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Information Systems in Health Care. Yung-Fu Chen, Ph.D. Department of Health Services Management, China Medical University. Learning Objectives. Distinguish between the concepts of data, information, and knowledge and give examples of each Describe the evolution of IS in health-care delivery

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information systems in health care

Information Systems in Health Care

Yung-Fu Chen, Ph.D.

Department of Health Services Management, China Medical University

learning objectives
Learning Objectives
  • Distinguish between the concepts of data, information, and knowledge and give examples of each
  • Describe the evolution of IS in health-care delivery
  • Discuss how the management of IS in health-care facilities has changed over time and how this has affected the development of IT in health-care delivery
  • Distinguish between in-house developed, shared, turnkey, and stand-alone IS
  • Provide examples of clinical and administrative IS
  • Discuss the elements of a HIS
  • Discuss current trends in health-care IS
key terms
Administrative and managerial information systems

Computer-based patient record (CPR)

Data

Hospital information system (HIS)

Information

In-house systems

Knowledge

Laboratory information systems (LIS)

Nursing information systems (NIS)

Patient monitoring systems

Pharmacy information systems

Shared systems

Stand-alone systems

Turnkey systems

Key Terms
outline
Outline
  • Information Systems in Health Care
    • History of IS in Health Care
    • Current Applications and Trends in Health Care
    • Current Trends in Health Information Systems
history of is in health care
History of IS in Health Care
  • Studied from different standpoints
    • Technology
    • System design approaches
    • Management approaches
    • Data-information-knowledge model
  • Focus on data-information-knowledge model and contrast it to other three standpoints
history of is in health care distinctions between data information and knowledge
Data are facts, images, or sounds that may or may not be useful to a particular task

Non-interpreted items

A data system only produces facts, images, or sounds without any contextual basis

Information consists of data or sets of data whose content or form is useful to a particulat task

Information systems maintain a long-term database use applications built on storage, retrieval, and communication concepts

Data need to be formatted. Filtered, and/or manipulated in order to be converted to information

Data can be converted to information in a number of ways: summarized, highlighted, and formatted or presented

Knowledge is a combination of rules, relationships, ideas, and experience

Knowledge systems are usually composed of an expert knowledge base, algorithms, or some type of rule-based or decision analysis adjunct.

Diagnostic decision support systems (DDSS), which provide collegial assistance in making decisions to the user, are good examples of knowledge systems

History of IS in Health CareDistinctions between data, information, and knowledge
history of is in health care distinctions between data information and knowledge7
History of IS in Health CareDistinctions between data, information, and knowledge

Figure 3-1

Hierarchical view of data-information-knowledge

  • Knowledge
  • Rules
  • Relationships
  • Ideas
  • Information
  • Formatted
  • Filtered
  • Manipulated
  • Data
  • Facts
  • Images
  • Sound
history of is in health care evolution of is in health care
History of IS in Health CareEvolution of IS in Health Care
  • 1960s-70s
  • Financial Focus
  • Few Clinical Systems
  • In-house Development
  • Shared Systems
  • Turnkey Systems
  • Transaction Processing

Figure 3-2

Timelining Health Information Systems Evolution

  • 1980s
  • Continuing Financial Focus
  • More Clinical Development
  • Stand-alone Systems
  • Distributed Systems
  • Management Information Systems
  • 1990s
  • Focus on Clinical Systems
  • Integration of Systems
  • Executive Information Systems
  • Decision Support Systems
  • Enterprise-wide Systems
  • Office Automation
  • Virtual Systems
  • 2000s
  • Standards
  • E-health
  • Intranets and Extranets
  • Internet
  • Clinical Repositories
  • Data Warehouses
  • Data Mining
history of is in health care evolution of is in health care9
History of IS in Health CareEvolution of IS in Health Care
  • Financial and Clinical Systems
    • Although automation has been occurring since 1960s, IS in health care still remain primarily paper based
    • The initial use of computers in health care occurred during the 1960s and early 1970, but mostly focused on financial applications
      • Transferred from other industries to health care was an lateral movement
      • The nature, scope, and development of computer technology then supported data systems better than IS
    • Several exemplary applications in the clinical area
history of is in health care evolution of is in health care10
In-House Developed, Shared, Turnkey, and Stand-alone System

