This textbook begins with an introduction to the US healthcare delivery system, its many systemic challenges and the prior efforts to develop and deploy informatics tools to help overcome those problems. It goes on to discuss health informatics from an historical perspective, its current state and its likely future state now that electronic health record systems are widely deployed, the HL7 Fast Healthcare Interoperability standard is being rapidly accepted as the means to access the data stored in those systems and analytics is increasing being used to gain new knowledge from that aggregated clinical data. It then turns to some of the important and evolving areas of informatics including population and public health, mHealth and big data and analytics. Use cases and case studies are used in all of these discussions to help readers connect the technologies to real world challenges. Effective use of informatics systems and tools by providers and their patients is key to improving the quality, safety and cost of healthcare. With health records now digital, no effective means has existed for sharing them with patients, among the multiple providers who may care for them and for important secondary uses such as public/population health and research. This problem is a topic of congressional discussion and is addressed by the 21st Century Cures Act of 2016 that mandates that electronic health record (EHR) systems offer a patient-facing API. HL7’s Fast Healthcare Interoperability Resources (FHIR) is that API and this is the first comprehensive treatment of the technology and the many ways it is already being used. FHIR is based on web technologies and is thus a far more facile, easy to implement approach that is rapidly gaining acceptance. It is also the basis for a ‘universal health app platform’ that literally has the potential to foster innovation around the data in patient records similar to the app ecosystems smartphones created around the data they store. FHIR app stores have already been opened by Epic and Cerner, the two largest enterprise EHR vendors. Provider facing apps are already being explored to improve EHR usability and support personalized medicine. Medicare and the Veteran’s Administration have announced FHIR app platforms for their patients. Apple’s new IOS 11.3 features the ability for consumers to aggregate their health records on their iPhone using FHIR. Health insurance companies are exploring applications of FHIR to improve service and communication with their providers and patients. SureScripts, the national e-Prescribing network, is using FHIR to help doctors know if their patients are complying with prescriptions. This textbook is for introductory health informatics courses for computer science and health sciences students (e.g. doctors, nurses, PhDs), the current health informatics community, IT professionals interested in learning about the field and practicing healthcare providers. Though this textbook covers an important new technology, it is accessible to non-technical readers including healthcare providers, their patients or anyone interested in the use of healthcare data for improved care, public/population health or research.
