Clinical Informatics Flashcards
(41 cards)
What is Clinical Informatics?
HIMSS defines Clinical Informatics as:
* “activities that promote the understanding, integration and application of
information technology in healthcare settings.”
AMIA differentiates clinical informatics by explicitly noting that it is the use of
information by clinicians
ANIA defines as:
* “explicitly addressing improvements for the health of populations, communities,
families and individuals by optimizing information management and
communication.”
Clinical Informatics Role
Need to understand the basic underpinnings of computers and how they work to manage healthcare information
Computer Technology Basics
Fundamental building blocks
* Bits
* Bytes
* Hardware
* Software
* Connectivity considerations
* Clinical informatics professionals need to understand these and often fill a
role to manage these components for the clinical teams alongside IT
colleagues
Hardware Specifications
Processing speeds
* Memory requirements
* Interface requirements
* Operating systems
Software Considerations
System software
* Used to start and run the computer
* Related to what the software does within the computer system to support the use of the
computer
* e.g. device-driver software operates and manages all devices attached to the computer
* Application software
* Generally has a function or purpose specific to its use
* e.g. accounting/financial applications
* Programming tools
* Used to compile programs and link, or translate, computer program source code and
libraries that belong to either the system software of the application
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Connectivity Considerations and Terminology
- Short messaging services (SMS)
- Virtual private network (VPN)
- Local area network (LAN)
- Mobile technologies
- Cloud computing
Workflow Redesign
- Used as a quality improvement technique
- Identify how the work is currently being done, the current or “as is” state
- Often uses visual representations which allow role and responsibility mapping as
well as determining when actions and decisions are made within the workflow - Can be useful in identifying the “root cause” of an adverse event and then
mitigate the error from happening again, often through a redesign producing a
“future” workflow
Data Visualization
- Clinical Informaticists should understand best practices in developing and
presenting data - Common methods include through graphs, charts and tables (examples of
these on following slides) - Graphical display of data can covey complex ideas with clarity, precision
and efficiency
Data Visualization Best Practices - Clear display of the data
- Induce the viewer to think about substance rather than methods
- Avoid distortion
- Present numbers in small space
- Make a large data set coherent
- Encourage the eye to compare different pieces of data
- Review the data at multiple levels
- Serve a clear purpose to describe, explore, tabulate or enhance a report
- Be closely integrated with verbal or descriptive information in a report
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Clinical Decision Support
Office of the National Coordinator for Health Information Technology (ONC)
defines clinical decision support (CDS) as:
* “a component that “provides clinicians, staff, patients, or other individuals with
knowledge and person-specific information, intelligently filtered or presented at
appropriate times, to enhance health and healthcare.”
* CDS tools may include;
* Computerized alerts and reminders to care providers and patients
* Clinical guidelines
* Condition-specific order sets
* Focused patient data reports and summaries
* Documentation templates;
* Diagnostic support
* Contextually relevant reference information
Who are Clinical Informaticists?
Translators in the interprofessional team, as a professional that speaks both
informatics and healthcare
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Basic Technology Vocabulary and Terms
AM Morning
BP Blood pressure
AC Before meals
BS Blood sugar
AD Right ear
CC Chief complaint
Ad lib Freely
Cap Capsule
Amp Ampule
CM Centimeter
Ante Before
CXR Chest x-ray
AS Left ear
DC Discontinue
ASA Aspirin
Disp Dispense
AU Both ears
ER/EC/ED Emergency Room
BID Twice a day
G Gram
BMI Body mass index
Gr Grain
National Standards for Health Information
Technology
- Standards support certification of electronic health records and the ability to
capture and report data with consistency - Have evolved over time and continue to evolve
- Critical to capturing and transmitting data effectively across institutions,
states, nationally and internationally - Developed and maintained by a number of global organizations
Technology Standards for Healthcare
Messaging Standards Used for
HL7® Clinical data
FHIR® Clinical and administrative data
X12N Financial data, HIPAA-mandated transactions, transport of data
DICOM Images
NCPDP Standards for pharmacy business functions, HIPAA-mandated transactions
IEEE Bedside instruments, medical information bus
Terminology Standards Used for
Lab LOINC
Drugs NLM/FDA/VA collaboration on RxNorm, NDF-RT
Billing CPT, ICD-10-CM
Clinical UMLS, SNOMED, and others
Computers in Healthcare
- Not a new phenomenon
- Largely impacted in the U.S. by the American Recovery and Reinvestment
Act (ARRA) passed in 2009 - Health Information for Economic and Clinical Health Act (HITECH)
- Created to motivate the implementation of electronic health records (EHRs) and supporting
technology - Created an economic stimulus effect
- New jobs/roles created to support the expansion of EHRs and the support of the clinicians who use the
systems
