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Health Informatics Fundamentals for Public Health

This project was funded by the Office of the National Coordinator for Health IT U.S. Department of Health and Human Services ARRA Grant # 90CC07701

1. Terminology in Health Care and Public Health Settings(4 hours; lectures 1 hour, 16 min.)

Topics, Descriptions and Objectives

a. What is Health Information Management and Technology?

This unit describes health information management and technology.

Objectives ONC file TimeDefine and explain the terms and concepts used in the field of Health Information Management and Technology.

Understand the terms that frame Health Information Management (HIM) and Health Information Technology (HIT) practice.

Comp 3, Unit 14 17 min.

b. Overview and Introduction to the Electronic Health Record

This unit describes the overview and introduction to the electronic health record (EHR).

Objectives ONC file TimeIdentify the function of the health record.

Describe the American Recovery and Reinvestment Act of 2009 (ARRA).

Define meaningful use.

Comp 3, Unit 15a 14 min.

Discuss the difference between an EHR, EMR, and PHR.

Identify the purposes of EHR components.

Describe methods to ensure data security and confidentiality.

Define functional requirements of an electronic health record (EHR).

Comp 3, Unit 15b 22 min.

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c. Standards to Promote Health Information Exchange

This unit describes definitions and concepts in the electronic health record (EHR).

Objectives ONC file TimeDefine terms related to standardized terminologies.

Identify and define terminologies and vocabularies that represent nursing care.

Identify and define HIPAA standard code sets.

Define and give examples of data interchange standards.

Define terms related to standardized terminologies.


Discussion Questions

1. What is your background with regard to Information Technology in general and Health Information Technology Specifically?

2. How does your current job relate to concepts introduced in this module?

3. Do you know if your physician has an EMR? How do you think the absence or presence of an EMR has changed or might change your health care experience?

Quiz Questions

1. In order to realize all the benefits of electronic health records, which of the following requirements represents a common language that allows data to be shared?

a) Requires only classificationb) Requires only terminologyc) *Requires both classifications and terminologiesd) Requires neither classifications nor terminologies

Feedback: Information on this topic can be found in Component 3, unit 16, slide 13.

2. Which of the following utilizes a computer technology that allows physicians to use handheld or personal computer devices to access drugs and formularies and transmit prescriptions to a printer or local pharmacy?

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a) Computerized Provider Order Entryb) Decision Support Systemc) *Electronic Prescribingd) Personal Health Record

Feedback: Information on this topic can be found in Component 3, unit 15a, slide 14.

3. The term used to describe the mobilization of healthcare information electronically across organizations within a region, community, or hospital systems is:

a) Regional Extension Centerb) *Health Information Exchangec) Personal Health Recordd) Electronic Prescribing


4. Because health information systems typically integrate information from more than one source and location, they must run on a network.

a) *Trueb) False

Feedback: Information on this topic can be found in Component 3, unit 14a.

5. Which of the following agencies is responsible for oversight of the HITECH initiatives to promote meaningful use of electronic health records?

a) NIHb) OCRc) NLMd) *ONC

Feedback: Information on this topic can be found in Component 3, unit 15a, slides 8-10.

6. “An electronic record of patient health information containing care received in all health facilities” is the definition of:

a) *An Electronic Health Recordb) An Electronic Medical Record

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c) A Computer-based Patient Recordd) A Healthcare Information Record

Feedback: Information on this topic can be found in Component 3, unit 15b, slides 2-5.

7. A friend of a patient asks the nurse if the patient is HIV positive. If the nurse provides this information, what is he or she guilty of?

a) Breaching information securityb) Information by consentc) *Breach of confidentialityd) Nothing—this is legal

Feedback: Information on this topic can be found in Component 3, unit 15b, slides 26.

8. Access codes, passwords, and key cards are examples of:

a) Auditsb) Access routesc) *Authenticationd) Security

Feedback: Information on this topic can be found in Component 3, unit 15b, slide 22.

9. Which of the following best describes a firewall?

a) Software that forms a barrier between systems or parts of systemsb) *Hardware and software that form a barrier between systems or parts of systemsc) Hardware that forms a barrier between systems or parts of systemsd) A lead wall around a computer system


10. You are asked to select the type of type of computer network that best suits your organizational needs. What factors should you take consideration when making this choice?

a) Purpose of system, type of hardware, type of organizationb) Budget, type of information system, purpose of systemc) End user work flow, purpose of system, available infrastructured) *All of the above

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Feedback: Information on this topic can be found in Component 3, unit 14, slides 17.

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2. Overview and Contribution to Public Health through Electronic Health Record Use(4 hours; lectures 44 min.)


a. Overview and Contribution to Public Health through Electronic Health Record Use

This unit synthesizes key reasons and current contextual factors for providers in clinical practice to improve public health practice using Electronic Health Records (EHRs).

Objectives ONC file TimeExplain public health. Comp 13, Unit 1a 22 min.

Discuss what distinguishes public health from the other health sciences.


Project

Case Study #1 – Communicating the Importance of Public Health

As a member of a public health informatics working group, you have been asked to act in an advisory capacity to the Office of the National Coordinator (ONC) for Health Information Technology. The ONC is looking for ways to include public health in the adoption and implementation of “Meaningful Use” of EHRs. Your job is to define the points that will be included in a report to a general audience.

Make a case for the importance of EHR data to public health. In addition, make suggestions about how population health might be improved.

The point of this exercise is to identify different strategies and key points communicating the importance of public health inclusion in national health information technology efforts. There is no “right” answer, so feel free to use your ingenuity.

Deliverables: A list of reasons or “messages” about the importance of public health inclusion in national

health information technology efforts A list of potential consequences if public health is not included A strategy or strategies to illustrate your reasoning and related consequences

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Case Study #1 is due week 4.


