Unit 2: Health Information Systems Overview

Lecture A defines the concept of an information system and its characteristics, describes the different types of information systems, and describe various types of technologies that support health care information systems. Lecture B examines the challenges presented by emerging trends in information technology (e.g., mobility, web services, the Internet, Intranet, and wireless computing), social media, and global communications and discusses the advantages and disadvantages of using the Internet as a platform for health care applications.

Lectures

Lecture A Notes

Slide 1

Welcome to Health Management Information Systems, Health Information Systems Overview. This is Lecture a

The component, Health Management Information Systems, is a “theory” component that provides an introduction to health care applications and the systems that use them, health information technology standards, health-related data structures, and enterprise architecture in health care organizations.

Lecture a defines the concept of an information system and its characteristics, describes the different types of information systems, and describes various types of technologies that support health care information systems.

Slide 2

The Objectives for this unit, Health Information Systems Overview are to:

  • • Define the concept of an information system and its characteristics;
  • • Describe the different types of information systems;
  • • Describe various types of technologies that support health care information systems;

Slide 3

Additional Objectives for this unit, Health Information Systems Overview are to: 

  •  Examine the challenges presented by emerging trends in information technology, social media, and global communications; and
  •  Discuss the advantages and disadvantages of using the Internet as a platform for health care applications.

Slide 4

Let’s begin with a definition of an information system. The American Health Information Management Association (AHIMA) defines an information system as “An automated system that uses computer hardware and software to record, manipulate, store, recover, and disseminate data (that is, a system that receives and processes input and provides output)” (AHIMA, 2012, p. 181).

Slide 5

Taking into consideration the components of an information system, general characteristics are the capability through the use of hardware and software to accept inputs from users, access and process the data received, as well as store, manage, and present information back to the user.

For example, a nurse would use medication management software which is part of a clinical decision support system, a type of information system, to verify the correct medication was ordered. This system also documents the actual administration of the medication through the use of a handheld barcode reader that registers each medication.

Slide 6

Betts (2007) described two characteristics of an information system as the organization of data into information and the ability to analyze the information. He further stated, “For data to be made meaningful it must have a purpose. The purpose of the stored data should reflect the purpose and type of the information system. Data needs to be processed and organized before it becomes information. Organizing the data will most likely involve the processes of sorting and filtering (classifying) before it can be analyzed and stored for later retrieval” (para. 1).

An example of how data may be organized is via a data dictionary. AHIMA (2012) defines a data dictionary as “A descriptive list of the names, definitions, and attributes of data elements to be collected in an information system or database whose purpose is to standardize definitions and ensure consistent use being a central repository of information about stored data, is used to help organize the data” (p. 94).

Going back to the previous slide’s example, using a handheld barcode reader that registers each medication, a nurse would use information systems to verify the correct medication was ordered and to document the actual administration of the medication.

Slide 7

With regards to information systems, there are three major categories. They are

  • Transaction Processing System (TPS),
  • Management Information System (MIS), and
  • Decision Support System (DSS).

Each will be defined in the next few slides.

Slide 8

A transaction processing system (TPS) processes information in order to complete a transaction. Two examples are the Admit, discharge, transfer (ADT) and patient billing systems.

Slide 9

AHIMA (2012) provides the following definition of an admission, discharge, and transfer system:

“The name given to software systems used in health care facilities that register and track patients from admission through discharge including transfers; usually interfaced with other systems used throughout a facility such as an electronic health record or lab information system” (p. 10).

Slide 10

HIMSS (2010) defines management information systems as “a class of software that provide management with tools for organizing and evaluating their department, or the staff that supports information systems” (p. 76).

Examples of health care management information systems include the laboratory or emergency department information systems.

Slide 11

The National Research Council (2007) recommended that “hospitals adopt robust information and communications systems to improve the safety and quality of emergency care and enhance hospital efficiency” (p. 7). Of particular importance to considerably improving emergency care were the following information technologies:

  • “dashboard systems that track and coordinate patient flow,
  • communications systems that enable ED physicians to link to patients’ records or providers,
  • clinical decision support programs that improve decision making,
  • documentation systems for collecting and storing patient data,
  • computerized training and information retrieval, and
  • systems to facilitate public health surveillance” (NRC, 2007, p. 7).

For example, benefits of a documentation system include the ability to facilitate the capture and storage of information on the patient care process which in turn provides the information necessary for billing and reimbursement as well as public health and research purposes.

