Information and Communication Technologies in Healthcare

Stephan Jones, Frank M. Groom, Stephan Jones, Frank M. Groom

• Editorial: Auerbach Publications
• Año: 2016
• ISBN:
  9781000755268
• Edición: 1
• Categoría: Business
• Categoría: Management

As the population ages and healthcare costs continue to soar, the focus of the nation and the healthcare industry turns to reducing costs and making the delivery process more efficient. Demonstrating how improvements in information systems can lead to improved patient care, Information and Communication Technologies in Healthcare explains how to cr

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HEALTHCARE SYSTEMS

Introduction

FRANK M. GROOM, PH.D.

Contents

Central Data Repositories

Data Information Entry, Verification, and Correction

Regional Sharing of Information

Data Privacy and Protection

Open Systems

Compliance

Conclusion

Areas Covered by This Book

References

As the population ages, the economy struggles, and healthcare costs soar, the focus of the nation and the Healthcare Industry is on determining the means to reduce costs and make the delivery process more effective. Systems experts are like carpenters in their view of these problems. To a carpenter, every information problem appears solvable with nails and a hammer (or screws and screwdriver, or at least a little carpenter’s hide or wood glue). To information technology people, solutions frequently involve collecting data into a repository and then making it searchable, understandable, and relatable.

In this book, we approach the healthcare industry and its problems from an Information Systems prospective and attempt to determine how to create a helpful and holistic Medical Records System as a core component to be employed in addressing a wide range of healthcare issues. A basic principle we flow is that data should be captured only once, stored in a repository, and then made available throughout the medical system for all medical purposes.

Such a Medical Records System Data Repository starts with a record created by a patient’s physician. Furthermore, additional records of request are sent by the patient’s physician for any tests and procedures that the physician determines must be undertaken and any specialists to whom the patient is referred. For an efficient systems process, a patient’s information file from that physician’s office should initially be forwarded into a common record-keeping system. All further information from other healthcare providers can subsequently be entered into a common file and updated with hospital, specialist, and further diagnostic and performed procedures. Any additional patient, symptom, and planned procedures can be inserted in an existing medical record that has previously been standardized, edited, and vetted for completeness by an initial medical provider and need not be re-entered at each subsequent registration time.

For each patient, from the time of physician prescribing a medication or ordering a set of tests, specialist evaluations, or full hospitalization, an Electronic Case Report (ECR) should be prepared and stored in a common repository. This ECR should then follow the patient throughout the healthcare process, office to office, doctor to doctor, with information accumulating as the process proceeds. The updated ECR should be stored in the central Health Care Data Repository (HCDR) (Figure 1.1) as the patient proceeds through each step of the medical process. Providers access a common patient ECR record, and subsequently update it with the additional information gathered from that stage’s processes. The accumulated set of patient information always remains in the central (HCDR) storage.

Figure 1.1 Health Care Data Repository: system sub-components.

Central Data Repositories

Initial versions of such a central repository are currently deployed in a number of specialized centers. As an example of such a repository, the Clinical Data Repository/Health Data Repository (CHDR)2 is a joint initiative between the Department of Veterans Affairs (VA) and the Department of Defense (DoD). Another example is AHLTA (Armed Forces Health Longitudinal Technology Application), an enterprisewide medical and dental information management system that provides secure online access to Military Health System (MHS) beneficiary records. To achieve computable interoperability, both agencies standardize their data for each given clinical domain (pharmacy, allergy, etc.) and exchange the standardized data through a common interface.

Thus, the CHDR repository consists of an interface between the DoD’s Clinical Data Repository (CHDR), the AHLTA repository, the DoD’s electronic health record, and the VA’s Health Data Repository (HDR). The CHDR is thus a Cross-Government Department Data Repository that enables the bi-directional exchange of patient, pharmacy and medication, and allergy data. Furthermore, common usage of the CHDR enhances decision support by permitting data from VA and DoD repositories to be cross-referenced for drug-to-drug interactions and drug-allergy effects.

