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. Information Management
3.1. General Tasks
3.1.1. Planning the information System and its archtecture
3.1.2. Directing its establishment and operation
3.1.3. Monitoring its development and operation with respect planned objectives
3.2. Definition
3.2.1. Comprises those management activities that deal with the management of information processing in an Institution, example Hospital
4. Modeling Health Information System
4.1. 3LGM - Three layer graph-based Metamodel : Developed for describing, evaluating and planning Health Information System over three layers
4.1.1. Domain layer: Enterprise Functions and Entity types (implementation- independent)
4.1.2. Logical tool layer: Application components (support enterprise functions)
4.1.3. Physical tool layer: Physical data processing systems (support application components)
5. Tasks of Information Management in Hospitals
5.1. Planning the Hospital information system and its architectures
5.2. Directing its establishment and its operation
5.3. Monitoring its development and operation in relation with the planned objectives
5.4. Deals with activities in 3 levels
5.4.1. Strategic Information Management
5.4.1.1. Deals with the Hospital's Information processing as a whole
5.4.1.2. Depends on the hospital´s business strategy and strategic goals and has to translate these in an adequate information stragtegy
5.4.1.3. The planning activities result in a strategic Information Management Plan
5.4.2. Tactical information Management
5.4.2.1. Deals with particular enterprise functions
5.4.2.2. Planning at this level means planning projects and all the resources needed for them
5.4.2.3. Directing at this level means the execution of information management projects
5.4.3. Operational Information Management
5.4.3.1. Responsible for operating the components of the Hospital Information system
6. KPI
6.1. COBIT Developed by IT Governance Institute; Defines 34 KPI in 4 domains
6.1.1. Plan and Organize
6.1.1.1. % of strategic IT objectives that are aligned to the strategic hospital plan
6.1.1.2. % of redundant data elements in the IT Architecture
6.1.1.3. Number of Business process that are not yet supported by IT
6.1.1.4. % of stakeholders that are satisfied with IT quality
6.1.1.5. % of IT projects that are on time and within budget
6.1.2. Acquire and Implement
6.1.2.1. % of users satisfied with the functionality of new IT system
6.1.2.2. Number of IT problems that lead to non operation periods
6.1.2.3. % of IT systems that do not conform to the defined technical standards
6.1.2.4. % of IT systems where adequate user training is provided
6.1.3. Deliver and Support
6.1.3.1. % od stakeholders that are satisfied with IT support
6.1.3.2. Number of user complaints with regard an IT Support
6.1.3.3. % of satisfactory response times of an IT system
6.1.3.4. Number of lost hours due to unplanned IT downtimes
6.1.4. Monitor and Evaluate
6.1.4.1. Frequency of Reporting from IT Management to enterprise management
6.1.4.2. Satisfaction of management with IT performance reporting
6.1.4.3. Number of independent IT reviews
6.2. HIS Benchmarking Report: uses HIS benchmarking criteria that have been agreed to a regional group of hospitals´ CIOs
6.2.1. KPI for HIS Organization
6.2.2. KPI for HIS costs
6.2.3. KPI for HIS mamanagement
6.2.4. KPI for HIS functionality
6.2.4.1. % of all documents available electronically
6.2.4.2. % of all diagnosis coded electronically
6.2.5. KPI for HIS architecture
6.2.5.1. Number of computer based application components
6.2.5.2. % of standard interfaces between applications
6.2.5.3. Functional redundancy rate
7. Medical Documentation
7.1. Objectives in Patient care
7.1.1. Makes patient care more effective and appropiate
7.2. Objectives in Administration
7.2.1. Forms the basis for refunding, process planning and control
7.3. Objectives in Clinical Research
7.3.1. Allows patient selection and statistical analysis
7.4. Multiple use of patient data
7.4.1. computer-based data Management systems offer the possibility of the multiple use of data recorded once to be used for different objectives and tasks
7.4.2. Patient-group analysis
7.4.3. Distinction by content
7.4.3.1. Clinical Information
7.4.3.1.1. Is general based on patient-related data
7.4.3.2. Medical knowledge
7.4.3.2.1. Abstracts from individual patient and describes general insights
7.4.3.3. Healthcare system
7.4.3.3.1. Provide statistical information about healthcare system's infrastructure
7.4.4. Patient-oriented analysis
7.5. Clinical Data Management systems
7.5.1. Distiction by utilization
7.5.1.1. Patient -group analysis
7.5.1.2. Patient-oriented analysis
