Departmental Information Systems and Management Information Systems in Healthcare Organizations

Departmental Information Systems &

Management Information Systems in Healthcare

Organizations

NawananTheera-Ampornpunthttp://www.slideshare.net/nawanan

Parts of this material were based on materials developed by Duke University, funded by the Office of the National Coordinator for Health Information Technology, U.S. Department of Health and Human Services under

Award Number IU24OC000024 (Health IT Workforce Curriculum v.2.0, Component 6/Unit 9-1).

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OutlineDepartmental Information Systems Hospital departments Nature of enterprise information systems Departmental IS categories Integration & interfaces System acquisition decisionsManagement Information Systems (MIS) Concepts of MIS Common MIS in healthcare organizations

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Class Exercise 1 Name some departments or

organizational units of a hospital that you can think of.

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Examples of Hospital Departments Clinical departments

Pediatrics (children) Ophthalmology (eye) Psychiatry (mental health) Nursing Pathology (lab) Radiology (x-rays) Anesthesiology Family medicine Physical medicine &

rehabilitation Surgery

Obstetrics/Gynecology -OB/GYN (childbirth & woman’s health)

Otolaryngology (Ear, nose, throat - ENT)

Orthopedics (bone diseases)

Internal medicine Emergency medicine Community medicine Pharmacy Operating rooms Outpatient departments Inpatient wards

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Examples of Hospital Departments Administrative departments

General administration office Hospital director’s office Human resources Finance Procurement & material management department Public relations Policy & planning Medical education Graphics design & media Academic affairs Student affairs Library Quality improvement department IT/Informatics etc.

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Health Care Information System (HCIS) Information system used within a health care

organization Facilitates communication Integrates information Documents health care interventions Performs record keeping Otherwise supports the functions of the

organizationShortliffe, E, Cimino J, eds: Biomedical informatics: Computer

Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.

Health IT Workforce Curriculum Version 2.0/Spring 2011

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Hospital Information System Information system used within a hospital Sometimes divided into

Front Office (Clinical information systems) Back Office (Management information

systems)

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Enterprise-wide Information Systems

Shortliffe, EH, Blois, MS., The Computer Meets Medicine and Biology: Emergency of a Discipline. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.

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Class Exercise 2 Choose 3-5 hospital departments and

discuss their specific information needs and circumstances

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Hospital Information System (HIS) Information system used within a hospital Sometimes divided into

Front Office (Clinical information systems) Back Office (Management information

systems)

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Some characteristicsFront Office

Focuses on patient care

Patient records should be accessible hospital-wide to clinical departments

Time may be critical

Back Office

Performs administrative functions

Some information is specific to the individual department

Often is not very time-dependent

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HIS Components Patient management and billing Care delivery and clinical documentation Clinical decision support Department management Financial and resource management

Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.


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Patient Management and Billing Systems that support patient

management functions Example

Patient identification Supporting technology

Master patient index Houses centralized database

Patient financial, demographic, registration and location data



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Care Delivery and Clinical Documentation

Systems that support the delivery of the care and documentation of that care Example

Clinical information systems, EHRs Supporting technology

Electronic clinical order entry and results reporting Houses centralized database

Patient clinical dataVogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In:

Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.


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Clinical Decision Support Systems that support the clinical staff with

data interpretation and decision-making Example

Medication Administration System Supporting technology

Bar-code medication administration (BCMA)

Accesses patient and other databases

Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006


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Financial and Resource ManagementSystems that support business

functions Example

Accounts Payable System Supporting technology

Claims administration

Houses centralized database Financial and employee data


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4 Ways IT Can Help Health Care

• Business Intelligence

• Data Mining/Utilization

• MIS• Research

Informatics• E-learning

• CDSS• HIE• CPOE• PACS• EHRs

Enterprise Resource Planning (ERP)• Finance• Materials• HR

• ADT• HIS• LIS• RIS

Strategic

Operational

ClinicalAdministrative

Position may vary based on local context

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Department Management Systems that support a department’s information

needs Example

Health Information Management Department systems Supporting technology

Electronic Document Management Systems Supplies data to patient databasesVogel, LH, Perreault, LE., Management of Information in Healthcare

Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.


