MTY1106 HEALTH INFORMATION SYSTEM FOR MEDICAL TECHNOLOGY (LECTURE)

W11
Health Information: Data Management System
Jilian Vanessa Lopez, RMT | FEU BS Medical Technology 2023 L9B
OUTLINE DATA AND INFORMATION
DATA AND INFORMATION 1 • Data
KNOWLEDGE GENERATION 1 – facts concerning people, objects, vents, or other entities.
DATA MANAGEMENT 1 – databases store data
HEALTHCARE DATA MANAGEMENT 1 • Information
BIG DATA IN HEALTHCARE 2 – data presented in a form suitable for interpretation
Health Data Hits All 4 V’s 2 • Knowledge
BENEFITS OF HEALTHCARE DATA MANAGEMENT 2 – insights into appropriate actions based on interpreted data
DATA SOURCES FOR HEALTH CARE QUALITY MEASURES 2 – a combination of rules, relationships, ideas, and experience
ADMINISTRATIVE DATE 2 – it is information applied to rules, experiences, and
Administrative Data 3 relationships with the result that it can be used for decision-
Logistic Data 3 making
Quality Assessments 3
Advantages of Administrative Data 3
Challenges of Administrative Data 3
KNOWLEDGE GENERATION
o health care data are the beginning of health care information
PATIENT MEDICAL RECORDS 3
o you cannot create information without data
Advantages of Patient Medical Records 3
Challenges of Patient Medical Records 3
PATIENT SURVEYS 3
Advantages of Patient Surveys 3
Challenges of Patient Surveys 3
COMMENTS FROM INDIVIDUAL PATIENTS 3
Advantages of Patient Comments 3
Challenges of Patient Comments 3
STANDARDIZED CLINICAL DATA 3
Advantages of Standardized Clinical Data 3
Challenges of Standardized Clinical Data 3
OTHER TYPES OF HEALTH DATA 4
OMICS DATA 4
DEMOGRAPHIC DATA 4
WELLNESS DATA 4
ELECTRONIC MEDICAL RECORDS 4
CLINICAL DATA 4
DIAGNOSES 5
ICD-9 Codes 5 DATA MANAGEMENT
DRG 5 • refers to these activities:
CPT Codes 6 a. manage incoming and outgoing information
MEDICATIONS 6 b. establish standards for gathering information
Same Drugs, Different Names 6 c. ensure the privacy and confidentiality of patient
CLINICAL NOTES 6 information
MICROBIOLOGY AND LAB RESULTS 6
CHART EVENTS 6 • explains that these activities can often be facilitated by
TRACKING A PATIENT 7 computers
DATA QUALITY IN HEALTHCARE 7 – if computers are used, personnel must be trained in
The Characteristics of Quality Healthcare Data 7 relevant computer skills such as word processing,
Data Accuracy 7 spreadsheet, and database
Data Accessibility 7 • present this component is closely linked to other
Data Comprehensiveness 7 components such as personnel, documents, and records
Data Consistency 7
Data Currency 7
Data Definition 7
Data Granularity 7
Data Precision 7
Data Relevancy 7
Data Timeliness 7

DIFFERENCE BETWEEN HEALTH DATA AND HEALTH

INFORMATION:
• health information is processed health data
– we interpret processing rudely to cover
everything from formal analysis to explanation
HEALTHCARE DATA MANAGEMENT
supplied by the individual decision-maker brain
o process of storing, protecting, and analyzing data pooled
– they are generally not very useful for decision-
from diverse sources
making
o Managing the wealth of available healthcare data allows
• health care data are raw health care facts, generally health systems to create holistic views of patients,
stored as character, words, symbols, measurements, personalize treatments, improve communication, and
or statistics enhance health outcomes.
– may describe a particular event
– alone and unprocessed, they are not particularly
helpful

FP DE JESUS | 2021 Page 1 of 7

 MTY1106 | LEC Health Information: Data Management System

Health Data Hits All 4 V’s

▪ very large volume of data
▪ a variety of types and sources of data
▪ the velocity at which data is accumulated and processed
▪ veracity or accuracy

