Technology In Healthcare

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Be familiar with the five forces compelling a transformation of the health care industry, and be able to identify the role Information Technology will play in achieving this transformation.
The five forces compelling a transformation of the healthcare industry are;
• Demographics; the baby boomer generation, and the need to serve and finance the aging.
• Consumerism; individuals are demanding the right to manage their own health care and to participate in decision making regarding choice of provider and treatment alternatives.
• Biological breakthroughs
• Information Technology;
 IT will envelop health care just as it has other industries., driven by the convergence of computing technologies with communications technologies, increased focus on improving both quality of care and the process of care delivery, and implementation of the electronic patient record….At the same time, the internet will facilitate consumer demands for a more responsive healthcare sector, which will be monitored for all to see. The healthcare sector must speed the adoption of new information technology the way virtually all other industries have done, and, in the process, vastly improve the safety, quality and cost-effectiveness of care.
• Public mandate Given an understanding of the business pressures facing the health care industry, describe the evolution
and the trends for health informatics and health care application systems.
When we talk about the “Future of Health Informatics”, we must first understand was informatics does. “Informatics is a key enabler both for addressing availability, access, quality, and cost, and also for supporting the work of health policy, finance, and management experts. Informatics provides the necessary information technology (IT) infrastructure, standards, tools, and data to be able to address these key topics and for carrying out the work of the experts” (Greenes, 2009, pp. 21). It is sad to learn that the U.S. health care “system” is ailing due to a multiplicity failures, documented in countless studies. Key among these failures being;
Spiraling costs.
• Disparities of access and large numbers of uninsured.
• Errors and unevenness of quality, and slow dissemination of advances.
• Inefficiencies and waste.
• Fragmentation and poor communication.
If we look at all these failures, we can both agree that the health care system itself can be considered to be a patient, one that is critically ill, if not actually on life support! Despite the ills of the U.S. system, its entrepreneurial system still currently leads the world in scientific and technical advances in health care. With respect to health care in particular, the advantage of the U.S. economy in the global market is counterbalanced by the concern that under-rationalized adoption of technological advances also contributes to the spiraling costs we are experiencing. It is therefore essential that we both preserve the ethos that fosters health care innovations and advances as well as seek ways to deploy them more effectively.
There is need in developing new technologies and therapies that will have potential for improving health. There is a tension between our capacity for innovation and development, and our inability to do systematic planning and execution that reflect a mistrust or fear of central planning, management, or control. The other issue is the fear for invasion of privacy or reduction of personal rights, while at the same time such large scale resources can be major enablers of discovery, validation, and dissemination of advances. Ideas have been pursued to address these issues by re-engineering the health care system to improve workflow and efficiency; by using informatics to reduce errors and improve quality
• by developing more efficient and effective organizational structures.
• by improving communication, and reducing administrative costs.
• by introducing systems, procedures, and regulations to protect the rights and privacy of individuals
• by modifying incentives to encourage cost-effective pursuit of best practices, and
• by other approaches
This is a multi-faceted challenge that needs a large-scale multi-disciplinary, multi-stakeholder, long-term effort. We need to have an environment where we can develop projects, expand promising approaches on a large scale, and use them as a basis for innovation and development of a reinvigorated, even redesigned, healthcare system.
Reference
Greenes, R. (2009). Strategy for the future of health. Informatics and a health care strategy for the future—general directions. Studies I Health Technology & Informatics, 21-28.

TCO B:
Have an understanding of the challenges to strategy implementation, and be prepared to propose a strategy implementation process and the critical success factors for carrying out the process.
The single greatest challenge within many healthcare enterprises is getting adequate business and clinical data on hospital operations. In some health systems this operation is already available and being used in specific areas to manage business units. However, there is still a tremendous void in specific area of metrics to assess technology performance relative to business contribution. The most common technology metrics include total cost, application and infrastructure availability statistics, responsiveness of the help desk, and overall use of specific applications. Not a single one of these metrics provides a direct measure on the contribution of IT to business objectives.
In recent years, the first set of metrics that has begun to help manage the performance of technology is often called error reporting. These reports provide information on when a patient registration was incomplete, a claim was denied by the payer, or a charge was not entered with proper documentation. At this time, not all metrics provide useful and actionable information to empower managers. Often these metrics identify when a process has failed, but do not identify what step in the process specifically was errant, resulting in overall process failure. For instance, was the clinic’s claim denied because the patient was not eligible for services or because it was the coded incorrectly?
Strategy implementation should begin with a clear communication of the IT strategy to the enterprise from executive management. Once the strategy has been communicated, a formal strategy implementation structure should be built. This involves three major levels;
• Selecting the right people;
 identify managers that can help lead change is crucial to overall success. Appoint managers with prior project management experience in relevant IT spaces and key leadership positions, a manager who have previously implemented the relevant application or is knowledgeable in the necessary business process engineering.
• Developing the appropriate core competencies;
 The specific core competencies will vary based on IT strategy, it is important to develop a focused core competency. They would like to have strong patient safety competencies. They muss recruit staff, invest in vendor systems, and effect organizational business process reengineering to truly get value out of their physician order entry systems.
• Aligning organizational structures;
 Each major IT strategic initiative must be aligned with a specific unit on the organizational chart to improve accountability and to ensure proper focus.

Given a scenario for a health care organization, evaluate the role health care informatics and application systems play in the strategic and tactical planning of how health care services will be delivered.
The final step of alternative evaluation involves a detailed technology risk assessment to understand the technology implications of the IT strategy alternatives. The overall goals of the risk assessment are to understand the technology feasibility of strategic alternatives while understanding long-term cost and operational implications. Although the level of detail of the assessment can be largely determined by available time and data, relevant vendor research should be at the center of the assessment. Common aspects of a technology risk assessment include:
• Infrastructure Assessment. Availability, level of hardware replacement, operating systems management, bandwidth, storage and backup, disaster readiness, and recovery procedures.
• Applications Assessment. Product life cycle evaluation, enterprise application integration strategy, user interface design, vendor support strategy, new system implementation costs, and total cost of ownership.
• Sourcing Assessment. Skill-mix analysis, availability of development and implementation resources, project management capabilities, and outsourcing analysis.

