HPR 601
Computerized Health Care Systems
November-December 2000
Professor Ed Lamie
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Chapter 1 - Information
Technology - Figure 1.1
• Clinical
• Administrative
• Strategic decision support
• Electronic networking
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Clinical
• Computerized patient records
• Medical decision support
• Automated instrumentation
• Clinical research and education
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Administrative
• Financial
• Scheduling
• Human resources
• Materials management
• Office automation
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Strategic Decision Support
• Planning and marketing
• Financial forecasting
• Resource allocation
• Performance assessment
• Outcomes measurement
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Electronic Networking
• Insurance billing and claims processing
• Regional/national databases
• Online purchasing
• Provider networks
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Objectives for Computer-based Records
(Fig. 1.4)
• Support patient care and improve its quality
• Enhance productivity of healthcare professionals
• Reduce administrative costs associated with
healthcare delivery and financing
• Support clinical and health services research
• Accommodate future developments in healthcare
technology, policy, management, and finance
• Protect patient data confidentiality
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Chapter 2
Essential Concepts
• General systems theory
“A system is a term used to describe the
relationships among a group of components that
function together to achieve a common
purpose.”
• Management control and decision-support
systems in health services organizations
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Systems Comprising Functioning
of Health Services Organizations
• Mechanical systems
integral part of physical plant
• Human systems
organized relationships among patients,
physicians, employees, family members of
patients, etc.
• Man-machine systems
formally defined systems in which human effort
assisted by various kinds of automated
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equipment
System Definition:
A Set of Objects and the Relationships
Between the Objects and Their Attributes
• Objects
component parts of the system
• Attributes
properties of objects, abstract descriptors
that characterize and define component
parts of the system
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System Characteristics
• Mechanical • Deterministic or
• Manual probabilistic
• Man-machine • Three essential
• Unity, integrity components
inputs, conversion
• Simple process, outputs
• Complex • Feedback
hierarchical structure,
generalized, self-adapting • Open or closed
• Stability and • Cybernetic (self-
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equilibrium regulating)
Simple System
With Feedback
Conversion
Input Process
Output
Feedback
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Health Services Organization Systems
Network
Patient Care System
Diagnositic Therapeutic
Subsystem Subsystem Support
Services
Rehabilitative
System
Subsystem
Community
Relations
System
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Closed and
Open Systems
• Closed system
completely self-contained and not
influenced by external events (closed
systems eventually die)
• Open system
components of system exchange materials,
energies, or info with their environment;
influenced by, and influence environment,
HPR systems
e.G., Health services 601 14
Health Services Systems
Environmental Factors
• Influenced by social factors
characteristics of individuals and groups of people
• Influenced by economic factors
directly dependent on resources and local/national
economy
• Influenced by political factors
competing demands by special interest groups and
politics
• Influenced by physical env.
