Computerized Health Care Systems

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HPR 601

• Computerized Health Care Systems
• November-December 2000
• Professor Ed Lamie

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Chapter 1 - Information Technology - Figure 1.1

• Clinical
• Administrative
• Strategic decision support
• Electronic networking

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Clinical

• Computerized patient records
• Medical decision support
• Automated instrumentation
• Clinical research and education

4
Administrative

• Financial
• Scheduling
• Human resources
• Materials management
• Office automation

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Strategic Decision Support

• Planning and marketing
• Financial forecasting
• Resource allocation
• Performance assessment
• Outcomes measurement

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Electronic Networking

• Insurance billing and claims processing
• Regional/national databases
• Online purchasing
• Provider networks

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Objectives for Computer-based Records (Fig. 1.4)

• Support patient care and improve its quality
• Enhance productivity of healthcare professionals
• Reduce administrative costs associated with
  healthcare delivery and financing
• Support clinical and health services research
• Accommodate future developments in healthcare
  technology, policy, management, and finance
• Protect patient data confidentiality

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Chapter 2Essential Concepts

• General systems theoryA system is a term used
  to describe the relationships among a group of
  components that function together to achieve a
  common purpose.
• Management control and decision-support systems
  in health services organizations

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Systems Comprising Functioning of Health Services
Organizations

• Mechanical systemsintegral part of physical
  plant
• Human systemsorganized relationships among
  patients, physicians, employees, family members
  of patients, etc.
• Man-machine systemsformally defined systems in
  which human effort assisted by various kinds of
  automated equipment

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System Definition A Set of Objects and the
Relationships Between the Objects and Their
Attributes

• Objectscomponent parts of the system
• Attributesproperties of objects, abstract
  descriptors that characterize and define
  component parts of the system

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System Characteristics

• Mechanical
• Manual
• Man-machine
• Unity, integrity
• Simple
• Complexhierarchical structure, generalized,
  self-adapting
• Stability and equilibrium

• Deterministic or probabilistic
• Three essential componentsinputs, conversion
  process, outputs
• Feedback
• Open or closed
• Cybernetic (self-regulating)

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Simple SystemWith Feedback
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Health Services Organization Systems Network
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Closed andOpen Systems

• Closed systemcompletely self-contained and not
  influenced by external events (closed systems
  eventually die)
• Open systemcomponents of system exchange
  materials, energies, or info with their
  environment influenced by, and influence
  environment, e.G., Health services systems

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Health Services Systems Environmental Factors

• Influenced by social factorscharacteristics of
  individuals and groups of people
• Influenced by economic factorsdirectly dependent
  on resources and local/national economy
• Influenced by political factorscompeting demands
  by special interest groups and politics
• Influenced by physical env.Space, component
  relationship

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Cybernetic System
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Fig. 2.9 - Characteristics of Useful Management
Information

• Information - not data
• Relevant
• Sensitive
• Unbiased
• Comprehensive

• Timely
• Action-oriented
• Uniform-for comparative purposes
• Performance-targeted
• Cost-effective

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Principles of Information Resource Management

• Treat information as an essential organizational
  resource
• Obtain top executive support for information
  systems planning and management
• Develop a strategic vision and plan

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Chapter 3Computer Hardware

• Major components of a computer system
• Central processing unit
• Primary storage

• Secondary storage
• Input units
• Output units
• Classes of computers

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Major Components of a Computer System
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Central Processing Unit

• Arithmetic/logic unitperforms operations such as
  computation and comparison
• Control unitcoordinates operation of other
  units 2-step process to execute one machine
  instruction (a) instruction received from
  primary storage and interpreted, and (b) locate
  required data from primary storage, instruct ALU
  to perform operation, and ensure result stored in
  proper primary storage location
• Registers - high speed memory locationstypes
  instruction register and address register also,
  word length, data bus width, RISC, and CISC

