1

E l e c t r o n i c H e a l t h

H a t e m M a g d y, P h D

Doctor of Computer Science

U n i v e r s i t y o f S c i e n c e a n d Te c h n o l o g y B e i j i n g
R e s e a r c h e r a t N A R SS
 2

TABLE OF CONTENT

1
Electronic Medical Record
4
Health Information Exchange

2Electronic Health Record

5 Do Doctors Like Health
Information Systems ?

3eHealth Reference Model

6 Case Studies and Project
 3

Patient Centric Architecture

 4

Patient
Participation
in eHealth
Purpose of a Patient (Medical) 5

Record

• To recall observations, to inform others, to

instruct students, to gain knowledge, to
monitor performance, and to justify
interventions

• Serves as the legal business record

 6

Patient Record Purposes :

1. Patient care
Provide the documented basis for planning patient
care and treatment.
eHealth
Critical tool for documenting each provider’s Reference
contribution to that care. Model
 7

Patient Record Purposes :

2. Communication
Facilitating communication among providers
across the continuum of care.
eHealth
Patients also have a right to access their records. Reference
Model
 8

Patient Record Purposes :

3. Legal documentation.
The primary evidence for what actually took place
during the care.
eHealth
4. Billing and refund. Reference
Patient records provide the documentation patients Model
and payers use to verify billed services.
 9

Patient Record Purposes :

5. Research and quality management.

Patient records are used in many facilities for
research purposes.
eHealth
Monitoring the quality of care provided. Reference
Model
 10

Patient Record Purposes :

6. Population health.
Monitor population health,
Assess health status,
Measure utilization of services, eHealth
Track quality outcomes. Reference
Focuses on prevention as a means of achieving Model
cost-effective care.
 11

Patient Record Purposes :

7. Public health.
Government and health agencies use information
from patient records to ensure that they protect
citizens from unhealthy conditions. eHealth
Reference
Model
 12

Electronic medical records (EMRs):

Digital version of the paper charts.
Track data over time.
Easily identify preventive screenings or checkups. Electronic
Monitor and improve overall quality of care Medical
within the practice. Record
(EMR)
 Electronic Medical Record (EMR)
13

• Electronic record of health-related information

on an individual
• Within one health care organization
EMR Purpose
14

• Provide an electronic equivalent of an

individual’s legal medical record
• Intra-organizational
 15

Electronic Health records (EHRs):

EHRs focus on the total health of patient.
They are built to share information with other
health care providers. Electronic
Contain information from all the clinicians involved Health Record
in the patient's care. (EHR)
Electronic Health Record (EHR)
16

• Electronic record of health-related

information on an individual
• Across more than one health care organization
EHR Purpose
17

• Provide an electronic equivalent of an

individual’s health record for use by
providers and staff across more than one
health care organization
• Support efficient, high-quality integrated
health care, independent of the place and
time of health care delivery
EHRs Versus Paper Records
18

• EHRs can make a patient’s health

information available when and where it is
needed
• EHRs can bring a patient’s total health
information together in one place, and
always be current
• EHRs can support better follow-up
information for patients
• EHRs can improve patient and provider
convenience
EHRs Versus Paper Records
19

• EHRs
• Can link information with patient computers to
point to additional resources
• Don’t just “contain” or transmit information,
they also compute with it
• Can improve safety
EHRs Versus Paper Records
20

• EHRs can
• Deliver more information in more directions
• While reducing “paperwork” time for providers
• Improve privacy and security
• Reduce costs
HL7 EHR Functions
21

The HL7 EHR-S Functional Model defines a

standardized model of the functions that
may be present in EHR Systems
• Direct care functions
• Supportive functions
• Information infrastructure functions

Health Management Information Systems

Electronic Health Records Lecture 21
3-a
Direct Care Functions 22

Table 3.2
HL7 2007 EHR-S Functional Model Direct Care Functions Subsets with Examples

Subset Examples
Care management Identify and maintain a patient record
Manage patient demographics
Manage problem lists
Clinical decision support Support for standard care plans, guidelines,
protocols
Support for medication and immunization
administration
Orders, referrals, results and care management

Operations Management and Clinical workflow tasking

Communication Support clinical communication
Support for provider-pharmacy communication

Health Management Information Systems

Electronic Health Records Lecture 22
3-a
EHR Progress Notes 23

eHealth
Reference
Model

Source: Medical University of South Carolina; Epic.

