Chapter 13

Management of Information in
Healthcare Organizations
 Healthcare organizations (HCOs)
Any business organization, such as a
physician’s practice, hospital, or health
maintenance organizations, that provides
care to patients.
 Healthcare information system
(HCIS)
An information system used within a
healthcare organization to facilitate
communication, to integrate information, to
document health care interventions, to
perform record keeping, or otherwise to
support the functions of the organization
 Challenges of Sharing data
• components purchased from different
vendors
• No national standards among products
• Systems created for specific users only
• Different programming languages
 Development to improve sharing
data
1. Development of the Interface Engine, a
computer system that translates and
formats data for exchange between
independent (sending and receiving)
computer systems.
2. Creation of the HL7, healthcare-based
initiative, to develop standards for the
sharing of data among individual
systems.
 President Obama’s
Summary of American Recovery and
Reinvestment Plan
Scientific Research:
• $2 billion in biomedical research, 1.5 million for
expanding good jobs involving biomedical
research to study Alzheimers, Parkinsons,
cancer, and heart disease.
• $900 million to prepare for pandemic influenza,
support advanced development of medical
countermeasures for chemical, biological,
radiological and nuclear threats and for cyber
security protection at HHS.
 PRESIDENT OBAMA’S
SUMMARY OF AMERICAN RECOVERY AND
REINVESTMENT PLAN

LOWER HEALTHCARE COSTS: TO SAVE NOT ONLY JOBS, BUT

MONEY AND LIVES, WE WILL UPDATE AND COMPUTERIZE
OUR HEALTHCARE SYSTEM TO CUT RED TAPE, PREVENT
MEDICAL MISTAKES, AND HELP REDUCE HEALTHCARE
COSTS BY BILLIONS OF DOLLARS EACH YEAR

•Health Information Technology: $20 billion to jumpstart efforts to

computerize health records to cut costs and reduce medical errors.
 Regional Health Information
Network (RHIN)
Also referred to sometimes as organization
rather than network (RHIN)
RHIN-A public-private alliance among health
care providers, pharmacies, public health
departments, and payers, designed to
share health information among all health
participants thereby improving
communication health and health care.
 National Health Information
Infrastructure
NHII- A comprehensive knowledge based
network of interoperable systems (RHIN)
of clinical, public health, and personal
health information that is intended to
improve decision making by making health
information available when and where it is
needed.
 Utah’s RHIO: UHIN
• In operation since 1993
– Governor Leavitt’s Health Print
• Statewide value added network
• Community-based; inclusive
– Community standards
• Not-for-profit
• Self-sustaining
– Began with what members thought would
bring the most value: Claims
UHIN today

Clinicians Clinics

Hospitals
Clinics Integrated health
care system
Payers

Clinicians Hospitals Clinicians

Billing
Provider
Payers Clearinghouse Services

Payers
Clearinghouse UHIN
UHIN
Gateway
Gateway
Other orgs

Laboratories
DOH
Banks
 UHIN’s RHIO Vision
• Goal: Create a sustainable business
• Begin with direct messages where the
receiver is known

Discharge
summary

• Easier to bring value to end user

• ADOPTION!
 One connection gets you all needed messages
RHIO
Clinicians
NHIO Clinics

RHIO Hospitals
Clinics Integrated health
care system
Payers

Providers Hospitals Clinicians

Billing
Provider
Payers Clearinghouse Services

Payers
Clearinghouse (UHINet)
(UHINet)
PBM
Other orgs Pharmacies

RxHub
Pharm Hub
Laboratories
Pharmacies PBM
DOH
Banks
 Challenges with moving to EMR
within a facility
• Paper environment
• Cost
• Change/training requirement
• HIPAA
Davis Hospital IASIS Challenge
1. ILE Component of the EMR
• low-volume scanning application
• Condition of admission
• HIPAA Privacy
• Insurance card
• Drivers license
Davis Hospital IASIS Challenge
2. HED, component of the EMR
• Nursing documentation
• Patient history
• Flowsheets
• Vitals
• Medication record
• assessments
Davis Hospital IASIS Challenge
3. DCS/QCI, component of the EMR
• High-volume scanning application
• All records that are not electronically
entered (records from other
facility,physician office)
Davis Hospital IASIS Challenge
4. Dictaphone, component of the EMR
• Transcription
• Dictated reports
Davis Hospital IASIS Challenge
5. STAR, component of EMR
• Contains MPI
• Ordering systems for labs/radiology
• Result systems for labs/radiology
Davis Hospital IASIS Challenge
6. MD Portal, component of the EMR
• Record viewing application
• Web-based
• Clinical use
• Current status of patient
• Trending
• Completion of Charts (Physician use)
 Davis Hospital HIM function
How will components interface with the HPF,
Component of the EMR
• Record viewing application
• Queues
• Deficiencies (HIM)
• Adjust images
Davis Hospital Challenge

