technology 101 and health information technology (hit)

8/7/2019 Technology 101 and Health Information Technology (HIT)

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MPH 210Public Health Informatics

Lecture 2: Technology 101


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Part 1:Technology Basics


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Information technology basics

Personal computers and servers

Computer basics - operating system, application,networking

Internet basics - tcp/ip, messages, data exchange

Databases 101 - storing information


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Computer Types

Desktop (PC), laptops

PDA

Server


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CPU centralprocessing

unit

Motherboard

PC internal view

Integrated

Circuit

Computer anatomy


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6 Computers softwareBIOS Basic Input/Output System

Low-level program that interfaces the CPU with its eyes and ears

(keyboard, mouse, drives)Manages control of the hardware that is attached to themotherboard/CPU (disk drive, keyboard, speaker, video card,etc..)

Loaded from an onboard chip that comes with the computer(cannot be erased)

Operating System

Medium-level program that provides more sophisticated controlover storage devices (drives), memory allocation, video, audio byhigher level programs

Typically is the brains of the computer must be read/loadedfrom a fixed disk each time the computer is turned on (can beerased)


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System.out.println(Hello World);

IDENTIFICATION DIVISION.

PROGRAM-ID. HELLO-WORLD.PROCEDURE DIVISION.PARA-1.

DISPLAY "Hello, world.".STOP RUN.

Applications

Application

A high-level program developed for specific functional purposes

(word processors, spreadsheets, web browsers, web servers, emailservers, etc..)

Interacts with the operating system to read/write data to devicessuch as the disk drives, USB memory sticks, video, printer, etc..

It is often operating system specific because it needs to interactwith all these devices, which are controlled by the operating system

you cant run a Mac program unmodified on a Windows machine

Applications are written in a programming language, which is anenglish-like syntax used to command the operating system to docertain things


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programprogram compiledcompiledprogramprogram

compiler

run program

programmer writesa program

Programs...


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9 Internet basicsThe Internet a collection of computers connected overphysical connections and using TCP/IP to communicate

TCP - Transmission Control Protocol

TCP enables two hosts to establish a connection andexchange streams of data. TCP guarantees delivery of dataand also guarantees that packets will be delivered in thesame order in which they were sent.

IP - InternetProtocol. IP specifies the format of packets, alsocalled datagrams, and the addressing scheme. IP is combinedwith TCP, which establishes a virtual connection between adestination and a source.


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server

client 1000111011001

server

server

client

TCP/IP =negotiatesinformation

transfer


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HELO

RETR 1

+OKmail

server

POP3

+OK

This is a dummy email.

DEL 1 +OK


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Database systems

Flat-file text databases (with storage/retrieval software)

Associative flat-file databases such as Berkeley DB

Relational databases

Object databases

Hierarchical databases such as MUMPS, a commonly used systemin healthcare even today


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Database managementsystems

A database management system (DBMS) is a collection ofsoftware which can be used to create, maintain and work withdatabases.

Most common DBMS today relational database systems (Oracle,Sybase, MS SQL, etc..)

SQL Structured Query Language

English-like language used to manipulate relational DBMSsystems

Example


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Hierarchical databases

Hierarchical databases organize data in tree-like structures

Parent-children structure

Examples

MUMPS

Berkeley DB


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Relational databases

Systems that use a relational model for organizing information - rows/columns

Examples

Oracle

Sybase

DB2

MySQL

PostgreSQL

Microsoft Access


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Healthcare IT (HIT)

Information technology used to improve

health quality and improve efficiency

prevent medical errors

optimize diagnosis and therapy (DSS)

decrease paper processesdisease management


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Uses of IT in healthcare

Electronic medical records

Imaging (digital radiology, digital pathology)

Electronic financial transactions

Administrative systems

Clinical Research - clinical informatics

Basic Research - bioinformatics

Public Health - public health informatics


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Computer-based Patient Records: An Essential Technology for Health Care

What is an EMR?

