HIMA 4160

Fall 2009
HIS: Health Information Systems
EHR: Electronic Health Records
EMR: Electronic Medical Records

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 Level of conception.
 Data – factual
 Information – meaning of data
 Knowledge – model for information

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 Data – Body temperature 103
 Information – The patient is having a fever
 Knowledge -- The knowledge used to

generate the information: if a patient

temperature is > 100 F, he might a fever (or
hyperthermia).

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Concrete Abstract

Factual Conceptual

Volatile Stable

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 General term cover all three levels
 Database – data level
 Information storage and retrieval system –

information level
 Knowledge system – knowledge level

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Information System

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 In-house – developed and managed in the
health care organization

 Shared – developed and managed at the vendor

site

 Turnkey system – developed by vendor, installed

and managed by health care organization

 Stand-alone – lack of information sharing.

Legacy system.

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 Integration
 Continuality
 Standards
 Consumer oriented

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 Clinical information systems – serving clinical
activities
◦ Hospital information system
◦ Patient monitoring system
◦ Nursing information system
◦ Laboratory information system
◦ Pharmacy information system
◦ Computer based patient record
◦ Others

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 Provide communication among health facility
workers and support organizational
information needs for operations, planning,
patient care, and documentation.
 Communication, coordination
 Various across different hosptials

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HIS should have following functions
 Central application
 Business and financial function
 Communications and Networking
 Department management
 Medical documentation
 Medical decision support

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 Patient management
◦ Scheduling
◦ RADT (registration, admission, discharge, and
transfer)
◦ RADT provides basic patient information to other
clinical systems.

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 Payroll
 General ledger
 Accounts receivable
 Insurance

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 Connect different systems.
 Need data standards to communicate.
 This is a disadvantage of paper based system.

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 Needs of individual department
 Pharm, lab, radiology, dietary, pathology, etc
 The trend is to integrate these systems while

maintaining their functional independence.

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 Medical record
 Will be paperless
 Provide support to managerial and

administrative decision making

 In order to do so, the medical record has to

be digitalized and codified.

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 Help clinicians make decision
 Not replace clinicians
 data from various sources – hard to managed

by human
 Often integrated into physician order entry

system
 focal role in decreasing medical errors

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 Physiological data
 Emergency room, operating room, intensive

are, critical care

 Can give real time alert

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 Support nurse care process
 Clinical and managerial

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 Associated with lab test
 Usually already available in the instrument
 Various types of lab tests have different

demands

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 Data related to drug usage for patient
 Also can help decreasing medication errors

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 IOM 1991 report first proposed the concept
 Other names include electronic health record

(EHR), electronic medical record (EMR).

 It is not a single computer product or

program
 Based an changed model of managing patient

data
 Computer and information technology is

necessary but not sufficient factor.

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 Focus on integration
 Government support

◦ http://www.cnn.com/2004/ALLPOLITICS/04/27/b
ush.healthcare.ap/
◦ National Health Information Infrastructure
◦ ARRA
 Standardization
◦ HL7

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 Financial information system
 Accounting information systems
 Human recourse management information

systems
 Material management information system
 Facilities management information system
 Management planning and decisin support

system

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 Computer based patient record
◦ National health information infrastructure
◦ Medical errors
 E-Health and e-HIM
◦ Web based technology
 Standards
 Privacy and Security
 Technology
◦ Wireless
◦ Voice recognition
◦ Data warehouse and data mining
 Enterprise information management
 Virtual information system – results of integration,
standardization, and personalization.
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Before we answer that, what is a patient record?
 
• commonly referred to as the patient's chart or
medical record
 
• amalgam of all the data acquired and created
during a patient's course through the heath care
system
 
 
 
 

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"to recall observations, to inform others, to
instruct students, to gain knowledge, to monitor
performance, and to justify interventions"

    Reiser, S. (1991). The Clinical Record in Medicine. Part 1: Learning from Cases. Annals of
Internal Medicine, 114(10): 902-907

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• create the basis for the historical data

• support communication among providers

• anticipate future health problems

• record standard preventive measures

• identify deviation from expected trends

• provide a legal record

• support clinical research and public health

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• Pragmatic and Logistical issues.
• Can I find the data I need when I need them?
• Can I find the medical record in which they are recorded?
• Can I find the data within the record
• Can I find what I need quickly?
• Can I read and interpret the data once I find them?
• Can I update the data reliably with new observations in a
form consistent with the requirements for future access by
me or other people?

