Fluent Essays

Make sure that you study before you begin this . It is timed and designed to gauge how much information that you have retained from this course (readings and presentation).  This is NOT an open note, book, or any other resource. Chapter 1: Health Information Systems Fundamentals Introduction HIS fundamentals Ideas, methods, practices, and principles necessary to build more advanced, elegant, complex initiatives and capabilities Fundamentals are important Key skills, training, methods, standards, and principles must guide the planning, design, testing, implementation, maintenance, and enhancement of HIS HIS Fundamentals HIS Strategic Planning The HIS Strategic Plan aligns the HIS and technologies to strategic business directions and initiatives Supports and enables the strategies to be accomplished Produces actionable, balanced portfolio of systems that support and enable clinical, business and administrative, and connectivity needs of the organization Covered in Chapters 2, 3, and 4 HIS Fundamentals Governance Use of consistent management methods, policies, decision rights, and processes across all units and departments Structural methods: steering committees, standards, auditability, consistent policies and processes Culture of ethics, integrity, and personal accountability HIS Fundamentals Managing HIS Techniques and activities deployed to achieve HIS goals and objectives Methods include generally accepted methods and standards for planning, implementing, supporting, and managing core HIS Activities involve the IT Department (information services, information resources, technology, and information systems) HIS Fundamentals Managing HIS, cont. Plan and manage HIS and infrastructure, data, analytics, people, implement systems/manage change, train tech staff and end users, and more One of the most essential functional areas of a HC organization Expenditures comprise significant portion of the organization’s capital and operating budgets Warrants attention from highest levels of the organization HIS Fundamentals HIS Planning and Budgeting Uses organization’s strategic business plan as a guide Should reflect exactly the forward movement and enablement of the organization toward its business and clinical strategies Annual or near-term plans and budgets are established based on 5- to 10- to 15-year view of the HIS Strategies Plans Annual plans drive the annual HIS capital and operating budgets HIS Fundamentals HIS Planning and Budgeting, cont. HIS plans and budgets must include everything needed and feasible to accomplish in the coming fiscal year Agenda for each year is planning in concert with strategic and operational needs of the organization Plans and budgets must stay in exact tune with the HIS Strategic Plan Deviations are dangerous HIS Fundamentals HIS Selection Process by which decisions are made about which new software systems to bring into the organization Methodologies are widely known, repeatable processes Must justify why a new system is best rather than using something that already exists in the HIS portfolio HIS Steering Committee oversees the process HIS Fundamentals Implementing HIS Set of activities that results in software system going from a business plan to a fully utilized HIS Requires a disciplined methodology that drives a carefully executed, highly detailed project plan Requires activating new software, training for end users, transition from the old system to the new Also involves testing and evaluating the new system to make sure it functions as designed HIS Fundamentals Managing Change The reality of what happens with a new HIS Work with interdisciplinary teams on design, requirements, training, testing, activation, and use Closely collaborate with end users, management, clinical staff Keep others not involved in the process in the loop HIS Fundamentals Managing Vendors Organizations rely heavily on external companies who produce, deliver, and support HIS software, hardware, and services For-profit corporations that exist to create value for shareholders or returns for their owners and investors Covered in Chapters 5 and 7 HIS Fundamentals Harvesting the Yield from HIS Magnitude of the work often prevents an organization from taking full advantage of the data and information resources it is creating HIS produces and captures data resources to create new knowledge through analytics, business intelligence, and clinical intelligence Increases the value and ROI in the core HIS Value garnered is widely underachieved Covered in Chapters 10 and 11 HIS Fundamentals Business, Clinical, and Artificial Intelligence Business intelligence, clinical intelligence, and artificial intelligence systems provide analytical systems, resources, data management, and personnel capabilities Allows organization to gain insights and knowledge Allows them to apply knowledge and insights to improve processes and outcomes Covered in Chapter 11 HIS Fundamentals Data Management and Stewardship To gain yield and value from data, they must be carefully and continuously tended Definition of each data element must be accurate and consistent in its use Must be managed according to the goals of the organization Consistency, accuracy, accessibility, and safety must be checked regularly HIS Fundamentals Creating New Knowledge Health care is a function of information and knowledge workers coming together to help patients, healthcare organizations, patient populations, and communities Needs of patients evolve Healthcare organizations must adapt Must be data driven to put new knowledge into practice Organizational culture must embrace adaptation and thirst for new knowledge HIS Fundamentals HIS Regulatory Compliance and Risk Management Actions, systems, policies, and management techniques used to accomplish these initiatives must be done in compliance with HC regulations HIPAA, MACRA, CMS, MIPS, APMs, DHS regulations, Joint Commission Health care is highly regulated because it is paid for by government/third-party insurance; fraud comprises ~10% of healthcare costs; and patient safety, data, and privacy must be protected HIS Fundamentals HIS Security Security of HIS, data, and protected health information (PIH) is a primary goal in healthcare Hackers, black market, and ransomware experts threaten HIS Prevention is among the highest priorities for any HIS agenda HIS Fundamentals HIS Standards HIS technical and data standards must be in place to communicate across providers, insurers, and users of HC Common protocols and terminology Proprietary software systems strategically withhold opportunity and flexibility for healthcare organizations