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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 in medical 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 among applications, allowing better system integration

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Benefits and limitations of standards Benefits Interoperability May allow innovation based on common foundation Limitations Dominance by one segment of industry: Microsoft standards, e.g., Windows, Office, etc. May stifle innovation

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The standards development process 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 for Standardization (ISO) http://www.iso.org/iso/home.html http://www.iso.org/iso/home.html ADA Standards Committee on Dental Informatics (ADA SCDI) http://www.ada.org/prof/resources/stand ards/informatics_reports.asp#a1031 http://www.ada.org/prof/resources/stand ards/informatics_reports.asp#a1031 International standards bodies

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Medical informatics standards 1.Identifiers 2.Transactions 3.Message exchange 4.Terminology

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1. Identifiers Various approaches have been proposed for Patients Providers Employers Health Plans

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Patient identifiers Unique only one person has a particular identifier Non-disclosing discloses no personal information Permanent will never be re-used Ubiquitous everyone has one Canonical each person has only one Invariable will 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 duplicate records Medical record identifier errors compromise quality of care and can be costly Cost increases with length of time error not identified Risks Easy linkage of records Potentially compromise privacy and confidentiality

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2. Transactions Transaction standards are designed to encourage electronic commerce for health claims. HIPAA (Health Insurance and privacy act) 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 encounter information Enrollment and disenrollment in a health plan 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 information depends upon its normalization Clinical language is inherently vague, which is at odds 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 or semantics of information represented in a compute

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Standardized terminology Information capture documenting findings, conditions, and outcomes Communication transferring information Knowledge organization classification of diseases, treatments, etc. Information retrieval accessing knowledge based information Decision support implementing decision support rules

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PRIVACY, CONFIDENTIALITY, AND SECURITY: BASIC CONCEPTS

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Personal privacy vs. the common good Personal privacy is important. Common good of society is more important. Where do your views fit?

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Privacy right to keep things to yourself Confidentiality right to keep things about you from being disclosed to others Security protection 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 of purposes Research Quality assurance Insurance

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Technologies to secure information 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 work hours Only a few practices implemented comprehensive quality improvement efforts, usually when insurers paid explicitly for it 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 delivery setting Laboratory and radiology order entry Reduction of time spent processing orders Pharmacy order entry Reduced adverse drug events Improved cost savings through better formulary compliance 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 to http://faculty.ksu.edu.sa/ealmadi/182DEN/default.as px http://faculty.ksu.edu.sa/ealmadi/182DEN/default.as px 1.View this lecture online for review. 2.Read article 3.Participate in discussion. 4.Submit Homework 5.Answer Quiz. ViewReadDiscussHomework Quiz

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Thank you Dr Ebtissam Al-Madi ealmadi@ksu.edu.sa