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HCA 517
Health Care Administration
HCA 517 (4281) Spring 2009
Advanced Healthcare Information Systems Management
Prerequisite: HCA 416, 502, 530 or consent of instructor
Purpose and This course is designed to provide the healthcare professional with a broad
Scope understanding of information systems and information management in healthcare.
This is not a course in computing, but rather an examination of the strategic and
tactical business needs of the healthcare executive as they pertain to information
technology (IT). A broad overview of healthcare information systems is provided,
with a close examination of the critical information management needs required to
deliver cost-effective, quality healthcare. The overall intent is to demystify the topic,
build a foundation of knowledge, illustrate how IT can and should support the
business, and provide tools for future use. Healthcare is an inherently information-
intensive business, one that has generally lagged in fully and effectively exploiting
information technology to help manage high volumes of information, reengineer
processes, and generally mitigate mounting business pressures. Today’s healthcare
managers require a working knowledge of IT as an important and distinguishing
individual competency.
Instructor Kim Brant-Lucich, Director of Process Redesign, St. Joseph Health System
Contact Kbrant007@gmail.com
Information Phone: 714-347-7591 Mobile: 818-371-4318 Fax: 714-347-7700
Office Hours: Mondays 6-7pm Location: HCA Main Office
Expected At the conclusion of this course, the student will be able to:
Outcomes: 1. Demonstrate an understanding of intermediate IT terminology.
2. Develop an understanding on how to identify needs and opportunities involving
IT.
3. Exhibit an understanding of the essential elements of IT planning and the
importance of aligning business and IT planning
4. Describe and discuss the methods to analyze and justify the cost of new systems.
5. Discuss the range of commercial system offerings in healthcare and how to
“shop” for systems.
6. Negotiate basic system contracting issues and agreement protections.
7. Identify common pitfalls of automation and ways to overcome typical challenges.
Objectives and The primary objective of this course is to provide healthcare professionals with the
Goals key concepts and tools required to understand and use healthcare information systems
effectively. The key goals are to provide the background necessary to be 1) a good
“consumer” of healthcare IT, 2) comfortable with systems and technologies that may
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be encountered in various settings, and 3) an effective partner with IT professionals in
the pursuit of organizational and process improvement and change involving IT. At
the conclusion of the course, students should be able to discuss and understand basic
technologies used in healthcare information systems. Students will have had an
exposure to project management, process analysis, and strategic planning. They will
have researched a specific area of health information management or technology that
is of interest to them and/or their organization. They will have analyzed real-life
situations through case studies to reinforce their learning process.
Curriculum Business-IT Alignment, Benefits Realization and Value
Focus Change Management
Consultants, Salespeople and Vendors
Healthcare Computer Applications
The Internet and Healthcare
IS Department Structure and Operations
Medical Errors and Computer-based Patient Record
Re-engineering and Quality Improvement
Regulation/Regulatory Organizations Affecting Healthcare IT
Strategic Planning
System Implementation and Integration
System Requirements, Justification and Acquisition
Class The class will be broken into a series of topical modules and adhere to the following
Format/Topics sequence:
Pre-class required readings from the text and/or the class reader
In-class lecture and discussion, supplemented by electronic materials and
hand-outs; and
Case study analysis, exercises, role-playing or presentations designed to
actively immerse students in the topic.
Method of Cases are from the text or from in-depth discussion of real-life situations that have
Instruction- been faced by business executives. They cut across a range of organizations and
Case Method situations and provide exposure not unlike that faced by a manager on a day-to-day
basis. The most important benefit of incorporating the case study into the curriculum
is to help managers identify the right questions to ask in both straightforward and
ambiguous situations. The intellectual efforts are insight, analysis, assessment, and
defending one’s viewpoint. Cases allow the student to explore and appreciate the
political, economic, and other challenges of being a manager without the inherent risk
or expense of a wrong decision. Below is a brief description of the purpose of a case
and how to prepare for the case study, including the written deliverables for each
case.
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Learning results from rigorous discussion and controversy. Each member of the class,
including the instructor, assumes a responsibility for preparing the case and for
contributing ideas to the case discussion. Here are some suggestions on how to
proceed with the case preparation. Imagine yourself as the key manager involved with
the case or as a consultant to this person.
