Healthcare Information Systems Overview

Chapter 8: Information Technology

• Information Technology is shifting from supporting back-office functions to clinical areas, driven by cost reduction and safety improvements.
• Electronic health records (EHRs) are expected for all US citizens.
• The changing role of technology in healthcare will significantly impact the role of healthcare managers.

Learning Objectives

• Distinguish between general industry information systems and those unique to healthcare.
• Evaluate key systems used by healthcare managers.
• Differentiate between electronic medical records (EMR) and electronic health records (EHR).
• Analyze the difficulties in adopting clinical systems.
• Examine and comprehend the concept of "meaningful use" and its implications for healthcare providers.
• Evaluate the future of healthcare information technology (HIT) and the goal of a unified US healthcare system.
• Critically assess the impact of HIT on healthcare managers.
• Research the effects of HIPAA and other regulations on patient information confidentiality.
• Analyze data sources to evaluate the effects of EHR implementation.

Health Information System (HIS)

• HIS encompasses all computer systems (hardware, software, operating systems, end-user devices connecting people to the system), networks (electronic connectivity between systems, people, and organizations), and the data captured and generated through software use.
• These components are the fundamental blocks for all functions and applications within healthcare.
• Balgrosky (2015) developed the HIS Scope Model.

Networks

• Networks are categorized into intranets (internal to an organization) and extranets (external, allowing user information sharing).
• Local Area Networks (LANs), Wireless LANs (WLANs), Wide Area Networks (WANs), Wireless WANs (WWANs), and Storage Area Networks (SANs) are types of networks.
• The Internet is a prime example of a WAN.

Information Systems Used by Managers

• Healthcare management systems primarily focus on managing organizational expenses and revenues using staff and equipment as major resources.
• Standard office applications, enterprise resource planning (ERP) systems, budget systems, cost accounting systems, fundraising systems, and billing/accounts receivable systems are widely used.
• ERP systems include HR, payroll, accounts payable, materials management, and general ledger functions.
• Systems for time and attendance, staffing, scheduling, and productivity are crucial for managing diverse healthcare workforces.

Systems Applications in Healthcare

• Standard office tools (word processing, spreadsheets, email) improve collaboration.
• Budget systems regulate expenses and income.
• Cost accounting models profit or loss for key services/products.

Systems in Healthcare (Continued)

• CRM systems, websites, and social media platforms are part of marketing efforts.
• Nonprofits utilize fundraising systems to manage donor contributions.
• Billing and accounts receivables track payments from patients and insurance for services rendered.

Historical Uses of Information Technology

• Historically, IT was used primarily for administrative support in healthcare settings (hospitals, clinics, insurance companies).
• Support of regulatory requirements (MOH & CBAHI) was an important aspect.
• The ability to reduce costs and improve patient safety and treatment effectiveness spurred more clinical use of IT.

Evolution of the Automation of Health Care

• Repetitive tasks in healthcare (e.g., filling prescriptions, lab work, radiology) lend themselves to automation.
• Initially, automation was applied to individual clinical areas but not integrated across entire systems.
• Early systems were often cumbersome and time-consuming for primary caregivers.

Evolution of the Automation of Health Care (Cont'd)

• Medical devices are increasingly sophisticated.
• Robotics (e.g., pharmacy robots) are automating tasks.
• Systems unification in the clinical arena is more prevalent.
• Healthcare managers must adapt to the use of these new systems in routine operations.

The Electronic Medical Record (EMR)

• In 1991, the Institute of Medicine (IOM) validated the value of computer-based patient records.
• IOM's 2000 report emphasized the value of automation to improve patient safety, and increased understanding of IT implementation was necessary for efficiency gains.
• Initial uses focused on improved patient safety through automated drug order entry systems, reminder systems prompting treatment reminders.
• Adoption rates for EMRs increased as clinicians prioritized safer patient care.

What is EMR?

• EMR is a computer application encompassing clinical data repositories, clinical decision support, controlled medical vocabularies, and physician/pharmacy order entries.
• EMR is used in inpatient and outpatient settings.
• It supports the patient's electronic medical record.
• It's used to document, monitor, and manage patient care across the organization.

