Module 1: MTHlthInfo: Health Information

System for MLS (Laboratory)

Clinical Data Repositories College A.Y. 2021 – 2022 – 2

12. SocialHistory
OUTLINE
o This includes the patient’s marital status and
I. Definition occupation
II. Types
III. Advantages 13. Vitals
IV. Data Visualization o Blood pressure and Pulse rate of the patient

TYPES OF CLINICAL DATA REPOSITORY

CLINICAL DATA REPOSITORY (CDR) 1. Study
o A database that collects observations for a
➢ A systematically structured and gathered storehouse specific clinical research study.
of patient-specific data, which is usually mirrored ➢ Example:
from a clinical application, or supplemented with data o National Addiction and HIV Data Archive
from other systems. Program (NAHDAP) → this study focuses on
➢ Integrates physician-entered data with data from addiction and HIV
different information systems

CDRs AVAILABLE INFORMATION

1. Patient Demographics
o This includes the patient’s full name, age, and
gender.

2. Patient’s Primary Healthcare Provider

o This includes who is the patient’s physician.

3. Medication List
2. Electronic Health Record (EHR)
o What are the medications that the patient is
o A database of observations made as a result of
taking?
direct health care.
o Used in hospitals; includes the patient’s
4. Allergies
demographics: name, age, gender
o Does the patient have any allergies to certain
o Diagnosis of the Patients
medications or food?
o Procedures
o Allergies
5. Hospital In-Patient Visits
6. Out-Patient Visits
7. Emergency Department

8. Immunizations
o Did the patient recently receive a flu shot or
tetanus shot?

9. Diagnoses
o Does the patient have asthma, diabetes, or
hypertension?

10. Procedures
o Did the patient recently have CT-Scan, X-ray,
Lipid Profile, or Complete Blood Count?

11. Laboratory Results

o What are the results of these procedures?

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 MODULE 1: CLINICAL DATA REPOSITORIES
3. Registry
o Observations are collected and organized for the
purpose of studying or guiding particular
outcomes on a defined population.
o Associated studies in a registry are either
multiple or long-term and evolving over time.
➢ Example:
o Integrated Chronic Non-Communicable
Diseases Registry System of the DOH
[Defined Population → Cancer, Diabetes,
CVDs]
o Autoimmune Registry → [SLE – Systemic
Lupus Erythematosus]
4. Warehouse
o Adds levels of integration and quality to the
primary (research or clinical) data of a single
institution to support flexible queries for multiple
uses.
o Used in order to structure data in one place;
serves as a single source for a certain institution.
➢ Example:
o CMS Database → Warehouse for Centers for
Medicare and Medicaid Services
5. Collection
o A library of heterogeneous datasets from more
organizations than a warehouse or more sources
than a registry.
o It includes different types of information which is
organized to help users find a particular data set.
➢ Example:
o EMERGE Network → Electronic Medical
Records and Genomics; funded by the
National Human Genome Research Institute
➢ EMERGE Network → collects from the different states
in the U.S
6. Federation
o A repository distributed across multiple locations
similar to a collection.
o Each location retains control over access to its
own data.
o Responsible for making the data comparable
with the data of other locations.
➢ Example:
o STARNet → South Texas Ambulatory
Research Network
ADVANTAGES OF CLINICAL DATA REPOSITORY
1. Provides longitudinal views of patient information
o CDRs are primarily organized around
patients and secondly around visits or
encounters.
o There is one record per patient, in this
record, data is further organized based on
time (by year, month, week, day).
o This allows clinicians to trend and chart
results of the patients.
➢ Example:
o A physician could study the trend of the
patient’s blood glucose level over the past 6
months.
2. Provides access to information when needed
o Wherever you are you can access the
information.
o This is possible with the use of an easy-to-
use graphical interface, using the GUI, the
physicians and other healthcare workers can
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 MODULE 1: CLINICAL DATA REPOSITORIES

access the patient’s

data through handheld devices and
computers located at the bedside, offices,
and nursing stations.

3. Provides a cross-continuum view of information

o It allows information to be gathered in view
from sources other than the actual setting.
o It is connected in the second advantage.

✓ If the physician is not around to make runs and they

want to be updated on the status of the patient, the
CDR will provide the information in real-time.

