INTRODUCTION TO HEALTH IT

Audio Component 6 Health Management Information Systems Transcript Unit 2 Health Information Systems Overview Lecture A

Slide 1 Welcome to Health Management Information Systems, Health Information Systems Overview. This is Lecture a.

The component, Health Management Information Systems, is a “theory” component that provides an introduction to health care applications and the systems that use them, health information technology standards, health-related data structures, and enterprise architecture in health care organizations.

Lecture a defines the concept of an information system and its characteristics, describes the different types of information systems, and describes various types of technologies that support health care information systems.

Slide 2 The Objectives for this unit, Health Information Systems Overview are to:

• Define the concept of an information system and its characteristics; • Describe the different types of information systems; • Describe various types of technologies that support health care information systems;

Slide 3 Additional Objectives for this unit, Health Information Systems Overview are to:

• Examine the challenges presented by emerging trends in information technology, social media, and global communications; and • Discuss the advantages and disadvantages of using the Internet as a platform for health care applications.

Slide 4 Let’s begin with a definition of an information system. The American Health Information Management Association (AHIMA) defines an information system as “An automated system that uses computer hardware and software to record, manipulate, store, recover, and disseminate data (that is, a system that receives and processes input and provides output)” (AHIMA, 2012, p. 181).

Slide 5 Taking into consideration the components of an information system, general characteristics are the capability through the use of hardware and software to accept inputs from users, access and process the data received, as well as store, manage, and present information back to the user.

For example, a nurse would use medication management software which is part of a clinical decision support system, a type of information system, to verify the correct medication was ordered. This system also documents the actual administration of the medication through the use of a handheld barcode reader that registers each medication.

Slide 6 Betts (2007) described two characteristics of an information system as the organization of data into information and the ability to analyze the information. He further stated, “For data to be made meaningful it must have a purpose. The purpose of the stored data should reflect the purpose and type of the information system. Data needs to be processed and organized before it becomes information. Organizing the data will most likely involve the processes of sorting and filtering (classifying) before it can be analyzed and stored for later retrieval” (para. 1).

An example of how data may be organized is via a data dictionary. AHIMA (2012) defines a data dictionary as “A descriptive list of the names, definitions, and attributes of data elements to be collected in an information system or database whose purpose is to standardize definitions and ensure consistent use being a central repository of information about stored data, is used to help organize the data” (p. 94).

Going back to the previous slide’s example, using a handheld barcode reader that registers each medication, a nurse would use information systems to verify the correct medication was ordered and to document the actual administration of the medication.

Slide 7 With regards to information systems, there are three major categories. They are

• Transaction Processing System (TPS), • Management Information System (MIS), and • Decision Support System (DSS).

Each will be defined in the next few slides.

Health IT Workforce Curriculum Health Management Information Systems 2 Version 3.0/Spring 2012 Health Information Systems Overview Lecture a

This material Comp6_Unit2a was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024. Slide 8 A transaction processing system (TPS) processes information in order to complete a transaction. Two examples are the Admit, discharge, transfer (ADT) and patient billing systems.

Slide 9 AHIMA (2012) provides the following definition of an admission, discharge, and transfer system:

“The name given to software systems used in health care facilities that register and track patients from admission through discharge including transfers; usually interfaced with other systems used throughout a facility such as an electronic health record or lab information system” (p. 10).

Slide 10 HIMSS (2010) defines management information systems as “a class of software that provide management with tools for organizing and evaluating their department, or the staff that supports information systems” (p. 76).

Examples of health care management information systems include the laboratory or emergency department information systems.

Slide 11 The National Research Council (2007) recommended that “hospitals adopt robust information and communications systems to improve the safety and quality of emergency care and enhance hospital efficiency” (p. 7). Of particular importance to considerably improving emergency care were the following information technologies: • “dashboard systems that track and coordinate patient flow, • communications systems that enable ED physicians to link to patients’ records or providers, • clinical decision support programs that improve decision making, • documentation systems for collecting and storing patient data, • computerized training and information retrieval, and • systems to facilitate public health surveillance” (NRC, 2007, p. 7).

For example, benefits of a documentation system include the ability to facilitate the capture and storage of information on the patient care process which in turn provides the information necessary for billing and reimbursement as well as public health and research purposes.

Health IT Workforce Curriculum Health Management Information Systems 3 Version 3.0/Spring 2012 Health Information Systems Overview Lecture a

This material Comp6_Unit2a was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024. Slide 12 AHIMA (2012) defines a decision support system (DSS) as “A computer-based system that gathers data from a variety of sources and assists in providing structure to the data by using various analytical models and visual tools in order to facilitate and improve the ultimate outcome in decision-making tasks associated with non-routine and non- repetitive problems” (p. 100).

