Chapter 8 Slides Transcript PDF

Chapter 8 Slides – Transcript Slide 1: Title - CHAPTER 8 HEALTH INFORMATION SYSTEMS AND TECHNOLOGY Objectives (1 of 3) Good day, everyone. Welcome to Chapter 8 of "Introduction to Health Care Management." In this chapter, we will delve into the world of Health Information Systems and Technology. L...

Chapter 8 Slides – Transcript Slide 1: Title - CHAPTER 8 HEALTH INFORMATION SYSTEMS AND TECHNOLOGY Objectives (1 of 3) Good day, everyone. Welcome to Chapter 8 of "Introduction to Health Care Management." In this chapter, we will delve into the world of Health Information Systems and Technology. Let's start by outlining our objectives for this chapter. Slide 2: Objectives (1 of 3) Our first set of objectives includes: 1. Differentiate between the levels of functionality in electronic health records (EHR). - This objective will enable you to understand the varying capabilities of electronic health records and how they impact patient care and healthcare management. 2. Appraise key information systems used by health care managers. - You will learn to evaluate the crucial information systems that healthcare managers rely on to streamline operations and improve decision-making. 3. Distinguish between information systems common to all industries and those unique to health care. - We'll explore the specialized information systems tailored to the unique needs of the healthcare industry, setting them apart from generic systems used in other sectors. These objectives will lay the foundation for our understanding of Health Information Systems (HIS). Slide 3: Objectives (2 of 3) [Instructor]: Moving on to our second set of objectives: 4. Analyze the challenges to clinical information system optimization. - We'll delve into the obstacles and complexities involved in optimizing clinical information systems, including data integrity, security, and usability challenges. 5. Examine the evolution of meaningful use and its continued implications for health care providers. - You'll gain insights into the historical development of meaningful use regulations and how they continue to shape the practices of healthcare providers. 6. Assess the future of health care information systems (HIS) in the health care delivery system and the health industry.  - We'll explore emerging trends and technologies that are shaping the future of healthcare management and delivery. These objectives will take us deeper into the realm of health care technology and its evolution. Slide 4: Objectives (3 of 3) Finally, let's explore our last set of objectives: 7. Investigate sources of data for assessing the active and passive use of EHRs. - We'll discover where the data used to assess the effectiveness and usage of Electronic Health Records (EHRs) comes from, both actively and passively. 8. Critique the impact of HIS interoperability on the health care manager. - We'll assess the pros and cons of Health Information Systems (HIS) interoperability and how it affects the role of healthcare managers. 9. Examine the impacts of HIPAA and other regulations, laws, and policies regarding confidentiality of patient information. - We'll delve into the legal and ethical aspects of healthcare information, including the implications of the Health Insurance Portability and Accountability Act (HIPAA). These objectives will help us understand the legal and ethical dimensions of health information systems. Slide 5: Health Information Systems (HIS) Defined Now, let's delve into the core concepts. Health Information Systems, often referred to as HIS, encompass various components: - Data that systems create: This includes the vast amount of patient and administrative data generated within healthcare organizations. - Software: The software applications used for storing, processing, and analyzing health-related data. - Hardware: The physical infrastructure, including servers, computers, and devices, used to run these software applications. - Operating systems: The software that manages hardware resources and allows other software to run. - End-user devices connecting systems: Devices such as computers, tablets, and smartphones that healthcare professionals use to access and input information. - Capture through the use of software: The process of collecting data electronically using software applications. These components form the building blocks for all functions and applications within health information systems. Moreover, we must not forget the significance of networks, the electronic connectivity between systems, people, and organizations. Slide 6: HIS Scope Model Networks Networks in health information systems can take various forms, including intranets, which are internal to an organization, and extranets, which are external and allow information sharing. These networks can be categorized as: - Local area networks (LANs): Networks covering a limited geographic area, such as within a single hospital or healthcare