Information Systems in Healthcare Research Assignment Paper (Coursework Sample)

Information systems in Healthcare
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As a concept in health care, electronic health record (EHR) is relatively new and it has been fueled through advance in technology around the world. In fact, EHR is increasingly dependent on technology as it involves health care providers storing as well as retrieving detailed information about a particular patient. This may involve storing and retrieving patient information during hospitalization, over time, as well as across health care settings. The aim of EHR involve the need to develop support systems to aid health care providers in their decision making process with respect to information and knowledge availability. What is more, EHR help hospitals to monitor advance, as well as report information regarding health care quality as well as safety. The implication is that EHR encompasses a variety of functionalities as well as information such as progress notes, patient demographics, lab data, e-prescribing, care alerts, past medical history, medications, and scheduling among others.
Two examples
ASTM’s Continuity of Care Record (CCR)
This represents a patient- centered record utilized by health care practitioners to determine the kind information deemed most significant in the health of patients at specific times. Indeed, CCR is increasingly focused on the kind of data that is required when a health care provider is necessitated to engage background information in delivering the best quality care to clients (CorePoint Health, 2016). In addition, a physicians group concerned with developing a standard generated CCR in Massachusetts (USA). In particular, CCR was developed with the aim of solving the issue of portability as well as to provide a patient-centered record for health care providers. This means that it is often viewed as a snapshot in time, organized and interoperable, as well as generated by a health care provider with the aim of aiding the next practitioner to access such information. A consortium of health care organizations was involved in developing the CCR including American Medical Association, ASTM, Patient Safety Institute, American Academy of Family physicians, and others.
CCR is associated with a number of key aspects including core data set. In fact, the CCR provides a core data set of the most vital information for a specified period. According to CorePoint Health (2016), some of the sections contained within the core data set includes CCR header. This part has data required to recognize the referred as well as referring health care provider. This also includes the date as well as clinical purpose as to why the document was developed. The other section making up the core data set involves patient identifying information, which includes data necessary to recognize the referred patient from admission via discharge and any additional contacts that may aid in providing the best care. It can be said that this feature is the most crucial simply because it facilitates the identification of a patient throughout the transfer process, which may involve transitioning from and o hospital, physician office, clinic, and home nursing environments.
In addition, another feature within the core data set involves patient’s insurance as well as financial information. This section often lists the patient’s commercial insurance or Medicare data including such elements as date of birth, member identification, and insurance company name. The other aspect attached to the core data set involves patient’s health status, which lists such crucial data elements as diagnosis, issues and conditions, alerts, ongoing medications, vital signs, procedures or examinations, as well as lab outcomes. This section is followed by care documentation, which includes detailed information about the clinician-patient encounter background including name of providers and the data/time of visits (Tessier et al, n.d). In addition, care plan recommendation section is a core element that includes scheduled examinations, procedures, as well as care regimes. It must be noted that CCR is still being developed and additional core features are likely to be incorporated including disease management and enterprise and institution specific information extensions.
HL7 s Continuity of Care Document (CCD)
CCD is an outcome of a collaboration between ASTM International and Health Level 7 (HL7), and its main aim was to address the gap between those using ASTM CCR and those who use HL7 Clinical Document Architecture (CDA). Nevertheless, the collaboration between the two bodies resulted in a standard that is increasingly compatible with existing systems and other standards that are similarly constructed (CorePoint Health, 2009). CCD was introduction keeping in mind that it would encourage as well as facilitate the groups of EHR systems and the utilization of electronic information exchange among care providers, which is crucial to care quality, safety, and efficiency. It must be noted that as care providers increasingly embrace electronic data exchange, universal standard emerges as an issue with regard to connectivity. The implication is that finding a standard that enables wide implementation as well as universality is of paramount significance, and CCD is increasingly designed to address this challenge. Indeed, CCD allows for broad compatibility and relatively easy assimilation into technologies as well as standards.
A major feature that is associated with CCD involves CDA elements even as the data tends to be defined through CCR. CCD utilizes a set of templates for CDA elements to develop the standard, and these templates define the manner in which to utilize CDA characteristics with respect to clinical data communication. CCD templates include such elements as header, problems, alerts, family history, advance directives, immunizations, vital signs, as well as results among others (CorePoint Health, 2009). As an example, medications element is made up of ongoing and relevant patient medication history. Optionally, this may involve complete medication history including the medication list source. Identifying information source and if it reports intended or actual medication use facilitates resolution of conflicting data from various sources. Nonetheless, other elements such as medical equipment describe implanted or external medical devices or equipments that a patient’s health may be dependent. This may include device history and other vital information contributing to overall health care success.
As far as easy integration is concerned, HL7 CDA RIM based specifications making up CCD base are widely attuned with current browsers, applications, and emergency medical records. In fact, any standard and document that has similar patterns including emerging forms of public safety reports and IHE specifications are plug- and-play with respect to using CCD. This means that users barely engage in any form of configuration task. What is mor...