1. ISC471/HCI 571 Isabelle Bichindaritz1 Introduction to Health Care Systems 8/27/2012

2. ISC471/HCI 571 Isabelle Bichindaritz2 Agenda Examples of biomedical information and information systems –Evolution of healthcare systems –Regulatory agencies and organizations –Health care delivery systems –Health care professionals –Financing health care –Technology in health care 8/27/2012

3. Examples of Information Systems Information systems Health care information systems Hospital information systems Clinical information systems Medical insurance information systems Pharmaceutical information systems … ISC471/HCI 571 Isabelle Bichindaritz38/27/2012

4. Examples of Information Systems Health care information systems (HCIS) The information system supports a health care organization, which is any organization in which health care services are provided: A physician’s practice (general practitioner, …), nurse practice, social worker practice … A clinic, such as rural health clinic, a nursing home A hospital A regional or national health care organization ISC471/HCI 571 Isabelle Bichindaritz 48/27/2012

5. Examples of Information Systems Health care information systems (HCIS) The health care information system consists of interacting components providing health care services information and data (core) people processes information technology ISC471/HCI 571 Isabelle Bichindaritz 58/27/2012

6. Examples of Information Systems Health care information systems (HCIS) The data and information in an HCIS are of two main types: Clinical – clinical and health-related data and information used by providers to diagnose and treat patients, and to monitor the patient’s care [Wager et al. 2009] Clinical information systems can be departmental (radiology, …), provider entry system, medical records, … Administrative – administrative or financial data used to support the management functions and general operations of the health care organization [Wager et al. 2009] ISC471/HCI 571 Isabelle Bichindaritz 68/27/2012

7. Examples of Information Systems Health care information systems (HCIS) Examples of administrative information systems Patient related information systems Admission, discharge, transfer (ADT) Registration Scheduling Patient billing or accounts receivable Utilization management Other administrative systems Accounts payable General ledger Personnel management Materials management Payroll Staff scheduling … ISC471/HCI 571 Isabelle Bichindaritz 78/27/2012

8. Examples of Information Systems Health care information systems (HCIS) A short history of HCIS context in the US [Wager et al. 2009] 1960s Enactment of Medicare (health care coverage for the elderly) and Medicaid (health care coverage for the poor) 1970s Rising expenditures of Medicare and Medicaid 1980s Introduction of prospective payment systems by Medicare (diagnosis related groups or DRGs) 1990s Managed care (intermediate organization between physician and patient) Institute of Medicine (IOM) call for computer-based patient record (CPR) adoption 2000s+ Focus on patient safety and medical errors (HIPAA) Call for electronic health records (EHR) Certification for healthcare information technology(CCHIT) Pay for performance ISC471/HCI 571 Isabelle Bichindaritz 88/27/2012

9. Examples of Information Systems Health care information systems (HCIS) A short history of information technology evolution 1960s Mainframe computers, centralized processing 1970s Mainframe computers and minicomputers 1980s Personal computers, local area networks, distributed processing 1990s World-Wide Web 2000s+ Spread of the Internet, semantic web, social networks Handheld devices, ubiquitous computing Information exchange standards, terminologies, ontologies ISC471/HCI 571 Isabelle Bichindaritz 98/27/2012

10. Examples of Information Systems Health care information systems (HCIS) A short history of HCIS developments in the US 1960s Administrative information systems in large hospitals developed in-house 1970s Information systems from vendors and start of clinical information systems (laboratory, …) 1980s Expansion of clinical information systems, integration between administrative and clinical information systems 1990s Growth of products available, Web-based in particular 2000s+ Focus on electronic health records Focus on safety in health care information systems Personal health records (insurers, Google, Microsoft) Health information exchange activities ISC471/HCI 571 Isabelle Bichindaritz 108/27/2012

11. Examples of Information Systems Hospital information systems (HIS) The hospital information system can be defined as “the set of information and information processes useful for the daily work as well as for the management and strategic decision-making” at the hospital. (document #275 of January 6, 1989)document #275 of January 6, 1989 Key components of HIS Electronic medical record, electronic health record Computerized provider order entry Medication administration Telemedicine Telehealth E-prescribing Personal health records ISC471/HCI 571 Isabelle Bichindaritz 118/27/2012

12. Examples of Information Systems Hospital information systems (HIS) Components of a hospital information system People Patients Staff Clinicians Administrators Support staff Organizations (managed care …) Software Components: By department (radiology, laboratory, wards, …) By function (EMR, CPOE, …) Hardware ISC471/HCI 571 Isabelle Bichindaritz 128/27/2012

13. Examples of Information Systems Hospital information systems (HIS) Types of information Data Medical data Clinical data Administrative data Accountancy data Insurance data Aggregated data extracted from individual data for evaluation, management, … Knowledge Decision support systems (DSS) Medical dictionaries and references Bibliographic references and databases Care protocols, clinical guidelines … ISC471/HCI 571 Isabelle Bichindaritz 138/27/2012

14. Examples of Information Systems The health information system : data Varied types of data: Clinical data Administrative data Accounting data Insurance data … Varied types of knowledge: Clinical DSS Medical dictionaries Bibliographic references Care guidelines Varied information systems: Clinical, hospital, healthcare, surveillance, … ISC471/HCI 571 Isabelle Bichindaritz 148/27/2012

