Princess Sumaya University for Technology

The King Hussein School for Computing Sciences

Course 13768: Health information systems

Topic 1: Introduction to Health Informatics

Dr. Rafat Hammad

Acknowledgements: Most of these slides have been prepared by Robert Hoyt, Elmer V Bernstam, and William Hersh
and adopted for our course. Additional slides have been
1 added from the mentioned references in the syllabus

Learning Objectives

∗ After reviewing these slides, the viewer should be able to:

∗ Define data, information, and knowledge
∗ State the definition and origin of health informatics
∗ Identify the drivers behind health informatics
∗ Describe the key players involved in health informatics
∗ List the barriers to health information technology (HIT)
adoption
∗ Describe educational and career opportunities in health
informatics
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 M.Sc. in Health Information
Technology
∗ The M.Sc. in Health Informatics aims to equip graduates with
the skills, knowledge and abilities to:
∗ Evaluate the opportunities and limitations of healthcare
technology and of its impact in improving the efficiency, cost-
effectiveness, safety and quality of healthcare delivery.
∗ Express user requirements for healthcare information systems.
∗ Integrate computing and managerial knowledge and experience
with health-related knowledge and experience.
∗ Ensure compliance with the standards and regulations
governing systems in this domain.
∗ Formulate, evaluate and apply evidence-based solutions in the
delivery of healthcare.

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Health Informatics Careers

∗ Chief Medical Information Officer: an executive who is

responsible for overseeing all of an organization’s initiatives
related to health informatics and patient records. While they
can be involved in specific projects, such as software launches
and new process development, they also draft and implement
strategic plans related to the long-term IT infrastructure of the
organization.
∗

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 Health Informatics Careers (cont.)

∗ Clinical Informatics Analysts: compile and analyze health data

and then use that analysis to adjust their organization’s
practices, processes, and workflows to improve patient
outcomes. For example, a hospital that has seen an increase in
post-op readmission rates might turn to a clinical informatics
analyst to identify methods for reducing that rate, which
might be as simple as educating patients on proper wound
care to reduce infections.

Health Informatics Careers (cont.)

∗ Health Information Technology Project Managers: are project

managers who focus specifically on projects related to health
informatics. They are responsible for performing all of the
primary duties of a project manager, including initiating,
planning, executing, monitoring, and closing the project. The
work can be incredibly varied, and the projects often focus on
implementing new technology or optimizing workflows.

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 Health Informatics Careers (cont.)

∗ Health Informatics Consultants: are professionals employed

by healthcare organizations, often on a contract or project
basis. Their job is to advise the organization on all informatics-
related questions, challenges, and initiatives. They typically
assist in a wide variety of projects, including selecting and
installing new software, updating and securing networks,
monitoring and troubleshooting systems and training teams.

Health Informatics Careers (cont.)

∗ Electronic Medical Record Keepers:

∗ Ensure patient records are filled out properly, accurately, and
completely
∗ Assign codes to patient data within electronic medical record
systems
∗ Consult with physicians to ensure the accuracy of patient
record(s)
∗ Collect information for medical researchers and studies
∗ Disperses information to those allowed to receive medical
information such as insurance companies, family members,
guardians etc.
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 Health Informatics Careers (cont.)

∗ Informatics Nurses: are responsible for bridging the gap

between clinical and IT — for example, the role might involve
evaluating a health care facility to determine what clinical IT
applications will help increase efficiency, then training staff
and on any new systems and technology. Informatics nurses
also facilitate communication between IT, vendors and the
staff.

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Healthcare Data

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 Healthcare Data

∗ With the advent of the internet, high speed computers, voice

recognition, mobile technology, etc. healthcare professionals
today have many more tools at their disposal
∗ But, technology is advancing faster than healthcare
professionals can assimilate it into practice
∗ Therefore, there is a new need for education and translation
of emerging technologies and the data/information they
generate into healthcare

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Information Hierarchy

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 Information Hierarchy
(Data)

∗ Data is a raw and unorganized fact that required to be

processed to make it meaningful.
∗ Data are symbols representing observations about the world.
∗ Data can be aggregated into a variety of formats such as
image files (JPG, GIG, PNG), text files, sound files (WAV, MP3)
or video files (WMV, MP4).
∗ There is no meaning associated with data; the 5 could
represent five fingers, five minutes or have no real meaning at
all.
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Information Hierarchy
(Information)

∗ Information is a set of data which is processed in a meaningful

way according to the given requirement. Information is
processed, structured, or presented in a given context to
make it meaningful and useful.
∗ From information, conclusions can be drawn by humans or
computers. For example, five fingers has meaning in that it is
the number of fingers on a normal human hand.

