Health Information Technology

Chapter 2 of 11

 

Definition

Information technology, or simply IT, is the application of computer and telecommunications equipment to collect, store, retrieve, manipulate and transmit data. Its application to healthcare is called health information technology (HIT).

Many diverse technologies comprise HIT and most of them involve the transmitting and managing of health information for use by health care providers, patients, payers, insurers and other concerned groups interested in health care. Overall, HIT involves collection, storage and transmission of health care information by using private and secured electronic processes [1].

Purpose

The application of information technology in the health care sector has diverse purposes [2,3,4], namely:

  • Improve health care quality and effectiveness
  • Prevent medical errors by improving accuracy and correctness or procedures
  • Increase health care efficiency and productivity
  • Decrease the need for paperwork
  • Improve communication between health care professionals
  • Reduce health care costs
  • Detect infectious disease outbreak as early as possible
  • Open communication between patients and healthcare providers to improve diagnosis, self-care and patient knowledge about their health
  • Improve tracking of chronic diseases and their management

History

The federal government’s and the states’ commitment to health care services was affirmed in 1965 with the implementation Medicaid and Medicare. The United States government chose this fixed option for a centralized, bureaucratic system. Most western nations have difficulty controlling their healthcare costs using these price fixed, bureaucratic health care systems; in the United States, the issue of healthcare costs became uncontrollably astronomical. Many people blame this healthcare price increase on the special interests, crony capitalism and expertise in squeezing out cash from the Federal Treasury. In the past, many attempts have been executed to fix this problem and regain control of runaway spending on health care at both the federal and state levels; sadly, none of these efforts yielded any significant results.

In 2009, the HITECH ACT – a part of the Obama administration’s economic stimulus –directed the use of Medicare penalties and rewards as incentives to those who aimed to computerize their Medicare patient records. Since almost all health care establishments and facilities cater to Medicare patients, these so-called incentives are in reality compulsory. The federal government’s goals for computerizing Medicare patient records are to collect health data for the nation, provide easy access to patient records regardless of location and most importantly, to monitor and control healthcare costs. During that time, no controlled studies proving that these goals could be obtained with the use of any commercial technologies existed. Because there were no scientific trials of these computer programs with their requirements for meaningful use, many apparent evidences of failure to accomplish these goals emerged. Interoperability between commercial health information technologies remained minimal, if not nonexistent. The collection of national health data has yet to undergo rigorous testing; in fact, the up coding of payment of services has further increased healthcare costs.

Many unintended consequences of the HITECH ACT also began to appear. First year residents, instead of obtaining a quality history and physical examination of patients and attending to their needs, spent more time entering data into the EMR.  Security and privacy concerns became apparent. Finally, the costs and complexity of using programs approved by the HITECH ACT forced many private-practicing healthcare providers to forgo their practices and find employment at hospitals to cut their overhead costs.

Going forward, EMRs have an important place in the practice of American healthcare providers. However, more innovative programs that have a voluntary market-driven approach to unburden doctors from further overhead costs and manual up coding time are needed to make HITECH ACT a reality [5].

Components

Applications

The following are IT programs used in the health care setting. These include but not limited to:

  • computerized physician order entry with clinical decision support
  • patient registries
  • e-Prescribing
  • accounting and practice management systems software
  • electronic medical records
  • the electronic record of a patient’s health-related information collected, managed and consulted by an authorized clinician or a staff within a health care organization
  • personal health records
  • a patient’s health-related information in a patient-managed electronic record that meets the nationally recognized interoperability standards
  • electronic health records
  • the health-related information of a patient in a clinician-controlled electronic record that meets the nationally recognized interoperability standards
  • electronic documentation
  • results reporting
  • appointment scheduling
  • telemedicine
  • interface engines
  • patient kiosks

Communication Standards

These are sets of standards used for HIT systems to communicate with each other in a uniform manner. These standards include:

  • Coding standards (e.g. RxNorm, CPT, NDC, ICD-9, LOINC, SNOMED CT) – Coding standards are the structure and form of procedure codes needed to communicate the exact procedure performed for a patient during a particular visit.
  • Messaging standards (e.g. ADT, X12, HCFA, ASTM, NCPDP, HL7, DICOM, UB92, EDIFACT – Messaging standards are the required form and structure needed for the information to be shared and be tracked from one health information system to another.

