Health Information System Integration

Chapter 5 of 11

 

Definition

Health information system integration is the process of merging the components of different health information systems into one system. It aims to combine different health computing and software applications within a healthcare organization and between two or more healthcare organizations to make them coordinate as a whole.

A health information system is overlapping, complimentary and interdependent. Given the large number of different information systems in the healthcare sector, it is not surprising that health information professionals are having a hard time creating a tighter integration system that will bridge the gap in the functionality of these various independent healthcare information systems. [7]

Purpose

Most modern operating rooms and intensive care units contain 50 to 100 different kinds of electronic equipment, yet most of it does not communicate or work efficiently in an integrated fashion. These limitations on equipment and technology often fail to improve productivity and reduce medical costs. This is a burden on clinicians, as if they are the ones who need to adjust to the agenda of vendors who develop such technologies. [6]  

The lack of healthcare integrated systems often leads to failure to identify deteriorating patients, diagnostic errors and inefficient work. As a result, many healthcare providers work under stress and experience burnout (Mathews & Pronovost, 2011).

Despite the increasing recognition of patient management risk in the healthcare system, the progress in patient care quality and safety has been relatively slow. The efforts exerted by healthcare providers to reduce potential harm to patients and to improve the quality of care often focus on a single or a collection of local interventions. These interventions seek to improve a single care process. Although this approach to healthcare is valuable, the method is incremental and results only in modest improvements. Most improvements in the quality of healthcare often miss a larger opportunity to improve the procedure of healthcare itself. The adoption of systems integration incorporates fundamental building blocks of healthcare from clinical insights, equipment and technology to workflow processes, encouraging a major leap in the improvement of safety and quality in healthcare practice. [6]  

History

Healthcare professionals across all specialties agree that effectively sharing information between machines, systems and users is one of the most important factors in improving the efficiency, quality and cost of patient care delivery. However, the inability to share information between different systems from different computer applications and different vendors has prevented healthcare information technology professionals from making a great progress in the healthcare sector.  

Integrating the Healthcare Enterprise (IHE) is a multinational healthcare initiative that publishes domain-based internationally accepted implementation guides known as Technical Framework. Technical Frameworks allow established standards to undergo uniform implementation. This enables the seamless transmission of important health information from system to system and application to application, regardless of setting. By following IHE guidelines, healthcare organizations worldwide have achieved systems integration and improved sharing of healthcare information within and across their respective domains, saving time and money and improving patient care.

In 1985, the representing radiologists of the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) jointly developed and published Digital Imaging and Communications in Medicine (DICOM), a set of standards used for handling, printing, storing and transmitting medical imaging information. Initially, DICOM specified the type of hardware connection or interface that should be used to transfer image data to and from the imaging equipment. After taking this step, DICOM specified network operation protocols to facilitate a smoother transfer of image data. Without such standards in place, imaging devices would require healthcare organizations to devise and maintain an expensive custom-developed interface.

From the late 1980s to mid-1990s, many vendors started selling DICOM-compliant digital radiographic systems. However, the interoperability of these so-called DICOM-compliant machines was limited to specific point-to-point interfaces that required higher coordination between information systems.

In 1987, the Health Level Seven (HL7) Standard Development Organization (SDO) developed the consensus-based HL7 Standard. This standard specified working interfaces for administrative and clinical structured data messages that allow disparate healthcare applications to exchange information.

To solve this dilemma and decrease the implementation costs of multiple vendor systems integration, the Healthcare Information Management Systems Society (HIMSS) and the Radiological Society of North America (RSNA) formally launched IHE. IHE Radiology Technical Framework was developed to clearly define DICOM and HL7 standards, and to resolve communication tasks within different information systems in radiology.

Today, aside from radiology, IHE is expanding to other clinical areas, including pharmacy, medication management and clinical engineering. It is now collaborating with medical specialists, IT experts, and other professional societies. [3]

Components

Health Informatics Service Architecture (HISA)

HISA is a standard that guides developers in creating modular open information technology systems by providing a formal basis for the service-oriented architecture required in health services. Architecture standards are used to put up frameworks for the development of coherent and consistent databases, workstations and applications. This process is carried out by using the definition of hardware and software construction requirements and the protocols for communication. [2]

Processes

Health information system integration has two kinds of processes: First, the process needed to gather data from its sources and transform it into the right kind of information. Healthcare providers can use this to analyze and make the right decision. Second, the process to determine which data requirements and solutions are needed for a project.

Many health information professionals mistakenly believe that the process of extracting, transforming and loading (ETL) data sources are their silver bullet for developing useful applications in the healthcare sector. However, ETL is just one part of the entire process [10].