Space, component relationship
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Cybernetic System
Environment
Converson
Input Output
Process
Correction Signals
Control Error Signal
Monitor Sensor
Unit
Standards
See Figure 2.7 (Generalized Management Control
System for a Health Services Organization) and Figure 2.8
(Clinical Laboratory as a Cybernetic System)
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Fig. 2.9 - Characteristics of Useful
Management Information
• Information - not data • Timely
• Relevant • Action-oriented
• Sensitive • Uniform-for
• Unbiased comparative purposes
• Comprehensive • Performance-targeted
• Cost-effective
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Principles of Information Resource
Management
• Treat information as an essential
organizational resource
• Obtain top executive support for
information systems planning and
management
• Develop a strategic vision and plan
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Chapter 3
Computer Hardware
Major components of • Secondary storage
a computer system • Input units
• Central processing • Output units
unit • Classes of
• Primary storage computers
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Major Components of a
Computer System
Primary
Storage
1. Arith-Logic Unit
Input 2. Control Unit Output
3. Registers
Secondary
Storage
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Central Processing Unit
• Arithmetic/logic unit
performs operations such as computation and comparison
• Control unit
coordinates operation of other units; 2-step process to execute one
machine instruction: (a) instruction received from primary storage and
interpreted, and (b) locate required data from primary storage, instruct
ALU to perform operation, and ensure result stored in proper primary
storage location
• Registers - high speed memory locations
types: instruction register and address register; also, word length, data
bus width, RISC, and CISC
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Primary Storage
• Early days: magnetic cores
• Terms: bit, byte, word, kilobyte (KB) 1,024 bytes, megabye
(MB) 1,048,576 bytes
• ROM (read-only memory)
(boot instructions, I/O instructions, nonvolatile)
• RAM (random access memory) - store instructions and data
- volatile
• Cache memory
keep important information in memory, and save frequently
used information for future use
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Secondary Storage
• Magnetic tape: archive purposes
• Magnetic disks: hard disk, floppy disk
• Optical disks: CD ROM - data resides on
single track that winds in spiral fashion,
WORM, and magneto-optical (erasable)
• Optical or laser cards
• Smart cards
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Input Units
• Keyboards
• Pointing devices: mouse, rollerball, touch
screen, light pen
• Scanners, handwriting recognition devices,
voice input
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Output Units
• Visual displays - VDT or monitor, LCD -
monochrome or color (active or passive
matrix display)
• Printed output - dot matrix printers, ink jet
printers, laser printers (memory and
resolution)
• Voice output
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Typical Layout of a Disk
Sector, Block, and Track
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Classes of Computers
• Supercomputers (parallel • Minicomputers
processing • Workstations
configuration) • Personal computers
• Mainframe computers
(shared configurations
including processor
clusters, front-end
processors, and networks
with microcomputers
and workstations)
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Chapter 4
Computer Software
• Programming languages
• Language translators
• System management software
• Utility programs
• Application software
• Integrated v interfaced systems
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Table 4.1 Five Generations of
Programming Languages
1 Machine Language; strings of zeros and ones
2 Assembly Language; Uses Mnemonics
3 Procedural Language; Focuses on Solution to
Problem
4 Variety of Application and Program-Generating
Languages; Focuses on Description of Problem
Itself
5 Natural Languages; Easy Communication with
Computer
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Table 4.2 Representative Third-
Generation Languages
FORTRAN - Early scientific language
COBOL - Early business-oriented language
ALGOL - Influenced the development of several
contemporary languages
PL/I - Intended to combine best features of above languages
BASIC - Important language in early days of personal
computer - now Visual Basic used extensively
MUMPS or M - Developed for use in healthcare environments
Pascal - Educational language
C or C++ - Ubiquitous development language
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Example of SQL (a 4GL)
Problem: For each department, find the average
experience of employees, and count the number of full-
time employees
select dept,
avg(years_exp),
count(ssn)
from emp_db
where fte >= 1;
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Language Translators
• Source code is the „input‟ to a language
translator; object code is the „output‟
• Assemblers (assembly language to machine
language)
• Compilers (high-level language to machine
language)
• Interpreters (statement-by-statement translation)
• Code-Generation Software
(4GL to 3GL)
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System Management Software
• Operating Systems
a. process user and user-program commands and
requests
b. managing, loading, and executing programs
c. managing hardware resources of computer
Examples: Win95 or Win98 or NT, UNIX, MVS
• Utility Programs - support operations, file
manipulation, computational programs
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Application Software
• General Purpose Application Software;
examples: word processors, desktop
publishing software, spreadsheet software,
statistical packages, database management
software, integrated software programs
• Application-Specific Software (see next
page for examples)
• Integrated / Interfaced Systems
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Table 4.3 Categories of Application-
Specific Software in Healthcare
• Financial Mgmt • Radiology
• Managed Care • Materials Mgmt
• Decision Support • Food Services and Nutrition
• Quality Mgmt • Clinical Services
• Case Mgmt • Clinic/Practice Management
• Clinical I.S. • Home Healthcare
• Patient Mgmt • LongTerm Healthcare
• Medical Records • Admin Support
• Lab Systems • Office Automation
• Pharmacy Systems • System Integration
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Chapter 5 Networking and
Telecommunications
• Why Computer Networks?
