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2015 | Buch

Practitioner's Guide to Health Informatics

verfasst von: Mark L. Braunstein

Verlag: Springer International Publishing

Enthalten in: Springer Professional "Wirtschaft+Technik" , Springer Professional "Technik" , Springer Professional "Wirtschaft"

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Über dieses Buch

"This book will be a terrific introduction to the field of clinical IT and clinical informatics" -- Kevin Johnson

"Dr. Braunstein has done a wonderful job of exploring a number of key trends in technology in the context of the transformations that are occurring in our health care system" -- Bob Greenes

"This insightful book is a perfect primer for technologists entering the health tech field." -- Deb Estrin

"This book should be read by everyone." -- David Kibbe

This book provides care providers and other non-technical readers with a broad, practical overview of the changing US healthcare system and the contemporary health informatics systems and tools that are increasingly critical to its new financial and clinical care paradigms. US healthcare delivery is dramatically transforming and informatics is at the center of the changes. Increasingly care providers must be skilled users of informatics tools to meet federal mandates and succeed under value-based contracts that demand higher quality and increased patient satisfaction but at lower cost. Yet, most have little formal training in these systems and technologies.

Providers face system selection issues with little unbiased and insightful information to guide them. Patient engagement to promote wellness, prevention and improved outcomes is a requirement of Meaningful Use Stage 2 and is increasingly supported by mobile devices, apps, sensors and other technologies. Care providers need to provide guidance and advice to their patients and know how to incorporated as they generate into their care. The one-patient-at-a-time care model is being rapidly supplemented by new team-, population- and public health-based models of care. As digital data becomes ubiquitous, medicine is changing as research based on that data reveals new methods for earlier diagnosis, improved treatment and disease management and prevention.

This book is clearly written, up-to-date and uses real world examples extensively to explain the tools and technologies and illustrate their practical role and potential impact on providers, patients, researchers, and society as a whole.

Inhaltsverzeichnis

Frontmatter

Introduction

Abstract

This book is about health informatics—the applications of information technology to healthcare delivery. This is distinct from bioinformatics, a related field with which it is often confused; bioinformatics is about using computational models and other methods to analyze and understand complex intracellular biochemical mechanisms. The term biomedical informatics is often used in medical schools to denote the merger of these two fields into one training and/or research program.

Mark L. Braunstein

The Current Situation

Abstract

Given current EHR adoption levels and provider survey data, I assume that many, if not most, healthcare provider readers of this book are using EHRs, may well be frustrated with them in one respect or another and are seeking advice or “wisdom” to help alleviate those frustrations or chose a better EHR in the future. I hope this book will help, but first, some perspective on where we’ve been and where we are today.

Mark L. Braunstein

Unique Complexity

Abstract

Healthcare providers are often so immersed in the highly unusual U.S. healthcare system that they take it for granted and accept its extraordinary complexity as the norm. In fact, no other country on earth has a healthcare system quite like ours. Its complexity is the core reason for some very difficult and long-standing problems we’ll now discuss.

Mark L. Braunstein

EHR Adoption and Meaningful Use

Abstract

As we’ve seen, there is a disconnect between what is required to successfully manage the chronic diseases that drive most healthcare costs and the structure and incentives of the U.S. healthcare system. We’ve also suggested that health IT could be a key tool for restructuring healthcare delivery to help address these issues. We’ll review that again here, from an engineering perspective, before turning to the policies the federal government has promulgated in recent years to encourage adoption of health information technology and new models of patient-centered care.

Mark L. Braunstein

Technologies for Sharing Health Information

Abstract

We know that coordination among the many providers who care for a patient with chronic disease is of paramount importance in improving quality and efficiency. In the age of the Internet, in which we’re all used to information anytime and anyplace, you would probably think that, once healthcare records are digital, exchanging them would be easy. The reality is quite different and health information exchange is another topic that illustrates the often skewed incentives within our complex healthcare system.

Mark L. Braunstein

Technologies to Assure Privacy, Security and Trust

Abstract

We’ve repeatedly emphasized that successful management of chronic diseases in our highly specialized and fragmented healthcare system requires digital data that can be shared to coordinate care. However, patient-specific healthcare data is highly sensitive and is protected by HIPAA which calls for severe penalties for failures to properly secure so-called protected health information (PHI).

