Key Advances in Clinical Informatics: Transforming Health Care Through Health Information Technology

Front Cover......Page 1
Key Advances in Clinical Informatics......Page 4
Copyright Page......Page 5
Contents......Page 6
List of Contributors......Page 16
About the Editors......Page 18
Foreword......Page 20
I. An Introduction to Clinical Informatics......Page 22
  Introduction: The Evolving and Expanding Role of Information Technology......Page 24
  What Is Clinical Informatics?......Page 25
  Empirical Evidence Surrounding Effectiveness of Clinical Informatics Applications......Page 27
  Clinical Informatics in Context......Page 28
  Visions Surrounding Future Developments in Clinical Informatics......Page 29
  References......Page 30
  Recommended Further Reading......Page 32
  Introduction......Page 34
  How Is HIT Used in Inpatient Settings?......Page 35
  The Social and Organizational Environments Into Which HIT Is Deployed......Page 38
  Implementation and Adoption Challenges......Page 40
  Continuing System Development and Optimization......Page 41
  International Strategies and Implementation Progress......Page 42
  Looking Ahead—Future Trends and Developments......Page 44
  References......Page 46
  Recommended Further Reading......Page 50
  Introduction......Page 52
  A Brief History of Outpatient Clinical Information Systems......Page 53
  Common Outpatient EHR Components......Page 54
   Problem Lists......Page 59
   Allergy Lists......Page 61
   Results Review......Page 62
   Patient Portals and Personal Health Records......Page 63
   Costs......Page 64
   Costs......Page 65
   Longitudinal Care......Page 66
  Looking Ahead—Future Trends and Developments......Page 67
  References......Page 68
  Recommended Further Reading......Page 71
 4 Electronic Clinical Documentation......Page 72
  What is ECD?......Page 73
  Goals for Redesigned Clinical Notes—Particularly to Support Diagnosis......Page 74
   Accurately Record Key Information From the Encounter......Page 76
   Meaningfully Portray Patient’s Unique Story and Clinician’s Thinking......Page 77
   Support Diagnostic Decision Making......Page 78
   Help Ensure Problems Do Not Got Lost or Overlooked......Page 80
   Succinct, Organized, Usable by Others......Page 81
   Ensure That Note Is Error/Defect-Free......Page 82
   Copy/Paste......Page 83
   Easing Entry: Scribes (Team Documentation) and Speech Recognition......Page 84
   Problem-Based Charting......Page 85
   Open Notes......Page 86
  References......Page 87
  The Interoperability Imperative......Page 90
  An Interoperability Framework......Page 91
  Technical Considerations......Page 93
  SMART and FHIR......Page 95
   Continual Evolution......Page 96
  References......Page 97
  Further Reading......Page 98
  What Is Privacy and Security?......Page 100
  A Framework for Reducing Security Risks in Healthcare Organizations?......Page 101
   Identity Management......Page 102
   User Awareness Training......Page 103
   Data Ownership, Classification, and Data Protection......Page 104
   Endpoint Security......Page 105
  References......Page 106
  Recommended Further Reading......Page 107
II. Improving the Quality, Safety and Efficiency of Care......Page 108
  Introduction: Types of Policies......Page 110
    Australia......Page 111
    United States and Meaningful Use......Page 112
  Specific Domains......Page 114
  Regulation of Healthcare Information Technology......Page 115
  Alignment With Broader Payment Policy......Page 116
  References......Page 117
  Recommended Further Reading......Page 119
  Introduction......Page 120
     Alerts and Reminders......Page 121
     Medications......Page 122
     Test Notification......Page 123
    Health Information Exchange......Page 124
     Laboratory......Page 125
  Barriers and Facilitators to Achieving HIT Value......Page 126
    User Satisfaction......Page 127
    Usability and Workflow Support......Page 128
  Global Perspectives on HIT Value......Page 129
   Asia......Page 130
  References......Page 131
  Introduction......Page 136
  The Golden Circle of Health Informatics Behavior......Page 137
   How Can People Succeed?......Page 138
   Basic Organizational Ingredients for Success (Circle 2a)......Page 139
   Using the Basic Ingredients to Develop Successful Strategies......Page 141
   A Three-Phase Change Management Process to Support “The How”......Page 143
   What Is It That We Are Trying to Accomplish?......Page 146
  Looking Ahead—Future Trends and Developments......Page 147
  References......Page 148
  Recommended Further Reading......Page 151
   Rate and Types of Medication Errors......Page 152
   The Use of HIT to Overcome Key Medication-Related Challenges......Page 153
   Natural Language Processing......Page 154