• Dumb Terminals
batch vs real-time processing
remote job entry
• Client/Server Computing
client - front end functions
servers - back end functions
personal, mini, workstation,
or mainframe computers
• File/Server Architecture (1 server)
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Networking and
Telecommunications (cont.)
• Distributed Data Processing
• Network Components
transmission media (copper wire, fiber optics, radio)
transmitters/receivers
network control software/NOS
network topologies
bus
ring
star
Ethernet - bus - CSMA/CD
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4 Important Network
Technologies
• Fiber Distributed Data Interface
(FDDI: > 100 million bits/sec)
• Asynchronous Transfer Mode
(ATM: > 1 billion bits/sec)
• Fast Ethernet (10X traditional ethernet) ~100
million bits/sec
• Switched Ethernet “gives smaller segments of
users access to full bandwidth”
gigabit Ethernet, 10 megabit Ethernet
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Networking Concepts - 1 of 3
• Electronic Data Interchange
transferring structured
information on network
incorporate standards and
procedures
• Mobile Computing
use of portable computing
devices; data must be uploaded for
updates; problem when update not timely
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Networking Concepts - 2 of 3
• Wireless Computing
ideally combined with mobile computing
portable computers connected to information
system
real-time, continuously updated
• Internet vs. internet
• WWW (1991) - collection of resources
distributed on Internet
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Networking Concepts - 3 of 3
• Internet Service Provider (ISP)
• T-1 lines ~1 megabit/sec
(dedicated digital phone line)
• T-3 lines ~45 megabits/sec
• Transmission Control Protocol/Internet
Protocol (TCP/IP) - packet switching
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Web Site
• HTML: HyperText Markup Language
• HTTP: HyperText Transfer Protocol
• Home Page
• Hypertext Links
• Uniform Resource Locator (URL)
• Sample domain names: org, edu, com, etc.
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Intranet
• Web-based corporate network (closed
system)
• need web server, browser, formatting
language, TCP/IP communication
protocols
• firewall - filter against unauthorized access
• Network Computers
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Chapter 6
Data Management
• Files - Records - Fields
• Sequential, example: tape
• Direct Access, example: disk
• Problems with Files
program dependence
data redundancy
data inconsistency (often a byproduct of
data redundancy)
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Database Advantages
• Reduce • Maintain Data
Redundancy Integrity
• Avoid • Balance
Inconsistency Conflicting
• Share Data Requirements
• Enforce Standards • Data Independence
• Apply Security
Restrictions
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Database Terminology
Database Models Database Management
hierarchical Systems (DBMS)
network
DDL - schema, subschema;
relational physical vs. logical view
DML - query language, or
embedded in procedural
language
Data dictionary
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Query Languages and SQL
Query Language • SQL example: (DB
• Natural Language on page 146)
• Query by Example List name and
(QBE) equipment number
for items in dept 15:
• Structured Query
Language (SQL) select
equip_name,equip_no
from Eqtable
where dept_no = 15;
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Another SQL Example
List dept names and managers for equip_no
850, 852, 879
select dept_name, dept_mgr, equip_no
from DepTable, Eqtable
where equip_no in (850,852,879) and
DepTable.dept_no = Eqtable.dept_no;
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Database Features
• Data Dictionary • Hypermedia
• Data Security Databases
• Privacy/ • Data Warehouses
Confidentiality • Clinical Data
Repository
• Virus Protection
master patient index
• Backup/Recovery standardization
terminology & format
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Chapter 7
Strategic Info. Systems Planning
• Identifying and assigning priorities to a set
of computer applications…
• Priorities
integration of systems (“islands of
automation”)
automation of patient records
improved decision support
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Planning (continued)
• Planning process needed
develop flexible information architecture
facilitate data exchange
provide remote user access
• Usual approach in past: “piecemeal” fashion in
developing systems; ad hoc basis for capturing,
storing, retrieving; crisis driven
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Planning (continued)
• 1996 survey: 35% did not have strategic Information
Systems plan
• Figure 7.1 Purposes of Strategic Information Systems
Planning
align Information Systems goals with organization
define specific requirements and priorities
define info. tech. infrastructure
develop budget for resource allocation
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1995 Survey
Infrastructure Priorities
• client/server network architecture
• optical disk storage and data warehouses for clinical
records
• interface engines for linking Information Systems of
members of integrated delivery systems
• wide-area fiber-optic networks
• relational databases
• multimedia workstations
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Figure 7.2 Organizing the
Planning Effort
Board of Trustees
Chief Executive Officer
Information Systems Steering Committee
Subcommittees
• Selecting a consultant
independence and objectivity
healthcare expertise
resources
effective personality
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Figure 7.3 Elements of Info.
