MEDICAL INFORMATION SYSTEMS

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MEDICAL INFORMATIONSYSTEMS

• Electronic Healthcare Record

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1. MEDICAL INFORMATION

• 1.1. TYPES OF ACTIVITY
• a. MEDICAL ACTIVITIES (CONSULTATIONS, VISITS)
• Different approaches
• Time oriented
• Patient oriented
• Problems oriented (Simptoms, Objective,
  Assesment, Plans - SOAP)
• Steps
• DIAGNOSING
• DATA - MEDICAL OBSERVATION, INVESTIGATIONS
• KNOWLEDGE - EDUCATION, ETC
• THERAPY / FOLLOW-UP
• NURSING

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1. MEDICAL INFORMATION

• b. LOGISTIC SUPPORTT
• ADMINISTRATION
• ACCOUNTING
• c. SOCIAL CONTEXT FRAME
• MEDICAL DATA CENTRALISATION
• d. MEDICAL EDUCATION (CME)
• STAFF
• PATIENTS
• e. MEDICAL DOCUMENTATION
• f. MEDICAL RESEARCH

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1.2. CYCLES OF MEDICAL INFORMATION FLOW
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1.3. Medical activities organisational levels

• PRIMARY CARE
• SECONDARY (SPECIALISED) CARE
• HOSPITAL - HEALTHCARE UNITS
• CENTRAL LEVELS
• COUNTY HEALTH DEPARTMENTS
• NATIONAL LEVEL HEALTH MINISTERY
• INTERNATIONAL BODIES WHO

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1.4. DEFINITIONS

• a. INFORMATIONAL SYSTEM ensemble of structural
  units exchanging information between them
• b. INFORMATION SYSTEM that part of the
  informational system which comprises computer use

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Terminology

• CPR (computer-based patient record)
• PCR (patient-carried record)
• CMR (computerized medical record)
• EMR (electronic medical record)
• EPR (electronic patient record)
• EHR (electronic healthcare record)

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Integrated Care EHR

• ISO/DTR 20514
• 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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Challenges facing todays health record systems

• The need to record more data
• The need to analyse more data
• The need to share more data

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• University Hospital of Heidelberg
• 400000 new medical records per year
• 6.3 million pages
• 1,7 km of storage
• 250000 reports generated

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The need to analyse more data

• to observe trends and patterns within the
  historical record of one patient
• to enable the use of clinical guidelines and
  decision support tools evidence based health
  care
• to perform clinical audit
• to inform management and commissioning decisions
• to support epidemiology, research and teaching

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Share more healthcare data

• with other clinicians in the same team
• clinical firms, practice partnerships or nursing
  shifts
• with other healthcare professions
• doctors, nurses, physiotherapists, midwives,
  dieticians...
• with other disciplines
• a diabetic patient may also be under
  ophthalmology, nephrology, orthopaedics,
  chiropody, wheelchair clinic..
• with other institutions
• with patients and their families

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The mains advantages of EHR

• Reducing the storing space of the medical data
• Facilitate researches activities
• Standardized environment for medical data
  evidence, based on efficient Database Management
  Systems
• Great level of data integration between different
  segments of information healthcare systems.
• Increasing the quality of healthcare by the
  informational support provided to local and
  central administrative structures.

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EHR adoption barriers

• Technical limitation for assuring the security,
  integrity and accesibility of stored data
• Concerning about the records ownership
• Big initial costs for implementation
• The lack of operate abilities and trust in
  computerized systems from the medical stuff and
  the changing resistance
• Low diversity of the quality EHR systems
• Lack of universal recognized quality standards
  and adequate legal framework

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Core Functionalities for an Electronic Health
Record System

• Health information and data management
• Results management
• Order entry/management
• Decision support management
• Electronic communication and connectivity
• Patient support
• Reporting and Population Health Management
• Administrative processes

