Database Characteristics and the Language of Health Information Systems (HIS module 4, case)
Paper details
1.For this Case Assignment, you will be assuming the role of a lead person on a technology review committee at a multifacility regional hospital. Your committee has been tasked with evaluating the plausibility and possible selection of a new Health Information System that will enable the hospital to electronically collect and share patient medical history information among its various hospital centers and departments.
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2.Currently, each hospital center maintains paper copies and files of patient records, which are separately managed and stored at each facility. Few of the electronically based information systems are integrated between the various centers and locations.
3.To add to the challenge, the CIO informs you that most of the members on the committee have limited experience with information systems and databases. However, the CIO is aware that you are studying Health Informatics, so she has asked you to help familiarize the committee with fundamental concepts related to database systems and relevant health information standards.
4.Specifically, the CIO (and your professor) request that you prepare a brief overview of the following:â—¦Fundamentals of database characteristics and structure.
â—¦Various types of medical data and information records relevant to this project.
â—¦The importance of uniform terminology, coding, and standardization of the data.
â—¦Various information standards and organizations that may be applicable, and possibly required, for this project.
5.In addition, search the Internet and find three healthcare information systems vendors that offer electronic medical record products. Compare and contrast the functions and features of each product and barriers to implementation (financial, physical, and personnel).
6.Remember, your committee mostly comprises clinicians and other healthcare practitioners. Accordingly, they do not have a great deal of technical knowledge related to information systems.
7.Submit your assignment by the end of this module.
Assignment Expectations
1.Your references and citations should be consistent with a particular formatting style such as APA.
2.Your response should be based on reliable and scholarly material, such as peer-reviewed articles, white papers, technical papers, etc. Do not include information from non-scholarly materials such as wikis, encyclopedias, or www.freearticles.com (or similar websites).
3.Your response should incorporate the outcomes of the module with the requirements of this assignment.
4.The paper should not exceed three pages.
Program Learning Outcome #2 “ Emphasis
The MSHA program learning outcome progression will be assessed by and within three signature assignments across three courses: MHA506 (Case 1), MHM514 (Case 4), and MHA599 (Case 5), on three levels: Introduced, œReinforced, and œEmphasized.
These three assignments build upon each other and enable us to see how well you are developing and attaining the program learning outcome: œEvaluate multiple or competing perspectives/options, and recommend an appropriate administrative plan or course of action for a healthcare problem or issue.
The rubric below has been developed to measure student success in meeting the modular assignment expectations related to the learning outcome, and similar rubrics are included in the other two courses.
Domain
Assignment Expectation(s)
Weak
Marginal
Adequate
Strong
Identification
Identify 3 health care information system vendor that offer electronic medical record products.
Failed to identify 3 health care information systems vendors that offer electronic medical record products.
Identified 3 health care information system vendors but failed to provide necessary elaboration.
Identified 3 health care information system vendors but the descriptions of the vendors and products were underdeveloped and lacked credible support by the literature.
Identified 3 health care information system vendors. The descriptions of the vendors and products were thoroughly discussed and supported by the literature.
Evaluation
Evaluate basic features, functions and attributes associated with three information systems.
Failed to demonstrate the ability to evaluate basic features, functions and attributes associated with three information systems.
Identified basic features, functions and attributes associated with three information systems; however, no evidence that critical evaluation was conducted.
Conducted an evaluation of the basic features, functions and attributes associated with three information systems; however, lacks specificity and proper support from the literature.
Provided a clear and logical evaluation of the basic features, functions and attributes associated with three information systems and supported these evaluations with credible and relevant literature.
Recommendation
Based on your evaluation of basic features, functions and attributes associated with three information systems recommend what systems and respective standards are most relevant for the committee to consider.
Failed to present recommendations regarding what systems and respective standards are most relevant for the committee to consider.
Presented recommendations regarding what systems and respective standards for the committee to consider were not clearly relevant.
Presented recommendations regarding what systems and respective standards for the committee to consider were clearly relevant, but lacked proper support from the literature.
