Standards of dental informatics, security issues, privacy and costs

Standards of dental informatics, security issues, privacy and costsDr Ebtissam Al-Madi

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Why are standards important inmedical informatics?Promote consistent naming of individuals,events, objects, etc.Allow better use of data for patient care,quality assurance, research, etc.Enhance ability to transfer data amongapplications, allowing better system integration

Benefits and limitations of standardsBenefitsInteroperabilityMay allow innovation based on common foundationLimitationsDominance by one segment of industry: Microsoft standards, e.g., Windows, Office, etc.May stifle innovation

The standards development process Groups agree to informal specificationsSingle vendor controls industryGovernment agency creates standard and mandates its use.Interested parties work in open process

International Organization for Standardization (ISO) http://www.iso.org/iso/home.html

ADA Standards Committee on Dental Informatics (ADA SCDI) http://www.ada.org/prof/resources/standards/informatics_reports.asp#a1031

International standards bodies

Medical informatics standardsIdentifiersTransactions Message exchangeTerminology

1. IdentifiersVarious approaches have been proposed forPatientsProvidersEmployersHealth Plans

Patient identifiers Unique only one person has a particular identifierNon-disclosing discloses no personal informationPermanent will never be re-usedUbiquitous everyone has oneCanonical each person has only oneInvariable will not change over time

Patient identifiersBenefitsEasy linkage of recordsFacilitate health information exchangeReduce errors and costs arising from duplicate recordsMedical record identifier errors compromise quality of care and can be costlyCost increases with length of time error not identifiedRisksEasy linkage of recordsPotentially compromise privacy and confidentiality

2. TransactionsTransaction standards are designed to encourage electronic commerce for health claims.HIPAA (Health Insurance and privacy act) mandates use of these standards for health care business electronic data exchange

Administrative simplification

Transactions standards coverHealth claims and equivalent encounter informationEnrollment and disenrollment in a health plan Eligibility for a health planHealth care payment and remittance advice Health plan premium payments Health claim statusReferral certification and authorizationCoordination of benefits

3. Message exchange standardsAllow data and application interoperabilityMajor standards includeHealth Level 7 (HL7)Digital Imaging and Communications (DICOM)IEEENCPDP and SCRIPTELINCSContinuity of Care Record (CCR)

4. Terminology standardsBenefits of computerization of clinical information depends upon its normalizationClinical language is inherently vague, which is at odds with the precision of computersComputers have no intelligenceComputers can only do what programmers and users tell them to doComputers process numbers and symbols very fast and accuratelyComputers have extraordinarily great memoryIt is up to humans to define the meaning or semantics of information represented in a compute

Standardized terminology Information capture documenting findings, conditions, and outcomesCommunication transferring informationKnowledge organization classification of diseases, treatments, etc.Information retrieval accessing knowledge based informationDecision support implementing decision support rules

Privacy, Confidentiality,and Security: Basic Concepts

Personal privacy vs. the common goodPersonal privacy is important.Common good of society is more important.

Where do your views fit?

Privacy right to keep things to yourselfConfidentiality right to keep things about you from being disclosed to othersSecurity protection of your personal information

Security IssuesWho owns information?How is informed consent implemented?When does public good exceed personal privacy?What conflicts are there with business interests?

Problems of Poor security Patients avoid health carePatients lieProviders avoid entering sensitive dataProviders devise work-aroundsDisclosure problems continue

Security for paper records Difficult to audit trail of paper chartFax machines are easily accessibleRecords frequently copied for many reasonsNew providers, insurance purposesRecords abstracted for variety of purposesResearchQuality assuranceInsurance

Technologies to secure informationDeterrentsAlertsAudit trailsSystem management precautionsSoftware managementAnalysis of vulnerabilityObstaclesAuthenticationAuthorizationIntegrity managementDigital signaturesEncryptionFirewallsRights management

Protected health information (PHI)NameAddress (street address, city,county, zip code)Names of relativesNames of employersE-mail addressFax numberTelephone numberBirth dateFinger or voice printsPhotographic images

Social security number Internet protocol (IP) addressAny vehicle or device serialnumberMedical record numberHealth plan beneficiarynumberAccount numberCertificate/license numberWeb URLAny other unique identifyingnumber, characteristic, or code

Costs of InformaticsHealth IT costs and return on investment (ROI)What do I get back (return) for the money I'mbeing asked to spend (investment)?Cost-benefit definedRatio of money value of benefit divided by costCost-benefit in the outpatient settingIncreased time for first 4 months but thereafter saved time that was either spent seeing more patients or reducing work hoursOnly a few practices implemented comprehensive quality improvement efforts, usually when insurers paid explicitly for it System payback achieved at average of 2.5 years.Factors associated with success includedNear complete use of system functionsHaving local EHR champion and supportive practice culture

Cost-benefit in integrated delivery settingLaboratory and radiology order entryReduction of time spent processing ordersPharmacy order entryReduced adverse drug eventsImproved cost savings through better formulary complianceDocumentationReduction in cost due to use of structured documentation in outpatient setting

Overcoming the economic obstaclesCentrally funded.GrantsFinancial incentives Tie into quality of care initiatives

This weeks assignmentsView this lecture online for review.Read article: How to write a term paperParticipate in discussion: Personal privacy vs Common good of society- which is more important.

ViewReadDiscuss

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Thank youDr Ebtissam Al-Madiealmadi@ksu.edu.saAny Questions?

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