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What are three values of Health Informatics?
- 1. Better Care - Improve the overall quality of care by
- making health care more patient-centered, reliable, accessible, effective,
- efficient and safe.
2. Better Health
- Improve the health of the population by supporting proven
- interventions to address behavioral, social and environmental determinants of
3. Affordable Quality
- Reduce the cost of quality health care for individuals,
- families, employers and government to improve access and ensure sustainability
- of the system
What is the Canada Health Act, and what are the core values?
- Values: comprehensiveness, universality, portability, public administration
- and accessibility.“
The Canada Health Act (CHA) a piece of Canadian federallegislation, adopted in 1984, which specifies the conditions and criteria with which the provincial and territorial health insurance programs must conform in order to receive federal transfer payments under theCanada Health Transfer. These criteria require universal coverage of all insured services (for all "insured persons") “Insured health services” means hospital services, physician services and surgical-dental services provided to insured persons, if they are not otherwise covered, for example by Workers Safety Insurance.The CHA deals only with how the system is financed. Because of the constitutional division of powers among levels of government, adherence to CHA conditions is voluntary. However, the fiscal levers have helped to ensure a relatively consistent level of coverage across the country. Although there are disputes as to the details, the CHA remains highly popular.In popular discussion, the CHA is often conflated with the health care system in general. However, the CHA is silent about how care should be organized and delivered, as long as its criteria are met. The Act states that "the primary objective of Canadian health care policy is to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers."
What is the structure of the federal/provincial governments in terms of health care?
- Responsibility is shared between the Federal and Provincial governments with delivery being owned by the individual Provinces
What are some Provincial Responsibilities?
Strategic Direction and Policy for provincial system
Determine the structure and scope of healthcare services
Control the flow of money to healthcare organizations
Deliver province-wide services
Registration and Eligibility of citizens
Licensing and Registration of health professionals
What are some Health Authority Responsibilities?
Assessing health needs of the population served
Development of policy and program priorities
Planning and coordinating service delivery including capital projects
- Guaranteeing reasonable access to high-quality health services in a
- coordinated and integrated system of care
Liaising with community agencies and the MOH
Managing and Operating service delivery, financing of institutions
How is healthcare funded?
• Healthcare spending this year are estimated 11.6% of GDP or $210 billion
• 70% public 30% Private
- Public – 60% Hospital, 18% medications, 16%
- Private – About 60billion dollars, Research
- about $7billion dollars
• BC will receive $5.8 billion in transfer payments this year
• The MOH is planning on spending approximately $17 billion of the provinces $46 billion overall budget on health this year
• BC will receive $5.8 billion in transfer payments this year
What are some Health System Social determinants of Health?
• The evidence indicates that the key factors which influence population health are:
• income and social status
• social support networks
• employment/ working conditions
• social environments
• physical environments
• personal health practices and coping skills
- • healthy child development; biology and genetic
• health services
• gender and culture
- § These
- are the levers that need to be moved to improve health!
Discuss Adverse Events in Healthcare
- The three most common areas for
- adverse events to occur include surgery, medication, and infection.
- 1 out of 13 adult patients
- admitted to a Canadian hospital encounter an adverse event.
- 1 out of 9 adults will
- potentially be given the wrong medication or wrong medication dosage.
- 187,500 out of 2.5 million
- patients admitted annually to acute care hospitals experience an adverse event.
- Between 9,000 and 24,000 patients
- die per year due to adverse events.
- 37% of adverse events are
- ‘highly’ preventable.
- 24% of preventable adverse
- events are related to medication error.
Sources of medication error:
- Physician ordering: 39-49%
- Nursing administration: 26-38%
- Transcription: 11-12%
- Pharmacy dispensing: 11-14%
- Establishes the necessary
- framework for information management
- Gives legitimacy and voice to
Provide a strategic vision
- Clarifies Custody (physical control)
- and Control (ability to make decisions) of the information enabling:
- Appropriate secondary uses of
Standards and Policies
What is Personal Health Information?
- Recorded information about an
- identifiable individual that relates to the physical or mental health of the
- individual and to the provision of health services to the individual, including
- the identification of a person as a provider of healthcare to the individual.
- Information about the registration
- of the individual for the provision of health services
- Information about payments or
- eligibility for healthcare for the individual
- Number assigned to an individual
- to uniquely identify him or her for healthcare purposes
- Any information about the individual
- that is collected in the course of providing health services to him or her
- Information derived from testing
- or examining a body part or bodily substance.
Discuss types of information we manage in health
- Clinical data captured during the
- process of patient assessments, testing, consultations, diagnosis, care
- planning, treatment, monitoring and care
- Epidemiological data about the
- health status and health determinants for the population
- Demographic data used to identify
- and communicate with and about an individual
- Resource utilization, workload,
- inventory, capital asset and financial data
- Information about healthcare
- providers, system capacity, care quality and wait times
- Information for quality
- improvement, customer satisfaction, and program and health outcome evaluation.
- Data gathered for specific
- research purposes in clinical trials
- Data related to adverse events
- and incidents
- Data related to privacy and
- security access and audit
- Tracking data related to change
- and configuration management.
Discuss Information and Privacy
- Privacy – fundamental right of an
- individual to control the flow of his or her personal information, including
- the collection, use and disclosure of that information
- Security – the process of
- protecting the confidentiality, integrity and availability of information by
- assessing risks and taking steps to mitigate the identified and measured risks
- Confidentiality – the obligation
- of a healthcare organization to protect the information entrusted to it and to
- maintain the secrecy of the information
- and not to misues it.