11
EHR Lab Report 24

eHealth
EHR
Reference
Model

Source: Medical University of South Carolina; Epic.

Data Analysis 25

Four basic elements of data analysis :

Source of data
– EHR, claims data, laboratory data, etc.

Stored in a retrievable manner eHealth

– Database or data warehouse
Reference
Analytical tool applied Model
– Mathematical statistics, probability models, predictive
models, etc.

Reported in a usable manner

 26

eHealth Reference Model

Governmental Efforts Related to 27

EHRs

Egypt Health Insurance system

 28

Electronic
Health
Reference
Model
 29

Electronic
Health
Reference
Model
 30

Electronic
Health
Reference
Model
 ‫‪Governance‬‬
‫‪31‬‬

‫رئاسة‬ ‫رئاسة‬
‫الجمهورية‬ ‫الوزراء‬
‫وزارة الصحة‬ ‫‪Electronic‬‬
‫والسكان‬ ‫‪Health‬‬
‫المجلس األعلى‬ ‫‪Reference‬‬
‫للتأمين الصحي‬ ‫‪Model‬‬
‫الشامل‬
‫هيئة االعتماد‬ ‫هيئة التأمين‬
‫هيئة الرعاية الصحية‬
‫والرقابة‬ ‫الصحي‬
 32

Electronic
Health
Reference
Model
 33

Rules and Regulations

Electronic
Health
Reference
Model
 34

Electronic
Health
Reference
Model
 35

Electronic
Health
Reference
Model
 36

Electronic
Health
Reference
Model
 37

Electronic
Health
Reference
Model
 38

Health Information Exchange

 39

EHR
 40

EHR
 41

EHR
Definition of Clinical Decision 42

Support (CDS)
• Computer applications that
• Match patient-specific information to a clinical
knowledge base
• Communicate patient-specific
assessments/recommendations at suitable
times
• Assist with the clinical decision making process
Clinical Decision Support Model
43

Boone, 2006
Image courtesy of Keith Boone
Clinical Decision Support System 44

Requirements

• Knowledge base
• Program for combining the knowledge
with patient-specific information
• Communication mechanism

44
Knowledge Base
45

• Automated representation of clinical

knowledge
• Clinical knowledge
• Facts, best practice, guideline, logical rule, reference
information, etc.
• Compiled clinical information on diagnoses,
drug interactions, and evidence-based
guidelines
Inference Engine
46

• Combines knowledge with patient-specific

information
• Combines input and other data according to
some logical scheme for output
• Examples of schemes
• Bayesian network
• Rules-based
Communication Mechanism
47

• Method for
• Entering patient data
• Import from the EMR
• Output to the user of the system so
a decision can be made
• Possible diagnoses, drug-allergy alerts, duplicate
testing reminder, drug interaction alerts, drug
formulary guidelines, or preventive care reminder
Examples of CDS Interventions by 48

Target Area of Care

Target area of care Example
Preventive care Immunization, screening, disease management
guidelines for secondary prevention
Diagnosis Suggestions for possible diagnoses that match a
patient’s signs and symptoms

Planning or implementing treatment Treatment guidelines for specific diagnoses, drug

dosage recommendations, alerts for drug-drug
interactions

Followup management Corollary orders, reminders for drug adverse event

monitoring

Hospital, provider efficiency Care plans to minimize length of stay, order sets

Cost reductions and improved patient Duplicate testing alerts, drug formulary guidelines
convenience

