Chapter 12 Integrated Information Systems for Chronic Care: A Model Linking Acute and Long Term Care

Integrated Information System n Multiple information sets linked together in an organized way – information sets n groups of similar items often collected together n e.g., participant characteristics, health and functional assessments, service use, service billing info n information sets can be collected at different points in time by different members of the service agency

Integrated Information System n Information system links or connects information collected by different units in the agency and makes it available to everyone who needs it n Organized means there is a well-defined plan for collecting and linking information sets to meet multiple information needs In the most efficient and effective manner

Integrated Information System n IIS Advantages – more efficient n eliminates need for duplicate data collection since one entry serves all – makes more information available to all users n improves service quality; increases efficiency – links information across services n provides a comprehensive picture of the participants – a description of health needs and conditions; services they receive; cost of care; outcomes of treatment – links summary information across IHDS

Integrated Information System n Primary Components: – Information – Computer Hardware – Computer Software – Communications – Peripherals

Information n Groups of similar information items collected together. n Important to analyze work process and information being used prior to implementing the integrated system. n Determine how information is shared: cross-departmentally or cross- organizationally.

Computer Hardware n Processing power quadruples every 2 1/2 years (Moore’s Law) making it less expensive and more feasible for organizations to process vast amounts of information. n Inexpensive automation replacing human labor. n Client servers manage the information network.

Computer Software n Operating systems n Applications n Operating system and applications must be compatible. n “Make”- you develop and build your software in-house. n “Buy”- you contract with a vendor to develop the software. Better approach.

Communications n Communication devices allow sharing of information between two or more parties. n The linking of computers allows asynchronous communication (e.g. ) so different data sets can be added at different times and places by different people.

Networks n Allow organizations/departments to share information. It is the linking of one or more computers through network cabling. n Types of Computer Networks: - LAN/WAN - Internet/ Intranet/ Extranet

Peripherals n All the other items necessary to process, store, convert, and transmit information (e.g printers, scanners). n Organizations must consider compatibility and costs when purchasing peripherals.

Hospital Information Systems n Accounting System, DRG Billing System n Specialized Systems n Focus on short term acute care rather than chronic care so the hospital system would not be useful as a model for chronic care information systems.

HMO Information Systems n Integrated HMO systems maintain membership information, scheduling, accounting, cost tracking n Designed for managing traditional health services for a generally healthy population n Would be applicable to chronic care but many HMOs are not organized to manage the ongoing information needs of chronic care

Long Term Care Information Systems n Mostly focuses on billing and external reporting. n Few are integrated into useful systems so could not be applied to chronic care information systems.

Chronic Care Information Systems n Currently no system fully meets the needs of chronic care management. n Requires a system that can process large volumes of information because of the long length of care and the various types of information.

Chronic Care IS Model Patient/Client Information n Identification and description n Assessment information n Treatment Plan n Service Use

Chronic Care IS Model Patient/Client Information n Identification and description – Master Participant Record would include: n identifying information n demographic information n program status information – Data collection frequency n recorded at time of enrollment n information relatively stable; updated as changes occur

Chronic Care IS Model Patient/Client Information n Assessment information – Participant Assessment Record would include: n health status information n functional status information n cognitive status information n environmental information n informal support information – Data collection frequency n information changes over time n needs to be assessed at regular intervals

Chronic Care IS Model Patient/Client Information n Service/Treatment Plan – Service/Treatment Plan Record would include: n service goal information n service orders – Data collection frequency: n information changes constantly as client needs change n initial plan development at time of assessment and stored with assessment record

Chronic Care IS Model Patient/Client Information n Service Use – Participant’s Service Record would include: n delivered services information n IHDS service information – Data collection frequency: n ongoing basis n summarized and reported for specified time periods –

Chronic Care IS Model Fiscal Information n Service Revenues – billing various insurance companies for multiple types of services with multiple forms of payment n Service costs – expenses

Chronic Care IS Model Fiscal Information n Service Revenue – Service Revenue Record would include: n service charge information n reimbursement information – Data collection frequency: n ongoing basis n total service charge information by participants on a monthly basis n revenue reported by funding source

Chronic Care IS Model Fiscal Information n Service costs – Program Cost Record would include: n personnel cost information n materials and supplies information n facility cost information – Data collection frequency: n reported on a regular basis

Non-automated Integration n Manual integration of client level data. – identification, assessment, service use, cost information – problem with the logistics of information placement n Integrating summary data. – Manual counts from existing participant records to prepare summary data sets reports for each information set – does not allow participant specific comparisons

Automated Information Integration n Periodic Data Sharing – Simplest form is periodic sharing of data files among participating agencies n Stand-alone System – Integrated information system developed for the integrated health care delivery system n Integrated Data System – Build integrated delivery information into the existing information system

Benefits of Integrated Information Systems n Reduction in time required for recording information n Service planning is enhanced n Allows for automated scheduling n Facilitates long-term study of care outcomes n Reduce duplication of effort/information n Monitor quality

Barriers to Integrated Information Systems n Lack of management commitment to integration n Lack of shared corporate directive n Unwillingness to change n Lack of available resources n Belief that technology is a barrier n Confidentiality concerns n Interagency cooperation