Health Information Management

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Health Information Management by Mind Map: Health Information Management

1. Objectives in Quality Management and Education

1.1. Supports critical reflection and Systematic Monitoring

2. CCHIT Functional requirement criteria. CCHIT is a non profit organization that offer certification for inpatient EHR, ambulatory EHR and other application components

3. Clinical students

4. Information Management

4.1. General Tasks

4.1.1. Planning the information System and its archtecture

4.1.2. Directing its establishment and operation

4.1.3. Monitoring its development and operation with respect planned objectives

4.2. Definition

4.2.1. Comprises those management activities that deal with the management of information processing in an Institution, example Hospital

5. Hospital Information System

5.1. Socio-technical Subsystem

5.1.1. All information processing

5.1.2. Associated Human or technical Actors in their respective information processing roles

5.1.3. Aim: Enable the adequate execution of Hospital Functions for patient care

5.2. Components

5.2.1. Hospital Functions Non-computer-based computer-based information processing Tool

5.2.2. Business Process Sequence of sub functions together with the conditions under which they are performed

5.2.3. Information Processing Tools: Application components that support Hospital Functions Patient Administration System Medical Documentation System Nursing Management and Documentation System Outpatient Management System Provider or Physician Order Entry System - POE Patient Data Management System - PDMS Operation Management System Radiology Information System - RIS Picture Archiving and Communication System - PACS Laboratory Information System - LIS Enterprise Resource Planning System - ERP Data Warehouse System Document Archiving System Clinical Information System and Electronic Patient Record System

5.3. Architectures

5.3.1. Describes its fundamental Organization represented by its components, their relationships to each others and to the environment

5.3.2. Styles at the logical tool layer of the computer based part are characterized by Number of databases being used to store patient related data DB1 Style DBn style Number of the application components used to support the hospital functions Monolithic "AC1" Only one computer-based application component Modular "Can": Several application components Number of software products and vendors All-in-one: Software from only one vendor "V1"- Homogeneus Best of breed: Software from several vendors "Vn" Communication Patterns Spaghetti style "CPn": Directly connect those application components that need to exchange certain related-patient data when connecting several application components Star architecture: "CP1" Interfaces are needed only between application components and communication server

5.4. Types of Integration: If application components at the logical layer are linked together through interfaces in order to cooperate, there may have different types of integration

5.4.1. Data Integration

5.4.2. Semantic Integration

5.4.3. Access Integration

5.4.4. Presentation Integration

5.4.5. Functional Integration

5.4.6. Process Integration

5.5. Communication Standards

5.5.1. Health Level 7 - HL7: Describes events and dedicated message types that are exchange between application components

5.5.2. DICOM - Digital Imaging and Communication in Medicine: Comprises file and message formats for all types of Medical Imaging Modalities

5.5.3. ISO/IEEE 11073: Defines a communication protocol for the exchange of bio-signals and vital parameters between several point of care devices

5.5.4. Standard for contextual Integration

5.5.5. Integrating the Healthcare Enterprise IHE: This Organization selects the most appropriate set of standards for a typical workflow Facilitate interoperability Definition Aspects involved Terms IHE Domain IHE Technical Framework IHE Integration Profile IHE Actor IHE Transaction

5.5.6. Electronic Data Interchange for administration, commerce and Transport - EDIFACT: Is a message format for electronic data interchange in electronic commerce

5.5.7. Clinical Document Architecture - CDA Components Header Body Definition Is a document markup standard that specifies the structure and semantics of "clinical documents" for its exchange Goals Give priority to delivery of patient care Support exchange of human-readable documents between users Promote longevity of all information encoded according to this architecture Enable a wide range of post-exchange processing applications Be compatible with a wide range of document applications Prepare the design quickly Levels Definition Narrative, sections and entry codes The Narrative block contains the human readable content to be represented

6. Modeling Health Information System

6.1. 3LGM - Three layer graph-based Metamodel : Developed for describing, evaluating and planning Health Information System over three layers

6.1.1. Domain layer: Enterprise Functions and Entity types (implementation- independent)

6.1.2. Logical tool layer: Application components (support enterprise functions)

6.1.3. Physical tool layer: Physical data processing systems (support application components)

7. Tasks of Information Management in Hospitals

7.1. Planning the Hospital information system and its architectures

7.2. Directing its establishment and its operation

7.3. Monitoring its development and operation in relation with the planned objectives

7.4. Deals with activities in 3 levels

7.4.1. Strategic Information Management Deals with the Hospital's Information processing as a whole Depends on the hospital´s business strategy and strategic goals and has to translate these in an adequate information stragtegy The planning activities result in a strategic Information Management Plan

7.4.2. Tactical information Management Deals with particular enterprise functions Planning at this level means planning projects and all the resources needed for them Directing at this level means the execution of information management projects

7.4.3. Operational Information Management Responsible for operating the components of the Hospital Information system

8. KPI

8.1. COBIT Developed by IT Governance Institute; Defines 34 KPI in 4 domains

8.1.1. Plan and Organize % of strategic IT objectives that are aligned to the strategic hospital plan % of redundant data elements in the IT Architecture Number of Business process that are not yet supported by IT % of stakeholders that are satisfied with IT quality % of IT projects that are on time and within budget

8.1.2. Acquire and Implement % of users satisfied with the functionality of new IT system Number of IT problems that lead to non operation periods % of IT systems that do not conform to the defined technical standards % of IT systems where adequate user training is provided

8.1.3. Deliver and Support % od stakeholders that are satisfied with IT support Number of user complaints with regard an IT Support % of satisfactory response times of an IT system Number of lost hours due to unplanned IT downtimes

