Views

1
Healthcare Information Systems
2
Introduction

• Without access to appropriate information, a
  health system is, at best, inefficient and
  frustrating and, at worst, dangerous. Modern
  healthcare services cannot function without those
  involved having the information they need to
  provide and receive care. Their needs for
  information cannot be met without electronic
  medical records and other computerised systems.
• NHS Information Authority (2002) Share with Care
  Peoples Views on Consent and Confidentiality of
  Patient Information

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Healthcare Provision in Ireland

• Irish healthcare system is a unique mix of
  private and public bodies, which creates
  information issues
• Large voluntary sector, particularly in mental
  health
• Health system does not exist in a vacuum from
  other aspects of society and government,
  particularly e-government and social services
• Health service reform is a major government
  priority
• Government Reports and Strategy Papers
• Value for Money Study (2001), National Health
  Strategy (2001), Primary Care Strategy (2001),
  Prospectus (2003), Brennan (2003), Hanly (2003),
  Health Information (2004)

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National Health Information Strategy (Ireland)

• Health Information A National Strategy,
  published by Department of Health Children in
  2004
• Available from http//www.dohc.ie/publications/
• Health information must be relevant and
  accessible to all those who require it, must be
  presented in the most useful formats and must
  utilise the power of information and
  communications technology (ICT) to the full in
  its collection and dissemination Access to good
  health information provides the tool for
  evidence-based decision making at all levels.
  (p.15)
• In the past resources have tended to focus on
  the collection of data that sometimes flow into
  islands of information that are not properly
  exploited on an everyday basis. (p.18)
• Guiding Principles (p.7)
• " Safeguard the privacy and confidentiality of
  personal health information
• " Ensure that health information systems are
  efficient and effective
• " Promote the optimal use of health information
• " Ensure the high quality of health information.

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Information Management

• In 1945, Vannevar Bush published a futuristic
  article titled As We May Think which
  established the principles of modern day digital
  libraries and on-line databases
• The summation of human experience is being
  expanded at a prodigious rate, and the means we
  use for threading through the consequent maze to
  the momentarily important item is the same as was
  used in the days of the square-rigged ships

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Information Management

• Storage of healtcare information what has
  changed in the past 100 years !?
• EHR is still a future pipedream by 2013, it is
  expected 90 of all patient records will still be
  paper-based (Haux)

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(No Transcript)
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Sources of Healthcare Information (Ireland)

• Department of Health Children
  http//www.dohc.ie/public/information/
• Health Service Executive (HSE)
  http//www.hse.ie
• Health Information Quality Authority (HIQA)
  http//www.hiqa.ie
• Institute of Public Health in Ireland
  http//www.publichealth.ie
• Economic Social Research Institute (ESRI)
  http//www.esri.ie/health_information/
• Information on in-patients (HIPE) and perinatal
  events (NPRS)
• Health Research Board (HRB)
  http//www.hrb.ie
• National Psychiatric Inpatient Reporting System
  (NPIRS), National Drug Treatment Reporting
  System, National Intellectual Disability Database
  (NIDD), National Physical and Sensory Disability
  Database (NPSDD), Community Care (COMCAR)
  Database, National Drug-Related Deaths Index
  (NDRDI)
• Health Protection Surveillance Centre
  http//www.ndsc.ie/hpsc/
• Health Intelligence
  http//www.healthintelligence.ie
  
• Mental Health Commission
  http//www.mhcirl.ie/
• National Cancer Registry
  http//www.ncri.ie
• National Parasuicide Registry
• Irish Nurses Organisation (INO)
  http//www.ino.ie
• Various information on nursing activities e.g.
  Trolley Watch
• Irish Medical Organisation (IMO)
  http//www.imo.ie
• Health Safety Authority
  http//www.hsa.ie
• Central Statistics Office (CSO)
  http//www.cso.ie/statistics/HealthandSocialCondit
  ions.htm

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Healthcare Stakeholders

• Information is not only for managers
• - Cibulskis, Bulletin of the WHO, August 2005
• Two principal types of information
• Aggregated, anonymised, or statistical health
  data for policy-making, management, service
  delivery decisions
• Personal health information for treatment,
  payments/refunds, service eligibility, etc.
• Stakeholders in healthcare provision, management,
  and consumption include
• Patients and their families
• Multi-disciplinary Team nurses, doctors,
  physiotherapists, occupational therapists,
  psychiatrists, social workers
• General practitioners
• Hospital administrators
• Local health authorities
• Government departments and agencies
• Health insurance providers
• Pharmacies and dispensaries
• Citizens / Tax-payers / General Public / Media

