1. Special Project Report
You should prepare a memorandum-type report that includes the following:
 Situation Analysis. Describe the "real" or hypothetical work environment, provider objectives and current information systems configuration, as well as any unmet needs or issues.
 Functional Requirements. List or otherwise characterize the key functional requirements to be met by a new or upgraded health information system.
 Evaluate Vendor Alternatives. Describe and evaluate several vendor alternatives. Indicate pros, cons and unresolved issues for each alternative. Give special attention to the “human factor” considerations.
 Provisional Recommendation. Given the admittedly incomplete information available to you, what would you recommend as next steps? Options include doing nothing, upgrading the current system, negotiating with one or more vendors, and evaluating other vendor alternatives. Be specific and indicate your rationales for each recommendation.
Special Project Report

2. “…a health care information system (HCIS) is an arrangement of information (data), processes, people, and information technology that interact to collect, process, store, and provide as output the information needed to support the health care organization.”
definition

3. Health Care Information System
Administrative
Contains primarily administrative or financial data
Used to support the management functions and general operations of the health care organization
Clinical
Contains clinical or health-related information relevant to the provider in diagnosing, treating and monitoring the patient’s care

4. Administrative Applications
Patient administration systems
Admission, Discharge, and Transfer Registration
Scheduling
Patient billing or accounts receivable
Utilization management
Financial management systems
Accounts payable
General ledger
Personnel management
Materials management
Payroll
Staff Scheduling

5. Clinical Applications
Ancillary information systems
Laboratory
Radiology
Pharmacy
Other clinical information systems
Nursing documentation
Electronic medical record (EMR)
Computerized provider order entry (CPOE)
Telemedicine and telehealth
Rehabilitation service documentation
Medication administration

6. History and Evolution of Health Care Information Systems

7. Terminology changes
HISTalk series

9. Confidential - ICW America © 2007
Viewing
Disk drive and disk pack 320K “floppy”
Punch Card reader
Line printer
Starting at $?? In 19__
Confidential - ICW America © 2007

10. Confidential - ICW America © 2007
Key punch for cards
Each line of code on the punch card to run the program, that needed to run sequenqually
Confidential - ICW America © 2007

11. 1960s “Billing Is the Center of the Universe”
Health Care Environment
Enactment of Medicare & Medicaid
Cost-based reimbursement
Building mode
Focus on financial needs and capturing revenues
State of Information Technology
Mainframe computers
Centralized processing
Few vendor-developed products
Needed to track costs to submit $ the need to track all of the costs needed to be computer based.
Few commercial vendors at the times. Developed in house.

12. 1960s HCIS Administrative and financial systems
Used primarily in large hospitals and academic medical centers
Developed and maintained in-house
Data processing was primarily centralized on mainframe computers
Technicon at El Camino Hospital
Larry Weed and the POMR at UVM

13. “The Mainframe”

14. 1970s “Clinical Departments Wake Up Debut of Minicomputer”
Health Care Environment
Time of hospital growth and expansion
Medicare and Medicaid expenditures rising
Need to contain health care costs
State of Information Technology
Mainframes still in use
Minicomputers become available, smaller and more affordable

15. 1970s HCIS “Turnkey” systems available through vendor community
Increased interest in clinical applications (particularly in ancillary departments)
Shared systems still used
HBOC  McKesson
SMS  Siemens
Gerber Alley  AMEX  oblivion
Many others

16. 1980s “Computers for the Masses”
Health Care Environment
Medicare introduces prospective payment system for hospitals
Medicaid and other private insurers follow suit
Need for financial and clinical information
State of Information Technology
Unveiling of the microcomputer (PC)
Advent of local area network
Departmental System Journey
Battle of the mini’s  LANs

17. 1980s HCISs Distributed data processing
Expansion of clinical information systems in hospitals
Physician practices introduce billing systems
Affordable, powerful computers now available to smaller organizations
Ability to integrate financial and clinical information becomes increasingly important

18. 1990s “Health Care Reform Advent of Internet”
Health Care Environment
Medicare changes in physician reimbursement
Health care reform efforts of Clinton administration
Growth of managed care and integrated delivery systems
IOM calls for adoption of computer-based patient record

19. 1990s continued State of Information Technology
Unveiling of the Internet (World Wide Web)
Internet revolutionizes how organizations communicate with each other, market services, conduct business
Cost of hardware drops

20. 1990s continued Health Care Information Systems
Health care organizations take advantage of Internet
Vendor community explodes
Wide range of HCIS products/services available
Growing interest in clinical applications
Still relatively small growth in adoption of CPR/EMR systems

23. 2000s “Health Care IT Arrives Patients Take Center Stage”
Health Care Environment
IOM reports on patient safety and medical errors
HHS calls for standards for EHRs
Spiraling health care costs
Economic upheaval and growing number of uninsured
Health care transparency and pay for performance
New administration
Federal stimulus money available for HIT

24. 2000s continued State of Information Technology
Internet use moves to new level
Voice recognition rebounds
Bar coding and RFID
PDAs and multipurpose cell phones
PHRs and consumers maintaining Web-based records
Web 2.0 technologies

25. 2000s continued Health Care Information Systems
National call for EHR adoption
Infusion of HIT funding
Office of the National Coordinator for HIT (ONC)
Regional health information organizations
Health care organizations “struggle” with how to successfully implement point of care clinical systems
CPOE
EHR
E-prescribing

27. 2010 and Beyond
An Era of Accountability, Transparency and Change--Affordable Care Act, Meaningful Use and ICD-10 All Kick In

28. 2010+ Information Technologies Cloud computing Mobile applications
Social Communication
Next Generation Analytics

29. Key Technology Milestones
1960s: “Mainframes Roam the Planet”
1970s: “Debut of the Minicomputer”
1980s: “Computers for the Masses”
1990s: “Advent of the Internet”
2000s: “Health Care IT Arrives”
2000s: Mobile Technology Arrives
2010s: Watson Comes to Healthcare?
Discussion and explanation of Watson
Listening to medical interview and then preparing the EMR for the visit.
The rise of NLP for documentation?

