Clinical Decision Support Systems (CDSS)

This weeks assignment is to think of a clinical scenario and suggest a clinical decision support system embedded within CHITS to address this.

clinical decision support system (CDSS) is a health information technology system that is designed to assist physicians and other health professionals with clinical decision-making tasks. while Community Health Information Tracking System (CHITS) is a low cost computerization initiative for local health centers that aims to automate the core processes in the health center and contribute to effective and efficient delivery of services.

A clinical scenario i think of that should be embedded in CHITS is the prevention of medication error.  Medical errors can occur anywhere in the health care system: In hospitals, clinics, surgery centers, doctors’ offices, nursing homes, pharmacies, and patients’ homes. Errors can involve medicines, surgery, diagnosis, equipment, or lab reports. If we embed this in our CHITS, we can minimize errors.

A sample would be if the doctor searching for a patient and notice a drug the patient is taking and is it not familiar with it, it should have the information of the drug the patient is taking. Another embedding Medication error prevention in CHITS is when a physician or nurse search for a particular patient and they will encode a prescribe drug, it should have an alert for any drug interactions, allergies or sound alike or look alike drugs.

Prevention of medication errors: detection and audit

1. Medication errors have important implications for patient safety, and their identification is a main target in improving clinical practice errors, in order to prevent adverse events.
2. Error detection is the first crucial step. Approaches to this are likely to be different in research and routine care, and the most suitable must be chosen according to the setting.
3. The major methods for detecting medication errors and associated adverse drug-related events are chart review, computerized monitoring, administrative databases, and claims data, using direct observation, incident reporting, and patient monitoring. All of these methods have both advantages and limitations.
4. Reporting discloses medication errors, can trigger warnings, and encourages the diffusion of a culture of safe practice. Combining and comparing data from various and encourages the diffusion of a culture of safe practice sources increases the reliability of the system.
5. Error prevention can be planned by means of retroactive and proactive tools, such as audit and Failure Mode, Effect, and Criticality Analysis (FMECA). Audit is also an educational activity, which promotes high-quality care; it should be carried out regularly. In an audit cycle we can compare what is actually done against reference standards and put in place corrective actions to improve the performances of individuals and systems.
6. Patient safety must be the first aim in every setting, in order to build safer systems, learning from errors and reducing the human and fiscal costs.

Sources:

1. http://healthmarketinnovations.org/program/community-health-information-tracking-system-chits
2. https://en.wikipedia.org/wiki/Clinical_decision_support_system#Purpose
3. http://www.biomedcentral.com/content/pdf/1748-5908-6-87.pdf
4. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2723204/

Healthcare Standards and Interoperability

For our standards and interoperability week, we must write a blog post and answer the following questions.

1. Why is Healthcare interoperability critical in delivering better Healthcare?

            Interoperability is defined as the ability of a system to exchange electronic health
information with and use electronic health information from other systems without special effort on the part of the user. This means that all individuals, their families and health care providers should be able to send, receive, find and use electronic health information in a manner that is appropriate, secure, timely and reliable to support the health and wellness of individuals through informed, shared decision-making. Based on the definition, if we apply this in the Philippine Healthcare system we can view a better healthcare; individuals and caregiver in active partnership in their healthcare. Interoperability will support critical public health functions, including real-time case reporting, disease surveillance and disaster response in the barangays. Data aggregation for research can lead to improved clinical guidelines and practices for our hospitals. Healthcare interoperability will benefit all — the patients and the healthcare providers.

2. In your opinion, what are the 3 biggest challenge in achieving healthcare interoperability in the country?

Key milestones in achieving interoperability:

A. A supportive payment and regulatory environment

B. Shared decision-making, rules of engagement and accountability
C. Ubiquitous, secure network infrastructure

D. Verifiable identity and authentication of all participants
E. Consistent representation of authorization to access electronic health information
F. Consistent understanding and technical representation of permission to collect, share and use identifiable health information
G. Industry-wide testing and certification infrastructure
H. Consistent data semantics
I. Consistent data formats
J. Standard, secure services
K. Consistent, secure transport technique(s)
L. Accurate individual data matching
M. Health care directories and resource location

The 3 biggest challenge for me in achieving Healthcare interoperability in the Philippines are:

• 1. Ubiquitous, secure network infrastructure- enabling an interoperable, learning health system requires a stable, trusted, secure, widely available network capability
  that supports technology developer-neutral protocols and a wide variety of core services.

In the Philippines, as of September 30, 2011, more than 30,000,000 people used the internet in the country accounting for 33% of the total population. The Philippines has the slowest internet connectivity speed in the southeast region, and is among the slowest in the world and not all the government office has a network administrator or security. Having a stable and secure internet in our country is a challenge for us.

• 2. Verifiable Identity and Authentication of All Participants – legal requirements and cultural norms dictate that users of systems—whether people or machines—be known so that
  access to data and services is appropriate.

