1. MEDICAL INFORMATION SYSTEMS Electronic Healthcare Record

2. 1. MEDICAL INFORMATION 1.1. TYPES OF ACTIVITY a. MEDICAL ACTIVITIES (CONSULTATIONS, VISITS) Different approaches: Time orientedTime oriented Patient orientedPatient oriented Problems oriented (Simptoms, Objective, Assesment, Plans - SOAP)Problems oriented (Simptoms, Objective, Assesment, Plans - SOAP)Steps: DIAGNOSINGDIAGNOSING –DATA - MEDICAL OBSERVATION, INVESTIGATIONS –KNOWLEDGE - EDUCATION, ETC THERAPY / FOLLOW-UPTHERAPY / FOLLOW-UP NURSINGNURSING

3. b. LOGISTIC SUPPORTT ADMINISTRATIONACCOUNTING c. SOCIAL CONTEXT FRAME MEDICAL DATA CENTRALISATION d. MEDICAL EDUCATION (CME) STAFFPATIENTS e. MEDICAL DOCUMENTATION f. MEDICAL RESEARCH 1. MEDICAL INFORMATION

4. 1.2. CYCLES OF MEDICAL INFORMATION FLOW

5. PRIMARY CAREPRIMARY CARE SECONDARY (SPECIALISED) CARESECONDARY (SPECIALISED) CARE HOSPITAL - HEALTHCARE UNITSHOSPITAL - HEALTHCARE UNITS CENTRAL LEVELS :CENTRAL LEVELS : –COUNTY HEALTH DEPARTMENTS –NATIONAL LEVEL: HEALTH MINISTERY –INTERNATIONAL BODIES: WHO 1.3. Medical activities organisational levels

6. 1.4. DEFINITIONS a. INFORMATIONAL SYSTEM = ensemble of structural units exchanging information between them b. INFORMATION SYSTEM = that part of the informational system which comprises computer use

7. Fluxul de informaţii în cadrul Sistemului Naţional Informaţional din Sănătate

8. Terminology CPR (computer-based patient record) PCR (patient-carried record) CMR (computerized medical record) EMR (electronic medical record) EPR (electronic patient record) EHR (electronic healthcare record)

9. Integrated Care EHR ISO/DTR 20514 : a repository of information regarding the health of a subject of care in computer processable form, stored and transmitted securely, and accessible by multiple authorised users. It has a commonly agreed logical information model which is independent of EHR systems. Its primary purpose is the support of continuing, efficient and quality integrated health care and it contains information which is retrospective, concurrent and prospective.

10. Challenges facing today’s health record systems  The need to record more data  The need to analyse more data  The need to share more data

11. University Hospital of Heidelberg: 400000 new medical records per year 6.3 million pages 1,7 km of storage 250000 reports generated

12. to observe trends and patterns within the historical record of one patient to enable the use of clinical guidelines and decision support tools: evidence based health care to perform clinical audit to inform management and commissioning decisions to support epidemiology, research and teaching The need to analyse more data

13. Share more healthcare data with other clinicians in the same team –clinical firms, practice partnerships or nursing shifts with other healthcare professions –doctors, nurses, physiotherapists, midwives, dieticians... with other disciplines –a diabetic patient may also be under: ophthalmology, nephrology, orthopaedics, chiropody, wheelchair clinic.. with other institutions with patients and their families

14. The mains advantages of EHR Reducing the storing space of the medical data Facilitate researches activitiesFacilitate researches activities Standardized environment for medical data evidence, based on efficient Database Management SystemsStandardized environment for medical data evidence, based on efficient Database Management Systems Great level of data integration between different segments of information healthcare systems.Great level of data integration between different segments of information healthcare systems. Increasing the quality of healthcare by the informational support provided to local and central administrative structures.

