Informatics

DR MOHAMMAD AAMIR HALEEM
1ST YEAR RESIDENT, DEPT OF PATHOLOGY,PIMS, KARIMNAGAR, TELENGANA.

1. INFORMATICS. PRESENTED BY : DR. AAMIR 1 ST YEAR RESIdENT PATHOLOGY 22-12-2015

2. It describes the combination of applied and basic sciences to the processing of data and information. The study and practice of data acquisition, storage, processing, retrieval, analysis, and presentation to facilitate workflow and increase the accuracy and value of the information contained within the data. 22-Dec-15 INFORMATICS 2 INTRODUCTION

3. When applied to medically related information term ‘ MEDICAL INFORMATICS ’ is used. Its scope includes clinical and pathological sciences, computer sciences, decision sciences, and information science . 22-Dec-15 INFORMATICS 3

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6. 1.PATHOLOGY INFORMATICS The practice of pathology produces vast amount of data, which are communicated to physicians and others. When this data is processed it becomes information which guides clinical decisions. So to make this data processing more efficient and useful the use of latest technology is put to use. 22-Dec-15 INFORMATICS 6

7. 22-Dec-15 INFORMATICS 7 The data produced by an Pathologist is not simply attaching names to pieces of tissue or report numbers measured by a machine; we provide an assessment which directs the clinical care of the patient . The “final interpretation” is based not solely upon the tissue and/or the results of analysis, but rather is tempered by the clinical setting. We choose the wording of our interpretive reports to trigger t he appropriate clinical response.

8. 22-Dec-15 INFORMATICS 8 T ools to Produce the Data. The histologic image is one of the richest data streams in medicine, and the ability of the pathologist to synthesize and interpret this information is unlikely to be duplicated electronically for some time. Other techniques: immunohistochemistry, flow cytometry, gene rearrangement studies, molecular tests

9. 22-Dec-15 INFORMATICS 9 2.PATHOLOGIST AS AN INFORMATION OFFICER. Pathologist would evaluate information and technology and install and us softwares that would add value to the current data stream passed to the clinician or a laboratory customer . In this regard models have been proposed to include informatics rotations in pathology residency.

10. 22-Dec-15 INFORMATICS 10 A universal theme for this is the development of computer proficiency and skills during this period. Skills include; Understanding of Hardware and Network connections, Ability to use Email and Internet access, Word processing, Software use, Spreadsheets, Use Statistical and graphical tools.

11. 22-Dec-15 INFORMATICS 11 In future informatics will be recognized as a distinct discipline. The pathologist is in unique position to capitalize on the current opportunities because of the long experience of laboratory computerization. For the purpose of being an information officer various laboratory information systems are being used.

12. 22-Dec-15 INFORMATICS 12 3.Common Health Care Enterprise Information Systems . SYSTEM FUNCTIONALITY Admission–discharge–transfer (ADT) Runs the entire patient care workflow, from registration of patient information to bed tracking and discharge Health information system (HIS) Stores patient information generated by different departments during one or more visits. Laboratory Information System (LIS) Electronic data processing and information management functions necessary for laboratory operations Electronic medical record (EMR) A chronologically ordered paperless chart that summarizes the clinical history with diagnostic test results Billing Receives information on charges and/or tests performed to calculate charges to patient insurance

13. 22-Dec-15 INFORMATICS 13 An information system (IS) refers empirically to the hardware, software, and network connectivity designed to p erform data management functions. Different types of ISs are listed in the previous Table. The LIS was classically a standalone insulated system that generated results from manual reporting by pathologist for viewing by the clinician.

14. 22-Dec-15 INFORMATICS 14 4. LABORATORY INFORMATION SYSTEM (LIS) LIS is an information system/software that processes, stores and manages data from all stages of medical processes and tests. Pathologists, physicians and lab technicians use LIS to coordinate varieties of IP and OP medical testing, including hematology, biochemistry, immunology and microbiology.

15. 22-Dec-15 INFORMATICS 15 Basic LIS commonly has features that manage 1. Patient check in 2. Order entry. 3. Specimen processing. 4. Result entry. 5. Patient demographics. The LIS is used to communicate with analyzers and external systems such as the larger health information system (HIS) and/or billing systems.

16. 22-Dec-15 INFORMATICS 16 Today, it is frequently a major part of a health care system network for communication with the patient registration and billing systems and the ( EMR ). The LIS exchanges information with all these systems, and the effectiveness of this exchange is dependent on successful hardware and software implementation. Most LIS constructs have an interface, which is a combination of software and connections that translate electronic messages , so that data can be exchanged with different systems.

17. 22-Dec-15 INFORMATICS 17 LIS ENVIRONMENT.

18. 22-Dec-15 INFORMATICS 18 5. FEATURES OF LABORATORY INFORMATION SYSTEM. ADVANTAGES ACCESS TO INFORMATION: Repetitive access to diagnostic information is required in most departments and areas of hospital/clinics. LIS gives instant access through computer network and improves patient care

19. 22-Dec-15 INFORMATICS 19 TURNAROUND TIME: It’s the time elapsed in specimen collection to reporting of result. An LIS shortens turnaround time by improving processing of specimen, transcription, distribution of results, and billing. PRODUCTIVITY AND FINANCIAL MANAGEMENT: LIS can improve productivity by use as management tool to collect data regarding the work load, turnaround time and potentially, cost accounting.

