Health Information System Design

Chapter 6 of 11

 

Definition

Health information system design is an organized structure of the health information system management that aims to ensure the proper use of resources and enable information processes to produce high quality information in a timely fashion. This design is an essential component of a health information system that focuses on formulating the right mixture of inputs that can produce the right type of outputs. The health information system design can only generate relevant and adequate information if the most important components of the information process have been adequately designed. [3]

Purpose

The main purpose of a health information system design is to match the health information system processes with the health services system. The health information system should provide effective information support to the decision-making processes at all levels of the health services. Designing a usable and efficient information process is necessary to make the health information system a useful management tool that is compatible with the overall management structure of the health services system. [3]

Other reasons for having a health information system design include:

  • Improve the relevance of the health information gathered
  • Increase the quality of data recorded
  • Avoid duplication and waste among parallel health information systems
  • Improve the timeliness of reporting and feedback
  • Encourage proper use of information
  • Permit the generation of the needed information for rational decision making at each level of the health services system

History

The inefficient and chaotic nature of most traditional health information systems was due to the structural weaknesses and lack of integration at almost all levels of the information system. These inadequacies can be traced back to the unexpected use of health information system in the integrated management support of the health services. Before 1985, most management information systems were focused on the use of computer technology. Most health organizations did not use information technology to handle the organizational aspects of information and improve systems in tertiary hospitals. These organizations only used information systems to address the need for recording admission and discharge, staff payroll, medical billing, medical insurance and other related tasks. [3]  

Today, the role of health information system has evolved from a mere information handler to an important tool for information management. With this shift, information system became an integral part of the clinical decision-making support, information management, communication and simulation for teaching and surgery. [1]

However, the remarkable progress of health information system is still hindered by inadequacies in security and privacy, access to and distribution of resources to achieve the greatest good for the greatest number of users and socio-economic differences. As a result, health information professionals are now pressured to design, develop and implement new systems that can keep pace with the rapid development of the technology itself. [1]

Components

The health information system design has two essential components, which include [3]:

Health information system resources: Form a holistic overview of people, process, and reports of health information most important for decision making in the health sector.

  • Persons: Data collectors, planners, managers, epidemiologists, statisticians
  • Hardware: Computers, registers, telephone
  • Software: Data processing programs, report forms
  • Financial resources

Organizational rules: Used to ensure efficient utilization of health information system resources

  • Diagnostic and treatment standards
  • Supply management procedures
  • Definition of staff responsibilities
  • Computer maintenance procedures

Tools and Techniques

Organizational model of health services

The organizational model of health services defines the different management functions at various concentration levels. Developers use organizational models to identify the information users from different concentration levels.  The decisions these users make to define the information needs and design methods for data collection, transmission, processing procedures and feedback reports are as follows. [3]  

Data sources

Information system developers use data sources to answer different questions that may help pinpoint the exact information system design needed for a healthcare organization. [4] The data for an integrated information system has five different sources, which include:

  1. Enrollment data: The enrollment data is the set of information generated by employers and individuals. These data identify people who are eligible for coverage under an insurance plan. By using the enrollment data, analysts can closely examine the performance of the current health information system. Also, health researchers can identify unmet health needs and differences in treatment outcomes across population subgroups.
  2. Administrative data: Administrative data is the information extracted from a patient’s healthcare provider. It is used to monitor changes in the healthcare system, compare the effect of different cost-sharing arrangement on the use of medical care, monitor the use of different health services and evaluate the relationship between hospital characteristics and hospital death rate.
  3. Clinical data: Medical records are the most important source of clinical data, as they describe the patient’s health problems from the doctor’s perspective. Clinical data contain confidential information, which cannot be accessed without special permission. Clinical data can be used to assess the quality of care performed by healthcare providers and health plans, learn the clinical outcomes for a treatment or procedure, study the extent to which surgical and medical procedures are appropriate and monitor and evaluate certain groups’ access to specific types of care.
  4. Survey data: Survey data is used to study specific issues not routinely captured in routine data collection system. Surveys can help extract useful information about person-level information and issues, improve understanding in the clinical practice guidelines, evaluate the type of services provided, identify the types of patients encountered and survey healthcare providers’ satisfaction with their current practices.

Other sources of data:

  • Birth certificates
  • Birth defect registries
  • Disease registries
  • Death certificates
  • Facility characteristics
  • Provider characteristics

These data sources are vital for studying the health information system, monitoring changes in the incidence and severity of diseases over time and tracking health outcomes.

