1. Health Management Information Systems
Welcome to Health Management Information Systems, Health Information Systems Overview. This is Lecture a.
This lecture defines the concept of an information system and its characteristics, describes the different types of information systems, and describes various types of technologies that support health care information systems.
Health Information Systems Overview
Lecture a
This material (Comp 6 Unit 2) was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC This material was updated by Normandale Community College, funded under Award Number 90WT0003.
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2. Health Information Systems Overview Learning Objectives
Define the concept of an information system and its characteristics
Describe the different types of information systems
Describe various types of technologies that support health care information systems
The Objectives for this lecture are to:
Define the concept of an information system and its characteristics;
Describe the different types of information systems;
Describe various types of technologies that support health care information systems;

3. Information System Automated system Computer hardware and software
Receives data
Processes data
Outputs data
Supports the functions of the organization
Let’s begin with a definition of an information system. The American Health Information Management Association (AHIMA) defines an information system as “An automated system that uses computer hardware and software to record, manipulate, store, recover, and disseminate data (that is, a system that receives and processes input and provides output)” (AHIMA, 2012, p. 181).

4. General Characteristics of an Information System
Inputs
Order for a drug
Data
Prescribed drug
Process
Notification of the medication order to appropriate individuals (Pharmacy, for example)
Outputs
Documentation of administration
Taking into consideration the components of an information system, general characteristics are the capability through the use of hardware and software to accept inputs from users, access and process the data received, as well as store, manage, and present information back to the user.
For example, a hospital nurse would typically use a medication reconciliation system to verify that medications which were ordered were administered in a timely and safe manner. This information system would also be used by a physician to continue and discontinue medications, sending appropriate communications to other staff.

5. Characteristics of an Information System
Organization of data into information
Example
Data dictionary
Ability to analyze the information
Medication management
Betts (2007) described two characteristics of an information system as the organization of data into information and the ability to analyze the information. He further stated, “For data to be made meaningful it must have a purpose. The purpose of the stored data should reflect the purpose and type of the information system. Data needs to be processed and organized before it becomes information. Organizing the data will most likely involve the processes of sorting and filtering (classifying) before it can be analyzed and stored for later retrieval” (para. 1).
An example of how data may be organized is via a data dictionary. AHIMA (2012) defines a data dictionary as “A descriptive list of the names, definitions, and attributes of data elements to be collected in an information system or database whose purpose is to standardize definitions and ensure consistent use being a central repository of information about stored data, is used to help organize the data” (p. 94).
Going back to the previous slide’s example, using a handheld barcode reader that registers each medication, a nurse would use information systems to verify the correct medication was ordered and document the actual administration of the medication.

6. Major Information System Categories
Transaction Processing System (TPS)
Management Information System (MIS)
Decision Support System (DSS)
With regards to information systems, there are three major categories. They are
Transaction Processing System (TPS),
Management Information System (MIS), and
Decision Support System (DSS)
Each will be defined in the next few slides.

7. Transaction Processing System (TPS)
Processes information in order to complete a transaction
Examples:
Admit, discharge, transfer (ADT)
Patient billing
A transaction processing system (TPS) processes information in order to complete a transaction. Two examples are the Admit, discharge, transfer (ADT) and patient billing systems.

8. Admission-Discharge-Transfer (ADT)
“The name given to software systems used in health care facilities that register and track patients from admission through discharge including transfers; usually interfaced with other systems used throughout a facility such as an electronic health record or lab information system.”
ADT systems can reside within other information systems, such as registration, scheduling, or pharmacy.
AHIMA (2012) provides the following definition of an admission, discharge, and transfer system:
“The name given to software systems used in health care facilities that register and track patients from admission through discharge including transfers; usually interfaced with other systems used throughout a facility such as an electronic health record or lab information system” (p. 10).
ADT systems are typically not standalone, but rather part of other systems. Some examples include pharmacy, registration, scheduling, or even a lab system may have ADT functionality.

9. Management Information System (MIS)
Helps managers plan, organize, and evaluate their department
Examples:
Laboratory department
Emergency department
HIMSS (2010) defines management information systems as “a class of software that provide management with tools for organizing and evaluating their department, or the staff that supports information systems” (p. 76).
Examples of health care management information systems include the laboratory or emergency department information systems.