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Primary Storage

• Early days magnetic cores
• Terms bit, byte, word, kilobyte (KB) 1,024
  bytes, megabye (MB) 1,048,576 bytes
• ROM (read-only memory)(boot instructions, I/O
  instructions, nonvolatile)
• RAM (random access memory) - store instructions
  and data - volatile
• Cache memorykeep important information in
  memory, and save frequently used information for
  future use

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Secondary Storage

• Magnetic tape archive purposes
• Magnetic disks hard disk, floppy disk
• Optical disks CD ROM - data resides on single
  track that winds in spiral fashion, WORM, and
  magneto-optical (erasable)
• Optical or laser cards
• Smart cards

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Input Units

• Keyboards
• Pointing devices mouse, rollerball, touch
  screen, light pen
• Scanners, handwriting recognition devices, voice
  input

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Output Units

• Visual displays - VDT or monitor, LCD -
  monochrome or color (active or passive matrix
  display)
• Printed output - dot matrix printers, ink jet
  printers, laser printers (memory and resolution)
• Voice output

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Typical Layout of a Disk
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Classes of Computers

• Supercomputers (parallel processing
  configuration)
• Mainframe computers (shared configurations
  including processor clusters, front-end
  processors, and networks with microcomputers and
  workstations)

• Minicomputers
• Workstations
• Personal computers

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Chapter 4Computer Software

• Programming languages
• Language translators
• System management software
• Utility programs
• Application software
• Integrated v interfaced systems

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Table 4.1 Five Generations of Programming
Languages

• Machine Language strings of zeros and ones
• Assembly Language Uses Mnemonics
• Procedural Language Focuses on Solution to
  Problem
• Variety of Application and Program-Generating
  Languages Focuses on Description of Problem
  Itself
• Natural Languages Easy Communication with
  Computer

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Table 4.2 Representative Third-Generation
Languages

• FORTRAN - Early scientific language
• COBOL - Early business-oriented language
• ALGOL - Influenced the development of several
  contemporary languages
• PL/I - Intended to combine best features of
  above languages
• BASIC - Important language in early days of
  personal computer - now Visual Basic used
  extensively
• MUMPS or M - Developed for use in healthcare
  environments
• Pascal - Educational language
• C or C - Ubiquitous development language

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Example of SQL (a 4GL)

• Problem For each department, find the average
  experience of employees, and count the number of
  full-time employees
• select dept,
• avg(years_exp),
• count(ssn)
• from emp_db
• where fte gt 1

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Language Translators

• Source code is the input to a language
  translator object code is the output
• Assemblers (assembly language to machine
  language)
• Compilers (high-level language to machine
  language)
• Interpreters (statement-by-statement translation)
• Code-Generation Software (4GL to 3GL)

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System Management Software

• Operating Systemsa. process user and
  user-program commands and requestsb. managing,
  loading, and executing programsc. managing
  hardware resources of computerExamples Win95 or
  Win98 or NT, UNIX, MVS
• Utility Programs - support operations, file
  manipulation, computational programs

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Application Software

• General Purpose Application Software examples
  word processors, desktop publishing software,
  spreadsheet software, statistical packages,
  database management software, integrated software
  programs
• Application-Specific Software (see next page for
  examples)
• Integrated / Interfaced Systems

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Table 4.3 Categories of Application-Specific
Software in Healthcare

• Financial Mgmt
• Managed Care
• Decision Support
• Quality Mgmt
• Case Mgmt
• Clinical I.S.
• Patient Mgmt
• Medical Records
• Lab Systems
• Pharmacy Systems

• Radiology
• Materials Mgmt
• Food Services and Nutrition
• Clinical Services
• Clinic/Practice Management
• Home Healthcare
• LongTerm Healthcare
• Admin Support
• Office Automation
• System Integration

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Chapter 5 Networking and Telecommunications

• Why Computer Networks?
• Dumb Terminalsbatch vs real-time
  processingremote job entry
• Client/Server Computingclient - front end
  functionsservers - back end functions
  personal, mini, workstation, or mainframe
  computers
• File/Server Architecture (1 server)

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Networking and Telecommunications (cont.)

