Healthlink Design Template

1
The Healthcare Information Technology Industry
Where We Are and How We Got Here
Randy L. Thomas, FHIMSS Vice President,
Healthlink Incorporated
March 4, 2004
2
HIT An Historical Perspective

• Clinical systems - 1968
• Rand study
• El Camino Hospital
• Computerized physician order entry
• 1969
• 25 critical criteria
• Financial systems 1961
• Boston University School of Public Health and the
  federal government, 1959 study
• Lack of transaction and content standards

3
Historical Perspective on Billing
1990s
2000s
Until 1983
1980s
4
In the Beginning
5
HIT Problem
ManagementInformation
General Accounting
PatientFinancials
Clinicals
6
Healthcare IT Evolution

• Computing in healthcare attempted to move from a
  focus of financially driven transactions that
  supported vertical business units to a more
  integrated focus by creating a best of breed
  model that tied the core competencies of HIT
  vendors for patient financials and clinicals
  together through interface engines and
  communication standards such as HL7

Patient Financials
Clinicals
7
HIT Evolution
Time and experience show that interfacing
disparate patient financial and clinical systems
across environments WITHOUT STANDARDS creates
levels of complexity that are costly and provide
sub-optimal work processes.
8
Interfaces vs. Integration The challenge
without industry standards

• Interfacing
• Adds layer of complexity between systems which
  may support single area of functionality (e.g.,
  Order Entry and Pharmacy Systems)
• Must constantly monitor for data consistency,
  accuracy and integrity across the interface
• Interfaces require staff and typically hardware
  and software resources for support
• With interface engine or equivalent, need
  dedicated resources to implement and support
• Not able to generate reports across applications
• Not able to execute rules across applications

• Integration
• Data transfer takes place within the application
  suite
• Vendor responsible for assuring data integrity
  within the application suite
• No need for staff, hardware or software resources
  to ensure data integrity across application
  modules
• Typically all patient data is stored in a single
  data base, facilitating report generation across
  application modules
• Facilitate report generation and clinical rules
  firing between modules

9
State of the HIT Industry

• Vendors are moving toward technologies that
• Have a common database infrastructure
• Use object oriented technologies and workflow
  engines

Financials
Clinicals
10
Clinical System Roadmap

• Cooperative
• Systems
• Scheduling
• Laboratory
• Radiology
• Pharmacy

• Context Systems
• EMPI
• Managed
• Care
• Registration

• Core CPR
• Physician OE
• Documentation
• Pathways
• Decision support
• Results viewing

• Subscriber Systems
• Billing
• Data warehouse
• EDI

Source Computer Patient Record Institute
11
Where HIT Needs to Focus

• Doctors and nurses (90) are the primary source
• Focus on automating what they do
• Clinician order processing
• Medication administration process
• Clinical documentation process
• Tightly integrate the entire system (pathways,
  orders, alerts, variance tracking)

12
Barriers to Leveraging HIT

• Over-promised, under-delivered
• Trend of automating old processes
• Lack of standards

13
External Compliance Pressures
IOM
JCAHO
Consumers
HIPAA
Leapfrog
Governmental regulations
NHII
14
Technology advances
15
Product Evolution

• Focus on user roles and how the user
  interacts/uses information in the flow of work
  activities
• Assigns roles to people in a process
• Handles the stops, starts and handoffs that occur
  in the course of how work is carried out
• In a business unit
• Across business units
• Divides tasks into queues where
  information/business decisions can be made
• Supports more intelligent business operations
• Has integrated rules engines that provides the
  intelligence to define how work can be carried
  out
• Supports easy to use GUI for designing, modeling,
  and modifying the workflow rules

16
Organizational Implications

• Refocuses system design from how a screen looks
  to how users will interact with information
• Pushes the need for understanding the HOW of
  how work will be carried out to the user
  community
• Feature and function is less important than
  content and knowledge management
• Increases the need for setting executive
  direction and standards up front so system design
  can be optimized to redesign how work is carried
  out
• New skills sets are required
• Systems analysts who understand operations
• Increase involvement of subject matter experts

17
Thank
You

• Healthlink Incorporated
• 3800 Buffalo Speedway, Suite 550
• Houston, Texas 77098
• 1.800.223.8956
• www.healthlinkinc.com