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Chapter 19 Informatics Challenges and Issues

 

Additional Information For This Chapter

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Helpful Websites For This Chapter

(The links in this section are off this site. Inclusion here is for your convenience in locating more information about a topic. Inclusion does not indicate endorsement.)

Biometrics

An Biometric Identification System by Extracting Hand Vein Patterns. Journal of the Korean Physical Society, Vol. 38, No. 3, March 2001, pp. 268272. (Added August 31, 2007)
http://nl.internet.com/ct.html?rtr=on&s=1,3fi8,1,jv3r,f0re,ek2t,hmlx

Biometric Consortium, the US Government's focal point for research, development, test, evaluation, and application of biometric-based personal identification/verification technology. Read the introduction to biometrics for a good definition. The biometric systems and examples leads to links to vendors of products in this area.
http://www.biometrics.org/

Biometrics Catalog. This government sponsored site contains links to much helpful information about biometrics including a paper about challenges in using biometrics (contains an excellent description of many methods), also an elementary description of biometrics named Biometrics 101. (These two are found under Government Documents.) (Added April 20, 2004)
http://www.biometricscatalog.org/

Daugman, J. (2001). Iris Recognition. An abstract of an article in Scientific American. Presents a very complete, yet easily understood description of this process. Some illustrations.
http://www.americanscientist.org/articles/01articles/Daugman.html

Iris Recognition: The Technology. A lengthy paper that describes this technology in fairly easy to understand language. Includes diagrams.
http://www.iris-scan.com/iris_technology.htm

Silverman, M, & Liu, S. A Practical Guide to Biometric Security Technology. (2000). An excellent easy to understand description of the various features that can be used in biometric security.
http://www.computer.org/itpro/homepage/Jan_Feb/security3.htm

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Community Health Information Network (CHIN) and Regional Health Information Organizations (RHIOs)

Improving Health in the Information Age. A report from the Markle Foundation that provides links to resources abour RHIOs. (Added June 8, 2005)
http://www.connectingforhealth.org/

Data Security, Privacy & Confidentiality

Badzek, L. & Gross, L. (1999). Confidentiality and Privacy: At the Forefront for Nurses. An article that discusses some of the issues involved.
http://www.nursingworld.org/ajn/1999/june/issu069c.htm

Cavoukian, A. (1996). Go beyond security -- build in privacy: one does not equal the other.
http://www.eff.org/Privacy/960514_cavoukian_priv-sec.speech

Curtin, M. et. al. (1996). Snake Oil Warning Signs: Encryption Software to Avoid. This piece presents a good description of the basics of encryption before providing information on misleading techniques that vendors may use to sell their software. Some of the misleading signs could apply to anyone purchasing any hardware or software.
http://www.interhack.net/people/cmcurtin/snake-oil-faq.html

Cutler, K. (2003). Information Security Checklist. A list of items to assess when to assure the privacy and security of data in an information system. (Added November 21, 2003)
http://www.net-security.org/article.php?id=556

EFF "Privacy, Security, Crypto, & Surveillance" Archive. A list of many resources about privacy on the Internet.
http://www.eff.org/Privacy/

Ghaemian, K. (1999). An Internet Security Primer. Discusses some techniques for safely sending data over the Internet.
http://www.govtech.net/magazine/story.php?id=94648&issue=3:1999

Gostin, L. (1997). Health Care Information and the Protection of Personal Privacy: Ethical and Legal Considerations. Annals of Internal Medicine, Part 2, 15 October 1997. 127:683-690. This article looks at the conflicts between the needs for healthcare data and the need for patient privacy.
http://www.annals.org/cgi/content/full/127/8_Part_2/683?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=Health+Care+Information&searchid=1136671450486_3151&FIRSTINDEX=0&journalcode=annintmed

Practice Brief: Information Security: A Checklist for Healthcare Professionals (Updated). An excellent source for checking to see if your agency is protecting sensitive patient data. (Updated 12/12/02)
http://library.ahima.org/xpedio/groups/public/documents/ahima/pub_bok1_000042.html

Thearling, K. (1998). Data Mining and Privacy: A conflict in the making? A white paper discussing the issue.
http://www.thearling.com/text/dsstar/privacy.htm

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Electronic Health Record

Achieving Electronic Connectivity in Healthcare: A Preliminary Roadmap from the Nation’s Public and Private- Sector Healthcare Leaders. (2004). An 83 page report from the Markle Foundation. Unfortunately, if there were any nurses on this committee, they omitted their credentials. However, the report is helpful in understanding the barriers to the growth of electronic connectivity in healthcare as well as some proposed solutions. (Added January 17, 2006). PDF File
http://www.connectingforhealth.org/resources/cfh_aech_roadmap_072004.pdf