to use different vendor products simultaneously Case Example: Common Fundamental Failures Background The challenges needing a solution The solution HIS Fundamentals HIS Model for the Health Professions HIS Terminology Health Information Systems (HIS) Technology Infrastructure Hardware Software Middleware Networks End-users “user interface” HIS Terminology Roles HIS planning HIS governance HIS management Design HIS development Activation/implementation Ongoing maintenance Communication Vendor and Provider Relations HIS development began in the 1960s Beginnings were local, humble, and rooted in data processing departments of hospitals There was no Internet to connect capabilities Unintended consequences of new technology: Collision of business interests of wealthy publicly traded or private vendor corporations vs. health provider, community, and patient interests Vendor marketplace is dynamic Covered in Chapter 8 History of HIS The Early Days HIS followed the advent of computerization of U.S. society in general 1960s: Early software applications focused on accounting and financial applications ”Data” of finance and accounting involved dollars and cents (standardized and universally understood data elements) 1970s: Early HIS and tech vendors (SMS, now Cerner) History of HIS The Early Days, cont. Hospitals began to develop their own software Gave rise to first HIS professional organizations (HISSG, ECHO) Members “shared”/exchanged software programs and applications ECHO for IBM hardware, HISSG for non-IBM First HIS were extensions of charge-capture systems for patient billing First comprehensive system was created by Lockheed Martin (Technicon) History of HIS The Early Days, cont. SAIC created early clinical information system for VA hospitals 1980s: Minicomputer (H-P, Digital Equipment Corporation, IBM) More efficient, less expensive, fewer people needed to operate Many early software systems sold by vendors were originally developed in hospital DP departments History of HIS Evolution of Clinical Systems and the EHR First-generation HIS clinical order entry systems were extensions of charge-capture systems for patient billing Initial clinical systems included “order entry” systems, early versions of computerized provider order entry (CPOE) Software was modeled after hotel software Through the 1990s, advent of the Internet transformed healthcare computing History of HIS The current climate Watershed To Err Is Human HDM report drove desire to improve quality and efficiency of care HIS and technology are essential tools in that process Government legislation: Title XIII Challenge: Change from fee-for-service reimbursement methodology to value-based reimbursement system Reliance on vendor marketplace increases cost of automation Prevention, wellness, chronic care, and care coordination are replacing acute-care model Summary The task for health professionals is to provide the education and support needed to create the kinds of HIS we need in today’s challenging and changing healthcare environment Clinical, business, and technology health professions now can only be done proficiently with HIS knowledge, ability, and activity Reliance on vendors and change from acute, medical, sickness-based, institutional scenario to new model based on prevention, wellness, chronic care management, and care coordination create HIS challenges Chapter 2: The Scope, Definition, and Conceptual Model of HIS Introduction Scope of HIS: all computer systems, networks, and data created and captured by software The conceptual model: systems and management; health informatics; data and analytics; research, policy and public health Progression and maturation of HIS Foundation, use, learning/knowledge, and change HIS uses in organization and community settings Systems and Their Management Scope of HIS Model for the Health Professions Systems and Their Management Meaningful health information and data are only as good as the HIS platform and technical foundation that serves as the data source Data are created and captured in HIS that provide features and functions to support Workflows (sequences of common tasks) and Processes (end-to-end methods) of healthcare providers and organizations, patients, and public health professionals Systems and Their Management HIS that create and capture data serve as the foundation upon which all other information- and data-related capabilities depend Essential building blocks of all other advanced uses of data and information Clinical decision support (CDS) Artificial intelligence (AI) Data must emanate from real healthcare processes Systems and Their Management Health informatics The use of information systems and technology to redesign, improve, and recreate the way work is done in medicine, nursing, medical imaging, and public health Focus on certain quality- or process-improvement objectives, which vary based on the setting Comprise the “use” of the computer capabilities HIS provide to end users Systems and Their Management Data Primary uses involve transactions that support day-to-day activities of professionals and organizations Must be aggregated and compiled to create meaningful information Creating of information and ability to conduct analysis and gain knowledge are dependent upon the creation and capture of individual data elements Systems and Their Management Data ”Business intelligence” (BI): Value realized by flexibly analyzing comprehensive stores of data representing the totality of an organization’s/provider’s scope of activity In health care, the BI concept leads to the notion of “clinical intelligence” (CI) Systems and Their Management Research, policy, and public health Data created and captured in HIS become available for research Fuel the work of university researchers and enable analysts to measure health and provide evidence for improving efficiency and effectiveness of healthcare processes and outcomes Policy makers rely on researchers’ findings Data captures in electronic health record (EHR) systems are aggregated into databases Systems and Their Management Data creation/data aggregation Systems and Their Management Research, policy, and public health Public health officials harvest HIS data Work expands from a individual to national to international in scope Data are analyzed according to dimensions Demographic, pathogen, disease, provider, payment mechanism, etc. Options/variations available for a particular scope are determined by the available data Progression and Maturation of HIS Through the HIS Conceptual Model HIS progression and maturation Progression and Maturation of HIS Through the HIS Conceptual