Presented recommendations regarding what systems and respective standards for the committee to consider were clearly relevant. The recommendations were well thought-out and supported by relevant and credible literature.
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BACKGROUND INFORMATION:
Module Overview
There is a need to describe healthcare concepts in a consistent manner. We as humans are able to assimilate, without confusion, many variations of descriptions. Computers, on the other hand, are very poor at recognizing concepts from inconsistent descriptions.
A preferred term is an agreed-upon short description of a concept, and a concept is the image created by the words that describe it. However, in some cases a definition of a concept may still be needed. This is because, too often, the wording of a preferred term means something different to different users.
A unique identifier (or code) for each concept is required. Anything would do, as long as it is unique and suitable. If a preferred term is used, its description should not be changed; however it does sometimes happen. Accordingly, a preferred term is generally not suitable as a code. In fact, words are not efficient ways to store identifiers in computers, as the computer may be required to store an identifier many times. Therefore, the code should be reasonably œcompact, preferably a œnumber of some sort. Using a number is not an issue, because the computer can always display equivalent descriptive words that are seen by the users.
Coding is the process of matching a healthcare entity to a term in a terminology and assigning it a code. The terminology may be called a coding system. Sometimes rules are offered to improve the accuracy of coding. These rules are commonly known as standards.
In this module, we will explore the language of Health Informatics. We will examine database fundamentals and types of health information data and records, and explore standards used to ensure the information is understood across various systems and disciplines.
This module covers a large amount of area and material. Do not get overwhelmed by trying to dig too deeply into the technical aspects. Indeed, each area can be an entire field of technical study of its own. Instead, focus on the concepts, application, and purpose surrounding structured data and standards as they relate to healthcare information.
Carefully read through the following material, which describes the fundamentals of databases, and their structure and function. Fundamental Database Characteristics1
Eric McCreath provides a well-illustrated and concise overview of database fundamentals in the following presentation: Database Basics Presentation2
The following slide presentation identifies various types of medical data and records. Presentation by Peter Szolovits, MIT (February, 2002). Nature of Medical Data3
There are many standards guiding the format and use of healthcare-related information. The following is a comprehensive list and review of these standards. It is not necessary to memorize every one of them. Instead, just get a sense for the vast number of standards that exist. Pay particular attention to those standards that reference Health Level Seven (HL7) and Unified Medical Language System (UMLS). Review of Healthcare Information Standards4
The following is a list of Standards Organizations. Standards Development Organizations5
Read through this overview of the Unified Medical Language System. UMLS6
Jiang Bo provides a good overview of Health Level Seven (HL7) in this presentation. HL77
Sources Referenced Above
1.Beaumont, R. (2000). Database and Database Management Systems. Retrieved August 12, 2009, from http://www.fhi.rcsed.ac.uk/rbeaumont/virtualclassroom/chap7/s2/dbcon1.pdf
2.McCreath, E. (2002). Lecture Notes for COMP1200: Perspectives on Computing, Information Systems Database Basics. Retrieved August 8, 2007, from http://cs.anu.edu.au/student/comp1200/lectures/10.2-1up.pdf
3.Szolovits, P. (2003). Nature of Medical Data. MIT, Intro to Medical Informatics: Lecture-2. Retrieved on August 12, 2009, from http://groups.csail.mit.edu/medg/courses/6872/2003/slides/lecture2-print.pdf
4.Blair, J. S. (1999). An Overview of Healthcare Information Standards, IBM Healthcare Solutions. Retrieved August 12, 2009, from http://lists.essential.org/med-privacy/msg00186.html
5.Health Level Seven: Links to Standards Developers. Retrieved August 9, 2009, from http://www.hl7.org/standards/developer.htm
6.Unified Medical Language Fact Sheet. (2003). National Library of Medicine: Office of Communications and Public Liaison. Retrieve August 12, 2009, from http://www.nlm.nih.gov/pubs/factsheets/umls.html
7.Bo, J. (2003). Health Level Seven Overview Presentation. Bioinformatics Institute.
