Clinical Information Systems
-
Upload
nawanan-theera-ampornpunt -
Category
Health & Medicine
-
view
811 -
download
1
description
Transcript of Clinical Information Systems
![Page 1: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/1.jpg)
Clinical Information Systems
Nawanan Theera-Ampornpunt, MD, PhDFaculty of Medicine Ramathibodi Hospital
Jun 29, 2013
http://www.slideshare.net/nawanan
![Page 2: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/2.jpg)
2003 M.D. (Ramathibodi)2009 M.S. in Health Informatics (U of MN)2011 Ph.D. in Health Informatics (U of MN)Deputy Chief, Informatics DivisionFaculty of Medicine Ramathibodi Hospital
[email protected]://groups.google.com/group/ThaiHealthIT
Research interests:• EHRs & health IT applications in clinical settings• Health IT adoption• Health informatics education & workforce development• Standards and interoperability
A Bit About Myself
![Page 3: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/3.jpg)
Class Outline
• Health Care & Health IT• Clinical Information Systems• Electronic Health Records
![Page 4: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/4.jpg)
Health Care & Health IT
![Page 5: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/5.jpg)
Manufacturing
Image Source: Guardian.co.uk
![Page 6: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/6.jpg)
Banking
Image Source: Cablephet.com
![Page 7: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/7.jpg)
Health care
ER - Image Source: nj.com
![Page 8: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/8.jpg)
• Life-or-Death• Many & varied stakeholders• Strong professional values• Evolving standards of care• Fragmented, poorly-coordinated systems• Large, ever-growing & changing body of
knowledge• High volume, low resources, little time
Why Health care Isn’t Like Any Others?
![Page 9: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/9.jpg)
• Large variations & contextual dependence
Why Health care Isn’t Like Any Others?
Input Process Output
Patient Presentation
Decision-Making
Biological Responses
![Page 10: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/10.jpg)
But...Are We That Different?
Input Process Output
Transfer
Banking
Value-Add- Security- Convenience- Customer Service
Location A Location B
![Page 11: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/11.jpg)
Input Process Output
Assembling
Manufacturing
Raw Materials
Finished Goods
Value-Add- Innovation- Design- QC
But...Are We That Different?
![Page 12: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/12.jpg)
But...Are We That Different?
Input Process Output
Patient Care
Health care
Sick Patient Well Patient
Value-Add- Technology & medications- Clinical knowledge & skills- Quality of care; process improvement- Information
![Page 13: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/13.jpg)
Information is Everywhere in Health Care
![Page 14: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/14.jpg)
Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic Health
Records (EHRs)
Picture Archiving and Communication System
(PACS)
![Page 15: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/15.jpg)
Still Many Other Forms of Health IT
m-Health
Health Information Exchange (HIE)
Biosurveillance
Information RetrievalTelemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, I
Personal Health Records (PHRs)
![Page 16: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/16.jpg)
Why Adopting Health IT?
“To Computerize”“To Go paperless”
“Digital Hospital”
“To Modernize”
“To Get a HIS”
“To Have EMRs”
“To Share data”
![Page 17: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/17.jpg)
• “Don’t implement technology just for technology’s sake.”
• “Don’t make use of excellent technology. Make excellent use of technology.”(Tangwongsan, Supachai. Personal communication, 2005.)
• “Health care IT is not a panacea for all that ails medicine.” (Hersh, 2004)
Some Quotes
![Page 18: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/18.jpg)
Health IT: What’s In A Word?
HealthInformationTechnology
Goal
Value-Add
Tools
![Page 19: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/19.jpg)
• Safety• Timeliness• Effectiveness• Efficiency• Equity• Patient-centeredness
Dimensions of Quality Healthcare
(IOM, 2001)
![Page 20: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/20.jpg)
• Guideline adherence• Better documentation• Practitioner decision making
or process of care• Medication safety• Patient surveillance &
monitoring• Patient education/reminder
Value of Health IT
![Page 21: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/21.jpg)
Fundamental Theorem of Informatics
(Friedman, 2009)(Friedman, 2009)
![Page 22: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/22.jpg)
Is There A Role for Health IT?