DATA VISUALIZATION

• Data Visualization
➢ The art of representing data in a pictorial or
graphical format.
➢ Makes it easier for us to analyze data and
simplifies a wide range array of information.
➢ Correlations, patterns, and trends which might
be undetected from text-based clinical data can
now be revealed and recognized more easily.
BP Values

Data
Visualization

Intake of
Medication

➢ Blue = Systolic
➢ Yellow = Diastolic
o The BP Values in the data are measured at
home.
➢ Home BP Values = Circles
➢ Office BP Values = Squares

REYES, R.A. (BSMT 1-B) 3

 Module 2:
Health Informatics (eHEALTH)
TOPIC OUTLINE
I. Definition
II. Application
III. Issues and Challenges
ELECTRONIC HEALTH (eHEALTH)
➢ A broad group of activities that use electronic means
to deliver health-related information, resources, and
services.
o Online Consultations with Physicians
▪ Bayanihan E-Konsulta
o Online Trackers
▪ Healthmap.org
➢ Aims to deliver the following
o Right health information to the right person
at the right place and time.
➢ Proven to prevent any clerical errors in reporting of
patient information.
o eHEALTH uses a unique identification system
for each patient. This makes it less likely to
have any mix-up of information.
o Provides a faster delivery of results because
the handling of patients’ information is
already automated.
➢ Refers to the use of Information and Communication
Technologies (ICT) in the field of healthcare
TYPES OF eHEALTH
1. Mobile Health (mHEALTH)
o Refers to the use of mobile communication
devices for health services and information.
o The development of these applications
served as a part of the advancement in
healthcare.
o Access to health through the palm of our
hands.
2. Telemedicine / Teleheath
o We make use of telecommunications for the
remote diagnosis and treatment of patients.
o Helps eliminate the distance barriers and
improves the access to medical services in
distant areas.
o Helps in saving lives in critical care and
emergency situations.
MTHlthInfo: Health Information
System for MLS (Laboratory)
College A.Y. 2021 – 2022 – 2
3. Automated Patient Records
o A lot of healthcare facilities have shifted
from manual to automated handling of
patient records.
o The information flow of an automated
patient record should follow the flow of a
manual health record.
o The information must be transmitted in a
way that it starts when a patient is admitted
to the hospital to the time that certain tests
and management procedures are
performed and lastly up to the time that a
final medical record is ready for filing.
TERMINOLOGIES
1. Automated Health Records (AHRs)
o Collections of computer-stored images of
traditional health record documents.
o A collection of health records on paper that
are simply scanned into a computer, then
these images are stored in the computer
itself or optical disks.
o They were able to address problems when it
comes to access space and control of paper-
based records. However, it was unable to
address data input or output at a patient
care level since it only simply converts paper-
based records into computer-stored images.
o Prompted the development of EMRs.
2. Electronic Medical Records (EMRs)
o Start of actual entering of clinical
information into an electronic record
system.
o Further improved into CPRs
3. Computer-Based Patient Records (CPRs)
o Collection of health information for one
patient linked by a patient identifier (unique
to each patient)
o Examples of Patient Identifiers
✓ Alphanumeric Codes / Barcodes
4. Electronic Health Records (EHRs)
o All information contained in a traditional
health record are all entered into an
electronic or automated system.
o Provide a dimension of time which allows
the inclusion of information across multiple
episodes and providers.
o Serves as a lifetime record of patients since
their entire medical history is in it.
REYES, RUBENELLI ALZEN A. (BSMT 1-B) | 1
 MODULE 2: HEALTH INFORMATICS (eHEALTH)

✓ Demographics SAFEGUARDS
✓ Lab Results ➢ These challenges may be addressed through the
✓ Medications following safeguards
✓ Allergies
✓ Previous Diagnosis 1. Data Back-up Systems
o It can be applied in: 2. Contingency Plans
✓ Pharmacy Systems (ePrescribing) o In using an EHR, healthcare facilities should
✓ Clinical Documentations have administrative physical, and technical
✓ Computerized Physician Order safeguards to ensure that patient
Entry (CPOE) information is kept secure and complete at
✓ Administrative Sector of the all times.
Hospital in Patient Registration
3. Secure workstations
o Requiring passwords and other verification
ADVANTAGES OF eHEALTH methods
1. Provides efficient use of health-related resources o Only the personnel assigned to handle the
2. Increases the speed of delivery patient information should be the ones who
3. Prevents overuse of medications. can only access the patient information
4. Removes the need for physical space.
4. Access control
ISSUES and CHALLENGES OF eHEALTH 5. Audit Control
1. Financial implications o The management of the healthcare facility
o Funding issues and the high cost of should implement regular checking and
computers and computer systems need to evaluating of their day-to-day operations, to
be critically evaluated prior to the ensure the maximum efficiency of the
implementation. safeguards is achieved.