Mark L. Braunstein

Data Standards

Abstract

Data and interoperability standards are the virtually ubiquitous plumbing that underlies all contemporary health informatics systems and tools. Given the complexity of healthcare it should not be surprising that this is a large topic. In this section we’ll cover the part of it that should already be familiar to most healthcare providers—data standards.

Mark L. Braunstein

Interoperability Standards

Abstract

To be maximally useful in care coordination, standardized data—typically along with other nonstandardized data such as free text notes—is often packaged into standardized clinical documents and sent using standardized messaging formats. We briefly mentioned messaging standards earlier. Developed as hospital health IT systems, they came into widespread use in the late 1970 s and ‘80 s. Even back then, there were some early attempts to provide a single-vendor, fully integrated hospital-wide solution, but most systems were developed for a particular department—such as pharmacy, clinical lab or radiology—and it was common for each of these departments to independently select the system that they felt best fit their needs.

Mark L. Braunstein

EHR Design and Usability Challenges

Abstract

In the 1950s the clinical data in medical records of patients in the United States were mostly recorded in a natural, English-language, textual form. … Such patients’ data were generally recorded by health-care professionals as hand-written notes, or as dictated reports that were then transcribed and typed on paper sheets, that were all collated in paper-based charts; and these patients’ medical charts were then stored on shelves in the medical record room.

Mark L. Braunstein

Patient Engagement and Empowerment

Abstract

Years ago, my professor told me that, as a practicing physician, I would occasionally see chronic disease patients for a few minutes and think that what I did during their visit would make all the difference. In fact, he said, it was what those patients did between the visits that would make that difference. Patients at home have historically been largely disconnected from what we think of as the healthcare system. Today, we have an increasingly rich set of technologies and tools to empower patients to be more involved in maintaining their wellness, preventing disease and managing disease more effectively, should they develop it. These tools can also connect patients to their providers, to interested family members and friends and to others with similar conditions or health issues.

Mark L. Braunstein

Population and Public Health

Abstract

So far in this book we’ve been looking at technologies and issues almost exclusively through the lens of the traditional one-patient-at-a-time approach to care delivery. It is likely that this will always be the primary focus of physicians in practice. However, a different approach is needed for patients who have multiple chronic diseases and for understanding the source and possible approaches to preventing disease across entire populations. Success in managing chronic disease requires engagement on a far more continuous basis than is possible under the traditional care model.

Mark L. Braunstein

Aggregating Data

Abstract

Here in the U.S., physicians who aren’t employed by or affiliated with a health system that makes the choice for them, can select any EHR—and there are literally hundreds from which to choose. Unless something like the JASON recommendations are mandated or an alternate interoperability framework such as CommonWell is universally implemented, these EHRs will not be sufficiently interoperable. This is problematic for aggregating data from them for care coordination and for other so-called “secondary uses” of EHR data, including research and population and public health.

Mark L. Braunstein

Health Big Data and Analytics

Abstract

As the quote from the IOM conveys, our ability to generate scientific knowledge has outstripped the ability of healthcare providers to absorb, integrate and use that knowledge in daily patient care. The ability of information systems to analyze huge amounts of clinical data and provide useful insights and guidance is a major focus for research and commercial development now that the substantial majority of healthcare providers are using electronic records that have the potential to provide the data for that analysis. This feedback loop is a key part of the IOM’s vision of a learning healthcare system, as indicated by the title of the book from which the quote is taken. In this section, we’ll explore early results from these exciting and potentially transformational analytic technologies.

Mark L. Braunstein

The Road Ahead

Abstract

So, we’ve now reached the end of the story … at least the part that has played out so far. We began with the nature and problems of our healthcare system and the key role that chronic disease plays in it. We made the case for digital records and data sharing and we learned what the federal government is doing to encourage their adoption. We examined the key underlying technologies of health information exchange; privacy, security and trust; and data and interoperability standards. We then looked at how these technologies are being used in actual systems and tools for providers, patients, public health and clinical research.

Mark L. Braunstein

Backmatter

Titel: Practitioner's Guide to Health Informatics
verfasst von: Mark L. Braunstein
Verlag: Springer International Publishing
Electronic ISBN: 978-3-319-17662-8
Print ISBN: 978-3-319-17661-1
DOI: https://doi.org/10.1007/978-3-319-17662-8