BENEFITS OF HEALTHCARE DATA MANAGEMENT

BIG DATA IN HEALTHCARE
• Harris and Schneider (2015) described the difference of
big data and traditional storage and analysis systems
– consider even enormous databases such as Medicare
Claims Databases as filing cabinets
– big data is more likely a conveyor belt
– the filing cabinet, no matter how large, is static, while
the conveyor belt is constantly moving and presenting
new data points and even data sources
• Create 360-degree views of consumers, patients, and
households. Deploy personalized, guided interactions by
integrating data from all available sources.
• Enhance patient engagement with predictive modeling and
analysis based on healthcare data.
• Improve population health outcomes in specific geographic
areas by tracking current health trends and predicting upcoming
ones.
• Make informed, high impact business decisions based on data
insights.
• Understand physician activity and align them with the
organization’s goals
DATA SOURCES FOR HEALTH CARE QUALITY
MEASURES

ADMINISTRATIVE DATA
o in the course of providing and paying for care, organization
generates administrative data on the characteristic of the
population they serve, as well as their use of services and
changes for those services
o often, at the level of individual users, the data is gathered
from:
➢ claims,
➢ encounter,
➢ enrollment,
➢ provider systems
o common data elements include:
✓ type of service
✓ number of units
✓ diagnosis
✓ procedure codes for clinical services
✓ location of service
✓ amount billed
✓ amount reimbursed

FP DE JESUS | 2021 Page 2 of 7

 MTY1106 | LEC Health Information: Data Management System

Financial Data PATIENT SURVEYS

▪ Primarily public and private insurance claims
▪ these are managed care plans, hospital discharge data
sets, and revenue cycle management organizations
▪ these are released by DOH and human services
Logistic Data
▪ logistical data pertaining to several aspects of patient care
▪ such as:
➢ resource utilization:
– service metric,
– medication usage,
– perform diagnostic steps,
– procedures
Quality Assessments
▪ quality and efficiency of care provided
▪ performance analyses of the service providers (i.e.,
reviews of clinician performance)
▪ Patient Satisfaction surveys
▪ Hospital Quality Measures
Advantages of Administrative Data
▪ Available electronically
▪ Less expensive than obtaining medical record data.
▪ Available for an entire population of patients and across
payers.
▪ Fairly uniform (and improving) coding systems and
practices.
Challenges of Administrative Data
▪ Limited clinical information
▪ Questionable accuracy for public reporting because the
primary purpose is billing
▪ Completeness
▪ Timeliness
PATIENT MEDICAL RECORDS
o a patient's medical history and care .
o increased the accessibility of patients’ files
o expected to improve the ease and cost of using this
information for quality measurement and reporting.
WHAT’S IN MY MEDICAL RECORD?
1. Personal Identification Information
(Name, Social Security, Address, etc.)
2. Medical History
(Allergies, Previous Diagnoses and Treatments, etc.)
3. Family Medical History
(heart diseases, cancers, and other conditions)
4. Medication History
(herbal, alternative, OTC, and prescription medicines)
5. Treatment History
(therapies that have failed and worked)
6. Medical Directives
(your wishes if you are unable to speak for yourself)
Advantages of Patient Medical Records
▪ rich in clinical detail
▪ viewed by providers as credible
Challenges of Patient Medical Records
▪ cost, complexity, and time required to compile data
▪ trained staff must manually abstract information
o capture self reported information from patients about their
health care experiences.
o aspects include:
➢ reports on the care,
➢ service, or treatment received and
➢ perceptions of the outcomes of care.
o surveys are typically administered to a sample of patients
by mail, telephone, or internet
Advantages of Patient Surveys
▪ Captures types of information for which patients are the
best source.
▪ Well established methods for survey design and
administration.
▪ Easy for consumers to understand and relate to survey
results.
Challenges of Patient Surveys
▪ Cost of survey administration.
▪ Possibility of misleading results if:
➢ questions are worded poorly,
➢ survey administration procedures are not
standardized,
➢ sampling bias
➢ response bias
COMMENTS FROM INDIVIDUAL PATIENTS
o anecdotal information
– include any type of information on health care quality
that is gathered informally rather than by carefully
designed research efforts
– becoming increasingly more common as private
websites make it possible for healthcare consumers
to share their personal experiences with health plans,
hospital, and most prominently, physicians.
Advantages of Patient Comments
▪ Compelling to consumers to read about other people’s
experiences
▪ Efficient means for conveying information and influencing
people’s decisions and behavior
Challenges of Patient Comments
▪ Not an impartial assessment of health care quality
(because comments are not collected systematically)
▪ Not representative of the patient population.
▪ Likely to have an undue influence on people’s health care
decision making.
STANDARDIZED CLINICAL DATA
o certain kinds of facilities such as nursing homes and home
health agencies are required to report detailed
information about the status of each patient at set time
intervals
o The Minimum Data Set (MDS), the required information for
nursing homes, and the Outcome and Assessment
Information Set (OASIS), the data required by Medicare for
certified home health agencies, store the data used in
quality measures for these provider types.
Advantages of Standardized Clinical Data
▪ Uses existing data sets.
▪ Characterizes facility performance in multiple domains of
care.
Challenges of Standardized Clinical Data
▪ May not address all topics of interest