2. Privacy and confidentiality issues

3. Quality and accuracy issues

4. Manpower issues
o The management of the health facility must
be careful in selecting the person who will be
assigned to handle the patient information.

5. Environmental issues
o Electricity and physical space must be
considered.
o The health facility must be prepared to
assure the safety of electronic health records
during times of disasters.

REYES, RUBENELLI ALZEN A. (BSMT 1-B) | 2

 Module 3:
Ethics, Privacy, Security & Confidentiality
➢ With the growing technology, recent advancements in
clinical diagnostics and clinical-scientific breakthroughs
happening in the past few decades, automation in the
clinical laboratory process has become a norm and
made work more bearable for the laboratory personnel
which aided them greatly in their work or duties in the
management of patients. Despite this, human values
❖ General Ethics Examples in Case Studies
must hold on to govern the actual practice of health
1. Assisted Reproductive Technology (ART) refers to
care. This is where the concepts of ethics in health
informatics step in.
ETHICS IN HEALTHCARE
➢ Healthcare informatics covers issues on proper
behavior and conduct in the healthcare setting as this
will guide healthcare professionals in evaluating their
actions and decisions whether they are good or bad -
giving them a moral compass.
o Usually, problems experienced by healthcare
practitioners are unfamiliarity with ethical
issues. This is one rationale for why there is a
need to address issues of privacy and
confidentiality in the industry.
➢ As mentioned previously, Health Information Systems
are used to manage patient information. The world of
health information systems must be guided by the
health information ethics, which refers to the
application of the principles of ethics into the realm of
health information systems.
3 MAIN ASPECTS OF HEALTHCARE INFORMATION
ETHICS
1. General Ethics
➢ Guides the reasoning and decision-making of all
people and organizations involved in health care.
o These include autonomy, beneficence and
nonmaleficence.
▪ Principle of Autonomy
• Refers to allowing the individuals such as allied
healthcare practitioners and patients to make their
own decisions and to be free from external
influence or control.
▪ Principle of Beneficence
• This promotes action that will support others,
particularly in a patient or client respectively.
MTHlthInfo: Health Information
System for MLS (Laboratory)
College A.Y. 2021 – 2022 – 2
▪ Principle of
Autonomy
• Refers to “doing no harm”
• This reminds you that the primary concern when
carrying out a task is to do no harm by minimizing
or eliminating the risk that a patient undergoes in a
certain situation.
the procedure to aid or treat the inability of
patients to reproduce offspring, Common
examples are In-Vitro Fertilization and Artificial
Insemination.
• The Principle of Autonomy dictates that a patient shall
understand all risks and benefits of the procedure and
the likelihood of success. This means that the
healthcare professional should have full disclosure so
that the patient is able to make a well-informed decision
that is devoid of coercion, bribery, and other forms of
external influence.
• The Principle of Beneficence is carried out when the
ART procedure is provided with the intent of doing good
for the patient or patients involved. Other self-serving
reasons shall be eliminated by the healthcare
professionals. An example of beneficence is when the
healthcare professional does the procedure correctly
and ensures that maximum success of the procedure is
obtained. In the ART procedure,
• The Principle of Nonmaleficence will dwell on not
harming the patient or others in society. If the risk
cannot be completely removed, it must be limited or
minimized.
2. COVID-19 Immunization
• The Principle of Autonomy ensures that the people
make a fully informed decision that they want to get
vaccinated.
• The Principle of Beneficence may be applied when
companies ensure that the vaccine effectively delivers
immunization against the COVID-19 virus.
• The Principle of Nonmaleficence deals with having the
post-vaccination adverse effects minimized or
eliminated.
2. Informatics Ethics
➢ Concerned with ethical behavior that is expected
specifically from individuals that are assigned to
handle health information.
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 Module 3: ETHICS, PRIVACY, SECURITY, & CONFIDENTIALITY

