1. WEEK #1 KARL GUMPPER, RPH, BCPS, CPHIMS, FASHP Understanding the IT Foundation: the importance of general components of system utility, reliability and information systems structure

2. What are all these abbreviations? CPOE BCMA POC CCHIT ONC HITSP AHIC HIMSS AMIA eRX ADC/ADM AHRQ NHIN RHIO HL-7 RxNorm SNO-Med CDSS EHR PHR NCPDP X-12 CCD/CCR ICD-10

4. What is Informatics? What IS Informatics?  Cross-training  Profession = medical, pharmacy, nursing, etc  Basic sciences = information, computer, cognitive, and organizational science, etc  Informatics = Practice + Basic sciences  Fundamental value / theorem  Pursuit of assisting people who work to improve health through appropriate use of information technology  Steps of understanding “Tower of Achievement”  Model formulation > System Development > System Deployment > Study of Effects Friedman CP. What Informatics is and isn’t. J Am Med Inform Assoc. 2013;20:224- 226.

5. What is Informatics? What is NOT Informatics?  “Tinkering with computers”  Analysis of large datasets (epidemiology)  Health Information Management  Anything done with a computer  Focused roles for deploying or configuring EHRs  Lack of cross-training or understanding the “Tower of Achievement” Friedman CP. What Informatics is and isn’t. J Am Med Inform Assoc. 2013;20:224-226.

6. What is Informatics? Biomedical Informatics Translational & Clinical Informatics Health Informatics Bioinformatics Pharmacy Informatics Basic Research Applied Research Practice People Ideas Software Medical Informatics (Providers) Health Information Technology Hospitals & Health Systems, Practices Clinical Software Systems Vendors Hardwar e Nursing Informatics

7. Definitions Integration: seamless interaction of various applications from a single vendor that forms a larger more complex system. Does not need interfacing to allow them to pass information between the applications. Pharmacy examples of integrated systems: Cerner, Eclipsys, MEDITECH, etc. Real world example: Microsoft Office McManus M et al. Suggested definitions for informatics terms: Interfacing, integration, and interoperability Am J Health Syst Pharm July 1, 2012 69:1163-1165.

8. Definitions (Continued) Interfacing: a method of communication using a standard language that allows different systems from different vendors to share information. An interface can be either uni-directional (one-way) where information only flows in one direction, or bi-directional (two-way) where information flows in both directions. Pharmacy example of a bi-directional interface is the pharmacy information system (PIS) passing order information to automated dispensing cabinets or robotic devices and receiving billing information back. Real world examples: synching of data between computer and hand held device (bi-directional interface); submitting an order online but only receiving order confirmation via snail mail. McManus M et al. Suggested definitions for informatics terms: Interfacing, integration, and interoperability Am J Health Syst Pharm July 1, 2012 69:1163-1165.

9. Definitions (Continued) Interoperability: allows a specific product or system to work with one or many different product(s) or system(s) without additional effort on the part of the customer. This is usually accomplished by a combination of integration and/or interfacing. Pharmacy example: retail pharmacy receiving eRx from various prescribing systems (hospital based, private practice based, etc.) and sending information back (dosing changes, refill requests, etc.) Real world example: electronic banking/finance (direct deposit, online bill pay, electronic transfers, using any ATM anywhere in the world - even from a different banking institution) McManus M et al. Suggested definitions for informatics terms: Interfacing, integration, and interoperability Am J Health Syst Pharm July 1, 2012 69:1163-1165.

10. Achieving Meaningful Use of Health Data Achieving Meaningful Use of Health Data HITECH Timetable 2009201120132015 Health IT-Enabled Health Reform Meaningful Use Criteria ARRA/HITECH Policies in Public Law 2011 Meaningful Use Criteria (Capture/share data) 2013 Meaningful Use Criteria (Advanced care processes with decision support) 2015 Meaningful Use Criteria (Improved Outcomes) Stage 1 Source: Public Law 111-5 Stage 2 Oct 1, 2013/ Jan 1, 2014 Proposed Stage 2 Start Dates

11. Meaningful Use Established expectations Give patients and providers quicker access to health information Help to protect medical privacy Give a summary of each visit Help to prevent from drug errors Make health information available to share with other organizations and with patients electronically

12. Resources www.HealthIT.gov  How to Implement EHRs  Privacy & Security  EHR Incentives & Certification  Success Stories & Case Studies  Resource Center SAFER guides – published January 2014  Safety Assurance Factors for EHR Resilience  Evidence-based guides and self-assessment tools for assessing and optimizing health IT safety in critical areas

13. Electronic Health Records and National Patient- Safety Goals Phase 1: Address Safety Concerns Unique to EHR Technology Reduce the effect of EHR downtime on patient safety Reduce miscommunication of data transmitted between different components of EHRs Phase 2: Mitigate Safety Concerns Arising from Failure to Use EHRs Appropriately Mandate CPOE for all orders of medications, laboratory tests, and radiologic tests Reduce alert fatigue Enter all medications, allergies, diagnostic test results, and clinical problems as structured or coded data Phase 3: Use EHRs To Monitor And Improve Patient Safety Use EHR-based “triggers” to monitor, identify, and report potential safety issues and events Sittig DF, Singh H. Electronic health records and national patient-safety goals. N Engl J Med. 2012 Nov 8;367(19):1854-60.