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Component 6:

Health Management
Information Systems
Instructor Manual
Version 3.0/Spring 202
!otes to Instructors
This Instructor Manual is a resource for instructors using this component. Each
component is broken down into units, which include the following elements:
Learning objectives
uggested student readings, te!ts, reference links to supplement the
narrated "ower"oint slides
Lectures #voiceover "ower"oint in $lash format%& "ower"oint slides
#Microsoft "ower"oint format%, lecture transcripts #Microsoft 'ord format%&
and audio files #M"( format% for each lecture
elf)assessment *uestions reflecting +nit ,bjectives with answer ke-s
and.or e!pected outcomes
/pplication /ctivities #e.g., discussion *uestions, assignments, projects%
with instructor guidelines, answer ke-s and.or e!pected outcomes
0ealth IT 'orkforce 1urriculum 0ealth Management 2
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Contents
6otes to Instructors............................................................................................................2
1omponent ,verview........................................................................................................7
1omponent 7.+nit 5...........................................................................................................8
1omponent 7.+nit 2.........................................................................................................5(
1omponent 7.+nit (.........................................................................................................59
1omponent 7.+nit :.........................................................................................................22
1omponent 7.+nit ;.........................................................................................................29
5.<erner, E. . #2448, =une%. 1linical decision support s-stems: tate of the /rt. /0>?
"ublication 6o. 48)4478)E$. >ockville, Mar-land: /genc- for 0ealthcare >esearch and
?ualit- http:..healthit.ahr*.gov.images.jun48cdsreview.48@4478@ef.html ....................(4
2.1A >ecommendations, #244B, /pril 22%. >etrieved from
http:..www.hhs.gov.healthit.documents.m244B4:22.7.2@cds@recs.html .......................(4
(.1enters for Medicare and Medicaid ervices. #2455, 6ovember 9%. E0> incentive
programs overview. >etrieved from
https:..www.cms.gov.ehrincentiveprograms.C<,,DM/>D5 .........................................(4
:.1enters for Medicare and Medicaid ervices& Medicare and Medicaid "rograms&
Electronic 0ealth >ecord Incentive "rogram& $inal >ule, :2 1$> "arts :52, :5(, :22 et
al. #=ul- 2B, 2454%. >etrieved from http:..edocket.access.gpo.gov.2454.pdf.2454)
59249.pdf .......................................................................................................................(4
;.Institute of Medicine. #2452%. 0ealth IT and patient safet-: <uilding safer s-stems for
better care. 'ashington , A1: The 6ational /cademies "ress......................................(4
7.Musen, M. /., hahar, E., F hortliffe, E. 0., #2447%. 1linical decision)support
s-stems. In hortliffe. E. 0., F 1imino, =. =. #Eds.%, <iomedical informatics: 1omputer
applications in health care and biomedicine #(rd ed% #pp. 78B)9(7%. 6ew Eork, 6E:
pringer cience G <usiness Media. ..............................................................................(4
9.6ational /cadem- of ciences. #2455, 6ovember%. >eport brief. >etrieved from
http:..iom.edu.H.media.$iles.>eportI24$iles.2455.0ealth)
IT.0ealthITand"atientafet-reportbrieffinal@new.pdf .....................................................(4
B.6ational /cadem- of ciences. #2444%. >eport brief. >etrieved from
0ealth IT 'orkforce 1urriculum 0ealth Management (
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
http:..iom.edu.H.media.$iles.>eportI24$iles.5888.To)Err)is)0uman.ToI24ErrI24is
I240umanI245888I24I24reportI24brief.pdf ........................................................(4
8.,sheroff, =. /., Teich, =. M., Middleton, <. $., teen, E. <., 'right, /., F Aetmer, A. E.
#2447, =une 5(%. / roadmap for national action on clinical decision support #,61
1ontract 00"2((244;44B99"%. >etrieved from /MI/ website:
http:..www.amia.org.sites.amia.org.files./)>oadmap)for)6ational)/ction)on)1linical)
Aecision)upport)=une5(2447.pdf ................................................................................(4
54.,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /. #244;%.
Improving outcomes with clinical decision support: /n implementerJs guide. 1hicago:
0IM .............................................................................................................................(4
55.irajuddin, /. M., ,sheroff, =. /., ittig, A. $., 1huo, =., 3elasco, $. F 1ollins, A. /.
#2448, $all%. Implementation pearls from a new guidebook on improving medication use
and outcomes with clinical decision support. =ournal of 0ealthcare Information
Management. 2(#:%, (B):;..............................................................................................(4
52.+.. Aepartment of 0ealth and 0uman ervices. #2454, eptember 28%. Institute of
Medicine will stud- best policies and practices for improving health care safet- with
health information technolog-. >etrieved from
http:..www.hhs.gov.news.press.2454pres.48.24544828b.html .....................................(4
1omponent 7.+nit 7.........................................................................................................((
5./merican Telemedicine /ssociation. #n.d.%. Telemedicine.Telehealth terminolog-.
>etrieved from
http:..www.americantelemed.org.files.public.standards.glossar-ofterms.pdf ...............(:
2.1enter for Technolog- and /ging. #2455%. >emote patient monitoring. >etrieved from
http:..www.techandaging.org.rpm@program@page.html .................................................(:
(.1enters for Medicare and Medicaid ervice. #n.d.%. Telemedicine. >etrieved from
http:..www.cms.gov.telemedicine. ..................................................................................(:
:.Koedert, =., #2454, ,ctober 5:%. /TFT to use, market diabetes tool. 0ealthAata
Management. >etrieved from http:..www.healthdatamanagement.com.news.health)
care)technolog-)news)diabetes)smart)phone)mobile):557:)5.html .............................(:
;.0ealth >esources and ervices /dministration. #n.d.%. Telehealth. >etrieved from
http:..www.hrsa.gov.telehealth.default.htm .....................................................................(;
7.0ebda, T., 1Lar, "., F Mascara, 1 #588B%. 0andbook of informatics for nurses and
health care professionals. Menlo "ark, 1/: /ddison)'esle-. .......................................(;
0ealth IT 'orkforce 1urriculum 0ealth Management :
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
9.Miller, L. M. F Eoung, D.M. #2444%. Telehealth. In Eoung, D. M. #Ed%. Informatics for
healthcare professionals. #pp. 225)2((% "hiladelphia, "/: $. /. Aavis 1ompan-..........(;
B.Mostashari, $. #245, /pril 22%. Testimon- on aging in place: The national broadband
plan and bringing health care technolog- home. >etrieved from
http:..aging.senate.gov.events.hr224fm.pdf ...................................................................(;
8.6elson, >. #2452 =anuar-%. E!ploring mobile health consumer trends. 1linical
Informatics Insights. >etrieved from http:..www.himss.org./".1ontent>edirector.aspM
t-peN0IM6ewsItemF1ontentIdN9855( .....................................................................(;
(.1enter for Technolog- and /ging. #2455%. >emote patient monitoring. >etrieved from
http:..www.techandaging.org.rpm@program@page.html .................................................(;
;.0ealth >esources and ervices /dministration. #n.d.%. Telehealth. >etrieved from
http:..www.hrsa.gov.telehealth.default.htm .....................................................................(;
;.0ebda, T., 1Lar, "., F Mascara, 1. #588B%. 0andbook of informatics for nurses and
health care professionals. Menlo "ark, 1/: /ddison)'esle-. .......................................(7
9.Miller, L. M. F Eoung, D.M. #2444%. Telehealth. In Eoung, D. M. #Ed%. Informatics for
healthcare professionals. #pp. 225)2((% "hiladelphia, "/: $. /. Aavis 1ompan-..........(7
B.Mostashari, $. #2454, /pril 22%. Testimon- on aging in place: The national broadband
plan and bringing health care technolog- home. >etrieved from
http:..aging.senate.gov.events.hr224fm.pdf ...................................................................(7
1omponent 7.+nit 9.........................................................................................................(B
1omponent 7.+nit B.........................................................................................................:2
1omponent 7.+nit 8.........................................................................................................:9
1omponent /cron-m Klossar-........................................................................................;2
1reative 1ommons /ttribution)6on1ommercial)hare/like (.4 +nported ....................72
0ealth IT 'orkforce 1urriculum 0ealth Management ;
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component "#er#ie$
Each Learning +nit re*uires 2)( contact #or instructional% hours and an additional 7)8
hours of independent or team work on the part of the student to be successfull-
completed. Each unit contains more material than would likel- be used in an- one
teaching.learning e!perience so that the instructor can pick and choose material most
applicable to local workforce needs.
1ontent covering 0ardware and oftware upporting 0ealth Information -stems can
be found in 1omponent :.
1ontent covering 0uman)1omputer Interaction can be found in 1omponent 5;.
1ontent covering "ublic 0ealth and <iosurveillance in 0ealth 1are -stems can be
found in 1omponent 5(.
This entire 1omponent is estimated to re*uire 24)(4 total contact.instructional hours
plus ;4)7; additional hours of independent or team work, depending on the learning
activities and assessments used within each unit.
Component "%&ecti#es
/t the completion of this component, the student will be able to:
Aescribe general functions, purposes and benefits of health information
s-stems in various health care settings
Aescribe the federal initiatives and other significant developments that
have influenced the evolution and adoption of health information s-stems
1ompare.1ontrast different t-pes of health information s-stems in terms of
their abilit- to meet the needs of various t-pes of health care enterprises
E!plain how electronic health records affect patient safet-, *ualit- care,
efficienc-, productivit-, and reporting.documentation mechanisms
"ropose strategies to minimiLe major barriers to the adoption of electronic
health records
E!plain how the principles of health care data e!change and health care
data standards relate to patient care, productivit- and data anal-sis
0ealth IT 'orkforce 1urriculum 0ealth Management 7
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 'uthors
'ssigne( Institution
Auke +niversit-, Aurham, 61
)eam *ea(
Dath- Kiannangelo, M/, >0I/, 11, 1"0IM, $/0IM/
"itt 1ommunit- 1ollege
+rimary Contri%uting 'uthors
1onstance M. =ohnson, M, "hA, >6
Auke +niversit-
andra 1rockett, >0I/
"itt 1ommunit- 1ollege
Lecture 6arration.ound Engineer
>aland Technologies LL1
5(B9 $airport >oad
uite 54;4 $airport, 6E 5::;4
http:..www.raland.com.
Aavid $lass O "roject Manager
)eam Mem%ers
<rian >e-nolds, "hA
"roject Lead, Auke Translational >esearch Institute
Auke +niversit-
0ealth IT 'orkforce 1urriculum 0ealth Management 9
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Aisclaimer
These materials were prepared under the sponsorship of an a!ency of the United
States 'overnment& Neither the United States 'overnment nor any a!ency thereof, nor
any of their employees, makes any warranty, e(press or implied, or assumes any le!al
liability or responsibility for the accuracy, completeness, or usefulness of any
information, apparatus, product, or process disclosed, or represents that its use would
not infrin!e privately owned ri!hts& )eference herein to any specific commercial
product, process, or service by trade name, trademark, manufacturer, or otherwise
does not necessarily constitute or imply its endorsement, recommendation, or favorin!
by the United States 'overnment or any a!ency thereof& The views and opinions of
authors e(pressed herein do not necessarily state or reflect those of the United States
'overnment or any a!ency thereof&

*ikewise, the above also applies to the Curriculum Development Centers +includin!
Columbia University, Duke University, ,ohns Hopkins University, Ore!on Health -
Science University, University of "labama at .irmin!ham, and their affiliated entities/&
The information contained in the Health T 0orkforce Curriculum materials is intended
to be accessible to all& To help make this possible, the materials are provided in a
variety of file formats& Some people may not find the 1lash video and &S01 files
accessible and should instead utili2e the 3ower3oint slides to!ether with the &mp4
audio file and5or 0ord transcript to access the lectures& 1or more information, please
visit the website of the National Trainin! and Dissemination Center at http655www&onc7
ntdc&or! or http655www&onc7ntdc&info to set up a profile and view the full accessibility
statement&
0ealth IT 'orkforce 1urriculum 0ealth Management B
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 6/,nit
,nit )itle
-hat is Health Informatics.
,nit /escription
Lecture a defines information management, information technolog-, and informatics,
describes the fundamental theorem of informatics, e!plains the meaning of biomedical
and health informatics as a field of stud-, and offers definitions of the major biomedical
informatics areas of applications. It also provides an overview of informatics drivers and
trends in the health care field. Lecture % defines the informatics team, their skills, roles
and responsibilities, and identifies how health informaticians process data into
information and knowledge for health care tasks with the support of information
technolog- to improve patient care.
,nit "%&ecti#es
<- the end of this unit the student will be able to:
5. Aefine information management, information s-stem #technolog-% and
informatics
2. E!plain the basic theoretical concept that underlies informatics practice
(. Aefine the meaning of biomedical and health informatics as a field of stud-
:. Aescribe the biomedical informatics areas of applications
;. ummariLe the informatics drivers and trends
7. tate the professional roles and skills of health informaticians
9. Identif- how health informaticians process data into information and
knowledge for health care tasks with the support of information technolog-
to improve patient care
,nit )opics / *ecture )itles
5a Introduction to 0ealth Informatics
5b >oles and kills of 0ealth Informaticians
,nit 0eferences
#/ll links accessible as of 52.5(.2455%
*ecture a
5. /ltman, >. <., F Moone-, . A. #2445%. <ioinformatics. In hortliffe. E., F 1imino,
=.=. #Eds.%, .iomedical informatics6 Computer applications in health care and
biomedicine #(
rd
ed.% #p. 97(. 6ew Eork, 6E: pringer cience G <usiness Media.
2. /merican 0ealth Information Management /ssociation. #2452%. 3ocket !lossary
for health information mana!ement and technolo!y #(
rd
ed.%. 1hicago, IL: /uthor.
(. /MI/. #2455%. /bout /MI/. >etrieved from http:..www.amia.org.about)amia
:. /MI/Ps /cademic $orum. #n.d.%. Aefinition of biomedical informatics. >etrieved
0ealth IT 'orkforce 1urriculum 0ealth Management 8
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
from http:..www.amia.org.biomedical)informatics)core)competencies
;. <ernstam E., mith =., F =ohnson T. #2448, /ugust%. 'hat is biomedical
Informatics. ,ournal of .iomedical nformatics, $4#5%.
doi: 54.5457.j.jbi.2448.4B.447
7. $riedman, 1. #2448%. / Qfundamental theoremQ of biomedical informatics. ,ournal
of the "merican 8edical nformatics "ssociation, 9:#2%, 578)594. doi:
54.5589.jamia.M(482
9. 0ealthcare Information and Management -stems ociet-. #244(, Ma- ;%.
