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Revision as of 17:28, 28 April 2015
Welcome to the OHSU Clinfowiki
The OHSU Clinical Informatics Wiki (aka ClinfoWiki) is the implementation of a wiki website devoted to topics in Biomedical Informatics.
The Department of Medical Informatics & Clinical Epidemiology (DMICE) is one of 27 academic departments in the School of Medicine at Oregon Health & Science University (OHSU). The mission of DMICE is to provide leadership, discovery and dissemination of knowledge in clinical informatics, clinical epidemiology, and bioinformatics / computation biology. This mission is fulfilled through programs of research, education, and service. DMICE programs are recognized internationally for their accomplishment and innovation. The OHSU Biomedical Informatics program is one of the largest of its kind in the world.
Clinfowiki is edited by Vishnu Mohan, M.D., M.B.I., and was created in 2005 by Dean F. Sittig, Ph.D..
To begin a new article, or edit an existing article, you must first create an account and login to the ClinfoWiki. The site can be browsed by anyone.
We are currently working on 1,585 articles, and we need your help to complete this study of Informatics. See Special:Statistics for more complete information on the site.
The Clinfowiki has recently been reorganized into the 20 categories below. When adding (or editing) content, please try to ensure the content traces back to one of these categories.
Contents
- 1 Technologies
- 1.1 Electronic Medical Record (EMR)
- 1.2 Computerized Physician Order Entry (CPOE)
- 1.3 Clinical Decisions Support (CDS)
- 1.4 Personal Health Record (PHR)
- 1.5 Reviews of scientific papers
- 1.6 Integrated Data Repositories (IDR)
- 1.7 Ancillary Systems
- 1.8 Medical Devices
- 1.9 Information Retrieval
- 1.10 Other Technologies
- 2 Applications
- 3 Reference
Technologies
Electronic Medical Record (EMR)
- What is the Electronic Medical Record
- EMR v. EHR
- EHR-enabled Research
- Security of the distributed electronic patient record: a case-based approach to identifying policy issues
Computerized Physician Order Entry (CPOE)
- Computerized Physician Order Entry
- Barcode medication administration
- Electronic Prescribing (E-prescribing)
Clinical Decisions Support (CDS)
- Clinical Decisions Support
- Timeline of the Development of Clinical Decision Support
- The Evolution of Clinical Decision Support
- Decision Support Service
- Effect of Computerized Clinical Decision Support on the Use and Yield of CT Pulmonary Angiography in the Emergency Department
Personal Health Record (PHR)
Reviews of scientific papers
Integrated Data Repositories (IDR)
Ancillary Systems
- Ancillary Clinical Information Systems
- Biobanking -- a.k.a. Biorepositories or Tissue Bank
- Anesthesia Information Management Systems (AIMS)
Medical Devices
- Digital Pathology
- Apple Watch
- Digital Therapeutics
- Glucometers
- Physiologic monitors
- Kiosks
- Omron Wrist Blood Pressure Monitor
- Automated dispensing machines
- Smart infusion pump
- Smart device
Information Retrieval
Other Technologies
- New CIS-related Technologies
- Free and Open Source Software (FOSS) licensing in medicine
- Unintended Consequences of HIT
- i2b2 Informatics for Integrating Biology and the Bedside
- The Cloud and it's impact on Health IT
Applications
Evidence Based Medicine (EBM)
- Evidence Based Medicine
- Rationale, design,and implementation protocol of an electronic health record integrated clinical prediction rule (iCPR) randomized trial in primary care
- Efficacy of an Evidence-Based Clinical Decision Support in Primary Care Practices A Randomized Clinical Trial
Methodologies and Frameworks
- Evaluation and Design Methodologies
- The Journey through Grief: Insights from a Qualitative Study of Electronic Health Record Implementation
- Sociotechnical systems
Government, Public and Private Initiatives
- Health Information Technology Regional Extension Centers (HITREC)
- Regional Health Information Organization (RHIO)
- Nationwide Health Information Network (NwHIN)
- Assistant Secretary for Planning & Evaluation
- Office of the National Coordinator for Health Information Technology (ONC)
- Council on the Application of Health Information Technology (CAHIT)
- Agency for Healthcare Research and Quality (AHRQ)
