09- networking and health information exchange- unit 7- supporting standards for ehr application-...
DESCRIPTION
The Health IT Workforce Curriculum was developed for U.S. community colleges to enhance workforce training programmes in health information technology. The curriculum consist of 20 courses of 3 credits each. Each course includes instructor manuals, learning objectives, syllabi, video lectures with accompanying transcripts and slides, exercises, and assessments. The materials were authored by Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, and University of Alabama at Birmingham. The project was funded by the U.S. Office of the National Coordinator for Health Information Technology. All of the course materials are available under a Creative Commons Attribution Noncommercial ShareAlike (CC BY NC SA) License (http://creativecommons.org/licenses/by-nc-sa/3.0/). The course description, learning objectives, author information, and other details may be found athttp://www.merlot.org/merlot/viewPortfolio.htm?id=842513. The full collection may also be accessed at http://knowledge.amia.org/onc-ntdc.TRANSCRIPT
Networking and Health Information Exchange
Supporting Standards for EHR Application
Lecture cThis material Comp9_Unit7c was developed by Duke University, funded by the Department of Health and Human Services,
Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024..
Supporting Standards for EHR ApplicationLearning Objectives
2
1. Understand the clinical decision support standard Arden Syntax (Lecture a)
2. Understand standards for clinical guidelines (Lecture b)
3. Understand object-oriented expression language for clinical decision support – GELLO (Lecture b)
4. Understand the clinical decision support standard Infobutton (Lecture c)
5. Understand disease management (Lecture c)6. Understand other clinical decision support
applications (Lecture c)
Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Supporting Standards for EHR ApplicationLearning Objectives
3
7. Understand other standards that help to support networking and reporting requirements as well as functionality to optimize the connectivity among heterogeneous systems deployed within a single enterprise (Lecture d)
8. Understand single sign-on standards and the HL7 Clinical Context Object Workgroup (CCOW) standard (Lecture d)
9. Understand regulatory standards (Lecture d)10. Understand issues relating to person identifiers, master
patient indices, and record locator services (Lecture d)
Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Infobutton
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
• Context-sensitive links embedded within a clinical information system to allow easy retrieval of relevant information
• Functions by generating and sending queries to CDSS using data from EHRs
• CIS displays button next to data such as a diagnosis or abnormal lab data– When clicked, Infobutton formulates a query – Based on context of the interaction
• Including patient demographics, activity being performed, and user role
Infobutton Manager
• Software that supports implementation of Infobuttons in an application independent manner
• Application passes parameters to the Infobutton Manager which generates an HTML document with a set of natural language questions that are hyperlinks to clinical information resources
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Information Resources• Many resources available
– Micromedex– MDConsult– UpToDate– Medline Plus
• Access different– http://resource1/com/search = “azithromycin” AND dose– http://resource2.com/query = “azithromycin” [Mesh Terms] AND
dose [All Fields]– http”//resource3.com/searchConcept = 3333 ^ azithromycin filter
= 11 ^ dosage
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Application Lecture c
HL7 Infobutton Standard
• Implementations– XML based– URL based
• Terminologies supported– RxNorm– LOINC– SNOMED-CT– MeSH
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Example of InfoButton
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Source: www.infobuttons.org
Example of InfoButton
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Source. www.infobutton.org
Example of InfoButton
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Source: Shared by Dr. James Cimino
Disease Management• Includes all data and treatments related to
a particular disease• Tracks events
– Reminders for required tests– Identifies patients whose goals are not
reached– Tracks compliance– Compares patients
• Manages Workflow11Health IT Workforce Curriculum
Version 3.0/Spring 2012Networking and Health Information Exchange
Supporting Standards for EHR Application
Lecture c
Example of Disease Management System
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Source: Dr. W. Ed Hammond
Order Entry Standards
• Sharing knowledge• Patient focused• Meets auditing requirements
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Application Lecture c
Pseudo-code
Heparin is started and adjusted according to the patient's weight and the last APTT
IF starting heparin drip THEN
Give kg based bolus. Adjust the dose by protocol
IF APTT < 35 THEN
Give 80/kg bolus and increase drip by 4 units/kg.h
Repeat APTT in 6 hours
…
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Application Lecture c
Vanderbilt CPOE Example 1
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Source: Dr. William W. Stead of Vanderbilt CPOE System
Vanderbilt CPOE Example 2
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Source: Dr. William W. Stead of Vanderbilt CPOE System
CARE - Regenstrief
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Application Lecture c
IF TODAY IS NOT AFTER 10/1 & BEFORE 12/31OR "FLU SHOT LAST" IS AFTER 8/1OR LAST "REFUSED FLU INJ" WAS = 1 & SINCE 1 YEAR AGOOR "DRUG ALLERGIES" WAS = "SERUM ALRGY"
THEN EXIT
IF "AGE" IS GT 65 THEN Consider use of "flu shot AB" if no egg allergy because age places patient in high risk category AND EXIT
IF "X LAST" WAS = ASTHMA" V "COPD" OR "CHEST X-RAY LAST" WAS = "COPD" THEN Consider giving "flu shot AB" if no egg allergy because patient's lung disease places him in high risk category. R:2124 AND EXIT
Example provided by: Dr. Clement McDonald
Calculation of Framingham Risk
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Application Lecture c
Framingham Heart Study
Source: Stroke After Atrial Fibrillation, n.d.
