General Use of Health Informatics - Essay Example

TABLE OF CONTENTS Introduction to Health informatics General use of Health Informatics The issue of Health care in Australia The information challenge Unlocking the information The potential benefits of Health informatics Impact of Health informatics in Health care Caring and sharing Target benefit groups HealthConnect and the impact on health consumers Data Integration levels Trend in Health care with health informatics HDI Project: Western Australia Data linkage Unit: Electronic health records - a prescription for better patient care Health information and knowledge representation Knowledge management Impact of Health informatics on different Organizational levels Informatics application in Hospital Management: Decision making-Decision support system in health care: Informatics application in health system management: Nursing Informatics: Standards and guidelines Frame Work References Introduction to Health informatics: Application of information technology to the health and allied sector is called health informatics. Application of information technology to practice of medicine is called medical informatics. Medical informatics tend to focus on digital interfacing of medical instruments, digital assistance to doctors, clinic management software, computerized patient record, etc. Health informatics tend to emphasize management information systems in health care institutions, electronic health record, electronic data interchange etc. The electronic health record concept is similar to computerized patient record but extends to healthy people as well. Coverage of information technology solutions in the medical and health field under the rubrics of the two terms is converging. - HI is concerned with the processing of data, information and knowledge, technology developments in all aspects of health care. - HI aims to study the principles and practices providing solutions. - HI domains are health operations, research, academia and teaching. - HI is delivered by the operational health community, managers, academics, researchers, educators, scientists and technologists. HI developments and achievements are primarily for the benevolent relief of sickness, suffering and helplessness of members of the Australian community Use of Health Informatics Computers in Health Care are well accepted the world over as clinical and diagnostic aids, to improve patient care, tone up administration, facilitate accounting and enable effective management control. An important application has been in hospital management, where computers have been an effective tool for doctors, nursing, administration and management. The issue of Health care in Australia The federal government, through the Australian Department of Health and Ageing, sets national health policies and subsidises the provision of health services by State and Territory governments and the private sector. Health currently accounts for about 9.3 per cent of Australias gross domestic product. Australia has a fairly complex healthcare system, comprising both public and private hospitals and medical practitioners and literally dozens of insurance schemes set up to fund them. The federal government funds universal medical services and pharmaceuticals, and gives financial assistance to public hospitals, residential care facilities, hostels, and home and community care. It is also the major source of funds for health research, and provides support for the training of health professionals and financial assistance to tertiary students.  State and Territory governments have primary responsibility under the Constitution for the actual provision of health services, including most acute and psychiatric hospital services. The States and Territories also provide a wide range of community and public health services, including school health, dental health, maternal and child health, occupational health, disease control activities and a variety of health inspection functions.  The main health responsibilities of local government are in environmental control such as garbage disposal, clean water, and health inspections. Local government also provides a range of home care and personal preventive services, such as immunisation. The information challenge One of the biggest challenges for consumers and health care providers at the point of care is the limited flow of essential health information associated with the current paper-based system of health records. Health care providers generally keep their own records about a consumer – often in a paper- based format. This means that parts of an individual’s health information are stored in many different locations and can be difficult to access in times of medical need. Even when information is kept in electronic form by some providers, it is scattered across incompatible databases preventing the information from being easily shared. As a result of this fragmentation, unnecessary stress and pressure can be placed on individuals to remember details of their medical history, at times leading to reliance upon inaccurate information in clinical decision-making processes. For the provider, valuable time and effort can be wasted trying to locate important health information – time that could be better spent on direct patient care. When the right information isn’t available at the point of clinical decision-making, the risk of inappropriate treatments or interventions increases. Diagnostic and pathology tests may also be unnecessarily duplicated because previous results were simply not available. Unlocking the information New technologies such as electronic health records have enormous potential to improve the flow of information across the health sector. At their most basic level, this simply involves changing the form in which health records are kept – from paper to electronic. With the addition of other tools such as medical alerts, electronic health records can become a powerful means for warning providers of possible interactions or inappropriate treatments. To achieve such benefits, the National Electronic Health Records Taskforce proposed the concept of a voluntary national health information network – HealthConnect – that would allow information held in electronic records to be collected, safely stored and exchanged within strict privacy safeguards. This process could only happen with the individual consumer’s permission. The potential benefits of Health informatics HealthConnect has enormous potential to improve quality and safety in Australia’s health care system, creating benefits for the whole community. Some of these benefits include: Rapid access to vital and accurate information; Reduced