health-informatics(ppt文档).ppt

“I Need to Make an Appointment”How do YOU make Appointments?DoctorsDentistsOptometristsBeauticiansOnline Booking?Health Infoways e-booking initiativeDr.Anthony Ocana N Van.Dr.John Hathorn-VancouverDr.Lucy Ting-VancouverFraser Street Medical-VancouverLonsdale&19th Medical Centre N VanMt.Seymour Medical Clinic N Van Park Royal Village W VanSpectrum Health-VancouverSteveston Medical Group-RichmondThe Doctors Office-VancouverWhat about UBC Student Health?Elements of Appointment DataWhat does the person(or machine)making an appointment for you need to know?The basic elements?A CustomerA ProviderA Date/TimeCan you think of anything else?So what are the elements?A CustomerA ProviderA Date/TimeCustomersWhat do we need to know about them?CustomersWhat do we need to know?NameAddressPhone NumberEmailNext of KinFamily membership?Billing information?Some kind of identifier?What kind of service you want or needWell Now Take an Important Digression!About healthcare customers and identifiersHealthcare IdentifiersIn 2001 Canada decided against the creation of a new federal healthcare identifier,despite the presence of some quasi-unique provincial identifiers.Instead the country adopted a client registry approach,already deployed in the majority of the provinces.(Fernandes,Lorraine.Patient Identification in Three Acts.Journal of AHIMA 79,no.4(April 2008):46-49.)Healthcare Identifiers“Identifying individuals uniquely is the first step to securely adding health information to their record.A Client registry is a directory that lists all patients and their relevant personal information(names,addresses,etc.)A component of an electronic health record(EHR)system,a client registry supports the centralized storage and retrieval of client(i.e.patient)identification data and enterprise client identifiers(ECIDs).”(Canada Health Infoway)Canadas Approach to Unique IdentificationInstead of just assigning a numberWe already have SIN,PHN,MRNSocial Insurance NumberPersonal Health NumberMedical Record Number Weve decided to create patient registries“Best Guess”lists of you and me compiled by“probabilistic linkage algorithms”based on demographics&our healthcare utilizationRegistry“provides a reliable cross-reference of all client identifiers belonging to the same person“Reliable”probably less than 99%accurateImplies that theres a chance at least one of us is mis-identified in the BC Client RegistryWhy not Just Have a National Health Identifier?Privacy ConcernsMay not control for someone perhaps an out-of-country visitor using my IDIn Europe and Asia Patient Identification increasingly uses Smart CardsHas any of you ever seen a Smart Card?Anyone who has seen one raise your handAnyone who has one in their pocketbook show it to usNeither US nor Canada has adopted Smart Cards in HealthcareyetHealth SmartCard UptakeClaims:After Germany introduced health smart cards to some 80 million citizens in 2006,an estimated 50,000 to 60,000 fewer Germans die annually from incorrect prescriptions and other medical mistakes.Based on Canadas population of 34 million,a similar smart card system could save at least 25,000 Canadian lives yearly.Health smart cards also generate big cost savings.In 2001,Taiwan invested$120 million to put health smart cards into the pockets of 22 million Taiwanese,realizing first-year savings of$550 million in reduced medical expenses plus another$210 million otherwise lost to identity theft.(“CreditCards.CA”In contrast,Canadas Registries are costly and very bureaucaratic.Infoways Proposed Governance StructureCanadas Approach(Infoway,2013)How does that correspond to your experience?The alternative?Works for our money,why not our healthcare?However it may be doneAccurate identification of patients is key to a successful informatics systemThis is the only time in the course well discuss this topic,but it is of fundamental importance to healthcare Informatics and still unresolved.Digression finished!So what are the elements?A CustomerA ProviderA Date/TimeProviderWhat do we need to know?ProviderNameHours of work and specific scheduleContact Information?Payment information?Unique Identifier(yes,another digression!)Unique Provider IdentifierBoth Canada and US have been more successful uniquely identifying providers:BCs Provider Registry System(PRS)The PRS contains core provider data such as provider identifier,provider status,name,demographic details,provider credentials,provider expertise,conditions,and work locations.Doctors,nurses,pharmacistsWhere does the BC PRS information come from?Each group of providers has a designated primary source-usually a professional college or association.Primary sources provide data,control access to the data and give others(secondary sources)permission to update specific information.For doctors,the primary sourceCollege of Physicians and Surgeons of B.C.Example from PRS WebsiteDr.Smith(provider)is