Managing Information Systems in a Hospital - Term Paper Example

 Managing Information systems in a hospital Many health care decision-makers share a concern that available health care in- formation is too limited or is of insufficient quality to meet these diverse information needs. The following are among the most important limitations of data from every source: • Lack of unique identifiers for patients, providers, and facilities, rendering it impossible to track the course of patients' care over time; • Variation in the quality of data provided, limiting the ability to draw reliable conclusions; • Lack of uniformity in data elements across data systems, making it difficult to compare patients, providers, and health plans; and • Lack of important pieces of information required to conduct even the simplest analysis. The absence of reliable, balanced information about the performance of the health care system has undesirable, and sometimes unintended, consequences. For example: • Prices not aligned with costs. Premiums are based on expectations about the cost of providing services to a population with certain characteristics. If a premium reflects a young, healthy population and policy changes result in large increases in the number of chronically ill enrollees, the premium may not be adequate to provide care. • Detrimental effects on health and functioning. Much of the limited information available about quality of care does not apply to individuals with chronic disease. If health plans that provide good preventive services are less successful in providing care for chronic conditions and if the available information on quality focuses primarily on preventive health services, individuals with chronic conditions who shift into health plans that provide poor chronic disease care may experience significant and perhaps irreversible declines in their health and functioning. • Distorted market for health care plans. Many purchasers have emphasized cost more heavily than quality in their decision-making. But equal attention must be given to developing good clinical indicators of quality. Without such information, excellent health plans that provide care at a somewhat higher cost may be driven out of the market or may choose to compromise the quality of care delivered to meet the cost requirements. • Disenfranchised groups with special needs. Failure to assess what is happening to individuals with rare disorders, those who do not speak English, or those with multiple health problems may result in system changes that leave those individuals without adequate sources of care. Most current monitoring efforts are not appropriately structured to analyze health issues for such groups. Concerns about poor health care information have stimulated efforts at many levels to build more integrated systems that will provide reliable information to inform decisions. Communities, states, managed care plans, and providers are seeking ways to enhance the quality of information currently being collected, to broaden its range, and to integrate information from a variety of sources to address more complex issues. Even more basically, those concerned with improving their health care information systems must focus clearly on the kinds of decisions they expect the system to support and the ways the system's results will be used. How will a Clinical Information System Work? A clinical information system incorporates various aspects of clinical data into an integrated whole. Pryor et al. stated that "a clinical data base is created when well-defined, discrete, and continuous data elements concerning patients are routinely recorded and coupled with outcome descriptors." Data from a variety of sources could be captured in real-time and entered into an electronic data base accessible to analysts. For example, to assess quality of care for diabetes in a health plan, the clinical data base would capture information on patient demographics from enrollment data, type of patient visits from administrative data, level of glycemic control from medical record data, and quality of life from focused patient surveys. Until these data bases become more widely available, analysts must obtain the data from original sources. A clinical information system would allow the analyst to answer specific questions more accurately and efficiently. Building an Integrated Information System Integrated information systems, designed to overcome limitations of existing data systems, will draw information from five basic sources: • Administrative files: data generated from an interaction between a patient and provider in the health care delivery system. • Enrollment files: data generated about individuals enrolled in employer-based or government (e.g., Medicare and Medicaid) health insurance plans. • Clinical information: data maintained in medical records, laboratory, or radiology test result systems and from other clinical contacts. • Surveys: data generated from routine or special surveys of individuals about issues such as health status and functioning, health risks and behaviors, and patient satisfaction. • Other data: data collected by various organizations on hospitals, health plans, and other areas of interest (e.g., vital statistics and cancer registries). Among the first decisions confronting those planning integrated information systems are the kinds of data to include in the system and the priorities for building its various components. In both cases, the decision depends on the expectations one has for the system, the type of information most needed by key decision-makers, and the ways in which the results will be used. One can gather useful information about the questions stakeholders want answered by asking representatives of stakeholder groups to generate a set of questions for which they feel they need answers to accomplish their role effectively. At a minimum, these groups should include consumers, health care providers, health plans/payors, policy-makers, employers, and researchers. An effective way to elicit this information is to convene focus groups -- a small number of individuals from a stakeholder community brought together under the leadership of a facilitator to collectively develop a list of key questions. The interactive nature of focus groups often produces a richer set of questions than might be generated if individuals were queried separately. Convening groups with similar backgrounds may provide a freer exchange of ideas. Gathering information from stakeholder groups is more than just a consensus building process. Various groups may share an interest in a general topic but want to ask very different questions about the topic. The ways in which those questions vary will have important implications for the data required. In this example, the substantive area of concern is the quality of preventive services, specifically, the provision of age-appropriate immunizations. The shared subgroup is children under age two, which suggests that one needs in- formation on the birth-date of children to identify the right group for analysis. More specific data elements can be identified by examining the questions posed by each group: • Consumers have framed the question in terms of health plans in their community, which implies the ability to produce plan-specific rates of immunization. • Providers are interested in how they might increase rates of immunization, so they need a link between rates of immunization and different methods for ensuring that children receive this service. • Health plans are interested in whether they are