Health Care Informatics

LESSON 9 Elements of Health Information Systems LECTURE NOTES ______________________________________________________________________________________

Introductory Lesson Comments This lesson focuses on the details of the elements that make up health information systems, including

both the paper-based system and the electronic version of the health record. The health care delivery

system evolved over the years to rely on the health information that is created for the organization.

While historically this has been a paper-based system, the information contained in the record is also

a critical part of the management of health care operations.

Health information is used for regulatory compliance, billing for services, assessing and creating

better outcomes, determining quality, supporting the legal process, and for just about everything that

is necessary to make the health care entity function successfully. Regardless of the type of health

care information system designed, developed, and utilized, the information must be protected,

accurate, complete, timely, and accessible.

While the process of evolution is well underway in the United States to convert to a full,

interoperable electronic health information system, paper-based information systems will still be with

health care professionals for many years into the future. Historical patient health records are too

voluminous to easily convert to an electronic version and the cost to value ratio is not very good, so

that an investment in time and resources needed for such a conversion is precluded. Health

information professionals and health care providers will need to be competent in both of these

information systems.

While the health care profession is moving towards the electronic version for information systems,

there are advantages and disadvantages to both types of recording systems. For example, paper-

based health records are simpler to input and access since providers merely need to pick up the

proper record and use a pen to input their information, commentary, and observations. An electronic

health care record requires some type of access using a user name and password. Then providers

need to have knowledge of the system, typically through training, in order to access the correct part

of the system for their input. They might need to review prior inputted information or type their own

information, commentary, and observations into the system.

As health care information systems developed in a paper format, if the writing was legible and in English,

the ability for anyone to review or exchange information was merely limited to having the proper

authorization and access to a copy, or to a device for reproducing the information. However, one of the

major flaws of the paper-based record was the legibility of the information being recorded. Physicians

and other providers have a reputation for poor or illegible writing, which results in documented errors or a

delay in the treatment of a patient’s condition.

The electronic health care record certainly has eliminated the problem of poor handwriting skills of

providers since now the ability to quickly type the information has become a desirable skill set. While

some providers have objected to being a “data entry clerk,” others, especially the young and those

technologically savvy, quickly adopt the system and use it to their advantage.

Interoperability Standards The development of the electronic health record is a major advance in the use of technology to

better utilize the information contained in the record. A computer is at its best use when a large

amount of information needs to be stored and accessed on a routine basis. Data can be compiled

and quickly analyzed using various types of software tools. Unfortunately, the information in the

health record is not necessarily formatted and stored the same way in all the operating systems

and software systems used in computers.

Without getting into the technical side of developing and coding software programs, the

challenge for health care providers is to be able to transfer information on a patient or patients to

other health care providers, so that sharing the information can produce the best outcomes,

eliminate the duplication of tests, and potentially reduce the cost of care. Without the ability to

transfer health information from provider to provider, the ultimate value of the electronic health

information system cannot be achieved.

The ability to transmit usable information from provider to provider is dependent on the format

and protocol used in the software and the requirements of the transmission system. The sender

needs to forward the information in a format that is compatible with the receiver.

For example, facsimile machine manufacturers have all adopted the same protocol for

transmitting a document from one brand of machine to another. Without this adoption of a

standard, we would not be able to easily transmit information from machine to machine.

With the electronic health record, a similar standard is necessary to assure that both systems are

communicating with the same protocol. While that sounds simple in concept, the challenge is

getting the numerous software vendors to agree to the protocol. This could be accomplished

through a mandate by a governmental entity. However, this would then require agreement with

not only the vendor community but also with other governments since health information needs

to be transmitted internationally as well.

One early international standard was created by the HL7 organization (www.HL7.org). This

organization is working to create standards that assure that health information is transmitted and

exchanged between various computer applications in a secure mode. Their desire is to promote

“functional” interoperability so that information is not lost and it is without error.

The United States government became involved in this process by proposing a rule as part of the

American Recovery and Reinvestment Act of 2009. This rule provides direction to providers on

what is needed in the future for health information systems in order to participate in the Medicare

and Medicaid programs. The terminology used by the rule is called “meaningful use,” which is

being adopted by voluntary organizations as part of their development of standards

(www.cms.gov)

The “meaningful use” criteria of the CMS electronic health record is being staged in three phases

over the next five years. Stage one (2011 and 2012) sets the baseline for data capture and

information sharing. Stage two and stage three (2013 to 2015) will continue to expand the

baseline and will create further requirements.

What has occurred is that vendors and stakeholders have formed a voluntary organization whose

intent is to create standards for the transmission of electronic health information. This

organization, the Commission for the Certification of Health Information Technology

(www.CCHIT.org), is working to create standards for software designers and vendors to follow

to assure that information can be transmitted securely and successfully in a usable format.

CCHIT creates certification standards for various categories of providers such as acute care,

physicians, long-term care, etc. However, all of the standards are designed to meet the federal

“meaningful use” requirement and to provide the capability of transmitting health information

across the Internet to any other provider segment that has achieved the CCHIT certification.