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Application Lecture c
.
Create the Decision Tree• Define the decision problem• Identify the decision alternatives• List the possible clinical outcomes of each of the
decision alternatives• Represent the sequence of events leading to the clinical
outcomes by a series of chance nodes and decision nodes
• Choose a time horizon for the problem• Determine the probability of each chance outcome• Assign a value to each clinical outcome
– Preference– Utility– Payoff
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Application Lecture c
Simple Decision Tree
Source: W. Ed Hammond, PhD.
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Application Lecture c
Operate
Do not operate
Disease present
Disease present
Disease absent
Disease absent
Outcome; Treatment with disease
Outcome; Treatment without disease
Outcome; Treatment with disease
Outcome; Treatment without disease
Standard gamble
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Application Lecture c
Source: Slide set from W. Ed Hammond (original source unavailable)
What is Evidence-based Practice?• Traditional conceptualizations
– Research utilization– Clinical trials-based– Clinical practice guidelines
• Application of domain knowledge to patient care– Evidence as a continuum
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Application Lecture c
PEPID – Clinical Guidelines
Source: Slide courtesy of Dr. Suzzane Bakken (original source unavailable)
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Cochrane Database of Systematic Reviews
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
WebCIS Instrument, Currie et al.
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Risk Assessment Toolkit
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Cancer Risk - Diet
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Risks for Developing Colon Cancer
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Supporting Standards for EHR Application
Summary – Lecture c
30
• Presented the HL7 InfoButton standard – Feature that provides context-sensitive access to key
knowledge.
• Showed InfoButton’s value – Easy to implement and use– Can be used for almost any purpose– Provides trusted links to key knowledge resources.
• Also illustrated several of the knowledge resources available on the Internet
Health IT Workforce Curriculum Version 3.0/Spring 2012
Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
Supporting Standards for EHR Application
References – Lecture c
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
References Slide 17: Source: Courtesy of Dr. Clem McDonaldAcknowledgment: Some of the material in this unit was taken from HL7 at www.hl7.org.
ImagesSlide 8: What are Infobuttons? (n.d.). Retrieved February 24, 2012, from NIH Laboratory for Informatics Development,
National Library of Medicine, University of Utah Department of Biomedical Informatics, and Columbia University Department of Biomedical Informatics website: http://www.infobuttons.org/
Slide 9: Source: Slide set from W. Ed Hammond (original source unavailable)Slide 10: Source: Courtesy of Dr. James Cimino Slide 12: Source: Dr. W. Ed HammondSlide 15: Source: Courtesy of Dr. William W. Stead of Vanderbilt CPOE System Slide 16: Source: Courtesy of Dr. William W. Stead of Vanderbilt CPOE SystemSlide 18: Source: Slide set from W. Ed Hammond (original source unavailable)Slide 19: Stroke After Atrial Fibrillation. (n.d.). Retrieved February 24, 2012, from Framingham Heart Study website:
http://www.framinghamheartstudy.org/risk/strokeatrial.html Slide 21: Source: W. Ed Hammond
Supporting Standards for EHR Application
References – Lecture c
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Networking and Health Information Exchange Supporting Standards for EHR
Application Lecture c
ImagesSlide 22: Source: Slide set from W. Ed Hammond (original source unavailable)Slide 24: Source: Slide courtesy of Dr. Suzzane Bakken (original source unavailable)Slide 25: Browse Databases and Tools. (n.d.). Retrieved February 24, 2012, from Essential Evidence Plus website:
http://www.essentialevidenceplus.com/content/poems Slide 26:Source: Courtesy of Suzzane Bakken, Columbia University
Slide 27: Welcome to the Risk Assessment Toolkit. (n.d.). Retrieved October 2, 2006, from MD Anderson Cancer Center website: www.cra.developerlabs.net
Slide 28: Cancer Risk Toolkit, My Diet. (n.d.). Retrieved October 2, 2006, from MD Anderson Cancer Center website: www.cra.developerlabs.net
Slide 29: Your ten-year and lifetime chance of developing colon cancer. (n.d.). Retrieved October 2, 2006, from MD Anderson Cancer Center website: www.cra.developerlabs.net