20. 22-Dec-15 INFORMATICS 20 REGULATORY COMPLIANCE: Compliance with rules and regulations created by accreditation Agencies requires data to be either manually accounted for or to utilize an information system to extract the information. e.g. correlation of biopsy and cytological diagnosis of Sq. cell ca of Cx. LIS allows rapid collection of such data and helps a lab to perform quality assurance.

21. 22-Dec-15 INFORMATICS 21 Ability to access large volumes of data, using and providing the data at several organizational levels is a important function. RESEARCH SUPPORT: The ability to analyze large quantities of data, collected over prolonged period of time is of great value. Databases can be used to perform statistical analysis comparing various parameters. Hence very essential in conducting medical research.

22. 22-Dec-15 INFORMATICS 22 6. HARDWARE The components of LIS are: Central Processing Unit(CPU). It performs the logical commands within the software. CPUs differ in design, functionality, and speed of executing these commands. Speed is designated as MHz or MIPS. Processor is the key to LIS.

23. 22-Dec-15 INFORMATICS 23 Storage device: Electronic storage is a key feature of LIS because it provides a permanent easily accessible record. Terminals: “dumb” terminals (cathode ray tubes ,CRTs) and “smart” terminals (PCs/workstations).

24. 22-Dec-15 INFORMATICS 24 7. NETWORK COMMUNICATIONS Definition of Network as per IEEE “A data communication system allowing a number of independent devices to communicate directly with each other, within a moderately sized geographic area or over a physical communication channel of moderate data rates.” Network uses dedicated or non dedicated communication lines. Dedicated are high speed lines as T1( 1.5Mbps ), T3( 45Mbps ) or Asynchronous transfer mode(ATM 100Mbps ).

25. 22-Dec-15 INFORMATICS 25 Networks are termed as per there geographic separations of its users. “ Wide area network ” or WAN “ Local area network ” or LAN Networks provide a bridge to integrate the laboratory system into an existing information system environment. Primary reason to install a LAN is to improve productivity through automation of routine job functions and improve manageability of information and improved accessibility.

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28. 22-Dec-15 INFORMATICS 28 8. SOFTWARE: The basic functionality of software used is to automate data and information handling in pathology, it includes 1. Registration 2. Demographics(admissions-discharge-transfer[ADT]) 3. Order Entry 4. Entry of results, 5. Printing of reports.

29. 22-Dec-15 INFORMATICS 29 9. SPECIALIZED FUNCTIONS Specialized functions of information system serve anatomic pathology and clinical lab functions. Anatomic Pathology functions: It contains modules or subsections for surgical pathology, cytology and autopsy pathology. Reports are usually composed of narrative descriptions of clinical, gross, and microscopic diagnosis.

30. 22-Dec-15 INFORMATICS 30 Coding mechanisms such as SNOMED( Standardized nomenclature of medicine )(College of American Pathologists, Skokie, Illinois) are used to sub classify cases based on key words in their narrative descriptions. M (Morphology) – Changes found in cells, tissues and organs (M-40000) Inflammation (M-44000) Granuloma (M-54700) Infarcted (M-54701) Microscopic infarct .

31. 22-Dec-15 INFORMATICS 31 F (Function) – Signs and symptoms (F-03003 ) Fever. T (Topography) – Anatomic terms (T-28000) Lung (T-32000) Heart Databases in which the diagnoses have been recorded may be searched by standardized codes by SNOMED These coding systems are less time consuming then natural language searching.

32. 22-Dec-15 INFORMATICS 32 Clinical Laboratory functions: Clinical Laboratory produces high volume of discrete data results that fit into numerical reference ranges or are Positive or Negative. E.g. in Blood Bank a bar code identification system has been implemented for disbursing of blood products.

33. Examples KIDMS

34. 22-Dec-15 INFORMATICS 37 10.INTERFACES Interface is an electronic or mechanical mechanism for data transfer between information systems. e.g. billing interface and an admission-discharge-transfer(ADT) between hospital admitting and LIS Transfer of ADT data to the LIS by means of a network saves lot of time. Its preferable to buy all components from same vendor so that data transfer is more efficient and relaible.

35. 22-Dec-15 INFORMATICS 38 RESULT REPORTING Reporting is done by either Printing reports or by electronic transmission of results to another LIS. Printing of reports may occur based upon the type of patient, either IP ( results are printed in rows and columns format like spreadsheets) or OP( results are printed singly with defined reference range values. Remote printing may also be accomplished by transmission to modem connected printer or through fax.

36. 22-Dec-15 INFORMATICS 39 An emerging and popular feature of the LIS is its ability to perform auto-verification, which refers to release of results from automated analyzers directly to LIS without prior human review. The auto-verification criteria are defined and detailed in LIS tables and specify things such as allowable numeric result range and delta checks (in comparison with previous results).

