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Healthcare Information Systems: An Overview Nancy B. Clark, M. Ed. Director of Medical Informatics Healthcare Information Systems: An Overview Nancy B. Clark, M. Ed. Director of Medical Informatics Education FSU College of Medicine FLORIDA STATE UNIVERSITY The College of Medicine

What is wrong with this picture? FLORIDA STATE UNIVERSITY The College of Medicine What is wrong with this picture? FLORIDA STATE UNIVERSITY The College of Medicine

What is wrong with this picture? • • illegible handwriting, ambiguous and incomplete data, What is wrong with this picture? • • illegible handwriting, ambiguous and incomplete data, data fragmentation- each lab report is a separate piece of paper which does not allow a physician to visualize the progress of a patient’s conditions. • poor availability- studies have shown that as much as 40% of the time the paper record can not be found. FLORIDA STATE UNIVERSITY The College of Medicine

What is wrong with this picture? • Insecure in open, unguarded shelving in a What is wrong with this picture? • Insecure in open, unguarded shelving in a clinic • In addition, paper records often become bulky with time, which leads to lack of overview. • When it comes time to share the record with another clinician, each individual piece of paper has to be hand copied, then mailed. It can cost a clinic up to $35 just to do this. • Employee cost of moving all this paper around – estimates it costs $5 just to pull one chart. • Space – most medical office space rents for $1822/sq ft/yr 240 sq ft FLORIDA STATE UNIVERSITY The College of Medicine

Outline • • What kinds of HIT systems are there? What are we using Outline • • What kinds of HIT systems are there? What are we using here at FSU Co. M? What major trends are emerging? What are the benefits to adoption? What are the barriers to adoption? What is the current state of adoption? How can you learn more? FLORIDA STATE UNIVERSITY The College of Medicine

Elements of IT Infrastructure • • • Hardware/Software Support Issues Workflow/Mindset Issues Training Issues Elements of IT Infrastructure • • • Hardware/Software Support Issues Workflow/Mindset Issues Training Issues Budgeting Issues FLORIDA STATE UNIVERSITY The College of Medicine

Basic Technology • High speed networks • Wireless Networks – PDAs – Tablets • Basic Technology • High speed networks • Wireless Networks – PDAs – Tablets • • Video conferencing Bar-code readers Voice over internet Speech recognition • Internet access • Web server • Intranets (Share. Point) FLORIDA STATE UNIVERSITY The College of Medicine

Administrative Applications • Security (virus protection, firewalls, retinal scans, thumb prints) • System wide Administrative Applications • Security (virus protection, firewalls, retinal scans, thumb prints) • System wide e-mail with external access via web • System wide calendaring • Single sign-on active user directory • Website • Intranet • Shared file systems • Personnel systems FLORIDA STATE UNIVERSITY The College of Medicine

HIT Applications • Patient registration/ demographics • Insurance validation • Billing systems • Appointment HIT Applications • Patient registration/ demographics • Insurance validation • Billing systems • Appointment systems • Computerized Physician Order Entry (CPOE) • EMR/EHR/CPR • Pharmacy systems • • Lab systems Imaging systems Telemedicine Patient education Decision Support Library resources Sensors FLORIDA STATE UNIVERSITY The College of Medicine

Sad Facts • Medical errors account for more deaths than breast cancer, AIDs and Sad Facts • Medical errors account for more deaths than breast cancer, AIDs and motorcycle accidents. • US has highest HC costs per capita in world • US has worst outcomes of industrialized nations. (infant mortality, lifespan, etc. ) • Healthcare is 10 -15 yrs behind business in adoption of IT FLORIDA STATE UNIVERSITY The College of Medicine

FSU College of Medicine Technology Supporting Medical Education What our graduates will expect to FSU College of Medicine Technology Supporting Medical Education What our graduates will expect to have in their residencies, practices, and hospitals. FLORIDA STATE UNIVERSITY The College of Medicine