• Distributed Data Processing
• Network Componentstransmission media (copper
  wire, fiber optics, radio)transmitters/receivers
  network control software/NOSnetwork topologies
  bus ring starEthernet - bus - CSMA/CD

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4 Important Network Technologies

• Fiber Distributed Data Interface (FDDI gt 100
  million bits/sec)
• Asynchronous Transfer Mode (ATM gt 1 billion
  bits/sec)
• Fast Ethernet (10X traditional ethernet) 100
  million bits/sec
• Switched Ethernet gives smaller segments of
  users access to full bandwidth gigabit
  Ethernet, 10 megabit Ethernet

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Networking Concepts - 1 of 3

• Electronic Data Interchange transferring
  structured information on network
  incorporate standards and procedures
• Mobile Computinguse of portable computing
  devices data must be uploaded for updates
  problem when update not timely

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Networking Concepts - 2 of 3

• Wireless Computingideally combined with mobile
  computingportable computers connected to
  information systemreal-time, continuously
  updated
• Internet vs. internet
• WWW (1991) - collection of resources distributed
  on Internet

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Networking Concepts - 3 of 3

• Internet Service Provider (ISP)
• T-1 lines 1 megabit/sec(dedicated digital
  phone line)
• T-3 lines 45 megabits/sec
• Transmission Control Protocol/Internet Protocol
  (TCP/IP) - packet switching

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Web Site

• HTML HyperText Markup Language
• HTTP HyperText Transfer Protocol
• Home Page
• Hypertext Links
• Uniform Resource Locator (URL)
• Sample domain names org, edu, com, etc.

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Intranet

• Web-based corporate network (closed system)
• need web server, browser, formatting language,
  TCP/IP communication protocols
• firewall - filter against unauthorized access
• Network Computers

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Chapter 6Data Management

• Files - Records - Fields
• Sequential, example tape
• Direct Access, example disk
• Problems with Filesprogram dependencedata
  redundancydata inconsistency (often a byproduct
  of data redundancy)

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Database Advantages

• Reduce Redundancy
• Avoid Inconsistency
• Share Data
• Enforce Standards
• Apply Security Restrictions

• Maintain Data Integrity
• Balance Conflicting Requirements
• Data Independence

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Database Terminology

• Database Models hierarchical network
  relational

• Database Management Systems (DBMS)
• DDL - schema, subschema physical vs. logical
  view
• DML - query language, or embedded in procedural
  language
• Data dictionary

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Query Languages and SQL

• Query Language
• Natural Language
• Query by Example (QBE)
• Structured Query Language (SQL)

• SQL example (DB on page 146)List name and
  equipment number for items in dept 15
• select equip_name,equip_no from Eqtable where
  dept_no 15

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Another SQL Example

• List dept names and managers for equip_no 850,
  852, 879
• select dept_name, dept_mgr, equip_no from
  DepTable, Eqtable where equip_no in
  (850,852,879) and DepTable.dept_no
  Eqtable.dept_no

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Database Features

• Data Dictionary
• Data Security
• Privacy/ Confidentiality
• Virus Protection
• Backup/Recovery

• Hypermedia Databases
• Data Warehouses
• Clinical Data Repositorymaster patient
  indexstandardization terminology format

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Chapter 7 Strategic Info. Systems Planning

• Identifying and assigning priorities to a set of
  computer applications
• Priorities integration of systems (islands of
  automation)automation of patient
  recordsimproved decision support

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Planning (continued)

• Planning process neededdevelop flexible
  information architecturefacilitate data
  exchangeprovide remote user access
• Usual approach in past piecemeal fashion in
  developing systems ad hoc basis for capturing,
  storing, retrieving crisis driven

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Planning (continued)

