Electronic Health Records
Foundation of Clinical Informatics (INLS 725)
Dr. Javed Mostafa
Tuesday & Thursday, 11:00-12:15PM
304 Manning Hall
Carolina Health Informatics Program (CHIP)
iSchool @ Carolina
University of North Carolina at Chapel Hill
Course Description
Healthcare has changed dramatically in the last few years whereby the use of digital tools and platforms is no longer an option but a basic requirement to offer optimal services to patients and support the day-to-day operations of core service units (including financial and administrative). A key driver has been the move toward an analytics-anchored organization, often referred to as the learning health system, which implies a sustained development of an organization based on smart use of evidence across full-range of the care organization. A basic pre-requisite for evolving toward a learning organization is comprehensive, continuous and accurate data collection and transforming the data to actions that match best practices and guidelines.
Electronic Health Record systems (EHRs) fit the latter milieu in a critical manner as they are the principal tools health organizations rely on to collect data and also support evidence-based care services. Beyond supporting primary services in day-to-day care settings, the data platform a modern EHR provides also can directly support interactions with patients, through the patient portal, and interfacing with a wide variety of wearable devices and tools that can collect patient-reported-data and outcomes (e.g., sleep patterns, blood pressure measurements, blood sugar levels, etc.). Social determinants of health outcome (SDHO) data are increasingly becoming critical to determining health conditions and can assist providers to improve diagnosis and treatments. SDHO data are also becoming important to payors in predicting care costs and managing care plans.
EHRs are also becoming important to long-term care quality assessments and refining enterprise-scale care provision approaches to ensure a good balance in work-load and optimizing the care so that patients receive the best care at the right time. EHRs are also becoming a powerful tool to ensure appropriate shift-in-care or care handoffs when a large group of providers are involved -- driving proper care coordination. Post-discharge, tracking of patients and compliance also demand a good interfacing with the base EHR platform used by the health care organization. As care payment models evolve, the reliance on care quality data and compliance become even more important -- particularly at the cohort and population health levels. Finally, a major secondary use of EHR data now is support for advanced biomedical research and translational projects that help learning health organization remain at the forefront of patient care.
In this class we will focus on EHR as a comprehensive platform to support best-in-class evidence-based care and as the core component for big data analytics to help the care organization adapt and transform itself into a learning organization. We will focus on a large number of health data architectures, data standards, quality assessment, and work-flow methods. A key aspect of the course is a project which involves an in-depth focus on collecting quality data and analyzing the data to improve care delivery. The project will involve direct interactions with patients and providers and learning to apply usability methods in the context of evaluating health care systems.
Objectives include learning about the following areas and engaging in related activities:
o EHR data architectures, data structures, and system use work-flows
o Data management, ware houses, and analytics platforms
o Clinical decision support and link to evidence-based care
o Secondary use of data, quality assessment and improvement, and research use of data
o Devices and patient-driven personalization systems
o Governance and medical data security
o Practical experience with EHR tools and applications
Course Requirements
* Project (Group Effort)
- 5% Topic Selection and Overview Presentation
- 5% Abstract and Outline
- 10% Draft of project report submission (emphasizing usability data)
- 30% Final Project Report
* 35% Take-home final exam
* 15% Class participation: Activities in class, regular attendance, and contributions to class list
Grading
Based on current UNC grading scales, the following grades and corresponding numeric ranges are applicable:
Graduate Students
Grad Grade |
Range |
H |
95-100 |
P |
80-94 |
L |
70-79 |
F |
69 or below |
Honor Code
All students are expected to follow general classroom decorum and respect the rights of everyone to have a safe and collegial environment for learning. Violations of general academic practices and norms will not be tolerated. Please refer to the Carolina Honor system to learn more about basic academic expectations at UNC at Chapel Hill: https://studentconduct.unc.edu/honor-system.
Do not hesitate to contact the instructor at any time if you have any questions about the honor system and related matters.
Required Text-book
Electronic Health Records: Understanding and Using Computerized Medical Records
Gartee, R. Pearson. 2017.
A version is available for rent from Amazon.com. This is the version we are recommending for this class.
Additional Recommended Books
Electronic Health Record: Standards, Coding Systems, Frameworks, and Infrastructures. Sinha, P. K., Sunder, G., Bendale, P., Mantri, M., Dande, A. Wiley-IEEE Press, 2013.
