Health Information Systems (HIS) Overview

• Key objectives include differentiating EHR functionality levels, appraising information systems for healthcare managers, and distinguishing between industry-common and healthcare-unique systems
• Objectives also include analyzing clinical information system optimization challenges, examining meaningful use evolution, and assessing the future of health information systems (HIS)
• Furthermore, the objectives cover the investigation of data sources for EHR use, the critique of HIS interoperability impact, and the examination of HIPAA's impact on patient data confidentiality

Health Information Systems Defined

• Health Information Systems encompass all computer system components including software, hardware, operating systems, and end-user connecting devices.
• Networks provide the electronic connectivity between systems, people, and organizations.
• Systems data can be created and captured through the use of software
• This data is used as building blocks for all functions and applications

HIS Scope Model

• HIS scope includes research, policy, public health, data analytics, and health informatics

Networks

• Networks are categorized as intranets (internal to an organization) and extranets (external, allowing information sharing)
• Networks can be classified as Local Area Networks (LANs), Wireless LANs (WLANs), Wide Area Networks (WANs), Wireless WANs (WWANs), and Storage Area Networks (SANs).
• The Internet is a well-known WAN for external use

Systems Used in Healthcare

• Standard office applications like word processing and spreadsheet management enable collaboration.
• Budget systems manage expenses and revenue.
• Cost accounting systems model the profitability of services/products.
• Enterprise resource planning (ERP) systems manage human resources, payroll, accounts payable, materials, and general ledger functions.
• Staffing, scheduling, time & attendance, and productivity systems manage 24/7, 365-days-a-year workforces.
• Marketing systems include customer relationship management (CRM), websites, and social media.
• Non-profits use fund-raising systems to manage donor contributions.
• Billing and accounts receivable systems are used to bill clients for services.

Historical Uses of Information Technology

• Healthcare settings that use information technology are hospitals, physician practices, nursing homes, home healthcare services, and insurance firms.
• Information technology was mainly used for regulatory requirements as defined by JCAHO, CMS, and CAP
• Information technology was mainly used for administrative support
• IT use has been encouraged to reduce costs as well as increase patient safety and treatment effectiveness

Evolution of Automation in Healthcare

• Automation benefits from repetitive tasks. These tasks are filling prescriptions, resulting lab tests, and completing radiology images.
• Initial automation occurred in individual areas and was not integrated across clinical areas.
• Primary caregivers initially did not use computers regularly
• Systems were too cumbersome and time-consuming.
• Now, medical devices are more sophisticated.
• Robotic use has increased, such as pharmacy robots that fill prescriptions.
• Unification of medical devices and information systems is occurring.
• Automation systems are now more prevalent
• Health care managers use the new systems in their daily routines

Electronic Medical Record (EMR)

• Institute of Medicine concluded computer-based patient records were essential technology in 1991
• The IOM report, "To Err is Human," in 2000, emphasized the need for increased patient safety through automation.
• The adoption of Electronic Medical Records has accelerated due to the call for safer care
• Healthcare is now in an era of optimization

What is an EMR?

• EMR's are computer applications
• Components are: clinical data repository, clinical decision support, controlled medical vocabulary, physician order entry, plus pharmacy and clinical documentation
• Used across inpatient and outpatient areas
• Practitioners use it for documenting, monitoring, and managing delivery
• It is a legal record of care for a patient during a health encounter at a health services organization (HSO)

Electronic Medical Record Analytical Model (EMRAM)

• The Healthcare Information and Management Systems Society (HIMSS) developed the Electronic Medical Record Analytical Model(EMRAM)
• EMRAM gauges hospital EMR adoption
• Hospitals are scored in a national database.
• Stages range from 0-7. A higher stage indicates more sophisticated clinical uses of HIT.
• Stages 0–1 indicate very basic automation of individual areas.
• Stage 2 shows the ability to start integrating disparate data.
• Stages 3-6 indicate execution of advanced clinical systems.
• Stage 7 indicates the ability to share data with entities outside the organization.
• Data from 2017 indicated 73% of U.S. hospitals progressed past stage 4
• Only 6.4% or 351 of 5,487 facilities progressed to stage 7 in 2017
• The slow progress has been attributed to the high costs of systems, slow development of data standards, and user unfriendliness

EMR vs EHR

• Electronic Health Record(EHR) is a broader term than Electronic Medical Record(EMR).
• EHR refers to a patient's total health, including immunizations, allergies, and medications.
• Data in an EHR is accessible to patients and other health providers.
• Most patient care in the U.S. occurs in the physician offices.
• Of all care settings, physician offices have the least amount of automation due to barriers to adoption.
• 98.6% of hospitals have some form of an EMR, and 67.9% of physician practices have an EMR.
• Larger practices tend to implement more quickly than smaller practices.

