Health Information Management

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Health Information Management by Mind Map: Health Information Management

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. Clinical students

4. Information Management

4.1. General Tasks

4.1.1. Planning the information System and its archtecture

4.1.2. Directing its establishment and operation

4.1.3. Monitoring its development and operation with respect planned objectives

4.2. Definition

4.2.1. Comprises those management activities that deal with the management of information processing in an Institution, example Hospital

5. Hospital Information System

5.1. Socio-technical Subsystem

5.1.1. All information processing

5.1.2. Associated Human or technical Actors in their respective information processing roles

5.1.3. Aim: Enable the adequate execution of Hospital Functions for patient care

5.2. Components

5.2.1. Hospital Functions

5.2.1.1. Non-computer-based

5.2.1.2. computer-based information processing Tool

5.2.2. Business Process

5.2.2.1. Sequence of sub functions together with the conditions under which they are performed

5.2.3. Information Processing Tools: Application components that support Hospital Functions

5.2.3.1. Patient Administration System

5.2.3.2. Medical Documentation System

5.2.3.3. Nursing Management and Documentation System

5.2.3.4. Outpatient Management System

5.2.3.5. Provider or Physician Order Entry System - POE

5.2.3.6. Patient Data Management System - PDMS

5.2.3.7. Operation Management System

5.2.3.8. Radiology Information System - RIS

5.2.3.9. Picture Archiving and Communication System - PACS

5.2.3.10. Laboratory Information System - LIS

5.2.3.11. Enterprise Resource Planning System - ERP

5.2.3.12. Data Warehouse System

5.2.3.13. Document Archiving System

5.2.3.14. Clinical Information System and Electronic Patient Record System

5.3. Architectures

5.3.1. Describes its fundamental Organization represented by its components, their relationships to each others and to the environment

5.3.2. Styles at the logical tool layer of the computer based part are characterized by

5.3.2.1. Number of databases being used to store patient related data

5.3.2.1.1. DB1 Style

5.3.2.1.2. DBn style

5.3.2.2. Number of the application components used to support the hospital functions

5.3.2.2.1. Monolithic "AC1" Only one computer-based application component

5.3.2.2.2. Modular "Can": Several application components

5.3.2.3. Number of software products and vendors

5.3.2.3.1. All-in-one: Software from only one vendor "V1"- Homogeneus

5.3.2.3.2. Best of breed: Software from several vendors "Vn"

5.3.2.4. Communication Patterns

5.3.2.4.1. Spaghetti style "CPn": Directly connect those application components that need to exchange certain related-patient data when connecting several application components

5.3.2.4.2. Star architecture: "CP1" Interfaces are needed only between application components and communication server

5.4. 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

5.4.1. Data Integration

5.4.2. Semantic Integration

5.4.3. Access Integration

5.4.4. Presentation Integration

5.4.5. Functional Integration

5.4.6. Process Integration

5.5. Communication Standards

5.5.1. Health Level 7 - HL7: Describes events and dedicated message types that are exchange between application components

5.5.2. DICOM - Digital Imaging and Communication in Medicine: Comprises file and message formats for all types of Medical Imaging Modalities

5.5.3. ISO/IEEE 11073: Defines a communication protocol for the exchange of bio-signals and vital parameters between several point of care devices

5.5.4. Standard for contextual Integration

5.5.5. Integrating the Healthcare Enterprise IHE: This Organization selects the most appropriate set of standards for a typical workflow

5.5.5.1. Facilitate interoperability

5.5.5.1.1. Definition

5.5.5.1.2. Aspects involved

5.5.5.2. Terms

5.5.5.2.1. IHE Domain

5.5.5.2.2. IHE Technical Framework

5.5.5.2.3. IHE Integration Profile

5.5.5.2.4. IHE Actor

5.5.5.2.5. IHE Transaction

5.5.6. Electronic Data Interchange for administration, commerce and Transport - EDIFACT: Is a message format for electronic data interchange in electronic commerce

5.5.7. Clinical Document Architecture - CDA

5.5.7.1. Components

5.5.7.1.1. Header

5.5.7.1.2. Body

5.5.7.2. Definition

5.5.7.2.1. Is a document markup standard that specifies the structure and semantics of "clinical documents" for its exchange