missing opportunities to immunize children; this requires being able to produce utilization profiles for children in this age group and to explore whether children who are not receiving immunizations are getting other services, during which time they could also have been given an immunization. • Policymakers are interested in knowing immunization rates at the community level, which requires linking children to geographic areas. Employers are interested in how well services are being delivered to their employees, which requires identifying children within health plans linked to a specific employer. Although many employers may accept information about overall health plan performance, some may want to know if their employees are receiving services at the same rate as others in the health plan. For most of the questions posed by stakeholders, the time frame is at a single point in time. However, the policymakers' question requires two points in time -- before and after implementation of a public health program. The providers' question implies a comparison between using and not using a mechanism for increasing immunization rates. Asking stakeholders what they are interested in knowing about the health care system can help shape the strategy for developing an effective integrated information system -- one that serves the needs of the widest group of potential users. The example above illustrates the slightly different data needs of groups asking questions about the same general area of concern. If only one of these groups had been queried, the data base might be missing a key variable required to answer questions posed by another group. Thinking Strategically about Information Systems In the last five years, the debate about the performance of the nation's health care system, once almost exclusively focused on costs and utilization, has broadened to include concern for increasing the value (quality) for health care dollars spent. Information systems are at the heart of monitoring the quality of care. Financial and organizational strategies can be blunt and clinically insensitive in their applications, and both needed and unneeded care can be eliminated as cost controls are introduced. In the absence of quality monitoring, we cannot determine whether cost-control efforts are compromising quality. Thus, quality monitoring is an important tool for making optimal resource allocation decisions. The National Committee for Quality Assurance ( NCQA) issued a clarion call for the development of information systems that will provide data making it possible for purchasers and health plans to make choices based on value, not just cost. Describing the measurement of the quality of health care as "one of the most critical challenges of coming years" but "primitive" compared to the assessment of the quality of other goods and services, the report provides a road map to communicate "directly to the managed care industry what upgrades in information systems will be necessary" to increase their ability to measure performance, thus creating an environment in which "advanced performance measures can be implemented at a reasonable cost". The report includes both immediate and longer-term initiatives. The NCQA urges health plans to improve the use of currently available data over the next two to three years, by improving its quality; create an environment that rewards automating clinical information; position themselves to implement new standards; improve their current data-management practices; establish policies for protecting confidentiality; and begin to plan for the cost of expanding, updating, and replacing their current software, hardware, and communications technology to meet new information requirements. In three to five years, the NCQA suggests, a number of likely developments will make it possible for health plans to implement new information systems that meet the full demands of performance measurement. These changes include federal standards for structure, contents, definition, and coding of the elements of a medical record; federal legislation to protect privacy; vendor software that automates patient records in compliance with standards; and communication technology that makes sharing of clinical data possible. Bringing about these changes requires support from other organizations, in particular the federal government. If these developments do not take place, health plans will have to continue their own efforts to improve their information capacity. While acknowledging that the challenges of implementing new information systems are formidable, the NCQA is developing performance measures that assume the implementation of its road map recommendations in the timeframe specified. The centrality of enhanced information systems in the nation's future health care system as well as the federal role in creating a supportive environment for them are highlighted in the report of the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry. Health care information systems of the 21st century must be able to guide internal quality improvement efforts; generate data on the individual and comparative performance of plans, facilities, and practitioners; help improve the coordination of care; advance evidence-based health care; and support continued research and innovation. Noting that existing information systems are not adequate for these purposes, the commission recommended a number of actions intended both to spur and to coordinate efforts to address these inadequacies. The recommendations include • Encouraging investment in information systems by having purchasers of health care services insist that providers and plans be able to produce quantitative evidence of quality; • Incorporating health care information systems, including automation of clinical information, improvement of data quality, and participation in regional or national health information networks, among the standards used by quality oversight organizations; • Establishing national standards for structure, content, definition, and coding of health information; • Implementing security programs to protect confidentiality; Making use of information technology in clinical settings a part of training health care professionals; and • Supporting demonstration projects designed to illustrate and test improvements in information systems. Both the federal government, through the Quality Interagency Coordinating Committee, and the private sector, through the Forum for Health Care Quality Measurement and Reporting, are working to implement the recommendations of the Advisory Commission. With respect to information systems, a key concern is that addressing the potential problems associated with computer handling of dates in the next century (known as the Y2K problem) is absorbing all resources that might otherwise be used to improve health information systems. There may be consensus about what we want and need health information systems to do in the 21st century, but as the NCQA report notes, many issues remain unresolved. The federal government, health care organizations, and foundations must collaborate to explore issues such as the effect of automation on the quality of patient care, the costs and benefits of computerized patient records, the effects of automation on provider work flow and productivity, the development of data input methods and technology that are adapted to the patient care process, and the requirements for structured medical language that is compatible with both the delivery of care and the discipline of information systems. Read More