Healthcare Information Management Systems: A Practical Guide

381 Pages·1991·13.535 MB·English

by  Edward H. Shortliffe (auth.), Marion J. Ball, Robert I. O’Desky, Judith V. Douglas, James W. Albright (eds.)

Computers in Health Care
Kathryn J. Hannah Marion J. Ball
Series Editors
Marion 1. Ball ludith V. Douglas
Robert I. O'Desky lames W. Albright
Editors
Healthcare Information
Management Systems
A Practical Guide
With 50 Illustrations
Springer Science+Business Media, LLC
Marion J. Ball Judith V. Douglas
Information Resources Information Resources
University of Maryland University of Maryland
Baltimore, MD 21201 U.S.A. Baltimore, MD 21201 U.S.A.
Robert I. O'Desky James W. Albright
Health Care Networking Corp. Bayfront Life Services
3408 Balboa Lane 701 6th Street South
Columbia, MO 65201 US.A. St. Petersburg, FL 33701 US.A.
Library of Congress Cataloging-in-Publication Data
Healthcare information managem'ent systems : a practical guide / Marion
J. Ball ... let al.], editors.
p. cm. - (Computers in health care)
Inc1udes bibliographical references.
Inc1udes index.
1. Health services administration - Data processing.
2. Information storage and retrieval systems - Medical care.
I. Ball, Marion J. 11. Series: Computers in health care (New York,
N.Y.
[DNLM: 1. Health Facilities - organization & administration.
2. Information Systems. 3. Information Systems - organization &
administration. WY 26.5 H434]
RA394.H424 1991
610' .285 - dc20
DNLM/DLC
for Library of Congress 90-10300
Printed on acid-free paper.
© 1991 Springer Science+Business Media New York
Originally published by Springer-Verlag New York Inc in 1991.
Softcover reprint of the hardcover 1s t edition 1991
All rights reserved. This work may not be translated or copied in whole or in part without the
written perrnission of the publisher (Springer Science+Business Media, LLC), except for brief
excerpts in connection with reviews or scholarly analysis. Use in connection with any form
of information storage and retrieval, electronic adaptation, computer software, or by similar
or dissirnilar methodology now known or hereafter developed is forbidden.
The use of general descriptive narnes, trade narnes, trademarks, etc., in this publication, even if
the former are not especially identified, is not to be taken as a sign that such narnes, as
understood by the Trade Marks and Merchandise Act, may accordingly be used freely by
anyone.
While the advice and information in this book are believed to be true and accurate at the date of
going to press, neither the authors nor the editors nor the publisher can accept any legal
responsibility for any errors or omissions that may be made. The publisher makes no warranty,
express or implied, with respect to the material contained herein.
Camera-ready copy provided by the editors.
9 8 765 432 1
ISBN 978-1-4757-4045-5 ISBN 978-1-4757-4043-1 (eBook)
DOI 10.1007/978-1-4757-4043-1
Dedication
Marion J. Ball
This work I would like to dedicate to the many individuals who have had a
major impact on my professional advancement. I have been extraordinarily
lucky in having so many people interested in furthering my career in the field
of health informatics. First, I would like to thank my husband, John C. Ball,
whose devotion and encouragement have made my entire professional career
possible. Second, my mother and father, Erica and Ernst Jokl, both in their
own ways have been an inspiration and supporter throughout my life. My two
children, Charles Ball and Elizabeth Ball, have done their share to make my
career possible. My extended family circle must include Donald A.B. Lindberg,
Phil R. Manning, Morris Collen, and Gary Hammon. Without their en
couragement and opportunities afforded me by them, I would not be where
I am today.
Judith V. Douglas
I dedicate this book to my son Christopher and my sister Beckett, who taught
me the value of information in healthcare; to my parents Dale and Frona
Vetter, who taught me language and ideas; to my husband Paul and sons
Matthew and Justin, who are my life; and to Marilyn Burnett, who turned our
manuscript into the pages that follow.
Robert I. O'Desky
Dedications are typically made to people who have assisted us in the past.
And in that fashion, I would like to dedicate this book to my mother, Mrs.
Ruth O'Desky. However, this book was created to celebrate the potential of
the future and with that in mind, I would also like to dedicate this book to
my niece and nephew, Aly and Charlie O'Desky. I can only hope that by the
time they are able to read and comprehend the book, the technology described
will be routinely employed by the healthcare community.
vi Dedication
Ja mes W. Albright
It is with sincere appredation that I dedicate my first work to two extraordi
nary people, Pat Albright and Robert Taylor.