TCO C: page 254 –260
You will see one of two aspects of quality performance in health care. The first is that patient outcomes are critical component of quality performance in health care delivery. Be able to discuss the information needed to analyze patient outcomes and the information systems that would be used to analyze those patient outcomes. The second is regarding quality improvement methodologies such as Six Sigma. Be prepared to discuss the steps to take to implement a quality project for a given health care scenario.
Six sigma
One of the six guiding principles that Clarian used was that care being provided be effective. Services that are provided should be based on evidenced based knowledge that everyone could benefit from. Clarian recognized that knowledge along with technology is what is needed to provide quality healthcare. Both technology and evidenced based knowledge are important separately, but bestow greater results when combined. In regards to Clarian, the knowledge framework was built by defining the care process for a specific disease. There was research done to determine what technology tools were needed.
Clarian Health’s administration developed a vision that focused on improving clinical, operational, service and financial excellence. Their focus was on improving the levels of quality in all these areas “rather than focusing on costs or cost savings as the driver” (Ball et al, 2004). To help with this initiative they used the Six Sigma principles that guide organizations to set goals and create a culture focused on quality and safety. The six principles state that care must be 1. Safe, patients should not be harmed by care that is supposed to help them. 2. Effective, care should be based on scientific evidence based knowledge and be provided to only those it will help. 3. Patient-Centered, care needs to be respectful of the individual patients’ preferences, needs and values. 4. Timely, harmful delays need to be reduced. 5. Efficient, care must avoid waste of equipment, supplies, ideas and energy. 6. Equitable, care quality should not vary due to gender, ethnicity, age, geographic location or socioeconomic status.
To help implement this quality improvement program Clarian formed the Quality and Patient Care Committee and the Quality Steering Committee. Members of the steering committee include representative from all departments, administration, chief medical and nursing officers. They primary functions of the quality committee is to develop a mission, medical staff oversight, develop a framework for improvement, prepare metrics and reports pertaining to quality measures that are to be presented to the Board. Clarian used metrics that showed clinical practice and quality improvements in area such as “adjusted length of stay, improved time to diagnostics, decreased adverse drug events, reduced complications, reduced mortality rates and improved quality of life. Other improvements such as patient safety, patient satisfaction, regulatory compliance, supply management, and operative services are measured for increased operational efficiencies” (Ball el al. 2004). The technology that Clarian has implemented include CPOE, electronic medical record, nurse and physician documentation and through the Clarian website a personal health record.
Having principles like the Six Sigma method to help guide any organizations journey through clinical improvements to excellence helps build a framework that can be followed and adjusted as the process goes forward. It also help future organizations that will start the process to look at an organization like Clarian and learn from their earlier mishaps and achievements during their journey.
The Lean Six Sigma has become a popular method for process improvement in many health care organizations. Six Sigma is a data driven quality improvement methodology that uses statistical analysis to reduce process variation and the term, Six Sigma refers to a defect rate of 3.4 defects per million opportunities and represents a statistically high standards of quality (Dean, 2012).
The Six Sigma approach help improve quality by focusing on value and eliminating waste. Value stream mapping (VSM) is the methodology used to identify waste. In the hospital setting the value is place on the patient (customers) and its family therefore it is imperative to remove all the waste like increased length of stay, delays in bed admissions and unsafe practices of health care professionals. Quality measures are done to remove all the “waste”. Informatics plays an important role in process improvements initiatives that relates to the values such as developing soft wares for bed control, CPOE, electronic chartings and coding programs (Dean, 2012). Six Sigma principles have become how hospitals do business on a daily basis and include it as a part of their strategic plan (Tata & Jones, 2011).
Ball, M.J., Weaver, C.A., & Kiel, J.M. (2010). Healthcare Information Management Systems: Cases, strategies and solutions (3rd ed.) New York, NY: Springer-Verlag.
Dean, C.A. (2012). The benefits of lean six sigma for nursing informatics. American Nursing Informatics Association, 27 (4) 5-7. Retrieved from

Given the requirements for reducing the cost of healthcare, analyze how health care application systems can be used to improve quality of care and patient safety while gaining cost efficiency in the organization.