What is EMR? (Cont'd.)

• EMRs serve as a legal record of patient care within the organization.
• It's used by all healthcare providers for documentation, monitoring, and delivery management.

EMR or EHR?

• Electronic Health Records (EHRs) are more encompassing than EMRs.
• EHR encompasses a complete patient health history (including immunizations, allergies, medications).
• EHR data is accessible to multiple providers.

Barriers to Adoption

• Costs are often cited as a barrier.
• Loss of productivity due to system issues is another issue.
• Annual maintenance costs add financial burdens.
• Training adequacy is another barrier.
• Identifying the right EHR for a healthcare practice is challenging.
• User-friendliness struggles are common to new systems.
• Industry practices can vary.

Challenges to Adoption (Cont'd)

• Patient privacy concerns exist.
• Lack of consistent medical terminology hinders system integration.
• The system implementation process can be slow and challenging.

Meaningful Use

• Meaningful Use initiatives specify five health outcomes policies to guide EHR implementation.
• These policies aim to improve quality, safety, and efficiency, reduce health disparities, support patient engagement, improve care coordination, and enhance population and public health.

Problems with EHRs

• Poor usability impacts the effectiveness of care delivery.
• Time-consuming data entry reduces efficiency.
• Interruption of face-to-face interactions with patients compromises trust and care continuity.
• Inefficient work processes and reduced job satisfaction can hinder provider engagement.
• Inability to exchange health information and degradation of clinical documentation can seriously complicate EHR adoption.

Solutions

• Scribes can assist physicians with patient-related data input while physicians engage the patients directly.
• Better training or improved system intuitiveness are key to increasing productivity.
• Implementing easier-to-use systems helps remove obstacles to physician adoption and improves the patient experience.

HIPAA

• The Health Insurance Portability and Accountability Act (HIPAA) of 1996 established standards for data, and privacy regulations, especially for PHI.
• Attention to confidentiality concerns has intensified.

PHI

• Individually Identifiable Health Information (PHI) relates to a person's past, present, or future physical or mental health or condition, and their healthcare.
• It also includes payment records related to the healthcare rendered to the beneficiary.

Future of Health Information Technology (HIT)

• Portability is growing, with EMRs being more easily accessible.
• Virtual health care visits are on the rise in many countries.
• Emerging technologies such as wearable computers or implanted microchips have the potential for improving healthcare.
• System improvements to handle growing complexities are necessary to improve the quality of care.

Potential Confounders

• Optimizing existing EHRs versus replacing them can be confusing.
• Data integrity is critical for system accuracy and reliability.
• Safe practices must accompany the integration of technological systems.
• Interoperability between systems needs improvement to share data easily, especially between different practices or facilities.
• Cybersecurity concerns increase, due to increased reliance on data.
• Industry practice variability requires custom methods.
• Bringing existing organization data into the EHR system is necessary to ensure proper data flow and management
• Systems are adopting ICD-10 for improved diagnostic classification.

Additional Areas

• E-health allows for secure electronic data transfers.
• mHealth leverages mobile technology for health-related activities, like patient record access.
• Telemedicine or telehealth allows for remote patient care.
• Health informatics, analytics, and big data aggregate, analyze, and share data trends, informing research and policy strategies.

HIT Impact on the Manager

• Healthcare management is in a constantly evolving environment.
• Effective managers must utilize technology and adequately train employees to leverage technology.
• Reliance on computer systems can generate new norms regarding operational competencies and downtime procedures.

Conclusion

• The impact of HIT on healthcare managers and quality and efficiency of patient care is growing.
• Costs continue to rise, whilst quality remains a challenge.
• Adoption of clinical systems is generally increasing.
• The EMRAM model gauges the effectiveness of EHR implementation.
• Enhanced competencies in using complex information systems are vital for healthcare managers.

This quiz examines various aspects of Healthcare Information Systems, including the roles and misconceptions surrounding technologies such as WWAN, CRM, ERP, EMR, and EHR. Participants will evaluate the integration of IT in clinical versus administrative settings and the concept of meaningful use. Test your knowledge of how these systems impact healthcare delivery and management.