Information Systems in Health Care

1
Information Systems in Health Care

• Yung-Fu Chen, Ph.D.
• Department of Health Services Management, China
  Medical University

2
Learning Objectives

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

3
Key Terms

• Administrative and managerial information
  systems
• Computer-based patient record (CPR)
• Data
• Hospital information system (HIS)
• Information
• In-house systems
• Knowledge

• Laboratory information systems (LIS)
• Nursing information systems (NIS)
• Patient monitoring systems
• Pharmacy information systems
• Shared systems
• Stand-alone systems
• Turnkey systems

4
Outline

• Information Systems in Health Care
• History of IS in Health Care
• Current Applications and Trends in Health Care
• Current Trends in Health Information Systems

5
History of IS in Health Care

• Studied from different standpoints
• Technology
• System design approaches
• Management approaches
• Data-information-knowledge model
• Focus on data-information-knowledge model and
  contrast it to other three standpoints

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History of IS in Health CareDistinctions between
data, information, and knowledge

• Data are facts, images, or sounds that may or may
  not be useful to a particular task
• Non-interpreted items
• A data system only produces facts, images, or
  sounds without any contextual basis
• Information consists of data or sets of data
  whose content or form is useful to a particulat
  task
• Information systems maintain a long-term database
  use applications built on storage, retrieval, and
  communication concepts
• Data need to be formatted. Filtered, and/or
  manipulated in order to be converted to
  information

• Data can be converted to information in a number
  of ways summarized, highlighted, and formatted
  or presented
• Knowledge is a combination of rules,
  relationships, ideas, and experience
• Knowledge systems are usually composed of an
  expert knowledge base, algorithms, or some type
  of rule-based or decision analysis adjunct.
• Diagnostic decision support systems (DDSS), which
  provide collegial assistance in making decisions
  to the user, are good examples of knowledge
  systems

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History of IS in Health CareDistinctions between
data, information, and knowledge
Figure 3-1 Hierarchical view of
data-information-knowledge

• Knowledge
• Rules
• Relationships
• Ideas

• Information
• Formatted
• Filtered
• Manipulated

• Data
• Facts
• Images
• Sound

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History of IS in Health CareEvolution of IS in
Health Care

• 1960s-70s
• Financial Focus
• Few Clinical Systems
• In-house Development
• Shared Systems
• Turnkey Systems
• Transaction Processing

Figure 3-2 Timelining Health Information Systems
Evolution

• 1980s
• Continuing Financial Focus
• More Clinical Development
• Stand-alone Systems
• Distributed Systems
• Management Information Systems

• 1990s
• Focus on Clinical Systems
• Integration of Systems
• Executive Information Systems
• Decision Support Systems
• Enterprise-wide Systems
• Office Automation
• Virtual Systems

• 2000s
• Standards
• E-health
• Intranets and Extranets
• Internet
• Clinical Repositories
• Data Warehouses
• Data Mining

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History of IS in Health CareEvolution of IS in
Health Care

• Financial and Clinical Systems
• Although automation has been occurring since
  1960s, IS in health care still remain primarily
  paper based
• The initial use of computers in health care
  occurred during the 1960s and early 1970, but
  mostly focused on financial applications
• Transferred from other industries to health care
  was an lateral movement
• The nature, scope, and development of computer
  technology then supported data systems better
  than IS
• Several exemplary applications in the clinical
  area

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History of IS in Health CareEvolution of IS in
Health Care

• In-House Developed, Shared, Turnkey, and
  Stand-alone System
• 1960s-1970s
• In-house systems included on-site systems that
  were designed, programmed, supported, and
  modified by hospital data processing staff
• The advantage is more flexible in meeting
  hospital needs than vendor-developed products

• Shared systems included those designed,
  programmed, and maintained by a system vendor and
  run on computer equipment at the vendor site
• Shared by multiple hospitals and communicated
  through telephone lines or paper forms
• The advantages were low start-up costs, low
  technical staffing requirement in the hospital,
  and the availability of fully tested and proven
  system
• The drawback is lack of system flexibility to
  meet specific institution needs