Systems Strategic Planning
• statement of corporate/institutional goals & objectives
• statement of Information Systems goals & objectives
• priorities for the application portfolio
• specification of overall systems architecture and
infrastructure
• software development plan
• Information Systems management plan
• statement of resource requirements
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Specific Info. Sys. Objectives
• Information Systems should be designed such that all records
from the master patient index file are available online to all
physicians in the plan
• Information Systems should be designed such that all diagnostic
test results are available within 2 hours after tests are completed
• Information Systems should be designed so that information or
inpatient and outpatient activity by major diagnostic categories is
reported to corporate management on a monthly basis with
reports indicating the health system‟s share of the total services
provided in the market area
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Specification of Overall System
Architecture
• centralized or decentralized
• communication linkage of computers,
workstations, and network servers
• data storage, distribution, and security
• application linkage for information
exchange
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Figure 7.4
Information Security
• Physical security • Management policies
hardware written security policy
data files employee training
• Technical safeguards disciplinary action for
passwords violations
encryption
audit logs
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Data Standardization
• Required for electronic data exchange
• Consider “date of birth” example in
textbook
• Projects to develop healthcare standards
ANSI X.12
HIBC
HL7
MEDIX
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Hardware and Software
Standards
• Technical policies developed by CIO or
director of Information Systems
• Information Systems steering committee
should oversee broad policies
• Should require central review and approval
of purchases
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Policies on Use of Internet
• Creation of home pages
• Security of information on Internet
• legal protection of intellectual property on
Internet
• Controlling employee use and potential
abuse
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Policies on Home Page
Development
• Organizational units authorized to create
home pages
• Use of corporate information, logos, etc.
• Maintenance responsibility
• Data security
• Graphic design and writing style
• procedures for central review and approval
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Chapter 8
Systems Analysis
• System development life cycle
• Project organization
• Systems analysis
• System analysis tools
• Selection of a design approach
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Figure 8.1 Information Systems
Development Life Cycle
• Analyze functional requirements (systems
analysis)
• Select design approach
• Specify system requirements (system design)
• Acquire or construct system
• Install system (implementation)
• Operate and maintain system
• Evaluate and improve system
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Figure 8.2 Information Systems
Project Organization
CIO
Project Leader
User Dept Med Staff Mgmt Rep Anal/Prog
Liaison
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Chap. 9 System Design,
Evaluation, & Selection
• System design specifications
• Evaluation of application software
• use contractual services (outsourcing)
• Selection process
• Negotiation and contracting
• Role of consultants
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Figure 9.1 System Design
Specifications
• Statement of system objectives
• Output specifications
• Input specifications
• Database specifications
• Procedures and data flow
• Cost-benefit estimates
• Management approvals
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Figure 9.3 Packaged Software
Evaluation Criteria
• Congruence with organizational requirements
• Level of satisfaction of other users
• Compatibility with existing hardware and
software
• Support available
• Costs
• Financial stability of vendor
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Use of
Contractual Services
• Review carefully prior experience
• Investigate financial stability
• Review credentials of specific personnel assigned to
project
• Review principles used in work plans and procedures
• Examine cost estimates; advocate fixed-price & and
fixed-time contracts
• Employ technical consultant to review proposed
services
• Design formal review process
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The Selection Process
• RFI - Request For Information
• RFP - Request For Proposals
1. into to organization
2. functional requirements
3. specify content and format
4. evaluation criteria
5. demonstrations and testing
6. system implementation
7. contractual requirements
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General Criteria for Evaluating
an RFP
• established performance record
• extent of vendor support
• reliability, maintainability, and quality control
• projected benefits
• adaptability and provisions for expansion
• costs of acquisition, implementation, &
maintenance
• number and scope of conditions
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Negotiation and Contracting
• Delivery dates
• Acceptance testing
• Payment schedule
• Warranties and guarantees
• Software ownership
• Interface responsibilities
