Health Informatics (formerly Computers in Health Care)

Kathryn J. Hannah Marion J. Ball Series Editors

Springer Science+Business Media, LLC

Health Informatics (formerly Computers in Health Care)

Series Editors: Kathryn J. Hannah Marion J. Ball

Dental Informatics Integrating Technology into the Dental Environment L.M. Abbey and J. Zimmerman

Aspects of the Computer-based Patient Record M.J. Ball and M.F. Collen

Performance Improvement Through Information Management Health Care's Bridge to Success M J . Ball and J.V. Douglas

Strategies and Technologies for Healthcare Information Theory into Practice M.J. Ball, J.V. Douglas, and D.E. Garets

Nursing Informatics Where Caring and Technology Meet, Second Edition M.J. Ball, K.J. Hannah, S.K. Newbold, and J.V. Douglas

Healthcare Information Management Systems A Practical Guide, Second Edition M.J. Ball, D.W. Simborg, J.W. Albright, and J.V. Douglas

Clinical Decision Support Systems Theory and Practice E.S. Berner

Strategy and Architecture of Health Care Information Systems M.K. Bourke

Information Networks for Community Health P.F. Brennan, S J . Schneider, and E. Tornquist

Introduction to Clinical Informatics P. Degoulet and M. Fieschi

Patient Care Information Systems Successful Design and Implementation E.L. Drazen, J.B. Metzger, J.L. Ritter, and M.K. Schneider

Introduction to Nursing Informatics, Second Edition K.J. Hannah, M.J. Ball, and M.J.A. Edwards

Computerizing Large Integrated Health Networks The VA Success R.M. Kolodner

Organizational Aspects of Health Informatics Managing Technological Change N.M. Lorenzi and R.T. Riley

(continued after Index)

Marion J. Ball Judith V. Douglas David E . Garets

Editors

Strategies and Technologies for

Healthcare Information Theory into Practice

With a Foreword by Larry D. Grandia

With 23 Illustrations

Springer

Marion J. Ba l l , E d D Adjunct Professor Johns Hopkins University

School of Nursing Baltimore, M D 21205, U S A

-and Vice President First Consulting Group Baltimore, M D 21210, U S A

Judith V . Douglas, M A , M H S David E . Garets Adjunct Lecturer Johns Hopkins University

School of Nursing Baltimore, M D 21205, U S A and Associate First Consulting Group Baltimore, M D 21210, U S A

Research Area Director IT Healthcare The Gartner Group Wakefield, M A 01880, U S A

Series Editors:

Kathyrn J. Hannah, P h D , R N Vice President, Health Informatics Sierra Systems Consultants, Inc. and Professor, Department of Community

Health Science Faculty of Medicine The University of Calgary Calgary, Alberta, Canada

Mar ion J. Ba l l , E d D Adjunct Professor Johns Hopkins University School

of Nursing and Vice President First Consulting Group Baltimore, M D , U S A

Cover illustration: Roy Wiemann/The Image Bank, © 1999.

Library of Congress Cataloging-in-Publication Data Ba l l , Marion J.

Strategies and technologies for healthcare information: theory into practice/Marion J. Ba l l , Judith V. Douglas, David E . Garets.

p. cm. — (Health informatics series) Includes bibliographical references and index. I S B N 978-1-4612-6801-7 I S B N 978-1-4612-0521-0 (eBook) DOI 10.1007/978-1-4612-0521-0 1. Health services administration—Data processing.

2. Information resources management. 3. Information technology. I. Ba l l , Marion J. II. Douglas, Judith V. III. Garets, David E . IV. Title. V Series. V I . Series: Health informatics. RA971.6.B34 1999

362.1 '068—DC21 98-30324

Printed on acid-free paper. © 1999 Springer Science+Business Media New York Originally published by Springer-Verlag New York, Inc. in 1999 Softcover reprint of the hardcover 1st edition 1999 Al l rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher Springer Science+Business Media, LLC, except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Production coordinated by Chernow Editorial Services, Inc., and managed by Francine McNeill; manufacturing supervised by Jacqui Ashri. Typeset by Best-set Typesetter Ltd., Hong Kong.

9 8 7 6 5 4 3 2 1

I S B N 978-1-4612-6801-7

To the doers, the implementers, and installers, who take theory into practice and make healthcare information technology work!

Marion J. Ball and Judith V. Douglas

To my father, Wallace E. Garets, an educator, journalist, and one of the most brilliant people 1 have ever known.