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Departmental information system

Supports specific needs of each department

Often designed to fit best with each department’s unique workflows & circumstances

Usually a small system used by a few users of one or two small departments

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Class Exercise 3 What are some issues you can think of

when developing an information system for a specific department

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Issues of Departmental IS Data integration (data sharing) Silos of information Process (workflow) integration In other words, standardization vs.

customization Implementation strategies (build or buy) Sustainability & system maintenance

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Integration Arrangement of an organization’s

information systems Efficient and effective communication Bring together related parts into a single

system


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Application Integration Patient management and billing

Patient tracking Department management

Electronic document management Care delivery and clinical documentation

Order entry and results reporting



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Application Integration Clinical decision support

Computer-based physician order-entry Financial and resource management

Provider profiling



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Systems Integration Strategies Data preservation Separate information management plan

components for Data management Applications and business logic User interface



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Key Components of Enterprise Integration Master person index Single sign-on Context management Common code sets Data warehouse


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Critical Integration Elements Information is available when and where it is

needed Users must have an integrated view Data must have a consistent interpretation Adequate security must be in place



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Data and Process Integration Data integration

Interface engine Process integration

Operational workflow Human organizational systems



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Interface Engine Translates and formats data for exchange Controls data flows between applications Central connecting point for all interfaces



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HL7 Messaging StandardHealth Level Seven (HL7)Message standardSupports clinical practiceMove data in standard

formats


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From Islands of Information to Meaningful Use


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System Acquisition Decisions for Departmental Information Systems

Build (in-house development) Buy (outsourcing) Combination (e.g. buy then maintain/customize

in house)

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Build or BuyBuild/Homegrown Full control of software &

data Requires local expertise Expertise

retention/knowledge management is vital

Maybe cost-effective if high degree of local customizations or long-term projection

Buy/Outsource Less control of software

& data Requires vendor

competence Vendor relationship

management is vital Maybe cost-effective

if economies of scale

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Build or Buy No universal right or wrong answer Depends on local contexts Strategic positioning Internal IT capability Existing environments Level of complexity/customization needed Market factors: market maturity, vendor choices,

competence, willingness to customize/learn Pricing arrangements Purchasing power Sustainability

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Outsourcing Decision Tree

Does service offer competitive advantage?

Is external deliveryreliable and lower cost?

Keep Internal

Keep Internal

OUTSOURCE!

Yes

No

Yes

No

From a teaching slide by Nelson F. Granados, 2006

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Outsourcing Dilemmas


Doig et al, “Has Outsourcing gone too far,” McKinsey Quarterly, 2001

• “One of the challenges Ford has is that it has outsourced so much of its process, it no longer has the expertise to understand how it all comes together” Marco Iansiti, CIO, 2003

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IT Outsourcing: Ramathibodi’s Case


Does service offer competitive advantage?

Is external deliveryreliable and lower cost?

Keep Internal

Keep Internal

OUTSOURCE!

Yes

No

Yes

No

Core HIS, CPOEStrategic advantages• Agility due to local workflow accommodations• Secondary data utilization (research, QI)• Roadmap to national leader in informatics

External delivery unreliable• Non-Core HISExternal delivery higher cost• ERP, IT Support?

PACS, RIS, Departmental

systems

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If Decision = BuildChallenges Recruitment & retention Keeping up with new technologies & requirements

The “legacy systems” trap

Justifying “slow” implementation

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SuggestionsRecruitment & retentionKnowledge management: Tacit -> ExplicitHave long-term vision/strategiesAim for system evolution New requirements New technologies/best practices Refactoring

PrioritizeReevaluate build/buy decision every 5 years

If Decision = Build

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Challenges Vendor selection Justifying long-term costs Managing risks The “vendor lock-in” problem Sharing data with other systems

If Decision = Buy

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Suggestions Take time & effort in knowing your potential vendors Be flexible in requirements, project delivery Look at vendor as partner, not contractor

Avoid “us-versus-them” mentality

Understand “learning curves” Be less bureaucratic, more collaborative Be specific in SLAs, MAs, IP, data ownership Choose technologies wisely, with rooms for later

migration if possible Knowledge transfer Always have a Plan B (Alternative vendors, internal workforce)

If Decision = Buy

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Management Information Systems (MIS) Provides information needed to manage an

organization (e.g. a hospital) effectively and efficiently

A broad category of information systems Administrative reports Enterprise resource planning (ERP) Supply Chain Management (SCM) Customer Relationship Management (CRM) Project management tools Knowledge management tools Business intelligence (BI)

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Business Intelligence Applications Allows for

Data analysis Correlation Trending Reporting of data across multiple sources


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Business Intelligence Applications Examples

Clinical and Financial Analytics and Decision Support

Query and Reporting Tools Data Mining Online Scoreboards and Dashboards

Business Intelligence & Data Warehousing for Healthcare. Clinical Informatics Wiki. 2008. Available from: http://www.informatics-review.com/wiki/index.php/Business_Intelligence_&_Data_Warehousing_for_Healthcare


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Summary Various departments and their information

needs in hospitals/healthcare organizations Applications that need to be integrated in

health care information systems Strategies to ensure integration of front-end

clinical data collection and back-end billing functions

Critical integration elements Information systems for organizational

management (MIS) Data analysis and trending (BI)


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References Vogel, LH, Perreault, LE., Management of

Information in Healthcare Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.


Health & Medicine

Departmental Information Systems and Management Information Systems in Healthcare Organizations