Integrating Healthcare Enterprise (IHE)

IHE is an initiative of healthcare providers and the healthcare industry as a whole that aims to establish standards that will improve the way computer systems share healthcare information. IHE’s greatest goal is to coordinate the existing standards such as HL7 and DICOM to meet the specific needs of clinicians in supporting optimal patient care. With IHE, health information developers can develop systems that can better communicate with one another, enable easier implementation and facilitate better information usage by healthcare providers [4].

Resources and skills

Resources and skills are the often-overlooked components of healthcare information systems integration. Experienced healthcare information professionals who understand data handling and healthcare workflow are necessary in order to have a complete process of health information system integration [10].

Tools and Techniques

Kaiser Permanente Model

Kaiser Permanente is the largest nongovernmental example of a fully integrated healthcare delivery system in the United States. It has more than 8.7 million members, 421 medical office buildings, 32 medical centers, 160,000 employees and 14,000 practicing doctors across nine states, including the District of Columbia. About 75 percent of its members and employees live in California, where the company started in 1945.  

The Kaiser Permanente-owned medical centers in California offer one-stop shopping for patients who want to avail services such as outpatient and inpatient management, pharmacy, radiology, surgery, laboratory, health education centers and other health procedures.

Kaiser Permanente is a recognized leader in healthcare. It is the only health plan located in California that has appeared for 11 consecutive years on the annual list of best health plans in the Pacific Region by the National Committee for Quality Assurance. Many economists and medical experts see Kaiser Permanente as a leader in increasing quality healthcare.  

Kaiser Permanente is also a leader in information technology. It has been using computers to deliver healthcare innovations for decades. Since 2003, it has fully integrated its systems, giving its members access to its many online features. It has implemented HealthConnect, a secure integrated electronic data system that aims to link all aspects of care experience nationwide.

This system is the communication and message medium that healthcare providers use for ordering tests and medications, and for receiving laboratory results. HealthConnect helps them in decision-making by providing them with practice guidelines, alerts and recommended medications for different illnesses. It also provides them with research information and measurement including feedback from other practitioners and teams.

HealthConnect gives members and patients online access to their medical records, test results, appointments, prescription refills and health education information. They can also email their physician using this system. On top of these benefits, they have the option to receive personalized health information and online health assessments customized to their individual needs.

Ambulatory care facilities of Kaiser Permanente have complemented the implementation of HealthConnect. Since July 2008, almost half of Kaiser Permanente hospitals have been fully electronic. Kaiser Permanente physicians have been using computers in their examination offices and more than 30 percent of its members have requested passwords to communicate with their doctors to access their medical records online.

Since most healthcare providers are new on the system, Kaiser Permanente learned from experience the importance of backfilling for them to implement information technology. However, when healthcare providers learned the system, they found that they were equally productive while delivering better quality of care to their patients. Most patients experienced better satisfaction due to Kaiser Permanente’s HealthConnect online features.  Physician offices had a drop in the number of visits and phone calls because HealthConnect allows patients to email their doctors using the system. The statistics of redundant testing and imaging were observed, and tests are no longer lost once they are entered into the HealthConnect system. Overall, improved patient health outcomes were observed with Kaiser Permanente’s model of healthcare information system integration [8].

Project management information system (PMIS):

A project management information system (PMIS) is the comprehensive organization of information needed to execute a project successfully. PMIS is usually made up of one or more software applications combined with a methodical process for gathering and using project information.

Implementing change in an organization is often a difficult process. In most cases, managers are the ones who continue searching for innovative procedures to carry out improvement plans. Project management is a standard guideline used to carry out project plans in different business sectors, and is now an essential tool for implementing large-scale changes in healthcare. [1]

Health information standards

Having an integrated patient information and management system enables a continuous flow that is cost-effective to the healthcare organization. This system minimizes the time needed to transmit information from the one sending the information to the department or practitioner who is waiting to receive it. A delay in the delivery of patient records and diagnostic results often cause bottlenecks in hospital and clinic waiting rooms.

The Integrated Healthcare Enterprise (IHE) paved the way for a comprehensive set of integration framework documentation that outlines the workflow of patient care in terms of information-exchange transactions and key integration points. Successful integration of electronic health record (EHR) can virtually eliminate waiting time for the healthcare provider and patient. Participants in the care of the patient are empowered to make decisions and execute accurate healthcare management based on the complete patient information and diagnostic results. With a fully integrated workflow in the clinical setting, minimized operating costs and optimized reimbursement of cost structure can be achieved. [12]  

Information systems evaluation tools

Healthcare information system evaluation tools have additional challenges compared to those in other organizations. The most striking difference lies in the use of more strict measurements of information systems in evaluating, leveraging improved treatment and care to potentially impact patients’ lives. [9]

Three measurements are commonly used to evaluate the impact of information systems in the healthcare sector:

  • User satisfaction
  • Individual impact
  • Organizational outcome

Best practices

There is no such thing as a “one size fits all” solution to integrating healthcare systems. However, best practices – also known as guiding principles – exist to help integrate efforts and achieve successful results.