1960s-1970s

In-house systems included on-site systems that were designed, programmed, supported, and modified by hospital data processing staff

The advantage is more flexible in meeting hospital needs than vendor-developed products

Shared systems included those designed, programmed, and maintained by a system vendor and run on computer equipment at the vendor site

Shared by multiple hospitals and communicated through telephone lines or paper forms

The advantages were low start-up costs, low technical staffing requirement in the hospital, and the availability of fully tested and proven system

The drawback is lack of system flexibility to meet specific institution needs

History of IS in Health CareEvolution of IS in Health Care
history of is in health care evolution of is in health care11
In-House Developed, Shared, Turnkey, and Stand-alone System

Turnkey systems

Developed by an information vendor, usually in only software side of the system

Installed on a hospital computer and operated by the hospital staff

The hospital could literally just turn the system on and be ready for business

Attractive to smaller hospitals

Stand-alone system

Developed to support functional tasks for separate departmental areas that each claims ownership of its data

Usually no attempt to share information among systems

Lack of system integration

Data that could be used on an enterprise-wide basis for decision making were difficult to provide through this decentralized approach

History of IS in Health CareEvolution of IS in Health Care
history of is in health care evolution of is in health care12
In-House Developed, Shared, Turnkey, and Stand-alone System

Information system types

TPS, MIS, DSS, EIS, ES, and OAS

Early systems were mainly TPS that automated operational functions such as accounting, payroll, inventory, and admission/discharge systems; order entry system was later added

The introduction of national prospective payment system for Medicare patients influenced the growth of MIS

Weakness in linking and integrating data for stand-alone system became magnified

In the 1990s, a need for developing EIS and DSS were manifested by increase of health maintenance organization, development of alliances, and focus on managed care

Optical fiber provided faster communication for both data and images

In the 2000s, progress in system integration has been promoted

Commitment to the development of standards such as HL-7, DICOM, and ASTM

Advancement of computer technologies

Client/server networks, DBMS, DDBMS, GUI, voice recognition, etc.

Improvements in IS development tools, such as CASE and RAD

History of IS in Health CareEvolution of IS in Health Care
current applications and trends in health care clinical applications and systems
Various system types

Patient monitoring systems

Nursing information systems

Laboratory information systems

Pharmacy information systems

Other clinically oriented information systems

There are frequently overlaps in function and purpose among system types

Broadly defined as hospital information system (HIS)

Provide communication among health facility workers and support organization need for operating, planning, patient care, and documentation

Help to handle this complexity by coordinating work tasks, integrating information, organizing and storing information, and providing information decision support through communication architectures, databases, and application programs,

HIS should provide the following functions

Core applications

Business and financial functions

Communications and networking

Departmental management

Medical documentation

Medical support

Current Applications and Trends in Health CareClinical Applications and Systems
current applications and trends in health care clinical applications and systems14
Core applications

Patient scheduling, admission, and discharge embodied in a registration-admission-discharge-transfer (RADT) system

Business and financial functions

Provide traditional functions such as payroll, general ledger, and accounts receivable

Communications and networking

HIS is a hub for communication to systems such as pharmacy, radiology, laboratory, dietary, OR, housekeeping, and other services

Order entry-results reporting system providing communication between physician orders and ancillary unit is another important function of HIS

Departmental management

Supports the internal needs of individual hospital departments

Integration of individual departmental systems with core HIS application is a trend

Medical documentation

Performs the functions of the standard medical record in collecting, storing, and presenting clinical information

Supports managerial and administrative decision making

Medical support

Assists health-care provider in interpretation of data and in making clinically related decisios

Data generated, stored, and integrated by various systems can be used to monitor patients, issue alerts, and provide limited advice for diagnosis or therapy

