Evolution of Health Care Information Systems - Essay Example

Introduction Change, like death is inevitable. In the midst of evolution and rapid technological advancements, the healthcare sector has not been left behind. A clear difference exists between health care facilities, systems and practices of the current era and those of the past. Both clinical methods and information systems have been subjects of tremendous change in the health care sector. The changes witnessed in these sectors have been brought about by two main factors; challenges and changes in the medical service environment, and developments in information technology. HCIS versus Clinical Information System An information system may simply be defined as an arrangement of people, technology, processes and data that interact to gather, process, store, transfer and provide output in form of useful information that supports the organization. The HCIS (Health Care Information System) traditionally was developed to primarily manage financial and administrative data with an aim of supporting management functions as well as general operations of the organization that deals in healthcare services (Tan, 2005). Administrative applications of HCIS include admission, transfer and discharge registration, scheduling, accounts receivable and patient billing, utilization management, payroll, staff scheduling, material management, general ledger and accounts payable administration (Tan, 2005). The clinical information system on the other hand contains clinical/ health related information that is related to diagnosing, monitoring and treating patients. Clinical applications generally consist of the ancillary information system and other systems which include nursing documentation, medication administration, tele-health and telemedicine, electronic medical record and provider order entry. Ancient Health Care Systems Changes witnessed in healthcare systems have become real, more as a result of advancements in information systems, medical technology and healthcare delivery, and management practices (Tan, 2005). Up to the early 1980s, HIS (Healthcare Information Systems) were more oriented towards information “supply” for purposes of conducting business. Attention however shifted over time to a system that is more “demand” oriented; information and its importance. This led to the gradual replacement of pencils, calculators, paper and cards, mechanical punches and people for performing vital tasks (Dudeck, Blobel, Lordieck & Bürkle, 1997). The typical office in the healthcare facility then was characterized by cumbersome and labor intensive work methods. These methods and systems were later replaced by early computers which improved the system substantially but still were cumbersome (Dudeck, Blobel, Lordieck & Bürkle, 1997). Although expensive, these computers improved accounting, billing, and inventory control and reduced the number of people who were required to perform specific tasks. The traditional HIS hence evolved from mundane functions like admission, transfer and discharge to billing then to much more sophisticated functions like clinical information management, simulation, advanced laboratory systems and image processing. Evolution of the HCIS from the 1980s In the 1980s the healthcare environment saw the introduction of prospective payment system and introduction of public and private medical insurance policies. These coupled with other factors necessitated the introduction of better ways of managing clinical and financial information aided by the unveiling of PCS and local area networks (Dudeck, Blobel, Lordieck & Bürkle, 1997). The unveiling of internet in the 90s in a mighty way revolutionized inter-organizational communication, business activities and market services. With it grew interests in clinical applications and mild adoption of EMR/CPR systems. The CPR however did not fully solve the problem; patients often had to recount present and past histories (medical) as they traversed one doctor’s office to the other, and one medical facility to the next. Yet another problem that persisted was the fact that valuable clinical information often got lost or remained buried in the patient’s files in different sites. The arrival of the 21st century saw new changes taking place in all sectors of human life. As internet expansion continued, new technologies such as PDAs, bar coding, voice recognition rebounds and wireless systems came into relatively wide application in the healthcare information system. Currently, many health organizations are making attempts to implement various point-of-care systems such as CPOE, E-prescribing and HER. With the continued adoption of technologically advanced systems paper records have been replaced by electronic formats which pose a risk in securing privacy. Although healthcare providers follow standard procedures, there is a relatively high risk in protecting privacy of information due to certain loopholes that existed within information systems (Dudeck, Blobel, Lordieck & Bürkle, 1997). This is one main challenge that the modern information system must seek to overcome. The ICD-9 System The ICD (International Classification of Diseases) descends from a series of events that date back to the early 1600s an idea of John Graunt. In 1948, the World Health Organization started using the coding system to track deaths and sicknesses worldwide. The ninth revision of the ICD-9 coding system was later published in 1977. The ICD-9 system basically is used to translate diagnoses written by medical practitioners into numbers just like zip codes are used to specify geographical locations. The codes are used to identify complaints, problems, conditions, symptoms, diseases and other medical reasons. It is applied by government and commercial players to determine liability for services based on the diagnoses that have been carried out. The coding involves the use of 17 main codes with each main code having a set of numbers which define specific conditions, in total the numbers are 999. Further to these there are V and E codes which are supplementary classifications. V-codes (V01 to V83) are supplementary factors that influence health status, while E-codes (e800 to e999) describe external causes of poisoning and injury. The ICD-9 structure