Research and Reactions:
Early Involvement in the Health Information Track at John Carroll University
Kathryn Ek
CS 476 Systems Technology and Practices Seminar
Final Project
May 9, 2011
If someone would have told me four years ago that I would be where I am right now, I would have thought that ‘someone’ was crazy. It’s not the idea that I would be majoring in Computer Information Systems with a minor in Business (although that would’ve sounded moderately improbable), it’s the idea that I would be one of the students on the brand new Health Information track to help pioneer the partnership with the Cleveland Clinic and John Carroll University.
That has been nothing but reality ever since I expressed an interest in the Health Information Systems track exactly one year ago. Even then, I knew this was an opportunity that I could not pass up. And that thought has been only been thoroughly reinforced as time passes by. I’m still in the process of earning my degree and the opportunities that have been presented to me have exceeded my expectations. Like I had stated before, I never saw this coming.
On February 10, 2011, I had the chance to shadow Dr. X, the Head of Neuroradiology at the Cleveland Clinic, along with Dr.Z. Upon hearing that Thursday’s was Dr. X’s day to operate, nerves started to fly. When we arrived to Dr. X’s office and were instructed to put on scrubs, reality set in. “Nervous” doesn’t even begin to describe the emotion I was feeling at that moment. But upon meeting Dr. X, his outgoing personality helped some of those nerves vanish. He showed us around one of the many buildings that compose the Cleveland Clinic. For lack of a better term, I felt like “a big deal.” But there was still the thought of observing an operation lingering in the back of my mind.
While we walked back towards the operating area, I felt like I was misplaced. I have no certification, no biological/medical experience, and I didn’t even sign a release form. I couldn’t back out now; we were instructed to put on hair nets and masks. We met other surgeons and technicians in the operating room who were very helpful and welcoming. I didn’t expect that at all; seeing as though we were intruding on their work. Because radiation was being used, we needed to wear lead vests, skirts, and thyroid guards. Again, there was no turning back, although seeing the patient on the operating table gave me the urge to do so. It was then time for us move past the glass that separated us in the control room from the operating area. It then had no purpose to serve as it was time for us to relocate behind Dr. X and the other surgeons and assistants who were near the patient.
The patient had a brain tumor that was scheduled to be removed the following day. Dr. X had to thread a wire through the patient’s femoral artery in order to see where in the brain the tumor was located. Once the location was found, he sent liquid which contained small water-balloon type particles through the tube that was in the artery directly to the tumor in the brain. The liquid cut the blood supply to the tumor, which eventually would “kill” it so the procedure the following day would be somewhat alleviated in terms of difficulty. While Dr. X was doing this, he proceeded to talk to the technicians about the conflict in Egypt, and then would turn around to Dr. Z and I to continue discussing a new HL7 program the Clinic has been working on. I was amazed at how lenient the operating room actually was. I was stunned about what was happening in front of me. It was an out of body experience, one that I would do all over again if I had the chance.
After the surgery, which seemed to be successful, Dr. X took us around other departments of the clinic. He showed us an imaging center, a new MRI machine/room, and the basement which contained robots that are programmed to transport pertinent supplies to specific rooms of the floor.
Upon leaving the clinic, I really couldn’t believe what had just occurred. I was speechless. I never would’ve thought I’d get an opportunity to do something like that. All of my nerves and anxieties I had days before the shadowing experience were completely worth it. Like I said before, I’d do it all over again if I had the chance.
The second shadowing experience I had the opportunity to participate was on April 14, 2011 with Dr. Y in the Department of Cardiology for imaging in the Clinic. Dr. Y influences the future electronic imaging distribution strategy for the Cardiac Catheterization lab. I was beyond apprehensive about this day; I had no idea what to expect. Once we found his office, Dr. Z, Paul and I were split up among three other IT specialists that work for Dr. Y. I had the opportunity to shadow Rolanda, a systems analyst for the Clinic. On that particular day, she had to go into the operating rooms to fix the audio output and work on the live internet feed for the head camera’s surgeon’s use while operating. We had to wear scrubs, hair nets and masks, something that I’ve become oddly familiar with this semester. I was able to walk into these rooms and watch what she had to do on the networks, then call in and order new parts for the audio system from California. We were able to walk in on two different open heart surgeries. I wasn’t able to view them directly, but I saw what was going on via head cam feed displayed on the 55-inch plasma screen right above the operating table. Watching this procedure while it was happening was astounding. Seeing the heart beat was so surreal; it is something that you only get to see in movies. But I was there; about ten feet away from the operation, witnessing these five surgeons replace valves in a patient’s heart.
