Scarlat, MD Electronic Health Record

A Systems Analysis of the Medications Domain
Erscheinungsjahr 2012
ISBN: 978-1-4665-5922-6
Verlag: Taylor & Francis
Format: EPUB
Kopierschutz: Adobe DRM (»Systemvoraussetzungen)

E-Book, Englisch, 399 Seiten

An accessible primer, Electronic Health Record: A Systems Analysis of the Medications Domain introduces the tools and methodology of Structured Systems Analysis as well as the nuances of the Medications domain. The first part of the book provides a top-down decomposition along two main paths: data in motion—workflows, processes, activities, and tasks in parallel to the analysis of data at rest—database structures, conceptual, logical models, and entities relationship diagrams.

Structured systems analysis methodology and tools are applied to: electronic prescription, computerized physician order entry, drug dispensation, medication administration, and clinical decision support. Assuming no previous clinical and/or informatics knowledge, the book supplies a comprehensive view of the EHR/EMR with dedicated chapters on: user interface considerations, reporting requirements, and standards and vocabularies for meaningful use.

Containing clear language and more than 170 figures and 100 review questions with answers—this book is a great companion for Healthcare IT professionals and an ideal resource for clinical informatics students.
Praise for the book:

… a common sense guide to this new world of informatics … should prove invaluable to the clinician making his/her way past the commercial hype into the realm of true understanding of the systems of medical informatics. … strongly recommended ….
—William F. Bria MD, CMIO Shriners Hospitals for Children, President of the Board, Association of Medical Directors of Information Systems

Finally, here’s a textbook that the market and the industry have been looking for. The author has captured the details of the information flows involved in the EHR while processing an order or prescription from inception to completion.
—Joseph T. Finn, RPh, MBA

… a thoughtful and well-constructed manual to understanding and incorporating the complex and many-sided aspects of medication concepts … a clear and accessible entry to this challenging topic.
—Don Martin, Managing Consultant

. encompasses high-value, high-volume therapeutic transactions of indescribable complexity that touch nearly every licensed professional in a hospital … I’m hoping the vendors of my own hospital’s systems take its recommendations to heart.
—Mr. HIStalk, Healthcare IT Blogger

…. a very useful guide … provides the necessary detail that is often missing in many books… very useful in health informatics education at universities and courses within community colleges.
—Jane M. Brokel, PhD, RN

… a welcome and valuable addition to the toolkit for IT professionals and clinicians participating in the design or implementation of EHR systems.
—Christine Greifzu, RN-BC, MBA, MSIS

Zielgruppe

Clinicians; physicians, nurses, pharmacists, C-level administrators and other healthcare professionals involved in the implementation of E.H.R. technology; IT professionals: software engineers; architects, data and process modelers, project managers, database administrators, analysts and testers working in the healthcare environment either on the vendor or provider side; academic programs in healthcare informatics; IT consultants.

Autoren/Hrsg.

Scarlat, MD, Alexander

Fachgebiete

• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Medizintechnik, Biomedizintechnik, Medizinische Werkstoffe
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Medizinische Mathematik & Informatik
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Telemedizin, e-Health
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizin, Gesundheitswesen Krankenhausmanagement, Praxismanagement

Inhaltsverzeichnis

Short Primer on Structured Systems Analysis
What Is a System?
Why Systems Analysis?
Why Structured Systems Analysis?
Processes and Data
Dataflow Diagram
Entity Relationship Diagram
Normalization
Data Dictionary
Functional Primitives Specification
Balancing the Models

The Medications Domain Workflows and Data Structures
Context Diagram
DFD 0
Workflow Responsibility
Data Model
Conceptual Model Step 1
One Brand—Many Packs
One Pack—Many Items
One Drug—Many Forms and Many Routes
One Drug Item—Many Ingredients and Strengths
National Drug Code
One Ingredient—Many Brands
One Ingredient—Many Classes
One Class—Many Ingredients
One Class—Many Parents and Many Children
Tall Man Letters
Conceptual Model Step 2
One Pack—Many Indications
One Ingredient—Many Contraindications
Dosing Types
Intermittent versus Continuous
Dose Units
Time Units
Frequency
Duration
SIG
Precaution
Not All Concepts Are Entities
Conceptual Model Step 3
The Patient Is Uniquely Identified
The Clinician Is Uniquely Identified
Medication Life Cycle
One Medication Life Cycle—Multiple Statuses
One Patient—Many Prescriptions, Orders, Dispensations, and Administrations
One Clinician—Many Prescriptions, Orders, Dispensations, and Administrations
One Prescription (Order, Dispensation, Administration)—Many Items
Not Indicated Is Not Equal to Contraindicated
The Actual Dose Has a Quantity
Dosing Regimens
Actual Dose May Be Different from the Recommended One
Drug Name and Other Parameters May Change during Medication Life Cycle
Half Tablets
Daily Dose versus Maximal Dose
Not All Drug Parameters Are Clinically Relevant

Prescribe/eRx
Processes
DFD 1 Prescribe Workflow
DFD 1.1 Communicate Prescription
DFD 1.2 Review Patient Data
DFD 1.3 Select Drug
DFD 1.4 Select Dose
DFD 1.5 Consider Formulary
DFD 1.6 Sign Rx
Controlled Substances
Data Elements
Prescription-Related Communications
Patient Medications
Patient Non-Drug-Related Parameters
CDS
PBM
Patient’s Preferred Pharmacies

