software interface to the hardware device
Firmware Controls the devices typically seen in items such as mobile phones and digital cameras
GUI A graphics display with user-friendly point-and-click capability that allows the end-user to interact with the computer through the mouse and touchpad
Middleware Software that resides as an interface between the operating system and the applications that allows developers to control input/output devices, also referred to as “software glue”
Utility software Software that helps analyze, configure, optimize, or maintain the computer
CAHIMS Review Course
Connectivity Considerations and Terminology
Short Messaging Services (SMS)
Virtual Private Network (VPN)
Local Area Network (LAN)
Mobile Technologies
Cloud Computing
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CAHIMS Review Course
Connectivity
Consider ↑home automation with IoT
Smart television systems
Voice assistants
Alarm systems
Also ↑Healthcare mobile technologies
Notification to patients (follow up, labs)
Barcode medication administration
Secure messaging
Vast offerings with tremendous growth
Cloud Computing
“Software as a service”
E.g. EHR hosted by vendor
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CAHIMS Review Course
Optimizing Clinical Effectiveness of Health Information Technology
Clinical Informaticists may use quality improvement techniques as a tool to optimize technology
Increased ability to capture data through the use of clinical systems, but can also lead to increased:
Burden of documentation
Interoperability challenges
Health IT safety consideration Clinician stress
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CAHIMS Review Course
Workflow Redesign
Used as a quality improvement
technique
Identify how the work is currently being done, the current or “as is”
state
Often uses visual representations which allow role
and responsibility
mapping as well as determining when actions and decisions
are made within the workflow
Can be useful in identifying the “root cause” of
an adverse event and then
mitigate the error from happening
again, often through a redesign
producing a “future” workflow
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CAHIMS Review Course
What Is Workflow?
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How work gets done,
not protocols
May involve
root cause analysis
May be mapped visually
Measuring: Process,
Outcomes, Balance
Current State Gap Analysis Future State
CAHIMS Review Course
Common Clinical Metrics Used in Healthcare
Defined across three categories
• Process• Reflective of a clinical guideline and key interventions that impact a clinical outcome
• e.g. 90-minute door to balloon time for a myocardial infarction (heart attack)• Outcome
• Outcome measures are often “risk-adjusted” and consider things such as comorbidities and other factors that may have influenced the metric• e.g. mortality rates, 30-day readmission rate, surgical site infection rate
• Balancing• Address potential unintended consequences of quality improvement interventions used
to improve process or outcomes• e.g. decreased patient satisfaction due to the reluctance of a provider to prescribe
pain medications for a patient due to the opioid crisis
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CAHIMS Review Course
QualityThe National Quality Forum is an organization tasked through federal contract to oversee quality measures development in the USCritical juncture in transforming how we pay for healthcare
Three interdependent levels of measurement, including individual performance measures, measure sets, and measurement systemsEstablishes a next generation approach to measuring quality in healthcare
Takeaway: Clinical Informatics key to quality measures, data analytics
More information see http://www.qualityforum.org/Home.aspx.
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CAHIMS Review Course
Data Visualization
Clinical Informaticists
should understand
best practices in developing
and presenting data
Common methods
include graphs, charts and
tables (examples of
these on following slides)
Graphical display of data
can covey complex ideas
with clarity, precision and
efficiency
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CAHIMS Review Course
Data Visualization Best Practices
Clear display of the dataInduce the viewer to think about substance rather than methodsAvoid distortionPresent numbers in small spaceMake a large data set coherentEncourage the eye to compare different pieces of dataReview the data at multiple levelsServe a clear purpose to describe, explore, tabulate or enhance a reportBe closely integrated with verbal or descriptive information in a report
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CAHIMS Review Course
Line Chart / Line Graph
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• Often used to reflect a metrics variability over time
• May show multiple series of data points over time
CAHIMS Review Course
Bar Chart
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Variables for Use of Computers and the Internet
• Used to reflect frequency, counts or percentages as reflected as a total frequency
CAHIMS Review Course
Table and Translation to a Bar Chart
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Frequency of Males and Females in a Population
CAHIMS Review Course
Histogram
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• Reflect distributions of data for discrete (categories) or continuous data
• Bars represent numerical data by showing the number of data points that fall within a specified range of values often called “bins”
CAHIMS Review Course
Pie Chart
31Comparisons of Income for Males and Females
• Can be effective at comparing differences to illustrate the percentage breakdown of a small number of data points
CAHIMS Review Course
Common Data Analytics Tools and Terminology
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Tool Purpose/Definition Example
FieldsVertical column in a database that contains data with common characteristics for the entire record
“First Name”“Last Name” “Date of Birth”
RecordsHorizontal rows in a database containing different pieces of data belonging to a given entity
All of the fields related to the row of “Billy”
TablesConsists of all records; combinations of all fields and records together
All horizontal and vertical rows together
ReportsAlternate view of data; typically assembled from a query
Generally generated on paper, can also be electronic for distribution of data
QueryProcess of selecting desired records; pulling the data
Pulling data related to all female patients older than 50 with a history of colon polyps
Graphs and ChartsTool for examining and presenting data Scatter plot, pie charts, bar charts, flowcharts,
Control Charts (Shewhart)Tool for looking at a process over time Common and special-cause variation, upper and lower
control limits
Predictive ModelingInstead of retrospective data analytics, the data is used to predict future outcomes
Pulling last five years of financial data to predict next years’ budget needs
CAHIMS Review Course
Database Samples
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Database Table Query based on data elements
Report – Output of querying database for specific elements
CAHIMS Review Course
Clinical Decision Support
Office of the National Coordinator for Health Information Technology (ONC) defines clinical decision support (CDS) as:•a component that “provides clinicians, staff, patients, or other individuals with
knowledge and person-specific information, intelligently filtered or presented at appropriate times, to enhance health and healthcare.”
CDS tools may include:•Computerized alerts and reminders to care providers and patients •Clinical guidelines•Condition-specific order sets •Focused patient data reports and summaries •Documentation templates;•Diagnostic support•Contextually relevant reference information
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CAHIMS Review Course
Five Rights of CDSCombine all the tools and types to strategically use CDS within
an organization following a “five rights” framework
Who, what, when, where and how
Emphasize the clear goals and objectives of all five
components
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Right information Right person Right intervention format Right channel Right time
in workflow
CAHIMS Review Course
Summary
Clinical Informaticists must understand and master:• Basics of clinical vocabulary• Common terminology represented in health informatics• Technology vocabulary• Types of metrics• Methods to optimize technology to improve care delivery
• Process improvement• Data visualization
• Proper use and development of clinical decision support tools
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