0IM E)0ealth IK white paper. >etrieved from
http:..www.himss.org.content.files.ehealth@whitepaper.pdf
B. Merriam)'ebster ,nline. #2455%. >etrieved from http:..www.merriam)
webster.com.dictionar-.theorem
8. >owle-, =. #2449, $ebruar-%. The wisdom hierarch-: >epresentations of the
AID' hierarch-. ,ournal of nformation Science, $$& doi:
54.5599.457;;;5;47494947
54. hortliffe, E., F <lois, M. #2447%. The computer meets medicine and biolog-:
Emergence of a discipline. In hortliffe. E., F 1imino, =.=. #Eds.%, .iomedical
informatics6 Computer applications in health care and biomedicine #(
rd
ed.% #pp.
():;%. 6ew Eork, 6E: pringer cience G <usiness Media.
55. The 6ational /lliance for 0ealth Information Technolog-. #244B, /pril 2B%.
Aefining ke- health information technolog- terms. >etrieved from
healthit.hhs.gov.portal.server.pt.gatewa-."T/>K@4@549:5@B:B5((@4@4@5B.54
@2@hit@terms.pdf
52. +MA6=)>obert 'ood =ohnson Medical chool, +MA6=)chool of 0ealth
>elated "rofessions Aepartment of 0ealth Informatics F 6ew =erse- Institute of
Technolog-. #n.d.%. 8D58S in .iomedical nformatics. R<rochureS. >etrieved from
http:..rwjms.umdnj.edu.education.current@students.academics.mdms@biomedical
informatics.pdf
5(. +.. Aepartment of 0ealth and 0uman ervices, The ,ffice of the 6ational
1oordinator for 0ealth Information Technolog-. #2448, Aecember :%. 0ealth IT
terms. >etrieved from http:..healthit.hhs.gov.portal.server.ptM
openN;52FmodeN2FcachedNtrueFobjIAN52;7F"ageIAN5;927
5:. 'orld 0ealth ,rganiLation. #2455%. e0ealth. >etrieved from
http:..www.who.int.topics.ehealth.en.
*ecture a Charts1 )a%les an( 2igures
5.5 $igure: $riedman, 1. #2448%. / Qfundamental theoremQ of biomedical informatics.
,ournal of the "merican 8edical nformatics "ssociation, 57#2%, 578)594. doi:
54.5589.jamia.M(482
5.2 $igure: <iomedical Informatics: Modified b- Ar. =iajie Thang, The +niversit- of
Te!as at 0ouston, chool of <iomedical Informatics from hortliffe, E., F <lois, M.
#2447%. The computer meets medicine and biolog-: Emergence of a discipline. In
hortliffe, E., F 1imino, =.=. #Eds.%, .iomedical informatics6 Computer applications in
health care and biomedicine #(rd ed.% #pp. ():;%. 6ew Eork, 6E: pringer cience G
0ealth IT 'orkforce 1urriculum 0ealth Management 54
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
<usiness Media.
*ecture %
5. /MI/. #2455%. The clinical informatics subspecialt-. >etrieved from
http:..www.amia.org.clinical)informatics)medical)subspecialt-
2. Aepartment of 0ealth and 0uman ervices, 6ational Librar- of Medicine. #2455%.
Institutional grants for research training in biomedical informatics #T5;%.
>etrieved from http:..grants.nih.gov.grants.guide.rfa)files.>$/)LM)47)445.html
(. $riedman, 1. "., /ltman, >. <., Dohane, I. ., Mc1ormick, D. /., Miller, ". L.,
,Lbolt, =. K., U'illiamson, =. #2448%. Training the ne!t generation of
informaticians: The impact of VV<ITIJJ and bioinformaticsW/ report from the
/merican 1ollege of Medical Informatics. ,ournal of the "merican 8edical
nformatics "ssociation, 99, 579)592. doi: 54.5589.jamia.M5;24
:. hortliffe, E., F <lois, M. #2447%. The computer meets medicine and biolog-:
Emergence of a discipline. In hortliffe. E., F 1imino, =.=. #Eds.%, .iomedical
informatics6 Computer applications in health care and biomedicine #(
rd
ed.% #pp.
():;%. 6ew Eork, 6E: pringer cience G <usiness Media.
;. +niversit- of Minnesota. #2455%. $re*uentl- asked *uestions about: <iomedical
health informatics. >etrieved from
http:..www.bmhi.umn.edu.ihi.fa*.informatics.shtml
,nit 0e3uire( 0ea(ings
5. /0IM/ F /MI/. #244B, ,ctober%. /0IM/ and /MI/ health information
management and informatics core competencies for individuals with electronic
health records. >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@4:492(.pdf
2. <ernstam E., mith =., F =ohnson T. #2448, /ugust%. 'hat is biomedical
Informatics. ,ournal of .iomedical nformatics, $4#5%.
doi: 54.5457.j.jbi.2448.4B.447
(. $riedman, 1. #2448%. / Qfundamental theoremQ of biomedical informatics. ,ournal
of the "merican 8edical nformatics "ssociation, 9:#2%, 578)594. doi:
54.5589.jamia.M(482
:. 0ersh. '. #244B%. 0ealth and biomedical informatics: opportunities and
challenges for a twent-)first centur- profession and its education. ;earbook of
8edical nformatics& >etrieved from
http:..www.schattauer.de.en.magaLine.subject)areas.journals)a)L.imia)
-earbook.imia)-earbook)244B.issue.B:4.manuscript.8B((.html
5. 0ersh, '. #2448, Ma- 5;%. / stimulus to define informatics and health
information technolog-. .8C 8edical nformatics and Decision 8akin!.
>etrieved from http:..www.biomedcentral.com.5:92)78:9.8.2:
7. Mantas, =., et al. #2454%. >ecommendations of the International Medical
Informatics /ssociation #IMI/% on education in biomedical and health informatics.
8ethods of nformation in 8edicine. >etrieved from
0ealth IT 'orkforce 1urriculum 0ealth Management 55
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
http:..www.schattauer.de.en.magaLine.subject)areas.journals)a)
L.methods.contents.archive.issue.54;(.manuscript.52;(B.html
,nit Suggeste( 0ea(ings
5. /l)horbaji, 6. #2445, Ma-%. 0ealth and medical informatics: Technical paper.
>etrieve from http:..www.emro.who.int.his.ehealth.MedicalInformatics.pdf
2. <ellinger, K., 1astro, A., F Mills, /. #244:%. Aata, information, knowledge, and
wisdom. >etrieved from http:..www.s-stems)thinking.org.dikw.dikw.htm
(. 1anadian 0ealth Informatics /ssociation. #2448, March%. 0ealth informatics
professional core competencies. >etrieved from
http:..www.coachorg.com.en.publications.resources.1ore1ompetencies@Ma-48)
web.pdf
:. $ricke, M. #244B, ,ctober 2(%. The knowledge p-ramid: / criti*ue of the AID'
hierarch-. ,ournal of nformation Science. >etrieved from
http:..jis.sagepub.com.cgi.rapidpdf.457;;;5;4B48:4;4v5.pdf
;. 0ersh, '. #2455, eptember%. 'hat is biomedical and health informaticsM
>etrieved from http:..www.billhersh.info.whatis .
7. Duhn D., et al. #244B%. Informatics and medicine))from molecules to populations.
8ethods of nformation in 8edicine. >etrieved from
http:..www.schattauer.de.en.magaLine.subject)areas.journals)a)
L.methods.contents.archive.issue.779.manuscript.54572.html
9. 6ational Librar- of Medicine. #2455, ,ctober 58%. 0ealth informatics. >etrieved
from http:..www.nlm.nih.gov.hsrinfo.informatics.html
B. ,regon 0ealthcare 'orkforce Institute. #2455%. <iomedical and health
informaticians. >etrieved from
http:..www.oregonhwi.org.careers.occupations.biomedical@health@info.shtml
8. +nimediaproduction. #2448, March 57%. Turning information into knowledge.
R3ideo fileS. >etrieved from http:..www.-outube.com.watchM
vNu/I+Kw0hDmkFfeatureNrelated
Stu(ent 'pplication 'cti#ities
comp7@unit5@discuss.doc
comp7@unit5@discuss@ke-.doc
comp7@unit5@activit-.doc
comp7@unit5@activit-@ke-.doc
comp7@unit5@self@assess.doc
comp7@unit5@self@assess@ke-.doc
0ealth IT 'orkforce 1urriculum 0ealth Management 52
Information -stems
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This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 6/,nit 2
,nit )itle
Health Information Systems "#er#ie$
NOTE: This Unit was previously titled Hardware and Software Supporting Health
Information Systems. It is now Health Information Systems Overview
,nit /escription
Lecture a defines the concept of an information s-stem and its characteristics,
describes the different t-pes of information s-stems, and describe various t-pes of
technologies that support health care information s-stems. Lecture % e!amines the
challenges presented b- emerging trends in information technolog- #e.g., mobilit-, web
services, the Internet, Intranet, and wireless computing%, social media, and global
communications and discusses the advantages and disadvantages of using the Internet
as a platform for health care applications.
,nit "%&ecti#es
<- the end of this unit the student will be able to:
5. Aefine the concept of an information s-stem and its characteristics
2. Aescribe the different t-pes of information s-stems
(. Aescribe various t-pes of technologies that support health care
information s-stems
:. E!amine the challenges presented b- emerging trends in information
technolog-, social media, and global communications
;. Aiscuss the advantages and disadvantages of using the Internet as a
platform for health care applications
,nit )opics / *ecture )itles
2a Introduction to 0ealth Information -stems
2b Emerging Trends in 0ealth Information Technolog-
,nit 0eferences
#/ll links accessible as of 2.54.2452%
*ecture 2a
5. /0IM/ e)0IM 'ork Kroup on Electronic Aocument Management as a
1omponent of E0>. #244(%. >etrieved from
http://li%rary.ahima.org/4pe(io/groups/pu%lic/(ocuments/ahima/%o56022
7.hcsp.(/oc!ame8%o560227
2. /merican 0ealth Information Management /ssociation. #2452%. 3ocket !lossary
for health information mana!ement and technolo!y #(
rd
ed.%. 1hicago, IL: /uthor.
0ealth IT 'orkforce 1urriculum 0ealth Management 5(
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
(. <etts, K. #2449%. 1haracteristics of an information s-stem. >etrieved from
http://$$$.%ettscomputers.com/characteristicsofinformationsystems.htm
:. Aas, M. F Eichner, =. #2454, March%. 1hallenges and barriers to clinical decision
support #1A% design and implementation e!perienced in the agenc- for
healthcare research and *ualit- 1A demonstrations #"repared for the /0>?
6ational >esource 1enter for 0ealth Information Technolog- under 1ontract 6o.
284)4:)4457.% /0>? "ublication 6o. 54)447:)E$. >etrieved from
http://healthit.ahr3.go#/portal/ser#er.pt/gate$ay/+)'09S6066::6:;666
0606</C/S6challenges6an(6%arriers.p(f
;. 0ealthcare Information and Management -stems ociet- #0IM%. #2454%.
H8SS dictionary of healthcare information technolo!y terms, acronyms and
or!ani2ations #2
rd
ed.%. 1hicago, IL: /uthor.
7. 6ational >esearch 1ouncil. #2449%. Hospital7.ased emer!ency care6 "t the
breakin! point. 'ashington, A1: The 6ational /cademies "ress.
9. 3ogel, L.0., F "erreault, L.E., #2447%. Management of information in healthcare
organiLations. In hortliffe. E. 0., F 1imino, =. =. #Eds.%, .iomedical informatics6
Computer applications in health care and biomedicine #(
rd
ed% #pp. :97);54%.
6ew Eork, 6E: pringer cience G <usiness Media.
*ecture 2%
5. /merican 0ealth Information Management /ssociation. #2452%. 3ocket !lossary
for health information mana!ement and technolo!y #(
rd
ed.%. 1hicago, IL: /uthor.
2. 1A1 and the 6ational 1ancer Institute. #2455, Ma-%. 0ealth communication
basics. >etrieved from
http://$$$.c(c.go#/healthcommunication/Health=asics/-hatIsHC.html
(. 1enters for Aisease 1ontrol and "revention. #2455, Ma-%. ocial media at 1A1.
>etrieved from http://$$$.c(c.go#/SocialMe(ia/)ools/
:. 0ealth >esources and ervices /dministration #0>/%. #244(, ,ctober%.
Telemedicine reimbursement report. #"repared b- the 1enter for Telemedicine
Law under contract 6o.42)0/<)/25;(4:%. >etrieved from
http://$$$.hrsa.go#/ruralhealth/a%out/telehealth/reim%urse.p(f
;. 0ealthcare Information and Management -stems ociet- #0IM%. #2454%.
H8SS dictionary of healthcare information technolo!y terms, acronyms and
or!ani2ations #2
rd
ed.%. 1hicago, IL: /uthor.
7. Daplan, /. M. F 0aenlein, M. #2454%. +sers of the world uniteX The challenges
and opportunities of social media. .usiness Hori2ons <4#5%, ;8)7B.
9. Mell, "., F Krance, T. #2448, ,ctober%. The 6IT definition of cloud computing.
>etrieved from http://$$$.nist.go#/itl/clou(/uploa(/clou(>(ef>#;.p(f
B. ,ffice of Aisease "revention and 0ealth "romotion #,A"0"%. #2452%. e)0ealth.
>etrieved from http://$$$.health.go#/communication/ehealth//efault.asp
8. +.. Aepartment of 0ealth and 0uman ervices. #2444%. 0ealth- people 2454:
,bjectives for improving health. >etrieved from
http://$$$.healthypeople.go#/200//ocument/ta%leofcontents.htm?#olume

0ealth IT 'orkforce 1urriculum 0ealth Management 5:
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
54. +.. Aepartment of 0ealth and 0uman ervices. #2447, =une%. E!panding the
reach and impact of consumer e)0ealth tools. >etrieved from
http://$$$.health.go#/communication/ehealth/ehealthtools/p(f/ehealthrepo
rt.p(f
,nit 0e3uire( 0ea(ings
5. /0IM/ e)0IM 'ork Kroup on Electronic Aocument Management as a
1omponent of E0>. #244(%. >etrieved from
http://li%rary.ahima.org/4pe(io/groups/pu%lic/(ocuments/ahima/%o56022
7.hcsp.(/oc!ame8%o560227
2. <etts, K. #2449%. 1haracteristics of an information s-stem. >etrieved from
http://$$$.%ettscomputers.com/characteristicsofinformationsystems.htm
(. 1alifornia 0ealth1are $oundation. #244B, /pril%. The wisdom of patients: 0ealth
care meets online social media. >etrieved from
http://$$$.chcf.org/@/me(ia/2iles/+/2/H/HealthCareSocialMe(ia.p(f
:. 1A1 and the 6ational 1ancer Institute. #2455, Ma-%. 0ealth communication
basics. >etrieved from
http://$$$.c(c.go#/healthcommunication/Health=asics/-hatIsHC.html
;. 0ealthcare Technolog- ,nline. #2448, eptember 2(%. 0ealthcare aa 3s.
licensed software. >etrieved from
http://$$$.healthcaretechnologyonline.com/article.m#c/Healthcare>Saas>
Vs>*icense(>Soft$are>000
7. 0ealth >esources and ervices /dministration #0>/%. #244(, ,ctober%.
