Key Advances in Clinical Informatics: Transforming Health Care Through Health Information Technology PDF
Preview Key Advances in Clinical Informatics: Transforming Health Care Through Health Information Technology
Key Advances in Clinical Informatics This pageintentionallyleftblank Key Advances in Clinical Informatics Transforming Health Care through Health Information Technology Edited by Aziz Sheikh University of Edinburgh,Edinburgh, United Kingdom; Brigham and Women’s Hospital/Harvard Medical School, Boston, MA,United States Kathrin M. Cresswell University of Edinburgh,Edinburgh, United Kingdom Adam Wright Brigham and Women’s Hospital/Harvard MedicalSchool,Boston, MA,United States David W. Bates Brigham and Women’s Hospital/Harvard MedicalSchool,Boston, MA,United States Foreword by Sir John Savill AcademicPressisanimprintofElsevier 125LondonWall,LondonEC2Y5AS,UnitedKingdom 525BStreet,Suite1800,SanDiego,CA92101-4495,UnitedStates 50HampshireStreet,5thFloor,Cambridge,MA02139,UnitedStates TheBoulevard,LangfordLane,Kidlington,OxfordOX51GB,UnitedKingdom Copyrightr2017ElsevierInc.Allrightsreserved. Nopartofthispublicationmaybereproducedortransmittedinanyformorbyanymeans,electronic ormechanical,includingphotocopying,recording,oranyinformationstorageandretrievalsystem, withoutpermissioninwritingfromthepublisher.Detailsonhowtoseekpermission,further informationaboutthePublisher’spermissionspoliciesandourarrangementswithorganizations suchastheCopyrightClearanceCenterandtheCopyrightLicensingAgency,canbefoundatour website:www.elsevier.com/permissions. Thisbookandtheindividualcontributionscontainedinitareprotectedundercopyrightbythe Publisher(otherthanasmaybenotedherein). Notices Knowledgeandbestpracticeinthisfieldareconstantlychanging.Asnewresearchandexperience broadenourunderstanding,changesinresearchmethods,professionalpractices,ormedicaltreatment maybecomenecessary. Practitionersandresearchersmustalwaysrelyontheirownexperienceandknowledgeinevaluating andusinganyinformation,methods,compounds,orexperimentsdescribedherein.Inusingsuch informationormethodstheyshouldbemindfuloftheirownsafetyandthesafetyofothers,including partiesforwhomtheyhaveaprofessionalresponsibility. Tothefullestextentofthelaw,neitherthePublishernortheauthors,contributors,oreditors,assume anyliabilityforanyinjuryand/ordamagetopersonsorpropertyasamatterofproductsliability, negligenceorotherwise,orfromanyuseoroperationofanymethods,products,instructions,orideas containedinthematerialherein. BritishLibraryCataloguing-in-PublicationData AcataloguerecordforthisbookisavailablefromtheBritishLibrary LibraryofCongressCataloging-in-PublicationData AcatalogrecordforthisbookisavailablefromtheLibraryofCongress ISBN:978-0-12-809523-2 ForInformationonallAcademicPresspublications visitourwebsiteathttps://www.elsevier.com/books-and-journals Publisher:MicaHaley AcquisitionEditor:RafaelTeixeira EditorialProjectManager:MarianaKuhl ProductionProjectManager:JuliaHaynes CoverDesigner:MarkRogers TypesetbyMPSLimited,Chennai,India Contents ListofContributors xv AbouttheEditors xvii Foreword xix Part I An Introduction to Clinical Informatics 1. An Overview of Clinical Informatics KathrinM.Cresswell,DavidW.Bates,AdamWrightandAzizSheikh Introduction:TheEvolvingandExpandingRoleofInformation Technology 3 ABriefHistoryoftheFieldofClinicalInformatics 4 WhatIsClinicalInformatics? 4 EmpiricalEvidenceSurroundingEffectivenessofClinical InformaticsApplications 6 ClinicalInformaticsinContext 7 VisionsSurroundingFutureDevelopmentsinClinicalInformatics 8 Conclusions 9 References 9 RecommendedFurtherReading 11 2. Inpatient Clinical Information Systems KathrinM.CresswellandAzizSheikh Introduction 13 ABriefHistoryofInpatientInformationSystems 14 HowIsHITUsedinInpatientSettings? 14 TheSocialandOrganizationalEnvironmentsIntoWhich HITIsDeployed 17 ImplementationandAdoptionChallenges 19 ContinuingSystemDevelopmentandOptimization 20 InternationalStrategiesandImplementationProgress 21 LookingAhead—FutureTrendsandDevelopments 23 Conclusions 25 References 25 RecommendedFurtherReading 29 v vi Contents 3. Outpatient Clinical Information Systems AdamWrightandDavidW.Bates Introduction 31 ABriefHistoryofOutpatientClinicalInformationSystems 32 CommonOutpatientEHRComponents 33 MedicationListsandElectronicPrescribing 38 ProblemLists 38 AllergyLists 40 ResultsReview 41 ClinicalDocumentation 42 ClinicalDecisionSupport 42 PatientPortalsandPersonalHealthRecords 42 IntegrationwithExternalSystems 43 BenefitsofOutpatientEHRs 43 Quality 43 Costs 43 AccesstoInformationforPhysiciansandPatients 44 ImplementationandAdoptionChallenges 44 Costs 44 AvailabilityofInternalTechnicalResourcesforSystem Implementation 45 IntegrationandInterfaces 45 SpecialtyWorkflows 45 LongitudinalCare 45 ChallengesinResource-ConstrainedEnvironments 46 LookingAhead—FutureTrendsandDevelopments 46 Conclusions 47 References 47 RecommendedFurtherReading 50 4. Electronic Clinical Documentation GordonD.SchiffandMaryJ.Tharayil WhatisECD? 