Info System / Health Care
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IFSMWeek1.pdf
Content
Week 1, Monday, October 21, 2019 - Sunday, October 27, 2019
IFSM 305 7980 Information Systems in Health Care …
The following should be completed in Week 1:
Read:
Overview (module at top of list on the left side of your screen)
Syllabus (module listed on left side of your screen)
Read/View all Week 1 Content
Read the Case Study, located in Course Resources (module on the left)
Read the Stage 1 assignment, located via the Assignments tab above, and skim the Stage 2, 3 and 4
assignments
Do:
Introduce yourself in the Introductions Discussion
Participate in Discussion(s), as assigned
Begin work on the Stage 1 Assignment, due at the end of next week
0 % 0 of 3 topics complete
Let's begin!
As a first step, you should read the Case Study and the Stage 1 assignment, and
skim the three additional assignments. These will provide a roadmap for you as
you read the course materials, and you will be able to take notes as you do your
readings.
Each week, there are several readings to help you understand the week's
concepts and to prepare you to complete the assignments. To help prepare you
Activities
Week 1 Learning Resources Link
to complete the Stage 1 assignment, this week's readings present a basic
overview of health informatics, health information systems, and how technology
supports a wide range of health care settings. Be sure to scroll down to see all
the Learning Resources for the week.
IMPORTANT NOTE about the lecture and audio files used in this course. Most
of the content for this course comes from a collection of Health Information
Technology Curriculum materials developed for the Office of the National
Coordinator for Health Information Technology (ONC). The content is presented
as a series of lectures (pdf files with slides and notes) and accompanying audio
files (where a speaker delivers the same words used in the notes). Each of these
will open in a new window, so you can open both the pdf and the accompanying
audio file and play the audio as you read through the slides. If you prefer to just
read the slides and notes without the audio, all the information will be covered.
If you would like to access the full suite of the curriculum, it is located at
http://knowledge.amia.org/onc-ntdc.
The following table lists the Week 1 outcomes, mapped to the corresponding
course outcome. The course outcome gives you "the big picture," and the weekly
outcomes provide more detailed information that will help you achieve the
course outcome.
Course Outcome Met in Week 1 Week 1 Outcomes
Evaluate the organizational
environment in the health
care industry to recognize
how technology solutions
enable strategic outcomes
describe health care settings and
organizations
define health informatics
describe health information systems
describe the role of information system
health care settings
Introductions Discussion Topic
Discussion for Week 1 Discussion Topic
Introduction to Information Systems in Healthcare Organizations
As the course catalogue describes IFSM 305, this is an "overview of how information systems provide value by supporting organizational objectives in
the health care sector. The goal is to evaluate how technology solutions support organizational strategy in the health care environment and improve
quality of care, safety, and financial management. Topics include the flow of data among disparate health information systems and the ethical, legal, and
regulatory policy implications." Information systems collect, organize, process, and make available or distribute data. The systems involve people,
technology, and processes. Each of us is impacted by information systems on a regular basis.
There is a clear relationship between information (derived from raw data), information technology (the computer-based tools used to work with
information), and people (you!). What is critical to keep in mind is that they all contribute (together) to organizational success. Investments in
technology and information systems are worthless if they do not support or contribute to the strategic goals of the organization.
People, processes and technology all work together. The “processes” are the activities of the organization. In order for those processes to work,
information is needed. Information, therefore, becomes the lifeblood of the organization. It is one of the most important assets in an organization, and
the primary way that people get information is through information technology. Information technology in and of itself is not useful unless it
delivers the right information to the right people at the right time. Since people, information and information technology (in that order of priority) are inextricably linked, if one fails, they all fail.
So, we will begin our study of “Information Systems in Health Care
Organizations” with developing an understanding of the health care organizational environment –including those organizations that deliver
health care and those that manage other aspects of health care (pharmacies, insurance companies, etc.). The same concepts apply in all of those environments.
As you approach each week's work, you should read and view the assigned items in the order presented. They are grouped by topic to aid
your understanding of the topic and to prepare you to demonstrate your learning when it comes time to complete the assignments.
Working with Health IT Systems is available under a Creative Commons Attribution-NonCommercial- ShareAlike 3.0 Unported license. © Johns Hopkins University. UMUC has modified this work and it is available under the original license.
Welcome to The Culture of Healthcare, Healthcare Settings—The Places Where Care is Delivered. This is Lecture (a).
The component, The Culture of Healthcare, addresses job expectations in healthcare settings. It discusses how care is
organized within a practice setting, privacy laws, and professional and ethical issues encountered in the workplace.
1
The objectives for this unit, Healthcare Settings—The Places Where Care is Delivered are to:
• Differentiate the range of care delivery organizations, including primary care, specialty care, tertiary care, inpatient and
outpatient facilities, long-term care hospitals, and long-term care facilities
• Analyze the organization of healthcare delivery from the perspective of a “Continuum of Care,” such as ambulatory services,
inpatient care, long-term care, and end-of-life care
• Evaluate the similarities and differences of community hospitals, teaching hospitals, and community health clinics
2
Additional objectives for this unit are to:
• Describe the various departments and services offered by an outpatient clinic, community hospital, academic medical center,
and
long-term care facility
• Explain the ways in which these departments interact and the services relate
• Speculate on the data and information that are created and used by people in these departments
• Describe ways in which medical and/or information technology has improved interdepartmental communication and how that
has improved the patient experience
3
This lecture will examine two aspects of healthcare settings—the range of care delivery organizations and the Continuum of Care
they provide. It will also provide an overview of healthcare organizations, including examining the range of the levels of care that
healthcare organizations can provide and the role that institutions have in providing a “Continuum of Care.” This refers to the care
that an institution provides from entry into the system until care is no longer needed. Throughout this presentation, the unique
functions of various healthcare organizations will be highlighted. The presentation will also provide examples of relationships
between healthcare organizations.
4
The best way to get a broad picture of the types of care delivery organizations is to look at the range of services that they provide.
Primary care organizations are usually the entry point for healthcare services. Secondary care is most often specialty care.
Tertiary [tər-shē-ˌer-ē] care organizations offer diagnostic and treatment options that are not available at most healthcare
organizations. The graphic shows that primary care organizations may refer patients to either secondary care or tertiary care
(indicated by an arrow from the Primary Care Organization text to both the Secondary Care and Tertiary Care text boxes).
Secondary care organizations also may refer directly to tertiary care organizations (indicated by an arrow from the Secondary
Care Organization text box to the Tertiary Care Organization text box).
5
This quote describes how primary care addresses the majority of personal healthcare needs. It is ideally easily accessible and
sustained. It is often the entry point into healthcare and includes screening, prevention, diagnosis, and treatment for acute and
chronic health problems.
6
Secondary Care Organizations represent more specialized care and are also called “Specialty Care Organizations.” These can
provide many types of specialty care such as surgery, cardiology [kärd-ē-äl-ə-jē], physical medicine, or burn care. The majority of
secondary care is provided by community hospitals and academic hospitals. Much of secondary care can now be provided in
free-standing ambulatory facilities such as surgery centers.
7
Tertiary provides care that is not available at other healthcare organizations. In many cases, a new procedure is perfected in only
a few organizations, and that is the only place the procedure can be obtained. Examples might include complex facial
reconstruction, many types of organ transplants, or specialized burn care. This quote also makes the point that bears repeating:
Many organizations provide multiple levels of care.
8
Many organizations seek to provide this broad range of care by developing Integrated Healthcare Delivery structures. This can be
as simple as an informal association between primary care providers and local hospitals or medical centers. There has also been
a rapid development of more complex structures where primary, secondary, and tertiary services and facilities are managed by a
single organization.
9
The “Continuum of Care” can be defined as the provision of care from the entry of the patient into the system until care is no
longer needed. The simplest way to envision this concept is “care from birth to death.” Another way to picture it is for a specific
medical problem. Imagine the number of organizations that are involved in a severe injury from a motor vehicle accident. It could
include emergency care to stabilize the patient, surgery to repair the injuries, and rehabilitation to return the patient to normal
function. There are some specialized organizations such as rehabilitation institutions that provide care only in a specific phase of
this continuum.
10
Ambulatory [am-byə-lə-ˌtōr-ē] services (also known as outpatient care) are provided to non-hospitalized patients. There are a
wide range of services that can be offered in ambulatory care organizations. This includes primary care that is often provided in a
doctor's office or a clinic. Increasingly, specialty medicine is being provided in ambulatory settings such as outpatient surgery,
sports medicine, and rehabilitation; X-rays; and other imaging such as Magnetic Resonance [rez-ən-ən(t)s] Imaging and
Computerized Tomography [tō-mäg-rə-fē].