• 1996 survey 35 did not have strategic
  Information Systems plan
• Figure 7.1 Purposes of Strategic Information
  Systems Planningalign Information Systems goals
  with organizationdefine specific requirements
  and prioritiesdefine info. tech.
  infrastructuredevelop budget for resource
  allocation

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1995 SurveyInfrastructure Priorities

• client/server network architecture
• optical disk storage and data warehouses for
  clinical records
• interface engines for linking Information Systems
  of members of integrated delivery systems
• wide-area fiber-optic networks
• relational databases
• multimedia workstations

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Figure 7.2 Organizing the Planning Effort

• Board of Trustees
• Chief Executive Officer
• Information Systems Steering Committee
• Subcommittees
• Selecting a consultantindependence and
  objectivityhealthcare expertiseresourceseffecti
  ve personality

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Figure 7.3 Elements of Info. Systems Strategic
Planning

• statement of corporate/institutional goals
  objectives
• statement of Information Systems goals
  objectives
• priorities for the application portfolio
• specification of overall systems architecture and
  infrastructure
• software development plan
• Information Systems management plan
• statement of resource requirements

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Specific Info. Sys. Objectives

• Information Systems should be designed such that
  all records from the master patient index file
  are available online to all physicians in the
  plan
• Information Systems should be designed such that
  all diagnostic test results are available within
  2 hours after tests are completed
• Information Systems should be designed so that
  information or inpatient and outpatient activity
  by major diagnostic categories is reported to
  corporate management on a monthly basis with
  reports indicating the health systems share of
  the total services provided in the market area

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Specification of Overall System Architecture

• centralized or decentralized
• communication linkage of computers, workstations,
  and network servers
• data storage, distribution, and security
• application linkage for information exchange

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Figure 7.4Information Security

• Physical securityhardwaredata files
• Technical safeguardspasswordsencryptionaudit
  logs

• Management policieswritten security
  policyemployee trainingdisciplinary action for
  violations

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Data Standardization

• Required for electronic data exchange
• Consider date of birth example in textbook
• Projects to develop healthcare standardsANSI
  X.12HIBCHL7MEDIX

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Hardware and Software Standards

• Technical policies developed by CIO or director
  of Information Systems
• Information Systems steering committee should
  oversee broad policies
• Should require central review and approval of
  purchases

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Policies on Use of Internet

• Creation of home pages
• Security of information on Internet
• legal protection of intellectual property on
  Internet
• Controlling employee use and potential abuse

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Policies on Home Page Development

• Organizational units authorized to create home
  pages
• Use of corporate information, logos, etc.
• Maintenance responsibility
• Data security
• Graphic design and writing style
• procedures for central review and approval

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Chapter 8Systems Analysis

• System development life cycle
• Project organization
• Systems analysis
• System analysis tools
• Selection of a design approach

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Figure 8.1 Information Systems Development Life
Cycle

• Analyze functional requirements (systems
  analysis)
• Select design approach
• Specify system requirements (system design)
• Acquire or construct system
• Install system (implementation)
• Operate and maintain system
• Evaluate and improve system

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Figure 8.2 Information Systems Project
Organization
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Chap. 9 System Design, Evaluation, Selection

• System design specifications
• Evaluation of application software
• use contractual services (outsourcing)
• Selection process
• Negotiation and contracting
• Role of consultants

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Figure 9.1 System Design Specifications

• Statement of system objectives
• Output specifications
• Input specifications
• Database specifications
• Procedures and data flow
• Cost-benefit estimates
• Management approvals

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Figure 9.3 Packaged Software Evaluation Criteria

• Congruence with organizational requirements
• Level of satisfaction of other users
• Compatibility with existing hardware and software
• Support available
• Costs
• Financial stability of vendor

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Use ofContractual Services

• Review carefully prior experience
• Investigate financial stability
• Review credentials of specific personnel assigned
  to project
• Review principles used in work plans and
  procedures
• Examine cost estimates advocate fixed-price
  and fixed-time contracts
• Employ technical consultant to review proposed
  services
• Design formal review process

