MIDTERM REVIEW
WEEK 1: INTRODUCTION TO THE HEALTH IT DISCIPLINE
Readings:
• HI, Ch. 1, "Overview of Health Informatics", pp. 1-36.
• Hersh, W.F. (2014). “Advice to a Young Person Considering a Career in Informatics,” a blog post on 7/3/14.
Video: “Escape Fire” - linked from D2L.
Lectures:
- On D2L, Week 1
KEY POINTS: In the introduction and in the video, "Escape Fire", you were asked to comment on the video, as well as understand the bigger picture of Health IT, which is part of a larger socio-technical system of technology, people, and policies. Examples from the lecture carry over to other course topics.
There are 11 sections to "Escape Fire" video. Below are the table of contents:
Consider, “What do you think about where we can look for optimistic outcomes, and where is the problem more entrenched and harder to dig our way out?”
Video Sections:
1 Escape Fire
2 Primary Care
3 Good People Bad System
4 A National Dependency
5 The Dark Matter of Medicine
6 The American Way
7 An Entrenched System
8 Throwing a Different Pitch
9 Change Your Lifestyle
10 Seeking Escape Fires
11 One Company
WEEK 2: UNDERSTANDING COMPLEXITY: A MORAL QUESTION
Readings:
- Berwick D., “The Moral Test“, talk given to the IHI, 12/7/2011
- T.R. Reid (2010). The Healing of America, Prologue: “A Moral Question” and Ch. 1, “A Quest for Two Cures”, Ch. 2, “Different Models/Common Principles”
- Robert Wachter (2015). The Digital Doctor, Preface and Ch. 1, “On Call”
- Eric Topol, M.D., The Creative Destruction of Medicine, Introduction,
- Lecture: on D2L, Week 2.
KEY POINTS: In the introduction, review the health reform vocabulary as well as the challenges still in front of us as we tackle the complex problem of healthcare. Key chapter learning objectives:
- State the definition and origin of health informatics as one of the information sciences (Also in reading by Hersh)
- Identify the perceived benefits of health information technology
- List the barriers to health information technology (HIT) adoption
- T.R. Reid investigates healthcare in the U.S. and in other countries. The moral question he asks is related to Nikki White's death due to the fact she could not afford healthcare that would have saved her life. Despite all that Americans enjoy, we have not decided to provide medical care to everyone who needs it. Other countries like us have provided healthcare to all without resorting to "socialized medicine."
- What are some other healthcare models that exist that differ from our "out of pocket" model?
- What does that say about the U.S.?
- In the end of the preface, Robert Wachter states that computers in healthcare don't simply replace my doctor's scrawl, [but] they transform the work, the people who do it, and their relationships with one another and with patients. The "On Call" chapter provides a harrowing example experienced by a first-year resident, Matthew Burton, and what he learned from that experience.
- What were a couple of take-aways from Burton's experience and later investigation?
WEEK 3: COST CONUNDRUM
Readings:
- Brill, S. (2015). “What I Learned From My $190,000 Open-Heart Surgery,” excerpt in Time magazine, 1/19/15, from Brill’s book, America’s Bitter Pill, Random House.
- T.R. Reid (2010). The Healing of America, Ch. 3, “The Paradox” (pp.22-45).
- What drives high healthcare costs - and how to fight back," HBR, April, 2010.
CASE:
- Elisabeth Rosenthal New York Times Series, “Paying Till It Hurts: A Case Study in High Costs”, 2013-14.
Videos:
- Steven Brill on Rising Medical Costs, based on his Time magazine special issue, “The Bitter Pill”, March 4, 2013.
- “Hot Spotting” Leads to Better Care at a Lower Cost”
Lecture: On D2L, Week 3.
KEY POINTS: These lectures were about the U.S. having the highest medical bills in the world. We presented the dilemmas in the NY Times series by medical doctor, Elisabeth Rosenthal.
The Brill article is not just about the costs, but about the complexities of healthcare. He discusses ways to save hundreds of billions of dollars by (1) Letting the Foxes Run the Henhouse (e.g., Cosgrove at Cleveland Clinic, Romoff at UPMC), (2) Cutting Out the Insurance Middleman through tight regulation from the hospitals carrying their own insurance. Brill has six extra regulations he'd like to see in place. We covered this briefly, but you should at least read what he has to say about fixing the cost problem (and examples).
• Quality of affordable care is a goal here. Healthcare costs (in addition to access) are very large problems.
• Hotspotting is one attempt to figure out this problem. What are others? Is there hope, or do we need a different model of healthcare (as Reid suggests)?
WEEK 4: EHR, EHR COMPONENTS, MEANINGFUL USE
Readings:
- HI, Ch. 4, "Electronic Health Records".
- Blumenthal, D., Tavenner, M. (2010). The “meaningful use” regulation for electronic health records. New England Journal of Medicine, 363: 501-4.
- Robert Wachter (2015). The Digital Doctor, Ch. 23, “Meaningful Use”
- Robert Wachter (2015). The Digital Doctor, Ch. 27, “Go Live”
Lectures:
- On D2L, and link to Meaningful Use (pdf)
Websites:
- IHI – Triple Aim,
- How to Implement EHRs - very helpful for assessing the lifecycle of EHR implementation and how eligibility and meaningful use fit into it.
- EHR Incentives homepage. Within that page, here are some good links:
- Incentive Program Basics
- Certified EHRs – you’ll get some idea of the many hundreds of EHR-certified vendors out there.
