1 Health Care Data: Acquisition, Storage, and Use Yaseen Hayajneh, RN, MPH, PhD

2 Objectives Student will discuss: Nature of Health Care data Uses of Health Care data Drawbacks of traditional patient paper record

3 Data in Health Care Observation, collection & interpretation of data has been central to providing health care. Observation, collection & interpretation of data has been central to management. Data is central to decision making. Raw Health Care data are voluminous and heterogeneous.

4 Health Care Data Health Care datum = any single observation of a patient. Defined by 4 elements patient in question parameter being observed value of the parameter in question time of the observation Uncertainty (more data vs. cost, risk, time) Health Care data = collection of such observations

5 Types of Health Care Data Narrative, textual data HPI, social/family Hx, gen’l review of systems loosely coded (“PERRLA”, “failure to thrive”) Numerical measurements lab results, vital signs, measurements Recorded signals e.g., ECG (graphical tracing) Pictures e.g., radiology images, sketches

The Data Continuum videoimagesignaltextcodes ContinuousDiscrete

7 Who Collects Data Physicians, nurses Office staff and admissions personnel Physical or respiratory therapists Laboratory personnel Radiology technicians, radiologists Pharmacists etc technological devices (e.g., ICU monitors)

8 Weaknesses of the Traditional Patient-Paper- Record System Pragmatic and logistical issues able to find needed data when need arises able to find patient record in which data recorded able to find data within the record able to find quickly able to read and interpret found data able to reliably update data w/new observations suitably for future access by self and others Redundancy and inefficiency

9 Weaknesses (con’t) Influence on clinical research Retrospective chart review to investigate a question that was not a subject of study at the time the data were collected laborious and tedious Prospective study-randomized, double-blind clinical hypothesis is known in advance research protocol designed specifically to collect future data relevant to study question Passive nature of paper records

10 The Computer and Health Care Data Collection Role of computer in Health Care data storage, retrieval, and interpretation Need for data entry by physicians data entry/retrieval by clerical staff automatic entry by device that measures or collects data direct entry by patients specialized devices to allow rapid and intuitive operator-machine interaction for physician and other health personnel use

11 Access to Health Care Data In general, information from a person's health records cannot be disclosed to an employer unless the patient specifically authorizes the disclosure. Patients can review their health records and request changes to correct errors. Researchers can use records to track an outbreak of disease if they strip the records of the patients' names, addresses, Social Security numbers and other "direct identifiers."

12 Uses of Health Care Data Form the basis for the historical record Support communication among providers Anticipate future health problems Record standard preventive measures Identify deviations from expected trends Provide a legal record Support clinical research

13 Uses of Health Care Data 2 Patient care: summary, trend comparability of data trending of data time representation Financial Reporting Accounting Inventory

14 Uses of Health Care Data 3 Management Quality assurance - Case management Information transfer (messaging) transfer to repository State reporting Clinical research epidemiology - symptoms, incidence, history of disease outcomes - effectiveness of therapy, ideal length of stay

15 Uses of Health Care Data 4 Expert systems Knowledge base construction Case abstraction Automated decision support Information retrieval Extraction of relevant data Conversion to index vocabulary Vocabulary discovery

16 Data Repository Clinicians: Physicians, Nurses, Pharmacists, …. Non Clinicians: Insiders ResearchStudents Payers Policy Management