FP DE JESUS | 2021 Page 3 of 7

 MTY1106 | LEC Health Information: Data Management System

OTHER TYPES OF HEALTH DATA DEMOGRAPHIC DATA

INTRINSIC EXTRINSIC
• physiological • often characteristics
characteristics: derived from an
– age individual’s environment
– sex and lifestyle, which may
– height include:
– weight (to some extent) – address
– ethnicity – marital status
– religion
• they may also include less – employment (type,
obvious characteristics, location, and salary)
such as allergies: – insurance plan
– foods or medications

WELLNESS DATA
o commonly associated with Fitness Tracker
o most prominently associated with wearable fitness
tracking such as:
➢ Fitbit,
➢ Apple Watches,
➢ wireless scales,
➢ digital pill boxes (for medication adherence)
o personal medical devices:
➢ digital glucometers
➢ personal blood pressure cuffs
➢ pulse oximeters
o basic monitoring tools (home monitoring):
➢ beds
OMICS DATA ➢ chairs
o broadly defined ➢ fall detection within flooring
o Omics represents the study of information contained within o more recently:
an individual’s genome and the biological derivatives of ➢ mHealth (phone)
these genes

♦ GENES (genomics)
o genes single nucleotide polymorphism
o short tandem repeats
o genome wide association studies
♦ GENE EXPRESSION and RNA (transcriptomics)
♦ PROTEINS (proteomics)
♦ METABOLITES (metabolomics)
♦ LIPIDS (lipidomics)
♦ (pharmacogenomics)
o explored how omics data can be utilized to
identify the treatment efficacy of various ELECTRONIC MEDICAL RECORDS
medications and medication dosage for a o provides a platform for the collection, review, and storage
particular individual of patient information as part of the patient care processes
o enables patient management of:
➢ demographics,
➢ allergies,
➢ advance directives,
➢ informed consent documents,
➢ vital signs managements, and
➢ order management

CLINICAL DATA
o consist of information ranging from determinants of health
and measures of health, and health status documentation
of care delivery