1. How does the overview and description of public health in this module relate to your experiences at your state Department of Health organization? That is, does the overview match your perceptions of what happens at the state health department?

2. How do you think widespread implementation of EMRs will affect how you work? Explain why.

Quiz Questions

1. Which of the following is an aim of the public health profession?

a) Promotion of health behaviorsb) Quality assurance of health servicesc) Prevention of the spread of diseased) A and Ce) *All of the above


2. The use of data that is collected for purposes other than public health surveillance defines which of the following?

a) Outbreak detectionb) *Syndromic surveillancec) Public health informaticsd) Information technology


3. The evaluation of the effectiveness of public health programs is an essential service that falls under which core function of public health?

a) Assessmentb) *Assurancec) Policy developmentd) All of the above

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Feedback: Information on this topic can be found in Component 13, unit 1 a, slide 8.

4. The investigation of health hazards in a community is an essential service that falls under which core function of public health?

a) *Assessmentb) Assurancec) Policy developmentd) All of the above


5. Educating people in a community about a health issue is an essential service that falls under which core function of public health?

a) Assessmentb) Assurancec) *Policy developmentd) All of the above


6. The search for new and innovative solutions to health problems through research is an essential service that falls under which core function of public health?

a) Assessmentb) Assurancec) Policy developmentd) *All of the above


7. What has long been the number one cause of preventable death in the United States?

a) Alcohol useb) Car accidentsc) Obesityd) *Smoking

Feedback: Information on this topic can be found in Component 13, unit 1a, slides 9-.

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8. Healthy People 2020 is a report produced by which formal organization?

a) The Centers for Disease Controlb) *Department of Health and Human Servicesc) The Institute of Medicined) The National Institute of Health

Feedback: Information on this topic can be found in Component 13, unit 1a, slide 10-.

9. Which of the following is NOT one of the four overarching goals of Health People 2020?

a) Eliminate preventable disease, disability, injury, and premature deathb) *Create school-based programs that promote nutrition and exercisec) Achieve health equity and eliminate health disparitiesd) Create social and physical environments that promote good health for alle) Promote health development and healthy behaviors at every stage of life

Feedback: Information on this topic can be found in Component 13, lecture 1a, slide 19.

10. Which of the following organizations is NOT part of the public health system network?

a) Policeb) Churchesc) Mass transitd) Schoolse) *None of the above

Feedback: Information on this topic can be found in Component 13, lecture 1b, slide 38.

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3. Privacy, Data Standards, and the Role of Public Health in Health Information Exchange(4 hours; lectures 1 hour, 18 min.)


a. Privacy, Confidentiality, and Security of Public Health Information

This unit describes how to apply health data definitions and standards, as well as privacy and confidentiality issues, to typical public health scenarios.

Objectives ONC file TimeDescribe the objectives and roles of the HIPAA Privacy Rule and exceptions to HIPAA as they apply to public health.

Describe the potential civil and criminal penalties for a HIPAA violation and Identify and summarize each HIPAA security requirement (administrative, physical, and technical).

Discuss policy, procedures, contracts, and plans in administrative safeguards.

Describe how the physical environment can impact security of information and develop solutions to increase security.

Discuss technical strategies that can be implemented for security purposes.

Identify the type of information that requires protection (e.g., diseases, demographics) and list examples.

Demonstrate the application of principles for the appropriate release of required patient information in given scenarios.

Identify examples of circumstances when patient information may be used without patient authorization.


b. Data Standards and Public Health IT

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This unit continues with the application of health data definitions and standards, as well as privacy and confidentiality issues, to typical public health scenarios.

Objectives ONC file TimeDemonstrate knowledge of public health-oriented clinical decision support, including an integrated strategy using multiple tools such as alerts, order sets, smart forms, and quality reporting.

Identify the essential features of at least four primary public health IT functions, such as syndromic surveillance, bi-directional immunization registries, public health alerts, and ad-hoc reporting.


c. Public Health-Enabled EHRs and the Role of Public Health in Health Information Exchange

This unit summarizes and describes the main role, functions, and applications of public health-enabled Electronic Health Records (EHRs).

Objectives ONC file TimeDiscuss the New York City Department of Health and Mental Hygiene partnership with a commercial EHR vendor and how it created a public health-enabled EHR.

Demonstrate knowledge of public health-oriented clinical decision support including an integrated strategy using multiple tools such as alerts, order sets, smart forms, and quality reporting.


Describe the EHR "meaningful use" movement and how it could transform existing clinical and public health practices.


Describe the strategies, features, and systems needed for public health agencies to define and build the necessary connections to EHRs as identified by the "meaningful use" legislation.

Comp 13, Unit 4c 16 min.


1. How does HIPAA relate to your current job? Explain.11



2. What are some of the privacy issues you may have seen or heard about at the Washington State Department of Health?

Quiz Questions

1. A patient of a medical practice gives specific instructions regarding organizations and people who can view his or her medical information. This is an example of the exercise of which principle regarding the treatment of public health information?

a) Confidentialityb) Securityc) *Privacyd) Protection

Feedback: Information on this topic can be found in Component 13, unit 2, slides 2-4.

