Professional Documents
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Biomedical informatics
0ealth informatics is part of a larger sub2ect referred to as *iomedical .nformatics which currently includes bio-informatics and health informatics as its ma2or sub-disciplines. Bioinformatics is a rapidly developing and highly interdisciplinary field, using techni3ues and concepts from computer science, statistics, mathematics, chemistry, biochemistry, physics, and even linguistics. *io-informatics has to date been primarily focused on computer analysis of biological data, ranging from basic data such as D4A and protein se3uences to genes and molecular structures. (arly research in bioinformatics focused on development of methods for storage, retrieval, and analysis of the data. Analysis of e5perimental results from various sources, patient statistics, and scientific literature are also included with bio-informatics research addressing problems like molecular modeling and simulation of biological processes. Health (medical or clinical) informatics is aimed at using informatics techni3ues to support routine clinical practice and patient care. Like bio-informatics it is multidisciplinary6 it was historically seen as at the intersection of information science, computer science, and health care and dealt with the resources, devices, and methods re3uired to optimi7e the ac3uisition, storage, retrieval, and use of information in health clinical practice, but the practical comple5ity of patient care means that social and organi7ational research have increasing influences. 0ealth informatics is applied to the areas of nursing, clinical care, dentistry, pharmacy, public health and medical research.
Medical informatics
At its inception in the 189)s medical informatics focused on general problems of information management which were common to .T systems in other fields as well, such as business and administration including: -*ack office1 services ;e.g. accounting, billing< &atient administration ;e.g. appointments, repeat prescribing, demographic and clinical data recording< =pecialist technical services ;e.g. image processing, radiotherapy planning, pathology lab management< and associated speciali7ed databases ;e.g. laboratory databases, picture archiving systems<
During the 18>)s and 188)s new topics began to become prominent which were distinctive in that they were designed to address problems that are specific to clinical practice, these included Architectures and systems for fle5ible storage and retrieval of clinical information ;electronic patient records<
=tandards such as D.#?' ;for coding and storage of medical images<, 0L9 messaging, facilitating the e5change of information between healthcare information systems and providers =ervices for placing and managing clinical orders ;e.g. tests and investigations< The design of controlled medical terminologies which are used to standardi7e the terms and vocabularies used to encode and store patient data ;e.g. =4?'(D and L?.4#< Decision support systems ;e.g. reminders for re3uired clinical tasks6 alerts for inappropriate prescriptions<
?ver the last ten years society has come to be very critical of its medical services, constantly demanding new services and e5pecting new ways of providing them. A new trend is that people are also increasingly aware of the kinds of treatment that are available and when they are not getting them when they think they are entitled to. These trends are having a ma2or impact on research and development in health informatics and its practical deployment. ?ne of the most significant events was the publication of a report in ))) by the @= .nstitute of 'edicine called -To err is human1 which led to general awareness of worryingly high levels of avoidable deaths and other harms to patients due to medical error, and also very high levels of waste. .n the @A recent research has shown that the position here is no different overall from the @=A and most other countries. Bincent and others reported in ))$ that about 11C of admissions of patients to 40= hospitals resulted in avoidable -adverse events1 where patients were harmed. Among the problems identified in the 40= and other health services are variation in clinical practice and 3uality of service delivery6 errors of commission and omission6 failure to implement new knowledge and technology systematically and appropriately6 over-use and under-use of tests and investigations, inappropriate care6 unsatisfactory patient e5perience6 poor 3uality clinical practice6 waste
A ma2or challenge is that medical knowledge is e5panding at an unprecedented rate, while the resources available to achieve proper dissemination and use remain comparatively static. =imilarly, medical technologies and technical capabilities are progressing rapidly while practices and skills within the medical profession have struggled to keep up. The disparity between clinical and technical capabilities and the results that it should be possible to achieve has led to the undesirable situation in which patients receive varying levels of care, with the likelihood of recovery often dependent on which medical centre the patient visits. The challenge is to integrate the vast pool of
e5isting information relevant to the care of any specific patient and deliver it in an effective and coordinated manner at the point of care Aey challenges ;adapted from #oiera p 1)%< 0ow do we apply knowledge to achieve a particular clinical ob2ectiveD 0ow do we decide how to achieve a particular clinical ob2ectiveD 0ow do we improve our ability to deliver clinical servicesD
0ealth Eecords
=ervice delivery, performance assessment (nsure right &atients receive right intervention