facility. - Wireless LANs (WLANs): Wireless networks that provide connectivity within a limited area. - Wide area networks (WANs): Networks that span larger geographic areas and connect multiple healthcare facilities. - Wireless WANs (WWANs): Wireless networks that cover wide geographic areas, often used for mobile healthcare solutions. - Storage area networks (SANs): Specialized networks designed for data storage and retrieval within healthcare systems. The internet itself is a well-known example of a WAN. Understanding these networks is vital to comprehending the structure of health information systems. Slide 7: Systems in Health Care (1 of 4) Health care systems rely on various information systems, some of which include standard office applications, budget systems, cost accounting systems, and more. These systems are essential for the day-to-day administrative operations of healthcare organizations, including financial management and document processing. Slide 8: Systems in Health Care (2 of 4) Additionally, health care organizations utilize enterprise resource planning (ERP) systems, which encompass human resource, payroll, accounts payable, materials management, and general ledger functions. ERP systems streamline various aspects of healthcare management, from human resources to financial management. Slide 9: Systems in Health Care (3 of 4) Marketing systems, including customer relationship management (CRM) and the organization's web presence on platforms like Facebook and other social media accounts, play a vital role in reaching and engaging with patients and the community. Nonprofit healthcare entities also rely on fund-raising systems to manage donor contributions effectively. Slide 10: Systems in Health Care (4 of 4) Finally, billing and accounts receivable systems are used to bill clients and customers, such as patients and insurance companies, for the goods or services provided by healthcare organizations. These systems are integral to financial management in healthcare, ensuring revenue generation and financial sustainability. Slide 11: Historical Uses of Information Technology Historically, information technology in healthcare was primarily used for administrative support, including tasks such as billing, record-keeping, and appointment scheduling. During this period, healthcare organizations mainly leveraged IT to meet regulatory requirements set by organizations like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Centers for Medicare & Medicaid Services (CMS), and the College of American Pathologists (CAP). However, the potential to reduce costs, enhance patient safety, and improve treatment effectiveness began encouraging the broader adoption of information technology in clinical settings. Slide 12: Evolution of the Automation of Health Care (1 of 2) The evolution of health information technology in healthcare has been significant. Initially, repetitive workloads like filling prescriptions, resulting laboratory tests, and completing radiology images were automated, albeit in separate clinical areas. Primary caregivers seldom used computers as part of their daily routines, and the systems in use were often fragmented, lacking integration. Slide 13: Evolution of the Automation of Health Care (2 of 2) Over time, medical devices became more sophisticated, and robotic technology, such as pharmacy robots for prescription filling, gained prominence. The unification of medical devices and information systems became more prevalent in clinical settings, paving the way for healthcare managers to integrate these technologies into their daily routines. Slide 14: The Electronic Medical Record (EMR) The concept of the Electronic Medical Record, or EMR, gained substantial recognition in 1991 when the Institute of Medicine (IOM) concluded that computer-based patient records were essential technology for healthcare. In 2000, the IOM's report "To Err is Human" emphasized the need to increase patient care safety through automation. Clinicians responded to this call, accelerating the adoption of EMRs, and we are now in the era of EMR optimization. Slide 15: What is EMR? (1 of 2) An EMR is a computer application that encompasses several key components: - Clinical data repository: A centralized database for storing patient-related clinical information. - Clinical decision support: Tools and features that assist healthcare professionals in making informed clinical decisions. - Controlled medical vocabulary: Standardized medical terminology used for consistency in documentation. - Physician order entry: The capability for physicians to input orders electronically. - Pharmacy and clinical documentation: Features for managing medication orders and documenting clinical encounters. EMRs are used across both inpatient and outpatient healthcare settings. Slide 16: What is EMR? (2 of 2) EMRs are used by all practitioners to document, monitor, and manage healthcare delivery to patients. Moreover, EMRs