HEALTH CARE

INFORMATION
SYSTEMS
A Practical Approach
for Health Care Management
Preface
• Having ready access to timely, complete, accurate, legible, and
relevant information is critical to health care organizations, providers,
and the patients they serve.
• The need for quality information in health care has never been
greater, particularly as this sector of our society strives to provide
quality care, contain costs, and ensure adequate access.
• as the demand for information has increased, we have seen advances
in information technology—such advances have the potential to
radically change how health care services are accessed and delivered
in the future.
• To not only survive but thrive in this new environment, health care
executives must have the knowledge, skills, and abilities to effectively
manage both clinical and administrative information within their
organizations and across the health care sector.
• Within the next decade or two the predominant model for maintaining
health care information will shift from the current, largely paper-based
medical record system, in which information is often incomplete, illegible,
or unavailable where and when it is needed, to a system in which the
patient’s clinical information is integrated, complete, stored electronically,
and available to the patient and authorized persons anywhere, anytime—
regardless of the setting in which services are provided.
Purpose
• To prepare future health care executives with the
knowledge and skills they need to manage
information and information systems technology
effectively in this new environment.
Coverage
This course is organized into four major sections:
1. Part One: “Health Care Information” (Chapters One
through Three)
2. Part Two: “Health Care Information Systems” (Chapters
Four through Seven)
3. Part Three: “Information Technology” (Chapters Eight
through Ten)
4. Part Four: “Senior Management IT Challenges” (Chapters
Eleven through Fifteen)
Part One, “Health Care Information,” is designed to be a health
information primer for future health care executives.

• Fundamental characteristics of the information and

processes such solutions are designed to support (Chapter
One)
• Data quality (Chapter Two)
• The laws, regulations, and standards that govern the
management of information (Chapter Three) in health care
organizations.
Part Two, “Health Care Information Systems”
• provides the reader with an understanding of how health care
information systems have evolved and the major clinical and
administrative applications in use today (Chapter Four).
• Chapter Five has been entirely revised from the first edition. It
provides up-to-date information on the adoption and use of a range
of clinical information systems, including systems for electronic
medical records and health records, computerized provider order
entry (CPOE), medication administration using bar coding,
telemedicine, and telehealth.
• the process that a health care organization typically goes through in
selecting health care IS(Chapter Six)
• and implementing (Chapter Seven) a health care information system.
 Part Three, “Information Technology,” turns to the technology
underlying these systems, that is,
how they work.

• basic understanding of information technology concepts such as

architectures and of the core technologies needed to support health
care information systems in terms of databases and networks
(Chapter Eight),
• standards (Chapter Nine),
• and security (Chapter Ten).
Part Four, “Senior Management IT Challenges,” provides a top-level view of what
it takes to effectively manage, budget, govern, and evaluate information technology
services in a health care organization.