Telemedicine reimbursement report. #"repared b- the 1enter for Telemedicine
Law under contract 6o.42)0/<)/25;(4:%. >etrieved from
http://$$$.hrsa.go#/ruralhealth/a%out/telehealth/reim%urse.p(f
9. Dassirer, =. ". #2444%. "atients, ph-sicians and the Internet. Health "ffairs 58#7%,
55;)52(. doi: 54.5(99.hlthaff.58.7.55;
B. Mell, "., F Krance, T. #2448, ,ctober%. The 6IT definition of cloud computing.
>etrieved from http://$$$.nist.go#/itl/clou(/uploa(/clou(>(ef>#;.p(f
8. 6ational >esearch 1ouncil. #2449%. Hospital7.ased emer!ency care6 "t the
breakin! point. 'ashington, A1: The 6ational /cademies "ress.
54. ,ffice of Aisease "revention and 0ealth "romotion #,A"0"%. #2452%. e)0ealth.
>etrieved from http://$$$.health.go#/communication/ehealth//efault.asp
,nit Suggeste( 0ea(ings
5. /-lward, . #2454, =une 2B%. 1loud computing in healthcare O private, public, or
somewhere in between. >etrieved from
http://%logs.technet.com/%/microsoft6%log/archi#e/200/06/2</clou(>
computing>in>healthcare>pri#ate>pu%lic>or>some$here>in>%et$een.asp4
2. Aimick, 1. #2454, =anuar- 2454%. "rivac- policies for social media. >etrieved
from http://&ournal.ahima.org/200/0/06/social>me(ia>policies/
(. Daplan, /. M. F 0aenlein, M. #2454%. +sers of the world uniteX The challenges
and opportunities of social media. .usiness Hori2ons <4#5%, ;8)7B.
0ealth IT 'orkforce 1urriculum 0ealth Management 5;
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
:. +.. Aepartment of 0ealth and 0uman ervices. #2444%. 0ealth- people 2454:
,bjectives for improving health. >etrieved from
http://$$$.healthypeople.go#/200//ocument/ta%leofcontents.htm?#olume

;. 3ogel, L.0., F "erreault, L.E., #2447%. Management of information in healthcare
organiLations. In hortliffe. E. 0., F 1imino, =. =. #Eds.%, .iomedical informatics6
Computer applications in health care and biomedicine #(
rd
ed% #pp. :97);54%.
6ew Eork, 6E: pringer cience G <usiness Media.
Stu(ent 'pplication 'cti#ity
comp7@unit2@activit-.doc
comp7@unit2@activit-@ke-.doc
comp7@unit2@self@assess.doc
comp7@unit2@self@assess@ke-.doc
0ealth IT 'orkforce 1urriculum 0ealth Management 57
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 6/,nit 3
,nit )itle
Alectronic Health 0ecor(s
,nit /escription
Lecture a defines an electronic medical record #EM>% and electronic health record
#E0>% and e!plains their similarities and differences, identifies attributes and functions
of an E0>, discusses the issues surrounding E0> adoption and implementation, and
describes the impact of E0>s on patient care. Lecture % links E0>s to the 0ealth
Information E!change #0IE% and the 6ationwide 0ealth Information 6etwork #60I6%
initiatives, discusses how 0IE and 60I6 impact health care deliver- and the practice of
health care providers, summariLes the governmental efforts related to E0> s-stems
including meaningful use of interoperable health information technolog- and a *ualified
E0>, describes the Institute of MedicineJs vision of a health care s-stem and its
possible impact on health management information s-stems, and lists e!amples of the
effects of developments in bioinformatics on health information s-stems.
,nit "%&ecti#es
<- the end of this unit the student will be able to:
5. tate the similarities and differences between an electronic medical record
#EM>% and electronic health record #E0>%
2. Identif- attributes and functions of an E0>
(. Aescribe the perspectives of health care providers and the public
regarding acceptance of or issues with an E0>, which can serve as
facilitators of or major barriers to its adoption
:. E!plain how the use of an E0> can affect patient care safet-, efficienc- of
care practices, and patient outcomes
;. Aiscuss how 0ealth Information E!change #0IE% and 6ationwide 0ealth
Information 6etwork #60I6% impact health care deliver- and the practice
of health care providers
7. ,utline issues regarding governmental regulation of E0> s-stems, such
as meaningful use of interoperable health information technolog- and a
*ualified E0>
9. ummariLe how the Institute of MedicineJs 3ision for 25st 1entur- 0ealth
1are and 'ellness ma- impact health management information s-stems
B. Identif- how ongoing developments in biomedical informatics can affect
future uses and challenges related to health information s-stems
,nit )opics / *ecture )itles
(a Introduction to Electronic 0ealth >ecords
(b E!ternal Influences
0ealth IT 'orkforce 1urriculum 0ealth Management 59
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
,nit 0eferences
#/ll links accessible as of 52.5(.2455%
*ecture 3a
5. /0IM/ e)0IM 'ork Kroup on Maintaining the Legal E0>. #244;%. +pdate:
Maintaining a legall- sound health recordWpaper and electronic. ,ournal of
"H8" =:#54%, 7:/)L. >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@42B;48.hcs
pMdAoc6ameNbok5@42B;48
2. <lumenthal, A. #2448, /pril 8%. timulating the adoption of health information
technolog-. New >n!land ,ournal of 8edicine 4:%,5:99)5:98& >etrieved from
http:..www.nejm.org.doi.full.54.54;7.6E=Mp4845;82
(. 0andler, T., 0oltmeier, >., MteLger, =., ,verhage, M., Ta-lor, ., F +nderwood,
1. #244(, =ul- 9%. H8SS electronic health record definitional model version 9&%.
>etrieved from
http:..www.providersedge.com.ehdocs.ehr@articles.0IM@EM>@Aefinition@Mod
el@v5)4.pdf
:. 0ealth Information Technolog-: Initial et of tandards, Implementation
pecifications, and 1ertification 1riteria for Electronic 0ealth >ecord Technolog-&
$inal >ule, :; 1$> "art 594 #=ul- 2B, 2454%. >etrieved from
http:..edocket.access.gpo.gov.2454.pdf.2454)59254.pdf
;. 0arris Interactive. #2454, =une 59%. 1ew "mericans usin! ?>7? medical records&
>etrieve from
http:..www.harrisinteractive.com.6ews>oom.0arris"olls.tabid.::9.ctl.>ead1usto
mI24Aefault.mid.5;4B./rticleId.:5:.Aefault.asp!
7. 0ealth Level even International. #n.d.%. /bout 0L9. >etrieved from
http:..www.hl9.org.about.inde!.cfmMrefNnav
9. 0ealth Level even International. #2449%. H*= #%%= >H)7S functional model&
>etrieved from http:..www.hl9.org.ehr.downloads.inde!@2449.asp
B. >adiological ociet- of 6orth /merica. #244;, eptember%. H> moves >H)
!oals forward& >etrieved from
http:..www.rsna.org."ublications.rsnanews.sep4;.ihe.cfm
8. >eiser, . =. #5885%. The clinical record in medicine. "art 5: Learning from cases.
"nnals of nternal 8edicine, 99$, 842)849.
54. The 6ational /lliance for 0ealth Information Technolog-. #244B, /pril 2B%.
Definin! key health information technolo!y terms& >etrieved from
http:..healthit.hhs.gov.portal.server.pt.gatewa-."T/>K@4@549:5@B:B5((@4@4@
5B.54@2@hit@terms.pdf
55. +.. Aepartment of 0ealth and 0uman ervices, 1enters for Medicare and
Medicaid ervices. #2454, =ul-5(%. >lectronic health records at a !lance.
>etrieved from https:..www.cms.gov.apps.media.press.factsheet.aspM
1ounterN(9BBFint6um"er"ageN54FcheckAateNFcheckDe-NFsrchT-peN5Fnum
Aa-sN(;44Fsrch,ptN4FsrchAataNFke-wordT-peN/llFchk6ewsT-peN7Fint"ag
eNFshow/llNFpEearNF-earNFdescNfalseFcbo,rderNdate
0ealth IT 'orkforce 1urriculum 0ealth Management 5B
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
*ecture 3a Charts1 )a%les an( 2igures
(.5 Table: EM> and E0> 1omparison
(.2 Table: 0L9 2449 E0>) $unctional Model Airect 1are $unctions ubsets with
E!amples
*ecture 3%
5. Aepartment of 0ealth and 0uman ervices. #n.d.%. Nationwide health information
network6 .ack!round and scope. >etrieved from
http:..www.hhs.gov.healthit.healthnetwork.background.
2. Aepartment of 0ealth and 0uman ervices. #2455, 6ovember 9%. >H) incentive
pro!rams overview& >etrieved from
https:..www.cms.gov.ehrincentiveprograms.C<,,DM/>D5
(. 0ealthcare Information and Management -stems ociet-. #2448, March%.
Health information e(chan!es6 Similarities and differences& >etrieved from
http:..www.himss.org.content.files.>0I,.0IE@1ommon"ractices'hite"aper2448
4((4.pdf
:. 0ealth Information Technolog- for Economic and 1linical 0ealth /ct of 2448.
"ublic Law 555);, ection (444#5(% #2448a%.
;. 0ealth Information Technolog- for Economic and 1linical 0ealth /ct of 2448.
"ublic Law 555);, ection (445#b% #2448b%.
7. 0ealth Information Technolog-: Initial et of tandards, Implementation
pecifications, and 1ertification 1riteria for Electronic 0ealth >ecord Technolog-&
$inal >ule, :; 1$> "art 594 #=ul- 2B, 2454%. >etrieved from
http:..edocket.access.gpo.gov.2454.pdf.2454)59254.pdf
9. tead '.'., F Lin 0.. #eds.%. #2448%. 1omputational technolog- for effective
health care: Immediate steps and strategic directions. 'ashington #A1%: 6ational
/cademies "ress.
B. The Airect "roject. #2454, ,ctober 55%. The direct pro@ect overview& >etrieved
from http:..wiki.directproject.org.file.view.Airect"roject,verview.pdf
8. The ,ffice of the 6ational 1oordinator for 0ealth Information Technolog-. #2454,
/ugust 5(%. State7*evel initiatives. >etrieved from
http:..healthit.hhs.gov.portal.server.pt.communit-.healthit@hhs@gov@@state@level@
initiatives.55;:
54. The ,ffice of the 6ational 1oordinator for 0ealth Information Technolog-. #2454,
eptember 55%. HT>CH temporary certification pro!ram for >H) technolo!y.
>etrieved from http:..healthit.hhs.gov.portal.server.ptM
openN;52FmodeN2FobjIAN2BB9F"ageIAN587(4
55. The ,ffice of the 6ational 1oordinator for 0ealth Information Technolog-. #2455,
6ovember 5:%. Health T policy committee. >etrieved from
http:..healthit.hhs.gov.portal.server.pt.communit-.healthit@hhs@gov@@health@it@po
lic-@committee.5278
52. The ,ffice of the 6ational 1oordinator for 0ealth Information Technolog-. #2455,
6ovember 2(%. Health T standards committee. >etrieved from
0ealth IT 'orkforce 1urriculum 0ealth Management 58
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
http:..healthit.hhs.gov.portal.server.pt.communit-.healthit@hhs@gov@@health@it@st
andards@committee.5295
5(. The 6ational /lliance for 0ealth Information Technolog-. #244B, /pril 2B%.
Definin! key health information technolo!y terms& >etrieved from
http:..healthit.hhs.gov.portal.server.pt.gatewa-."T/>K@4@549:5@B:B5((@4@4@
5B.54@2@hit@terms.pdf
*ecture 3% Images
lide B: Aepartment of 0ealth and 0uman ervices. #2454, /pril 25%. 6ationwide health
information network #60I6% e!change architecture overview A>/$T v.4.8. >etrieved
from
http://healthit.hhs.go#/portal/ser#er.pt/community/healthit6hhs6go#66nhin6resou
rces/:7
,nit 0e3uire( 0ea(ings
5. 1ommittee on Aata tandards for "atient afet-. #244(, =ul- (5%. De-
1apabilities of an Electronic 0ealth >ecord -stem. Letter >eport. Institute of
Medicine 1ommittee on Aata tandards for "atient afet-. >etrieved from
http:..www.iom.edu.>eports.244(.De-)1apabilities)of)an)Electronic)0ealth)
>ecord)-stem.asp!
2. Aepartment of 0ealth and 0uman ervices. #2454, /pril 25%. 6ationwide health
information network e!change: /rchitecture overview. >etrieved from
http:..healthit.hhs.gov.portal.server.pt.communit-.healthit@hhs@gov@@nhin@resour
ces.558:
(. 0ertelend-, /., $enton, .0., F Kriffin, A. #2454, ummer%. The implications of
health reform for health information and electronic health record implementation
efforts. 3erspectives in Health nformation 8ana!ement. >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@4:97:;.pdf
4. 0IM E0> +sabilit- Task $orce. #2448, =une%. Aefining and testing EM>
usabilit-: "rinciples and proposed methods of EM> usabilit- evaluation and
rating. >etrieved from
http:..www.himss.org.content.files.0IM@AefiningandTestingEM>+sabilit-.pdf
;. Morton, M.E., F 'iedenbeck, . #2448, eptember 57%. / framework for
predicting E0> adoption attitudes: / ph-sician surve-. 3erspectives in Health
nformation 8ana!ement. >etrieved from
http:..www.ncbi.nlm.nih.gov.pmc.articles."M12B4::;7.
