BHIS 410 – Final Exam Study Guide
BHIS 410 FINAL EXAM Study Guide
I. Overview of the EHR
a. EMR vs. EHR – differences and similarities
• EMR – NOT interoperable
o EMR (electronic medical record) is often used to describe systems
based on document imaging in a hospital or systems
implemented in physician offices. NAHIT defines EMR as local to
one healthcare organization
• EHR – Interoperable
o EHR (electronic health record) is a system to achieve the goals
of structured and standardized data collection that benefit
patients wherever they may be treated. NAHIT adds the
dimension of interoperability across more than one healthcare
organization..
b. Drivers to EHR
c. Meaningful Use as Incentive to EHR development
• Meaningful Use (MU)= Federal incentive program; used to drive
widespread adoption of EHR technology in the U.S.
d. Benefits/Barriers to EHR development
e. Systems Theory as it relates to EHR
• Explains how information, and ultimately knowledge and wisdom,
are generated by data processed in predictable ways to contribute
value. Information systems:
o Use devices to capture data
o Apply instructions to index, store, calculate, compare, and
perform other functions on the data
o Use devices to display the data and present results of
calculations, comparisons, and other functions to users in various
formats
f. Role of Consumerism, PHR’s, E-health
g. Limitations to EHR
• While an EHR is a system of systems, the systems are generally limited
to those supplied by a single vendor or use customized software to
make connections with other systems
• EHR systems are not as interoperable as desired with systems external to
, BHIS 410 – Final Exam Study Guide
an organization, largely due to the proprietary nature of vendor software
, BHIS 410 – Final Exam Study Guide
II. Networks
a. ISO/OSI model
• OSI model = Open Systems Interconnection
o Defines the framework for hardware and software protocol
for networks
o Includes 7 layers, each responsible for an aspect of communication
• HL7 = Health Level 7
o Most common healthcare application level standard that helps
to ensure data exchange across health info systems
o Top level (Application Layer)
b. Local Area Networks – star, bus, ring
• Star = Each node connects to center hub and then is rerouted
o A - can easily add nodes
o D - crash at hub bring down network
• Bus = single line of nodes, like “party line”
o A - speed
o D - limit on length
• Ring = group of nodes in a circle
o A - high speed, large distances
o D - difficult to add nodes
c. Wide area and wireless networks
• Intranet – private internet network within a firewall
• Extranet – connection of private internet networks outside the
firewall
• LAN = Local Area Network
o a network providing communication within a small
geographic
• WAN = Wide Area Networks
o Used for geographically larger environments; many
LAN in one area
• VPN = Virtual Private Network
o Private “tunnels” within an unsecure public network
d. Internet tools and protocols – TCP/IP, HTML, XML
• TCP/IP
• HTML – Hypertext Markup Language
o Formatting language, uses tags that instruct the
browser, but treats whole document as one item
• XML – Extensible Markup Language (XML)
o Tags can identify text within a document, probable
standard for EHR
e. Internet technologies and the EHR
• Telemedicine - send images, do consultations
• Patient pre-registration
• Link to expert systems, Medline
, BHIS 410 – Final Exam Study Guide
• Insurance verification
• Access info from several patient databases through web
browser
• Mayo Clinic - links all three sites
f. Interoperability – definitions
• Interoperability is the ability to exchange data among information systems
• Semantic
o conveying meaning in a manner that ensures the receiver of
data intercepts the data in the same manner as the sender
intended
• Process
o the human factors of usability and workflow, standardized
through business or operating rules
g. Health Information Exchange organizations – Purpose, current status,
initiatives; proposed architecture models
• HIE
o The electronic movement of health- related information
among organizations according to nationally recognized
standards
• HIE organization
o An organization that oversees and governs the exchange of
health- related information among organizations according to
nationally recognized standards
• Purpose
o To reduce clearinghouse costs
o To share patient data in geographically tight location
o To improve exchange of lab results
o To exchange data with public health
• Proposed architecture models
o Consolidated: Multiple independent organizations share data in
a central repository, managed centrally (not used much)
o Federated:
▪ Consistent databases: Stored separately but
managed centrally
▪ Inconsistent databases: Stored separately but shared in a
point-to-point manner
III. Databases
a. File management vs. databases for data collection
• File Management Systems – a one table system where all data reside in
a single file (spreadsheet); single user of file
o Advantages
▪ easy to learn
▪ less expensive software needed
▪ less time to develop application
o Disadvantages
▪ redundancy of data
BHIS 410 FINAL EXAM Study Guide
I. Overview of the EHR
a. EMR vs. EHR – differences and similarities
• EMR – NOT interoperable
o EMR (electronic medical record) is often used to describe systems
based on document imaging in a hospital or systems
implemented in physician offices. NAHIT defines EMR as local to
one healthcare organization
• EHR – Interoperable
o EHR (electronic health record) is a system to achieve the goals
of structured and standardized data collection that benefit
patients wherever they may be treated. NAHIT adds the
dimension of interoperability across more than one healthcare
organization..
