Healthcare Information Systems - An Overview

Healthcare Information
Systems: An Overview
Nancy B. Clark, M.Ed.
Director of Medical Informatics Education
FSU College of Medicine
FLORIDA STATE UNIVERSITY

The College of Medicine
What is wrong with this picture?

• illegible handwriting,
• ambiguous and
• incomplete data,
• data fragmentation- each lab report is a separate
piece of paper which does not allow a physician to
visualize the progress of a patient’s conditions.
• poor availability- studies have shown that as much
as 40% of the time the paper record can not be
found.

• Insecure in open, unguarded shelving in a clinic
• In addition, paper records often become bulky with
time, which leads to lack of overview.
• When it comes time to share the record with another
clinician, each individual piece of paper has to be
hand copied, then mailed. It can cost a clinic up to
$35 just to do this.
• Employee cost of moving all this paper around –
estimates it costs $5 just to pull one chart.
• Space – most medical office space rents for
$18-22/sq ft/yr 240 sq ft
Outline
• What kinds of HIT systems are there?

• What are we using here at FSU CoM?
• What major trends are emerging?
• What are the benefits to adoption?
• What are the barriers to adoption?
• What is the current state of adoption?
• How can you learn more?
Elements of IT Infrastructure
• Hardware/Software
• Support Issues
• Workflow/Mindset Issues
• Training Issues
• Budgeting Issues

Basic Technology
• High speed • Video conferencing
networks • Bar-code readers
• Wireless Networks • Voice over internet
– PDAs • Speech recognition
– Tablets
• Internet access
• Web server
• Intranets
(SharePoint)
Administrative Applications
• Security (virus protection, firewalls, retinal
scans, thumb prints)
• System wide e-mail with external access via
web
• System wide calendaring
• Single sign-on active user directory
• Website
• Intranet
• Shared file systems
• Personnel systems
HIT Applications
• Patient registration/ • Lab systems
demographics • Imaging systems
• Insurance validation • Telemedicine
• Billing systems • Patient education
• Appointment systems • Decision Support
• Computerized • Library resources
Physician Order Entry • Sensors
(CPOE)
• EMR/EHR/CPR
• Pharmacy systems

Sad Facts
• Medical errors account for more deaths
than breast cancer, AIDs and motorcycle
accidents.
• US has highest HC costs per capita in world
• US has worst outcomes of industrialized
nations. (infant mortality, lifespan, etc.)
• Healthcare is 10-15 yrs behind business in
adoption of IT

FSU College of Medicine
Technology Supporting
Medical Education
What our graduates will expect to have in
their residencies, practices, and hospitals.

Technology Highlights
• Tablet PCs
• PDAs for Medical Reference
• IT Enchanced Environment – printing,
scanner, classroom & small group
presentation system
• The Portals: The College Web Site, the
Electronic Library & Blackboard

The Tablet PC
Issue First Day Lenovo ThinkPad

1.88 GHz Processor TabletPC
3 G MB RAM
130 GB Hard Disk
External DVD-RW
drives
SD card slot
PCM/CIA slot
3 USB ports
4.5 lbs FLORIDA STATE UNIVERSITY
Software Installed
– Windows Vista (7) – Tablet Edition

– Office 2007, including Word, Excel,
PowerPoint, Publisher, Access, Outlook,
Internet Explorer
– Adobe Acrobat Reader, Microsoft Digital
Image Suite, WinZip, Sonic Record Now,
medical spell checker, and EndNote
– Anti-virus, anti-spyware, & other security
software
Interesting Tablet Software
• Microsoft Office
OneNote
• Windows Journal
• Microsoft Educational
Pack for Tablet PC
• Microsoft Experience
Pack for Tablet PC
• Sticky Notes
• Snipping Tool

EMR
• SOAPware
• Use 3rd year

PDAs
• Issues Fall 1st year
• Used to track all patient encounters
• Used as extension of library resources,
to find information quickly in clinical
environments at the point of care.