52 ChiefComplaints:CurrentProblemsWithECD 53 GoalsforRedesignedClinicalNotes—ParticularlytoSupport Diagnosis 53 EightGoalsforECD 55 AccuratelyRecordKeyInformationFromtheEncounter 55 ProduceNotesQuicklyandEfficiently 56 MeaningfullyPortrayPatient’sUniqueStoryandClinician’sThinking 56 SupportDiagnosticDecisionMaking 57 HelpEnsureProblemsDoNotGotLostorOverlooked 59 Succinct,Organized,UsablebyOthers 60 TooltoFacilitateCoordinationAcrossVisits,Team 61 EnsureThatNoteIsError/Defect-Free 61 Contents vii KeyEmergingIssuesinECD 62 Copy/Paste 62 EasingEntry:Scribes(TeamDocumentation)andSpeechRecognition 63 Problem-BasedCharting 64 OpenNotes 65 Conclusions—VisionforFuture 66 References 66 5. Interoperability MarkE.Frisse AnOperationalDefinitionforInteroperability 69 TheInteroperabilityImperative 69 WaystoExchangeInformation 70 AnInteroperabilityFramework 70 TechnicalConsiderations 72 NewerStandardsandApproaches 74 SMARTandFHIR 74 Omics 75 ContinualEvolution 75 Conclusions 76 References 76 FurtherReading 77 6. Privacy and Security JohnD.Halamka Introduction 79 WhatIsPrivacyandSecurity? 79 WhatAretheThreats? 80 AFrameworkforReducingSecurityRisksinHealthcare Organizations? 80 RiskManagement 81 IdentityManagement 81 LoggingandMonitoring 82 InformationSecurityProgramGovernance,Policies,andProcedures 82 UserAwarenessTraining 82 ManagedSecurityServicesProgram 83 WebApplicationSecurityandSoftwareDevelopmentLifecycle 83 DataOwnership,Classification,andDataProtection 83 ConfigurationManagement 84 AssetManagement 84 Third-PartyRiskManagement 84 EndpointSecurity 84 EnterpriseResilience 85 PhysicalSecurity 85 viii Contents Conclusions 85 References 85 RecommendedFurtherReading 86 Part II Improving the Quality, Safety and Efficiency of Care 7. Public Policy and Health Informatics DavidW.BatesandAzizSheikh Introduction:TypesofPolicies 89 SpecificExamplesofNationalHITPolicyInitiatives 90 SpecificDomains 93 RegulationofHealthcareInformationTechnology 94 AlignmentWithBroaderPaymentPolicy 95 PerverseConsequences 96 Conclusions 96 References 96 RecommendedFurtherReading 98 8. Health Information Technology and Value BlackfordMiddletonandNgaiT.Cheung Introduction 99 BenefitsofHIT 100 ClinicalValue 100 FinancialValue 104 CostsofHIT 105 BarriersandFacilitatorstoAchievingHITValue 105 KeyBarriersandFacilitators 106 GlobalPerspectivesonHITValue 108 NorthAmerica 109 Europe 109 Asia 109 FutureDirections:EnhancingtheValueofEHR 110 Conclusions 110 References 110 9. Organizational and Behavioral Issues JoanS.AshandNancyM.Lorenzi Introduction 115 TheGoldenCircleofHealthInformaticsBehavior 116 WhyArePeopleMotivated? 117 HowCanPeopleSucceed? 117 Contents ix BasicOrganizationalIngredientsforSuccess(Circle2a) 118 TheContingencyTheoryApproach—TailoringtotheSituation 120 UsingtheBasicIngredientstoDevelopSuccessfulStrategies 120 AThree-PhaseChangeManagementProcesstoSupport“TheHow” 122 WhatIsItThatWeAreTryingtoAccomplish? 125 LookingAhead—FutureTrendsandDevelopments 126 Conclusions 127 References 127 RecommendedFurtherReading 130 10. Medication Management, and Laboratory and Radiology Testing SarahP.SlightandDavidW.Bates Introduction 131 Medications 131 RateandTypesofMedicationErrors 131 TheUseofHITtoOvercomeKeyMedication-RelatedChallenges 132 NaturalLanguageProcessing 133 LaboratoryTesting 134 RateandTypesofLaboratoryErrors 134 PreanalyticalErrors 134 AnalyticalErrors 135 PostanalyticalErrors 135 TheUseofHITtoOvercomeKeyLaboratoryChallenges 135 RenalPatientView 136 RadiologyTesting 137 RateandTypesofRadiologicalErrors 137 HITInterventionstoImprovetheEfficiencyofRadiologyTest Utilization 138 AlertNotificationofCriticalResults 138 Conclusions 140 References 140 11. Bioinformatics and Precision Medicine ArjunK.ManraiandIsaacS.Kohane Introduction 145 Nosology 146 OntologicalCommitments 146 EarlyDaysofDiseaseTaxonomy 147 DiseaseDefinitionintheEraofPrecisionMedicine 147 BioinformaticsandNosology 148 HumanGeneticsLeadingtoPrecisionMedicine 150 UsefulDichotomiesandEarlyDiscoveries 150
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