- The CSA model code for the
- protection of personal information is based on the OECD Fair Information
- principles and is the basis for privacy legislation in Canada
- PIPEDA (Personal Information
- Protection and Electronic Documents Act) is Canada’s federal privacy
- Provincially there are two main
- piece of legislation: Personal Information Protection Act, Freedom of
- Information and Protection of Privacy Act.
What are main tenets of Acts and Compliance?
- Accountability, Accuracy,
- Compliance, Consent, Identifiable Purpose, individual access, Limiting
- Collection, Limiting use, disclosure and retention, Openness and Safeguards.
- Document the appropriate consent
- model to follow
PIA – Privacy Impact Assessment
- STRA – Security Threat Risk
What are some HI Standards, SDOs and CO?
SNOMED CT, LOINC, ICMP
ICD, CCI, ICPC
HL7, DICOM, CDA, CCOW, IHE
Cerner STANDARD, Accreditation Canada, ROP, VIHA policies and procedures and governance
Discuss Interoperability and Quality
- Level 0: Stand-alone
- systems have No Interoperability.
- Level 1: On the level
- of Technical Interoperability, a communication protocol exists for
- exchanging data between participating systems. On this level, a communication
- infrastructure is established allowing systems to exchange bits and bytes, and
- the underlying networks and protocols are unambiguously defined.
- Level 2: The
- Syntactic Interoperability level introduces a common structure to exchange
- information; i.e., a common data format is applied. On this
- level, a common protocol to structure the data is used; the format of the
- information exchange is unambiguously defined. This layer defines structure.
- Level 3: If a common
- information exchange reference model is used, the level of Semantic
- Interoperability is reached. On this level, the meaning of the data is
- shared; the content of the information exchange requests are unambiguously
- defined. This layer defines (word) meaning. There is a related but slightly
- different interpretation of the phrase semantic
- interoperability, which is closer to what is here termed Conceptual
- Interoperability, i.e. information in a form whose meaning is independent
- of the application generating or using it.
- Level 4: Pragmatic
- Interoperability is reached when the interoperating systems are aware of
- the methods and procedures that each system is employing. In
- other words, the use of the data – or the context of its application – is
- understood by the participating systems; the context in which the information
- is exchanged is unambiguously defined. This layer puts the (word) meaning into
- Level 5: As a system
- operates on data over time, the state of that system will change, and this
- includes the assumptions and constraints that affect its data
- interchange. If systems have attained Dynamic Interoperability, they are able
- to comprehend the state changes that occur in the assumptions and constraints
- that each is making over time, and they are able to take advantage of those
- changes. When interested specifically in the effects of operations, this
- becomes increasingly important; the effect of the information exchange within
- the participating systems is unambiguously defined.
- Level 6: Finally, if
- the conceptual model – i.e. the assumptions and constraints of the meaningful
- abstraction of reality – are aligned, the highest level of interoperability is
- reached: Conceptual Interoperability. This requires that conceptual models are
- documented based on engineering methods enabling their interpretation and
- evaluation by other engineers. In essence, this requires a “fully specified,
- but implementation independent model” as requested by Davis and Anderson;
- this is not simply text describing the conceptual idea.
What are some Canadian Data Sources for Planning?
- clinical - DAD, HMDB, NACRS,
- HMHDB, NRS, CCRS, HCRS, CJRR…
- Human Resource – HPDB, NPDB,
Financial – NHEX, CMDB, OECD
MOH Health Data Warehouse
- MOH Repositories and Registries
- (e.g. Renal, Heart Health)
Physician office systems
- Transactional Systems – Cerner,
- PARIS, Meditech, ESP, White
Discharge Abstract Database
- Hospital Morbidity Database
- National Ambulatory Care Reporting
Hospital Mental Health Database
- National Rehabilitation Reporting
Continuing Care Reporting System
Home Care Reporting System
- Canadian Joint Replacement
Health Personnel Database
National Physicians Database
- National Health Expenditure
Canadian MIS Database
OECD Health Database
What are some challenges to IM in the Canadian Context?
- Explosion of Information –
- Finding the signal through the noise
- Big Data, Hadoop, Data
- Visualization, Semantic Search
Dashboards and Portals
- CDA, Blue-Botton, E2E, Direct
Usability and Quality
Benefits and Outcomes planning
Real Time Analytics, Bio-Feedback
Define Information Technology
- The application of computers and telecommunications equipment to store, retrieve,
- transmit and manipulate data often in the context of a business or other
- The term
- is commonly used as a synonym for computers and computer networks but also
- encompasses other distribution technologies such as television and
- the context of this discussion the definition also includes “IS” or information
- systems which generally bridge “IM” and “IT”.
What makes up the Pan Canadian
Electronic Health Record (Infoway)?
- Health Infoway put forward a conceptual model for a pan-canadian electronic
- health record over a decade ago. The
- original model was described using the Zachman architectural framework and has
- subsequently been converted to TOGAF.
- All the original architecture represents is a conceptualization of a
- typical computer abstracted to be able to conceptualize it as a national
- the core components you have the HIAL or health integration access layer which
- is the equivalent of a service bus on a computer motherboard. The various registries are equivalent to data
- stores on a computer and the various services for security, authentication,
- search, etc… are equivalent such services on a computer operating system.
- components of the EHR blueprint include the HIAL and:
- data and services – information about people, places and resources that need to
- be referenced to assemble a longitudinal health record
- EHR data
- and services – such as drug, lab, medical imaging information registries
- Record Services – index services, data normalization services, authentication –
- common services for the EHR
- Key to
- the ability to scale a common PC motherboard to a national system is the
- abstraction of key services via what is known as service oriented
- architecture. This simply means taking
- key functions that the system performs such as authentication and packaging in
- to a service such that it can be invoked not only by the local system but also
- by remote systems that understand how to interface or call the service.