Knowledge Management, Intro to Electronic Databases, Health Data Analysis

1. Knowledge Management, Intro to Electronic Databases, Health Data Analysis INTD 560 Survey of Health Informatics Osmar R. Zaïane

2. UNIVERSITY OF ALBERTA Osmar R. Zaïane, Ph.D. Professor Department of Computing Science Telephone: Office +1 (780) 492 2860 Fax +1 (780) 492 1071 E-mail: zaiane@cs.ualberta.ca http://www.cs.ualberta.ca/~zaiane/ 352 Athabasca Hall Edmonton, Alberta Canada T6G 2E8 Who am I? • Computer Scientist • No medical training • Specialize in Data Mining • Many years of sporadic experience designing and implementing health care systems • Not a chronic patient yet

3. Health Information Management • What kind of information is collected in health care? • Who collects it? • Why is it collected? • What is it used for? • By who? • Where is stored • Who does it belong to? • Who is entitled to access it?

4. Example: • Physicians assess patient status; • Clinicians administer treatment; • Administrators determine appropriate staffing levels; • Administrators manage inventory of supplies; • Administrators negotiate contracts and payment for services; • Pharmacists manage inventory of drugs; • Administrators and statisticians evaluate clinical outcome, quality and cost of healthcare provided per population; • Politicians make decisions investing in new services or eliminating underutilized services; • Researchers analyze and compare clinical treatment and outcome and devise new treatments

6. Patient Profile: Mary Smith • Mrs. Mary Smith • 73 year old female • recently moved to Red Deer • previously lived in Toronto • Where are her medical records? • Not in Red Deer • Not in Alberta • Spread in Ontario (Toronto hospitals, health centres, etc.) • What will happen if she needs them?

7. Mrs. Smith visits the Red Deer regional hospital • She has come for an “Initial Visit” appointment at 10:00am with Dr. Robertson • Upon arrival, Mrs. Smith checks in with the front desk • Front desk staff enters her information into the registration system

8. Interface Engine / Aggregator Red Deer Registration System Federal Aggregator Gateway Ideal Scenario on Information Flow Health System 1 4- External sites identified 6- Receive data: Smith’s Medications and Allergies Health System 2 1- New Patient message 3- External Request 2- Internal Request Health System 3 5- Request information for Mrs. Smith 7- Provide data Health System n Local HIS Interface

9. Wish list The data exchange occurs automatically and transparently, between registration at Red Deer and the health organization custodian of medical data in Ontario When Dr. Robertson walks into the exam room, Mrs. Smith’s known Medications and Allergies are available for review on local health information system

10. Gateway Red Deer Registration System Federal Aggregator Interface Engine / Aggregator Ideal Scenario on Information Flow Health System 1 4- External sites identified 6- Receive data: Smith’s Medications and Allergies Health System 2 1- New Patient message 3- External Request 2- Internal Request Health System 3 5- Request information for Mrs. Smith 7- Provide data Dr. Robertson examines Mrs. Smith, then writes prescriptions into the Health Information System… • Reordering a previous prescription • Verification of allergy • Decision support • Allergy detection • Drug-Drug Interaction • Select pharmacy to receive electronic prescriptions Health System n Local HIS Interface

11. Reality Check • Mrs. Smith has 3 months to get an Alberta health card and number • Dr. Robertson would ask Mrs. Smith about her medical history and her previous medical providers (doctors, hospitals, etc.) • Dr. Robertson (or hospital) has to contact Mrs. Smith’s previous medical providers for her file. • They might reply, by mail or fax. E-mail is not considered secure (but fax is ???) • Her medical record in Alberta has to be created from scratch.

12. Healthcare=Information Intensive • Healthcare professionals = heterogeneous group with divers objectives and information requirements • “The purpose of a HealthCare Information System is to manage the information that health professionals need to perform their jobs effectively and efficiently.”

13. Automation of Healthcare Systems • Historically, different units and services within a hospital were automated (introduction of IT) separately; • Separate in terms of function, hardware, operating system, programming language, vendors; • Connecting and communicating between the pieces is a challenging obstacle: consistency, updates, etc. • Locating where the patient is and any given time; Identifying the kind of care provided; recognizing the clinical results, etc. are significant real challenges.

14. Automation of Healthcare Systems Hospital Registration Billing Medical Unit Medical Unit Medical Unit Medical Unit Lab Unit Separate automation of specific functions within the hospital Integration via Interface Engine or Protocol (HL7)

15. Separate functional automation • Significant duplication; for instance registration and demographic data can be entered many times for the same visit. • Contradictions and missing data • Integration difficult and prone to error • Software maintenance and upgrades expensive • Infrastructure and training expensive

16. Hospital Registration Billing Medical Unit Medical Unit Medical Unit Medical Unit Lab Unit Enterprise Automation automation within the hospital as a whole enterprise

17. Automation of Healthcare Systems Healthcare Organization Healthcare Organization Integration via Aggregator/Mediator/Protocol (HL7) Healthcare Organization Healthcare Organization “The expertise gained from managing an inpatient driven organization (e.g. a hospital) does not translate easily to the successful management of other organizational activities, nor in some cases, even to other hospitals.” Idem for automation

18. Functions and components of HIS • Patient Management and Billing • Departmental Management • Care Delivery and Clinical Documentation • Clinical Decision Support • Financial and Resource Management

19. Benefits • Cost reduction • Productivity enhancement • Quality and service improvement • Regulatory compliance • Research enabler • Competitive advantage

20. Requirements • Information requirements • Operational • Planning • Communication • Documentation and Reporting • Integration requirements • Security and confidentiality requirements

21. Personal Information Protection • Alberta: Personal Information Protection Act (PIPA), 2003 (http://pipa.alberta.ca/) • The purpose of this Act is to govern the collection, use and disclosure of personal information by organizations in a manner that recognizes both the right of an individual to have his or her personal information protected and the need of organizations to collect, use or disclose personal information for purposes that are reasonable. • Ontario: Personal Health Information Protection Act (PHIPA); outlines privacy regulations for health information custodians • Saskatchewan: Health Information Protection Act (HIPA), 2005 • Canada: Personal Information Protection and Electronic Documents Act (PIPEDA), 2001 (applies to federally regulated industries) • USA: Health Insurance Portability and Accountability Act (HIPAA), 1996 http://www.hipaa.org/ Not Health Specific

22. Privacy of health information Why protect the privacy of health information? • Do you know who accessed your health information this week? • Do you know what they did with your health information? • Does this concern you? What increased threats to privacy, if any, does the emerging ‘electronic health record’ pose? • Privacy incorporates much more than “confidentiality” and “security”. • Privacy is about protecting an individual’s right to have a choice about how their health information is handled. • Challenge: maximise both the protection of individual privacy AND positive health outcomes. Identity theft and being impersonated may lead to financial losses Identity theft in healthcare and being impersonated may lead to death.

23. Active Participants • Physician • Nurse • Lab technician • Pharmacist • Other care providers • Administrators • Insurance • Patient (becomes an active participant)

24. Patients can be active Participants • The patient is a participant in their care with self-entered data and consent preferences for this data. Patient in control over what goes into the Personal Health Record and who has access to it. • Some companies see this as business opportunity • Let consumers opt-in to share the output from a device measuring their blood sugar or blood pressure or other medical sensors. • This information is viewable in an aggregated format allowing for a more accurate overall clinical picture • Clinicians can view self entered data as well as historical prescriptions and conditions from multiple sources electronically • goals: “To create integrated online environments where you can create and store your personal records, get information, find doctors, make medical appointments, communicate online, manage medications, share information with providers and more.”

26. Questions?