7.5.2. Distinction by level of standarization
7.5.2.1. Not standarized
7.5.2.1.1. It is useful to specify all the details or characteristics of a situation
7.5.2.2. Partly standarized
7.5.2.3. Mainly standarized
7.5.2.4. Fully standarized
7.5.2.4.1. It allows comparability of data objects at 2 levels
8. Clinical students
9. Hospital Information System
9.1. Socio-technical Subsystem
9.1.1. All information processing
9.1.2. Associated Human or technical Actors in their respective information processing roles
9.1.3. Aim: Enable the adequate execution of Hospital Functions for patient care
9.2. Components
9.2.1. Hospital Functions
9.2.1.1. Non-computer-based
9.2.1.2. computer-based information processing Tool
9.2.2. Business Process
9.2.2.1. Sequence of sub functions together with the conditions under which they are performed
9.2.3. Information Processing Tools: Application components that support Hospital Functions
9.2.3.1. Patient Administration System
9.2.3.2. Medical Documentation System
9.2.3.3. Nursing Management and Documentation System
9.2.3.4. Outpatient Management System
9.2.3.5. Provider or Physician Order Entry System - POE
9.2.3.6. Patient Data Management System - PDMS
9.2.3.7. Operation Management System
9.2.3.8. Radiology Information System - RIS
9.2.3.9. Picture Archiving and Communication System - PACS
9.2.3.10. Laboratory Information System - LIS
9.2.3.11. Enterprise Resource Planning System - ERP
9.2.3.12. Data Warehouse System
9.2.3.13. Document Archiving System
9.2.3.14. Clinical Information System and Electronic Patient Record System
9.3. Architectures
9.3.1. Describes its fundamental Organization represented by its components, their relationships to each others and to the environment
9.3.2. Styles at the logical tool layer of the computer based part are characterized by
9.3.2.1. Number of databases being used to store patient related data
9.3.2.1.1. DB1 Style
9.3.2.1.2. DBn style
9.3.2.2. Number of the application components used to support the hospital functions
9.3.2.2.1. Monolithic "AC1" Only one computer-based application component
9.3.2.2.2. Modular "Can": Several application components
9.3.2.3. Number of software products and vendors
9.3.2.3.1. All-in-one: Software from only one vendor "V1"- Homogeneus
9.3.2.3.2. Best of breed: Software from several vendors "Vn"
9.3.2.4. Communication Patterns
9.3.2.4.1. Spaghetti style "CPn": Directly connect those application components that need to exchange certain related-patient data when connecting several application components
9.3.2.4.2. Star architecture: "CP1" Interfaces are needed only between application components and communication server
9.4. 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
9.4.1. Data Integration
9.4.2. Semantic Integration
9.4.3. Access Integration
9.4.4. Presentation Integration
9.4.5. Functional Integration
9.4.6. Process Integration
9.5. Communication Standards
9.5.1. Health Level 7 - HL7: Describes events and dedicated message types that are exchange between application components
9.5.2. DICOM - Digital Imaging and Communication in Medicine: Comprises file and message formats for all types of Medical Imaging Modalities
9.5.3. ISO/IEEE 11073: Defines a communication protocol for the exchange of bio-signals and vital parameters between several point of care devices
9.5.4. Standard for contextual Integration
9.5.5. Integrating the Healthcare Enterprise IHE: This Organization selects the most appropriate set of standards for a typical workflow
9.5.5.1. Facilitate interoperability
9.5.5.1.1. Definition
9.5.5.1.2. Aspects involved
9.5.5.2. Terms
9.5.5.2.1. IHE Domain
9.5.5.2.2. IHE Technical Framework
9.5.5.2.3. IHE Integration Profile
9.5.5.2.4. IHE Actor
9.5.5.2.5. IHE Transaction
9.5.6. Electronic Data Interchange for administration, commerce and Transport - EDIFACT: Is a message format for electronic data interchange in electronic commerce
9.5.7. Clinical Document Architecture - CDA
9.5.7.1. Components
9.5.7.1.1. Header
9.5.7.1.2. Body
9.5.7.2. Definition
9.5.7.2.1. Is a document markup standard that specifies the structure and semantics of "clinical documents" for its exchange
9.5.7.3. Goals
9.5.7.3.1. Give priority to delivery of patient care
9.5.7.3.2. Support exchange of human-readable documents between users
9.5.7.3.3. Promote longevity of all information encoded according to this architecture
9.5.7.3.4. Enable a wide range of post-exchange processing applications
9.5.7.3.5. Be compatible with a wide range of document applications
9.5.7.3.6. Prepare the design quickly
9.5.7.4. Levels
9.5.7.4.1. Definition
9.5.7.4.2. Narrative, sections and entry codes
9.5.7.4.3. The Narrative block contains the human readable content to be represented
