Health Care Information Systems E-Book

Karen A. Wager

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1145

Veröffentlichungsjahr: 2013

Beschreibung

This most widely used textbook in the field has been thoroughlyrevised and updated to reflect changes in the health care industryand the renewed focus on health care information technologyinitiatives. Two new chapters cover Federal efforts to enhancequality of patient care through the use of health care informationtechnology and strategy considerations. Additionally, reflectingthe increased focus on global health, the book features aninternational perspective on health care information technology.Case studies of organizations experiencing management-relatedinformation system challenges have been updated and several newcases have been added. These reality-based cases are designed tostimulate discussion among students and enable them to applyconcepts in the book to real-life scenarios. The book's companionWeb site features lecture slides, a test bank, and other materialsto enhance students' understanding.

Leseprobe

Table of Contents

Cover

Title page

Copyright

Tables, Figures, and Exhibits

TABLES

FIGURES

EXHIBITS

Foreword

Dedication

Preface

PURPOSE AND ORGANIZATION OF THIS BOOK

IT CHALLENGES IN HEALTH CARE

RISING TO THE CHALLENGES

Acknowledgments

The Authors

PART ONE:

H

ealth

C

are

I

nformation

CHAPTER 1: Introduction to

H

ealth

C

are

I

nformation

TYPES OF HEALTH CARE INFORMATION

INTERNAL DATA AND INFORMATION: PATIENT SPECIFIC—CLINICAL

INTERNAL DATA AND INFORMATION: PATIENT SPECIFIC—ADMINISTRATIVE

INTERNAL DATA AND INFORMATION: PATIENT SPECIFIC—COMBINING CLINICAL AND ADMINISTRATIVE

INTERNAL DATA AND INFORMATION: AGGREGATE—CLINICAL

INTERNAL DATA AND INFORMATION: AGGREGATE—ADMINISTRATIVE

INTERNAL DATA AND INFORMATION: AGGREGATE—COMBINING CLINICAL AND ADMINISTRATIVE

EXTERNAL DATA AND INFORMATION: COMPARATIVE

EXTERNAL DATA AND INFORMATION: EXPERT OR KNOWLEDGE BASED

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 2: Health Care Data Quality

DATA VERSUS INFORMATION

PROBLEMS WITH POOR-QUALITY DATA

ENSURING DATA AND INFORMATION QUALITY

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 3: Health Care Information Regulations, Laws, and Standards

LICENSURE, CERTIFICATION, AND ACCREDITATION

PATIENT SAFETY ORGANIZATIONS

LEGAL ASPECTS OF MANAGING HEALTH INFORMATION

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

PART TWO: Health Care Information Systems

CHAPTER 4: History and Evolution of Health Care Information Systems

DEFINITION OF TERMS

HISTORY AND EVOLUTION

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 5: Clinical Information Systems

THE ELECTRONIC HEALTH RECORD

OTHER MAJOR HCIS TYPES

FITTING APPLICATIONS TOGETHER

OVERCOMING BARRIERS TO ADOPTION

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 6: Federal Efforts to Enhance Quality of Patient Care through the Use of Health Information Technology

HITECH ACT

HEALTH CARE REFORM: NEW MODES OF CARE AND PAYMENT REFORM

HEALTH INFORMATION EXCHANGE

INFORMATION TECHNOLOGY RAMIFICATIONS OF NEW MODELS OF CARE AND PAYMENT REFORM

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 7: System Acquisition

SYSTEM ACQUISITION: A DEFINITION

SYSTEMS DEVELOPMENT LIFE CYCLE

SYSTEM ACQUISITION PROCESS

PROJECT MANAGEMENT TOOLS

THINGS THAT CAN GO WRONG

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 8: System Implementation and Support