15. EHR adoption barriers Technical limitation the dataTechnical limitation for assuring the security, integrity and accesibility of stored data Concerning about the records ownershipConcerning about the records ownership Big initial costs for implementation The lack of operate abilities and trust in computerized systems from the medical stuff and the changing resistance Low diversity of the quality EHR systems Lack of universal recognized quality standards and adequate legal framework

16. Core Functionalities for an Electronic Health Record System Health information and data management Results management Order entry/management Decision support management Electronic communication and connectivity Patient support Reporting and Population Health Management Administrative processes

17. EHR ARHITECTURE Object oriented, relational DBMS Interoperability - transport of information over: –Time –Space –Context, Communities, and Cultures

19. Logical building blocks of the EHR: FOLDER COMPOSITION –Tranzactional unit –Contribution –all compositions created/modified during a session HEADED SECTIONS - data segments for navigation purposes ITEM – single clinical "statement"

21. The Record attributes PacientPacient identification Medical stuff identification Utilized standards identification The Name of the parameter measured/observedThe Name of the parameter measured/observed The value of the parameterThe value of the parameter –[measure unit] –value [measured] –[normal value] data / time stamp Observation circumstancesObservation circumstances

22. The “Core” EHR Key characteristics: Concerns a single subject of care Primary purpose is the support of present and future healthcare of the subject Principally concerned with clinical information Simplifies standardization of the EHR has a clear, limited scope enabling a manageable set of requirements to be specified and a manageable standardized model to be defined Fits more closely with the distributed systems or “system-of-systems” paradigm Allows more modular health information systems to be built

23. The “Extended EHR” Includes not only clinical information but essentially the whole health information landscape. It is a superset of the Core EHR Extended EHR functions beyond the scope of the Core EHR include: – Patient administration – Scheduling and resource allocation – Billing – Decision support – Access control and policy management – Demographics – Order management – Population health recording, querying, and analysis – Health professional recording, querying, and analysis – Business operations recording, querying, and analysis

24. User view: functional grouping of data Demographic and general data –Name, gender, date of birth, picture.. –Residence and contact data –Current job, education –Insurance condition Alerts – allergies, special conditions (pregnancies) Current medication Vaccines Consultations –SOAP –Schedule Surgical interventions Reports Healthcare costs

25. OMS 1623/2004 Setul minim de date la nivel de pacient (SMDP)

26. Standard definition ISO/IEC defines a standard as a document, established by consensus and approved by a recognized body, that provides, for common and repeated use, rules, guidelines or characteristics for activities or their results, aimed at the achievement of the optimum degree of order in a given context

27. STANDARDS Standard Attributes (SMART): S = specific M = measurable A = acceptable R = realistic T = time related Standard Organizations –ASRO – Romanian Association for Standardisation (TC 319) –CEN - Comité Européen de Normalisation –CEN/TC251 – Medical informatics Technical Committee –ANSI - –ANSI - American National Standards Institute –ISO -. –ISO - International Organization for Standardization.

28. Standard Organizations 28 ASRO

29. ISO DTR 20514 - EHR definition and scopeISO DTR 20514 - EHR definition and scope ISO TS 18308 - EHR RequirementsISO TS 18308 - EHR Requirements CEN TS 14796 - Data TypesCEN TS 14796 - Data Types CEN/TC 251 EN 13606 - EHR CommunicationsCEN/TC 251 EN 13606 - EHR Communications HL7 - EHR Functional SpecificationHL7 - EHR Functional Specification HL7 - Templates specificationHL7 - Templates specification HL7 - Clinical Document ArchitectureHL7 - Clinical Document Architecture DICOM – Digital Imaging and Communications in MedicineDICOM – Digital Imaging and Communications in Medicine EDIFACT, XML – Messaging standardsEDIFACT, XML – Messaging standards

30. DATA PROTECTION DATA PROTECTION a) CONFIDENTIALITY - limited, leveled accessibility b) PROTECTION - against accidental deterioration / access / loss c) SECURITY - intended d/a

31. EHR exemples OfficeMed ver 1.60 –Integrated system for family physicians (GP) Conform to CoCa 2003 FoxPro / MSDOS “Programul este agreat de Direcţia de sănătate publică Bistriţa Năsăud” Medins –GP –MEDINET

32. INFO WORLD HL7 DICOM “... soluţiile oferite au fost dezvoltate conform celor mai noi standarde în domeniu, precum HL7 şi DICOM” Hospital Manager SuiteHospital Manager Suite CabiMed – GPCabiMed – GP Cabinet Manager – ambulatory healthcare systemCabinet Manager – ambulatory healthcare system. ePractice – EPR systemePractice – EPR system