Survey of Medical Informatics

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Survey of Medical Informatics

• CS 493 Fall 2004
• October 18, 2004
• V. Juggy Jagannathan

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Review

• Chapter 1-6 Patient Safety - Achieving a New
  Standard of Care.
• IOM Report

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Crossing the Quality Chasm A new health system
for the 21st Century

• IOM Report that identified six major quality
  goals
• Safety
• Effectiveness
• Patient Centeredness
• Timeliness
• Efficiency
• Equitable

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Recommendation 1

• Establishment of patient safety systems that rely
  on
• Access to complete EHR and decision support tools
  at the point of care
• Capture safety information near misses and
  adverse events as a by-product of delivering care

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Recommendation 2

• Develop a National Health Information
  Infrastructure (NHII) that will serve as the
  foundation for all care
• Federal Government should provide incentives for
  the creation of NHII
• Healthcare providers should invest in EHR systems
  that support key capabilities facilitating safe
  delivery of care and implement a process of
  continuous improvement

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EHR System

• Longitudinal collection of health information
  pertinent to care received by a person
• Access to any authorized person
• Knowledge and decision support tools
• Tools and infrastructure to provide efficient
  support for care delivery process

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Recommendation 3

• This recommendation focuses on roles and
  responsibilities of various government agencies
• Department of Health and Human Services (DHHS)
  to promote standards supporting patient safety
• Consolidated Health Informatics (CHI) initiative
  with National Committee on Vital and Health
  Statistics (NCVHS) identify appropriate data
  standards and needs for standardizations
• Agency for Healthcare Research and Quality (AHRQ)
  to oversee and support implementation efforts
• The National Library of Medicine (NLM) to be the
  lead organization dealing with national clinical
  terminologies

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Data Standards

• Data Interchange Formats
• X12 Administrative/Financial
• HL7 Clinical Data
• DICOM Medical Images
• NCPDP Prescription Data
• MIB Medical device data
• Coding/Terminologies
• ICD, CPT, SNOMED, LOINC
• Knowledge Representations

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Recommendation 4

• Federal Government to encourage acceleration and
  adoption of standards in
• Clinical Data Interchange
• Eg. HL7 CDA
• Clinical Terminologies
• Initially focusing on 20 priority areas
• Knowledge Representation
• Develop standards for supporting evidence-based
  medicine practice and clinical guidelines

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Recommendation 5

• All healthcare systems should establish patient
  safety programs that
• Identify failures
• Analyze failures
• Redesign processes to prevent such failures from
  happening again

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Recommendation 6

• The federal government should pursue an applied
  research agenda that focuses on
• Knowledge Generation
• Identifying patients at high risk
• Analyze near-misses to improve overall safety
• Hazard analysis retrospective and prospective
  techniques
• Identifying approaches that work the best
• Identifying the role of the patient
• Develop tools
• To support early detection, prevention, data
  mining techniques
• Dissemination
• Knowledge and tools

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Recommendation 7

• Entrust AHRQ with developing
• Adverse and near miss events taxonomy
• Standardized format for reporting such event
• Identifying data elements that needs to be used
  in such reporting and use of Eindhoven
  Classification Model Medical Version
• Clinical context documentation

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From IOM Report, pg 57
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European Standards and overlapping efforts

• Comite European de Normalisation (CEN)
• ANSI counterpart in Europe
• Significant overlap in standards body roles and
  responsibilities (Table 3-1 page 102)
• Standards in US are formulated by voluntary
  participation by vendors and providers
• Europe, Japanese, Australian and others rely on
  government funds to establish standards for their
  country.

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Terminologies

• Over 150 terminology systems in use
• Very little standardization not interoperable
• International Classification of Diseases ICD
• Box 3-2 pg 104

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CCOW Visual Integration
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The Reference Information Model
Act something happened or may happen. Any
action of interest. Entity a person, animal or
organization or thing Role a part played by an
entity Participation the involvement of a role
in a act Act_Relationship a relationship
between two acts Role_Link a relationship
between two Roles
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Healthcare Standards
Technology solutions

• Sample CDA Document

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HL7 EHR Functional Model
Slide courtesy of Dr. Don Mon, Vice President
of AHIMA
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Criteria for terminologies

• Technical Criteria used by NCVHS for evaluating
  and selecting terminologies
• Page 145 Table 4-2
• CHI focus areas
• Page 146 Table 4-3

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Overview of Core and Supplemental Terminologies

• Box 4-1
• Pages 150-151
• Figure 4-4
• Page 157

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Online Mendelian Inheritance in Man
National Center For Biotechnology Information
Gene Ontology
University of Washington Digital Anatomist
Figure Source Material Oliver Bodenreider The
Unified Medical Language System (UMLS)
integrating biomedical terminologies, Nucleic
Acids Research, 2004, Vol. 32, Database issue
D267-D270
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Clinical Guidelines

• National Guideline Clearinghouse ? contains 1,000
  publicly accessible guidelines
• http//www.guideline.gov/
• Box 4-2 pg. 159
• Comparison of these representative schemes
• http//www.openclinical.org/gmmcomparison.html
• http//www.pubmedcentral.nih.gov/articlerender.fcg
  i?artid150359

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Safety

• A model for introducing safer care
• Pg 179 Figure 5-1
• Retrospective reviews based on ICD-9 CM discharge
  codes and External Causes of Injury Codes
  (E-Codes)
• Pg 182 Figure 5-2
• Pg 183 Table 5-1

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Automated review approach

• Four different approaches
• ICD-9 codes
• Reports of new allergy
• Rule-based
• Box 6-2 rules for detecting ADEs., page 207
• Data mining of textual reports
• Diuretic drug ? fatigue could be a potential
  adverse event
• Box 6-3, page 208

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Near miss

• Phases
• Initial failures
• Dangerous situation
• Inadequate defenses
• Recovery
• Figure 7-1 pg 228