2. The Health Information Management director noticed a small leak in the ceiling in the file room. She immediately removed charts from the area. What aspect of HIPAA was she following?

a) Confidentialityb) *Securityc) Privacyd) Protection


3. You are charged with conducting a risk analysis for a healthcare facility in accordance with the Health Insurance Portability and Accountability Act (HIPAA) security requirements. Which of the following would place the facility at risk?

a) A computer system without firewallsb) Lack of locked doors and cabinetsc) Employee accessd) A and B onlye) *All of the above


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4. Which of the following is an example of a component to consider when developing information architecture?

a) Printersb) Databasesc) Business processd) B and Ce) *All of the above


5. The purpose of which of the following is to provide uniformity to the availability of different types of systems and communication methods in public health informatics?

a) *Data standardsb) Architecturec) Data configurationd) None of the above


6. Which of the following is a component to consider when implementing context and data standards required for communication in informatics?

a) Hardwareb) Softwarec) Confidentiality requirementsd) A and Be) *All of the above


7. Which of the following is the standards development organization responsible for the interchange of clinical and financial information?

a) Accredited Standards Committee X12b) American Society for Testing and Materialsc) *Health Level 7d) Institute of Electrical and Electronics Engineers


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8. Which of the following statements is true concerning the implementation of eClinicalWorks Software through the Primary Care Information Project?

a) The hardware to run the EHR is provided to enrolled providersb) *Post go-live consulting support is provided to the providersc) The Technical Assistance fee for two providers is $10,000d) PCIP's services are focused exclusively on getting providers live on the EHR


9. All of the following are amongst the primary priorities of the NYC Regional Extension Center EXCEPT for which one?

a) Assisting providers to adopt an EHRb) *Assisting patients to purchase personal health records softwarec) Providing assistance to reach “Meaningful Use” of the EHRd) Enabling the electronic exchange of health information between EHRs


10. The partnership between the Primary Care Information Project and eClinicalWorks software was initiated in response to which initiative?

a) Healthy People 2020b) *Take Care New Yorkc) Meaningful Use Policyd) Quality improvement


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4. Epidemiology Databases, Registries, and Biosurveillance(4 hours; lectures 57 min.)


a. Epidemiology Databases and Registries—Public Health Information Tools

This unit explains how varying types of information technologies have application in public health practice.

Objectives ONC file TimeIdentify the functions and key issues of epidemiology compared to clinical practice.

Define and distinguish among the components that make up epidemiology.

Identify the difference between environmental and mechanistic causes of disease.

Describe the components of epidemiological reasoning.

List the different types of epidemiology.

Define clinical epidemiology and its relationship with evidence-based practice.

Explain the current applications of epidemiology and how the results influence evidence-based practice.


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Objectives ONC file TimeIdentify different sources of epidemiological databases and how information is updated and exchanged with clinical entities.

Describe the purpose of a registry, the types of information contained within public health registries, and how this information can be used.

Identify the defining characteristics of epidemiological registries.

Identify different entities that operate registries and how information from clinical practice gets imported into these registries.

Identify security and access issues in the information exchange between communities, clinical institutions, public health departments, and federal agencies involved in public health prevention and control.


b. Biosurveillance, Situational Awareness, and Disaster Response

This unit focuses on identifying current needs and future directions for EHR biosurveillance, disaster-preparedness, and situational awareness in improving public health.

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Objectives ONC file TimeDescribe the traditional means used to monitor and report on disease spread within a community.

Identify current data sources used to track disease.

Describe the typical process of syndromic surveillance.

Identify strengths and weaknesses of using EHRs for biosurveillance.

Describe process for monitoring, reporting, and analyzing EHR biosurveillance data.

Identify how current and future findings from EHR biosurveillance improve public health operations and services.


Optional Resources

CDC guidelines for evaluating surveillance systems

Project

Case Study #2 – Design a Surveillance System

Choose a health condition of your choice (cancer, birth defects, syndromic surveillance, etc.). Then, design a new surveillance system for this health condition. Identify the indicators of health status for that health condition and determine how you might monitor those indicators to determine the health of a population.

Assume that you have unlimited resources to design and deploy a surveillance system. Identify the stakeholders involved and data sources for your indicators, and then draw a flow chart for the indicator data. Discuss the political, organizational, and technical issues you might be presented with. What are the trade-offs associated with resolving these issues? In particular, discuss how your system design may be affected by your issue resolution choices. Don’t forget to take into account the utility of the delivered system for each group of stakeholders.

The point of this exercise is to illustrate that stakeholders may not be identified, data sources for indicators may not currently exist, and political or organizational context may make a seemingly simple design project more complex than it appears at first glance.

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http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5013a1.htm



Team work is encouraged on this project. You may choose to form a design team of up to five members. Alternatively, you may choose to design your surveillance system on your own. There are strengths to both approaches. The most important thing about this project is that it should be fun.

Deliverables: Health condition and a list of possible indicators Data sources for indicators and how data are generated Stakeholder list Flow chart of data from source to output according to your surveillance system Value to stakeholders of your system and how indicators are presented to them. In other

words, how does your system help them work to improve the health condition? Socio-technical issues associated with negotiating the design and deployment of the system

Case study #2 is due week 6.


1. For this week's discussion, please talk about some of the issues you ran into working on your case study. Did you or your team run into anything unexpected? Interaction with other students about their project is encouraged to facilitate collaborative design and "face validity" checks of designs. Constructive feedback is welcomed.

2. What are some of the strengths and weaknesses that you perceived with regard to individual vs. team design work?

Note: this is not a simple solicitation of your preference, although it is fine for you to state it. The expectation here is to recognize the differences between working alone or in a group setting.

Quiz Questions

1. All of the following are key issues of health and disease application to epidemiology EXCEPT for which of the following?

a) Population preventionb) Determinants of healthc) Distribution within a communityd) *Individual treatment

Feedback: Information on this topic can be found in Component 13, unit 5a, slides 5, 6.