(IOM, 2000)
![Page 23: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/23.jpg)
Landmark IOM Reports
(IOM, 2001)(IOM, 2000)
![Page 24: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/24.jpg)
• Humans are not perfect and are bound to make errors
• Highlight problems in the U.S. health care system that systematically contributes to medical errors and poor quality
• Recommends reform that would change how health care works and how technology innovations can help improve quality/safety
Landmark IOM Reports: Summary
![Page 25: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/25.jpg)
• Health care is very complex (and inefficient)• Health care is information-rich• Quality of care depends on timely availability &
quality of information• Clinical knowledge body is too large• Short time during a visit• Practice guidelines are put “on-the-shelf”• “To err is human”
Why We Need Health IT
![Page 26: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/26.jpg)
• Perception errors
To Err Is Human
Image Source: interaction-dynamics.com
![Page 27: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/27.jpg)
Image Source: aafp.org
• Lack of Attention
To Err Is Human
![Page 28: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/28.jpg)
• Cognitive Errors - Example: Decoy Pricing
The Economist Purchase Options
• Economist.com subscription $59• Print subscription $125• Print & web subscription $125
Ariely (2008)
16084
The Economist Purchase Options
• Economist.com subscription $59• Print & web subscription $125
6832
# of People
# of People
To Err Is Human
![Page 29: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/29.jpg)
• It already happens....(Mamede et al., 2010; Croskerry, 2003; Klein, 2005)
• What if health IT can help?
What If This Happens in Healthcare?
![Page 30: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/30.jpg)
Health IT Across Settings
![Page 31: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/31.jpg)
M/B/H Informatics As A Field
(Shortliffe, 2002)
![Page 32: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/32.jpg)
M/B/H Informatics As A Field
(Hersh, 2009)
![Page 33: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/33.jpg)
Various Forms of Health IT
Hospital Information System (HIS) Computerized Provider Order Entry (CPOE)
Electronic Health
Records (EHRs)
Picture Archiving and Communication System
(PACS)
![Page 34: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/34.jpg)
Still Many Other Forms of Health IT
m-Health
Health Information Exchange (HIE)
Biosurveillance
Information RetrievalTelemedicine &
Telehealth
Images from Apple Inc., Geekzone.co.nz, Google, PubMed.gov, and American Telecare, I
Personal Health Records (PHRs)
![Page 35: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/35.jpg)
Health IT in Clinical Settings (“Clinical Information Systems”)
![Page 36: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/36.jpg)
• Master Patient Index (MPI)
• Admit-Discharge-Transfer (ADT)
• Electronic Health Records (EHRs)
• Computerized Physician Order Entry (CPOE)
• Clinical Decision Support Systems (CDSSs)
• Picture Archiving and Communication System (PACS)
• Nursing applications
• Enterprise Resource Planning (ERP)
Enterprise-wide Hospital IT
![Page 37: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/37.jpg)
• Pharmacy applications• Laboratory Information System (LIS)• Radiology Information System (RIS)• Specialized applications (ER, OR, LR, Anesthesia,
Critical Care, Dietary Services, Blood Bank)• Incident management & reporting system
Departmental IT
![Page 38: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/38.jpg)
Workflow
Hospital Information System
Master Patient
Index (MPI)
ADT
Scheduling
Order
Pharmacy IS
Operation Theatre
Billing
Clinical Notes
LIS
RIS
PACS
CCIS
Medical Records
Portals
Modified from Dr. Artit Ungkanont’s slide
![Page 39: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/39.jpg)
HIT Systems (Inpatient)Clinical Decision Support:“Any system designed to improve clinical decision making related to diagnostic or therapeutic processes of care.”