• Maintenance & updates
• Personnel training
• Documentation
• Expiration date & cancellations
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Role of Consultants
• Facilitate selection process
• Provide technical information
• Provide outside perspective
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Appendix A & B (pp 233-243)
• Break into 4 groups
• Study and critique each of the 2 case studies
• Determine where each case study fits in
Information Systems development life cycle
• Discuss each component of the case study
• Determine the next step in the development life
cycle
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Chapter 10 Managing
Information Resources
• System implementation
• Operation and maintenance
• System evaluation and improvement
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Figure 10.1
Information Systems
Implementation
• Equipment acquisition
• Programming or software installation
• Training
• Database preparation
• System testing
• Final documentation
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Figure 10.2 Elements of a
System Test
• System objectives
• Computer and network hardware
• Computer software
• Personnel training
• Accuracy of cost estimates
• Adequacy of system documentation
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System Operation and
Maintenance
• Scheduled and • Continuous quality
unanticipated improvement
maintenance TQM
• About 25% of technical Information Systems
staff time devoted to evaluations
maintenance a. functionality
• Develop emergency b. user satisfaction
backup procedures c. costs and benefits
d. errors and exceptions
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Healthcare CIO Attributes
• Leadership ability
• Vision/imagination
• Business acumen
• ? Technical competence
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Role of CIO
• be a leader of information utilization, not a
controller of data and technology
• focus on long-term strategy, not day-to-day
operations
• champion the development and constant
monitoring of a strategic information plan, an
intricate component of the corporate strategic
plan
• participate as a full member of the executive
team
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1996 Survey of Healthcare CIOs
• 57% hold advanced degrees
• 37% have BA/BS degrees
• Figure 10.3 - Typical Information Systems
Organization
• N.B.: Network programmers are replacing
mainframe computer programmers
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Outsourcing Benefits
• reduction of in-house staffing requirements
• smaller investment in capital equipment
• more flexibility in meeting changing
requirements and adopting new technology
• reduction in the time required to implement new
applications
• more predictable cost structure, particularly if
fixed-price contracting is employed
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Outsourcing Pitfalls
• too much dependence on vendors, with
possibility that a critical contractor might
go bankrupt of change business direction
• high costs associated with vendor fees and
profit structure
• employment of contractors who do not
understand the operation and culture of
healthcare organizations
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Executive Management
Responsibilities
• Information Systems are useful if process for
planning, designing, installing, and operating
such systems is well managed
• information is essential for strategic planning,
cost and productivity management, continuous
quality improvement, and program evaluation
• 14 important executive management
responsibilities listed on pages 256-257
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Chapter 11 Patient Care
Applications
• 1996 survey of most important application
priorities
1. Implement a clinical data
repository
2. Implement new clinical
systems
3. Implement an electronic
medical record
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Computer-Based
Patient Records
• continuous treatment record of active patients
• archival record for inactive patients
• working documents for medical audit, utilization
review, quality improvement, and cost control
• database for research
• development of completely electronic medical
record has been an “elusive goal”
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National Computer-Based
Patient Records (CPRs)
• Advocated by 1991 report of Institute of Medicine,
National Academy of Science
1. Include problem list and status for patient clinical
problems
2. Systematic measurement and recording of patients‟
health status and functional levels
3. Documents clinical rationale for diagnoses or
conclusions
4. Longitudinal record of events for each person
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Major barriers to electronic
patient records
• Legal issues
• need for universal standards
• technological limitations (although
diminishing)
• user resistance
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3 examples of CPRs (page 267)
• City of Hope Medical Center
• Stuyvesant Polyclinic
• Dr. Kim Charles Meyers
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Order Entry and
Results Reporting
• Software available for entry of orders for diagnostic
tests and patient treatments, and subsequent reporting
of test results
• physician orders entered and transmitted to appropriate
clinical service units
• test results, treatment summaries, and charges for
services transmitted electronically
• issue: who will enter the orders (i.e., physician or
clerical personnel)?