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History of IS in Health CareEvolution of IS in
Health Care

• In-House Developed, Shared, Turnkey, and
  Stand-alone System
• Turnkey systems
• Developed by an information vendor, usually in
  only software side of the system
• Installed on a hospital computer and operated by
  the hospital staff
• The hospital could literally just turn the system
  on and be ready for business
• Attractive to smaller hospitals

• Stand-alone system
• Developed to support functional tasks for
  separate departmental areas that each claims
  ownership of its data
• Usually no attempt to share information among
  systems
• Lack of system integration
• Data that could be used on an enterprise-wide
  basis for decision making were difficult to
  provide through this decentralized approach

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History of IS in Health CareEvolution of IS in
Health Care

• In-House Developed, Shared, Turnkey, and
  Stand-alone System
• Information system types
• TPS, MIS, DSS, EIS, ES, and OAS
• Early systems were mainly TPS that automated
  operational functions such as accounting,
  payroll, inventory, and admission/discharge
  systems order entry system was later added
• The introduction of national prospective payment
  system for Medicare patients influenced the
  growth of MIS
• Weakness in linking and integrating data for
  stand-alone system became magnified

• In the 1990s, a need for developing EIS and DSS
  were manifested by increase of health maintenance
  organization, development of alliances, and focus
  on managed care
• Optical fiber provided faster communication for
  both data and images
• In the 2000s, progress in system integration has
  been promoted
• Commitment to the development of standards such
  as HL-7, DICOM, and ASTM
• Advancement of computer technologies
• Client/server networks, DBMS, DDBMS, GUI, voice
  recognition, etc.
• Improvements in IS development tools, such as
  CASE and RAD

13
Current Applications and Trends in Health Care
Clinical Applications and Systems

• Various system types
• Patient monitoring systems
• Nursing information systems
• Laboratory information systems
• Pharmacy information systems
• Other clinically oriented information systems
• There are frequently overlaps in function and
  purpose among system types
• Broadly defined as hospital information system
  (HIS)
• Provide communication among health facility
  workers and support organization need for
  operating, planning, patient care, and
  documentation

• Help to handle this complexity by coordinating
  work tasks, integrating information, organizing
  and storing information, and providing
  information decision support through
  communication architectures, databases, and
  application programs,
• HIS should provide the following functions
• Core applications
• Business and financial functions
• Communications and networking
• Departmental management
• Medical documentation
• Medical support

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Current Applications and Trends in Health Care
Clinical Applications and Systems

• Core applications
• Patient scheduling, admission, and discharge
  embodied in a registration-admission-discharge-tra
  nsfer (RADT) system
• Business and financial functions
• Provide traditional functions such as payroll,
  general ledger, and accounts receivable
• Communications and networking
• HIS is a hub for communication to systems such as
  pharmacy, radiology, laboratory, dietary, OR,
  housekeeping, and other services
• Order entry-results reporting system providing
  communication between physician orders and
  ancillary unit is another important function of
  HIS

• Departmental management
• Supports the internal needs of individual
  hospital departments
• Integration of individual departmental systems
  with core HIS application is a trend
• Medical documentation
• Performs the functions of the standard medical
  record in collecting, storing, and presenting
  clinical information
• Supports managerial and administrative decision
  making
• Medical support
• Assists health-care provider in interpretation of
  data and in making clinically related decisios
• Data generated, stored, and integrated by various
  systems can be used to monitor patients, issue
  alerts, and provide limited advice for diagnosis
  or therapy
• Alert of drug allergies

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Current Applications and Trends in Health Care
Clinical Applications and Systems

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

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Current Applications and Trends in Health Care
Clinical Applications and Systems

