HEALTH

MANAGEMENT
INFORMATION
SYSTEM (HMIS)
Course Director: Dr. Hanna Khair Tunio
Week#1 Lecture -1-2
Dated: 24-25/11/2021
Learning Objectives:
■ Understand the role of IT as it affects work process design and
organizational strategy.
■ Understand the issues facing healthcare organizations regarding the
application and use of IT.
■ Apply knowledge about IT to make informed operational and
strategic decisions in healthcare organizations.
■ Synthesize how the clinical and business functions in healthcare
organizations are structured and how IT can facilitate effective
business and clinical decision making.
■ Evaluate the potential and limitations of IT in a functioning
healthcare organization.
The Role Of Information Technology In
Transforming Health Systems: Overview
■ The application of advanced information technology (IT) to improve health
system performance has probably generated more hope than any development in
the health system.
■ IT has at the same time frequently failed to meet expectations
■ Those studying the problem define it in different ways and propose varied
solutions.
■ Some chief information officers (CIOs) view it as a financial problem caused by
underinvestment in IT by healthcare organizations. Others feel that it is a vendor
problem, in that software vendors cannot deliver on their promises.
■ Vendors claim that applying information systems (IS) to the health field is
difficult because of the exceedingly complex nature of health services delivery.
Continue…
■ The argument that applications in health systems are more difficult
because health services and health systems are so complex is
probably true.
■ The issue is not primarily in the new technology or how it is being
implemented in healthcare organizations. These may be problems, but
the issue is much more complex. It suggests a failure to understand or
accept changes in business and clinical processes that are enabled by
IT.
■ Some encouraging achievements in the performance of health- care
organizations have been credited to IT. The critical factor is the
consistency between how IT is designed and managed and the design
of the work processes it supports.
Information As A Transforming
Technology:
■ Only three fundamental changes have taken place in society in the history of
humankind: the agricultural revolution, the industrial revolution, and the information
and technology revolution.
■ Although we are in the information and technology age, we still typically function with
the mind-set of the industrial revolution.
■ Financial and other sectors of society provide emerging examples of how the new age
might be structured and function. The structures that have emerged are innovative but
can be understood only within the context of the process by which they were derived
■ The health system, being primarily in the information business, might be expected to be
a leading sector in the third-wave transformation. On the other hand, being an
information-dominated industry might make the potential of change greater but the
probability of change less.
The Role of IT in Organizations:

■ There are two basic approaches to the application of IT to healthcare organizations:

1. To automate existing processes
2. To enable the transformation of processes.
■ Neither is right or wrong, but they are very different in approach and outcome
Automation Of Existing Processes:

■ Automating processes replaces back-office operations with computer applications such

as payroll, billing, scheduling, and inventory control.
■ These functions characterized early business applications of computers in health and
other organizations and resulted in increased processing speed and greater efficiencies.
■ In hospitals, early information activities were located in finance departments because
financial data were standardized, included repetitive processes, and were relatively
easily automated.
■ This was an ideal application of data processing technology.
Transformation of Processes:

■ By Definition “any activity or group of Activities that takes one or more inputs, transforms and
adds value to them, and provides outputs for customers or clients”.
■ The use of IT as an enabling technology for transforming work processes.
■ The application of IT in such transformations has been well developed in some product and
service industries.
■ Evidence shows that IT investment by organizations has not been effective as a means of
initiating or stimulating business process design. Responsibility for the failure is frequently
directed at the software, CIO, IT staff, or underinvestment.
■ The problem is that the enabling technology was purchased without sufficient understanding of
or commitment to work process redesign
Note: Go through Case Study 1.1 Health Valley Hospital IT System.
Example of Transformation:
Work Process Redesign:
■ By Definition “The approach to ensuring that a particular set of interconnected activities are
performed correctly and in the most efficient and effective manner possible”.
■ The purchase of advanced IT without a commitment to work process redesign can be a
wasted investment by the institution.
■ The strategy of installing and institutionalizing new technology prior to process redesign can
contribute to the failure of the redesign by further freezing current processes into place.
■ A strategy without a strong IT infrastructure designed to support it, have failed or had limited
success. Information technology has been found to be an essential enabling technology when
closely integrated with the redesign of the business or clinical functions.
■ Global competition changed the market and nature of the competition. Businesses using
traditional management approaches and theories found they could no longer compete.
What is Six Sigma Levels of Quality
■ By definition “ Six sigma is a set of techniques and tools for process improvement”. It is a
statistical representation of defects per volume of activities performed
Overview:

■ It employs statistical analysis to boost quality and efficiency.