Pat, my wife, is a superb healthcare professional who continues to shape
my formal education in healthcare management by demonstrating the
compassion and wisdom needed to fully understand the patient care process.
Robert, the ultimate teacher, introduced me to the concepts of organization
behavior, systems theory and finandal management enabling me to com
prehend the business of healthcare.
To these two friends and mentors, I say, "Thank you for your patience,
guidance and understanding while I learn."
Foreword
William G. Anlyan, M.D.
Chancellor
Duke University
Many foreeasters prediet that the eosts of healthcare will eontinue to inerease
with the strong potential for eontinued erosion of historical patterns of
reimbursement. The socioeconomic and political elimate of the 1990s will
mandate that healtheare praetitioners and institutions foeus on improved
efficiency and effeetiveness. The eontinuing demand to provide reasonably
priced, high quality services in a productive manner eonsistent with esealating
expeetations of quality assuranee can only be met through aeeess to informa
tion about what is being done and what works. It is essential that the
teehnology of information systems be applied in equal measure in support of
those who render direet patient eare services and those who manage the
healthcare institutions.
It is inereasingly apparent that, in spite of the growth of systems teehnology
in the healtheare setting to date, today's health praetitioner and health
exeeutive lack sufficient information to strueture organizations or praetiee
patterns for enhaneed produetivity and eomplianee with quality assuranee
standards. Praetitioners and institutions will need to eommit inereasing
amounts of leadership time and money to the information management
resouree. A eommitment of inereased funding to the information management
eomponent during times of predictably strained fmancial resourees will
mandate a eommitment to the principle that information is an essential
strategie resouree. Traditionally, decisions eoneerning the eost benefit
outcomes of an information system have been based upon its ability to
accelerate or to automate an existing proeess. A systems infrastrueture whieh
results in institutional databases must be judged upon its value as a new
teehnology to support information based deeision making, and not solely as a
means of automating historie deeision methodologies.
Existing information management teehnology is adequate to serve the needs
of the healthcare industry. However, mueh remains to be learned about how
to integrate systems so that praetitioners and managers can eolleetively benefit
from the advantages of institutional databases. For these ehanges to occur,
institutional eultures and historical patterns of professional praetiee must
evolve to permit information to be viewed as a shared resource. Decisions
viii Foreword
regarding an institution's approach to information management, and decisions
based upon the information being managed, will be major determinants of
organizational character and outcome.
A key factor related to the success of managing information systems will
be the style of systems leadership and the increased involvement of all systems
users in the development and at the application of systems technology. This
shared responsibility is integral to the principle that the information needs of
the healthcare industry must give rise to new patterns of management, clinica1
practice, and information systems support. Such responsibility must be shared,
not delegated. Success in the 1990s will depend on the extent to which the
broad spectrum of health practitioners and managers/executives have a
practica1 understanding of the need for information management and a
common commitment to applying the evolving information technology to
address the needs of an increasingly demanding healthcare system.
Morris F. Collen, M.D.
Director Emeritus, Division of Research
The Permanente Medical Group
The evolution of healthcare information systems began in the 1970s using
large, expensive mainframe computers. In the 1980s, smaller, lower cost
minicomputers and microcomputers appeared in many hospital departmental
subsystems, and local area networks were developed to integrate the patient
data they collected. In the 1990s, advanced computer and communications
technology has made available more powerful and lower cost computers, mass
direct access storage, high speed and high bandwidth networks, and worksta
tions, which support data selector pointers, barcode readers, text, graphics,
windowing, images, and sound. In Healthcare Infonnation Management
Systems: A Practical Guide, Marion Ball and associates provide healthcare
administrators with a very informative overview of the current complex field
of healthcare information systems, containing powerful workstations, alllinked
by communications networks to an integrated database for the patient record
data.
The increasingly important role of a chief information officer (CIO) in a
healthcare facility can become very evident to a chief executive officer trying
to meet the rising pressures for larger, faster, more comprehensive, and more
expensive computer based information systems. This book gives a CIO step
by step guidelines for planning and managing a hospital information system,
and makes an important contribution to the rapidly enlarging field of health
informatics. The CIO is responsible for the hardware, software and com
munications networks of the healthcare information system. This book
discusses long range and strategie planning for a hospital information system
with a computer based patient record. Generally, the model of choice meets
the needs of individual hospital departments with dedicated small computers,
all linked by a communications network to a larger central, integrating
database computer. The CIO is the best architect of a strategie plan for the
Foreword ix
integration and connectivity of the many departmental subsystems within a
health information system. The CIO also will fmd helpful the chapters on
information system consultants and on vendors of systems.
