Lecture 3 Health Care Information Systems PDF

3/17/2024 HCMT 2001 Hospital Functions and Management Topic 3: Health Care Information Systems (HCIS) www.udst.edu.qa Learning Objectives Identify the major types of administrative and clinical information systems used in health care Give a brief explanation of the history and evolution of health ca...

3/17/2024 HCMT 2001 Hospital Functions and Management Topic 3: Health Care Information Systems (HCIS) www.udst.edu.qa Learning Objectives Identify the major types of administrative and clinical information systems used in health care Give a brief explanation of the history and evolution of health care information systems Discuss the key functions and capabilities of electronic health record systems and current adoption rates in hospitals, physician practices and other settings Describe the use and adoption of personal health records and patient portals Discuss current issues pertaining to the use of HCIS systems including interoperability, usability, and health IT safety 1 3/17/2024 Outline Administrative v. clinical information systems Brief history of health care information systems Electronic (EHR) and personal (PHR) health records EHR adoption rates Value of EHR systems Key issues related to EHR systems 3 What’s the difference between information system and information technology? 2 3/17/2024 A few definitions ▸ Information System (IS): an arrangement of data (information), processes, people, and information technology that interact to collect, process, store, and provides as output the information needed to support the organization. ▸ Information Technology (IT): a contemporary term that describes the combination of computer technology (hardware and software) with data and telecommunications technology (data, image, and voice networks). 5 Ancient Egypt Provider Organization: is the hospital, health system, physician practice, integrated delivery system, nursing home, or rural health clinic. 3 3/17/2024 2 information systems Administrative ▸ Administrative: contains administrative or financial data, usually used to support the management functions. It includes the following: ▹ Charge capture ▹ Coding and documentation review ▹ Managed care contracting ▹ Denial management of claims ▹ Payment posting ▹ Accounts receivable follow-up ▹ Patient Collections ▹ Reporting and benchmarking 7 2 information systems Clinical ▸ Clinical: contains clinical or health related information. ▹ May be departmental systems (radiology, pharmacy, etc.). ▹ May be decision support (medication administration, EHR systems, etc.). ▹ They can be limited in scope to a single area or comprehensive and cover all aspects of patient care. 8 4 3/17/2024 Characteristics Example of the two primary information systems 9 Characteristics Example of the two primary information systems 10 5 3/17/2024 History and Evolution 1970 1960 1960s:the technological advances and environmental impact changed the development and use of information systems dramatically. 1960s – 1970s: health care executives invested primarily in administrative and financial information systems that could automate the patient billing process and facilitate accurate Medicare cost reporting. Administrative applications were generally only used in large hospitals. These applications were often developed in-house, and ran on mainframe computers. Smaller hospitals could not bear the cost, which led vendors to offer shared systems between small hospitals for computer time and storage. 1970s: with the development with minicomputers, departmental systems started to be developed. 1980 1980s: the development of microcomputers or personal computers was a significant turning point in the use of health care information systems. The change in reimbursement practices also had a big impact. The development of local area network facilitated sharing information among microcomputers. 11 History and Evolution 1990 1990s: the evolution and widespread use of the internet and e-mail were the most profound technological advances of the era. The institute of medicine published its first computer based patient records (PCRs) which was the precursors of today’s EHR. 2000 2000s: the Institute of Medicine (IOM) published a report that stated that 44000 to 98000 patients die each year due to medical errors. Other reports stated that these figures are underestimated. A subsequent report called for health care providers to adopt information technology to help prevent and reduce error. 