From Dr. Artit Ungkanont’s slide
![Page 40: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/40.jpg)
Master Patient Index (MPI)
• A hospital’s list of all patients
• Functions– Registration/identification of patients (HN)– Captures/updates patient demographics– Used in virtually all other hospital service applications
![Page 41: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/41.jpg)
Admission-Discharge-Transfer (ADT)
• Functions– Supports Admission, Discharge & Transfer of patients
(“patient management”)– Provides status/location of admitted patients– Used in assessing bed occupancy– Linked to billing, claims & reimbursements
![Page 42: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/42.jpg)
Bed Management (from ADT System)
![Page 43: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/43.jpg)
Insurance Eligibility System
• Functions– Determines if a patient is eligible or is covered by a particular
insurance scheme– Determines the services covered by the patient’s insurance
plan– May need to link with the eligibility verification system of the
government agencies
![Page 44: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/44.jpg)
Appointment Scheduling
• Functions– Records appointments of patients– Pre-specified number of open slots– Ability to postpone/cancel appointments– Displays list of patients with appointments in a specific date– Ability to adjust number of open slots
![Page 45: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/45.jpg)
Computerized Physician Order Entry (CPOE)
![Page 46: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/46.jpg)
Values
• No handwriting!!!• Structured data entry: Completeness, clarity,
fewer mistakes (?)• No transcription errors!• Entry point for CDSSs• Streamlines workflow, increases efficiency
Computerized Physician Order Entry (CPOE)
![Page 47: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/47.jpg)
• The real place where most of the values of health IT can be achieved
– Expert systems• Based on artificial intelligence,
machine learning, rules, or statistics
• Examples: differential diagnoses, treatment options
Clinical Decision Support Systems (CDSSs)
(Shortliffe, 1976)
![Page 48: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/48.jpg)
– Alerts & reminders• Based on specified logical conditions• Examples:
–Drug-allergy checks–Drug-drug interaction checks–Drug-disease checks–Drug-lab checks–Drug-formulary checks–Reminders for preventive services or certain
actions (e.g. smoking cessation)–Clinical practice guideline integration
Clinical Decision Support Systems (CDSSs)
![Page 49: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/49.jpg)
Example of “Alerts & Reminders”
![Page 50: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/50.jpg)
– Evidence-based knowledge sources e.g. drug database, literature
– Simple UI designed to help clinical decision making• E.g., Abnormal Lab Highlights
Clinical Decision Support Systems (CDSSs)
![Page 51: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/51.jpg)
Clinical Decision Support Systems (CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN
From a teaching slide by Don Connelly, 2006
![Page 52: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/52.jpg)
Clinical Decision Support Systems (CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIANAbnormal lab
highlights
![Page 53: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/53.jpg)
Clinical Decision Support Systems (CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIANDrug-Allergy
Checks
![Page 54: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/54.jpg)
Clinical Decision Support Systems (CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN Drug-Drug Interaction
Checks
![Page 55: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/55.jpg)
Clinical Decision Support Systems (CDSSs)
External Memory
Knowledge Data
Long Term Memory
Knowledge Data
Inference
DECISION
PATIENT
Perception
Attention
WorkingMemory
CLINICIAN
Diagnostic/Treatment Expert Systems
![Page 56: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/56.jpg)
• CDSS as a replacement or supplement of clinicians?– The demise of the “Greek Oracle” model (Miller & Masarie, 1990)
Clinical Decision Support Systems (CDSSs)
The “Greek Oracle” Model
The “Fundamental Theorem”
(Friedman, 2009)
![Page 57: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/57.jpg)
Clinical Decision Support Systems (CDSSs)
Issues• Alert sensitivity & alert fatigue
![Page 58: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/58.jpg)
Clinical Decision Support Systems (CDSSs)
Issues• Unintended Consequences (e.g. workarounds)
![Page 59: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/59.jpg)
Nursing Applications
Functions• Document nursing assessments, interventions & outcomes• Facilitate charting & vital sign recording• Utilize standards in nursing informatics• Populate and documents care-planning• Support communication within teams & between shifts
– e-Kardex• Risk/incident management
![Page 60: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/60.jpg)
Pharmacy Applications
Functions• Streamlines workflow from medication orders to dispensing and
billing• Reduces medication errors, improves medication safety• Improves inventory management
![Page 61: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/61.jpg)
Stages of Medication Process
Ordering Transcription Dispensing Administration
CPOEAutomatic Medication Dispensing
Electronic Medication
Administration Records (e-MAR)
BarcodedMedication
Administration
BarcodedMedication Dispensing
![Page 62: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/62.jpg)
Laboratory Information System (LIS)
Functions• Receives and processes lab orders• Matches tube & specimen• Internal workflow within labs
– Order processing– Specimen registration & processing– Lab results validation & reporting– Specimen inventory
• Lab results viewing
![Page 63: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/63.jpg)
Imaging Applications
Picture Archiving and Communication System (PACS)• Captures, archives, and displays electronic images captured from
imaging modalities• Often refers to radiologic images but sometimes used in other
settings as well (e.g. cardiology, endoscopy, pathology, ophthalmology)
• Values: reduces space, costs of films, loss of films, parallel viewing, remote access, image processing & manipulation, referrals
Radiology Information System (RIS) or Workflow Management• Supports workflow of the radiology department, including patient
registration, appointments & scheduling, consultations, imaging reports, etc.
