1. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Chapter 13 Health Information Systems and Strategy

2. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Objectives After completing this chapter, you will be able to: –Discuss the factors that are contributing to the widespread adoption and use of health information technology, including electronic health records (EHRs) –Define the major components and functions of an EHR system

3. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Objectives (cont’d.) –Discuss the major barriers to EHR implementation and strategies that are being employed to overcome them –Describe the process a health care organization generally goes through when planning and implementing health information technology, including EHR systems

4. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Objectives (cont’d.) –Understand the importance of aligning health information technology (IT) plans with the overall strategic plans of a healthcare organization

5. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Purpose Information systems technology plans must be well-aligned with overall strategic plans of health care organization: –Investing in health information technology can have profound impact –Focus on: Efforts to promote adoption and use of electronic health records Process for effectively implementing and evaluating health information systems technology

6. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Historical Overview and Today’s Health Information Technology Landscape: a National Perspective Twenty years ago, Institute of Medicine published landmark report outlining numerous problems inherent with paper- based medical record systems: –Called for widespread adoption of electronic health record (EHR) systems –Today, U.S. health care organizations still lag behind in adoption and use of EHR systems

7. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Terms and Definitions Health information technology: broad range of technologies for transmitting and managing health information Electronic health record (EHR): conforms to nationally recognized interoperability standards Personal health record (PHR): generally managed and controlled by patient

8. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Terms and Definitions (cont’d.) Main functions of electronic health record: –Collect electronically and store data about patients –Supply information to providers on request –Permit providers to directly enter orders into computer –Provide health care professionals with advice in making decisions about patient’s care

9. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Terms and Definitions (cont’d.) –Enable health information exchange (HIE) across organizational boundaries and –More fully engage patient in his or her own care through home monitoring and telehealth –Administrative processes, such as prior authorizations and benefits/insurance verification, will occur automatically and greatly simplify labor-intensive processes –Public and private health reporting will become standardized

10. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved.

11. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Factors Driving Demand for Health IT and Current Adoption Rates Reducing medical errors and making health care system “safer” is priority: –Electronic health records (EHRs) viewed as means of improving quality of care –As EHR systems are becoming more widely deployed, further research into their impact on quality, efficiency, and overall health care costs will be needed

12. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Adoption Rates of Health Information Technology Current adoption rates of electronic health records (EHRs) in U.S. hospitals and physician/ambulatory care settings are relatively low –Approximately 8-15% of hospitals are estimated to have fully operational EHR systems –4% of physician practices have fully functional EHR system; 13% have basic system

13. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Barriers to Adoption and Strategies for Overcoming Them Cost Misalignment of incentives Unclear return on investment Lack of availability of staff with adequate expertise in information technology Privacy and security concerns; issues with interoperability Lack of strong track record of success

14. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Barriers to Adoption and Strategies for Overcoming Them (cont’d.) Overarching goal is providers will use technology as a tool to accomplish: –Improve quality, safety, efficiency, and reduce health disparities –Engage patients and families in health care –Improve care coordination –Improve population and public health –Ensure adequate privacy and security protections for personal health information

15. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Strategic Alignment Organization must align IS function with organizational strategy: –Premise: information systems do not have strategic value stems from view of IS as utility- like commodity similar to electricity –Alternate view: IS can provide strategic advantage to organizations because it is not commodity-like However, IS consists of number of different components, commodity-like and not

16. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Strategic Alignment (cont’d.) Framework for high-performing IS function: –Governance –Management –Business strategy –Information architecture

17. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Strategic Alignment (cont’d.) Capabilities of little or no strategic value that can be minimized or outsourced: –Building and operating technical infrastructure and systems acquisition or development –Activities with strategic impact remain within organization, while those with little or no strategic impact can be done either internally or externally

18. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Strategic Alignment (cont’d.) Approaches to IS function: –Structure of IS function should mirror that of organization –IS function should be organized around various activities it is responsible for, similar to functional arrangement –Federated approach has benefit of improving ability of IS organization to develop relationships with business managers within organization

19. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Critical Success Factors Ability to align IS strategy with organizational strategy: key factor for successful adoption of health information technologies Organization can make strategic decisions about needed IS capabilities in many ways: –Example: Analysis of environments and identification of strategic opportunities and threats

20. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Critical Success Factors (cont’d.) Organizational strategies can drive development of IS strategies: –Results in set of IS goals and objectives that are explicitly linked to higher level goals and objectives –May be used regardless of how alignment is achieved, but is sometimes problematic, particularly for infrastructure types of projects

21. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Critical Success Factors (cont’d.) Successful strategic alignment should result in set of IS projects that organization has identified as important: –Portfolio of projects includes pending requests, projects approved but not begun, and projects that are in progress –Organization must move from the “what and why” to the “how” of adopting health information technology

22. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Systems Development Life Cycle Generic methodology for selecting, acquiring, implementing and maintaining system: –Definition (planning) –Construction (analysis, design and testing) –Implementation –Maintenance phases

23. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Systems Development Life Cycle (cont’d.) Places great deal of emphasis on definition or planning phase: –Begins with feasibility analysis –Requirements definition: most important part of project, focuses on logical design instead of the specific physical implementation –Requirements definition serves as basis for construction phase

24. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Project Management Project management has significant impact on success of IS projects Steps in IS project initiation: –Developing project charter –Identifying project manager –Project sponsor –Project champion

25. Copyright 2012 Delmar, a part of Cengage Learning. All Rights Reserved. Assessing HIT Performance and Value Choose correct metric(s) for assessment Agency for healthcare research and quality (AHRQ): –Developed toolkit for evaluating IT projects –Evaluation begins with defining goals of project and goals of evaluation itself –Next, link project goals to outcome measures –Measures should be assessed for validity, importance, and feasibility