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The Selection Process

• RFI - Request For Information
• RFP - Request For Proposals1. into to
  organization2. functional requirements3.
  specify content and format4. evaluation
  criteria5. demonstrations and testing6. system
  implementation7. contractual requirements

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General Criteria for Evaluating an RFP

• established performance record
• extent of vendor support
• reliability, maintainability, and quality control
• projected benefits
• adaptability and provisions for expansion
• costs of acquisition, implementation,
  maintenance
• number and scope of conditions

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Negotiation and Contracting

• Delivery dates
• Acceptance testing
• Payment schedule
• Warranties and guarantees
• Software ownership
• Interface responsibilities
• Maintenance updates
• Personnel training
• Documentation
• Expiration date cancellations

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Role of Consultants

• Facilitate selection process
• Provide technical information
• Provide outside perspective

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Appendix A B (pp 233-243)

• Break into 4 groups
• Study and critique each of the 2 case studies
• Determine where each case study fits in
  Information Systems development life cycle
• Discuss each component of the case study
• Determine the next step in the development life
  cycle

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Chapter 10 Managing Information Resources

• System implementation
• Operation and maintenance
• System evaluation and improvement

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Figure 10.1Information Systems Implementation

• Equipment acquisition
• Programming or software installation
• Training
• Database preparation
• System testing
• Final documentation

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Figure 10.2 Elements of a System Test

• System objectives
• Computer and network hardware
• Computer software
• Personnel training
• Accuracy of cost estimates
• Adequacy of system documentation

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System Operation and Maintenance

• Scheduled and unanticipated maintenance
• About 25 of technical staff time devoted to
  maintenance
• Develop emergency backup procedures

• Continuous quality improvementTQMInformation
  Systems evaluationsa. functionalityb. user
  satisfactionc. costs and benefitsd. errors and
  exceptions

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Healthcare CIO Attributes

• Leadership ability
• Vision/imagination
• Business acumen
• ? Technical competence

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Role of CIO

• be a leader of information utilization, not a
  controller of data and technology
• focus on long-term strategy, not day-to-day
  operations
• champion the development and constant monitoring
  of a strategic information plan, an intricate
  component of the corporate strategic plan
• participate as a full member of the executive team

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1996 Survey of Healthcare CIOs

• 57 hold advanced degrees
• 37 have BA/BS degrees
• Figure 10.3 - Typical Information Systems
  Organization
• N.B. Network programmers are replacing mainframe
  computer programmers

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Outsourcing Benefits

• reduction of in-house staffing requirements
• smaller investment in capital equipment
• more flexibility in meeting changing requirements
  and adopting new technology
• reduction in the time required to implement new
  applications
• more predictable cost structure, particularly if
  fixed-price contracting is employed

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Outsourcing Pitfalls

• too much dependence on vendors, with possibility
  that a critical contractor might go bankrupt of
  change business direction
• high costs associated with vendor fees and profit
  structure
• employment of contractors who do not understand
  the operation and culture of healthcare
  organizations

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Executive Management Responsibilities

• Information Systems are useful if process for
  planning, designing, installing, and operating
  such systems is well managed
• information is essential for strategic planning,
  cost and productivity management, continuous
  quality improvement, and program evaluation
• 14 important executive management
  responsibilities listed on pages 256-257

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Chapter 11 Patient Care Applications

• 1996 survey of most important application
  priorities1. Implement a clinical data
  repository2. Implement new clinical
  systems3. Implement an electronic medical
  record

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Computer-BasedPatient Records

• continuous treatment record of active patients
• archival record for inactive patients
• working documents for medical audit, utilization
  review, quality improvement, and cost control
• database for research
• development of completely electronic medical
  record has been an elusive goal

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National Computer-Based Patient Records (CPRs)

• Advocated by 1991 report of Institute of
  Medicine, National Academy of Science1. Include
  problem list and status for patient clinical
  problems2. Systematic measurement and recording
  of patients health status and functional
  levels3. Documents clinical rationale for
  diagnoses or conclusions4. Longitudinal
  record of events for each person

