Data compiled from individual patient data fields and formed into data about certain
groups of patients is as example of:
A comprehensive, standardized
nomenclature designed to facilitate the storage and automatic encoding of
medical text is known as
(formly known as the Systematized Nomenclature of Human and Veterinary Medicine - originally developed by the College of American Pathologists (CAP) in the 1960s - now maintained by a separate company based in Denmark - International Health Terminology Standards Development Organization)
Coined by the IOM; designed to support users by providing accessibility to complete links to medical knowledge and other aids
EHR (Electronic Health Record)
Chosen by the IOM and carried forward by HL7; most comprehensive term
EMR (Electronic Medical Record)
- Used to describe systems based on document imaging or systems implemented physicians
OC/RR (Order Communication/Results Retrieval)
Similar to CPOE (computerized provider order entry); provides the capability of transmitting ancillary department orders and viewing results
Steps taken to build an EHR system; uniquely created by each organization
CPOE (Computerized Provider Order Entry)
System that provides electronic provider order entry with linked retrieval of diagnostic testing results
CDSS (Clinical Decision Support System)
CIS (clinical information system) designed to support providers with knowledge based decisions; contains preprogrammed logic, point of care technology
PHI (protected health information)
Confidential patient specific information
ED/CM (electronic document/content management)
System which stores imaged documents and provides for indexing; may also include voice files, e-mail and e-fax system information
Laser disk storage systems
Clinical messaging systems
Adds real-time access and web-based applications to the OC/RR and ED/CM systems
PDAs and COWs
Point of care devices that allow for ease in data capture; hardware for patient care charting systems
Produces the MEDLINE database
Natural language processing
Narrative text is converted into discrete data
Private internet network: not open to the general public
Large databases that are centralized to the healthcare enterprise
Direct access database; provides users with detailed patient-level data, as well as administrative, financial and clinical data
An SDO; accredited by ANSI; working to standardized EHR data formats
Give an example of a mechanical system as discussed in the text
A home heating and cooling system
What is the difference between a deterministic system and a probabilistic system?
A deterministic system is like the climate control system in the hospital, and the probabilistic system is like a human body.
What is the primary difference between a closed and an open system?
The difference is determined by whether or not the system interacts with environment.
What is the definition of data flow?
- The flow of data from a source to a destination
- Data does not flow it actually leaps from point to point
Information systems can stand alone
as they function within the guidelines for their specific purpose whereas the
EHR cannot stand alone. Why?
EHR is a system within a systems and each component contributes to the whole to produce a fully functional medical record.
What do the initials in the acronym
SDLC stand for?
Systems Development Life Cycle
Information Systems that incorporated self regulation would be considered what type of systems?
According to the author, the primary
reason for lack of interpretability among systems has been due to:
The use of the closed system approach
What is another name for the traditional SDLC methodology?
The existing (manual) system is evaluated and deficiencies are identified. The result is the determination as to whether it makes sense to proceed with the project.
New (automated) system requirements are defined. In particular, deficiencies in the existing system are addressed with specific proposals for improvement.
The proposed system is designed. Plans are laid out concerning the physical construction, hardware, operating systems, programming, communications, and security issues.
The new system is developed. The new components and programs are obtained and installed. Users of the system are trained in its use, and all aspects of performance are tested. If necessary, adjustments are made at this stage
The system is put into use. This can be done in various ways. The new system can be phased in, according to application or location, and the old system gradually replaced. In some cases, it may be more cost- effective to shut down the old system and implement the new system all at once.
When the new system is up and running for a while, it should be exhaustively evaluated. Maintenance must be kept up rigorously at all times. Users of the system should be kept up- to-date concerning the latest modifications and procedures.
What is the legal precedent created by judges rather than legislatures wherein judges can either interpret statutory law or common law?
Which federal law called for the adoption of standards to support e-prescribing?
The Federal Electronic Signatures in Global and National Commerce Act of 2000, also known as the E-SIGN bill, furthered what aspect of the EHR adoption process?
Helped make electronic signatures legal
What is the name of the model act relating to the use of electronic online communications and contracts, electronic records, and online signatures?
The Uniform Electronic Transactions Act of July 1999
What is a digitized signature?
Scanned image of a “wet” signature
SDLC (system development life cycle)
Information systems must be created in a logical manner. The system development life cycle SDLC is the traditional way to plan and implement an IS in an organization.
The four major phases of the SDLC are:
- Planning and analysis
There are 12 steps of the SDLC and they are:
- Request for development
- Requirements and system analysis
- System design
- Specification of functions
- Coding of computer programs
- Testing of system
- Development of system documentation
- User training
- System conversion
- Operation of the system
- System maintenance
- System changes and upgrades
You are developing a list of functions needed by users of a release of information system. You are also evaluating the current system to see what opportunities there are to improve the system. Which stage of the system development life cycle stages are you in?
The administrator has asked us to develop a patient satisfaction database internally. This database will be used to collect data that can be used to improve our services. He does not want this to be a long, drawn-out process. Which of the following could speed up this process?
The EHR system implementation team is using simulated patients and simulated patient information to add progress notes, nurses’ notes, ect., to the EHR prior to implementation. Which phase is the team involved in?
The laboratory system was installed 3 years ago. It is running well and meeting the needs of the department. Which stage of the IS life cycle is the lab system in?
Your facility is developing a new information system. Your department is viewing the product as it develops and providing feedback that is used to update the system. This process is called
Electronic health record (EHR)
a computerized record of health information and associated processes. An electronic patient record housed in a system designed to provide users with access to complete and accurate data, practitioner alerts and reminders, clinical decision support systems, and links to medical knowledge.