registered and licensed by the College of Physicians&Surgeons of British Columbia.The college authenticates Dr.Smith and assigns a unique,public identification number.This data is sent to the registry.A certificate authority may then record links to certificate information for Dr.Smith in the registry.When Dr.Smith works in Prince George and accesses health data at a Vancouver hospital,authentication and authorization to view this data can occur because of the information available in the registry.So what are the elements?A CustomerA ProviderA Date/TimeWhat do we need to know?So what are the elements?A CustomerA ProviderA Date/TimePerhaps different time lengths for different kinds of appointments?Who recorded the appointment?When the appointment was made?Was the person sent a reminder?“I want to make an appointment”Making an appointment isnt a trivial process in todays informatics worldWe need to uniquely identify patientsWe need to uniquely identify providersWe need to flexibly match the needs and schedules of bothThese are the essential tasks of a Database SystemLets Start with“Setmore”A“free”appointment system available onlineWhat does it look like?Database Structures are Corporate Secrets!LF to Setmore:Hello.Im teaching a class about healthcare informatics at the University of British Columbia in Canada,and next week our topic is about appointment booking.I hope you dont mind,but Im using Setmore as one example of a useful simple system.Could you tell us something of the underlying structure of Setmore?What tables does it use(presumably one for customers,one for staff,one for calendar-are there others?)What language do you use to tie these together into the very smooth system you have created?Setmore to LF:Thank you,but sorry for the inconvenience we can not share this.Our Tasks TodayTo understand databases as they apply to healthcareWe will do that in two waysFirst,we will view five excellent short video presentations about an hour of videoThen after another break-we will work together to create a(simple)appointment system using an on-line database systemI will happily share with you(or anyone)the necessary tables and particulars!However the vendor wont help since were not payingMy Goal For Your LearningUnderstand and be able to employ the basic ideas behind relational databases and their common search language(SQL)Be aware of several other database approaches:XML(Our course Electronic Medical Record“SpringCharts”stores or converts its data to XML You will submit XML files for credit later in the courseJSON(closely related to XML)and integral to online data searching using“APIs”and the“RESTFUL”system.“Graph”data structures using“nodes”and“vertices”This is the way data is stored and displayed in Social Network Analysis.Youll be using Graph data structure a lot in your group assignment Questions?Comments?Lets take a five minute stretch break!DatabaseHopefully youve already looked at the two videos I assigned for class preparation.Today:Five talksThree short lectures by Dr.Jennifer Widom“Jennifer Widom is the Fletcher Jones Professor of Computer Science and Electrical Engineering at Stanford University.She was the chair of the Computer Science Department from 2009 to 2014“I think she gives brilliant lectures.I hope you agree.Dr.Widoms Talks1.Introduction to Databases2.The Relational Model3.XML and dataAfter each talk well have a few moments for questions or comments.Well then have what I think is a lucid explanation of APIs followed by a short introduction to“Restful APIs”.Online access via APIs is the future of databases,and currently REST is the most common API format.1.Introduction to Databases2.The Relational Model3.XML and dataAfter each talk well have a few moments for questions or comments.Well then have what I think is a lucid explanation of APIs followed by a short introduction to“Restful APIs”.Online access via APIs is the future of databases,and currently REST is the most common API format.XML vs.HTMLIf you want some further information on the difference between these two markup languages,try http:/courses.cs.vt.edu/cs1204/XML/htmlVxml.html.We wont be spending any time with HTML in this course,but you should be able to look at examples of the two and know which is which.Crucial as databases are to health informatics,this is pretty much the only formal course content on this topic.Question,Comments?Do you feel youve understood the basics?Lets take a 10 minute break!Our Own Appointment SystemWell now use“Caspio”to construct an online appointment systemYou can either just follow along orYou can create your own system with usHow many of you have already registered for a Caspio account?How many who havent already registered want to make your own Caspio system?Does anyone not have a printed out copy of the instructions for this exercise?If youre going to create your own it might be helpful to move next to someone who has a copy.