departmental information systems and management information systems in healthcare organizations
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Departmental Information Systems &
Management Information Systems in Healthcare
Organizations
NawananTheera-Ampornpunthttp://www.slideshare.net/nawanan
Parts of this material were based on materials developed by Duke University, funded by the Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services under
Award Number IU24OC000024 (Health IT Workforce Curriculum v.2.0, Component 6/Unit 9-1).
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OutlineDepartmental Information Systems Hospital departments Nature of enterprise information systems Departmental IS categories Integration & interfaces System acquisition decisionsManagement Information Systems (MIS) Concepts of MIS Common MIS in healthcare organizations
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Class Exercise 1 Name some departments or
organizational units of a hospital that you can think of.
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Examples of Hospital Departments Clinical departments
Pediatrics (children) Ophthalmology (eye) Psychiatry (mental health) Nursing Pathology (lab) Radiology (x-rays) Anesthesiology Family medicine Physical medicine &
rehabilitation Surgery
Obstetrics/Gynecology -OB/GYN (childbirth & woman’s health)
Otolaryngology (Ear, nose, throat - ENT)
Orthopedics (bone diseases)
Internal medicine Emergency medicine Community medicine Pharmacy Operating rooms Outpatient departments Inpatient wards
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Examples of Hospital Departments Administrative departments
General administration office Hospital director’s office Human resources Finance Procurement & material management department Public relations Policy & planning Medical education Graphics design & media Academic affairs Student affairs Library Quality improvement department IT/Informatics etc.
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Health Care Information System (HCIS) Information system used within a health care
organization Facilitates communication Integrates information Documents health care interventions Performs record keeping Otherwise supports the functions of the
organizationShortliffe, E, Cimino J, eds: Biomedical informatics: Computer
Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Hospital Information System Information system used within a hospital Sometimes divided into
Front Office (Clinical information systems) Back Office (Management information
systems)
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Enterprise-wide Information Systems
Shortliffe, EH, Blois, MS., The Computer Meets Medicine and Biology: Emergency of a Discipline. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
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Class Exercise 2 Choose 3-5 hospital departments and
discuss their specific information needs and circumstances
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Hospital Information System (HIS) Information system used within a hospital Sometimes divided into
Front Office (Clinical information systems) Back Office (Management information
systems)
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Some characteristicsFront Office
Focuses on patient care
Patient records should be accessible hospital-wide to clinical departments
Time may be critical
Back Office
Performs administrative functions
Some information is specific to the individual department
Often is not very time-dependent
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HIS Components Patient management and billing Care delivery and clinical documentation Clinical decision support Department management Financial and resource management
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Patient Management and Billing Systems that support patient
management functions Example
Patient identification Supporting technology
Master patient index Houses centralized database
Patient financial, demographic, registration and location data
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Care Delivery and Clinical Documentation
Systems that support the delivery of the care and documentation of that care Example
Clinical information systems, EHRs Supporting technology
Electronic clinical order entry and results reporting Houses centralized database
Patient clinical dataVogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In:
Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Clinical Decision Support Systems that support the clinical staff with
data interpretation and decision-making Example
Medication Administration System Supporting technology
Bar-code medication administration (BCMA)
Accesses patient and other databases
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Financial and Resource ManagementSystems that support business
functions Example
Accounts Payable System Supporting technology
Claims administration
Houses centralized database Financial and employee data
Health IT Workforce Curriculum Version 2.0/Spring 2011
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4 Ways IT Can Help Health Care
• Business Intelligence
• Data Mining/Utilization
• MIS• Research
Informatics• E-learning
• CDSS• HIE• CPOE• PACS• EHRs
Enterprise Resource Planning (ERP)• Finance• Materials• HR
• ADT• HIS• LIS• RIS
Strategic
Operational
ClinicalAdministrative
Position may vary based on local context
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Department Management Systems that support a department’s information
needs Example
Health Information Management Department systems Supporting technology
Electronic Document Management Systems Supplies data to patient databasesVogel, LH, Perreault, LE., Management of Information in Healthcare
Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Departmental information system
Supports specific needs of each department
Often designed to fit best with each department’s unique workflows & circumstances
Usually a small system used by a few users of one or two small departments
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Class Exercise 3 What are some issues you can think of
when developing an information system for a specific department
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Issues of Departmental IS Data integration (data sharing) Silos of information Process (workflow) integration In other words, standardization vs.