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 Information Hierarchy
(Knowledge)

∗ Knowledge is information that is justifiably considered to be

true. For example, an elevated fasting blood sugar level
suggests an increased likelihood of diabetes mellitus.
∗ Knowledge is really about facts and ideas that we acquire
through study, research, investigation, observation, or
experience.

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Information Hierarchy
(Wisdom)

∗ Wisdom is the critical use of knowledge to make intelligent

decisions. For example, a rising blood sugar can indicate
diabetes and other secondary causes of hyperglycemia.
∗ Wisdom is the ability to distinguish and judge which aspects of
that knowledge are true, right, lasting, and applicable to your
life.

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 Information to Knowledge

∗ A modern way to convert medical information to

knowledge is to use a clinical data warehouse (CDW)
∗ EHRs are now a huge source of healthcare data and
information. They contain both structured (coded e.g.
ICD-9 codes) and unstructured text (free text or
natural language)
∗ Interpreting free text requires natural language
processing (NLP)

Clinical Data Warehouse

∗ A clinical data warehouse (CDW) is a database system that

collects, integrates and stores clinical data from a variety of
sources including electronic health records, radiology and other
information systems.
∗ Data from EHRs, Radiology, Pathology, etc. are copied into a
staging database where they are cleaned and loaded into another
common database and associated with meta data (data that
describes data).
∗ Tools can be applied to the data in the CDW, such as simple
descriptive analytics that reports the number of patients with
breast cancer, their age, menopausal status, etc.

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 Clinical Data Warehouse (cont.)

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Clinical Data Warehouse

∗ CDWs do a better job of analyzing and reporting aggregate

healthcare data than the average EHR, which tends to focus
on the individual
∗ CDWs can be used to evaluate a critical clinical process, cost
estimates and they can analyze potential solutions
∗ CDWs are highly valuable for informatics and evidence
based medical research
∗ CDWs can help track infections and report trends to public
health.

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 Example of CDW schema
(i2b2 platform)
https://www.i2b2.org

∗ Informatics for Integrating Biology and the Bedside (i2b2)

is a Harvard project used by many other academic
institutions in the US
∗ The program is open source and modular and
incorporates genomic and clinical information for research
purposes
∗ Data base consists of facts (diagnoses, lab results, etc.)
queried by users and dimensions that describe the facts
∗ With this model data can be aggregated from multiple
hospitals

i2b2 star schema

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 Concept Extraction

∗ In order to extract concepts from free text in EHRs or

CDWs several systems have been developed. See below

Concept Extractor Gold Standard Precision Recall F-score (F1)

cTAKES17 Mayo clinic 0.80 0.65 0.72

MetaMap20 NLM 500 articles 0.32 0.53 0.40

MEDLEE21 Proprietary 0.86 0.77 0.81

What Makes Informatics Difficult?

∗ With other industries such as banking, data and

information are much closer (smaller semantic gap).
∗ For example, banking data such as $100.50 is close to an
account balance of $100.50. It leaves little leeway for a
different interpretation
∗ In healthcare, there are subjective factors (“I feel sick”)
that are difficult to measure and vary from patient to
patient and physician to physician. Lab results are more
objective and easier to interpret

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What Makes Informatics Difficult?

∗ It is difficult to model all of healthcare. View the HL7 RIM

model on next slide
∗ Biomedical information is difficult due to incomplete,
imprecise, vague, inconsistent and uncertain information
∗ Humans can adapt to this dynamic and vague
information but computers can not. Clinical decision
support in EHRs is precise, when in reality it might need
to be flexible over time

HL7 version 3 RIM model

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 Why Health IT Fails Sometimes

∗ Health IT is an attractive solution to our troubled

healthcare system, but is it realistic?
∗ Other IT fields have experienced serious “ups and
downs” such as artificial intelligence
∗ There is a large gap between healthcare data
generated and information (semantic gap)
∗ Is it too early to expect EHRs and computerization to
change healthcare?

Sources of Healthcare Data

∗ The advent of electronic health records (EHRs) and multiple

other healthcare information systems provided the ability and
the need to collate and analyze large amounts of data to
improve health and financial decisions.
∗ As genetic information collection grows, datasets are huge
(big data) and part of EHRs

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 Sources of Healthcare Data (cont.)