• User-friendly and efficient systems needed
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Clinical Services Applications
• Laboratory Information Systems
• Pharmacy Information Systems
• Radiology Information Systems
• Other service department systems
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Ambulatory Care Information
Systems, typical applications
• Patient scheduling and appointment systems
• electronic medical records and medical
management systems
• patient and third-party billing
• managed care contract management
• electronic communications with other providers
in an integrated delivery system
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Nursing Information Systems:
advantages of Point-of-Care
systems
• Reduction in nursing service costs
• improved quality of care
• more timely access and improved
recording of information
• cost reduction
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Clinical Decision-Support
Systems (CDSS)
• Passive CDSS - make information available and usable,
but do not process for further analysis
• Active CDSS - provide direct assistance to physician in
diagnosis and treatment planning, combine patient-
specific data with generalized medical knowledge to
reach a conclusion or make a recommendation
a. expert systems
b. systems that employ probabilistic algorithms
reminder/alert systems
• Statement by Dr. P. Ellwood (pp279-280)
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Other Clinical Applications
• Telemedicine
• Long-term care
• Hone health care
• Computer applications in clinical research
and education
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Chapter 12 Administrative
Applications
• Typical first use of computers
• Types of software
a. design and program in-house
b. participate in shared service arrangements
c. purchase predesigned or packaged software
• Turnkey systems popular given low-cost
microcomputers
• Table 12.1-software vendor list
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Financial Information Systems
(Figure 12.1)
• Inputs
transaction processing systems
external sources
strategic organizational plans
• Outputs
financial statements
forecasts
management reports
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Human Resources Information
Systems (Figure 12.2)
• Inputs
employee record
payroll
budget
benefits information
• Outputs
government reports
management reports
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Other Information Systems
• Facility utilization and scheduling systems
• Materials management systems
• Facilities management systems
• Office automation systems
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Chapter 13 Strategic Decision-
Support Apps.
• Decision-Support Systems (DSS)
Definition: Information Systems to support
the data retrieval, modeling, and reporting
of results for executive queries
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Desirable Attributes
of a DSS
• Easy interaction with the system
• Executives can retrieve data themselves
• Data are displayed in a meaningful format
• System has modeling capability
• System generates clear reports
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Components of a DSS (Fig.13.3)
• User interface
• Model manager
• Model library
• Databases
• DBMS
• Report writer
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Characteristics of Useful
Management Information
• Information - not raw • Action-oriented
data • Uniform
• Relevant • Performance targeted
• Sensitive • Cost-effective
• Unbiased • “contains an element
• Comprehensive of surprise”
• Timely
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Sources of Information for
Decision Support
• Internal transaction processing systems
• Specially constructed databases
• External data sources
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Categories of Information Needed for
Decision Support
• Information to support strategic planning
• Information to support the marketing function
prospectors
defenders
analyzers
reactors
• Information to assist in resource allocation
• Information to support enhancement of productivity
and operating efficiency
• Information to support outcomes assessment
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Development of DSS
• Write programs from scratch
• Use suitable “program generators”
• Customize a package
• Purchase a turnkey package
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Expert Systems Components
• Knowledge base (or rule base)
• Database
• Inference engine
• User interface
• Workspace
Example of expert system on page 331
E.Information Systems def‟n on pages 331-333
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Chapter 14 Managed Care
Applications
• Users of Managed Care Information
Purchasers
Consumers
Providers of Health Services
Managed Care Organizations
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Figure 14.1