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2. From the list below, identify the descriptions as being a function of epidemiology, clinical practice, or shared by both.

a) Epidemiologyb) Clinical practicec) Applies to both

1 – Study of the frequency distribution of disease2 – Treatment of individual patients to restore health3 – Study of the determinants of health4 – Includes hospitals, clinics, and medical practitioners5 – Provides health services to patients

Answers:1. -- a2. -- b3. -- a4. -- c5. -- b


3. Understanding and calculating the risk for disease in a population consists of analyzing what two measures of health?

a) *Disease incidence and prevalenceb) Unemployment and insurance copaymentc) Alcohol consumption and teen pregnancyd) Mortality rate and genetic susceptibility

Feedback: Information on this topic can be found in Component 13, lecture 5a, slides 8.

4. Which of the following statements about epidemiology are true?

a) Epidemiology is focused on the health care treatment of individual patients in order to prevent or restore health.

b) Epidemiology focuses on community and population health in order to prevent disease and maintain health.

c) Epidemiology provides a systematic methodology to understand the relationships between potential determinants of disease and the health of populations.

d) A, Be) *B, Cf) None of the above

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5. Which of the following potential determinants for disease can be categorized as mechanistic?

a) Gas fumesb) Alcohol consumptionc) *Gene mutationd) Mistrust of physicians


6. Match the term or phrase with the associated definition from the process of epidemiological reasoning:

a) Observationb) Research questionc) Hypothesisd) Potential disease determinants

1 Generating a statement that can be proven true or false2 Calculating mortality rate for disease from a sample population3 Identifying sources of information to help test a hypothesis4 Defining potential reasons why the mortality rate exists for a sample population

a) _ 2b) _ 4c) _ 1d) _ 3


7. Which of the following is an example of how clinical epidemiology is used in evidence-based practice?

a) *Studying health outcomes of previous patients to improve current treatment practicesb) Using medical errors to identify staff training issues and rectify these problemsc) Measuring how long a patient waits to see a physician to improve customer serviced) Identifying disease prevalence leads to better understanding of the determinants of disease


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8. All of the following are true about traditional biosurveillance reporting by health providers EXCEPT for which one?

a) It is labor intensive for providers to enter patient datab) There is low compliance among providers for reporting disease casesc) There is a lag period (sometimes weeks) to report a suspected case following a patient visitd) *It does not require a diagnosis confirmed by a laboratory test before a report can be

generated

Feedback: Information on this topic can be found in Component 13, unit 6, slides 7, 8.

9. True or False. All four of the following items are possible EHR fields used in conducting syndromic surveillance.

1) Chief complaint/reason for visit2) Measured temperature3) Diagnosis code4) Progress note

a) *Trueb) False


10. Which of the following is the correct order of the steps in the typical process of syndromic surveillance using EHR systems?

a) Establish baseline, collect data, process and code data, identify outbreak, sound alarmb) *Collect data, process and code data, establish baseline, identify outbreak, sound alarmc) Collect data, identify outbreak, process and code data, establish baseline, sound alarmd) Identify outbreak, establish baseline, collect data, process and code data, sound alarm


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5. Public Health IT: Reporting and Potential for Health Promotion and Chronic Disease Prevention(4 hours; lectures 1 hr., 5 min.)


a. Public Health Reporting, Alerts, and Decision Support

This unit summarizes the essential public health services and methods by which they can be improved through the use of EHRs in the context of the clinical care environment.

Objectives ONC file TimeDescribe the current role of public health in the context of the clinical care environment.

Identity and describe three services essential to public health: Monitor Health; Diagnose and Investigate; Inform, Educate, and Empower.

Identify current public health practice challenges in the essential public health services of: Monitor Health; Diagnose and Investigate; and Inform, Educate, and Empower.

Identify the opportunities and limitations for EHRs to address these challenges in three primary areas (syndromic surveillance, notifiable disease reporting, and public health case investigation).

Describe challenges and limitations of EHRs to address these service areas.


b. The Potential of Public Health IT for Health Promotion and Chronic Disease Prevention

This unit explains a novel approach to developing and implementing health promotion programs in public health practice.

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Objectives ONC file TimeDescribe and categorize issues, questions, data sets, and factors (variables) that are used in descriptive epidemiology.

Describe how evidence-based recommendations may be appropriately used in implementing and evaluating health promotion and disease prevention.

Describe different types of health promotion and disease prevention and different methods of enacting health promotion programs.

Identify the steps in the process of implementing and evaluating prevention programs and interventions.

Identify the clinical preventive services that are linked to health promotion and disease prevention.

Describe how informatics can be incorporated into clinical preventive services.

Describe the history and foundation of geographic information systems, and explain the systems’ role in evidence-based practice.

Identify the barriers to incorporating public health IT into clinical practice and potential methods for resolving these limitations.

Identify the existing and innovative methods for communicating and sharing health information with the public.



1. How does the clinical care environment relate to your current job at the Washington State Department of Health?

2. Can you think of possible ways to integrate data from clinical care or other environments that you do not currently have access to at work?

Quiz Questions23



1. Which of the following is/are example(s) of public health information provided by the clinical care environment?

a) Communicable disease reportingb) Influenza-like-illness surveillancec) Ozone levelsd) *Both A and Be) All of the above


2. Which of the following groups is/are mandated by law to report instances of communicable disease?

a) Outpatient healthcare providersb) Hospitalsc) Medical laboratoriesd) *All of the above


3. Which of the following is considered a barrier to mandated provider reporting of communicable disease?

a) Lack of knowledge about reporting requirementsb) Patient refusal to consent for treatmentc) Time constraintsd) *A and C onlye) A and B only


4. Which of the following is/are advantage(s) of automating syndromic surveillance with EHR systems?

a) Reduced burden on providers to maintain datab) Ensured timely reporting of datac) Increased granularity of the reported datad) A and B onlye) *All of the above

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5. Which type of surveillance is necessary to monitor the natural course of illness in a community?

a) *Communicable disease surveillanceb) Syndromic surveillancec) Notifiable disease reportingd) Public health case investigation