2009 2009: the US government launched an “unprecedented effort to reengineer” the way we capture, store and use health information. This effort was realized in the Health Information Technology for Economic and Clinical Health (HITECH) Act. Nearly $30 billion was set aside over a ten-year period to support the adoption and Meaningful Use of EHRs and other types of health information technology with the goal of improving health and health care. 12 6 3/17/2024 History and Evolution 13 Example of a medical technology https://www.youtube.co m/watch?v=hyK7G2X1 6Ng&t=76s https://www.youtube.co m/watch?v=sKDbp8UJmE 7 3/17/2024 Features of EHR Features and Functions Electronic Health Records Electronic health records (EHRs) allow direct input into a computerized provider order entry (CPOE) system and advise health care practitioners 16 8 3/17/2024 What is CPOE? Computerized provider order entry (CPOE) is a computer application that accepts provider orders electronically, replacing handwritten and verbal orders. CPOE provide physician with decision support capabilities that would minimize error. 17 Features and Functions Electronic Medical Record Systems in Qatar The current implementation of a single, Electronic Medical Record (EMR) system across all Hamad Medical Corporation (HMC) hospitals and Primary Health Care Corporation (PHCC) sites is the best example of the financial and organizational commitment of these entities to automate their clinical processes and digitize their health data. 18 9 3/17/2024 19 Patient Portals in Qatar ▸ A patient portal is a secure website ▸ Patients can electronically access their medical records ▸ Schedule appointments ▸ Communicate with providers ▸ Request refills on prescriptions ▸ Review test results ▸ Pay bills ▸ Some providers allow scheduling e-visits 20 10 3/17/2024 Personal Health Account (PHA), Qatar’s EHealth Program “Ministry of Public Health.” Ministry of Public Health , www.moph.gov.qa/english/strategies/SupportingStrategies-and-Frameworks/NationalEHealthAndDataManagementStrategy/Pages/default.aspx. 21 Personal Health Account (PHA), Qatar’s E-Health Program ▸ ▸ ▸ ▸ The National Health Strategy has as one of its main goals: enhancing the wellness of the people of Qatar so that a vibrant, healthy, and productive society can be established for today, and for the future. Individuals need to be engaged and empowered to manage their own health status and that of other people they may be responsible for. This is the principal purpose of the Personal Health Account (PHA), which forms the primary focus of this strategy. The PHA will not only provide the desired single point of interaction between individuals and their health data and services, it will also act as the primary guide to decisions and priorities to be made by the national E-Health Program. “Ministry of Public Health.” Ministry of Public Health , www.moph.gov.qa/english/strategies/SupportingStrategies-and-Frameworks/NationalEHealthAndDataManagementStrategy/Pages/default.aspx. 22 11 3/17/2024 Did you know that… 5% of consumers use PHRs in 2008 and the number reached 17% in 2013. PHR use will increase significantly within the next decade. Did you know that… PHRs and personal health applications can positively affect medication adherence and quality of life for patients with chronic diseases. 12 3/17/2024 Did you know that… Initially envisioned as a tool to enable individuals to keep their own health records , share their information with health care professionals and receive customized content based on needs, values, and preferences Personal Health Records(PHR) ▸ ▸ PHRs should be lifelong, comprehensive, support information exchange and portability Reduce costs by avoiding unnecessary duplicate tests and improving communications 26 13 3/17/2024 Personal Health Records(PHR) ▸ Person-generated health data (PGHD) technologies ▹ ▹ ▹ Mobile technologies and applications to capture health and wellness Step trackers, web-based food diaries, networked weight scales, blood pressure machines Consumers use social media networks to connect with others sharing similar conditions. 27 EHR Adoption Rates in US Hospitals 28 14 3/17/2024 EHR Adoption Rates in US Hospitals ▸ ▸ In 2015, nearly 84% of US non-federal acute care hospitals had adopted EHR. This accounts for a nine fold increase since 2008. EHR adoption among specialty hospital’s is lower than general medicine hospitals (55% children, 15% psychiatric hospitals), because these hospitals were not eligible for Health Information Technology for Economic and Clinical Health Act (HITECH) incentive payments. 29 EHR Adoption EHR adoption use and characteristics among office-based physician practices in the US EHR Adoption in Office-Based Physician Practices 30 15 3/17/2024 EHR Adoption EHR Adoption in Office-Based Physician Practices ▸ There is significant increase in EHR adoption in office-based physician practices. By 2014, 79% of primary care physicians, and 70% of medical and surgical specialties had adopted a certified EHR systems. ▸ 98% of physicians in community health centers had adopted EHR. Physicians in solo and small group practices were less likely to have adopted EHR systems. 31 EHR Adoption EHR Adoption in Other Settings Resnick, H. E., & Alwan, M. (2010). Use of health information technology in home health and hospice agencies: United States, 2007. Journal of the American Medical Informatics Association, 17(4), 389-395. 