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Presentation
to medical students at the Faculty of Medicine King Fahad Medical City December
28, 2014 by Professor Omar Hasan Kasule Sr
Learning
Objectives:
- Introduction to the concept of management of information and the use of appropriate information technology especially in the context of health professions education and practice.
- Key words: Information technology, information management, information access,
- information dissemination
Information Revolution 1: Increased Generation
And Use Of Data
- All organizations generate and use a lot of data.
- Many managerial and planning functions are based on information in the database.
- A lot of data operational is generated. For example a hospital schedules a lot appointments and surgery.
- There is a lot of billing and financial data.
- A lot of this data is now computerized. Use of computers is facilitated by that fact that operational data (from hospitals and vital records) is already computerized.
Information Revolution 2: Storage Of Large Data
Sets
- The invention of the computer enabling humans to handle large amounts of data has created an information revolution.
- New computers can manage (collection & storage) and analyze large amounts of data, a feat that was unthinkable a few years ago.
Information Revolution 3: Processing Of Large
Data Sets
- Statisticians could handle little data before the development of rapid computing. They were able to do a bit more when hand calculators were available. The calculators however could not store or manage large data sets.
- Computers that are in essence programmable calculators that in addition are able to store and manage massive amounts of data superseded hand calculators.
- The growth of computational techniques enabled deeper and more sophisticated analyses. More powerful computers with more sophisticated statistical packages are now available.
Information
Revolution 4: Development Of Statistical Methodology
- Availability of high speed and efficient computing has encouraged growth in statistical methodology that was un-thought of before. Procedures that were rare are now carried out routinely.
- Statisticians in the past used to rely on approximate methods because exact methods were computationally difficult.
- Modern computers can complete the most complicated exact computations in a fraction of a second.
- Procedures that required repeated iterations before finding the right value could not be carried out before but are now routine thanks to the fast computers now available.
Information
Revolution 5: Development Of Statistical Theory
- The increased availability of computing power has encouraged the developed of more sophisticated statistical analysis.
- This has in turn called for developments in statistical theory that is later translated into newer and more powerful analysis programs.
Information
System 1: Components Of An Information System
- People
- Procedures for example computer manuals
- Software (system software or applications software either custom-made or packaged)
- Hardware
- Data.
Information
System 2: Database Management Systems
- Database management systems create. Modify, and access data.
- Database management systems serve the following purposes: sharing data, security of data by use of passwords, fewer files, and data integrity.
- The database management system has an element as basic building block. Several element values are arrayed as a single observation or record belonging to say one person. Several observations are put together to make a rectangular file showing values of variables for several individuals. Several files make a database. A data dictionary describes the structure of the data.
Information System 3: Types Of Databases
- Several types of databases can be identified depending in the architecture of information storage in the computer.
- A relational database is one in which all fields are related by the identifying variable. It is in the form of a table with rows and columns.
- A hierarchical database is several layers of information such that lower layers are not reached before higher ones are opened. The hierarchical database is a one-to-many arrangement. There are parent and child nodes. In searching for an item you start at the top and go deep into the data.
- A network database is a many-to-many architecture. An item can be reached in more than one way.
Information System 4: System Analysis And Design
- System analysis
- System design
- System development
- System implementation
- System maintenance.
- The setting up of a database or a transactional computer system is a highly intellectual exercise that requires full understanding of all operations of the organization, the routine and the exceptional ones.
Information System 5: Steps Of Programming
- A program is a series of instructions that the computer executes.
- There are 6 steps in programming:
- Program specification which states the objectives,
- The input and the output;
- Program design which indicates the logic structure by means of flow charts to show all steps from input through processing to output;
- Coding is the actual writing of the program at the computer terminal using a programming language;
- Program testing or debugging is correction of syntax and logic errors; documentation is stating the purpose and process of the program;
- Program maintenance is development and improvement.
Information System 6: Programming Languages
- Software engineering tools help produce more efficient programs.
- There are 5 generations of programming languages.
- Machine language is the binary code.
- Assembly language is still in binary code but is more readable than machine language.
- High level procedural languages like BASIC, Pascal, C, COBOL, and FORTRAN are source codes converted by the machine into machine language (also called object code).
- Problem oriented languages are query languages used in searching databases.
- Natural language is usual human language.
Information
System 6: Ethical Problems
- Privacy
- Accuracy
- data ownership
- data access data security
Information
System 7: Threats To Data Security
- Computer hackers who gain entrance to databases and cause havoc commit computer crimes.
- Viruses attack and destroy databases.
- Encryption is used to decrease the chance of stealing data in transit.
- Restriction of access using passwords also helps keep away intruders.
Health
Information Management 1
- Uses of IT: management, error reduction, coordination (IT overcomes the challenge of fragmentation in the health care system), quality control.
- Clinical care, IT, and health care business coalesce
- Introduction of IT requires strategic planning. Best of the breed vs hybrid system
Health
Information Management 2
- Computerized medical records / electronic medical record / electronic health record (HER) woumb to tomb EHR.
- Standardization of clinical documentation.
- Patient-centered documentation.
- Selayang Hospital in Malaysia is paperless and has a total hospital information system.