Electronic Medical Record System vs. Computer

Based Patient Record SystemComputer-based Patient Record System(CPRS). "The set of components that form themechanisms by which patient records arecreated, used, stored and retrieved...It includes

people, data, rules and procedures, processingand storage devices, and communications andsupport facilities


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A focus on the EMR

a medical record in digital format

Are all EMRs the same? Everyone talks like they are the same, but are they?

What is an EMR? Outpatient (ambulatory records) vs. Inpatient, has the hospital implementedall components? What to implement first?

Functional viewpoint - what does your EMR do for you?

Results reporting - text, digital images

Medical Management

Clinical documentation

Communication

Order Entry - CPOE

Clinical Decision Support Systems (CDSS)


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Blum, West J Med. 1986 December; 145(6): 791797.

Clinical Information Systems- how modern are they?


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Adoption statistics

DesRoches et al (NEJM,2008)

~2500 physicians surveyed(62% res rate)

4 % had a fully functionalsystem

13% had a basic system


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Simon et al (JAMIA, 2007)

1,345 surveyed ( corresponds to a 71% response rate)random sample of Massachusetts practices

45% of physicians using EHRs

23% of practices had an EHR

Practices with >7 had 52% adoption, solo practitionershad 14% adoption


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Simon et al

(J. of Evaluation in Clinical Practice, 2006)most common functionality

notes

lab results

medication lists


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Barriers to adoption

Simon et al (J. of Evaluation in Clinical Practice,2006)


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Costs

Roughly $30,000 - $50,000 per physician as a

start up, then 20% of that annually to supportit

Predicted break even point has beencalculated as anywhere between 3-12 years.

2002 study - 280 bed hospital, 16 outpatientclinics, ~400 physicians = $19 million


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ADEs

Adverse Druge Events (ADEs) - estimated

770,000 people annually are injured or diein hospitals from ADEs

28% of ADEs are due to medication errors(judged to be preventable)

Of preventable ADEs, 56% happened duringdrug ordering

Kaushal, Shojania, and Bates. Arch Intern Med. 2003;

163:1409-1416


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CPOE

Computerized Physician Order Entry (CPOE)

Overhage et al (1997) - 25% improvement in ordering medicationsby faculty and residents

Bates (1998) - 6,771 adult inpatients. 55% decrease in non-intercepted serious medication errors

Bates (1999) - 1,817 adult inpatients. 81% decrease in medicationerrors

Chertow (2001) - 7,490 adult patients with renal disease. 13%decrease in wrong dosing, 25% decrease in wrong frequency

Kaushal, Shojania, and Bates. Arch Intern Med. 2003;163:1409-1416


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90% adoption of health IT could result in$35 billion -140 billion annual productivitysavings

If effect of HIT is 1.5 %productivity increase(effect of IT on retail

industry)

If effect of HIT is 4% productivity improvement(1/2 that of what telecomm experienced with

IT use)

35

billion

perye

ar

107

billion

perye

ar


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Failures in Healthcare IT

Cedars Sinai Medical Center (Los Angeles) -- administration forced to scrap aCPOE ($34 million) due to physician dissatisfaction with the system

Upwards of 30% of EHR implementation attempts have failed over the pastfew years [National Health Information Network Co-ordinator, David Brailer]

In general, 20-30% of Information technology projects are canceled beforethe produce anything [ CHAOS Study, 2006]

Dr. Brailer's own Santa Barbara County Care Data Exchange, and the basisfor the Regional Health Information Organization (RHIO), failed for a variety

of reasons including poor project management, technical challenges, and afailure to evolve to a sustainable business model


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Meaningful Use

Stage 1 - primarily focuses on collecting electronic health datain coded formats

Stage 2 - focuses on implementation of structured dataexchange and continuous quality improvement

Stage 3 - focuses on advanced decision support and populationhealth

Incentive Payments

Eligible providers (EPs) - up to $63,750 over 6 years underMedicaid

Hospitals - $2 million per hospital

technology 101 and health information technology (hit)

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