6. Based on information provided in this instructional module, which of the following is a challenge for EHR systems regarding the integration of public health alerts?

a) Alert fatigueb) Inability to create content that can be readily implemented by EHR systemsc) Balancing specificity of alert criteria with sensitivity of alerting all relevant casese) *All of the above


7. Which of the following is an advantage of EHR pre-populated reporting forms?

a) Demographic information that is stored in a structured mannerb) Information that enables the provider to focus on reporting clinical datac) Information that alerts the clinician to provide recommendations to the patientd) *A and B onlye) All of the above


8. Which of the following is a voluntary network of providers associated with the Centers for Disease Control (CDC) that tracks the total number of influenza-like illness nationally?

a) CSTEb) *ILINetc) RHIOsd) CDSS


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9. Which of the following is/are important consideration(s) when communicating the results of health research to a broad audience?

a) Accurate presentation of resultsb) Research designc) Accounting for interactions among factorsd) *Making appropriate inferences of statistical analysise) All of the above


10. Which of the following influence(s) the widespread adoption of a health promotion program when implemented in the field?

a) Application of results on the efficacy of an innovationb) Organizational implementation of an innovationc) Support of the workforce implementing such programsd) A developer’s acknowledgement of user needse) *All of the above have an influence on the adoption of programs

Feedback: Information on this topic can be found in Component 13, unit 8, slides 30, 31.

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6. Adoption and Use of Population Health Functions:for EHRs and PHRs and Common EHR Systems in Ambulatory and Inpatient Care Settings (4 hours; lectures 49 min.)


a. Encouraging Adoption and Use of Population Health Functions for Electronic Health Records and Consumer Functions for Personal Health Records

This unit delineates the critical role of advocacy in adoption and use of EHRs and consumer functions for PHRs to improve public health.

Objectives ONC file TimeIdentify and describe public health functions of EHRs.

Describe the meaningful use criteria that are applicable to public health, population health, and disease management and prevention.

Provide examples of common PHR systems.

Define EHR adoption and use, with a focus on fidelity to public health goals.

Describe the challenges and barriers to adoption and use of population health functions for EHRs and consumer functions for PHRs.

Explain and apply a rationale that would encourage adoption and use of public health functions for EHRs and consumer functions for PHRs.

Demonstrate the ability to formulate a plan to encourage adoption and use of public health functions for EHRs and consumer functions for PHRs, given the setting, population and workflow environment.


b. Common Commercial Electronic Health Record Systems Used in Ambulatory and Inpatient Care Settings

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This unit provides an introduction to common commercial electronic health record systems used in ambulatory and inpatient care, and provides ratings to facilitate organizational decision making.

Objectives ONC file TimeDescribe the most common commercial electronic health record (EHR) systems used in ambulatory and inpatient care settings.

List Health Information and Management Systems Society (HIMSS) resources available on EHR systems.

Describe functions and applications of HIMSS resources available on EHR systems.

Describe functions and applications of KLAS ratings available on EHR systems.

Apply the KLAS rating system to evaluate software selections for ambulatory and acute care EHRs.

Provide a summary of inpatient and ambulatory vendors.



1. What are some aspects of consumer health information that relate to public health policy and practice?

2. How might consumer health informatics applications change the way public health practice is accomplished?

Quiz Questions

1. Which of the following is/are functional component(s) of Electronic Health Records (EHRs) that could support population health?

a) Registry functions to create a specific population setb) Data capture of information regarding QALYc) Determinant and outcome measures of health informationd) *A and C onlye) A, B, and C

Feedback: Information on this topic can be found in Component 13, unit 10, slide 11.28



2. All of the following are a focus of meaningful use of EHRs in regards to population health and public health EXCEPT for which one?

a) Safetyb) *Hospital eligibility and patient carec) Patient empowermentd) Clinical outcomese) Disease prevention


3. Which of the following is/are function(s) of personal health records (PHRs)?

a) Allow the patient to view laboratory resultsb) Allow the patient to request a prescription refillc) Allow patients to input data such as glucose readingsd) A and B onlye) *A, B, and C


4. Name the three types of internet-based personal health records (PHRs) offered?

a) *Health plans, employers, and consumer websitesb) Consumer websites, simple diaries, and pen (USB) drivec) Google health, consumer websites, and employersd) Employers, hospital records, and simple diaries


5. Which of the following best describes the adoption of population or public health functions of the EHR system in the country up until this point in time?

a) *There is a low adoption rate with a focus on syndromic surveillance and quality reportingb) There is a high adoption rate with a focus on reports to health plans and internal quality

auditsc) There is a low adoption rate with a focus on personal health records (PHRs) and patient

inputd) There is a high adoption rate with a focus on JCAHO compliance and accreditation reports

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6. Which of the following is/are considered barrier(s) to adoption and use of EHRs for population health functions?

a) *Financial incentivesb) Privacy concernsc) Front-end system designd) A and B onlye) A, B, and C


7. All of the following are ways to encourage the adoption of EHRs EXCEPT for which one(s)?

a) *Improve EHR functions to include care delivery and management capabilitiesb) Improve EHR functions to include the capability to email patients a summary after each visitc) Encourage third party developers to make applications to provide more useful servicesd) A and Be) A and C


8. To supplement knowledge of factors and trends in the use of EHRs, a HIMSS resource that may be useful includes which of the following?

a) *Industry research reportsb) Product reviewsc) Rating scales of systemsd) Vendor comparisons


9. If you wish to make comparisons between two vendor-specific EHR systems, you would rely on:

a) *KLAS rating systemb) HIMSS resourcesc) Both of these sourcesd) None of the above

Feedback: Information on this topic can be found in Component 14, unit 1, slide 9.30



10. Which of the following is NOT a criterion used to calculate the KLAS overall score for EHRs?

a) Quality of trainingb) Quality of phone and web supportc) Overall satisfactiond) *Numbers of customers


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7. Working With, Installing and Maintaining Health IT Systems(4 hours; lectures 1 hour, 47 min.)


a. Working with Health IT Systems

This unit introduces the generic functions of HIT systems that underpin inpatient and outpatient (ambulatory) processes. Crafted HIT lab exercises lead the student through a simulated patient encounter to highlight how HIT systems support, and sometimes thwart, information flow.