Table 5.1 Target Area of Care (Berner, 2009)

CDS Intervention Types/Examples
49

Intervention Types Examples

Documentation forms/templates Patient history, visit note

Relevant data presentation Flowsheets, surveillance

Order/prescription creation Order sentences, sets

facilitators
Protocol/pathway support Pathways

Reference information and guidance Infobuttons, Web

Alerts and reminders Proactive warnings

Table 5.2 Intervention Types (Osheroff, 2009)

49
Documentation Forms/ 50

Templates Intervention Subtypes

Subtypes Example
Patient self-assessment forms Pre-visit questionnaire, for example, that
outlines health problems and current
medications

Clinician patient assessment forms Inpatient admission assessment

Clinician encounter documentation forms Structured history and physical examination
template
Departmental/multidisciplinary clinical Emergency Department (ED) documentation
documentation forms
Data flowsheets (usually a mixture of data Health maintenance/disease management
entry form and relevant data presentation, see form
next entry)

Table 5.3 Documentation Forms/Templates Intervention Subtypes

(Osheroff et al., 2005)

50
Relevant Data Presentation 51

Intervention Subtypes
Subtypes Example

Relevant data for ordering, Longitudinal display of key patient

administration, or documentation information to highlight trends and issues
requiring attention
Retrospective/aggregate reporting or Adverse drug event (ADE) tracking
filtering
Environmental parameter reporting Recent hospital antibiotic sensitivities
Choice lists Suggested dose choice lists, possibly
modified as needed for patient’s kidney
or liver function and age
Practice status display ED tracking display
Table 5.4 Relevant Data Presentation Intervention Subtypes

(Osheroff et al., 2005)

51
Order/Prescription Creation 52

Intervention Subtypes
Subtypes Example
Single-order completers including Suggested drug and/or dose choice lists
consequent orders integrated into ordering function—possibly
modified by patient’s kidney or liver function
and age

Order sets General order sets (for example, for hospital

admission or problem-oriented ambulatory
visit)
Tools for complex ordering Guided dose algorithms based on weight, body
surface area (BSA), kidney function, etc.

Table 5.5 Order/Prescription Creation Intervention Subtypes

(Osheroff et al., 2005)

52
Protocol/Pathway Support 53

Intervention Subtypes
Subtypes Example
Stepwise processing of multi-step Tools for monitoring and supporting
protocol or guideline inpatient clinical pathways (for example,
for pneumonia admissions) and
multiday/multi-cycle chemotherapy
protocols in the inpatient or outpatient
setting

Support for managing clinical problems Computer-assisted management

over long periods and many encounters algorithm for treating hyperlipidemia over
many outpatient visits

Table 5.6 Protocol/Pathway Support Intervention Subtypes

(Osheroff et al., 2005)

53
Reference Information and 54

Guidance Intervention Subtypes

Subtypes Example
Context-insensitive General link from EMR or clinical portal to
a reference program (at table of contents
or general-search level)
Context-sensitive Link within patient-messaging application
to relevant patient drug information
leaflets

Table 5.7 Reference Information and Guidance Intervention Subtypes

(Osheroff et al., 2005)

54
Alerts and Reminders Intervention 55

Subtypes
Subtypes Example
Alerts to prevent potential Drug interaction alert, for example,
omission/commission errors or with drugs, pregnancy, laboratory,
hazards food
Alerts to foster best care Disease management, for example,
alert for needed therapeutic
intervention based on
guidelines/evidence and patient-
specific factors

Table 5.8 Alerts and Reminders Intervention Subtypes

(Osheroff et al., 2005)

55
Drug-Allergy Alert
56

(HIMSS, n.d.)
Image courtesy of HIMSS

56
 57

Administrative, Billing, and

Financial Systems

The applications that need to be integrated in health care

information systems
Whole System Components
58

(Agosta, 2010)
Image courtesy of Dr. Agosta

58
 59

Do Doctors Like the Healthcare

Information Systems?
Self – Study part
Reading Part
 60

EHR
 61

EHR
 62

Patient Monitoring System

Patient Monitoring Systems
63

• Patient monitoring:
“Repeated or continuous measurement of
physiological parameters for the purpose of
guiding therapeutic management.”