1. Read the case quickly. Later, read the case carefully, highlighting key facts.
Ask yourself what are the basic problems the manager has to resolve. What’s
wrong?
2. Develop alternative solutions to the problems identified. Identify the pros and
cons of each alternative solution. Select the best alternative solution and
specify how you would implement that solution. What would you do?
3. Identify possible issues and barriers that might impede implementation of
your solution. Develop action plans and strategies to help overcome barriers to
a successful implementation of your preferred solution. Outline a plan of
action.
4. Be prepared to present the results of your analysis and defend your position.
5. Also, be prepared to answer the question posed at the end of the case.
Textbook: Brown, G. D., Stone, T. T., Patrick, T. B. Strategic Management of Information
Systems in Healthcare. Health Professions Press, Chicago, 2005.
Grading: COURSE EVALUATION AND CUTOFF POINTS
In this course, students can accumulate up to 250 points form all course
requirements. Students caught cheating will fail the course. Course grades will be
determined based on the following schedule:
225 points or greater A
Less than 225 and greater than 200 points B
Less than 200 and greater than 175 points C
Less than 175 and greater than 150 D
Less than 150 F
1. Discussion Questions (4) assignments 40
2. Article Abstracts (4) assignments 40
3. Case Studies (2) 20
4. Project Paper/Presentation 50
5. Participation and Attendance 50
6. Final Examination 50
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Term Project The term project will be a comprehensive demonstration of the student’s ability to
Paper apply information theory, concepts, and tools to health administration and public
health problems. Examples of topics include:
1. Managing patient demand using Internet and email technology
2. Public Health Information Systems / Regional Health Information
Organizations
3. Electronic Medical Record
4. Physician usage of Internet technology-how, why, what value?
5. Intranets-do they improve organizational performance and control cost
6. Clinical decision-support systems
7. New technologies
8. Consumer-focused technologies
Each student will present their finding at the end of the semester in a formal
presentation. Appropriate presentation tools must be used
Session 1: Introduction and Overview , K. Brant-Lucich - Jan. 26th
Core Principles
Information as a transforming technology
IT in Healthcare Organizations
The constraining potential of IT
Readings
Chapter 1 course text
“For Board Members Only: Ten Trends to Watch in 2007,” The Governance Institute,
January 2007 (on Beachboard)
“Famous Quotes,” Internet
Class Exercise
1. Your employer or dream employer – type of organization (e.g., hospital, medical group, health plan,
etc.), size of the organization, your role, the IT organization
2. Select your favorite quote from “Famous Quotes” and prepare to discuss why you appreciate the
quote, and how you think it might relate to Healthcare Information Technology
Session 2: Overview II, K. Brant-Lucich – Feb. 2
Core Principles
Information skills for health systems leaders
Strategy network in healthcare organizations
IT as a social good
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Readings
Chapter 2 Course text
“The Readiness Gap,” Howard Baldwin, CIO Insight, August 2001
“Health Care IT: The Right Dose of Technology Helps the Medicine Go Down,” CIO, November
2005
“CIOs Rank Their Top Priorities for 2008,” CIO Insight, December 2007
In Classroom Discussion: Key takeaways from readings
1. What are the key healthcare industry drivers impacting IT decision-makers?
2. What are the top priorities for healthcare decision makers?
3. What are the Critical Success Factors for successful IT implementation
4. What is the difference between Organizational Strategy, Business Strategy and IT Strategy?
5. What are the consequences of failing to fully integrate enterprise, organizational and information
strategies?
Session 3: K. Brant-Lucich - Feb. 9
Core Principles
Integration of clinical strategy with business strategy
Clinical decision support systems
Aligning information strategy with clinical strategy
Project Management 101
The role of Project Management in IT
Readings
Chapters 3 course text
“How To Kill A Troubled Project,” Gopal K. Kapur, CIO Insight, September 1 2001
ASSIGNMENT: Article Abstract #1 on the subject of IT Management or IT Project
Management. Please select an article that pertains to HealthCare Information Systems. Please
read the article and be prepared to discuss in class. Please follow the Article Review Abstract
Format (on beachboard)
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Session 4: K. Brant-Lucich - Feb. 16
Core Principles
Leveraging IT for a competitive advantage
Resource base enterprise
Intellectual capital
IT transformation
Human resource and IT
Knowledge management
Knowledge workers
Commitment based management
Readings
Chapter 4, course text
ASSIGNMENT: Questions #1 due
1. What is competitive advantage? Is it always important to achieve a sustainable
competitive advantage in the healthcare industry?