■ Six Sigma concept is based on the idea that identifying defects ultimately leads to
perfection.
■ When defects are identified in a process, product or service, they can easily be
eliminated. As a result, quality improvement is achieved.
■ The six sigma concept lays emphasis on quality.
■ It aims at eliminating errors that exist in a process, product or service. Thereby,
enhancing process, product or service improvements.
Advantages of Six Sigma:

■ Six sigma helps to measure process quality.

■ The main aim of six sigma is to improve the final product by eradicating all forms of
defects in the process.
■ The goal of the six sigma concept is to work smarter, not harder.
■ It uses data collated to improve the process, reduce/ eliminate mistakes and increase
sigma rating.
Disadvantages Of Six Sigma:

■ six sigma is very rigorous to implement.

■ It involves a somewhat difficult process that takes a long time to achieve.
■ It ensures that everyone involved in the process is following closely enough to realize
the value of six sigma.
■ Six sigma is performed by a selected team of trained and certified professionals.
 IT in Healthcare Organizations:
■ Evidence of how advanced IT can facilitate work process redesign is
Compelling.
■ The level of evidence over time and across a large section of the
service and product industries provides considerable support for
application of advanced IT to healthcare organizations.
■ The evidence supporting the enabling power of IT to improve work
processes raises questions of why such a lag exists in the health
industry.
■ Information technology has been developed within the hospital
around the clinical function, separate from the business function.
■ The traditional structures of the business and clinical functions have
defined the design of information systems to support them.
Are healthcare organizations more complex, resource rich,
or poorly managed, or are there other factors to consider?

■ Healthcare organizations present a particularly difficult challenge

because of their traditional structure and assumptions about work
processes, especially clinical work processes.
■ Health services are viewed by the institutions more as a commodity than
as a continuing commitment. Services are evaluated on the basis of the
quality of the given service and level of satisfaction reported by the
patient.
■ Patients, on the other hand, increasingly view health services as a
continuous process because of the increasing rate of chronic diseases and
changing attitudes about healthcare.
■ Under these conditions, information on health status, disease history,
treatment history, and health risks is shared among all health providers
and with the patient
Complex Health Care System
Operational efficiency:
■ The business function in healthcare organizations has been focused on
internal operations and operational efficiency.
■ Business operations consisted of relatively simple processes of
scheduling, billing and collections, accounting, budgeting, personnel,
payroll, purchasing, inventory, and supply
■ Computer applications in business processes first automated these back-
office operations, which resulted in increased processing speed and
greater efficiencies
■ Since the late 1940s, business operations have became increasingly
complex because of third-party reimbursement, legal issues, training
requirements and certifying agencies, proliferating public regulations,
and services marketing.
Hospital Functional Design:
Transforming the Clinical Function

■ Healthcare organizations need to increase focus on clinical process

improvement and how IS supporting health professionals, organizations,
and systems must change.
■ Greater accountability for health outcomes by healthcare organizations
has increased the need to structure and manage the clinical process
■ Managing the clinical function will become much more complex in the
future as chronic care increases, patient expectations change, and
genomic information is incorporated into clinical decision making.
The Institutional Perspective
■ The traditional perspective of IT applied to the clinical function has been
institution-centric.
■ Clinical support services include pharmacy, laboratory, diagnostic
radiology, medical records, and services of other health professionals.
■ The pattern of automating existing processes defined by functional
departments continues to be followed by hospitals and clinics, producing
improved efficiency and accuracy.
■ Many departments used the application of IT to evaluate and improve
existing processes.
To be Continued…
Increasing Resistance to Change
■ The cost of installing advanced IS applied to old business and clinical processes or structural
assumptions might be greater than simply the loss of investment.

■ Early IT applications to clinical support areas were on a functional or departmental basis such as
laboratory, nursing, pharmacy, and radiology. Each function had its own information system with
its own purpose, logic, architecture, and data structure.

■ The next generation of IT linked these disparate systems into common data architectures,
databases, and integrated processes.

■ Developing an integrated system to support clinical services has proven to be a complex task
because the purpose or use of data underpins the logic of the architecture.
 Clinical IT systems:
■ Although clinical IT systems are becoming integrated, they are designed to integrate processes
that are functional in nature, consisting of lateral data models with interface structures.