duplication of services; More time available for direct care; Greater portability of health records for an increasingly mobile population; More control for consumers over who can access their health information; More active participation by consumers in decisions about their health care; Better quality information exchange between health providers for improved diagnoses and better quality care; and A more comprehensive picture of Australians’ health to promote advances in the diagnosis and treatment of illnesses and better targeted decisions about health care. Impact of Health informatics in Health care Under HealthConnect, a person’s health-related information would be collected in a standard, electronic format at the point of care (such as at a hospital or a GPs clinic). This information would take the form of health summaries, rather than all the notes that a health care provider may choose to keep about a consultation. With the consumer’s consent, these summaries would then be able to be retrieved at any time they were needed and exchanged via a secure network between those particular health care providers authorized by the consumer to access this information. Having more complete and up-to-date information available would mean that consumers and their providers would be in a better position to make decisions in partnership, through shared information. Caring and sharing Shared electronic health records promise tremendous efficiencies throughout the healthcare system. A patients record need only be created once, saving hours of time practitioners currently spend re-entering basic details such as names, addresses, birth dates, medical history and things like allergies and current medications. When a patient visits a GP or hospital, their consent enables the clinician to access their individual EHR from the secure HealthConnect network. The doctor still uses their own practice management tools (whether computerised or paper-based) to record full details of the consultation and complete tasks such as prescriptions and referrals. At the end of the visit, the doctor can upload an event summary recording any significant developments during the consultation, such as a new diagnosis, a prescription or a treatment. This data can then be made available (with consent) to other practitioners treating the patient, ensuring all healthcare providers and patients themselves use the same information for best possible care. "Giving all providers access to the same information allows different carers to work in concert with the patient to make the best decisions for each individuals health needs," Mr Parker says. "Research indicates that up to 30 per cent of mishaps in hospitals are caused by lack of access to necessary information. A move to standardised EHRs that are available at the point of care presents a real opportunity to reduce mistakes and improve safety and quality for patients." Advantage to different health care providers. The health informatics particularly makes the medical communication easy among the following health care providers: Reduces patient journeys, hospital visits and hospital admissions saves the time of healthcare professionals supports individuals living at home to look after themselves improves the quality or effectiveness of the care or treatment that is delivered. Target benefit groups HealthConnect and the impact on health consumers Under HealthConnect, every time consumers went to a different doctor or health service, or moved interstate, their vital health information would be readily available to them and could be shared with their health care providers. Information would only be collected for those consumers and health care providers who agreed to participate in HealthConnect. Those who did participate would have full control over their personal health information, including who could access it and for what purpose. They would also be able to view their personal health information held on HealthConnect. The information included in event summaries would be held as close as practicable to the point of care. Event summaries generated from general practice, for instance, could be held in a secure storage service at a regional level. Some event summaries, such as prescriptions, could be held in one facility to aid rapid access. Wherever held, the information would be securely stored and communicated. At the point of clinical care, the health provider would be able to draw together (with the consumers permission) relevant information held in different HealthConnect storage systems. Data Integration levels Integration of data layers between Health Connect- Several trials around Australia and NEHTA - Accelerate the uptake of e-health in Australia - Standard for Patient Summaries and Electronic Medical Records Data integration through Data Linkage Units National Data Network (NDN) Various software solutions Collecting the required data Electronic Health Records Clinical Information Systems Trend in Health care with health informatics Source http://www.ehrc.net HDI Project: HDI Project enables effective and efficient interpretation of data to support innovation in health care for Australia, by providing effective linkage of health data in a secure environment with ease-of-use in multiple applications IT offers development of software tools for linking, integration and analysis of data for cancer patients, Old Health Cancer Control and Analysis team for improving clinical and patient outcomes for Lung Cancer MoU National Bowel Cancer Program - Qld Health, Royal Melbourne Hospital & Flinders Medical Centre HDI is a, tool that integrates disparate sets of data through sophisticated algorithms to match patient records while protecting the privacy and security of patients’ data. HDI enables all users to work with authorized data sets through a standardized layer of metadata over the source databases. And provides for both data integration as well as analysis and reporting on that data in one tool. Western Australia Data linkage Unit: Electronic health records - a prescription for better patient care Notoriously illegible doctors handwriting could soon be a thing of the past as Australia embarks on an ambitious initiative to migrate paper-based health records to efficient computer networks. Launched in 2000, the HealthConnect project is a nationwide effort to coordinate standards, develop prototype platforms and more recently to commence implementation of electronic health records (EHRs). HealthConnect enables authorised healthcare providers to collect, store and exchange patients health information in a secure and reliable manner. Importantly, healthcare consumers can also access and review summaries of