• Laboratory information systems
• Support processing of data associated with
  laboratory tests and management functions
  associated with daily operations
• Store, analyze, and distribute data of tests and
  examination including clinical chemistry,
  hematology, clinical microbiology, cytology,
  surgical pathology, and blood bank
• Perform test ordering and results reporting,
  patient and specimen identification, data
  processing and record keeping, data acquisition,
  report generation, quality control, and
  managerial reporting
• Pharmacy information systems
• Collect, store, and manage information related to
  drugs and use of drugs in patient care.
• Provide medications for patient care in response
  to a physicians order is the primary activity

• Provide information regarding identification of
  drug-drug interactions, contraindications with
  patient allergies, and drug sensitivities
• Supported functions include online order entry,
  pharmacist review, medication profile update,
  label printing, drug-dispensing reports,
  medication administration reports, inventory
  maintenance and automatic drug reorder, drug-use
  reports, and controlled-drug reports
• Other clinically oriented information systems
• Radiological information systems
• Dietary information systems
• Emergency department systems
• Support system for central supply, operating room
  systems, anesthesia systems, etc.

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Current Applications and Trends in Health Care
Computer-Based Patient Record (CPR)

• A concept of maintaining health-related and
  patient-related data electronically in a system
  so that end users may access complete and
  accurate data, and be provided with alerts,
  reminders, clinical support systems, and links to
  medical knowledge
• A system of technology, software, and data
  subsystems working together to provide accurate,
  complete, and timely information when and where
  it is needed
• Make up of one technology but supported by many
  technologies
• Web-enabling technologies, client/server
  networks, fast computing speed, voice
  recognition, and DDMS
• Multiple data sources are required to support CPR
  concept

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Current Applications and Trends in Health Care
Computer-Based Patient Record (CPR)

• CPR requirements
• An integrated view of patient data
• Access to knowledge resources
• Physician and clinician order entry
• Integrated communications support
• Clinical decision support
• Barrier to CPR Development
• Lack of a clear definition of a CPR and costs and
  risks associated with development
• Barriers to diffusion including
• Fragmented organization of the health-care system
  
• Lack of leadership for establishing the necessary
  infrastructure for national CPR implementation
• Requirements for education and training of
  health-care personnel
• CPR adoption costs
• Legal and social issues
• Lack of a communications infrastructure and
  standards

• Current status of CPR
• Development of integration among a variety of
  independent systems, such as pharmacy,
  laboratory, radiology, and nursing information
  systems, is a trend
• Integration involves the application of
  client/server protocols, DDMS, and application of
  vocabulary and other types of standard
• Work on defining the basic architecture for data
  contained in the CPR needs to be accomplished if
  data are to be seamlessly transmitted among
  health-care providers, internal and external to
  the organization
• Computer-Based Patient Record Institute (CPRI)
  has established the Nicholas E. Davies Annual CPR
  Recognition Symposia

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Current Applications and Trends in Health Care
Administrative and Management Applications

• The applications, especially in the financial
  areas, were the first functions widely deployed
• Clinical and financial systems were rarely
  integrated, also poor integration among various
  managerial and administrative systems
• Lack of appropriate integration has adverse
  impact on decision making

• Examples
• Financial information system
• Accounting information system
• Human resource MIS
• Material management systems
• Facilities MIS
• Management planning and decision support systems

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Current Trends in Health Information Systems
Administrative and Management Applications

• Financial information system
• Initially automated accounting functions such as
  payroll preparation, accounts payable, patient
  accounting, general ledger, and budgeting with
  the implementation of DRG the need for case-mix
  management systems and integration of clinical
  and financial systems were recognized
• Categorization
• Cash management
• Investment management
• Capital budgeting
• Financial forecasting and planning
• Accounting information system
• Essential business operations that record
  organizational business and economic transactions
  by recording and reporting how funds flow through
  the organization, producing financial statement

• A mix of different systems
• Order processing system captures and process
  order
• Inventory control system processes data related
  to inventory and inventory tracking
• Account receivable system records the amounts
  owed by health-care facility patients, clients,
  clients, and produce invoices, monthly
  statements, and credit management reports
• Account payable system records the purchases, the
  amount of purchases, and from whom purchases were
  made
• Payroll transaction system includes mechanisms
  for timekeeping for work performed, records
  employee compensation data, and produces paycheck
  and other payroll documents
• General ledger system glues all of the accounting
  systems together