David E. Garets

Foreword

Changes in health care are at a breakneck pace. Regardless of the many changes we have collectively experienced, delivering health care has been, is, and will continue to be an enormously information-intensive process. Whether caring for a patient or a population, whether managing a clinic or a continuum, we are in a knowledge exchange business. A major task for our industry, and the task for chief information officers (CIOs), is to find and apply improved strategies and technologies for managing healthcare information.

In a fiercely competitive healthcare marketplace, the pressures to suc­ceed in this undertaking-and the rewards associated with success-are enormous. While the task is still daunting, we can all be encouraged by progress being made in information management. There are documented successes throughout health care, and there is growing recognition by healthcare chief executive officers and boards that information strategies, and their deployment, are essential to organizational efficiency, quite pos­sibly organizational survival.

In my own career, I have had the good fortune to serve as CIO at Intermountain Health Care (IHq, an organization that has long under­stood the value of technology-enabled health care. Building on the work of pioneers like Homer Warner, Al Pryor, Reed Gardner, and Paul Clayton, we have put academic theory into practice. Automated medical data acqui­sition and computerized decision support systems have transformed how we manage information, and we are moving closer to making evidence­based medicine a reality. More and more, our operational leadership at IHC tells me, only somewhat tongue-in-cheek, that "IS might just as well run my department. I can't do the job expected of me unless IS gives me improved automation tools and services to make it happen." This is a sobering responsibility and an inspiring opportunity.

In the process of attempting to meet the expectations of our users, I have come to believe that true integration of care and services in our industry is not possible without dramatically improving information systems applications and services. Tightly coupling business strategy and work

VII

Vlll Foreword

processes with information systems is essential in order to merit the trust given us and to improve the care and enhance the experience of those we serve. It is the hope and promise of those who contributed to this work that that trust is both warranted and assured. I welcome their valued help, commend their efforts, and recommend this work for your benefit.

Larry D. Grandia Vice President and Chief Information Officer

Intermountain Health Care, Inc. Salt Lake City, Utah

Series Preface

This series is directed to healthcare professionals who are leading the transformation of health care by using information and knowledge. Launched in 1988 as Computers in Health Care, the series offers a broad range of titles: some addressed to specific professions such as nursing, medicine, and health administration; others to special areas of practice such as trauma and radiology. Still other books in the series focus on interdisci­plinary issues, such as the computer-based patient record, electronic health records, and networked health care systems.

Renamed Health Informatics in 1998 to reflect the rapid evolution in the discipline now known as health informatics, the series will continue to add titles that contribute to the evolution of the field. In the series, eminent experts, serving as editors or authors, offer their accounts of innovations in health informatics. Increasingly, these accounts go beyond hardware and software to address the role of information in influencing the transforma­tion of healthcare delivery systems around the world. The series also will increasingly focus on "peopleware" and the organizational, behavioral, and societal changes that accompany the diffusion of information technology in health services environments.

These changes will shape health services in the next millennium. By making full and creative use of the technology to tame data and to trans­form information, health informatics will foster the development of the knowledge age in health care. As coeditors, we pledge to support our professional colleagues and the series readers as they share advances in the emerging and exciting field of health informatics.

Kathryn 1. Hannah Marion 1. Ball

IX

Preface

We offer this book as a companion volume to Performance Improvement Through Information Management. Within its pages, our contributors speak to the issues that they themselves have encountered by using the capabilities that information technology provides. They offer us the wisdom they have gained as they translated promise into reality and turned theory into practice.

Whether we are dreamers or doers, we can learn from them. They can help us understand that we should not wait for the 100 percent solution, but should build incrementally. The greatest obstacle we face today is not technology. We have powerful new tools at hand.

We can use these tools to transform health care-if we have the vision and the will to do so. We must see clearly what health care should be, and we must discern whether, when, and how information technology can serve to enable change. We must remember that information technology gives us a tool set only; it is up to us to provide the design.

Above all, we should never underestimate the importance of people. According to Reed Gardner, a colleague of Larry D. Grandia, who wrote the Foreword for this volume, successful implementations are only 20 per­cent dependent on technology. The remaining 80 percent depends on the people involved.

Today it is people who are making technology work and who will trans­form health care around the world.

