Scholia Tutorial Club

HISMT LECTURE REVIEWER

SECOND SHIFTING
By: Danica Yambao

FUNDAMENTALS OF INFORMATION SYSTEMS

Information System (IS)
• Arrangement of data (information), processes,
people, and information technology that interact to
collect, process, store, and provide as output the
information needed to support the organization
(Whitten & Bentley, 2007).
Health Information Systems
• Refer to any system that “captures, stores, manages
or transmits information related to the health of
individuals or the activities of organizations that
work within the health sector.”
Information Technology (IT)
• Contemporary term that describes the combination of
computer technology (hardware and software) with
data and telecommunications technology.
• Models in IT Computational Models for the Automation of Data
o Define the way we learn about the world, Interpretation:
interpret what we see and apply our
knowledge to effect change, whether that is
through our own actions or using technology
such as a computer.
• Data
o Raw facts.
o Building blocks of information.
o Must be formatted for storage, processing
and presentation.
• Knowledge
o Defines relationships among data.
• Information
o Produced by processing data.
o Requires applying knowledge to reveal
Components of Information Technology
meaning.
• Hardware

Data Interpretation Requirements

• Database
o Collection of data and its associated model. • Software
• Knowledge Base o Collective term for computer programs,
o Collection of rules can be thought of as a which are sets of instructions to computer
database containing elements of knowledge. hardware.
• Ontology o Two General Categories:
o Set of concepts understood in a knowledge ▪ System Software
base and how these concepts are arranged • Operating systems.
meaningfully. • Memory allocation.
• Rules of Inference ▪ Application Software
o Specify how a knowledge base can be • Detailed tasks.
applied to a database. • Task-specific.
 • Telecommunications
o Communication over distance, primarily
communication of bits representing many
forms of data and information.
• Networks
o Combination of devices connected to each
other through one of the communications
media (cables, radio waves, etc.).
o Types (according to reach and complexity):
▪ LAN
▪ WAN
▪ MAN
▪ PAN
• Database
o Collections of interrelated data that are
shared by many units and contribute to
productivity and efficiency.
• People
o Information systems professionals and users.
o Analyze organizational information needs,
design and construct information systems,
write computer programs, operate the
hardware, and maintain software.
• Procedures
o Rules for achieving optimal and secure
operations in data processing; procedures
include priorities in dispensing software
applications and security measures.
Types of Information Systems
• Operations Support Systems
o Its role include processing business
transactions, controlling industrial processes,
supporting enterprise communications and
collaborations, and updating corporate
databases efficiently.
• Management Support Systems
o It provides information and support for
decision making by all types of managers.
• Specialized Processing Systems
o It can support either operations or
management applications.
Systems Development Life Cycle (SDLC)
• Plan, Do, Control, Assess.
• Phase 1 Planning
o Review project requests.
o Prioritize project requests.
o Allocate resources.
o Identify project development team.
• Phase 2 Analysis
o Conduct preliminary investigation.
o Perform detailed analysis activities:
▪ Study current system.
▪ Determine user requirements.
▪ Recommend solution.
• Phase 3 Design
o Acquire hardware and software, if
necessary.
o Develop details of system.
• Phase 4 Implementation
o Develop programs, if necessary.
o Install and test new system.
o Train users.
o Convert to new system.
• Phase 5 Support
o Conduct post-implementation system
review.
o Identify errors and enhancements.
o Monitor system performance.
Information Systems Development Life Cycle
Data Resource Management ▪ Limit access to certain fields
• Entity depending on type of user.
o Any object about which an organization • Database Model
chooses to collect data. o Refers to the general logical structure in
o Types of People which records are stored within a database
▪ Employees and the method used to establish
▪ Students relationships among the records.
▪ Patients o Types
▪ Members ▪ Hierarchical Model
o Events ▪ Network Model
▪ Sales Transactions ▪ Relational Model
▪ Sports Events
▪ Machine Outputs
o Inanimate Objects
▪ Inventoried or For-sale Products
▪ Buildings
• Character
o Smallest piece of data.
• Field
o One piece of information about an entity.
• Record
o Fields related to the same entity.
• File
o Collection of related records.
• Database
o Collection of files that are kept together.
o Hierarchy of Data