Health
Information Management 3: Benefits Of EMR
- Immediate access to info for decisions
- Integration which increases patient safety
- Communication
- Graphic display
- Save time in dealing with insurance
- No need to ask the patient the same questions again.
- No problems with bad doctor handwriting.
Health
Information Management
3: Benefits Of EMR
- to consumer
- to provider
- to public health researcher.
Health
Information Management 4: Challenges Of HER:
- Security
- Privacy and confidentiality
Health
Information Management 4: Benefits Of EMR In Clinical Management
- Computer based patient interview is useful because diagnosis can be based on history in 90% of the cases but doctors do not have time to listen
- Doctor entry of information into HER interferes with patient-doctor relationship
- The patient can enter information into the computer so that the physician can have a print out to guide the interview. It is not easy to design neutral questions. There is a need for sophisticated interview software.
- IT helps in nursing management
Health
Information Management: Advantages Of IT Based Prescription Systems:
§
Automation of the whole process
§
Automatic substitution of products
§
Tracking inventory
§
Detecting drug interactions
§
Limit clinicians prescriptions
§
Check allergies
§
Manage compliance / refills
§
Automated dispensing: 1. Storage and retrieval
2. Remote dispensing
§
Error reduction: 1. Bar coding 2. Pill imaging
to check that what was prescribed is what was dispensed
Health
Information Management: Computer enhanced radiology:
§
Registration
§
Scheduling
§ Patient tracking
§
Record management and retrieval
§
Report generation
Health
Information Management: IT and patient safety
§
Problem of downtime
§
Use of portable devices
§
Patient outcome for IT: morbidity and mortality,
quality of life, satisfaction
§
Integration of patient in the MIS
§
Complete prescription reduces mistakes
§
IT and evidence based practice
§
Infobia is resistance to change
§
Role of CIO
Bayesian Clinical Decision Making And Epidemiology
§
Use of the Bayesian formulation in diagnostic
tests:
§
Use of probability in Questing Theories
Data Management
§
Data storage
§
Data retrieval
§
Data warehousing
§
Data mining
§
Data replication
SOURCES
Kubias D1. Health and
clinical management - from the pen and paper to the digital era. Adapting the
healthcare environment to take full advantage of information and communication
technology. Yearb Med Inform. 2011;6(1):48-50.
- In constant evolution, the healthcare environment has multiple challenges to meet: cost containment, increase and ageing of the population, enormous quantities of data and quickly evolving knowledge, complex and multi-disciplinary approaches for healthcare, need for safer care, to mention but a few.
- While health IT has already helped healthcare in facing these challenges, there still is much more that could be done.
Misono AS1, Cutrona SL, Choudhry
NK, Fischer MA, Stedman MR, Liberman JN, Brennan TA, Jain SH, Shrank WH. Healthcare
information technology interventions to improve cardiovascular and diabetes
medication adherence. Am J Manag Care. 2010 Dec;16(12 Suppl HIT):SP82-92.
- There is a paucity of data about HIT's efficacy in improving adherence to medications for cardiovascular disease and diabetes, although simple patient reminder systems appear effective.
- Future studies should focus on more sophisticated interactive interventions that expand the functionality and capabilities of HIT and better engage patients in care.
Abraham C1, Nishihara E,
Akiyama M. Transforming healthcare with information technology in Japan: a
review of policy, people, and progress. Int J Med Inform. 2011 Mar;80(3):157-70.
doi: 10.1016/j.ijmedinf.2011.01.002. Epub 2011 Feb 2.
- The research highlights the efforts of Japan for using HIT in healthcare reform.
- We present outcomes from a case study of the Kyoto Yamashina area medical community as proof of concept for past and present policy in Japan that are insightful for proliferation of successful projects in Japan and adoption of HIT in general.
Govindan M1, Van Citters
AD, Nelson EC, Kelly-Cummings J, Suresh G.
Automated detection of harm in healthcare with information technology: a
systematic review. Qual Saf Health Care.
2010 Oct;19(5):e11
- Automated methods of harm detection are feasible and some can potentially detect patient harm efficiently.
- However, effectiveness varied widely, and most studies had methodological weaknesses.
- More work is needed to develop and assess these tools before they can yield accurate estimates of harm that can be reliably interpreted and compared.
Huryk LA1. Factors
influencing nurses' attitudes towards healthcare information technology. J Nurs
Manag. 2010 Jul;18(5):606-12.
- Overall, the attitudes of nurses toward HIT are positive.
- Increased computer experience is the main demographic indicator for positive attitudes.
- The most common detractors are poor system design, system slowdown and system downtime. Nurses are also fearful that the use of technology will dehumanize patient care.
- Involving nurses in system design is likely to improve post-implementation satisfaction. Creating a positive, supportive atmosphere appears to be instrumental to sustainability.
ISSUES FOR DISCUSSION
§
Overview of the challenges of the Information
Age
§
Influence of Information Technology on medical
education and medical practice
§
Evaluation of the accuracy and worth of
available information
§
Effective management of information, especially
the aspects of its access, use and dissemination?
§
Examples of local and international solutions
for management of information in the education and practice of medicine