After seeing the operating rooms, we were all able to venture up to the server room. Only a computer science major would get excited about this place; but it was thrilling to see all of these servers working in one room, keeping the clinic running. If you think about it, that room is the center of that foundation. If something goes wrong there, it goes wrong elsewhere. One of the many servers has the space to hold one petabyte of information. We also traveled down in the basement to see the transportation robots again. I was told that if one was to break, or you were to cause one to break, you would be charged $250,000.
This experience was quite different from the first one I had. It was focused more on the hardware aspect of computing. While interesting and intriguing, I realized that I’d rather be on the software side of things. If I had the chance to do that again, I definitely would. It opened my eyes to a lot, and there are not many people who can just walk into an open heart surgery, or two, especially as a college student.
Healthcare Information Technology has somewhat of a silent prominence in our society. Many don’t realize how imperative it is in day-to-day medical operations in offices or hospitals. In 2004, President Bush made this importance visible by stating a ten-year, $100 million plan to convert to Electronic Health Records by 2014 (Healthcare). Bush felt that this adoption would drive change to the health care system in America, by evolving with the technology push. The original plan was to advance this even further so that patients could carry key chains that contained all of their medical information. This electronic record would be easily available for any authorized physician to access when necessary (Healthcare). This plan also was designed to create incentives for health care providers to adopt and use electronic medical records (EMR’s). Also with this plan, the Office of the National Coordinator for Health Information Technology (ONC) was created (Mearian). ONC was created to lead the establishment of EMR’s in the nation’s health care systems.
As of 2009, only 25-35% of 5000 American hospitals are using EMR’s (Mearian). Bush’s ten-year plan has now been extended to at least 2015 and needs further funding to keep on the track it had originally set out on. Obama has now taken on the project and pledged to supply $10 billion per year to fund this movement. This threatens the budget with a $100 billion deficit over the next ten years. That number seems daunting upon first glance; however in an industry that spends over $2.7 trillion per year, it’s a rather miniscule portion of spending compared to the total (Mearian). Dr. David Brailer, an advocate for EMR’s, claims that a successfully implemented EHR system has the ability to save the nation $200-300 billion per year (Mearian). If the system has the ability to cut down duplications, reduce costly errors, avoid fraudulent claims, and coordinate care between doctors and physicians, the nation’s health care system will display the essence of efficiency.
With this need for efficiency comes the responsibility of maintaining privacy. These records, once in place, cannot and should not be easily accessed. For those who have access, it was necessary for a standard to be put in place for the security of the information available. In 1996, The Department of Health and Human Services was required to establish national standards for electronic health record transactions (HHS). With the implication of the Health Insurance Portability and Accountability Act (HIPPA), effectiveness of the nation’s health care system would improve along with security of the information attached to it (HHS).
HIPPA is divided into two main titles.
Title I works with group and individual health insurance plans to ensure availability to you. Title II of HIPAA’S “Administrative Simplification” contains three rules. The first rule is The Security Rule. This rule is self-explanatory; it involves security precautions used with a patient’s Electronic Protected Health Information (ePHI). This rule constructs principles that health care providers and physicians should abide by to guarantee ideal confidentiality of all electronic records that are accessed. This rule also ensures proper safety measures each provider should employ to defend electronic threats such as viruses or breaches of security by other employees or hackers (Jeffries).
The next rule is The Privacy Rule. This rule guarantees any health information (paper or electronic) is protected, even including health care payments and medical insurance information. For this to be properly implemented, those with access to Electronic Medical Records are required to study guidelines, watch a video, and pass a test to become HIPAA certified. (Jeffries).