(Gardner & Shabot, 2006, p. 969)

63
Primary Applications
64

• Intensive/critical care units, operating

suites, recovery rooms
• Other locations within the hospital
• Remote locations

64
Primary Applications
65

• Application
• Intensive/Critical Care Units, Operating
Suites/Recovery Rooms
• Example: Bedside monitor
• Outcome
• Strengthen the caregivers’ clinical expertise
• Reduce mortality risk

65
Primary Applications
66

• Application
• Other hospital locations
• Example: respiratory therapy
• Outcome
• Facilitate early diagnosis and timely decisions

66
Primary Applications
67

• Application
• Remote
• Outcome
• Better tracking
• Patient conditions
• Medication regimen adherence
• Follow-up scheduling
• Improves compliance

67
 Primary Applications
68

CC BY-NC 2.0 by Tim Gee

Health Management Information Systems

Patient Monitoring Systems 68
Lecture 6-a
 Qo 69

S
 QoS : Quality of Service
 The wide variety of e- services impose
Health Quality of Service (QoS) requirements
different
on underlying networks.
QoS 70
 QoS Requirements for e-Health Services
71

 e-Health Service Classification

 Multimedia Conferencing
a) Still and Streaming Medical
Images
b) Transmission of Patient Vital Signs
c) Tele-Robotic System
d) Research and Education
 72

Case Studies and Project

e-Health Classification
73
 Mapping of e-Health 74

services
•Mapping in e-Health is
a particular service
may comprise
multiple media
types and traffic
flows that may
need to be mapped
to different areas
where the service
is required.
 Tele- 75

Consultation
 Tele-Consult or e-consult or Tele-Medicine
 It involves real-time video conferencing and streaming ofECG
signals between a patient and a doctor. The service enables a
patient or doctor to initiate an e-consult session using an
appropriate research prototype client service media
application.
Tele-medicine
76
77
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 79

Use of tele-consultation &

e-consultation in Diabetes
and Endocrine related
Diseases
 e-Health Related 80

services
• Index of available programs and services.
• Calendar of events.
• Patient satisfaction surveys.
• Service provider directories.
• Patient e-mail services.
• Health news.
 m- 81

Health
• m-Health includes the use of
mobile devices in collecting
aggregate and patient
health data. level
• Providing healthcare information
to practitioners, researchers, and
the patients.
• It ensures a great support to the
e-Health programs.
 Disease management 82

scopes
 Health risks assessment
 Patient support groups
 Online discussion forums
 Moderated chat with guest experts
 comprehensive patient education
“Ask an expert” triage for patients seeking
medical advice
 Electronic newsletter subscription
 Benefits of e- 83

Health
 Improve communication among healthcare
stakeholders.
 Facilitate better decision support.
 Reduce medical errors.
 Enhance reporting capabilities.
 Encourage disease prevention and
wellness.
 e-Health 84

challenges
 6 main areas of e-Health challenges are...

o Information (Inaccurate and Incomplete)

o Human resources (Inadequate or
Brain- drained)
o Infrastructure
o Quality and security of data.
o Financial and legal issues.
o Authenticity
 85

An Overview of
Database Management System
DBMS
 What is a 86

DBMS?
2

 A large, integrated collection of data

 Models a real-world enterprise

 Entities (e.g., Students, Courses)
 Relationships (e.g., Alice is enrolled in 145)

