Medical Informatics Practical Guide for the Healthcare Professional Third Edition Robert E. Hoyt MD FACP Editor Melanie Sutton PhD Ann Yoshihashi MD FACE Associate Editors University of West Florida School of Allied Health and Life Sciences Medical Informatics Program Pensacola Florida Medical Informatics Practical Guide for the Healthcare Professional Disclaimer Every effort has been made to make this book as accurate as possible but no warranty is implied. The information provided is on an “as is” basis. The authors and the publisher shall have neither liability nor responsibility to any person or entity with respect to any loss or damages arising from the information contained in this book. The views expressed in this book are those of the author and do not necessarily reflect the official policy or position of the University of West Florida, Department of the Navy, Department of Defense, nor the U.S. Government. Copyright © 2009 First Edition: June 2007 Second Edition: August 2008 All rights reserved. No part of this book may be reproduced or transmitted in any form, by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the publisher, except for inclusion of brief excerpts in connection with reviews or scholarly analysis. ISBN-13: 978-0-557-13323-9 Published by: Lulu.com Preface to the Third Edition ompiling and editing this third edition has been challenging because of the non-stop changes occurring in Medical Informatics in 2009. In some respects this has been a banner year Cbecause of new opportunities related to the American Recovery and Reinvestment Act. The stimulus package will undoubtedly impact multiple areas of health information technology, to include electronic health records, health information exchanges and informatics research. We have made every attempt to provide the most up to date information about Medical Informatics issues by constantly reviewing the medical and lay literature. Our goal is to present the most recent changes, the most interesting concepts and both sides of each controversy. Our book is intended to be an introduction to the field of Medical Informatics that will entice individuals to go further in their education. In our experience, individuals from all walks of life seem to be interested in this relatively new field. We hope our book will better educate technology workers about clinical issues and better educate clinical workers about technology issues. Given the newness of this field, research may be lacking or inadequate in many areas of Medical Informatics. We have to rely on surveys and expert opinions in many areas. Frequently, this can result in more noise than signal and more hype than fact. We are dedicated to presenting the issues fairly and objectively. Approximately 1200 medical literature references and web links are included in this book that direct readers to more information. While we are vendor-agnostic we are not opposed to presenting interesting hardware and software we think will be of interest to our readers. This will include all relevant open-source initiatives. One of the goals of this book is to promote and disseminate innovations that might help healthcare workers as well as technology developers. The fact we mention specific hardware or software or web-based applications does not mean we endorse the vendor; instead, it is our attempt to highlight an interesting concept that might lead others in a new direction. In our 2009 book we have added new content to each chapter and added chapters on practice management systems and networks. Chapters on electronic health records and mobile technology have been completely redone, reflecting the rapid change in those areas. Also, the HITECH Act as part of the stimulus package is discussed in regards to its impact on Medical Informatics in the first chapter. We hope that you will see interrelationships between the topics mentioned in multiple chapters in this book. Articles written on the use of technology to improve patient care often involve telemedicine, patient safety, patient informatics, disease management and evidence based medicine. Our book’s emphasis will always be on the medical issues that the average clinician or hospital faces, with solutions that are easy to understand. We won’t be reluctant to present the obstacles new innovations face or negative publications written on the subject. If we can introduce you to a single new concept or tool that improves patient care or makes your day easier, we will consider our work successful. We appreciate feedback regarding corrections or future additions. We welcome your input so we can continue to publish the most accurate and up-to-date information. Please note that all proceeds will be donated to the University of West Florida Foundation for the advancement of Medical Informatics education. Robert E. Hoyt MD FACP Melanie Sutton PhD Ann Yoshihashi MD FACE Acknowledgements We would like to express thanks to our families for their patience and understanding during the lengthy process of writing and updating this book annually. We would also like to thanks Kat Irion for her diligent proofreading of this book and Stephanie Reedy for her ability to format and tame all images and tables Editors Robert E. Hoyt MD, FACP Co-Director Medical Informatics Instructor, School of Allied Health and Life Sciences University of West Florida Pensacola, FL Assistant Professor of Medicine Adjunct Assistant Professor of Family Medicine The Uniformed Services University of the Health Sciences Bethesda, MD Melanie A. Sutton PhD Co-Director Medical Informatics Associate Professor, School of Allied Health and Life Sciences University of West Florida Pensacola, FL Ann K. Yoshihashi MD, FACE Guest Lecturer, School of Allied Health and Life Sciences Medical Informatics University of West Florida Medical Analyst Naval Operational Medicine Institute Pensacola, FL Contributors M. Hassan Murad MD, MPH Assistant Professor of Medicine Mayo Clinic College of Medicine Rochester, MN Jane A. Pellegrino, MSLS, AHIP Head, Library Services Department Naval Medical Center Portsmouth Portsmouth, VA Steve Steffensen, MD, LCDR Chief Medical Information Officer Telemedicine and Advanced Technology Research Center Fort Detrick, MD Fred Trotter Director, Liberty Health Software Foundation Houston, TX Brandy Ziesemer, RHIA, CCS Health Information Manager and Associate Professor Lake-Sumter Community College, Leesburg, FL Table of Contents Chapter 1 Overview of Medical Informatics ................................................................. 1 Chapter 2 Electronic Health Records .......................................................................... 29 Chapter 3 Integrated Practice Management Systems ................................................... 63 Chapter 4 Health Information Technology Interoperability......................................... 72 Chapter 5 Networks ................................................................................................... 99 Chapter 6 Patient Informatics ................................................................................... 107 Chapter 7 Online Medical Resources........................................................................ 128 Chapter 8 Search Engines......................................................................................... 145 Chapter 9 Mobile Technology .................................................................................. 162 Chapter 10 Evidence Based Medicine ........................................................................ 184 Chapter 11 Clinical Practice Guidelines ..................................................................... 198 Chapter 12 Disease Management and Disease Registries ............................................ 209 Chapter 13 Pay for Performance (P4P) ....................................................................... 220 Chapter 14 Patient Safety and Technology ................................................................. 231 Chapter 15 Electronic Prescribing .............................................................................. 253 Chapter 16 Telehealth and Telemedicine .................................................................... 267 Chapter 17 Picture Archiving and Communication Systems (PACS) .......................... 284 Chapter 18 Bioinformatics ......................................................................................... 291 Chapter 19 Public Health Informatics ......................................................................... 300 Chapter 20 E-Research ............................................................................................... 308 Chapter 21 Emerging Trends in Health Information Technology ................................ 316 Index…………………………………………………………………………………….330 1 Overview of Medical Informatics ROBERT E. HOYT Learning Objectives After reading this chapter the reader should be able to: • State the definition and origin of Medical Informatics • Identify the forces behind Medical Informatics • Describe the key players involved in Medical Informatics • State the impact of the HITECH Act on Medical Informatics • List the barriers to health information technology (HIT) adoption • Describe the educational and career opportunities in Medical Informatics “I think there is a world market for maybe five computers ” IBM Chairman Thomas Watson, 1943 edical informatics has evolved as a new field in a relatively