Order/CPOE
Processes
DFD 2 Order Workflow
DFD 2.1 Communicate Order
DFD 2.2 Review Patient Data
DFD 2.3 Select Drug
DFD 2.4 Select Dose
DFD 2.5 Consider Formulary
DFD 2.6 Sign Order
Reuse Considerations
DFD 2.7 Use Order Set
DFD 2.8 Reconcile Meds
Data Elements
Internal Data Store
External Actors
Multiple Destinations for One Drug Communication
Multiple Physical Measurements
BMI and BSA
Conditional and Sequential Complex Orders
Patient A/D/T Settings Location and Time Frames
Data Exchange with External Actors

Dispense/ePharmacy
Dispense Workflow
Automated Dispensing Cabinet
Processes
DFD 3 Dispense Workflow
DFD 3.1 Communicate Dispensation
DFD 3.2 Review Patient Data
DFD 3.3 Select Drug
DFD 3.4 Select Dose/Prepare
DFD 3.5 Consider Formulary
DFD 3.6 Dispense/Deliver
Data Elements

Administer/eMAR
5 Rights
Processes
DFD 4 Administer Workflow
Bar Code Medication Administration
Smart Pumps
Drug Storage
DFD 4.1 Communicate Administration
DFD 4.2 Review Patient Data
DFD 4.3 Select Drug
DFD 4.4 Select Dose/Prepare
DFD 4.5 Interact with Storage
DFD 4.6 Administer/Sign
Data Elements
Calculation of Dosing Parameters for a Continuous Drip

User Interface
Usability
Cognitive Load
Principles of Graphic Excellence
Characteristics of a Clinical Story
Cause and Effect
Titrate to Effect
Parallel Channels of Information
UI Main Elements
Time Axis
Caution: The Direction of Time Axis
Parameters Axis
Caution: Hidden Information
Tabular Versus Graphical Display of Data
Number of Clicks and Data Density
Trends Are Nice, but Where Are the Numbers?
Layers of Information
Review Patient Data: Ambulatory UI
Refill a Medication
Modify a Medication
Prescribe a New Medication
Order Set
Medication Administration
Medication Reconciliation

Clinical Decision Support
What Is CDS?
Types of CDS
Why Is CDS Needed?
Clinical Decision Characteristics
Trustworthy Medical Information
CDS Configuration
CDS Adaptability
CDS—A Binary Classification System
False-Positive versus False-Negative Alerts
Medication Errors
Medication CDS
Dialog Paradigm
Automated CDS Algorithm Outline
Processes
DFD 5 CDS Workflow
DFD 5.1 Filter Drug
DFD 5.2 Adjust Dose
DFD 5.3 Consider Demographics
5.3.1 Consider Age
5.3.2 Consider Gender
5.3.3 Consider Weight, Height
5.3.4 Consider Ethnicity
DFD 5.4 Consider Patient Condition
5.4.1 Consider Indication & EBM
5.4.2 Consider Allergy and C/I
5.4.3 Consider Adverse Reaction & Side Effect
5.4.4 Consider Pregnancy and Lactation
5.4.5 Consider Drug-Lifestyle
5.4.6 Consider Drug-Vital
5.4.7 Consider Drug-Procedure
DFD 5.5 Consider Patient Drugs
5.5.1 Consider Interaction
5.5.2 Consider Duplicate Therapy
5.5.3 Consider Alternative
5.5.4 Consider Setting
5.5.5 Consider IV Admixture
DFD 5.6 Consider Lab
5.6.1 Lab Affect Drug & Dose
5.6.2 Monitor Lab
5.6.3 Drug Interfere with Lab
DFD 5.7 Educate
Data Elements
Temp CDS Drug
Temp CDS Dose
Precaution
Drug Interaction
IV Admixture
Dose Adjustment
Monitor Drug Lab
Drug Interfere Lab
Barriers to CDS Adoption
Recommendations
CDS and Genomics: Personalized Medicine

Report
Motivation
Types of Reports
Measuring Healthcare Quality
Goals for the Healthcare System
Dimensions of Quality Measures
Evaluating Quality Measures
Organizations Involved in Quality Reports
PQRS and MU Measures
Anatomy of a Quality Measure
Reporting Methods
Medications Reports
Data Warehouse
Data Mining
CDS versus Reports
Processes
DFD 6 Report Workflow
DFD 6.1 Report on Single Patient
DFD 6.2 Report on Multiple Patients
Data Elements

Interoperability Standards and Vocabularies
Interoperability
Open Systems Interconnection Model
Language and Ontologies
Interfaces
Rocket Science Standards
U.S. Government and MU
Qualities of a Modern Clinical Terminology
Healthcare Standards Organizations
EHR Standards and Vocabularies
Medications Standards and Vocabularies
Processes
DFD 7 Update/Sync Workflow
HIE/Regional Health Information Organization/HUB
Data Elements
Discrete Data Elements
Semistructured Documents
Appendix
Acronyms List
Answers to Review Questions
Index
Each chapter includes a Summary, References, and Review Questions

Über Autor(innen)

Alexander Scarlat, MD is board certified in Anesthesiology. He has practiced medicine for 18 years and holds a degree in Computer Sciences. Dr. Scarlat has a strong background in healthcare informatics, working for more than two decades with vendors in electronic health records R&D and with hospitals implementing healthcare information technology. Fluent in both medical and IT languages, he is a knowledgeable and experienced liaison between clinicians and IT specialists.