Standards of dental

informatics, security issues,

privacy and costs
Dr Ebtissam Al-Madi
Why are standards important in
medical informatics?
Promote consistent naming of individuals,
events, objects, etc.
Allow better use of data for patient care,
quality assurance, research, etc.
Enhance ability to transfer data among
applications, allowing better system
integration
Benefits and limitations of
standards
Benefits
Interoperability
May allow innovation based on common
foundation
Limitations
Dominance by one segment of industry:
Microsoft standards, e.g., Windows,
Office, etc.
May stifle innovation
The standards development
process
Groups agree to informal specifications
Single vendor controls industry
Government agency creates standard
and mandates its use.
Interested parties work in open process
International Organization for
Standardization (ISO)
http://www.iso.org/iso/home.html

ADA Standards Committee on Dental
Informatics (ADA SCDI)
http://www.ada.org/prof/resources/stand
ards/informatics_reports.asp#a1031


International standards bodies
Medical informatics standards
1. Identifiers
2. Transactions
3. Message exchange
4. Terminology
1. Identifiers
Various approaches have been
proposed for
Patients
Providers
Employers
Health Plans
Patient identifiers
Unique only one person has a
particular identifier
Non-disclosing discloses no personal
information
Permanent will never be re-used
Ubiquitous everyone has one
Canonical each person has only one
Invariable will not change over time
Patient identifiers
Benefits
Easy linkage of records
Facilitate health information exchange
Reduce errors and costs arising from duplicate
records
Medical record identifier errors compromise
quality of care and can be costly
Cost increases with length of time error not
identified
Risks
Easy linkage of records
Potentially compromise privacy and
confidentiality
2. Transactions
Transaction standards are designed to
encourage electronic commerce for
health claims.
HIPAA (Health Insurance and privacy
act) mandates use of these standards
for health care business electronic data
exchange

Administrative simplification
Transactions standards cover
Health claims and equivalent encounter
information
Enrollment and disenrollment in a health
plan
Eligibility for a health plan
Health care payment and remittance
advice
Health plan premium payments
Health claim status
Referral certification and authorization
Coordination of benefits
3. Message exchange standards
Allow data and application interoperability
Major standards include
Health Level 7 (HL7)
Digital Imaging and Communications
(DICOM)
IEEE
NCPDP and SCRIPT
ELINCS
Continuity of Care Record (CCR)
4. Terminology standards
Benefits of computerization of clinical information
depends upon its normalization
Clinical language is inherently vague, which is at
odds with the precision of computers
Computers have no intelligence
Computers can only do what programmers and
users tell them to do
Computers process numbers and symbols very
fast and accurately
Computers have extraordinarily great memory
It is up to humans to define the meaning or
semantics of information represented in a compute

Standardized terminology
Information capture documenting
findings, conditions, and outcomes
Communication transferring
information
Knowledge organization classification
of diseases, treatments, etc.
Information retrieval accessing
knowledge based information
Decision support implementing
decision support rules
PRIVACY, CONFIDENTIALITY,
AND SECURITY: BASIC
CONCEPTS
Personal privacy vs. the common
good
Personal privacy is important.
Common good of society is more
important.

Where do your views fit?
Privacy right to keep things to yourself
Confidentiality right to keep things
about you from being disclosed to
others
Security protection of your personal
information
Security Issues
Who owns information?
How is informed consent implemented?
When does public good exceed
personal privacy?
What conflicts are there with business
interests?
Problems of Poor security
Patients avoid health care
Patients lie
Providers avoid entering sensitive data
Providers devise work-arounds
Disclosure problems continue
Security for paper records
Difficult to audit trail of paper chart
Fax machines are easily accessible
Records frequently copied for many
reasons
New providers, insurance purposes
Records abstracted for variety of
purposes
Research
Quality assurance
Insurance
Technologies to secure
information
Deterrents
Alerts
Audit trails
System management
precautions
Software
management
Analysis of
vulnerability
Obstacles
Authentication
Authorization
Integrity
management
Digital signatures
Encryption
Firewalls
Rights management

Protected health information
(PHI)
Name
Address (street address, city,
county, zip code)
Names of relatives
Names of employers
E-mail address
Fax number
Telephone number
Birth date
Finger or voice prints
Photographic images

Social security number
Internet protocol (IP) address
Any vehicle or device serial
number
Medical record number
Health plan beneficiary
number
Account number
Certificate/license number
Web URL
Any other unique identifying
number, characteristic, or code

Costs of Informatics
Health IT costs and return on investment (ROI)
What do I get back (return) for the money I'm
being asked to spend (investment)?
Cost-benefit defined
Ratio of money value of benefit divided by cost
Cost-benefit in the outpatient setting
Increased time for first 4 months but thereafter saved time
that was either spent seeing more patients or reducing work
hours
Only a few practices implemented comprehensive quality
improvement efforts, usually when insurers paid explicitly for
it
System payback achieved at average of 2.5 years.
Factors associated with success included
Near complete use of system functions
Having local EHR champion and supportive practice culture

Cost-benefit in integrated delivery
setting
Laboratory and radiology order entry
Reduction of time spent processing orders
Pharmacy order entry
Reduced adverse drug events
Improved cost savings through better formulary
compliance
Documentation
Reduction in cost due to use of structured
documentation in outpatient setting
Overcoming the economic obstacles
Centrally funded.
Grants
Financial incentives
Tie into quality of care initiatives
This weeks assignments
Log on to
http://faculty.ksu.edu.sa/ealmadi/182DEN/default.as
px
1. View this lecture online for review.
2. Read article
3. Participate in discussion.
4. Submit Homework
5. Answer Quiz.




View Read Discuss Homework
Quiz
Thank you
Dr Ebtissam Al-Madi
ealmadi@ksu.edu.sa