Integrated Information Systems 授課教師：陳芬如 老師 班 級：醫管碩一 學生： M 范雅婷 M 賴秋吟 M 李欣樺 M 呂增玲 長期照護服務

Introduction Describing a model for an information systems integrating medical and social services information across providers and payers.

Background Clinician uses information from the client ， and knowledge of similar clients and problems in the past ， to determine a plan of care. In recent years ， the volume and complexity of information have increased exponentially.

Background Early information systems focus on accounting and external reporting. Policymakers --make next year’s funding decisions. Payers --feed information back to the source agency for reimbursement and oversight.

Definition Integrated information system （ IIS ） is an array of multiple information sets linked together in an organized way. Information sets are groups of similar items often collected together. Organized means that there is a well- defined plan for collecting and linking information sets.

Definition In the multiservice agency, an IIS would link information across different services and would integrate information across agencies for a given participant. This information allows provider- based managers of care to make decisions that improve the quality and limit the total costs of chronic care.

Client Example Mrs. C

A Model Integrated Information System A model for an integrated information system to manage an integrated service program for a long-term care population. Figure 13.2

Components of the System Many pieces of information are needed to manage and deliver high-quality services to a long-term care population in a cost- effective way.

Participant (Client) Information Identification and Description Identifying information Demographic information Program status information

Participant (Client) Information Assessment Health status information Function status information Cognitive status information Environmental information Informal support information

Participant (Client) Information Service/Treatment Plan Service goal information Service orders

Participant (Client) Information Service Use Delivered service information Service coordination

Fiscal / Management information Service Revenue Service charge information Payment information For those who participate in prepaid health plans, capitation amounts per enrollee.

Fiscal / Management information Service Costs Personnel cost information Materials and supplies information Facility cost information

Integration across Funding Streams The model described in the preceding section is a general model for the integration of participant and fiscal data within a single provider organization. The system become more complex when one attempts to integrate multiple funding streams. The same service may be paid for by more than one paper or program. Figure13.3

Integrated information systems: state of the art Other industries have been more aggressive in the development and use of information systems than health and human services.

Hospital information systems Every major hospital and medical center has a computerized accounting system and a DRG billing system to help collect, organize, and document medical information to ensure appropriate reimbursement. Unfortunately, these systems have focused on the short-term acute care encounter.

Health plans and managed care Health plans have developed large, sophisticated information systems to track information on their members over time. But existing systems do not include long-term care services and are not designed to manage the more intensive and ongoing needs of a chronic care population.

Long-term care information systems There are information systems for nursing homes, home health agencies, and adult day care centers. Example 1:San Meteo’s Department of aging and adult services (DAAS) Example 2: The state of Michigan also adopted the MDS-HC for care planning and reporting of the various home and community-based services programs the state runs.

Chronic care information systems None of these systems by itself fully meets the needs of chronic care management. In California, legislation was passed to promote the integration of chronic and long-term care in demonstration projects at the county level. Goals for this legislation

Electronic medical records (1/2) An EMR offers the technical ability to integrate information across providers and settings. Vertical integration VS Horizontal integration

Electronic medical records (2/2) Several initiatives have already started working toward the development of a comprehensive EMR, as well as on strategies for overcoming many of the barriers that EMR adoption faces. Another initiative has focused on creating systems that allow providers on different technical platforms to “talk” with each other.

Methods of integrating information The key ingredient is integration- integration of key information for clinical, management, and policy decision making. A number of methods can be used to integrate information, include manual compilation of data, automated systems, and the Internet.

BENEFITS OF AN INTERGRATED SYSTEM Any health and human service organization has a number of different audiences or consumers of infor- mation. An IIS potentially benefits all those in contact with the system.

Clients and Clinicians The client can benefit from IIS. Better information across services over time will enable clinicians to improve quality of care, because they will be able to valuate the effecti- veness of various clinical practices.

Program Managers Program managers can use the IIS to actively manage, rather than merely administer, the managed chronic care program. A good IIS would reduce administrative costs by eliminating duplicate entry of data and by automating internal and external reports. IIS would provide information to help the manager track costs and outcomes across individuals and over time to continually evaluate and refine the service program.

External Funders External funders impose many reporting requirements so that they can monitor how their funds are being spent. An IIS could be an extremely efficient way to maintain regulatory compli- ance.

Insurers The goal should be to allocate scarce resources fairly and efficiently in an integrated system for all long-term care consumers while focusing on continuity of care.

Policymakers Policymakers want to know about the relationship between acute and long- term care and the impact of alter- native service delivery and financing models. By integrating information on acute and long-term care, an IIS could provide this information.

BARRIERS TO IMPLEMENTATION The development of an IIS is not easy; it often involves many changes in and across organizations. Many new information systems have created more problems than benefits, especially during the initial develop- ment period.

Commitment Many senior executives, providers, and policymakers pay lip service to the benefits of information, but are not willing to make it a priority.

Resources (People, Time, and Dollars) The development of a good IIS will take considerable time, money, and organizational energy. Lack of resources is a common reason cited for not developing an IIS.

Shared Objectives The development of an IIS requires agreement on objectives from all the parties concerned. An IIS can meet the information needs of many audiences; However, these different objectives should be clearly stated, shared, and built into the system.

Interagency Cooperation Perhaps the biggest barrier to integrating information is lack of cooperation by participating organ- izations. Changing the way providers do business to meet an external request is difficult. A collaboration is more complicated and requires the commitment of many.

Willingness to change Change is difficult even when the alternative is clearly better. Change takes time and effort. An IIS will cause problems and the organization should be prepared for them.

Privacy and Security Privacy concerns are raised by integration. Sharing of data across multiple services and providers will increase the threat to privacy of personal information. The Health Insurance Portability and Accountability Act (HIPAA).

CONCLUSION The health and human services sector is finally joining other industries in realizing the importance of IISs in accessing data records and providing quality care Health care organizations must equip themselves with IISs to maximize quality, manage costs, and meet external reporting demands from both payers and consumers.

Thank you for listening.