Technology Highlights • Tablet PCs • PDAs for Medical Reference • IT Enchanced Environment Technology Highlights • Tablet PCs • PDAs for Medical Reference • IT Enchanced Environment – printing, scanner, classroom & small group presentation system • The Portals: The College Web Site, the Electronic Library & Blackboard FLORIDA STATE UNIVERSITY The College of Medicine

The Tablet PC Issue First Day Lenovo Think. Pad Tablet. PC 1. 88 GHz The Tablet PC Issue First Day Lenovo Think. Pad Tablet. PC 1. 88 GHz Processor 3 G MB RAM 130 GB Hard Disk External DVD-RW drives SD card slot PCM/CIA slot 3 USB ports 4. 5 lbs FLORIDA STATE UNIVERSITY The College of Medicine

Software Installed – Windows Vista (7) – Tablet Edition – Office 2007, including Word, Software Installed – Windows Vista (7) – Tablet Edition – Office 2007, including Word, Excel, Power. Point, Publisher, Access, Outlook, Internet Explorer – Adobe Acrobat Reader, Microsoft Digital Image Suite, Win. Zip, Sonic Record Now, medical spell checker, and End. Note – Anti-virus, anti-spyware, & other security software FLORIDA STATE UNIVERSITY The College of Medicine

Interesting Tablet Software • Microsoft Office One. Note • Windows Journal • Microsoft Educational Interesting Tablet Software • Microsoft Office One. Note • Windows Journal • Microsoft Educational Pack for Tablet PC • Microsoft Experience Pack for Tablet PC • Sticky Notes • Snipping Tool FLORIDA STATE UNIVERSITY The College of Medicine

EMR • SOAPware • Use 3 rd year FLORIDA STATE UNIVERSITY The College of EMR • SOAPware • Use 3 rd year FLORIDA STATE UNIVERSITY The College of Medicine

PDAs • Issues Fall 1 st year • Used to track all patient encounters PDAs • Issues Fall 1 st year • Used to track all patient encounters • Used as extension of library resources, to find information quickly in clinical environments at the point of care. FLORIDA STATE UNIVERSITY The College of Medicine

HP i. PAQ • Windows Mobile 6 • 1 GB SD card • Color, HP i. PAQ • Windows Mobile 6 • 1 GB SD card • Color, backlit, 240 -360 screen • Sound recorder, mp 3 player • Wireless - both Wi. Fi & Bluetooth FLORIDA STATE UNIVERSITY The College of Medicine

FSU Licensed PDA Software • • Epocrates Essentials ($149/yr) Essential Evidence Plus ($249/yr) Dyna. FSU Licensed PDA Software • • Epocrates Essentials ($149/yr) Essential Evidence Plus ($249/yr) Dyna. Med ($200/yr) PEPID ($199/yr) Pediatric Care Online ($289/yr) Clinical Evidence ($99/yr) Harrison’s Practice ($325/yr) Geriatrics at Your Fingertips ($30) • Savings to each faculty and student > $1, 500/yr F S U LORIDA 3/18/2018 TATE NIVERSITY Intro The to Medical Library. Medicine College of Resources 19

i. Phone Revolution • Cell phone technology expanding to PDAs • Medical reference websites i. Phone Revolution • Cell phone technology expanding to PDAs • Medical reference websites reformatting • Software versions availability expanding – 6 resources: Epocrates, PEPID, Dynamed, e. PSS, Pediatric Care Online, Clinical Evidence • WM cell phones popular FLORIDA STATE UNIVERSITY The College of Medicine

PDA Versions Available FLORIDA STATE UNIVERSITY The College of Medicine 21 PDA Versions Available FLORIDA STATE UNIVERSITY The College of Medicine 21