Hacking Healthcare. Trotter, F., & Uhlman, D. O'Reilly, 2011.
Reinventing American Health Care. Emanuel, E. PublicAffairs, 2014.
Health Care Information Systems. Wager, K. & Lee, Frances. Jossey-Bass, 2013.
Consumer Health Informatics. Wetter, T. (Ed.). Springer, 2016.
Implementing an Electronic Health Record System. Walker, J.M., Bieber, E.J., & Richards, F. (Eds.). Springer, 2014.
Additional readings will be assigned and shared as needed.
Course Outline & Calendar
Class 1 - Jan 9
Introduction to the class and distribution of the syllabus. Important dates, exam, and assignments described.
Class project requirements discussed.
Class 2 - Jan 14
Overview of EHR; platform, standards, applications, and evolution
Readings: Chapter 1
Class 3 - Jan 16
EHR as a gateway and integration hub. Applications contd.
Readings: Chapter 1
Class 4 - Jan 21
EHR in action from the perspectives of patients & clinicians
Reading: Trotter, F., & Uhlman (additional suggested text-book)
Class 5 - Jan 23
Health data architectures, standards, and protocols I.
Readings: Payne et al., 2010 (Current Case Study); Fernandopulle & Patel, 2010 (Current Case Study)
Class 6 - Jan 28
Health data architectures, standards, and protocols II.
Readings: Payne, T. (2008). In Practical Guide to Clinical Computing Systems (Thomas Payne, Ed.). Architecture of Clinical Computing Systems (Chapter 2)
Class 7 - Jan 30
Data management I.
Class 8 - Feb 4
Health vocabularies, taxonomies, and ontologies I.
Class 9 - Feb 6
Data Standards and Usability
Class 10 - Feb 11
Class Presentations: Project Part 1
Class 11 - Feb 13
Knowledge Representation. Ontologies II. Expert Systems.
Readings: Chapter 2; Cimino, J. (2000). From Data to Knowledge through Concept-Oriented Terminologies: Experience with Medical Entities Dictionary. J. Am Med Inform Assoc (7): 288-297.
Class 12 - Feb 18
Data modelling in basic and data warehousing contexts. Usabilty.
Readings: Health Information Tech Usability
Class 13 - Feb 20
Data modelling in basic and data warehousing contexts II.
Class 14 - Feb 25
Data analytics and interchange formats based on XML and APIs.
Readings: Chapter 12.
Class 15 - Feb 27
Data analytics contd.
Class 16 - March 3
Evidence-based care and quality improvement I
Readings: Chapter 7 and 8. Additional readings will be assigned.
Class 17 - March 5
Guest Speaker.
Class 20 - March 24
Medical Guidelines: Evidence-based Care I
Class 21 - March 26
Evidence-based care and quality improvement II.
Implementing EHR and evaluating systems. Data Governance. Meaningful use.
Readings: Chapter 9; Buntin, et. al. (2011).
Reading: Caleen, J.L., Braithwaite, J. & Westbrook, J.A. (2008). Hamalka, J.D. (2010).
Class 22 - March 31
Clinical decision support
EHR regulations, privacy, and security I
Reading: Chapters 9, 10 and 11
Class 23 - April 2
EHR regulations, privacy, and security contd.
Reading: Chapter 11
Class 24 - April 7
Meaningful Use & its implications
Consumer-centric Health Information I
Class 25 - April 9
Consumer-centric Health Information II
Class 26 - April 14
Advanced Topics: Consumer-centric Health Information III
Draft Project Report Due.
Class 27 - April 16
Advanced Topics: Patient enagagement, mobilie health, and patient-generated health data
Class 28 - April 21
Guest Presentation
Take-home Final Due.
Class 29 - April 23
Guest Presentation
Class presentations. Wrap-up.
Contact Information
Instructor Office hours: Thursday 2P-3PM. The instructor will be in Room 300A, Manning Hall.
TA Office hours: Thursday 1P-2PM. The TA will be in Room 300, Manning Hall.
Please do not hesitate to contact the instructor or the TA to schedule other meeting times.
Ph: (919) 610-6230
Email: jm@unc.edu (instructor) and eric_cui@med.unc.edu (TA)