Healthcare informatics

Healthcare Informatics Skill

Clinical terminology, healthcare compliance (HIPAA/HITECH), patient safety, and health data management.

Core Principle

Healthcare information systems exist to improve patient outcomes. Every data decision balances access (clinicians need information) against privacy (patients deserve protection). When in doubt, protect the patient.

HIPAA Compliance

Protected Health Information (PHI)

PHI is any individually identifiable health information. The 18 HIPAA identifiers:

#	Identifier	Example
1	Names	Full name
2	Geographic data	Address, ZIP (3-digit OK if population >20K)
3	Dates	DOB, admission, discharge, death (year OK)
4	Phone numbers	All
5	Fax numbers	All
6	Email addresses	All
7	SSN	All
8	Medical record numbers	All
9	Health plan beneficiary numbers	All
10	Account numbers	All
11	Certificate/license numbers	All
12	Vehicle identifiers	VIN, plates
13	Device identifiers/serial numbers	All
14	Web URLs	All
15	IP addresses	All
16	Biometric identifiers	Fingerprints, voice
17	Full-face photographs	All
18	Any other unique identifying number	All

De-identification Methods

Method	Approach	Use When
Safe Harbor	Remove all 18 identifiers	Standard approach, lower risk
Expert Determination	Statistical/scientific analysis	Need richer dataset, qualified expert available

Minimum Necessary Standard

• Use or disclose only the minimum PHI necessary for the purpose
• Role-based access controls in EHR systems
• Audit logs for every PHI access

HITECH Act Extensions

Requirement	Detail
Breach notification	60 days for breaches affecting 500+ individuals
Business Associate liability	BAs directly liable for HIPAA violations
Audit trail	All access to electronic PHI must be logged
Encryption safe harbor	Encrypted data breach = not a reportable breach

FHIR Patient Resource Example

{
  "resourceType": "Patient",
  "id": "example",
  "identifier": [
    {
      "system": "http://hospital.org/mrn",
      "value": "12345"
    }
  ],
  "name": [
    {
      "use": "official",
      "family": "Doe",
      "given": ["John"]
    }
  ],
  "gender": "male",
  "birthDate": "1985-06-15",
  "address": [
    {
      "use": "home",
      "city": "Springfield",
      "state": "IL",
      "postalCode": "62704"
    }
  ]
}

Clinical Terminology Standards

Key Coding Systems

System	Purpose	Example
ICD-10	Diagnosis codes	E11.9 (Type 2 diabetes without complications)
CPT	Procedure codes	99213 (Office visit, established patient)
SNOMED CT	Clinical terms	73211009 (Diabetes mellitus)
LOINC	Lab/observation codes	2345-7 (Glucose, serum/plasma)
RxNorm	Medications	Metformin 500mg oral tablet
NDC	Drug packaging	10-digit national drug code

Interoperability Standards

Standard	Role
HL7 FHIR	RESTful API for health data exchange
HL7 v2	Legacy messaging (ADT, ORM, ORU)
CDA/C-CDA	Structured clinical documents
DICOM	Medical imaging format and protocol
X12 EDI	Insurance claims (837), eligibility (270/271)

Electronic Health Records (EHR)

Core EHR Functions

1. Clinical Documentation — Progress notes, assessments, plans
2. CPOE — Computerized Provider Order Entry (meds, labs, imaging)
3. CDS — Clinical Decision Support (alerts, reminders, pathways)
4. Results Management — Lab values, imaging reports
5. Medication Management — e-Prescribing, interaction checks, reconciliation

Patient Safety Checks

Check	Purpose
Drug-drug interactions	Prevent harmful combinations
Drug-allergy alerts	Match known allergies
Dose range checking	Flag outlier dosages
Duplicate order detection	Prevent redundant tests/meds
Clinical pathway adherence	Evidence-based care protocols

Healthcare Data Analytics

Quality Measures

Measure Type	Example	Source
Process	% of diabetics with annual HbA1c	HEDIS
Outcome	30-day readmission rate	CMS
Patient Experience	HCAHPS survey scores	CMS
Structure	EHR adoption rate, nurse-to-patient ratio	Various

Risk Adjustment

• HCC (Hierarchical Condition Categories) for Medicare risk scoring
• Comorbidity indices (Charlson, Elixhauser) for severity adjustment
• Social Determinants of Health (SDOH) as contextual factors

Research & Clinical Trials

IRB Requirements

Element	Requirement
Informed consent	Written, plain language, voluntary
Risk minimization	Reasonable procedures, minimal risk where possible
Privacy protections	De-identification or limited datasets
Vulnerable populations	Extra safeguards for children, prisoners, pregnant women

Clinical Trial Phases

Phase	Purpose	Size
Phase I	Safety, dosage	20–100
Phase II	Efficacy, side effects	100–300
Phase III	Confirm efficacy, monitor adverse	1,000–3,000
Phase IV	Post-market surveillance	Thousands

AI in Healthcare — Guardrails

Critical: AI-generated medical information must never be presented as clinical advice.

• Always include disclaimer: "This is informational only. Consult a healthcare professional."
• Never diagnose or recommend treatment
• Flag when confidence is low or data is ambiguous
• Cite clinical guidelines (USPSTF, ACC/AHA, IDSA) when referencing evidence-based practices
• Document provenance of any clinical data used in analysis