37. 22-Dec-15 INFORMATICS 40 11.COMMUNICATION STANDARDS The use of conventions and definitions to standardize information exchange between different systems is a less complex and time-consuming strategy than the traditional creation of custom interfaces between such applications . For this purpose, coding of laboratory procedures using Current Procedural Terminology (CPT ) and coding of medical conditions using the International Classification of Diseases have been the norm.

38. 22-Dec-15 INFORMATICS 41 The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes . There are three types of CPT code: Category I, Category II, and Category III.

39. 22-Dec-15 INFORMATICS 42 Codes for evaluation and management: 99201–99499. (99201–99216) Office/other outpatient services. (99217–99220)Hospital observation services. (99221–99239) Hospital inpatient services. (99241–99255) Consultations. Codes for pathology and laboratory: 80000–89398. (80000–80076) organ or disease-oriented panels. (88104–88199) cytopathology. (88230–88299) cytogenetic studies. (88300–88399) surgical pathology.

40. 22-Dec-15 INFORMATICS 43 One example of a newer, and currently the most prevalent, standard developed by the health care industry is Health Level 7 (HL7) which is a protocol for electronic data exchange that specifies syntax and rules for messaging. Another standard is Logical Observation Identifier Names and Codes, which is a set of universal identifiers for laboratory test code data fields within HL7 messages and in databases.

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42. 22-Dec-15 INFORMATICS 45 12.SELECTION OF AN INFORMATION SYSTEM. Evaluation of current needs and operations Understanding current needs and operations of laboratory is essential for proper selection of an LIS. Financial considerations , cost analysis and cost justification studies need to be considered .

43. 22-Dec-15 INFORMATICS 46 Tangible B enefits Time saved in performing specific tasks which include 1. Specimen processing. 2. Results reporting. 3. Administration and management. Intangible Benefits Decreased turnaround time. Improved report formats. Increased access to results.

44. 22-Dec-15 INFORMATICS 47 Reduced transcription errors. Reduction in duplicate resting. Printing of pending lists & overdue lists. Access to data for research. Computer proficiency etc.

45. 22-Dec-15 INFORMATICS 48 13. EVALUATION AND SELECTION OF AVAILABLE SYSTEMS New vendors are entering the market constantly and there are few established vendors. So selection becomes an arduous task. Few publications provide annual lists and updates on LIS vendors including, CAP today, Healthcare Informatics, and Medical Laboratory Observer(MLO).

46. 22-Dec-15 INFORMATICS 49 17. LEGAL REQUIREMENTS A number of regulatory/accrediting bodies are pertinent to LIS constructs The legal requirements for LISs involve issues such as unique specimen and patient identification, date of specimen collection , date and time of specimen receipt in the lab, records and dates of all specimen testing , personnel who performed the test(s), and the name and address of the laboratory where testing was performed .

47. 22-Dec-15 INFORMATICS 50 Security is of paramount concern when it comes to transferring patient data many times over a network. To comply with HIPAA (Health insurance portability and accountability act), all laboratories should have safeguards in place to ensure that patient data are accessed only by appropriate individuals in appropriate circumstances. This is essential not just with transfer of data between information systems, but also with electronic correspondence (e.g., e-mail), which laboratory personnel frequently use.

48. 22-Dec-15 INFORMATICS 51 14.T HE F UTURE OF I NFORMATICS With the emergence of new technologies, especially in the realm of bioinformatics , the roles of pathologists and of the laboratory will undoubtedly be redefined over time. Microfluidic instrumentation is being applied to common laboratory techniques, essentially providing a “lab-on-a-chip ” solution that allows a patient-centric approach to testing, and may eventually perform at levels comparable to centralized analyzers.

49. 22-Dec-15 INFORMATICS 52 EMERGING TECHNOLOGIES . SPEECH RECOGNITION; Computerized speech recognition allows computers to transform spoken words into text or to recognize spoken words to execute commands with a computer program. IMAGE MANAGEMENT; Digital images can be captured by various techniques. Insight into this technology can be drawn from experience in the radiology department.

50. 22-Dec-15 INFORMATICS 53 CONCLUSION With all these developments taking place, the traditional role of the pathologist as one who provides data and interpretation to the clinician from which a therapeutic decision will be made will be expanded to include informatics design and management. The pathologist will have to use informatics tools that span different diagnostic methods to integrate all available data and produce an outcomes-based treatment recommendation for optimal patient care.

51. 22-Dec-15 INFORMATICS 54 THANK YOU

52. 22-Dec-15 INFORMATICS 55 REFERENCES Richard A. McPherson, MD, Matthew R. Pincus, MD, PhD, HENRY’S Clinical Diagnosis and Management by Laboratory Methods, Twenty Second Edition. Ivan Damjanov, James Linder, ANDERSON’S Pathology, Tenth Edition. Julie- Gai B. Harris 1 RN, GradCertHlthSci (CDM), Clinical Data Manager. Claire F. Snyder, PhD,* Albert W. Wu, MD, MPH , Robert S. Miller, MD, Roxanne E. Jensen, PhD, Elissa T. Bantug, MHS, and Antonio C. Wolff, MD. The Role of Informatics in Promoting Patient-Centered Care. Internet Sources.