Patient focus

The most important goal for any healthcare system integration is to meet the needs of patients rather than those of healthcare providers. Patients will actively resist every feature meant to improve their health status and communication with their healthcare provider if the providers fail to concentrate their efforts on patient satisfaction.

Inter-professional teams

One of the most important principles for healthcare system integration is inter-professional team approach. All professionals working on a project should be considered equal. Professionalism should be maintained. Each team member should receive incentives for meeting efficiency and performance standards.

Performance evaluation

The measuring and reporting of care outcomes is critical for successful health systems integration and should be performed on an ongoing basis. With a methodical and analytic approach, systems performance issues can reinforce organizational plans as well as high-quality, cost-effective and patient-centered care.

Effective technology

High-caliber technology is critical for assessing patient information anywhere in the healthcare system and enabling communication between providers. Having a quality information system can enhance information workflow and communication between users, including the payers, consumers, and the providers.

Leadership

Strong leadership is needed for the successful integration of healthcare information systems. A good leader can bring different organizational cultures together by ensuring that training and incentives are in place to facilitate the successful adoption of information systems.

Physician integration

A strong physician system alignment is important to achieve the best results in the design and implementation of health system integration. Physicians must consistently be involved at all levels and they should embrace leadership roles to overcome barriers to healthcare systems integration.

Structure and oversight

Newly integrated healthcare systems information requires new governance structures. All stakeholder groups, including healthcare providers, must participate to achieve diversified governance. Accountability and structure for decision-making must be developed.  

Comprehensive vision

A truly integrated healthcare information system must cover all core services of health for the population. To achieve full systems integration in the healthcare sector, the focus should be on population health. [7].

Outcomes

With successful healthcare information system integration, the following outcomes can be expected [5]:

Organizational and operational

  • Improvement in productivity
  • Reduction of costs
  • Improvement in data quality, sharing and flow
  • Better data access
  • Better data exchange
  • Improvement of data presentation
  • Reduction in medical errors

Managerial

  • Improvement in managerial control
  • Better understanding and controlling of different health system processes
  • Improvement in decision-making, allocation of resources, quality of care, work efficiency and performance
  • Better return of investment

Strategic

  • More effective healthcare management planning
  • Increased synchronous collaboration among users and providers
  • Improvement in the relationship with suppliers
  • Improvement in the population’s health, quality of life and survival rates
  • Better process of knowledge sharing among healthcare practitioners

IT infrastructures

  • Reduction in development risks
  • Better reusability of objects
  • Improvement in the use of e-healthcare and telemedicine-based patient support models
  • Achievement of non-invasive solutions
  • Improvement in process, object/component and data integration
  • Integration of customs systems and e-business solutions in the healthcare practice

References

  1. Chittick, P. K. (2001). Project Management: An Essential Tool for Implementing Integrated Information Technology in Healthcare. In Healthcare Management Forum.
  2. Engel, K. (2006). 4. Standards for Enabling Health Informatics Interoperability; Ubiquity: Technologies for Better Health in Aging Societies.
  3. Indrajit, I., & Verma, B. (2007). DICOM, HL7 and IHE: A basic primer on Healthcare Standards for Radiologists. Indian Journal of Radiology and Imaging, 17(2), 66-68.
  4. Integrating the Healthcare Enterprise (IHE) (2015). In IHE. Retrieved July 20, 2015.
  5. Mantzana, V., & Themistocleous, M. (2004). Identifying and Classifying Benefits of Integrated Healthcare Systems Using an Actor-Oriented Approach. Journal of Computing and Information Technology, 265-278.
  6. Mathews, S. C., & Pronovost, P. J. (2011, March 2). The Need for Systems Integration in Health Care. American Medical Association, 305.
  7. Monteiro, E. (2003). Integrating Health Information Systems: A Critical Appraisal. In Department of Computer and Information Science.
  8. Porter, M., & Kellogg, M. (n.d.). Kaiser Permanente: An Integrated Healthcare Experience. In RISAI.
  9. Salmela, H., & Turunen, P. (n.d.). Evaluation of information systems in healthcare: a framework and its application.
  10. Sherman, R. (2003, October 1). Five Essential Components of a Data Integration Framework in Information Management.
  11. Suter, E., Oelke, N. D., Adair, C. E., & Armitage, G. D. (2009). Ten Key Principles for Successful Health Systems Integration. Healthcare Quarterly (Toronto, Ont.), 13(Spec No), 16–23.
  12. The Role of Clinical Decision Support and Analytics In Improving Long-Term Care Outcomes (n.d.). In SigmaCare. Retrieved July 20, 2015.