11
Community Health Clinics are usually community-based health centers where patients have input into management. Most
community clinics provide care to underserved populations. Federally Qualified Health Centers meet certain qualifications and
receive federal funding. They include Community Health Centers, Migrant Health Centers, Healthcare for the Homeless
Programs, and Public Health Primary Care Programs. “Look Alikes” do not receive the same grant funding but have been certified
as meeting the definition of a health center. Those operated by tribal organization usually receive funding from the Indian Health
Services. There also many community health centers run by non-profit organizations, health departments, and cities or counties.
12
School-Based Health Centers are located in schools and offer a wide range of services depending on state and local policy. They
often provide screening, preventive care, and some acute care (minor injuries, colds, etc). They may also offer behavioral and
other forms of counseling. They often have a linkage with other local healthcare organizations so that they may refer patients in
need of additional or more specialized care.
13
Employer-based health clinics have expanded their roles in the last few decades. The original focus was more on occupational
health and injury prevention. These clinics have expanded into preventive care, screening, wellness, and chronic disease
management. They may be located in an office at the facility or have a mobile clinic that can serve several facilities. For the
employer, these clinics have the advantage of providing control over healthcare cost including an emphasis on prevention and
wellness. For the employee, it allows them to receive healthcare without having to take time off. It is estimated that by 2015,
employer-based health clinics will serve 10% of the US population under 65 years old.
14
Inpatient Care is healthcare that requires admission to a hospital for greater than 24 hours. There are broad ranges of services
provided including care for acute problems (heart attacks or appendicitis [ə-ˌpen-də-sīt-əs]); for chronic problems such as
diabetes [dī-ə-bēt-ēz] or heart failure); and for mental health issues.
15
There are two general types of hospitals. Community hospitals are non-federally funded hospitals but may be non-profit or for
profit. They consist of local hospitals that provide short term, general care but may also include specialty hospitals that focus on
obstetrics [əb-ste-triks]; gynecology [gīn-ə-käl-ə-jē]; orthopedic [ȯr-thə-pēd-ik]; or rehabilitation. Teaching hospitals are usually
associated with a university or medical school. Also termed academic hospitals, they have a major role in training health
professions. The range of clinical care provided by community and teaching hospitals may be the same.
16
Long-term care facilities are healthcare organizations that provide assistance to aging adults or those with chronic illness. There
are a variety of types of institutions that serve different needs. Adult day care provides meals and activities during the day.
Independent living situations are typically retirement communities that have separate condos or apartments. Residents can
typically purchase options individually, such as meals or housekeeping services. Assisted living can be an apartment or individual
room where a number of services like personal care, medication administration, meals, and housekeeping are part of the
package.
17
Skilled Nursing Facilities provide full medical care; they also provide assistance with activities of daily living such as meals,
personal care, housekeeping, and laundry. Long-Term care hospitals are a special category in which the facility manages the
transition of acute illness or injury to return to home. Many community hospitals have long-term care units that serve that purpose.
The average patient’s stay in long-term care units or hospitals is greater than 25 days.
18
A hospice is a facility designed to serve patients who are dying from a fatal disease. This includes managing side effects of
treatment, pain control, and loss of abilities. Families are typically very involved, and services are often provided to them including
grief counseling and help with managing the patient’s final affairs. The services are designed to be the most comforting for the
patient and family and may include assistance through home hospice care, day hospice facilities, or admission to hospice homes
or centers.
19
There are three main federally funded healthcare institutions in the United States: the Veterans Health Administration, Military
Medicine, and the Indian Health Services.
20
The Veterans Health Administration (VA) is the largest integrated health system in the United States, consisting of 153 medical
centers and 1400 community-based outpatient facilities. The VA also includes community living centers; Vet Centers (for
outreach); and Domiciliaries [dom-uh-sil-ee-er-ees] to care with patients with long-term medical conditions in a home-like
atmosphere. As with any integrated health system, the VA provides primary, secondary, and tertiary care.
21
The Military Health System is part of the US Department of Defense. It provides services to service members, retirees, and their
families. Each branch of the armed forces has its own network of hospitals and healthcare facilities. TRICARE is a healthcare
program that ensures care worldwide. This includes military facilities and is supplemented by civilian healthcare providers,
organizations, and pharmacies
22
The Indian Health Services is an agency that is part of Health and Human Services. It provides healthcare to American Indians
and Alaskan natives. The main goals are to provide access to care and to reduce health disparities.
23
The Indian Health Service consists of a federal system and healthcare organizations managed independently by American Indian
tribes and Alaska Native corporations. There are additional services that are provided by contract with private providers. The
system includes 28 hospitals, 63 health centers, 31 health stations, and 34 urban projects. American Indian tribes and Alaska
Native corporations administer 17 additional hospitals, 263 health centers, 92 health stations, and 166 Alaska village clinics. Like
most systems, the Indian Health Service offers primary and secondary care. Some areas have tertiary care capabilities or
contract with private providers for these services.
24
This concludes Lecture (a) of Healthcare Settings-The Places Where Care is Delivered. This lecture discussed the range of
healthcare organizations include those that provide primary care, secondary care, and tertiary care. The lecture defined the type
of services that are provided in the “Continuum of Care”: the care a patient receives from entry into the system until care is no
longer needed. This lecture also described some the unique healthcare organizations and relationships between different types of
healthcare organizations.
25
References slide. No audio.
26
References slide. No audio
27
Working with Health IT Systems is available under a Creative Commons Attribution-NonCommercial-ShareAlike 3.0 Unported license.
© Johns Hopkins University.
Welcome to Introduction to Healthcare and Public Health in the US: Delivering Healthcare (Part 1). This is Lecture (c).
This component, Introduction to Healthcare and Public Health in the US is a survey of how healthcare and public health are organized and services are delivered in the US.
1
The objectives for Delivering Healthcare (Part 1) are to:
• Describe the organization of healthcare at the federal, state, and local levels. • Describe the organization of the VA system and Military Health System. • Describe the structure and function of hospital clinical and administrative units. • Describe different types of long-term care facilities, with an emphasis on their function.
2
This lecture discusses outpatient and inpatient care facilities.
Relevant healthcare facilities include individual and group physician practices, health maintenance organizations, or HMOs [aych-em- ohz], preferred provider organizations, or PPOs [pee-pee-ohz], urgent or immediate-care clinics, and hospitals. The different types of hospitals and their clinical and corporate structures, including hospital systems, will be discussed.
3
A sole proprietorship outpatient clinic is generally a small private office in which a physician works alone, assisted by one person or at most a few nurses and administrative personnel. Because of legal and financial liabilities for the physician, this form of practice is increasingly rare.
4
Two or more physicians may practice medicine together in what is called a partnership. One or both of the “partners” can actually be a corporation rather than a person. In a corporate group practice, a hospital or corporation owns the practice and the physicians are employees, each earning a salary.
An Independent Practice Association, or IPA [eye-pee-ay], is another type of group practice where physicians work together to provide services while sharing economic risk. The IPA is a registered legal entity such as a corporation, a partnership, or a foundation. Each physician runs his or her own office, maintaining separate medical records, support staff, and professional identities. The physicians themselves own the IPA. Although distinct from HMOs, IPAs may contract with HMOs to provide services to HMO patients.
5
Managed care began in the late 1970s in an attempt to improve healthcare while controlling costs. An HMO is a prepaid health plan that provides healthcare for members and their families. The HMO contracts with physicians and hospitals, which are called the provider network. The HMO pays the physician a certain amount for each patient, and the patient pays a small fee, or co-payment, at each visit. Patients must use providers in the network and obtain a referral before accessing specialty care.
A PPO is similar to an HMO, except that the physicians operate independently. The PPO network may be organized by an insurance company, an employer, or by the physicians themselves. Plan members pay a deductible and a co-payment. Members do not need a referral to see a specialist, but fees are lower if they do.
Point-of-service plans are essentially a combination of HMOs and PPOs. Patients can use physicians in the provider network, as in an HMO, but they can also go out of network without a referral, as in a PPO. The catch is that out-of-pocket costs are higher for using the PPO option.
6
There are different types of healthcare facilities where patients receive medical care. Urgent care centers, also called immediate care centers, are community clinics that provide care on a walk-in basis. These centers are intended for acute illnesses or injuries that need immediate care but are not serious enough for a hospital emergency room, or ER [ee-are]. The word “acute” refers to an illness that has started or worsened in a fairly short amount of time.
Urgent care centers do not have all the medical capabilities or around-the-clock operation of an ER. However, they are better equipped and have longer office hours than general clinics. Urgent care centers are considered advantageous to the healthcare system because they allow more people to access care and they reserve ERs for more life-threatening conditions.
7
One of the reasons people use ERs is that they cannot pay for healthcare. To alleviate this problem, community health centers provide primary care for all individuals, regardless of insurance status or ability to pay. Located in all 50 states and US territories, community health centers treat those living in poverty, homeless people, public housing residents, migrant workers, and others. Most community health centers rely on public financing. Like urgent care clinics, community health centers enhance access to healthcare and treat people who would otherwise go to hospital ERs.
