Health Information Systems Quiz

Training Approaches

• Five training approaches are listed: instructor-led, technology based, on-the-job training, blended approach, and adjunct aids/training materials.

Instructor-Led Training (ILT)

• Classroom techniques engage participants through active participation, group activities, hands-on exercises, and various instructional approaches to enhance attention and learning.
• Classroom training is expensive and labor-intensive.

Technology-Based/eLearning

• Uses technology to teach technology.
• Includes computer-based and web-based training.
• Web-based training is a lower-cost alternative, typically viewable on any computer.
• Less flexible than classroom training.

On-the-Job Training/Just-in-Time

• Suitable for short sessions.
• Prone to interruptions.
• May not include all necessary trainees.
• A trainer or a super user will guide the needed training.

Blended Learning

• Maximizes retention.
• Addresses different learning styles.
• Encourages active participation.
• Combines web- or print-based instruction with classroom time.
• Less expensive than classroom training.

Adjunct Training Materials

• Includes job aids, e-mail reminders, ongoing training tips, easily accessible audio-video clips, and ongoing trainer/super user presence in work areas.

Administrative Approach

• Risk analysis: risks attacking network components at any time, hence real-time management is crucial.
• Boundary definitions: detailed inventory of IS systems.
• Threat Identification: listing all potential threats (human, natural, or environmental).
• Vulnerability identification: identifying system design weaknesses or flaws/

Security Control Analysis

• Preventive control: access control, authentication, procedures.
• Control design: audit trails and alarms.
• Risk likelihood determination: high, medium, low risk rating system.
• Impact analysis: impact of security on the organization.
• Risk determination.
• Risk control

Centralized Security Functions (Administrative Approach, cont.)

• A comprehensive security plan.
• Accurate and complete information security policies.
• Information asset ownership and sensitivity classification.
• Identification of a comprehensive security program.
• Information security training and user support.
• Institution-wide information security awareness.

Chief Security Officer

• Reports to CIO.
• Manages security plans.
• Applies sanctions and influences employees.

Technical Safeguards

• Access control
• Entity authentication
• Audit trail
• Data encryption
• Firewall protection
• Virus checking

Access Control-Technical Safeguards, Cont.

• Need-to-know.
• User-based access (who and how-read, write, edit, execute, print).
• Role-based access (who and how-easily assign new application privileges).
• Context-based access (who, how, context).

Entity Authentication-Technical Safeguards, Cont.

• The process of determining if someone is who they claim to be.
• Something you know (passwords, PIN).
• Something you have (ATM cards, tokens, swipe cards).
• Something you are (biometric fingerprints, voice scan, iris or retina scan).

Access Authentication Methods (Technical Safeguards, cont.)

• Access codes.
• Logon passwords.
• Digital certificates.
• Public or private keys used for encryption.
• Biometric measures, voice recognition, fingerprints.

Passwords (Technical Safeguards)

• Collection of alphanumeric characters.
• Required after access code or user name entry.
• Assigned after successful system training.
• Inexpensive but not the most effective authentication method.

Audit Trails (Technical Safeguards, cont)

• Record system and application process and user activity of systems and applications.
• Individual accountability.
• Rebuilding of electronic transactions.
• Monitoring of problems.
• Intrusion detection.
• Security violations.
• Performance issues.
• Application flaws.

Security Mechanisms-Automatic Sign-Off

• Logs a user off the system after inactivity.

Security Mechanisms-Firewalls

• Component of computer systems/networks.
• Prevents unauthorized access but permits authorized communications.
• Software and hardware created barrier.
• Two types: packet filter (network level router), proxy server (application level gatekeeper).

Security Mechanisms-Antivirus Software

• Locates and eradicates viruses and malicious programs.
• Identifies issues in scanned devices, computers and networks.
• Includes ransomware - malware that hijacks, encrypts and demands payment for decryption keys.