ANA Position Paper On Computer-based Patient Record Standards (1995). Although dated, this provides information about the CPR (current terminology is EHR) that is still pertinent.
http://nursingworld.org/readroom/position/joint/jtcpri1.htm

CPRI-HOST Web Page. This organization combined with Healthcare Information and Management Systems Society (HIMSS). Information that was originally on their page can be found by going to the site and searching using the letters CPRI. (Information change October 14, 2003)
http://www.himss.org/ASP/index.asp

EHR Walk through. This site provides a user view of the Indian Health Service Electronic Health Record. There are links to both a PDF File and a Flash version. The latter downloads to the user's computer and can then be played whenever a user wishes. This EHR is for outpatient service. Worthwhile to look at and use with students. (Added May 7, 2005)
http://www.ihs.gov/cio/ehr/index.cfm?module=walkthru

Electronic medical records: Why their time has come. (2003). Although an advertising brochure, this pdf file has some excellent information about the electronic health record. (Added October 11, 2003)
http://www.healthcare-informatics.com/reports/HCI-HIMMS-EMR.pdf

Institute of Medicine (1997) TheComputer-Based Patient Record (Revised Edition). The complete book is available online.
http://www.nap.edu/html/computer/

Andrew, W. Dick, R. (1997). Computer-Based Patient Records Venturing Off the Beaten Path: It's Time to Blaze New CPR Trails. An excellent article, could be described as the definitive article, exploring what the CPR is, and what it is not.
http://www.healthcare-informatics.com/issues/1997/05_97/cpr.htm

Institute of Medicine (2003). Key Capabilities of an Electronic Health Record System. PDF File Complete report detailing eight core capabilities that an electronic health record should have.
http://www.nap.edu/catalog.php?record_id=10781

Lander, L.M., & Daniel, A. (n.d.). The journey to the electronic health record. A discussion of the possibilities for the "virtual health record" together with a description of the components. (Added October 8, 2003).
http://www.infotivity.com/dynamic.htm

Szende, A. (2001, October 1). A lifelong ehealth record. Canadian Healthcare Manager. A description of the Health Information Network (HiNET), an electronic record that is in use for pediatric patients in Ontario. HiNet's current database includes 80,000 patients, 400,000 patient encounters and 1.5 million transactions. (Added October 8, 2003)
http://www.chmonline.ca/issue/article.jsp?content=20011001_230095_9495

Siman, A. (2000, January). An agenda for the future: A national electronic health records system. Healthcare Information Management & Communications Canada, XIV(1). An excellent description of what a patient birth to death electronic health record can accomplish. (Added October 7, 2003) PDF File
http://www.hc-sc.gc.ca/ohih-bsi/pubs/coach/coach4_ehrdse_e.pdf

Walker, J. (2003, October). Clinical-information connectivity nationwide. Healthcare Informatics. An excellent article that addresses how the Patient Safety Institute is working with one state to insititute a forerunner of an electronic health record. Presents an excellent way around the unique identifier problem. (Added October 11, 2003)
http://www.healthcare-informatics.com/issues/2003/10_03/partnerships.htm

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Electronic Signatures

Digital Signatures Tutorial. Explains the criteria for a legal signature, then explains how digital signature technology works, provides information about public key certificates and closes with a discussion of challenges and opportunities. (Added January 7, 2006)
http://www.abanet.org/scitech/ec/isc/dsg-tutorial.html

Electronic Signatures in Global and National Commerce Act. This act went into effect October 1, 2000. Full text is available. (Added October 14, 2003)
http://www.ftc.gov/os/2001/06/esign7.htm

Grabbe, J. O. (n.d.) Digital signatures. This article is extremely informative and offers visual aids to depict what encrytping looks like "behind the scenes" of a digital signature. The information provided tot he reader includes: digital signature process, how to perform a digital signature, how messages are "crunched", what happens when a key error is made, and the process for verifying signatures. A brief, but very good article that leaved the reader with a better understanding of the digital process. (Added October 8, 2003)
http://www.aci.net/kalliste/digsig.htm

Signature Update. An educational forum focused on the validity of electronic signatures in the legal spectrum. Provides updates on electronic signatures with information for each state.
http://www.reallegal.com/valueAddEsignatures.asp

UNCITRAL (A UN Group) Model Law on Electronic Signatures with Guide to Enactment (2001). An 83 page PDF File comprehensive report.
http://www.uncitral.org/pdf/english/texts/electcom/ml-elecsig-e.pdf