![Page 64: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/64.jpg)
Billing System
• Functions– Calculates service charges for services provided– Calculations based on patient’s insurance coverage and
eligibility– Records amount of money paid by the patient and remaining
amount– Sends information to accounting or Back Office ERP to send
reimbursement claims to government agencies
![Page 65: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/65.jpg)
Enterprise Resource Planning
• Some Functions– Finance
• Accounting• Budgeting• Cost control and management
– Materials Management• Procurement• Inventory management
– Human Resources• Recruitment, evaluation, promotion & disciplinary actions• Payroll
![Page 66: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/66.jpg)
The Bigger Picture:Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
![Page 67: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/67.jpg)
Strategic
Operational
ClinicalAdministrative
4 Quadrants of Hospital IT
CPOE
ADT
LIS
EHRs
CDSS
HIE
ERP
Business Intelligence
VMI
PHRs
MPIWord
Processor
Social Media
PACS
![Page 68: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/68.jpg)
Electronic Health Records/Electronic Medical Records
![Page 69: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/69.jpg)
What Is A Medical Record?
![Page 70: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/70.jpg)
What Is A Medical Record?
• A record or documentation of a patient’s medical history, examination, and treatments.
• Medical Record vs. Health Record– Essentially the same
![Page 71: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/71.jpg)
Potential Uses of Medical Records
• Continuity of providing care– Note important information for later use– Especially important in chronic diseases
(e.g. hypertension, diabetes) or in follow-up (e.g. after surgery)
• Patient safety– Preventing something bad because of lack of information– Such as drug allergies, list of current medications,
“problem list”
![Page 72: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/72.jpg)
Potential Uses of Medical Records
• Communications between providers– Referral to specialists or other physicians– Consulting among physicians– Communications between physicians and nurses,
pharmacists, physical therapists, etc.– Transfer from a hospital to another
• Medico-legal purposes– e.g. Court evidence against malpractice– What was done or provided to the patient? Why? By
whom? When?– Was the care provided up to the professional standard?
![Page 73: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/73.jpg)
Potential Uses of Medical Records
• Claims and reimbursements– What services were provided to the patient– How (and how much) will the hospitals/doctors be paid?– Audit of medical records by “payers”
• Patient’s uses– Health insurance claims– Self-education & self-care
• Clinical research– Find ways to improve health care through new knowledge
![Page 74: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/74.jpg)
Data Elements in Medical Records
• Patient demographics• General information about each visit (visit = encounter)
– Type (outpatient, inpatient, emergency)– Date/Time– Location (clinic or ward)
“Clinical Notes”• Patient’s problems (“Patient history”)
– Chief complaint– Present illness– Past history– Family and social history
![Page 75: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/75.jpg)
Data Elements in Medical Records
• Clinical findings by physicians (“Physical examination”)– Any important positive (usually abnormal) findings– Also important negative (usually normal) findings
• “Investigations”– Laboratory tests (blood tests, urine, etc.)– Radiological examinations (X-rays, CT, MRI, ultrasound)– Other diagnostic procedures
• Electrocardiography (EKG/ECG) -- heart’s function• Electroencephalography (EEG) -- brain wave scans• Etc.