According to (Burstin, 2002) there are there areas that can improve patient safety. The first of these areas was the use of technology to improve patient safety, which includes: 1) The effect of clinical informatics tools in reducing medical errors and improving the quality of patient care; 2) The use of evidence-based, real-time, decision support systems that provide information critical to the delivery of high-quality care and their effects on patient/provider decision-making, patient safety, and outcomes; 3) Determining data elements that are necessary to identify and classify medical errors across various health care settings; 4) The use of interactive technology, such as electronic mail, web-based medical records, hand-held wireless devices, computer kiosks, and electronic patient assessment tools that facilitate informed, shared decision-making and result in improved patient safety; 5) Data exploration technologies (e.g., data mining) to assess patterns of medical errors; and 6) The strengths and limitations of existing systems that provide information on patient safety and medical errors.
The second area was in assessing barriers to the acceptance and adoption of IT for improved patient safety and quality of care. This includes: 1) The impact of IT on efficiency, productivity, time management, workload, training, satisfaction, and return on investment; 2) The influence of human factors on the acceptance and utilization of IT and decision support systems; 3) The sociology and culture of health care professionals and patients that limit acceptance of new technology; 4) The cost-effectiveness, value and return-on-investment of IT solutions for improving patient safety and quality; and 5) Development of effective strategies to overcome these barriers.
The third area involved developing effective strategies for ensuring patient confidentiality, which includes: 1) Understanding patient and provider preferences regarding privacy and the use of medical information; 2) Developing methods of ensuring data security; and 3) Determining the appropriate balance between maintaining the confidentiality of personal health information and using data for research and quality improvement efforts that can result in safer and better health care for all.
Burstin, H. M. (2002, Dec). Clinical informatics and patient safety at the agency for healthcare research and quality. Retrieved from National Center for Biotechnology Information: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC419407/ Collins (2013) stated that “If hospitals view safety as their primary objective, combined with technology-based solutions to improve their record, they will likely see quality of care strengthened and costs reduced”(Collins, 2013, pp.89). He went on to say that he is the champion at Winthrop and he mandated that CPOE be their top priority. The reason he chose this over other applications is that physicians should go to their office and treat their patients. He said it could be problematic if one focuses on installing batch processing systems such as lab orders. The benefits for technology-based patient safety initiatives have been enormous in many areas. Taking just from a coding perspective, coders can enter in their information electronically without having to interpret physician’s handwriting, a critical aspect to improving patient safety. We should note that errors that result from using a computer can occur at any phase of the medication-use process. There was one incident which happened at my facility. I was off-duty for three days. When I get back, I was informed that one of my patient was sent out to the ER (please note that I work in the Psychiatric facility). The reason was that she fell and she was unresponsive. The patient was introduced to a drug called Invega (paliperidone). This patient was 72 years old. The physician prescribed a handwritten order for 12mg at 9:00am and 12 mg at 9:00pm. I went through the order, go my drug book. I was startled when I came across the information that stated the maximum dose for the drug per day is 12 mg, for the younger and middle aged adults. The drug should be lowed for elderly patients and children. The nurse had picked up the order and sent it to the pharmacy, and the pharmacy dispensed the drug. I called the Psychiatrist, and I mentioned to him that the error was to be reported. We further gave the information to the Hospital where our patient was. Thanks goodness she survived. If the physician had used the CPOE, this could be avoided.
Information technology (Its) consists of devices that transmit, manipulate, analyze, or exploit information that is integral to the communication channels or the task of decision-making associated with computerization. When applied to health care, these systems are generally grouped into a category representing various types of clinical decision-support systems (CDSSs) that encompass computer systems capable of managing automated medication delivery and dispensing systems, reminder systems, documentation templates, clinical workflow tools, record keeping, patient information systems, and computer-driven clinical information systems (CISs). (Hanuscak, Szeinbach, Seoane-Vazquez, Riechert, & McCluskey, 2009, pp. 1119).
Collins, J. (2013). Patient safety comes first in journey to automate. Technology investment can help save live. Healthcare Executive, 28(2), 88-89.
Hanuscak, T., Szeinbach, S., Seoane-Vazquez, E., Riechert, B., & McCluskey, C. (2009). Evaluation of causes and frequency of medication errors during information technology downtime. American Journal of Health-system Pharmacy, 66(12), 1119-1124. Doi:10.2146/ajhp080389

TCO D:
You should be able to discuss one of two key concepts regarding health care applications. The first requires an understanding of the advantages, disadvantages, and strategy for single-vendor versus best of breed systems alternatives. The second is around the benefits, barriers and strategy for CPOE implementation. Utilizing a single-vendor approach to the technology needs, as much as is possible, helps eliminate complex and inefficient problems seen with organizations who have multiple vendors. Using Decision Support Systems improve a multitude of needs in an organization from outcomes and process improvement of patient care to billing, HR needs and supply and order managing. Statistics and reports can be pulled regarding acuity of patients on floors to better manage staffing, monitor supply flow for ordering and monitoring cost between contracted supply vendors and allow for consideration of cost-effective, alternative treatments, budget analysis, clinician performance evals and other due date requirements, payroll and a host of other information. Vital sign and lab reports can be quickly pulled to aid in determining effectiveness of treatment regimens. It helps save practitioner time in filtering through charts and multiple programs for necessary information. An example of quality and clinical information use in analysis and decision making is IV catheter related infections that are studied and those patients who experienced the problem can be studied from a standpoint of supplies used vs others who had different IV caths or topical dressings, for instance. A cheaper type of IV supply without antibacterial properties such as silver may result in problems moreso than a more expensive type that includes that property. Due to the hospital acquired problem that may result in an extended stay and cost to the hospital it may be deemed more cost effective and less traumatic for the patients if the more expensive equipment/supplies are purchased for use throughout the organization. Evidence based information related to the use of silver can be utilized to put a new process/policy in place regarding invasive procedures.

Since the onslaught of reimbursement model changes and stiff competition is much higher, the profit margins are tigher therefore cost and care outcome requirements must be considered in order to stay solvent. EBM/EBP studies can be time consuming and we all know we are pressed for time and especially physicians who have very little and prefer "tailored, user friendly evidence summaries" (Treveno, et al., 2007). "GPs need to overcome their lack of time — the main barrier found in this review — in order to be able to apply EBM" (Zwolsman, et al., 2012). Many times managing clinical changes requires the input and acceptance of physicians who historically have a hard time believing study results. "Clever nihilism, a cynical attitude towards EBM, has been shown to occur in EBM learners when maturing from EBM-naïve to mature stages, and could have a major impact on the preparedness of GPs to learn the skills necessary and apply EBM in daily practice" (Zwolsman, et al., 2012). Sometimes when all else fails or at least is not as effective as previously thought, it may be time to consider alternatives that have shown promise in qualitative and/or quantitative studies. There are many things to consider such as patient types, diagnoses, complicating factors, equipment, technological needs and cost, etc. All levels of practice from Bd. of Directors to clinicians and doctors must be involved and willing to move beyond attitude and be forward thinking with patient improvement and outcomes in mind.

