SPECIAL PROJECT REPORT You should prepare a memorandum-type report that includes the following: Situation Analysis. Describe the "real" or hypothetical work environment, provider objectives and current information systems configuration, as well as any unmet needs or issues. Functional Requirements. List or otherwise characterize the key functional requirements to be met by a new or upgraded health information system. Evaluate Vendor Alternatives. Describe and evaluate several vendor alternatives. Indicate pros, cons and unresolved issues for each alternative. Give special attention to the “human factor” considerations. Provisional Recommendation. Given the admittedly incomplete information available to you, what would you recommend as next steps? Options include doing nothing, upgrading the current system, negotiating with one or more vendors, and evaluating other vendor alternatives. Be specific and indicate your rationales for each recommendation.
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SPECIAL PROJECT REPORT You should prepare a memorandum-type report that includes the following: Situation Analysis. Describe the "real" or hypothetical.
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SPECIAL PROJECT REPORT
You should prepare a memorandum-type report that includes the following:
Situation Analysis. Describe the "real" or hypothetical work environment, provider objectives and current information systems configuration, as well as any unmet needs or issues.
Functional Requirements. List or otherwise characterize the key functional requirements to be met by a new or upgraded health information system.
Evaluate Vendor Alternatives. Describe and evaluate several vendor alternatives. Indicate pros, cons and unresolved issues for each alternative. Give special attention to the “human factor” considerations.
Provisional Recommendation. Given the admittedly incomplete information available to you, what would you recommend as next steps? Options include doing nothing, upgrading the current system, negotiating with one or more vendors, and evaluating other vendor alternatives. Be specific and indicate your rationales for each recommendation.
DEFINITION
“…a health care information system (HCIS) is an arrangement of information (data), processes, people, and information technology that interact to collect, process, store, and provide as output the information needed to support the health care organization.”
Health Care Information System
Administrative– Contains primarily
administrative or financial data
– Used to support the management functions and general operations of the health care organization
Clinical– Contains clinical or
health-related information relevant to the provider in diagnosing, treating and monitoring the patient’s care
Administrative Applications
• Patient administration systems– Admission, Discharge, and Transfer Registration– Scheduling– Patient billing or accounts receivable– Utilization management
• Ancillary information systems– Laboratory– Radiology– Pharmacy
• Other clinical information systems– Nursing documentation– Electronic medical record (EMR)– Computerized provider order entry (CPOE)– Telemedicine and telehealth– Rehabilitation service documentation– Medication administration
History and Evolution of Health Care Information Systems
• Health Care Environment– Enactment of Medicare & Medicaid– Cost-based reimbursement– Building mode– Focus on financial needs and capturing revenues
• State of Information Technology– Mainframe computers– Centralized processing– Few vendor-developed products
1960s HCIS
• Administrative and financial systems• Used primarily in large hospitals and academic
medical centers• Developed and maintained in-house• Data processing was primarily centralized on
mainframe computers• Technicon at El Camino Hospital• Larry Weed and the POMR at UVM
“The Mainframe”
1970s“Clinical Departments Wake Up
Debut of Minicomputer”
• Health Care Environment– Time of hospital growth and expansion– Medicare and Medicaid expenditures rising– Need to contain health care costs
• State of Information Technology– Mainframes still in use– Minicomputers become available, smaller and
more affordable
1970s HCIS
• “Turnkey” systems available through vendor community
• Increased interest in clinical applications (particularly in ancillary departments)
• Shared systems still used
1980s“Computers for the Masses”
• Health Care Environment– Medicare introduces prospective payment system for
hospitals– Medicaid and other private insurers follow suit– Need for financial and clinical information
• State of Information Technology– Unveiling of the microcomputer (PC)– Advent of local area network
• Departmental System Journey – Battle of the mini’s LANs
1980s HCISs
• Distributed data processing• Expansion of clinical information systems in
hospitals• Physician practices introduce billing systems• Affordable, powerful computers now available
to smaller organizations• Ability to integrate financial and clinical
information becomes increasingly important
1990s“Health Care ReformAdvent of Internet”
• Health Care Environment– Medicare changes in physician reimbursement– Health care reform efforts of Clinton
administration– Growth of managed care and integrated delivery
systems– IOM calls for adoption of computer-based patient
record
1990s continued
• State of Information Technology– Unveiling of the Internet (World Wide Web)– Internet revolutionizes how organizations
communicate with each other, market services, conduct business
– Cost of hardware drops
1990s continued
• Health Care Information Systems– Health care organizations take advantage of
Internet– Vendor community explodes– Wide range of HCIS products/services available– Growing interest in clinical applications– Still relatively small growth in adoption of
CPR/EMR systems
2000s“Health Care IT Arrives
Patients Take Center Stage”
• Health Care Environment– IOM reports on patient safety and medical errors– HHS calls for standards for EHRs– Spiraling health care costs– Economic upheaval and growing number of
uninsured– Health care transparency and pay for performance– New administration– Federal stimulus money available for HIT
2000s continued
• State of Information Technology– Internet use moves to new level– Voice recognition rebounds– Bar coding and RFID– PDAs and multipurpose cell phones– PHRs and consumers maintaining Web-based
records– Web 2.0 technologies
2000s continued
• Health Care Information Systems– National call for EHR adoption– Infusion of HIT funding– Office of the National Coordinator for HIT (ONC)– Regional health information organizations– Health care organizations “struggle” with how to
successfully implement point of care clinical systems• CPOE• EHR• E-prescribing
2010 and Beyond
• An Era of Accountability, Transparency and Change--Affordable Care Act, Meaningful Use and ICD-10 All Kick In
2010+
• Information Technologies– Cloud computing– Mobile applications– Social Communication– Next Generation Analytics
Key Technology Milestones
1960s: “Mainframes Roam the Planet”
1970s: “Debut of the Minicomputer”
1980s: “Computers for the Masses”
1990s: “Advent of the Internet”
2000s: “Health Care IT Arrives”
2000s: Mobile Technology Arrives
2010s: Watson Comes to Healthcare?