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Current Trends in Health Information Systems
Administrative and Management Applications

• Human resource MIS
• Traditional functions include only maintaining
  and updating employee records, currently access
  to data for monitoring productivity, assessing
  personnel-related barriers to productivity, and
  determining appropriate levels of the human
  resources mix are implemented
• Be able to support three important functions
• Staff administration supports recording and
  tracking of human resources
• Training administration helps managers to plan
  and monitor employee training and to develop and
  analyze the success of training programs
• Development and compensation administration
  analyze the range and distribution of employee
  compensation including wages, salaries,
  incentives, and fringe benefits internal and
  external to the organization

• Material management systems
• Management of inventory and purchasing of
  materials and supplies
• Encompasses front-end and back-end processes
• Front-end processes involve handling requisitions
  for supplies and materials from departments
• Back-end process include managing inventory and
  ordering materials and supplies
• Benefits of this system
• Reductions in inventory
• Improvement in bid and contracting procedures
• Updating of daily patient charges
• Improvements in avoiding lost patient charges
• interface with accounts payable to obtain
  payment discounts
• Reduction in labor costs

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Current Trends in Health Information Systems
Administrative and Management Applications

• Facilities MIS
• Well-maintained physical facilities are essential
  for the provision of quality patient care as well
  as providing a pleasing atmosphere for workers
  and patients and their families
• Include capture, storage, and manipulation of
  data used to monitor preventive maintenance,
  energy management, and project (construction)
  scheduling
• Management planning and decision support systems
• Information from external and internal is
  necessary for good strategic decision making

• External prospective
• Understand the environmental context, know the
  strength and weakness of its competition, and
  understand opportunities upon which it can
  capitalize
• Internal prospective
• Recognize its own internal strengths and weakness
  and how these decision making must integrate data
  from internal and external database
• DSS provides information for strategic decision
  making by supplying tools for the manipulation of
  data and presenting answers to what-if scenarios
• DSS includes forecasting, marketing, cost
  accounting, and case-mix systems
• Quality improvement systems

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Current Trends in Health Information Systems
Administrative and Management Applications

• Elements of management information, decision
  support, and executive information systems
• IS designed to help in the support of strategic
  and managerial decision making are classified
  into three categories MIS, DSS, and EID
• Management information systems
• Developed for managing daily business operations
• Exception report is generated when exceptional
  conditions occur
• Some allow managers to interactively request
  information through Web browser, query languages,
  and report generators

• Decision support systems
• Include more sophisticated features for analysis
  of data than MIS
• Consist of several characteristics such as a body
  of knowledge or a database, analytical models
  used to analyze data, and interactive modeling
  capability to support semi-structure and
  unstructured management decisions
• Software for managers to develop their own DSS
  spreadsheet, management sciences packages (SPSS
  or SAS), query languages, and data mining
  packages
• Executive information systems
• Combine many features of MIS and DSS, but is
  developed for top executive decision making

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Current Trends in Health Information Systems

• Systems can be examined and views in relations to
  management of the resources, architecture,
  applications, communications, and technology
• Vision must be toward fully integrated systems
  supported by flexible data models, communication
  technologies, and tools that enhance decision
  making, improve quality and productivity, and
  reduce administrative costs

• Current trends in
• Clinical information systems
• E-commerce and E-health
• Standard development
• Privacy and security
• Technology developments
• Management of information resources and standards
  development
• The virtual health-care system

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Current Trends in Health Information
SystemsClinical Information System

• Continued design, development, and implementation
  of CPR
• CPR will require continued development and
  application of a number of technologies
• Clinical data repositories
• Communication technologies to link various
  repositories, information resources, and users
• Enterprise-wide and inter-enterprise data models
• Voice entry to improve user input
• AI and DSS
• Communications and other standards
• Integration of voice, text, data, and image
  processing systems
• Policies, procedures, and methods that will
  ensure security of patient-related data and
  communications

