Health
Informatics
BCA-2020: Semester-V

Module 4:
Chapter 3
DESIGNAND EVALUATION
OF INFORMATION
SYSTEMSAND SERVICES
QUALITY IMPROVEMENT
STRATEGIES
PROTOCOLSAND
EVIDENCE BASED
HEALTHCARE

Module
Content
 Design and Evaluation of Information Systems and Services:
principles of designing information systems, strategies for
Information system evaluation, Information Systems
Effectiveness Measures.
 Quality Improvement Strategies: quality improvement tools,
factors that help to create and sustain Healthcare Informatics as a
new field. quality improvement cycle: PDCA (Plan, Do, Check,Act)
Cycle.
 Protocols and Evidence based Healthcare: information
technology tools to support best practices in health care,
information technology tools that inform and empower patients.

LearningObjectives
 Information technology tools to support best
practices in health care
 Information technology tools that inform and
empower patients

Introduction:
EBM
 Medical decisions and actions should be based on the best
available evidence.
 Clearly, information technology has the potential to improve
decision making through online medical resources, electronic
clinical practice guidelines, electronic health records (EHRs) with
decision support, online literature searches, digital statistical
analysis and online continuing medical education (CME).
 According to the Center for EvidenceBased Medicine, EBM can be
defined as: “the conscientious, explicit and judicious use of current
best evidence in making decisions about the care of individual
patient”.
 Furthermore, the Institute of Medicine (IOM) states: “Patients
should receive care based on the best available scientific
knowledge. Care should not vary illogically from clinician to
clinician or from place to place

Importance of
EBM
 Learning EBM is like climbing a mountain to gain a better view.
One might not make it to the top and find the perfect answer but
individuals will undoubtedly have a better vantage point than
those who choose to stay at sea level.
 Reasons for studying EBM resources and tools include:
 Current methods of keeping medically or educationally up-to-
date do not work
 Translation of research into practice is often very slow
 Lack of time and the volume of published material results in
information overload
 The pharmaceutical industry bombards clinicians and
patients every day; often with misleading or biased
information
 Much of what is considered the “standard of care” in every
day practice has yet to be challenged and could be wrong

Traditional
Methods for
Gaining
Medical
Knowledge
 Continuing Medical Education (CME).TraditionalCME is desired by
many clinicians but the evidence shows it to be highly ineffective
and does not lead to changes in practice.
 Clinical Practice Guidelines (CPGs). Unfortunately, just publishing
CPGs does not in and of itself change how medicine is practiced
and the quality of CPGs is often variable and inconsistent.
 Expert Advice. Experts often approach a patient in a significantly
different way compared to primary care clinicians because they
deal with a highly selective patient population. Patients are often
referred to specialists because they are not doing well and have
failed treatment. For that reason, expert opinion needs to be
evaluated with the knowledge that their recommendations may
not be relevant to a primary care population. Expert opinion
therefore should complement and not replace EBM.
 Reading. It is clear that most clinicians are unable to keep up with
medical journals published in their specialty. Most clinicians can
only devote a few hours each week to reading.

Evidence
Based Health
Informatics
(EBHI)
 EBHI is not a separate field, it represents the application of EBM
tools to the field of health informatics.
 While the quality of health informatics research has improved in
the past decade, the overall report card for most studies is mixed,
regardless of which technology is being studied.
 There are at least three reasons why published research studies in
health informatics have not been optimally evidence based:
 Early Hype: The optimistic predictions regarding the impact of HIT
on healthcare quality, safety, proficiency and cost reduction is
pointed out. Many of these predictions were based on expert
opinions or modeling and not high quality research.
 Methodological challenges. Early research studies frequently
suffered from internal validity (quality of study design and
execution) and external validity (whether results are generalizable to
other locations and patients) issues. Most studies reported on health
information technology (HIT) are observational and retrospective in
nature.
 The failure to anticipate unintended consequences related to HIT
adoption.

