History of Health IT Unit 3 Lesson 1 Applied Informatics

Lesson Objectives At the end of this lesson, you will be able to: Describe the history and evolution of health care information systems Trace the development of IT systems in health care and public health Discuss the experiments of the 1950s and 1960s Discuss the dynamics of incentives and health care IT adoption and use

Definition of Terms Health Care Information System (HCIS) An arrangement of information and data Interacts to collect, process, store, and provide output information Information system and information technology are interchangeable Recommended to support a health care organization

Definition of Terms Cont. Two types of HCIS Administrative information system Contains primarily administrative or financial data Used to support the management functions and general operations of the health care organization Clinical information system Also known as departmental systems such as radiology or pharmacy May be clinical decision support such as medication administration computerized provider order entry, or electronic medical record systems

History and Evolution The 1960s Health Care Environment President Lyndon B. Johnson signed Medicare and Medicaid into law. 1960s Information Technology Large mainframe computers Centralized processing Few vendor-developed products

History and Evolution Cont. 1960s Uses of Health Care Information Systems Administrative or financial information systems were used primarily in large hospitals and academic medical centers Developed and maintained in house Shared systems available to smaller hospitals Centralized data processing

History and Evolution Cont. 1970s Health Care Environment Health care costs escalating due to high Medicare/Medicaid expenditures Economic inflation Expansion of hospital expenses and profits Increased need for better access to clinical information Emergence of departmental systems to improve productivity and capture charges to maximize revenues

History and Evolution Cont. 1970s Information Technology Mainframes still utilized Minicomputers debut Handling of clinical data becomes more efficient 1970s Use of Information Technology Vendor Relationships Direct result of increased demand for patient specific data Low cost microcomputers contribute to opening vendor market Vendors developed applications for clinical departments Turnkey systems created

History and Evolution Cont. 1970s Use of Information Technology cont. Health Care Executive Interaction Involvement limited to securing funds System Limitations Most systems were stand alone Did not interface well with other administrative or clinical information systems within organizations

History and Evolution Cont. 1980s Health Care Environment Changes to Medicare/Medicaid Medicare introduces prospective payment systems for hospitals Medicare shifts from a cost-based reimbursement to a prospective payment system Medicaid and private insurers follow suit Need for financial and clinical information

History and Evolution Cont. Other Impacts Health care cost rose by double the rate of inflation Providers argued that fee-for-service payment failed to promote cost containment Emergence of Managed Care Plans HMOs reimburse physicians based on fixed rates

History and Evolution Cont. Impact to Big Business Integration of organizations making up the hospital system Enter many other health care-related businesses Consolidated control Overall shift toward privatization and corporatization of health care Integrated delivery system begins to emerge

History and Evolution Cont. 1980s Information Technology Microcomputer or personal computer (PC) becomes available Far more powerful Brings computing to desktops Revolutionizes data processing Changes how companies do business Computer market opened among different types of health care organizations Advent of local area networks (LANs)

History and Evolution Cont. 1980s Use of Health Care Information Systems Advancements resulted in Distributed data processing Expansion of clinical information systems in hospitals Physician practices introduce billing systems Integrating financial and administrative information becomes important

History and Evolution Cont. 1990s Health Care Environment Medicare changes physician reimbursement to a resource-based relative value scale (RBRVS) Health care reform efforts initiated by the Clinton administration (HIPAA) Growth of managed care and integrated delivery systems Institute of Medicine calls for computer-base patient record (CPR) adoption

History and Evolution Cont. 1990s Information Technology The Internet and World Wide Web arrives 1990s Uses of Health Care Information Systems Growth of the Internet has profound effect on health care organization business Vendor community growth explodes Products more widely available and affordable Enterprise wide systems Increased interest in clinical application Relatively small percentage of health care organizations adopt CPR

History and Evolution Cont. 2000 to Today Health care environment IOM reports on patient safety and medical errors Bush and Obama call for electronic health record (EHR) adoption HIPAA privacy and security regulations in effect Medicare Modernization Act To trigger giant leaps forward in the safety, quality and affordability of health care by:  • Supporting informed healthcare decisions by those who use and pay for health care; and,  • Promoting high-value health care through incentives and rewards. The Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. Among other initiatives, Leapfrog works with its employer members to encourage transparency and easy access to health care information as well as rewards for hospitals that have a proven record of high quality care.

History and Evolution Cont. Information Technology Internet expansion continues Broadband access in rural areas Portable devices become more widespread Bar codes Use of Health Care Information Systems Focus on EHR systems Vendors promote CCHIT certification Health care organization invest in information systems

Summary Types of HCIS – Administrative & Clinical Started in mid’60s with Johnson - Medicare & Medicaid 1960s – ‘birth’ of technology 1970s - health care costs high; IT more efficient; vendors developed clinical systems 1980s & 90s – Medicare changes generate changes in technology, Internet 2000 –HIT; CCHIT certification of EHR