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Survey of Medical Informatics CS 493 – Fall 2004 October 18, 2004 V. “Juggy” Jagannathan.

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Presentation on theme: "Survey of Medical Informatics CS 493 – Fall 2004 October 18, 2004 V. “Juggy” Jagannathan."— Presentation transcript:

1 Survey of Medical Informatics CS 493 – Fall 2004 October 18, 2004 V. “Juggy” Jagannathan

2 Review Chapter 1-6: Patient Safety - Achieving a New Standard of Care. IOM Report

3 Crossing the Quality Chasm: A new health system for the 21 st Century IOM Report that identified six major quality goals:  Safety  Effectiveness  Patient Centeredness  Timeliness  Efficiency  Equitable

4 Recommendation 1 Establishment of patient safety systems that rely on  Access to complete EHR and decision support tools at the point of care  Capture safety information – near misses and adverse events as a by-product of delivering care

5 Recommendation 2 Develop a National Health Information Infrastructure (NHII) that will serve as the foundation for all care Federal Government should provide incentives for the creation of NHII Healthcare providers should invest in EHR systems that support key capabilities facilitating safe delivery of care and implement a process of continuous improvement

6 EHR System Longitudinal collection of health information pertinent to care received by a person Access to any authorized person Knowledge and decision support tools Tools and infrastructure to provide efficient support for care delivery process

7 Recommendation 3 This recommendation focuses on roles and responsibilities of various government agencies  Department of Health and Human Services (DHHS) – to promote standards supporting patient safety  Consolidated Health Informatics (CHI) initiative with National Committee on Vital and Health Statistics (NCVHS) identify appropriate data standards and needs for standardizations  Agency for Healthcare Research and Quality (AHRQ) to oversee and support implementation efforts  The National Library of Medicine (NLM) to be the lead organization dealing with national clinical terminologies

8 Data Standards Data Interchange Formats  X12 – Administrative/Financial  HL7 – Clinical Data  DICOM – Medical Images  NCPDP – Prescription Data  MIB – Medical device data Coding/Terminologies  ICD, CPT, SNOMED, LOINC Knowledge Representations

9 Recommendation 4 Federal Government to encourage acceleration and adoption of standards in:  Clinical Data Interchange Eg. HL7 CDA  Clinical Terminologies Initially focusing on 20 priority areas  Knowledge Representation Develop standards for supporting evidence-based medicine practice and clinical guidelines

10 Recommendation 5 All healthcare systems should establish patient safety programs that:  Identify failures  Analyze failures  Redesign processes to prevent such failures from happening again

11 Recommendation 6 The federal government should pursue an applied research agenda that focuses on:  Knowledge Generation Identifying patients at high risk Analyze near-misses to improve overall safety Hazard analysis – retrospective and prospective techniques Identifying approaches that work the best Identifying the role of the patient  Develop tools To support early detection, prevention, data mining techniques  Dissemination Knowledge and tools

12 Recommendation 7 Entrust AHRQ with developing:  Adverse and near miss events taxonomy  Standardized format for reporting such event  Identifying data elements that needs to be used in such reporting and use of Eindhoven Classification Model – Medical Version  Clinical context documentation


14 From IOM Report, pg 57

15 European Standards and overlapping efforts Comite’ European de Normalisation (CEN)  ANSI counterpart in Europe Significant overlap in standards body roles and responsibilities (Table 3-1 – page 102) Standards in US are formulated by voluntary participation by vendors and providers Europe, Japanese, Australian and others rely on government funds to establish standards for their country.

16 Terminologies Over 150 terminology systems in use Very little standardization – not interoperable International Classification of Diseases [ICD] Box 3-2 – pg 104

17 CCOW – Visual Integration The Provider's Workstation “Data” Integration The Clinical Applications Server Visual Integration * Acknowledgement: Slide provided by Wes Rishel, Gartner Group The Provider

18 The Reference Information Model Act – something happened or may happen. Any action of interest. Entity – a person, animal or organization or thing Role – a part played by an entity Participation – the involvement of a role in a act Act_Relationship – a relationship between two acts Role_Link – a relationship between two Roles

19 Healthcare Standards Technology solutions Sample CDA Document

20 HL7 EHR Functional Model* Care Management II7.0Workflow Ops Mgt & Comm Care Management II6.0Business Rules - Administrative Functions II5.0Interoperability Ops Mgt & Comm Care Management II4.0Support for Health Informatics & Terminology Standards II3.0Unique Identity, Registry, and Directory Ops Mgt & Comm Care Management DC3.0Ops Mgt & Comm DC1.0Care Management S3.0Admin & Financial S2.0Measurement, Analysis, Research, Reporting S1.0Clinical Support Direct Care Direct Care Supportive Information Infrastructure Information Infrastructure DC2.0Clinical Decision Support Ops Mgt & Comm Care Management II2.0Information and Records Management II1.0Security * Slide courtesy of Dr. Don Mon, Vice President of AHIMA

21 Criteria for terminologies Technical Criteria used by NCVHS for evaluating and selecting terminologies  Page 145 – Table 4-2 CHI focus areas  Page 146 – Table 4-3

22 Overview of Core and Supplemental Terminologies Box 4-1  Pages 150-151 Figure 4-4  Page 157

23 Figure Source Material: Oliver Bodenreider: “The Unified Medical Language System (UMLS) integrating biomedical terminologies,” Nucleic Acids Research, 2004, Vol. 32, Database issue D267-D270 National Center For Biotechnology Information Online Mendelian Inheritance in Man University of Washington Digital Anatomist Gene Ontology


25 Clinical Guidelines National Guideline Clearinghouse  contains 1,000 publicly accessible guidelines  Box 4-2 pg. 159 Comparison of these representative schemes   gi?artid=150359 gi?artid=150359

26 Safety A model for introducing safer care  Pg 179 – Figure 5-1  Retrospective reviews based on ICD-9 CM discharge codes and External Causes of Injury Codes (E-Codes)  Pg 182 – Figure 5-2  Pg 183 –Table 5-1

27 Automated review approach Four different approaches:  ICD-9 codes  Reports of new allergy  Rule-based Box 6-2 rules for detecting ADEs., page 207  Data mining of textual reports Diuretic drug  fatigue could be a potential adverse event Box 6-3, page 208

28 Near miss Phases  Initial failures  Dangerous situation  Inadequate defenses  Recovery Figure 7-1 pg 228

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