Community mental health centers provide outpatient services for mental health to similar populations.
8
Community hospitals are technically defined as non-government, short-term general hospitals that are open to the public. Despite the designation of “general,” some community hospitals specialize in certain fields, such as obstetrics and gynecology, rehabilitation, or orthopedics, and some are academic or teaching institutions. Community hospitals may operate on a for-profit or nonprofit basis. Community hospitals play an important role in the delivery of healthcare. They are perfectly suited for routine illnesses or surgery, providing a cost-effective and accessible option for residents.
9
Teaching and research hospitals are usually large institutions affiliated with medical schools. Physicians there are aware of all the latest medications, surgical procedures, equipment, and technology. Because of this, teaching hospitals are capable of treating complex medical problems, such as rare diseases, and they perform special types of surgery. Teaching hospitals provide instruction for physicians and other healthcare providers, support and perform medical research, offer special services such as burn centers, and perform a charitable function by treating uninsured patients.
A well-known example of a teaching hospital is Massachusetts General Hospital in Boston, which is affiliated with Harvard Medical School.
10
A critical access hospital is one that is certified to receive Medicare reimbursement for services. Medicare is the government insurance program for older people. Typically, critical access hospitals are acute care hospitals in rural areas, although smaller health clinics may be eligible. In many cases, Medicare reimbursement saves these hospitals from having to close because of financial difficulty. They can therefore continue to provide services in areas that may otherwise lack hospital care.
11
It is important to note that hospitals and other healthcare facilities are accountable for their performance. In the US, an organization called the Joint Commission evaluates and certifies medical care facilities. The goal of the Joint Commission is to improve the effectiveness, safety, and overall value of healthcare. The Joint Commission is the oldest and largest accrediting body for healthcare in the US, and its judgments are considered fair because it is an independent nonprofit organization.
The Joint Commission evaluates more than 18,000 US healthcare organizations and programs of all types, such as hospitals, urgent care centers, ambulatory clinics, surgery centers, and laboratories. These organizations undergo periodic on-site visits to identify and resolve problems.
12
Hospitals are structured according to type and level of care. Areas of the hospital with similar inpatients are called wards, such as the maternity ward or the pediatric ward for children. An “inpatient” is simply a person who has been admitted to the hospital. Other specialized areas include the emergency room, or ER [ee-are], the operating room, or OR [oh-arr], and the intensive care unit, or ICU [eye-see-you]. There are different types of ICUs for specific patients; for example, a CCU [see-see-you] is a cardiac care unit. Healthcare is provided mainly by physicians and nurses. Physicians may specialize in various types of medicine. All departments are assisted by ancillary [ann-sill-air-ree] personnel, who perform specific technical tasks.
13
Practically everyone has heard of the hospital ER, if only because of TV dramas. Open twenty-four hours a day, every day, the ER treats patients with a range of medical problems, whether relatively minor, such as an ankle sprain, or life-threatening, such as heart attack, drug overdose, or serious injuries. Physicians and nurses in the ER evaluate patients by a process called triage [tree-ahj], whereby the sickest patients are treated first. After patients are treated, they may be able to go home right away. Those with more serious conditions are transferred to other areas of the hospital, possibly the ICU or CCU, for further care.
14
The OR, of course, is where surgery takes place. The environment is kept sterile, or free of germs, to prevent infection in the patient. The surgical team generally includes one or more surgeons, various nurses with specialized roles, and an anesthesiologist, who makes sure the patient is safely unconscious. Surgical instruments vary, depending on the operation to be performed. Equipment is available to monitor the patient’s vital signs and to resuscitate the patient in case of emergency.
Surgery is also performed at freestanding surgery centers, which are separate from hospitals. Operations are done on an outpatient basis, meaning that the patient goes home directly afterward. As mentioned earlier in this lecture, surgery centers are also subject to Joint Commission certification.
15
The ICU is a separate area of the hospital for treatment and continuous monitoring of very ill patients. Many kinds of illnesses may need ICU care, including lung conditions such as pneumonia and emphysema [em-fih-see-mah]; sepsis, or blood infection; and traumatic injuries. As mentioned earlier, CCUs are ICUs dedicated to patients with cardiac, or heart, disease. Patients may come to the ICU from another section of the hospital, such as the ER or OR, or they may arrive after transfer from a different hospital. Machines in the ICU monitor the patient’s vital signs, such as breathing and heart rate. Various tubes may be inserted to give medicine, provide nutrition, or drain urine, and mechanical ventilators may be used to help with breathing. The need for other sophisticated equipment depends on the patient’s condition.
16
In most cases, people who provide acute care are emergency medicine physicians and critical care physicians, along with nurses and other personnel working as a team. Serious acute care encompasses medical problems such as heart attack, stroke, unexpected childbirth, or sudden complications of surgery. It also includes accidents such as poisoning, or trauma from such events as car crashes, gunshot or stab wounds, falls, or burns.
Emergency medicine is a medical specialty dedicated to saving patients with life-threatening problems. It is a high-stress field where physicians must make difficult decisions quickly, often with limited information about the patient. The goal is short-term care, to immediately stabilize the patient so he or she can move on to more definitive treatment.
Emergency physicians work in ERs. When possible, however, patients receive treatment from emergency medical technicians (EMTs, ee-em-teez) before reaching the hospital. EMTs travel to emergencies, perform basic medical care, and transport patients to hospitals by ambulance. Paramedics are EMTs with extra training that allows them to perform some medical procedures right at the scene, before transport.
Like emergency medicine, critical care is a specialty for treating patients with life-threatening conditions. In critical care medicine, however, the focus is on long-term care. The sickest patients are sent to the ICU or CCU after they are stabilized.
17
Hospitals employ many types of personnel. In the OR, of course, there are both surgeons and anesthesiologists. Surgeons perform operations, and many specialize in certain fields, such as orthopedic surgery, cardiovascular surgery, or plastic surgery. Anesthesiologists care for patients during surgery by monitoring their body functions while they are unconscious. They also treat pain outside the OR, such as in the ICU, during childbirth, and in medical conditions associated with chronic pain.
Medical specialties of physicians include general internal medicine, cardiology, obstetrics and gynecology, and psychiatry, among many others. There are even medical subspecialties, such as pediatric cardiology. Registered nurses, or RNs [are-enz], licensed practical nurses, or LPNs [ell-pee-enz], and physician’s assistants, or PAs [pee-ayz], are thoroughly trained in their own right, and some of them specialize in certain fields of medicine. Pharmacists are licensed professionals who usually have a doctor of pharmacy degree. They are essential members of the hospital team who evaluate and dispense medications.
18
All hospitals employ personnel to provide ancillary services for diagnosis, treatment, rehabilitation, and education. Nursing assistants provide for the patient’s most basic needs, under the supervision of RNs or LPNs. The various types of technicians include phlebotomists [fleh-bot-uh-mists], who are trained to take blood; x-ray and ultrasound technicians; and laboratory personnel. Rehabilitation personnel include physical therapists, occupational therapists, respiratory therapists, and speech therapists. Other hospital workers educate or counsel patients, including dietitians, nutritionists, diabetes educators, and social workers. This is only a sampling of additional hospital personnel.
19
The corporate structure of hospitals includes a governing board, or board of directors, that provides oversight. For nonprofit hospitals, the board of directors may be a religious order or influential figures in the healthcare community. Hospitals affiliated with universities may have the same board of directors as the university.
In any corporation, the chief executive officer is responsible for daily operations. Most hospitals also designate chief medical officers, nursing officers, information officers, financial officers, and operating officers.
Each department in a hospital has a head administrator who is responsible for its performance. In addition, departments are likely to have managers who oversee patient care, such as supervising physicians and nurse managers.
Nonmedical service personnel, such as cooks and laundry workers, are also critical, as is the hospital business office that deals with such issues as billing and insurance, scheduling, maintenance of medical records, personnel issues, and reports and budgets.
20
Hospitals may be publicly or privately owned and funded, and they may be either for-profit or nonprofit. A public hospital is funded by the government and therefore may have limited financial resources. A private hospital is owned by a private organization, such as a medical insurance company. It tends to have greater capital and more up-to-date equipment, so its services may be more expensive.
21
A hospital system consists of two or more hospitals or other healthcare facilities that are owned, leased, or managed by an organization such as a corporation. Oversight is provided by a single board of directors. Single hospitals can be part of a hospital system if they own or lease other healthcare facilities. Healthcare networks are groups of hospitals, physicians, other healthcare providers, insurers, and/or agencies that collaborate to provide many types of healthcare in a community.
One example of a hospital system is the Greenville Hospital System University Medical Center, a nonprofit organization located in South Carolina. The system includes five major medical centers and other facilities.