Model Foundation Progression begins with a strong foundation of technology and infrastructure and core HIS and their effective and proper management Subsequent layers cannot exist without this Progression and Maturation of HIS Through the HIS Conceptual Model Use (people, process, data, and informatics) Health informatics Support of healthcare activities and use of HIS to develop more effective workflows in the care of patients Success is an outcome of the balanced involvement of people-process-technology “Informaticist”: intersection of computers; the work of professionals using those systems; and the work of IT professionals designing, building, and implementing Progression and Maturation of HIS Through the HIS Conceptual Model Learning/knowledge (Analytics: BI, CI, AI) Use of data for gaining new knowledge begins when transactional data are created and captured in HIS through use of HIS software and then coalesced into databased and analytics platforms These data are used for analysis and creation of CDS, BI, CI AI employs newer technological capabilities Machine learning, natural language processing Progression and Maturation of HIS Through the HIS Conceptual Model Change (global HIS, policy, and research) Eventually the progression and maturation of use of HIS and data they produce will improve our ability to conduct research, create effective policy, and improve public health through change Path to change for the better is illuminated by evidence HIS Uses in Organizational and Community Settings Mission, vision, and goals of each organization will drive types of systems “core” to its purpose “What is the fundamental reason for using HIS?” Requires thinking through types of systems and access to data different kinds of providers will need to deliver care and measure outcomes Also need to determine types of HIS needed by different types of payers, patients/consumers, public health agencies, or research organizations HIS Uses in Organizational and Community Settings Inpatient, outpatient, and ambulatory healthcare provider organizations Anywhere care is delivered, HIS and data they house play an essential role Internet was a game-changer in spread of HIS across all settings Kaiser Permanente, Intermountain Health System, Veterans’ Administration were pioneering organizations Current norm in U.S. health care is automation Has created a multibillion-dollar HIS industry HIS now connect to external partners HIS Uses in Organizational and Community Settings Patients’/consumers’ homes Mobile computing and use of Internet allow patients to access their records and providers, monitor personalize health data Health-related information is accessible Best outcomes in organizational performance and clinical care involve patient engagement People expect to be part of their own healthcare process Innovators are embracing means of personal connectivity and engagement using IT tools widely applied in other industries HIS Uses in Organizational and Community Settings Payers, insurance companies, and government programs and agencies Private insurance companies, government programs, self-pay Public health organizations Exist to monitor, protect, and improve public health Serve as “safety net” by providing health care for uninsured/underinsured patients Typically funded by government programs Some exist to measure, monitor, and report statistics (CDC, Public Health Institute) Case Example: Vista’s Future: Exchanging Innovation for Commercialization? Background The challenges needing a solution The solution Anticipated outcomes of the new approaches 21 HIS Uses in Organizational and Community Settings Health information exchanges and regional health information organizations Health information exchange (HIE): collaborative arrangements with goal of sharing patient-related health information Aim is to improve timeliness of data availability, support clinicians in emergency situations, make existing data available in an emergency, reduce need to repeat tests Interoperability: Health Information Technology for Economic and Clinical Health (HITECH) Act and Meaningful Use (MU) HIS Uses in Organizational and Community Settings Health information exchanges and regional health information organizations Regional health information organizations (RHIOs) Organizations designed to accomplish HIE have gained momentum as result of HITECH Act Work in MU initiated through HITECH Act is being built upon by Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which combines quality and process improvement activities into one program HIS Uses in Organizational and Community Settings External regulatory, reporting, research, and public health organizations Some third-party organizations set standards (metrics) for healthcare providers to use when measuring quality and cost of services They then create benchmarks from aggregated data and issue report cards Some external organizations are state or federal regulatory agencies Some monitor key metrics regarding quality of care for a particular state or the country as a whole HIS Uses in Organizational and Community Settings External regulatory, reporting, research, and public health organizations The Joint Commission: quasi-regulatory organization that inspects and accredits hospitals based on ability to meet a rigorous set of scored criteria The Cardiac Reporting Organization: established to monitor cardiac mortality rates nationally Some third-party reporting relationships are voluntary to enable comparison to similar organizations in an effort to improve cost performance, quality of care, and transparency to communities HIS Uses in Organizational and Community Settings External regulatory, reporting, research, and public health organizations Secondary uses of data: data originally created and captured in the clinical and administrative transactions systems of health provider organizations Primary uses of data: data created and housed in these providers’ HIS HIS Uses in Organizational and Community Settings Summary of Meaningful Use Criteria Stages 1, 2, and 3 HIS Uses in Organizational and Community Settings Primary and secondary uses of HIS data Data from the Institute of Medicine Report “Key Capabilities of an Electronic Health Record System: Letter Report.” Washington, DC: The National Academies Press, 2003. Summary The layers of the HIS conceptual model provide a comprehensive view of the total scope of HIS activity HIS and management Health information Business intelligence/clinical intelligence Research, policy, and public health HIS are used extensively in a wide variety of organizational and community settings