Objectives ONC file TimeIdentify the Health IT functions that support a generic ambulatory care process.


Identify the Health IT functions that support a generic inpatient care process.


b. Installation and Maintenance of Health IT Systems

This unit provides an overview of what a typical electronic health record system is and focuses on the elements that make up such a system -- hardware, networks, software, and storage requirements.

Objectives ONC file TimeDescribe the use of client and server hardware for access to and storage of EHRs.

Identify the core elements that comprise an EHR system.

Identify the application software and back-end data storage software needed for a comprehensive, effective health IT system.

Describe network needs for access to and storage of EHRs.

Comp 8, Unit 1aComp 8, Unit 1b

21 min.24 min.

c. System Selection – Software and Certification

This unit discusses the differences in COTS (Commercial Off-The-Shelf) and in-house or homegrown systems and how to select the system to meet the needs of the end users. The unit

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also explores the advantages of purchasing a CCHIT-certified system and discusses ARRA and “meaningful use” in the context of EHR systems. Lastly, the unit discusses estimating the typical costs associated with an EHR system startup.

Objectives ONC file TimeCompare and contrast COTS (Commercial Off-The-Shelf) and in-house or homegrown systems and describe their relative advantages and disadvantages.

Verify system compliance with ONC-ATCB certification.

Identify purpose and categories of ARRA “Meaningful Use” criteria.


Project

If participants have access to an academic EHR practice tool, a hands-on lab activity such as the following is recommended. The activities below were related to the Open Source CPRS VistA system used at the Department of Veterans Affairs.

a. Activity I

Mr. Outpatient Eleven is coming in today (August 28, 2010) for a regularly scheduled primary care clinic appointment. The appointment already exists in the system. You will be using the VistA system to help you complete your assessment and to fully complete all of the documentation required.

As you walk through this exercise, you should consider the following: Make a few brief notes/suggestions of where you thought the software could have been

more supportive of the process being undertaken, be specific – and you may want to take a screen picture to illustrate your suggestions to the instructor.

In the video you witnessed the completion of the Mini Mental State Exam. Why does the system require that the user tally up the results?

A good suggestion for improved support of workflow would be to have the system be able to add up the scores to arrive at the total score instead of putting that burden on the user.

Steps to complete Activity 1:

1. From within the VistA system, select Eleven, Outpatient, and then open his record.

2. Change from “Visit Not Selected” to the ambulatory clinic location of “Primary Care, August 28, 2010”.

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3. As the clinician, you want to add a new note to reflect your actions in the clinic on August 28th with the patient. Choose “Note” and then “New Note”.

4. Assign “Admission/Eval Assessment” as the title for the new Progress Note (ignoring any warning or error boxes, should they appear).

5. Change the date of your new Progress Note to match the date of the visit – in this example it will be August 28, 2010 and click OK.

6. A “new note in progress” should appear in the Note box to the left.

7. As the clinician, you choose “Template”, because you know that the exam that you are going to perform on Mr. Eleven has a template that will guide your exam and make the documentation easier.

8. Choose “Shared Template”, and then choose “National Templates” and “Mental Health Templates”.

9. Your goal in today’s visit is to do an MH Abbreviated Assessment, and tend to other needs that Mr. Eleven has during this visit. Double click “VA MH Abbreviated Assessment” to display the template. What is then displayed is an institutionally vetted assessment template that guides best practice for the Mental Health Assessment and documentation process.

10. Complete only the parts of the MH Abbreviated Assessment noted below. Students are to refrain from entering unprofessional data, remembering that all entries are linked to your login. Data approximating reality is close enough – as it is understood that not all students have a clinical background.

a. Marital Status (married)b. Presenting Chief Complaint (depression)c. History of Current Illness (example: “Patient presents with depression of three days

duration”)d. Pertinent Past Psychiatric History, Family, and Medical History (example: “None” or

“Vietnam war vet with significant family issues” or “History of substance abuse”, etc. For medical history – think about this patient’s current active problem list……)

e. Complete the Mental Status Exam, the Assessment of Danger to Self, and Assessment of Danger to Others. Note the “fan-out” function. Ignore the rest of the examination. Again, we are not grading on quality of clinical documentation, understanding that not all students will understand the terminology and meaning. The purpose is to demonstrate HIT support for vetted practices.

f. Scroll to the bottom and click “PREVIEW”. If you need to make corrections, do so.g. If satisfied, highlight all of the material in the PREVIEW box. When highlighted, click

CTRL-C (to copy what is highlighted), open a word document and CRTL-P (or paste) your highlighted material into the document. Save it for submission to instructor.

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h. Click OK at the bottom of the template to transfer the note from the template into the patient’s chart. The results of your MH Abbreviated Assessment will appear in the Note window to the right. As the clinician, you have now completed the assessment and recorded your findings.

i. Click finish.j. Verify yourself as the Primary Care Provider in the box that will pop up.k. Right click in the body of the note to “sign note now”. Your note will now appear as a

“signed” note in the left margin. Exit the system.

11. Keep any notes you jotted down, including brief suggestions about how the system could be improved to support user workflow, for use in Activity II.

b. Activity II

Using your notes, make suggestions of where you thought the software could have been more supportive of the process being undertaken. Be specific –you may want to take a screen picture to illustrate your suggestions to the instructor. Please post your deliverable in the weekly discussion forum.