❖ Seven Principles of Informatics Ethics 7. Principle of Accountability

1. Principle of Information-Privacy & Disposition
o This follows the premise that everyone in the
healthcare industry has a fundamental right to
privacy.
o Both healthcare professionals and patients should
ensure that they have control over the
management and disposal of their personal health
data.
3.
2. Principle of Openness
o States that the control measures of data should be
disclosed to the concerned individual in an
appropriate and timely fashion.
3. Principle of Security
o This shows that legitimately collected should be
protected through appropriate measures.
o Unauthorized access, use, manipulation or
destruction of data should be prevented through
such security measures.
o This complements both the principle of access and
principle of least intrusive alternative.
o This principle states that any infringement of
privacy rights must be justified or accounted to all
who were involved or all who were recorded to
have had possibly accessed or manipulated patient
information.
Software Ethics
➢ This gives an ethical responsibility to software
developers since they work on a core component of
the health information system, particularly in the
software aspects. They should urgently disclose any
threats or identify defects in the software. In
addition, they should be guided by the principles of
beneficence that they should adhere to the best
interest of the society.

4. Principle of Access
o This means that within the healthcare facility, only
authorized individuals should be given access to
patient records.
o Only these individuals have the right to access and
correct the data with respect to their
completeness, accuracy, and relevance.

5. Principle of Legitimate Infringement PRIVACY & CONFIDENTIALITY IN HIS

o This only means that rights to privacy and control
❖ Privacy
over personal data should follow the rules and
o The privacy of personal health information
regulations of a certain region.
pertains to the collection, storage, and use
o Hence, the term “legitimate” in the Philippines, our
of personal information and addresses the
rights to privacy and control of personal data are
question of who has access to personal
guided by the Republic Act No. 10173 or Data
information and under what conditions.
Privacy Act of 2012.
Example:
o Violation of privacy happens when
6. Principle of Least Intrusive Alternative
someone is eavesdropping on a particular
o Access to patient information cannot be completely
person and finding about this person's visit
locked away from healthcare
to an AIDS clinic.
o professionals.
o For example, most of the time, healthcare
❖ Confidentiality
professionals would need to refer to existing
o Addresses the issue of how personal data
patient information for verification and quality
that have been collected for one approved
control purposes.
person may be held and used by the
o This principle simply dictates to us that any
organization that collected the data, what
interference with the right of privacy should be
other secondary or further uses may be
kept in the least intrusive manner or only necessary
made of the data, and when the permission
information should be accessed.
of the individual is required for such uses.
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 Module 3: ETHICS, PRIVACY, SECURITY, & CONFIDENTIALITY

➢ Example:
o In comparison, violation of confidentiality
happens when a person intentionally Administrative Physical Technical
Safeguards Safeguards Safeguards
breaks into an AIDS clinic to view a specific
Regular risk Placing office Configuration of
patient's record. This violates
assessment of the alarm systems; computing
confidentiality since the duty of the
health IT equipment to
healthcare personnel to protect patient environment; Locking offices ensure security;
data was breached. and areas that
Continuous contain Using certified
SECURITY assessment of the computing applications and
effectiveness of equipment that technologies that
❖ Security Measures → Safeguards safeguards for stores electronic store or
o Solutions and tools that are used to electronic health health exchange
information; information electronic health
implement security and policies at
information;
different levels of organizations
Detailed process Having security
o Termed as “The procedural and technical measures and guards that make Setting up access
required (a) to prevent unauthorized access, procedures for a regular rounds controls to
modification, use, and dissemination of data stored or viewing and in the vicinity. health IT and
processed in a computer system, (b) to prevent any administering electronic
deliberate denial of service, and (c) to protect the electronic health health
system in its entirety from physical harm.” (Turn and information; information;
Ware, 1976).
Encryption of
1. Administrative Safeguards Training for the electronic
o Refers to the policies and procedures inside the users in health IT health information
organization that help protect against any unauthorized to appropriately
electronic health Regular audit of
access to health information.
information; the health
o Continuous Training of Laboratory Personnel in
IT operations;
HIS Reporting of
o Regular Review of Laboratory Policies security Having backup
breaches capabilities.
2. Physical Safeguards
o Make sure that data is physically protected.
Includes security systems, door, window locks, and
secure locations.

3. Technical Safeguards
o Concerned with technology and related policies
from unauthorized access.

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