• Chapter Eleven introduces the reader to the IT function, the services

typically found in an IT department in a large health care organization,
and the types of professionals and staff generally employed there.
• organization’s IT strategy (Chapter Twelve),
• IT budgeting and governance (Chapter Thirteen)
• management’s role in major IT initiatives (Chapter Fourteen),
• and methods for evaluating return on investment or the value of
health care information systems to the organization, the provider, and
the patient (Chapter Fifteen).
IT CHALLENGES IN HEALTH CARE
• The health care industry is one of the most information intensive and
technologically advanced in our society. Yet if you asked a roomful of
health care executives and providers from a typical health care
organization if they have easy access to timely, complete, accurate,
reliable, and relevant information when making important strategic or
patient-care decisions, most would respond with a resounding no.
• Despite the need for administrative and clinical information to
facilitate the delivery of high-quality, cost-effective services, most
organizations still function using paper-based or otherwise insufficient
information systems.
Large Numbers of Small Organizations
• The health care industry includes large numbers of very small
organizations
• Small organizations often find it difficult to fund information system
investments.
• The small size of these organizations also makes it difficult for
software and hardware vendors to make money from them.
Incentive Misalignment
• Many health care information system applications have the potential
to improve the quality of care. CPOE can reduce adverse drug events.
Reminder systems in the electronic medical record can improve the
management of the chronically ill patient.
• Improvements in care are worthy goals, and providers may opt to
bear the costs of the systems to gain them. In truth, however, the
provider does not always reap a reward for such actions.
• The insurance payment mechanism may not provide a financial
reward for the provider who has fewer medical errors. There may be
no direct financial reward for better management of the diabetic.
Fragmented Care
• Most of us, over the course of our lives, will seek care in several
health care organizations. At times this care will also occur in various
regions of the country. The data about our care are not routinely
shared across the organizations we use. And the organizations do not
have to be on different sides of this country for this failure to occur;
they may be across the street from each other.
• This failure to share data means that any given provider may not be
fully aware of allergies, history, and clinical findings that were
recorded in other settings. Medical errors and inefficiencies—for
example, unnecessary repeats of tests—can result.
fundamental problems of implementing an
integrated data repository
• The clinical data typically reside in multiple care settings, potentially
dozens or hundreds of settings. Implementing the IT infrastructure
needed to support the resulting “pattern” of system interconnections
that could access these data may prove to be too expensive or
challenging.
• The desired data are randomly dispersed. The site where the patient
is currently receiving care may not know whether other data about
this patient exist or whether these other data are relevant.
Complexity of the Process of Care
• If one views the process of care as a manufacturing process (sick
people are inputs, a “bunch of stuff” is done to them, and the outputs
are better or well people), it is arguable that medical care is the most
complex manufacturing process that exists. This high level of
complexity has three major sources: the difficulty of defining the best
care, care process variability, and process volatility.
Our current ability to define the best care process for treating a
particular disease or problem can be limited. Process
algorithms, guidelines, or pathways are often:
• Based on heuristics (or rules of thumb), which makes consensus within and
between organizations difficult or impossible. Available facts and science
are often insufficient to define a consistent, let alone the most effective,
approach. As a result, competing guidelines or protocols are being issued
by payers, provider organization committees, and provider associations.
• Condition or context specific. The treatment of a particular acute illness,
for example, can depend on the severity of the illness and the age and
general health of the patient.
• Reliant on outcome measurements with severe limitations. For example,
these measures may be insensitive to specific interventions, be proxies for
“real” outcomes, or reflect the bias of an organization or researcher.
Complexity of Health and Medical Data
• A patient’s health status and medical condition are difficult to
describe using comprehensive, coded data. Several factors contribute
to this problem.
Nature of Provider Organizations
• Health care organizations, particularly providers, have attributes that can
hinder information system adoption.
• Provider organizations are unusual in that they have two parallel power
structures: the administrative staff and the medical staff. The medical
staff side is often loosely organized and lacks an organizational chart with
clear lines of authority.
• This two-part structure leads to a great deal of negotiating and coalition
building. Negotiation is an aspect of any major decision within a provider
organization, including decisions about health care information systems.
This can result in very long decision-making cycles; reaching an
agreement on an IT vendor can take months or years.
RISING TO THE CHALLENGES
• this discussion of complexity and structure to lead the reader to the edge of
inconsolable despair, only to an understanding of the landscape. Despite
the complexity described here, significant progress may be made. Health
care is carried out by many small organizations, but advances are being
made in developing IT applications that are both inexpensive and robust.
Efforts are under way to address the problem of misaligned incentives. The
care process is complex, but the appropriate way to manage many diseases
(diabetes, for example) is well understood. Medical data are complex, but
there are established data standards for diseases, procedures, and
laboratory tests. Care crosses boundaries, but an electronic medical record
that has most of a patient’s data is better than a paper record that has most
of a patient’s data.
• Both the consumers and suppliers of health care information system
products and services struggle to develop and implement systems
that improve care and organizational performance. And their efforts
are often successful. These efforts confront the health care industry’s
core challenges—size, fragmentation, misaligned incentives, and
complexity of care processes and medical data.
• Health care consumers, payers, and purchasers are demanding that
more be done to ensure that health care providers are equipped with
the information needed to decrease administrative costs, improve
access to care, and improve patient safety, in spite of the significant
industry challenges. We hope you will find this book to be a useful
resource in ensuring that your health care organization and its
information systems are well equipped to handle patients’, providers’,
administrators’, and all other stakeholders’ health care information
needs.