Security Measures - Antivirus and Spyware

• Signature-based scanning: organizes unique virus patterns.
• Terminator and stay-resident monitoring: runs in background for application runs in foreground;
• Multilevel generic security: uses expert analysis techniques

Security Measures-Other

• User sign-on and passwords or other identity management.
• Access on a need-to-know basis.
• Automatic sign-off.
• Physical restrictions to system access.
• Spyware detection software: installs itself without permission collects passwords/PINs and sends data to third parties.

Security Measures-Proper Handling and Disposal

• Acceptable uses.
• Audit trails to monitor access.
• Encourage accuracy review.
• Establish controls for information use
• Use lock receptacles
• Shred materials with personal health details

Clinical Data Repository

• Online transaction processing (OLTP) is a traditional data collection method.
• It supports daily operations for healthcare organizations.
• Not suited for decision support; tracking patterns or trends is challenging.
• Clinical data repository is a large database that aggregates data from various application systems across an organization

Real-Time VS. Batch Processing

• Real-time processing occurs immediately for speed needs.
• Batch processing runs once daily to reduce processor demands.

Classification of Interoperability

• Emerging, Pilot, and National classifications based on the Office of National Coordinator for Health Information Technology (OCHIT).
• Top standards and implementations are in Table 14-1 (Textbook version 6th).

Types of Interoperability

• Syntactic (functional): exchanging data structure, but not meaning.
• Semantic: guarantees meaning exchange between points.

Health Information Exchange (HIE)

• Electronic transfer of health-related information.
• Clinical data follows patients across care settings.
• Follows nationally recognized standards.

Effort for Interoperability

• Health Level Seven (HL7) Clinical Document Architecture (CDA).
• European Committee for Standardization (CEN) EN 13606-1 (EHRcom).
• OpenEHR.
• Service-oriented architecture (SOA).

Integration Issues

• Massive undertaking.
• Vendors fail to deliver promises.
• Lack of agreement on standards.
• Politics and power.
  • Lack of agreement on data dictionary, data mapping and clinical data repository.
  • Fear of change.
  • Competition.

Benefits of Interoperability

• Improved access to information.
• Improved physician workflow, productivity, and patient care.
• Improved safety.
• Fully standardized healthcare information exchange.
• Estimated savings of 5% of annual U.S. healthcare expenditures

Data Exchange Standards

• HL7 is a major standard for the exchange of clinical data.
• DICOM is used for digital imaging communications in medicine.

Steps in Developing a Preparedness Program

• Program management.
• Planning.
• Implementation.
• Testing and exercise.
• Program improvement.

Steps of the Continuity Planning Process

• Business Impact Assessment or Analysis (BIA).
• Planning.
• Implementation of strategies for continuity.
• Evaluation.

Planning Process

• Secure top management support and commitment.
• Select the planning committee.
• Risk assessment: disaster types, risk range (low-high), impact, and cost of disaster, cost of replacement, and restoration, establishing processing and operating priorities.
• Data collection.
• Write the plan.

Threats to Business Operations and Information Systems (IS)

• Environmental disasters.
• Human error.
• Sabotage.
• Acts of terrorism and bioterrorism.
• High-tech crime.
• Viruses.
• Overtaxed infrastructure
• Power fluctuations and outages.
• Equipment failure.
• Operating system or application software bugs.

Data Backup

• Continuous delivery of services.
• Zero downtime options are expensive.
• Common anti-disaster protection:
  • Automated backups.
  • Off-site media storage.
  • Data mirroring.
  • Server replication.
  • Remote data replication.

Downtime or Backup Procedures

• Different means for common tasks than ordinary methods.

Recovery Cost

• Lost consumer confidence and profits.
• Temporary services, space, equipment, utilities, personnel.
• Shipping and installation costs.
• Post-disaster replacement of equipment and repairs.
• Overtime hours for staff.
• Reconstruction of lost data.