5.5.7.3. Goals

5.5.7.3.1. Give priority to delivery of patient care

5.5.7.3.2. Support exchange of human-readable documents between users

5.5.7.3.3. Promote longevity of all information encoded according to this architecture

5.5.7.3.4. Enable a wide range of post-exchange processing applications

5.5.7.3.5. Be compatible with a wide range of document applications

5.5.7.3.6. Prepare the design quickly

5.5.7.4. Levels

5.5.7.4.1. Definition

5.5.7.4.2. Narrative, sections and entry codes

5.5.7.4.3. The Narrative block contains the human readable content to be represented

6. Modeling Health Information System

6.1. 3LGM - Three layer graph-based Metamodel : Developed for describing, evaluating and planning Health Information System over three layers

6.1.1. Domain layer: Enterprise Functions and Entity types (implementation- independent)

6.1.2. Logical tool layer: Application components (support enterprise functions)

6.1.3. Physical tool layer: Physical data processing systems (support application components)

7. Tasks of Information Management in Hospitals

7.1. Planning the Hospital information system and its architectures

7.2. Directing its establishment and its operation

7.3. Monitoring its development and operation in relation with the planned objectives

7.4. Deals with activities in 3 levels

7.4.1. Strategic Information Management

7.4.1.1. Deals with the Hospital's Information processing as a whole

7.4.1.2. Depends on the hospital´s business strategy and strategic goals and has to translate these in an adequate information stragtegy

7.4.1.3. The planning activities result in a strategic Information Management Plan

7.4.2. Tactical information Management

7.4.2.1. Deals with particular enterprise functions

7.4.2.2. Planning at this level means planning projects and all the resources needed for them

7.4.2.3. Directing at this level means the execution of information management projects

7.4.3. Operational Information Management

7.4.3.1. Responsible for operating the components of the Hospital Information system

8. KPI

8.1. COBIT Developed by IT Governance Institute; Defines 34 KPI in 4 domains

8.1.1. Plan and Organize

8.1.1.1. % of strategic IT objectives that are aligned to the strategic hospital plan

8.1.1.2. % of redundant data elements in the IT Architecture

8.1.1.3. Number of Business process that are not yet supported by IT

8.1.1.4. % of stakeholders that are satisfied with IT quality

8.1.1.5. % of IT projects that are on time and within budget

8.1.2. Acquire and Implement

8.1.2.1. % of users satisfied with the functionality of new IT system

8.1.2.2. Number of IT problems that lead to non operation periods

8.1.2.3. % of IT systems that do not conform to the defined technical standards

8.1.2.4. % of IT systems where adequate user training is provided

8.1.3. Deliver and Support

8.1.3.1. % od stakeholders that are satisfied with IT support

8.1.3.2. Number of user complaints with regard an IT Support

8.1.3.3. % of satisfactory response times of an IT system

8.1.3.4. Number of lost hours due to unplanned IT downtimes

8.1.4. Monitor and Evaluate

8.1.4.1. Frequency of Reporting from IT Management to enterprise management

8.1.4.2. Satisfaction of management with IT performance reporting

8.1.4.3. Number of independent IT reviews

8.2. HIS Benchmarking Report: uses HIS benchmarking criteria that have been agreed to a regional group of hospitals´ CIOs

8.2.1. KPI for HIS Organization

8.2.2. KPI for HIS costs

8.2.3. KPI for HIS mamanagement

8.2.4. KPI for HIS functionality

8.2.4.1. % of all documents available electronically

8.2.4.2. % of all diagnosis coded electronically

8.2.5. KPI for HIS architecture

8.2.5.1. Number of computer based application components

8.2.5.2. % of standard interfaces between applications

8.2.5.3. Functional redundancy rate

9. EHR - Electronic Health Record

9.1. Trans-institutional digital repository of information regarding the health status of a subject of care

9.2. PHIR - Personal Helath Record

9.2.1. If the EHR allows the patient to actively manage his data

9.2.2. Types

9.2.2.1. Off line personal Health records, generally paper-based and comprise copies of clinical documents

9.2.2.2. web-based personal health records

9.2.2.3. Provider-based personal health records where hospitals and other providers make some of patient health information available for the patient