Health information technology professionals need to note that users of these programs do not need to know all of these codes and structures. These sets of information should only run in the background in order for different systems within and between healthcare establishments to work together for better interoperability, which is the ability of a system to work in conjunction with another, unrelated system [6].

Processes

Processes involve the actual necessary steps to retrieve, send and receive data from one computer to another, from one system to another and from many systems to a centralized system [6].

  • Health Information Exchanges (HIE) – The processes involved in providing backbone hardware and systems that facilitate the process of health information exchange
  • Message Passing Interface (MPI) – The interfaces involved in guiding the message transfer from one system to another

HIPAA (Health Insurance Portability and Accountability Act of 1996 ) Security/Privacy

Vendors, health institutions and healthcare providers must comply with HIPAA in their exchange of personal health information. It is imperative to ensure the patient’s confidentiality while allowing the exchange of healthcare information in order to achieve quality health care [6].

Devices

Devices are different hardware components that help HIT work. They may include tablet PCs, desktops, laptops, mice, pens, servers, bar coding devices and more. As HIT continues to develop, more and more devices are added to the list. Many in-home devices, such as scales and blood pressure monitors, are rapidly becoming HIT devices due to their ability to transfer data directly to a patient’s provider for continuous monitoring and review [6].

Tools and Techniques

Evaluation Toolkit

The evaluation toolkit is essential to help health information technology professionals develop an evaluation plan for their health IT project. It is developed into three sections [7]:

  • Section I – A systematic guide to help determine the goals of a project, the priorities important to their stakeholders, the need of the stakeholders they need to satisfy and the items they truly need to measure
  • Section II –Involves a list of measures needed in health IT projects, including possible measures, cost considerations, data sources to leverage, potential pitfalls and other general notes
  • Section III –Includes a variety of examples from different implementation projects

Literacy guide

Much of the population has limited literacy when it comes to using software developed for health information technology. Therefore, every health information technology professional should have thorough background knowledge of what this population needs in an application as well as the technical standard and other aspects characteristic of accessible health IT design. By following a literacy guide, health IT professionals can have a clearer grasp about the strategies, structures and other resources for the proper development of these technologies [8].

Workflow Assessment Tools

Collection and analysis of workflow information requires workflow assessment tools. Workflow assessment tools help the health IT professionals understand how the current workflows function, enable them to modify these workflows and help them formulate new workflows for new health IT applications.

Workflow assessment tools are divided into five basic groups [9]:

  • Benchmarking tools  – Benchmarking describes the process of evaluating best practices from another organization and then applying them into one’s own organization. Benchmarking tools are used to find potential solutions, bring in new ideas from another organization and specify organization areas that can be improved.
  • Checklist tools – Health IT professionals use checklists to record data easily and quickly, identify requirements and specify actions that need to be executed. Checklist tools are essential for collecting information for pattern recognition and converting raw data into useful information.
  • Flowchart tools – Flowcharts are used to visually describe the steps within a process. These tools are useful in finding the main sources of a problem. They also help identify personnel, groups or entire departments that are responsible for processes, examine the handoffs that occur in a process, show the steps in a process, demonstrate current processes and identify areas for improvement.
  • Interview tools – An interview aims to extract information from individuals such as their knowledge, opinion or behaviors. Interview tools are also used to determine users’ needs and clarify findings. Interviewers use these tools when they want to ask sensitive questions and gain insight into why particular issues are significant to users.
  • Usability evaluation tools – Usability evaluation tools analyze the user-friendliness of a system, identify necessary improvement in an application, compare systems for purchase, obtain user feedback, design suggestions and determine the impact of a system on the workflow.

Best Practices

There are several things to keep in mind when deciding to implement health IT in an organization. HIT implementation is a process that needs constant attention and management. Implementers found the best practices that make HIT successful, and these include [6]:

Organizational Needs Assessment

Before implementing HIT in a health organization, it is important to do an organizational needs assessment first. Some of the most important questions to consider include:

  • Why is this solution implemented?
  • What problems are being solved?
  • What are the ways to improve the organization’s practices?