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Ergonomics

Bailin, J. (2001). Ergonomics & Computer Injury: FAQs. This resource contains some frequently asked questions about computers and ergonomics by Jonathan Bailin, Ph.D. who specializes in Exercise Physiology /Ergonomics/ Biomechanics Sports Medicine & Ergonomics.
http://www.netsci.org/Science/Special/feature01.html

Cornell University Ergonomics Web Site. This constantly updated site contains links to many helpful items about ergonomics including a self help guide to ergonomics, children's computer use, OSHA's April 2002 Ergonomics Plan, access to a 52 minute video on The Mysteries of Ergonomics, and Research Studies. Unlike too many Web Sites that just trumpet accomplishments, this one provides real information.
http://ergo.human.cornell.edu/

Ergonomics at Work. From the University of California Berkeley, this site has information about many aspects of ergonomics including its importance and symptoms of difficulties (Program for Faculty & Staff), things to consider in a thorough description of computer Ergonomics, and tips for supervisors. Although for faculty, would be useful in any agency.
http://www.uhs.berkeley.edu/facstaff/ergonomics/

Healthy Computing. This website features information on many ergomically reltaed topics such as keyboard placement, how far to sit from a monitor, and mobile computing as well as providing information about various health related topics. Also includes a buyers guide that describes various products. Well worth a look! ( Added August 30, 2003)
http://www.healthycomputing.com/

Mobile ergomics. This site presents information about ergonomic problems with laptop computers, PDAs, and cell phones as well as tips for making their use less likely to cause difficulties. (Added October 22, 2003)
http://www.healthycomputing.com/mobile/

Pillar, B. & Golumbic, N. (Eds.). (1993). Chapter 5, Applying Patient Care Ergonomics to the Patient- Nurse-Machine Interaction Nursing Informatics: In Nursing Informatics: Enhancing Patient Care. Bethseda, MD: National Center for Nursing Research, 23-30. [Electronic Version]. This chapter, although old, presents a good picture of ergonomic problems as well as areas that need research. Still a valuable resource. Enter and select chapter 5 from the table of contents. (Added October 21, 2003)
http://www.nih.gov/ninr/research/vol4/

Sweere, H. (2003, June). Ergomonics of the non-office. This article presents some measurements that would be useful in designing a computer work station that is used by many different people. (Added October 21, 2003)
http://www.ergoweb.com/news/detail.cfm?id=750.

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Ethics

Commission of the European Communities (2002). eEurope 2002: Quality Criteria for Health related Websites. Journal Medical Internet Researcy 4(2). Retrived March 25, 2003 from http://www.jmir.org/2002/3/e15

Hook, K. G., White, G. B. Code of Ethics for Nurses with Interpretive Statements: An Indpendent Study Module. Includes history of code, reasons for current changes, the key interpretive statements, the significance of the code, and application of the code to practice. (Added January 7, 2006)
http://nursingworld.org/mods/mod580/code.pdf

IMIA Code of Ethics for Informatics. http://www.imia.org/English_code_of_ethics.html

Links to Codes of Ethics for many different technological societies sponsored by the Illinois Institute of Technology.
http://ethics.iit.edu/codes/codes_index.html

Medicine, Ethics & Medical Informatics (2001). This website was prepared as a class project at the Oregon Health Sciences University. Besides the introduction contains links to parts of the project concerned with areas of study, definitions, electronic medical records, privacy & security, standardization, artificial intelligence, telemedicine and research.
http://www.journeyofhearts.org/jofh/jofh_old/minf_528/intro.htm Added August 8, 2003

Sage, W. M. (2000). Accountability through Information: What the Health Care Industry Can Learn from Securities Regulation. A rather lengthy look at the situation that the change in healthcare from a professional to a marketing industry has created in terms of accountability.
http://www.milbank.org/0012sage.html

The Scope of Medical Informatics Ethics (2001). Paper prepared by a class that enumerates the ethics of broad areas of informatics.
http://www.journeyofhearts.org/jofh/jofh_old/minf_528/areas.htm

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Health Level 7 (HL7)

Bakken, S., Campbell, K.E, Cimino, J.J.,Huff, S. M. Hammond, W. E. (2000). Toward vocabulary domain specifications for health level 7—coded data elements. Journal of the American Medical Association 7 (4), 333-342. [Electronic Version]. Retrieved August 8, 2003 from
http://www.pubmedcentral.gov/articlerender.fcgi?tool=pmcentrez&artid=61438. PDF File available at
http://www.pubmedcentral.gov/picrender.fcgi?tool=pmcentrez&action=stream&blobtype=pdf&artid=61438