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Electronic Healthcare Records (EHR)

• Irelands National Health Information Strategy
  commits to the phased introduction of an
  Electronic Healthcare Records (EHR) scheme

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EHR Privacy Confidentiality

• Most people consider health information to be
  highly personal, and therefore need to be
  confident that their privacy will be protected
  whenever they use a health service Clear and
  open communication between the health service
  provider and health consumer is integral to good
  privacy.
• Australian Federal Privacy Commissioner, October
  2001
• Integrated care means more sharing, sharing needs
  control
• Data protection law is no barrier to a proper
  functioning health service because it provides an
  assurance that in this delicate area peoples
  privacy rights are protected. In this regard data
  protection complements the confidentiality
  obligations of medical ethics.
• Irish Data Protection Commissioner, Annual Report
  2002
• In Irish / EU law, consent to store personal
  information must be informed and voluntary

12
EHR Standards

• EHR standards and interchange formats include
  ISO/DTR 20514, CEN HISE, and openEHR (see
  http//www.openEHR.org)

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EHR Standards

• ISO/DTR 20514 definitions
• The basicgeneric definition for the EHR is a
  repository of information,regarding the health
  status of a subject of care, in computer
  processable form.

• The Integrated Care EHR is defined as a
  repository of information regarding the health of
  a subject of care in computer processable form,
  stored and transmitted securely, and accessible
  by multiple authorised users.
• It has a commonly agreed logical information
  model which is independent of EHR systems.
• Its primary purpose is the support of
  continuing, efficient and quality integrated
  health care and it contains information which is
  retrospective, concurrent and prospective.

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Potential Benefits of EHR

• Greater accessibility, legibility, accuracy,
  consistency
• See e-Health An Example in Information Society
  Commission (2004) An E-Healthy State, pp.10-12
• Improved workflow less redundancy of effort and
  less paperwork
• Improved clinical decision making more complete
  information
• Automatically generate alarms, alerts and
  reminders
• Mothers receiving computer-generated reminders
  had 25 higher on-time immunisation rate for
  their infants (Alemi, 1996)
• Greater safety through reduction of errors
• Computerised physician order-entry reduced
  adverse drug events by 55 (Bates, 1998)
• Epidemiology e.g. control of SARS, Avian
  Influenza
• Reduced storage space no more data warehouses
  (literally!)
• See HSE South (2006) Response to Parliamentary
  Question 41993/06
• It is easier to backup electronic documents than
  paper documents

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Barriers to EHR Implementation

• Complexity and fragmentation of data
• Lack of common standards for data interchange
• See European Institute for Health Records
  http//www.eurorec.org
• Legislative context law-suits, tribunals,
  digital signatures
• Doctors fear of making their information so
  available
• Confidentiality needs of patients the
  Hippocratic Oath is not enough to safeguard
  electronic data !
• Differing national legislation on privacy and
  consent
• Clinician fear of more data entry
• Cost and consequences of user training
• Lack of capital resources
• Problems with legacy data in paper-based systems
  how to port to electronic system
• Loss of productivity during transition period
• Insufficient return on investment
• Often, available EHR software does not match needs

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Additional Readings

• Gans, D., Kralewski, J., Hammons, T. Dowd, B.
  (2005) Medical Groups' Adoption of Electronic
  Health Records and Information Systems. Health
  Affairs. 24(5), 1323-1333.
• Goldschmidt, P. G. (2005) HIT and MIS
  implications of health information technology and
  medical information systems. Communications of
  the ACM. 48(10), 68-74.
• Fieschi, M. (2002) Information technology is
  changing the way society sees health care
  delivery. International Journal of Medical
  Informatics. 66(1-3), 85-93.
• Haux, R., Ammenwerth, E., Herzog, W. Knaup, P.
  (2002) Health care in the information society. A
  prognosis for the year 2013. International
  Journal of Medical Informatics. 66(1-3), 3-21.
• Information Society Commission (2004) An
  E-Healthy State.
• See http//www.nuigalway.ie/bis/mlang/courses/ms
  899/readings.html