Trevena, L. J., Irwig, L., Isaacs, A., & Barratt, A. (2007). GPs want tailored, user friendly evidence summaries--a cross sectional study in New South Wales. Australian Family Physician, 36(12), 1065-1069. Retrieved from http://www.racgp.org.au/afpbackissues/2007/200712/200712trevena.pdf

Zwolsman, S., Tr Pas, E., Hooft, L., Wierenga-de Waard, M., & Van Dijk, N. (2012). Barriers to GPs ' use of evidence-based medicine: a systematic review. British Journal of General Practice, 62(600), e511-e521. doi:10.3399/bjgp12X652382 Integrated systems provide multiple applications with a common architecture and consistent user interface so that all modules/functionality have a familiar look and feel. The downside is that some applications may not have the maturity or capability to address all functional areas, causing users in these areas to become disgruntled or slow down adoption. “The complexity of supporting an integrated system is lessened through the elimination of duplicate interfaces, databases, and maintenance” (Ball, Weaver, & Kiel, 2010, pp. 213)

According to Ball, Weaver, and Kiel (2010), ‘Best-of-Breed systems provide for departmental control, optimization of the application for user requirements, and the ability for an institution to replace any system without replacing the entire information system structure” (pp. 213). Best of breed systems, are designed to address processes and common problems in certain functional areas, generally provide the maximum functionality to a set of organizational process. They pose challenges, such as increased training and support, complex integrations with other systems, possible duplicate data entry (redundant data).

According to Ball, Weaver, and Kiel (2010), ‘Best-of-Breed systems provide for departmental control, optimization of the application for user requirements, and the ability for an institution to replace any system without replacing the entire information system structure” (pp. 213). Best of breed systems, are designed to address processes and common problems in certain functional areas, generally provide the maximum functionality to a set of organizational process. They pose challenges, such as increased training and support, complex integrations with other systems, possible duplicate data entry (redundant data).

In summary, the decision needs to be based on organizational needs and constraints placed by budget and resource availability. Be mindful that each system has its own benefits and shortcomings and you have to plan accordingly.

References
Ball, M. J., Weaver, C. A., & Kiel, J. M. (Eds.). (2010). Health information management systems: Cases strategies, and solutions (3rd ed.), 212-213, New York: Springer-Verlag.
With the best-of-breed approach, our Facility selected each software application based on its inherent qualities. If the practice management and EMR systems chosen come from different vendors and need to exchange data, they build an interface that allows that to happen. When combining EMR and practice management systems from different vendors, registration interfaces are the most common. This allows our front desk to automatically send data for new patients entering our practice to our new EMR. Without a registration interface, our staff must separately enter patient data into our practice management and EMR systems.
Integrated systems share the same database.
This means that when your front-desk staff enters patient data into your integrated system, the information becomes instantly available to everyone in the office, using the scheduling, billing, or EMR portion of the system. With integrated systems, you are dealing with only one vendor, so you have the convenience of a single point of contact for support and technical concerns. In addition, you need not manage the technical aspects of building and maintaining an interface between your EMR and practice management systems. And you’ll also gain from the systems’ shared
applications.
This last point is probably the most important. Because truly integrated systems share a common database, they allow sophisticated interactions between your EMR and practice management systems. In this case, I will suggest Integrated systems for a smaller practice.
Professor Woodside & class,
Both of the systems have a number of pros/cons but I think I would go with the integrated system. The reason is because the system uses one vendor so the hospital will go to one source for any problems, standardization across the system, meaning all user logins and passwords are the same for every application, less maintenance overal regarding security and HIPPA requirements, great reporting capabilities because one database contains all of the data. Although this system has some disadvantages it does not require specialists to troubleshoot and maintain the system, and does not require additional staff to constantly monitor the stystem to make sure it doesn 't time out or stop functioning (Hermann, 2010).

Hermann, S.A. (2010). Best-of-breed versus integrated systems. American Journal of Health-System Pharmacy 67, 1406-1410.

Class and Professor Woodside,

In this situation, I would chose best-of-breed. According to Halley (2011), effective information technology is that set of tools that facilitates the flow of information in support of operational processes that allow people to perform their work. Physician offices usually have to deal with vast information about patients, guarantors, payer eligibility plans, clinical services, insurance claims, patient payments and balances, referrals, and much more. Rather than selecting a single solution from a single vendor that may have a great practice management system and a fair electronic medical record (or vice versa), a physician network may be better served by selecting the best of breed for each application and dealing with the interfacing issues (Halley, 2011).

Reference:
Halley, M. (2011). Choosing IT for the physician network. H&HN Daily. Retrieved from http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=3110004681

Given the structure of a health care organization, examine the potential health care application systems for use by various health care disciplines, such as electronic medical records, patient care systems, patient monitoring systems, pharmacy systems, imaging solutions, and physician practices.
The information technology (IT) revolution has led to the digitalization of every kind of information, Electronic Medical Records is no exception. Usage of EMR in U.S. and Canada is up to 50% since 2009 (Colpas, 2013, pp. 6). He goes on to state that the importance of interoperability and integration becomes clear. EMR reduce the face time doctors and nurses enjoy with patients; keeping records in the “secure” cloud is often touted as a possible solution; and patient engagement by connecting EMR to a personal health record. When quality PHR and EMR platforms are properly linked (interoperable) and supported by engaged patients and providers, outcomes can and do improve.
Other studies using large samples of hospitals have found evidence that overall spending on health information technology (IT) is associated with improved patient safety, higher quality of care and reduced costs. The Institute of Medicine (IOM) has encouraged adopting EMR to reduce medical errors, and the American Recovery and Reinvestment Act (ARRA) of 2009 established financial incentives for hospitals to promote the adoption and meaningful use of health IT. (Lee, Kuo, & Goodwin, 2013).
However, there had been concerns in database and application maintenance. Provider organizations and ISVs are attempting to preempt disastrous future system crashes caused by unmanageable database size. Such methods include system optimization through application and database rearchitecture, total rewrites of certain modules, hardware platform maximization, and archiving to a separate database
Colpas, P. (2013). Integration, analytics key to next-generation EMRs. Health Management Technology, 34(1), 6 – 11.
Lee, J., Kuo, Y., & Goodwin, J. (2013). The effect of electronic medical record adoption on outcomes in US hospital. BMC Health Services Research, 1339. Doi: 10.1186/1472-6963-13-39
Sindiswa,