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Major barriers to electronic patient records

• Legal issues
• need for universal standards
• technological limitations (although diminishing)
• user resistance

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3 examples of CPRs (page 267)

• City of Hope Medical Center
• Stuyvesant Polyclinic
• Dr. Kim Charles Meyers

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Order Entry andResults Reporting

• Software available for entry of orders for
  diagnostic tests and patient treatments, and
  subsequent reporting of test results
• physician orders entered and transmitted to
  appropriate clinical service units
• test results, treatment summaries, and charges
  for services transmitted electronically
• issue who will enter the orders (i.e., physician
  or clerical personnel)?
• User-friendly and efficient systems needed

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Clinical Services Applications

• Laboratory Information Systems
• Pharmacy Information Systems
• Radiology Information Systems
• Other service department systems

92
Ambulatory Care Information Systems, typical
applications

• Patient scheduling and appointment systems
• electronic medical records and medical management
  systems
• patient and third-party billing
• managed care contract management
• electronic communications with other providers in
  an integrated delivery system

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Nursing Information Systems advantages of
Point-of-Care systems

• Reduction in nursing service costs
• improved quality of care
• more timely access and improved recording of
  information
• cost reduction

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Clinical Decision-Support Systems (CDSS)

• Passive CDSS - make information available and
  usable, but do not process for further analysis
• Active CDSS - provide direct assistance to
  physician in diagnosis and treatment planning,
  combine patient-specific data with generalized
  medical knowledge to reach a conclusion or make a
  recommendationa. expert systemsb. systems that
  employ probabilistic algorithmsreminder/alert
  systems
• Statement by Dr. P. Ellwood (pp279-280)

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Other Clinical Applications

• Telemedicine
• Long-term care
• Hone health care
• Computer applications in clinical research and
  education

96
Chapter 12 Administrative Applications

• Typical first use of computers
• Types of softwarea. design and program
  in-houseb. participate in shared service
  arrangementsc. purchase predesigned or packaged
  software
• Turnkey systems popular given low-cost
  microcomputers
• Table 12.1-software vendor list

97
Financial Information Systems (Figure 12.1)

• Inputs transaction processing systems
  external sources strategic organizational plans
• Outputs financial statements forecasts
  management reports

98
Human Resources Information Systems (Figure 12.2)

• Inputs employee record payroll budget
  benefits information
• Outputs government reports management reports

99
Other Information Systems

• Facility utilization and scheduling systems
• Materials management systems
• Facilities management systems
• Office automation systems

100
Chapter 13 Strategic Decision-Support Apps.

• Decision-Support Systems (DSS)Definition
  Information Systems to support the data
  retrieval, modeling, and reporting of results for
  executive queries

101
Desirable Attributesof a DSS

• Easy interaction with the system
• Executives can retrieve data themselves
• Data are displayed in a meaningful format
• System has modeling capability
• System generates clear reports

102
Components of a DSS (Fig.13.3)

• User interface
• Model manager
• Model library
• Databases
• DBMS
• Report writer

103
Characteristics of Useful Management Information

• Information - not raw data
• Relevant
• Sensitive
• Unbiased
• Comprehensive
• Timely

• Action-oriented
• Uniform
• Performance targeted
• Cost-effective
• contains an element of surprise

104
Sources of Information for Decision Support

• Internal transaction processing systems
• Specially constructed databases
• External data sources

105
Categories of Information Needed for Decision
Support

• Information to support strategic planning
• Information to support the marketing function
  prospectors defenders analyzers reactors
• Information to assist in resource allocation
• Information to support enhancement of
  productivity and operating efficiency
• Information to support outcomes assessment

106
Development of DSS

• Write programs from scratch
• Use suitable program generators
• Customize a package
• Purchase a turnkey package

107
Expert Systems Components

• Knowledge base (or rule base)
• Database
• Inference engine
• User interface
• WorkspaceExample of expert system on page
  331E.Information Systems defn on pages 331-333

