CIO Survey: Significance
The growing complexities of business functions mandate surveying of as much stakeholders as possible for more informed decisions. For current purposes, CIOs are not main stakeholders in HMIS. If anything, CIOs are IT experts having broad experience in information management across different business functions. By managing information management system recommendations, bidding, installation, implementation, integration, maintenance, recovery / backup, and/or update, CIOs are one most engaged stakeholder in HMIS and hence surveying CIOs. Further, given increasing integration of HMIS into day-to-day operations of healthcare ecosystems, CIOs are becoming at critical cross points of healthcare provision. Specifically, being "initial" HMIS recommenders, CIOs are, if anything, primary "educators" on HMIS usages, applications and maintenance methods. Therefore, by surveying CIOs in different healthcare contexts, HMIS industry gains primary insights by main stakeholders into current status and future patterns.
Hardware Investments: Predictions & Comparisons
Given growing demand on more systematic information streams across healthcare management, specific equipments might be critical to meet patient and physician demand. Further, certain areas would prove instrumental to catering for stakeholder needs. Specifically, monitoring, health management dealing center, dynamic data store and management layer equipments (Xue-yan, Academy of Equipment Command & Technology, Hong-min & Tong-na, 2011). These equipment usability areas combine, moreover, structure design and function design (Xue-yan, Academy of Equipment Command & Technology Hong-min). If anything, monitoring has been used in healthcare systems for decades. By using monitoring systems integrated into a broader health management system, main stakeholders would able to record histories of monitoring results, an advancement which should make chronological comparisons for one or more patients a more systematic and insightful process. By adopting health management dealing center equipments, healthcare providers would be able to manage processing patient and physician applications, for example, in more expedient and systematic manner. If anything, waiting lists would be more manageable and more accurately prioritized. For dynamic data store hardware, big data storage facility cannot be overemphasized. Given growing volume of patient data, storage facilities would be critical in catering healthcare services. For management layer equipments, enterprise resource planning (ERP) supporting hardware cannot be overemphasized in current healthcare practice. By enabling healthcare manager to manage day-to-day operations using effective equipment and applications, collaboration across different stakeholders – using different corporate resources – would lead, predictably, to more optimum resource management.
According to survey in case ("2008 CIO Survey Results," n.d.), findings show highest percent (20%) of CIOs in a hospital or integrated delivery system view backup/disaster recovery as of utmost priority compared to 19% in a clinic/group practice in favor of investment in laptops/tablets/PDAs.
Comparing survey findings and author's predictions, a number of interesting similarities as well as differences emerge. For similarities, predictions of paper author and survey converges on growing significance of data storage and recovery (as discussed in further detail later) particularly in a hospital or integrated delivery system context. This is justified by increasing patient data volumes, a pattern corroborated by growing importance of Big Data as an independent discipline. Unsurprisingly, data storage, backup and/or recovery ranks higher in a hospital or integrated delivery system context, compared to a clinic/group practice in which more personalized (and less data volumes are available) hardware (i.e. laptops/tablets/PDAs) are recommended.
For differences between author and survey predictions, one particular major difference emerges. By emphasizing data backup/disaster recovery exclusively, paper author fails in accounting for specific clinical needs not of particular concern to hospitals or integrated delivery systems. Compared to hospitals, clinics are usually driven by more business needs, involve fewer stakeholders, more concerned about brand image and, not least, are more accountable to immediate stakeholders, i.e. staff. Aptly, more personalized hardware are, predictably enough, more significant and are ranked higher in priority list compared to hospitals.
Electronic Health Records: Top Priority for CIOs
As noted, growing significance in documenting patient data has mandated particular attention to, if not adoption of, certain application designs for more effective patient information management. Unsurprisingly, electronic health records (EHR) has been shown to have a high priority as recommended by CIOs ("2008 CIO Survey Results"). This result is congruent to later developments, unprecedentedly initialed by U.S. federal government. In 2009, American Recovery and Reinvestment Act (ARRA) stimulus bill was enacted (Blumenthal, 2009). One specific progress made by enacting ARRA is earmarking $19 billion for a program aimed at promoting incorporation and use of health information technology (HIT) and EHRs in healthcare systems (Blumenthal). Notwithstanding perceived challenges (including, for example, cost, perceived lack of financial return, technical and logistic challenges of installation, maintenance and update as well as concerns about privacy and security of electronically managed health information), projected ROIs are substantial including, for example, extra physician Medicare payments for “meaningful use” of a “certified” EHR capable of exchanging data with other health care system parts in return for "meaningful use" and a "certified" EHR (Blumenthal). Most notably, ARRA offers complementary safeguards against possible privacy and security breaches not adequately offered by Health Insurance Portability and Accountability Act (Blumenthal).
Thus, investing in EHR programs enhances chain value across different healthcare categories. By enabling EHRs, patient records are well maintained in a more effective and systematic manner, physicians are better able to manage healthcare provision process more insightfully, physicians receive higher pay in return for value-added services and healthcare administrators can optimize management processes by incorporating EHRs (a significant ERP core component) into integrated HMIS.
Clinics & Hospitals: Different Data Recovery Concerns
The case for backup/recovery becomes more complicated in implementing HMIS in different healthcare contexts. Notably, comparing backup/recovery plans of clinics and hospitals, hospitals appear more concerned in maintaining sophisticated and up-to-date backup/recovery systems. This could be justified by a broad range of reasons. Significantly, hospitals handle much larger data volumes compared to clinics. The loss of patient data could lead to far more organizational complexities in hospitals compared to clinics. Specifically, hospitals are, supposedly, accountable to a broader range of stakeholders, including government (local or federal). In losing patient data, hospitals are more vulnerable to accountability, financial consequences and, not least, reputation damage. Therefore, in backing up data repositories, hospitals safeguard against broader implications compared to clinics. In contrast, clinics are less concerned about backup/recovery not only because of data volumes and less accountability but also for substantial costs (not subsidized by federal funds in case of public clinics or leading to uncompetitive patient fees in case of private practice) and perceived lack of investment returns.
This approach to backup/recovery is, in author's view imprudent, if not unsustainable. Indeed, by failing to set up proper backup/recovery plans and/or systems, healthcare institutions do not only risk potential losses but existing ones. Specifically, a lack of a proper backup/recovery system would lead to losses in actual investments made in collecting and integrating patient data over extended periods, an effort which might not be replicated (particularly in cases of patient contact loss). This is not to mention lost potential research insights, physicians and researchers could build on for more effective patient servicing. Further, in failing to implement a proper backup/recovery system and/or plan, particularly for clinics, less concerned healthcare institutions risk integrating existing (now lost) patient data to broader HMISs. In losing data integration, less concerned institutions could be vulnerable to lost insights into broader patient data pool (as offered by partner institutions, if any) or, worse, distorted patient data rebuilt, usually hurriedly, to appease dissatisfied patients for data loss.
References
2008 CIO Survey Results. (n.d.). Health Data Management. Retrieved from http://www.healthdatamanagement.com/CIO_Survey/
Blumenthal, D. (2009). Stimulating the Adoption of Health Information Technology. The New England Journal of Medicine. doi: 10.1056/NEJMp0901592
Xue-yan, Z., Academy of Equipment Command & Technology, Hong-min, Y., & Tong-na, M. (2011, August). Design of Equipment Health Management Information System. 2011 International Conference on Management and Service Science (MASS), Wuhan, China. IEEE Xplore. doi: 10.1109/ICMSS.2011.5998614