30. Evolution of the CIO TITLES REPORT Data Processing Manager
VP (administration)
IS/IT Manager or Director
CFO
CIO
SVP
“Super” CIO (with CTO & CMIO)
CEO or COO

31. Health Information Technology Jobs
What did you learn?
Health Information Technology Jobs

32. Chapter 5 Clinical Information Systems
Less than Comprehensive
E-Prescribing, lab, PACS and many other clinical information systems omitted
Not Current
E.g., newly-reported EMR problems
Overly Positive
E.g., Cedar-Sinai case study
Insufficient focus on research bias
Challenges Understated
Adoption Rates Misleading
Security/Privacy concerns minimized

33. Various terms used over time
CPR
Computer-Based Patient Record
EMR
Electronic Medical Record
PHR
Personal Health Record
EHR
Electronic Health Record

34. PHR vs. EHR vs. EMR “The Conceptual Ideal” EMR EHR PHR
(includes clinic records only)
PHR vision thing. PHR a super set as a tethered to EHR
EHR
(also includes other provider records)
PHR
(also includes personal health information)

35. Core Functions

36. EHR Adoption in US Hospitals

38. 2012 Physician Adoption of EHRs

39. EHR Use in Other Post Acute and LTC Settings
Extremely low
6%--Long term care
4%--Rehabilitation
2%--Psychiatric
Source: Health Affairs, 2012

40. Value of EHR Improved quality, outcomes and safety
Computerized reminders and alerts
Improved compliance with practice guidelines
Reduction in medical errors
Improved efficiency, productivity, and cost reduction
Improved service and satisfaction

41. CPOE Driven by need to improve patient safety
Automates the ordering process
Accepts orders electronically, provides decision support, may aid in diagnosis and treatment

42. Use and Status of CPOE Estimates vary up to 77%
Historically teaching hospitals more likely to use
Many organizations are in various stages of implementation
Required for achieving meaningful use

44. Historical Barriers to CPOE Use
Complexity of ordering process
Physician entry an issue
Takes longer to place order; many systems are ‘cumbersome’, take too many steps
Incentives may not be aligned with use
Lack of confidence in system reliability
Insufficient training
Mandating use – should you?

45. CPOE Implementation at Cedars-Sinai Medical Center
perspective

46. Medication Administration
Use of barcoding becoming more widespread
Aids in correctly identifying patient, drug, dose, etc.
HIMSS implementation guide—good resource
More widely accepted
Has been used successfully by many health care organizations
Again, has potential to aid in making sure the right meds, get to the right patient, at the right dose…

47. Pharmacy Purchasing and Practice Aug 2013

48. Telemedicine
Use of telecommunciations for the direct provision of care to patients at a distance
Over 200 telemedicine programs involving over 3500 health care institutions
Store and forward
Two-way interactive TV
Funding an issue
Cost effectiveness not established

49. Telehealth
Using telecommunications to communicate with patients and deliver services
Electronic consultations (e-consultations)
Patient portals
Refilling prescriptions
Registering patient
Scheduling appointments

50. Telehealth
Current use of communication between patients and physicians
Value to patients and providers
Issues
Complexity of infrastructure
Degree of integration
Message structure
Cost
Security
Reimbursement

51. Personal Health Record & Patient Portals
Managed by consumer
May include both health and wellness information
Patient portal—secure web site through which patients can access PHR or EHR
Approximately 7% of consumers have PHR

52. Barriers to Adoption & Strategies for Overcoming Them
Financial
Organizational or Behavioral
Technical Barriers
Privacy and Security Barriers

53. Fitting Pieces Together

54. Case Study Acquiring an EHR System
How Realistic Is the Valley Practice Scenario?
How Well Do You Think the Indicated System Acquisition Approach Would Work?
What Are the Problems or Risks?
What Would You Have Done Differently?

55. Wager’s System Acquisition Process
Establish a Project Steering Committee
Define Project Objectives and Scope of Analysis
Screen the Marketplace and Review Vendor Profiles
Determine System Goals
Determine and Prioritize System Requirements

56. Wager’s System Acquisition Process (cont.)
Develop and Distribute the Request for Proposal or Request for Information
Explore Other Options for Acquiring System
Evaluate Vendor Proposals
Conduct a Cost-Benefit Analysis Prepare a Ratings Matrix
Prepare a Summary Report and Recommendations
Conduct Contract Negotiations

57. SDLC

58. Assess Usability

59. Despite the best made plans, things can and do go wrong…
Failure to manage vendor access to organization leadership
Failure to keep the process objectives (getting caught up in the vendor razzle-dazzle)
Overdoing or under-doing the RFP
Failure to involve the leadership team and users extensively during the system selection
Turning negotiations into a blood sport
20% of the people will claim…….

60. Executives Sharing With Executives IT Purchasing Strategies