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Title: Computerized Health Care Systems


1
HPR 601
  • Computerized Health Care Systems
  • November-December 2000
  • Professor Ed Lamie

2
Chapter 1 - Information Technology - Figure 1.1
  • Clinical
  • Administrative
  • Strategic decision support
  • Electronic networking

3
Clinical
  • Computerized patient records
  • Medical decision support
  • Automated instrumentation
  • Clinical research and education

4
Administrative
  • Financial
  • Scheduling
  • Human resources
  • Materials management
  • Office automation

5
Strategic Decision Support
  • Planning and marketing
  • Financial forecasting
  • Resource allocation
  • Performance assessment
  • Outcomes measurement

6
Electronic Networking
  • Insurance billing and claims processing
  • Regional/national databases
  • Online purchasing
  • Provider networks

7
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

8
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

9
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

10
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

11
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)

12
Simple SystemWith Feedback
13
Health Services Organization Systems Network
14
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

15
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

16
Cybernetic System
17
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

18
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

19
Chapter 3Computer Hardware
  • Major components of a computer system
  • Central processing unit
  • Primary storage
  • Secondary storage
  • Input units
  • Output units
  • Classes of computers

20
Major Components of a Computer System
21
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

22
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

23
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

24
Input Units
  • Keyboards
  • Pointing devices mouse, rollerball, touch
    screen, light pen
  • Scanners, handwriting recognition devices, voice
    input

25
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

26
Typical Layout of a Disk
27
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

28
Chapter 4Computer Software
  • Programming languages
  • Language translators
  • System management software
  • Utility programs
  • Application software
  • Integrated v interfaced systems

29
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

30
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

31
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

32
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)

33
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

34
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

35
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

36
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)

37
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

38
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

39
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

40
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

41
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

42
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.

43
Intranet
  • Web-based corporate network (closed system)
  • need web server, browser, formatting language,
    TCP/IP communication protocols
  • firewall - filter against unauthorized access
  • Network Computers

44
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)

45
Database Advantages
  • Reduce Redundancy
  • Avoid Inconsistency
  • Share Data
  • Enforce Standards
  • Apply Security Restrictions
  • Maintain Data Integrity
  • Balance Conflicting Requirements
  • Data Independence

46
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

47
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

48
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

49
Database Features
  • Data Dictionary
  • Data Security
  • Privacy/ Confidentiality
  • Virus Protection
  • Backup/Recovery
  • Hypermedia Databases
  • Data Warehouses
  • Clinical Data Repositorymaster patient
    indexstandardization terminology format

50
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

51
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

52
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

53
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

54
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

55
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

56
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

57
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

58
Figure 7.4Information Security
  • Physical securityhardwaredata files
  • Technical safeguardspasswordsencryptionaudit
    logs
  • Management policieswritten security
    policyemployee trainingdisciplinary action for
    violations

59
Data Standardization
  • Required for electronic data exchange
  • Consider date of birth example in textbook
  • Projects to develop healthcare standardsANSI
    X.12HIBCHL7MEDIX

60
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

61
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

62
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

63
Chapter 8Systems Analysis
  • System development life cycle
  • Project organization
  • Systems analysis
  • System analysis tools
  • Selection of a design approach

64
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

65
Figure 8.2 Information Systems Project
Organization
66
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

67
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

68
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

69
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

70
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

71
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

72
Negotiation and Contracting
  • Delivery dates
  • Acceptance testing
  • Payment schedule
  • Warranties and guarantees
  • Software ownership
  • Interface responsibilities
  • Maintenance updates
  • Personnel training
  • Documentation
  • Expiration date cancellations

73
Role of Consultants
  • Facilitate selection process
  • Provide technical information
  • Provide outside perspective

74
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

75
Chapter 10 Managing Information Resources
  • System implementation
  • Operation and maintenance
  • System evaluation and improvement

76
Figure 10.1Information Systems Implementation
  • Equipment acquisition
  • Programming or software installation
  • Training
  • Database preparation
  • System testing
  • Final documentation

77
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

78
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

79
Healthcare CIO Attributes
  • Leadership ability
  • Vision/imagination
  • Business acumen
  • ? Technical competence

80
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

81
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

82
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

83
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

84
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

85
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

86
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

87
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

88
Major barriers to electronic patient records
  • Legal issues
  • need for universal standards
  • technological limitations (although diminishing)
  • user resistance

89
3 examples of CPRs (page 267)
  • City of Hope Medical Center
  • Stuyvesant Polyclinic
  • Dr. Kim Charles Meyers

90
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

91
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

93
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

94
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)

95
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?

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Figure 15.4 Three Levels of HIN
  • Extraorganizational Level Coordination/Managemen
    t
  • Interorganization Level Enterprise Management
  • Organizational Level Organizational Management
    Patient Management Patient Care

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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

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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

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Figure 16.5 Categories of Internet Applications
  • Improving internal communications
  • Distributing organizational information
  • Delivering educational programs

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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

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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

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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
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