2. Why is IT management so important to ensuring that organizational resources are
deployed effectively? What role does IT management play in the deployment
process? In what ways could IT management hinder the deployment of
organizational resources?
3. How does culture play a role in allowing organizations to perform clinical
and business processes effectively through the support of IT
Session 5, K. Brant-Lucich - Feb 23
Core Principles
Data vs. Information
Knowledge base systems
Controlled terminology
Knowledge representation
Interoperability
Standards
Readings
Chapter 5, course text
For discussion:
1. Discuss the significance of interoperability in a healthcare environment
2. Describe a controlled terminology; provide examples for how it might be used in a healthcare
environment.
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ASSIGNMENT: Article Abstract #2 Due on Managing Data
Session 6, K. Brant-Lucich - Mar. 2
Core Principles
Value Migration
Aligning Business Strategy and Clinical Strategies
Integrated Delivery Systems
Community Health Networks
Intellectual capital
Readings
Chapter 6, course text
Questions (for discussion in class only – no papers due)
1. This chapter highlights major forces causing strategic management thinking and practice. Are
these forces really new, why did they arise, and why at this particular point in history?
2. Describe a clinical IT initiative.
ASSIGNMENT: Article Abstract #3 Due on CPOE or EMR/EHR
Session 7, K. Brant-Lucich - March 9
Core Principles
Consumer informatics
e-health
Telemedicine
Tele home care
Patient empowerment
Disease management
Readings
Chapter 7, course text
Website Review:
o www.zynx.com
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o www.mdconsult.com
o www.firstconsult.com
o www.uptodate.com
ASSIGNMENT: Questions #2 due
1. Review each of the web sites listed above and discuss the purpose of each site and how it
relates to e-Health
2. Please review case 7.1, Chapter 7, page 150 and 151 Green Valley Home Care and list the
organizational considerations surrounding a tele-home care system
3. In your opinion, what does consumer empowerment mean?
Session 8: Kim Brant-Lucich - Mar. 16
Core Principles
Genomic Medicine
Clinical genetics
Bioinformatics
Decision support
Standardization
Readings
Chapter 8, course text
ASSIGNMENT: Article Abstract #4 due on Genomic Medicine
Session 9: Kim Brant-Lucich - Mar. 23
Core Principles
IT investment
Evaluation
ROI (Return on Investment)
Benefit-cost analysis
Business case
Economic value
Readings
Chapter 9, course text
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Questions (for discussion – no papers due)
1. How can IT add value?
2. Please read case 9.1, page 199 in course text and explain some of the lessons learned from
HC’s experience
March 30 – Spring Break
April 6 – Independent Study
Case Scenarios: Independent Session
Case Study: Implementation of CPOE System
The director of HIM at a community hospital is having lunch with a few colleagues in the
hospital cafeteria. The nursing supervisor from the intensive care unit sits down at the table and
mentions casually, “We just got the go-ahead. The new computerized physician order entry (CPOE)
system is going live in three months.” The director of HIM is momentarily stunned. This is the first she
has heard of the project.
After lunch she calls her boss the vice president (VP) of patient services, to ask about the project.
The VP describes the project, but when the HIM director asks why the HIM department had not been
involved, the VP sounds surprised by the question. She explains, “This is a system that affects
physicians, nurses, pharmacy, and other clinical departments, not the HIM department. Why would
anyone from HIM be involved?” The director takes a deep breath, slowly exhales, and calmly asks,
“How will the signatures for verbal and telephone orders be handled?” The VP relies, “I’m not involved
in that level of detail.”
After a moment of silence in which she controls her frustrations, the HIM director continues.
“Will the physician orders be kept on line permanently, or is the HIM department expected to print them
out and file them with the paper record?” she asks Again, surprised by the question, the VP replies, I
haven’t given that specific issue any thought, but I’m sure IT and the others on the team worked it all
out”.