Epocrates Essentials • Epocrates Essentials – Most widely used PDA program by medical practitioners Epocrates Essentials • Epocrates Essentials – Most widely used PDA program by medical practitioners – Rx, (Drugs & Complementary meds) – Sx/Dx (Symptom & Disease Reference) – Labs & other tools. FLORIDA STATE UNIVERSITY The College of Medicine

IT Enhanced Environment • Wireless networking • Classroom Presentation Systems • Multi-function – copier, IT Enhanced Environment • Wireless networking • Classroom Presentation Systems • Multi-function – copier, printer, scanner - machines • A/V equipment in small group rooms and community learning centers • Large format printing for posters and signs is available for school related projects FLORIDA STATE UNIVERSITY The College of Medicine

Clinical Learning Center FLORIDA STATE UNIVERSITY The College of Medicine Clinical Learning Center FLORIDA STATE UNIVERSITY The College of Medicine

Sim Center FLORIDA STATE UNIVERSITY The College of Medicine Sim Center FLORIDA STATE UNIVERSITY The College of Medicine

The College Portals • Our Electronic Library • Share. Point Intranet – Internal document The College Portals • Our Electronic Library • Share. Point Intranet – Internal document sharing – Policies, procedures, etc. • Enterprise Exchange e-mail system with integrated calendars and contacts • Blackboard Courseware FLORIDA STATE UNIVERSITY The College of Medicine

www. med. fsu. edu FLORIDA STATE UNIVERSITY The College of Medicine www. med. fsu. edu FLORIDA STATE UNIVERSITY The College of Medicine

Our Library is always open FLORIDA STATE UNIVERSITY The College of Medicine Our Library is always open FLORIDA STATE UNIVERSITY The College of Medicine

24/7 Access to Resources • >1900 medical e. Journals (3. 5 M articles) • 24/7 Access to Resources • >1900 medical e. Journals (3. 5 M articles) • Hundreds of clinical e. Books • Evidence-based medicine resources and Guidelines • Disease, drug, images and patient education resources • Web-based course materials • Medical search engines • 200 periodicals databases • PDA versions of 7 web resources FLORIDA STATE UNIVERSITY The College of Medicine

Blackboard - Course Websites • All Course Materials – Syllabus & Assignments – Power. Blackboard - Course Websites • All Course Materials – Syllabus & Assignments – Power. Points & Lecture notes FLORIDA – Discussion board. STATEGrades Posting & UNIVERSITY The College of Medicine

Overview of Current State of Healthcare IT Adoption FLORIDA STATE UNIVERSITY The College of Overview of Current State of Healthcare IT Adoption FLORIDA STATE UNIVERSITY The College of Medicine

Source of Stats • 2009 HIMSS Leadership Survey – 304 IT Health. Care Executives Source of Stats • 2009 HIMSS Leadership Survey – 304 IT Health. Care Executives representing 700 hospitals – http: //www. himss. org/2009 Survey/healthcare. CIO_final. asp • FSU Co. M - Center on Patient Safety – Robert Brooks, MD, Associate Dean, Health Affairs – Nir Menachemi Ph. D. , MPH, Director, Center on Patient Safety FLORIDA STATE UNIVERSITY The College of Medicine

Projected IT Priorities FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 th Annual Projected IT Priorities FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 th Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

Top Business Issues Facing Health. Care FLORIDA STATE UNIVERSITY The College of Medicine Source: Top Business Issues Facing Health. Care FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

Most Significant Barriers to Implementing IT FLORIDA STATE UNIVERSITY The College of Medicine Source: Most Significant Barriers to Implementing IT FLORIDA STATE UNIVERSITY The College of Medicine Source: 19 th Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

Status of Electronic Medical Record Implementation FLORIDA STATE UNIVERSITY The College of Medicine Source: Status of Electronic Medical Record Implementation FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

Florida Hospitals Brooks R, et al. Patient Safety-Related Information Technology Utilization in Urban and Florida Hospitals Brooks R, et al. Patient Safety-Related Information Technology Utilization in Urban and Rural FLORIDA STATE UNIVERSITY Hospitals. Journal of Medical Systems, Vol. 29, No. 2, April 2005 The College of Medicine