The CHDR is an important step forward toward system and provider interoperability and represents a departure from a “viewable” data approach. Instead of healthcare providers merely being empowered to a have a common view of the patient data, the data is only entered and stored once and does not merely appear the same to all providers but is in fact only a single common record in a common file. By employing an agreed-upon “vocabulary” for their data and thus a common procedure naming convention, the VA and the DoD have standardized their data so that they can to use each other’s data in decision support applications and in making medical decisions and reaching common medical conclusions.

Another Data Repository System, Microsoft’s Azyxxi Data Repository, was developed by a group of doctors and initially used in Washington Hospital Center’s emergency department beginning in 1996. Microsoft subsequently purchased the system from these doctors. The University of Washington currently employs the system, now called the Azyxxi Data Repository system, to centralize all information associated with their Pain Control Clinic. The Azyxxi Data Repository system has since been deployed at six other hospitals, among which are Georgetown University Hospital and the MedStar Health group, a nonprofit network in the Baltimore-Washington region.

In addition to storing basic patient information, the Azyxxi software and associate Data Repository system is designed to retrieve and quickly display information from many sources, including scanned documents, EKGs, x-rays, MRI scans, angiograms, and ultrasound images (Figure 1.2). Essentially, the Azyxxi Data Repository is an advanced multimedia, object-oriented database system with user-oriented interfaces, displays, and search engines.

There are several more established suppliers of clinical information technology systems, including Cerner, Epic, G.E., Eclypsis, and others. A current list of software vendors providing healthcare data repository software systems is available by means of Google search or Wikipedia.

Figure 1.2 Information available in Microsoft’s Azyxxi healthcare repository.

Figure 1.3 Data verification and correction processes.

Data Information Entry, Verification, and Correction

Although a common, central repository is critical, additional subsystems are required for each of the groups and organizations that will use data in the repository. A standardized report system should be created with a format and vocabulary that is understood by all information users. Furthermore, a patient data verification process should be conducted whenever a patient has any medical procedure performed. Additionally, an overall information quality assurance procedure should be performed against the stored data on a regular basis (Figure 1.3).

Regional Sharing of Information

It is important that all medical facilities in a region have access to a commonly stored and shared information set. This commonality ensures that a least cost data acquisition, verification, and storage processes are employed for all users in a given area without duplication, variation, or proprietary restrictions. Such an example is contained in Figure 1.4 from the West Coast.

Figure 1.4 Regional employment of a common healthcare repository.

Data Privacy and Protection

When multiple people within a physician’s office, hospital, support facility, and imaging and laboratory sites have access to a common shared Health Care Record System, many opportunities exist for misuse of the data by people with malicious or inappropriate intent. Federal and state laws have been enacted to enforce the privacy of such records. The operators of a common Health Care Records System must carefully follow such regulations. These measures include restriction as to access, both at the device and at the system level. These may include encrypting the data, employing and frequently changing passwords, requiring the use of authentication and certification systems, employing tracking systems, and the maintenance of a support team that is trained and experienced with the system and the deployed technologies.

Open Systems

Medical Information Systems have been plagued by a number of issues. They have frequently been built by small companies with limited financial stability. They tend to be designed for a specific specialized need and limited user group. They frequently have been developed with a proprietary programming system, deployed to operate on proprietary hardware and software, and based upon a limited data management and storage system.

This proprietary situation may be difficult to address. For example, the various scanning and imaging devices that exist may produce records of results that are in a proprietary format associated with the hardware deployed. That imaging information could possibly limit the ability to directly enter the resulting data into a central repository system written with standard C, C++, COBOL, or other commonly used software, or with an operating system of Unix, Linux, Windows^®, MVS (IBM’s Multiple Virtual Storage now called Z/OS), VM (IBM’s Virtual Machine now called Z/VM), or other generally deployed operating systems. As a result, an organization that employs such systems frequen...