The director goes on to explain that all these issues affect workflow in the HIM department. At
the very least, she says she will need to know the answers to these questions because she will need to
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start reengineering some of the HIM department’s work processes immediately.
Becoming Impatient, the VP suggests that the HIM director talk with the project leader in the IT
department for specific details on the system.
The director leaves several messages for the project leader, but a week goes by with no response.
Finally, the director goes to the IT project manager’s office unannounced to talk with him about the
project. He is polite for a few minutes, and then
tells her, “The physician order entry system is an IT project, and it’s near completion. It’s really too late
in the process for you to get involved.”
Deflated by the IT project director’s lack of concern, the HIM director sees no options and
returns to the Him department, seething and exasperated. She takes no further action.
A few weeks later, shortly after the implementation of the CPOE system, physicians start
complaining to the HIM director about problems using e-signatures and increases in the number of their
incomplete records. The director gets caught up in intense conflicts between the physicians and the IT
staff, with all parties blaming each other for their miseries. The HIM department develops backlogs
because he staff falls behind. Printing the physicians’ orders has increased their processing time.
The VP is surprised and visibly upset when the local board of health assesses a fine for failure to
sign verbal order within the required time frame. Eventually the physicians threaten the CEO and Board
of Trustees that if the CPOE system isn’t discontinued, they will start admitting patients to other
hospitals in the area. The CEO immediately aborts the project, and the CPOE system is “temporarily”
taken down until the design problems can be fixed and the medial staff re-engaged in the project.
ASSIGNMENT: Case Study #1 Questions: (due on April 13)
1. What happened?
2. What is clearly missing in this situation
3. Who is at fault?
4. How would you have handled the situation if you were the HIM Director?
5. What would you do differently if you were the project manager/leader?
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Session 11: April 13
Core Principles
IT governance
Role of the CIO
IT strategic planning
IT project planning
IT life cycle planning
IT department organization
Readings
Chapter 10, course text
“Does it Take a Psychopath to Make a Good CIO?,” CIO Insight, September 2005
“Can a CIO Become Too Strategic?,” CIO Insight, February 2005
“ABC: An Introduction to IT Project Management,” cio.com
ASSIGNMENT: Case Study #1 Questions: (due on April 13)
1. What happened?
2. What is clearly missing in this situation
3. Who is at fault?
4. How would you have handled the situation if you were the HIM Director?
5. What would you do differently if you were the project manager/leader?
Session 12 – April 20
Guest Lecture: Tony Lucich, Chief Information Security Officer, County of Orange
Core Principles
Security Architecture
HIPAA Security
Patient Confidentiality
Auditing
Contingency planning
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Readings
Chapter 11, course text
Questions #3 due
1. Please sketch an outline of a project plan - what components or elements should be in the plan?
2. In your opinion, who is responsible for IT strategic planning? Please explain your answer
Session 12: April 27
Core Principles
Transforming the U.S. Health System
Personal Health Record
Clinical Information Networks
Future Technologies
Advanced Healthcare IT Review
Readings
Chapter 12, course text
ASSIGNMENT: Questions #4 due
1. Suggest a security review process that ensures business and security issues are both considered in
a systems design or purchase decision making.
2. Is a healthcare executive concerned exclusively with external security threats, or do real threats
exist inside an organization? Demonstrate by a discussion of these points and understanding of
how the two may relate to each other.
Session 14: May 4
In Class Exercise/Case Study – I.T. Strategic Planning
Think about the role of various constituents in the IT Strategic Planning Process. Be prepared to take on
the role of CEO, COO, CMO or VP, Medical Affairs, CIO, CNO, or an individual department director,
or Medical Group Administrator. Think about what is important to each stakeholder. Be prepared to
justify why, in a given role, you would make particular strategic decisions.
