Records linked together by pointers that use a key piece of data
Relational databases consist of
Several tables
Relational databases r/t Ease of usage
Users need to only know name of table to locate data
Fields vs. Records vs. Tables
F:vertical columns of database, R:horizontal rows of database, T:consists of all records
Tables r/t Records r/t Fields
T:consist of records, R:consist of fields, F:consists of smallest entity necessary to obtain meaning
Label at the head of a column
Field name
Querying
Process of selecting desired records
Algorithim
Set of rules to follow that are inclusive of all cases
Basis r/t Forms and reports
Results of data manipulation
2 Types r/t Data manipulation
Sorting data, Querying data, Both are dependent on structure of data & entries in fields
Sorting
Reordering records
Primary vs. Secondary vs. Tertiary sorting
Primary is broadest and then narroms
Can be used to perform calculations on data in specified fields
Query
Underlying logic r/t Queries
Boolean arithmetic
Reduction of all decisions r/t Boolean logic
Decisions are reduced to true or false
And vs. Or vs. Not r/t Boolean logic
A:narrows search, O:broadens search, N:further define criteria and narrow search
Wildcard symbols
Greater than(>), Less than(<)
Heart of any database
Table
Table consists of
Data organized into fields(vertical) and records(horizontal)
Database consisting of a single table
Flat database
Relational database
2 or more tables related by unique identifiers
Unique identifier synonym
Key field
List of all tables in a database
Data dictionary
Size of database r/t Necessity of a quickly referenced data dictionary
As a database becomes large, imperative to maintain quickly referenced data dictionary
2 Types of Decision Support Systems(DSS) in health care
Administrative & clinical
Agency relationship vs. Maximally effect care vs. Optimally effect care
A:decisions made to ensure welfare of Pt and family, M:max improvement in health regardless of cost, O:improvement in health at point w/the greatest difference b/w benefits and costs of care
5 Themes that shape health care paradigm
Mandates to measure and quantify services, Financial pressures from increased demand for services, Pressure to recruit and retain health care workers, Management of workload, Efforts to reduce variation in practice
Forecasting
Knowledge about past should improve ability to estimate what will happen in future
Decision analysis is making the best possible decision based on
Information available
3 Steps r/t Decisions
Consider feasible alternatives, Identify positive states of nature, Construct payoff table
Maximax criterion vs. Maximin criterion vs. Minimax criterion
Maximax:choose alternative w/"best of best" payoff, Maximin:choose alternative w/"best of worst" payoff, Minimax:assess opportunity costs w/each decision
Criterion of realism vs. Expected value criterion
Realism:weighted average for each alternative w/coefficients of 0 or 1, Expected:weighted average of each alternative
Maximum likelihood criterion vs. Criterion of rationality
Max:decision w/highest probability and alternative w/highest payoff, Rat:all decisions are equally likely
Simplest inventory model
Economic order quantity model, Balances ordering costs vs. costs of maintaining iventory to optimize ordering quantity
Linear programming determines
Best consumption of resources to meet objective
Simulation
Imitation of system to evaluate and improve system performance
Advantages vs. Disadvantages r/t Spreadsheets
A:embedded formula/functions and optimization capabilities, D:people are unfamiliar w/advanced spreadsheet applications
Data manipulation language allows non-programmers to
Perform variety of operations on data
Query language is usage
Directly interact w/database and pose conditions for retrieval
Clinical data repository vs. Data warehouse
C:real-time retrieval and queries, D:works retrospectively
Data marts are sorted by
Specific subject of data to support a specific function
4 Categories of clinical decision support facilitated by the computer
Assist provider in making decisions, Provide alerts, Provide guidance to alter care, Support quality assurance activities
Electronic data interchange allows linked computers to conduct
Business transactions
Geographical information system
System capable of assembling, storing, manipulating and displaying geographically referenced material
Production jobs are used to perform
Data-processing
System development/Project management function
Selection & installation of new computer systems
IT departments r/t Shift to off-site vendors
Systems development/Project management, Network
Application support function
Assist users w/application functionality
Support function vs. Systems administration r/t Function
Support:help desk, Systems:operating systems management & IS security
Primary leadership role r/t IS department
Chief information officer
Division of time r/t Manager
Time spent w/staff vs. Time spent w/system users
Supervisor performs hands-on functions with
Staff members they supervise
Telecommunications operator vs. Telecommunications technician
O:manages switchboard, T:support for equipment
Responsible for creating lasting impression of organization
Telecommunications operator
Systems analyst role
Bridge technology gap b/w specific application and knowledge that applies for the business function of that application
Consultant services are acquired by this method, Contract basis
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Mainframe computers vs. Mid-range computers
Mainframe:run large health care organization's core applications & rely upon proprietary operating systems, Mid-range:run medium-smaller organization's core applications & support specialized software w/large health care organizations
Workstations vs. Portable computers
W:support staff members for local & remote functions, P:document Pt information at point of care
Peripherals r/t Technology infrastructure
Input & output devices
Primary clients r/t IS departments
Internal staff of a health care organization
Variation r/t Characteristics of IS departments
Depend upon type of organization
Community hospital vs. Teaching hospital r/t IS departments
Ensure messages b/w systems are communicated effictively & reliably
Health care systems r/t IS department formation
Formed after merger of serveral independent organizations
IS support r/t Smaller health care settings
Usually outsourced
Clinical decision support system(CDSS)function
Automated decision support system that mimics human decision
Problem-solving/Decision-making conditions
Stress, Cognitive overload, Uncertainty, Increasing levels of scrutiny