Health Level 7 Organization. The home page of the HL7 organization. Links to much information about the group. Links under resources may be helpful.
http://www.hl7.org/

Hammond, E. (1997). Testimony before the National Committee on Vital and Health Statistics [NCVHS], Subcommittee on Health Data Needs, Standards and Security. Although a plea for understanding of the need for the NCVHS to understand the need for standards there is much information about what HL7 is.
http://www.ncvhs.hhs.gov/970211t3.htm

Medical Application Integration (HL7 Interfacing). A easily understood description of the need for HL7 with a link to a brief description of what HL7 is. Only accessible with Internet Explorer. In the definition, grammar refers to the protocols for interchange and vocabulary for the terminology.
http://www.timesquared.net/HealthCare/HL7/

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HIPAA

Frequently Asked Questions About the National Provider Identifier (NPI) (2000). A list of questions and answers, many items here including information about what it is, who needs an NPI, and how to get one. (Added October 13, 2003)
http://aspe.os.dhhs.gov/admnsimp/faqnpi.htm .

Final. HIPAA Privacy Rules
http://www.hhs.gov/ocr/hipaa/

Health Insurance Portability and Accountability Act of 1996: Just an Incremental Step in Reshaping Government. (2005). Article in Online Journal of Issues in Nursing that looks at some of the possible and potential results of the HIPAA regulations. (Added December 15, 2005)
http://nursingworld.org/ojin/tpclg/leg_16.htm

HIPAA Fact Sheets. There are many different fact sheets available here, mostly addressing privacy. (Added October 5, 2004)
http://www.hhs.gov/ocr/hipaa/

HIPAA Glossary. Terms are well defined in easy to understand language.
http://www.himinfo.com/howto/hipaa/glossary.cfm

HIPAA on HAND. A download for some PDAs that contains the Regulation Text of the HIPAA Regulations & Standards for privacy. (Added August 25, 2003)
http://www.pdacortex.com/HIPAA_on_HAND_Download.htm

HIPAA Privacy Summary (2003). Written in easy to understand language.
http://www.hhs.gov/ocr/privacysummary.pdf

Frequently asked questions about a National Provider Identifier. Although HIPAA originally required this, it is currently on hold.
http://aspe.os.dhhs.gov/admnsimp/faqnpi.htm

Unique Health Identifier for Individuals: A White Paper from US HEW that examines the need for a unique health identifier. (Added January 7, 2006)
http://www.epic.org/privacy/medical/hhs-id-798.html

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Human-Computer Interface

Ambler, S. (2000). User Interface Design: Tips and Techniques. A PDF File 16 pages in length. Introduction addresses the economics of a good user interface. Details 20 items that should be considered in design. Discusses prototyping and interface flow diagrams. The summary presents bulleted points for general guidelines, screen design, and prototyping.
http://www.fiit.stuba.sk/~bielik/courses/psi-slov/material/ui-design.pdf

Human Computer Interaction. This site features a full online book devoted to the teaching of this issue by the Association for Computing Machinery and the IEEE Computer Society. Chapter 2, Human Computer Interaction is especially valuable to anyone interested in this phenomenon. Includes a detailed description, a brief history, and the nature of human-computer interaction.
http://sigchi.org/cdg/

National Information Infrastructure

Agency for Healthcare Research and Quality (AHRQ) page for Health IT. Many informative links here to government projects in relation to informatics. (Added September 29, 2005)
http://healthit.ahrq.gov/home/index.html

Department of Health and Human Services (2003). Federal government announces first federal egov health information exchange standards. Standards that will be used in the National Information Infrastructure as part of the administrations eGov initiative. (Added October 15, 2003) http://www.os.dhhs.gov/news/press/2003pres/20030321a.html

Information for Health: A Strategy for Building the National Health Information Infrastructure (2001). The full report and recommendations from the national committee on vital and health statistics. (Added May 26, 2004)
http://www.aspe.hhs.gov/sp/nhii/Documents/NHIIReport2001/default.htm

National Health Information Infrastructure Web Page. Use this page to keep up on current happenings. (Added May 26, 2004)
http://www.aspe.hhs.gov/sp/nhii/

Summary of Nationwide Health Information Network (NHIN) Request for Information (RFI) Responses. In November 2004, the the Office of the National Coordinator for Health Information Technology (ONC) released a Request for Information (RFI). This report summarizes the 5,000 pages that resulted. It was released June 5, 2005. (Added June 6, 2005)
http://www.hhs.gov/healthit/rfisummaryreport.pdf