Author(s): Mark L. Braunstein
Edition: 1
Publisher: Springer
Year: 2018
Language: English
Pages: 314
Dedication
Foreword
Comments
Foreword
Preface
About This Book
Acknowledgments
Contents
Part I: Perspective
Chapter 1: A Brief History and Overview of Health Informatics
1.1 Introduction
1.2 Early Electronic Records and Clinical Decision Support
1.3 Health Information Exchange
1.4 The Interoperability Challenge
1.5 Exciting and Potentially Transformational Times
1.6 A Pivotal Point
Chapter 2: The US Healthcare System
2.1 Introduction
2.2 High Costs, Mediocre Results
2.3 The Uninsured Can Raise Costs by Delaying Treatment
2.4 The Payment Model
2.5 Alternate Payment Models
2.6 Wasteful Healthcare Spending
2.7 Chronic Disease Drives Most Costs
2.8 Alternate Care Models: Health Maintenance Organizations (HMOs)
2.9 Alternate Care Models: The Patient Centered Medical Home (PCMH)
2.10 Alternate Payment Models: Accountable Care Organizations (ACOs)
2.11 The Role of Health Informatics in ACOs
2.12 A Learning Healthcare System
2.13 Informatics for a Learning Healthcare System
2.14 Recap
Chapter 3: Health Informatics in the Real World
3.1 Introduction
3.2 The Hospital EHR Adoption and Functionality Challenge
3.3 The Similar Provider EHR Challenges
3.4 Health Information Technology for Economic and Clinical Health Act (HITECH)
3.5 Health IT Certification
3.6 Meaningful Use
3.7 Beyond Meaningful Use
3.8 Physician EHR Satisfaction
3.9 EHR Challenges
3.10 A Universal Health App Platform
3.11 Innovative EHR Functionality
3.12 Recap
Part II: Beyond Direct Patient Care
Chapter 4: The Empowered Patient
4.1 Introduction
4.2 Personal Health Records
4.3 A Personally Controlled Health Record (PCHR)
4.4 PHR Exercise
4.5 Medlio’s FHIR App
4.6 CareEvolution’s FHIR Based PHR
4.7 Apple’s FHIR-Based Health App
4.8 The CMS Blue Button 2.0 API
4.9 OpenNotes
4.10 PatientsLikeMe®
4.11 Telecare
4.12 Recap
Chapter 5: Health Information Exchange
5.1 Introduction
5.2 The Interoperability Challenge
5.3 Clinical Information Modeling Initiative: CIMI
5.4 Applicadia Video
5.5 Semantic Interoperability Through Machine Learning
5.6 Interoperability and Meaningful Use
5.7 HIPAA
5.8 Privacy
5.9 Security
5.10 Trust
5.11 Blockchain in Healthcare
5.12 Health Information Exchange: Direct
5.13 Health Information Exchange: HL7 Messaging
5.14 Health Information Exchange: Semantic Interoperability
5.15 The Federated Model
5.16 The Utah Health Information Network
5.17 The OneFlorida Clinical Research Consortium
5.18 CommonWell Health Alliance®
5.19 Georgia Tech’s Health Data Analytics Platform (HDAP)
5.20 Data Lockers
5.21 HIE Challenges
5.22 The Future of Health Information Exchange
5.23 Final Thoughts
Chapter 6: Payer Applications of FHIR
6.1 Interoperability in the Payer Space
6.2 The Da Vinci Project
6.3 Future Uses of FHIR by Payers
6.4 Recap
Part III: Interoperability Essentials
Chapter 7: Data and Interoperability Standards
7.1 Introduction
7.2 Why Standards?
7.3 Standards Structure and Purpose Evolution
7.4 Standards Technology Evolution
7.5 The Key Data Standards
7.6 International Classification of Diseases
7.7 Current Procedural Terminology (CPT)
7.8 Logical Observation Identifiers Names and Codes (LOINC)
7.9 National Drug Codes (NDC)
7.10 RxNorm
7.11 SNOMED Clinical Terms (SNOMED-CT)
7.12 Recap
Chapter 8: Pre-FHIR Interoperability and Clinical Decision Support Standards
8.1 Introduction
8.2 HL7 Evolution
8.3 HL7 V2 Versus V3
8.4 Reference Information Model (RIM)
8.5 RIM and FHIR
8.6 Clinical Document Architecture Uses RIM
8.7 C-CDA Templates
8.8 Clinical Decision Support
8.9 Dr. Homer Warner’s HELP System
8.10 MYCIN
8.11 INTERNIST
8.12 Arden: A Standard for Medical Logic
8.13 Arden Explained
8.14 Contemporary Tools for CDS Authoring and Dissemination
8.15 Recap
Chapter 9: FHIR
9.1 The Origins of FHIR
9.2 Grahame’s Philosophy
9.3 FHIR Modules
9.4 FHIR Resources
9.5 FHIR Resource Representations
9.6 FHIR Resource Examples
9.7 FHIR Resource Activity
9.8 FHIR Extensions
9.9 FHIR Resource IDs
9.10 FHIR Enabling Existing Systems
9.11 FHIR API
9.12 FHIR Profiles and Graphs
9.13 FHIRPath
9.14 Public FHIR Servers
9.15 FHIR Recap
Chapter 10: SMART on FHIR
10.1 A Grand Challenge
10.2 The Evolution to SMART on FHIR
10.3 SMART on FHIR Technology Stack
10.4 Developer Support
10.5 OAuth2
10.6 Scopes and Permissions
10.7 OpenID Connect
10.8 SMART App User and Access Authorization
10.9 SMART Backend Services
10.10 CDS Hooks
10.11 Specifying Quality Measures and Clinical Logic for Decision Support
10.12 FHIR Genomics
10.13 Recap
Part IV: New Frontiers
Chapter 11: mHealth
11.1 The Role of Patients in Preventing and Managing Chronic Disease
11.2 Does mHealth Produce Positive Results?
11.3 mHealth Data Quality
11.4 The FDA
11.5 AliveCor
11.6 Device and App Interoperability
11.7 Commercial mHealth Data Integrators
11.8 Open mHealth
11.9 Open mHealth Tools
11.10 Apple’s HealthKit
11.11 Recap
Chapter 12: Public and Population Health
12.1 Introduction
12.2 The Roots of Public Health
12.3 Public Health Today
12.4 Electronic Mortality Reporting
12.5 The Future of Public Health
12.6 Population Health
12.7 popHealth®
12.8 A FHIR Solution for Population Level Diabetes Care
12.9 FHIR Bulk Data Protocol
12.10 Recap
Chapter 13: Analytics and Visualization
13.1 Health Data at Scale
13.2 Big Data
13.3 Real World Data
13.4 Data Aggregation
13.5 Research Using the OHDSI Network
13.6 OHDSI Use Case 1: Risk of a Serious Drug Side Effect
13.7 OHDSI Use Case 2: Care Pathways
13.8 Different Questions and Methods
13.9 Children with Complex Chronic Conditions
13.10 i2b2 Introduction
13.11 i2b2 Based Federated Research
13.12 ResearchKit and ResearchStack
13.13 Genomics Research Networks
13.14 Recap
Postscript
Useful Web Tools and Resources
Glossary of Terms and Acronyms
Index
