Paper Title
Analysis
While proprietary systems have not gone the way of the dinosaur, they are increasingly uncommon and infrequent to come across because of the possible or expectable headaches that arise when such standards are used. Healthcare and information technology in particular are fields where having proprietary and standalone system is far from being a good idea. When such systems and languages do not mesh or get along, this leads to bad performance, lack of data integration and so forth. Having anything like this going on is a terrible thing for a hospital or other clinical arena because having data that moves quickly in a real-time fashion, has facets that interact and fuse well together and otherwise operate properly when in motion is a must due to the literal life and death implications involved for the patients (Reynolds & Wyatt, 2011).
One of the buzzwords that goes around when it comes to information technology is standardization. The concept is simple. Irrespective of the different computers, locations and so forth that exist, it is important that everyone and everything be speaking the same language at some level. Indeed, having two nurses that speak two different languages, such as French and English, will not be able to communicate all that well if they do not know each other’s language. Computers and healthcare frameworks are no different. While variations and different forms of setups do exist, it is important that the systems involved understand each other. To use a clinical example, all healthcare systems must know the ICD-9-CM framework even if they use different processes and procedures to get to the point where the systems talk. Indeed, different vendors and systems might do things a bit differently before they get to the communication threshold of their systems and their flowcharts, but the different systems must be able to talk when it comes time for it. For sure, a smartphone and a computer operate quite differently in many ways but they will typically both know Java computer language, if not other or different languages besides that. This is what allows them to talk and work together despite being very different in other regards (Modern Healthcare, 2016).
Even though these clinical computer systems do speak the same languages at some level, these languages and frameworks are fluid to some degree. Indeed, ICD itself has change a good deal over the years. Some of the level changes of ICD have been so jarring and different that computer systems talking at different levels of the ICD framework cannot talk to each other. Indeed, many interface situations require that the same or at least similar ICD levels be present or the systems cannot communicate. This would be akin to a Windows 95 system communicating with a Windows 7 system. They are technically in the same realm of operating systems but they are still going to be very different because Windows 7 (and beyond) is literally one to two decades ahead of what Windows 95 was capable of doing. Of course, no one actually uses Windows 95 nowadays but the point to be made is clear to see. Not only must the systems involved be speaking the same language, they must be speaking at least somewhat close (if not identically) to the same level of that language. Otherwise, there may be issues (HIMSS, 2016).
When it comes to integration and clinical systems working together, there are three major things that should be taken into account. These three things are decision support, interoperability and legacy systems. Decision support is often referred to as clinical decision support, or CDS for short. It is indeed one of the most important parts of functionality and level of operation when it comes to healthcare information technology systems and frameworks. As explained by the United States federal government, it is a “centerpiece” of programs such as Medicare and Medicaid when used properly. Their way of describing clinical support decisions is to say that when it is use effectively, it “increases quality of care, enhances health outcomes, helps to avoid errors and adverse events, improve efficiency, reduces costs and boosts provider and patient satisfaction. Clinical decision support systems include several tools. These include, but are not limited, to the following:
Computerized alerts
Clinical guidelines
Condition-specific order sets
Focused patient data reports and summaries
Documentation guidelines
Diagnostic support
Contextually relevant reference information (CMS, 2016).
Further, a proper CDS system, whether it pertains to electronic healthcare records or
something else, must provide all of the following:
The right information
Through the proper channels
In the right intervention formats
At the right points of the workflow (CMS, 2016).
Another important facet of data integration functioning as it should would be interoperability. Of course, many healthcare information systems are going to have disparate systems and setups that are not always completely plug and play. Indeed, there are indeed says to get around that and allow for these systems to talk to each other and otherwise get along. However, this must be fashioned and created in such a way so that data is provided timely, that it is accurate, that is secure and that meets all of the applicable privacy and other laws pertaining to electronic healthcare records and healthcare in general such as HIPAA and the Patient Protection and Affordable Care Act. Some systems get along very well together, some are not compatible and some are somewhere in between. Regardless, the information technology professionals and executives involved in a clinical data and electronic healthcare records framework need to make sure that the combination of hardware and software solutions they use are going to “get along” sufficiently so as to deliver and ensure the proper level of performance and interfacing between systems (HIMSS, 2016).
