Health Information Technology

Chapter 2 of 11

 

Ensuring the accuracy of patient data, organizing, and maintaining databases may not be as smooth as it is today without the advent of Health Information Technology (HIT). How profound is HIT’s impact on the medical universe? Well-equipped healthcare facility can electronically check patients, update their medical records, and send them the results of a test that was conducted in their online chart. Health information technology is the power that makes all these possible as it ensures every aspect of the system is running seamlessly.

2.1. DEFINITION

Information Technology (IT) is the application of computer and telecommunications equipment to collect, store, retrieve, manipulate, and transmit data. Application of IT to healthcare is called Health Information Technology (HIT).

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

The merging of technology with healthcare has made it possible to obtain more accurate electronic health records that follow a patient from one healthcare facility to another. This has given such patients more control over their health condition via applications as well as increased access to vital information. HIT includes technology such as e-prescriptions, electronic health records (EHRs), and technological tools that help patients to meet health goals such as managing diabetes or quitting smoking.

Although HIT covers several systems as well as many types of technology, its sole focus is on maintaining a patient’s privacy while enhancing patient care. Advanced secure HIT networks have given physicians or healthcare professionals on a patient’s care team to have improved communication in a much better way than ever before.

2.2. PURPOSE

The application of information technology in the healthcare aim to:

  • Prevent medical errors by improving accuracy and correctness or procedures
  • Increase healthcare efficiency and productivity
  • Decrease the need for paperwork
  • Improve communication between healthcare professionals
  • Reduce healthcare 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

2.2.1. THE IMPORTANCE OF HIT

HIT is crucial in this digital age. According to the Director of Healthcare Solutions at Advocates for Human Potential, Inc. healthcare consumers in 2019 will continue to demand accessibility, personalization, and transparency.

HIT has made it possible to quickly share confidential and crucial patient information between clinics and hospitals via a concept that is called “interoperability.” This can mean the difference between life and death for critically ill patients.

According to the Office of the National Coordinator for HIT (ONC), EHRs, as well as other HIT tools, help patient care teams coordinate with each other, resulting in higher-quality patient care as well as more pocket-friendly healthcare costs. HIT has hit its stride and will continue to develop even as technology transforms the healthcare sector.

2.3. HISTORY

The federal government’s and the states’ commitment to healthcare services was affirmed in 1965 with the implementation of 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 this fixed price. Due to bureaucratic healthcare systems in the United States, the issue of healthcare increased and became uncontrollable. This healthcare price has been blamed mainly on special interests, crony capitalism, and expertise in extracting cash from the Federal Treasury. Many attempts have been executed to fix this problem and regain control of runaway spending on healthcare at both the federal and state levels with no significant results.

In 2009, the HITECH ACT – a part of President Barack 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 healthcare 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. No controlled studies proving that these goals could be obtained with the use of any commercial technologies existed at the time. 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 upcoding of payment of services has further increased healthcare costs.

Unintended consequences of the HITECH ACT 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 electronic medical record (EMR). Security and privacy concerns became apparent. The costs and complexity of using programs approved by the HITECH ACT forced many private healthcare providers to forgo their practices and find employment at hospitals to cut overhead costs.

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 necessary to make HITECH ACT a reality.

2.4. COMPONENTS
2.4.1. APPLICATIONS

The following are IT programs used in the healthcare setting. These include but are 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
  • A patient’s health-related information in a patient-managed electronic record that meets the nationally recognized interoperability standards
  • Electronic and personal health records
  • The health-related data of a patient in a clinician-controlled electronic record that meets the nationally recognized interoperability standards
  • Electronic documentation
  • Appointment scheduling
  • Telemedicine
  • Interface engines

2.4.2. COMMUNICATION STANDARDS

These are sets of standards used for HIT systems to communicate with each other uniformly. 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 system to another.

HIT professionals need to note that users of these programs do not need to know all codes and structures. These sets of information should only run in the background for different systems within and between healthcare establishments to work together for better interoperability.

2.4.3. PROCESSES

Processes involve the actual necessary steps to retrieve, send, and receive data from one computer to another.

Health Information Exchange (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.