FP DE JESUS | 2021 Page 4 of 7

 MTY1106 | LEC Health Information: Data Management System

DIAGNOSES DRG
• MIMIC provides 2 forms of diagnosis information: o Diagnosis Related Groups
ICD Diagnosis (International Classification of Disease), o patient classification system to standardize prospective
Diagnosis Related Groups (DRG) payment to hospital and encourages cost containment
– Diagnosis codes are billing codes initiative
o in general, a DRG covers all charges associated with an
• ICD Diagnosis Codes
in-patient stay from the time of admission to discharge
– all codes are in the ICD-9 Standard
– ordered by “priority” o Patient classification scheme which provides a means of
relating the type of patients a hospital treats to the costs
• Diagnosis Related Groups the hospital incurs.
– classification based on clinical factors and utilization of – DRGs consist of classes of patients that are similar
resources clinically and in terms of their consumption of hospital
➢ TWO TYPES: All Payers / Health Care Financing resources
Administration (now known as CMS DRGs) o The All Patient DRGs (AP-DRGs) are an expansion of the
basic DRGs to be ore representative of non-Medicare
ICD-9 Codes populations such as pediatric patients.
o The International Statistical Classification of Diseases and o Each Base APR-DRG is divided into 4 subclasses
Related Health Problems (commonly known as the ICD) – TWO TYPES OF SUBCLASSES
provides alpha-numeric codes to classify diseases and a ♦ Severity of Illness (SOI)
wide variety of: ♦ Risk of Mortality (ROM)
✓ signs,
✓ symptoms,
✓ abnormal findings,
✓ complaints,
✓ social circumstances, and
✓ external causes of injury or disease

ICD-9-CM Code Format

Infectious and Parasitic Diseases (001-009)

Neoplasms (140-239)
Endocrine, Nutritional and Metabolic Diseases, (240-279)
and Immunity Disorders
Diseases of the Blood and Blood-Forming (280-289)
Organs
Mental Disorders (290-319)
Diseases of the Nervous System and Sense (320-389)
Organs
Diseases of the Circulatory System (390-459)
Diseases of the Respiratory System (460-519)
Diseases of the Digestive System (520-579)
Diseases of the Genitourinary System (580-629)
Complications of Pregnancy, Childbirth, and (630-676)
the Puerperium
Diseases of the Skin and Subcutaneous Tissue (680-709)
Diseases of the Musculoskeletal System and (710-739)
Connective Tissue
Congenital Anomalies (740-759)
Certain Conditions Originating in the Perinatal (760-779)
Period
Symptoms, Signs, and Ill-defined Conditions (780-799)
Injury and Poisoning (800-999)

FP DE JESUS | 2021 Page 5 of 7

 MTY1106 | LEC Health Information: Data Management System

CPT Codes CLINICAL NOTES

o 5 Digits Codes – fall into three categories: • MIMIC provides detailed clinical notes across a range of
♦ Category I categories:
– these five-digit (5) codes have descriptors – ECG
which correspond to a procedure or service – Respiratory
– Radiology
– Codes range from 00100 - 99499 – Discharge summary
♦ Category II – Rehab services
– these alphanumeric tracking codes are used – Nursing/other
for execution measurement – Nutrition
– using them is often optional – Pharmacy
♦ Category III – Social work
– these are provisional codes for new and – Case Management
developing technology, procedures, and – Physician
– Consult
services
– the codes were created for data collection and MS is a 77 y/o woman who presents with a rash. The rash began one week
assessment of new services and procedures ago and first appeared on her back an extended to her abdomen on the left
o no decimal marks side. She first noticed the rash after working in her garden. For the first 3 days
she had no associated symptoms, however on the 4th day, she began to
o some have 4 numbers and 1 letter experience severe pain “like being stung by a bee”. The pain is worse in the
o codes are uniquely assigned to different actions evenings and she is having difficulty sleeping. She has been taking Tylenol
every 4-6 hours and using Vitamin E lotion with minimal relied. She is worried
she may have Poison Ivy.

She has a history of hypertension. Her medications include: Nifedipine XL

30mg daily and Metoprolol 50mg BID.

MS is an elderly woman who appears energetic and in no distress. VS: BP

130/80, P 60, RR 12, T 37˚. Skin exam reveals an erythmatous rash of
grouped vesicles with clear fluid, approximately half of which are crusted over.
The rash extends from the midline of the back anterior to the left side of the
T12/L1 dermatome region.

A new onset painful rash in a dermatomal distribution. This is most likely

secondary to herpes zoster because of the location, distribution, and
associated pain. A less likely possibility is contact dermatitis, given her recent
gardening. She may also have a cellulitis, but the lack of temperature doesn’t
support this.

#1 MS will continue to use Tylenol for pain relief.

