1A History and current state of informatics Flashcards
(76 cards)
1
Q
EHR developed by VA that is known in field as an examplar is
A
VistA
2
Q
CMIO best described by what category
A
Professional
3
Q
Biomedical informatics area most concerned with processing of data from the human genome
A
Bioinformatics
4
Q
Area of biomedical informatics who works mostly with data captured by state and local health authorities
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Public health informatics
5
Q
According to Friedman, what is not informatics
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Processing large data sets and other general uses of computers
6
Q
Biomedical informatics (BMI)
A
“the interdisciplinary field that studies and pursues
the effective uses of biomedical data, information, and knowledge for scientific
inquiry, problem solving, decision making, motivated by efforts to improve human
health.”
* “BMI investigates and supports reasoning, modeling, simulation, experimentation, and
translation across the spectrum from molecules to individuals and to populations,
from biological to social systems, bridging basic and clinical research and practice
and the healthcare enterprise.
7
Q
More definitions of biomedical informatics
A
“The science of information applied to biomedicine … data plus meaning.”
(Bernstam, 2010)
European and global perspectives (Haux, 2010; Hasman, 2011; Geissbuhler,
2011)
Early definition: “storage, acquisition, and use of information” (Greenes, 1990)
“Fundamental theorem” (Friedman, 2009
8
Q
Informatics is
A
Cross-training where basic
informational science meets a
biomedical application domain
* Relentless pursuit of assisting
people
* Tower of achievement
* Model formulation
* System development
* System implementation
* Study of effects
9
Q
Informatics isn’t
A
Scientists or clinicians tinkering
with computers
* Analysis of large data sets per se
* Circumscribed roles related to
deployment of electronic health
records (*point of disagreement)
* Profession of health information
management
* Anything done using a computer
10
Q
History of informatics
A
Origin of term attributed to Dreyfus in 1962 (Fourman, 2002)
Achieved widespread use in France (informatique), Russia, and later rest of
Europe in 1960s to denote computing issues related to information use
“Medical informatics” first used in 1974 (Collen, 1994)
* More European history from Moehr (2004)
* History of field documented by Collen (2015)
At present, most significant use is in biomedical arena, but it is used by other
domains, such as law, chemistry, social sciences, etc
11
Q
Early EHRS
A
- COSTAR – Massachusetts General Hospital (Barnett, 1979)
- HELP – Utah (Kuperman, 1991)
- TMR – Duke (Stead, 1988)
- Regenstrief – Indiana (McDonald, 1999)
- El Camino – California (Carter, 1987)
- VistA – Veteran’s Administration (Brown, 2003)
12
Q
Early systems in informatics
A
- MYCIN (Shortliffe, 1975; Clancy, 1984)
- Internist-1/QMR (Miller, 1982)
- ELHILL (Lindberg, 1986)
- Problem-knowledge coupler (Weed, 1969
13
Q
Traditional groupings of information professionals in
health care
A
Information technology (IT) – usually with computer science or
information systems background
* Health information management (HIM) – historical focus on medical
records
* Clinical informatics (CI) – often from healthcare backgrounds, performing
analysis, training, etc.
* Others – librarians, managers, etc.
14
Q
Careers in informatics: academic, professional, liaison
A
Category Jobs
Academic Informatics researcher or teacher
Professional Chief Information Officer, Chief Medical/Nursing
Informatics Officer, Developer, Trainer
Liaison Represent clinical or research community in IT initiatives,
e.g., clinical champion
15
Q
Who are the leaders in IT and informatics?
A
- Chief Information Officer (CIO)
- Chief Clinical Informatics Officer (CCIO) (Kannry, 2016), including
- Chief Medical/Health Informatics Officer (CMIO)
- Chief Nursing Informatics Officer (CHIO)
- Other Chief X Officer (CXO) – security, quality, data, etc.
- Many other titles, no standards
16
Q
Hospitals and healthcare organizations increasingly creating operational
“clinical informatics” departments
A
Often separate from IT (and CIO)
* Usually with clinical leadership, often CMIO
* Increasingly incorporate HIM
17
Q
Current and Future Challenges – Start of a List
A
Healthcare spending continues to rise; most see need to stabilize or reduce
* Implementation is difficult
* Return on investment is difficult to measure (and conceptualize)
* How much is too much? Is it all hype?