Alert of drug allergies

Current Applications and Trends in Health CareClinical Applications and Systems
current applications and trends in health care clinical applications and systems15
Current Applications and Trends in Health CareClinical Applications and Systems
  • Patient monitoring systems
    • Collect, store, interpret, and display physiological patient data
    • Critical in helping to detect life-threatening events
    • Found in various areas, such as emergency departments, operating rooms, general acute-care units, and intensive-care units
  • Nursing information systems
    • Support the nursing-care process both from clinical and managerial perspectives
      • Helping nurses in determining diagnosis, preparing and implementing of nursing-care plans, and evaluating care that was provided
      • Supporting nursing management functions including scheduling of personnel having appropriate level of education, training, or skill
current applications and trends in health care clinical applications and systems16
Laboratory information systems

Support processing of data associated with laboratory tests and management functions associated with daily operations

Store, analyze, and distribute data of tests and examination including clinical chemistry, hematology, clinical microbiology, cytology, surgical pathology, and blood bank

Perform test ordering and results reporting, patient and specimen identification, data processing and record keeping, data acquisition, report generation, quality control, and managerial reporting

Pharmacy information systems

Collect, store, and manage information related to drugs and use of drugs in patient care.

Provide medications for patient care in response to a physician’s order is the primary activity

Provide information regarding identification of drug-drug interactions, contraindications with patient allergies, and drug sensitivities

Supported functions include online order entry, pharmacist review, medication profile update, label printing, drug-dispensing reports, medication administration reports, inventory maintenance and automatic drug reorder, drug-use reports, and controlled-drug reports

Other clinically oriented information systems

Radiological information systems

Dietary information systems

Emergency department systems

Support system for central supply, operating room systems, anesthesia systems, etc.

Current Applications and Trends in Health CareClinical Applications and Systems
current applications and trends in health care computer based patient record cpr
Current Applications and Trends in Health CareComputer-Based Patient Record (CPR)
  • A concept of maintaining health-related and patient-related data electronically in a system so that end users may access complete and accurate data, and be provided with alerts, reminders, clinical support systems, and links to medical knowledge
  • A system of technology, software, and data subsystems working together to provide accurate, complete, and timely information when and where it is needed
  • Make up of one technology but supported by many technologies
    • Web-enabling technologies, client/server networks, fast computing speed, voice recognition, and DDMS
    • Multiple data sources are required to support CPR concept
current applications and trends in health care computer based patient record cpr18
CPR requirements

An integrated view of patient data

Access to knowledge resources

Physician and clinician order entry

Integrated communications support

Clinical decision support

Barrier to CPR Development

Lack of a clear definition of a CPR and costs and risks associated with development

Barriers to diffusion including

Fragmented organization of the health-care system

Lack of leadership for establishing the necessary infrastructure for national CPR implementation

Requirements for education and training of health-care personnel

CPR adoption costs

Legal and social issues

Lack of a communications infrastructure and standards

Current status of CPR

Development of integration among a variety of independent systems, such as pharmacy, laboratory, radiology, and nursing information systems, is a trend

Integration involves the application of client/server protocols, DDMS, and application of vocabulary and other types of standard

Work on defining the basic architecture for data contained in the CPR needs to be accomplished if data are to be seamlessly transmitted among health-care providers, internal and external to the organization

Computer-Based Patient Record Institute (CPRI) has established the Nicholas E. Davies Annual CPR Recognition Symposia

Current Applications and Trends in Health CareComputer-Based Patient Record (CPR)
current applications and trends in health care administrative and management applications
The applications, especially in the financial areas, were the first functions widely deployed

Clinical and financial systems were rarely integrated, also poor integration among various managerial and administrative systems

Lack of appropriate integration has adverse impact on decision making

Examples

Financial information system

Accounting information system

Human resource MIS

Material management systems

Facilities MIS

Management planning and decision support systems

Current Applications and Trends in Health CareAdministrative and Management Applications
current trends in health information systems administrative and management applications
Financial information system

Initially automated accounting functions such as payroll preparation, accounts payable, patient accounting, general ledger, and budgeting; with the implementation of DRG the need for case-mix management systems and integration of clinical and financial systems were recognized