22
This concludes Lecture (c) of Delivering Healthcare (Part 1).
In summary, healthcare facilities range from small offices of single physicians to large hospital systems. Most people obtain healthcare through managed care plans of various types. Community centers and freestanding clinics offer a range of services, from acute medical care or mental healthcare to outpatient surgery. Hospitals of various types treat patients in the community, perform research and teaching, and provide care for the poor. All healthcare facilities are accountable for their effectiveness and safety performance. Healthcare practitioners work singly or together to provide the best possible emergency care, surgical services, critical care, long-term treatment, and ancillary services.
23
References slide. No audio.
24
References slide. No audio.
25
Working with Health IT Systems is available under a Creative Commons Attribution-NonCommercial- ShareAlike 3.0 Unported license. © Johns Hopkins University. UMUC has modified this work and it is available under the original license.
Welcome to Health Management Information Systems, What is Health Informatics. 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 will define information management, information technology, and informatics, describe the fundamental theorem of
informatics, explain the meaning of biomedical and health informatics as a field of study, and offer definitions of the major
biomedical informatics areas of applications. It also will provide an overview of informatics drivers and trends in the health care
field.
1
The Objectives for this unit, What is Health Informatics? are to:
• Define information management, information system (technology) and informatics;
• Explain the basic theoretical concept that underlies informatics practice;
• Define the meaning of biomedical and health informatics as a field of study;
2
Additional Objectives for this unit, What is Health Informatics? are to:
• Describe the biomedical informatics areas of applications;
• Summarize the informatics drivers and trends;
• State the professional roles and skills of health informaticians; and
• Identify how health informaticians process data into information and knowledge for health care tasks with the support of
information technology to improve patient care.
3
This introductory lecture will define information management, information system (technology), and informatics, describe the
fundamental theorem of informatics, explain the meaning of biomedical and health informatics as a field of study, offer definitions
of the major biomedical informatics areas of applications, and provide an overview of informatics drivers and trends.
Let’s begin with defining information management, information system (technology), and informatics.
According to the American Health Information Management Association (AHIMA), information management is “The generation,
collection, organization, validation, analysis, storage, and integration of data as well as the dissemination, communication,
presentation, utilization, transmission, and safeguarding of the information” (AHIMA, 2012, p. 181).
If the type of information were health, then health information management would entail acquisition, organization, storage,
retrieval, and dissemination of health information from a multitude of places. The purpose is ensuring availability, accuracy, and
protection of health information that is needed by a variety of individuals in the delivery of health care services and to support
decision-making activities.
An example of information management would be deploying a content or document management system.
4
The next definition in the series of terms closely related to information management and informatics is information system or
technology. AHIMA defines 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); often
used interchangeably with information technology (IT)” (AHIMA, 2012, p. 181).
When you think of information technology, some things that should come to mind are computer networks, database and systems
administration, security, and programming.
Therefore, information technology could be used in the management of information.
Connecting information technology to health, consider the following defintion by the Office of the National Coordinator for Health
Information:
“Health Information Technology (HIT) – The application of information processing involving both computer hardware and software
that deals with the storage, retrieval, sharing, and use of health care information, data, and knowledge for communication and
decision making” (U.S. Department of Health and Human Services, 2009, para. 8).
An example of health information technology would be administrative and financial systems that facilitate billing, accounting, and
other administrative tasks.
5
The final definition in this “information” series comes from authors Elmer Bernstam, Jack Smith, and Todd Johnson in their article,
What is Biomedical Informatics? Based on their research they determined data, information, and knowledge were central to
informatics. Their literature review and subsequent analysis concluded in the following definition of informatics: “Informatics is the
science of information, where information is defined as data with meaning” (Bernstam, Smith, & Johnson, 2009, p. 106).
Thus, the similarity between all three terms is that all involve information in some way. However a critical difference between
information management, information technology, and informatics is in the object of study where information management
focuses on the organization and dissemination of information, information technology on the tools and machines, and informatics
on the optimal use of meaningful data.
6
In order to gain a better understanding of informatics, one needs to learn the differences between data, information, knowledge,
and wisdom.
As explained on the previous slide, the research performed by Bernstam, Smith, & Johnson (2009) showed that data, information,
and knowledge were central to informatics. In their article, they referenced Ackoff’s Data, Information, Knowledge, and Wisdom
(DIKW) hierarchy. Jennifer Rowley, explored further the DIKW hierarchy. Rowley states, “The hierarchy is used to contextualize
data, information, knowledge, and sometimes wisdom, with respect to one another and to identify and describe the processes
involved in the transformation of an entity at a lower level in the hierarchy…to an entity at a higher level in the hierarchy (e.g.
information). The implicit assumption is that data can be used to create information; information can be used to create knowledge,
and knowledge can be used to create wisdom” (Rowley, 2007, p. 164).
Data are simple symbols, isolated facts, and measurements. When such data are processed, put into a context, and combined
within a structure, information emerges. Information provides the answers to “who, what, when and where.” When information is
given meaning by interpreting it, that is there is an application of data, information becomes knowledge. Knowledge answers the
“how” questions. Finally, wisdom is evaluated understanding and answers the “why” questions.
Central to informatics is the processing of data so it becomes meaningful.
7
Building on what has been learned so far, Dr. Friedman’s proposed fundamental theorem of informatics will be reviewed next. Other theories, such as Bayes’ Theorem, also apply to informatics but will not be addressed in this unit. Merriam-Webster’s Online Dictionary defines a theorem as “an idea accepted or proposed as a demonstrable truth often as a part of a general theory” (Merriam-Webster, 2011). Dr. Friedman utilized Figure 1.1 to represent the theorem. The picture is that of parentheses, picture of a head of a person, a plus sign, picture of a computer, parentheses, greater than symbol, picture of a head of a person. According to Dr. Friedman, this figure is to be interpreted to mean “A person working in partnership with an information resource is ‘better’ than that same person unassisted” (Friedman, 2009, p. 169). He further explains, “the metaphoric ‘person’ depicted in the theorem can be a clinician, a scientist, a student, a patient or an administrator. The “person” can also be a team or group, or even an organization. The ‘information resource’ is any mechanism capable of providing information or knowledge or advice to support the person's completion of a task. Information resources are usually, but do not have to be, computer-based. The ‘plus’ in the figure is intended to convey interaction between the person and the resource, the outcome of which is determined by what the information resource is capable of, as well as how the person elects to use it. The ‘plus’ symbol is employed because of its universal recognition, but is not to be read literally in the sense of mathematical addition. The parentheses further connote a bonding between the person and resource, and suggest that the person-resource interaction is shaped by its environment or organizational context. ‘Better’ and the ‘greater than’ inequality are used loosely by intention, so as not to convey specific requirements for testing the theorem” (Friedman, 2009, p. 169).
8
Now that you have a better understanding of informatics, let’s look at where one would find this science applied.
As one would expect there is not just one segment or domain for informatics. Any domain where there is a need for analysis of
data and dissemination of information through the use of computer applications is a possible application domain. These include a
wide range of industries including entertainment, hotel management, law and law enforcement, health care, and many other fields
where computer technology interfaces with people.
As the focus of this unit is “What is Health Informatics?,” informatics and its application to health care will be explored further.
9
While various perspectives of informatics and its application to health care have been published, two have been chosen for review and
discussion because of their significance within the field.
The first definition comes from the American Medical Informatics Association or AMIA. AMIA is a non-profit organization dedicated to the
development and application of medical informatics in the support of patient care, teaching, research, and health administration. This
organization is seen as the prominent informatics organization in the US. According to their web site, “AMIA is the professio nal home of leading
informaticians: clinicians, scientists, researchers, educators, students, and other informatics professionals who rely on data to connect people,
information, and technology” (AMIA, 2011, para. 2).
AMIA’s definition, therefore, is essential to understand. Accordingly, “Biomedical informatics (BMI) is the interdisciplinary field that studies and
pursues the effective uses of biomedical data, information, and knowledge for scientific inquiry, problem solving, and decisi on making,
motivated by efforts to improve human health” (AMIA's Academic Forum, n.d., para. 3).
The second definition comes from another highly respected source for biomedical informatics material, the textbook Biomedical Informatics:
Computer Applications in Health Care and Biomedicine.
Shortliffe and Blois define biomedical informatics as “the scientific field that deals with biomedical information, data, and knowledge – their
storage, retrieval, and optimal use for problem solving and decision making” (Shortliffe & Blois, 2001, p. 24). As a field of study, Shortliffe and
Blois state biomedical informatics is “concerned with the broad range of issues in the management and use of biomedical infor mation, including
biomedical computing and the study and nature of biomedical information itself” (Shortliffe & Blois, 2001, p. 920).
10
Another term you may come across is health informatics. It has various interpretations but each one connects information science
to health care in some fashion.