- Centers for Medicare and Medicaid Services (CMS)
- U.S. Food and Drug Administration (FDA)
- National Institutes of Health (NIH)
- Big Data to Knowledge (BD2K)
- Indian Health Service (IHS)
- Health Services and Resource Administration (HRSA)
- Centers for Disease Control and Prevention (CDC)
- U.S. Department of Commerce
- Combined U.S. Department of Defense / Veterans Affairs Initiatives
- U.S. Department of Defense (DoD) Initiatives
- Department of Veterans Affairs Initiatives
- U.S. Department of Homeland Security
- Healthcare Information Technology Standards Panel (HITSP)
- International perspectives
- UK
- National Electronic Health Record Program in United Kingdom
- All articles resulting from the Blogposium collaboration
- Maternal and Perinatal Quality Care Collaboratives
- EHealth Initiative
- Meaningful use
- Electronic Laboratory Reporting
- Department of Education
Training and User Support
Terminology and Coding
- Glossary of acronyms
- Definition and Use of Interface Terminologies
- Common Terminology Services (CTS)
- Distributed Cognition and Knowledge-based Controlled Medical Terminologies
- Ontology
- International Statistical Classification of Diseases (ICD)
- Systematized Nomenclature Of Medicine (SNOMED)
- International Dietetics and Nutrition Terminology (IDNT)
- International Classification of Primary Care (ICPC)
- Unified Medical Language System (UMLS)
- Aggregated data
Business and Organization
Medicare Advantage
History of Medicare:
Original medicare is a fee for service program where the government pays health care providers directly for Part A (inpatient services) and Part B (outpatient) benefits. It was established in 1966 to address the medical needs of Americans over age 65. It also provides health insurance to younger individuals with disabilities.
Medicare Advantage, or Part C benefits, are offered by private companies approved by Medicare. Medicare plans administered by private companies have been around since the 1970’s, Medicare Advantage was formalized in 2003 through the Medicare Modernization Act.
Segmental payment through 4 different programs:
Medicare Part A is an entitlement, which means that those who are eligible do not have to pay for it. This covers inpatient services at hospitals, nursing homes, home health and hospice care.
Medicare Part B is not an entitlement, which means those that are eligible must pay for it. Average premium is $100/ per month. The premium covers outpatient services such as doctor’s visits, durable medical equipment, physical therapy and mental health.
Medicare Part C (Medicare Advantage) covers both inpatient and outpatient services (C=A+B).
Medicare Part D, which is prescription drug coverage, is usually included in Part C programs. This was established in 2003, also as a result of the Medicare Modernization Act.
Payment structure of Original Medicare and Medicare Advantage:
Both Original Medicare and Medicare Advantage will contract with approved medical providers. These are medical doctors, osteopathic doctors, nurse practitioners and physician assistants. The way providers are paid differ between the two programs. Original Medicare is fee for service - each individual office visit must stand on its own and have supporting documentation in the medical record for that specific visit.
Medicare Advantage pays on a risk adjustment basis. This means more medically complex patients are paid higher premiums. To collect payment on a diagnosis - for example diabetes - the patient must be seen at least one time a year. It must be a face to face visit with one of the four types of providers listed above.
The Center for Medicare and Medicaid Services (CMS) has three risk adjustment structures for Medicare Advantage. All three share a common basic approach of assigning a risk score. The risk score represents the expected cost of the patient normalized to the expected average cost for the population:
1. Part C will assign a “risk score” for chronic diseases such as diabetes, heart disease, HIV infection. Acute catastrophic events such as a heart attacks, strokes or fractures are also assigned risk scores. 2. End stage renal disease will pay for dialysis, kidney transplant and post transplant care. 3. Prescription drug coverage.
