Nursing informatics

2. By / MahmoudShaqria
‫شقريه‬ ‫محمد‬ ‫محمود‬

3. OUTLINES
Definition of terms
Integrated care - Integrated Health Networks - Clinical Integration
Steps To Clinical Integration
Interface Engine
 Different modalities of integration
Integration Issues and barriers
Role of Nurse

4. Integrated care
 Well-planned and well-organized set of services and care
processes, targeted at the multidimensional needs of an individual
client, or a category of persons with similar needs … built up by
elements of acute health care, long-term care, social care, housing
and services.

5. Integrated Health Networks
 Is a network of organizations (e.g., ambulatory care clinics,
physician groups, diagnostic centers, hospitals, nursing homes,
home health care agencies) which provides, or arranges to provide,
a coordinated continuum of services to a defined population and is
willing to be held clinically and fiscally responsible for the health
status of that population. These systems often own, or are closely
aligned with, an insurance service.

6. Clinical Integration
An active and ongoing program to evaluate and modify the clinical
practice patterns of the physician participants so as to create a high
degree of interdependence and cooperation to control costs and
ensure quality.

7. Different Names for The Same Concept
Integrated Delivery Networks.
Integrated Delivery System (IDS).
Integrated Health Care System.
Integrated Health Delivery System.
Integrated Health Networks.
Integrated Healthcare Delivery Systems.
Integrated Healthcare Network (IHN).
Organized Delivery Systems.

8. Steps To Clinical
Integration

9. Step 1: Gather Interested Stakeholders
Decide if the network will be
regional, statewide or only
encompass a few counties.
Leverage admissions data to
know your top referrers and
talk with them first.
Itemize capital and resource
commitments and determine
the technology you will use early in the process.

10. Step 2: Create a Value Proposition
Value propositions serve as building
blocks and lead to strong governance.
Every stakeholder will help define the
network’s value; physicians must lead
patient care processes.
Articulate how the network will better
care for patients, together.

12. Begin by measuring quality not clinical outcomes
Identify measures then review claims-based data to gauge provider performance
Quality data also pin points care coordination education opportunities
Best Practices:
Form a quality measures committee
Review national standards
Document quality measures
Leverage technology to track and improve
Step 4: Select Quality Measures

13. Data Sources:
Medical Claims.
Pharmacy Claims.
Clinical Events from labs (biometrics, lab values, screenings, follow-ups,
immunizations).
Survey data at an aggregate (down to physician) level.

14. Step 5: Recruit Physicians
oIdentify types of providers the network needs.
oReview existing clinical performance metrics, if available.
oPersonalize the reasons for joining the network.
oIsolate provider gaps and overlaps in the care network; understand that few
networks are fully formed right out of the gate.

15. Step 6: Measure and Improve Programs
Primary care physicians are central to managing
patient care across specialties.
Train all providers on quality measurement
and reporting.
Communicate regularly to
drive network’s support of
better patient outcomes.

16. Step 7: Engage Payers
Understand risk and the costs for each
member per month.
Explore Medicaid Managed Home and
government contracts.

17. Interface
Definition:
Software that tells different systems “how” to exchange data
Types:
Point-to-point: Directly connects 2 systems
*Requires custom programming
*Expensive
Interface engine: Allows data exchange between sending and receiving systems

18. Interface Engine
Allows data exchange between sending and receiving systems
Uses translation tables to move data from each system to the clinical data
repository,
a database where collective data from all information systems are stored and
managed.

19. Clinical Data Repository
Provides data definition consistency through mapping
May also be referred to as the clinical data warehouse
(CDW)
Mapping—terms defined in one system are associated with
comparable terms in another system

20. Benefits of Interface Engine
Timeliness and availability
Decrease integration cost, time, effort as alternative to point-to-point type
Improve data quality with data mapping
Preserve institutional investment in existing systems
Simplify data processing
Improve management of care, financial tracking for care rendered, and efficacy
of treatment

21. DIFFERENT MODALITIES OF INTEGRATION
Horizontal integration
Refers to the coordination of activities across operating units that are at the
same stage in the process of delivering services.
Examples of this type of integration are consolidations and shared
services within a single level of care.

22. MODALITIES OF INTEGRATION CONT,,,
Vertical integration
Refers to the coordination of services among operating units that are at different
stages of the process of delivering services.
Examples of this type of integration are the linkages between hospitals and
medical groups, outpatient surgery centers and home based care agencies.

23. Integration Issues and barriers
Massive undertaking.
Vendors failure to deliver on promises.
Lack of agreement on standards.
Politics and power
*Lack of agreement on data dictionary, data mapping,
and clinical data repository.
*Fear of change.
*Competition among providers.

24. BARRIERS CONT ,,,
Institutional segmentation and weakness of the health system, including weak
steering role of the health authority.
competition among providers for resources;
lack of job security
Deficiencies in the information, monitoring and evaluation systems.
Weak management.

25. SEGMENNTATION
The segmentation of health systems, that is, the coexistence of subsystems with
different financing modalities and arrangements, reflecting social segmentation by
ability to pay or type of employment. This structural feature increases inequality
between social groups and is a factor of social exclusion. So, the poor and informal
workers are left out;….

26. INTEGRATION REQUIREMENTS
Data Dictionary —defines terminology to ensure consistent understanding and use
Master Patient index (MPI)—database that lists all identifiers assigned to a client in
all the information systems within an enterprise
Clinical Data Repository
Uniform Language:
*Provides uniform definition of terms
*Facilitates communication and ability to exchange data with a shared meaning
*Facilitates ability to replicate research

27. ROLE OF THE NURSE
Must be involved in:
oIdentifying and defining data elements that an interface can supply.
oDetermining measures to ensure the quality of data exchanged among individual
systems.
oFormation and maintenance of the electronic health record.

28. EXAMPLE
•When nurse noticed sensitivity of a specific drug
towards a patient, she recorded that in the patient
sheet.
•then.,if a doctor tries to enter the same drug in the
patient record , the system will refuse it.

29. INTERNATIONAL STANDARDS DEVELOPING
ORGANIZATIONS
•International Standards Organization (ISO),
•European Committee for Standardization (CEN),
•Health Level 7 (HL7) International,
•Digital Imaging and Communications in Medicine (DICOM),
•Institute of Electrical and Electronic Engineers (IEEE), and
•Clinical Data Interchange Standards Consortium (CDISC)