Good point about system crashes being one of the concerns within the information technology (IT) realm. With the data explosion that is happening right now in IT, database and application maintenance are two of the criteria that are driving the re-architecture of our information systems (Valente, Costa, & Silva, 2013). The larger the data database, the more maintenance is required to keep it operable at optimum levels. System crashed are inevitable, so new upkeep methods for are focused on maximizing hardware and archiving data/images to other databases that can then be linked to original databases. Measures like this are aimed at maintaining manageability in these times of increased demand for storage of information/files.

Maribeth

Reference

Valenti, F., Costa, C., & Silva, A. (2013). Dicoogle, a PACS featuring profiled content based image retrieval. PLOS ONE, 8(5): e61888, 1-5. doi: 10.1371/journal.pone.0061888

Very interesting post. The goal of healthcare reform is to improve care while decreasing cost. Incentives put in place as part of the HITECH Act give reimbursements to physicians who convert from paper-based records to Electronic Medical Records (EMRs). The other benefit to physicians’ practice is to ensure that physicians step up as PHR proponents in order to inspire more patients to get with the program. Colpas (2013) in his article “Integration, analytics key to next-generation EMRs” stated that;
And it’s not just the right thing to do for patients, it’s also a smart thing for providers to do to help achieve and exceed meaningful-use goals. Beyond that, the interoperable EMR/PHR platform also creates a solid foundation for exploring new practice innovations, such as e-consult and other telemedicine options, which will play an increasing role in helping more Americans access care as the final components of the Affordable Care Act are put in place. (Colpas, 2013).
Colpas, P (2013). Integration, analytics key to next-generation EMRs. Health Management TechnologyHealth Management Technology, 34(1), 6-11.

