Health Care Information Systems: A Practical Approach for Health Care Management

✍ Scribed by Wager, Karen A;Lee, Frances Wickham;Glaser, John P

• Publisher: Jossey-Bass
• Year: 2013
• Tongue: English
• Leaves: 738
• Category: Library

✦ Synopsis

This most widely used textbook in the field has been thoroughly revised and updated to reflect changes in the health care industry and the renewed focus on health care information technology initiatives. Two new chapters cover Federal efforts to enhance quality of patient care through the use of health care information technology and strategy considerations. Additionally, reflecting the increased focus on global health, the book features an international perspective on health care information technology. Case studies of organizations experiencing management-related information system challenges have been updated and several new cases have been added. These reality-based cases are designed to stimulate discussion among students and enable them to apply concepts in the book to real-life scenarios. The book's companion Web site features lecture slides, a test bank, and other materials to enhance students' understanding.

✦ Table of Contents

Cover......Page 1
Title page......Page 5
Copyright page......Page 6
Contents......Page 7
Tables, Figures, and Exhibits......Page 13
Foreword......Page 17
Dedication......Page 20
Preface......Page 21
Acknowledgments......Page 33
The Authors......Page 35
PART ONE: Health Care Information......Page 39
CHAPTER 1: Introduction to Health Care Information......Page 41
Definitions of Health Care Information......Page 42
Health Care Data Framework......Page 44
Internal Data and Information: Patient Specific—Clinical......Page 46
Purpose of Patient Records......Page 47
Content of Patient Records......Page 48
Organization of Record Content......Page 52
Overview of a Patient Encounter......Page 54
Internal Data and Information: Patient Specific—Administrative......Page 59
Data Needed to Process Reimbursement Claims......Page 60
Other Uniform Data Sets......Page 63
Internal Data and Information: Patient Specific—Combining Clinical and Administrative......Page 66
ICD-10......Page 67
CPT......Page 69
Internal Data and Information: Aggregate—Clinical......Page 71
Specialized Registers......Page 72
Medicare Cost Reports......Page 73
Internal Data and Information: Aggregate—Combining Clinical and Administrative......Page 74
Outcome Measures and Balanced Scorecards......Page 75
Comparative Health Care Data Sets......Page 76
Summary......Page 81
Key Terms......Page 82
Learning Activities......Page 83
References......Page 84
CHAPTER 2: Health Care Data Quality......Page 87
Data Versus Information......Page 88
Problems with Poor-Quality Data......Page 89
Ensuring Data and Information Quality......Page 92
MRI Principles of Health Care Documentation......Page 93
AHIMA Data Quality Model......Page 94
Types and Causes of Data Errors......Page 97
Using IT to Improve Data Quality......Page 98
Learning Activities......Page 101
References......Page 103
CHAPTER 3: Health Care Information Regulations, Laws, and Standards......Page 105
Licensure......Page 106
Certification......Page 108
Accreditation......Page 109
Patient Safety Organizations......Page 117
Legal Aspects of Managing Health Information......Page 119
The Health Record as a Legal Document......Page 120
Retention of Health Records......Page 121
Privacy and Confidentiality......Page 123
Release of Information......Page 128
Key Terms......Page 134
Learning Activities......Page 135
References......Page 136
PART TWO: Health Care Information Systems......Page 139
CHAPTER 4: History and Evolution of Health Care Information Systems......Page 141
Definition of Terms......Page 142
History and Evolution......Page 145
1960s: Billing Is the Center of the Universe; Managing the Money; Mainframes Roam the Planet......Page 148
1970s: Clinical Departments Wake Up; Debut of the Minicomputer......Page 150
1980s: Computers for the Masses; Age of the Cheap Machine; Arrival of the Computer Utility......Page 151
1990s: Round One of Health Care Reform; Advent of the Internet......Page 153
2000 to 2010: Health Care IT Arrives; Patients Take Center Stage......Page 157
2010 to Today: The Era of Accountability, Transparency, and Change; Affordable Care Act, Meaningful Use, and ICD-10 All Kick in......Page 161
Summary......Page 165
Learning Activities......Page 166
References......Page 167
CHAPTER 5: Clinical Information Systems......Page 171