2.4.4. HIPAA SECURITY AND PRIVACY

Vendors, health institutions, and healthcare providers must comply with HIPAA (Health Insurance Portability and Accountability Act of 1996) in their exchange of personal health information. It is imperative to ensure patient confidentiality while allowing the exchange of healthcare information.

2.4.5. DEVICES

Devices are different hardware components that help HIT function. They may include tablet PCs, desktops, laptops, pens, servers, 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.

2.5. TOOLS AND TECHNIQUES

2.5.1. EVALUATION TOOLKIT

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

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

2.5.2. 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 of accessible health IT design. By following a literacy guide, health IT professionals can have a more precise grasp of the strategies, structures, and other resources for reference.

2.5.3. WORKFLOW ASSESSMENT TOOLS

Workflow assessment tools help the health IT professionals understand how the function of the current workflow help them formulate new workflows for new health IT applications. Workflow assessment tools are divided into five basic groups:

  • 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 quickly, identify requirements, and specify actions that need to be executed. Checklist tools collect information for pattern recognition and converting data to useful information.
  • Flowchart tools – Flowcharts are used to describe the steps within a process visually. 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. 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 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.

2.6. BEST PRACTICES

There are several things to keep in mind when deciding to implement health IT in an organization. Implementers found the best practices that make HIT successful, which include:

2.6.1. ORGANIZATIONAL NEEDS ASSESSMENT

Before implementing HIT in a health organization, it is essential to first conduct an organizational needs assessment. 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.

2.6.2. BOARD BUY-IN

Getting board buy-in is one of the most critical 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.

2.6.3. ADMINISTRATIVE BUY-IN

Another crucial step is to gain organizational support for the HIT initiative, it must be the primary agenda in all executive meetings.

2.6.4. 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 and staff.

2.6.5. 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.

2.6.6. STAFF NEEDS ASSESSMENT

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

2.6.7. INFRASTRUCTURE NEEDS

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

2.6.8. OPPORTUNITIES

Finding the right organizational opportunities is essential to accomplish HIT implementation successfully. A significant change in the flow of the organization needs new workflows and processes to meet the organization’s new goals. Identify the best procedures within the organization and implement the HIT solution around those processes. The successful HIT solution requires 80 percent of implementation in the workflow and process change management and 20 percent in hardware and software implementation.

2.7. OUTCOMES

Successful implementation of a HIT solution is a complex process. The inputs and outputs of HIT implementation need considerable additional time beyond the usual time spent developing mere software. It does not 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 healthcare management and more affordable healthcare.

2.7.1. HIT PROFESSIONALS AND WHAT THEY DO

There are myriads of roles which are categorized under health information technology, focused primarily on patient medical records such as:

  • Health information technician
  • Health informatics specialist
  • Health information manager

Some HIT experts focus more on traditional information technology work such as the design, implementation as well as maintenance of computer networks. The following are a few of the common positions in health information technology:

  • Software developer
  • Systems analyst
  • EHR implementation specialist
  • Data quality analyst
  • Programmer analyst
  • Data architect
  • Chief information security officer
  • Software engineer
  • Chief information officer
  • Chief technology officer

These HIT professionals share one common goal, and that is to make use of technology in order to improve the healthcare field, both for providers and patients alike.

Since medical documents mostly contain secret or confidential information about patients, HIT focuses mainly on the maintenance of patient privacy as well as abiding by strict government regulations. HIT professionals ensure that the healthcare facility’s technology systems are so securely encrypted and up to regulatory standards that all sensitive medical documents are kept safe from any unauthorized person.

2.7.2. PRIMARY RESPONSIBILITIES OF A HIT PROFESSIONAL

It is vital to get the correct patient information to the right healthcare provider and at the right time. This huge responsibility is managed by three departments found in most health facilities:

  • HIM (Health Information Management): Data quality and patient data
  • Data analytics: analytics and reporting
  • HIT: Implementation and maintenance of electronic health records (EHRs)

As other healthcare departments deal directly with data, health information technology experts build, implement as well as support electronic health records along with other systems that capture, handle, and store the data of patients.

These HIT specialists must possess a substantial understanding of information and technology systems, which includes data and programming structures, communication, and information technologies as well as a storage structure for information and data. At the top of their priority list is the security and privacy of patient data.