For example, AMIA’s perspective is “The informatics community typically uses the term health informatics to refer to applied
research and practice of informatics across the clinical and public health domain” (AMIA, 2011, para. 3). While AHIMA defines
health care informatics as “The field of information science concerned with the management of all aspects of health data and
information through the application of computers and computer technologies” (AHIMA, 2012, pp. 154-155).
As you can imagine, applying information science to health care requires health informatics standards to define acceptable
methods for collecting, organizing, maintaining, and exchanging data among health management information systems.
11
Shortliffe & Blois (2001) view biomedical informatics as four subfields which is represented by Figure 1.2 shown on the slide:
Public health informatics, clinical informatics, imaging informatics, and bioinformatics each with a specific focus as represented by
the left-hand side. The right hand side lists the component sciences in biomedical informatics which includes computer science,
clinical science, basic biomedical science, cognitive science, bioengineering, management science, and epidemiology and
statistics.
The next few slides explain Figure 1.2 further.
12
To begin, Shortliffe & Blois define biomedical informatics as “the scientific field that deals with biomedical information, data, and
knowledge – their storage, retrieval, and optimal use for problem-solving and decision-making” (Shortliffe & Blois, 2001, p. 24).
As a field of study, Shortliffe & Blois state that biomedical informatics is “concerned with the broad range of issues in the
management and use of biomedical information, including biomedical computing and the study and nature of biomedical
information itself” (Shortliffe & Blois, 2001, p. 920).
13
Biomedical informatics encompasses public health, clinical, and imaging informatics, as well as the biological and biomolecular
informatics domains. These four subfields -- public health informatics, clinical informatics, imaging informatics, and bioinformatics
-- are where the informatics applications are geared toward a specific area; such as the individual in the case of clinical
informatics.
The University of Medicine & Dentistry of New Jersey and the New Jersey Institute of Technology published some examples of a
biomedical informatics application including:
• “Reducing diagnostic uncertainties and improving clinical decision-making by using computing techniques and information
technologies
• Utilizing computational approaches and modern computer-based techniques in drug design, molecular genetics and
cellular genetics to solve complex clinical problems
• Designing and managing clinical, pharmacy, radiology, laboratory or hospital information systems” (“MD/MS,” n.d.).
The next four slides provide additional information for each subfield.
14
The first informatics segment is public health informatics. Shortliffe & Blois define public health informatics as “an application area
of biomedical informatics in which the field’s methods and techniques are applied to problems drawn from the domain of public
health” (Shortliffe & Blois, 2001, p. 977).
Public health informatics is population- and society-focused.
Examples of public health informatics applications include:
The National Notifiable Disease Surveillance System
The National Electronic Telecommunications System for Surveillance (NETSS)
Immunization registries
Immunization information systems
Homeland Security
15
Bioterrorism
15
The second informatics segment is clinical informatics. As defined by Shortliffe & Blois, “clinical informatics is the application of
biomedical informatics in the patient care domain; a combination of computer science, information science, and clinical science,
designed to assist in the management and processing of clinical data, information, and knowledge to support clinical practice”
(Shortliffe & Blois, 2001, p. 924).
Clinical informatics is individual (patient-oriented) focused.
An example of clinical informatics applications would be the electronic medical record.
16
The third informatics segment is imaging informatics. Imaging informatics is “concerned with the common issues that arise in all
image modalities, relating to the acquisition of images in ,or conversion to, digital form; and the analysis, manipulation, and use of
those images once they are in digital form” (Shortliffe & Blois, 2001, p. 948).
Imaging informatics is tissues and organs focused.
An example of imaging informatics applications is a computerized tomography (CT) scanner, which uses software algorithms to
recreate a three-dimensional image of the body parts. Another example is Picture Archiving and Communication Systems (PACS)
which are a combination of hardware and software dedicated to the short- and long-term storage, retrieval, management,
distribution, and presentation of images.
17
The final informatics segment is bioinformatics or “the study of how information is represented and transmitted in biological
systems, starting at the molecular level” (Altman & Mooney, 2001, p. 763).
Bioinformatics is molecular- and cellular processes-focused.
An example of bioinformatics applications is genomic sequencing.
18
Having covered the subdiciplines of biomedical informatics, Shortliffe & Blois (2001) addresses the component sciences that
biomedical informatics draws on and contributes to. These include: computer science, clinical science, basic biomedical science,
cognitive science, bioengineering, management science, and epidemiology and statistics.
19
Let’s now explore what is a driving force in health care, that is fueling the need for informatics applications.
The American Recovery and Reinvestment Act or ARRA is officially Public Law 111-5 signed into law February 2009.
The Health Information Technology for Economic and Clinical Health, often referred to as HITECH, is a provision of the American
Recovery and Reinvestment Act. The HITECH section of ARRA deals with many of the health information communication and
technology provisions.
ARRA, and specifically HITECH, has become a major driver of health informatics through its many different stimulus
opportunities, one of which is $19.2 billion for health information technology. The Office of the National Coordinator for Health
Information Technology defines health information technology (HIT) as “The application of information processing involving both
computer hardware and software that deals with the storage, retrieval, sharing, and use of health care information, data, and
knowledge for communication and decision making” (U.S. Department of Health and Human Services, 2009, para. 8).
The funding is expected to assist providers and states in adopting and utilizing health IT in order to achieve widespread adoption
of health IT and enable electronic exchange of health information.
20
Why else are informatics applications a growing need?
Trends which are stimulating the need for health informatics applications include: the focus on eHealth, the adoption and
implementation of electronic medical records or EMRs, and electronic health records or EHRs, and the growing desire to be able
to electronically exchange health information across organizations within a region, community or hospital system.
The application of information technology to health care is a critical tool in achieving the benefits of eHealth, EMRs, EHRs, and
health information exchange.
As you will learn later in this unit, practitioners of informatics known as informaticians use information technology to advance cost-
effective care, high-quality care, and patient safety.
But first, let’s review the connection informatics has to eHealth, electronic medical records, electronic health records, and health
information exchange.
21
A general direction with regards to health IT relates to the global environment. The World Health Organization or WHO, a United
Nations agency responsible for directing and coordinating international health activities, recognized a trend involving the use of
information and communication technologies and its impact on health care delivery, public health, research and health-related
activities.
With this recognition, WHO set about defining eHealth and developing a WHO eHealth strategy to help direct WHO’s activities on
eHealth. As defined by the WHO, “eHealth is the use of information and communication technologies (ICT) for health to, for
example, treat patients, pursue research, educate students, track diseases and monitor public health” (WHO, 2011).
The HIMSS definition is “The application of Internet and other related technologies in the healthcare industry to improve the
access, efficiency, effectiveness, and quality of clinical and business processes utilized by healthcare organizations, practitioners,
patients, and consumers to improve the health status of patients” (HIMSS, 2003, p.4).
Thus, there is a very close connection between eHealth and informatics as it is the combined use of electronic communication
and information technology in the health segment. Some in the industry see eHealth as a sub-discipline of health informatics.
Certainly, the application of information and communication technology to health care is a critical tool in achieving the benefits of
eHealth, such as improving health care delivery.
An example of eHealth is telemedicine which is delivery of health care at a distance most often via the Internet.
22
Another trend of health IT which is impacting the field of health informatics is the adoption of electronic medical records or EMRs,
and electronic health records or EHRs. These applications could be thought of as centerpieces of health informatics.
The report, Defining Key Health Information Technology Terms defines an EMR as “an electronic record of health-related
information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within one
health care organization” (NAHIT, 2008, p. 6).
An electronic medical record is a record of medical care created, managed, and maintained by one health care organization.
EMRs, being an electronic equivalent of an individual’s legal medical record for use by providers and staff within one health care
organization, are part of the health information technology infrastructure and have a direct tie to health informatics.
23
A related trend driving the health IT market, and the direction the health care industry is going, is the implementation of electronic
health records.
As with electronic medical records, EHRs could be considered to be the center of health informatics. In the report, Defining Key
Health Information Technology Terms, is this definition:
“An electronic record of health-related information on an individual that conforms to nationally recognized interoperability
standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one health care
organization” (NAHIT, 2008, p. 6).
Key components of electronic health records include: administrative system components, laboratory system components,
radiology system components, pharmacy system components, computerized provider order entry, and clinical documentation.
Being a repository of individual health records that reside in numerous information systems and locations, EHRs are intended to
support efficient, high-quality integrated health care, independent of the place and time of health care delivery. Consequently,
EHRs, too, are part of a health information technology infrastructure, and therefore, linked to health informatics.
24
The final trend is the utilization of health IT, in order to achieve widespread adoption of health IT and enable electronic exchange
of health information. Included in the report, Defining Key Health Information Technology Terms, is the following definition for
health information exchange (HIE):
“The electronic movement of health-related information among organizations according to nationally recognized standards”
(NAHIT, 2008, p. 6).