Causes development of Knowledge-based systems
Challenges facing clinical decision-making
Knowledge-based system are used to enhanced
Human abilities during health-related conditions
Conditions r/t CDSS acceptance resistance
Narrowness of scope, Mistrust of clinical decisions, Inability to incorporate new discoveries, Nonportability to other systems, Lack of integration w/exitsting systems
Classic view vs. Knowledge-based view r/t Decision-making
C:focus on analysis of alternatives, K:knowledge is generated every time a decision is made
Stuctured vs. Unstructured vs. Semistructured decision-making
Structured:routine decisions are made using established guidelines & static rules, U:highly unique decisions are made in emergent situations in which alternatives are unknown, Semi:some background information is known
Common decision-making process r/t Health care
Semistructured
Knowledge r/t Decision-making
New knowledge is created OR old knowlege is altered/discarded
Descriptive vs. Procedural knowledge
D:description of some kind, P:how-to/step-by-step procedure
Methods r/t Gaining procedural knowledge
Observation, Learning, Experience
Examples r/t Descriptive knowledge
Past, Present, Future, What if's
Reasoning vs. Inferencing
R:assists in drawing a conclusion, I:drawing conclusions from evidence
Reasoning vs. Inferencing r/t Basis
R:product of experience & exposure, I:based on probabilities
2 Formats that assist w/standardizing interface b/w CDSS & other systems
Arden syntax, Guideline interchange format
Arden syntax is a way to share
Medical knowledge in a manner that can be utilized by a computer
Intelligent agents ability
Autonomously accomplish a task
Indication r/t Future size of data warehouses
Human Genome Project
Data mining allows understanding of patterns in
Data
Process r/t Knowledge discover in large data sets
Identify problem, Obtain data set, Preprocess the data, Apply algorithm, Interpret findings
Trending data is collected
Over time
Backbone of most health iformation systems
Admission, discharge and transfer(ADT)
Functions r/t Admission, discharge and transfer
Collect, store & track Pt information from admission to discharge
Interface is exchange of information b/w
Systems
Interface avoids
Redundant data entry
Advantage r/t Best of breed
Increase each system's robustness w/data entered into other systems & reported in all connected systems
Data integration accomplishment
Accomplished by interfacing many information systems together
Clinical data repository is a single database that captures
Information from numerous systems
Allows one person to find, access or enter data at the same time
Automation
End user
Person who uses components of a system
4 Perspectives r/t Health care information systems
Clinical, Enterprise, Technical, Client
3 Paths r/t Input
User enters data, Transfer of data from interfaced systems, Automatic data transfer from other systems
Networks allow data & files to be shared regardless of
Location
Point-of-service vs. Point-of-care
POS:device is located where information is required/collected, POC:data entered at bedside
System architecture ensures
Efficient/effective access to data
Data archive vs. Data purging
A:how long data is kept , P:what should be deleted
Core component r/t eHealth
Electronic health record
Any information r/t individual which resides in an electronic system for the primary purpose of providing health care
Electronic health record
Electronic health records constantly change d/t
New technology
Core idea r/t Electronic health records
Availability on demand anywhere data are needed w/sufficient detail
Problems r/t Paper-based records
Only one person can access at a time, Illegible handwriting, Security/confidentiality breaches, Removed/lost sections
Setup standards and precedence r/t Electronic health records
Institute of Medicine(IOM)
Advantages r/t Electronic health reports
Improved quality of provided health care, More complete, Better organization, Legible information, Discrete storage
Downfall r/t Websites offering personal electronic health records
Privacy
Functions implemented via internet
Remote access, Access to multiple information systems, Direct Pt access
Standardization of terms in naming data elements allows
Consistency, Validity
Every acute care hospital uses
Uniform hospital discharge data sets as a summary of Pt's hospital experience
Classifications vs. Vocabularies vs. Nomenclatures
C:grouping similar items together, V:list of standard terms w/specific definitions, N:systematic listing of the proper names of a particular area of interest
Privacy vs. Confidentiality
P:Pt has right to decide what info they will disclose, C:disclosed info will not be shared w/out permission
Properly designed electronic health record systems r/t Security
Can be more secure than paper systems
Most important element r/t Electronic health record security
Human element
Consumer shift r/t Electronic health record
Individual responsibility for health
3 Dimensions of performance
Access, Integrity, Availability
Access is the ability to obtain
Data and information for specific purposes
Security r/t Access
Measures organizations implement to protect information and systems
Integrity ensures
The completeness and accuracy of data and information, Protection of data and information from processes that would invalidate them
Threats r/t Data integrity
Accidental entry of incorrect data, Unauthorized access
Availability is the ability to
Access data and information appropriate to their authorization level
Basis r/t Ensuring that data is reliably and readily available
Storage capabilities, Media life expectancies
Definition of health record in 2010
Record is maintained by multiple providers and shared when necessary
What we can expect r/t Virtual health records
Improvement of care, Reduction of medical errors, Reduction of administrative costs
Past vs. Present r/t Ownership of health information
Past:hospital-owned material, Present:Pt has right to control use of their private health information
DNA & Human Genome Project r/t Pt privacy
Provides tools to look specifically at generations of a family and predict future health conditions accurately
HIPAA
Health Insurance Portability and Accountability Act of 1996
HIPAA provides
Standards and a regulatory framework, Mandate that HCP must obtain Pt consent before sharing their information
Application of a signature to a document by electronic means
Electronic signature
Health care informatics necessities
Knowledgeable of vulnerabilities, Develop plan for information management and protection, Integrity of data, Efficient availability processes
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