mnia introduction to health informatics

MNIA Introduction to Health Informatics

The Basics of Data Norma Alberg

Epidemiologist

DatabasesMarch 17, 2008

Databases in Health Care

Definitions Record Structure

“Wild Cards” (ie. local chart numbers)

Relational Databases Unique identifiers (MHSC, PHIN)

Maintenance Data Entry Standardized coding structures (mutually exclusive)


“Ah, those Databases!


What is a Database?

A Database,

• Is essentially a tool for storing information for later sorting and retrieval of specific records, based on inclusion criteria determined by the end-user.

• The main element of its structure is a FIELD of information.


Why do we need a Database?

Nursing Informatics,

• “Integrates nursing science, computer science, and information science to manage and communicate data, information, and knowledge in nursing practice. Nursing informatics facilitates the integration of data, information, and knowledge to support clients, nurses, and other providers in their decision-making in all roles and settings." (Staggers & Bagley-Thompson, 2002).

– Source www.CNIA.ca


What is File Structure?

A Template for a single record is established to determine

the required fields of information. This defines the file structure.

– Field name– Type of information– Size (length)– Code structure– Linkages (code lists, numeric, text…)– Data entry criteria (acceptable ranges and types)


Record template

Field Name Field Type

First name Text (35 characters)

Last name

Date of Birth yy/mm/dd

Street number and name Alphanumeric (50 characters)

City or town

Province or state (full or postal abbreviated – typos!)

Postal Code Alphanumeric

Gender Male=1, female=2

First visit Yes/No

Date of visit Yy/mm/dd

“wild card” Yes/No

MH number Numeric (7 characters) Big enough?

PHIN number Numeric (9 characters)

Relational DatabasesExample - Manitoba Health


Relational DatabasesExample – Hospital Admissions


Relational DatabasesWhat can they do?

• Cohort Studies (Study on Aging)• Health Care Delivery Trends (LOS)• Patient Transfer Patterns (rural-urban)• Utilization Patterns (Ca, occup, chronic)• Illness Severity and outcome• Risk Factor Identification• And so on and so on……


StandardizationWhy do we need it?

Minimum data requirements (MDS)Methods of collection (forms)Coding structures

ICD-10, E-coding Severity scoring (AIS, ISS, ICU indices) Laboratory reporting units (SI units) Ranges for “normal”


Funneling InformationWhat if we misclassify a record?

Client

Ward

Hospital

Area

Province

Nation

World


How do we fit in to the big picture?

Canadian representation on HL7 international board, Toronto, March 6, 2008 -

• Canada Health Infoway's (Infoway) Chief Technology Officer, Dennis Giokas, was recently appointed to the Health Level 7 (HL7) International board.

• Giokas' appointment will help Canada shape the strategic direction of HL7, which is critical to the interoperability and standardization that is fundamental to the success of the interoperable electronic health record (iEHR).

• "Canada is a strong contributor to the global acceleration of electronic health records and we look forward to their continued collaboration, and to leveraging their strengths and experience," said HL7 Board Chair Dr. Ed Hammond.

• Infoway uses HL7 in defining the interoperability standards that are used in every clinical domain and demographic registry Infoway invests in. Thus they are critical to the 245 Infoway-funded electronic health projects currently underway across Canada. The appointment of Mr. Giokas will ensure the needs of Canadian patients, clinicians and vendors are well represented on the international stage.

Some of the Challenges of Maintaining Databases

Optimizing RELIABILITY Trained personnel Inter-rater reliability Commitment to end product Timeliness on data entry Up-to-date on standards changes Responsive to client needs Multiple stake holders


Plan it well and things may actually roll your way.

GOOD LUCK !

mnia introduction to health informatics

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