   Preanalytical Errors......Page 155
   The Use of HIT to Overcome Key Laboratory Challenges......Page 156
  Renal Patient View......Page 157
   Rate and Types of Radiological Errors......Page 158
   Alert Notification of Critical Results......Page 159
  References......Page 161
  Introduction......Page 166
   Ontological Commitments......Page 167
   Disease Definition in the Era of Precision Medicine......Page 168
   Bioinformatics and Nosology......Page 169
   Useful Dichotomies and Early Discoveries......Page 171
   The Human Genome Project......Page 172
   Accelerating the Discovery of Disease Genetics: GWASs and Next-Generation Sequencing......Page 173
   Responsible Data Sharing......Page 174
   Unique Challenges of Precision Medicine......Page 175
   Citizen Science......Page 176
  References......Page 177
   Scope of This Chapter......Page 182
   A Brief History and Inventory of CDS......Page 184
   CDS as Variations or Aspects of Guidelines......Page 185
   Discrete CDS Capabilities......Page 188
   Guideline Modeling......Page 189
   A Mismatch With the Status Quo......Page 191
    The Current Milieu—a Time of Disruption and Transformation......Page 192
   Implications for CDS......Page 193
   Problems of Multiple Venues......Page 195
  Approaches to Managing the Knowledge......Page 196
  Where We Need to Go......Page 200
  Conclusions......Page 201
  References......Page 202
  Introduction......Page 204
  A Brief History of mHealth......Page 205
  The Marketplace of Health Apps......Page 208
  Evidence Supporting the Use of mHealth Apps......Page 212
  Other Key Issues With mHealth Apps......Page 213
  Looking Ahead—How mHealth Will Power the Future......Page 214
  References......Page 215
  The Need for a Sociotechnical Approach to Electronic Health Record Safety......Page 218
  What Is “EHR-Related Safety”?......Page 220
  Addressing EHR-Related Safety Concerns......Page 223
  Conceptual Approaches Useful for Improving EHR Safety......Page 225
  Recommendations to Improve EHR Safety and System Resilience......Page 226
  National and International Initiatives for EHR-Related Safety......Page 229
  Policy Efforts for Improving EHR-Related Safety......Page 230
  References......Page 234
  What Is Predictive Analytics and Why It Is Important......Page 238
  Historical Approaches to Prediction in Healthcare......Page 239
  Statistical and Analytical Methods......Page 240
  Current Challenges and a Need to Do Better......Page 241
  New Opportunities and Big Data......Page 242
  New Tools for Predictive Analytics......Page 243
  A Foundation for Precision Medicine......Page 244
  Conclusions......Page 245
  Further Reading......Page 246
   Classical Electronic Health Records......Page 248
   Integration Without APIs......Page 249
   SMART Health IT; Substitutable Apps......Page 250
   The SMART API—Technical Specifications......Page 251
   Diffusion of SMART Technology......Page 253
   Scenario 2. Third-Party Decision Support......Page 254
   Modular Extensions to the FHIR Ecosystem......Page 255
  Conclusions......Page 256
  References......Page 257
III. Future Developments......Page 258
  Introduction......Page 260
   Definition......Page 261
   Cloud Service and Deployment Models......Page 264
   Cloud Computing in Healthcare: Examples and Use Cases......Page 265
   High Scalability and Elasticity......Page 266
   Cloud Deployment Models for Healthcare......Page 267
   Security and Privacy......Page 269
   Interoperability and Standardization......Page 270
   Governance, Regulations, and Trust......Page 271
  Future Trends......Page 272
  References......Page 273
  The Importance of Patient Engagement in Care Delivery and Health Management......Page 278
  Health Information Technologies That Enable and Optimize Patient Engagement......Page 280
  Patient Portals/Personal Health Records......Page 282
  Telehealth......Page 283
  Real-Time Patient Experience Feedback......Page 284
  Social Media Usage for Disease Detection and Patient Engagement......Page 285
  Smartphones, Wearables, Apps, and Self-Monitoring......Page 288
  Future Opportunities......Page 291
  Conclusions......Page 292
  References......Page 293
  Introduction......Page 300
  From Scoring Systems to Statistical Models......Page 303
  Challenges in Building and Deploying EHR-Based Models......Page 305
  Opportunities for Machine Learning in Healthcare......Page 308
  Conclusions......Page 309
  References......Page 310
  Introduction......Page 314
   Social Media......Page 315
   Mobile Technologies......Page 316
   Big Data......Page 317
   The Cloud......Page 318
   The Internet of Things......Page 319
  References......Page 320
  Further Reading......Page 321
Index......Page 322
Back Cover......Page 335