Chapter 8 Information Technology PDF

Chapter 8 Information Technology  Learning Objectives Distinguish between information systems common to all industries and those unique to health care. Appraise key systems used by health care managers. Differentiate between the electronic medical record (EMR) and the electr...

Chapter 8 Information Technology  Learning Objectives Distinguish between information systems common to all industries and those unique to health care. Appraise key systems used by health care managers. Differentiate between the electronic medical record (EMR) and the electronic health record (EHR).  Learning Objectives (Cont’d.) Analyze the challenges to clinical system adoption. Examine the concept of meaningful use and its implications for health care providers. Assess the future of health-care information technology (HIT) and the vision of an integrated U.S. health care system.  Learning Objectives (Cont’d.) Critique the impact of HIT on the health care manager. Examine the impacts of HIPAA and other regulations, laws, and policies regarding confidentiality of patient information. Investigate sources of data for assessing the impact of electronic health record implementation.  Introduction Information Technology is moving from supporting back office healthcare functions to the clinical areas. Result of mounting pressure to reduce cost of care and increase safety. Electronic health records expected for all US citizens. Acceleration of use of technology in healthcare will profoundly impact role of the manager.  Health Information System Definition of HIS- “Include all computer systems (Including hardware, software, operating systems and end user devices connection people to the system), networks (the electronic connectivity between systems, people, and organizations), and the data those system capture and create through the use of software” Balgrosky (2015) These are the building blocks for all of the functions and applications that comprise the work of healthcare providers, organizations and professionals. From these building blocks Balgrosky has developed the “HIS Scope Model”  Health Information Systems (HIS) Defined All components of computer Data that systems create and systems, including: capture through the use of – Software software. – Hardware – Operating systems These become the building – End-user devices blocks for all functions and connecting people to applications. systems Networks – the electronic Source: Balgrosky, 2015, p.13. connectivity between systems, people, and organizations.  HIS Scope Model Figure 8-1  Networks Networks can be categorized as Intranets, which are internal to an organization, or Extranets, which are external and allow users to share information. Networks also can be characterized as: – local area networks (LANs) – wireless LANs (WLANs) – wide area networks (WANs) – wireless WANs (WWANs) – storage area networks (SANs) “The Internet is a well-known WAN” (Balgrosky, 2015, p.81).  Information System Used By Managers System Application in healthcare Key purpose of traditional systems is to manage organization’s expenses and revenues. Mostly costly healthcare resources are staff and equipment. Widely implemented systems include: – Standard office applications -Enterprise Resource Planning – Budget systems -Cost accounting – Fundraising -Billing and receivables Systems Application in Health Care Standard office applications such as word processing, spreadsheet management, and e- mail and other administrative tools to enable collaboration. Budget systems to manage expenses and income. Cost accounting systems to model the profit (or loss) of key services/products.  Systems in Health Care (Cont’d.) Enterprise resource planning (ERP) systems, which include human resource, payroll, accounts payable, materials management, and general ledger functions. Time and attendance, staffing and scheduling, and productivity systems to manage a diverse exempt and nonexempt—and in many health care organizations a 24/7, 365-days-a-year— workforce.  Systems in Health Care (Cont’d.) Marketing systems including customer relationship management (CRM) and typically the organization’s website, Facebook, and other social media accounts. For those health care entities that are non- profit, fund-raising systems that play a key role in identifying and managing the contributions of donors.  Systems in Health Care (Cont’d.) Billing and accounts receivable systems used to bill clients and customers (e.g., patients and insurance companies) for the goods or services of the entity.  Historical Uses of Information Technology Health care settings include hospitals, physician practices, nursing homes, home health care, insurance companies. Mainly used for administrative support. To support regulatory requirements such as those defined by MOH and CBAHI. Opportunity to reduce costs and increase patient safety and treatment effectiveness has encouraged use in more clinical settings.  Evolution of the Automation of Health Care Repetitive workloads lend themselves to automation: – Filling prescriptions – Resulting laboratory tests – Completing radiology images Initial automation was in each clinical area and not ‘hooked’ together or integrated. Primary caregivers did not use computers as part of their daily routines. Systems were too cumbersome and time consuming. Evolution of the Automation of Health Care (Cont’d.) Medical devices are more sophisticated. Robotic use has increased, e.g., pharmacy robots that fill prescriptions. Unification of medical devices and information systems. Systems more prevalent in the clinical setting. Health care managers will need to use these new systems in their daily routines. The Electronic Medical Record (EMR) 1991, Institute of Medicine (IOM) concluded computer- based patient records to be an essential technology. 