■ Organizations that have made large IT investments might have more difficulty undertaking
process redesign because they will have to redesign both the clinical process and the data system
to support it.

■ This makes the process of change more difficult, as existing processes are more rigidly structured
and there is a reluctance or inability to abandon the large investment in IT to start again.
Business IT systems:
■ A parallel IT development is occurring on the business side of the organization by
automating existing purchasing, materials management, engineering, and other functions.
■ There is greater probability of success undertaking business process redesign because it
occurs on the business side of the enterprise and is under the control of management.
■ The lagging development in this area is difficult to explain but probably results from a
number of factors.
■ First, healthcare organizations have not been forced to undertake business process redesign
because of the ability to solve financial problems by securing more favorable reimbursement
rates.
■ Second, the structure of the health industry as small, independent units has been a constraint
on the power they bring to the table in restructuring the business value chain with suppliers.
■ Third, health managers in small institutions might lack the skills to lead an effective strategy
to redesign business processes.
Continue….

■ Evidence shows that business process redesign is progressing at a faster rate than
clinical process redesign.

■ Managers might logically decide that they will focus on the business process and avoid
clinical process redesign or delay it until business process design has been further
developed.
Enlightened Organizational Change

■ The nature of change needed in healthcare organizations and the health system is easily described but
very difficult to achieve.

■ In the technology and information age all assumptions about existing processes, structures, and even
theories are no longer valid.

■ Leaders must envision a totally new order based on the power of IT and the assumptions this
technology makes on the existing order.

■ It will not be possible to incrementally derive this new order on a function-by-function or project-by-
project basis; it will have to be envisioned by top leadership and instilled throughout all facets of the
organization.
Transformational leadership:
■ It is difficult to envision a transformational leader as a department director functioning
within a structured and controlled environment.

■ The visioning function enables leaders to fix clearly for the organization how it can
position itself to achieve exceptional levels of performance in clinical quality, patient
satisfaction, and efficiency.

■ The vision must enlist transformational leaders from throughout the organization to put
in place new processes and structures for achieving the ideal.
Organizational alignment

■ The governing board must fully understand and be firmly committed to supporting and
investing in the transformation. The board will have to assume risks and transformation
in its own right.
■ The leadership team will likely need technical expertise in clinical medicine, IT,
financial management, and human resources management. All members of the team will
have a good understanding of organizational strategy and change, IS, and clinical
performance.
■ The return on investment in IT will be measured by the value of the clinical outcomes
and patient satisfaction, not merely by efficiencies resulting from automating back-
office functions.
Skills Needed by Health System’s Leaders for IT Decisions:
Information Skills for Health Systems Leaders

■ The skills necessary to participate in IT decisions include a basic understanding of IT

and capacity, organizational structure and function, clinical outcomes measurement,
quality assessment, organizational leadership, and change.
■ In addition to general skills identified in above figure, a need exists for involvement of
individuals with a mastery of specialty skills including informatics, medicine, nursing,
finance, human resources, and management. These skills will not be contained within a
single person, but rather will come from a team of organizational leaders.
■ In addition to specific and shared technical skills, the top executive team must have
accomplished leadership skills as you can see in above figure. They must be able to
transcend their own professional and technical areas to understand the complexities of
the organization and communicate effectively using expert inter- personal skills.
Summary:

■ This chapter explores the role of IT in transforming work processes in health organizations.
IT has been oriented more toward automating traditional business and clinical processes
than transforming them.
■ Increasingly, advanced IT systems have focused on integration within clinical functions,
within business functions, and between business and clinical functions
■ Integration of disparate IT systems has been difficult to achieve because of issues of
database vocabularies and standards and that existing information systems have been
customized to specific uses.
■ While these technical problems have been addressed and are being resolved, organization
are finding that the integration of processes requires profound organizational change,
including structures, processes, behaviors, and, to some degree, culture.
Continue…...

■ The transformation of clinical and business processes will require the application of
advanced IT, although IT alone will not produce it.
■ Change in the operations and strategies of organizations using advanced IT will require
a leadership team with a common basic set of skills and appreciation of organization
design and change, IT clinical processes and outcomes, and leadership, as well as
advanced skills in these areas by members of the top leadership team.
Use of Information Technology in Health
care:
Reference:

■ Strategic Management of Information Systems in Healthcare Gordon D. Brown, Tamara

T. Stone, and Timothy B. Patrick (Chapter # 1: Page; 1-8)
Thank You…....