Health Care Organizations
main features, capabilities, and operational benefits
1. Information Management (IM) / Information Technology (IT) Analysis is being incorporated into many types of organizations and healthcare is no different. Hospitals are discovering that with the appropriate implementation and training, comprehensive electronic health record (EHR) systems are coordinating services for more efficient service and shorter patient stays. (Silow-Carroll, Edwards and Rodin, 2012, p. 16) The purpose of installing EHR systems into health care organizations is to integrate and streamline and outpatient and inpatient care. Another purpose is to harmonize the spectrum of services so each patient is appropriately matched with the services they need the most therefore the needs of patients will not fall through the cracks without being addressed.
Patient care applications are an aspect of healthcare that Oracle® refers to as “Patient Management without Walls” (Bithell & Read, 2010, p. 1). Three of the major types of patient-care applications are the EHRs, electronic medical records (EMRs), and personal health records (PHRs). The main features of patient-care applications are connected care, shared decision making and incentives and access to alternative (complimentary) medicines. Connected care and shared decision making result in higher transparency. The purpose of the incentives is to enable a mechanism to reward healthy behavior. Another incentive is to offer “differential premiums” from insurance companies for patients who stay healthy (Keckley, 2010, p. 6). Management and enterprise systems have been designed into new coordinated health care models. Kickley (2010) describes one example of a primary care model as “the New ‘Medical Home’” (6). The new Medical Home has three main features “reimbursement realignment, primary care workforce and MD-led clinical care co-ordination” (Kieckly, 2010, 6). e-Health applications provide “decreased costs, better patient outcomes, improved data quality, enhanced process and superior patient care” (Bithel & Read, 2010, p. 2). In order to offer e-Health management the Medical Home offers a comparative effectiveness center and knowledge sharing.
2. The Director General of London’s International Hospital Federation, P-G. Svenson (2002) noted that the variety of applications for IT health service management can cause so much excitement that IT is “sometimes bypassing traditional scrutiny and quality control.” I agree that this can happen when setting up a new health care IT/IM system without the proper planning. a strategic plan is essential to long term success of the operation. One of the best strategies is to plan all impacts of the desired technology. It may be great for one department in the system while at the same time causing negative impacts on another part of the system. When that happens the new ‘solution’ is not a solution but instead it is a problem. Although taking time to work out each step in a strategic plan may delay installation; implementing the system in a rush poses too big of a risk. A strategic plan needs to address three basic components and then build up from the basics; (a) consumer informatics, (b) clinical and medical informatics and (c) bio-informatics. Consumer informatics or e-health is the part of IT / IM which encompasses the electronic communications that share health information with patients and communities. The clinical and medical informatics impact the ability of health care providers to work successfully. The type of data includes the structure of health care processes, the outcomes, and patient medical records. Bioinformatics help the doctors and laboratories exchange data and knowledge with other doctors and researchers.
The goals of transformation
The strategic decision-support applications focus on electronic health records (EHR) shared decision making (PHR), and Regional Health Information Organization (RHIO). The IT healthcare concept has several goals including fewer errors, fewer shortfalls in healthcare, less malpractice risk and overall improved efficiency. (Kieckly, 2010, p. 6). RHIOs are also known as Health Information Exchange Organizations. RHIOs connect health care organizations in a local region to make it easier to share knowledge in an electronic health information exchange (HIE). The RHIO has a role to enhance the “the information exchange among various provider settings, payers, and government agencies” (Rouse, 2010, p. 2)
There are many reasons that a strategic plan will benefit our organization; in fact a strategic plan is critical for good communication and reaching common goals in the least amount of time. The strategic plan should contain the following elements. Careful planning is necessary because there are so many stakeholders and so many components that require decision making. In order the make a flexible but strong eHealth based organization a focus needs to be kept on the purpose of the organization; to offer excellent quality care for community members when they need support. Therefore the stakeholders include community members as well as physicians, nurses, technicians and support staff. The health insurance company, pharmacies and other business that meet medical needs should be included as stakeholders. The benefits for investing time for planning and costs for studies that may be necessary are (a) a higher quality health care service, (b) better access to health care, and (c) more efficient use of resources and personnel. The IM / IT system makes the collaboration between stakeholders and the division of resources much simpler.
The main components that must be included in the strategic plan in order to ensure the system will run well include the following. The four foundational components are the (a) professional management identity management system, (b) the patient identity management system, (c) the planning system and (d) the billing system. (p. 18)
3. The importance of a systems development life cycle as it pertains to both the development of a custom application, coupled with the selection of proprietary systems.