SYSTEM IMPLEMENTATION PROCESS

MANAGING THE ORGANIZATIONAL ASPECTS

SYSTEM SUPPORT AND EVALUATION

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

PART THREE: Information Technology

CHAPTER 9: Technologies That Support Health Care Information Systems

INFORMATION TECHNOLOGY ADOPTION CHALLENGES

DATA MANAGEMENT AND ACCESS

NETWORKS AND DATA COMMUNICATIONS

INFORMATION DISTRIBUTION SCHEMES

REMOTE ACCESS TECHNOLOGIES

INTERNET AND WEB CONCEPTS AND APPLICATIONS

E-COMMERCE IN HEALTH CARE

CLINICAL AND MANAGERIAL DECISION SUPPORT

INFORMATION SYSTEMS ARCHITECTURE

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 10: Health Care Information System Standards

STANDARDS DEVELOPMENT PROCESS

CLASSIFICATION STANDARDS

VOCABULARY AND TERMINOLOGY STANDARDS

HEALTH RECORD CONTENT AND FUNCTIONAL STANDARDS

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 11: Security of Health Care Information Systems

THE HEALTH CARE ORGANIZATION’S SECURITY PROGRAM

THREATS TO HEALTH CARE INFORMATION

OVERVIEW OF THE HIPAA SECURITY RULE

OUTLINE OF THE HIPAA SECURITY RULE

HITECH EXPANSION OF THE HIPAA SECURITY RULE

ADMINISTRATIVE SAFEGUARDS

PHYSICAL SAFEGUARDS

TECHNICAL SAFEGUARDS

SECURITY IN A WIRELESS ENVIRONMENT

REMOTE ACCESS SECURITY

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

PART FOUR: Senior Management IT Challenges

CHAPTER 12: Organizing Information Technology Services

INFORMATION TECHNOLOGY FUNCTIONS

ORGANIZING IT STAFF AND SERVICES

IN-HOUSE VERSUS OUTSOURCED IT

EVALUATING IT EFFECTIVENESS

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 13: IT Alignment and Strategic Planning

IT PLANNING OBJECTIVES

OVERVIEW OF STRATEGY

VECTORS FOR ARRIVING AT IT STRATEGY

THE IT ASSET

A NORMATIVE APPROACH TO DEVELOPING ALIGNMENT AND IT STRATEGY

IT STRATEGY AND ALIGNMENT CHALLENGES

CHARACTERISTICS OF STRATEGIC THINKING

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 14: Strategy Considerations

COMPLEMENTARY STRATEGIES

STRATEGY EVOLUTION

GOVERNING CONCEPTS

THE COMPETITIVE VALUE OF IT

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 15: IT Governance and Management

IT GOVERNANCE

IT EFFECTIVENESS

IT BUDGET

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 16: Management’s Role in Major IT Initiatives

MANAGING CHANGE DUE TO IT

MANAGING IT PROJECTS

UNDERSTANDING IT INITIATIVE FAILURES

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 17: Assessing and Achieving Value in Health Care Information Systems