10. Emergency Department Information Systems
Dashboard systems
Communication systems
Clinical decision support
Documentation systems
Computerized training and information retrieval
Systems to facilitate public health surveillance
The National Research Council (2007) recommended that “hospitals adopt robust information and communications systems to improve the safety and quality of emergency care and enhance hospital efficiency” (p. 7). Of particular importance to considerably improving emergency care were the following information technologies:
“dashboard systems that track and coordinate patient flow,
communications systems that enable ED physicians to link to patients’ records or providers,
clinical decision support programs that improve decision making,
documentation systems for collecting and storing patient data,
computerized training and information retrieval, and
systems to facilitate public health surveillance” (NRC, 2007, p. 7).
For example, benefits of a documentation system include the ability to facilitate the capture and storage of information on the patient care process which in turn provides the information necessary for billing and reimbursement as well as public health and research purposes.

11. Decision Support System (DSS)
Information system
Gathers data from a variety of sources
Assists in providing structure to the data
Facilitates and improves the outcome of business and organizational decision-making activities
Example:
Clinical DSS
AHIMA (2012) defines a decision support system (DSS) as “A computer-based system that gathers data from a variety of sources and assists in providing structure to the data by using various analytical models and visual tools in order to facilitate and improve the ultimate outcome in decision-making tasks associated with non-routine and non-repetitive problems” (p. 100).
An example is a clinical decision support system.

12. Health Care Information System (HCIS)
Information system used within a health care organization
Facilitates communication
Integrates information
Documents health care interventions
Performs record keeping
Otherwise support the functions of the organization
Having defined the concept of an information system and identified the major categories of information systems, the next step is to unite information systems to the health care domain and describe the various types of technologies that support a health care information system.
As defined by Vogel & Perreault (2006), a health care information system is “an information system used within a health care organization to facilitate communication, to integrate information, to document health care interventions, to perform record keeping, or otherwise support the functions of the organization” (p. 945).
An example would be a hospital information system (HIS). This is a system which is comprehensive in that it contains the clinical, administrative, financial, and demographic information about each patient (AHIMA, 2012). In addition, administrative, billing, and financial systems that facilitate the revenue cycle and other administrative tasks are components of information systems used in provider and health care organizations.

13. HCIS Components Patient management and billing Department management
Care delivery and clinical documentation
Clinical decision support
Financial and resource management
Coming from a functional perspective, Vogel & Perreault (2006) identified HCIS components that support the following purposes:
Patient management and billing
Department management
Care delivery and clinical documentation
Clinical decision support
Financial and resource management
Each will be briefly described in the next few slides.

14. Patient Management and Billing
Systems that support the management of the patient
Example
Patient identification
Supporting technology
Master patient index
Patient-identifying directory
Links to the patient record
Facilitates patient identification
Assists in maintaining a longitudinal patient record
Patient management and billing systems are systems that support the management of the patient. An example would be the patient identification functionality and the supporting technology, a master patient index. AHIMA (2012) defines a master patient index as “A patient-identifying directory referencing all patients related to an organization and which also serves as a link to the patient record or information, facilitates patient identification, and assists in maintaining a longitudinal patient record from birth to death” (p. 210).

15. Department Management
Systems that support a department’s information needs
Example
Health Information Management Department Systems
Supporting technology
Electronic Document Management Systems
Supplies data to patient databases
Department management systems are systems that support a department’s information needs. An example would be the health information management (HIM) department systems which may be used to manage the organization’s medical records. An electronic document management system would be a supporting technology for the HIM department. According to an AHIMA e-HIM Work Group (2003), an electronic document management system (EDMS) is “any electronic system that manages documents (not data) to realize significant improvements in business work processes” (para. 24).
Department management systems supply data to patient databases. For example, the HIM department contributes transcribed history and physicals to EMRs.

