1392739075.2754ch3 standards of dental informatics, security issues

8/12/2019 1392739075.2754ch3 Standards of Dental Informatics, Security Issues

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Standards of dental

informatics, security issues,privacy and costs

Dr Ebtissam Al-Madi


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Why are standards important inmedical informatics?

Promote consistent naming of individuals,

events, objects, etc.Allow better use of data for patient care,

quality assurance, research, etc.

Enhance ability to transfer data amongapplications, allowing better system

integration


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Benefits and limitations ofstandards

Benefits Interoperability

May allow innovation based on common

foundationLimitations

Dominance by one segment of industry:

Microsoft standards, e.g., Windows,

Office, etc.

May stifle innovation


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The standards developmentprocess

Groups agree to informal specifications Single vendor controls industry

Government agency creates standard

and mandates its use. Interested parties work in open process


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International Organization forStandardization (ISO)

http://www.iso.org/iso/home.html

ADA Standards Committee on Dental

Informatics (ADA SCDI)

http://www.ada.org/prof/resources/standards/informatics_reports.asp#a1031

International standards bodies
http://www.iso.org/iso/home.htmlhttp://www.ada.org/prof/resources/standards/informatics_reports.asphttp://www.ada.org/prof/resources/standards/informatics_reports.asphttp://www.ada.org/prof/resources/standards/informatics_reports.asphttp://www.ada.org/prof/resources/standards/informatics_reports.asphttp://www.iso.org/iso/home.html


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Medical informatics standards

1. Identifiers2. Transactions

3. Message exchange

4. Terminology


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1. Identifiers

Various approaches have beenproposed for

Patients

Providers Employers

Health Plans


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Patient identifiers

Uniqueonly one person has aparticular identifier

Non-disclosingdiscloses no personal

information Permanentwill never be re-used

Ubiquitouseveryone has one

Canonicaleach person has only one

Invariablewill not change over time


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Patient identifiers

Benefits Easy linkage of records Facilitate health information exchange

Reduce errors and costs arising from duplicaterecords

Medical record identifier errors compromisequality of care and can be costly

Cost increases with length of time error notidentified

Risks Easy linkage of records

Potentially compromise privacy andconfidentiality


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2. Transactions

Transaction standards are designed toencourage electronic commerce for

health claims.

HIPAA (Health Insurance and privacyact) mandates use of these standards

for health care business electronic data

exchange

Administrative simplification


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Transactions standards cover

Health claims and equivalent encounterinformation

Enrollment and disenrollment in a healthplan

Eligibility for a health plan Health care payment and remittance

advice

Health plan premium payments

Health claim status

Referral certification and authorization

Coordination of benefits


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3. Message exchange standards

Allow data and application interoperability Major standards include

Health Level 7 (HL7)

Digital Imaging and Communications(DICOM)

IEEE

NCPDP and SCRIPT ELINCS

Continuity of Care Record (CCR)


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4. Terminology standards

Benefits of computerization of clinical informationdepends upon its normalization

Clinical language is inherently vague, which is atodds with the precision of computers

Computers have no intelligence Computers can only do what programmers and

users tell them to do

Computers process numbers and symbols very

fast and accurately Computers have extraordinarily great memory

It is up to humans to define the meaning orsemantics of information represented in a compute


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Standardized terminology

Information capturedocumentingfindings, conditions, and outcomes

Communicationtransferringinformation

Knowledge organizationclassificationof diseases, treatments, etc.

Information retrievalaccessing

knowledge based information Decision supportimplementing

decision support rules


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PRIVACY CONFIDENTIALITYAND SECURITY: BASICCONCEPTS


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Personal privacy vs. the commongood

Personal privacy is important. Common good of society is more

important.

Where do your views fit?


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Privacyright to keep things to yourself Confidentialityright to keep things

about you from being disclosed to

others Securityprotection of your personal

information


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Security Issues

Who owns information? How is informed consent implemented?

When does public good exceed

personal privacy? What conflicts are there with business

interests?


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Problems of Poor security

Patients avoid health care Patients lie

Providers avoid entering sensitive data

Providers devise work-arounds

Disclosure problems continue


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Security for paper records

Difficult to audit trail of paper chart Fax machines are easily accessible

Records frequently copied for many

reasons New providers, insurance purposes

Records abstracted for variety ofpurposes

Research

Quality assurance

Insurance


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Technologies to secureinformation

Deterrents Alerts

Audit trails

System management

precautions

Software

management

Analysis of

vulnerability

Obstacles Authentication

Authorization

Integrity

management Digital signatures

Encryption

Firewalls

Rights management


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Protected health information(PHI)

Name

Address (street address, city,

county, zip code)

Names of relatives

Names of employers

E-mail address

Fax number Telephone number

Birth date

Finger or voice prints

Photographic images

Social security number

Internet protocol (IP) address

Any vehicle or device serial

number

Medical record number

Health plan beneficiary

number Account number

Certificate/license number

Web URL

Any other unique identifying

number, characteristic, or code


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Costs of Informatics

Health IT costs and return on investment (ROI) What do I get back (return) for the money I'm

being asked to spend (investment)?

Cost-benefit defined Ratio of money value of benefit divided by cost

Cost-benefit in the outpatient setting Increased time for first 4 months but thereafter saved time

that was either spent seeing more patients or reducing workhours

Only a few practices implemented comprehensive qualityimprovement efforts, usually when insurers paid explicitly forit

System payback achieved at average of 2.5 years. Factors associated with success included

Near complete use of system functions

Having local EHR champion and supportive practice culture


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Cost-benefit in integrated deliverysetting

Laboratory and radiology order entry Reduction of time spent processing orders

Pharmacy order entry Reduced adverse drug events

Improved cost savings through better formularycompliance

Documentation Reduction in cost due to use of structured

documentation in outpatient setting


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Overcoming the economic obstacles Centrally funded.

Grants

Financial incentives Tie into quality of care initiatives


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This weeks assignments

Log on tohttp://faculty.ksu.edu.sa/ealmadi/182DEN/default.as

px

1. View this lecture online for review.

2. Read article3. Participate in discussion.

4. Submit Homework

5. Answer Quiz.

View Read Discuss Homework Quiz
http://lms.ksu.edu.sa/http://faculty.ksu.edu.sa/ealmadi/182DEN/default.aspxhttp://faculty.ksu.edu.sa/ealmadi/182DEN/default.aspxhttp://faculty.ksu.edu.sa/ealmadi/182DEN/default.aspxhttp://faculty.ksu.edu.sa/ealmadi/182DEN/default.aspxhttp://lms.ksu.edu.sa/


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Thank you

Dr Ebtissam Al-Madi

[email protected]

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