Computer Technology Basics – Internal Components
Motherboard The backbone of the computer Connects all of the parts of the computer together
Central processing unit (CPU) Often thought of as “the brains” of the computer Responsible for interpreting and executing most of the commands from the computer’s hardware and software
Random-access memory (RAM) The working memory of the computer Allows a computer to work with more information at the same time in active memory processing
Power supply A converter that supplies the power to the machine Used to convert the power provided from the outlet into usable power for the many parts inside the computer case
Video card Graphics adapter or expansion card Allows the computer to send graphical information to a video display device such as a monitor, TV, or projector
Hard disc drive (HDD) Data storage device and an electromechanical magnetic disk drive The HDD is the main, and usually largest, data storage hardware device in a computer where the operating system, software, and most files are stored
Solid-state drive (SSD) Data storage device; no moving (mechanical) components Storage device that is typically more resistant to physical shock, runs silently, and has lower access time and less latency, but more expensive than HDD
Optical drive (e.g., Bluray/DVD/CD drive) Optical storage devices Optical drives retrieve and/or store data on optical discs like CDs, DVDs, and Blu-ray discs (BDs)
Optimizing Clinical Effectiveness of Health
Information Technology
- Increased ability to capture data through the use of clinical systems, but can
also lead to - Increased
- Burden of documentation
- Interoperability challenges
- Health IT safety consideration
- Clinician stress
- Clinical Informaticists may use quality improvement techniques as a tool to
optimize technology
Workflow Redesign
- Used as a quality improvement technique
- Identify how the work is currently being done, the current or “as is” state
- Often uses visual representations which allow role and responsibility mapping as
well as determining when actions and decisions are made within the workflow - Can be useful in identifying the “root cause” of an adverse event and then
mitigate the error from happening again, often through a redesign producing a
“future” workflow
Common Clinical Metrics Used in Healthcare
- Defined across three categories
- Process
- Reflective of a clinical guideline and key interventions that impact a clinical outcome
- e.g. door to balloon time for a myocardial infarction (heart attack)
- Outcome
- Outcome measures are often “risk-adjusted” and take into account things like comorbidities
and other factors that may have influenced the metric - e.g. mortality rates, 30-day readmission rate, surgical site infection rate
- Balancing
- Address potential unintended consequences of quality improvement interventions used to
improve process or outcomes - e.g. decreased patient satisfaction due to the reluctance of a provider to prescribe pain medications
for a patient, because of the opioid crisis
Five Rights of CDS
- Combine all the tools and types to strategically use CDS within an
organization following a “five rights” framework - Who, what, when, where and how
- Emphasize the clear goals and objectives of all five components
Regulatory and Compliance Terms
Health Insurance Portability and Accountability Act (HIPAA): A U.S. law designed to provide privacy standards to protect patients’ medical records and other health information provided to health plans, doctors, hospitals, and other healthcare providers2.
Affordable Care Act (ACA): A comprehensive healthcare reform law enacted in March 2010, aimed at expanding health insurance coverage, controlling healthcare costs, and improving healthcare delivery systems2.
Accountable Care Organization (ACO): A group of healthcare providers who come together voluntarily to give coordinated high-quality care to their Medicare patients
Standards and Interoperability
Health Level Seven (HL7): A set of international standards for the exchange, integration, sharing, and retrieval of electronic health information2.
Systematized Nomenclature of Medicine-Clinical Terms (SNOMED CT): A systematically organized computer processable collection of medical terms providing codes, terms, synonyms, and definitions used in clinical documentation and reporting2.
International Classification of Diseases (ICD): A globally used diagnostic tool for epidemiology, health management, and clinical purposes
Health Information Exchange (HIE)
The electronic movement of health-related information among organizations according to nationally recognized standards
Data and Analytics
Big Data: Large and complex data sets that traditional data-processing software cannot manage. In healthcare, big data can be used to improve patient outcomes, predict epidemics, gain valuable insights, and reduce healthcare costs1.
Predictive Analytics: The use of data, statistical algorithms, and machine learning techniques to identify the likelihood of future outcomes based on historical data1.
Data Warehouse: A central repository of integrated data from one or more disparate sources, used for reporting and data analysis
Needs Analysis and Requirements Gathering
Identify Clinical Needs: Understand the specific clinical needs and workflows that the system must support. This includes gathering input from clinicians, nurses, and other healthcare professionals.
Define Requirements: Clearly define the functional and non-functional requirements of the system. This includes clinical decision support, patient management, data integration, and reporting capabilities.
