Health Information Systems

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1 HealthInformationSystems CourseProgram Context ThisdocumentdescribesaPhDlevelcourse,correspondingtoaCurriculumUnit credited with 5 ECTS (Opção temática), intended for the MAP I doctoral program. It is offered by Serviço de Bioestatística e Informática Médica, FaculdadedeMedicina,UniversidadedoPorto. CourseDescription Healthcare is information and knowledge driven. Good healthcare depends on taking decisions at the right time and place, according to the right patient data and applicable knowledge (1). Communication is of most relevance in today s healthcaresettings,ashealthrelatedactivities,suchasdeliveryofcare,research andmanagementdependoninformationsharingandteamwork(2). Providinghigh qualityhealthcareservicesisaninformation dependentprocess. Indeed,thepracticeofmedicinehasbeendescribedasbeingdominatedbyhow wellinformationisprocessedorreprocessed,retrieved,andcommunicated(3). An estimated 35 to 39 percent of total hospital operating costs have been associated with patient and professional communication activities (4). Physiciansspendoveraquarter(5,6)andnurseshalf(7)oftheirtimewriting uppatients charts. A patient record is a set of documents containing clinical and administrative information regarding one particular patient, supporting communication and decisionmakingindailypractice,andhavingdifferentusersandpurposes(8).it existstomemoriseandcommunicatethedataexistingonaparticularindividual, inordertohelpdelivercaretohimorher.recordsarenotonlyaninformation system but also a communication system, that enable communication between different health professionals and between the past and the present (9, 10). Patientrecords,thepatientandpublishedevidencearethethreesourcesneeded for the practice of evidence based medicine (1). They are used for immediate clinical decisions (either by the author, or by others), future clinical decisions, quality improvement, education, clinical research, management and reimbursement,andtoactasevidenceinacourtcase(11). Patient data quality in computer based patient records has been found to be ratherlowinseveralhealthinformationsystems(12 14).Mostsourcesofpoor data quality can be traced back to human error (13, 15) or bad system design (14). Moreover, the assessment of the correctness of collected patient data is a difficult process even when we are familiar with the system in which it was collected (16). One of the main challenges of health information systems or networks is to be able to gather the different parts of the medical record of a patientwithoutanyriskofmixingthemwiththoseofanotherpatient(17,18). The proposed unit intends to be a specialization in health information systems (HIS), namely in the developing HIS, integration and interoperability issues,

2 terminologies,auditingandclinicaldataquality,andhisevaluation. IntroonPACS/RIS References 1. WyattJC,WrightP.Designshouldhelpuseofpatients'data.Lancet.1998Oct;352: CoieraE.Guidetohealthinformatics:Arnold; BarnettO.Computersinmedicine.JAMA.1990;263: RichartR.Evaluationofamedicaldatasystem.ComputBiomedRes.1970;3: AuditCommission.Foryourinformation:astudyofinformationmanagementandsystems intheacutehospital MamlinJ,BakerD.Combinedtime motionandworksamplingstudyinageneralmedicine clinic.medcare.1973;11: KorpmanR,LincolnT.Thecomputer storedmedicalrecord:forwhom?jammedinform Assoc.1998;259: WyattJC.Clinicaldatasystems,Part1:Dataandmedicalrecords.Lancet.1994 Dec;344: DickR,SteenE.TheComputer basedpatientrecord:anessentialtechnologyfor HealthCare NygrenE,WyattJC,WrightP.Helpingclinicianstofinddataandavoiddelays.Lancet.1998 Oct;352: WyattJ.Clinicaldatacaptureandpresentation.MedicalInformaticsSummerSchool HoganW,WagnerM.Accuracyofdataincomputer basedpatientrecords.jammedinform Assoc.[Review].1997;4(5): HammondK,HelbigS,BensonC,BMB S,editors.Areelectronicmedicalrecords trustworthy?observationsoncopying,pastingandduplication.amiaannualsymposium; HohnloserJ,FischerM,KonigA,EmmerichB.Dataqualityincomputerizedpatientrecords. Analysisofahaematologybiopsyreportdatabase.IntJClinMonitComput.1994;11(4): WeirC,HurdleJ,FelgarM,HoffmanJ,RothB,NebekerJ.DirectTextEntryinElectronic ProgressNotes AnEvaluationofInputErrors.MethodsInfMed.2003;42(1): BernerE,MossJ.InformaticsChallengesfortheImpendingPatientInformationExplosion.J AmMedInformAssoc.2005;12(6): QuantinC,BinquetC,BourquardK,PattisinaR,Gouyon CornetB,FerdynusC,etal.A peculiaraspectofpatients'safety:thediscriminatingpowerofidentifiersforrecordlinkage. StudHealthTechnolInform.2004;103: ArellanoMG,WeberGI.Issuesinidentificationandlinkageofpatientrecordsacrossan integrateddeliverysystem.jhealthcinfmanag.1998;12(3): Courseobjectives Thecourseaims: Makestudentsacknowledgeanddescribethemaincharacteristicsand problemsrelatedtohisdevelopment ProvidethestudentswithatoolstohelpdevelopHISthatarecompliant withthebestinternationalpracticesofhisdevelopment HelpthestudentdeveloprigorousHISevaluationmethodologies. ProvidethestudentsahandsonapproachtothePACS/DICOMuniverse Coursetopics 1. DevelopmentofHIS a. ToidentifytheneedforanIS