HP iPAQ
• Windows Mobile 6
• 1 GB SD card
• Color, backlit, 240-360
screen
• Sound recorder, mp3
player
• Wireless - both WiFi &
Bluetooth

FSU Licensed PDA Software
• Epocrates Essentials ($149/yr)
• Essential Evidence Plus ($249/yr)
• DynaMed ($200/yr)
• PEPID ($199/yr)
• Pediatric Care Online ($289/yr)
• Clinical Evidence ($99/yr)
• Harrison’s Practice ($325/yr)
• Geriatrics at Your Fingertips ($30)
• Savings to each faculty and student > $1,500/yr

09/23/23 Intro to Medical Library Resources 19
iPhone Revolution
• Cell phone technology
expanding to PDAs
• Medical reference websites
reformatting
• Software versions availability
expanding
– 6 resources: Epocrates, PEPID,
Dynamed, ePSS, Pediatric Care
Online, Clinical Evidence
• WM cell phones popular
PDA Versions Available

21
Epocrates Essentials
• Epocrates
Essentials
– Most widely used
PDA program by
medical practitioners
– Rx, (Drugs &
Complementary
meds)
– Sx/Dx (Symptom &
Disease Reference)
– Labs & other tools.
IT Enhanced Environment
• Wireless networking
• Classroom Presentation Systems
• Multi-function – copier, printer, scanner
- machines
• A/V equipment in small group rooms
and community learning centers
• Large format printing for posters and
signs is available for school related
projects
Clinical Learning Center

Sim Center

The College Portals
• Our Electronic Library
• SharePoint Intranet
– Internal document sharing
– Policies, procedures, etc.
• Enterprise Exchange e-mail system
with integrated calendars and contacts
• Blackboard Courseware

www.med.fsu.edu

Our Library is always open

24/7 Access to Resources
• >1900 medical eJournals (3.5 M articles)
• Hundreds of clinical eBooks
• Evidence-based medicine resources and
Guidelines
• Disease, drug, images and patient education
resources
• Web-based course materials
• Medical search engines
• 200 periodicals databases
• PDA versions of 7 web resources

Blackboard - Course Websites
• All Course Materials

– Syllabus & Assignments
– PowerPoints & Lecture notes
– Discussion Fboard
LORIDA STATE UNIVERSITY
& Grades Posting
Overview of Current State of
Healthcare IT Adoption

Source of Stats
• 2009 HIMSS Leadership Survey

– 304 IT HealthCare Executives representing 700
hospitals
– http://www.himss.org/2009Survey/healthcareCIO_final.asp
• FSU CoM - Center on Patient Safety
– Robert Brooks, MD, Associate Dean, Health Affairs
– Nir Menachemi Ph.D., MPH, Director, Center on
Patient Safety

Projected IT Priorities

Source: 20th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
Top Business Issues Facing
HealthCare

Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions
Most Significant Barriers to
Barriers to Implementing IT

Status of Electronic Medical
Record Implementation

Florida Hospitals
Brooks R, et al. Patient Safety-Related

FLORIDAInformation
STATE UTechnology
NIVERSITY Utilization in Urban and Rural
Hospitals. Journal of Medical Systems, Vol. 29, No. 2, April 2005
Top Security Concerns of
Computerized Medical Information

Security Tools

Technology Adoption Curve
75%
50%
25%

Technology Adoption
(Next Two Years)

2008 Health IT Staffing Needs

2009 Health IT Staffing Needs

National Initiatives

“Wiring” Healthcare
Current system fragments patient information Future system will consolidate information
and creates redundant, inefficient efforts and provide a foundation for unifying efforts
Payers
Hospital
Hospitals
Public health
Health Information Exchange
Primary care
Laboratory physician
Labs
Pharmacy
Specialty Data Server

Network
physician repository applications
Outpatient RX
Payers
Ambulatory center
(e.g. imaging centers)

Physician office
The College of Medicine Ambulatory centers Public health

Sharing Medical Data
• Increase patient safety
• Lower Healthcare costs
• Allow for coordination of care
• Increase communication between
providers
• Banking analogy

Office of the National
Coordinator for Health IT
Established by Executive Order 13335 (April 27, 2004)
• Responsible for realizing the President’s vision of
Health IT:
– Widespread adoption of interoperable
EHR within 10 years
– Medical information follows consumer
– Clinicians have complete, computerized patient information
– Quality initiatives measure performance and drive
quality-based competition
– Public health and bioterrorism surveillance are seamlessly
integrated into care