Session 15: May 11 Project Presentations
Session 16: May 18 Final Examination (Essay Format)
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Online Sources/References
SUPPLEMENTAL READINGS
“18th Annual HIMSS Leadership Survey,” HIMSS, Summer 2007
“2007 Gartner Healthcare Provider Hype Cycles” August 2007
“The Five Competitive Forces that Shape Strategy,” Harvard Business Review, December 2006
“Fixing Healthcare from the Inside Today,” Harvard Business Review
“The Hard Side of Change Management,” Harvard Business Review
“Healthcare 2015: Win-Win or Lose-Lose,” IBM Global Business Services White Paper
“Six IT Decisions Your IT People Shouldn’t Make,” Harvard Business Review
”Why Good Projects Fail Anyway,” Harvard Business Review, November-December 2000
“The 30 Most Important IT Trends for 2007,” CIO Insight, November 2006
“CIOs at the Crossroads,” CIO Insight, January 2008
“Intelligent Disobedience,” Computerworld, August 2004
Web Sites
www.hospitalconnect.com
www.cio.com
www.cioinsight.com
www.himss.org
www.ihi.org
www.aha.org
www.hhs.gov
www.healthcareitnews.com
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CHEATING AND PLAGIARISM
The following is excerpted from the California State University, Long Beach Policy Statement
85-19, dated December 13, 1985.
It is the policy of the faculty and administration to deal effectively with the student who practices
cheating or plagiarism. These acts are fundamentally destructive of the process of education and the
confident evaluation of a student's mastery over a subject. A University maintains respect and
functions successfully within the larger community when its reputation is built on honesty. By the
same token, each student benefits in helping to maintain the integrity of the University. This policy,
therefore, provides for a variety of faculty actions including those which may lead to the assignment of
a failing grade for a course and for administrative actions which may lead to dismissal from the
University. It is the intent to support the traditional values that students are on their honor to perform
their academic duties in an ethical manner.
GENERAL:
The following definitions of cheating and plagiarism shall apply to all work submitted by a student.
DEFINITION OF PLAGIARISM:
Plagiarism is defined as the act of using the ideas or work of another person or persons as if they were
one's own, without giving credit to the source. Such an act is not plagiarism if it is ascertained that the
ideas were arrived at through independent reasoning or logic or where the thought or idea is common
knowledge.
Acknowledge of an original author or source must be made through appropriate references, i.e.,
quotation marks, footnotes, or commentary. Examples of plagiarism include, but are not limited to, the
following: the submission of a work, either in part or in whole, completed by another; failure to give
credit for ideas, statements, facts or conclusions with rightfully belong to another; in written work,
failure to use quotation marks when quoting directly from another, whether it be a paragraph, a
sentence, or even a part thereof; close and lengthy paraphrasing of another writing or paraphrasing
should consult the instructor.
Students are cautioned that, in conducting their research, they should prepare their notes by (a) either
quoting material exactly (using quotation marks) at the time they take notes from a source; or (b)
departing completely from the language used in the source, putting the material into their own words.
In this way, when the material is used in the paper or project, the student can avoid plagiarism resulting
from verbatim use of notes. Both quoted and paraphrased materials must be given proper citations.
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DEFINITION OF CHEATING:
Cheating is defined as the act of obtaining or attempting to obtain or aiding another to obtain academic
credit for work by the use of any dishonest, deceptive or fraudulent means. Examples of cheating
during an examination would include, but not be limited to the following: copying, either in part or in
wholes, from another test or examination; discussion of answers or ideas relating to the answers on an
examination or test unless such discussion is specifically authorized by the instructor; giving or
receiving copies of an exam without the permission of the instructor; using or displaying notes; "cheat
sheets," or other information or devices inappropriate to the prescribed test conditions, as when the test
of competence includes a test of unassisted recall of information, skill, or procedure; allowing someone
other than the officially enrolled student to represent the same. Also included are plagiarism as defined
and altering or interfering with the grading procedures.
It is often appropriate for students to study together or to work in teams on projects. However, such
students should be careful to avoid use of unauthorized assistance, and to avoid any implication of
cheating, by such means as sitting apart from one another in examinations, presenting the work in a
manner which clearly indicates the effort of each individual, or such other method as is appropriate to
the particular course.
ACADEMIC ACTION:
One or more of the following academic actions are available to the faculty member who finds a student
has been cheating or plagiarizing.
(a) Review -- no action.
(b) An oral reprimand with emphasis on counseling toward prevention of further
occurrences;
(c) A requirement that the work be repeated;
(d) Assignment of a score of zero (0) for the specific demonstration of competence,
resulting in the proportional reduction of final course grade;
(e) Assignment of a failing final grade;
(f) Referral to the Office of Judicial Affairs for possible probation, suspension, or
expulsion.
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