Health Information System

LABORATORY | MIDYEAR – MIDTERMS

Health Informatics
Health Information Technology Health Informatics
▪ “The area of IT involving the design, ▪ “The application of technology tools and
development, creation, use and maintenance of information system in a healthcare setting or
information systems for the healthcare context.”
industry.”
o (Applied Educational Systems Inc., 2012)
o Rouse, 2016
▪ “Vows to provide innovation to health care
delivery and connection among users and
stakeholders in the e-health market.”
o Kushniruk & Borycki, 2017
Health Information Management Health Care Software Systems
▪ “Management of health data and medical
records needed to deliver quality healthcare”
o American Health Information
Management Association (AHIMA)
▪ AHIMA is a global nonprofit association of
health information (HI) professionals –
represents professionals who work with health
data Health Interoperability Ecosystem

o 1928: the American College of Surgeons Health Information Exchange

established the Association of Record
Librarians of North America (ARLNA) to
“elevate the standards of clinical records
in hospitals and other medical institutions”
o has had three name changes in history,
all were justified with an explanation that
reflected the progression of contemporary
medical record use, practices and
perceptions
1. American Association of Medical
Record Librarians (AAMRL) –
1938
2. American Medical Record
Association (AMRA) – 1970
3. American Health Information
Management Association
(AHIMA) – 1991
▪ health data clearinghouse which is comprised
of healthcare organizations that share data
among health information technology systems
▪ allows doctors, nurses, pharmacists, and other
healthcare provider and patients to
appropriately access and securely share a
patient’s vital information electronically -
improving the speed, quality, safety, and cost of
patient care
▪ appropriate timely sharing of vital patient
information can better inform decision making
at the point of care and allows providers to:
o avoid readmissions
o avoid medication errors
o improve diagnoses
o decrease duplicate testing
 ▪ Delta Checking
o checking or looking for previous
laboratory reports of the patient
Electronic Health Record (EMR)
• local and internal system of healthcare
organization
• electronic versions of medical records and an
internal system within a healthcare organization
like a clinic, a clinician’s office or hospital, which
allows them to organize their medical records
• enable clinicians to:
- track patient improvements over time
- identify patients who need screenings
- improve their diagnosis and treatment
- identify patients with particular needs
Electronic Health Record (EHR)
• an inter-organizational system
• quite similar to an EMR
• also, a digital version of a patient’s medical
record
• medical data from a patient or health record
• the biggest advantage of a patient with an EHR
is that medical practitioners can get cross-
provider medical information
- diagnoses and allergies
- medications and other treatment plans
- immunization date
- test results and radiology images
- provider contact information
Personal Health Record (PHR)
• patient-centered organizational system
• same as the EHR but are meant to be owned,
set up, and managed by patients
• just like EHRS, contain information like
diagnoses, medications, immunizations, family
medical histories, and provider contact
information
• the information can come from different sources:
- from the EHR of healthcare providers like
clinicians, testing centers, and hospitals
- from healthcare devices like home
monitoring devices, Fitbit, Apple Watch,
point of care devices, etc.
- from patients themselves entering data
manually, like over-the-counter medications,
lifestyle choices, etc.
• no matter where the data comes from - be it from
an EHR, a monitoring device, or the patient
themselves - the patients can access it
PACs and VNA
▪ the two widely used types of health information
technology which manage and store the
patient’s medical images
Picture Archiving and Communication Systems
(PACs)
• allows the presentation and retrieval of patient’s
medical images
Vendor Neutral Archives (VNA)
• technology used in Medical Imaging that store
medical imaging files and clinically relevant files
in standard format
• consolidates all the images into one
HITECH Act of 2009
▪ “The Health Information Technology for
Economic and Clinical Health Act of 2009”
▪ signed into law on February 17, 2009 by
President Barack Obama
▪ created to motivate the implementation of
electronic health records (EHR) and supporting
technology in the United States
▪ goals of HITECH act:
o promote and expand the adoption of
health information technology
o removed loopholes in the Health
Insurance Portability and Accountability
Act of 1996 (HIPAA) by tightening up the
language of HIPAA
o tougher penalties for HIPAA compliance
failures
American Recovery and Reinvestment Act
• nicknamed the “Recovery Act”
• signed into law by President Barack Obama on
February 2009 as a stimulus package enacted
by the 111th US Congress
• developed in response to the Great Recession
• the primary objective of this federal statute was
to save existing jobs and create new ones as
soon as possible
• other objectives were to provide temporary relief
programs for those most affected by the
recession and invest in infrastructure, education,
health, and renewable energy
• rationale was during recessions; the government
should offset the decrease in private spending
with an increase in public spending in order to
save jobs and stop further economic
deterioration
• allocates $787 billion to fund tax cuts and
supplements to social welfare programs as well
as increased spending for education, health
care, infrastructure, and the energy sector
Centers for Medicare and Medicaid Services
(CMS Rule)
• defines meaningful use criteria
• establishes incentive payments for meeting
meaningful use criteria (and penalties for not
meeting)
• agency within the U.S Department of Health and
Human Services that administrates the nation’s
major healthcare programs
• CMS Strategic Pillars:
- Advance Equity: advance health equity by
addressing the health disparities that
underlie our health care system
- Expand Access: build on the Affordable
Care Act and expand access to quality,
affordable health coverage and care
- Engage Partners: engage our partners and
communities we serve throughout the policy-
making implementation process
- Drive Innovation: drive innovation to tackle
our health system challenges and promote
value-based, person-centered care
- Protect Programs: protect our programs’
sustainability for generations by serving as a
responsible steward of public funds
- Foster Excellence: foster a positive and
inclusive workplace and workforce, and
promote excellence in all aspects of CMS’s
operations
Office of the National Coordinator for Health
Information Technology (ONC Rule)
• establishes certification criteria that HER
technology will need to meet in order to support
meaningful use
• staff division of the Office of the Secretary, within
the U.S. Department of Health and Human
Services
• leads national health IT efforts, charged as the
principal federal entity to coordinate nationwide
efforts to implement and use the most advanced
health information technology and the electronic
exchange of health information
• with the passage of the HITECH Act, the ONC is
charged with building an interoperable, private,
and secure nationwide health information system
and supporting the widespread, meaningful use
of health information technology
• ONC is working to improve these five areas:
- Adoption: increase end user adoption of
electronic health records and health IT to
capture and use the information
- Standards: establish standards so the
various technologies can speak to each
other
- Incentives: provide the right incentives for
the market to drive financial and clinical
advances
- Privacy and Security: make sure protected
(personal) health information remains private
and secure
- Governance: provide governance and
structure for the exchange of health
information
Meaningful Use
▪ using certified technology in EHR
implementation to:
o improve quality, safety, efficiency, and
reduce health disparities
o improve care coordination and population
and public health
o maintain privacy and security of patient
health information
HIPAA Violation Penalties
 MACRA
▪ “Medicare Access and Children’s Health
Insurance Plan (CHIP) Reauthorization Act”
▪ signed into law on April 16, 2015
▪ repealed the flawed Medicare sustainable
growth rate (SGR) formula that calculated
payment cuts for physicians
▪ created a new framework for rewarding
physicians for providing higher quality care by
establishing two tracks for Quality Payment
Program
o Merit-Based Incentive Payment System
(MIPS)
• Quality reporting under MIPS
- the quality performance category requires
providers to report on six measures of their
choice, including one outcome measure
- the CMS will evaluate providers on their
performance relative to their peers
Advanced Alternative Payment Models (APMs)
• provider models that emphasize coordination of
care, tying reimbursement to value
• can focus on specific diseases or populations
and span a variety of specialties, including
primary care, cardiology, cardiothoracic surgery,
orthopedic surgery, oncology, and nephrology