Patient records
A patient record is a repository of information about a single person in a medical setting, including clinical, demographic and other data. (ver since "lorence 4ightingale medicine has seen good clinical and patient records as the foundation of good patient care. Traditionally patient records are kept on paper and stored in a secure place in an organi7ed way ;in theory<. There are many pros and cons to paper records. !he "a"er record# "ros &ortable "amiliar and easy to use (5ploits everyday skills of visual search, browsing etc 4atural: -direct1 access to clinical data 0and writing, drawings, images, charts F<
!he "a"er record# cons #an only be used for one task at a time .f people need notes one has to wait
#an lead to long waits ;unavailable up to $)C of time in some studies< Eecords can get lost or out of order ;effectively lost< #onsume space Large individual records are hard to use "ragile and susceptible to damage (nvironmental cost
$lectronic health records# "ros #ompact =imultaneous use (asily copiedGarchived &ortable ;handheld and wireless devices< =ecure =upports many value-adding services Decision support Horkflow management &erformance audits Eesearch
$lectronic health records# cons 0igh capital investment 0ardware, software, operational costs Transition from paper to computer Training re3uirements &ower outs ! the whole system goes down #ontinuing security debate =tealing one paper record is easy, ) is harder, 1),))) effectively impossible ! the security risks are very different for electronic data
Functionality of a comprehensive electronic health record system (T enson) .nformation retrieval services for accessing patient data selectively, and in a timely way at any or all times by authori7ed individuals. Tools support clinical problem solving such as decision analysis tools, clinical reminders, prognostic risk assessment and other clinical aids. "acilities to support structured data collection using a defined vocabulary. Links to both local and remote databases of knowledge, literature and bibliography or administrative databases and systems so that such information is readily available to assist practitioners in decision making.
$. "le5ible input capabilities ;from forms on screens to email to automated image capture and interpretation<6 %. (rgonomically designed data presentation ;to ma5imi7e speed and ease of use and minimi7e errors<6 K. Automated support for clinical decision-making and workflows. The 40= .nformatics Eeview, ))>, identified five key features of a modern (0E: &atient Administration =ystem ;&A=< with integration with other systems and sophisticated reporting ?rder #ommunications and Diagnostics Eeporting ;including all pathology and radiology tests and tests ordered in primary care< Letters with coding ;discharge summaries, clinic and Accident and (mergency letters< =cheduling ;for beds, tests, theatres etc.< e&rescribing including -over the counter1 medicines
;=ub2ective data, ?b2ective data, Assessment decision, &lan of action<. #oiera views the &?'E as a hybrid of task and protocol-oriented structures.
*ased on material from Princi"les of Health Intero"erabilit& H53 and /6%M$7 8 2,,9 !im Benson
$ppendi% on Professionalism &'( the )HS Care !ecord guarantee -He have a duty to: M maintain full and accurate records of the care we provide to you6 M keep records about you confidential, secure and accurate6 and M provide information in a format that is accessible to you .t is good practice for people in the 40= who provide your care to: M discuss and agree with you what they are going to record about you6 M give you a copy of letters they are writing about you6 and M show you what they have recorded about you, if you ask. The NHS Care Records Service =ome of your health records are already held on computer, but many are still kept on paper. Hhile the paper records we keep are protected by strict confidentiality and security procedures, these records are not always available to the care team looking after you. 0andwritten entries in the record may be difficult to read and important information may be missing. The 4ational &rogramme for .T is introducing modern secure computer systems into the 40= over the ne5t few years. This new system will: M allow you to control whether the information recorded about you by an organisation providing you with 40= care can be seen by other organisations that are also providing you with care6 M show only those parts of your record needed for your care6 M allow only authorised people ;who will need a NsmartcardI as well as a password< to access your record6 M allow only those involved in your care to have access to records about you from which you can be identified, unless you give your permission or the law allows6 M allow us to use information about your healthcare, in a way that doesnIt make your identity known, to improve the services we offer or to support research6 $ppendi% on Professionalism &#( Connecting for Health &*S$( Policy Principles
http:GGwww.connectingforhealth.orgGcommonframeworkGdocsG?verview.pdf
%"enness and !rans"arenc&. There should be a general policy of openness about developments, practices, and policies with respect to personal data. .ndividuals should be able to know what information e5ists about them, the purpose of its use, who can access and use it, and where it resides. Pur"ose /"ecification and Minimi-ation. The purposes for which personal data are collected should be specifi ed at the time of collection, and the subse3uent use should be limited to those purposes or others that are specifi ed on each occasion of change of purpose.