The third rule is the Enforcement Rule. This rule involves penalties against any who violate the previous two rules. Violators are subject to pay large fines if any of the following rules are broken. Medical information is very sensitive; if handled or accessed incorrectly, threatening issues to all parties involved can arise. The Enforcement Rule also details the process of an investigation, how penalties are determined, and how to appeal these violations in a court setting (Jeffries). Some cases even involve time in jail for those who violate HIPAA laws. A doctor in California was sent to jail for four months for inappropriately accessing medical records. He was also fined $2000 (Dimick). However, a nurse is facing a charge of ten years in jail and a $250,000 fine for inappropriately accessing medical records for personal gain in a case that directly involved her husband (Latner).
According to the U.S. Bureau of Labor and Statistics, jobs in medical records and health information technology are expected to grow 16% through 2018 (Bureau of Labor Statistics). The technical field keeps growing, and such high demand is not being filled with enough qualified employees. Employment in this area is expected to grow faster than the average field. There are jobs available that just require an associate’s degree, but bachelors and masters programs in Health Information Technology create the opportunity for advancement. Bachelors programs require four years of education, with a basis of computer science instruction and a math and statistics background as well. Masters degree programs require an additional two years of education, requiring the degree-seeker to specialize in a certain area of the field (Bureau of Labor Statistics). With the requirements for EHR’s in the next few years, jobs should be secure for those with degrees in health information.
The classes that I have taken this past year have given me many opportunities to grow as a student, computer science major, and an adult. I was exposed to different programming methods, career paths, people and opinions. Taking Programming Perspectives (CS 302) was a struggle for me, but I feel like I learned so much in that class; computer related and otherwise. I had never been exposed to languages such as C, Python, C++, or HL7; which is why I felt the need to register for this particular course. I knew it was going to be a tough class. I went for extra help on a daily basis; something that I was never really used to before then. Prior to last semester, many classes came naturally to me. I’d occasionally hit a road block, but I would overcome it within a day’s time. This class took me a semester to overcome. I became extremely frustrated and second-guessed my decision to major in Computer Information Systems a handful of times. If I didn’t understand basic concepts in certain programming languages, how was I supposed to make a career out of this? But with the constant help and reassurance by Dr. Z, I fought through the difficult programs and passed the class. That class helped me realize that sometimes in life there will be bumps in that road. I’m going to struggle, I’m going to need help, and I’m going to doubt myself. Shutting down isn’t any way to get through those tough times. I just need to open my mind and accept that things aren’t going to arrive to forefront easily, and I will need to employ outside sources for assistance from time to time. On that same note, I can say that after this class, I have experience in more than one programming language. I wish we had more time with to work with HL7; I think an entire class could be dedicated to that language alone. It’s extremely complex and intricate, but would be beneficial to the Health Information track/major.
Health Information Seminar (CS 476) exposed me to many different career paths I could consider after graduation. It was beneficial for the entire class because there were many different career choices represented; most of them beginning with a degree in Computer Science. Personally, I was interested in those who were involved in Health Information; but many other paths represented were equally as intriguing. I also feel a bit relieved about life after college thanks to the content and discussion associated with this course. There have been times where I feel like I have so much to learn before I graduate. While some of this is true, learning also happens after college as well. I’ve learned that it is a “learn as you go” type of industry. I’ve accepted that I can’t learn everything about computers and programming in 2-3 years time. I’m going to need experience out of the classroom, as well as time with a text book. I also enjoyed that many of these speakers that took time out of their day to speak to us were John Carroll graduates. They know where we’re coming from; a few of them have taken some of the same classes we have. It was refreshing to get that similar point of view from those who have been out of the classroom for years. It was reassuring to see the successes of these graduates as well.
I am also very grateful that we were able to contact some medical doctors from the Clinic to speak to us. While on the Health Information track, I now understand that association with those other than IT specialists is integral to this profession. Communication is a vital skill in this field. I understood that it was important, but after this class, I realize that communication is imperative to success and promotion in this field. It was beneficial to see an MD’s point of view of IS, which is a point of view that I must be able to understand if I continue on this track. The shadowing experience also helped with that understanding. I’m not really sure where else I would have gotten the experience to come to that awareness so early in the game.