* Complexity creates risk; simplicity seems unsatisfying
18
Q
Bayes’ Theorem
A
19
Q
Moore’s Law
A
20
Q
Metcalfe’s Law – but not really: n(n-1)/2
A
21
Q
Greek Oracle problem (Miller, 1990
A
22
Q
“Curly braces” problem (Samwald, 2012
A
23
Q
Homer Warner’s summarization of informatics:
A
“10% medicine, 10%
technology, 80% sociology” and its implications for the field
24
Q
recall/sensitivity
A
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precision,
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specificity
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Biomedical and health informatics (BMHI)
e field concerned with the
optimal use of information, often aided by technology, to improve individual
health, healthcare, public health, and biomedical research
* Informatics applied in a more focused domain is {X} informatics, e.g., nursing, dental, pathology,
primary care, etc.
* Can be classified by “level” of domain but also has some overarching areas, e.g., imaging and
research
Practitioners of BMHI are usually called informaticians (sometimes
informaticists)
2
28
Chief Medical Informatics Officer (CMIO)
Position now an important part of healthcare organizations, serving as
(Kilbridge, 2012)
* Liaison between clinicians and IT
* Executive informatician
* Director of clinical IT systems – leading the path forward
Analysis of five CMIOs (Leviss, 2006)
* Leadership, communication, and consensus-building among most important skills
* Desired to be part of senior physician executive team
* Did not want to be seen as just “techie” doctors
29
Gartner-AMDIS CMIO Annual Surveys
(Shaffer, 2015-2018)
Respondents mostly from integrated delivery systems, followed by hospitals
and group practices
Priorities now include EHR optimization, data analytics, and population health
Key challenges are competing priorities, organizational culture, clinician
disconnect as systems expand, and shortages of resources and talent
87% have additional master’s degree, PhD, and/or training such as AMIA
10x10
Many pursued/pursuing clinical informatics subspecialty
* 48% have received
* 20% pursuing
68% still practice medicine – slowly declining over years
Reporting relationships
* 33% to Chief Medical Officer (CMO)
* 32% to CIO
* 17% to Chief Executive Officer (CEO) or Chief Operating Officer (COO)
* 9% dual to CMO and CIO
* Most would prefer to report to CMO or dual CMO/CIO
64% have people reporting to them, with most of rest having small staffs
* Responsibility without authority?
Average salary $353K
30
AMIA mission
AMIA advances the informatics professions relating to health and disease. To this end it
advances the use of health information and communications technology in clinical care and
clinical research, personal health management, public health/population, and translational
science with the ultimate objective of improving health.
31
Some unique challenges in “evidence-based informatics”
(Friedman, 2006)
Appropriate outcomes measures may be indirect from system intervention
* Unit of analysis – may be beyond person and include clinic, hospital unit,
etc.
32
Universal Declaration of Human Rights
Article 12
No one shall be subjected to
arbitrary interference with his
privacy, family, home or
correspondence, nor to attacks
upon his honour and reputation.
Everyone has the right to the
protection of the law against such
interference or attacks.
33
Hippocratic Oath
Whatever I see or hear in the
lives of my patients, whether in
connection with my professional
practice or not, which ought not
to be spoken of outside, I will
keep secret, as considering all
such things to be private.
34
Code of Fair Information Practice
1.There must be no personal data record-keeping systems whose very existence is secret.
2.There must be a way for a person to find out what information about the person is in a record
and how it is used.
3.There must be a way for a person to prevent information about the person that was obtained
for one purpose from being used or made available for other purposes without the person's
consent.
4.There must be a way for a person to correct or amend a record of identifiable information
about the person.
5.Any organization creating, maintaining, using, or disseminating records of identifiable
personal data must assure the reliability of the data for their intended use and must take
precautions to prevent misuses of the data.
9
U.S
35
Belmont Report and Common Rule
The Belmont Report on Ethical Principles and Guidelines for the Protection of Human
Subjects of Research. April 18, 1979
1. Respect for Persons.
2. Beneficence. (1) do not harm and (2) maximize possible benefits and minimize
possible harms.
3. Justice.
Federal Policy for the Protection of Human Subjects or the “Common Rule”, published
in 1991, codified in separate regulations by 15 Federal departments and agencies
For all participating departments and agencies the Common Rule outlines the basic
provisions for IRBs, informed consent, and Assurances of Compliance
36
AMIA Conflict of Interest Policy
A real or apparent conflict of interest may arise when a leader has some
other interest that might suggest divided loyalty on the part of the leader
between obligations to AMIA, on one hand, and to some other organization
or cause, on the other. The “other interest” may arise from a transaction
between AMIA and a third party, or a leader’s volunteer or paid relationship
with a third party, which may compromise their ability to provide unbiased
and undivided loyalty to AMIA. There is no monetary threshold for a
COI. The AMIA COI policies extend to relationship that a spouse, domestic
partner, parent or child of an affected individual.