10. EHR - Electronic Health Record
10.1. Trans-institutional digital repository of information regarding the health status of a subject of care
10.2. PHIR - Personal Helath Record
10.2.1. If the EHR allows the patient to actively manage his data
10.2.2. Types
10.2.2.1. Off line personal Health records, generally paper-based and comprise copies of clinical documents
10.2.2.2. web-based personal health records
10.2.2.3. Provider-based personal health records where hospitals and other providers make some of patient health information available for the patient
10.3. According to the Institute of Medicine it has 5 core functions
10.3.1. Health Information
10.3.2. Data storage
10.3.3. Order Entry
10.3.4. Results Management
10.3.5. Decision suport
11. ehealth
11.1. Definition
11.1.1. 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
11.2. Evaluation
11.2.1. Act to assess whether an ehealth system is working and producing the effects as expected
11.2.2. 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
11.2.3. Scope
11.2.3.1. Planning
11.2.3.1.1. Example: If the intended system is aligned with the organization strategy
11.2.3.2. Design
11.2.3.2.1. Example: If the specifications of the system have been met in terms of its features and behaviors
11.2.3.3. Implementation
11.2.3.3.1. Example if the implementation is under scope and budget
11.2.3.4. Use
11.2.3.4.1. Example: evaluate the extent to which the system is used and its impact on health outcome
11.2.3.5. Maintenance
11.2.3.5.1. Example: Evaluate how well the system has been supported and adapted to changing needs
11.3. stakeholders
11.3.1. Service Providers
11.3.1.1. Organizations
11.3.1.1.1. Hospitals
11.3.1.1.2. Medical Providers
11.3.1.1.3. Community Healthcare centers
11.3.1.1.4. Medical Centers in Universities
11.3.1.1.5. Prison care centers
11.3.1.2. Individuals
11.3.1.2.1. Clinicians
11.3.1.2.2. Nurses
11.3.1.2.3. Physiotherapists
11.3.1.2.4. Volunteers
11.3.2. Consumers
11.3.2.1. Organizations
11.3.2.1.1. Private companies
11.3.2.1.2. Day care baby centers
11.3.2.1.3. Airport
11.3.2.1.4. Armed forces
11.3.2.1.5. Government
11.3.2.2. Individuals
11.3.2.2.1. Patients
11.3.2.2.2. Patients families
11.3.2.2.3. Researchers
11.3.2.2.4. Citizens
11.3.2.2.5. Employees
11.3.3. Supporters
11.3.3.1. Organizations
11.3.3.1.1. Technology Vendors
11.3.3.1.2. Health Insurance companies
11.3.3.1.3. Clinical Specialty Departments
11.3.3.1.4. Rehabilitation Centers
11.3.3.1.5. Technical Support Centers
11.3.3.2. Individuals
11.3.3.2.1. Engineers
11.3.3.2.2. Administrators
11.3.3.2.3. Application specialists
11.3.3.2.4. Care givers
11.4. OID
11.4.1. Object Identifier Domain
11.4.2. Identifier mechanism standardized by the International Telecommunication Union and ISO/IEC for naming any object, concept or thing with a globally unambiguous persistent name
11.4.3. Has a nod in the "OID tree" or Hierarchy
11.4.3.1. The format of each node in the tree is represented by a series of numbers separated by periods
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
12.2.2.1. Combines SNOMED RT and NHS's clinical terms version 3
12.2.2.2. 320,000 concepts, 800,000 descriptions or terms and 1 million explicit relationships
12.2.2.3. There are 3 core relational tables: Concepts, descriptions (or terms) and relationships
12.2.2.4. Approaches of Implementation
12.2.2.4.1. As a reference terminology for data integration
12.2.2.4.2. As an indexing system for data retrieval
12.2.2.4.3. As a reference terminology for communication
12.2.2.4.4. As a code system for clinical data storage
12.2.2.4.5. As a interface terminology for data entry
12.2.2.4.6. For complex analytics using description logic
12.2.2.4.7. For simple aggregation and analysis
12.2.2.4.8. For knowledge linkage
12.2.2.4.9. As an extensible base for representing clinical data
12.2.2.4.10. Full use of all SNOMED CT features
12.2.2.5. components for system operation
12.2.2.5.1. Data storage
12.2.2.5.2. knowledge resources
12.2.2.5.3. user interface
12.2.2.5.4. Reporting and Analytics
12.2.2.5.5. Analysis data store
12.2.2.5.6. Terminology and other reference data
12.2.2.6. components categorized by use
12.2.2.6.1. used by clinicians caring for individual patients: Entry, display, use of decision support
12.2.2.6.2. used by those interested in management, statistical or other population/cohort data: retrieval, analysis, research, epidemiology
12.2.3. SNOMED RT: SNOMED Reference Terminology
12.2.3.1. Establishes a hierarchical system of clinical concepts that is divided in 12 root hierarchies, describing different semantic dimensions
12.2.3.2. Multiaxial Nomenclature
12.2.3.3. Contains more than 120,000 concepts and 190,000 terms