▪ Object-oriented Model

• Database Management System (DBMS)

o A program used to build databases, populate
them with data, and manipulate the data.
• Queries
o Messages sent to the database to access data.
o Purpose:
▪ Display results.
▪ Manipulate data (adding, deleting,
and updating).
▪ Sort the order of the records.
• Reports
o DBMSs are usually bundled with report
generation module which can facilitate • Data Warehouse
queries and produce predesigned reports. o A large database that supports management
• Security decision making.
o Use of databases may raise security and o Contains data, or summaries of data, from
privacy issues. millions of transactions over many years
o Solution: provide restricted access. and/or from national or global transactions.
▪ Require login before accessing
database.
 Healthcare Data Management
• Process of storing, protecting, and analyzing data
pulled from diverse sources.
• Managing the wealth of available healthcare data
allows health systems to create holistic views of
patients, personalize treatments, improve
communication, and enhance health outcomes.
• Health data is many things.

• “Big Data”
o A magnification or expansion of the amount,
types, and level of detail of data that is
collected and stored.
o Involves high volumes of data compiled
from traditional, ordinary business activities,
as well as newer, nontraditional sources such
as social media.
• Outcome of Data Warehousing
o Data Mining
▪ The process of selecting, exploring,
and modeling large amounts of data
to discover previously unknown
relationships that can support
decision making.
▪ Data-mining software searches
through large amounts of data for
meaningful patterns of information.
o Online Analytical Processing
▪ Applications that respond to
commands by composing tables to
analyze different dimensions of
multidimensional data.

DATA MANAGEMENT SYSTEM

Difference between health data and health information:
• Health information is processed health data.
• Health care data are raw health care facts, generally
stored as characters, words, symbols, measurements,
or statistics.
Data and Information
• Data
o Facts concerning people, objects, vents or
other entities.
o Databases store data.
• Information
o Data presented in a form suitable for
interpretation.
• Knowledge
o Insights into appropriate actions based on
interpreted data.
Data Management
• Information Flow
• Data Collection and Management
• Patient Privacy and Confidentiality
• Computer Skills
Big Data in Healthcare Benefits of Healthcare Data Management
• Create 360-degree views of consumers, patients, and
households. Deploy personalized, guided interactions
by integrating data from all available sources.
• Enhance patient engagement with predictive
modeling and analysis based on healthcare data.
• Improve population health outcomes in specific
geographic areas by tracking current health trends
and predicting upcoming ones.
• Make informed, high-impact business decisions
based on data insights.
• Understand physician activity and align them with
the organization’s goals.
Data Sources of Health Care Quality Measures
• Administrative Data

o Financial Data
▪ Primarily public and private
insurance claims.
▪ Managed care plans, hospital
discharge datasets, and revenue
cycle management organizations.
▪ Released by Department of Health
and Human Services (HHS).

