Lesson 1


Please read the lesson below and click the assignment link when you are done.  Upon completion of this lesson you will be able to discuss the many changes in healthcare that dictate the need for informatics as a discipline, and define the different types of information systems their abilities and requirements.


Introduction to Health Information Systems/Informatics

      Delivering health services is an information intensive process.  Quality patient care relies upon  careful documentation of each patients medical history, medical condition, health status, and treatment plans.  Effective healthcare information systems can provide up-to-the-minute information on clinical and administrative matters, and they can process the information to allow doctors and healthcare executives to make decisions.  In addition healthcare information systems can provide:

                        1.  computerized patient records

                        2.  centralized patient data

                        3.  enhanced intra-organizational communication and data sharing.

     The healthcare industry is in the midst of a period of great change.  Pressures for improving the management of healthcare is growing as health services organizations face increasing demands to lower the cost of healthcare services, improve the quality of healthcare, and expand the access to healthcare.  Market-driven healthcare reform has led to a rapid expansion of managed care, development of integrated delivery systems , and changes in systems of payment of services.  As a result, healthcare service organizations have grown larger and more complex, and information systems must keep pace with the organizational complexity and continued advances in medical technology.

    Before we began to examine the different categories of health information systems a careful distinction should be drawn between data and information. Data is raw facts collected by an organization.  For example, the demographic information that is collected for billing purposes when you are admitted into a hospital.  Information, on the other hand, is data that has been processed and analyzed so that the results are useful to clinicians and managers.

    The four different categories of health information systems are as follows:

                         1.  Clinical Information Systems

                         2.  Operational administrative systems support

                         3.  Strategic decision-support

                         4.  Electronic networking applications

Clinical Information systems - Provide information for use in strategic planning and management and support patient care.  Applications include automated medical instrumentation, the electronic patient record, computer-aided diagnosis and treatment planning, and information systems that support clinical research and education.

Operational administrative systems support - Provides support for non-clinical care activities.  Examples of the systems that fall into this category are payroll, inventory, outpatient clinic scheduling, financial information systems, etc.

Strategic decision-support systems -  Provides support for the executive management team in strategic planning, managerial control, performance monitoring, and outcomes assessment.  These systems retrieve information from clinical and administrative systems as well as external data on community health, market-area demography, and activities of competitors. 

Electronic networking applications -  Allows organizations to integrate (share and exchange information) with one another.  Healthcare organizations engage in electronic data interchange with external organizations for activities such as insurance billing and claims processing, accessing clinical information from regional and national databases, and communicating among providers in an integrated delivery systems.


Historical Overview of Healthcare Systems

1960s - First computers in healthcare.  A small number of hospitals began to automate administrative operations such as payroll, patient accounting, and the retrieval of abstracts of inpatient medical records (these systems contained limited information and were operated on a post-discharge, retrospective basis).  Little attention was given to the development of clinical information systems to support patient care.  These systems were developed by analysts and computer programmers and were run on large expensive centralized computers called "mainframes."

1970s - Expanded the use of information systems in hospitals and marked the beginning of limited applications in other organizational settings such as, clinics, physician practices, and long-term facilities.  During this period computer became much smaller and less expensive, and some vendors began to develop application software packages (computer programs that could be used by hospitals, clinics, or physician's offices that purchased the system).  Most of these software packages supported administrative operations.  However, some clinical systems were developed as well for hospital laboratories, radiology departments, and pharmacies.

1980s - Powerful and inexpensive personal computers (PCs) were developed.  These PC's had computer power and storage capacity that equaled or exceeded the large mainframe systems of the 1960s and 1970s.  Electronic data networks in which personal computers and larger systems could be inked together to share information on a decentralized basis was developed during this period.  In addition the number of vendors increased and a much larger array of products became available for both administrative and clinical support.  The use of personal computers in physician offices for practice management became common place.

1990s - This period marked a dramatic change in healthcare with the advent of market-driven healthcare reform and the rapid expansion of managed care.  Much greater attention was given to the development of clinical information systems and  strategic decision-support systems to assist providers in achieving a balance between costs and quality in the delivery of care.  Consequently, the employment of information technology became more important than ever during this time.

Managed Care

A new paradigm for the delivery of healthcare services resulting from the rapid escalation in the costs of healthcare.

           Managed care is a  system of providing and paying for medical care that includes a panel of providers who 

                agree to deliver services at an agreed upon fee.  Financial incentives are included for patients to use the 

                identified providers that make up the panel.  (Wozmak 1995)

Integrated Delivery Systems (IDS)

In responding to managed care, many health service organizations have come together to form integrated delivery systems.  An IDS is a network of hospitals, physicians, and other healthcare providers that is accountable for the costs and clinical outcomes of a population.  IDS systems are linked together by information about the patients being served.  The success of an integrated delivery systems will be dependent upon the ability for healthcare organization to provide good clinical, financial, and customer service information from those who purchase health services.

Information Technology Today

Healthcare organization in this environment of change are in the process of deploying sophisticated information systems that will support clinical operations and strategic management.  The following is a list of some of the priorities for system development:

1.  Development of the Electronic Patient Record/Computerized Patient Record - In 1991 the Institute of Medicine formed a committee calling for the development of a national system of a computer-based patient record (CPRs).  A CPR is a patients entire medical record captured on the computer.  The availability of a electronic patient record would ultimately improve the quality of patient care, the productivity of healthcare workers would be enhanced since demographic and medical information would need to be captured and entered into the system only once, information on insurance coverage and eligibility would be available electronically to physicians, hospitals, and other providers of health services, etc.  In addition data captured in such a system would be useful in health services research and policy formation.  

Before a system supporting a CPR can be put into place many problems would need to be addressed including funds for developmental cost and systems to protect the confidentiality of patient information.  Healthcare organizations around the world are in the process of developing or planning to build a data warehouse containing complete clinical, financial, and administrative data on every patient.  These repositories of patient records will be centralized in one large computer file and will be virtual systems that will be distributed across a number of departmental systems in a hospital.  Data warehouses require solid computer architecture in their design and must employ industry-wide standards for data definition and coding.

2.  Enterprise-wide computer networks to support integrated delivery systems - Integration of diverse systems developed by provider organizations who have come together through mergers, acquisitions, or joint ventures.  This type of systems must include an electronic network infrastructure to facilitate sharing of clinical and financial information among members of the integrated delivery system.  The members include, physicians, hospitals, ambulatory care centers, home health service agencies, long-term care facilities, etc.  

3.  A shift from inpatient systems to ambulatory systems - With the advent of managed care and market-based reform there has been a shift from acute inpatient care to services delivered on an outpatient basis.  As a result, healthcare organizations are placing an increased emphasis on the development of ambulatory care information systems.  An ambulatory care information system would support advanced system support to patient care and strategic management in the multiple clinics operated by a hospital/care center.  All clinic sites would be linked electronically to a centralized database (data warehouse).  Again, this type of system will enable  physicians and staff members at any clinic to access patient records from other sites, schedule appointments with other physicians, and schedule laboratory and radiology procedures at the central facility.  Data from the information system will be used to generate performance reports and other key indicators of cost and quality.

4.  Decision Support Systems - Will enable providers to access the health risks of the populations they serve or plan to serve, forecast the costs and revenues anticipated from contracts with HMOs and exclusive provider arrangements, measure clinical outcomes of services provided, and continuously improve service quality in order to compete for successful business in the medical market-place.  Vendors are developing software products for decision-support purposes.  The software will be able to search databases and build profiles of resource consumption for a typical patient for a given procedure, etc.                                                                                                                                                                          

Assignment 1