For a computer to work, the equipment must use the set of instructions or software. Without system software, nothing would happen. System software has 3 basic components:
- Operating System
- Utility programs
- Language translator
Database management system DBMS
Computer software that enables the user to create, modify, delete, and view the data in a database. Relational database, Object-oriented database, Object-related database
stores data in predefined tables that contain rows and columns similar to a spreadsheet. The kinds of data that can be stored in a relational database are currency, real numbers, integers, and strings (characters of data). This type is a popular model used in healthcare applications.
stores objects of data. An object is a discrete or abstract thing such as a car or a line at the grocery store. Data objects can model relational data or advanced data types such as graphics, movies, and audio.
combines the best of relational and object-oriented databases. It uses both traditional data types such as currency, integers, and strings and advanced data types such as graphics, movies, audio, ect
Application software is categorized into 4 types:
- Productivity software
- Specialty software
- Education and reference software
- Entertainment software
A descriptive list of the data elements to be collected in an information system or database whose purpose is to ensure consistency of terminology.
A data dictionary is the equivalent of a detailed road map of the database. Maintain the data dictionary frequently is an HIMN function. A data dictionary is essential in ensuring consistent definitions of what data names mean and making sure that data are accurate. A data dictionary is essential in development of HER systems.
A type of system used to analyze data for decision-making purposes. Most organizations use multiple databases in their daily business operations. Data warehouses provide organizations with the ability to access data from multiple databases and to combine the results into a single question and reporting interface
connect computers in a small area. For example in room one in a building. It can take the form of a client-server network, a peer-to-peer network, or a hybrid network. One special form of a LAN is an intranet. An intranet is a specialized client-server network that uses Internet technologies. Intranets let corporations supply Internet service over their LANs. Intranets are private Internets with the security required to protect a corporation’s assets. An extranet however provides network connectivity between suppliers to allow direct connection to each other’s network.
connects devices across a large area. For instance across a state or even the world. WANs can take several forms but often simply consist of two or more LANs connected by telephone lines. The world’s largest public WAN is the Internet. It consists of hundreds of thousands, if not millions, of interconnected LANs around the world. By connecting private LANs to the internet individuals and corporations can create an inexpensive WAN
an automated system that uses computer hardware and software to record, manipulate, store, recover, and disseminate data (that is, a system that receives and processes input and provides output) often used interchangeably with information technology. An IS consists of data, people, and work processes and a combination of hardware (machines and media), software (computer programs), and communication technology (computer networks) known as information technology
The machines and media used in an information system. Physical equipment of computers and computer systems Consists of both electronic and mechanical equipment
programs and applications on a computer. Set of instructions required to operate computers Operating system software: sets of instructions that direct actual computer functions Application software: set of instructions used to accomplish various types of processes
Types of Computers
– largest, fastest, and most expensive type of computer that exists today. These computers are the fastest and highest capacity machines built today. May cost millions and are used in large-scale activities such as weather forecasting and mathematical research.
– A computer architecture built with a single central processing unit to which dumb terminals and/or personal computers are connected. Were the only computers available until 1960s. Perform millions of instructions per second, and hundreds of users can be connected at the same time. Size ranges from middle to large capacity. Used in healthcare to handle input/output-intensive transactions. Most hospitals use mainframes dating back to the 1960s and 1970s to store payroll, personnel, billing, and accounting data.
- Midrange Systems -
- Minicomputers – small mainframe computer. Workstations Minicomputers introduced in the 1960s and can support up to 4,000 connected users at the same time via terminals consisting of a keyboard and video screen. Cheaper than mainframes Workstations Introduced in the 1980s. A very powerful desktop computer used mainly by power users such as graphics specialists for multimedia production. Comparable to midsize mainframes but sit on a desktop. May be used as servers to microcomputers connected through a network.
– A personal computer characterized by its relatively small size and fast processing speed. PC – personal computers Introduced in the early 1970s. The fastest growing type of computer today. Come in a variety of sizes including desktop, laptop, palmtop, and pen based. Can be used in stand-alone environment or connected to a network.
Web Appliances Used in conjunction with the Internet.
One device sits on top of a television and allows the user to surf the Internet using a remote control device. Web appliances have no processing unit or storage device. Main purpose is Web navigation.
Different pieces of hardware and software connected to CPUs or central processing units to make the CPU user-friendly and more functional are known as peripherals.
any hardware device connected to a computer (such as a keyboard, mouse, or printer).
- Pointing devices such as “mice”
- Light pens
- Intelligent tablets
- Biometrics such as fingerprints, handprints, and iris scans.
Storage Devices Secondary storage devices include:
- Floppy disk drive
- Hard disk drive
- Magnetic tape
- Optical disk drive
- Drives may be internal or external.
- Digital data can be stored permanently on any of these media.
- Optical storage allows for extremely large quantities of data to be stored on one CD. This medium is very useful for storing image and sound data and has the longest life span of secondary storage media.
The evolution of healthcare systems:
- 1960s to 1970s - More of a financial focus. Had few clinical systems, systems developed in-house/by the hospital, shared systems, turnkey systems, transaction processing.
- 1980s - Financial focus continues, Clinical development had increased, Standalone systems, Disturbed systems, Management information systems.
- 1990s - Clinical system focus, System integration, Executive information systems, Decision support systems, Enterprise wide systems, Office automation, Virtual systems.
- 2000s - Standards, E-health, Internet, Intranets, Extranets, Clinical repositories, Data warehousing, Data mining