week 4 lecture

1. Standards of dental
informatics, security issues,
privacy and costs
Dr Ebtissam Al-Madi

2. • Why are standards important in
medical informatics?
– Promote consistent naming of individuals,
events, objects, etc.
– Allow better use of data for patient care,
quality assurance, research, etc.
– Enhance ability to transfer data among
applications, allowing better system
integration

3. Benefits and limitations of
standards
Benefits
– Interoperability
– May allow innovation based on common
foundation
Limitations
– Dominance by one segment of industry:
Microsoft “standards,” e.g., Windows,
Office, etc.
– May stifle innovation

4. The standards development
process
• Groups agree to informal specifications
• Single vendor controls industry
• Government agency creates standard
and mandates its use.
• Interested parties work in open process

5. International standards bodies
• International Organization for
Standardization (ISO)
http://www.iso.org/iso/home.html
• ADA Standards Committee on Dental
Informatics (ADA SCDI)
http://www.ada.org/prof/resources/stand
ards/informatics_reports.asp#a1031

6. Medical informatics standards
1. Identifiers
2. Transactions
3. Message exchange
4. Terminology

7. 1. Identifiers
• Various approaches have been
proposed for
– Patients
– Providers
– Employers
– Health Plans

8. Patient identifiers
• Unique – only one person has a
particular identifier
• Non-disclosing – discloses no personal
information
• Permanent – will never be re-used
• Ubiquitous – everyone has one
• Canonical – each person has only one
• Invariable – will not change over time

9. Patient identifiers
Benefits
– Easy linkage of records
– Facilitate health information exchange
– Reduce errors and costs arising from duplicate
records
– Medical record identifier errors compromise
quality of care and can be costly
– Cost increases with length of time error not
identified
Risks
– Easy linkage of records
– Potentially compromise privacy and
confidentiality

10. 2. Transactions
• Transaction standards are designed to
encourage electronic commerce for
health claims.
• HIPAA (Health Insurance and privacy
act) mandates use of these standards
for health care business electronic data
exchange
“Administrative simplification”

11. Transactions standards cover
– Health claims and equivalent encounter
information
– Enrollment and disenrollment in a health
plan
– Eligibility for a health plan
– Health care payment and remittance
advice
– Health plan premium payments
– Health claim status
– Referral certification and authorization
– Coordination of benefits

12. 3. Message exchange standards
Allow data and application interoperability
• Major standards include
– Health Level 7 (HL7)
– Digital Imaging and Communications
(DICOM)
– IEEE
– NCPDP and SCRIPT
– ELINCS
– Continuity of Care Record (CCR)

13. 4. Terminology standards
Benefits of computerization of clinical information
depends upon its “normalization”
• Clinical language is inherently vague, which is at
odds with the precision of computers
• Computers have no intelligence
• Computers can only do what programmers and
users tell them to do
• Computers process numbers and symbols very
fast and accurately
• Computers have extraordinarily great memory
• It is up to humans to define the meaning or
semantics of information represented in a compute

14. Standardized terminology
• Information capture – documenting
findings, conditions, and outcomes
• Communication – transferring
information
• Knowledge organization – classification
of diseases, treatments, etc.
• Information retrieval – accessing
knowledge based information
• Decision support – implementing
decision support rules

15. PRIVACY, CONFIDENTIALITY,
AND SECURITY: BASIC
CONCEPTS

16. Personal privacy vs. the common
good
• Personal privacy is important.
• Common good of society is more
important.
Where do your views fit?

17. • Privacy – right to keep things to yourself
• Confidentiality – right to keep things
about you from being disclosed to
others
• Security – protection of your personal
information

18. Security Issues
• Who owns information?
• How is informed consent implemented?
• When does public good exceed
personal privacy?
• What conflicts are there with business
interests?

19. Problems of Poor security
• Patients avoid health care
• Patients lie
• Providers avoid entering sensitive data
• Providers devise work-arounds
• Disclosure problems continue

20. Security for paper records
• Difficult to audit trail of paper chart
• Fax machines are easily accessible
• Records frequently copied for many
reasons
– New providers, insurance purposes
• Records abstracted for variety of
purposes
– Research
– Quality assurance
– Insurance

21. Technologies to secure
information
Deterrents Obstacles
– Alerts – Authentication
– Audit trails – Authorization
System management – Integrity
precautions management
– Software – Digital signatures
management – Encryption
– Analysis of – Firewalls
vulnerability – Rights management

22. Protected health information
(PHI)
• Name • Social security number
• Address (street address, city, • Internet protocol (IP) address
county, zip code) • Any vehicle or device serial
• Names of relatives number
• Names of employers • Medical record number
• E-mail address • Health plan beneficiary
• Fax number number
• Telephone number • Account number
• Birth date • Certificate/license number
• Finger or voice prints • Web URL
• Photographic images • Any other unique identifying
number, characteristic, or code

23. Costs of Informatics
• Health IT costs and return on investment (ROI)
– “What do I get back („return‟) for the money I'm
being asked to spend („investment‟)?”
• Cost-benefit defined
– “Ratio of money value of benefit divided by cost”
• Cost-benefit in the outpatient setting
– Increased time for first 4 months but thereafter saved time
that was either spent seeing more patients or reducing work
hours
– Only a few practices implemented comprehensive quality
improvement efforts, usually when insurers paid explicitly for
it
– System payback achieved at average of 2.5 years.
– Factors associated with success included
• Near complete use of system functions
• Having local EHR champion and supportive practice culture

24. • Cost-benefit in integrated delivery
setting
– Laboratory and radiology order entry
• Reduction of time spent processing orders
– Pharmacy order entry
• Reduced adverse drug events
• Improved cost savings through better formulary
compliance
– Documentation
• Reduction in cost due to use of structured
documentation in outpatient setting

25. • Overcoming the economic obstacles
– Centrally funded.
– Grants
– Financial incentives
– Tie into quality of care initiatives

26. This weeks assignments
1. View this lecture online for review.
2. Read article: How to write a term paper
3. Participate in discussion: Personal privacy vs
Common good of society- which is more important.
View Read Discuss

27. • Thank you
– Dr Ebtissam Al-Madi
– ealmadi@ksu.edu.sa