There are no specific discussion questions for this module, as time is given to students to interact with an EHR system. It is suggested that an open lab discussion forum be used to post any comments or questions about the EHR system.

Quiz Questions

1. Which of the following, according to the IOM, is a software element of an EHR?

a) *Patient supportb) Softwarec) Hardwared) All of the above


2. Which of the following is one of the four key components of any EHR system?

a) Provides mobility for healthcare workersb) *Provides “longitudinal health data” on individualsc) Provides secure access by sacrificing efficiency

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3. Most EHR systems today are based on what kind of computer model?

a) Non-networked stand-alone systemsb) *Client-serverc) Hosted


4. What are three things to consider when purchasing an EHR server?

a) *Reliability, performance, scalabilityb) Size of the unit, performance, power consumptionc) Client-Server, Service Requester, client requests


5. Name three types of servers you may find in a typical EHR system?

a) Hardware, RAM, Dellb) *Configuration, terminal, VPNc) Application, Database, Citrixd) Internal, external, hosted


6. Software can be defined as:

a) The nuts and bolts that make things workb) The physical components of serversc) *A collection of computer programs and related data that provide instructions for telling a

computer what to dod) A collection of computers and devices connected by communications channels that

facilitates communications among users and allows users to share resources with other users


7. Hardware can be defined as:36



a) *The physical components that make things workb) Data needed to tell the computer what to do and how to behavec) Fast, low-cost PC systems, often less than $500 each, that permeate the workplaced) A computer designed to efficiently run server applications


8. True or false? Server applications and client applications can exist on the same physical device.

a) *Trueb) False


9. True or false? Business practices may have to be modified for, and workflow often has to be adapted to, the particular design of the COTS product.

a) *Trueb) False


10. Which are advantages to using COTS software?

a) Development costs are typically lowerb) It integrates best with your present IT system componentsc) The learning curve is easier for users and administratorsd) *A and C


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8. Working with Electronic Health Records(4 hours; lectures 16 min.)


a. Building Order Sets

This unit identifies the value of order sets as a quality control and quality improvement mechanism and an efficiency tool in clinical settings. Typically, order sets are created by clinicians with expertise in treatment plans. Ideally, through a series of lab exercises, students learn how to take those treatment plans and implement them into specific order sets within an EHR simulation system.

Objectives ONC file TimeDefine and describe an order set.

Describe the benefits and costs associated with order sets.

Demonstrate the ability to build a variety of order sets in a simulated EHR environment through lab exercises.


b. Creating Data Entry Templates

Templates are important tools in the collection of data manually entered into Electronic Health Record systems. When implemented appropriately, they can help to standardize the data entered into the system, provide controls that ensure the quality of the data captured, and provide data capture efficiencies through effective design and use. This unit provides a brief lecture followed by lab exercises that provide the student with practical experience creating and using data entry templates.

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Objectives ONC file TimeAccess and use the template editor.

Effectively use the different field controls to promote data quality and efficiency of data entry.

Design, create and view personal and shared templates for data entry.

Describe how the effective use of data entry templates supports quality care, patient safety, and efficiency.


Project

It is recommended that an additional hands-on EHR lab activity be included in this module as well.


There are no discussion questions this week.

Quiz Questions

There is no quiz this week due to lab activities.

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9. Vendor-Specific Systems(4 hours; lectures 53 min.)


a. Certification of Commercial EHRs

This unit focuses on quality of certification of commercial EHRs, and how to apply Certification Commission for Health Information Technology (CCIHT), Joint Commission, and National Patient Safety Goals to decisions about commercial EHR vendor selections.

Objectives ONC file TimeDescribe the Certification Commission for Health Information Technology (CCHIT) and its role in the certification of commercial EHRs.

Describe or give examples illustrating how CCHIT criteria are used for certification of EHR systems.

Identify the benefits of “meaningful use” of EHRs and identify examples of “meaningful use” of EHRs in given scenarios.

Identify the three stages of implementation requirements for “meaningful use” of EHRs.

Identify the role of governing bodies certifying commercial EHRs, including FDA oversight, the Joint Commission, and National Patient Safety Goals.


b. System and Database Architectures Used in Commercial EHRs

This unit compares database architectures employed by various vendor applications for fulfilling different user purposes.

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Objectives ONC file TimeDemonstrate concept knowledge of system and database architectures used in commercial EHRs.

Describe the health information systems landscape, including CPOE, Pharmacy, Lab, etc.

Identify the different EHR hardware platforms.

Compare different EHR operating systems and databases.

Explain the importance of security, privacy, auditing and performance monitoring in EHRs.


c. Vendor Strategies for Terminology, Knowledge Management, and Data Exchange

This unit evaluates EHR systems based on vendor strategies for terminology management, knowledge management, and data exchange.

Objectives ONC file TimeDefine interoperability.

Describe vendor strategies for terminology and knowledge management and how these impact interoperability.

Describe processes and requirements for exchanging data with personal health records.


Optional Resources

ePatients.net

Lee, A. (2011). Google Closes Health and PowerMeter Services. Huffington Post.


1. Think about the public health information systems you have used. Have any of these systems undergone a certification process? Do you think such a process would help the information systems used in public health?

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http://www.huffingtonpost.com/2011/06/24/google-health-powermeter_n_884246.html

http://e-patients.net/



2. What type of architecture do you think might work well for an information system that supports your work at a state health department. Explain. You may have real life examples of systems that work or do not work well for their designed purposes.