7. 6ational e0ealth 1ollaborative. #2454, $ebruar- 22%. 60I6 545: /n introduction
to the nationwide health information network. >etrieved from
http:..www.nationalehealth.org.nhin)544)series)spring)semester)2454
9. tead '.'., F Lin 0.. #eds.%. #2448%. 1omputational technolog- for effective
health care: Immediate steps and strategic directions. 'ashington #A1%: 6ational
/cademies "ress.
B. The 6ational /lliance for 0ealth Information Technolog-. #244B, /pril 2B%.
0ealth IT 'orkforce 1urriculum 0ealth Management 24
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Definin! key health information technolo!y terms& >etrieved from
http:..healthit.hhs.gov.portal.server.pt.gatewa-."T/>K@4@549:5@B:B5((@4@4@
5B.54@2@hit@terms.pdf
8. 'ilkins, M. #2448, eptember 57%. $actors influencing acceptance of electronic
health records in hospitals. 3erspectives in Health nformation 8ana!ement.
>etrieved from http:..www.ncbi.nlm.nih.gov.pmc.articles."M12B4::75.
,nit Suggeste( 0ea(ings
5. /0IM/. #n.d.%. 0ealth information e!change. >etrieved from
http:..ahima.org.advocac-.healthinformatione!change.asp!
2. e0ealth Initiative. #2454%. The state of health information e!change in 2454:
1onnecting the nation to achieve meaningful use. >etrieved from
http:..www.thcc2.org."A$s.ehealth@meaningfull@use.pdf
(. 0IM principles in health information e!change. #2449, eptember%. ,ournal of
"H8". >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@4(;48;.hcs
pMdAoc6ameNbok5@4(;48;
:. I<M. #2454, =une 57%. I<M smarter planet: Electronic health records for evolving
healthcare. R3ideo fileS. >etrieved from http:..www.-outube.com.watchM
vNv2"hKg$+7sB
;. Daufman, =.0. #244;, Aecember 7%. $rom regional healthcare information
organiLations to a national healthcare information infrastructure. 3erspectives in
Health nformation 8ana!ement. >etrieved from
http:..www.ncbi.nlm.nih.gov.pmc.articles."M124:9(57.
7. tate 0ealth Information E!change "rogram. #n.d.%. >etrieved from
http:..statehieresources.org.
Stu(ent 'pplication 'cti#ities
comp7@unit(@assign.doc
comp7@unit(@assign@ke-.doc
comp7@unit(@discuss.doc
comp7@unit(@discuss@ke-.doc
comp7@unit(@self@assess.doc
comp7@unit(@self@assess@ke-.doc
0ealth IT 'orkforce 1urriculum 0ealth Management 25
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 6/,nit 7
,nit )itle
ComputeriBe( +ro#i(er "r(er Antry CC+"AD
,nit /escription
Lecture a defines 1",E, states the purpose of 1",E, lists attributes and functions of
1",E, and e!plains how 1",E is currentl- being used in health care. Lecture %
describes the major value to adopting 1",E applications, identifies the common
barriers to adoption, and summariLes the potential impact 1",E has on patient care
safet-, *ualit- and efficienc-, and patient outcomes.
,nit "%&ecti#es
<- the end of this unit the student will be able to:
5. Aescribe the purpose, attributes and functions of 1",E
2. E!plain wa-s in which 1",E is currentl- being used in health care
(. Aiscuss the major value to 1",E adoption
:. Identif- common barriers to 1",E adoption
;. Identif- how 1",E can affect patient care safet-, *ualit- and efficienc-, as
well as patient outcomes
,nit )opics / *ecture )itles
:a Introduction to 1",E
:b /spects of 1",E
,nit 0eferences
#/ll links accessible as of 52.5(.2455%
*ecture 7a
5. <ooth, 1.=. #Ed.%. #;
th
Ed.%. #588(%. >>> standard dictionary of electrical and
electronic terms. 6ew Eork, 6E: Institute of Electrical and Electronics Engineers,
Inc.
2. 1enters for Medicare and Medicaid ervices& Medicare and Medicaid "rograms&
Electronic 0ealth >ecord Incentive "rogram& "roposed >ule, :2 1$> "arts :52,
et al. #=anuar- 5(, 2454%. >etrieved from
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9. H8SS dictionary of healthcare information technolo!y terms, acronyms and
or!ani2ations. #2454%. 1hicago, IL: 0ealthcare Information and Management
-stems ociet-.
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applications in health care and biomedicine #(
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7. Doppel, >., Metla-, =. "., 1ohen, /., /baluck, <., Localio, /. >., Dimmel, . E., F
trom, <. L. #244;, March 8%. )ole of computeri2ed physician order entry
systems in facilitatin! medication errors, >etrieved from http:..jama.ama)
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9. 6ational ?ualit- $orum #6?$%. #2454%. Safe practices for better healthcareD#%9%
update6 " consensus report. 'ashington, A1: author.
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impact of C3O>& >etrieved from
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>etrieved from http:..www.ncbi.nlm.nih.gov.pmc.articles."M122::BBB.
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order entry fact sheet. >etrieved from
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fact)sheet
2. 1alifornia 0ealth1are $oundation. #2444, eptember%. " primer on physician
order entry& #"repared b- $irst 1onsulting Kroup%. >etrieved from
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computeriLed ph-sician order entr- s-stems. Health "ffairs. >etrieved from
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:. Ai!on, <.E. F Tafar, /. #2448, =anuar-%. npatient computeri2ed provider order
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;. $irst 1onsulting Kroup. #244(, =anuar-%. Computeri2ed physician order entry6
Costs, benefits and challen!es& >etrieved from
http:..www.leapfroggroup.org.media.file.Leapfrog)
1",E@1osts@<enefits@1hallenges.pdf
7. Doppel, >., Metla-, =. "., 1ohen, /., /baluck, <., Localio, /. >., Dimmel, . E., F
trom, <. L. #244;, March 8%. )ole of computeri2ed physician order entry
systems in facilitatin! medication errors, >etrieved from http:..jama.ama)
assn.org.cgi.content.full.28(.54.5589M
ijke-NB(e2c:(:89(9abBb959ca8f52ccdca:a5de8f27a
7. =ohnston, A., "an, E., 'alker, =., <ates, A. '., F Middleton, <. #244:, /pril%.
3atient safety in the physicianGs office6 "ssessin! the value of ambulatory C3O>.
1alifornia 0ealth1are $oundation. >etrieved from
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,ffice.pdf
B. "oon, E.K., <lumenthal, A., =aggi, T., 0onour, M. M., <ates, A. '., F Daushal,
>. #244:, =ul-%. ,vercoming barriers to adopting and implementing computeriLed
0ealth IT 'orkforce 1urriculum 0ealth Management 2:
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This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
ph-sician order entr- s-stems in +.. hospitals. Health "ffairs. >etrieved from
http:..content.healthaffairs.org.cgi.content.full.2(.:.5B:M
ijke-N9847925f:52a:2ba97ec:2B7f;cf;;(;f9:a;49e
8. The Leapfrog Kroup. #244B, /pril 8%. Computeri2ed physician order entry fact
sheet& >etrieved from http:..www.leapfroggroup.org.media.file.Leapfrog)
1omputer@"h-sician@,rder@Entr-@$act@heet.pdf
54. The Leapfrog Kroup. #2454, =une%. *eapfro! 'roup report on C3O> evaluation
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http:..www.leapfroggroup.org.media.file.6ew1",EEvaluationTool>esults>eport.
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5. 0ook, =. 0., F 1usack, 1. #244B, Ma-%. /mbulator- computeriLed provider order
entr- #1",E%: $indings from the /0>? health IT "ortfolio. #"repared b- the
/0>? 6ational >esource 1enter for 0ealth IT%. /0>? "ublication 6o. 4B)447()
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447()E$.pdf
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and 'omenPs 0ospital 1",E 'orking Kroup. #2447 Ma-)=une%. >eturn on
investment for a computeriLed ph-sician order entr- s-stem. ,ournal of the
"merican 8edical nformatics "ssociation. >etrieved from
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(. Massachusetts Technolog- 1ollaborative F 6ew England 0ealthcare Institute.
#244B, $ebruar- 5:%. Savin! lives, savin! money6 The imperative for
computeri2ed physician order entry in 8assachusetts hospitals. >etrieved from
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or@computeriLed@ph-sician@order@entr-@in@massachusetts@hospitals
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$ebruar-%. /0>? "ublication 6o. 48)44(B. >etrieved from
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5B."ercent@of@,rders@Entered.pdf
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R3ideo fileS. >etrieved from http:..il.-outube.com.watchMvNfjn-A6TE(>E
9. iemens. #244B =ul- 2;%. The end of illegible prescriptions. R3ideo fileS. >etrieved
from http:..il.-outube.com.watchMvN?n*d27>oh+FfeatureNrelated
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physician order entry. "aper presented at the 244B /0IM/ 1onvention, eattle,
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spMdAoc6ameNbok5@4:2777
0ealth IT 'orkforce 1urriculum 0ealth Management 2;
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Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Stu(ent 'pplication 'cti#ities
comp7@unit:@discuss.doc
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comp7@unit:@self@assess.doc
comp7@unit:@self@assess@ke-.doc
0ealth IT 'orkforce 1urriculum 0ealth Management 27
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3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 6/,nit ;
,nit )itle
Clinical /ecision Support Systems
,nit /escription
Lecture a will offer a definition of clinical decision support, provide some historical
conte!t surrounding clinical decision support, describe the re*uirements of a clinical
decision support s-stem, and discuss the relationship of clinical practice guidelines and
evidence)based practice to clinical decision support s-stems. Lecture % will identif- the
challenges and barriers in building and using clinical decision support s-stems, e!plain
how legal and regulator- technologies ma- affect their use, and introduce the future
directions for clinical decision support s-stems.
,nit "%&ecti#es
<- the end of this unit the student will be able to:
5. Aescribe the histor- and evolution of clinical decision support
2. Aescribe the fundamental re*uirements of effective clinical decision
support s-stems
(. Aiscuss how clinical practice guidelines and evidence)based practice
affect clinical decision support s-stems
:. Identif- the challenges and barriers to building and using clinical decision
support s-stems
;. Aiscuss legal and regulator- considerations related to the distribution of
clinical decision support s-stems
7. Aescribe current initiatives that will impact the future and effectiveness of
clinical decision support s-stems
,nit )opics / *ecture )itles
;a Introduction to 1linical Aecision upport
;b "erspectives on 1linical Aecision upport
,nit 0eferences
#/ll links accessible as of 2.54.2452%
*ecture ;a
5. /genc- for 0ealthcare >esearch and ?ualit-. #n.d.%. T-pes of 1A interventions.
>etrieved from
http://healthit.ahr3.go#/images/mar0:6c(s6%oo56chapter/C/S6Me(Mgmnt6
ch66sec676inter#entions.htm
2. <ecker Medical Librar-. #2454, =anuar-%. 1linical."ractice guidelines. >etrieved
from https://%ec5er.$ustl.e(u/impact/assessment/clin/gui(elines.html
0ealth IT 'orkforce 1urriculum 0ealth Management 29
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
(. <erner, E. . #2448, =une%. 1linical decision support s-stems: tate of the /rt.
/0>? "ublication 6o. 48)4478)E$. >ockville, Mar-land: /genc- for 0ealthcare
>esearch and ?ualit-
http://healthit.ahr3.go#/images/&un0:c(sre#ie$/0:6006:6ef.html
:. <oone, D. #2447, =une 29%. 1linical decision support R'eb log postS. >etrieved
from http://motorcycleguy.%logspot.com/200</06/clinical>(ecision>
support.html
;. Aas, M. F Eichner, =. #2454, March%. 1hallenges and barriers to clinical decision
support #1A% design and implementation e!perienced in the agenc- for
healthcare research and *ualit- 1A demonstrations #"repared for the /0>?
6ational >esource 1enter for 0ealth Information Technolog- under 1ontract 6o.
284)4:)4457.% /0>? "ublication 6o. 54)447:)E$. >etrieved from
http://healthit.ahr3.go#/portal/ser#er.pt/gate$ay/+)'09S6066::6:;666
0606</C/S6challenges6an(6%arriers.p(f
7. 0IM dictionar- of healthcare information technolog- terms, acron-ms and
organiLations. #2454%. 1hicago, IL: 0ealthcare Information and Management
-stems ociet-.
9. Duperman, K., Kardner, >., F "r-or, T. /. #5885%. H>*36 " dynamic hospital
information system. 6ew Eork: pringer)3erlag.
B. Mar*ueL, L. 2445. 0elping healthcare providers perform according to standards.
,perations >esearch Issue "aper 2#(%. <ethesda, MA: "ublished for the +..
/genc- for International Aevelopment #+/IA% b- the ?ualit- /ssurance "roject.
8. Musen, M. /., hahar, E., F hortliffe, E. 0., #2447%. 1linical decision)support
s-stems. In hortliffe. E. 0., F 1imino, =. =. #Eds.%, .iomedical informatics6
Computer applications in health care and biomedicine #(
rd
ed% #pp. 78B)9(7%.
6ew Eork, 6E: pringer cience G <usiness Media.
54. 6ational Librator- of Medicine. #2452%. Me0 descriptor data. Evidence)based
practice. >etrieved from http://$$$.nlm.nih.go#/cgi/mesh/202/M=6cgi.
mo(e8Ein(e4827<20
55. 6ational Librator- of Medicine. #2452%. Me0 descriptor data. "ractice guideline.
>etrieved from http://$$$.nlm.nih.go#/cgi/mesh/202/M=6cgi.
mo(e8Ein(e486067
52. ,sheroff, =. 2448, =anuar- 25%. Aid our 1A interventions help or harmM "aper
presented at / 6ational 'eb 1onference on 1onnecting for 0ealth 1ommon
$ramework >esources for Implementing ecure 0ealth Information E!change
virtual conference. >etrieved from
http://healthit.ahr3.go#/images/&an0:c(s$e%conference/te4tonly/sli(e2<.ht
ml
5(. ,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /. #244;%.
Improving outcomes with clinical decision support: /n implementerJs guide.