HIE involves networks that give providers the ability to electronically transmit in a secure manner an individual’s health records.
Through the utilization of EHRs, HIE supports the sharing of health-related information to facilitate coordinated care. EHRs draw
information from many sources through health information exchange. Thus, the process of health information exchange is another
piece of the health information technology infrastructure and informatics. There are many local, state, and national HIE initiatives
going on throughout the U.S.
25
This concludes Lecture a of What is Health Informatics?.
Lecture a defined information management, information technology, and informatics, described the fundamental theorem of
informatics, explained the meaning of biomedical and health informatics as a field of study, and offered definitions of the major
biomedical informatics areas of applications. It also provided an overview of informatics drivers and trends in the health care field.
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Working with Health IT Systems is available under a Creative Commons Attribution-NonCommercial- ShareAlike 3.0 Unported license. © Johns Hopkins University. UMUC has modified this work and it is available under the original license.
Welcome to Health Management Information System, What is Health Informatics. 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 will define the informatics team, their skills, roles and responsibilities, and identify how health informaticians process
data into information and knowledge for health care tasks with the support of information technology to improve patient care.
1
The Objectives for this unit, What is Health Informatics? are to:
• Define information management, information system (technology) and informatics;
• Explain the basic theoretical concept that underlies informatics practice;
• Define the meaning of biomedical and health informatics as a field of study;
2
Additional Objectives for this unit, What is Health Informatics? are to:
• Describe the biomedical informatics areas of applications;
• Summarize the informatics drivers and trends;
• State the professional roles and skills of health informaticians;
• and Identify how health informaticians process data into information and knowledge for health care tasks with the support of
information technology to improve patient care.
3
To begin to gain an understanding of the individuals involved with informatics applications and the type of work they do, let’s first
settle on what is the practice of informatics?
According to the report Training the Next Generation of Informaticians, “The practice of informatics, most generally requires the
presence of two components: (1) a set of skills and methodologic tools derived from knowledge of the basic informational and
computing sciences and (2) knowledge, experience, and activity in one or more application domains. The coexistence of, and
interactions between, these key components give meaning and significance to informatics as a field” (Friedman, et al., 2004,
p.169)
For example, many who practice informatics have training in the subject of human-computer interaction, an application domain
covering how people use computers and how to design computer systems that help people use them more effectively.
4
Taking into consideration the first component, a set of skills and methodological tools derived from knowledge of the basic
informational and computing sciences, let’s review the list of component sciences. Shortliffe & Blois (2001) state that the sciences
biomedical informatics draws on and contributes to include computer science, clinical science, basic biomedical science, cognitive
science, bioengineering, management science, epidemiology and statistics.
Individuals working in the informatics field possess cognitive skills in logical and analytical thinking and have a technical
understanding of the computing environment that is the basis for informatics work.
5
The report Training the Next Generation of Informaticians also identified a second component to the practice of informatics as the
knowledge, experience, and activity in one or more application domains. Some examples of domains identified by (Friedman, et
al., 2004) include:
• Cognitive/human factors and interfaces
• Data structures
• Database design
• Information retrieval
• Knowledge representation
• Networking/architecture
• Ontology/vocabulary
• Software engineering
For example, a review of coursework at several universities on knowledge representation indicated the course covers how
knowledge can be represented in a computer system and what kinds of reasoning can be done with the use of the knowledge.
6
So, given the definition of the practice of informatics, who would be involved in this field of study? Practitioners of informatics.
These individuals are known as informaticians.
Members of the team vary in the types of skills, roles, and responsibilities which in turn are tied to their level of education and
experience gained through stages of career progression.
For example, the team might consist of individuals with an Associate’s degree whose role is clinical data analyst; individuals with
a Bachelor’s degree whose role is research and development scientist; an individual with a Master’s degree taking on the role of
nursing informatics officer, and an individual with a Doctorate whose role is chief medical informatics officer.
Health informaticians use information technology to advance cost-effective care, high-quality care, and patient safety. Therefore,
no matter their level of education or experience, all health informaticians need to know how to efficiently and responsibly use
information and communication technology.
However, a professional with a Bachelor’s degree right out of school uses information differently, compared to a professional with
the same degree who has been in the field for 10 years. Likewise, a professional with a two-year degree uses information
differently compared to a professional with a Master’s degree.
7
Just as there are subdisciplines of biomedical informatics there are subdisciplines of the informaticians. As expected, the
informatics applications utilized and the type of work they do will vary. For example, the University of Minnesota’s Institute for
Health Informatics Web site states “bioinformaticians develop, and apply computational tools and approaches for expanding the
use of biological data, including those to acquire, store, organize, archive, analyze, or visualize such data” (University of
Minnesota, 2011, para. 4).
The type of work would involve analysis/modeling of genomic datasets.
The health care industry requires all types of informaticians to meet the ever-increasing information needs.
8
From a more general view, health informaticians are professionals in health care who acquire knowledge in the component
sciences and skills in information processing and information and communication technology. To perform the duties of a health
informatician, they must have training in the processes associated with the acquisition, storage, retrieval, privacy and security,
presentation, and use of information in health and biomedicine.
9
Health informaticians may have a varied assortment of responsibilities. Some of those functions include “health informaticians
help to design software for patient care, build and maintain research systems for clinical research, purchase and implement
information systems that support health care, provide training and assistance to health care providers in using health information
technology, conduct analyses of large health datasets, conduct research and development to advance the science of health
informatics” (University of Minnesota, 2011, para. 2).
10
Health informaticians are in great demand and may work in many different environments including colleges and universities,
research facilities, health care delivery organizations, local, state and federal government agencies, medical software firms,
medical information services companies, and other private industries such as insurance or medical device companies to name a
few.
Roles for the health informaticians in the first three environments are discussed in the next few slides.
11
A role for health informaticians working in colleges and universities is that of a professor where the focus is on teaching and
research. Health informaticians with an academic role have two main responsibilities. They are to:
- Educate those interested in the field of health informatics and
- Conduct research to improve the acquisition, storage, retrieval, representation, and use of information in health and biomedicine.
12
While a health informatician working in a college or university may conduct research to improve the acquisition, storage, retrieval,
and use of information in health and biomedicine, there is a research role outside of the academic setting.
Research facilities hire health informaticians to focus on informatics applications in clinical and translational research for the
purpose of advancing medical science and public health. Other responsibilities for researchers include conducting research in
informatics in order to:
- Expand the scope of the discipline of health informatics
- Research and evaluate new regions or domains in health informatics, and
- Lead interdisciplinary teams in the search for solutions to health informatics problems.
13
As mentioned earlier, clinical informatics is often further broken down into specific fields or subareas. The term clinical
informatician is usually associated with physicians. Other clinical personnel involved in health informatics science are called
informaticians as well, and their field of study distinguishes them from each other, that is, nursing informaticians, dentistry
informaticians, or pharmacy informaticians.
The health care delivery role for clinical personnel focuses on the patient care domain. These individuals combine the knowledge
of computer science, information science, cognitive science, and clinical science to assist in the management and processing of
clinical data, information, and knowledge to support clinical practice.
For example, a role for an informatician whose background is in medicine might be a chief medical informatics officer who’s
managing clinical data, information, and knowledge to support clinical practice and who’s involved in the design, implementation,
maintenance, and the evaluation of EMRs.
14
Other roles for clinical informaticians involve the use of their knowledge of patient care combined with their understanding of
informatics science to:
• “Assess information and knowledge needs of health care professionals and patients;
• Characterize, evaluate, and refine clinical processes;
• Develop, implement, and refine clinical decision support systems; and
• Lead or participate in the procurement, customization, development, and implementation, management, evaluation, and
continuous improvement of clinical information systems such as electronic health records and order-entry systems” (AMIA,
2011, para. 2).
15
Besides clinical personnel, there are other health care professionals involved in informatics applications in relation to health care
delivery. Sometimes referred to as applied health informatics, those often found in this subarea include, but are not limited to,
health information management professionals, health information exchange specialists, programmers and software engineers,
and privacy and security specialists. Individuals involved with applied informatics applications provide a vital link between
clinicians, technology designers, and information technology.
These health information professionals focus on the strategic and operational relevance and robustness of clinical information
resources, workflow, end-user support, and connectivity within the health care industry and public heath sectors. Their
responsibilities include such things as:
• constructing computer health information systems by studying the needs of doctors, nurses, patients, and health care
organizations;
• producing requirements and use case documents for EMRs/EHRs;
• building health networks that allow doctors and nurses to share knowledge and best practices;
• designing new methods of information delivery that motivate patients to follow treatment recommendations; and
• working with the vendor to implement the builds which form the documentation, order entry, and data repository system.
16
In conclusion, let’s take a final look at informatics as a field of study and how health informaticians process data into information
and knowledge for health care tasks with the support of information technology to improve patient care.
