062/100 《Contemporary Health Informatics》第二章

作者:信息科学    来源:未知    发布时间:2019-12-18 22:27    浏览量:


Meaningful Use

Three objectives:

  1. Certified EHR are used.
  2. Health information is being exchanged.
  3. clinical quality measures are being collected and submitted.

Meaningful use is undergoing 3 stages. Stage 1 & 2 are defined and Stage 3 is proposed.



How Did Healthcare Evolve

The invention and availability of antibiotic meds changes the morbidity of human being. Infectious disease are not leading cause of death any more. People live longer and adapt to a more sedative life style, together these causes the increasing prevalence of chronic diseases. all these drives up the cause of the healthcare.

Technology (e.g. CAT, MRI) also drives up the spending. Also, people used to pay for the care by themselves, but nowadays, the insurance companies and government programs are paying a big chunk of the whole cost.

Cost is high but the return is not so good.

Accountable Care

Studies showed that "Pay-for-Performance" approach of incentive might improve the quality of care. these led to the Physician Group Practice (PGP) project by Medicare. PGPs receive incentives (from Medicare) by achieving benchmark quality performance. They receive additional bonus if they can provide better care AND lower the cost. Marshfield Clinic get more bonus because (one of the reason) they established a fully functional electronic health record (EHR) system.PGP led to Accountable Care organizations (ACOs).

Basic requirements of ACOs is enrolling 5000 Medicare beneficiaries.

Characteristics of ACOs: Still paid-for-service, but receive bonus based on improvement of quality and savings of costs. Formation of the ACOs are self administered. They use more community resources (pharmacies, home care) and adopt HIT.

Pioneer ACOs give preferences to organizations with advanced HIT capabilities.

Summary of the book

Part I: Problems and Policies

Chapter 1 The US Healthcare Systems

Electronic Health Records:

The use of electronic records can reduce some human error: E.g. pharmacist misreading physician's handwriting and giving patient wrong meds.

Key elements of Contemporary HIT:

EMR is the foundation. Personal Health records (PHR) and HIE allowing the secure and private sharing of protected health data. EHR is build on EMR PHR and HIE to manage patient data for providers. Care Coordination Systems are needed to enable communication and data sharing among different providers and their EHR systems. The ultimate goal is to build Databases for Second Use to collect and store health data for research.

The Challenge of Chronic Disease

Acute medical problems: Often kill people in short amount of time if untreated. E.g. infections (H1N1, flu), fractions (e.g. car accident). -- The US healthcare system is good at this.

Chronic medical problems: Incurable, but can be managed so patients can avoid complications and live a better life. E.g. Obesity, Hypertension, diabetes, etc. They will:

  • last for the rest of the patient's life
  • they can cause each other
  • They usually have a behavioural cause

about Obesity: 1) The largest behavior causing chronic disease is Obesity(吃货们注意了). 2) Obesity can cause other problems: type II diabetes, heart failure, hypertension, some cancer. 3) The greatest single cause of rising healthcare cost is the rising prevalence Chronic disease

We need a system of "continuity of care" which to address wellness and prevention of chronic diseases.

Why coordinated Care?

It's the need of effective and efficient management of chronic diseases. The key is to coordinating care among many physicians involved in patient care.

Clinical information systems are not new insight. The development of EMR systems started in 1970s, but the adoption rate of the these types of systems were very low. One of reason is that there is no financial incentives for doing so.

A Brief Review of the Current US Healthcare System

The root of the problem: the current healthcare system is designed to treat acute medical problems but 84% of the spendings it for chronic disease.

The US healthcare system typically adapts a fee-for-service model. The healthcare providers are paid for providing services no matter what the outcome is. and there is no incentive for care coordination, wellness or prevention.

Incentive payments

Providers who adopted certified EHR and achieved meaningful use are qualified for incentive payments from Medicare or Medicaid.

The incentive payments are based on when a provider enrolls and achieves the three stages of Meaningful Use.

As of March 2015, 86% eligible hospitals and 73 eligible professionals received incentive payments.

70% adopters of EHRs reported 1) administrative, financial and clinical benefits and 2) improved clinical communications. But not everyone are happy about their EHR systems.

急性医疗问题,我的理解就是你的了短时间内不治疗就会死亡的那种。比如非典那样的传染病,车祸这样的意外。而慢性病也会死人,但不是马上死。如果调养得当,也能活很长时间。一般的慢性病的例子,高血压高血脂肥胖,糖尿病。一些先天的遗传病也可以归入这里面去。这些病,目前没治,只能维持。之前在《The World Until Yesterday》的读书笔记里也提到了现代人的各种慢性病的行为成因,如有兴趣,不妨与这篇同读。

New Care Models Require Health Informatics to succeed.

Patient Centered Medical Home (PCMH): Team-oriented approach to care, primarily for chronic diseases; continuous involvement with the patient between physical visits and widespread use of HIT.

HIT is crucial for PCMH, however, different systems are not designed to be "interoperable" so they can not share data seamlessly.


Intro to Health Informatics 第一周课程笔记

2015-08-30 初稿



Stage 1:

measurement category # of measures
core measures 15 (all mandatory)
menu set measures 5 of 10
clinical quality measures 6 of 41 (3 mandatory)

Core measures are divided into 4 groups:

  • Improve quality, Safety, and efficiency, and reduce health disparities
  • Engage patients and families
  • Improve care coordination
  • Privacy and security

Menu set measures can also be divided in the similar groups.

Under quality, Safety, and efficiency, a report listing patients of a specific condition must be provided as surveillance data.