Dictaphone

ILE HED

STAR MD Portal

DCS
Mountainside Medical Center

See text on pg 493

 HCO’s Operational Information
needs
1. Operational requirements
2. Planning requirements
3. Communication requirements
4. Documentation and reporting
requirements
 Operational requirements
Required detail and up-to-date factual
information. (bread & butter of the
institution)
 Planning Requirements
Short and long term decisions about patient
care. Clinical decision making. High-
quality care.
 Communication requirements
• Communication among caregivers,
multiple personnel, business units.
 Documentation and reporting
requirements
Need/requirement to maintain records for
future reference or analysis and reporting.
Legal health record
 HIPAA Acronyms
HIPAA: Health Insurance Portability and
Accountability Act
TPO: Treatment, payment, and operations
PHI: Protected health information
 Security & Confidentiality
Requirements
1. Designated Security officer
2. Train employees so they understand the
appropriate uses of patient-identifiable
information and the consequences of violations
3. Use electronic tools such as access controls
and information audit trails not only to
discourage misuse of information, but to teach
employees and patients that people who
access confidential information can and will be
tracked and held accountable.
 HIPAA Security standards &
Implementation Specifications
Pg 488 of text
1. Administrative safeguards
-security management process (risk
analysis)
-Assigned security responsibility
-workforce security (authorization)
-security awareness and training
Administrative safeguards cont.
-Security Incident Procedures
-Contingency plan
-Evaluation
Business Associate Contracts &
Arrangements
 2. Physical Safeguards
-Facility Access Controls (Access controls
& validation procedures)
-Workstation use
-workstation security
-Device and media controls
 Intranet vs Internet

Intranet is a private corporate network that

uses the same structures as the Internet.
Internet a global network of networks,
connecting innumerable smaller networks,
computers, and users.
How do we protect our intranet?
 Ways of Protecting Information
A firewall is either the program or the
computer it runs on, usually an Internet
gateway server, that protects the
resources of one network from users from
other networks. Typically, an enterprise
with an intranet that allows its workers
access to the Internet will want a firewall to
prevent outsiders from accessing its own
private data resources.
 Firewall example
firewall Home network
internet

blocker
 Encryption
Encryption is the process of encoding information in such a way that only the
person (or computer) with the key can decode it.

What would you want encrypted?

• Name
•Address
•Credit card number
•Social security number
•Bank account information
•Health information

Computer encryption is based on the science of cryptography, which has been

used throughout history. Before the digital age, the biggest users of
cryptography were governments, particularly for military purposes. The
existence of coded messages has been verified as far back as the Roman
Empire. But most forms of cryptography in use these days rely on computers,
simply because a human-based code is too easy for a computer to crack. Most
computer encryption systems belong in one of two categories:
Symmetric-key encryption
Public-key encryption
Understand your Threat & Risk
Assessment at your facility
 3. Technical Safeguards
-Access controls (audit trails)
-Integrity
-Personal authentication
-Transmission Security (integrity controls,
encryption)
 Functions & Components of the
Healthcare Information System
(HCIS)
Patient Management & Billing
-Master patient index (MPI)-the module of a
health care information system used to identify a
patient uniquely within a system. The MPI
stores patient identification information, basic
demographic data, and basic encounter-level
data such as dates and locations of service.
 Functions & Components of the
Healthcare Information System
Admission-discharge-transfer: One
component of a hospital information
system that maintains and updates the
hospital census, including bed
assignments of patients.
 Functions & Components of the
Healthcare Information System
Care Delivery
Order Entry: online entry of orders for drugs,
laboratory tests, and procedures, usually by
nurse or physician.

Results reporting: online access to results of

laboratory tests and other procedures.

Clinical Pathways: Disease-specific plan that

identifies clinical goals, interventions, and
expected outcomes by time period.
 Functions & Components of the
Healthcare Information System
Care Delivery
Clinical decision-support system: a computer-
based system that assists physicians in making
decision about patient care.
Computer based physician order entry: A
clinical information system that allows physicians
and other clinicians to record patient-specific
orders for communication to other patient care
team members and to other information systems
(such as test orders to lab systems or
medication orders to pharmacy systems).
 Functions & Components of the Healthcare
Information System
Financial & Resource Management
Electronic data interchange (EDI): Electronic
exchange of standard data transactions, such as
claims submissions and electronic funds
transfer.
Contract-management system: A computer
system used to support managed care
contracting by estimating the costs and
payments associated with potential contract
terms and by comparing actual with expected
payments based on contract terms.
 Functions & Components of the Healthcare
Information System
Financial & Resource Management
Provider-profiling systems: computer system
used to manage utilization of health resources
by tracking and comparing physicians’ resource
utilization (e.g. cost of drugs prescribed, lab
tests ordered) compared to severity-adjusted
outcomes
Patient triage: A computer system that helps
health professionals to classify new patients and
direct them to appropriate health resources