EHR=electronic health records,

PHR=personal health record,
HIE=health information exchange

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Healthcare Big Data

∗ Data so large it can’t be analyzed or stored on one

computational unit.
∗ Five Vs: the definition started with three Vs but has increased
to five:
∗ Volume: massive amounts of data are being generated each
minute
∗ Velocity: data is being generated so rapidly that it needs to be
analyzed without placing it in a database

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 Healthcare Big Data (cont.)

∗ Variety: roughly 80% of data in existence is unstructured so it

won’t fit into a database or spreadsheet. There is tremendous
variety, in terms of the data that could potentially be analyzed.
However, to do this requires new training and tools.
∗ Veracity: current data can be “messy” with missing data and
other challenges. Because of the very significant volume of data,
missing data may be less important than in the past
∗ Value: data scientists now have the capability to turn large
volumes of unstructured data into something meaningful.
Without value, data scientists will drown in data and not
information or knowledge. 33

Avalanche of Healthcare Data

∗ HealthData.gov makes federal datasets available to

healthcare organizations, developers and researchers
∗ Datasets are available in categories: health, state, national,
Medicare, hospital, quality, community and inpatient
∗ Users can use filters: data type, subject, agency, date updated,
coverage period, collection frequency, geographic area,
release date and output format

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 Healthdata.gov

∗ Community Health Status ∗ Fourth National Survey of

Indicators Older Americans
∗ Child Growth Charts ∗ Health Indicators
∗ Health Data Interactive Warehouse
∗ Behavioral Risk Factor ∗ Population (census) (CDC)
Surveillance System (CDC) ∗ Cancer Profiles
∗ Births (CDC) ∗ Archimedes data modeling
∗ Mortality (CDC) and analytics tool
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Health Information Technology

∗ Health information technology (HIT) is defined as the

application of computers and technology in healthcare
settings
∗ HIT is not solely a technical discipline but focuses on the
relationship between the technology and its use in real-world
settings i.e. solutions are designed in context, taking into
account the social, cultural and organizational settings in
which computing and information technology will be used in
healthcare sectors.
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 Health Information Technology

∗ Ideally, health information technology provides the tools to

generate information from data that humans (clinicians and
researchers) can turn into knowledge and wisdom. Thus,
enabling and improving human decision making with usable
information is a central concern of informaticians.
∗ HIT facilitates the processing, transmission and analysis of
information and interacts with many important functions in
healthcare organizations and serves as a common thread.

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Driving Forces Behind Health

Information Technology
∗ Increase healthcare efficiency and productivity
∗ Improve healthcare quality (patient outcomes) resulting in
improved patient safety
∗ Reduce healthcare costs
∗ Improve healthcare access with technologies such as
telemedicine and online scheduling
∗ Improve coordination and continuity of care
∗ Improve medical education of clinicians and patients
∗ Standardize medical care
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 Reducing Errors

∗ Order entry systems

∗ Reduce medication errors
∗ Detect potential drug interactions
∗ Clinical decision support systems
∗ Improve drug dosing
∗ Improve preventive care
∗ Not diagnosis

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Barriers to HIT Adoption

∗ Inadequate time: Busy clinicians complain that they

don’t have enough time to read or learn about new
technologies or research vendors. They are also not
reimbursed to become technology experts.
∗ Inadequate information: clinicians need information,
not data. Current HIT systems are data rich, but
information poor.
∗ Inadequate expertise and workforce: to experience the
widespread of HIT adoption and implementation, it will
require education of all healthcare workers.

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 Barriers to HIT Adoption (cont.)

∗ Inadequate cost and return on investment data: There

is a mismatch between costs and benefits of HIT. The
clinicians/providers bear the costs (and/or do the extra
work), whereas hospitals/insurers/government reap the
benefits.
∗ High cost to adopt: There is still limited evidence that
most technologies will save money.
∗ Change in workflow: Significant changes in workflow
will be required to integrate technology into the
inpatient and outpatient setting.

Barriers to HIT Adoption (cont.)

∗ Privacy concerns: different organizations have different

privacy rules. In the past decade, there have been many
serious healthcare security breaches and stolen
identities.
∗ Legal issues: Some laws prevent hospital systems from
providing or sharing technology such as computers and
software with referring physicians.
∗ Behavioral change: large number of medical personnel
will be slow to accept any information technology
innovations and they will be perceived as dragging their
feet.