#2 MS was informed that she may continue to experience pain after the
rash resolves.
#3 MS should return to clinic if the pain becomes more severe or if she
develops warm, redness, or a fever

MICROBIOLOGY AND LAB RESULTS

• The lab results contain both in-hospital laboratory measurements
and out of hospital laboratory measurements from clinics which
the patient has visited. This data contains:
MEDICATIONS ✓ value (can be non-numeric)
• extensive information is provided for the medications offered to ✓ unit (if appropriate)
patients: ✓ flag
♦ Dosage and Unit – indicates whether the value is considered abnormal,
– e.g., 1500 mg using pre-defined thresholds
♦ Form and Form Unit
– e.g., 3 TABS • Microbiology results capture data from various cultures
♦ Route ✓ specimen which is tested for bacterial growth
– IV (intravenous) ✓ organism that grew (none, i.e., negative culture)
– PO (taken orally) ✓ Antibiotic testing

Same Drugs, Different Names CHART EVENTS

o since there are many forms of the same drug, MIMIC • This is by far the largest table in MIMIC and contains an immense
provides: array of information, reflective of anything put into a patient’s
✓ Generic Sequence Number (GSN) medical chart.
✓ National Drug Code (NDC) • This can include:
o This is a platform called RxNorm which helps to map these ✓ patients’ routine vital signs
ingredients ✓ ventilator settings
✓ code status
✓ mental status
✓ even small items like bed adjustments
✓ much more…

FP DE JESUS | 2021 Page 6 of 7

 MTY1106 | LEC Health Information: Data Management System
TRACKING A PATIENT
PATIENTS Every unique patient in the database
ADMISSIONS Every unique hospitalization for each
patient
ICUSTAYS Every unique ICU stay in the database
SERVICES Clinical service under which a patient is
registered
TRANSFERS Patient movement from bed to bed within
hospital, including ICU admission and
discharge
CALLOUT Information regarding when a patient was
cleared for ICU discharge and when the
patient was actually discharged
DATA QUALITY IN HEALTHCARE
• American Health Information Management Association
developed and published a set of Healthcare Data Quality
Characteristics as a component of a Comprehensive Data Quality
Management Models
– defined Data Quality Management as the business
processes that ensures the integrity of an organization’s
data during collection, application, warehousing, and
analysis
The Characteristics of Quality Healthcare Data
Data Accuracy
▪ data that reflect correct, valid, accurate
▪ typographical errors and misspelled names are inaccurate
data
Data Accessibility
▪ data should be available to decision-makers
Data Comprehensiveness
▪ all of the data required for a particular use must be
available to the user
▪ relevant data may not be useful when they are incomplete
FP DE JESUS | 2021
Data Consistency
▪ quality data are consistent
▪ use of an abbreviation that has two different meanings is a
good example of how lack of consistency can lead to
problems
Data Currency
▪ many types of health care data become obsolete after a
period of time
▪ a patient’s admitting diagnosis is often not the same as the
diagnosis recorded on discharge
Data Definition
▪ clear definitions of data elements must be provided so that
current and future data users will understand what the data
mean
Data Granularity
▪ Data granularity is sometimes referred to as data
atomicity
▪ That is, individual data elements are “atomic” in the sense
that they cannot be further subdivided.
▪ values for data should be defined at the correct level for
their use
▪ example:
♦ A typical patient’s name should generally be stored
in three (3) data elements [last name], [first name],
[middle name]
Data Precision
▪ Precision often relates to numerical data.
▪ Precision denotes how close to an actual size, weight, or
other standard a particular measurement is.
▪ Some health care data must be very precise.
▪ example:
♦ in figuring a drug dosage, you must not round up to
the nearest gram (g) if it used to be dosed in
milligrams (mg)
Data Relevancy
▪ Data must be relevant to the purpose for which they are
collected.
Data Timeliness
▪ Timeliness is a critical dimension in the quality of many
types of health care data.
▪ example:
♦ critical lab values must be available to the health
care provider in a timely manner
♦ accurate results after the patient have been
discharged may have no value to the patient’s care
Page 7 of 7