![Page 76: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/76.jpg)
Data Elements in Medical Records
• “Problems” or “Diagnoses”– Summary of problems relevant to this visit
• Treatments– Medications– Surgical procedures– Advice to patients– Admission (hospitalization)
• Plans– Surgeries– More investigations to be done later– Follow-up appointments
![Page 77: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/77.jpg)
Data Elements in Medical Records
• Inpatient clinical notes– Admission notes– Orders (medications, procedures, investigations, nursing
care, etc.)– Medication administration records– Vital signs and other measurements– Results of lab tests and radiological examinations– Progress notes– Discharge summary
![Page 78: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/78.jpg)
“Electronic” Medical Records
• Electronic Medical Records (EMRs) vs. Electronic Health Records (EHRs)
• Debate about similarities & differences• Summary
– Definitions subjective, depending on how people think– EMRs mostly refer to electronic documentation of
medical care at one visit– EHRs mostly refer to electronic documentation that is
longitudinal in nature (may be several visits)– EMRs commonly used in Thailand (but means the same
as EHRs)
![Page 79: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/79.jpg)
Longitudinal Records
• Records documented over time (multiple encounters)• Ideally, “life-long” is a complete record of the patient’s health
![Page 80: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/80.jpg)
Electronic Medical Records (EMRs)
Computer-Based Patient Records
(CPRs)
Electronic Patient Records (EPRs)Electronic Health
Records (EHRs)Personal Health Records (PHRs)
The Confusing Acronyms
Hospital Information
Systems (HIS)
![Page 81: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/81.jpg)
• Are they just electronic documentation?
• Or do they have some other values?
Diag-nosis
History & PE
Treat-ments ...
Electronic Health Record (EHR) Systems
![Page 82: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/82.jpg)
• Literature suggests improvement in health care through
– Guideline adherence– Better documentation– Practitioner decision making or process of care – Medication safety– Patient surveillance & monitoring– Patient education/reminder– Cost savings and better financial performance
Literature Shows Benefits of Health IT
![Page 83: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/83.jpg)
• Patient Demographics• Physician Notes• Computerized Medication Order Entry• Computerized Laboratory Order Entry• Computerized Laboratory Results• Problem Lists• Medication Lists• Discharge Summaries• Diagnostic Test Results• Radiologic Reports
Functions That Should be Part of EHR Systems
![Page 84: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/84.jpg)
EHR Adoption: Thailand (2011)
Estimate (Partial or Complete Adoption)
Nationwide
Basic EHR, combined inpatient & outpatient settings
49.8%
Comprehensive EHR, combined 5.3%order entry of medications, combined 90.2%order entry of all orders, combined 79.4%
Basic EHR: a score > 1 in a 5-point scale for IT support for demographics, MD notes, nursing assessments (inpatient only), discharge summaries (inpatient only), test results, order entry for medications
Comprehensive EHR: a score > 3 in a 5-point scale for Basic EHR functions + electronic image viewing, order entry for lab tests and radiologic tests, drug-allergy alerts, drug-drug alerts
![Page 85: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/85.jpg)
EHR/HIS Adoption in Thailand (2004)
Pongpirul et al., 2004
![Page 86: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/86.jpg)
EHR/HIS Adoption in Thailand (2011)
HOSxP50%
Self-developed or outsourced16%
Hospital OS7%
SSB4%
Mit-Net2%
MRecord2%
H.I.M. Professional2%
MedTrak/TrakCare
2%
HoMC2%
None 2% THIADES2% HIMS
1%
Abstract ePHIS1%
Other7%
Theera-Ampornpunt, 2011 [Dissertation]
![Page 87: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/87.jpg)
EHRs and the Bigger Picture
![Page 88: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/88.jpg)
Health Information Exchange (HIE)
Hospital A Hospital B
Clinic C
Government
Lab Patient at Home
![Page 89: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/89.jpg)
Google Flu Trends (Biosurveillance)
Source: Google.org/FluTrends
![Page 90: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/90.jpg)
• EHRs (or EMRs) are both– Electronic documentation of patient care and– a broad term for an information system used to
improve the process of patient care through better documentation and other care processes such as ordering medications, lab tests, or x-rays and viewing lab results and x-ray reports (among others)
Summary
![Page 91: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/91.jpg)
• There are various kinds of applications in hospitals
• HIS often refers to the “Front Office” part of hospital IT
• Sometimes HIS refers to the entire hospital IT• HIS and EHRs are used to support clinical
workflows, improve decision-making and care quality, and reduce costs
• EHRs and HIS are just one piece of the big puzzle for the whole healthcare system
Summary
![Page 92: Clinical Information Systems](https://reader036.fdocuments.in/reader036/viewer/2022081403/554b1aefb4c90569098b5083/html5/thumbnails/92.jpg)
Questions?