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 Health (Medical) Informatics

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Health (Medical) Informatics

∗ Medical informatics is the application of computers,

communications and information technology and systems to
all fields of medicine - medical care, medical education and
medical research.
MF Collen, MEDINFO '80, Tokyo

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 Health (Medical) Informatics

∗ Medical informatics is the rapidly developing scientific field

that deals with resources, devices and formalized methods for
optimizing the storage, retrieval and management of
biomedical information for problem solving and decision-
making.
Edward Shortliffe, M.D., Ph.D. What is medical informatics? Stanford University, 1995.

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Health (Medical) Informatics

∗ Medical Informatics is the branch of science concerned with

the use of computers and communication technology to
acquire, store, analyze, communicate, and display medical
information and knowledge to facilitate understanding and
improve the accuracy, timeliness, and reliability of decision-
making.
Warner, Sorenson and Bouhaddou, Knowledge Engineering in Health Informatics, 1997

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 Informatics Use in Healthcare

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Informatics Use in Healthcare

∗ Communication ∗ Decision Support

∗ Telemedicine ∗ Reminder systems
∗ Tele-radiology ∗ Diagnostic Expert Systems
∗ Patient e-mail ∗ Drug Interaction
∗ Presentations ∗ Information Management
∗ Knowledge management ∗ Electronic Medical Records
∗ Journals ∗ Billing transactions
∗ Consumer Health ∗ Ordering Systems
information
∗ Evidence-based medical
information
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 Healthcare Information Systems

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Information System

∗ An information system (IS) is an arrangement of data

(information), processes, people, and information technology
that interact to collect, process, store, and provide as output
the information needed to support the organization (Whitten
& Bentley, 2007).
∗ Healthcare information system (and hospital information
system)—a group of systems used to support and enhance
healthcare

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 History and Evolution

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Key Users of Health Information

Systems

∗ Patient – the individual who receives healthcare, often called a

consumer or citizen when they are well
∗ Provider – those who “provide” healthcare, e.g., physicians,
nurses, allied health providers
∗ Purchaser – those who buy healthcare, usually employers or
the government
∗ Payor – those who “pay” the healthcare system, i.e., the
insurance companies and government
∗ Public health – protectors of the public’s health
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 Categories of healthcare
Information Systems

∗ There are two primary categories of healthcare information

systems: administrative and clinical.
∗ Administrative Information System (or an administrative
application) contains primarily administrative or financial data
and is generally used to support the management functions
and general operations of the healthcare organization.
∗ Clinical Information System (or clinical application) contains
clinical or health-related information used by providers in
diagnosing and treating a patient and monitoring that
patient’s care. 53

Common Types of Administrative

Information Systems

∗ Admission, discharge, transfer (ADT) tracks the patient’ s

movement of care in an inpatient setting
∗ Registration may be coupled with ADT system; includes
patient demographic and insurance information as well as
date of visit(s), provider information
∗ Scheduling aids in the scheduling of patient visits; includes
information on patients, providers, date and time of visit,
rooms, equipment, other resources

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 Common Types of Administrative
Information Systems (cont.)

∗ Patient billing or accounts receivable includes all information

needed to submit claims and monitor submission and
reimbursement status
∗ Utilization management tracks use and appropriateness of
care
∗ Accounts payable monitors money owed to other
organizations for purchased products and services
∗ General ledger monitors general financial management and
reporting
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Common Types of Administrative

Information Systems (cont.)

∗ Personnel management manages human resource

information for staff, including salaries, benefi ts, education,
and training
∗ Materials management monitors ordering and inventory of
supplies, equipment needs, and maintenance
∗ Payroll manages information about staff salaries, payroll
deductions, tax withholding, and pay status

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 Common Types of Administrative
Information Systems (cont.)

∗ Staff scheduling assists in scheduling and monitoring staffing

needs
∗ Staff time and attendance tracks employee work schedules
and attendance
∗ Revenue cycle management monitors the entire flow of
revenue generation from charge capture to patient collection;
generally relies on integration of a host of administrative and
financial applications

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Common Types of Clinical

Information Systems (cont.)

∗ Laboratory information supports collection, verification, and

reporting of laboratory tests
∗ Radiology information supports digital image generation
(picture archiving and communication systems [PACS]), image
analysis, image management
∗ Pharmacy information supports medication ordering,
dispensing, and inventory control; drug compatibility checks;
allergy screening; medication administration

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 Common Types of Clinical
Information Systems (cont.)

∗ Nursing documentation facilitates nursing documentation

from assessment to evaluation, patient care decision support
(care planning, assessment, flowsheet charting, patient acuity,
patient education)
∗ Electronic health record (EHR) facilitates electronic capture
and reporting of patient’ s health history, problem lists,
treatment and outcomes; allows clinicians to document
clinical findings, progress notes, and other patient
information; provides decision-support tools and reminders
and alerts
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Common Types of Clinical

Information Systems (cont.)