37
United States Bill of Rights 4th amendment
Fourth Amendment – Protection from
unreasonable search and seizure.
The right of the people to be secure in
their persons, houses, papers, and
effects, against unreasonable
searches and seizures, shall not be
violated, and no warrants shall issue,
but upon probable cause, supported
by Oath or affirmation, and particularly
describing the place to be searched,
and the persons or things to be
seized.
38
HITECH act
39
Privacy Protections within EHRs
* It is very difficult to predict which clinician will need
* It is very difficult to predict which clinician will need to
view which record.
* Most US hospitals use policy and audits to protect
against access to records for which physicians have
no professional relationship.
* Sanctions occur for inappropriate access
40
Clinical Computing Systems and the Law
* The importance of authentication and authorization
* Concept of non-repudiation
* Patient billing is based on codes, and codes have to
be based on Medical Record documentation.
* Audit trails, document version history
* Close cooperation with compliance and general
counsel
41
30(b)6 witness
* This particular rule is designed to allow a party to
serve a notice of deposition or subpoena upon
another party without designating a particular
person to testify but to “describe with reasonable
particularity the matters for examination.”
* CMIOs may serve as 30(b)6 witnesses as experts in
electronic health records and other topics as called
by plaintiff or defense teams in litigation
42
True or False
The HITECH Act refers to sections of the Affordable Care Act that provide
financial incentives for meaningful use of certified electronic health records
FALSE. The HITECH Act is part of ARRA, not ACA
43
The HIPAA Security Rule
A. Requires awareness and compliance of security professionals but does not
extend to the general workforce.
B. Requires protection against published and known security threats only
C. Defines confidentiality, integrity and availability
D. Does not cover availability of electronic PHI
E. Pertains to transmission and storage but not impermissible use of e-PH
C. Defines confidentiality, integrity and availability
44
TJC (JCAHO) IM Standards
Patient-Specific information
6.1 The hospital has a complete and accurate medical record for
every individual assessed, cared for, treated or served.
* 6.2 Records contain patient-specific information, as appropriate, to
the care, treatment, and services provided.
* 6.3 The medical record thoroughly documents operative or other
high risk procedures and the use of moderate or deep sedation or
anesthesia.
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TJC IM Standards
Information Management Planning
1.1 The hospital plans and designs information management
processes to meet internal and external information needs.
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TJC IM Standards
6.4 For patients receiving continuing ambulatory care services,
the medical record contains a summary list of all significant
diagnoses, procedures, drug allergies, and medications.
6.5 Designated qualified personnel accept and transcribe
verbal orders from authorized individuals.
6.6 The hospital can provide access to all relevant information
from a patient’s record when needed for use in patient care,
treatment and services
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Medical Records Committee
* Oversight to meet goals of information management.
* Oversight for implementation of regulations
* Oversight for meeting accreditation standards.
* Policy and Procedure approval
* Understanding of record and systems functionality and impact on
information flow.
* Advisory and direction in areas of
* System functionality and workflow
* Appropriate Entries into the record
* Chart Completion
* Forms management
* Audits and Quality review with action steps.
48
Health Information Management
Hospital leaders have overall responsibility for managing information.
* Hospital Bylaws, Rules & Regulations establishes the Medical
Records Committee, and professional staff record responsibilities.
* Hospital Policy & Procedures guide hospital operations.
* Regulatory Bodies – State & Federal
* State: Division of Health,
* Federal: CMS; Medicare, HIPAA
* Accreditation – Joint Commission
(on Accreditation for Healthcare Operations) (TJC)
49
Key Operations
Coding and the analysis of coded data are key
operations
* Clinical Classification Systems
* There are many other recognized
classification systems
* ICD-10 and CPT (HIPAA standard)
* Billing and Payment for healthcare
services
* Research
* Turns data into useful information for
process improvement, quality and patient
safety
50
HIM Key Operations
Release of Information (ROI
Disclosures to outside organizations must meet all HIPAA, state
and federal disclosure regulations.
* Dept. handles all incoming requests for records.
* Determine and prepare records to be disclosed according to
regulations
51
HIM Key Operations Master Patient Index and Encounters
* Every patient has one medical record number.
* Every patient visit has an encounter
52
HIM Credentials and Certifications
Coding Certifications
Privacy Certifications
Health Information Credentials
* RHIA (Registered Health Information Administrator)
* RHIT (Registered Health Information Technician)
53
Clinical Decision Support and the Law
Protecting Access to Medicare Act (2014)
requires that ordering
clinicians consult appropriate use criteria (AUC) through a qualified
clinical decision support mechanism when requesting advanced
imaging services (ie, SPECT/PET MPI, CT, and MR) on outpatients
and nonemergent emergency room for the furnishing provider to
receive payment approval from CMS.