Slide 12

AHIMA (2012) defines a decision support system (DSS) as “A computer-based system that gathers data from a variety of sources and assists in providing structure to the data by using various analytical models and visual tools in order to facilitate and improve the ultimate outcome in decision-making tasks associated with non-routine and non-repetitive problems” (p. 100).

An example is a clinical decision support system. 

Slide 13

Having defined the concept of an information system and identified the major categories of information systems, the next step is to unite information systems to the health care domain and describe the various types of technologies that support a health care information system.

As defined by Vogel & Perreault (2006), a health care information system is “an information system used within a health care organization to facilitate communication, to integrate information, to document health care interventions, to perform record keeping, or otherwise support the functions of the organization” (p. 945).

An example would be a hospital information system (HIS). This is a system which is comprehensive in that it contains the clinical, administrative, financial, and demographic information about each patient (AHIMA, 2012). In addition, administrative, billing, and financial systems that facilitate the revenue cycle and other administrative tasks are components of information systems used in provider and health care organizations. 

Slide 14

Coming from a functional perspective, Vogel & Perreault (2006) identified HCIS components that support the following purposes:

  • Patient management and billing
  • Department management
  • Care delivery and clinical documentation
  • Clinical decision support
  • Financial and resource management

Each will be briefly described in the next few slides.

Slide 15

Patient management and billing systems are systems that support the management of the patient. An example would be the patient identification functionality and the supporting technology, a master patient index. AHIMA (2012) defines a master patient index as “A patient-identifying directory referencing all patients related to an organization and which also serves as a link to the patient record or information, facilitates patient identification, and assists in maintaining a longitudinal patient record from birth to death” (p. 210).

Slide 16

Department management systems are systems that support a department’s information needs. An example would be the health information management (HIM) department systems which may be used to manage the organization’s medical records. An electronic document management system would be a supporting technology for the HIM department. According to an AHIMA e-HIM Work Group (2003), an electronic document management system (EDMS) is “any electronic system that manages documents (not data) to realize significant improvements in business work processes” (para. 24).

Department management systems supply data to patient databases. For example, the HIM department contributes transcribed history and physicals to EMRs. 

Slide 17

Care delivery and clinical documentation systems are systems that support the delivery of the care and documentation of that care. An example of an HCIS component would be clinical information systems.  A clinical information system is “designed to support the delivery of patient care, including order communications, results reporting, care planning, and clinical documentation” (Vogel & Perreault, 2006, p. 924). An example of a supporting technology would be the clinical documentation module found within an electronic medical record system. Patient clinical data are stored in delivery and clinical documentation systems.

Slide 18

A clinical decision support system supports the clinical staff with data interpretation and decision-making (Vogel & Perreault, 2001).

Osheroff, Pifer, & Teich (as cited in Das & Eichner, 2010) stated “CDS provides clinicians, patients, or caregivers with clinical knowledge and patient-specific information to help them make decisions that enhance patient care” (Das & Eichner, 2010, p. 4). Das & Eichner (2010) go on to explain, “The patient’s information is matched to a clinical knowledge base, and patient-specific assessments or recommendations are then communicated effectively at appropriate times during patient care” (p. 4).

An example would be a prescription decision support system and a supporting technology would be drug-drug interactions.

Clinical decision support systems access patient clinical data in order to perform various functions. 

Slide 19

Financial and resource management systems are systems that support the business functions of the organization or practice. An example would be an accounts payable system and a supporting technology would be claims administration. Financial and employee data are stored in these systems. 

Slide 20

In a physician setting, the practice management system (PMS) provides a combination of financial and administrative functions. A PMS automates a physician office’s patient appointment, scheduling, registration, billing, and payroll functions (AHIMA, 2012).

Integration of the electronic medical record with the PMS is paramount in today’s health care environment. For example, the stage 1 meaningful use criteria, which came about via the Health Information Technology for Economic and Clinical Health (HITECH) Act, include requirements for the electronic collection and reporting of patient demographics along with clinical data.

Slide 21

This concludes Lecture a of Health Information Systems Overview. 

In lecture a, an information system and its characteristics were defined, the types of information systems that support the health care enterprise requirements were identified, and the various types of technologies that support health care information systems were described.

Lecture B Notes

Slide 1

Welcome to Health Management Information Systems, Health Information Systems Overview. This is Lecture b

The component, Health Management Information Systems, is a “theory” component that provides an introduction to health care applications and the systems that use them, health information technology standards, health-related data structures, and enterprise architecture in health care organizations.

Lecture b examines the challenges presented by emerging trends in information technology (e.g., mobility, web services, the Internet, Intranet, and wireless computing), social media, and global communications and discusses the advantages and disadvantages of using the Internet as a platform for health care applications.