Finally, we come to something that was touched upon earlier in the system and that is legacy systems. A legacy system is another way of referring to a system that is more dated and pre-existing than some of the newer and more modern systems. While having a legacy system may sometimes require an upgrade to reasonably make everything legal and operable, this is not always the case. However, having legacy systems in the mix can also mean that some adjustments and changes are necessary to make everything work. It is entirely possible that legacy system can be part of a modern solution and costs or timetables may demand that. It should also be noted that legacy systems will have to be replaced and/or modernized at some point. There are situations, though, where upgrading a legacy system at a certain point is not possible or practical. Indeed, upgrades can be done in stages over one or several years. In the meantime, healthcare information systems professionals need to ensure that legacy and non-legacy systems alike work together in a fashion that provides for the minimum level, if not more than such, of performance (HIMSS, 2011).
The last overall topic to be discussed in this report is clinical data and clinical process modeling. For the purposes of this report, there are two main facets that can and should be looked at when it comes to this overall topic. Those two things would be UML and UP. UML is short for Unified Modeling Language and UP is short for Unified Process. The applications of UML are certainly not limited to the healthcare sector. Indeed, information technology at large is full of the use of UML. Even so, the applications and facets specific to healthcare should be mentioned. A reference was made earlier in this report to proprietary frameworks and languages. UML is the opposite in that it is a non-proprietary language. Rather than being controlled by a corporation or other private interest in a way that keeps things secret, the models and frameworks of UML are openly communicated and widely known. In a healthcare setting, UML is used to help in specifying, visualizing, constructing, documenting and communicating the model of healthcare information system that is being used from the user’s personal perspective. UML centers on what is known as object-oriented analysis, or OOA for short. UML allows for advanced methods and ways of doing things with data such as reuse technology. This alone allows for high software productivity in a healthcare setting or whatever other type of application is being used. UML can also be used to create an information technology component paradigm. This can help to enhance the capabilities of healthcare information systems and at the same time help simplify the management and maintenance of the same system (Aggarwal, 2002).
Unified Process is similar in many respects but should get its own label and body of knowledge, and it has. Unified Process can actually be used to address and analyze different aspects of healthcare delivery and process. Just one of those is the physical space that is used for healthcare delivery and practice. Indeed, there are about 120,000 buildings that are used for healthcare in the United States. However, healthcare is still growing at a very fast rate but new construction of healthcare buildings and facilities is falling off significantly. While this may seem like a problem or even a crisis, that is not really the case. The use of the Unified Process model allows for healthcare facilities to make better and more efficient use of its space and facilities. Rather than just building more locations and building on more to existing ones, there can instead be the more efficient and less costly use of what is already available and present. This can be done in a way that lowers operating costs, energy consumption and water use. It could easily be compared to the inventory management system of a manufacturer. Sure, it can be said that the more space the better when it comes to inventory management but that is not actually the case in many situations. Indeed, what is currently being accomplished with 100,000 square feet could easily be done with 70,000 square feet if the space is managed in the right way. Healthcare is no different. This is true in regards to physical spaces and virtual ones as well. One huge upside of electronic healthcare records is that the physical space to store the required records and information is not nearly as much as it used to be. Even data that is initially physical such as forms and such can be digitized and there is no need to keep the original form so long as the data is present and backed up in the systems used by a clinic or hospital. However, all of this has to be managed the proper way. For example, documents must be scanned before they are shredded or otherwise disposed of. Data should generally be backed up locally and offsite in case there is a natural or other disaster or even a hacking of the system. Electronic healthcare systems, in addition to the physical facilities and inventories used by the same, are all examples of systems and frameworks that need to be managed and used in a “lean” fashion so as to push down costs but maintain or create the proper clinical outcomes for patients. Healthcare costs continue to soar and simply passing along those costs to the consumers in a direct fashion is becoming harder and harder to do, especially for those people that do not have healthcare insurance or the means to pay for their own care (Enache-Pommer, Horman, Messner & Riley, 2010).
Conclusion
In the end, it is clear that healthcare systems need to be modernized and streamlined in a major way. These updates and changes will require adept healthcare professionals and the use of the proper frameworks and systems. Something must be done to combat the increased inefficiencies and cost explosions that are happening in the healthcare industry. While this is far from the only problem that exists and while there are clearly other things that need to be done to help the system, what is covered in this report is certainly among the top of the list when it comes to what could and should be done to make things better for providers and patients alike. Healthcare is one of those industries where the opinion of the patient always matters because their quality of life and outcomes can be major to life-ending if things go amiss in any number of ways. Thus, ethics and the virtues of the nursing and healthcare profession dictate that the information technology side of things be as on point, if not more so, than the actual medical care that is being provided by nurses and doctors.
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