An example is a clinical decision support system.

Slide 13 Having defined the concept of an information system and identified the major categories of information systems, the next step is to unite information systems to the health care domain and describe the various types of technologies that support a health care information system.

As defined by Vogel & Perreault (2006), a health care information system is “an information system used within a health care organization to facilitate communication, to integrate information, to document health care interventions, to perform record keeping, or otherwise support the functions of the organization” (p. 945).

An example would be a hospital information system (HIS). This is a system which is comprehensive in that it contains the clinical, administrative, financial, and demographic information about each patient (AHIMA, 2012). In addition, administrative, billing, and financial systems that facilitate the revenue cycle and other administrative tasks are components of information systems used in provider and health care organizations.

Slide 14 Coming from a functional perspective, Vogel & Perreault (2006) identified HCIS components that support the following purposes:

• Patient management and billing • Department management • Care delivery and clinical documentation • Clinical decision support • Financial and resource management

Each will be briefly described in the next few slides.

Health IT Workforce Curriculum Health Management Information Systems 4 Version 3.0/Spring 2012 Health Information Systems Overview Lecture a

This material Comp6_Unit2a was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024. Slide 15 Patient management and billing systems are systems that support the management of the patient. An example would be the patient identification functionality and the supporting technology, a master patient index. AHIMA (2012) defines a master patient index as “A patient-identifying directory referencing all patients related to an organization and which also serves as a link to the patient record or information, facilitates patient identification, and assists in maintaining a longitudinal patient record from birth to death” (p. 210).

Slide 16 Department management systems are systems that support a department’s information needs. An example would be the health information management (HIM) department systems which may be used to manage the organization’s medical records. An electronic document management system would be a supporting technology for the HIM department. According to an AHIMA e-HIM Work Group (2003), an electronic document management system (EDMS) is “any electronic system that manages documents (not data) to realize significant improvements in business work processes” (para. 24).

Department management systems supply data to patient databases. For example, the HIM department contributes transcribed history and physicals to EMRs.

Slide 17 Care delivery and clinical documentation systems are systems that support the delivery of the care and documentation of that care. An example of an HCIS component would be clinical information systems. A clinical information system is “designed to support the delivery of patient care, including order communications, results reporting, care planning, and clinical documentation” (Vogel & Perreault, 2006, p. 924). An example of a supporting technology would be the clinical documentation module found within an electronic medical record system. Patient clinical data are stored in delivery and clinical documentation systems.

Slide 18 A clinical decision support system supports the clinical staff with data interpretation and decision-making (Vogel & Perreault, 2001).

Osheroff, Pifer, & Teich (as cited in Das & Eichner, 2010) stated “CDS provides clinicians, patients, or caregivers with clinical knowledge and patient-specific information to help them make decisions that enhance patient care” (Das & Eichner, 2010, p. 4). Das & Eichner (2010) go on to explain, “The patient’s information is matched to a clinical knowledge base, and patient-specific assessments or recommendations are then communicated effectively at appropriate times during patient care” (p. 4).

Health IT Workforce Curriculum Health Management Information Systems 5 Version 3.0/Spring 2012 Health Information Systems Overview Lecture a

This material Comp6_Unit2a was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.

An example would be a prescription decision support system and a supporting technology would be drug-drug interactions.

Clinical decision support systems access patient clinical data in order to perform various functions.

Slide 19 Financial and resource management systems are systems that support the business functions of the organization or practice. An example would be an accounts payable system and a supporting technology would be claims administration. Financial and employee data are stored in these systems.

Slide 20 In a physician setting, the practice management system (PMS) provides a combination of financial and administrative functions. A PMS automates a physician office’s patient appointment, scheduling, registration, billing, and payroll functions (AHIMA, 2012).

Integration of the electronic medical record with the PMS is paramount in today’s health care environment. For example, the stage 1 meaningful use criteria, which came about via the Health Information Technology for Economic and Clinical Health (HITECH) Act, include requirements for the electronic collection and reporting of patient demographics along with clinical data.

Slide 21 This concludes Lecture a of Health Information Systems Overview.

In lecture a, an information system and its characteristics were defined, the types of information systems that support the health care enterprise requirements were identified, and the various types of technologies that support health care information systems were described.

Slide 22 No audio.

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Health IT Workforce Curriculum Health Management Information Systems 6 Version 3.0/Spring 2012 Health Information Systems Overview Lecture a

This material Comp6_Unit2a was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.