∗ Computerized provider order entry (CPOE) enables clinicians

to directly enter orders electronically and access decision-
support tools and clinical care guidelines and protocols
∗ Telemedicine and telehealth supports remote delivery of care;
common features include image capture and transmission,
voice and video conferencing, text messaging
∗ Rehabilitation service documentation supports the capturing
and reporting of occupational therapy, physical therapy, and
speech pathology services
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 Common Types of Clinical
Information Systems (cont.)

∗ Medication administration is typically used by nurses to

document medication given, dose, and time
∗ Monitoring: Comprised of devices that monitor temperature,
pulse, respirations, blood pressures, oxygen saturation, or
other measures automatically feeding the input into a clinical
information system. Alarms notify caregivers of readings that
are outside the range of “normal”

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Definitions

∗ Electronic Medical Records (EMR)

∗ Electronic Health Records (EHR)
∗ Personal Healthcare Records (PHR)

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 What is EMR software?

∗ EMR in healthcare, which stands for ‘Electronic Medical

Records', is a digitized version of hand-written paper records
maintained at the office of medical specialists.
∗ Such documents include medical diagnosis, treatment, and
prescribed medications aimed at tracking patient data over
time.

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What is EMR software? (cont.)

∗ The main advantage of EMR healthcare data is that it helps

practitioners to receive quick access to the patient’s basic
vitals, including age, weight, blood pressure, and so on.
∗ Based on EMR, medical specialists can provide a more
personalized medical treatment for patients.
∗ While EMR software solutions could be used within a
particular office, doctors can not share this data with other
departments.

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 What is EMR software? (cont.)

[Example of an electronic medical record interface, source: YUKSEL SETHWI]

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What is the EHR software?

∗ EHR, which means ‘Electronic Health Records software.

∗ The main difference between EHR and EMR is that EHR
systems offer much more. EHR systems collect information
about patients from multiple sources, such as hospitals,
physicians, labs, and patients.
∗ Such an approach improves the way patients receive
treatment.

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 What is the EHR software? (cont.)

∗ The advanced features of EHR systems significantly improve

life for both patients and doctors:
∗ Patient portals: a secure website through which patients
can electronically access their medical records. Portals
often also enable users to complete forms online, schedule
∗ appointments, communicate with providers, request refills
on prescriptions, review test results, or pay bills

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What is the EHR software? (cont.)

∗ The advanced features of EHR systems significantly improve

life for both patients and doctors:
∗ Patient portals: a secure website through which patients
can electronically access their medical records. Portals
often also enable users to complete forms online, schedule
∗ appointments, communicate with providers, request refills
on prescriptions, review test results, or pay bills

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What is the EHR software? (cont.)

∗ Electronic prescriptions, transmitted directly to

pharmacies, save patients’ time since all the medicine will
be processed while the patient travels to the pharmacy
from the doctor’s office
∗ Voice-to-text translation and speech recognition saves
doctors’ time rather than having to manually write patient
healthcare information.
∗ Reporting makes it easy to track revenue projections and
provide details on how many patients have paid or failed
to pay their bills. 69

What is the EHR software? (cont.)

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 What is the PHR software?

∗ PHR or ‘Personal Healthcare Records' may seem similar to

EHRs or EMRs. However, the patient is responsible for
updating and keeping all data up to date.
∗ Such data may include past critical information from doctor
visits, medical procedures, medical & lab reports and data, and
even family health history.

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What is the PHR software? (cont.)

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Which one will work for you?

∗ If your healthcare facility has specific expertise in particular

healthcare services, such as dentistry, choose Electronic
Medical Records.
∗ In the case of your medical facility including numerous
departments, such as labs, X Rays, emergency, and surgery,
and you need to provide seamless transactions of patient-
related data across these departments, consider developing
the Electronic Health Records system.
∗ If your healthcare organization puts patients first and needs
to track their recovery progress, Patient Healthcare Records is
your system of choice.
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 Conclusions

∗ Health Informatics is a relatively new and exciting field with

many new educational and job opportunities
∗ Research in health informatics is being published at an
increasing rate so hopefully new approaches and tools will be
evaluated more often and more objectively.
∗ Although technology holds great promise, it is not the
solution for every problem facing medicine today. We must
continue to focus on improved patient care as the single most
important goal of this new field.
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