DEFINITION OF IT-ENABLED VALUE

THE IT PROJECT PROPOSAL

STEPS TO IMPROVE VALUE REALIZATION

WHY IT FAILS TO DELIVER RETURNS

ANALYSES OF THE IT VALUE CHALLENGE

SUMMARY

KEY TERMS

LEARNING ACTIVITIES

CHAPTER 18: Health IT Leadership: A Compendium of Case Studies

CASE 1: BOARD SUPPORT FOR A CAPITAL PROJECT

CASE 2: THE DECISION TO DEVELOP AN IT STRATEGIC PLAN

CASE 3: SELECTION OF A PATIENT SAFETY STRATEGY

CASE 4: STRATEGIC IS PLANNING FOR THE HOSPITAL ED

CASE 5: PLANNING AN EHR IMPLEMENTATION

CASE 6: IMPLEMENTING A CAPACITY MANAGEMENT INFORMATION SYSTEM

CASE 7: IMPLEMENTING A TELEMEDICINE SOLUTION

CASE 8: REPLACING A PRACTICE MANAGEMENT SYSTEM

CASE 9: CONVERSION TO AN EHR MESSAGING SYSTEM

CASE 10: CONCERNS AND WORKAROUNDS WITH A CLINICAL DOCUMENTATION SYSTEM

CASE 11: STRATEGIES FOR IMPLEMENTING CPOE

CASE 12: IMPLEMENTING A SYNDROMIC SURVEILLANCE SYSTEM

CASE 13: THE ADMITTING SYSTEM CRASHES

CASE 14: BREACHING THE SECURITY OF AN INTERNET PATIENT PORTAL

CASE 15: ASSESSING THE VALUE AND IMPACT OF CPOE

CASE 16: SELECTING AN EHR FOR DERMATOLOGY PRACTICE

CASE 17: WATSON’S AMBULATORY EHR TRANSITION

CASE 18: ASSESSING THE VALUE OF HEALTH IT INVESTMENT

SUGGESTED LISTING OF PUBLISHED HEALTH IT-RELATED CASES

APPENDIXES

APPENDIX A: Overview of the Health Care IT Industry

THE HEALTH CARE IT INDUSTRY

SOURCES OF INDUSTRY INFORMATION

HEALTH CARE IT ASSOCIATIONS

SUMMARY

LEARNING ACTIVITIES

APPENDIX B: Sample Project Charter

FOREWORD

BUSINESS REQUIREMENTS

VISION OF THE SOLUTION

SCOPE AND LIMITATIONS

PROJECT SUCCESS FACTORS

BUDGET HIGHLIGHTS

TIMELINE

PROJECT ORGANIZATION

PROJECT MANAGEMENT STRATEGIES

APPENDIX C: International Adoption and Use of Health Information Technology

THE ADOPTION AND USE OF HEALTH IT FROM VARIOUS REGIONS OF THE WORLD

LESSONS FROM GLOBAL LEADERS

CONCLUSION

Index

End User License Agreement

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Guide

Cover

Contents

Start Reading

List of Illustrations

Figure 1.1

Figure 1.2

Figure 1.3

Figure 1.4

Figure 1.5

Figure 1.6

Figure 1.7

Figure 1.8

Figure 1.9

Figure 1.10

Figure 1.11

Figure 1.12

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Figure 11.1

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Figure 12.3

Figure 13.1

Figure 13.2

Figure 13.3

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List of Tables

Table 1.1

Table 2.1

Table 4.1

Table 4.2

Table 5.1

Table 5.2

Table 5.3

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Table 9.1

Table 9.2

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Table 10.3

Table 10.4

Table 10.5

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Table 13.1

Table 13.2

Table 13.3

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Table 15.1

Table 16.1

Table 17.1

Table 17.2

Table 18.1

Table A.1

Table A.2

Table A.3

Table B.1

Table B.2

Table C.1

Health Care Information Systems

A Practical Approach for Health Care Management

Third Edition

Karen A. Wager

Frances Wickham Lee

John P. Glaser

Cover design by JPudaCover image: © Michael Adendorff/GettyCopyright © 2013 by John Wiley & Sons, Inc. All rights reserved.

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Library of Congress Cataloging-in-Publication Data

Wager, Karen A., 1961– author.

Health care information systems : a practical approach for health care management / Karen A. Wager, Frances W. Lee, John P. Glaser. – Third editon.    p. ; cm.Includes bibliographical references and index.ISBN 978-1-118-17353-4 (paperback), ISBN 978-1-118-41936-6 (ePDF), ISBN 978-1-118-42093-5 (ePub)I. Lee, Frances Wickham, 1953– author. II. Glaser, John P. (John Patrick), 1955– author. III. Title.[DNLM: 1. Health Information Systems–organization & administration. W 26.55.I4]R858610.68–dc232013019370

Foreword

Two pieces of recent federal legislation in the United States—the American Recovery and Reinvestment Act in 2009 and the Patient Protection and Affordable Care Act in 2010—have put health care information technology (IT) on center stage. On the one hand, physicians now have financial incentives to adopt electronic health records (EHRs) and make meaningful use of their capabilities. On the other hand, accountable care organizations have financial incentives to support these and other IT investments (such as computerized physician order entry systems and decision-support systems) to measure, monitor, and achieve defined metrics for the quality of care they deliver.