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TITLES REPORT
Data Processing Manager VP (administration)
IS/IT Manager or Director CFO
CIO SVP
“Super” CIO (with CTO & CMIO) CEO or COO
Evolution of the CIO
HEALTH INFORMATION TECHNOLOGY JOBS
What did you learn?
Chapter 5Clinical Information Systems
• Less than Comprehensive– E-Prescribing, lab, PACS and many other clinical information
• Extremely low– 6%--Long term care– 4%--Rehabilitation– 2%--Psychiatric
• Source: Health Affairs, 2012
Value of EHR
• Improved quality, outcomes and safety• Computerized reminders and alerts• Improved compliance with practice guidelines• Reduction in medical errors
• Improved efficiency, productivity, and cost reduction
• Improved service and satisfaction
CPOE• Driven by need to
improve patient safety• Automates the
ordering process• Accepts orders
electronically, provides decision support, may aid in diagnosis and treatment
Use and Status of CPOE
• Estimates vary up to 77%• Historically teaching hospitals more likely to
use• Many organizations are in various stages of
implementation• Required for achieving meaningful use
Historical Barriers to CPOE Use
• Complexity of ordering process• Physician entry an issue• Takes longer to place order; many systems are
‘cumbersome’, take too many steps• Incentives may not be aligned with use• Lack of confidence in system reliability• Insufficient training• Mandating use – should you?
PERSPECTIVE
CPOE Implementation at Cedars-Sinai Medical Center
Medication Administration
• Use of barcoding becoming more widespread
• Aids in correctly identifying patient, drug, dose, etc.
• HIMSS implementation guide—good resource
• More widely accepted• Has been used
successfully by many health care organizations
• Again, has potential to aid in making sure the right meds, get to the right patient, at the right dose…
Pharmacy Purchasing and Practice Aug 2013
Telemedicine• Use of telecommunciations
for the direct provision of care to patients at a distance– Over 200 telemedicine
programs involving over 3500 health care institutions
– Store and forward– Two-way interactive TV
• Funding an issue• Cost effectiveness not
established
Telehealth
• Using telecommunications to communicate with patients and deliver services– Electronic consultations (e-consultations)– Patient portals– Refilling prescriptions– Registering patient– Scheduling appointments
Telehealth
• Current use of email communication between patients and physicians
• Value to patients and providers• Issues
– Complexity of infrastructure– Degree of integration– Message structure– Cost– Security– Reimbursement
Personal Health Record & Patient Portals
• Managed by consumer• May include both health and wellness
information• Patient portal—secure web site through which
patients can access PHR or EHR• Approximately 7% of consumers have PHR
Barriers to Adoption & Strategies for Overcoming Them
• Financial
• Organizational or Behavioral
• Technical Barriers
• Privacy and Security Barriers
Fitting Pieces Together
Case StudyAcquiring an EHR System
• How Realistic Is the Valley Practice Scenario?
• How Well Do You Think the Indicated System Acquisition Approach Would Work?
• What Are the Problems or Risks?
• What Would You Have Done Differently?
Wager’s System Acquisition Process
Establish a Project Steering Committee Define Project Objectives and Scope of Analysis Screen the Marketplace and Review Vendor
Profiles Determine System Goals Determine and Prioritize System Requirements
Wager’s System Acquisition Process (cont.)
Develop and Distribute the Request for Proposal or Request for Information
Explore Other Options for Acquiring System Evaluate Vendor Proposals Conduct a Cost-Benefit Analysis Prepare a Ratings
Matrix Prepare a Summary Report and
Recommendations Conduct Contract Negotiations
SDLC
Assess Usability
Despite the best made plans, things can and do go wrong…
• Failure to manage vendor access to organization leadership
• Failure to keep the process objectives (getting caught up in the vendor razzle-dazzle)
• Overdoing or under-doing the RFP
• Failure to involve the leadership team and users extensively during the system selection