Assignment: Computerizing medical process
Marianna Foster went to the emergency room in October 2008. She was having chest pain and was short of breath. Before she could be seen by an ER physician, she died. The coroner concluded that the length of her wait time in the ER was partly responsible for her death. Ms. Foster had a history of diabetes and congestive heart failure. She had checked into the ER at 2:00 pm in the afternoon. A triage nurse who saw her took an EKG reading and an oxygen (O2) saturation reading. Ms. Foster was told to have a seat and wait until a physician could review her chart. By 6:30 pm she was still waiting to be seen. She expired at 6:45 p.m.
Your job is to discuss the types of information the health care facility should develop to prevent this sort of event from happening again in the future. What information should the hospital have known about the patient? Who could be responsible for collecting the necessary data, and when? Consider using computerized information systems. Do you think this would help or hinder the process?
You may assume that the emergency department is staffed with triage nurses, physicians, and an admissions clerk.
Management Concepts for HMIS
Data - Information - Knowledge Triad
Health care trends are leading to ever increasing needs for information processing and connectivity across provider types and across platforms. Health Management Information Systems (HMIS) include the application of both computerized and paper based information systems. The electronic health record (EHR) is just one of the many systems utilized by health care providers for administrative and clinical purposes.
Provider types needing to develop and exchange information include:
• Hospitals
• Physicians
• Outpatient clinics
• Outpatient surgical centers
• Urgent care centers
• Pharmacies
• Home health care
• Pharmacies
• Nursing homes
• DME suppliers (durable medical equipment)
Data - Information - Knowledge Triad.
Data
Data are the raw, basic building blocks used to identify or characterize objects and events. Data alone are isolated facts that do not convey much meaning. Data can be stored, manipulated, converted, and (generally) observed. Data and information are not actually the same things, though people often use the terms interchangeably.
Examples of data elements include:
• Patient ID number
• Insurer name
• Drug NDC code
• Admitting Physician ID
• Zip code of patient
• Encounter date
• Discharge Date
• Diagnosis Code ICD-9
Information
Information is developed after we have applied processes to manipulate and aggregate (put together) data. Information implies usefulness. The processes applied to data may be quantitative, qualitative, or both. Information is data which have been converted to become useful to decision making, or for record-keeping for possible later decisions and observations.
Information Development
The hospital CEO asked the health information management department for a report on all patients of Dr. J. Jones admitted over the past year, including:
• Admission date
• Length of stay
• Principal Diagnosis
• Total Billed Charges
• List of medications used
• List of surgical procedures performed
Each of these is an example of a data element. By examining the report that compiled this information on a physician, hospital administration forms a picture of how Dr. Jones used the hospital over the past year.
Information is used to support the decision-making and organizing functions of a health care organization. The decision makers may use the information above about Dr. Jones to further analyze and develop financial information, quality of care statistics, and utilization measures. The CEO probably already receives a routine report on monthly statistics on the hospital's utilization. Comparison of this information may conclude that Dr. Jones used 5% of the hospital days available, but generated 10% of billed charges. So what could that mean? To understand what it might mean, we need the third element of the triad: Knowledge!
Knowledge
Knowledge is the additional element that will be used when considering information about Dr. Jones' role and quality of care. A health care manager uses his or her background, education, and experience to determine what the information provided above actually could mean to the organization's finances and quality. The Health Information Manager has extensive knowledge about coding, security issues and processes for tracking patient information. In the same way, each profession that is part of the care process has a unique expertise as a knowledge base.
Considering information contributing to care helps each health care organization meet its mission. Health care providers have highly specialized knowledge. Health care is multi-faceted and complex in its knowledge bases. The physician considering many possible diagnoses for a patient draws upon years of education and experience. This is one of the greatest challenges to designing and utilizing systems for health care.
Capturing all the data elements needed for care, along with organizing information in ways that are readily accessible during the care process, has presented numerous challenges in development of the electronic health record and other HMIS systems.
Layers of HMIS - Description of HMIS Layers and Examples
Management Concepts for HMIS
There are actually five important layers of HMIS, of which the Data/Information/Knowledge layer is only the first. When information managers design a HMIS, they must keep all five layers in mind:
1. Data/Information/Knowledge
2. Hardware/software/technology
3. Process/Task/System
4. Integration/Interoperability
5. User/Administration Management
Select a link above or to the left to take a look at the other layers of Health Management Information systems.
Hardware / Software / Technology Layer
Information managers have choices available regarding hardware, software and networks.
These instruments of technology allow us to store, process, and connect information and data. Software is also a part of this layer. Software includes operating software, such as Linux and Microsoft Windows®. Operating system software tells the hardware how to start itself, function and communicate with applications software.
For example, in order to send a prescription via electronic means from a physician office to pharmacy, the technology layer must be in place. Each endpoint for that communication needs hardware (computer); operating software; a communications network; and a standard way of communicating via applications.
The hardware and software layer is continually evolving and improving. Each new development in hardware and communications technology brings with it new challenges to insure security.
Process / Task / System Layer
Local processes and tasks are determined by the organization and its objectives. The layer allows the organization to:
• Collect relevant data
• Formulate useful information
• Adhere to regulations
• Meet the mission and objectives
This layer includes systems to support essential functions including: financial management and reporting; human resources information; facility scheduling (including internal units such as surgical suites and ICU); materials management/ purchasing/ inventory; and clinical applications such as the EHR and CPOE (computerized physician order entry).
Even dietary and housekeeping departments will have a process/task layer, although not every process may be computerized.
Integration / Interoperability Layer
How do we know our system can communicate or create outputs useful to any other system? Both internal and external data exchange protocols are necessary.
Standardizing nomenclatures in health care has been a particular challenge.
Also, when health care organizations bring in a new system, what changes need to be made to existing systems to transfer information rapidly? If the laboratory system does not change, how will it communicate with the new EHR?
These sorts of challenges are met within the integration/interoperability layer.
Nomenclatures such as SNOMED CT, along with data exchange standards such as HL7/ Health Level Seven, work toward solutions. SNOMED is a system of terminology of clinical terms. It can be used to code, retrieve, and analyze clinical data. The SNOMED system has greater specificity and granularity than coding systems used for billing processes, such as the ICD-9-CM. In order to design information systems that exchange data efficiency, this increased granularity is called for.
User / Administration / Management Layer
Those who perform tasks and activities in service to the organization and its clients, patients, and various customers, will all utilize the user/ administration/ management layer. When the user element of systems is working properly, people know how to get their tasks done using the system. They find the system meets their basic needs, and its representations of tasks make sense to them. The flow of work might change with a new system but it is effective in helping the job get done.