16. Care Delivery and Clinical Documentation
Systems that support the delivery of the care and documentation of that care
Example
Clinical information systems
Supporting technology
Clinical documentation
Houses patient clinical data
Care delivery and clinical documentation systems are systems that support the delivery of the care and documentation of that care. An example of an HCIS component would be clinical information systems. A clinical information system is “designed to support the delivery of patient care, including order communications, results reporting, care planning, and clinical documentation” (Vogel & Perreault, 2006, p. 924). An example of a supporting technology would be the clinical documentation module found within an electronic medical record system. Patient clinical data are stored in delivery and clinical documentation systems.

17. Clinical Decision Support
Systems that support the clinical staff with data interpretation and decision-making
Example
Prescription decision support
Supporting technology
Drug-drug interactions
Accesses patient clinical data and acts on rules configured in the system
A clinical decision support system supports the clinical staff with data interpretation and decision-making (Vogel & Perreault, 2001).
Osheroff, Pifer, & Teich (as cited in Das & Eichner, 2010) stated “CDS provides clinicians, patients, or caregivers with clinical knowledge and patient-specific information to help them make decisions that enhance patient care” (Das & Eichner, 2010, p. 4). Das & Eichner (2010) go on to explain, “The patient’s information is matched to a clinical knowledge base, and patient-specific assessments or recommendations are then communicated effectively at appropriate times during patient care” (p. 4).
An example would be a prescription decision support system and a supporting technology would be drug-drug interaction checking.
Clinical decision support systems access patient clinical data and act on rules in order to perform various functions.

18. Financial and Resource Management
Systems that support business functions
Example
Accounts Payable System
Supporting technology
Claims administration
Houses financial and employee data
Financial and resource management systems are systems that support the business functions of the organization or practice. An example would be an accounts payable system and a supporting technology would be claims administration. Financial and employee data are stored in these systems.
Not to be confused with patient billing systems.

19. Practice Management Practice management system (PMS)
Combination of financial and administrative functions
Patient appointment, scheduling, registration, billing, and payroll functions
PMS and electronic medical records integration
In a physician setting, the practice management system (PMS) provides a combination of financial and administrative functions. A PMS automates a physician office’s patient appointment, scheduling, registration, billing, and payroll functions (AHIMA, 2012).
Integration of the electronic medical record with the PMS is paramount in today’s health care environment. For example, the meaningful use criteria, which came about via the Health Information Technology for Economic and Clinical Health (HITECH) Act, includes requirements for the electronic collection and reporting of patient demographics, including race and ethnicity, along with clinical data.

20. Health Information Systems Overview Summary – Lecture a
Definition of an information system and its characteristics
Types of information systems that support the health care enterprise requirements
Types of technologies that support health care information systems
This concludes Lecture a of Health Information Systems Overview.
In this lecture an information system and its characteristics were defined, the types of information systems that support the health care enterprise requirements were identified, and the various types of technologies that support health care information systems were described.

21. Health Information Systems Overview References – Lecture a
AHIMA e-HIM Work Group on Electronic Document Management as a Component of EHR. (2003). Retrieved from
American Health Information Management Association. (2012). Pocket glossary for health information management and technology (3rd ed.). Chicago, IL: Author.
Das, M. & Eichner, J. (2010, March). Challenges and barriers to clinical decision support (CDS) design and implementation experienced in the agency for healthcare research and quality CDS demonstrations (Prepared for the AHRQ National Resource Center for Health Information Technology under Contract No ) AHRQ Publication No EF. Retrieved from
Healthcare Information and Management Systems Society (HIMSS). (2010). HIMSS dictionary of healthcare information technology terms, acronyms and organizations (2rd ed.). Chicago, IL: Author.
National Research Council. (2007). Hospital-Based emergency care: At the breaking point. Washington, DC: The National Academies Press.
Vogel, L.H., & Perreault, L.E., (2006). Management of information in healthcare organizations. In Shortliffe. E. H., & Cimino, J. J. (Eds.), Biomedical informatics: Computer applications in health care and biomedicine (3rd ed) (pp ). New York, NY: Springer Science + Business Media.
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22. Health Information Systems Overview Lecture a
This material was developed by Duke University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC This material was updated by Normandale Community College, funded under Award Number 90WT0003.
No audio
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