Reimbursement rates are set by the federal government on a county-by-county basis using formulas established by CMS. The reimbursement rate is linked to the average cost of caring for Medicare beneficiaries who are enrolled in Part A and Part B in the county. The government has estimated that the typical Medicare Advantage plan collects 12-14 percent more for each member than the cost of caring for a person enrolled in traditional Medicare.
Role of Electronic Health Records:
Many EHR programs can be linked into Medicare formularies. This will avoid searching in a separate source on whether a particular drug is covered. It will also help patients avoid paying more for a non-formulary medications.
Medicare patients tend to be older than that of the general population, thus there are more recommend preventative measures. Examples include colon cancer screening, mammography, blood pressure check, vaccines, cholesterol and diabetes testing. A structured data entry system based on recommendations from the US Preventive Services Task Force can give providers and patients guidance on timely best practice.
Of particular challenge for providers who accept Medicare Advantage patients is collecting at a rate that is reflective of medical complexity. Computerized patient support tools have been designed to capture chronic diagnosis. To use the diabetes example above, the support tools are integrated into electronic health records such that all visits which address diabetes are flagged for billing. At audit only one occurrence per year is needed to justify payment, the single best record to justify diabetes risk adjustment is sent. A robust support tool will also send reminders to patients for chronic condition follow up.
References:
Medicare.gov
Yvonne Zhou, James Wang, Marianne Turley. Impact of Panel Support Tool Use on Quality Outcomes. Kaiser Permanent Northwest. July 2008
Medicarenewsgroup.com
Workflow
- Methods to capture workflow
- Measurement
- Importance of Workflow Analysis During Physician Office EMR Implementation
- Workflow Management System
- Process Mining
- Using Evidence-Based Layout Design to Enhance Workflow in the Clinical Laboratory
- Planning for Radiology CDS Technology
Interface, Usability and Accessibility
- Usability
- Enhancing patient safety and quality of care by improving the usability of electronic health record systems: recommendations from AMIA
- Software Test Documentation
- Data Model to Enhance the Security and Privacy of Healthcare Data
Reference
Academics and Education
- Contributions from OHSU students
- List of Informatics Departments
- Endowed Professorships and Chairs in Health / Medical / Nursing / Biomedical Informatics
- Graduate Medical Education Milestones
Specialites and Disciplines
- Medical Subspecialty Board of Clinical Informatics
- Clinical Informatics Fellowship
- Health informatics
- Nursing informatics
- Imaging informatics
- Consumer health informatics
- Public Health Informatics
- Dental informatics
- Medical laboratory informatics
- Quality Informatics
- Bioinformatics
- Translational Bioinformatics
- Clinical Social Work Informatics
- Pharmacy Informatics
- Clinical research informatics
- Traditional Chinese Medicine (TCM) informatics
Research Groups
Literature
External Links
- Oregon Health & Science University
- The Department of Medical Informatics and Clinical Epidemiology at OHSU
- Website of the Provider Order Entry Team from Oregon Health
- Links to online tools for HIT/RHIO development
- Health Information Technology Dashboard
- Wellness Wiki: Use Evolving Health Information Technology Tools
- eMedicine Physician contributed medical articles and CME
- KMLE Medical Dictionary Medical dictionary and medical related links
- Merck Medicus Contains a significant number of textbook resources (requires free registration
- NLM (US National Library of Medicine)
- WebMD General comprehensive online health information
- Medicine 2.0 Comprehensive online Personal health record information.
- SearchMedica.com Searches medical literature for health care professionals
- AHIMA American Health Information Management Association
- AMIA American Medical Informatics Association
- ANIA-CARING American Nursing Informatics Association and the Capital Area Roundtable on Informatics in NursinG
- HIMSS Healthcare Information and Management Systems
- IMIA International Medical Informatics Association
- Use Evolving Health Information Technology Tools
- Blueprint for an Integrated HIT system - The Patient Life-Cycle Wellness System
- CIRCLE: Clinical Informatics Research Collaborative