3 b. ImplementationofHIS c. ElectronicPatientRecords 2. IntegrationandinteroperabilityinHIS a. Standards(HL7,DICOM,OpenEHR,CENTC/251) b. Semanticinteroperability c. Integrationofexternalservicestotheinstitution 3. Codingandclassification a. Terminologies,nomenclaturesandontologiesofclinicalconcepts b. InternationalClassificationofDiseasesandtheDiagnosisRelated Groups 4. Auditingandclinicaldataquality a. Possibletypesoferrors b. Methodsforerrordetection c. Methodstoincreasedataquality 5. HISevaluation a. Levelsofevidence b. Developmentofmeasurementinstruments c. Demonstrationstudies d. Cost benefitandcost effectivenessstudies e. Studyplanning 6. RIS/PACS a. Imagedemographics b. Architectures c. ImageDistribution,StorageandArchivingStrategies d. WorkfloweDataflowinRadiology e. CriticalScenarios:CardiacPACS f. Future:S PACS(Surgery PACS); g. SecurityandPrivacy h. PACSandE LearninginMedicalScience i. PACS/RIS/HISintegrationissues j. RegionalPACS,TelemedicineandTelework 7. TheDICOMstandard a. History b. Standard:StorageandCommunications c. DataStructureanddataEncoding d. DICOMServices e. WorkfloweWorklistService f. StructuredReporting Teachingmethodology Lectures Lecturesofinvitedspeakers PracticalimplementarionsofHealthInformationSystemsormodules IntegrationofstudentsonResearchProjects EvaluationCriteria 50% Awrittenfinalexamcoveringthetopicsstudiedinthelearningunit. 50% Awrittenscientificarticle,concerningeitherresultsobtainedduring

4 theirexperimentalworkorastate of the artreviewonahealth InformationSystemtopic,whichmustbepresentedorallyinapublic seminar. Coursebibliography H.Pardes,HaroldP.Lehmann,PatriciaA.Abbott,NancyK.Roderer,Adam Rothschild,StevenF.Mandell,JorgeA.Ferrer,RobertE.Miller,MarionJ. Ball.AspectsofElectronicHealthRecordSystems.Springer;2edition (March21,2006) EdwardH.Shortliffe,JamesJ.Cimino.BiomedicalInformatics:Computer ApplicationsinHealthCareandBiomedicine.Springer;3edition(May25, 2006) KarenA.Wager,FrancesWickhamLeeDBA,JohnP.Glaser.Managing HealthCareInformationSystems:APracticalApproachforHealthCare Executives.JohnWileyandSons H.K.Huang,"PACSandimaginginformatics:basicprinciplesand applications",j.wiley&sons,2004 KeithDreyeretal(eds),"PACSAGuidetotheDigitalRevolution",2Ed, Springer2006 HermanOosterwijk,"DICOMBasicsBook",3rdEd,OTech,2005 OlegS.Pianykh DigitalImagingandCommunicationsinMedicine(Dicom): APracticalIntroductionandSurvivalGuide,Springer2008

5 TeachingStaff Theteachingstaffiscomposedby: RicardoCorreia(principalinstructor),computerscientist,PhDinthe integrationofhospitalis,currentlywith21publications,teachinghealth InformationSystemsontheMastercourseofMedicalInformaticsofthe UniversityofPorto,andwhosecurrentinterestisElectronicPatient RecordsandHealthInformationSystems; JoãoFonseca,medicaldoctor,PhDinmedicine,teachingEvaluationof HealthInformationSystemsontheMastercourseofMedicalInformatics oftheuniversityofporto,andwhosecurrentinterestincludeevaluation techniquesandpatienthealthrecords. AugustoSilva,PhDinElectricalEngineering,isanAssistantProfessoratthe DepartmentofElectronics,TelecommunicationsandInformaticsofthe AveiroUniversityandaresearcherattheInstituteofElectronicsand TelematicsEngineeringofAveiro(IEETA).Currentresearchinterests includemedicalimagingsystems,medicalimageprocessingand PACS/RISsystems. CarlosCosta,PhDinElectricalEngineeringisanAssistantProfessoratthe DepartmentofElectronics,TelecommunicationsandInformaticsofthe AveiroUniversityandaresearcherattheInstituteofElectronicsand TelematicsEngineeringofAveiro(IEETA).Researchactivityismainly focusedintheareaofpacs DICOM(medicalimagingsystemsand networks),healthcareinformationsystemsincludingsecurityandaccess controlissues.