1hicago: 0IM
5:. ,sheroff, =. /., Teich, =. M., Middleton, <. $., teen, E. <., 'right, /., F Aetmer,
A. E. #2447, =une 5(%. " roadmap for national action on clinical decision support
#,61 1ontract 00"2((244;44B99"%. >etrieved from /MI/ website:
0ealth IT 'orkforce 1urriculum 0ealth Management 2B
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
http://$$$.amia.org/sites/amia.org/files/'>0oa(map>for>!ational>'ction>
on>Clinical>/ecision>Support>Fune32006.p(f
5;. pooner, ./., #2449%, Mathematical foundations of decision support s-stems. In
<erner, Eta . #Ed.%, 2nd ed., Clinical decision support systems6 Theory and
practice, 6ew Eork, 6E: pringer, 0ealth Informatics eries
*ecture ;a )a%les an( 2igures
;.5 Table: <erner, E. . #2448, =une%. 1linical decision support s-stems: tate of the
/rt. /0>? "ublication 6o. 48)4478)E$. >ockville, Mar-land: /genc- for 0ealthcare
>esearch and ?ualit- http:..healthit.ahr*.gov.images.jun48cdsreview.48@4478@ef.html
;.2 Table: ,sheroff, =. 2448, =anuar- 25%. Aid our 1A interventions help or harmM
"aper presented at / 6ational 'eb 1onference on 1onnecting for 0ealth 1ommon
$ramework >esources for Implementing ecure 0ealth Information E!change virtual
conference. >etrieved from
http:..healthit.ahr*.gov.images.jan48cdswebconference.te!tonl-.slide2B.html
;.( Table: ,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /.
#244;%. Improving outcomes with clinical decision support: /n implementerJs guide.
1hicago: 0IM
;.: Table: ,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /.
#244;%. Improving outcomes with clinical decision support: /n implementerJs guide.
1hicago: 0IM
;.; Table: ,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /.
#244;%. Improving outcomes with clinical decision support: /n implementerJs guide.
1hicago: 0IM
;.7 Table: ,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /.
#244;%. Improving outcomes with clinical decision support: /n implementerJs guide.
1hicago: 0IM
;.9 Table: ,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /.
#244;%. Improving outcomes with clinical decision support: /n implementerJs guide.
1hicago: 0IM
;.B Table: ,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /.
#244;%. Improving outcomes with clinical decision support: /n implementerJs guide.
1hicago: 0IM
*ecture ;a Images
lide 9: 1linical Aecision upport Model. <oone, D. #2447, =une 29%. 1linical decision
support R'eb log postS. >etrieved from
http:..motorc-clegu-.blogspot.com.244B.47.clinical)decision)support.htm
lide 24: 0IM. #n.d.%. o -ou want to do 1AM >etrieved from
http://himss.org/'S+/topics6c(s60.asp.fai(8;0:Eti(87
lide 2:: 6ational Kuideline 1learinghouse. /genc- for 0ealthcare >esearch and
?ualit-. #2448, Ma-%. Taken from summar- of +.. "reventive ervices Task $orce
>ecommendation, +sing nontraditional risk factors in coronar- heart disease risk
assessment. >etrieved from http://$$$.gui(eline.go#
0ealth IT 'orkforce 1urriculum 0ealth Management 28
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
*ecture ;%
5. <erner, E. . #2448, =une%. 1linical decision support s-stems: tate of the /rt.
/0>? "ublication 6o. 48)4478)E$. >ockville, Mar-land: /genc- for 0ealthcare
>esearch and ?ualit-
http://healthit.ahr3.go#/images/&un0:c(sre#ie$/0:6006:6ef.html
2. 1A >ecommendations, #244B, /pril 22%. >etrieved from
http://$$$.hhs.go#/healthit/(ocuments/m200<0722/6.26c(s6recs.html
(. 1enters for Medicare and Medicaid ervices. #2455, 6ovember 9%. >H)
incentive pro!rams overview& >etrieved from
https://$$$.cms.go#/ehrincenti#eprograms/?=""GM'0G
:. 1enters for Medicare and Medicaid ervices& Medicare and Medicaid "rograms&
Electronic 0ealth >ecord Incentive "rogram& $inal >ule, :2 1$> "arts :52, :5(,
:22 et al. #=ul- 2B, 2454%. >etrieved from
http://e(oc5et.access.gpo.go#/200/p(f/200>H20H.p(f
;. Institute of Medicine. #2452%. Health T and patient safety6 .uildin! safer systems
for better care. 'ashington , A1: The 6ational /cademies "ress.
7. Musen, M. /., hahar, E., F hortliffe, E. 0., #2447%. 1linical decision)support
s-stems. In hortliffe. E. 0., F 1imino, =. =. #Eds.%, .iomedical informatics6
Computer applications in health care and biomedicine #(
rd
ed% #pp. 78B)9(7%.
6ew Eork, 6E: pringer cience G <usiness Media.
9. 6ational /cadem- of ciences. #2455, 6ovember%. >eport brief. >etrieved from
http://iom.e(u/@/me(ia/2iles/0eportI202iles/20/Health>
I)/HealthI)an(+atientSafetyreport%rieffinal6ne$.p(f
B. 6ational /cadem- of ciences. #2444%. >eport brief. >etrieved from
http://iom.e(u/@/me(ia/2iles/0eportI202iles/:::/)o>Arr>is>Human/)o
I20ArrI20isI20HumanI20:::I20I20reportI20%rief.p(f
8. ,sheroff, =. /., Teich, =. M., Middleton, <. $., teen, E. <., 'right, /., F Aetmer,
A. E. #2447, =une 5(%. " roadmap for national action on clinical decision support
#,61 1ontract 00"2((244;44B99"%. >etrieved from /MI/ website:
http://$$$.amia.org/sites/amia.org/files/'>0oa(map>for>!ational>'ction>
on>Clinical>/ecision>Support>Fune32006.p(f
54. ,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /. #244;%.
Improving outcomes with clinical decision support: /n implementerJs guide.
1hicago: 0IM
55. irajuddin, /. M., ,sheroff, =. /., ittig, A. $., 1huo, =., 3elasco, $. F 1ollins, A.
/. #2448, $all%. Implementation pearls from a new guidebook on improving
medication use and outcomes with clinical decision support. ,ournal of
Healthcare nformation 8ana!ement& #4#:%, (B):;.
52. +.. Aepartment of 0ealth and 0uman ervices. #2454, eptember 28%. Institute
of Medicine will stud- best policies and practices for improving health care safet-
with health information technolog-. >etrieved from
0ealth IT 'orkforce 1urriculum 0ealth Management (4
Information -stems
3ersion (.4.pring 2452
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*ecture ;% )a%le
;.5 Table: <erner, E. . #2448, =une%. 1linical decision support s-stems: tate of the
/rt. /0>? "ublication 6o. 48)4478)E$. >ockville, Mar-land: /genc- for 0ealthcare
>esearch and ?ualit- http:..healthit.ahr*.gov.images.jun48cdsreview.48@4478@ef.html
,nit 0e3uire( 0ea(ings
5. /genc- for 0ealthcare >esearch and ?ualit-. #n.d.%. T-pes of 1A interventions.
>etrieved from
http://healthit.ahr3.go#/images/mar0:6c(s6%oo56chapter/C/S6Me(Mgmnt6
ch66sec676inter#entions.htm
2. /genc- for 0ealthcare >esearch and ?ualit-. #2448, ,ctober 25%. 1linical
Aecision upport O Improving 0ealth 1are ?ualit-. >etrieved from
http://healthcare7.ahr3.go#/feature'u(io.asp4.i(8070
(. <erner, E. . #2448, =une%. 1linical decision support s-stems: tate of the /rt.
/0>? "ublication 6o. 48)4478)E$. >ockville, Mar-land: /genc- for 0ealthcare
>esearch and ?ualit-
http://healthit.ahr3.go#/images/&un0:c(sre#ie$/0:6006:6ef.html
:. Aas, M. F Eichner, =. #2454, March%. 1hallenges and barriers to clinical decision
support #1A% design and implementation e!perienced in the agenc- for
healthcare research and *ualit- 1A demonstrations #"repared for the /0>?
6ational >esource 1enter for 0ealth Information Technolog- under 1ontract 6o.
284)4:)4457.% /0>? "ublication 6o. 54)447:)E$. >etrieved from
http://healthit.ahr3.go#/portal/ser#er.pt/gate$ay/+)'09S6066::6:;666
0606</C/S6challenges6an(6%arriers.p(f
;. Mar*ueL, L. #2445%. 0elping healthcare providers perform according to
standards. ,perations >esearch Issue "aper 2#(%. <ethesda, MA: "ublished for
the +.. /genc- for International Aevelopment #+/IA% b- the ?ualit-
/ssurance "roject.
7. ,sheroff, =. #2448, =anuar- 25%. Aid our 1A interventions help or harmM "aper
presented at / 6ational 'eb 1onference on 1onnecting for 0ealth 1ommon
$ramework >esources for Implementing ecure 0ealth Information E!change
virtual conference. >etrieved from
http://healthit.ahr3.go#/images/&an0:c(s$e%conference/te4tonly/sli(e2<.ht
ml
9. ,sheroff, =. #2448, Aecember%. /chieving 8eanin!ful Meaningful +se: 'hat it
has to do with 1A and wh- failure is not an option. >etrieved from
http:..www.himss.org.1I@Insights.0IM1linicalInformaticsInsights.aspM
dateN2448525:
B. ,sheroff, =. /., Teich, =. M., Middleton, <. $., teen, E. <., 'right, /., F Aetmer,
A. E. #2447, =une 5(%. / roadmap for national action on clinical decision support
#,61 1ontract 00"2((244;44B99"%. >etrieved from /MI/ website:
0ealth IT 'orkforce 1urriculum 0ealth Management (5
Information -stems
3ersion (.4.pring 2452
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Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
http://$$$.amia.org/sites/amia.org/files/'>0oa(map>for>!ational>'ction>
on>Clinical>/ecision>Support>Fune32006.p(f
,nit Suggeste( 0ea(ings
5. <ates, A.'., Duperman, K.=., 'ang, . et al. #244(, 6ovember.Aecember%. Ten
commandments for effective clinical decision support: making the practice of
evidence)based medicine a realit-. =/IM/. ;2();(4.
2. <utton, ".. Evidence)based plans of care: / solution to save hospitals time and
improve patient care. #2448, Aecember%. >etrieved from
http:..www.himss.org.1I@Insights.0IM1linicalInformaticsInsights.aspM
dateN2448525:
(. A-kes, ". #2448, Aecember%. "artners healthcare information s-stems and the
clinical decision support consortium. >etrieved from
http:..www.himss.org.1I@Insights.0IM1linicalInformaticsInsights.aspM
dateN2448525:
:. 0a-nes, >., 'ilcL-nski, 6. #2454, $ebruar-%. Effects of computeriLed clinical
decision support s-stems on practitioner performance and patient outcomes:
Methods of a decision)maker)researcher partnership s-stematic review.
mplementation Science. >etrieved from
http:..www.ncbi.nlm.nih.gov.pmc.articles."M12B28:B8.MtoolNpmcentreL
;. Musen, M. /., hahar, E., F hortliffe, E. 0., #2447%. 1linical decision)support
s-stems. In hortliffe. E. 0., F 1imino, =. =. #Eds.%, <iomedical informatics:
1omputer applications in health care and biomedicine #(rd ed% #pp. 78B)9(7%.
6ew Eork, 6E: pringer cience G <usiness Media
7. ,sheroff, =. /., "ifer, E. /., Teich, =. M., ittig, A. $., F =enders, >. /. #244;%.
Improving outcomes with clinical decision support: /n implementerJs guide.
1hicago: 0IM
9. pooner, ./., #2449%. Mathematical foundations of decision support s-stems. In
<erner, Eta . #Ed.%, 2nd ed., 1linical decision support s-stems: Theor- and
practice, 6ew Eork, 6E: pringer, 0ealth Informatics eries
B. 'arner, A. #2454, March%. Evaluating /lerts and Triggers: Aetermining whether
alerts and triggers are part of the legal health record. ,ournal of "H8" C9 #(%,
:4):5.
Stu(ent 'pplication 'cti#ities
comp7@unit;@activit-.doc
comp7@unit;@activit-@ke-.doc
comp7@unit;@self@assess.doc
comp7@unit;@self@assess@ke-.doc
0ealth IT 'orkforce 1urriculum 0ealth Management (2
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 6/,nit 6
,nit )itle
+atient Monitoring Systems
,nit /escription
Lecture a offers a definition of patient monitoring s-stems, describes the purpose,
attributes, and functions of patient monitoring s-stems, discusses the primar-
applications and how automation can improve *ualit- of care, and anal-Les how the
integration of data from man- sources assists in medical decision making. Lecture %
discusses how telehealth communication technologies support clinical care, e!plains
the effectiveness and economic benefit of telehealth, and e!amines the role smart
technolog- in the home and remote links to health information s-stems pla- in
enhancing the *ualit- of patient care.
,nit "%&ecti#es
<- the end of this unit the student will be able to:
5. Aescribe the purpose, attributes, and functions of patient monitoring
s-stems
2. Aiscuss wa-s in which automation can improve the *ualit- of patient care
(. /nal-Le how the integration of data from man- sources assists in making
clinical decisions
:. Aiscuss how telehealth communication technologies support clinical care
;. Aiscuss the effectiveness and economic benefit of telehealth
7. E!amine how smart technolog- in the home and remote links to health
information s-stems can enhance the *ualit- of patient care
,nit )opics / *ecture )itles
7a Introduction to "atient Monitoring -stems
7b Telehealth and ,ther >emote "atient Monitoring Technolog-
,nit 0eferences
#/ll links accessible as of 2.54.2452%
*ecture 6a
. <ujnoch, T. #2449, 6ovember 22%. /dvances in patient monitoring: $urthering the
need for efficient information management. >etrieved from $rost F ullivan
http://$$$.frost.com/pro(/ser#let/mar5et>insight>top.pag.(oci(826:<:;0
2. 1enter for Technolog- and /ging. #2454, =ul- 58%. 1enter for technolog- and
aging award remote patient monitoring #>"M% technolog- diffusion grants.
>etrieved from
http://$$$.techan(aging.org/+062000H:60+M69rants6'$ar(e(.p(f
0ealth IT 'orkforce 1urriculum 0ealth Management ((
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
(. Kardner, >. M. F habot, M. M. #2447%. 3atient78onitorin! systems. In hortliffe.
E. 0., F 1imino, =. =. #Eds.%, .iomedical informatics6 Computer applications in
health care and biomedicine #(
rd
ed% #pp. ;B;)72;%. 6ew Eork, 6E: pringer
cience G <usiness Media.