serve as the legal record of care for patients during their encounters at healthcare service organizations (HSOs). Slide 17: Electronic Medical Record Analytical Model (EMRAM) The Electronic Medical Record Analytical Model, or EMRAM, was developed by the Healthcare Information and Management Systems Society (HIMSS), an industry association of healthcare information technology professionals. EMRAM serves as a model for gauging the adoption of EMRs by hospitals. Hospitals are scored on a scale from 0 to 7, indicating progressively higher and more clinically sophisticated uses of health information technology. Slide 18: EMRAM & O-EMRAM Models EMRAM stages are divided as follows: - Stages 0–1: Represent very basic automation of individual areas. - Stage 2: Signifies the ability to start bringing disparate data together. - Stages 3–6: Mark the implementation of advanced clinical systems. - Stage 7: Indicates the ability to share or exchange data with external entities. Slide 19: Table 8-2 Comparison of 2008 to 2017 EMRAM Scores for American Hospitals, and Baseline O- EMRAM scores The table illustrates the comparison of EMRAM scores between 2008 and 2017 for American hospitals, along with baseline O-EMRAM scores. This data provides insights into the progress and adoption of EMRs in healthcare organizations over the years. Slide 20: Hospital EMR Adoption As of Q4 2017, a significant portion, 73%, of all U.S. hospitals had progressed beyond stage 4 of EMRAM. However, only 6.4% of over 5,487 hospitals had reached stage 7, indicating a slow progression. Several factors contribute to this slow progress, including the high cost of systems, slow development of data standards, user-unfriendliness of systems, and patient concerns about the security of their health information. We will continue exploring EMR adoption and its implications further in this chapter. Slide 21: Physician EMR Adoption (2 of 2) When examining physician EMR adoption, it's important to note that most patient care in the U.S. occurs in physician offices. However, they have historically had the least amount of automation due to barriers to adoption, as previously defined. Interestingly, while 98.6% of hospitals have "some" form of an EMR, only 67.9% of physician practices have adopted EMRs. Larger practices with more resources tend to adopt more quickly, while smaller practices face greater challenges. However, exceptions are emerging where the adoption and use of EMRs are leading to better patient outcomes. Slide 22: Barriers to Adoption & Optimization Adoption and optimization of health information systems in healthcare face numerous challenges: - Cost to deploy and sustain: Implementing and maintaining these systems can be financially burdensome. - Major changes to clinical workflow: Transitioning to digital systems often requires significant changes in how healthcare professionals work. - Annual maintenance costs: Ongoing expenses for system upkeep and updates. - Complex user interface and experience: The usability of some systems can be challenging, affecting productivity. - Interoperability issues: Ensuring that different systems can communicate with each other seamlessly. - Lack of business education: Healthcare managers and professionals may not have the necessary business knowledge to make informed technology decisions. - Lack of change management: Adequate strategies to manage the transition to health information technology are sometimes lacking. These barriers must be addressed for successful implementation and optimization of health information systems. Slide 23: Federal Response (1 of 2) The federal government has played a significant role in shaping health information technology. The establishment of the Notice of Privacy Practice (NOPP) and other initiatives influenced the development of HIT in healthcare. However, despite these efforts, adoption remained slow until the American Recovery and Reinvestment Act (ARRA) was enacted. Slide 24: Federal Response (2 of 2) The American Recovery and Reinvestment Act (ARRA) included the Health Information Technology for Economic and Clinical Health (HITECH) Act. This legislation aimed to increase adoption by providing financial incentives to hospitals, physicians, and other care providers for the meaningful use of electronic health records and health information technology. The intervention of the Obama administration through ARRA was a pivotal moment in accelerating the adoption of health information technology. Slide 25: Beginning of Meaningful Use The concept of "meaningful use" criteria for EHRs emerged as a significant policy development. These criteria were designed to achieve five health outcomes policy priorities: 1. Improve quality, safety, and 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. These meaningful use criteria have been instrumental in guiding the adoption and use of EHRs and health information technology in healthcare. Slide 26: Meaningful