o Logistic Data
▪ Pertaining to several aspects of
patient care.
▪ Care-team composition and staffing
metrics.
▪ Resource Utilization
• Service metrics (e.g.,
inpatient, outpatient, and
 emergency department
visits).
• Medication usage.
• Performed diagnostic tests
and procedure.
o Quality Assessment
▪ Performance analyses of the service
providers (i.e., reviews of clinician
performance).
▪ Patient satisfaction surveys.
▪ Hospital quality measures.
o Advantages of Administrative Data
▪ Available electronically.
▪ Less expensive than obtaining
medical record data.
▪ Available for an entire population
of patients and across payers.
▪ Fairly uniform (and improving)
coding systems and practices.
o Challenges of Administrative Data
▪ Limited clinical information.
▪ Questionable accuracy for public
reporting because the primary
purpose is billing.
▪ Completeness.
▪ Timeliness.
• Patient Medical Records
o A patient's medical history and care.
o Increased the accessibility of patients’ files.
o To improve the ease and cost of using this
information for quality measurement and
reporting.
o Advantages of Patient Medical Records
▪ Rich in clinical detail.
▪ Viewed by providers as credible.
o Challenges of Patient Medical Records
▪ Cost, complexity, and time required
to compile data.
▪ Trained staff must manually
abstract information.
• Patient Surveys
o Self-reported information from patients
about their health care experiences.
o Reports on the care, service, or treatment
received and perceptions of the outcomes of
care.
o Advantages of Patient Surveys
▪ Captures types of information for
which patients are the best source.
▪ Well-established methods for
survey design and administration.
▪ Easy for consumers to understand
and relate to survey results.
o Challenges of Patient Surveys
▪ Cost of survey administration.
▪ Possibility of misleading results.
• Questions are worded
poorly.
• Survey administration
procedures are not
standardized.
• Sampling bias.
• Response bias.
• Comments from Individual Patients
o Anecdotal information, include any type of
information on health care quality that is
gathered informally as private Web sites
make it possible for health care consumers
to share their personal experiences with
health plans, hospitals, and, most
prominently, physicians.
o Advantages of Patient Comments
▪ Compelling to consumers to read
about other people’s experiences.
▪ Efficient means for conveying
information and influencing
people’s decisions and behavior.
o Challenges of Patient Comments
▪ Not an impartial assessment of
health care quality.
▪ Not representative of the patient
population.
▪ Likely to have an undue influence
on people’s health care decision
making.
• Standardized Clinical Data
o Detailed information about the status of each
patient at set time intervals
o The Minimum Data Set (MDS), the required
information for nursing homes, and the
Outcome and Assessment Information Set
(OASIS), the data required by Medicare for
certified home health agencies, store the data
used in quality measures for these provider
types.
 o Advantages of Standardized Clinical Data • Demographic Data
▪ Uses existing data sets. o Intrinsic
▪ Characterizes facility performance ▪ Physiological Characteristics:
in multiple domains of care. • Age
o Challenges of Standardized Clinical Data • Sex
▪ May not address all topics of • Height
interest. • Weight (to some extent)
Other Types of Health Data • Ethnicity
▪ May also include less obvious
characteristics, such as allergies:
food or medications.
o Extrinsic
▪ Often characteristics derived from
an individual’s environment and
lifestyle.
▪ May include:
• Address
• Marital Status
• Religion
• Employment (type,
location, and salary)
• Insurance Plan
• Wellness Data
o Commonly associated with fitness tracker.
o More recently: mHealth (mobile health).
o Electronic Medical Records
• Omics Data
o Broadly defined.
o Represents the study of information
contained within an individual’s genome and
the biological derivatives of these genes.
o Includes:
▪ Genes (Genomics)
▪ Gene Expression and RNA
(Transcriptomics).
▪ Proteins (Proteomics)
▪ Metabolites (Metabolomics)
▪ Lipids (Lipidomics)
o Pharmacogenomics has explored how omics
data can be utilized to identify the treatment
efficacy of various medications and
medication dosages for a particular
individual. • Clinical Data

o Diagnoses
▪ MIMIC provides two forms of
diagnosis information: ICD
Diagnosis and Diagnostic Related
Groups (DRG)
▪ ICD Diagnosis
• All codes are in the ICD-9
Standard.
• Ordered by priority.