Barriers to Adoption & Optimization

• Barriers to implementation include costs, workflow changes, maintenance fees, complex interfaces, and interoperability problems.
• In addition, lack of business education and change management contribute to issues

Federal Response

• The passing of The Notice of Privacy Practice (NOPP)
• The American Recovery and Reinvestment Act (ARRA) includes the Health Information Technology (HITECH) Act to increase adoption through incentives

Beginning of Meaningful Use

• The "meaningful use" criteria, for EHRs, strives for five health outcome goals.
• This means that healthcare should: improve quality, safety, and efficiency; engage patients and families; improve care coordination; improve population and public health; and ensure the privacy/security of patient health information

Meaningful Use vs. EMRAM

• The stages of meaningful use were; stage 1 (2011-2012) data capture; stage 2 (2014) advance clinical processes; stage 3 (2016) improve outcomes
• In relation to ERHAM, meaningful use stage 1 = ERHAM stage 4, meaningful use stage 2 = ERHAM stage 6 and meaningful use stage 3 = ERHAM stage 7

Meaningful Use and MIPS

• Merit-Based Incentive Program (MIPS) evolved from defining goals for EHR utilization to optimizing EHRs
• MIPS utilizes four pillars: quality(50%), advancing care info(25%), improvement activities (15%) and cost (10%)

Problems with EHRS

• Common complaints are poor design, poor usability and that they are time-consuming
• Patients worry about interference with face-to-face care and that it is less fulfilling
• Additionally they lack interoperability

Solutions

• Solutions are scribes who make notes on EHR while physician speaks with the patient
• There should be better training and more intuitive systems as difficulty using EHR decreases productivity

HIPAA

• Established in 1996, the Health Insurance Portability and Accountability Act (HIPAA) set standards for data and regulations on privacy.
• HIPAA increases attention to measures to protect confidential information: Personally Identifiable Health Information (PHI)

The term PHI is defined as

• Individually Identifiable Health Information (IIHI) that relates to an individual's past, present, or future physical or mental health or condition
• Includes the provision of healthcare, the payment of healthcare or anything that identifies the individual.
• In 2018, for breaches were fined between 100−100 - 100−50,000 up to 1.5 million
• Breaches with criminal intent had penalties up to $250,000 and 10 years

Considerations for PHI Breach Enforcement include

• The nature and extent of PHI involved and to whom it may have been disclosed.
• Whether the PHI was acquired or viewed and the risk to the PHI was mitigated

Business Associate Agreements

• Agreements are extended to hospitals, covered entities, or subcontractors.
• Contracts are required to address HIPAA when a business associate or subcontractor is involved

Avenues for Future HIT

• HIT can be portable and held on smartphone
• Virtual health care: be "seen" without need for a physical exam.
• Future Technology Use: patients wearing computers (smart vests) to monitor, and regulate with embedded microchips
• There will be system improvements for complex information

Potential Confounders

• Factors that could be issues: Interoperability, Optimizing existing vs replacing EHRs, Data integrity, Promoting patient safety, Cybersecurity Cloud-based Systems and Bring Your Own Device (BYOD) and Passive and active use of the EHR

Additional Areas

• E-health= electronic data transfer
• mHealth= mobile technologies for health-related activities
• Telemedicine & Telehealth= practicing at a distant site
• Health informatics, analytics, & big data= aggregating, analyzing, and sharing data trends will inform research and policy.

HIT Impact on the Manager

• Managers are working in an increasingly complex environment.
• Therefore, effective managers must use technology in order to manage it's effectiveness and improve employee use.
• Dependency on technology will create new policies around processes during “downtimes,” etc.