Top Security Concerns of Computerized Medical Information FLORIDA STATE UNIVERSITY The College of Medicine Top Security Concerns of Computerized Medical Information FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

Security Tools FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 h Annual HIMSS Security Tools FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

Technology Adoption Curve 75% 50% 25% FLORIDA STATE UNIVERSITY The College of Medicine Technology Adoption Curve 75% 50% 25% FLORIDA STATE UNIVERSITY The College of Medicine

Technology Adoption (Next Two Years) FLORIDA STATE UNIVERSITY The College of Medicine Source: 19 Technology Adoption (Next Two Years) FLORIDA STATE UNIVERSITY The College of Medicine Source: 19 th Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

2008 Health IT Staffing Needs FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 2008 Health IT Staffing Needs FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

2009 Health IT Staffing Needs FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 2009 Health IT Staffing Needs FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 h Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

National Initiatives FLORIDA STATE UNIVERSITY The College of Medicine National Initiatives FLORIDA STATE UNIVERSITY The College of Medicine

“Wiring” Healthcare Current system fragments patient information and creates redundant, inefficient efforts Future system “Wiring” Healthcare Current system fragments patient information and creates redundant, inefficient efforts Future system will consolidate information and provide a foundation for unifying efforts Payers Hospital s Public health Health Information Exchange Primary care physician Laboratory Labs Pharmacy Data repository Specialty physician Network applications Outpatient RX Payers Ambulatory center (e. g. imaging centers) FLORIDA STATE UNIVERSITY Physician office The College of Medicine Ambulatory centers Public health

Sharing Medical Data • • Increase patient safety Lower Healthcare costs Allow for coordination Sharing Medical Data • • Increase patient safety Lower Healthcare costs Allow for coordination of care Increase communication between providers • Banking analogy FLORIDA STATE UNIVERSITY The College of Medicine

Office of the National Coordinator for Health IT Established by Executive Order 13335 (April Office of the National Coordinator for Health IT Established by Executive Order 13335 (April 27, 2004) • Responsible for realizing the President’s vision of Health IT: – Widespread adoption of interoperable EHR within 10 years – Medical information follows consumer – Clinicians have complete, computerized patient information – Quality initiatives measure performance and drive quality-based competition – Public health and bioterrorism surveillance are seamlessly integrated into care FLORIDA STATE UNIVERSITY The College of Medicine

Goals • Develop a nationwide health information network (NHIN) • Establish standards for data Goals • Develop a nationwide health information network (NHIN) • Establish standards for data transfer and storage: – Continuity of care records • Develop Regional Healthcare Information Organizations (RHIOs) • See article: Burton, et al. Using electronic health records to help coordinate care. Milbank Quarterly. V(82); 457 -81. 2004 FLORIDA STATE UNIVERSITY The College of Medicine

Status of Health Information Exchange (HIE) FLORIDA STATE UNIVERSITY The College of Medicine Source: Status of Health Information Exchange (HIE) FLORIDA STATE UNIVERSITY The College of Medicine Source: 20 th Annual HIMSS Leadership Survey Sponsored by ACS Health. Care Solutions

Needed for CCR • Universally agreed-on medical vocabulary • Principled and standard formats for Needed for CCR • Universally agreed-on medical vocabulary • Principled and standard formats for laboratory data, medical images, medical record… • Standardization of medical literature formats --structured abstracts • Health care standards -- treatment guidelines • Standards for health data exchange FLORIDA STATE UNIVERSITY The College of Medicine