Provider Functions
• Financial Monitoring
• Management of Capitated Contracts
• Strategic Planning and Decision Making
• Patient/Member Services
• Management of Multiple Lines of Business
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Figure 14.2 Managed Care
Organization Functions
• Financial Monitoring • Management of Multiple
• Preparation of Standard Lines of Business
Analytical Reports and • Marketing and Sales
Decision Models Support
• Management Control • Profitability
and Reporting • Member/Customer
• Claims Payment and Services
Prospective/Capitation • Employer Information
Payment Processing Needs
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Information Needs in the
Managed Care Marketplace
• Economic Incentives
• Wellness and Health Promotion
• Capitation
• Quality of Outcomes
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Chapter 15 Health Information
Networks
• 1996 Survey of leaders in healthcare
computing:
60% are part of, or in process
of, forming integrated
delivery system
11% plan to become part of
such a system within next year
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Figure 15.1 Model of Integrated
Delivery Systems
• Defined Population(s)
• System/Network Integrator
• Information Systems
Hospitals
Subacute Units
Nursing Homes
Hospice
Home Health
Ambulatory Care Centers
Specialist
Primary Care Providers
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Figure 15.2 Community Health
Care Mgmt Sys
• Community Needs Assessment
• Resource Requirements and Service
Offerings
• Caregiver, Managerial, and Governance
Integration and Alignment
• Information Systems
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Terms and Definitions
• HIN - Health Information Network
• CHIN - Community Health Information
Network
• Evolution of HIN parallels evolution of
computer-based patient record (CPR)
systems
• CPR systems and HIN are related; each
impacts the other
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Figure 15.3 Defining the HIN
Continuum
Evolving Scope ------->
Enterprise --->
Community --->
National --->
Global
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More Terms
• Enterprise Network - support information
management and communication requirements
of a single organization
• Community Network (CHIN) - support region,
state, or national community
• National Network - great promise, consider
“National Information Infrastructure” or
“information superhighway”
• Global Network - next decade?
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Figure 15.4 Three Levels of HIN
• Extraorganizational Level
Coordination/Management
• Interorganization Level
Enterprise Management
• Organizational Level
Organizational Management
Patient Management
Patient Care
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Planning Activities
or Issues
• Understand business objectives
• Assess current information system needs
• Identify information system requirements and user
needs
• Determine type of organization or ownership
• Determine method of financing
• Address legal and security issues
• Establish infrastructure for managing network
• implement process for ongoing HIN evaluation and
future development
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Chapter 16
Internet Applications
Key Terms:
Internet Browser
Intranet web site
WWW home page
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Figure 16.1 Business Strategies
and Internet Applications
• Improving internal business processes and
services
• Establishing external linkages with
business partners
• Increasing marketshare and stability
• Providing public service information to the
community
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Figure 16.5 Categories of
Internet Applications
• Improving internal communications
• Distributing organizational information
• Delivering educational programs
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Internet Technology Issues (Pro and Con)
Pro Con
• relatively inexpensive • security issues
• convenient to use • “lost in Cyberspace”
• international in scope • slow response time
• user friendly • hidden costs
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Guidelines for Internet or
Intranet Applications
• Get small successes early
• Nurture pilot projects
• Understand that Web experiments require
leaps of technology, skills, and
investments
• Focus on clearing technological, financial,
political, and organizational culture
hurdles
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Strategies for Implementation
• Make sure Internet technologies complement
existing architectures
• Establish governance group to set policies,
guidelines, et al
• Evaluate implication on current business
strategies & processes
• Develop network of Internet experts for
support and advice
• Ensure access to web & email
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