Slide 2

The Objectives for this unit, Health Information Systems Overview are to:

  • • Define the concept of an information system and its characteristics;
  • • Describe the different types of information systems;
  • • Describe various types of technologies that support health care information systems; 

Slide 3

Additional Objectives for this unit, Health Information Systems Overview are to: 

  • Examine the challenges presented by emerging trends in information technology, social media, and global communications; and
  • Discuss the advantages and disadvantages of using the Internet as a platform for health care applications.

Slide 4

The United States Department of Health and Human Services (HHS 2000) made several points regarding how advances in consumer health informatics are changing the delivery of health information and services, in particular the following: “The convergence of media and emergence of the Internet create a nearly ubiquitous networked communication infrastructure. This infrastructure facilitates access to an increasing array of health information and health-related support services and extends the reach of health communication efforts. Delivery channels such as the Internet expand the choices available for health professionals to reach patients and consumers and for patients and consumers to interact with health professionals and with each other (for example, in online support groups)” (p. 11-7).

Slide 5

Some trends in information technology that are creating challenges for health care organizations include Internet, Intranet, Web services, wireless, social media and global communications. Definitions for the first four are provided followed by a discussion of how social media is being used in health care and the effect of global communications after which the challenges will be discussed.

AHIMA (2012) defines the terms as follows:

“Internet: An international network of computer servers that provides individual users with communications channels and access to software and information repositories worldwide” (p. 190).

“Intranet: A private information network that is similar to the Internet and whose servers are located inside a firewall or security barrier so that the general public cannot gain access to information housed within the network” (p.192).

“Web services: An open, standardized way of integrating disparate, web browser-based and other applications” (p. 359).

“Wireless technology: A type of technology that uses wireless networks and wireless devices to access and transmit data in real time” (p. 360).

Slide 6

Kaplan and Haenlein (2010) define social media as “a group of Internet-based applications that build on the ideological and technological foundations of Web 2.0, which allows the creation and exchange of user-generated content” (p. 59).

While not originally created with health care in mind, today these media are seen as valuable health care tools. They are used in the health care environment for a variety of purposes including, for example, the use of a social network such as PatientsLikeMe where individuals connect with others who have a specific disorder. Some media are used by health care providers to provide information to their patients. For example, Mayo Clinic uses both blogs and podcasts to discuss diseases, conditions and treatments.

Health care organizations may use social media to assist patients in making informed choices and to build or maintain reputation in the marketplace. Photo videos such as those found on YouTube are popular. Mayo Clinic has a “Mayo Clinic Channel” where multiple YouTube videos are available for viewing.

The legitimacy of social media has increased as well. Respected health care organizations such as Mayo Clinic and governmental agencies such as the Centers for Disease Control and Prevention (CDC) have established social media centers. For example, CDC (2011) “uses social media to provide users with access to credible, science-based health information when, where, and how you want it” (para.1). 

Slide 7

Many organizations are using the latest communication technologies in order to provide individuals with information and thereby increasing ways to stay connected. For example, there is a broad cultural shift toward using technology and the Internet as a normal part of everyday life. Government policy is placing great emphasis on both health information technology and personal health management for consumers. The integration of communication media means electronic access to health information with Web-enabled telephones, handheld devices, and other emerging technologies. Interactive health communication enables consumers to gather information, make health care decisions, communicate with health care providers, manage chronic disease, and engage in other health-related activities.

This is resulting in a trend towards an increase in the ability to communicate globally.  CDC and the National Cancer Institute (2011) define health communication as: “The study and use of communication strategies to inform and influence individual decisions that enhance health” (para. 10). Global communications involves the use of computer networking tools for international communications and information exchange. Some of the focus areas identified by the CDC for global health communications include health communication and marketing strategies, emergency communication, and eHealth. According to the Office of Disease Prevention and Health Promotion (ODPHP, 2012), “e-Health is the use of digital information and communication technologies to improve people’s health and health care. The increasing use of technologies, especially the Internet and mobile devices, to manage health highlights the potential of e-Health tools to improve population health” (para. 1).

Slide 8

Having described various trends in information technology, what challenges do these technologies and media present? They include privacy and security concerns, liability risk, lack of law or legislation governing the boundaries, lack of payment for engagement, lack of frequent updates, and resistance by health care providers.

While the Health Insurance Portability and Accountability Act or HIPAA contains privacy and security requirements, it does not contain guidelines regarding the transmission of personal health information over the Internet. However, Subtitle D of the Health Information Technology for Economic and Clinical Health Act (HITECH Act), enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009, addressed the privacy and security concerns associated with the electronic transmission of health information. Even so, privacy and security issues are still not a part of HIPAA and remain a challenge for health care providers wishing to use the emerging IT trends.