8.1.4. Monitor and Evaluate Frequency of Reporting from IT Management to enterprise management Satisfaction of management with IT performance reporting Number of independent IT reviews

8.2. HIS Benchmarking Report: uses HIS benchmarking criteria that have been agreed to a regional group of hospitals´ CIOs

8.2.1. KPI for HIS Organization

8.2.2. KPI for HIS costs

8.2.3. KPI for HIS mamanagement

8.2.4. KPI for HIS functionality % of all documents available electronically % of all diagnosis coded electronically

8.2.5. KPI for HIS architecture Number of computer based application components % of standard interfaces between applications Functional redundancy rate

9. EHR - Electronic Health Record

9.1. Trans-institutional digital repository of information regarding the health status of a subject of care

9.2. PHIR - Personal Helath Record

9.2.1. If the EHR allows the patient to actively manage his data

9.2.2. Types Off line personal Health records, generally paper-based and comprise copies of clinical documents web-based personal health records Provider-based personal health records where hospitals and other providers make some of patient health information available for the patient

9.3. According to the Institute of Medicine it has 5 core functions

9.3.1. Health Information

9.3.2. Data storage

9.3.3. Order Entry

9.3.4. Results Management

9.3.5. Decision suport

10. ehealth

10.1. Definition

10.1.1. Is an emerging field of Medical Informatics referring to the organization and delivery of health services and information using internet and related technologies to improve health care locally, regional and globally

10.2. Evaluation

10.2.1. Act to assess whether an ehealth system is working and producing the effects as expected

10.2.2. In this context ehealth system refers not only the technical TIC artifact but also the socio-organizational and environmental factors and process that influences its behaviors

10.2.3. Scope Planning Example: If the intended system is aligned with the organization strategy Design Example: If the specifications of the system have been met in terms of its features and behaviors Implementation Example if the implementation is under scope and budget Use Example: evaluate the extent to which the system is used and its impact on health outcome Maintenance Example: Evaluate how well the system has been supported and adapted to changing needs

10.3. stakeholders

10.3.1. Service Providers Organizations Hospitals Medical Providers Community Healthcare centers Medical Centers in Universities Prison care centers Individuals Clinicians Nurses Physiotherapists Volunteers

10.3.2. Consumers Organizations Private companies Day care baby centers Airport Armed forces Government Individuals Patients Patients families Researchers Citizens Employees

10.3.3. Supporters Organizations Technology Vendors Health Insurance companies Clinical Specialty Departments Rehabilitation Centers Technical Support Centers Individuals Engineers Administrators Application specialists Care givers

10.4. OID

10.4.1. Object Identifier Domain

10.4.2. Identifier mechanism standardized by the International Telecommunication Union and ISO/IEC for naming any object, concept or thing with a globally unambiguous persistent name

10.4.3. Has a nod in the "OID tree" or Hierarchy The format of each node in the tree is represented by a series of numbers separated by periods

11. Medical Documentation

11.1. Objectives in Patient care

11.1.1. Makes patient care more effective and appropiate

11.2. Objectives in Administration

11.2.1. Forms the basis for refunding, process planning and control

11.3. Objectives in Clinical Research

11.3.1. Allows patient selection and statistical analysis

11.4. Multiple use of patient data

11.4.1. computer-based data Management systems offer the possibility of the multiple use of data recorded once to be used for different objectives and tasks

11.4.2. Patient-group analysis

11.4.3. Distinction by content Clinical Information Is general based on patient-related data Medical knowledge Abstracts from individual patient and describes general insights Healthcare system Provide statistical information about healthcare system's infrastructure

11.4.4. Patient-oriented analysis

11.5. Clinical Data Management systems

11.5.1. Distiction by utilization Patient -group analysis Patient-oriented analysis

11.5.2. Distinction by level of standarization Not standarized It is useful to specify all the details or characteristics of a situation Partly standarized Mainly standarized Fully standarized It allows comparability of data objects at 2 levels

12. Medical Coding System

12.1. ICD: International Classification of diseases

12.1.1. The most important Diagnosis classification

12.1.2. Globally accepted

12.1.3. Published by WHO World Health Organization since its 6 revision in 1946

12.1.4. The 10th revision is a monoaxial and monohierarchical classification with 4 to 5 digit code

12.2. SNOMED: Systematized Nomenclature of Medicine

12.2.1. Purpose: Label or index Medical statements in a way that covers all their content

12.2.2. SNOMED CT: SNOMED Clinical Terms Combines SNOMED RT and NHS's clinical terms version 3 320,000 concepts, 800,000 descriptions or terms and 1 million explicit relationships There are 3 core relational tables: Concepts, descriptions (or terms) and relationships Approaches of Implementation As a reference terminology for data integration As an indexing system for data retrieval As a reference terminology for communication As a code system for clinical data storage As a interface terminology for data entry For complex analytics using description logic For simple aggregation and analysis For knowledge linkage As an extensible base for representing clinical data Full use of all SNOMED CT features components for system operation Data storage knowledge resources user interface Reporting and Analytics Analysis data store Terminology and other reference data components categorized by use used by clinicians caring for individual patients: Entry, display, use of decision support used by those interested in management, statistical or other population/cohort data: retrieval, analysis, research, epidemiology

12.2.3. SNOMED RT: SNOMED Reference Terminology Establishes a hierarchical system of clinical concepts that is divided in 12 root hierarchies, describing different semantic dimensions Multiaxial Nomenclature Contains more than 120,000 concepts and 190,000 terms