Use vs. EMRAM The stages of meaningful use were closely aligned with the stages of the Electronic Medical Record Analytical Model (EMRAM). Stage 1 of meaningful use corresponds to Stage 4 of EMRAM, focusing on data capture and sharing. Similarly, Stage 2 of meaningful use corresponds to Stage 6 of EMRAM, emphasizing advanced clinical processes. Stage 3 of meaningful use seeks to improve patient outcomes and aligns with Stage 7 of EMRAM, where data can be shared with external entities. However, as the healthcare landscape evolved, physicians pushed back against the rapid implementation of these stages, leading to calls for changing the adoption timeframes. Slide 27: From Meaningful Use to MIPS (1 of 2) The transition from Meaningful Use to the Merit-Based Incentive Program (MIPS) marked a shift from merely defining goals for utilizing electronic health records (EHRs) to optimizing EHRs for better patient care. MIPS evaluates healthcare providers based on four pillars: - Quality (50%): Emphasizes the provision of high-quality care. - Advancing care information (25%): Focuses on the meaningful use of EHRs. - Improvement activities (15%): Encourages activities that improve clinical practice. - Cost (10%): Evaluates the cost-effectiveness of care delivery. This transition reflects the evolving landscape of health information technology and the need to balance the meaningful use of EHRs with optimizing their functionality. Slide 28: From Meaningful Use to MIPS (2 of 2) MIPS represents a more comprehensive approach to evaluating healthcare providers, emphasizing not only the meaningful use of EHRs but also the optimization of EHR systems. It recognizes that the mere adoption of technology is not enough; it must be leveraged effectively to improve patient care. As MIPS has evolved, it has introduced measures to ensure that EHRs are used in ways that genuinely benefit patients and healthcare organizations. Slide 29: Problems with EHRs Despite the promise of EHRs, they have faced several challenges: - Poor design: Some EHRs suffer from suboptimal user interface and experience design. - Poor usability: Complex workflows and time-consuming data entry processes can hinder healthcare professionals. - Interference with face-to-face patient care: EHRs can divert the attention of healthcare providers from patients during clinical encounters. - Inefficient and less fulfilling work content: Some EHR systems introduce inefficiencies and repetitive tasks. - Lack of interoperability: Incompatibility between different EHR systems can hinder the seamless exchange of patient data. These issues must be addressed to realize the full potential of EHRs. Slide 30: Solutions? Finding solutions to EHR challenges is critical for improving healthcare delivery. Some potential solutions include: - Scribes: These are individuals trained in medical terminology and pathophysiology who assist by making notes in EHRs while physicians interact with patients. - Better training and more intuitive systems: Improved training for healthcare professionals and more user-friendly EHR systems can enhance usability and productivity. Addressing these issues will contribute to more effective and efficient healthcare delivery. Slide 31: HIPAA The Health Insurance Portability and Accountability Act (HIPAA), established in 1996, brought significant changes to the healthcare industry. It introduced standardization of data and regulations related to the privacy and security of healthcare information. HIPAA heightened attention to measures that protect personally identifiable health information (PHI), making it a fundamental aspect of healthcare information management. Slide 32: HIPAA in 2018 In 2018, the consequences of HIPAA violations became more pronounced. Fines for breaches ranged from $100 to $50,000 per violation, with a cap of $1.5 million. Furthermore, HIPAA breaches with criminal intent carried penalties of up to $250,000 and 10 years' imprisonment. Ensuring the privacy and security of PHI remains a top priority in healthcare. Slide 33: PHI Breach Notification & Enforcement When a PHI breach occurs, several factors are considered, including: - Nature and extent of PHI involved: The scope of the breach in terms of the type and amount of PHI. - To whom the PHI may have been disclosed: Identifying parties that may have gained access to PHI. - Whether the PHI was actually acquired or viewed: Determining if the information was accessed and used. - The extent to which the risk to the PHI has been mitigated: Steps taken to minimize harm, such as assuring the destruction of compromised information. These considerations guide the response to PHI breaches. Slide 34: Business Associate Agreements The requirements of HIPAA are extended to all groups that healthcare organizations or covered entities do business with. This includes subcontractors and business associates. Contracts with business associates and subcontractors must address HIPAA