:ollection 5imitation. &ersonal health information should only be collected for specified purposes, should be obtained by lawful and fair means and, where possible, with the knowledge or consent of the data sub2ect. .se 5imitation &ersonal data should not be disclosed, made available, or otherwise used for purposes other than those specifi ed. Indi'idual Partici"ation and :ontrol. .ndividuals should control access to their personal information: M .ndividuals should be able to obtain from each entity that controls personal health data, information about whether or not the entity has data relating to them. .ndividuals should have the right to: M 0ave personal data relating to them communicated within a reasonable time ;at an affordable charge, if any<, and in a form that is readily understandable6 M *e given reasons if a re3uest ;as described above< is denied, and to be able to challenge such denial6 and M #hallenge data relating to them and have it rectifi ed, completed, or amended. 7ata Integrit& and ;ualit& All personal data collected should be relevant to the purposes for which they are to be used and should be accurate, complete, and current. /ecurit& /afeguards and :ontrols. &ersonal data should be protected by reasonable security safeguards against such risks as loss or unauthori7ed access, destruction, use, modifi cation, or disclosure. (ccountabilit& and %'ersight. (ntities in control of personal health data must be held accountable for implementing these information practices. <emedies Legal and financial remedies must e5ist to address any security breaches or privacy violations. Technology principles Ma)e it =!hin> ?nly the minimum number of rules and protocols essential to widespread e5change of health information should be specified as part of a #ommon "ramework. .t is desirable to leave to the local systems those things best handled locally, while specifying at a national level those things re3uired as universal in order to allow for e5change among subordinate networks. ('oid =<i" and <e"lace> Any proposed model for health information e5change must take into account the current structure of the healthcare system. Hhile some infrastructure may need to evolve, the system should take advantage of what has been deployed today. =imilarly, it should build on e5isting .nternet capabilities, using appropriate standards for ensuring secure transfer of information. /e"arate (""lications from the 6etwor) The purpose of the network is to allow authori7ed persons to access data as needed. The purpose of applications is to display or otherwise use that data once received. The network should be designed to support any and all useful types of
applications, and applications should be designed to take data in from the network in standard formats. This allows new applications to be created and e5isting ones upgraded without re-designing the network itself. 7ecentrali-ation Data stay where they are. The decentrali7ed approach leaves clinical data in the control of those providers with a direct relationship with the patient, and leaves 2udgments about who should and should not see patient data in the hands of the patient and the physicians and institutions that are directly involved with his or her care. Federation The participating members of a health network must belong to and comply with agreements of a federation. "ederation, in this view, is a response to the organi7ational difficulties presented by the fact of decentrali7ation. "ormal federation with clear agreements builds trust that is essential to the e5change of health information. Fle?ibilit& Any hardware or software can be used for health information e5change as long as it conforms to a #ommon "ramework of essential re3uirements. The network should support variation and innovation in response to local needs. The network must be able to scale and evolve over time. Pri'ac& and /ecurit&. All health information e5change, including in support of the delivery of care and the conduct of research and public health reporting, must be conducted in an environment of trust, based upon conformance with appropriate re3uirements for patient privacy, security, confidentiality, integrity, audit, and informed consent. (ccurac& Accuracy in identifying both a patient and his or her records with little tolerance for error is an essential element of health information e5change. There must also be feedback mechanisms to help organi7ations to fi5 or -clean1 their data in the event that errors are discovered.