There is renewed promise that IT investments can help the United States to not only improve the quality of care provided to the population but also lower the cost (or at least moderate the rate of increase in that cost). Recent studies and meta-analyses suggest this promise may be difficult to achieve, especially on the cost side. Mark Pauly and I have summarized the evidence on the cost-reducing potential of various types of information technology and found it wanting (see the November 2012 issue of Health Affairs). Moreover, while the impacts of IT on quality are a bit more positive, the results are neither consistent nor overwhelmingly strong. What is going on? Are we all mistaken about IT? Will this ship ever come in?

Information systems (IS) constitute the source of many of the problems in the health care industry. Health care is one of the most transaction-intensive industries (estimated at thirty billion transactions annually), given all the encounters between patients and providers, providers and other providers, providers and insurers, suppliers and providers, and so on. Yet compared to other industries, health care has historically underinvested in IS—and it shows. The transactions between parties in health care take place not so much electronically as through a mixture of telephone, paper, fax, and electronic data exchange (EDI) media. The result is that much information is never captured, is captured incorrectly, is captured inefficiently, or is difficult to retrieve and use. Moreover, the industry relies heavily on legacy systems that cannot communicate with one another, not only between organizations but often within the same organization.

What is required to fix this messy situation? To paraphrase an old adage, the system may be the solution. The U.S. health care industry is in need of a massive infusion of capital to fund the adoption of new IS. Such capital is already being invested right now in EHRs and meeting meaningful use requirements. But money is not enough. In order to work well and live up to its promise, IS must be integrated into clinicians’ daily workflow to speed up (rather than slow down) their decision making, as well as to efficiently and conveniently bring greater information to bear at the point of diagnosis and treatment. Scholars call such integration a “sociotechnical system.” Finally, to convince all parties to adopt the necessary IS systems, we will need rigorous studies that document the cost and quality returns from these investments and the parties to which these returns accrue. This is not a small task; the value of IS investments still remains a messy discussion.

This book provides an incredibly thorough overview of information systems and their importance in the health care industry. It provides an overview of the health care information industry; a history of health care IS in the United States; a review of the fundamental characteristics of information, the uses to which it is put, and the processes it supports; and a highly detailed discussion of the primary clinical and managerial applications of information (including electronic medical records), the value of information and IS to multiple stakeholders, and, most important, the management of information and IS. This approach is particularly helpful when one considers that the vast majority of health system executives underwent their graduate training at a time when information systems were in their infancy and thus when no such text existed. The second edition of this book also included a dozen minicases documenting the challenges of IT implementation. This is incredibly valuable, since the technology costs are usually outweighed by the process costs of installation and achieving adoption by end users. This new edition is thus a great primer, offering a systematic presentation of a complex, important topic.

The reader will benefit from the collaborative effort that went into this volume. Authors Wager and Lee are academics with considerable experience in teaching health care information management; Glaser is the former chief information officer at one of the most prominent hospital (and integrated) systems in the United States, and is now CEO of Siemens. The combined talents of these two academics and one practitioner (all of whom have doctoral degrees) are reflected in the scope and depth presented here. This book is both systematic and practical, serving the needs of graduate students and current executives in the industry. What I have found particularly helpful is the book’s ability to show how information and IS integrate with the other functions of the health care provider organization. The reader comes away from this book with a more profound understanding of how information serves as the lifeblood of the institution and as the real glue that can cement together professionals and departments within a health care organization—and that can also tie the organization more closely to its upstream trading partners (manufacturers, wholesalers, and group purchasing organizations) and downstream trading partners (insurers and managed care organizations). At the end of the day, information and IS construct the real pathway to the utopia sought by providers during the past decade: integrated health care.

This book is required reading for all those who toil in the field of health care management—whether as managers, professionals, consultants, suppliers, customers, students, or scholars. The topic of IS in health care is simply too important, and until recently too often ignored, to be left to haphazard learning. I commend the authors for their great contribution to the field of health care management and information management.

Lawton Robert Burns

James Joo-Jin Kim Professor

The Wharton School

March 2013

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