Clinical Data Standards • Current – – – HL 7 messages for most lab Clinical Data Standards • Current – – – HL 7 messages for most lab data DICOM messages for images LOINC for laboratory results content CPT-4 for procedures content ICD-9 for diagnoses content (10 coming) NDC ▬► Rx. Norm for medication content • Anticipated medical vocabulary Patient: John Doe MRN: 123 -0 Diagnosis: 410. 0 WBC: 14, 000/cm 3 – SNOMED/UMLS Concept Unique Identifiers for microbiology content FLORIDA STATE UNIVERSITY The College of Medicine

Where can you learn more? FLORIDA STATE UNIVERSITY The College of Medicine Where can you learn more? FLORIDA STATE UNIVERSITY The College of Medicine

Web Sites/Organizations • American Medical Informatics Association (AMIA) • Healthcare Information and Management Systems Web Sites/Organizations • American Medical Informatics Association (AMIA) • Healthcare Information and Management Systems Society (HIMSS) • Healthcare IT News • Healthcare Informatics • Health Informatics at Wikipedia • Medical Group Management Association (MGMA) • The Informatics Review • To Err Is Human: Building a Safer Health System (IOM) • Crossing the Quality Chasm (IOM) • Health Professions Education (IOM) FLORIDA STATE UNIVERSITY • Patient Safety: Achieving a New Standard for Care (IOM) The College of Medicine

Web 2. 0 • http: //www. hitsphere. com/ FLORIDA STATE UNIVERSITY The College of Web 2. 0 • http: //www. hitsphere. com/ FLORIDA STATE UNIVERSITY The College of Medicine

Journals • JAMIA – J. of the American Medical Informatics Assoc. • Telemedicine and Journals • JAMIA – J. of the American Medical Informatics Assoc. • Telemedicine and e-Health • IEEE Trans. on Information Technology in Biomedicine • Health Informatics • Studies in Health Technology and Informatics • Biosensors and Bioelectronics • Healthcare Informatics Online (Magazine) • IEEE Technology and Society • British Computer LORIDA STATE UNIVERSITY Society F The College of Medicine

More Journals • Artificial Intelligence in Medicine (Elsevier) • Computers in Biology and Medicine More Journals • Artificial Intelligence in Medicine (Elsevier) • Computers in Biology and Medicine (Pergamon Press) • Computers in Biomedical Research (Academic Press) • Computer Methods and Programs in Biomedicine (Elsevier) • IEEE Engineering in Medicine and Biology Magazine • Journal of Medical Systems (Plenum Press) • MD Computing (Springer-Verlag) • Medical Informatics & The Internet in Medicine (Taylor & Francis) • Methods of Information in Medicine (Schattauer) • Yearbook of Medical Informatics (Schattauer) FLORIDA STATE UNIVERSITY The College of Medicine

Conferences • HIMSS: regional and national conferences. 3/10/10 Atlanta • AMIA: Annual Symposium (and Conferences • HIMSS: regional and national conferences. 3/10/10 Atlanta • AMIA: Annual Symposium (and Spring Congress) • HEALTHCOM: Health Communication Conference • MEDINFO: (every 3 years, next in 2007), run by the IMIA (International Medical Informatics Association) • MGMA: 2007 MGMA Health Care Information FLORIDA STATE UNIVERSITY Technology Forums of Medicine The College

Training • AMIA/Oregon Health Sciences 10 x 10 program http: //www. amia. org/10 x Training • AMIA/Oregon Health Sciences 10 x 10 program http: //www. amia. org/10 x 10/partners/ohsu/ FLORIDA STATE UNIVERSITY The College of Medicine

Health IT Conclusions • Financial Support for Health IT on-going concern • Patient Centric Health IT Conclusions • Financial Support for Health IT on-going concern • Patient Centric Focus – Customer Satisfaction – Patient Safety • High-speed networks, Intranet and wireless information systems currently in use, to be expanded across regions • Electronic Medical Records (EMR) and Computerized Physician Order Entry (CPOE) most important applications • Interoperability is a must for Health IT FLORIDA STATE UNIVERSITY The College of Medicine