7. 0ealthcare Aata Integration Market ,verview. #244B, eptember (4%. >etrieved
from Impact /dvisors, LL1 http://$$$.impact>a(#isors.com/,ser2iles/file/I'
I20-hitepaperI20>I20HCI20/ataI20IntegratorI20Mar5etI20"#er#ie$
I20200<030.p(f
;. m0ealth /lliance. #2454a%. /bout. >etrieved from
http://$$$.mhealthalliance.org/a%out
6. m0ealth /lliance. #2454b%. Klossar- of terms. >etrieved from
http://$$$.mhealthalliance.org/me(ia6center/glossary>terms
H. 6elson, >. #2452 =anuar-%. E!ploring mobile health consumer trends. Clinical
nformatics nsi!hts& >etrieved from
http://$$$.himss.org/'S+/Content0e(irector.asp.
type8HIMSS!e$sItemEContentI(8H:3
<. hindell, >. #2454, eptember 59%. >emote monitoring: "atient benefits galore.
>etrieved from http://eBinearticles.com/.0emote>Monitoring>>>+atient>
=enefits>9aloreEi(8;02:222
:. 'ang, D., Dohane, I., <radshaw, <., F $ackler, =. #n.d.%. The role of knowledge
bases in patient monitoring s-stems. >etrieved from
http://groups.csail.mit.e(u/me(g/ftp/5ohane/GohaneI20G0I20in
I20Monitoring.rtf
0. 'orld 0ealth ,rganiLation. #n.d.%. 'hat is e0ealth: The 'orld 0ealth
,rganiLation #'0,% definition. >etrieved from http://e>
healthe4pert.org/(efehealth
*ecture 6a 2igure
lide 5;: Med/ps health"/L ) mobile wireless health monitoring. #244B, =ul- 9%. Rimage
on the InternetS. /vailable from: http:..www.flickr.com.photos.timgee.27;((8:4B5.
/ttribution)6on1ommercial 2.4 Keneric #11 <E)61 2.4%
*ecture 6%
5. /merican Telemedicine /ssociation. #n.d.%. Telemedicine.Telehealth terminolog-.
>etrieved from
http://$$$.americanteleme(.org/files/pu%lic/stan(ar(s/glossaryofterms.p(f
2. 1enter for Technolog- and /ging. #2455%. >emote patient monitoring. >etrieved
from http://$$$.techan(aging.org/rpm6program6page.html
(. 1enters for Medicare and Medicaid ervice. #n.d.%. Telemedicine. >etrieved from
http://$$$.cms.go#/teleme(icine/
:. Koedert, =., #2454, ,ctober 5:%. /TFT to use, market diabetes tool. HealthData
8ana!ement& >etrieved from
http://$$$.health(atamanagement.com/ne$s/health>care>technology>
ne$s>(ia%etes>smart>phone>mo%ile>767>.html
0ealth IT 'orkforce 1urriculum 0ealth Management (:
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
;. 0ealth >esources and ervices /dministration. #n.d.%. Telehealth. >etrieved from
http://$$$.hrsa.go#/telehealth/(efault.htm
7. 0ebda, T., 1Lar, "., F Mascara, 1 #588B%. Handbook of informatics for nurses
and health care professionals. Menlo "ark, 1/: /ddison)'esle-.
9. Miller, L. M. F Eoung, D.M. #2444%. Telehealth. In Eoung, D. M. #Ed%. nformatics
for healthcare professionals. #pp. 225)2((% "hiladelphia, "/: $. /. Aavis
1ompan-
B. Mostashari, $. #245, /pril 22%. Testimon- on aging in place: The national
broadband plan and bringing health care technolog- home. >etrieved from
http://aging.senate.go#/e#ents/hr220fm.p(f
8. 6elson, >. #2452 =anuar-%. E!ploring mobile health consumer trends. Clinical
nformatics nsi!hts& >etrieved from
http://$$$.himss.org/'S+/Content0e(irector.asp.
type8HIMSS!e$sItemEContentI(8H:3
,nit 0e3uire( 0ea(ings
5. <olton, L.<., Kassert, 1./., F 1ipriano, ".$. #244B, $all%. mart technolog-,
enduring solutions. =0IM 22 #:%, 2()(4. >etrieved from
http:..www.rwjf.org.files.research.2448495(smarttechnolog-.pdf
2. <ujnoch, T. #2449, 6ovember 22%. /dvances in patient monitoring: $urthering the
need for efficient information management. >etrieved from $rost F ullivan
http:..www.frost.com.prod.servlet.market)insight)top.pagMdocidN55278B8;4
3. 1enter for Technolog- and /ging. #2455%. >emote patient monitoring. >etrieved
from http://$$$.techan(aging.org/rpm6program6page.html
:. 1enters for Medicare and Medicaid ervices. #n.d.%. Telemedicine and telehealth.
>etrieved from www.cms.gov.telemedicine
;. 0ealth >esources and ervices /dministration. #n.d.%. Telehealth. >etrieved from
http://$$$.hrsa.go#/telehealth/(efault.htm
7. 0ealthcare Aata Integration Market ,verview. #244B, eptember (4%. >etrieved
from Impact /dvisors, LL1 http:..www.impact)advisors.com.+ser$iles.file.I/
I24'hitepaperI24)I2401I24AataI24IntegratorI24MarketI24,verview
I24244B4(4.pdf
9. MajerowicL, /., F Trac-, . #2454, Ma-%. Telemedicine: <ridging gaps in
healthcare deliver-. ,ournal of "H8" C9#;%, ;2);(, ;7& >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@4:9(2:.hcs
pMdAoc6ameNbok5@4:9(2:
8. 6elson, >. #2452, =anuar-%. E!ploring mobile health consumer trends. 1linical
Informatics Insights. >etrieved from
http:..www.himss.org./".1ontent>edirector.aspM
t-peN0IM6ewsItemF1ontentIdN9855(
8. hindell, >. #2454, eptember 59%. >emote monitoring: "atient benefits galore.
>etrieved from http:..eLinearticles.com.M>emote)Monitoring)))"atient)<enefits)
KaloreFidN;428222
0ealth IT 'orkforce 1urriculum 0ealth Management (;
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
54. 'ang, D., Dohane, I., <radshaw, <., F $ackler, =. #n.d.%. The role of knowledge
bases in patient monitoring s-stems. >etrieved from
http:..groups.csail.mit.edu.medg.ftp.kohane.DohaneI24D>I24in
I24Monitoring.rtf
,nit Suggeste( 0ea(ings
5. /T/ Issue "aper. #2447, Ma-%. Telemedicine, telehealth, and health information
technolog-. >etrieved from
http:..www.americantelemed.org.files.public.polic-.0IT@"aper.pdf
2. 1ronin, M. #2454, eptember%. mart health: Impact of />>/ funding on the
adoption of smart technolog-. >etrieved from
http:..m2m.tmcnet.com.topics.smart)health.articles.544;:()impact)arra)funding)
the)adoption)smart)technolog-.htm
(. Eramo, L./. #2454, Ma-%. "ersonal medical devices: Managing personal data,
personall- collected. ,ournal of "H8" C9#;%, 27)2B. >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@4:9(28.hcs
pMdAoc6ameNbok5@4:9(28
:. Kardner, >. M. F habot, M. M. #2447%. "atient)Monitoring s-stems. In hortliffe.
E. 0., F 1imino, =. =. #Eds.%, <iomedical informatics: 1omputer applications in
health care and biomedicine #(rd ed% #pp. ;B;)72;%. 6ew Eork, 6E: pringer
cience G <usiness Media.
;. 0ebda, T., 1Lar, "., F Mascara, 1. #588B%. Handbook of informatics for nurses
and health care professionals. Menlo "ark, 1/: /ddison)'esle-.
7. Delle-, ". #2454%. Medical device data s-stems and $A/ regulations, ,H8 #$
#(%, (7):4.
9. Miller, L. M. F Eoung, D.M. #2444%. Telehealth. In Eoung, D. M. #Ed%. nformatics
for healthcare professionals. #pp. 225)2((% "hiladelphia, "/: $. /. Aavis
1ompan-
<. Mostashari, $. #2454, /pril 22%. Testimon- on aging in place: The national
broadband plan and bringing health care technolog- home. >etrieved from
http://aging.senate.go#/e#ents/hr220fm.p(f
8. 6ugent, L., =ohnson, M., Malone-, A., F Ko-al, ". #2449, ,ctober%. Aeveloping
and implementing telehealth program: the 3/Ps stor-. /0IM/Ps 98th 6ational
1onvention and E!hibit "roceedings
54. >ussell, D.K. #2448, ,ctober%. <ringing healthcare home: Technolog- and
telehealth adoption in home care. 2448 /0IM/ 1onvention "roceedings
11. Thielst, 1.<. #2454%. The 1rossroads of telehealth, electronic health records F
health information e!change. >etrieved from
http:..www.nrtrc.org.documents.1rossroadsI24ofI24TelehealthI24'hite
I24"aper.pdf
Stu(ent 'pplication 'cti#ities
comp7@unit7@activit-.doc
comp7@unit7@activit-@ke-.doc
0ealth IT 'orkforce 1urriculum 0ealth Management (7
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
comp7@unit7@self@assess.doc
comp7@unit7@self@assess@ke-.doc
0ealth IT 'orkforce 1urriculum 0ealth Management (9
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 6/,nit H
,nit )itle
Me(ical Imaging Systems
,nit /escription
The lecture offers a definition of medical imaging, describes the purpose, processes,
and management issues of medical imaging s-stems, anal-Les the economic and
technological factors that must be considered in the adoption of digital displa-s in
radiolog- departments, looks at the major challenges with imaging s-stems faced b-
health care institutions and informaticians, and e!amines the future directions for
imaging s-stems.
,nit "%&ecti#es
<- the end of this unit the student will be able to:
5. E!amine the purposes, processes, and management issues
2. +nderstand the economic and technological factors associated with digital
displa-s
(. Aescribe the major challenges
:. Aescribe the future directions
,nit )opics / *ecture )itles
9 Medical Imaging -stems
,nit 0eferences
#/ll links accessible as of 2.54.2452%
*ecture H
1. /0IM/ e)0IM 'ork Kroup on peech >ecognition in the E0>. #244(%. peech
recognition in the electronic health record. >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@422549.hcs
pMdAoc6ameNbok5@422549
2. /merican 0ealth Information Management /ssociation. #2452%. 3ocket !lossary
for health information mana!ement and technolo!y #(
rd
ed.%. 1hicago, IL: /uthor.
3. /renson, >. L., /ndriole, D. "., /vrin, A. E., F Kould, >. K. #2444%. 1omputers in
imaging and health care: 6ow and in the future. =ournal of Di!ital
ma!in!,94#:%,5:;)5;7. /bstract retrieved from
http:..www.ncbi.nlm.nih.gov.pubmed.555542;(
:. <hachu, A. #244;, eptember 5%. The medical digital imaging revolution.
>etrieved from http:..www.hospitalmanagement.net.features.feature7B5.
;. <ranstetter, <. $. #Ed.%, 3ractical ima!in! informatics6 1oundations and
applications for 3"CS professionals #pp. :28)::2%. 6ew Eork, 6E: pringer
0ealth IT 'orkforce 1urriculum 0ealth Management (B
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
cience G <usiness Media.
6. 1enters for Medicare and Medicaid ervices. #2455, 6ovember 9%. >H)
incentive pro!rams overview& >etrieved from
https:..www.cms.gov.ehrincentiveprograms.C<,,DM/>D5
7. 1ollege of /merican "athologists. #2454, eptember 57%. Medical imaging
standard e!tension for patholog- will help advance health information
interoperabilit-. >etrieved from http:..tin-url.com.2elpbvh
8. Koedert, =. #2454, ,ctober 5:%. /dvanced imaging app approved. >etrieved from
http:..www.healthdatamanagement.com.news.health)care)technolog-)news)
imaging)nasa)mammogram)anal-tics):557;)5.html
8. Kreenes, >. /. F <rinkle-, =. $., #2447%. Imaging s-stems in radiolog-. In
hortliffe. E. 0., F 1imino, =. =. #Eds.%, .iomedical informatics6 Computer
applications in health care and biomedicine #(
rd
ed% #pp. 727)7;8%. 6ew Eork, 6E:
pringer cience G <usiness Media.
10. 0ealth Level even International. #n.d.%. /bout 0L9. >etrieved from
http:..www.hl9.org.about.inde!.cfmMrefNnav
55. Drupinski, E. /. #2454%. 3iewing images. In <ranstetter, <. $. #Ed.%, 3ractical
ima!in! informatics6 1oundations and applications for 3"CS professionals #pp.
88)54B%. 6ew Eork, 6E: pringer cience G <usiness Media.
12. 6ational Electrical Manufacturers /ssociation. #n.d.%. AI1,M. >etrieved from
http:..medical.nema.org.dicom.geninfo.<rochure.pdf
5(. 6ational Librar- of Medicine. #244:, /ugust 2:%. <iomedical imaging. >etrieved
from http:..www.nlm.nih.gov.tsd.ac*uisitions.cdm.subjects5;.html
14. 6ational Librar- of Medicine. #2452%. Aiagnostic imaging. >etrieved from
http:..www.nlm.nih.gov.cgi.mesh.2452.M<@cgiM
modeNFinde!N(9B7FfieldNallF0MNFIINF"/NFformNFinputN
5;. >alston, M. A., F 1oleman, >. M., #2454%. Introduction to "/1. In <ranstetter,
<. $. #Ed.%, 3ractical ima!in! informatics6 1oundations and applications for 3"CS
professionals +pp. (():B%. 6ew Eork, 6E: pringer cience G <usiness Media.
16. ociet- for Imaging Informatics in Medicine. #2452%. Imaging informatics.
>etrieved from http:..www.siimweb.org.inde!.cfmMidN(2:
59. van <emmel, =.0., F M./. Musen, eds. #5888%. Handbook of 8edical nformatics&
3ol. (.(. >otterdam, 6etherlands: Erasmus +niversit- and tanford +niversit-
*ecture H 2igure
lide B: "/1 1onfigurations: $acilit-)wide solution Rimage on the InternetS. #n.d.%.
>etrieved from http:..www.ke-stonemedicalus.com.Multi)Modalit-)"/1.av)advanced)
visualiLation)(d):d
,nit 0e3uire( 0ea(ings
1. /renson, >. L., /ndriole, D. "., /vrin, A. E., F Kould, >. K. #2444%. 1omputers in
imaging and health care: 6ow and in the future. =ournal of Di!ital ma!in!, 94#:%,
5:;)5;7. /bstract retrieved from http:..www.ncbi.nlm.nih.gov.pubmed.555542;(
0ealth IT 'orkforce 1urriculum 0ealth Management (8
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
2. <hachu, A. #244;, eptember 5%. The medical digital imaging revolution.