Categorization

Cash management

Investment management

Capital budgeting

Financial forecasting and planning

Accounting information system

Essential business operations that record organizational business and economic transactions by recording and reporting how funds flow through the organization, producing financial statement

A mix of different systems

Order processing system captures and process order

Inventory control system processes data related to inventory and inventory tracking

Account receivable system records the amounts owed by health-care facility patients, clients, clients, and produce invoices, monthly statements, and credit management reports

Account payable system records the purchases, the amount of purchases, and from whom purchases were made

Payroll transaction system includes mechanisms for timekeeping for work performed, records employee compensation data, and produces paycheck and other payroll documents

General ledger system glues all of the accounting systems together

Current Trends in Health Information SystemsAdministrative and Management Applications
current trends in health information systems administrative and management applications21
Human resource MIS

Traditional functions include only maintaining and updating employee records, currently access to data for monitoring productivity, assessing personnel-related barriers to productivity, and determining appropriate levels of the human resources mix are implemented

Be able to support three important functions

Staff administration supports recording and tracking of human resources

Training administration helps managers to plan and monitor employee training and to develop and analyze the success of training programs

Development and compensation administration analyze the range and distribution of employee compensation including wages, salaries, incentives, and fringe benefits internal and external to the organization

Material management systems

Management of inventory and purchasing of materials and supplies

Encompasses front-end and back-end processes

Front-end processes involve handling requisitions for supplies and materials from departments

Back-end process include managing inventory and ordering materials and supplies

Benefits of this system

Reductions in inventory

Improvement in bid and contracting procedures

Updating of daily patient charges

Improvements in avoiding lost patient charges

interface with accounts payable to obtain payment discounts

Reduction in labor costs

Current Trends in Health Information SystemsAdministrative and Management Applications
current trends in health information systems administrative and management applications22
Facilities MIS

Well-maintained physical facilities are essential for the provision of quality patient care as well as providing a pleasing atmosphere for workers and patients and their families

Include capture, storage, and manipulation of data used to monitor preventive maintenance, energy management, and project (construction) scheduling

Management planning and decision support systems

Information from external and internal is necessary for good strategic decision making

External prospective

Understand the environmental context, know the strength and weakness of its competition, and understand opportunities upon which it can capitalize

Internal prospective

Recognize its own internal strengths and weakness and how these decision making must integrate data from internal and external database

DSS provides information for strategic decision making by supplying tools for the manipulation of data and presenting answers to what-if scenarios

DSS includes forecasting, marketing, cost accounting, and case-mix systems

Quality improvement systems

Current Trends in Health Information SystemsAdministrative and Management Applications
current trends in health information systems administrative and management applications23
Elements of management information, decision support, and executive information systems

IS designed to help in the support of strategic and managerial decision making are classified into three categories: MIS, DSS, and EID

Management information systems

Developed for managing daily business operations

Exception report is generated when exceptional conditions occur

Some allow managers to interactively request information through Web browser, query languages, and report generators

Decision support systems

Include more sophisticated features for analysis of data than MIS

Consist of several characteristics such as a body of knowledge or a database, analytical models used to analyze data, and interactive modeling capability to support semi-structure and unstructured management decisions

Software for managers to develop their own DSS: spreadsheet, management sciences packages (SPSS or SAS), query languages, and data mining packages

Executive information systems

Combine many features of MIS and DSS, but is developed for top executive decision making

Current Trends in Health Information SystemsAdministrative and Management Applications
current trends in health information systems
Systems can be examined and views in relations to management of the resources, architecture, applications, communications, and technology

Vision must be toward fully integrated systems supported by flexible data models, communication technologies, and tools that enhance decision making, improve quality and productivity, and reduce administrative costs