There is no definite answer in this assessment. The only wrong answers are “We just want a computer system” and “Everybody else is implementing one.”

Reviewing the organizational needs assessment is the first step to formulate an organizational plan. Once the health IT professionals pinpoint the exact issues and obtain a baseline within the organization, the team can decide what segment of the organization needs improvement.

Board Buy-In

Getting the board buy-in is one of the most important requirements to make a health information project a reality. Without buy-in, no project can move forward. Thus, the most important steps in realizing a project are determining what the board knows about HIT and determining what the members should expect from it. Educating board members about the advantages of implementing HIT is essential for a successful HIT implementation.

Administrative Buy-In

After the go-signal of the board members, the second most important step is to gain administrative support for the HIT initiative. Once the administrative decision to implement HIT has been made, it must be the primary agenda in all executive meetings.

Clinical Leadership

Clinical leadership is essential for finding the right HIT solution. Having the best clinical leader to convey clinician concerns can be beneficial in developing clinical workflows that will meet the needs of the organization.

Non-Clinical Staff

In addition to the significance of clinical leadership, a non-clinical staff leader should also be identified. Front desk clerks, billing clerks, medical record staff and patient navigators can help shape a system that will meet all the needs of the organization.

Staff Needs Assessment

Once the organization is ready to move forward to HIT implementation, it is necessary to assess the staff’s ability to make this transition. The first step in doing so is to assess their computer skills. Although testing these skills is very basic, such issues are oftentimes overlooked. Plan to provide trainings to fill the gap and improve staff competencies.  

Infrastructure Needs

Organizational readiness is not the only criterion essential for a successful transition to HIT implementation. Checking the readiness of the organization’s infrastructure – such as the current computer hardware, the computer communication between and within each department and bandwidth capability – is needed to start an HIT solution.

Opportunities

Finding the right organizational opportunities is essential to accomplish an HIT implementation. A major change in the flow of the organization needs new workflows and processes to meet the organization’s new goals. Identify the best processes within the organization and implement the HIT solution around those processes. With these new organizational challenges, improved teamwork is encouraged. The successful HIT solution requires 80 percent of implementation in the workflow and process change management and 20 percent in hardware and software implementation.

Outcomes

Successful implementation of an HIT solution is a recognized and documented complex process. The inputs and outputs of an HIT implementation need considerable additional time beyond the usual time spent developing a mere software [10]. It doesn’t matter whether the healthcare establishment is a small single-physician clinic or a medical center. By using the HIT tools and following the best practices expected from a health information technology professional, great organizational HIT solutions can be reached, resulting in  better health care management and more affordable healthcare costs.

References:

  1. HHS.gov. (n.d.). Retrieved September 17, 2015, from http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/
  2. HealthIT.gov. (n.d.). Retrieved September 17, 2015, from http://www.healthit.gov/patients-families/benefits-health-it
  3. HealthIT.gov. (n.d.). Retrieved September 17, 2015, from http://www.healthit.gov/patients-families/ehr-benefits-our-countrys-health
  4. HealthIT.gov. (n.d.). Retrieved September 17, 2015, from http://www.healthit.gov/patients-families/health-it-makes-health-care-convenient
  5. Fisher, Kenneth A. (2013). “Health Information Technology in American Medicine: A Historical Perspective”. Transactions of the International Conference on Health Information Technology Advancement. Paper 21. 
  6. Lardiere, M. R. (2008). An Introduction to health information technology (HIT) and best practices for implementation. National Association of Community Health Centers (NACHC). Washington DC, USA.
  7. Cusack, C. M., & Poon, E. G. (2007). Health information technology evaluation toolkit. Rockville, MD: Agency for Healthcare Research and Quality.
  8. Eichner J, Dullabh P. (2007). Accessible Health Information Technology (Health IT) for     Populations With Limited Literacy: A Guide for Developers and Purchasers of Health IT. Rockville, MD: Agency for Healthcare Research and Quality.
  9. All Workflow Tools. (n.d.). Retrieved September 17, 2015, from https://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/all-workflow-tools
  10. Jaén, C. (n.d.). Successful Health Information Technology Implementation Requires Practice and Health Care System Transformation. Retrieved September 17, 2015, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3185471/