Challenges in Implementing Information in a Health Care Organization - Essay Example

?Challenges in Implementing Information in a Health Care Organization I. Introduction Implementing Information System in an organization has always been a major decision for the organization’s leadership. Not only would it entail a substantial investment in terms of capital expenditures the human resource retooling or retraining would involve a major commitment from both management and line staff. The stress for the organization as it deals with the paradigm shift will also take its toll on the management time spent for every employee. Therefore, it is but proper and logical that all aspect of the endeavour, its challenges, operational requirements and return on investment needs to be evaluated and explained to all the stakeholders. The first are the various international commitments like those made with World Health Organization (WHO) and government regulatory and monitoring bodies that need to be complied to or the system may have to interact with once it is operational. Interoperability with the major Health Maintenance Organization (HMO) and other hospital system should also be taken into consideration due to the importance of collaboration in the medical care field. There are also international standards that will be presented to provide insights on what other healthcare organizations are using. This paper shall also explore the impact at the organizational level of any implementation of information systems. This paper shall likewise present the minimum requirements of a Healthcare Information System that would be responsive and compliant to the various challenges presented in this paper. This paper shall also provide operational imperatives that need to be taken into consideration in operating and maintaining an information system. II. World Health Organization – In the third millennium people interact globally, a person can be in Europe when he wakes up and can be in North America in the afternoon for dinner. The likelihood of a person contracting a pathogen in the morning and spreading this on the plane and then to the airport, and then to his destination is a nightmare that is not only possible but is happening to some degree every day. The best way to combat epidemics is early detection to enable governments to arrest its spread. In the 21st century, health is a shared responsibility, involving equitable access to essential care and collective defence against transnational threats (World Health Organization, 2010). Global partners and countries have developed a common monitoring and evaluation (M&E) framework for health systems strengthening (HSS). The operationalization of this framework requires a common platform for M&E of National Health Strategies (NHS) – also referred to as the country health systems surveillance (CHeSS) platform. The country-led platform aims to improve availability, quality and use of data needed to monitor health progress and performance and inform country health sector reviews and planning processes (World Health Organization, 2010). This will enable WHO to monitor diseases and its spread to countries or regions that will be the basis for a concerted global response to wide spread health threats. A direct link to a healthcare organization’s information system will enable WHO to pinpoint index patients that would hasten medical forensic investigation. The WHO is also responsible for the implementation and compliance to the IHR or International Health Regulation. The IHR mandates that each nation set-up a monitoring and surveillance system in all its health care system. Therefore the compatibility of the Information System that will be implemented by the healthcare organization to the WHO’s health surveillance is an important aspect of the organization’s social responsibility. “The stated purpose and scope of the IHR (International Health Regulation) are "to prevent, protect against, control and provide a public health response to the international spread of disease in ways that are commensurate with and restricted to public health risks, and which avoid unnecessary interference with international traffic and trade." Because the IHR are not limited to specific diseases, but are applicable to health risks, irrespective of their origin or source, they will follow the evolution of diseases and the factors affecting their emergence and transmission. The IHR also require States to strengthen core surveillance and response capacities at the primary, intermediate and national level, as well as at designated international ports, airports and ground crossings. They further introduce a series of health documents, including ship sanitation certificates and an international certificate of vaccination or prophylaxis for travellers” (World Health Organization, 2008). The issue of compatibility with the government’s health care monitoring system is a primary consideration in implementing an Information System. III. Privacy Rights Patient privacy right is gaining grounds as a basic human right under certain conditions. The Universal Declaration of Human Rights Article 3 explicitly stated that “Everyone has the right to life, liberty and security of person” (United Nation, 1948). Security extends to his privacy as a person that would include his privacy rights as a patient. In the United States, the Health Insurance Portability and Accountability Act (HIPAA) mandate that healthcare services implement several security measures to ensure patient privacy. In the United Kingdom they have the Data Protection Act of 1998 and the Caldicott Principles working hand in hand. In other countries similar laws that assure patient-doctor confidentiality and patient privacy are also enforced. The level of enforcement and security to protect the privacy of patient may not be the same but the gist of the law which is to protect the privacy of patients is there. In order to interconnect and exchange data with other similar system the HIPAA