Week 3 summary

1. 

Which of the following is NOT a challenge associated with EHRs?

Insufficient choices in the marketplace

2. 

Current EHRs:

Can create new problems for patient safety

3. 

MCIS Clinicals provides:

All of the above

4. 

Which of the following is NOT true about the Praxis EHR?

It presents Datum items pre-populated with the correct current value for each patient

5. 

Which of the following is NOT true of HealthVault?

It is a portal provided by physicians to their patients

6. 

Which of the following is NOT true?

The majority of providers using EHRs feel they improve patient communication during office visits

7. 

Which of these is NOT true about the TPO exception?

It allows providers to get Incentive Payments without achieving Meaningful Use

8. 

Which of the following is NOT true about de-identification of protected health information?

The Safe Harbor approach involves removing 123 key fields that could be used to re-identify the patient

9. 

What is data segmentation?

Separating the fields that the patient is willing to share

10. 

All of the above are true

Week 2 Summary

A patient arrives at a lab for their annual blood test as prescribed by their physician. Which coding system would most likely be used to describe the tests in an electronic report of their results back to the physician? LOINC

A patient is scheduled to be discharged from the hospital. Before they leave, the care team must send an electronic DOCUMENT to the patient’s physician so that the patient's care will continue without interruption or error. Which of the following is true of the standard that will most likely be used in this situation?

The latest version uses XML for formatting

Which one of the following is the most comprehensive data standard?

Snowmed CT

Only the following are health data standards. LOINC

NDC

ICD

Which of these data standards has simple numeric (up to 7 digit) codes but complex names for the coded entities divided into fields by a delimiter (e.g. : or ^)?

LOINC

Which one of these has three segments in its codes to identify vendors, medications and packages? NDC

Which is true about EDI? More compact

Which of the following might a physician use to code a patient's medical problems?

ICD-9/10

A FHIR Resource could be which of the following?

A JSON object

An XML object

One of over 100 possible object

FHIR Resources are accessed using:

An API

Health Informatics on FHIR

I'm taking this course offered by Georgia Institute of Technology, taught by Mark L. Braunstein, MD and I hope to share my class notes with all those interested. I'll also be taking other courses periodically and updating the blog as I go along.

Feel free to check out some of my notes and writings.

Health Data & Interoperability Standards

SNOMED-CT

Summary: 
Classifications vs. Ontologies
Basics of SNOWMED -CT

Classification: a list
Ontology: encompasses relationship among lists
- ICD-10, LOINC & SNOWMED-CT all include relationships

SNOWMED-CT relationships
Example: Heart Attack

311,000 concepts and 1.3 million relationships in this system. Very complex.

OID
Classifications of standard - ensure that operators know which database or system to be used/is using

MESSAGING STANDARDS

Outline:
Rationale for HL7 messages
Basics of HL7 messages
Recognize difference btween EDI/X12 (v2) and XML (v3)


Messaging standards - Hospital Order Entry/Results reporting

Sample message (EDI/X12) lab message from lab back to ward

Sample message (XML) same message
- easier viewing for people
- shown on browser (EDI/X12 before browsers existed)

DOCUMENT STANDARDS

Outline
Understand purpose of document standards
understand basics of HL7 CCDA


Key justifications: transition of care - errors made mostly between transfer from specialist to specialist. 80% of medical errors happened during the hand off between medical providers.

HL7 Consolidated Clinical Document Architecture

Objective data - physician done by inspecting patient.

Sections
 - entries

Reference Information Model of Healthcare (RIM)

Proposed stage 3 - providers must send electronic document for over 50% and receive 40%. Must use data in document to reconcile medications etc.

User interface. Can be used as portal for patients to see their own data too.

ADVANCED STANDARDS

Clinical Decision support
-  guide decisions for physicians and deliver most efficient care.

Example: ARDEN syntax

Blood thinner

Example: CIMI Clinical Information Modeling Initiative

Context management specification (CMS)
- Allow independent developed applications from many systems to synchronize and coordinate.


FHIR STANDARDS

Outline
Understand rationale for FHIR
Have basic understanding of web services and a simplified data model

To solve the problem of interoperability

Rise and Fall of HL7
- Eliot Muir: Complicated standards can be pushed for a while but ultimately market reject them. Even government will reject them." Cost too high. Too complex.

JASON AHRQ April 2014
- Should move to API based approach

FHIR - Fast Healthcare Interoperability Resources
- API (application programming interface) for exchanging Eletronic Heatlh records.
- Eaiser to implement because uses modern web-based suite of API technology
- represented by JASON or XML
- Can search patient, all of patient's problem
- Implication: can ensure real-time data gathering
- CRUD - create, read, update and delete


Example

Cool website - FHIR resource builder: http://clinfhir.com/

SMART on FHIR Apps

Arthritis App - get patient feedback, show trends and treatment effectiveness

Some also designed for patients: inform on risk etc.

Health Data & Interoperability Standards 1

Health Data and Interoperability Standards

Why is there a problem?

There is a problem because of the difference between syntax and semantics.

Example: National Drug Code system (FDA)

Medication is mainstay of all dieases so standardization across all of them is very important.

National Library of Medicine

–      RxNorm (RXCUI unique number) to access the drug names

–      UMLS – unified medical language system

Standards for Medical problems

Brief history: 

-                    Mid 1400 Northern Italy – Death certificates – name & age of deceased, cause of death certified by physician

-                    Black death 1629-1631: Death certificates used as source of data for analysis

-                    1661 London – Captain John Graunt interested in why children die – turned to death certificates to learn

-                    Massachusetts 1639 – death certificate made available for analysis

-                    London 1839 William Farr discovers interoperability

o   Each disease described in many ways, many terms (this is a problem!)

-                    London 1851 Great exposition, demonstrate top technology. Difficult to compare because no standards

-                    Chicago 1893, International List of Causes of Death (Bertillon Classification) He grouped disease by what we recognize today

-                    Denmark 1899, ICD (international classification of diseases) Decennial revisions, 10^th in 1994, first disease “ontonogy” US want to use it in Oct 2015, only advanced industrial country to not use it.

-                    ICD-10: Radical departure. Introduce content model to facilitate automatic coding of diseases. More specific and detailed.

Another example:

Result: vast increase in complexity. 16X more codes. Lots of complaints from providers.

Example:

 

LOINC Codes – Logical Observation Identifier Names and Codes

            - developed by Regenstrief Institude in Indiana, leading health information center in US.

Personalized Health - Ivey Whitepaper

Personalized health

Ivey Whitepaper

http://sites.ivey.ca/healthinnovation/files/2014/02/Personalized-Health-Systems-Exec-Summary-Feb24-final.pdf

Trends

1. Consumers getting more empowered - through apps

Lessons

1. Banking industry - personalized portfolio, multi-channel with online banking

Implications

1. Focus on patient not the procedure
2. Define value in terms of what people care about
3. Put people behind decisions
4. Tailor fit solutions to patients
5. Connectivity
6. More collaboration, less competition
7. Provide personalized health information - enable better decision making
8. Provide care differently to different segment