TCO E: chpter 34
Be ready to discuss the practice of evidence-based medicine and the data and application systems needed for successful use of EBM. As healthcare transforms, so must the traditional physician diagnosis and treatment process. No longer can a physician diagnosis and decide on a course of treatment based on just his knowledge, physicians must be able to access new evidence as it becomes available. Timely access to information and evidence along with analytical skills enable a physician to make the best decision when determining care. Evidenced based medicine (EBM) is a support system for the care decision process, EBM does not dictate the decision process. Together with EBM, a physician integrates clinical expertise, with patient preferences and the best available external clinical evidence. The process for utilizing EBM begins with the formulation of the clinical question. By defining the patient 's problem a literature search is conducted using a well developed PICO question. The development of the PICO question ensures that the correct population (P), intervention chosen (I), and outcome desired (O) is addressed. Comparison (C) can also be included if the intervention is compared to another. Clinical questions fall into four types or categories; Therapy, harm, diagnosis, and prognosis. Determining the type of question and the type of study will create a question that is most beneficial when searching for evidence. Innovation and technology have enabled physicians and other healthcare workers to rapidly gather, summarize, and apply critical evidence to their care. Textbooks are a valuable source for information, but are hard to keep up to date. Evidence databases, evidence journals, and online services and available clinical decision support systems are the the most common internet based sources of evidence in healthcare today. Integration of the most up to date evidence into clinical decision support systems and systems that allow wireless access to evidence anywhere gives physicians access to valuable information at the site of care. Clinical practice guidelines are used by many organizations to assist with care decisions regarding specific clinical circumstances. The guidelines are created by a group of decision makers who consider and decide the implications. Front line clinicians and experts are part of this decision making group, registered nurses can be valuable to this group, offering information regarding the front line delivery of decisions based on the best evidence and input on processes. Challenges to using EBM continue even with the advancements in technology and availability to information through the internet. There continues to be difficulty with finding sound evidence, a lack of clarity or standards of evidence and the interpretation of those standards, a poorly matched question regarding the evidence and the clinical situation, increasing time pressures on clinicians that prevent finding, analyzing, and interpreting EBM relevant to the patient 's problem. Point of care access to evidence information continues to hinder optimal use of EBM and incorporation of researched based evidence into clinical practice is often hindered by organizational or institutional barriers. Reference
Payne, V. L., (2010). Evidence-based medicine: Enabling physicians to make better decisions. In Ball, M.J., Weaver, C. A., & Kiel J. M. (Eds.) Healthcare Information Management Systems: Cases, Strategies, and Solutions, pp 435-452. New York: Springer-Verlag. Ever since I worked in the Quality Management Department as a Quality Management Specialist, I have realized that defining and measuring quality of care is essential for healthcare providers to demonstrate accountability to insurers, patients, and legislative and regulatory bodies. Achieving quality care is not just a matter of better training for providers or delivering more care. I used to think that outcomes were the only indicators of quality. But what I have experienced is that; sometimes patients receive the best possible care with the information available and poor outcomes occur. Some of the times, I have notices that poor care may still result in good outcomes. So I realized that using outcomes alone as a way to measure quality care is flawed. Our facility has begun using benchmarking (the process of measuring products, practices, and services against best-performing organization) as tool for identifying desired standards of organizational performance. We have initiated best practice program that invites healthcare professionals to submit a description of a program or protocol relating to improvements in quality of life, quality of care, staff development, or cost –effectiveness practices. Our experts review the submissions, examine outcomes, and then designate a best practice. ”Information systems provide means of analyzing comparative date from which performance improvement plans can be suggested” (Ball, Weaver, & Kiel, 2010. pp. 324).
The collection, coordination, and communication of information to support complex patient care, organizational, and regulatory requirements are of growing importance. Integration provides a cost-effective approach to systemwide coverage and an effective way to access and manage information that supports complex decision making…Organizations are beginning to incorporate evidence-based clinical knowledge, integrated clinical and financial information systems, point-of-care technology, and related work process redesign. (Ball, Weaver, & Kiel, 2010. pp. 325).
The collection, coordination, and communication of information to support complex patient care, organizational, and regulatory requirements are of growing importance. Integration provides a cost-effective approach to systemwide coverage and an effective way to access and manage information that supports complex decision making…Organizations are beginning to incorporate evidence-based clinical knowledge, integrated clinical and financial information systems, point-of-care technology, and related work process redesign. (Ball, Weaver, & Kiel, 2010. pp. 325).
Ball, M. J., Weaver, C. A., & Kiel, J. M. (2010). Healthcare information management systems: Cases strategies and solutions (3rd ed.). New York, NY: Springer
Manchikanti, L., Datta, S., Smith, H. S., Hirsch, J. A. (2009). Evidence-based medicine, systematic reviews, and guidelines in interventional pain management: part 6. Systems reviews and meta-analyses of observational studies. Pain Physician Journal, 12(5), 819-850. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/19787009 The process for evidence based medicine involves five steps. The first step is to formulate a question. The information needs to be converted into a question that can be answered. The information is related to diagnosis, prognosis, therapy and prevention. The second step is to find the evidence. The research should be done using the best evidence to answer the anticipated question. Thirdly, analyze the evidence. Review the evidence and determine if it is relevant in the clinical practice. Then apply the results. Apply the clinical expertise, and patient’s values. Finally, assess the outcome. Evaluate the effectiveness of the research and the patient’s response (Ball, Weaver, & Kiel, 2013). Technology plays an important role in evidence based medicine. Internet has helped with the speed and quality of information. This helps with faster diagnosis, treatment and also education for patients. Patients are able to have access to information to help with disease management. Technology advancements has made it easy for patients to even receive lab results and diagnostic results without going to an office or even with the use of a phone (Flagg, Lane, Lockett, 2013). One challenge that management can face is lack of ability to acquire a new behavior. Also, if a process is time consuming, the staff may be is less likely to follow the processes set in place. Lack of awareness and familiarity with guidelines can also be a challenge (Flagg, Lane, & Lockett, 2013).
Flagg, J., Lane, J., & Lockett, M. (2013). Need to Knowledge (NtK) Model: an evidence-based framework for generating technological innovations with socio-economic impacts. Implementation Science, 8 (1), 1-10.
The process behind evidence-based medicine (EBM) involves five steps: formulate the question, find the evidence, analyze the evidence, apply the results, and assess the outcome (Ball, Weaver, & Kiel, 2004). Formulating the question involves converting he need for information about diagnosis, prognosis, therapy, causation, and prevention into a question that can be answered (Ball, Weaver, & Kiel, 2004). Finding the evidence involves conducting research on the best evidence that will answer the proposed question (Ball, Weaver, & Kiel, 2004). Analyzing the evidence involves critically appraising and summarizing the evidence for validity and determining its impact and applicability in clinical practice (Ball, Weaver, & Kiel, 2004). Applying the results involves integrating the critical appraisal, clinical expertise, and the patient values and circumstances (Ball, Weaver, & Kiel, 2004). Assessing the outcome involves evaluating the effectiveness and efficiency of the evidence research and the patient response to treatment (Ball, Weaver, & Kiel, 2004).
Technology is important to the implementation of EBM because it facilitates the research of the evidence. Most research is now performed online through medical journals or databases. Almost all of the evidence-based tools are Internet based, with many of them being available for handheld devices (Ball, Weaver, & Kiel, 2004). The more up-to-date the technology, the better and quicker the research is completed. The use of technology not only facilitates researching evidence-based practice, but it also facilitates sharing the results of the evidence through emails, websites, or company memos. There are some challenges when implementing EBM into actual practice. Every decision involves weighing the benefits, risks, gains, and losses as well as recommending the correct course of action that will provide the best outcome for the patient (Ball, Weaver, & Kiel, 2004).
Major barriers of implementing EBM include: difficulty finding evidence, lack of clarity of standards of evidence and interpretation, discrepancies between current evidence and the clinical situation at hand, and the increasing time constraint on clinicians being able to find, synthesize, and interpret evidence relevant to the patients’ problems (Ball, Weaver, & Kiel, 2004). Integrating administrative information from different systems throughout the patient’s hospital visit can be used in analysis and decision-making because it allows the clinician quick access to an abundance of patient information. The more information available to the clinician, the better and more individually designed a patient plan of care can be. It can involve all aspects of a patient’s history to improve the possibility that that patient will be compliant with the plan and provide the best chance of recovery.
Ball, M.J., Weaver, C.A., & Kiel, J.M. (2004). Healthcare information management systems: Cases strategies and solutions (3rd ed.). New York, NY: Springer.