With those remarkable experiences came other realizations as well. I had to face the truth that, at times, dated views of society can still make an appearance in humanity today. I was faced with opinions of others that I could’ve either taken personally or just ignored. Initially, I wasn’t sure how to react, but after much thinking, I understand that dwelling on it or taking it personally was not going to get me anywhere. I could have spoken up and disagreed, but decided against it given my current position as an undergraduate. This position I am in is as much as an advantage as it is a disadvantage, given the “behind-the-times” opinions of some of those in the industry. Being exposed to this before going entering the “real world” has made me realize that no matter where I go, I’m going to have to prove my ability to co-workers; even more so than I had initially prepared.
Switching back to the effectiveness of the class, I enjoyed the class wiki idea. It gave us work to do, and helped us to better understand the topics we couldn’t get that much in depth with during class time. The wiki was also vital to the grading aspect of the course. I don’t really see any other alternatives used for grading in this class other than writing weekly papers; something that would quickly become tedious for the both the student and the professor. I also think that the assignment we had to do with Cathy S’s speech helped the class understand a topic we wouldn’t usually be exposed to. Researching a relative topic before the speech gave the host team a chance to be able to ask more questions and appear somewhat educated on what the speaker is talking about. I think having each host team do some research before the speaker arrives would utilize class time most efficiently.
To begin the semester, Rosann S visited the class to discuss her career and her involvement with the Knowledge Program at the Cleveland Clinic. Without any idea of how the class was going to go, Roseann set the bar high. I liked how she wanted her visit to be more of a conversation than a presentation. The atmosphere was very relaxed and I did feel like we had a discussion with her. I remember a lot from her presentation given the format of that specific class. I’m more inclined to remember conversations I have with people than I am content presented in lecture form.
I felt that Jim W’s and John H’s presentations were also beneficial and extremely crucial to the Health Information Technology track. We were exposed to software and programming languages that I had only briefly heard of, but after their presentations I felt like I learned (and retained) a lot of information. I felt somewhat familiar with EPIC systems and EMR’s after John Hurt’s presentation, and I could also relate some of my minimal (yet expanding) knowledge of HL7 to Jim W’s presentation. It was also extremely helpful that these two were recent John Carroll graduates. It was amazing to see how much information they learned after their college education. It reinforces that impending notion that you have a lot more information to learn after formal schooling.
Dr. Tom X’s presentation was useful in the sense that it gave us a different perspective on medical informatics. We were able to see ideas pertaining to IT through the eyes of a medical doctor. I also felt honored that a doctor with such prestigious standing at the Clinic took time out of his week to talk to us. It shows that he is dedicated to the program in the works here at John Carroll, and gives me great hope for the future of this track/major. To the dismay of a few, this presentation may have been too graphic for the purpose of the class. I felt that it kept things interesting; although it may not have been directly connected to IT.
Dr. P’s presentation with Albert E, Roy K, and John Pwas also extremely pertinent to the class. I think I enjoyed this presentation the most out of all of them. I wish we had more time with these gentlemen. What they all had to say was extremely interesting and relevant to the purpose of the course. It was also interesting to see the doctor/IT relationship in person. Electronic storage of medical information is a controversial yet recent discussion that has direct relation to the way healthcare is being run today and in the future. It was intriguing to get “insider information” from the Clinic firsthand. Like I stated before, I wish we had more time with these professionals. It could’ve been beneficial to possibly divide that specific presentation in two parts; have one group of two go one week, and the last two pick up where the first two left off. I felt that they all had a lot to say, but not enough time to say it.
To change gears, there were not many speakers that I didn’t find effective. But there were a few that I probably could’ve gotten more out of if approached differently. For example, Jason S’s presentation went completely over my head. There were so many things he discussed that I really did not know one thing about. Most times, I would’ve at least heard of the topic, or been familiar with the acronym used, but in this case I was completely lost. It was difficult to ask questions because there were so many other questions building up as he went along. I think the approach used with Cathy S’s presentation would have been beneficial in this case. On that same note, I think Cathy S’s presentation had the potential to relate to IT if given more time. The biological background was a lot to get my head around initially, so that took more time and careful consideration before getting into the IT portion of the presentation. I think if each person on the host team took a topic to research and post on the wiki, the class would’ve been more up to date on the background of the presentation. That way, we could get away with about a half hour of background, and had the rest of the class to discuss the IT segment of the talk.