KEY POINTS: First introduction to EHR, EHR components, what it includes, etc. and meaningful use and how reimbursements work.
- State the definition and history of electronic health records
- Identify the benefits of electronic health records
- List the key components of an electronic health record
- Describe the Medicare and Medicaid reimbursement programs for electronic health records
- Discuss the objectives and measures of “Meaningful Use”, their significance and potential impact on EHR adoption (see text and Appendices 3.1 and 3.2, plus slides and pdf articles above)
- See Wachter chapters for a different take. “Go Live” points out some of the difficulties often encountered with EHR implementation (also related to the Emory Case).
- Describe the perceived benefits and limitations of computerized order entry and clinical decision support systems (see also Appendix 3.3 of text).
- Emory case discusses CPOE before and after, workarounds, and other challenges
WEEK 5: HEALTH INFORMATION EXCHANGE
Readings:
- HI, Ch. 5, “Health Information Exchange”
- Huixin Wu & Elizabeth LaRue (2015). “Barriers and Facilitators of Health Information Exchange (HIE) Adoption in the United States.” 48th Hawaii International Conference on System Sciences (HICSS) - 10-page pdf on D2L. Good summary in tables.
- Almoaber, Basmah & Amyot, Daniel (2017). “Barriers to Successful Health Information Exchange Systems in Canada and the USA: A Systematic Review,” International Journal of Healthcare Information Systems and Informatics. Volume 12(1). Discussed on slides on D2L. Excellent discussion of the current health systems and issues.
Lecture: On D2L, Week 5.
KEY POINTS: Health information exchange (HIE) is the electronic sharing of clinical information among healthcare organizations to facilitate care coordination and transitions across settings. The primary goal of HIE is to deliver the right information to the right person at the right time.
- The Nationwide Health Information Network (NwHIN), now known as the eHealth Exchange is a set of standards, services and policies to permit secure exchange of data between civilian and federal healthcare entities over the Internet. With those building blocks in place data can originate in an electronic health record (EHR) and be shared with local physicians, other HIOs, as well as state and federal agencies. In turn, data can be directed (pushed) back to the EHR as well.
- Chapter 5 of the Health Informatics book provides a very good history of HIE as well as the different types of HIE, and this was covered in the lecture notes on D2L.
- There are the three types of HIE we discussed in class. Direct, Query-based, and Consumer-Generated. Know what these are.
- Direct was discussed specifically because it played an important role in how messages were sent from one hospital to the next. Know how Direct a secure way to send messages.
- In discussing the challenges to HIE (in the US and Canada), after over two decades of efforts from both the Canadian and the American sides to promote HIE, failures far outnumber successes.
- What are some of the barriers that have an influence on the success of HIE systems in the U.S.? Are they substantially different than the barriers in Canada? It is important to be aware of the many obstacles facing the creation and maintenance of HIOs and state designated entity organizations.
- Also, keep in mind that HIEs are tied to the requirements for Meaningful Use stages 2 and 3.
WEEK 6: HIE AND BLOCKCHAINS
Readings:
- Moving Patient Data is Messy, But Blockchain is Here to Help
- Use of Blockchain in Health IT and Health-Related Research Challenge (view Winners)
- ONC's Shared Nationwide Interoperability Roadmap (pdf)
Videos:
- Posted on lecture slide, D2L, and Class blog.
WEEK 7-8: PATIENT-CENTERED CARE
Readings:
- HI, Ch. 10: “Consumer Health Informatics”
- D Lewis (2011). Multidimensional role of social media in healthcare. Interactions, July-August, pp.17-21
- R. Wachter (2015). Ch. 21, “Personal Health Records and Patient Portals” pp.183-93.
- E. Topol (2015). Ch. 3, “To What Extent are Consumers Empowered?”(Part 1, to the bottom of p.44)
- N. Shute (2011). Patients want to read doctors' notes but many doctors balk. NPR
- Test for Hospital Budgets: Are the Patients Pleased? New York Times, 11/7/11.
Videos:
- “Meet e-Patient Dave” (TedMed, 2011). (story in D. Lewis article cited above)
- “EHRs Can Save Lives: Regina Holliday Story” (story/artwork presented in D. Lewis article cited above)
- Patients Like Me: Jamie Heywood, “What Does Open Research and Medicine Look Like?“ (TedMed talk)
- OpenNotes: The Evidence is In (http://www.opennotes.org)
- Blue Button at the VA
Case: Health Care's Service Fanatics; Cleveland Clinic
There is also general consensus regarding the need to (1) increase the quality of care provided to all patients, (2) increase patient engagement with their providers and the healthcare system and (3) make healthcare services more patient centered. But many of the same obstacles associated with other health information technologies persist. Are the incentives properly aligned to support concepts such as virtual patient visits and personal health records? Patients and physicians alike are not willing to take on another “unfunded mandate” that pushes a new technology without financial support. What about security? Are personal health records, tethered or untethered truly safe from identity theft and hacking?
- Identify the origin of consumer health informatics/PHRs
- Discuss the features and formats of PHRs, including difference between tethered and untethered formats
- What are the different types of social media offered?
- Regarding the many health education and patient information websites, be able to have a general idea of what these websites offer and their differences. These include
- health education sites (e.g., WebMD)
- patient web portals (e.g., ReachMyDoctor)
- personal health record systems
- What is Blue Button?
- Patients First!
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