15. Examples of Information Systems Hospital information systems (HIS) ISC471/HCI 571 Isabelle Bichindaritz 158/27/2012

16. Examples of Information Systems Clinical information systems (CIS) Clinical information system encompasses the parts of the hospital information system involving direct care of the patients. Users of the CIS are Clinicians Staff supporting patient care Patients ISC471/HCI 571 Isabelle Bichindaritz 168/27/2012

17. Examples of Information Systems Hospital information systems (HIS) Example of the VA (Veterans Army) in the US VistA is the integrated health information system of the VA: “VHA’s integrated health information system, including its framework for using performance measures to improve quality, is considered one of the best in the nation.” Institute of Medicine (IOM) Report, Leadership by Example: Coordinating Government Roles in Improving Health Care Quality (2002) ISC471/HCI 571 Isabelle Bichindaritz 178/27/2012

18. Examples of Information Systems VA health information systems (HCIS) - VistA VistA / CPRS is a famous example of successful health information system Built by Veterans Army Administration (VHA) Publicly owned by VA Made available to interested public/private entities (OpenVA) VAH is the US largest integrated health system Serves 4.1 million American veterans annually Supports $23+ billion nationwide health system 1,300 care sites, incl. 163 hospitals & 800+ community & facility based clinics 180,000 health care staff; 85,000 trainees Vista / CPRS is largest integrated health information system Best overall health information system ISC471/HCI 571 Isabelle Bichindaritz 188/27/2012

19. V IST A INFORMATION SYSTEM USER SECURITY MAILMAN DEVICE MANAGER MENU MANAGER RPC BROKER INTEGRATED DATABASE PATIENTS WARDS DRUGS PERSONS INVENTORYPRESCRIPTIONS IMAGES LAB RESULTS VISTA SOFTWARE PACKAGES SCHED- ULING INPATIENT PHARMACY LABORATORY SURGERY MEDICINE SOCIAL WORK DENTAL ENGINEERING INTEGRATED FUNDS CONTROL ACCOUNTING & PROCUREMENT ADMISSION DISCHARGE TRANSFER DIETETICS MENTAL HEALTH SUMMARY NURSING LIBRARY PATIENT FUNDS MEDICAL RECORDS TRACKING ACCOUNTS RECEIVABLE VOLUNTARY SERVICE REHAB MEDICINE RADIOLOGY ONCOLOGY COMPUTERIZED PATIENT RECORD SYSTEM (CPRS) KERNEL TASK MANAGER VA FILEMAN TEXT INTEGRATION UTILITIES (TIU) OUTPATIENT PHARMACY CLINICAL PATIENT RECORD AUTHORIZATION SUBSCRIPTION UTILITY (ASU) BAR CODE MEDICATION ADMINISTRATION WOMEN’S HEALTH BLOOD BANK PROBLEM LIST VistA IMAGING CONSULTS / RESULT TRACKING CLINICAL REMINDERS MEDICAL CARE COST RECOVERY Sites of Care Clinics Hospitals Nursing Homes Domiciliaries Home/Workplace 19ISC471/HCI 571 Isabelle Bichindaritz8/27/2012

20. Examples of Information Systems VA health information systems (HCIS) - VistA Nationally integrated outpatient & inpatient information system Mostly developed and owned by VA (publicly owned) Long evolution Began as Decentralized Hospital Computer Program (DHCP 1980s) Transformed into VistA (1990s) Next generation VistA (2002-20__)  HealtheVet-VistA on improved platform using modern tools & languages following enterprise architecture National software with local flexibility/innovation Innovation developed locally & enterprise wide Standard packages distributed enterprise wide, e.g. latest version of CPRS (January 2002) ISC471/HCI 571 Isabelle Bichindaritz 208/27/2012

21. Examples of Information Systems VA health information systems (HCIS) - HealtheVet Moves from facility-centric to person / data-centric Uses natioanl, person-focused health data repository for production & management/analysis/research Builds on, enhances & utilizes VistA Moves from legacy VistA to HealtheVet-Vista Uses best, appropriate modern technology Programming, software, hardware, networking Moves “core” applications to run “enterprise-wide” Standardizes core data & communications Enhances the five major systems Regis / eligibility / enrollment, health data, provider, management / financial, “e” commun/transactions Enhances cross-cutting Security/privacy, architecture, data quality/standards, infrastructure, enterprise system/resources management ISC471/HCI 571 Isabelle Bichindaritz 218/27/2012

22. Examples of Information Systems Health information systems (HIS) Key set of problems Evolution from hospital information systems to health information systems Patient-centered approaches Connection between different medical records of a patient Linkage between all participants in patient care Integration between different applications Data input Representation of clinical data Market volatility Lack of funding, financial data Risk of failure ISC471/HCI 571 Isabelle Bichindaritz 228/27/2012

23. Examples of Information Systems Health information systems (HIS) Players ISC471/HCI 571 Isabelle Bichindaritz 238/27/2012

24. Examples of Information Systems Health information systems (HIS) Core challenges and research directions Integration and standardization Human-computer interaction Representation and structure of data / information / knowledge Socio-technical and organizational issues Healthcare processes ISC471/HCI 571 Isabelle Bichindaritz 248/27/2012