A Database Management System

(DBMS) is a piece of software designed
to store and manage databases
Simplified database system 87

environment
Basic 88

Definitions
 “Data” – are raw facts
-It must be formatted for storage, processing, and
presentation.
 “Database” –collection of logically interrelated
data
 “Database Management”-the creation &
maintenance of a collection of organized data.
 “Database Management System (DBMS) ” - It is
a software package designed to define, manipulate,
retrieve and manage data in a database.
Example of a 89

Database
 Mini-world for the example:
 Part of a UNIVERSITY environment.
 Some mini-world entities:
 STUDENTs
 COURSEs
 SECTIONs (of COURSEs)
 (academic) DEPARTMENTs
 INSTRUCTORs
Example of a simple database 90
Example of a Database 91

(cont’d.)
 Some mini-world relationships:
 SECTIONs are of specific COURSEs
 STUDENTs take SECTIONs
 COURSEs have prerequisite COURSEs
 INSTRUCTORs teach SECTIONs
 COURSEs are offered by DEPARTMENTs
 STUDENTs major in DEPARTMENTs

 Note: The above entities and relationships are typically

expressed in a conceptual data model, such as the
ENTITY-RELATIONSHIP data model
Example of a simplified database catalog 92
 Need for 93

DBMS
 Provide a highly efficient method for handling
large amount of different types of data with ease.
 Database allows data to be stored
systematically.
 Data can be easily retrieved, filtered, sorted and
updated efficiently and accurately.
Types of Databases
94

1. Centralized Database:
Based on Database location(s) 95

2. Distributed Database:
Components of 96

DBMS

1. Database Users
2. Data
3. Software and Procedures
4. Hardware
5. Database Access Language
97
1. Database Users 98

 End-users: They use the data for queries,

reports and some of them update the database
content.
Database Users 99

(cont’d.)
 Database administrators:
Responsible for authorizing access to the database, for
coordinating and monitoring its use, acquiring software
and hardware resources, controlling its use and
monitoring efficiency of operations.

 Application programmers(Software
Engineers):
Responsible for writing database
application programs
in some programming language.
2. Data 100

 The collection of facts stored in the

database
 data is stored, updated and retrieved
to from a database.
 Database contains both operational data
and metadata.
3. Software 101

 Operating System software

 DBMS software
 Network Software
 Application Programs and utility software
 Procedures: instructions and rules that govern the
design and use of the database system.
4. Hardware 102

 PC
 Network of computers
 Various Storage devices
 Input devices
 Output Devices
5. Database Languages 103

• Data Definition Language (DDL)

Create, Alter, Drop
• Data Manipulation Language (DML)
Insert, Select, Update, Delete
• Data Control Language (DCL)
Grant, Revoke
• Transaction Control Language (TCL)
Commit, Rollback.
Application of 104

DBMS
 Banking  Credit and
Transactions

 Airline
 Health

 Universities
Human resourc e
Application of DBMS 105

(cont’d.)
 Traditional Applications:
 Numeric and Textual Databases

 More Recent Applications:

 Multimedia Databases
 Geographic Information Systems (GIS)
 Data Warehouses
 Real-time and Active Databases
 E-health
 Many other applications
Advantages of Using the Database 106

Approach
 Controlling redundancy in data storage and in
development and maintenance efforts.
 Sharing of data among multiple users.
 Restricting unauthorized access to data.
 Providing Storage Structures (e.g. indexes) for
efficient Query Processing.
 Providing backup and recovery services.
 Providing multiple interfaces to different classes of
users.
 Representing complex relationships among data.
 Enforcing integrity constraints on the database.
 When not to use a 107

DBMS
 If the database and applications are simple, well
• defined, and not expected to change.
 High initial investment and possible need for

additional hardware.
 Overhead for providing generality, security,

concurrency control, recovery, and integrity functions.

 If access to data by multiple users is not required.
 108

Project
Hospital Management System
(Database Design)
Data Types 109
DB Tables 110
DB Tables 111
DB Tables 112
DB Tables 113