• Redundancy and Inefficiency

• Influence on Clinical Research

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 Accessibility
 Legibility
 Adaptive
 Structure
 Reusability
 Flexibility

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 Comprehensiveness of information
 Duration of use and retention of data
 Degree of structure of data
 Ubiquity of access

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 Disease Pattern Change
 Health Care Delivery System Change
 Specialization of Medicine
 Advances of Computer and Information

Technology

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 Primary Uses
◦ Patient Care Delivery
◦ Patient Care Management
◦ Patient Care Support Processes
◦ Financial and Other Administrative Processes
◦ Patient Self-Management

 Second Uses
◦ Education
◦ Regulation
◦ Research
◦ Public Health and Homeland Security
◦ Policy Support

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 Health Information and Data
 Results management
 Order entry/management
 Decision support
 Electronic communication and connectivity
 Patient support
 Administrative processes
 Reporting and population health

management

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 Key Data
◦ Problem list
◦ Procedures
◦ Diagnoses
◦ Medication list
◦ Allergies
◦ Demographics
◦ Diagnostic test results
◦ Radiology results
◦ Health maintenance
◦ Advance directives
◦ Dispositions
◦ Level of service

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 Minimum Data Set (MDS) for nursing homes
◦ From CMS
◦ Support Long Term Care
◦ Current Version 3.0

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 Narrative (clinical and patient narrative)
◦ Free text
◦ Template based
◦ Deriving structures from unstructured text
 NLP
◦ Structured and coded
 Signs and symptoms
 Diagnoses
 Procedures
 Level of service
◦ Treatment plan
 Single discipline
 interdiscipline

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 Patient Acuity/Severity of Illness/ Risk
Adjustment
◦ Nursing workload
◦ Severity adjustment
 Capture of identifiers
◦ People and roles
◦ Products/devices
◦ Places (including directions)

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 Results Reporting
◦ Laboratory
◦ Microbiology
◦ Pathology
◦ Radiology
◦ Consult

 Results notification
 Multiple views of data/presentations
 Multimedia support

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 Computerized provider order entry
◦ Electronic prescribing
◦ Laboratory
◦ Microbiology
◦ Pathology
◦ Radiology
◦ Ancillary
◦ Nursing
◦ Supplies
◦ Consults

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 Access to knowledge sources
◦ Domain knowledge
◦ Patient education
 Drug alert
◦ Drug dose defaults
◦ Drug dose checking
◦ Allergy checking
◦ Drug interaction checking
◦ Drug-lab checking
◦ Drug-condition checking
◦ Drug-diet checking

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 Other rule-based alert (e.g., significant lab
trends, lab test)
 Reminders
◦ Preventive services
 Clinical guidelines and pathways
◦ Passive
◦ Context-sensitive passive
◦ Integrated
 Chronic Disease Management

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 Clinician work list
 Incorporation of patient and/or family

preference
 Diagnostic decision support
 Use of epidemiologic data
 Automated real-time surveillance

◦ Detect adverse vents and near misses

◦ Detect disease outbreaks
◦ Detect bioterrorism

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 Provider to provider
 Team coordination  Integrated medical
 Patient-provider record
◦ Email ◦ Within setting
◦ Secure web messaging ◦ Cross-setting
 Medical Devices  Inpatient-outpatient
 Other cross-setting
 Trading partners ◦ Cross-organizational
(external)
◦ Outside pharmacy
◦ Insurer
◦ Laboratory
◦ Radiology

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 Patient education  Data entered by
◦ Access to patient patient, family,
education materials and/or informal
◦ Custom patient caregiver
education ◦ Home monitoring
◦ Tracking ◦ Questionnaires
 Family and informal
caregiver education

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 Scheduling management
◦ Appointments
◦ Admissions
◦ Surgery/procedure schedule

 Eligibility determination
◦ Insurance eligibility
◦ Clinical trial recruitment
◦ Drug recall
◦ Chronic disease management

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 Patient safety and quality reporting
◦ Clinical dashboard
◦ External accountability reporting
◦ Ad hoc reporting
 Public health reporting
◦ Reportable diseases
◦ Immunizations
 De-identifying data
 Disease registry

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 Ambulatory (NEJM 2008)
◦ 4% fully functional EHR
◦ 13% basic system
◦ Small and solo practices struggle

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 Standardization of Clinical Information
 Cost of implementation and maintenance
 Physicians' readiness to adopt the EHR
 Privacy issues and patients’ concerns with

information sharing.
 Legal liability

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