Healthcare Information Systems: An Overview

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

2. What is wrong with this picture?

3. 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.

4. 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 $18-22/sq ft/yr 240 sq ft

5. Outline • What kinds of HIT systems are there? • What are we using here at FSU CoM? • 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?

6. Elements of IT Infrastructure • Hardware/Software • Support Issues • Workflow/Mindset Issues • Training Issues • Budgeting Issues

7. High speed networks Wireless Networks PDAs Tablets Internet access Web server Intranets (SharePoint) Video conferencing Bar-code readers Voice over internet Speech recognition Basic Technology

8. 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

9. 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 HIT Applications

10. 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

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

12. 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

13. The Tablet PC Lenovo ThinkPad TabletPC Issue First Day 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

14. Software Installed • Windows Vista (7) – Tablet Edition • Office 2007, including Word, Excel, PowerPoint, Publisher, Access, Outlook, Internet Explorer • Adobe Acrobat Reader, Microsoft Digital Image Suite, WinZip, Sonic Record Now, medical spell checker, and EndNote • Anti-virus, anti-spyware, & other security software

15. Microsoft Office OneNote Windows Journal Microsoft Educational Pack for Tablet PC Microsoft Experience Pack for Tablet PC Sticky Notes Snipping Tool Interesting Tablet Software

16. EMR • SOAPware • Use 3rd year

17. PDAs • Issues Fall 1st 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.

18. HP iPAQ • Windows Mobile 6 • 1 GB SD card • Color, backlit, 240-360 screen • Sound recorder, mp3 player • Wireless - both WiFi & Bluetooth

19. FSU Licensed PDA Software • Epocrates Essentials ($149/yr) • Essential Evidence Plus ($249/yr) • DynaMed ($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 Intro to Medical Library Resources

20. iPhone Revolution • Cell phone technology expanding to PDAs • Medical reference websites reformatting • Software versions availability expanding • 6 resources: Epocrates, PEPID, Dynamed, ePSS, Pediatric Care Online, Clinical Evidence • WM cell phones popular

21. PDA Versions Available

22. Epocrates Essentials Most widely used PDA program by medical practitioners Rx, (Drugs & Complementary meds) Sx/Dx (Symptom & Disease Reference) Labs & other tools. Epocrates Essentials

23. 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

24. Clinical Learning Center

25. Sim Center

26. The College Portals • Our Electronic Library • SharePoint Intranet • Internal document sharing • Policies, procedures, etc. • Enterprise Exchange e-mail system with integrated calendars and contacts • Blackboard Courseware

27. www.med.fsu.edu

28. Our Library is always open

29. 24/7 Access to Resources • >1900 medical eJournals (3.5 M articles) • Hundreds of clinical eBooks • 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

30. Blackboard - Course Websites • All Course Materials • Syllabus & Assignments • PowerPoints & Lecture notes • Discussion board & Grades Posting

31. Overview of Current State of Healthcare IT Adoption

32. Source of Stats • 2009 HIMSS Leadership Survey • 304 IT HealthCare Executives representing 700 hospitals • http://www.himss.org/2009Survey/healthcareCIO_final.asp • FSU CoM - Center on Patient Safety • Robert Brooks, MD, Associate Dean, Health Affairs • Nir Menachemi Ph.D., MPH, Director, Center on Patient Safety

33. Projected IT Priorities Source: 20th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

34. Top Business Issues Facing HealthCare Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

35. Most Significant Barriers to Barriers to Implementing IT Source: 19th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

36. Status of Electronic Medical Record Implementation Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

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

38. Top Security Concerns of Computerized Medical Information Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

39. Security Tools Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

40. Technology Adoption Curve 75% 50% 25%

41. Technology Adoption (Next Two Years) Source: 19th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

42. 2008 Health IT Staffing Needs Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

43. 2009 Health IT Staffing Needs Source: 20h Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

44. National Initiatives

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

46. Sharing Medical Data • Increase patient safety • Lower Healthcare costs • Allow for coordination of care • Increase communication between providers • Banking analogy

47. 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

48. 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

49. Status of Health Information Exchange (HIE) Source: 20th Annual HIMSS Leadership Survey Sponsored by ACS HealthCare Solutions

50. 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