108
Chapter 14 Managed Care Applications

• Users of Managed Care Information Purchasers
  Consumers Providers of Health Services
  Managed Care Organizations

109
Figure 14.1Provider Functions

• Financial Monitoring
• Management of Capitated Contracts
• Strategic Planning and Decision Making
• Patient/Member Services
• Management of Multiple Lines of Business

110
Figure 14.2 Managed Care Organization Functions

• Financial Monitoring
• Preparation of Standard Analytical Reports and
  Decision Models
• Management Control and Reporting
• Claims Payment and Prospective/Capitation Payment
  Processing

• Management of Multiple Lines of Business
• Marketing and Sales Support
• Profitability
• Member/Customer Services
• Employer Information Needs

111
Information Needs in the Managed Care Marketplace

• Economic Incentives
• Wellness and Health Promotion
• Capitation
• Quality of Outcomes

112
Chapter 15 Health Information Networks

• 1996 Survey of leaders in healthcare computing
  60 are part of, or in process of,
  forming integrated delivery system
  11 plan to become part of such a
  system within next year

113
Figure 15.1 Model of Integrated Delivery Systems

• Defined Population(s)
• System/Network Integrator
• Information Systems Hospitals Subacute Units
  Nursing Homes Hospice Home Health
  Ambulatory Care Centers Specialist Primary
  Care Providers

114
Figure 15.2 Community Health Care Mgmt Sys

• Community Needs Assessment
• Resource Requirements and Service Offerings
• Caregiver, Managerial, and Governance Integration
  and Alignment
• Information Systems

115
Terms and Definitions

• HIN - Health Information Network
• CHIN - Community Health Information Network
• Evolution of HIN parallels evolution of
  computer-based patient record (CPR) systems
• CPR systems and HIN are related each impacts the
  other

116
Figure 15.3 Defining the HIN Continuum

• Evolving Scope -------gt
• Enterprise ---gt
• Community ---gt
• National ---gt
• Global

117
More Terms

• Enterprise Network - support information
  management and communication requirements of a
  single organization
• Community Network (CHIN) - support region, state,
  or national community
• National Network - great promise, consider
  National Information Infrastructure or
  information superhighway
• Global Network - next decade?

118
Figure 15.4 Three Levels of HIN

• Extraorganizational Level Coordination/Managemen
  t
• Interorganization Level Enterprise Management
• Organizational Level Organizational Management
  Patient Management Patient Care

119
Planning Activitiesor Issues

• Understand business objectives
• Assess current information system needs
• Identify information system requirements and user
  needs
• Determine type of organization or ownership
• Determine method of financing
• Address legal and security issues
• Establish infrastructure for managing network
• implement process for ongoing HIN evaluation and
  future development

120
Chapter 16Internet Applications

• Key Terms
• Internet Intranet WWW

• Browser web site home page

121
Figure 16.1 Business Strategies and Internet
Applications

• Improving internal business processes and
  services
• Establishing external linkages with business
  partners
• Increasing marketshare and stability
• Providing public service information to the
  community

122
Figure 16.5 Categories of Internet Applications

• Improving internal communications
• Distributing organizational information
• Delivering educational programs

123
Internet Technology Issues (Pro and Con)

• Pro
• relatively inexpensive
• convenient to use
• international in scope
• user friendly

• Con
• security issues
• lost in Cyberspace
• slow response time
• hidden costs

124
Guidelines for Internet or Intranet Applications

• Get small successes early
• Nurture pilot projects
• Understand that Web experiments require leaps of
  technology, skills, and investments
• Focus on clearing technological, financial,
  political, and organizational culture hurdles

125
Strategies for Implementation

• Make sure Internet technologies complement
  existing architectures
• Establish governance group to set policies,
  guidelines, et al
• Evaluate implication on current business
  strategies processes
• Develop network of Internet experts for support
  and advice
• Ensure access to web email