Given a business scenario that requires the use of health care information technology, analyze the applicability of potential application systems’ solutions for administrative and clinical decision-making.
Data obtained from the clinical and functional departments of an organization can be used for education, training, policy and procedural changes and used as the basis for improvement. Just this year there was a study done in a large English hospital 's ePDSS system. "Through a combination of rapid audit, feedback to clinical teams, detailed and critical review of apparent omissions in executive-led meetings, a focus on personal professional responsibility for patients ' safety and quality care, and the correction of organizational or systems defects, technovigilance was-based on the hospital 's own evidence-highly effective in improving specific indicators" (Dixon-Woods, et al., 2013). I see, on occasion, even older physicians who are open to the use of technology, use their PDA 's and other programs to do much as nurses do when it comes to using Care Maps to ensure that specific needs and steps are not missed in the treatment of patients. Key technical requirements for smooth functioning is that integrative access to all departments is smooth and enables them all to obtain access to needed information seamlessly. "Diagnostic Errors of Omissions or (DEOs) account for a large proportion of medical adverse events and form the second-leading cause for malpractice suits against hospitals" (Braithwaite & Scott, 2013). One of the problems they discuss is that many programs do not allow for advanced technology that includes determining the potential for multiple diagnoses related needs or 'differential diagnoses '.

Another major problem that was encountered is dependence on these programs and the risk of "focusing attention on aspects of patient safety made visible by the system at the expense of other, less measurable but nonetheless important, concerns" Dixon-Woods, et al., 2013). In other words, all individuals and organizations must incorporate the human factor of observation and assessment of professionals/clinicians in decision making. Proper action requires proper interpretation of the data, symptoms and input of many others. Medicine, in my view, is still an educated guess. What doesn 't work the first time must be changed to attempt to improve the status based on findings from the first attempt. One can benefit from all that technology has to offer but can never be 100% effective or dependent on devices without human involvement; patient assessment and discussion of s/sx, devices, meds or tests used or dismissed based on that information among other things. As long as we concentrate on quality of care with the patient in the front of our minds, technology will improve the care we render.

Braithwaite, R. S., & Scott, M. (2013). Using value of information to guide evaluation of decision supports for differential diagnosis: is it time for a new look? BioMed Central Medical Informatics and Decision Making, 13(1), 105. Retrieved from http://www.biomedcentral.com/1472-6947/13/105; 10.1186/1472-6947-13-105
According to Healthit.gov (2013), Clinical decision support (CDS) systems provide clinicians, staff, patients, and other individuals with knowledge and person-specific information, intelligently filtered and presented at appropriate times, to enhance health and health care. Early CDS systems were derived from expert systems research, with the developers striving to program the computer with rules that would allow it to “think” like an expert clinician when confronted with a patient. From this early research there was growing recognition that these systems might be useful beyond research, that they could be used to assist clinicians in decision making by taking over some routine tasks, warning clinicians of potential problems, or providing suggestions for clinician consideration.
Many of the early CDS systems provided expert consultation to the clinician for diagnosis and medication selection. CDS today also encompasses a range of options, from general references, through specific guidelines for a given condition, to suggestions that take into account a patient’s unique clinical data. CDS can include nationally recommended guidelines at one end of the continuum and customized order sets designed by an individual clinician at the other.
Common features of CDS systems that are designed to provide patient-specific guidance include;
• “The knowledge base (e.g., compiled clinical information on diagnoses, drug interactions, and guidelines).” (healthit.gov, 2013).
• “A program for combining that knowledge with patient-specific information, and a communication mechanism—in other words, a way of entering patient data (or importing it from the EMR) into the CDS application and providing relevant information (e.g., lists of possible diagnoses, drug interaction alerts, or preventive care reminders) back to the clinician”. (healthit.gov, 2013).
• “CDS can be implemented using a variety of platforms (e.g., Internet-based, local personal computer, networked EMR, or a handheld device).” (healthit.gov, 2013).
There is growing recognition that CDS, when well-designed and implemented, holds great potential to improve health care quality and possibly even increase efficiency and reduce health care costs For the potential to be realized, CDS should not be viewed as a technology or as a substitute for the clinician, but as a complex intervention requiring careful consideration of its goals, how it is delivered, and who receives it. To gain optimal benefit, clinician users need to understand its benefits and limitations, and the unique challenges of designing and implementing the different types of CDS. Those responsible for implementation need to recognize that CDS requires careful integration into the clinical workflow, which will take effort and involvement on the part of clinician users. The high frequency of failure to attend to the CDS alerts and recommendations represents a challenge for both researchers and vendors. Researchers need to address the cognitive, informatics, structural, and workflow issues that lead to less than optimal CDS design or implementation and, therefore, limited use and effectiveness. Vendors need to use the insights gained from research and development efforts to design systems that will increase, rather than decrease, clinician efficiency. Dissemination of careful evaluations of commercial CDS systems in community settings is also important for presenting the full picture of CDS design, implementation, and impact.
Policymaking, Regulation, & Strategy (2013). What is Clinical Decision Support (CDS). Retrieved from

TCO F:
You should be familiar with the three primary communities involved with most information technology implementations. Be prepared to discuss the critical success factors for a successful implementation and the issues associated with those success factors.
The five critical factors for managing successful implementations must be addressed together. These include: advanced technology, software solutions, transition management, knowledge, measurement, and content, and workflow optimization (Ball, Weaver, & Kiel, 2004). In order to successfully address these factors together, the primary communities in healthcare must work together as well. These communities are: clinical, IT, and operations/administrative subcultures (Ball, Weaver, & Kiel, 2004). Issues between the communities can hinder a successful implementation. Examples include organizational, cultural, and personal barriers that may exist between the communities (Ball, Weaver, & Kiel, 2004).
Techniques to ensure a collaborative environment include cooperation of the communities in order to reach common goals. Negotiations between communities involving bargaining, communication, and understanding were necessary for positive outcomes. Spending time in different communities can give all members insight into what capabilities, problems, or resources each of them have (Ball, Weaver, & Kiel, 2004). Thus, allowing for a better understanding of what they are working with. The role of the CIO is to be involved in all discussions between the three communities. Contribute to discussions of implementation and strategy of using technology better to enhance the healthcare facility. Creating an environment that supports the use of communication and respect will be another role of the CIO. Delegation of tasks to members of his team throughout the implementation and reviewing results is a necessary part of the position as well.
Ball, M.J., Weaver, C.A., & Kiel, J.M. (2004). Healthcare information management systems: Cases strategies and solutions (3rd ed.). New York, NY: Springer.