2000, IOM report, To Err Is Human, emphasized further need to increase the safety of patient care through automation. One of the initial area of attention was to “Increase understanding of the use of the information technology to improve patient safety(e.g., Automated drug order entry systems, reminder systems that prompt nurses and other care providers when patient medication or other treatment are due). As clinicians have responded to call for safer care, adoption of EMRs has accelerated.  What is EMR? An EMR is a computer application that includes: – Clinical data repository – Clinical decision support – Controlled medical vocabulary – Physician order entry – Pharmacy and clinical documentation Used across inpatient and outpatient areas. This environment supports the patient’s electronic medical record across inpatient and outpatient and used by healthcare practitioners to document, monitor and manage healthcare delivery within a care delivery organization.  What is EMR? (Cont’d.) Used by all practitioners to document, monitor, and manage health care delivery. Legal record of care for a patient during their encounter at a care delivery organization (CDO).  EMR or EHR? Electronic health record (EHR) is a broader term than EMR. Refers to total health of patient, including immunizations, allergies, medications, etc. Data in EHR accessible to many, including patient and other health providers. That’s mean EHR is a broader term than EMR  Barriers to Adoption Cost of purchasing a system. Loss of productivity. Annual maintenance costs. Adequacy of training. Finding EHR to meet practice needs. (ONC, 2014, p.15)  Challenges to Adoption Patient privacy Lack of standard vocabulary Cost Lack of user friendliness – not intuitive like web based applications Industry very driven by units of service completed – early systems slowed them down  Meaningful Use Concept of “meaningful use” criteria for EHRs focused on achieving five health outcomes policy priorities: 1. Improve quality, safety, efficiency, and reduce health disparities 2. Engage patients and families in their health 3. Improve care coordination 4. Improve population and public health 5. Ensure adequate privacy and security of patient health information  Problems with EHRs Poor usability. Time-consuming data entry. Interference with face-to-face patient care. Inefficient and less fulfilling work content. Inability to exchange health information, and degradation of clinical documentation. (Friedberg, Chen, Van Busum, Aunon, Pham, Caloyeras, Mattke, Pitchford, Quigley, Brook, Crosson & Tutty, 2013).  Solutions? Scribes: people trained in medical terminology and pathophysiology who make notes on EHR while physician speaks with the patient. Better training and more intuitive systems: difficulty using EHR decreases productivity, increasing provider frustration with hassle factor.  HIPAA In 1996, Health Insurance Portability and Accountability Act (HIPPA) established, among other things, – standardization of data, and – regulations on its privacy. Heightened attention to measures to protect personally identifiable health information (PHI).  PHI “Individually identifiable health information” relates to: the individual’s past, present, or future physical or mental health or condition; the provision of health care to the individual, or, the past, present, or future payment for the provision of health care to the individual; and, that identifies the individual or for which there is a reasonable basis to believe it can be used to identify the individual.  Future of Health Information Technology (HIT) Portability – EMR in your pocket. There’s an app for that! Virtual health care – be “seen” without need for physical exam. Future uses of technology in health care include: – Patients wearing computers to regulate and/or monitor (smart vests). – Embedded microchips. Systems improvements for complex information.  Potential Confounders Some of the areas which are likely confound this process include: Optimizing existing EHRs vs. replacing EHRs Data integrity Promoting patient safety Interoperability Cybersecurity BYOD Capturing socioeconomic data in EHRs ICD-10 adoption  Additional Areas E-health: Electronic data transfer mHealth: Mobile technologies for health related activities (look at your phone—there is probably a health app on it!) Telemedicine & Telehealth: Practicing at a distant site. Health informatics, analytics, and big data: aggregating, analyzing, and sharing data trends will inform research and policy.  HIT Impact on the Manager Complex and quickly evolving work environment. Effective managers must use technology themselves and understand well enough to manage effectiveness of their employees. Dependency will create new norms around computer competencies, processes to use during “downtimes,” etc.  Conclusion HIT impact on health care/manager increasing. Costs have risen; quality has not. While still many barriers, adoption of clinical systems is increasing. There is a model, EMRAM, that helps gauge adoption. Competencies for the healthcare manager will need to include comfort with and use of increasingly complex information system for both themselves and those they manage