BHIS 410 FINAL EXAM Study Guide

BHIS 410 FINAL EXAM Study Guide I. Overview of the EHR a. EMR vs. EHR – differences and similarities • EMR – NOT interoperable o EMR (electronic medical record) is often used to describe systems based on document imaging in a hospital or systems implemented in physician offices. NAHIT defines EMR as local to one healthcare organization • EHR – Interoperable o EHR (electronic health record) is a system to achieve the goals of structured and standardized data collection that benefit patients wherever they may be treated. NAHIT adds the dimension of interoperability across more than one healthcare organization.. b. Drivers to EHR c. Meaningful Use as Incentive to EHR development • Meaningful Use (MU)= Federal incentive program; used to drive widespread adoption of EHR technology in the U.S. d. Benefits/Barriers to EHR development e. Systems Theory as it relates to EHR • Explains how information, and ultimately knowledge and wisdom, are generated by data processed in predictable ways to contribute value. Information systems: o Use devices to capture data o Apply instructions to index, store, calculate, compare, and perform other functions on the data o Use devices to display the data and present results of calculations, comparisons, and other functions to users in various formats f. Role of Consumerism, PHR’s, E-health g. Limitations to EHR • While an EHR is a system of systems, the systems are generally limited to those supplied by a single vendor or use customized software to make connections with other systems • EHR systems are not as interoperable as desired with systems external to an organization, largely due to the proprietary nature of vendor software II. Networks a. ISO/OSI model • OSI model = Open Systems Interconnection o Defines the framework for hardware and software protocol for networks o Includes 7 layers, each responsible for an aspect of communication • HL7 = Health Level 7 o Most common healthcare application level standard that helps to ensure data exchange across health info systems o Top level (Application Layer) b. Local Area Networks – star, bus, ring • Star = Each node connects to center hub and then is rerouted o A - can easily add nodes o D - crash at hub bring down network • Bus = single line of nodes, like “party line” o A - speed o D - limit on length • Ring = group of nodes in a circle o A - high speed, large distances o D - difficult to add nodes c. Wide area and wireless networks • Intranet – private internet network within a firewall • Extranet – connection of private internet networks outside the firewall • LAN = Local Area Network o a network providing communication within a small geographic • WAN = Wide Area Networks o Used for geographically larger environments; many LAN in one area • VPN = Virtual Private Network o Private “tunnels” within an unsecure public network d. Internet tools and protocols – TCP/IP, HTML, XML • TCP/IP • HTML – Hypertext Markup Language o Formatting language, uses tags that instruct the browser, but treats whole document as one item • XML – Extensible Markup Language (XML) o Tags can identify text within a document, probable standard for EHR e. Internet technologies and the EHR • Telemedicine - send images, do consultations • Patient pre-registration • Link to expert systems, Medline • Insurance verification • Access info from several patient databases through web browser • Mayo Clinic - links all three sites f. Interoperability – definitions • Interoperability is the ability to exchange data among information systems • Semantic o conveying meaning in a manner that ensures the receiver of data intercepts the data in the same manner as the sender intended • Process o the human factors of usability and workflow, standardized through business or operating rules g. Health Information Exchange organizations – Purpose, current status, initiatives; proposed architecture models • HIE o The electronic movement of health- related information among organizations according to nationally recognized standards • HIE organization o An organization that oversees and governs the exchange of health- related information among organizations according to nationally recognized standards • Purpose o To reduce clearinghouse costs o To share patient data in geographically tight location o To improve exchange of lab results o To exchange data with public health • Proposed architecture models o Consolidated: Multiple independent organizations share data in a central repository, managed centrally (not used much) o Federated: ▪ Consistent databases: Stored separately but managed centrally ▪ Inconsistent databases: Stored separately but shared in a point-to-point manner III. Databases a. File management vs. databases for data collection • File Management Systems – a one table system where all data reside in a single file (spreadsheet); single user of file o Advantages ▪ easy to learn ▪ less expensive software needed ▪ less time to develop application o Disadvantages ▪ redundancy of data ▪ greater chance of data entry error ▪ updating of information becomes time consuming • Database – collection of stored data about multiple entities and their relationships, organized into fields, records, and files o Advantages (of DBMS) ▪ linking of tables makes data query, entry and updating easy ▪ less redundancy, reduce staff and time ▪ less storage space needed and better reports produced ▪ data can be shared between applications ▪ increased data consistency and integrity o Disadvantages (of DBMS) ▪ costly more complex ▪ takes time to learn ▪ more cost and time for development ▪ failure has greater impact on organization b. Characteristics of good DB design • Communication Tools • A plan or pattern for an information system, including database structure and content • Other activities usually performed at same time as data model relate to methods to input, store, retrieve, analyze, and display data c. Types of Databases (hierarchical, network, relational, object oriented) IV. Data Modeling a. Types – conceptual, logical, physical • Conceptual o Enterprise-wide (one) • Logical o View of a specific dept or group o Based on conceptual model, but based on specific group’s needs o May be more than one • Physical o Actual data structures, resides in computer b. Degree and cardinality • Degree – number of relationships among entities • Cardinality – number of instances of an entity that can be associated with each instance of another entity; zero, one or many o One-to-One/OnlyOne – Patient/Bed o One-to-Many– Patient/Order– Patient/Clinic Visit o Many-to-Many– Patient/Physician o One-to-Many-or-None – Patient/Test c. ER diagrams • Used at both conceptual and logical level • Shows main data objects and relationships • Entity - Person, Place, Thing, Concept o Entity Type = Table o Entity Instance = Record • Attribute - Fact that describes an entity o Field or column within a table • Relationship - association between one or more entities d. Normalization • A process of insuring well-structured tables, reducing data redundancy • 1st normal form – remove all repeating groups o each row is identified by a unique data item (primary key) • 2nd normal form – remove all partial dependencies o Create relationships between the new tables and their predecessors through the use of foreign keys (a unique identifier which is a primary key in another table) • 3rd normal form – remove transitive dependencies o remove fields that are not dependent on (or do not provide a fact about) the primary key V. Data Dictionaries a. Content of data dictionary • User owners/authorities • Security codes/access restrictions • Keys identification • Relationships among entities or classes • Database location • Programs, screens, and reports where field is used b. Process for building Data dictionary • Inventory existing systems and identify new data content • Develop consensus: Meet with users • Define scope of project • research, document, and review • validation by stakeholders, governing body VI. Data Repositories, Warehouses a. Definitions and functions of: Repository, warehouse, mart • Repository o which collects and organizes data to provide an integrated, multidisciplinary view for transactions o data collected from multiple systems and applications • Warehouse o Hierarchical or multi-dimensional database that collects data on which complex analysis is performed • Mart o A form of data warehouse o A well-organized, user-centered, searchable database system, usually drawing data from data warehouse that are specific to a user’s needs b. OLTP vs. OLAP • OLTP = online transaction processing, repositories o Used when speed is important • OLAP = online analytical processing, warehouse o Used when precise analysis is desired c. ROLAP, MOLAP, Star Schema data models • ROLAP = Relational OLAP o Relational DB systems, optimized with star schema modeling o Used for larger, detailed data marts, more flexible but requires more skill of analyst • MOLAP = Multidimensional OLAP o cubed DB systems o best for smaller data marts, used with limited number of attributes VII. Database Administration a. Data administrator vs. database administrator role • Data administrator