Data→Wisdom

• Data-characters, numbers, or facts to analyze and take action.
• Information-interpreted data, such as blood pressure readings.
• Knowledge-synthesis of information from many sources to create a single concept.
• Wisdom-when knowledge is used correctly to manage problems.

Forces Driving Information Technology-Push for Patient Safety

• Accurate Patient Identification.
• Computerized Provider Order Entry (CPOE).
• E-Prescribing.
• Bar-Code and RFID Medication Administration.
• Decision support software (DSS).

Forces Driving Information Technology-Other Forces

• Increase accessibility of information.
• Move towards evidence-based practice.
• Genomics.
• Demand for cost-efficient and quality care.
• Research.
• Pay for performance

Hospital Information Systems-Lecture 1

• Informatics in Healthcare Profession and Information Technology Overview

Hospital Information Systems-Lecture 2

• Ensuring the Quality of information, Electronic Communication and the Internet

System Checks

• System mechanisms to prompt user completion & verification of tasks, and prevent inappropriate input.
• Data cleansing software at entry point to verify/select "right" patients and remove redundant data.
• Force users to complete required fields.
• Alert users about duplicate entries.
• Generate reports of incomplete actions

Data Storage Considerations

• Speed/frequency of access needs.
• Environmental hazards.
• Equipment/media control and contingency planning.
• Storage periods of each record type.
• Media degradation and obsolescence of hardware/software.
• Maintenance of access devices.

Outsourcing

• Costs.
• Personnel.
• Space.
• Equipment maintenance.
• Expertise.

Quality Information

• Timely.
• Precise.
• Accurate.
• Numerically quantifiable
• Verifiable by independent means.
• Rapidly and easily available
• Free from bias.
• Comprehensive.
• Appropriate to the user's need
• Clear.
• Reliable.
• Convenient

Data Mining-Knowledge Discovery in Databases (KDD)

• Technique using software for analyzing large datasets
• Hidden patterns and relationships analysis
• Data used for research, outcomes/treatment efficacy

Hospital Information Systems - Lecture 3

• Healthcare Information Systems History and Evolution

Information Systems

• Use computer hardware/software for data-to-information conversion.
• Healthcare information systems (including hospital information systems) are groups of systems that effectively support and enhance healthcare.

Why Health Care Lags in IT

1. Health care information is complex (texts, images, graphics). No single standards procedures are present. Health terminology is complex.
2. Health care is highly sensitive and personal (confidentiality is important).
3. Health care IT is expensive.
4. US health systems are a combination of heterogeneous systems (integration is needed)

Types of Information Systems-Clinical/Administrative Systems

• Clinical Information Systems (CISs): Directly supporting care, individual systems (may be stand-alone), data exchange among systems
• Administrative Systems: Indirectly supporting patient care, individual systems (may be stand-alone), data exchange among systems

Clinical Information Systems

• Support provider order entry, results retrieval, documentation, evidence-based practice, and decision support across locations and disciplines.

Clinical Information Systems (CISSs)-Subsystems

• Nursing.
• Multidisciplinary Monitoring.
• Laboratory.
• Pharmacy.
• Radiology.
• Emergency Department.
• Physician practice management.
• Long-term care.
• Homecare

Monitoring

• Devices monitoring temperature, pulse, respirations, blood pressure, oxygen saturation, or other measures; automatically inputting into clinical information systems.
• Alarms notify caregivers of abnormal readings.

Order Entry Systems

• Orders entered into the computer, transmitted to relevant hospital areas (e.g., pharmacy, lab, radiology, social service).
• Direct entry by physician, nurse practitioner, physical therapist, etc. is preferred (CPOE).

Administrative Systems

• Client management (registration).
• Financial.
• Payroll.
• Human resources (HR).
• Quality assurance (QA).
• Contract management.
• Risk management systems.
• Materials management.