o CPT Codes
▪ 5 digit codes.
▪ Diagnosis Related Groups (DRG) ▪ Three categories.
• Classification based on ▪ Category I
clinical factors and • Five-digit codes have
utilization of resources. descriptors which
• Two Types: All Payers correspond to a procedure
and Healthcare Financing or service.
Administration (CMS • Codes range from 00100-
DRGs) 99499.
• Patient classification ▪ Category II
scheme which provides a • Alphanumeric tracking
means of relating the type codes.
of patients a hospital treats • Used for execution
to the costs the hospital measurement.
incurs. • Often optional.
• Consist of classes of ▪ Category III
patients that are similar • Provisional codes for new
clinically and in terms of and developing
their consumption of technology, procedures,
hospital resources. and services.
• The All Patient DRGs • Codes were created for
(AP-DRGs) are an data collection and
expansion of the basic assessment of new
DRGs to be more services and procedures.
representative of non-
Medicare populations such
as pediatric patients.
• Each Base APR-DRG is
divided into 4 subclasses.
• Two types of subclasses:
Severity of Illness (SOI)
and Risk of Mortality
(ROM)
 ▪ Diagnosis codes are billing codes.
o Medications
▪ Extensive information is provided
for the medications offered to
patients:
• Dosage and Unit (1500
mg)
• Form and Form Unit (3
TAB)
• Route (IV or PO)
o Same Drugs, Different Names
▪ Since there are many forms of the
same drug, MIMIC provides:
• Generic Sequence Number
(GSN)
• National Drug Code
(NDC)
▪ RxNorm: platform which helps to
map these ingredients.
o Clinical Notes
▪ MIMIC provides detailed clinical
notes across a range of categories:
• ECG
• Respiratory
• Radiology
• Discharge Summary
• Rehab Services
• Nursing/Other
• Nutrition
• Pharmacy
• Social Work
• Case Management
• Physician
• Consult
o Microbiology and Lab Results
▪ Contains both in-hospital
laboratory measurements and out of
hospital laboratory measurements
from clinics which the patient has
visited.
▪ Contains:
• Value (can be non-
numeric)
• Unit (if appropriate)
• Flag (indicates whether
the value is considered
abnormal, using pre-
defined thresholds)
▪ Microbiology results capture data
from various cultures.
• Specimen which is tested
for bacterial growth.
• Organism that grew (none,
i.e. negative culture).
• Antibiotic testing.
o Chart Events
▪ This is by far the largest table in
MIMIC and contains an immense
array of information, reflective of
anything put into a patient’s
medical charts.
▪ Include:
• Patients’ Routine Vital
Signs
• Ventilator Setting
• Code Status
• Mental Status
• Small things like bed
adjustments, etc.
o Tracking a Patient
▪ Patients
• Every unique patient in
the database.
▪ Admissions
• Every unique
hospitalization for each
patient.
▪ Icustays
• Every unique ICU stay in
the database.
▪ Services
• Clinical service under
which a patient is
registered.
▪ Transfers
• Patient movement from
bed to bed within the
hospital, including ICU
admission and discharge.
▪ Callout
• Information regarding
when a patient was cleared
for ICU discharge and
when the patient was
actually discharged.
Data Quality in Healthcare
• The Characteristics of Quality Healthcare Data
o Data Accuracy
▪ Data that reflect correct, valid
values are accurate.
▪ Typographical errors in discharge
summaries and misspelled names
are examples of inaccurate data.
o Data Accessibility
▪ Data that are not available to the
decision makers needing them are
of no value to those decision
makers.
o Data Comprehensiveness
▪ All of the data required for a
particular use must be present and
available to the user.
▪ Even relevant data may not be
useful when they are incomplete.
o Data Consistency
▪ Quality data are consistent.
▪ Use of an abbreviation that has two
different meanings is a good
example of how lack of consistency
can lead to problems.
o Data Currency
▪ Many types of health care data
become obsolete after a period of
time.
▪ A patient’s admitting diagnosis is
often not the same as the diagnosis
recorded on discharge.
o Data Definition
▪ Clear definitions of data elements
must be provided so that current
and future data users will
understand what the data mean.
o Data Granularity
▪ Sometimes referred to as data
atomicity.
▪ Individual data elements are
“atomic” in the sense that they
cannot be further subdivided.
o Data Precision
▪ Precision often relates to numerical
data.
▪ Precision denotes how close to an
actual size, weight, or other
standard a particular measurement
is.
▪ Some health care data must be very
precise.
o Data Relevancy
▪ Data must be relevant to the
purpose for which they are
collected.
o Data Timeliness
▪ Timeliness is a critical dimension
in the quality of many types of
health care data.