customization Implementation strategies (build or buy) Sustainability & system maintenance
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Integration Arrangement of an organization’s
information systems Efficient and effective communication Bring together related parts into a single
system
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Application Integration Patient management and billing
Patient tracking Department management
Electronic document management Care delivery and clinical documentation
Order entry and results reporting
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Application Integration Clinical decision support
Computer-based physician order-entry Financial and resource management
Provider profiling
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Systems Integration Strategies Data preservation Separate information management plan
components for Data management Applications and business logic User interface
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Key Components of Enterprise Integration Master person index Single sign-on Context management Common code sets Data warehouse
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Critical Integration Elements Information is available when and where it is
needed Users must have an integrated view Data must have a consistent interpretation Adequate security must be in place
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Data and Process Integration Data integration
Interface engine Process integration
Operational workflow Human organizational systems
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Interface Engine Translates and formats data for exchange Controls data flows between applications Central connecting point for all interfaces
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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HL7 Messaging StandardHealth Level Seven (HL7)Message standardSupports clinical practiceMove data in standard
formats
Health IT Workforce Curriculum Version 2.0/Spring 2011
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From Islands of Information to Meaningful Use
Health IT Workforce Curriculum Version 2.0/Spring 2011
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System Acquisition Decisions for Departmental Information Systems
Build (in-house development) Buy (outsourcing) Combination (e.g. buy then maintain/customize
in house)
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Build or BuyBuild/Homegrown Full control of software &
data Requires local expertise Expertise
retention/knowledge management is vital
Maybe cost-effective if high degree of local customizations or long-term projection
Buy/Outsource Less control of software
& data Requires vendor
competence Vendor relationship
management is vital Maybe cost-effective
if economies of scale
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Build or Buy No universal right or wrong answer Depends on local contexts Strategic positioning Internal IT capability Existing environments Level of complexity/customization needed Market factors: market maturity, vendor choices,
competence, willingness to customize/learn Pricing arrangements Purchasing power Sustainability
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Outsourcing Decision Tree
Does service offer competitive advantage?
Is external deliveryreliable and lower cost?
Keep Internal
Keep Internal
OUTSOURCE!
Yes
No
Yes
No
From a teaching slide by Nelson F. Granados, 2006
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Outsourcing Dilemmas
From a teaching slide by Nelson F. Granados, 2006
Doig et al, “Has Outsourcing gone too far,” McKinsey Quarterly, 2001
• “One of the challenges Ford has is that it has outsourced so much of its process, it no longer has the expertise to understand how it all comes together” Marco Iansiti, CIO, 2003
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IT Outsourcing: Ramathibodi’s Case
From a teaching slide by Nelson F. Granados, 2006
Does service offer competitive advantage?
Is external deliveryreliable and lower cost?
Keep Internal
Keep Internal
OUTSOURCE!
Yes
No
Yes
No
Core HIS, CPOEStrategic advantages• Agility due to local workflow accommodations• Secondary data utilization (research, QI)• Roadmap to national leader in informatics
External delivery unreliable• Non-Core HISExternal delivery higher cost• ERP, IT Support?
PACS, RIS, Departmental
systems
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If Decision = BuildChallenges Recruitment & retention Keeping up with new technologies & requirements
The “legacy systems” trap
Justifying “slow” implementation
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SuggestionsRecruitment & retentionKnowledge management: Tacit -> ExplicitHave long-term vision/strategiesAim for system evolution New requirements New technologies/best practices Refactoring
PrioritizeReevaluate build/buy decision every 5 years
If Decision = Build
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Challenges Vendor selection Justifying long-term costs Managing risks The “vendor lock-in” problem Sharing data with other systems
If Decision = Buy
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Suggestions Take time & effort in knowing your potential vendors Be flexible in requirements, project delivery Look at vendor as partner, not contractor
Avoid “us-versus-them” mentality
Understand “learning curves” Be less bureaucratic, more collaborative Be specific in SLAs, MAs, IP, data ownership Choose technologies wisely, with rooms for later
migration if possible Knowledge transfer Always have a Plan B (Alternative vendors, internal workforce)
If Decision = Buy
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Management Information Systems (MIS) Provides information needed to manage an
organization (e.g. a hospital) effectively and efficiently
A broad category of information systems Administrative reports Enterprise resource planning (ERP) Supply Chain Management (SCM) Customer Relationship Management (CRM) Project management tools Knowledge management tools Business intelligence (BI)
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Business Intelligence Applications Allows for
Data analysis Correlation Trending Reporting of data across multiple sources
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Business Intelligence Applications Examples
Clinical and Financial Analytics and Decision Support
Query and Reporting Tools Data Mining Online Scoreboards and Dashboards
Business Intelligence & Data Warehousing for Healthcare. Clinical Informatics Wiki. 2008. Available from: http://www.informatics-review.com/wiki/index.php/Business_Intelligence_&_Data_Warehousing_for_Healthcare
Health IT Workforce Curriculum Version 2.0/Spring 2011
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Summary Various departments and their information
needs in hospitals/healthcare organizations Applications that need to be integrated in
health care information systems Strategies to ensure integration of front-end
clinical data collection and back-end billing functions
Critical integration elements Information systems for organizational
management (MIS) Data analysis and trending (BI)
Health IT Workforce Curriculum Version 2.0/Spring 2011
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References Vogel, LH, Perreault, LE., Management of
Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version 2.0/Spring 2011
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