9.3. According to the Institute of Medicine it has 5 core functions

9.3.1. Health Information

9.3.2. Data storage

9.3.3. Order Entry

9.3.4. Results Management

9.3.5. Decision suport

10. ehealth

10.1. Definition

10.1.1. 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

10.2. Evaluation

10.2.1. Act to assess whether an ehealth system is working and producing the effects as expected

10.2.2. 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

10.2.3. Scope

10.2.3.1. Planning

10.2.3.1.1. Example: If the intended system is aligned with the organization strategy

10.2.3.2. Design

10.2.3.2.1. Example: If the specifications of the system have been met in terms of its features and behaviors

10.2.3.3. Implementation

10.2.3.3.1. Example if the implementation is under scope and budget

10.2.3.4. Use

10.2.3.4.1. Example: evaluate the extent to which the system is used and its impact on health outcome

10.2.3.5. Maintenance

10.2.3.5.1. Example: Evaluate how well the system has been supported and adapted to changing needs

10.3. stakeholders

10.3.1. Service Providers

10.3.1.1. Organizations

10.3.1.1.1. Hospitals

10.3.1.1.2. Medical Providers

10.3.1.1.3. Community Healthcare centers

10.3.1.1.4. Medical Centers in Universities

10.3.1.1.5. Prison care centers

10.3.1.2. Individuals

10.3.1.2.1. Clinicians

10.3.1.2.2. Nurses

10.3.1.2.3. Physiotherapists

10.3.1.2.4. Volunteers

10.3.2. Consumers

10.3.2.1. Organizations

10.3.2.1.1. Private companies

10.3.2.1.2. Day care baby centers

10.3.2.1.3. Airport

10.3.2.1.4. Armed forces

10.3.2.1.5. Government

10.3.2.2. Individuals

10.3.2.2.1. Patients

10.3.2.2.2. Patients families

10.3.2.2.3. Researchers

10.3.2.2.4. Citizens

10.3.2.2.5. Employees

10.3.3. Supporters

10.3.3.1. Organizations

10.3.3.1.1. Technology Vendors

10.3.3.1.2. Health Insurance companies

10.3.3.1.3. Clinical Specialty Departments

10.3.3.1.4. Rehabilitation Centers

10.3.3.1.5. Technical Support Centers

10.3.3.2. Individuals

10.3.3.2.1. Engineers

10.3.3.2.2. Administrators

10.3.3.2.3. Application specialists

10.3.3.2.4. Care givers

10.4. OID

10.4.1. Object Identifier Domain

10.4.2. Identifier mechanism standardized by the International Telecommunication Union and ISO/IEC for naming any object, concept or thing with a globally unambiguous persistent name

10.4.3. Has a nod in the "OID tree" or Hierarchy

10.4.3.1. The format of each node in the tree is represented by a series of numbers separated by periods

11. Medical Documentation

11.1. Objectives in Patient care

11.1.1. Makes patient care more effective and appropiate

11.2. Objectives in Administration

11.2.1. Forms the basis for refunding, process planning and control

11.3. Objectives in Clinical Research

11.3.1. Allows patient selection and statistical analysis

11.4. Multiple use of patient data

11.4.1. computer-based data Management systems offer the possibility of the multiple use of data recorded once to be used for different objectives and tasks

11.4.2. Patient-group analysis

11.4.3. Distinction by content

11.4.3.1. Clinical Information

11.4.3.1.1. Is general based on patient-related data

11.4.3.2. Medical knowledge

11.4.3.2.1. Abstracts from individual patient and describes general insights

11.4.3.3. Healthcare system

11.4.3.3.1. Provide statistical information about healthcare system's infrastructure

11.4.4. Patient-oriented analysis

11.5. Clinical Data Management systems

11.5.1. Distiction by utilization

11.5.1.1. Patient -group analysis

11.5.1.2. Patient-oriented analysis

11.5.2. Distinction by level of standarization

11.5.2.1. Not standarized

11.5.2.1.1. It is useful to specify all the details or characteristics of a situation

11.5.2.2. Partly standarized

11.5.2.3. Mainly standarized

11.5.2.4. Fully standarized

11.5.2.4.1. It allows comparability of data objects at 2 levels

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