Given the specificity of each presentation, I think the Tuesday’s of the class could be better utilized in preparation for Thursdays. If Tuesdays were dedicated to actual research of the speaker to come on Thursday, it would create for a more interactive environment during the presentation. It could be beneficial to have topics on the board to research during class, and then possibly present our findings after a lead in from the professor. It would help take off some apprehension for the following Thursday. The class would be able to walk into the room and have more of an understanding on the information that will be presented within the next 75 minutes. This would set up for a discussion with the presenter based on previous findings rather than a lecture. I understand that they don’t expect us to know as much as they do, but having a basic understanding of the presentation before could greatly improve the effectiveness of the course. Also, while researching, it would be valuable to have a list of questions generated before the presentation. With that being done, Thursday’s class may run more smoothly with avid preparation for them on Tuesdays.
As for the outlook of the future, I’ve recently registered for more classes that will help to expand my knowledge of health information. I’m hoping that Software Engineering has a project that has some kind of relation to health care. I also look forward to researching and writing more on topics such as HIPAA and HL7 in Technical Writing in Computer Science. As of now, I’m also enrolled in Public Health in U.S. Society, a sociology course that introduces basic concepts of public health and major public health issues in the United States. The class’s central focus is on health disparities in who becomes ill and inequalities of access to treatment due to stereotypes, racism, and social class.
Given the progress of the past few months, I can see this Health Information track growing into something dynamic. Not only will this offer a remarkable opportunity for current and prospective students, but it will also be advantageous for the John Carroll community. The opportunity forming out of this relationship with the Cleveland Clinic adds to the already prestigious reputation that John Carroll University upholds. My outlook on future plans have been somewhat altered due to this path. I’m even more interested in Health Information Systems than I had been before. It has opened my eyes to an industry that is not only growing and prospering on its own, but also one that is vital to the health care industry. As a child growing up, I always wanted to be a doctor. But as my opinions and interests changed, I realized that wasn’t the right path for me. But seeing the opportunities available in the Health Information track, I may end up in the health industry after all, just on a different front.
Works Cited
Bureau of Labor Statistics. "Medical Records and Health Information." Occupational Outlook Handbook 2010-11. US Department of Labor, 29 Sept. 2010. Web. 3 May 2011. <http://www.bls.gov/oco/ocos103.htm>. (Bureau of Labor Statistics)
Dimick, Chris. "Californian Sentenced to Prison for HIPAA Violation." Journal of Ahima. American Health Information Management Association, 29 Apr. 2010. Web. 3 May 2011. <http://journal.ahima.org/2010/04/29/californian-sentenced-to-prison-for-hipaa-violation/>. (Dimick)
Healthcare IT News Staff. "President Bush continues EHR push, sets national goals." Healthcare IT News. Ed. Medtech Media. HIMMS, 26 Apr. 2004. Web. 3 May 2011. <http://www.healthcareitnews.com/news/president-bush-continues-ehr-push-sets-national-goals>. (Healthcare)
Jeffries, Melissa. "How HIPAA Works." Discovery Fit & Health. Discovery Communications, LLC,2011. Web. 3 May 2011. <http://health.howstuffworks.com/medicine /healthcare/insurance/ hipaa4.htm>. (Jeffries)
Latner, Ann W., JD. "Staff Nurse Faces Jail Time for HIPAA Violations." Renal & Urology News. Haymarket Media, 1 Oct. 2008. Web. 3 May 2011. <http://www.renalandurologynews.com/staff-nurse-faces-jail-time-for-hipaa-violations/ article/119854/>. (Latner)
Mearian, Lucas. "Obama's national health records system will be costly, daunting." ComputerWorld. The IDG Network, 20 Jan. 2009. Web. 3 May 2011. <http://www.computerworld.com/s/article/9126279/Obama_s_national_ health_records _system_will_be_costly_daunting>. (Mearian)
US Department of Health and Human Services. "HIPAA-General Information." Centers for Medicare & Medicaid Services. www.hhs.gov, 14 Apr. 2011. Web. 3 May 2011. <https://www.cms.gov/ hipaageninfo/>. (HHS)