The size of the healthcare organization also goes a long way in determining the roles. In small healthcare facilities, there may be health IT experts who possess diverse technical skills and knowledge that will enable them to work with more than a few EHR applications or systems. In a much larger healthcare facility, the health IT professional could specialize in a set of workflows or a particular EHR application.

2.7.3. THE HEALTH INFORMATION TECHNOLOGY TRENDS AT HIMSS 2019

The following are the key takeaway trends that were seen at the annual Healthcare Information and Management Systems Society (HIMSS) meeting, the world’s largest health informatics conference held in February 2019 and attended by over 1,300 vendors.

2.7.4. THE INTEGRATION OF WEARABLE DEVICES INTO PATIENT CARE

There is a chance that most patients already make use of one form of wearable health device or another, including the popular Fitbits, Apple Watches, Garmins, etc. Although these wearable devices provide data valuable to physicians, integrating the technology into the present-day healthcare model is not all that common.

According to Karl Poterack, M.D., applied clinical informatics at Mayo Clinic, there will be a ruin of data when wearable devices used in tracking health data are integrated with healthcare organizations.

This data needs a storage system, and there have to be clarifications on who owns the data, the purpose for collection, as well as what happens to the data when it has been transmitted to hospitals, which have different rules on data collection under HIPAA.

The medical director says a massive infrastructure will have to be set up to handle these concerns as well as the volume of wearable data that is out there. Adequate research must establish benchmarks for this data before anyone will consider investing.

The main challenge is what the healthcare system will do with the available data and how it can be linked to outcomes. It is not yet clear how wearable data can be interfaced into usable formats that are digestible for electronic medical records and clinicians. A good example of how health applications such medical monitoring devices and wearables can be integrated into current patient care is piloted by one of the largest hospitals in the Middle East known as Sheba Medical Center in Israel.

Patient compliance rates have increased with the use of wearables. Patients who are monitored remotely do not need to take public transportation or drive to hospitals for face-to-face or in-person sessions.

Cybersecurity: Top Concerns with Electronic Medical Records

Cybersecurity has become a primary concern, even as healthcare continues to become more interconnected. Many healthcare facilities have become the targets of several high-profile attacks by hackers, which have affected millions of health records. This could open up facilities to liabilities and bring about significant disruptions in patient care, especially if data is blocked by hackers or systems are shut down remotely.

What most people think is that the security of digital systems is limited to patient data in the EMR. Healthcare information technology experts at HIMSS have stated that the biggest threats to healthcare facilities are those back-door computer systems that are not updated or encrypted for security.

Protenus, a healthcare analytics firm, says more than 32 million patient records were penetrated between January and June 2019, doubling about 15 million medical records hacked in 2018. This happens when hackers access hospital network via a wireless inventory connection with a vending machine. Therefore, several HIMSS vendors drew attention to their security software for ancillary devices that are connected to the HIS (hospital information systems), PACS (picture archiving and communication systems), or EMR.

These devices include:

  • Imaging scanners
  • ECG machines
  • Telemetry systems
  • Infusion pumps
  • Contrast injectors
  • Any computer that interfaces with wireless, wired, and/or Bluetooth connections

Medigate, a cybersecurity company with its corporate partners – Cisco and Palo Alto, showcased a perfect example of this innovative technology. When the platform is installed on medical device networks, it detects early signs of cyber-attacks and offers security risk assessments to reinforce equipment or disconnect the from the network.

The security company has been able to identify tens of thousands of devices for a large number of healthcare systems in the United States and Canada. The cybersecurity company stated that many of the security flaws they have encountered stem from electronic medical device operating systems that were not installed, adequately patched, or systems that were considered obsolete and therefore had no tech support.

Analytics: The Next Big Trend Following Implementation of Digital Health Records

The United States has since issued a federal mandate under healthcare reform that every healthcare facility should change over from paper-based systems to EMRs. This has efficiently connected almost all aspects of healthcare systems into digital format over the past ten years. This has made many medical institutions focus their efforts on leveraging data via the implementation of innovative analytics software.

