1ISC471/HCI 571 Isabelle Bichindaritz

Introduction to

Health Care Systems

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2ISC471/HCI 571 Isabelle Bichindaritz

Agenda

• Examples of biomedical information and information systems– Evolution of healthcare systems– Regulatory agencies and organizations– Health care delivery systems– Health care professionals– Financing health care– Technology in health care

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Examples of Information Systems

• Information systems

• Health care information systems

• Hospital information systems

• Clinical information systems

• Medical insurance information systems

• Pharmaceutical information systems

• …

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Examples of Information Systems

• Health care information systems (HCIS)

• The information system supports a health care organization, which is any organization in which health care services are provided:

• A physician’s practice (general practitioner, …), nurse practice, social worker practice …

• A clinic, such as rural health clinic, a nursing home

• A hospital

• A regional or national health care organization

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Examples of Information Systems

• Health care information systems (HCIS)

• The health care information system consists of interacting components providing health care services

• information and data (core)

• people

• processes

• information technology

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Examples of Information Systems

• Health care information systems (HCIS)

• The data and information in an HCIS are of two main types:

• Clinical – clinical and health-related data and information used by providers to diagnose and treat patients, and to monitor the patient’s care [Wager et al. 2009]

• Clinical information systems can be departmental (radiology, …), provider entry system, medical records, …

• Administrative – administrative or financial data used to support the management functions and general operations of the health care organization [Wager et al. 2009]

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Examples of Information Systems• Health care information systems (HCIS)• Examples of administrative information systems

• Patient related information systems• Admission, discharge, transfer (ADT)• Registration• Scheduling• Patient billing or accounts receivable• Utilization management

• Other administrative systems• Accounts payable• General ledger• Personnel management• Materials management• Payroll• Staff scheduling …

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Examples of Information Systems• Health care information systems (HCIS)• A short history of HCIS context in the US [Wager et al. 2009]

• 1960s• Enactment of Medicare (health care coverage for the elderly) and Medicaid (health care

coverage for the poor)• 1970s

• Rising expenditures of Medicare and Medicaid• 1980s

• Introduction of prospective payment systems by Medicare (diagnosis related groups or DRGs)

• 1990s• Managed care (intermediate organization between physician and patient)• Institute of Medicine (IOM) call for computer-based patient record (CPR) adoption

• 2000s+• Focus on patient safety and medical errors (HIPAA)• Call for electronic health records (EHR)• Certification for healthcare information technology(CCHIT)

• Pay for performance

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Examples of Information Systems• Health care information systems (HCIS)

• A short history of information technology evolution • 1960s

• Mainframe computers, centralized processing• 1970s

• Mainframe computers and minicomputers• 1980s

• Personal computers, local area networks, distributed processing• 1990s

• World-Wide Web• 2000s+

• Spread of the Internet, semantic web, social networks• Handheld devices, ubiquitous computing• Information exchange standards, terminologies, ontologies

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Examples of Information Systems• Health care information systems (HCIS)

• A short history of HCIS developments in the US• 1960s

• Administrative information systems in large hospitals developed in-house• 1970s

• Information systems from vendors and start of clinical information systems (laboratory, …)

• 1980s• Expansion of clinical information systems, integration between administrative and

clinical information systems• 1990s

• Growth of products available, Web-based in particular• 2000s+

• Focus on electronic health records• Focus on safety in health care information systems• Personal health records (insurers, Google, Microsoft)

• Health information exchange activities

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Examples of Information Systems

• Hospital information systems (HIS)

• The hospital information system can be defined as “the set of information and information processes useful for the daily work as well as for the management and strategic decision-making” at the hospital. (document #275 of January 6, 1989)

• Key components of HIS • Electronic medical record, electronic health record• Computerized provider order entry• Medication administration• Telemedicine• Telehealth• E-prescribing• Personal health records 118/27/2012

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Examples of Information Systems

• Hospital information systems (HIS)• Components of a hospital information system

• People• Patients• Staff

• Clinicians• Administrators• Support staff

• Organizations (managed care …)• Software

• Components: • By department (radiology, laboratory, wards, …)• By function (EMR, CPOE, …)

• Hardware128/27/2012

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Examples of Information Systems

• Hospital information systems (HIS)• Types of information

• Data• Medical data• Clinical data• Administrative data• Accountancy data• Insurance data

• Aggregated data extracted from individual data for evaluation, management, …• Knowledge

• Decision support systems (DSS)• Medical dictionaries and references• Bibliographic references and databases• Care protocols, clinical guidelines …

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Examples of Information Systems

• The health information system : data

• Varied types of data:• Clinical data• Administrative data• Accounting data• Insurance data …

• Varied types of knowledge:• Clinical DSS• Medical dictionaries• Bibliographic references• Care guidelines

• Varied information systems:• Clinical, hospital, healthcare, surveillance, …

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Examples of Information Systems

• Hospital information systems (HIS)•

15

KNOWLEDGE

Decision Support

Guidelines Protocols

Medical References

Bibliographic Databases

INFORMATION / DATA

Medical

Clinical

Administrative

Accounting

Insurance

EMR

CPOE

Decision support

Medication administration

Patient accounting

Teleme

dicine

Telehealth

Laboratory Oncolo

gy ER

Pediatry

Radiology

Pharmacy

Cardiology

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Examples of Information Systems

• Clinical information systems (CIS)

• Clinical information system encompasses the parts of the hospital information system involving direct care of the patients.

