Health Care Information Systems

A Practical Approach for Health Care Management

Karen A. Wager, Frances W. Lee, John P. Glaser

• Publisher: Jossey-Bass
• Year: 2021
• ISBN:
  9781119853879
• Edition: 5
• Topic: Medizin
• Subtopic: Gesundheitswesen, Verwaltung & Pflege

The most up-to-date edition of the gold standard in health care information system references

In the newly revised Fifth Edition of Health Care Information Systems, veteran healthcare information management experts and educators Karen A. Wager and Frances Wickham Lee, along with nationally-recognized leader in health information technology, John P. Glaser, deliver a one-stop resource for graduate and upper-level undergraduate students to gain the knowledge and develop the skills they need to manage information and information systems technology in the new healthcare environment.

The latest edition sees its focus shift from the adoption of health care information systems and electronic health records to making effective use of health care data, information, and systems and optimizing their impact. New additions to this celebrated text include:

• Explorations of how health care information systems and information technology can be used to support national quality initiatives, value-based payment, population health management, and precision health and quality reporting
• Discussions of how issues like interoperability, electronic health record usability, and health IT safety are being (or not being) addressed
• Treatments of the roles played by data governance and analytics in clinical decision making and healthcare operations.

Filled with case studies, supplemental resources, and engaging examinations of critical areas in health care information system use, management, implementation, and support, Health Care Information Systems is an ideal reference for students taking courses in business administration, public health, health administration, medicine, health informatics and health care management.

PART ONE
Foundational Concepts

CHAPTER 1
Evolution of Health Care Information Systems in the United States

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LEARNING OBJECTIVES

• To define health care information systems and health information technology.
• To be able to discuss some of the most significant influences shaping current and future health information technology in the United States.
• To understand the roles national private sector and government initiatives have played in the advancement of health information technology in the United States.
• To be able to describe major events since the 1990s that have influenced the adoption of health care information technologies and systems.

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Today's health care providers and organizations across the continuum of care have come to depend on reliable health care information systems (HCIS) to manage their patient populations effectively while reducing costs and improving the quality of care. This chapter will explore some of the most significant influences shaping current and future HCIS in the United States. Certainly, advances in information technology affect HCIS development, but national private sector and government initiatives have played key roles in the adoption and application of the technologies in health care.

REVIEW OF KEY TERMS

Information technology (IT) is a broad term describing the combination of computer and electronic device hardware and software, local and internet network infrastructures, and data, including images, videos, and voice, across all industries. An information system (IS) is an arrangement of data, processes, people, and information technology that interact to collect, process, store, and provide as output the information needed to support the organization (Whitten & Bentley, 2007). Note that IT is a component of every information system, but the term IT includes technologies within and outside of an organization. From an organizational perspective, computer applications are components of information systems that are needed to support specific processes.

Throughout this textbook, IT is the preferred term for technologies that support health care information systems. The technologies, however, are not exclusive to health care. The term health IT (HIT) is often used in literature and other publications to describe IT when it is deployed in a health care environment. A health care information system (HCIS) includes the processes, people, and information technology that come together to provide health or health-related information to support the health care organization. Within health care organizations, computer applications are necessary to support both clinical and administration processes. Central to HCIS in hospitals and most physician office-based practices is an electronic health record (EHR) system that integrates clinical applications (provider order entry and documentation, medication administration, laboratory, decision support, telehealth, and many more) and administrative applications (scheduling, communication through e-mail or messaging, billing, and others). Clinical and administrative applications within HCIS can also be stand alone. Figure 1.1 describes some common clinical and administrative applications and shows a schematic representation of their associations with IT, HCIS, and EHR. Keep in mind that what is presented here is not the only way these terms are defined and classified. Other publications, for example, use these terms interchangeably, use alternate terms such as electronic medical record (EMR) versus EHR, or define the scope HCIS differently.

FIGURE 1.1 Schematic representation of relationships among IT, HCIS, EHR, and clinical applications

HISTORY AND EVOLUTION

Since the 1960s, the development and use of HCIS have changed dramatically with advances in technology and the impact of environmental influences and payment reform. In the 1960s to 1970s, health care executives invested primarily in administrative and financial information systems that could automate the patient billing process and facilitate accurate Medicare cost reporting. The administrative applications that were used were generally found in large hospitals, such as those affiliated with academic medical centers. These larger health care organizations were often the only ones with the resources and staff available to develop, implement, and support such systems. It was common for these facilities to develop their own administrative and financial applications in-house in what were then known as “data processing” departments. The systems themselves ran on large mainframe computers, which had to be housed in large, environmentally controlled settings. Recognizing that small, community-based hospitals could not bear the cost of an in-house, mainframe system, leading vendors began to offer shared systems, so called because they enabled hospitals to share the use of a mainframe with other hospitals. Vendors typically charged participating hospitals for computer time and storage, for the number of terminal connections, and for reports.

By the 1970s, departmental systems such as clinical laboratory or pharmacy systems began to be developed, coinciding with the advent of minicomputers. Minicomputers were smaller and more powerful than some of the mainframe computers and available at a cost that could be justified by revenue-generating departments. These clinical applications became more commonplace. Most systems were stand-alone and did not interface well with other clinical and administrative systems in the organization.

The 1980s brought a significant turning point in the use of HCIS, primarily because of the development of the microcomputer, also known as the personal computer (PC). The microcomputer was smaller, often as or more powerful, and far more affordable than a mainframe computer. Additionally, the microcomputer was not confined to large hospitals. It brought computing capabilities to a host of smaller organizations, including small community hospitals, physician practices, and other care delivery settings. Sharing information among microcomputers also became possible with the development of local area networks. The notion of best of breed systems was common; individual clinical departments would select th...