26
Current Trends in Health Information
SystemsE-Commerce and E-Health

• E-commerce can be defined as the marketing,
  buying, selling, and support of products and
  services over the Internet, Intranet, and
  Extranet
• E-commerce involves electronic data interchange
  (EDI) and secure electronic funds transfer (EFT)
• Health-care organization will continue to use the
  Internet to create a dialog with customers and
  others through online discussion groups,
  electronic bulletin boards, electronic surveys,
  newsletters, blogs, and e-mail exchanges
• Continuing growth in e-health companies which
  provide a range of services including storing
  personal health data, providing reference
  information on a variety of health issues,
  running health-care superstores
• Telehealth applications, such as telehome health
  care, teleradiology, telecardiology,
  teledentistry, teledermatology, and others, will
  continue to grow

27
Current Trends in Health Information
SystemsStandard Development

• Standards are essential for the collection,
  storage, and exchange of data, which are
  fundamentals of developing CPR and e-commerce
  applications, therefore the development of
  standards will continue
• Vocabulary standards establish common definitions
  for medical terms
• Structure and content standards identify
  essential data elements and provide for
  standardization of element characteristics such
  as length, data type, and content
• Message standards establish the format and
  sequence of data during transmission
• Security standards identify practices required to
  maintain the confidentiality, integrity, and
  availability of health-care information

• Organizations
• International Standard Organization (ISO)
• American National Standards Institute (ANSI) does
  not develop standards but serves as a
  clearinghouse for nationally coordinated
  voluntary standards
• Health Level 7 (HL7)
• Accredited Standards Committee (ASC)
• Digital Imaging and Communications in Medicine
  (DIACOM)
• National Council on Prescription Drug Programs
  (NCPDP)
• American Society for Testing and Materials 9ASTM)
• Mandatory standards
• Health Insurance Portability and Accountability
  Act of 1996 (HIPAA)

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Current Trends in Health Information
SystemsPrivacy and Security

• HIPAA promulgated mandatory rules with regard to
  both data privacy and security for health-care
  organizations
• Health-care organizations must be concerned with
  confidentiality, integrity, and availability of
  the information resource
• Management of data security will force
  organizational change in structure, behavior,
  training and education, and management of
  technology
• Chief security officer (CSO) will be a new role
• Encrypted keybased authentification and biometric
  authentification for guarding data access
• Web server guards and server-side session
  management through a secure socket layer will be
  a regular feature for engaging in any type of
  e-commerce

29
Current Trends in Health Information
SystemsTechnology Development

• Wireless technology accompanied with handheld
  computers and personal digital assistants will be
  applied widely in health-care institutions
• Interactive technologies such as continuous
  speech recognition, touch screen, and multimedia
  technology will be applied more widely,
  especially in CPR
• Continuing growth and applications of database,
  data repository, and data warehousing
  technologies in the health-care arena

30
Current Trends in Health Information Systems
Management of information resources and standards
development

• A distinction between information technology and
  systems and IM will emerge
• An expended role for information resources
  manager, CIO, reporting directly to CEO by
  providing him/her with vision and leadership in
  the strategic planning, implementation, and
  operation of enterprise-wide IS
• CIO will play a vital role on the leadership team
  in helping to define the strategic objectives of
  the organization as a whole

31
Current Trends in Health Information SystemsThe
virtual health-care system

• In a virtual IS, health-care enterprises view
  their information resource from the perspective
  of VR
• View of information goes beyond an IS confined in
  an organization
• Critical data reside anywhere, either internal or
  external to an organization
• Virtual IS will be embraced by developing and
  implementing the following facility communication
  links
• Physician-healthcare
• Third-party-healthcare
• Government-healthcare
• Alliance and partner-healthcare
• Customer/client-healthcare