requirements, ensuring that PHI remains protected throughout its lifecycle. Slide 35: Future of Health Information Technology (HIT) Looking ahead, the future of health information technology holds immense potential: - Portability: EMRs may become easily accessible, akin to having your entire medical history in your pocket. - Emergence of healthcare apps: With advancements in mobile technology, there is an increasing availability of health-related apps. - Virtual healthcare: The ability to receive healthcare services without the need for a physical examination, revolutionizing access to care. - Innovative uses of technology: Patients wearing computers, smart vests, and embedded microchips are some examples of how technology will continue to impact healthcare. The future promises significant advancements in how healthcare is delivered and managed. Slide 36: Potential Confounders [Instructor]: As health information technology evolves, several potential challenges or confounding factors must be considered: - Interoperability: Ensuring that different systems and technologies can work together seamlessly. - Optimizing existing vs. replacing EHRs: Decisions about whether to enhance existing systems or invest in new ones. - Data integrity: Maintaining the accuracy and consistency of healthcare data. - Promoting patient safety: Ensuring that technology supports, rather than hinders, patient care and safety. - Cybersecurity: Protecting healthcare systems from cyber threats and breaches. - Cloud-based Systems and Bring Your Own Device (BYOD): Managing data security in an increasingly cloud-centric and mobile world. - Passive and active use of the EHR: Understanding how healthcare professionals engage with EHRs. These factors will continue to influence the trajectory of health information technology. Slide 37: Additional Areas In addition to the aforementioned areas, several other domains are shaping the future of health information technology: - E-health: Involves the electronic transfer of healthcare data. - mHealth: Mobile technologies used for health-related activities, including the abundance of health apps on smartphones. - Telemedicine & Telehealth: The practice of healthcare at a distant site, facilitated by technology. - Health informatics, analytics, & big data: Aggregating, analyzing, and sharing data trends that inform research and policy in healthcare. These domains will continue to drive innovation and transform healthcare delivery. Slide 38: HIT Impact on the Manager The impact of health information technology on healthcare managers is profound: - Complex and quickly evolving work environment: Healthcare managers must adapt to a rapidly changing landscape. - Effective managers must use technology: Managers themselves must be proficient in using technology and understand it well enough to manage its effective use by their teams. - Dependency on technology: Healthcare managers will increasingly rely on technology, creating new norms and practices, such as computer competencies and processes during system downtimes. Healthcare managers play a crucial role in harnessing technology for improved patient care and operational efficiency. Slide 39: A Sampling of Research Sources In your journey through health information management and healthcare technology, you'll find valuable resources for research and reference. Here are a few sources to get you started: - Agency for Healthcare Research and Quality Health Information Technology Tools and Resources: AHRQ offers a wealth of tools and resources for healthcare professionals and researchers. - American Hospital Association: The AHA provides insights, resources, and updates on healthcare management and technology. - Centers for Medicare and Medicaid Services Electronic Health Records Incentive Programs: CMS offers information on EHR incentive programs and regulations. - HealthIT.gov: This website provides comprehensive information on health information technology and its impact on healthcare delivery. - Healthdata.gov: A valuable resource for healthcare data and statistics. These sources can aid in your exploration and understanding of the dynamic field of health information technology. Slide 40: Conclusion In conclusion, health information technology's impact on healthcare management is undeniable. While costs have risen, the quality of care has not always kept pace. However, many barriers to the adoption and optimization of clinical systems are being addressed. Models like EMRAM and OEMRAM help organizations evaluate and advance their use of technology. The future promises exciting advancements, but healthcare managers must navigate complex challenges. As healthcare increasingly depends on technology, healthcare managers will play a pivotal role in driving innovation, ensuring quality care, and safeguarding patient data. Thank you for joining me in this exploration of Health Information Systems and Technology in healthcare management.