First consider the application domains as described by the National Library of Medicine:
• “Health care/clinical informatics: Applications of informatics principles and methods to direct patient care, such as advanced
clinical decision support systems and multimedia electronic health records, and to the provision of informational support to health
care consumers.
• Bioinformatics and/or computational biology: Applications of informatics principles and methods to support basic research in
such areas as genomics, proteomics, cheminformatics, systems biology, and simulation/modeling of biological systems.
• Clinical research and translational informatics: Applications of informatics principles and methods to “bench to bedside”
translational research exploring genome-phenome relationships, to pharmacogenomics, to drug discovery, and to the support of
clinical trials.
• Public health informatics: Applications of informatics principles and methods to build public health infrastructure, to “intelligent”
support of public health agencies and practitioners, to support of research in health behavior and health literacy, and to syndromic
surveillance” (NLM, 2011).
17
Second, individuals working in the informatics field possess cognitive skills in logical and analytical thinking, and have a technical
understanding of the computing environment that is the basis for informatics work. They also possess an awareness of privacy
and security policies around health informatics such as the secure collection, management, retrieval, exchange, and/or analysis of
information in electronic form. Given the different backgrounds, experience, and education, along with varied roles and skills
described previously, who is better equipped to transform data into information and information into knowledge than health
informaticians?
Third, health informatics is an interdisciplinary, interrelated discipline, undergoing rapid change. As issues in health care become
more complex, the amount of data collected and stored escalates. There is a widespread, generally acknowledged need for
health informaticians who understand data, information, and knowledge.
18
This concludes What is Health Informatics.
Lecture a defined information management, information technology, and informatics, described the fundamental theorem of
informatics, explained the meaning of biomedical and health informatics as a field of study, and offered definitions of the major
biomedical informatics areas of applications. It also provided an overview of informatics drivers and trends in the health care field.
Lecture b defined the informatics team, their skills, roles and responsibilities and identified how health informaticians process data
into information and knowledge for health care tasks with the support of information technology to improve patient care.
19
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20
Working with Health IT Systems is available under a Creative Commons Attribution-NonCommercial- ShareAlike 3.0 Unported license. © Johns Hopkins University. UMUC has modified this work and it is available under the original license.
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.
1
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;
2
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.
3
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).
4
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.
5
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 document the actual administration of the medication.
6
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.
7
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.
8
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).
9
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.
10
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.
11
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.
12
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.
13
Coming from a functional perspective, Vogel & Perreault (2006) identified HCIS components that support the following
purposes:
1) Patient management and billing
2) Department management
3) Care delivery and clinical documentation
4) Clinical decision support
5) Financial and resource management
Each will be briefly described in the next few slides.
14
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).
15
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.
16
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.
17
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.
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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.
19
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.
20
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.
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Working with Health IT Systems is available under a Creative Commons Attribution-NonCommercial- ShareAlike 3.0 Unported license. © Johns Hopkins University. UMUC has modified this work and it is available under the original license.
Welcome to Health Management Information Systems, Administrative, Billing, and Financial Systems. 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 examines the relationship of administrative, billing, and financial systems to the health care information system,
explains applications that need to be integrated in health care information systems, explores health care organizations’
integration strategies, identifies the critical elements for integration of these systems with clinical information systems, and
discusses how health care organizations may gain valuable insights from integrated data through data analytics and trending.
1
The Objectives for this unit, Administrative, Billing, and Financial Systems are to:
• Explain applications that need to be integrated in health care information systems;
• Describe the strategies used by health care organizations to ensure integration of functions;
• Discuss the critical elements needed to integrate billing, financial, and clinical systems;
2
Additional Objectives for this unit, Administrative, Billing, and Financial Systems are to:
• Discuss the core elements of a Master Patient Index (MPI)
• and Describe current trends to establish a Unique Patient Identifier (UPI).
3
Let’s begin with a definition of an information system. American Health Information Management (AHIMA) defines 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).
Connecting information system to health, a health information system is one which is used within the health care domain. For
example, Vogel & Perrault (2001) view a health care information system (HCIS) as the system that facilitates communication,
organizes, integrates, and stores information, coordinates work among various health care professionals, supports
documentation, record-keeping and reporting functions, and otherwise supports the needs of the health care organization.
Another example is 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).
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.
4
Coming from a functional perspective, Vogel & Perrault (2006) identified HCIS components that support the following purposes:
• Patient management and billing
• Department management
• Care delivery and clinical documentation
• Clinical decision support and
• Financial and resource management
Patient management and billing and financial and resource management will be briefly described in the next few slides.
5
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). Lecture 9b will discuss the master patient index in more detail.
6
Another example of a system that supports patient management is the admission-discharge-transfer (ADT) module. AHIMA
(2012) provides the following definition of this component:
“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).
7
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.
8
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 (AHIIMA,
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, includes requirements for the electronic collection and reporting of patient demographics along with clinical data.
9
As the previous slide shows, separate information systems are needed because they must meet the specific and often unique
needs of a clinical or support department with specialized functionality. With so many systems in use in a health care
organization, information integration is required in order to have the right information available to those who need it in an
expeditious manner.
According to the Healthcare Information and Management Systems Society (HIMSS, n.d. a), “HIMSS is a cause-based, not-for-
profit organization exclusively focused on providing global leadership for the optimal use of information technology (IT) and
management systems for the betterment of health care” (para. 1).
HIMSS (n.d. b) defines integration as “the arrangement of an organization’s information systems in ways that allows them to
communicate efficiently and effectively and brings together related parts into a single system” (para. 1).
Finally, Vogel & Perreault (2006) state “The objectives of coordinated, high-quality, and cost-effective health care cannot be
completely satisfied if an organization’s multiple computer systems operate in isolation” (p. 484).
10
Patient care is often organized around department or function, and applications were developed to support them. For example,
as noted previously, patient management and billing systems are systems that support patient management functions such as
patient identification whereas clinical information systems support health care provider’s functions such as clinical
documentation.
A number of applications need to be integrated. Some of theses applications are:
First, from the patient management and billing component – patient tracking which monitors patient movements. The master
patient index, addressed in lecture b, is another application found in this component which needs integration.
Second, from the department management component – electronic document management which manages documents (not
data).
Third, from the care delivery and clinical documentation component – order entry and results reporting.
11
Two more examples of applications that need to be integrated:
• from the clinical decision support component – Computerized provider order entry where clinical-event monitors integrated
with results-reporting applications can trigger alerts, and
• from the financial and resource management component - Patient profiling.
12
Vogel & Perreault (2006) describe the two strategies health care organizations use to ensure integration of functions as “First, a
strategy for data preservation must be developed by providing access to data and implementing an approach for standardizing
the meaning of those data” and second is the need to have separate components in the information management plan for data
management, applications and business logic, and user interface in order to permit flexibility (p. 503).
13
HIMSS (2007), identified the following key components of enterprise integration:
• “Master Person Index: A database and rules engine that contains a unique identifier for every patient or person in the
enterprise, and generally finds a patient's medical records regardless of prior names used by the patient. This ensures that a
complete medical record can be obtained for a patient for patient safety purposes.
• Single Sign-on with context management: This permits a user to enter one name and password in order to access multiple
applications; context management passes the patient identifier from one application to the other.
• Data Warehouse: Permits access of information across the enterprise through the use of a central data repository or storage
system. This functionality is more recently being delivered by “just-in-time” coordinated access across multiple databases
(known as “threading”), which allows for on-demand compilation of patient records” (p. 9).
14
Selection and implementing standards is also key to enterprise integration. These standards include structure and content,
(e.g., patient identifier), vocabulary, i.e., clinical data representations, (e.g., Systematized Standard Nomenclature of Medicine
Clinical Terms), content exchange, (e.g., Health Level Seven International (HL7) Standard Clinical Document Architecture), and
privacy and security (e.g., National Institute of Standards and Technology (NIST) encryption algorithm).
Using standards allows for the transfer of data as well as having the data be “understood” in multiple systems.
15
The Office of the National Coordinator for Health Information Technology published The Health Information Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology Final Rule (2010) which includes the following standards for the certification of EHR technology:
• Content exchange standards for exchanging electronic health information. For example, the National Council for the Prescription Drug Programs (NCPDP) Prescriber/Pharmacist Interface SCRIPT standard or the HL7 Clinical Document Architecture (CDA) Release 2, Continuity of Care Document (CCD),
• Vocabulary standards for representing electronic health information. Two examples of vocabulary standards are the Systematized Nomenclature of Medicine Clinical Terms and Logical Observation Identifiers Names and Codes.
• Standards for health information technology to protect electronic health information created, maintained, and exchanged. For example, one standard is an encryption algorithm identified by the National Institute of Standards and Technology (NIST) as an approved security function in Annex A of the Federal Information Processing Standards (FIPS) Publication 140–2. Another example is a hashing algorithm with a security strength equal to or greater than SHA–1 (Secure Hash Algorithm) as specified by the NIST in FIPS PUB 180–3. (p. 44650).