Fact Sheet
National Library of Medicine: Office of Communications and Public Liaison (July 2003)
http://www.nlm.nih.gov/pubs/factsheets/umls.html
Background
In 1986, the National Library of Medicine (NLM), began a long-term research and development project to build a Unified Medical Language System (UMLS®). The purpose of the UMLS is to aid the development of systems that help health professionals and researchers retrieve and integrate electronic biomedical information from a variety of sources and to make it easy for users to link disparate information systems, including computer-based patient records, bibliographic databases, factual databases, and expert systems. The UMLS project develops œKnowledge Sources that can be used by a wide variety of applications programs to overcome retrieval problems caused by differences in terminology and the scattering of relevant information across many databases.
Development Strategy
The project is directed by a multidisciplinary team of NLM staff. NLM encourages broad use of the UMLS products by distributing quarterly editions free of charge under a license agreement. The Knowledge Sources are iteratively refined and expanded based on feedback from those applying each successive version.
UMLS Knowledge Sources
There are three UMLS knowledge sources:
UMLS Metathesaurus®
SPECIALIST Lexicon
UMLS Semantic Network
The Metathesaurus provides a uniform, integrated distribution format from over 100 biomedical vocabularies and classifications (the majority in English and some in multiple languages) and links many different names for the same concepts. The Lexicon contains syntactic information for many terms, component words, and English words, including verbs, that do not appear in the Metathesaurus. The Semantic Network contains information about the types or categories (e.g., œDisease or Syndrome, œVirus) to which all Metathesaurus concepts have been assigned and the permissible relationships among these types (e.g., œVirus causes œDisease or Syndrome). NLM also distributes associated lexical programs and software helpful in producing customized versions of the UMLS Metathesaurus. Annual editions of the Metathesaurus have been distributed since 1990.
There have been significant additions and changes to the UMLS Metathesaurus and the SPECIALIST Lexicon, which should improve their usefulness for many applications. For example, the normalization process used by norm has been changed to allow multiple normalized forms when an input form could be an inflection of more than one base form. This scheme allows a more linguistically motivated uninflection algorithm.
The œMetamorphoSys software has been improved and is useful in producing customized versions of the Metathesaurus. œMetamorphoSys facilitates exclusion of any vocabulary for which an additional license arrangement has not been negotiated, or to exclude vocabularies inappropriate to the purposes of the UMLS user.
UMLS Applications
NLM and many other institutions are applying the UMLS Knowledge Sources in a wide variety of Applications including patient data creation, curriculum analysis, natural language processing, and information retrieval. NLM™s own applications include PubMed®, the NLM Gateway, ClinicalTrials.gov, and the Indexing Initiative.
An issue of NLM™s Current Bibliographies in Medicine series, Unified Medical Language System (UMLS) covers the structure and semantics of the UMLS Knowledge Sources, their development and maintenance, and assessments of their coverage and utility for particular purposes, and the full range of UMLS applications. It contains 280 citations covering the period from January 1986 through December 1996. More recent references can be found by searching for Unified Medical Language System on MEDLINE ® /PubMed.
Obtaining the Knowledge Sources
NLM does not charge for the UMLS products. They are available to U.S. and international users. Requestors must sign and submit a License Agreement for the Use of UMLS Products. Licensees are responsible for complying with the restrictions on use of the contents of the UMLS Metathesaurus detailed in the agreement. Some uses of some vocabularies contained in the Metathesaurus require separate agreements with the producers of the individual vocabularies.
All the Knowledge Sources are available to licensed UMLS users via the Internet from the UMLS Knowledge Source Serverwhich has a Web interface and an applications program interface (API). ASCII relational files by ftp are available from the Server and may also be requested on CD-ROM. A complete description of the Knowledge Sources and their distribution formats can be found in the UMLS Documentation.
A complete list of NLM Fact Sheets is available at:
(alphabetical list) http://www.nlm.nih.gov/pubs/factsheets/factsheets.html
(subject list): http://www.nlm.nih.gov/pubs/factsheets/factsubj.html
