Management of Information Systems
Samenvatting
INTRODUCTORY SESSION
Information system = the means by which people and organizations, increasingly utilizing
technology, gather, process, store, use and disseminate information.
DIKW pyramid
Data: this is purely. Eg: red.
Information: more information. Eg: the traffic light is on red.
Knowledge. Eg: if the traffic light is on red, you all know what to do.
Wisdom. Eg: you know that you better stop.
eHealth
- First time use of term eHealth in 1999.
o Before it was called: medical informatics, telematics, telemedicine, telemonitoring,
health informatics,….
- “e-health is the use of emerging information and communications technology, especially the
Internet, to improve or enable health and healthcare”.
- “e-health is an emerging field of medical informatics, referring to the organization and
delivery of health services and information using the Internet and related technologies. In a
broader sense, the term characterizes not only a technical development, but also a new way
of working, an attitude, and a commitment for networked, global thinking, to improve
health care locally, regionally, and worldwide by using information and communication
technology”.
→ If you talk about eHealth it is about using IT technologies, computers, internet within a healthcare
setting.
But it is not only about technology. It’s about another way of working, other workflows, it’s about
business models that have to be remodelled and that we use in healthcare based on those
technologies.
1
,Electronic Medical Records (EMR)
Different terms are used interchangeably:
Electronical Medical Record (EMR):
- This is typically what a general practitioner, medical doctor, physician,… is using.
- This is a database/software that the doctor is using in order to collect and to store clinical
and medical information about the patient.
- This is not the kind of information that is exchanged with other professionals. It is most of
the time kept locally (the doctor is storing the information on his computer).
- Not to share information with others.
Electronical Patient Record (EPR):
- It doesn’t only have to contain medical information. It can also be information that for
example a physiotherapist is needing for his treatment to the patient, the information a
nurse is collecting of the patient.
- It’s a bit broader than EMR.
Electronic Health Record (EHR):
- This is typically designed to share information with others.
- It does contain information about the patient.
Personal Health Record (PHR):
- It is typically owned by the patient.
- It is the patient who can see the personal health record and who can add and change the
information.
- PHR can also be used to make an appointment by your GP.
There are 2 differences between EMR and EHR:
- EMR:
o Only contains most of the time purely medical, clinical information.
o It’s not designed for sharing.
- EHR:
o Does not only contain the medical information of the health of a patient, but can also
contain information about the lifestyle of the patient.
o It is typically designed for sharing information between systems.
▪ It can contain information that is physically stored at a number of locations (eg:
information that is stored by a GP, coming from hospitals,…) which can be
connected in a EHR.
PHR → is typically owned by the patient.
EMR, EPR, EHR → are owned by the professionals.
Some trends of Electronic Medical Records
When he says Electronic Medical Records he means the whole bundge of databases software that
contains information about the patient (dus over alle 4 de puntjes van hierboven).
- Patient-centered:
o That kind of information systems are more and more patient-centered. We put the
patient in the centre of their management of healthcare.
o Patient empowerment: involving the patient.
- Longitudinal:
2
, o Those systems are longitudinal. Longitudinal episodes of proving care to a patient
can be recorded.
- Multidisciplinary:
o They are more and more multidisciplinary: some information can be shared with
many health practitioners if needed and sometimes things are restriced (eg: a nurse
of specific therapist is not allowed to see the medical information which is only for
the doctor to see).
- Transmural.
- Structured and coded:
o Unstructured text is a bit difficult to process. We like to have structured text.
o Coding to avoid many issues.
- Metadata:
o eg: when was a diagnosis entered to the system, wie heeft de diagnosis gesteld, who
has entered which information on what time,….
o Meta data is important to get the context.
- Intelligent (decision support):
o Those systems become more and more intelligent.
o All kinds of decision support are offered nowadays
▪ (eg: je moet medicatie nemen en je neemt al medicatie, dan kan een
systeem zeggen dat het andere medicatie moet zijn omdat die niet matcht
met je huidige medicatie).
o Decision support is implemented in all kind of hospitals information systems, in GP
information systems.
- Personalised:
o Personalised medicine: it’s a kind of medical care model in which prevention and
treatments can be given to certain groups of individuals.
- Integrated:
o Integrated hospital information system: integrated means that you have one medical
record which contains all the information from several departments within a
hospital.
- Secondary use:
o It means that we use the information collected in electronical medical records, in
medical information system not for the primary use (primary use is providing care to
the patient), but for secondary use (reuse the information collected in electronic
medical records/ electronic health records for clinical purposes, for research aspect).
- Certified/quality labelled:
o Certification and quality labelling of the information system.
Secondary use
Using data for secondary purposes is one of the most promising ways to improve health outcomes
and costs.
Health data constitutes a significant resource in most OECD countries and it makes economic and
ethical sense to use this data as much as possible: to improve population health and to improve the
effectiveness, safety and patient-centeredness of health care systems.
3
, Why using EMR’s for research purposes?
Current practices of clinical research need to be changed (cf. cost savings, less time consuming, more
efficient,…).
- Research and Development cost for new medicines is on average 1 billion euro.
- It takes several years for a new drug to be available on the market.
- Problems in several phases of clinical research (e.g. protocol feasibility, patient
recruitment,...) → see next two slides.
- Some statistics:
o 27% of suitable subjects are not found via manual search (not found via the
traditional way) compared to an electronic search.
o 40% of clinical trial data are entered into the EMR, EDC system (Electronic Data
Capture system) and possibly also on paper.
o More than 70% of the data is replicated (EMR vs clinical trial system).
EMR’s offer huge opportunities for clinical research (cf. EMR trends).
Protocol design based on estimates
Protocol feasibility.
- Protocols governed by established standards.
- With no, or limited access to actual patient data, trial design is based on discussions with
expert clinicians.
- Increased amendments, slower than expected enrolment, costly changes to add new sites
and countries, even failed trials.
Patient recruitment is a major cause of trial delays.
- Identifying and recruiting suitable patients and trial sites are principal causes of trial delays.
Common challenges to use of health date for person centred care, and the re-use of
health date for clinical research
Volgende zaken gaan we nog bespreken tijdens de lessen.
- Data quality:
o All data has to be complete and accurate at the point of capture.
o A single error presents risk to patient safety, and may can be magnified as data are
communicated and analysed.
- Interoperability:
o Disparate and incompatible EHR systems.
o Variable quality, uniformity and organisation of the data.
o Different coding and content standards.
o Different languages across Europe.
- Data security, privacy and ethics:
o Complying with ethical, legal and privacy requirements that differ from country to
country is critical to gain acceptance with the general public, patients and health
professionals.
- Scalability and sustainability:
o Solutions need to be adaptable and reusable and governed within a sustainable
ecosystem.
4