their own records to ensure accuracy. HealthConnect standardises the way patient data is collected and recorded by healthcare providers, including general practitioners, specialists, consultants, dentists, radiologists, pathologists, anaesthetists, pharmacists, nurses and hospitals. Provided the patient consents, a summary of their treatment is recorded electronically at every link in the healthcare chain - reducing the time spent on administration, reducing errors and giving all practitioners a complete view of the patients history and healthcare needs. "Electronic health records are all about improving the quality of care provided to patients: that is the primary focus of HealthConnect," says Jeff Parker, Associate Director of Strategic Consulting at Fujitsu Australia, which is closely involved in the national EHR initiative. "At the same time, everyone in the healthcare sector expects significant secondary benefits, including reduced administrative overheads for medical staff and greater transparency in system-wide information. The ability to aggregate data and analyse health system usage is vital to plan and provide for an efficient health system that accurately reflects community needs, both current and future." Health information and knowledge representation Knowledge management: Health informatics is an evolving scientific discipline that deals with the collection, storage, retrieval, communication and optimal use of health related data, information and knowledge. The discipline utilizes the methods and technologies of the information sciences for the purposes of problem solving and decision-making thus assuring quality healthcare in all basic and applied areas of biomedical sciences. Health informatics is concerned primarily with the processing of data, information and knowledge in all aspects of healthcare. Health informatics aims to study the principles and provide solutions. The domains of Health informatics are research, academia, operations and commercial and are delivered by operational health practitioners, managers, academics, researchers, educators, scientists and technologists. Impact of Health informatics on different Organizational levels: Informatics application in Hospital Management: In all over the world the health problems and needs are increasing and becoming more complex. The demands and pressures on the hospitals and health care institutions are also increasing. At the same time the resources are becoming increasingly limited. Achievement of goals, efficiently, effectively, and economically is the primary responsibility of all the administrators. This can be achieved through business, medical and technical management systems in hospitals. Decision making-Decision support system in health care: There is a growing trend to apply computers for tasks other than tabulation. The health care providers are increasingly interested in the feasibility of applying the "expert system technology" to assist in improved health care delivery. The earliest research contributions in the area of artificial intelligence were the program to simulate expert behavior in the selection of an antibiotic for an infection. The trend of research in Medical Informatics is increasingly in the area called expert systems/decision support systems. Informatics application in health system management: The deployment and development of health services has been less influenced by the collection of specific data than by what has been referred to as "Impressionistic Planning" a process wherein information may be minimal and the basis for decision making is intuitive and political, the end results being determined by past experience, popular pressures and rough estimates and guess work. Health professionals tended to cooperate more readily and communicate more freely working and a local level and this promoted the free exchange of health activities and information. At the central level the need to coordinate and control health service development was government largely by the constraints of the resources available. The emphasis, until recent years has been that if there were enough staff, facilities, equipment and finance, the public health and health care services could be expanded and the health status of the population would automatically be improved. In the early 1960s, it became apparent to most health administrators that health expenditure was not infinite and that the emphasis in planning and development must focus on the more effective and efficient use of the limited resources available. When the time came to transmit priorities and proposed programmes into actual operation it soon became evident that there was a serious deficit in relevant information. The major areas in which health service data was lacking or not readily available were health workforce development programming, and the evaluation of service effectiveness and efficiency. Heath managers found they urgently required this information to enable them to initiate and control the progress and outcomes of the programme operation. The establishment of health information unit enables the health organisation to have a single focus for the coordination and collation of any forms and sources of data available within the health systems. Nursing Informatics: Historically, nurses have been the interface between all other professionals and, currently, nursing is poised to become the central unifying component of the health care delivery system in the 21st century. This is illustrated by the major strides that have been made in the delivery of health care, and the recognition of advanced practice roles for nurses. Nurses are usually the first to observe and report changes in a patient’s condition. They alert other health professionals to these changes and often begin stabilization measures before other practitioners arrive. Nurses communicate with all members of the health care team and have the authority and capacity for contemporaneous reporting within the structures of the health care system. Nurses spend at least 20 per cent of their time processing written information and up to a further 30 per cent engaging in verbal communication between themselves, patients and co-workers (Hovenga & Hindmarsh 1996). Appropriate and timely information at the point of care is known to improve nurses’ decisions about the care to be delivered; thus, reducing risk and improving the quality and outcomes of the care. Although nursing has had serendipitous involvement, and nurses have been engaged as trial managers and so on, nursing as a profession has not been the target of any research and development activity in HealthConnect. However, the nursing profession has much to offer