Neural Networks

Stergiou C. & Siganos, D. (1996) Neural networks. An easily understood introduction to Artificial Neural Networks.
http://www.doc.ic.ac.uk/~nd/surprise_96/journal/vol4/cs11/report.html

Patient Safety

AHRQ Web M & M site (Morbidity and Mortality).This AHRQ sponsored site is an online journal and forum on patient safety and health care quality. There is expert analysis of medical errors reported anonymously by readers, interactive learning modules on patient safety ("Spotlight Cases"), and forums for online discussion. CME credit is available. To submit a case one must register, but registration is free. (Added November 23, 2003)
http://www.webmm.ahrq.gov/

The National Center for Patient Safety (NCPS) site presents a comprehensive site for much information related to patient safety including a glossary, description of a root cause analysis and several other topics. Has active participation by VA hospitals. Very useful site! (Added October 4, 2003)
http://www.patientsafety.gov/index.html

User Interface (Usability)

Ease of Use. Ten rights of users. (Added February 12, 2006)
http://www-3.ibm.com/ibm/easy/eou_ext.nsf/publish/12

Head, A. J. (2003). Personas: Setting the Stage for Building Usable Information Sites. This article describes how to create a persona, or composite person, to use when desiging Web sites. This same approach could be used in designing user interfaces in information systems. Added September 4, 2003
http://www.infotoday.com/online/jul03/head.shtml

Kushniruk, A. W., Patel , V. L., & Cimino, J. J. (1998). Usability testing in medical informatics: Cognitive approaches to evaluation of information systems and user interfaces. An excellent pdf article that describes how to evaluate systems for cognitive usability. (Added October 20, 2003)
http://www.dbmi.columbia.edu/cimino/Publications/1997%20-%20SCAMC%20-%20Usability%20Testing%20in%20Medical%20Informatics%20-%20Cognitive%20Approaches%20to%20Evaluation%20of%20Information%20Systems%20and%20User%20Interfaces.pdf

Nielsen, Jakob, Ten Usability Heuristics. Ten general rules of thumb for usability in computer interfaces. (Added February 12, 2006) http://www.useit.com/papers/heuristic/heuristic_list.html

Snyder, Carolyn (2003). Six Signs You Should Use Paper Prototyping. An excellent paper explaining not only when to use paper prototyping, but how. Great way to ensure good usability. (Added May 26, 2006)
http://today.java.net/pub/a/today/2003/12/23/sixSigns.html

Usability First. Although theoretically designed primarily for Web Site designers, this is valuable information for any software designer. Best information is found by scrolling down and clicking on "Introduction to Usability" and "Glossary."
http://www.usabilityfirst.com/

User Interface Analysis (1999). This is a series of detailed papers that present ideas for what to explore when designing a user interface. As contrasted with the Head article above, this site recommends using real persons. Although written for a business audience, the items listed can easily be changed to meet healthcare needs. It should be helpful in making syystems that do not impede work flow. (Added October 15, 2004)
http://www.uidesign.net/1999/papers/UIA1.html

More references for usability can be found on the Chapter 7 page

 

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Online References For This Chapter

(These references are from the chapter. This list only include the ones that are still available. Please report broken links to Linda Q. Thede)

Ambler, S. (2000). User interface design: Tips and Techniques. Retrieved April 8, 2002 from
http://www.ambysoft.com/userInterfaceDesign.html.

Baillin, J. (1995). Ergonomics & Computer Injury: FAQs. Retrieved April 8, 2002 from
http://www.netsci.org/Science/Special/feature01.html.

Code of Ethics for Health Informatics Professionals (2001). PDF File. Retrieved April 10, 2002 from
http://www.imia.org/pubdocs/Code_of_ethics.pdf

CUErgno. (2001). Ideal typing posture: Negative slope keyboard support. . Figure 19-1 on page 329. Retrieved October 10, 2003. (Change in URL)
http://128.253.253.139/ahtutorials/tutorialimages/idealtyping.jpeg

DOH Medicaid Update (2001). Retrieved April 6, 2002 from
http://www.health.state.ny.us/nysdoh/mancare/omm/2001/mar2001.htm. (No longer available)

HHS Fact Sheet.(2002). Administrative simplification under HIPAA: National standards for transactions, security and privacy. Retrieved April 6, 2002 from
http://www.hhs.gov/news/press/2002pres/hipaa.html.

Real Legal E-Transcript (2002). Retrieved April 8, 2002 from
http://www.reallegal.com/sigsindepth.asp Now at http://www.reallegal.com/index.asp

 

 

This page was last updated January 7, 2006

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