>etrieved from http:..www.hospitalmanagement.net.features.feature7B5.
(. <oochever, .. #244:, Ma-.=une%. 0I.>I."/1 integration: Ketting to the
gold standard. )adiolo!y 8ana!ement& >etrieved from
http:..www.ihealthstrategies.com.pdf.I0/rticle2.pdf
:. 1ollege of /merican "athologists. #2454, eptember 57%. Medical imaging
standard e!tension for patholog- will help advance health information
interoperabilit-. >etrieved from http:..tin-url.com.2elpbvh
5. $ratt, L. #2454, /ugust 2;% 1harting a course for interoperabilit-: 1onnecting
data, connecting patients. >etrieved from
http:..www.healthimaging.com.inde!.phpM
optionNcom@articlesFviewNarticleFidN2(B5(:charting)a)course)for)
interoperabilit-)connecting)data)connecting)patients
7. Klaser, =. #2449%. The evolution of the role of imaging informatics in the health
care deliver- s-stem. >etrieved from
http:..www.siim2449.org.2449opensession.html
9. Koedert, =. #2454, ,ctober 5:%. /dvanced imaging app approved. >etrieved from
http:..www.healthdatamanagement.com.news.health)care)technolog-)news)
imaging)nasa)mammogram)anal-tics):557;)5.html
B. Images, an-where, an-time: 'eb)based "/1 F >I."/1. #244B, =ul-%
>etrieved from http:..cdn.trimedmedia.com.cdn.@v.webcast.web)
based@pacs.494B@0IIT@KE.pdf
9. 6ational Electrical Manufacturers /ssociation. #n.d.%. AI1,M. >etrieved from
http:..medical.nema.org.dicom.geninfo.<rochure.pdf
10. 6ational Librar- of Medicine. #244:, /ugust 2:%. <iomedical imaging. >etrieved
from http:..www.nlm.nih.gov.tsd.ac*uisitions.cdm.subjects5;.html
55. 6ational Librar- of Medicine. #2452%. Aiagnostic imaging. >etrieved from
http:..www.nlm.nih.gov.cgi.mesh.2452.M<@cgiM
modeNFinde!N(9B7FfieldNallF0MNFIINF"/NFformNFinputN
52. "ersons, D. F Langer, . #2449, $all%. 1hallenges of implementing an enterprise
image archive. >etrieved from http:..www.siimweb.org.inde!.cfmMidN(B(B
5(. >alston, M. A., F 1oleman, >. M., #2454%. Introduction to "/1. In <ranstetter,
<. $. #Ed.%, 3ractical ima!in! informatics6 1oundations and applications for 3"CS
professionals +pp. (():B%. 6ew Eork, 6E: pringer cience G <usiness Media.
5:. ociet- for Imaging Informatics in Medicine. #2452%. Imaging informatics.
>etrieved from http:..www.siimweb.org.inde!.cfmMidN(2:
5;. The Aorenfest Institute. #2454%. "icture archiving and communication s-stems: /
2444)244B tud-. >etrieved from
http:..www.himss.org.foundation.docs."/1@>esearch'hite"aper$inal.pdfM
srcNpr
,nit Suggeste( 0ea(ings
5. <assett, M. #2454, March 2;%. 6e!t)generation "/1: ,ut with the old F in with
the new. 0ealthImaging F IT. >etrieved from
0ealth IT 'orkforce 1urriculum 0ealth Management :4
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
http:..www.healthimaging.com.inde!.phpM
optionNcom@articlesFviewNarticleFidN25:54:ne!t)generation)pacs)out)with)the)
old)a)in)with)the)new
2. <ranstetter, <. $. #Ed.%, 3ractical ima!in! informatics6 1oundations and
applications for 3"CS professionals +pp. :28)::2%. 6ew Eork, 6E: pringer
cience G <usiness Media.
3. AiMarcantonio, T. #2447, =ul-%. "h-sicians weigh the costs, benefits and
challenges of digital imaging s-stems. Orthopedics Today. >etrieved from
http:..www.orthosupersite.com.view.asp!MridN597(:
4. $ratt, L. #2454, =ul- 2(%.Top 2; connected facilities: The refining of radiolog-.
Healthma!in! - T. >etrieved from http:..www.healthimaging.com.inde!.phpM
optionNcom@articlesFviewNarticleFidN2(((::top)2;)connected)facilities)the)
refining)of)radiolog-
;. Keis, =.>. #2449, =une%. Medical imaging informatics: 0ow it improves radiolog-
practice toda-. ,ournal of Di!ital ma!in!. >etrieved from
http:..www.springerlink.com.content.l(49:5:95B;45t;4.fullte!t.pdf
7. Kreenes, >. /. F <rinkle-, =. $., #2447%. Imaging s-stems in radiolog-. In
hortliffe. E. 0., F 1imino, =. =. #Eds.%, .iomedical informatics6 Computer
applications in health care and biomedicine #(
rd
ed% #pp. 727)7;8%. 6ew Eork, 6E:
pringer cience G <usiness Media.
9. Integrating >I."/1 for the Enterprise. #2449, 6ovember%. >etrieved from
http:..cdn.trimedmedia.com.cdn.@v.webcast.integrating@rispacs.494(.pdf
B. Drupinski, E. /. #2454%. 3iewing images. In <ranstetter, <. $. #Ed.%, 3ractical
ima!in! informatics6 1oundations and applications for 3"CS professionals #pp.
88)54B%. 6ew Eork, 6E: pringer cience G <usiness Media.
9. "/1 for the 1ommunit- 0ospital. #2447, 6ovember%. >etrieved from
http:..cdn.trimedmedia.com.cdn.@v.webcast."/1@for@the@1ommunit-@0ospital.
files."/1@for@the@1ommunit-@0ospital.pdf
54. vanonnenberg, 1. #2454, ,ctober ;%. urve-: "/1 brings benefits, despite
training gaps. Healthima!in!&com. >etrieved from
http:..www.healthimaging.com.inde!.phpM
optionNcom@articlesFviewNportalFidNpublication:52:article:2::;2:surve-)pacs)
brings)benefits)despite)training)gaps
Stu(ent 'pplication 'cti#ities
comp7@unit9@activit-.doc
comp7@unit9@activit-@ke-.doc
comp7@unit9@self@assess.doc
comp7@unit9@self@assess@ke-.doc
0ealth IT 'orkforce 1urriculum 0ealth Management :5
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 6/,nit <
,nit )itle
Consumer Health Informatics
,nit /escription
Lecture a provides a definitions of health communication, e)0ealth, consumer health
informatics, and interactive health communication, identifies how the Internet has
impacted consumer health informatics, e!plains how current and emerging technologies
ma- affect consumer health informatics, and introduces the role of genomics in
consumer health informatics. Lecture b offers definitions of personal health records or
"0>s, describes the role of "0>s and their implications within health care, and
discusses the challenges of consumerism in health information s-stems.
,nit "%&ecti#es
<- the end of this unit the student will be able to:
5. E!plain how current and emerging technologies have impacted and ma-
continue to affect consumer health informatics
2. Aescribe the role of genomics in consumer health informatics
(. Aescribe the emergence of personal health records and their implications
:. Aiscuss how consumerism influences the ongoing development and use
of health information s-stems
,nit )opics / *ecture )itles
Ba Introduction to 1onsumer 0ealth Informatics
Bb "ersonal 0ealth >ecords and 1onsumerism
,nit 0eferences
#/ll links accessible as of 2.54.2452%
*ecture <a
5. /merican 0ealth Information Management /ssociation. #2452%. 3ocket !lossary
for health information mana!ement and technolo!y #(
rd
ed.%. 1hicago, IL: /uthor.
2. 1enters for Aisease 1ontrol and "revention. #2454%. Kenomics and health.
>etrieved from http:..www.cdc.gov.genomics.public.inde!.htm
3. 1enters for Aisease 1ontrol and "revention. #2455, Ma-%. ocial media at 1A1.
>etrieved from http:..www.cdc.gov.ocialMedia.Tools.
4. Kibbons, M.1., 'ilson, >.$., amal, L, Lehmann, 1.+., Aickersin, D., Lehmann,
0."., /boumatar, 0., $inkelstein, =., helton. E., harma, >., F <ass, E.<. #2448,
,ctober%. mpact of consumer health informatics applications& Evidence
>eport.Technolog- /ssessment 6o. 5BB. #"repared b- =ohns 0opkins +niversit-
Evidence)based "ractice 1enter under contract 6o. 00/ 284)2449)54475)I%.
0ealth IT 'orkforce 1urriculum 0ealth Management :2
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
/0>? "ublication 6o. 48#54%)E458. >ockville, MA. /genc- for 0ealthcare
>esearch and ?ualit-. >etrieved from
http:..www.ncbi.nlm.nih.gov.books.6<D(27(B.pdf.T,1.pdf
5. 0ealth >esources and ervices /dministration #0>/%. #244(, ,ctober%.
Telemedicine reimbursement report. #"repared b- the 1enter for Telemedicine
Law under contract 6o.42)0/<)/25;(4:%. >etrieved from
http:..www.hrsa.gov.ruralhealth.about.telehealth.reimburse.pdf
7. Daplan, /. M. F 0aenlein, M. #2454%. +sers of the world uniteX The challenges
and opportunities of social media. .usiness Hori2ons <4#5%, ;8)7B.
7. 6ational 0uman Kenome >esearch Institute. #2454%. Kenetic information
nondiscrimination act of 244B. >etrieved from http:..www.genome.gov.54442(2B
8. ,ffice of Aisease "revention and 0ealth "romotion #,A"0"%. #2452%. e)0ealth.
>etrieved from http:..www.health.gov.communication.ehealth.Aefault.asp
8. >atLan, .1. #Ed.%. #588:%. 0ealth communication, challenges for the 25st
centur-. pecial issue. "merican .ehavioral Scientist 4C#2%, 242)249.
54. >obinson, T.6.& "atrick, D.& Eng, T.>.& F Kustafson, A, for the cience "anel on
Interactive 1ommunication and 0ealth. #588B, ,ctober%. /n evidence)based
approach to interactive health communication: / challenge to medicine in the
Information /ge. ,ournal of the "merican 8edical "ssociation, #C%#5:%, 527:)
5278.
55. 3aldeL >., Eoon, ".'., ?ureshi, 6., Kreen, >. $., F Dhour-, M. =. #2454, /pril%.
$amil- histor- in public health practice: / genomic tool for disease prevention
and health promotion. "nnual )eview of 3ublic Health 49, 78)B9.
12. +.. Aepartment of 0ealth and 0uman ervices. #2444%. 0ealth- people 2454:
,bjectives for improving health. >etrieved from
http:..www.health-people.gov.2454.Aocument.tableofcontents.htmCvolume5
13. +.. Aepartment of 0ealth and 0uman ervices. #2447, =une%. E!panding the
reach and impact of consumer e)0ealth tools. >etrieved from
http:..www.health.gov.communication.ehealth.ehealthtools.pdf.ehealthreport.pdf
14. +.. Aepartment of 0ealth and 0uman ervices. #2455%. 0ealth- people 2454
final review. >etrieved from
http:..www.cdc.gov.nchs.health-@people.hp2454.hp2454@final@review.htm
5;. +.. Aepartment of 0ealth and 0uman ervices. #2452%. Kenomics. >etrieved
from http:..www.health-people.gov.2424.topicsobjectives2424.overview.asp!M
topicidN5;
*ecture <a 2igure
lide 57: /des, =. #2448, Ma- 5%. "rescription form with A6/ double heli!. Rimage on
the InternetS. >etrieved from http:..www.genome.gov.pressAispla-.cfmMphotoIAN245;B
*ecture <%
1. /etna. #2452%. Klossar-. >etrieved from http:..www.planfor-ourhealth.com.tools)
resources.glossar-.glossar-c.Term.glossar-a.single.termofglossar-.health)care)
consumerism.
0ealth IT 'orkforce 1urriculum 0ealth Management :(
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
2. /merican 0ealth Information Management /ssociation. #2452%. Klossar- of
terms. >etrieved from http:..www.m-phr.com.0ealthLiterac-.glossar-.asp!
3. $ahrenholL, 1. K., F <uck, . L. #2449%. "0>s and ph-sician practices. ,ournal
of "H8", =C#:%, 95)9;. >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@4((B59.hcs
pMdAoc6ameNbok5@4((B59
4. 0ealth Level even International. #2455%. /bout 0L9. >etrieved from
http:..www.hl9.org.about.inde!.cfmMrefNnav
5. 0ealth Level even International. #244B%. "roduct "0> $M. >etrieved from
http:..wiki.hl9.org.inde!.phpMtitleN"roduct@"0>@$M
6. Mead 6., F <ower ". #2444%. "atient)centredness: a conceptual framework and
review of the empirical literature. ocial cience F Medicine. Social Science -
8edicine, <9. >etrieved from
http:..med.over.net.javne@datoteke.novice.datoteke.(52)
reading2;c"atientccentrednesscacconceptualcframework5.pdf
7. The 6ational /lliance for 0ealth Information Technolog- #6/0IT%. #244B, /pril
2B%. Definin! key health information technolo!y terms& >etrieved from
http:..healthit.hhs.gov.portal.server.pt.gatewa-."T/>K@4@549:5@B:B5((@4@4@
5B.54@2@hit@terms.pdf
B. +.. Aepartment of 0ealth and 0uman ervices. #2455%. 0ealth- people 2454:
,bjectives for improving health. >etrieved from
http:..www.health-people.gov.2454.Aocument.tableofcontents.htmCvolume5
,nit 0e3uire( 0ea(ings
5. /0IM/ e)0IM "ersonal 0ealth >ecord 'ork Kroup. #244;, =ul-)/ugust%. The
role of the personal health record in the E0>. =ournal of /0IM/ >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@4:B;59.hcs
pMdAoc6ameNbok5@4:B;59
2. /0>?. #2448%. Internet access for health information and advice. >etrieved from
http:..www.cahps.ahr*.gov.*iguide.content.interventions.Internet/ccess.asp!
3. 1enters for Aisease 1ontrol and "revention. #2454%. Kenomics and health.