Goals
• Develop a nationwide health
information network (NHIN)
• Establish standards for data transfer
and storage:
– Continuity of care records
• Develop Regional Healthcare
Information Organizations (RHIOs)
• See article: Burton, et al. Using electronic health records to
help coordinate care. Milbank Quarterly. V(82);457-81. 2004

Status of Health Information
Exchange (HIE)

Needed for CCR
• Universally agreed-on medical vocabulary
• Principled and standard formats for
laboratory data, medical images, medical
record…
• Standardization of medical literature
formats--structured abstracts
• Health care standards -- treatment guidelines
• Standards for health data exchange

Clinical Data Standards
• Current
– HL7 messages for most lab data
– DICOM messages for images
– LOINC for laboratory results content
– CPT-4 for procedures content
– ICD-9 for diagnoses content (10 coming)
– NDC ▬► RxNorm for medication content
• Anticipated medical vocabulary Patient: John Doe
MRN: 123-0
– SNOMED/UMLS Concept Unique Identifiers for Diagnosis: 410.0

WBC: 14,000/cm3
microbiology content
Where can you learn more?

Web Sites/Organizations
• American Medical Informatics Association (AMIA)
• Healthcare Information and Management Systems Society
(HIMSS)
• Healthcare IT News
• Healthcare Informatics
• Health Informatics at Wikipedia
• Medical Group Management Association (MGMA)
• The Informatics Review
• To Err Is Human: Building a Safer Health System (IOM)
• Crossing the Quality Chasm (IOM)
• Health Professions Education (IOM)
• Patient Safety: Achieving a New Standard for Care (IOM)
Web 2.0
• http://www.hitsphere.com/

Journals
• JAMIA – J. of the American Medical Informatics
Assoc.
• Telemedicine and e-Health
• IEEE Trans. on Information Technology in
Biomedicine
• Health Informatics
• Studies in Health Technology and Informatics
• Biosensors and Bioelectronics
• Healthcare Informatics Online (Magazine)
• IEEE Technology and Society
• British Computer Society
More Journals
• Artificial Intelligence in Medicine (Elsevier)
• Computers in Biology and Medicine (Pergamon
Press)
• Computers in Biomedical Research (Academic
Press)
• Computer Methods and Programs in Biomedicine
(Elsevier)
• IEEE Engineering in Medicine and Biology Magazine
• Journal of Medical Systems (Plenum Press)
• MD Computing (Springer-Verlag)
• Medical Informatics & The Internet in Medicine
(Taylor & Francis)
• Methods of Information in Medicine (Schattauer)
• Yearbook of MedicalFLORIDAInformatics (Schattauer)
STATE UNIVERSITY
Conferences
• HIMSS: regional and national conferences.
3/10/10 Atlanta
• AMIA: Annual Symposium (and Spring
Congress)
• HEALTHCOM: Health Communication
Conference
• MEDINFO: (every 3 years, next in 2007), run by
the IMIA (International Medical Informatics
Association)
• MGMA: 2007 MGMA Health Care Information
Technology Forums
Training
• AMIA/Oregon Health Sciences 10 x 10
program
http://www.amia.org/10x10/partners/ohsu/

Health IT Conclusions
• Financial Support for Health IT on-going concern
• Patient Centric Focus
– Customer Satisfaction
– Patient Safety
• High-speed networks, Intranet and wireless
information systems currently in use, to be
expanded across regions
• Electronic Medical Records (EMR) and
Computerized Physician Order Entry (CPOE) most
important applications
• Interoperability is a must for Health IT

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FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

• What kinds of HIT systems are there?

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

Issue First Day Lenovo ThinkPad

– Windows Vista (7) – Tablet Edition

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

• Savings to each faculty and student > $1,500/yr

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

• All Course Materials

FLORIDA STATE UNIVERSITY

• 2009 HIMSS Leadership Survey

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

Brooks R, et al. Patient Safety-Related

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

Specialty Data Server

FLORIDA STATE UNIVERSITY

The College of Medicine Ambulatory centers Public health

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

– SNOMED/UMLS Concept Unique Identifiers for Diagnosis: 410.0

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

FLORIDA STATE UNIVERSITY

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