Computerized Provider Order Entry (CPOE)

• Initiative by the Institute of Medicine and the Leapfrog Group.
• To improve quality of care and reduce medication errors.
• Eliminates transcription errors, expedites treatment and increases accuracy

Laboratory Information Systems

• Turnaround time, duplicate testing, errors management
• Alert providers about new/stat test results
• Sending results to clinical systems for viewing.
• Receiving input from bedside devices.
• Generating specimen collection labels.
• Using rules for ordering additional tests.

Radiology Information Systems

• Allows order entry or acceptance of orders from other systems.
• Provides scheduling for diagnostic imaging tests.
• Generates client instructions.
• Allows transcription of results.
• Provides picture archiving and transmission of images, and image tracking after procedures done.

Pharmacy Information Systems

• Provide check in order and administration process using evidence-based guidelines,
• Errors when used with bar code technology
• Use lab results, allergy, and interaction information from clinical systems.
• Track medication use, costs, and billing information.

Pharmacy Information Systems, Cont.

• May incorporate more than one system.
• Involve pharmacy dispensing systems (robots) and unit-based dispensing cabinets in patient care areas.
• Utilize barcode and RFID medication administration.
• Incorporate E-prescribing as a process that allows physicians to enter prescriptions electronically which are then sent to the pharmacy electronically via computers and PDAs.

Barcode and RFID Medication Administration

• Quality initiative by Leapfrog Group and the VA National Center for Patient Safety.
• Uses barcodes on medication packages and patient bracelets to ensure right patient, right drug, right dose, right time, right route.

E-Prescribing Benefits

• Provides a longitudinal prescription record.
• Checks formulary compliance and reimbursement.
• Provides alerts about drug interactions.
• Generates reminders for home medications for discharged clients.
• Eliminates phone authorization for refills.

Physician Practice Management Systems

• Includes capturing demographic and insurance data.
• Facilitates scheduling, billing, outcome tracking, and report capability.
• May or may not connect to hospital electronic patient records; may maintain separate patient records.

Home Healthcare Systems

• May exchange data with hospital systems.
• Support excessive documentation demands.
• Improve payment for services; easier to find information needed for billing.

Long-Term Healthcare Systems

• Slow to develop in this area.
• Needed for enhanced care quality and efficiency.
• Important for business survival.
• Integration with other systems is essential for best patient care.
• Can include similar features as other clinical information systems

Decision Support and Expert Systems

• Aid in selecting viable options; using organizational information to facilitate decision-making and overall efficiency.
• Decision support software organizes information to suit new environments.

Registration Systems

• Admission/discharge/transfer (ADT) systems collect and store demographic/insurance data, verified at each visit.
• Crucial for accurate patient identification and reimbursement.

Impact of Mobile Computing

• Allows data access at the point of care to improve treatment decisions.
• Supports evidence-based guidelines/test results.
• Facilitates improved documentation accuracy at point of care.

Hospital Information Systems - Lecture 4

• IT Strategic Planning, IT alignment and strategic planning

Strategic Planning Process

• Define the corporate vision and mission
• Specify achievable goals and objectives
• Develop strategies
• Set policy guidelines
• Determine products and services offered for market penetration
• Articulate goals for planned outcomes and acceptable progress

Strategic Planning Process-Considerations

• Technology must be factored into the strategic plan.
• Strategic planning is an outcome of strategic thinking.

Strategic Planning

• Provides the focus for how the vision will be achieved.

Project Manager Role

• Define scope and results of project.
• Identify tasks within the project.
• Identify when tasks must occur.
• Define who is responsible for each task.
• Establish timelines for completion.
• Establish process for project decisions.
• Provide communication about project status

Needs Assessment

• Initiated by someone with a vision of the future.
• Analyzes the organization’s needs.
• Examines segments within the organization.
• Identifies deficits and issues.
• Uses data to generate a list of possible solutions for developing a timeline or Gantt chart.