We must require all participants, regardless of role (e.g., individual, provider, researcher), be
identified and authenticated to access. Sharing of access and log in should be posted and what will the access or role of the participant in the healthcare system. Here in the country, it is possible for participants to share access for ease of access, bypass protocols, and high level of trust in the work group.

• 3. An Industry-wide Testing and Certification Infrastructure – a variety of health IT testing tools and resources must be broadly available to stakeholders to support technology from development through deployment. Testing and certification programs must provide health IT users with reasonable assurance that health IT is interoperable.

Industry wide testing and certification would be lackluster for the country. Not everyone knows the benefit of having an interoperable HCS, not all wants a change in their system. Even the structure of our country would be a hindrance in testing and certification due to being an archipelago with multiple islands and minimal testing units.

3. What are the role of each in achieving Healthcare interoperability?

• Government – the government should enforce laws, provide standardization projects, mandate others to ensure privacy and confidentiality, encourage innovation and build IT infrastructures.
• NGO’s- help the government in provided guidelines for standardization, an encourage stakeholders in providing budget for interoperability.
• Private sector- should secure stable and quality internet for all.
• Healthcare provider – secure data, ensure the safety and privacy of the patients information
• Patients – ensure that the data they provide is complete and correct.

4. If you plan out a national/institutional strategy on Healthcare interoperability what specific activities would you focus on in the first month to 1 year?

My focus would be to inform others of the plan of healthcare interoperability, explain the possible outcomes and benefit to encourage the people or stakeholders to participate. Encourage others to participate in standardization to improve health care quality and outcomes. Encourage institution to invest in network security to improve privacy and prevent hacking. I choose this because it will encourage others to trust in healthcare interoperability and encourage participations, informing them with the benefits, having standard of care and safety and security would garner trust for our people.

Usefulness of Personal Health Records (PHR)

Our next assignment is to sign up for a free trial on an online PHR service and rate its usefulness. My chosen online PHR is WebMD Health Manager. I chose this app because upon going to their website, the register button is Right There! Other sites, you need to find the download button or read paragraphs on why you want to have a PHR. Accessibility for this this sites or apps would be my first rating, having a accessible and easy sign up would encourage user to try or explore this application. Another point to consider is that it is web based, meaning you can access it whenever you are granted you have internet connection.

I rate WebMD Health Manager 4 out of 5.

WebMD Health Manager defines PHR as:

A personal health record permits you to securely gather, store, manage and share your own and your family’s health information – when you want, where you want, and with whom you choose. And the WebMD Health Record is more than your personal health history. It’s smart. It works within the WebMD Health Manager to provide you useful information and direct you to tools that you might find helpful.

Why should I create a PHR?

• To easily gather, store and manage lifelong personal health information
• To share relevant information with authorized care providers
• To maximize your health benefits

Our next rating would be Data storage, or the data the patient enters in their PHR upon registration.

Here’s a screenshot of what it looks like inside:

On the left side you can input all relevant data regarding your health, medications, allergies, procedures, lab test to name a few. You can print or download your data after input. This data are useful to use to maintain, or communicate to our health care providers. You can also upload your own health related documents for storage.

I rate this as 4 out of 5.

Another critical point is privacy and confidentiality of our records, for this PHR at the start page, you can read about the privacy policy. Here’s the summary you can find in the landing page.

• Unless specifically authorized by you, or legally required, WebMD will not release any data in which individuals can be personally identified.
• WebMD does analyze data and produce reports for client organizations, but only using data collected from large populations of users. Such aggregate data cannot be used to identify any individuals. Clients use aggregate data to better understand the needs of their organization and design appropriate health improvement programs to meet those needs.
• WebMD helped create the Hi-Ethics Principles as a founding member of the Hi-Ethics Alliance. We are committed to helping consumers improve their health and the health of their families. WebMD has received e-Health accreditation and privacy seal awards from URAC (formerly the American Accreditation HealthCare Commission), TRUSTe, andHON for our high quality standards and privacy practices.

I also rate this 4 out of 5.

The usefulness of using PHR like this is that we can records or store our data in the Internet. Meaning we can access it anywhere when we have an internet connection. The only problem I see here is that Not ALL have internet connection, not all have sufficient hardware, not all patients are given their records, hospitals have their own records and not all are aware that there’s an existing PHR’s and during emergency cases, we are required to know the username and password of the user itself, how can we access their info? Yes it is useful, but it must improve, 4 out of 5.

Sources:

1. Tang PC et al. Personal Health Records: Definitions, Benefits and Strategies for Overcoming Barriers to Adoption. J Am Med Inform Assoc 2006;13:121-126 http://jamia.bmj.com/content/13/2/121.full.pdf+html
2. Kim MI and Johnson KB. Personal health records: evaluation of functionality and utility. J Am Med Inform Assoc 2002;9:171-180 http://jamia.bmj.com/content/9/2/171.full.pdf+html
3. How patients can improve the accuracy of their medical records. eGEMs (Generating Evidence & Methods to improve patient outcomes): Vol. 2: Iss. 3, Article 10. http://repository.academyhealth.org/egems/vol2/iss3/10/
4. http://www.webmd.com/phr