HIS design principles and Guidelines for HIS

The HIS design principles are the result of the integration of ethical and professional guidelines for both the medical and computing professions. On the other hand, the guidelines for HIS have three important dimensions, namely:

  • General moral principles
  • Technical responsibilities for HIS design
  • Responsibilities for HIS designers

These principles serve as the cornerstone for the development of advanced directives decision support system (ADDSS). ADDSS, in turn, refines and tests these guidelines through an iterative and collaborative development process.  The result of this process is the set of design principles that guides health information system developers in creating unique and complex information systems tailored to the needs of different healthcare organizations. [5]

Best Practices

Start every health information system design development with the definition of indicators based on a health services system and the management function within each of these services. [3]

The ideal outcome of health information system redesigning is to ensure better information support for the different levels of the health services system. To guarantee solid support, the health information system designer should clearly understand the structure of the health services system and the management function in which each service level is involved. By designing a support system based on a conceptually sound health system model, the designer can easily translate information support into appropriate and relevant indicators.

Therefore, to redesign a health information system, the health information system designer must select the right indicators for the health services support, monitoring and management. To do this, he or she must embark on a consensus-building process involving the health services managers from different levels, such as the program managers, senior executives and district service staff.

Apply an evolutionary, problem-directed approach to uplift the health information system.

The health information system designer needs to assess and confirm the opportunities that can improve the collection, retrieval and use of information. The system needs to communicate important health data and undertake assessments of all health information subsystems to learn the cause of different management and service issues. He or she can then use these findings to find and prioritize information-related problems and formulate a short-term plan to address them. As the implementation progresses, the designer can extend the plan of action and include new issues, opportunities and more components of the information system that need improvement.

Make policy a part of the full health information system assessment

To successfully implement a health information reform, the health information system designer cannot simply depend on technical improvements. He or she must also understand the sociocultural, administrative and political factors at play. The designer must add rationality to the health information system design while accommodating the diverse interests of different value systems and constituencies. The assessment of the health information system should include identifying all the stakeholders in the health information system reform and researching the administrative, socioeconomic and contextual political factors that are most likely to influence the outcome of such reform.

Encourage the broad participation in the process of health information system design

The health information system design team should encourage the key actors to participate in the reformation process to foster their understanding of and support for the system during its implementation. Choose the program managers and service staff needed for the selection of essential health indicators, assessment of health information system performance and overseeing of specific functions, such as clinical diagnosis and recording as well as disease surveillance and control.

Attempt to demonstrate useful information processes and products early in the development of the health information system

To gain the confidence and support of all the key actors, such as the program managers, senior managers and service staff, the designer must generate useful processes and products early during the health information system development. The key actors’ confirmation of one such product often leads to their confirmation of the upcoming products.  

Outcome

The health information system plays an increasingly important role in the improvement of coverage and quality of health services in the United States. National healthcare has shifted from curative to preventive, inpatient to outpatient and community to public. This shift has created a need to redesign the fragmented health information systems into an integrated and comprehensive health and management health information system. [1]

Restructuring the health information system is now an important trend in the entire healthcare sector and is strengthening the information system into an in-demand learning process. However, a standard package for health information system design that could be adapted to all situations has yet to be discovered. Health information system professionals and healthcare providers are continuously working to help better our understanding of the role and design of health information system in improving the quality of healthcare services. [3] With the growing needs of the continuously evolving global environment, the present condition of the traditional institution-based health information system design needs to catch up to deal with global “transinstitutional” demand for a stable and highly reliable health information system. [2]  

The health information system redesigning approach can help designers and developers address the weaknesses found in the existing health information systems. It will also address different information needs of health services at different operational and strategic planning levels, including the healthcare providers. By reinventing the wheel of traditional health information system, designers can develop an information system that supports the health services system in its entirety, rather than fragmented systems with different disease-oriented vertical programs. [2] By using the health information system development as a strategy to improve the healthcare organization’s management environment, health information system designers and developers can match the information system with the planned or existing health service system more imperative.[3] Finally, by continuously improving the quality and specification of the health information system design, a globally integrated and interoperable “transinstitutional” health information system can be achieved.

References

  1. Chaulagai, C. N., Moyo, C. M., Koot, J., Moyo, H. B., Sambakunsi, T. C., Khunga, F. M., & Naphini, P. D. (2005, November). Design and implementation of a health management information system in Malawi: issues, innovations and results. InHealth Policy and Planning.
  2. Haux, R. (2006). Health information systems — past, present, future. International Journal of Medical Informatics, 268-281.
  3. Lippeveld, T., Sauerborn, R., & Bodart, C. (2000). Design and implementation of health information systems. Retrieved June 26, 2015.
  4. McGlynn, E. A., Damberg, C. L., Kerr, E. A., & Brook, R. H. (1998). Health information systems: design issues and analytic applications. In Rand.
  5. Richardson, S. M. (2006). HEALTHCARE INFORMATION SYSTEMS: DESIGN THEORY, PRINCIPLES AND APPLICATION. In fcla.