The life cycle can be considered in three parts (a) planning and development, (b) implementation, and finally (c) routine operations but each part needs to be planned in great detail to meet the requirements of the users. A big difference in needs exist between an office with five general practitioners compared to a large municipal hospital. On the other hand the needs parallel each other in many ways. For example both need to have service-oriented architecture that can enhance connectivity and flexibility. A service oriented architecture that can handle data inputs, process building, and business applications has been designed by MD Anderson and is used at Cancer Care Ontario (CCO). (Vogel and Skinner, 2010, p. 14) An important concept when developing the right life cycle is to remember that new kinds of data may need to be added later. Genome information may become acceptable to store. If that happens the MD Anderson architecture can adapt and be changed to accept the new data without negative effects to the rest of the system. (Vogel and Skinner, 2010, p. 14)
4. The key element necessary to ensure secure access to health care and patient information within a health care management electronic system
The key element essential for ensuring secure access to health care and patient information is state regulation. The government needs to be involved in establishing laws that people can trust because they will keep their health records safe. For example the US has established the Office of the National Coordinator of Health Information Technology and Clinical Data Systems Inoperability. (Perlman and Davids, 2010, p. 11) Two of the greatest difficulties in accomplishing the secure management are the sensitivity of the personal data and the huge quantity of data. The health information is most useful when it can be exchanged. The US Nationwide Health Information Network (NHIN) is a framework for the collaboration between “a groups of federal agencies, local and regional and state-level health information exchange organizations” working together with integrated networks to establish NHIN standards, services and policies. Hospitals and other health providers do not have time set standards so having standards to follow which will enhance sharing information will help them.
5. Make at least two (2) recommendations for improving the application of systems theory to health care IM / IT governance and planning. Provide specific examples to support the response
Systems theory should be used to understand a system holistically while still understanding how each of the parts interact. The point is to never focus on one part of the system in isolation because that will not give a true picture. That is why it is important to use the system to enhance communication with the patients as much as possible. Communication fits well with systems theory because interactions and interoperability are important components of both. Systems theory can be applied to health care facilities in order to make sure different offices or departments are not doing the same work. Another place systems theory can be improved is between patients-pharmacies-healthcare-providers to share knowledge about drugs, good response to medicine, and unwanted side effects. A systems theory approach can also improve moral when punishing individuals is replaced with finding the problem in the system. People might not talk about a mistake or a problem if they are likely to be punished. But if a process is improved when people point out problems then everyone wins.
References
S. Bithel. & M. Read (Eds.). (2010). Introducing e-Healthcare Patient Management without Walls. Oracle® Healthcare, pp. 1-17, Available from http://www.oracle.com/us/industries/healthcare/ehealthcare-patient-management-wp-173073.pdf
Keckley, P. H. (2010). eHealthcare-Charting the Future Healthcare Prognosis. In S. Bithel. & M. Read (Eds.). (2010). Introducing e-Healthcare Patient Management without Walls. Oracle® Healthcare, pp. 1-17, Available from http://www.oracle.com/us/industries/healthcare/ehealthcare-patient-management-wp-173073.pdf
Perlman, M. and Davids, M. (2010). Healthcare without walls: Delivering the future paradigm. pp. 8-11, In S. Bithel. & M. Read (Eds.). (2010). Introducing e-Healthcare Patient Management without Walls. Oracle® Healthcare, pp. 1-17, Available from http://www.oracle.com/us/industries/healthcare/ehealthcare-patient-management-wp-173073.pdf
Rouse, M. (2010). Regional Health Information Organization (RHIO). TechTarget, May 2010, Available from http://searchhealthit.techtarget.com/definition/Regional-Health-Information-Organization-RHIO
Silow-Carroll, S., Edwards, J. N., & Rodin, D. (2012). Using electronic health records to improve quality and efficiency: The experiences of leading hospitals. The Commonwealth Fund, pub. 1608, vol. 17, Retrieved from http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Jul/1608_SilowCarroll_using_EHRs_improve_quality.pdf
Stroetmann, V. N., Jones, T., Ambroise, D., Varoutas, P-C., Jarossay, M. et al. Evaluating the economic impact of eHealth applications: Approach and Method. eHEALTHIMPACT, Available from www.ehealth-impact.org
Svenson, P-G. (2002). eHealth Applications in Health Care Management. eHealth International, 1.5, Available from http://www.ehealthinternational.org/content/1/1/5
Vogel, L. H. and Skinner, R. I. (2010) Building connectivity, interoperability, and communication in eHealthcare: The healthcare provider perspective. pp. 11-16, In S. Bithel. & M. Read (Eds.). (2010). Introducing e-Healthcare Patient Management without Walls. Oracle® Healthcare, pp. 1-17, Available from http://www.oracle.com/us/industries/healthcare/ehealthcare-patient-management-wp-173073.pdf
eHealth Applications in Health Care Management
Per-Gunnar Svensson
http://www.biomedcentral.com/1476-3591/1/5
- Correspondence: Per-Gunnar Svensson
Director General, International Hospital Federation, London, UK
eHealth International 2002, 1:5 doi:10.1186/1476-3591-1-5
The electronic version of this article is the complete one and can be found online at:
© 2002 Svensson; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.