Steering Committee Members

• Key process members, ensure congruence with strategic plan.
• Include representatives from all impacted departments to prevent overlooking problems.
• Incorporate end-users.
• Chair should be a member of the administration.

Committee Considerations

• Steering committee members need release time from other duties.
• Require members with functional expertise, good communication skills, and computing background.
• Seek input from consultants when needed.

Analysis of Current System

• A documented process of hardware and software produces a blueprint.
• Must involve a thorough understanding of the used information including who uses the data and its usage.
• May involve questionnaires, observation and interviews to assess the internal environment and to weigh strengths and weaknesses.

Technical Criteria

• Necessary hardware/software for desired performance level.
• Architecture type (compatibility with other systems).
• Response time.
• Downtime.
• Test/training environments.
• Support for other technologies.

Administrative Criteria

• Compliance with regulatory and legal requirements.
• Report capability.
• Ease of use.
• Purging and restoring data.
• Security levels.

Request for Information (RFI)

• Brief document for vendors to state purchase and installation plans.
• Asks for vendor system descriptions, company information (installed sites, service/technical capabilities, updates).

Request for Proposal (RFP)

• Formal document for vendors describing system requirements.
• Solicited proposals from vendors describing their capabilities to meet 'wants' and 'needs'.
• Responses used for narrowing choices.

Request for Proposal (RFP), cont.

• RFP sections may include instructions for vendors, organization objectives, organization background, system goals/requirements, vendor qualifications, proposal solutions, criteria for evaluating proposals, general contractual requirements, and pricing/support information.

System Implementation and Maintenance and Role HIM Professionals-Lecture 6

• Third phase of the life cycle.
• Begins with purchase of the system; pre-purchase planning essential.
• Implementation committee selection needed.

System Implementation Process

1. Organize the implementation team and identify a system champion.
2. Determine project scope and expectations.
3. Establish and institute a project plan.

Typical Component of an Implementation Plan

1. Workflow and process analysis: analyze/determine existing procedures/identify ways to improve processes/identify data sources from other systems/determine workstation needs/revise physical location
2. System installation: determine system configurations/order and install hardware/prepare computer room/upgrade and implement IT infrastructure
3. Staff training: train staff and trainers/update procedure manuals
4. Conversion: convert data. Data should be cleaned first. Test data
5. Communications: establish mechanism for identifying and resolving/involving stakeholders in problem solving
6. Preparation for go-live: select time for go-live when patient volume is low; ensure sufficient staffing; establish problem reporting mechanisms/process reengineering review.
7. Go-Live Planning: GoLive of the systems/implementation strategy (staggered/all); data conversion process (older data transfer); establishing the support schedule/developing evaluation procedures and procedures to request post-go-live changes

Test Environment

• Copy of information system software.
• Programmed changes tested for proper design implementation.

Implementation Pitfalls

• Underestimating time and resources.
• Continuous feature and scope creep additions.
• Considerations of maintenance costs and expenses.
• Problems with testing/user training.
• Lack of user ownership of system.

The Role of HIM

• HIM professionals input to integrate clinical and financial information.
• Understand patient data origins and contents.

HIM Responsibilities During the Analysis Phase

• Assist with identifying issues in current health record systems.
• Determine the needs of various user groups.
• Aid project team in outlining user requirements for RFPs.

HIM Responsibilities During the Design Phase

• Share knowledge about designing/implementing/using vendor systems.
• Participate/attend vendor demonstrations.
• Conduct site visits and evaluate vendors’ RFP responses.
• Provide valuable input when security and confidentiality are needed.

HIM Responsibilities During the Maintenance and Support Phases

• Evaluate the system’s impact on the department on an ongoing basis.
• Identify and communicate issues to vendors and IT personnel.
• Develop ongoing training programs.

HIM Responsibilities During the Implementation Phase

• Participate in system testing.
• Train staff on system procedures.
• Identify errors.
• Create backup and disaster recovery plans.