图片 1

Contemporary Health Informatics


Case Study: informatics for improved use of medications.

Superscripts, allows physicians prescribe medication and send the prescription to the pharmacy of patients' choice electronically. All physicians who use the system can get the patient's medication list when they see them. So they will not make duplicate orders or prescribe anything that will interact with the meds that the patients are currently taking.

It's convenient to patients because then don't need to drop off their prescription by themselves any more.

这本书是我正在上的一门课 Intro to Health Informatics的教材。教材的内容与课程的内容相对应。读这本书目的是对这门课进行预习,然后做一些读书笔记以备以后复习之用。读书笔记和课程笔记之间会有重复的地方,但是,学习过程就是一个不断重复的过程呀。

图片 2

Contemporary Health Informatics


还有一些对美国医疗保险制度和健康信息科学的看法,我写在了Intro to Health Informatics 第一周课程笔记里面。这里不多写了。

第二个方面是实现有意义的使用(meaningful use)。光买了系统,放在那里不用,是从政府拿不到钱的。正是这个Meaningful use这里,分了三步。

The Problems

The US healthcare system is very good at acute care, AKA "rescue care". E.G. the mortality rates for Heart Attack, Major Trauma are low in the US when compared to other developed countries.

But the US healthcare system has its own problems

  • High cost: probably the highest in the world, both in absolute $ number and percentage of GDP.
  • Cost are rising faster than other countries.
  • Return on investment are poor: People die younger in the US than citizens in other advanced countries
  • Health disparities within the country: E.g. infant mortality rate is higher in African Americans.
  • Many people do not have health insurance.
  • The US face huge future spending increase in healthcare.
  • The US healthcare system is more attuned to the management of acute than chronic conditions.
  • The system is not effective or efficient: Each of the agent (e.g. pharmaceutical company, physician) of the system has its own interest
  • No one is in charge of the system, so no one is taking responsibility
  • Perverse financial incentives: physicians makes more money if they prescribe more test, labs. Alternative pay-for-performance.


other Models

<this section is more about private sector?>

Health maintenance Organizations (HMOs): One goal is to lower medical cost, use less expensive forms of care. it is a form of "managed care", a Primary Care Physician (PCP) is required as a "gate keeper" for access of specialists.

HMO is early adopters of Health information technology (HIT) to audity physicians' performance.

HMO do incent physicians based on the quality of the care but also focus on if they keep the cost low. it's not a "pay-for-performance" model.

Accountable care organizations (ACOs). ACOs are very much like HMOs but they accept more physician by making them accountable.<it seems to me that ACOs are something between traditional PPOs and HMOs.>

See also

Intro to Health Informatics 第二周笔记.

2015-08-31 初稿

Stage 2

Stage 2 raised the bar of quality measures similar to those in Stage 1. And it focus on patient access to their data. Viewing, Downloading or Transmitting (VDT) directly or via API count as measurements.

图片 3

Stage 2 encourages User engagement: VDT

Summary of the book

Part I: Problems and Policies

Chapter 2 Current US Federal Policies and Initiatives

Incentives in healthcare, the models of care and the adoption of health information technology (HIT) are connected.

Roughly, 20% percent of Medicare patients have five or more chronic diseases and they account for half of all Medicare costs. In an average year, such a patient sees about 14 providers and s/he faces a logistics problem from the point of view of IT professional.

It's more challenging for PCPs. One typical PCP often sees about about 6 such patients, send them to about 86 providers, and keep connection with about 229 providers for all patients. The logistics needs are more complex for physicians.

The more physician one patient sees, the more errors might emerge because the lack of coordination among physicians. unavailable tests, duplicate test orders or prescriptions, information sharing failures...

EHR certification

EHR must be verified by the National Institute of Standards and Technology(NIST).

EHR systems should do three things:

  1. record key data (demographic and clinical health information)
  2. Provide tools to measure and improve care quality
  3. Protect confidentiality, integrity and availability of data.

Details about the three criteria:

图片 4

  1. record key data

图片 5

  1. Provide tools to measure and improve care quality

图片 6

  1. Protect confidentiality, integrity and availability of data.

EHR systems must be able to change status of problems based on input (ICD codes or SNOMED CT codes) and provide quality reporting.


Stage 3

Stage 3 is proposed but not approved yet. For more information about stage 3, please see Intro to Health Informatics 第二周笔记.

Policy Overview

In 2004, George W. Bush set a 10-year goal for universal computerization of health records and created Office of the National Coordinator for Health IT (ONC). ONC has funded some research and projects to develop and promote HIT and health information Exchange(HIE). HIE has a focus on data sharing between different HIT systems.

In 2009,Health Information Technology for Economic and Clinical Health(HITECH) Act was passed. It provides funding to providers who adopt EMR.

In 2010, Patient Protection and Affordable Care Act was passed. It started to change the financial incentives in healthcare.

The goal of these two act: universal adoption of HIT by 2014 and changing healthcare to outcome-based incentives.

HIT adoption is implemented in three parts:

  • EHR certification: minimal acceptable requirements of EHR, if met the requirements of Meaningful Use, would qualify for incentive payments
  • Meaningful use: what to do with EHR to qualify incentive payments;
  • Incentive payments: how to apply for incentives if met the requirement of EHR certification and Meaningful use.


Quality Measurement in Healthcare

A working definition of healthcare quality: Healthcare quality measure should indicate the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.

Process measure: e.g. whether a test for a problem done?

Outcome measure: e.g. whether the problem controlled?







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