In the past, to pull data was an incredibly tedious process, and to get numbers in real-time was a big challenge. The recent generation of analytics software (most of which are offered by every major health IT vendor) has to an extraordinary extent, simplified analytics, thereby allowing for customizable dashboards to view every aspect of the care continuum. This includes:

  • The time it takes for patients to go through several procedures based on the specific types and number of procedures conducted in each facility
  • The length of stay of a patient based on ICD-10 codes
  • Equipment downtime or utilization
  • Workload by the clinician
  • Hospital-acquired infection based primarily on departments, etc.

A great example of this particular type of software was showcased by GE Healthcare. It is a new analytics software for radiology business management and provides an excellent view over the whole department and changes granular drill down to analytics for specific protocols, machines, rooms as well as technologists to find inefficiencies and bottlenecks. This data can be presented in a line graph, numeric, or pie graph format.

2.7.5. CREATING VIRTUAL ORGANS FROM MEDICAL IMAGING TO TEST DEVICES BEFORE IMPLANT

A group of health engineers for Siemens Science are currently working on technology that creates digital copies of patients’ organs to implantation of the device and evaluates if there is improved outcomes or function in a virtual environment before a patient enters an operating room.

The HIT company revealed a prototype software utilizing digital twin technology to create virtual hearts. The software creates a digital organ with the same characteristic and electrophysiology as the real heart of a patient using the patient’s ECG (electrocardiogram), MRI scan as well as other data.

According to the vendor, a digital twin heart can precisely mirror the behavior of a patient’s real heart, and display the same contraction, electrical activity, pressure dynamics, and ejection fraction. Siemens also stated that smart algorithms could be made to “learn” the function of nearly all the organs via the potential mining of data from patient images as well as their electronic medical record data. This could be a new direction for individualized healthcare that leverages existing patient data and imaging.

Other HIT vendors have also showcased several work-in-progress techs over the past year. A few are focused on the virtual replacement of heart valves to appraise the hemodynamic function pre-procedure or virtual placement of stents in coronary arteries. Nearly all these advances are complex, image-based virtual physiologic assessments made possible by new computer algorithms with a sprinkling of artificial intelligence.

2.7.6. THE FUTURE OF HIT

It should not come as a surprise that as technology continues to develop and expand across all fields, the HIT sector will not be left out but grow alongside it. According to the owner of Best Rx for Savings, Jason Reed, a clinical HIT worker, government entities have made it incredibly easier for healthcare organizations to share data which gives room for the next wave of health information technology that comes into the fold. The stage is all set for an explosion of health information technology that will take the entire world into the next phase of medical care.

HIT workers will soon be making use of cutting-edge technology such as artificial intelligence, virtual reality surgeries, monitors that report the state of health of a patient to healthcare professionals via smartphones, etc.

Artificial Intelligence (AI) is a growing field and many jobs that require the use of algorithms that are designed to teach machines how to discover trends and sort mountains of data garnered by EHRs. Such advances in HIT hold an exciting future for consumers and patients. This means patients will continue to enjoy excellent innovative healthcare services via wearable trackers that promote uncomplicated communication with the care team.

2.8. CITATIONS

  1. HHS.gov. (n.d.). Retrieved September 17, 2015, from http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/healthit/
  2. Ibid.
  3. HealthIT.gov. (n.d.). Retrieved September 17, 2015, from http://www.healthit.gov/patients-families/benefits-health-it
  4. HealthIT.gov. (n.d.). Retrieved September 17, 2015, from http://www.healthit.gov/patients-families/health-it-makes-health-care-convenient
  5. Fisher, K.A. (2013). Health Information Technology in American Medicine: A Historical Perspective. Transactions of the International Conference on Health Information Technology Advancement. Paper 21. Retrieved from http://scholarworks.wmich.edu/ichita_transactions/21
  6. Ibid.
  7. Ibid.
  8. Ibid.
  9. Ibid.
  10. 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.
  11. Cusack, C. M., & Poon, E. G. (2007). Health information technology evaluation toolkit. Rockville, MD: Agency for Healthcare Research and Quality.
  12. 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.
  13. Op. Cit. Fisher
  14. AHRQ (n.d.). All Workflow Tools. Health Information Technology. Retrieved from https://healthit.ahrq.gov/health-it-tools-and-resources/workflow-assessment-health-it-toolkit/all-workflow-tools