Chapter 14

The Need to Establish Health Informatics Standards

- Because there is a very little coordination and sharing of data between inpatient care and
outpatient care, thus it creates diversity in healthcare process. Standardization must
carefully establish first.
- There should be standard data requirement, standard data format, standard data reporting,
and standard data repository.
- Advance tool must be included such as clinical workstation and decision-support system.
- There should be simple identifiers for users, nurses, health care providers and healthcare
staff. Issuing identifiers to nurses, healthcare users, facilities management staff, and other
healthcare providers for maintaining database of identifying information and for authorizing
access to such information.

Establishment of Standard Clinical Vocabularies for Information System

- Vocabularies play a strategic role in providing access to computerized health information
because clinicians use a variety of terms for the same concept.
- For example “Ptriasis Rosea” layman’s term skin rashes
- Standard vocabularies are not means of encoding data for exchange, translation,
comparison, assessment and validation.
- But they are means of encoding data for exchange, translation, comparison, assessment
and validation because in automated system cannot recognize these medical to translate
equivalent terms.
- Data vocabulary translator or just a simple lookup table will help the healthcare provider
to fully understand such medical terms and it will enhance the data storage system and data
processing.

Establishment of Clinical Standard Units for Information System

- These units are already been in useful to us but there are various standards that still very
common to the society, such as the use of inches instead of centimeter, feet/foot rather
than meter, pounds than kilogram in many healthcare forms and tables.
- Standard units are a means of encoding data for exchange, translation, comparison,
assessment and validation.
- Standards are a recognized way to improve transaction, optimize performance and
capabilities, increases production efficiency and enhance effectiveness of the system

Developing Clinical Standards

- The holistic objective of every healthcare professional is quality of serve, timely delivery of
assistance and effectiveness of the support. Also with basic initiatives like evidence-based
medicine, quality monitoring and improvement, reduced medical errors, reduced
administrative and delivery costs.
- Without such standardized infrastructure the service being given to the patient is limited,
costly, protracted ways and the quality of service is not optimized properly.
- Structure versus un-structured standards

Structure of Data Interchange Standards

- Standard data propelled at each department through a push or pull system and will be sent
to the data warehouse system.
- DWS will arrange all the relevant data into a single table
- The users will just simple select the file through a structured query system (SQL)

Structure of Data Query Process

 - Standard data sent by every department will be processed independently by software that
will translate the data into information.
- Once information are available the nurses, healthcare provider and other healthcare staff
can access the data
- Only users with proper access code ( identifiers) are required to download data
- Users of every department can use structured query system (SQL)

Structure of Data Fetching Standards

- generally based on the ability of a computer to fetch and store data at any place in
its memory, specified by a pointer—a bit string, representing a memory address, that
can be itself stored in memory and manipulated by the program.

Structure of Standard Data Format and File Name

DD O/I Pu/PR YYYMMDD_HHMMSS
department Out/inpatient Public/Private Date/TIME
- other structure that should be standardize
- data file path
- data repository
- data warehouse folder, tables and selection process
- data content, messages and reports

Chapter 15
Electronic Health Record
- Electronic Medical Records or Computerized patient records
- Found more useful when the number of data being processed are highly prioritized or a
large data are being stored.
- It provides the ability to manage health information using modern information techniques
that are impossible to apply to paper record keeping.
- It provides the tools that can be used to begin to solve problems such as missing or
misplaced charts, paper-based laboratory reporting, illegible handwriting, without access to
their own medical information if the provider can’t manage their information.
- It has a repository of electronically sustain information and data of every patients
transactions, health condition, medical records and other pertinent information’s
- It is capable of remote storage and retrieval often over a computer network or system.
- EHR is made up of electronic medical records (EMR) from the different departments such as
Nurse Department, laboratory department, pharmacology department etc.
- It adds information management tools to provide clinical reminders and alerts, linkages with
knowledge sources for health care decision support and analysis of aggregate data both for
care management and for research.
- Only concern with EHR is that it does not support statistical information system

Structure of an Electronic Health Records System

- When the data are stored on a secure network, authorized clinicians with a need to know
can access them from the office, home, or emergency room to make timely informed
decisions.
- Reusability of data is also one of the capabilities which promotes efficiency and
effectiveness of the system

Issues and Concerns of HER

- Conversion of paper-based data into electronic format
- More pronounce when the converted data is not complete or not in standard field.
- Digitizing a hard printed data
- Additional scanner with optical character recognition software is needed to convert the data
into electronic format.
 - Scanned materials may exist in many formats, sizes, media types and qualities.
- Note: they should implement with a correct and standard format

Types of Data Stored in EHR

- Patient profile
- Results of Medical examination
- Development of health condition and status
- Results of laboratory test
- Information about allergies, illness, immunizations, disorder, diseases
- Medicine taken and its compatibility with drug interaction
- Records of appointments
- Billing records

Issues in Electronic Health Records System

- Integration and synchronization of historical records and incoming records
- Readiness of the patient profile system
- Continuing preservation of data warehouse and its associated facilities
- Purchasing of computer system, specialized networking and communication system and
sophisticated software
- Preservation of integrity of security of data
- Conversion of historical data into electronic data
- Continuous updating of storage capacity
- Computer system may experience short term crashing, bugs, virus etc.
- Start-up costs and software maintenance costs
- Additional manpower to support the computer-based process
- Responsibility and ownership of EHR
- Data can be altered
- System crashes

Workflow Implications
- Varies in type of patient care facility and professional responsibility
- Increased in efficiencies, optimized hospital operations and capabilities, improved accuracy,
promotes suitability and productivity.
- As health professionals who use the EHR will spend less time updating data, statistical
calculation can be performed with hard math equations
- Patient profiling can be made easily
- With the help of EHR healthcare provider could focus more on the quality of service and
care to the patient and customers.

Continuous Communication with Patients

- It is important to remember that there is no substitute for face-to-face interaction which is
why it’s still part of the day to day process of a nurse and healthcare provider to the patient.

Chapter 16
Dependability of Health Information System

Dependable System
- Is the measure of the reliability, integrity and performance of the system
- Is defined as the trustworthiness of a computing system which allows reliance to be
justifiably place on the service it delivers.
- Availability performance and its influencing factors: reliability performance, maintainability
performance and maintenance support performance
- It measures the effectiveness of the healthcare delivery, quality of care through the use of
health information system.
 - Encompasses the reliability, integrity, confidentiality and security of the data, information
and the process.

Factor that affects Dependability of Systems

1. Error
- Discrepancy between actual results and behavior from the expected or the reference
condition or expected performance.
- Incorrect reading is registered in the measuring equipment, the measuring device is
malfunctioning unnoticeably, mishandling of data, incorrect reading of data, a potential bug
is existing in the program
- BP for systolic and diaslotic readings
- Temperature in degree Celsius or Fahrenheit
2. Fault
- Due to computer program bug which is considered as defect in a system
-
3. Failure
- A condition in which the system performs unnecessarily or the function is contrary to its
specifications or the expected condition