1. History of Health IT Unit 3 Lesson 1
Applied Informatics

2. Lesson Objectives At the end of this lesson, you will be able to:
Describe the history and evolution of health care information systems
Trace the development of IT systems in health care and public health
Discuss the experiments of the 1950s and 1960s
Discuss the dynamics of incentives and health care IT adoption and use

3. Definition of Terms Health Care Information System (HCIS)
An arrangement of information and data
Interacts to collect, process, store, and provide output information
Information system and information technology are interchangeable
Recommended to support a health care organization

4. Definition of Terms Cont.
Two types of HCIS
Administrative information system
Contains primarily administrative or financial data
Used to support the management functions and general operations of the health care organization
Clinical information system
Also known as departmental systems such as radiology or pharmacy
May be clinical decision support such as medication administration computerized provider order entry, or electronic medical record systems

5. History and Evolution The 1960s Health Care Environment
President Lyndon B. Johnson signed Medicare and Medicaid into law.
1960s Information Technology
Large mainframe computers
Centralized processing
Few vendor-developed products

6. History and Evolution Cont.
1960s Uses of Health Care Information Systems
Administrative or financial information systems were used primarily in large hospitals and academic medical centers
Developed and maintained in house
Shared systems available to smaller hospitals
Centralized data processing

7. History and Evolution Cont.
1970s Health Care Environment
Health care costs escalating due to high Medicare/Medicaid expenditures
Economic inflation
Expansion of hospital expenses and profits
Increased need for better access to clinical information
Emergence of departmental systems to improve productivity and capture charges to maximize revenues

8. History and Evolution Cont.
1970s Information Technology
Mainframes still utilized
Minicomputers debut
Handling of clinical data becomes more efficient
1970s Use of Information Technology
Vendor Relationships
Direct result of increased demand for patient specific data
Low cost microcomputers contribute to opening vendor market
Vendors developed applications for clinical departments
Turnkey systems created

9. History and Evolution Cont.
1970s Use of Information Technology cont.
Health Care Executive Interaction
Involvement limited to securing funds
System Limitations
Most systems were stand alone
Did not interface well with other administrative or clinical information systems within organizations

10. History and Evolution Cont.
1980s Health Care Environment
Changes to Medicare/Medicaid
Medicare introduces prospective payment systems for hospitals
Medicare shifts from a cost-based reimbursement to a prospective payment system
Medicaid and private insurers follow suit
Need for financial and clinical information

11. History and Evolution Cont.
Other Impacts
Health care cost rose by double the rate of inflation
Providers argued that fee-for-service payment failed to promote cost containment
Emergence of Managed Care Plans
HMOs reimburse physicians based on fixed rates

12. History and Evolution Cont.
Impact to Big Business
Integration of organizations making up the hospital system
Enter many other health care-related businesses
Consolidated control
Overall shift toward privatization and corporatization of health care
Integrated delivery system begins to emerge

13. History and Evolution Cont.
1980s Information Technology
Microcomputer or personal computer (PC) becomes available
Far more powerful
Brings computing to desktops
Revolutionizes data processing
Changes how companies do business
Computer market opened among different types of health care organizations
Advent of local area networks (LANs)

14. History and Evolution Cont.
1980s Use of Health Care Information Systems
Advancements resulted in
Distributed data processing
Expansion of clinical information systems in hospitals
Physician practices introduce billing systems
Integrating financial and administrative information becomes important

15. History and Evolution Cont.
1990s Health Care Environment
Medicare changes physician reimbursement to a resource-based relative value scale (RBRVS)
Health care reform efforts initiated by the Clinton administration (HIPAA)
Growth of managed care and integrated delivery systems
Institute of Medicine calls for computer-base patient record (CPR) adoption

16. History and Evolution Cont.
1990s Information Technology
The Internet and World Wide Web arrives
1990s Uses of Health Care Information Systems
Growth of the Internet has profound effect on health care organization business
Vendor community growth explodes
Products more widely available and affordable
Enterprise wide systems
Increased interest in clinical application
Relatively small percentage of health care organizations adopt CPR

17. History and Evolution Cont.
2000 to Today
Health care environment
IOM reports on patient safety and medical errors
Bush and Obama call for electronic health record (EHR) adoption
HIPAA privacy and security regulations in effect
Medicare Modernization Act
To trigger giant leaps forward in the safety, quality and affordability of health care by:  • Supporting informed healthcare decisions by those who use and pay for health care; and,  • Promoting high-value health care through incentives and rewards.
The Leapfrog Group is a voluntary program aimed at mobilizing employer purchasing power to alert America’s health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded. Among other initiatives, Leapfrog works with its employer members to encourage transparency and easy access to health care information as well as rewards for hospitals that have a proven record of high quality care.

18. History and Evolution Cont.
Information Technology
Internet expansion continues
Broadband access in rural areas
Portable devices become more widespread
Bar codes
Use of Health Care Information Systems
Focus on EHR systems
Vendors promote CCHIT certification
Health care organization invest in information systems

19. Summary Types of HCIS – Administrative & Clinical
Started in mid’60s with Johnson - Medicare & Medicaid
1960s – ‘birth’ of technology
1970s - health care costs high; IT more efficient; vendors developed clinical systems
1980s & 90s – Medicare changes generate changes in technology, Internet
2000 –HIT; CCHIT certification of EHR