security provision that assures the protection of patient information mandates that the system intending to connect to a HIPAA certified system should be HIPAA certified as well (Centers For Medicare and Medicaid Services, 2003). A HIPAA certification process ensures the compliance of systems intending to connect with any United States is protected from vulnerabilities that threaten patient information integrity. The value of connecting with any United Kingdom and US based medical knowledge base cannot be overstressed because the wealth of knowledge that can be extracted from these healthcare systems. IV. HMO and insurance One of the stake holders that needs to be interconnected with any healthcare organization are the Health Management Organization or (HMO). Any patient engagement from mere well-care consultation to Diagnostic Laboratory Procedures done on any patient the patient’s HMO should be well informed of it since the HMO will mostly likely shoulder the cost of such procedures (eHealth insurance, 2010). To verify and assess the insurance worth of such procedures the HMOs are likewise allowed to-connect to the Healthcare Information systems. The interconnection is for getting patient information and records for the purpose of evaluating the procedures and medical intervention for verification. As stated above and for emphasis, the interconnection is for the HMO who will shoulder the cost of the diagnostic procedure to evaluate and verify if the attending physician, have valid reasons for requesting such costly procedure. However, the interconnection is subject to the requirements of the patient privacy rules of the country governing the HMO and Health care provider. V. Information System Interoperability The system should subscribe to standard communication protocol as well as medical language code. This will ensure that even if it communicates with other systems in the medical industry it will be able to communicate seamlessly (American Medical Association, 2009). These standards normally interact transparently with other system if their standard communication set is compatible. It is an important aspect of information technology to be compatible with other system that are equally mission critical. An aspect that is worth considering in evaluating information system is the exchange of vital data that would be used for the following: organ donation (Cheng, Ko, Chien, Huang, Chen, & Lai, 2003), Mapping public health issues and surveillance and monitoring the spread of communicable diseases (Centers for Disease Control and Prevention, 2008). The system should not only be able to communicate with other systems as mentioned above. Productivity tools like PACS or Picture Archiving and Communication System (Choplin, 1992) should also be compatible with the information system being considered for implementation. Transcription system that is being offered by Nuance Dragon’s speak easy (Nuance.com, 2002). PAC System enable the output of digital radiology equipments, MRI, CTScan and other system capable of digitizing captured images to attach and store these images as well as the readings associated with the images to the hospital records of the patient. The interpretation or professional diagnostic readings of the images can either be in voice or transcribed version thus the requirement for a system capable of digitizing voices and storing and attaching the same to the hospital records of the patient. All of these systems should be able to work together seamlessly and the interoperability of these system should be one of the consideration in implementing an information system. It is a fact that healthcare service providers are not organization with altruistic intentions, they have business and revenue concerns thus their operation is often assisted by ERP systems (Hadfield, 2007). Enterprise Resource Planning includes financial systems and process flow systems. Financial systems records and monitors all financial records including the receivables and cash position of a company or in this case the Health care provider organization. The financial systems also create financial reports for decision support or government reports required by the government. To illustrate: Diagnostic examination and tests are normally charged against the patient’s account. Operating these diagnostic equipments also cost money and other resources such as electricity and other safety or hazard mitigation devices. The financial implication of the operation and other incidental expenses of these diagnostic equipments need to be monitored to determine the viability of operating such equipment on a continuing basis if not reassess the charges or cost for the patient. However, arbitrary increases or decreases in the cost of diagnostic procedure may not be feasible due to market forces or the availability of patients who wants to avail or the presence of other cheaper hospitals offering similar services. These data can be supplied by the ERP system. However, to ensure the accuracy of the data the diagnostic system should be compatible with the ERP, the Hospital Information Systems and other system that make use of data or stores data. VI. Healthcare Information Technology Standards Panel “The Healthcare Information Technology Standards Panel has the following objectives: To serve and establish a cooperative partnership between the public and private sectors to achieve a widely accepted and useful set of standards that will enable and support widespread interoperability among healthcare software applications in a Nationwide Health Information Network for the United States. To harmonize relevant standards in the healthcare industry enable and advance interoperability of healthcare applications, and the interchange of healthcare data, to assure accurate use, access, privacy and security, both for supporting the delivery of care and public health” (Healthcare Information and Management System, 2010). VII. Healthcare ISO Standards Over a hundred ISO standards