b. Drivers to EHR
c. Meaningful Use as Incentive to EHR development
• Meaningful Use (MU)= Federal incentive program; used to drive
widespread adoption of EHR technology in the U.S.
d. Benefits/Barriers to EHR development
e. Systems Theory as it relates to EHR
• Explains how information, and ultimately knowledge and wisdom,
are generated by data processed in predictable ways to contribute
value. Information systems:
o Use devices to capture data
o Apply instructions to index, store, calculate, compare, and
perform other functions on the data
o Use devices to display the data and present results of
calculations, comparisons, and other functions to users in various
formats
f. Role of Consumerism, PHR’s, E-health
g. Limitations to EHR
• While an EHR is a system of systems, the systems are generally limited
to those supplied by a single vendor or use customized software to
make connections with other systems
• EHR systems are not as interoperable as desired with systems external to
, BHIS 410 – Final Exam Study Guide
an organization, largely due to the proprietary nature of vendor software
, BHIS 410 – Final Exam Study Guide
II. Networks
a. ISO/OSI model
• OSI model = Open Systems Interconnection
o Defines the framework for hardware and software protocol
for networks
o Includes 7 layers, each responsible for an aspect of communication
• HL7 = Health Level 7
o Most common healthcare application level standard that helps
to ensure data exchange across health info systems
o Top level (Application Layer)
b. Local Area Networks – star, bus, ring
• Star = Each node connects to center hub and then is rerouted
o A - can easily add nodes
o D - crash at hub bring down network
• Bus = single line of nodes, like “party line”
o A - speed
o D - limit on length
• Ring = group of nodes in a circle
o A - high speed, large distances
o D - difficult to add nodes
c. Wide area and wireless networks
• Intranet – private internet network within a firewall
• Extranet – connection of private internet networks outside the
firewall
• LAN = Local Area Network
o a network providing communication within a small
geographic
• WAN = Wide Area Networks
o Used for geographically larger environments; many
LAN in one area
• VPN = Virtual Private Network
o Private “tunnels” within an unsecure public network
d. Internet tools and protocols – TCP/IP, HTML, XML
• TCP/IP
• HTML – Hypertext Markup Language
o Formatting language, uses tags that instruct the
browser, but treats whole document as one item
• XML – Extensible Markup Language (XML)
o Tags can identify text within a document, probable
standard for EHR
e. Internet technologies and the EHR
• Telemedicine - send images, do consultations
• Patient pre-registration
• Link to expert systems, Medline
, BHIS 410 – Final Exam Study Guide
• Insurance verification
• Access info from several patient databases through web
browser
• Mayo Clinic - links all three sites
f. Interoperability – definitions
• Interoperability is the ability to exchange data among information systems
• Semantic
o conveying meaning in a manner that ensures the receiver of
data intercepts the data in the same manner as the sender
intended
• Process
o the human factors of usability and workflow, standardized
through business or operating rules
g. Health Information Exchange organizations – Purpose, current status,
initiatives; proposed architecture models
• HIE
o The electronic movement of health- related information
among organizations according to nationally recognized
standards
• HIE organization
o An organization that oversees and governs the exchange of
health- related information among organizations according to
nationally recognized standards
• Purpose
o To reduce clearinghouse costs
o To share patient data in geographically tight location
o To improve exchange of lab results
o To exchange data with public health
• Proposed architecture models
o Consolidated: Multiple independent organizations share data in
a central repository, managed centrally (not used much)
o Federated:
▪ Consistent databases: Stored separately but
managed centrally
▪ Inconsistent databases: Stored separately but shared in a
point-to-point manner
III. Databases
a. File management vs. databases for data collection
• File Management Systems – a one table system where all data reside in
a single file (spreadsheet); single user of file
o Advantages
▪ easy to learn
▪ less expensive software needed
▪ less time to develop application
o Disadvantages
▪ redundancy of data