>etrieved from http:..www.cdc.gov.genomics.public.inde!.htm
:. 1enters for Aisease 1ontrol and "revention. #2455, Ma-%. ocial media at 1A1.
>etrieved from http:..www.cdc.gov.ocialMedia.Tools.
;. 1enters for Medicare and Medicaid ervices. #2448, =anuar-% "ersonal health
records. "ublication 6o. 55(89. >etrieved from
http:..www.medicare.gov."ublications."ubs.pdf.55(89.pdf
7. $ahrenholL, 1. K., F <uck, . L. #2449%. "0>s and ph-sician practices. ,ournal
of "H8", =C#:%, 95)9;. >etrieved from
http:..librar-.ahima.org.!pedio.groups.public.documents.ahima.bok5@4((B59.hcs
pMdAoc6ameNbok5@4((B59
9. Kibbons, M.1., 'ilson, >.$., amal, L, Lehmann, 1.+., Aickersin, D., Lehmann,
0."., /boumatar, 0., $inkelstein, =., helton. E., harma, >., F <ass, E.<. #2448,
,ctober%. mpact of consumer health informatics applications& Evidence
0ealth IT 'orkforce 1urriculum 0ealth Management ::
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
>eport.Technolog- /ssessment 6o. 5BB. #"repared b- =ohns 0opkins +niversit-
Evidence)based "ractice 1enter under contract 6o. 00/ 284)2449)54475)I%.
/0>? "ublication 6o. 48#54%)E458. >ockville, MA. /genc- for 0ealthcare
>esearch and ?ualit-. >etrieved from
http:..www.ncbi.nlm.nih.gov.books.6<D(27(B.pdf.T,1.pdf
B. 0ealth Level even International. #244B%. "roduct "0> $M. >etrieved from
http:..wiki.hl9.org.inde!.phpMtitleN"roduct@"0>@$M
8. 0ealth >esources and ervices /dministration #0>/%. #244(, ,ctober%.
Telemedicine reimbursement report. #"repared b- the 1enter for Telemedicine
Law under contract 6o.42)0/<)/25;(4:%. >etrieved from
http:..www.hrsa.gov.ruralhealth.about.telehealth.reimburse.pdf
54. Markle $oundation. #244B, =une%. 1onnecting consumers: 1ommon framework
for networked personal health information. >etrieved from
http:..www.markle.org.publications.:42)connecting)health)common)framework)
networked)personal)health)information
55. Mead 6., F <ower ". #2444%. "atient)centredness: a conceptual framework and
review of the empirical literature. ocial cience F Medicine. Social Science -
8edicine, <9. >etrieved from
http:..med.over.net.javne@datoteke.novice.datoteke.(52)
reading2;c"atientccentrednesscacconceptualcframework5.pdf
52. 6ational 0uman Kenome >esearch Institute. #2454%. Kenetic information
nondiscrimination act of 244B. >etrieved from http:..www.genome.gov.54442(2B
5(. ,ffice of Aisease "revention and 0ealth "romotion #,A"0"%. #2452%. e)0ealth.
>etrieved from http:..www.health.gov.communication.ehealth.Aefault.asp
5:. ,ffice of Aisease "revention and 0ealth "romotion. #2447, =une%. E!panding the
reach and impact of consumer e)0ealth tools. >etrieved from
http:..www.health.gov.communication.ehealth.ehealthTools.default.htm
5;. >atLan, .1. #Ed.%. #588:%. 0ealth communication, challenges for the 25st
centur-. pecial issue. "merican .ehavioral Scientist 4C#2%, 242)249.
16. +.. Aepartment of 0ealth and 0uman ervices. #2447, =une%. E!panding the
reach and impact of consumer e)0ealth tools. >etrieved from
http:..www.health.gov.communication.ehealth.ehealthtools.pdf.ehealthreport.pdf
59. +.. Aepartment of 0ealth and 0uman ervices. #2452%. Kenomics. >etrieved
from http:..www.health-people.gov.2424.topicsobjectives2424.overview.asp!M
topicidN5;
,nit Suggeste( 0ea(ings
5. Aimick, 1. #2454, Ma-%. 0ealth IT for the people: /n increasing movementWbut
no road mapWfor patient)centered health IT. =ournal of /0IM/ B5#;%, 24)2:.
2. Aimick, 1. #2454, $ebruar-%. Empowered patient: "reparing for a new patient
interaction. =ournal of /0IM/ B5#2%, 27)(5.
(. $eero, '.K., 0olden, ., F $uller, <. #2448, 6ovember)Aecember%. Kenomics
and 0IM: Three areas of increasing intersection. ,ournal of "H8" C%#55%, ;2)
;(, ;B.
0ealth IT 'orkforce 1urriculum 0ealth Management :;
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
:. Daplan, /. M. F 0aenlein, M. #2454%. +sers of the world uniteX The challenges
and opportunities of social media. <usiness 0oriLons ;(#5%, ;8)7B. Y1onnecting
for 0ealth 1ommon $ramework for 6etworked "ersonal 0ealth Information:
,verview and "rinciplesZ published b- Markle $oundation 1onnecting for 0ealth,
www.connectingforhealth.org, =une 244B.
;. Delso, L., F 'alker, >. #2448, ,ctober%. The consumer view of "0>s:
,bservational stud- finds most value "0>s, but issues remain. ,ournal of
"H8" C%#54%, ;7);9, ;8.
7. Deckle-, "., F Eelius, L. #244B%. 1onsumerism in health care. >etrieved from
http:..www.deloitte.com.view.en@+.us.Insights.<rowse)b-)1ontent)
T-pe.deloitte)review.:7fba9d2994fb5543gn31M544444ba:2f44a>1>A.htm
9. Markle $oundation. #244:, =ul-%. 1onnecting /mericans to their healthcare: $inal
report. >etrieved from http:..www.markle.org.publications.52;4)connecting)
americans)their)health)care
B. Mead 6., F <ower ". #2444%. "atient)centredness: a conceptual framework and
review of the empirical literature. Social Science - 8edicine. >etrieved from
http:..med.over.net.javne@datoteke.novice.datoteke.(52)
reading2;c"atientccentrednesscacconceptualcframework5.pdf
8. 6ational 1ommittee on 3ital and 0ealth tatistics. #2447, $ebruar-%. "ersonal
health records and personal health record s-stems. >etrieved from
http:..www.ncvhs.hhs.gov.4742nhiirpt.pdf
54. "ringle, .L. #2454, Ma-%. Trusting "0>s: The standards that protect the securit-
and confidentialit- of "0>)stored "0I. ,ournal of "H8" C9#;%, :4):5.
55. >obinson, T.6.& "atrick, D.& Eng, T.>.& F Kustafson, A, for the cience "anel on
Interactive 1ommunication and 0ealth. #588B, ,ctober%. /n evidence)based
approach to interactive health communication: / challenge to medicine in the
Information /ge. ,ournal of the "merican 8edical "ssociation, #C%#5:%, 527:)
5278.
52. >ose, <., F 1assid-, <. #,ctober, 2448%. "0> certification: <uilding consumer
trust. /0IM/ 1onvention "roceedings.
5(. 3aldeL >., Eoon, ".'., ?ureshi, 6., Kreen, >. $., F Dhour-, M. =. #2454, /pril%.
$amil- histor- in public health practice: / genomic tool for disease prevention
and health promotion. "nnual )eview of 3ublic Health 49, 78)B9.
5:. 'arner, A. #2454, =ul-%. Managing patient)provided information in E0>s. ,ournal
of "H8" C9#9%, ::):;.
Stu(ent 'pplication 'cti#ities
comp7@unitB@activit-.doc
comp7@unitB@activit-@ke-.doc
comp7@unitB@self@assess.doc
comp7@unitB@self@assess@ke-.doc
0ealth IT 'orkforce 1urriculum 0ealth Management :7
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
Component 6/,nit :
,nit )itle
'(ministrati#e1 =illing1 an( 2inancial Systems
,nit /escription
Lecture a e!amines the relationship of administrative, billing, and financial s-stems to
the health care information s-stem, e!plains applications that need to be integrated in
health care information s-stems, e!plores health care organiLationsJ integration
strategies, identifies the critical elements for integration of these s-stems with clinical
information s-stems, and discusses how health care organiLations ma- gain valuable
insights from integrated data through data anal-tics and trending. Lecture b defines a
master patient inde! or M"I and describes its core elements and discusses current
trends to establish a uni*ue patient identifier.
,nit "%&ecti#es
<- the end of this unit the student will be able to:
5. E!plain applications that need to be integrated in health care information
s-stems
2. Aescribe the strategies used b- health care organiLations to ensure
integration of functions
(. Aiscuss the critical elements needed to integrate billing, financial, and
clinical s-stems
:. Aiscuss the core elements of a Master "atient Inde! #M"I%
;. Aescribe current trends to establish a +ni*ue "atient Identifier #+"I%
,nit )opics / *ecture )itles
8a Introduction /dministrative, <illing, and $inancial -stems and 0ealth 1are
Information -stems Integration
8b Master "atient Inde! and the +ni*ue "atient Identifier
,nit 0eferences
#/ll links accessible as of 2.54.2452%
*ecture :a
1. /gosta, L. #2454, =une 5%. Aata integration delivers healthcare meaningful use.
/lleingang >esearch. >etrieved from
http:..www.pervasiveintegration.com.dcontent.1ollateral."ervasive0IT>.pdf
2. /merican 0ealth Information Management /ssociation. #2452%. 3ocket !lossary
for health information mana!ement and technolo!y #(
rd
ed.%. 1hicago, IL: /uthor.
3. 1linfowiki. #2455%. <usiness intelligence. /vailable from: http:..www.informatics)
review.com.wiki.inde!.php.<usiness@Intelligence@F@Aata@'arehousing@for@0e
0ealth IT 'orkforce 1urriculum 0ealth Management :9
Information -stems
3ersion (.4.pring 2452
This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
Coordinator for Health nformation Technolo!y under "ward Number U#$OC%%%%#$&
althcare
4. 0ealthcare $inancial Management /ssociation. #n..d.%. 0$M/ glossar-.
>etrieved from http:..www.hfma.org.forms.glossar-.search.asp!.search.asp!
5. 0ealthcare Information and Management -stems ociet- #0IM%. #n.d.a%.
/bout 0IM. http:..www.himss.org./".about0imss0ome.asp
6. 0ealthcare Information and Management -stems ociet- #0IM%. #n.d.b%.
Interoperabilit- F standards. >etrieved from
http:..www.himss.org./".topics@integration.asp
7. 0ealthcare Information and Management -stems ociet- #0IM%. #2449%.
Enterprise integration: Aefining the landscape. >etrieved from
http:..www.himss.org.content.files.Ent@Integr@whitepaper@4(4B49.pdf
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8. 0ealthcare Information and Management -stems ociet- #0IM%. #2454%.
H8SS dictionary of healthcare information technolo!y terms, acronyms and
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5(. 3ogel, L.0., F "erreault, L.E., #2447%. Management of information in healthcare
organiLations. In hortliffe. E. 0., F 1imino, =. =. #Eds.%, .iomedical informatics6
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ed% #pp. :97);54%.
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Inde!.Enterprise Master "atient Inde! #+pdated%: /ppendi! / >ecommended
core data elements for EM"Is. ,ournal of "H8", C9#:%, ;2);9. >etrieved from
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/lleingang >esearch. >etrieved from
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2. /0IM/. #2454, /pril%. $undamentals for building a Master "atient
Inde!.Enterprise Master "atient Inde! #+pdated%: /ppendi! / >ecommended
core data elements for EM"Is. ,ournal of "H8", C9#:%, ;2);9. >etrieved from
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(. /0IM/. #2454, /pril%. >econciling and managing EM"Is. ,ournal of "H8"
C9#:%, ;2);9. >etrieved from
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pMdAoc6ameNbok5@4:78:2
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55. 0IM. #2449%. Enterprise integration: Aefining the landscape. >etrieved from
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52. 6ational 1ommittee on 3ital and 0ealth tatistics. #5889%. "art three: +ni*ue
patient identifier. >etrieved from http:..ncvhs.hhs.gov.app(.htmC"art(
5(. >aths, A. #2448, March%. / house divided. Healthcare nformatics. >etrieved
from http:..www.healthcare)informatics.com.article.house)divided
5:. >aths, A. #2449, Aecember%. Ketting on schedule. Healthcare nformatics.
>etrieved from http:..www.healthcare)informatics.com.article.getting)schedule
15. >aths, A. #2448, eptember%. Ketting together. Healthcare nformatics& >etrieved
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financial decision support. C8O. >etrieved from http:..www.cmio.net.inde!.phpM
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master patient inde!. /0IM/Ps 98th 6ational 1onvention and E!hibit "roceedings
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1omputer applications in health care and biomedicine #(rd ed.% #pp. :97);54%.
6ew Eork, 6E: pringer cience G <usiness Media.
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/AEs /dverse Arug Events
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"MI "atient Master Inde!
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?$A ?ualit- $unction Aeplo-ment
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>$ >adio $re*uenc-
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>IM >eference Information Model
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>MIM >efined Message Information Model
>M"I >egistr- Master "atient Inde!
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>"M >emote "atient Monitoring
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>6/ >adiological ociet- of 6orth /merica
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/E/$ ervices)/ware Enterprise /rchitecture $ramework
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/6 torage /rea 6etwork
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1, A, 1harter ,rganiLation
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AM -stems Aevelopment Method
A, tandard Aevelopment ,rganiLation
ATM tud- Aata Tabulation Model
EI ubject Matter E!pert
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6,MEA -stematiLed 6omenclature of Medicine
6,MEA
1T -stematiLed 6omenclature of Medicine))1linical Terms
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>T -stematiLed 6omenclature of Medicine))>eference Terminolog-
6," -stematiLed 6omenclature of "atholog-
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This material was developed by Duke University funded by the Department of Health and Human Services, Office of the National
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T1".I" Transmission 1ontrol "rotocol . Internet "rotocol
TE"> Toward an Electronic "atient >ecord 1onference
TL Transport La-er ecurit-
T,1 Table of 1ontents
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T" Transaction "rocessing -stem
T1 0L9 Technical teering 1ommittee
TTL Time to Live
+/T +ser /cceptance Testing
+A" +ser Aatagram "rotocol
+ML +niform Modeling Language
+ML +nified Medical Language -stem
+>Ls +niversal >esources Locators
+"I +ni*ue "atient Identifier
+" +n)interrupted power suppl-
+ +ltrasound
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3+M1 3anderbilt +niversit- Medical 1enter
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