covering a number of practices and operation standard were developed by the International Organization for Standardization (International Organization for Standards, 2005). Recognizing the need to standardize the different disciplines in the Health care Information System industry the ISO have developed more than a hundred ISO standards. VIII. Integration Challenges Information Technology has not always been that much of a priority in the Medical Healthcare Industry. Thus, development in this area has not only lagged behind but remained reclusive to a specific and finite group of specialist. In hospitals, physician practices, and other healthcare provider organizations, IT usage has historically lagged that of other U.S. industries. But this is changing due to several factors: pressure from consumers, health plans and the government; increasingly stringent compliance and regulatory reporting requirements; and a growing recognition by the industry that IT is a critical component of strategies to improve care quality and patient safety. All of these factors have combined to accelerate the adoption of IT, particularly in support of clinical processes and workflows. In recent years, the focus of this increased IT investment has shifted from financial and administrative applications to the clinical information systems that are the essential foundation of an electronic health record (EHR). Building an EHR typically involves the need to aggregate data from multiple, specialized applications. Typically, multiple vendors supply these applications, and as the number of applications and the diversity of data increase, the effective integration of that data becomes crucial to the success of these clinical information system deployment initiatives. Furthermore, large provider organizations are seeking to integrate data sources across their health systems by creating longitudinal care records often referred to as clinical data repositories (CDRs). The goals of this integration are twofold: (1) to create electronic health records (EHRs) that make individual patient clinical data accessible to caregivers across the continuum of care and (2) to provide an aggregated, rich source of population data to support operational and clinical research (Dunbrak, 2008). IX. Change Management It’s important to understand why you should make an investment in the people side of the project—bringing in the best technology possible doesn’t mean anything unless users are comfortable and proficient in its use. The truth is just because you build it doesn’t mean they will come (McCarthy & Eastman, 2010). Training for the new system is an essential strategy to ensure wide acceptance and use of the information system that is being considered for implementation. It should be considered in training modules that different levels of professionals and job description are amongst the audience. X. Return on Investments As posited earlier Healthcare Service Providers are not altruistic endeavours for their continued existence they need to concern themselves with money matters. Therefore for a responsible acquisition of an item it is but necessary to determine the return on investment. To conduct a proper study on the rate of return of the system a time motion study should be conducted with the aim of determining the process turn-around time for each department that will be automated by the information system. Additional consideration in implementing Information Systems is the vendor’s capacity to support and enhance the product for the long term. Hospitals cannot afford to repurchase an integration platform because the selected vendor was not truly committed to the product or market and have sun setted the acquired integration platform, or ceased operations altogether” (Dunbrak, 2008). XI. Things to consider in implanting an Information System in a health care organization All things considered a well implemented Information System in a healthcare organization would enable its internal core processes to be well documented, auditable and manageable. Losses from legal cases or insurance premiums because of legal cases will be lessen because of an efficient documentation system. Efficiency will also be increased amongst the user enabling them to concentrate more on their core competency which is providing medical care. It is stressed that the information system being considered for implementation not only manage the process of the healthcare organization’s operation it should be able to manage the myriad of information that would be available in case interconnection with other system is operable. An effective system should be compatible or can easily be integrated with other regulating bodies tasked to monitor the health system landscape of the country or even the world in reference to WHO. The security level and protection given to assure patient privacy should be compatible at the very least with the HIPAA law of the US to ensure that collaboration with similar system existing within the borders of the US can be connected to the information system being considered to be implemented. For HMO due diligence requirements the system should be compatible with PACS for storing radiology records, Dragon Speech for transcription system. Since most of the time HMO pay through their ERP system, the information system being considered to be implemented should be compatible or can be made to integrate seamlessly to standard ERP applications. XII. Recommendation/A complete and comprehensive Healthcare Information System Also considering the above functionality the healthcare information system should have the following functionality at the very least: Electronic Health Record of patients that would include immunization records since birth and emergency room visit within the organization or even in other hospitals; Provisions for storing the Patient’s Historical diagnostic laboratory and radiology records from current and even those performed in other hospitals in the past. The