The Electronic Health Record......Page 172
EHR Definition and Functions......Page 173
EHR Current Adoption and Use......Page 176
Factors Influencing EHR Adoption......Page 178
Value of EHR Systems......Page 179
Other Major Hcis Types......Page 183
Computerized Provider Order Entry......Page 186
Medication Administration Systems Using Bar-Coding Technology......Page 192
Telemedicine and Telehealth......Page 194
Personal Health Record and Patient Portals......Page 197
Fitting Applications Together......Page 200
Financial Barriers......Page 202
Organizational and Behavioral Barriers......Page 203
Technical Barriers......Page 204
Strategies for Overcoming Barriers......Page 205
Learning Activities......Page 206
References......Page 207
CHAPTER 6: Federal Efforts to Enhance Quality of Patient Care through the Use of Health Information Technology......Page 217
An Overview of the Legislation......Page 219
Meaningful Use: Definition and Criteria......Page 223
Role of Office of the National Coordinator for Health Information Technology and CMS......Page 226
Health Care Reform: New Modes of Care and Payment Reform......Page 227
Accountable Care Organizations......Page 228
Patient-Centered Medical Homes......Page 229
New Forms of Payment for Health Services Delivery......Page 231
Health Information Exchange......Page 232
Nationwide Health Information Network......Page 233
The HIE Lessons......Page 234
Information Technology Ramifications of New Models of Care and Payment Reform......Page 236
Accurately Identify and Link Patient Data......Page 237
Other Important IT Considerations......Page 238
Summary......Page 240
Key Terms......Page 241
Learning Activities......Page 242
References......Page 243
CHAPTER 7: System Acquisition......Page 247
System Acquisition: A Definition......Page 248
Systems Development Life Cycle......Page 249
System Acquisition Process......Page 252
Establish a Project Steering Committee......Page 256
Define Project Objectives and Scope of Analysis......Page 257
Screen the Marketplace and Review Vendor Profiles......Page 258
Determine System Goals......Page 259
Determine and Prioritize System Requirements......Page 260
Develop and Distribute the RFP or RFI......Page 261
Explore Other Acquisition Options......Page 263
Evaluate Vendor Proposals......Page 266
Prepare a Summary Report and Recommendations......Page 270
Project Management Tools......Page 271
Things That Can Go Wrong......Page 273
Summary......Page 275
Learning Activities......Page 276
References......Page 277
CHAPTER 8: System Implementation and Support......Page 279
Organize the Team and Identify a Champion......Page 281
Determine Project Scope and Expectations......Page 283
Establish and Institute a Project Plan......Page 285
Managing the Organizational Aspects......Page 295
Create an Appropriate Environment......Page 296
Know Your Culture and Do Not Underestimate User Resistance......Page 297
Allocate Sufficient Resources......Page 300
Provide Adequate Training......Page 301
Manage Unintended Consequences......Page 302
Establish Strong Working Relationships with Vendors......Page 303
System Support and Evaluation......Page 304
Summary......Page 305
Learning Activities......Page 306
References......Page 307
PART THREE: Information Technology......Page 309
CHAPTER 9: Technologies That Support Health Care Information Systems......Page 311
Information Technology Adoption Challenges......Page 312
Database Models......Page 317
Database Operations......Page 318
Clinical Data Repositories, Data Warehouses, and Data Marts......Page 320
Networks and Data Communications......Page 322
Types of Networks......Page 323
Network Components and Performance......Page 324
Network Protocols and Standards......Page 327
Cloud Computing......Page 331
Remote Access Technologies......Page 332
The Internet......Page 333
Intranets and Extranets......Page 336
Web Applications in Health Care......Page 337
Clinical and Managerial Decision Support......Page 341
Decision-Support Systems......Page 342
Artificial Intelligence......Page 343
Information Systems Architecture......Page 345
A Definition of Architecture......Page 346
Architecture Perspectives......Page 347
Architecture Examples......Page 348
Observations about Architecture......Page 349
Key Terms......Page 351
References......Page 353
CHAPTER 10: Health Care Information System Standards......Page 355
Standards Development Process......Page 356
Classification Standards......Page 360
National Drug Codes......Page 361