Quiz Questions

1. Which of the following is NOT a reason why Electronic Health Record (EHR) system should be certified by the Certification Commission for Health Information Technology (CCHIT)?

a) To evaluate patient care through quality assurance measuresb) To foster information exchange among clinicians and patientsc) *To ensure adoption of the system by all clinicians in a facilityd) To support clinical decision making by clinicians and patients


2. The Certification Commission for Health Information Technology (CCHIT) can best be described as:

a) A consortium of EHR vendorsb) *An independent, non-profit organizationc) A professional societyd) A regulatory agency of the U.S. Government


3. Which of the following is a good example of meeting the functionality criterion, as given by the Certification Commission for Health Information Technology (CCHIT)?

a) Is An EHR that requires authorized accessb) *An EHR that has a Computerized Provider Order Entry (COPE) functionc) An EHR that uses HL7 standardsd) All of the above are good examples of meeting the “functionality criterion”


4. Which of the following is NOT a criterion used by the Certification Commission for Health Information Technology (CCHIT) for EHR systems?

a) Functionalityb) Interoperability

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c) *Return on investmentd) Security


5. It is important to certify that EHRs are up to certain quality standards for all of the following reasons EXCEPT for which one?

a) Acceptance of records by cliniciansb) Health information exchangec) Impact on patient safetyd) *Mandated regulations by governing bodies


6. Under the American Recovery and Reinvestment Act (ARRA) of 2009, hospitals and health care professionals are required to become “meaningful users” of certified EHR technology in order to do which of the following?

a) Avoid financial penaltiesb) Practice medicinec) Receive incentive paymentsd) *A and C onlye) A and B only


7. Which of the following is an example of ‘meaningful use’ of EHRs?

a) Keeping track of patient appointments using an EHR systemb) Keeping track of patient demographic information using an EHR systemc) Keeping track of practitioner work schedules using an EHR systeme) *Keeping track of medications administered to a patient using an EHR system.


8. Which of the following is/are component(s) of the architecture of an Electronic Health Record (EHR)?

a) Users of EHRb) Pharmacy

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c) Clinical data repositoryd) A and C onlye) *All of the above


9. Which of the following is an example of “front end” hardware platforms for EHRs?

a) Database serverb) Application serverc) *Mobile deviced) A and C onlye) All of the above


10. Which type of EHR hardware platform may use online document processors as opposed to the traditional software?

a) *Thick clientb) Thin clientc) *Web basedd) Citrix


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10. People and Technology: Studies of Technology and Usability Evaluation Methods

(4 hours; lectures 1 hour, 25 min.)


a. People and Technology

This unit applies methods of cognitive research, sources of usability evidence, and principles of user-centered design to decisions regarding systems evaluation, technology evaluation, and iterative design, given a population of users.

Objectives ONC file TimeExplain the importance of technology in health.

Describe the contributions of human-computer interaction to the health field.

Describe the seven stages of user activity in Norman’s Theory of Action.


Demonstrate concept knowledge of principles of user-centered design, methods of cognitive research, and sources of usability evidence.

Apply the principles of user-centered design to address the challenges to effective design.

Compare and contrast usability evaluation methods.


Identify and differentiate various types of errors in medicine. Comp 15, Unit 1c 11 min.

b. Usability Evaluation Methods

Select the most appropriate usability evaluation method, given a particular system, setting, and development phase.

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Objectives ONC file TimeDescribe the importance of usability in relation to health information technologies.

List and describe usability evaluation methods.

Given a situation and set of goals, determine which usability evaluation method would be most appropriate and effective.


Describe the appropriate tasks for a usability test.

Describe the usability testing environment, required equipment, logistics, and materials.



1. What is the value of including people in the design of systems that will support their work?

2. If you were tasked with the design of an information system that was intended for other people, how would you ensure that all stakeholders were included in the design process?

Quiz Questions

1. Which of the following are reasons why technology is important in healthcare today?

a) Technological applications save patient livesb) Technology needs constant updating in the healthcare settingc) *Technology permeates all facets of the healthcare systemd) A and Be) A, B, and C


2. The quality of a user’s experience when interacting with the technological system refers to which of the following concepts?

a) *Usabilityb) Gulf of executionc) Iterative designd) Digital-divide

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3. Which of the following is NOT a primary factor that affects the user’s experience?

a) Ease of learningb) Efficiency of usec) Memorabilityd) *Cost of usee) None of the above


4. According to the Health Information and Management Systems Society (HIMSS), what is perhaps one of the most important factors hindering the adoption of EHR systems?

a) Cost of systemb) *Usabilityc) Time for trainingd) Lack of resourcese) Resistance to change


5. Which population of users is more susceptible to usability problems?

a) Adults over the age 65b) Patients with disabilitiesc) Patients with chronic illnessd) A and Ce) *All of the above


6. Which type of interview would be most appropriate for exploring ideas early in the design cycle?

a) Structured interviewb) *Unstructured interviewc) Semi-structured interviewd) Focus groups

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Feedback: Information on this topic can be found in Component 15, unit 5a, slide 8.7. Which type of interview is characterized by a set of predetermined questions and a very specific

agenda?

a) *Structured interviewb) Unstructured interviewc) Semi-structured interviewd) Focus groups


8. How many participants are typically represented in a focus group?

a) 1-3b) *3-10c) 10-15d) 20 or more


9. Which of the following is FALSE regarding the selection of a representative sample for usability testing?

a) It is recommended that users be as similar as possible to each other to represent an accurate result

b) It is recommended that the sample size should be limited in terms of how many participants allowed

c) *It is recommended that you employ as large a sample size as possible to ensure representativeness

d) A and Ce) All of the above are false


10. What role do researchers tend to play in a field-testing environment compared to other settings?

a) *Research will be more activeb) Research will be less activec) Research will be the same regardless


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bellevue college--wacmhc health it curriculum web viewin the video you witnessed the completion of...

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