Current trends in

Clinical information systems

E-commerce and E-health

Standard development

Privacy and security

Technology developments

Management of information resources and standards development

The virtual health-care system

Current Trends in Health Information Systems
current trends in health information systems clinical information system
Current Trends in Health Information SystemsClinical Information System
  • Continued design, development, and implementation of CPR
  • CPR will require continued development and application of a number of technologies
    • Clinical data repositories
    • Communication technologies to link various repositories, information resources, and users
    • Enterprise-wide and inter-enterprise data models
    • Voice entry to improve user input
    • AI and DSS
    • Communications and other standards
    • Integration of voice, text, data, and image processing systems
    • Policies, procedures, and methods that will ensure security of patient-related data and communications
current trends in health information systems e commerce and e health
Current Trends in Health Information SystemsE-Commerce and E-Health
  • E-commerce can be defined as the marketing, buying, selling, and support of products and services over the Internet, Intranet, and Extranet
  • E-commerce involves electronic data interchange (EDI) and secure electronic funds transfer (EFT)
  • Health-care organization will continue to use the Internet to create a dialog with customers and others through online discussion groups, electronic bulletin boards, electronic surveys, newsletters, blogs, and e-mail exchanges
  • Continuing growth in e-health companies which provide a range of services including storing personal health data, providing reference information on a variety of health issues, running health-care superstores
  • Telehealth applications, such as telehome health care, teleradiology, telecardiology, teledentistry, teledermatology, and others, will continue to grow
current trends in health information systems standard development
Standards are essential for the collection, storage, and exchange of data, which are fundamentals of developing CPR and e-commerce applications, therefore the development of standards will continue

Vocabulary standards establish common definitions for medical terms

Structure and content standards identify essential data elements and provide for standardization of element characteristics such as length, data type, and content

Message standards establish the format and sequence of data during transmission

Security standards identify practices required to maintain the confidentiality, integrity, and availability of health-care information

Organizations

International Standard Organization (ISO)

American National Standards Institute (ANSI) does not develop standards but serves as a clearinghouse for nationally coordinated voluntary standards

Health Level 7 (HL7)

Accredited Standards Committee (ASC)

Digital Imaging and Communications in Medicine (DIACOM)

National Council on Prescription Drug Programs (NCPDP)

American Society for Testing and Materials 9ASTM)

Mandatory standards

Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Current Trends in Health Information SystemsStandard Development
current trends in health information systems privacy and security
Current Trends in Health Information SystemsPrivacy and Security
  • HIPAA promulgated mandatory rules with regard to both data privacy and security for health-care organizations
  • Health-care organizations must be concerned with confidentiality, integrity, and availability of the information resource
  • Management of data security will force organizational change in structure, behavior, training and education, and management of technology
    • Chief security officer (CSO) will be a new role
    • Encrypted keybased authentification and biometric authentification for guarding data access
    • Web server guards and server-side session management through a secure socket layer will be a regular feature for engaging in any type of e-commerce
current trends in health information systems technology development
Current Trends in Health Information SystemsTechnology Development
  • Wireless technology accompanied with handheld computers and personal digital assistants will be applied widely in health-care institutions
  • Interactive technologies such as continuous speech recognition, touch screen, and multimedia technology will be applied more widely, especially in CPR
  • Continuing growth and applications of database, data repository, and data warehousing technologies in the health-care arena
slide30
Current Trends in Health Information SystemsManagement of information resources and standards development
  • A distinction between information technology and systems and IM will emerge
  • An expended role for information resources manager, CIO, reporting directly to CEO by providing him/her with vision and leadership in the strategic planning, implementation, and operation of enterprise-wide IS
  • CIO will play a vital role on the leadership team in helping to define the strategic objectives of the organization as a whole
current trends in health information systems the virtual health care system
Current Trends in Health Information SystemsThe virtual health-care system
  • In a virtual IS, health-care enterprises view their information resource from the perspective of VR
    • View of information goes beyond an IS confined in an organization
    • Critical data reside anywhere, either internal or external to an organization
    • Virtual IS will be embraced by developing and implementing the following facility communication links
      • Physician-healthcare
      • Third-party-healthcare
      • Government-healthcare
      • Alliance and partner-healthcare
      • Customer/client-healthcare