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EHR ARHITECTURE

• Object oriented, relational DBMS
• Interoperability - transport of information over
• Time
• Space
• Context, Communities, and Cultures

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Modelul dual - CEN/TC 251
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Reference Model

• Logical building blocks of the EHR
• FOLDER
• COMPOSITION
• Tranzactional unit
• Contribution all compositions created/modified
  during a session
• HEADED SECTIONS - data segments for navigation
  purposes
• ITEM single clinical "statement"

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The Record attributes

• Pacient identification
• Medical stuff identification
• Utilized standards identification
• The Name of the parameter measured/observed
• The value of the parameter
• measure unit
• value measured
• normal value
• data / time stamp
• Observation circumstances

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The Core EHR

• Key characteristics
• Concerns a single subject of care
• Primary purpose is the support of present and
  future healthcare of the subject
• Principally concerned with clinical information
• Simplifies standardization of the EHR
• has a clear, limited scope enabling a manageable
  set of requirements to be specified and a
  manageable standardized model to be defined
• Fits more closely with the distributed systems or
  system-of-systems paradigm
• Allows more modular health information systems
  to be built

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The Extended EHR

• Includes not only clinical information but
  essentiallythe whole health information
  landscape.
• It is a superset of the Core EHR
• Extended EHR functions beyond the scope of the
  Core EHR include
• Patient administration
• Scheduling and resource allocation
• Billing
• Decision support
• Access control and policy management
• Demographics
• Order management
• Population health recording, querying, and
  analysis
• Health professional recording, querying, and
  analysis
• Business operations recording, querying, and
  analysis

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User view functional grouping of data

• Demographic and general data
• Name, gender, date of birth, picture ..
• Residence and contact data
• Current job, education
• Insurance condition
• Alerts allergies, special conditions
  (pregnancies)
• Current medication
• Vaccines
• Consultations
• SOAP
• Schedule
• Surgical interventions
• Reports
• Healthcare costs

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OMS 1623/2004 Setul minim de date la nivel de
pacient (SMDP)
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Standard definition

• ISO/IEC defines a standard as a document,
  established by consensus and approved by a
  recognized body, that provides, for common and
  repeated use, rules, guidelines or
  characteristics for activities or their results,
  aimed at the achievement of the optimum degree of
  order in a given context

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STANDARDS

• Standard Attributes (SMART)
• S specific
• M measurable
• A acceptable
• R realistic
• T time related
• Standard Organizations
• ASRO Romanian Association for Standardisation
  (TC 319)
• CEN - Comité Européen de Normalisation
• CEN/TC251 Medical informatics Technical
  Committee
• ANSI - American National Standards Institute
• ISO - International Organization for
  Standardization.

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Standard Organizations
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EHR Relevant Standards

• ISO DTR 20514 - EHR definition and scope
• ISO TS 18308 - EHR Requirements
• CEN TS 14796 - Data Types
• CEN/TC 251 EN 13606 - EHR Communications
• HL7 - EHR Functional Specification
• HL7 - Templates specification
• HL7 - Clinical Document Architecture
• DICOM Digital Imaging and Communications in
  Medicine
• EDIFACT , XML Messaging standards

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• DATA PROTECTION
• a) CONFIDENTIALITY - limited, leveled
  accessibility
• b) PROTECTION - against accidental deterioration
  / access / loss
• c) SECURITY - intended d/a

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EHR exemples

• OfficeMed ver 1.60
• Integrated system for family physicians (GP)
• Conform to CoCa 2003
• FoxPro / MSDOS
• Programul este agreat de Directia de  sanatate
  publica Bistrita Nasaud
• Medins
• GP
• MEDINET

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INFO WORLD

• ... solutiile oferite au fost dezvoltate conform
  celor mai noi standarde în domeniu, precum HL7 si
  DICOM
• Hospital Manager Suite
• CabiMed GP
• Cabinet Manager ambulatory healthcare system.
• ePractice EPR system

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