Information
technology
tools to
support best
practices in
health care
 Healthcare InformationTechnology (IT) tools help providers and
patients to manage vital health information.They also help improve
the quality of care and make healthcare more cost-effective for
providers and patients.
 According to the Agency for Healthcare Research and Quality, health
IT enables providers to manage patient care more efficiently through
secure sharing and utilization of health information.The following
health IT tools making health information available anywhere on a 24-
hour basis.
 1. Electronic Health Records
 An electronic health record (EHR) system collects digital health
information for patients and the larger population. Other names used
for this tool include Electronic Medical Record (EMR) and Patient
Health Record (PHR). Simply put, it is a digital version of a patient’s
medical history.The primary health provider usually maintains the
EHR. A patient’s electronic health records may include administrative
and clinical data such as demographics, medications, allergies, and
medical insurance cover.

Information
technology
tools to
support best
practices in
health care
 2. ReferralTrackers
 A referral tracking system is a software tool that healthcare providers use to
monitor their patient referrals. It provides an effective communication
channel between two medical institutions. It also helps doctors and specialists
to maintain constant communication while taking care of a patient.
 A referral tool enables physicians to solve many practical problems associated
with medical referrals. For instance:
 Physicians can use it to know the exact time their patient sees a specialist and the
result of the appointment
 It eliminates the need for faxing referral letters
 It allows physicians to communicate with a specialist and decide if a patient’s visit
will be necessary and beneficial to the patient
 Using this type of tool removes many operational inefficiencies associated
with patient referrals.
 3. Patient Portals
 The Medlineplus.gov website defines a patient portal as a website designed
for your personal healthcare. It is an online tool that enables patients to
monitor their visits to their healthcare provider, check test results, billing,
payments, and prescriptions. Some portals also allow patients to have live
interactions with their physicians and book new appointments.

Information
technology
tools to
support best
practices in
health care
 4. Remote Patient Monitoring
 Remote patient monitoring (RPM) uses tech tools to track and
respond to a continuous stream of patient data outside a hospital
or clinic.This type of telehealth is beneficial for monitoring
patients with chronic conditions like heart failure, diabetes, and
hypertension. Clinicians may use it to respond promptly with an
ambulance when a patient’s health data shows they are in dire
need of emergency care.
 5. Computerized Provider Order Entry
 Computerized provider order entry (CPOE) systems are supposed
to replace the traditional paper-based ordering system.They allow
clinicians to write, send, and manage various treatment
instructions such as laboratory tests, radiology orders, and
medication requests. All these are done through a CPOE system
rather than through fax, printed paper, or telephone.

Information
technology
tools that
inform and
empower
patients
 The use of IT can lead to a fundamental redesign of home care
processes based on the use and integration of electronic
communication at all levels.
 Many anticipate that IT platforms may lead to patient
empowerment and a transition from a passive role, in which the
patient is the recipient of care services, to an active role, in which
the patient is informed, has choices, and is involved in the
decision-making process.
 Such a transition may be possible due to the active involvement of
patients in the management of their disease using home
monitoring devices and software, the access to information and
online communities, and the use of personal health records
maintained by patients themselves.

Information
technology
tools that
inform and
empower
patients
 Information technology can be introduced in home care in a
multitude of ways.The following taxonomy captures the multiple
levels of IT function and functionality in the context of home care:
 Active monitoring and management (requiring
end-user involvement and participation)
 Telehealth applications for home-based disease
management (that link patients and their families to
their health care providers)
 Web-based communities for home care patients (that
link patients and their families to health care providers,
peers, and the community)
 Personal health records (that enable patients to create
and store their personal health information)

Information
technology
tools that
inform and
empower
patients
 Information technology can be introduced in home care in a
multitude of ways.The following taxonomy captures the multiple
levels of IT function and functionality in the context of home care:
 Passive monitoring and management (for which IT
implementation does not require training or
operation by the end-user)
 Robotic applications (standalone artificial
intelligence applications that support home care
needs)
 “Smart homes” (in which IT based on the use of
sensors becomes part of the residential
infrastructure)

ThankYou!