consists of sections, categories, subcategories and fifth-digit classification. Sections are groups of categories with three digits, categories are 3-digit code numbers, and sub-categories are 4-digit code numbers while fifth digit sub-classifications are 5-digit code numbers. All codes that are used have at minimum three digits. Most other codes have subcategories and others have fifth digits. A decimal point separates the 3-digit category from the subcategory and sub-classification. The system also has a supplementary section that contains a table of chemicals and drugs, an index to poisoning and external causes of injuries as well as hypertension and neoplasm tables ICD-9 Sign Conventions In order to make it easier for practical use, the ICD-9 code also includes surgical procedure codes, special tables, conventions, basic coding rules and steps. Conventionally, a number of conventions are used to communicate when using the ICD-9 code. NEC is used to mean Not Elsewhere Classified while NOS implies Not Otherwise Specified. The square brackets are used to enclose alternate wording, explanatory phrases or synonyms. The full colon following an incomplete term implies that the term needs more modifiers in order to make it assignable to a specific category. Braces are used to embrace a series of terms each of which is modified by the statement that appears on the right side of the brace. These together with other conventional notations are used with an aim of assigning the highest accurate diagnosis code. Currently, an ICD-10-CM update has been established and is passing through the implementation stage in many major hospitals across the World. Current State of the Health Care System Today’s healthcare facility shares great similarity with many service and production organizations but with specific variations that result from the complex and diverse nature of healthcare production. Efficiency and effectiveness in service delivery and in managing information system has greatly been observed in the modern healthcare institution on top of improvements in medical equipment. One main development in healthcare was brought about by the development of CPR (Computer-based Patient Record) in response to a need to enable sharing by medical practitioners to share information regarding their patients. Traditionally, patients would visit different health practitioners on episodic basis with related ailments or symptoms. (Dudeck, Blobel, Lordieck & Bürkle, 1997). The creation of CPR has enabled practitioners to track medical records of patients thereby offering better services to them. Information relating to financial and administrative issues like payer transactions is of great importance and more especially when health insurance is involved (Wager, Wickham & Glaser, 2005). The issue of inter-organization communication like sharing information between the insurance company and the healthcare facility which was a challenge in yester years is a thing of the past. The modern information system is well networked and is well capable of displaying the patients’ particulars; calculate the bills and other important information which are needed by both organizations. The modern health office however enjoys a host of benefits accredited to the advances in modern information systems. These benefits can be stated as follows: The modern system supports multicentric and concurrent administrative and clinical utilization and exchange which also support synchronous decision making – not just retrospective decision-making (Wager, Wickham & Glaser, 2005). Another benefit is the ability to capture, intensively manipulate and deliver data instantaneously at point of service. Clinicians can today review pathology slides, and radiological films in remote sites and assist or perform surgery through application of remote robotics (Wager, Wickham & Glaser, 2005). Better methods of activities such as lab testing, scripting, condition-specific diagnoses and treatment and patient monitoring have been developed and are currently applied in many health care institutions. Conclusion The health care environment and several advances in information technology have played a monumental role in developing the current state of health care information system. With more developments being witnessed both in the IT sector and global health environment, much more changes are bound to be witnessed in the continuous attempt to overcome challenges that never cease to emerge. Embracing modern information systems in health care has contributed widely to the effectiveness and efficiency of service delivery in the health sector. Today, there is still a great need for the development of an electronic system that makes health planning easy and focuses on a person’s wellness right from birth through youth, and from adulthood to old age on all aspects. Such a system will be all encompassing and will ensure all registered members have their health histories securely stored in a system that contains all the necessary information that is needed by health care facilities, insurance companies, banks and other institutions that may be of interest to the individual’s health. Yet another development that is expected to hit the health care sector is the application of Ambient Intelligence (Aml) which involves the application of artificial intelligence. Aml is expected to give good attention to human factors, technology, ergonomics, project management and organizational changes that are relevant to health service. It is anticipated that Ambient intelligent will bring the changes that are witnessed in other sectors that apply artificial intelligence such as in airplane piloting. Reference Tan H 2005 E-health care information systems an introduction for students and professionals edition illustrated published by J Wiley and Sons Dudeck J Blobel B Lordieck W Bürkle T 1997 New technologies in hospital information systems Edition illustrated Published by IOS Press Wager A Wickham L Glaser J 2005 Managing health care information systems a practical approach for health care executives published by John Wiley and Sons ICD-M coding http://74.125.95.132/search?q=cache:k8V1Uymk2MkJ:www.wellmark.com/e_Business/provider/online_training/icd-9workbook.pdf+ICD-9+structure&cd=3&hl=en&ct=clnk Read More