Other challenges include the risk of liability, especially with relation to what constitutes medical advice which goes hand-in-hand with the lack of law or legislation governing designated boundaries for these emerging electronic device or communication technology tools.

Health care providers are also reluctant to use emerging electronic device or communication technology tools in their practices, due to the lack of payment for their time and effort. For example, according to Health Resources and Services Administration (HRSA, 2003), “The absence of consistent, comprehensive reimbursement policies is often cited as one of the most serious obstacles to total integration of telemedicine into health care practice” (p. 2).

Not all web site data may be updated in a timely manner to reflect advances in clinical care. Web sites need to be reviewed and revised regularly or consumers can receive out-of-date information.

Finally, health care providers may be reluctant to get on-board with some of these technologies due to wariness regarding their usefulness. There is also concern over the potential replacement of some person-to-person interactions, and a danger of losing essential benefits of the doctor/patient relationship, which include appreciation of a patient’s needs and personal preferences. 

Slide 9

Let’s take a closer look at the Internet as a platform for health care applications.

According to HHS (2006), “Significantly, there are indicators that Internet access is growing in every segment of the population and that many of these segments are ready to think about new uses of the Internet and other digital technologies for health” (p. XV).

Just how is the Internet affecting health care? Some examples are:

  • There is increased use of the Internet to find out information about health care providers and treatment options. Opportunities to select information based on their personal interests and preferences.
  • The sponsoring organization provides consumers with tools to develop and maintain their own PHRs.
  • E-mail exchange is possible between consumers and health care providers and
  • Increased marketing sophistication results in accessibility of health care products for purchase.

Slide 10

So, what advantages does the Internet offer as a platform for health care applications? Five are listed on this slide and include that implementations are more cost effective and can be deployed quickly, there is little or no need for IT support, the Internet is designed for sharing, and it is a better technology for mobile computing.

For example, some more recent trends involve cloud computing and software as a service, both of which have associations with the Internet. Mell and Grance (2009) define cloud computing as “…a model for enabling convenient, on-demand network access to a shared pool of configurable computing resources (e.g., networks, servers, storage, applications, and services) that can be rapidly provisioned and released with minimal management effort or service provider interaction” (p. 1). One of the service models described by Mell and Grance is Cloud Software as a Service (SaaS). With this model, “The capability provided to the consumer is to use the provider’s applications running on a cloud infrastructure. The applications are accessible from various client devices through a thin client interface such as a web browser (e.g., web-based email). The consumer does not manage or control the underlying cloud infrastructure including network, servers, operating systems, storage, or even individual application capabilities, with the possible exception of limited user-specific application configuration settings” (Mell and Grance, 2009, p. 2).

With SaaS, a health care provider would license an application through a subscription, thereby paying for only what is needed. Deployment would be quicker since there is no need to install and run the application on the provider’s hardware, IT support is diminished or eliminated as all ongoing support, maintenance, and upgrades are provided by the vendor as part of the service, connectivity with many stakeholders is easier and access via any internet connection – including a tablet or smartphone, such as an iPhone or Blackberry –  is possible.

Slide 11

There are, however, disadvantages to using the Internet as a platform for health care applications. These include the problems associated with keeping personal health information private and secure as well as scalability.

As was previously mentioned, while HIPAA contains privacy and security requirements, it does not contain guidelines regarding the transmission of personal health information over the Internet. However, Subtitle D of the HITECH Act enacted as part of the American Recovery and Reinvestment Act of 2009 addressed the privacy and security concerns associated with the electronic transmission of health information. Even so, privacy and security issues are still not a part of HIPAA and remain a challenge for health care providers.

To be scalable means the system is able to grow with the increase in number of users, volume of data, etc.

Thus, health care providers who use cloud computing services are dependent upon the vendor to “scale” as necessary. The application must not only handle the current base but it must also keep pace with the growth of that base. If the vendor is slow to add computer and personnel resources, then performance degradation is likely to occur.

Slide 12

This concludes Health Information Systems Overview. 

This unit defined an information system and its characteristics, identified the types of information systems that support the health care enterprise requirements, and described the various types of technologies that support health care information systems. The unit also described some challenges with the use of emerging information technology trends. These included concerns with privacy and security, risk of liability, lack of law or legislation governing the boundaries, lack of payment for engagement, and resistance by health care providers. The advantages and disadvantages of the Internet as a platform for health care applications were also discussed.

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