Introduction
There are seemingly an endless number of possible applications of information technology (IT) to health service management. Enthusiasm in introducing IT solutions in health care is sometimes bypassing traditional scrutiny and quality control. Without proper assessment and system thinking (how implementation, in part of the system, may sometimes produce negative effects in other parts of the system) one should not introduce new IT solutions.
The area of e-health is as said, very broad, covers topics such as telemedicine, electronic records, recruitment, going paperless, procurement, healthcare score cards, audits, information systems etc.
Detmer [1] defines three areas of health informatics:
• Consumer informatics
• Medical and clinical informatics, and
• Bio informatics.
These categories are based on the predominant type of user or use.
In this paper, the focus will be on the first two types mentioned.
Consumer informatics
Often this category – Consumer Informatics – is the one commonly referred to as 'e-health' and focuses communications to patients and the public about health topics.
Consumer-to-consumer (C-to-C) applications are potentially strong means of empowering individuals and the public. There are 25,000 – 30,000 health-oriented websites and they are among the most visited. These sites are and will be major sources of information and mis-information. There is an urgent need for all concerned, including politicians/lawmakers, health professionals and industry to put in place adequate standards and quality control for these websites.
Already C-to-C applications have contributed to the creation of "virtual" and sometimes powerful communities; sometimes with questionable outcomes, such as the violence in connection with the World Trade Organization Summits. But, sometimes, more in line with the spirit of well-informed democracy, such as networking among landowners suffering flooding in England. Both examples cited were focussing on government(s) and other concerned parties.
Medical / clinical informatics
This category relates directly to health care structure, processes and outcomes. A main application is computer-based medical records, a sub-category of which is computer-based personal records that will facilitate access to low cost therapies, for example, with certain areas of mental health, such as depression.
Another sub-category is computer-based patient records that will facilitate clinical decision-making. These later records may be linked to knowledge-oriented systems that may contribute to quality control of clinical processes. Such a decision support has been demonstrated to have improved outcomes.
Computer-based population or community health records are usually anonymized patient and/or personal records. These systems are particularly valuable in public health where one is trying to trace different types of health hazards, linked either to medical, environmental or social agents.
What general comments, therefore, can be made regarding computer-based records? There is certainly important ethical concerns in relation to composition of records and access to the same. Also, linking different record systems to each other sometimes raises criticism, in particular in cases, which may involve personal/patient records. Again, there is need to secure standards and qualities and for appropriate steps, nationally and internationally, to be taken in the search for solutions.
Also, lack of guidance from central authorities, have in many instances led to a mish-mash of non-compatible computer-based patient record systems. Such circumstances have caused problems to arise in the smooth processing of patients between health service units, even within the same health authority (or equivalent). In spite of the many positive aspects of devolution/decentralisation, there is, as demonstrated in the above-cited examples, a need for central coordination. This observation may also have some bearing internationally with the high volume of people travelling across national boarders and sometimes needing emergency health treatment outside of their respective countries. In these cases, quick and efficient transfer, electronically, of medical records may be essential for achieving delivery of good quality acute care.
Telemedicine
Finally, telemedicine provides a category by itself. Telemedicine, meaning healthcare delivered by electronic means, has been on the road for over a century – if care provided by telegraph and telephone is considered. However, towards the end of the last century, this emerged as a delivery system with huge potential due to the information technology revolution, which made two-way, audio-visual transmission possible at reasonable cost.[2]
The views expressed by Hjelm, point to the difficulties (that can not be fairly presented here) telemedicine is facing, result in many shortcomings. It has a long way to go before it can be effectively integrated into a healthcare delivery system. One crucial difficulty is that many telemedicine applications have yet to be developed, evaluated and implemented in the hospital environment, before application of the system over longer distances.
Concluding remarks
As mentioned, information technology and e-health have great potential. Research and development studies, however, are needed in assessing narrow and broader implications of IT applications. These cannot be left to IT enthusiasts alone, neither to less well-informed politicians or health professionals. Applications should, in my mind, be built up incrementally by starting from smaller scale pilot projects. At later stages and after careful assessment, larger scale implementations may be appropriate. Nationally and internationally, there is a need for concerted action in developing standards (in order to reach compatibility) and ethical frameworks.
References
- Detmer D: Transforming Health Care in the Internet Era.
World Hospitals and Health Services 2001, 37:2.
- Hjelm M: Making Telemedicine an In-patient.
Hospitals International 2001, 37:2.