• Users of the CIS are• Clinicians

• Staff supporting patient care

• Patients

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Examples of Information Systems

• Hospital information systems (HIS)

• Example of the VA (Veterans Army) in the US• VistA is the integrated health information system of the VA:

• “VHA’s integrated health information system,

including its framework for using performance measures to improve quality, is considered one of the best in the nation.”

• Institute of Medicine (IOM) Report, Leadership by Example: Coordinating Government Roles in Improving Health Care Quality (2002)

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Examples of Information Systems

• VA health information systems (HCIS) - VistA

• VistA / CPRS is a famous example of successful health information system• Built by Veterans Army Administration (VHA)• Publicly owned by VA• Made available to interested public/private entities (OpenVA)

• VAH is the US largest integrated health system• Serves 4.1 million American veterans annually • Supports

• $23+ billion nationwide health system• 1,300 care sites, incl. 163 hospitals & 800+ community & facility based clinics• 180,000 health care staff; 85,000 trainees

• Vista / CPRS is largest integrated health information system • Best overall health information system

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19

VISTA INFORMATION

SYSTEM

USERSECURITY

MAILMAN

DEVICE MANAGER

MENU MANAGER

RPCBROKER

INTEGRATED DATABASE

PATIENTS

WARDS

DRUGS

PERSONS

INVENTORYPRESCRIPTIONS

IMAGES

LAB RESULTS

VISTA SOFTWARE PACKAGES

SCHED-ULING

INPATIENTPHARMACY

LABORATORY

SURGERY

MEDICINE

SOCIAL WORK

DENTAL

ENGINEERING

INTEGRATED FUNDS CONTROLACCOUNTING &PROCUREMENT

ADMISSIONDISCHARGETRANSFER

DIETETICS

MENTALHEALTH

HEALTHSUMMARY

NURSING

LIBRARY

PATIENTFUNDS

MEDICALRECORDSTRACKING

ACCOUNTSRECEIVABLE

VOLUNTARYSERVICE

REHABMEDICINE

RADIOLOGY

ONCOLOGY

COMPUTERIZEDPATIENT RECORDSYSTEM

(CPRS)

KERNELTASKMANAGER

VA FILEMAN

TEXTINTEGRATION

UTILITIES (TIU) OUTPATIENTPHARMACY

CLINICAL PATIENT RECORD

AUTHORIZATION SUBSCRIPTION

UTILITY (ASU)

BAR CODEMEDICATIONADMINISTRATION

WOMEN’SHEALTH

BLOOD BANK PROBLEM LIST

VistAIMAGING

CONSULTS /RESULTTRACKING

CLINICALREMINDERS

MEDICAL CARECOST RECOVERY

Sites of Care• Clinics• Hospitals• Nursing Homes• Domiciliaries• Home/Workplace

ISC471/HCI 571 Isabelle Bichindaritz 8/27/2012

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Examples of Information Systems• VA health information systems (HCIS) - VistA

• Nationally integrated outpatient & inpatient information system

• Mostly developed and owned by VA (publicly owned)

• Long evolution• Began as Decentralized Hospital Computer Program (DHCP 1980s)• Transformed into VistA (1990s)• Next generation VistA (2002-20__) HealtheVet-VistA on improved

platform using modern tools & languages following enterprise architecture

• National software with local flexibility/innovation• Innovation developed locally & enterprise wide• Standard packages distributed enterprise wide, e.g. latest version of

CPRS (January 2002)208/27/2012

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Examples of Information Systems• VA health information systems (HCIS) - HealtheVet

• Moves from facility-centric to person / data-centric• Uses natioanl, person-focused health data repository for production &

management/analysis/research• Builds on, enhances & utilizes VistA

• Moves from legacy VistA to HealtheVet-Vista• Uses best, appropriate modern technology

• Programming, software, hardware, networking• Moves “core” applications to run “enterprise-wide”• Standardizes core data & communications• Enhances the five major systems

• Regis / eligibility / enrollment, health data, provider, management / financial, “e” commun/transactions

• Enhances cross-cutting• Security/privacy, architecture, data quality/standards, infrastructure,

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Examples of Information Systems

• Health information systems (HIS)• Key set of problems

• Evolution from hospital information systems to health information systems• Patient-centered approaches • Connection between different medical records of a patient• Linkage between all participants in patient care

• Integration between different applications• Data input• Representation of clinical data• Market volatility • Lack of funding, financial data• Risk of failure

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Examples of Information Systems

• Health information systems (HIS)

• Players

23

Patient

ClinicianHospital

Organization

Application

Hardware/Infrastructure

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Examples of Information Systems

• Health information systems (HIS)

• Core challenges and research directions• Integration and standardization

• Human-computer interaction

• Representation and structure of data / information / knowledge

• Socio-technical and organizational issues

• Healthcare processes

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