Vocabulary and Terminology Standards......Page 362
Logical Observation Identifiers Names and Codes......Page 363
RxNorm......Page 364
Data Interchange Standards......Page 366
HL7 EHR-S Functional Model......Page 375
ASTM Health Record Content Standards......Page 376
Continuity of Care Document......Page 378
Federal Initiatives Affecting Health Care IT Standards......Page 379
Summary......Page 383
Learning Activities......Page 384
References......Page 385
CHAPTER 11: Security of Health Care Information Systems......Page 389
The Health Care Organization’s Security Program......Page 390
Threats to Health Care Information......Page 392
Overview of the Hipaa Security Rule......Page 393
Outline of the Hipaa Security Rule......Page 395
Hitech Expansion of the Hipaa Security Rule......Page 399
Administrative Safeguards......Page 400
Risk Analysis and Management......Page 401
Chief Security Officer......Page 403
Contingency, Business Continuity, and Disaster Recovery Planning......Page 404
Contingency Plan......Page 405
Physical Safeguards......Page 407
Physical Access Controls......Page 408
Workstation Security......Page 409
Access Control......Page 410
Entity Authentication......Page 412
Data Encryption......Page 416
Firewall Protection......Page 419
Security in a Wireless Environment......Page 420
Remote Access Security......Page 422
Summary......Page 425
Learning Activities......Page 426
References......Page 427
PART FOUR: Senior Management IT Challenges......Page 431
CHAPTER 12: Organizing Information Technology Services......Page 433
Information Technology Functions......Page 434
Core Functions......Page 435
IT Senior Leadership Roles......Page 438
IT Staff Roles......Page 448
Staff Attributes......Page 451
Recruitment and Retention of IT Staff......Page 452
Definition and Formation of Major IT Units......Page 454
Degree of IT Centralization or Decentralization......Page 457
Core IT Competencies......Page 459
Departmental Attributes......Page 460
In-House versus Outsourced IT......Page 461
Budget Development and Resource Allocation......Page 464
IT Service Levels......Page 465
Key Terms......Page 472
References......Page 473
CHAPTER 13: IT Alignment and Strategic Planning......Page 475
It Planning Objectives......Page 476
Formulation......Page 478
Implementation......Page 479
Vectors for Arriving at It Strategy......Page 480
IT Strategies to Continuously Improve Core Processes and Information Management......Page 481
IT Strategies Based on Assessment of Strategic Trajectories......Page 483
The It Asset......Page 484
Applications......Page 485
Data......Page 486
A Normative Approach to Developing Alignment and It Strategy......Page 487
Strategy Discussion Linkage......Page 488
IT Liaisons......Page 489
Synthesis of Discussions......Page 492
Planning Methodologies......Page 496
Persistence of the Alignment Problem......Page 497
Alignment at Maturity......Page 498
IT Alignment and Strategy Summary......Page 500
Characteristics of Strategic Thinking......Page 501
Summary......Page 502
References......Page 503
CHAPTER 14: Strategy Considerations......Page 505
Broad Leverage......Page 506
Initiative-Specific Strategies......Page 507
Strategy Evolution......Page 509
Continuous Improvement of Processes......Page 510
Leveraging of Data......Page 511
Observations about Strategy Evolution......Page 512
Governing Concepts......Page 513
Architecture Becomes Very Important......Page 514
Foundation Replacement......Page 515
The Competitive Value of It......Page 516
Sources of Advantage......Page 517
Observations on IT Use for Competitive Advantage......Page 519
Summary of the Competitive Value of IT......Page 525
Learning Activities......Page 526
References......Page 527
CHAPTER 15: IT Governance and Management......Page 529
It Governance......Page 530
Governance Characteristics......Page 532
Linkage of Governance to Strategies......Page 533
IT, User, and Senior Management Responsibilities......Page 535
Specific Governance Structures......Page 540
It Effectiveness......Page 545
It Budget......Page 551
Basic Budget Categories......Page 552
IT Budget Development......Page 554
Learning Activities......Page 557
References......Page 558
CHAPTER 16: Management’s Role in Major IT Initiatives......Page 559
Managing Change Due To It......Page 560
Types of Organizational Change......Page 561
Effecting Organizational Change......Page 563
Managing It Projects......Page 566
Project Roles......Page 567
Project Committees......Page 570