Marion J. Ball Judith V. Douglas

David E. Garets

xi

Acknowledgments

Many friends and associates helped us to envision this book and see it into print. Our contributing authors took the time they did not have to write the chapters we could not do without. Other colleagues, who gave of their time to review the chapters and suggest improvements, added richness and value to the content. Our thanks to all of our experts who serve on our review board: Homi Arabshahi, Dean Arnold, Marion Ball, Dave Beaulieu, Ray Bell, Bob Bonstein, Jim Burke, Joe Casper, Dave Chennisi, Mike Cornick, John Conway, Jerry Davis, Dave Dimond, Steve Ditto, Erica Drazen, Jim Edgemon, Jim Gaddis, Hal Gilreath, Mike Gorsage, Sharon Graugnard, Kent Gray, Steve Heck, Gordon Heinrich, Barbara Hoehn, Todd Hollowell, Tom Hurley, Beth Ireton, Anna Kanski, Tom Kelly, Peter Kilbridge, Rick Kramer, Christi Liebe, Bill Looney, Keith MacDonald, John Manson, Scot McConkey, Marcia McCoy, Jim McPhail, Jane Metzger, Jeff Miller, Jerry Mourey, Mychelle Mowry, John Odden, Dave Pedersen, Leslie Perreault, Briggs Pille, Jim Porter, Nabil Qawasmi, Ted Reynolds, Keith Ryan, Debra Slye, John Stanley, Paul Steinichen, Don Tompkins, Pankaj Vashi, Tim Webb, Dale Will, Dave Williams, and Roy Ziegler. Bill Day, our former editor at Springer-Verlag New York, Inc., helped us launch this project, with the support and advice of our colleagues at First Consulting Group, includ­ing Jim Reep, Luther Nussbaum, Ralph Wakerly, Philip Lohman, Patricia Robinson, and Carol Moore. Dave Garets helped us structure this volume while he was at First Consulting Group and stayed on as coeditor after he left the firm to joinThe Gartner Group. Jennifer Lillis, a gifted young editor, painstakingly reviewed all the pages that follow. And, as always, our hus­bands and our children gave us unfailing love and support.

Marion J. Ball and Judith V. Douglas

I would not be where I am without the friendship, guidance, and support of Joan Huebl, Gary Bardon, Craig Gunn , John Bingham, Jim Martin, Bill Jahsman, Steve Heck, Jim Adams, and especially Ardele Hanson.

David E. Garets

Xlii

Contents

Foreword by Larry D. Grandia vii Series Preface ix Preface xi Acknowledgments Xlll

SECTION 1 THE TECHNOLOGY INFRASTRUCTURE

CHAPTER 1

CHAPTER 2

CHAPTER 3

CHAPTER 4

Introduction 2

Local Area Networks and Wide Area Networks 3 David Dimond, Robert Burgess, and lames Marra

Data Warehouses and Clinical Data Repositories 17 Alan Smith and Michael Nelson

Internet Technologies 32 lim Kazmer

Information System Integrity and Continuity 43 Briggs T. Pille and Keith Ryan

SECTION 2 INFORMATION MANAGEMENT ISSUES FOR THE INTEGRATED DELIVERY SYSTEM

CHAPTER 5

Introduction 60

Managed Care: Business and Clinical Issues 61 James R. McPhail

xv

XVI Contents

CHAPTER 6

CHAPTER 7

CHAPTER 8

Integrated Delivery Networks 72 Alyson Widmer and Joan Hovhanesian

Information Strategies for Management Services Organizations 82 David Lubinski

Health Plan Performance Measurement 92 Sharon Graugnard

SECTION 3 MANAGING THE HEALTHCARE INFORMATION ENTERPRISE

CHAPTER 9

CHAPTER 10

CHAPTER 11

Introduction 108

Meta-Planning: Solutions, Not Projects 109 Philip M. Lohman and Pamela Mon Muccilli

Managing Vendor Relationships 119 Joan Hovhanesian

Outsourcing 125 David Pedersen

SECTION 4 MAXIMIZING THE VALUE FROM INFORMATION MANAGEMENT INVESTMENTS

CHAPTER 12

CHAPTER 13

CHAPTER 14

Introduction 146

Ensuring Value from Information Technology 147

Alberta Pedroja

Tactics for Optimizing Information Technology 156

Ray Bell and Bill Weber

The Clinical Workstation: Integrating an Academic Health Center 162 Stanley Schwartz, Mary Alice Annecharico, and Stephen Smith

CHAPTER 15

CHAPTER 16

Contents xvii

Process Redesign 175 David Beaulieu, William Krenz, Gara Edelstein, and Jordan Battani

Data Modeling 191 Dale Will

Index 203 Contributors 209