Tbe diverse and substantive benefits from a properly designed, installed,
and operated healthcare information system are described. The system will
be essential to meet the ever increasingly complex requirements for utilization
review and quality of care assuranee. Many suggestions are provided as to how
decision support programs can help the executive; and how end user
computing can increase productivity. Tbe authors consider information as a
resouree, just as are people, money, or supplies; and the effective management
of all of these resourees requires an integrated view of the entire organization.
Since hospitals are the quintessential example of an information based
organization, in wbich the information is related primarily to patient care, an
efficient information system is indeed essential for patient data to be collected
from widely scattered locations where the data originates, and always be
accessible in various locations where needed. Thus, a computer based
information system is a powerful integrating force in the operation of a
modern hospital. The distributed computer models discussed in tbis book help
to preserve the functional autonomy of departments in a hospital, spread out
and support decision making, and facilitate the sharing of essential patient
information.
A basic focus of tbis book is to help design healthcare information systems
that serve as adecision making resouree to produee better, more cost effective
patient care; and better, more usable information for hospital administrators
and planners. Informative sections of the book discuss the important
participatory roles of physicians and nurses and the need to integrate the
clinical ancillary serviees of radiology and clinicallaboratory.
Tbis comprehensive book presents the state of the art in the 1990s for
healthcare information systems, wbich presents an opportunity for substantial
improvements in providing more cost effective patient care.
Michael J. Mestrovich, Ph.D.
Deputy Assistant Secretary
Department of Defense
Change. The one constant that we can all count on is rampant in the world
of information management and tecbnology. Those of us who have labored
for a good number of years trying to apply the principles of information
resouree management to healthcare delivery see the next decade as one of
unparalleled excitement and opportunity.
The changes that will occur will not only touch on information management
but will extend throughout healthcare delivery institutions and systems.
Changes will affect researching, training, personnel productivity, and organiza
tion. Perhaps the single most important change, however, will affect the
mindset of the healthcare professional team delivering the healthcare
tecbnology within the clinical workplace and will force a necessary transforma-
x Foreword
tion of that workplace as healthcare professionals utilize the new and powerful
tools available to them.
This transformation will not come without pain. The demands on the staffs
and institutions will be immense and intense. Some will immediately see the
benefits and work vigorously to effeet the change. Others will resist and will
have to be convinced of the necessity and efficacy of the ehanges demanded
of them. Totally new methods of training and management will evolve out of
neeessity to cope with the transformation.
Today many dedicated people are diligently working on the strategie plans
for information systems, the training programs, the process, and change
management eoncepts that are mentioned above. In the federal sector , both
the Department of Defense and the Department of Veterans Affairs have
information systems programs ongoing and therefore are beginning to deal
with the issues previously mentioned. In the Defense Department that
program is called Corporate Information Management (CIM).
The major dinical system within that program is called the Composite
Health Care System (CHCS). CHCS has been designed and is operating
around the principle of a single patient database for both inpatient and
outpatient care. All elinical and aneillary services will have the ability to access
that reeord as required, and as permitted allowing for patient record seeurity.
CHCS, therefore, is a totally integrated, dinically based, patient care
information system whieh ties the Defense Department hospitals and outlying
patient dinics together through a network allowing aeeess to the integrated
patient oriented database.
The medical portion of the CIM program does not stop, however, with just
installing a elinically based hospital information system. It has already initiated
an examination of the longer term issues of strategie planning, eost eontain
ment,resouree management, training, and change management as the
necessary tools to aehieve the full benefits of automating the healthcare
professional workplaee. The same issues will have to be examined in other
healthcare delivery systems to aeeommodate the rapidly changing business
environment in whieh health professionals are now working.
This text provides an excellent eompilation of thought provoking treatises
on a wide range of neeessary issues that must be examined as the healthcare
profession enters its age of information explosion. I fmd it comprehensive and
direet in assisting both the uninitiated as weil as the grizzled veteran in the
field. I believe the emphasis on strategie planning, end user involvement in
requirements defmition and the impact of automation on the elinical setting
to be especially helpful.
This book is an enormously praetieal guide to assist all of us as we seek
to provide better access and quality of healthcare at a reasonable cost through
the infusion of information teehnology into the healthcare delivery workplace.