Key Project Elements......Page 572
Lack of Belief in the Project......Page 580
Organizational Inertia......Page 581
Lack of Candor......Page 582
Project Complexity......Page 583
Initiative Undernourishment......Page 584
Invisible Progress......Page 585
Lack of Technology Stability and Maturity......Page 586
How to Avoid These Mistakes......Page 587
Summary......Page 589
References......Page 590
CHAPTER 17: Assessing and Achieving Value in Health Care Information Systems......Page 593
Both Tangible and Intangible......Page 594
Variable......Page 596
Diverse across Proposals......Page 597
Different Analyses for Different Objectives......Page 598
Sources of Value Information......Page 603
Comparing Different Types of Value......Page 604
Tactics for Reducing the Budget......Page 607
Common Proposal Problems......Page 609
Make Sure the Homework Was Done......Page 612
Increase Accountability for Investment Results......Page 613
Conduct Postimplementation Audits......Page 616
Shorten the Deliverables Cycle......Page 617
Why IT Fails to Deliver Returns......Page 618
Asking the Wrong Question......Page 620
Not Stating Investment Goals......Page 621
Not Managing Outcomes......Page 622
Leaping to an Inappropriate Solution......Page 623
Factors That Hinder Value Return......Page 624
The Investment-Performance Relationship......Page 625
The Value of the Overall Investment......Page 626
IT as a Commodity......Page 627
Summary......Page 628
Learning Activities......Page 629
References......Page 630
CHAPTER 18: Health IT Leadership: A Compendium of Case Studies......Page 633
Background Information......Page 635
Information Systems Challenge......Page 636
Discussion Questions......Page 637
Discussion Questions......Page 638
Background Information......Page 639
Information Systems Challenge......Page 640
Background Information......Page 641
Information Systems Challenge......Page 642
Background Information......Page 644
Discussion Questions......Page 645
Information Systems Challenge......Page 646
Background Information......Page 647
Information Systems Challenge......Page 648
Background Information......Page 649
Discussion Questions......Page 650
Information Systems Challenge......Page 651
Discussion Questions......Page 652
Information Systems Challenge......Page 653
Background......Page 655
Information Systems Challenge......Page 656
Discussion Questions......Page 657
Information Systems Challenge......Page 658
Background Information......Page 659
Information Systems Challenge......Page 660
Information Systems Challenge......Page 661
Discussion Questions......Page 662
Information Systems Challenge......Page 663
Background Information......Page 664
Information Systems Challenge......Page 665
Background Information......Page 666
EHR Project Plan......Page 667
Background Information......Page 672
Information Technology and Clinical Operations at Beth Israel Deaconess Medical Center......Page 674
Mount Auburn Hospital: Physician Order Entry......Page 675
University Health Network: The MOE-MAR Initiative......Page 676
Secrets of HIE Success Revealed: Lessons from the Leaders......Page 677
The Health Care IT Industry......Page 679
IT Spending Relative to Other Industries......Page 680
Structure of the Health Care Market......Page 682
Major Suppliers of Health Care IT Products and Services......Page 684
Periodicals......Page 685
Books......Page 686
Health Care IT Associations......Page 687
College of Healthcare Information Management Executives (CHIME)......Page 688
Other Industry Groups and Associations......Page 689
References......Page 690
APPENDIX B: Sample Project Charter......Page 691
Foreword......Page 692
Project Objectives......Page 693
Vision Statement......Page 694
Major Features......Page 695
Scope of Initial Release......Page 696
Out of Scope......Page 697
Timeline......Page 698
Scope Change Management......Page 699
Project Work Paper Organization and Coordination......Page 701
APPENDIX C: International Adoption and Use of Health Information Technology......Page 703
The Adoption and Use of Health IT from Various Regions of the World......Page 704
In Northern Europe: Norway, Sweden, Finland, and Denmark......Page 705
In Western Europe: United Kingdom and Germany......Page 708
South Pacific: Australia and New Zealand......Page 709
Asia: Japan......Page 710
North America: Canada and the United States......Page 711
Lessons from Global Leaders......Page 712
Conclusion......Page 715
References......Page 716
Index......Page 719