FDA and ONC regulation—see References
54
Capital budgeting
Planning process for expenditure of relatively large sums on
long-term assets such as replacing worn out assets with new ones and
developing new business opportunities. [Tiffen 2007]
55
Operating budgeting
A detailed projection of all estimated income and
expenses based on forecasted revenue during a given period (usually one
year). a complete operating budget consists of not only a projected profit and
loss statement but also a supporting cash flow statement, as well as a balance
sheet. [Rollins]
56
Depreciation
To lower the price or estimated value of [Webster], particularly
of a long-term asset that has diminishing value over time.
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Net present value
The difference between the present value of all cash inflows
and the present value of all cash outflows; used to determine whether or not a
project is an acceptable investment. [Garrison, 1994].
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Principles of Managerial Accounting
* Managerial accounting is concerned with providing information to managers,
in contrast to financial accounting, which is concerned with providing
information to stockholders and others outside an organization.
* Includes accounting information (budgets, performance reports for
controlling), tools for organizing and directing and decision making.
* There are many differences between financial and managerial accounting.
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Managerial Accounting, in Contrast to Financial
Accounting:
Focuses on providing data for managers
* Places more emphasis on the future
* Places more emphasis on non-monetary data
* Emphasizes segments of an organization rather than just the organization as
a whole.
* Is not governed by generally accepted accounting principles
60
Budget Types
Statistics
Calculates the budget needed for various "what-if" scenarios.
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Revenue Budget Type
revenue receipts of government and the expenditure met from these
revenues
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Cash budget types
A prediction of future cash receipts and expenditures for a particular
time period
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Expense budget type
. Includes spending data items.
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Time Value Analysis
Future value of
lump sum
Present value
of lump sum
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Net present value
is the value of the sum of
future cash flows presented in today’s dollars.
Net Present Value formula
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time value of money
accounted for by the concept of compounding
interest. Because a sum invested today will accrue interest in the future, a
fixed sum paid in the future is worth less than the same amount today
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Balance Sheet
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Income Statement
Operating earnings = Gross Profit – (Operating Expenses + Depreciation)
69
True or false:
Cash flow is basically the same thing as profit.
ANSWER:
False. A sale may contribute to profit for the year, but may not result in
cash until the next year
70
The Costs of HICT
Implementation
* Support
* Training program
* Build processes
* Administration
RDTE (research,
development, training,
evaluation)
48
* Maintenance
* Support/maintenance
contracts
* Application support
* User support
* Technical support
* Upgrades—hardware and
software
* Complying with legal and
regulatory requirements
71
Basic Revenue Cycle
Revenue cycle is the
administrative and clinical
processes of capture,
management and collection of
medical service revenue.
Starts with appointment/admission
and ends when fully paid for
services provided.
Appointment/pre-registration
* Charge capture: Information about an episode of care is translated into a medical
claims system for billing purposes.
* Coding: Codes are applied to a patient’s record by coding specialists.
* Claims submission: Providers send a claim requesting payment from insurers.
* Insurer communications: Communication with insurers to determine patient
coverage levels, collect reimbursements and negotiate contracts with insurers.
* Payment collections: After insurance reimbursements are received, healthcare
facilities bill patients for any remaining balance.
* Medical service review: Analysis of clinical treatment data to find ways to lower
expenses, maximize resources and improve health outcomes.
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The largest category of hospital expenses for
most organizations is:
A. Pharmaceuticals
B. Depreciation
C. Salaries and benefits
D. Provision for uncollectable accounts
ANSWER: C. Salaries and benefits are almost always the largest
component of expenses.
73
ROI from Clinical Systems
“The adoption of interoperable EMR
systems could produce efficiency and
safety savings of $142–$371 billion.”
[Hillestad, 2005
“Studies on return on investment in health
IT are few, and are unlikely to be rigorously
and convincingly performed.” [Payne, 2013
74
Business Case Analysis
a structured methodology and document that aids decision
making for obtaining best value for achieving operational requirements while balancing
cost, schedule, performance, and risk by identifying and comparing alternatives including
the mission and business impacts (both financial and non-financial), risks, and
sensitivities
75
Pro forma
Latin for “as a matter of form” or “for the sake of form”, is a method of
calculating financial results using certain projections or presumptions. Pro forma
financials may not be GAAP (generally accepted accounting principles) compliant but can
be issued to the public to highlight certain items for potential investors
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