o Advanced Alternative Payment Models

(APMs)
Merit-Based Incentive Payment System (MIPS)
• more closely resembles previous Medicare
payment methods
• physicians are reimbursed primarily via fee-for-
service, with relative payment rates for each
service determined by the resource-based
relative value scale
• physicians will also receive bonuses or penalties
related to their performance
• assesses provider value through quality reporting
measures (formerly known as the Physician Health Information Ecosystem
Quality reporting System) and episodes of care,
▪ The Health IT System as a Learning Health
which measure costliness (previously the Value-
System
Based Performance Metrics)
• performance-based payments will be based on
quality of care, resource use, meaning use of
electronic health records, and clinical practice
improvement, replacing several previous
Medicare incentive programs

▪ a composition of individuals, systems, and

processes that share, exchange, and access all
forms of health information including discrete,
narrative, and multimedia
o The Health Information and Management
Systems Society (2017)
 Health Informatics in the Cloud
Advantages of Cloud Technology
1. Integrated and Efficient Patient Care
o single access point for patient information
2. Better Management of Data
o allowing researchers to assess the health
of the general public
3. Error Reduction
Disadvantages of Cloud Technology
1. Potential Risks to Personal Information
o data breaches of patient information
2. Cloud Set-up Seems Cumbersome
o transition from handwritten notes in paper
charts to completely electronic system
3. Cost Justification
Health Informatics in the Philippines
Community Health Information Tracking System
(CHITS)
▪ an extensible, modular, open-source
information system for rural health units (initially
for the Philippines)
▪ an electronic medical record developed through
the collaboration of the Information and
Communication technology community and
health workers
▪ PhilHealth certified