Information system should also have an interactive Patient Management system that would include the following: Treatment Plan Maintenance and Management, Medication and Assisted Therapy Maintenance and Management. And to comply with the social responsibility covenant of the any Healthcare organization the system should have the capability for Bio-surveillance that interacts and interconnect with international monitoring body like the WHO. The information system should also be able to contribute to the international medical knowledge base by simply making its allowable records open for public scrutiny and scientific comparative study. XIII. System Implementation and Roll-out approach/System Integration In the systems implementation integration and roll-out, the approach should consider the impact of the paradigm shift the employees and medical professionals are being asked to adapt to. Proper training that would make them confident users and not reluctant users should be considered. The services of a strong technical support organization experienced in the maintenance and support of information system should also be considered by the organization’s leadership. The approach on the kind of operation process mapping should be considered not only peripherally but strategically since it is possible that efficiency can still be attained once proper operations mapping is implemented. The different user’s job function with the aim of having an ambidextrous organization should be taken into consideration when the training plan is devised. In compliance to standard practices and regulatory requirements a new set of Policies and Procedures should be drawn up that will be responsive to the demands of the new and emerging organization. These enabling policies and procedures should be supported by an active and current work-instruction that can be used even by neophyte employees. Compliance Monitoring Strategy requires a good help desk or exception and violations handling. The primary aim of this kind of system is to detect and plug the leak before violations to policies and procedures become endemic and considered as part of the operation processes. Allowing these operational lapses can result to business disasters or even the lives of patients. System and Operation Review and Improvement should be conducted regularly to ensure that recurring problems are corrected and mitigated. The aim of the regular session is not to prosecute offenders but to detect lapses and possible lapses that can result to more serious problems later on. As such key performance indicators for each process should be devised and determined for the appreciations of the process owners. All of these will help in the successful implementation, maintenance, and use of an Information System being considered for implementation in the organization. XIV. Conclusion Health care is a global concern and information technology is a global solution. With the use of the internet, collaborations between two diverse cultures from different parts of the world to solve medical problems are now a reality. Donor matching to ensure near perfect compatibility to lessen rejection if not organ wastage can be achieved with the use of information technology enabled by the internet. Preventing epidemics from escalating is now possible with the use of technology by making information and knowledge about localize out-breaks available. In the realm of medical solutions and cures to malady available in other parts of the world can now be made available. Information regarding the availability of medical procedures perfected in other parts of the world to save lives can now be made widely available. Information about availability of pharmaceutical products in parts of the world where they are not needed but are very much needed in other parts of the world can be made available. Information technology can save lives, however, in order for it to be effective interoperability and compatibility between the systems being used in each hospital should first exist. Health Level 7, ISO and ANSI are international organizations that promote standard protocol that could be used as a framework for Hospital Information Systems, Radiology Information Systems and Picture Archiving and Communication Systems interoperability. Without interoperability or compatibility to other hospital systems or governing bodies such as the WHO, the CDC or even the equivalent health department of the country exchange of information that could save lives would not be possible. However, in developing the information system of a health care organization no matter how well meaning the intention is, without the assurance that patient’s right to privacy is protected the Information system will remain a pariah or an island amidst the sea of systems that protect the privacy of patients. The United States has the HIPAA law that protects its patient’s privacy while the United Kingdom has the Data Protection Act of 1998 and the Caldicott Principles. These laws and other similar laws in other countries exist to protect the privacy rights of patients. One of the primary considerations before any system can connect or interact with hospital systems governed by such laws is that the Hospital Systems intending to connect or collaborate information with should guarantee the protection of privacy as well. Once operational, the information system should abide with an acceptable security and information technology governance standard such as the BS77991 or the ITIL2 in order for it to be continually acceptable to the system it is connected and relevant to the operation of the hospital. On the financial, organizational and operational perspective the information systems would be a valuable way to monitor and gather data. Aside from producing essential quality, performance and financial reports information system reduced the need for paper works, reduced the chances that papers will get lost or misplaced. 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