32 16 3/17/2024 EHR Adoption EHR Adoption in Other Settings ▸ ▸ ▸ Less is known about EHR adoption in settings other than hospitals and physician practices. The latest national estimate dates to 2007 indicates that 44% of home health and hospice agencies have adopted EHR systems. EHR adoption in long-term care facilities in New York is 56.3% of 473 nursing homes. Facilities that did not have EHR indicated that the biggest barriers are initial cost, lack of IT staff and the lack of fiscal incentives. Resnick, H. E., & Alwan, M. (2010). Use of health information technology in home health and hospice agencies: United States, 2007. Journal of the American Medical Informatics Association, 17(4), 389-395. 33 What do you think is the impact of EHR on healthcare quality? 17 3/17/2024 EHR Adoption Impact of EHR 35 EHR Adoption Impact of EHR ▸ The major benefits of using EHR fall in one of three categories: ▹ Quality, outcomes and safety ▹ ▹ ▹ Impacts on quality are: increased adherence to evidence-based care, enhanced surveillance and monitoring, and decreased medication error. 59% of studies that examined the impact of IT on patient quality and safety demonstrated positive effects, 25% had mixed-positive outcomes, 9% were neutral and 8% were negative. Hospitals adopting EHR experienced a 27% reduction in reported patient safety events, 30% decline in medication error and 25% decline in procedurerelated errors 36 18 3/17/2024 Do you think doctors want their patient to access their health record? EHR Adoption Limitations and Need for Further Research 38 19 3/17/2024 EHR Adoption Limitations and Need for Further Research ▸ ▸ ▸ Not all studies reported positive outcomes from using EHR systems. The same EHR system can be implemented in different organizations and have different results. Two children’s hospitals implemented the same EHR system in their pediatric intensive care units. One experienced a significant increase in mortality and the other did not. 39 Challenges again... 20 3/17/2024 Key Issues & Challenges HCIS 1. Interoperability 41 Key Issues & Challenges HCIS 2. Usability ▹ Clinicians often express frustration with the usability of EHR systems. 55% of physicians reported that it was difficult or very difficult to use. Common frustration include: ▹ Confusing displays ▹ Iconography that lacks consistency ▹ Intuitive meaning ▹ The feeling that systems do not support clinicians’ cognitive workflow. ▹ The effectiveness, efficiency, and satisfaction with which the intended users can achieve their tasks in the intended context of product use ▹ Poor usability does not only result in physician frustration but can lead to error and patient safety concerns Howe JL, Adams KT, Hettinger AZ, Ratwani RM. Electronic Health Record Usability Issues and Potential Contribution to Patient Harm. JAMA. 2018;319(12):1276–1278. doi:10.1001/jama.2018.1171 42 21 3/17/2024 Key Issues & Challenges HCIS 2. Usability ▸ Key recommendations for critical usability issues: ▹ Usability and human factors research ▹ Policy recommendations ▹ Industry recommendations, ▹ Clinical end user recommendations Howe JL, Adams KT, Hettinger AZ, Ratwani RM. Electronic Health Record Usability Issues and Potential Contribution to Patient Harm. JAMA. 2018;319(12):1276–1278. doi:10.1001/jama.2018.1171 43 Key Issues & Challenges HCIS 3. Health IT Safety ▹ The institute of medicine published a report suggesting that safety is a shared responsibility between vendors and health care organizations. It requires: ▹ Building systems using user-centered design principles with adequate testing and simulation ▹ Embedding safety considerations throughout the implementation process ▹ Developing and publishing best practices ▹ Having accreditation agencies (such as the Joint Commission) assume a significant role in testing as part of their accreditation criteria ▹ Focusing on shared learning and transparency ▹ Creating a nonpunitive environment for reporting (IOM, 2011) 44 22 3/17/2024 Key Issues & Challenges HCIS 3. Health IT Safety ▹ ▹ Include (1) adverse events that reached the patient, (2) near misses that did not reach the patient, or (3) unsafe conditions that increase the likelihood of a safety event Measuring, monitoring, and creating an environment that is conducive to detecting, fixing, and learning from system vulnerabilities 45 Videos Resources Electronic Health Card System, Electronic Medical Record System in Chennai, India @Bloom1: https://www.youtube.com/watch?v=zX4A8vi1bBE 1 2 EMR Movie: Electronic Medical Records Hawaii https://www.youtube.com/watch?v=3sBe3rdisRo 46 23 3/17/2024 Summary ▸ Two main health care information systems ▹ Administrative ▹ Clinical ▸ Brief history of health care information systems ▸ Electronic health records (EHR) ▸ Personal (PHR) health records ▸ Patient Portals ▸ EHR adoption rates ▹ Higher for those eligible for HITECH incentives ▸ Value of EHR systems ▹ Safety ▹ Revenue ▹ Satisfaction ▸ Key issues related to EHR systems ▹ Interoperability ▹ Usability ▹ Health IT Safety 47 24