HealthConnect. As key stakeholders and participants in the care delivery processes, nurses are well positioned to take a lead role in supporting the evaluation of the value, feasibility and implementation of HealthConnect. Value and feasibility evaluation includes consumer empowerment, better decision-making, a reduction in unnecessary tests, time savings, flexible integrated care, acceptability, usefulness, and alignment to business processes. Nurses’ understanding of the health care environment and processes positions them to assess achievements in these areas. This knowledge base can also assist in the determination, collection, analysis and reporting of benefits (which also measure value). Nurses are in a strong position to guide the evaluation of their contribution to the changes in health outcomes expected in the long term from HealthConnect. As a key contributor of data and most consistent user of an EHR, nurses are well placed to be actively involved in the design evaluation to ensure the design meets their information needs. From a care integration perspective, design evaluation should consider the effectiveness of nursing contributions in meeting other stakeholder needs. In conjunction with design are the business and data aspects of the EHR. Only nurses can define the business context, information flow and practices of what nursing information is required where, and only nurses can evaluate the effectiveness of this design component. Nurses can offer advice on all aspects of defining the building blocks of HealthConnect. In conjunction with other health care providers, nurse informaticians can ensure the applicability of these building blocks in areas such as information architecture and standards, privacy, security, unique identification, event summary definition, provider registration, central medicines repository, medication currency and the development of clinical archetypes. Some of these areas are also crucial to the success of the Clinical Information Project. Nurses can also support HealthConnect by advising on and building informatics workforce capacity. Employers and nurses need incentives and support to facilitate or undertake health informatics education and/or professional development. However, it has been demonstrated that nursing knowledge is specific to nursing although there is an overlap with other clinicians. However, with the development of openEHR, the need for a nursing knowledge repository is essential. Standards and guidelines Frame Work: The Health Informatics Society of Australia (HISA), NSW Branch is the New South Wales branch of the national body. The aim of the local branch is to provide networking and education opportunities for the professional development of HISA members. The National E-Health Transition Authority (NEHTA) has been established to accelerate the adoption of e-health by supporting the process of reform in the Australian health sector. NEHTA will develop the specifications, standards and infrastructure necessary for an interconnected health sector. The Australian National Health Information Standards Plan (NHISP) provides a national position on directions and basis for ongoing development and maintenance of adopted standards like Data models and terminology standards and Privacy standards The recently released framework describes approaches, policies and tools that could facilitate interoperability among health care organizations, Government Health IT reports. The framework encourages a "data-driven approach to interoperability," Government Health IT reports. It also calls for a system design that encourages accessibility and interoperability policies that offer privacy safeguards. The framework states that information transfers must include security measures such as identification, authentication and confidentiality and that larger health care organizations should implement measures only if they can be implemented cost-effectively by smaller organizations. According to Government Health IT, the framework also states that the EHR systems should be created around open standards to encourage interoperability and collaboration (Brewin, Government Health IT, 8/22). The technical and semantic standards that are needed can be classified functionally under the three Health Online policy themes: empowering the consumer and communities for better health, better management of clinical information to support care, and using information to build a more efficient and effective health care system References: 1. National Health Information Standards Advisory Committee. National health information standards plan. Canberra: Commonwealth of Australia, 2001. 2. National Electronic Health Records Taskforce. A health information network for Australia. Canberra: Commonwealth of Australia, 2000. 3. Heard S, Schloeffel P, Beale T. The good electronic health record in Australian general practice: Background paper of the GPCG implementation trial. Canberra: GP Computing Group, 1999. 4. National Health Information Management Advisory Council. Health online: A health information action plan for Australia. Canberra: Commonwealth of Australia, 1999. 5. Standards Australia. AS 4700.2:1998: Implementation of HL7 V2.3. Pathology orders and results, 1998. 6. National Centre for Coding and Classification in Health. ICD10: International statistical classification of diseases and related health problems, 2001. 7. Britt H. A new coding tool for computerised clinical systems in primary care: ICPC plus. Aust Fam Physician 1997; 26(82):S79–S82. 8. Fetter R B. Casemix classification systems. Aust Health Rev 1999; 22(2):16–34. 9. GP Computing Group. General practice data model and data dictionary. Canberra: AGPS, 2000. 10. Heitman K, Blobel B, Dudeck J. HL7 communication standard in medicine. 1st edn. Cologne: Verlag Alexander Monch, 1999. 11. National Health Data Committee. National health data dictionary. Version 5.0. Canberra: Australian Institute of Health and Welfare, 1996. 12. GP Computing Group. Final report of the coding jury. Canberra: AGPS, 2000. 13. Rogers J, Solomon D, Rector A. Clinical terminology ad clinical applications: mind the gap. In: Towards an electronic health record Europe. London: Medical Records Institute, 1999; 99–103. 14. Health Connect- An Introduction; available at http://www.healthconnect.gov.au/pdf/fshci.pdf. 15. The Impact of e-Health and Assistive Technologies on Healthcare Available at < http://www.health-informatics.org/tehip/tehipstudy.PDF> 16. Dr David Hansen, Team Leader, HDI Project, EHRC, Trends in Health Data Integration, Accessed from Ehrc.net, accessed on 26, October, 2005. 17. Trends in Health Data Integration; available at http://www.ehrc.net Read More