16
Lack of connectivity among billing and financial and clinical systems creates problems with care delivery. Vogel & Perreault
(2006), point out the following problems that can occur if administrative and clinical data are not integrated:
“If clinical and administrative data are stored on separate systems, then data needed by both must either be entered directly
into both systems or be copied from one system to the other. In addition to the expense of redundant data entry and data
maintenance incurred by this approach, the consistency of information tends to be poor because data may be updated in one
place and not in the other, or information may be copied incorrectly” (p. 484).
Vogel & Perreault (2006) explain the integration requirements. “From an organizational perspective, information should be
available when and where it is needed; users must have an integrated view, regardless of system or geographic boundaries;
data must have a consistent interpretation; and adequate security must be in place to ensure access only by authorized
personnel and only for appropriate uses” (p. 483).
Two types of integration, data and process, will be reviewed next.
17
It is no wonder that information systems to support data and process integration are vital to the operations of a health care
organization (Vogel & Perreault, 2006). A tool for data integration is the interface engine.
In addition, as Vogel & Perreault (2006) point out, “Even with an interface engine managing data among disparate systems,
however, an organization still must solve the thorny issues of synchronization of data and comparability of similar data types”
(p. 484). The next slide will explain the interface engine in more detail.
For process integration, technologies must address operational workflow and human organizational systems.
18
HIMSS (2010) defines an interface engine as “…an interface tool that translates functions from different systems and protocols
into a common format to facilitate information sharing. It is a translator for data for files to pass between systems” (p. 65). Thus,
an interface engine is a type of tool for sharing data among disparate systems.
According to Vogel & Perreault (2006), the interface engine serves as the central connecting point for all interfaces and thus a
system needs only to be linked to the interface engine as the engine then handles the exchange of data to other systems that
need it.
19
To move data from one functional application to another also requires a content exchange standard. Content exchange
standards supply the specifications for the format of data exchanges, thereby providing the ability to send and receive medical
and administrative data in an understandable and usable manner across information systems.
Health Level Seven International (HL7) provides a comprehensive framework and related standards for the exchange,
integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery,
and evaluation of health services. According to HL7’s web site, HL7 is “an American National Standards Institute (ANSI)-
accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the
exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management,
delivery and evaluation of health services” (HL7, 2011, para. 1).
HL7 messaging standards move data in standard formats.
20
The revenue cycle is an example of where system integration is essential. Managing the revenue cycle performance for
hospitals and health care organizations requires the integration of various information systems. AHIMA (2012) defines revenue
cycle as “The process of how patient financial and health information moves into, through, and out of the health care facility,
culminating with the facility receiving reimbursement for services provided” (p. 305).
Revenue cycle management is the management of “all administrative and clinical functions that contribute to the capture,
management, and resolution of patient service” (Health Care Financial Management Association (HFMA), n.d., para 1).
Hospitals and health care organizations integrate systems between front-end clinical data collection via the electronic medical
record systems and the backend billing functions and data analyses thus combining all systems to successfully manage the
revenue cycle.
21
Next we move on to a discussion on how health care organizations can gain valuable insights from integrated data through data
analytics and trending. A data-driven organization has the capacity to analyze the clinical as well as financial data thereby
providing opportunities to improve patient care.
The image from Agosta (2010) shows the dynamic between islands of information represented by the individual health care
information systems’ components, that is admissions, lab, radiology, surgery, pharmacy, discharge, billing, etc., data
integration, and meaningful use.
As Agosta (2010) points out, “The problem is data fragmentation – islands of information. The goal is demonstrating meaningful
use of Health Information Technology (HIT) to improve quality, increase revenue, and reduce cost – and also to qualify for
financial reimbursements. The proposed method to get there is data integration” (p. 1).
Agosta (2010) goes on to state “Meaningful use of HIT requires designing data integration so that HIT adds value in
transforming the delivery of health care services. At the front end, an example is capturing and encoding clinical data such as
vital signs like pulse, blood pressure, heart rate and so on in electronic form, then using this data for clinical decision support”
(p. 6).
A more complex example of data integration is computerized physician order entry (CPOE). For this situation Agosta (2010)
explains, “CPOE requires the integration of several sets of data. Patient demographics are required. Physician identification is
22
needed. Diagnosis data is needed. The procedure and treatment of data have to be integrated with the diagnosis and patient
demographics and physician data. If the physician order is more complex than ‘take two aspirin and call me in the morning,’ then
supplementary data stores need to be marshaled to encode prescription drug identifiers, laboratory services and test results,
consultations with other providers, imaging studies, and so on” (p. 6).
22
“Healthcare organizations have historically struggled to find the elusive link between the investment in information technology
and improved organizational performance. At least a portion of this gap has been driven by the focus on the implementation of
information technology (IT) solutions to support transactional workflow with little to no attention paid to how people actually use
the information contained in these solutions to make decisions. The strategic value of IT lies in its power to provide clinicians
and leadership with direct visibility into the care delivery process. When little or no attention is given to the strategic use of
information as part of an electronic health record (EHR) implementation, organizations are often disappointed by the return on
investment and value received as a result of the significant investment” (Clinfowiki, 2011, para. 1).
One solution to help close this gap is in the implementation of business intelligence and data warehousing. Loshin (2003) (as
cited in The Data Warehousing Institute Faculty Newsletter, (2002), defined business intelligence as “The processes,
technologies, and tools needed to turn data into information, information into knowledge, and knowledge into plans that drive
profitable business actions. Business intelligence encompasses data warehousing, business analytic tools, and
content/knowledge management” (p. 6).
23
Clinfowiki (2011, para. 3) lists the following examples of Business Intelligence applications:
• Decision Support Systems,
• Executive Information Systems,
• Online Analytical Processing (OLAP),
• Query and Reporting Tools,
• Business Process Monitoring,
• Performance Scorecards and Dashboards,
• Data Mining, and
• Predictive Analytics
24
This concludes Lecture a of Administrative, Billing, and Financial Systems.
In this lecture, administrative, billing, and financial systems that need to be integrated in health care information systems were
explained, health care organizations’ strategies to ensuring integration of functions were described, and critical integration
elements discussed. The final topic covered was business intelligence applications. These tools can help health care
organizations gain valuable insights from integrated data through data analytics and trending.
25
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26
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27
IFSM Week 1 Discussion
A medical billing system not only generates invoices but is a vital part of the entire process from management to patients. The billing documents clinical, financial, and administrative information that all play a role in the business’s decision making and functions (Asharani, Ramachandra, & Nagesha, 2016).
People impacted by a medical billing system are insurance carriers, patients, doctor’s office and their employees. Generally, billing or coding specialist handles the medical billing system. The codes entered into the system determine how much is charged and on the insurance carrier’s side how much they will pay.
The medical billing system is generally tied to an electronic health record. The billing system is driven by the medical record notes (i.e. type of doctor, type of service, place of service) are all important to a billing system.
An article I read made an interesting correlation between a hospital billing process and the overall progression of the health care industry. Prior health records and costs reflect the evolution and trends of the health care industry (Asharani, Ramachandra, & Nagesha, 2016). In addition, the billing system even has legal importance because it is made up of all the medical transactions between the medical provider and patient.
The medical billing system is driven by codes, specifically ICD-10 diagnosis codes. These codes describe the patients illness, condition, or preventive service provided. Properly processing of these codes result in a medical claims/bills and reimbursements. Medical coding or billing requires specialize training. The information required for the billing system should include patients information, payment history, insurance information, and to HIPAA compliance measurements (Exploring the Fundamentals of Medical Billing and Coding, 2018).
(Asharani, Ramachandra, & Nagesha, 2016)
(Exploring the Fundamentals of Medical Billing and Coding, 2018)
Bibliography Asharani, N., Ramachandra, K., & Nagesha, H. N. (2016, October). A Study to Assess the Functioning of
Billing Department in a Tertiary Care Hospital. International Journal of Management and Applied Sciences, 2(10), 25-30. Retrieved October 23, 2019
Exploring the Fundamentals of Medical Billing and Coding. (2018, June 15). Retrieved from Recycle Intelligence: https://revcycleintelligence.com/features/exploring-the-fundamentals-of-medical- billing-and-coding
- IFSM 305 - Week 1
- IntroductiontoInformationSystemsinHealthcareOrganizations
- comp2_unit3a_lecture_slides
- comp1_unit2c_lecture_slides
- comp6_unit1a_lecture_slides
- comp6_unit1b_lecture_slides
- comp6_unit2a_lecture_slides
- comp6_unit9a_lecture_slides
- IFSM Week 1 Discussion
- Bibliography
- Bibliography