According to (Waldron, 2012), business Transformation Projects involve a number of players and business units, various systems, large-scale change, and, in many cases, an entirely new culture of collaboration and sharing. We can help improve the probability of success by helping to ensure the fundamentals are in place. Five key success factors are:
1. Strong Governance and decision-making. A strong governance and decision-making structure can help ensure that issues are addressed in a timely manner and also that the scope of the project is managed tightly.
1. Stakeholder engagement. Business transformation projects typically have a number of stakeholders. It is a critical success factor for the stakeholder community to be engaged and managed throughout the project.
1. A strong and experienced team. Nothing can beat the wisdom of experience when it comes to transformation projects. The challenge is to find the right combination of experiences. A successful project will require resources who understand the business as well as resource who are knowledgeable in the system(s) to be deployed and the tools needed to ensure success.
1. Strong Project management. Leading a business transformation project requires a good balance between the hard skills – maintaining the plan, managing the budget and the softer skills – empowering the team, ensuring they have everything they need and maintaining an environment in which they can deliver.
1. An achievable plan. Achievability is often a matter of opinion and also of circumstance. The challenge of developing an achievable plan is often about ensuring the team has bought in to the plan. This critical success factor is then, ensuring the team has confidence in their ability to deliver to the plan.
Project success is dependent on good communication and ongoing engagement, working closely with stakeholders helps to integrate programs and systems in order to deliver implementations on-time and on-budget.
Waldron, T. (2012, December 6). 5 Keys for Success in Every Business Transformation Project . Retrieved from Tricia Waldron: http://triciawaldron.com/

The five critical factors discussed in our text for successful, implementation of a healthcare information technology (HIT) system are: 1) Advanced technology; 2) Knowledge measurement and content; 3) Workflow optimization; 4) Transition management; and 5) Software solutions (Rose, 2010). Of these five critical factors, the author believes that the most crucial but frequently neglected is transition management, in which organizational leadership successfully change employee behavior by addressing and overcoming resistance (Rose, 2010). Perhaps the greatest source of employees’ resistance is the fear of losing face, either by appearing to be technologically incompetent, or by losing authority to a computer. Leadership needs to recognize resistance and tackle it head on by acknowledging employees’ anxieties, listening to employees, respecting employees’ opinions, promoting a vision of what the system can do for individuals and the organization, and providing long term training and support (Rose, 2010). In a Swedish study of a university hospital, the critical factors that the authors identified from a clinic where HIT implementation was most successful included alignment of the HIT project with a previously implemented change in the clinic’s patient referral process, the people involved in the HIT implementation were explicitly charged with change management, there was a “ change champion” who doggedly pursued the HIT implementation despite criticism and resistance, and senior management supported the change agent (Axelsson, Melin, & Söderström, n.d.).
The three primary communities involved in HIT implementation are clinical, information technology (IT), and administration/operations. Issues that the clinical community may experience during implementation include perceptions that clinical decision support systems are overriding clinical judgment, system glitches disrupting workflow, and communication breakdowns between health care team members. Issues that IT professionals may experience during implementation are lack of understanding of how clinicians interact with each other and with patients, and how the healthcare team receives and acts on information. Administration/operational personnel may not understand why clinicians are having difficulty accepting a new IT system if they have been isolated from the clinical environment, and are only interested in the bottom line, rather than the impact on the end users.
Techniques that can be used to foster a collaborative environment include forming a team with representatives from the three domains, and having each function “shadow” each other for a set period of time, so that each domain can learn what the others “do” on a daily basis (Rose, 2010). Clinicians need to spend time with the IT team and learn about hardware, software, and systems. The IT team must get out on the floors and observe the healthcare team in action, so that they can visualize how patient care workflow actually occurs. Administrators should leave their offices and practice MBWA (management by walking around), to see how both clinicians and IT are functioning, and also to provide visible leadership support for IT system implementation. The roles of the Chief Information Officer (CIO) in HIT implementation are to be a strategist, combined with technical skills and operational know-how of IT systems, a leader, a visionary, a communicator, and a collaborator (Hersher, 2010). The CIO is the go-to person for the rest of the executive team when contemplating the implementation of an HIT system, and unfortunately is often the scapegoat when an IT system fails to deliver what was promised.
Axelsson, K., Melin, U. and Söderström, F. (n.d.). Analyzing best practice and critical success factors in a health information system case – are there any shortcuts to successful it implementation? Retrieved from http://www.vits.org/publikationer/dokument/764.pdf
Hersher, B.S. (2010).The role of the CIO: The evolution continues. In Ball, M.J., Weaver, C.A. and Kiel, J.M. (Eds.), Healthcare information management systems (3rd ed.)(pp 161-172). New York, NY: Springer-Verlag
Rose, J.S. (2010). IT: Transition fundamentals in care transformation. In Ball, M.J., Weaver, C.A. and Kiel, J.M. (Eds.), Healthcare information management systems (3rd ed.)(pp 145-160). New York, NY: Springer-Verlag

Given a scenario for a health care organization, analyze how application systems and other information technology are evaluated and implemented successfully into the organization. Hello Professor Woodside and Class,
The implementation process must involve a determination of how healthcare processes work within an organization. The five critical factors for managing successful implementation, according to (Ball, Weaver, & Kiel 2010) are advanced technology, transition management, workflow optimization, knowledge of measurement of content, and software solutions. These are the core elements that need to be present to achieve transformation in healthcare through the application of information technologies. Three communities most affected by the transformation process are healthcare business, clinical care, and information technology. These are subcultures that need collaboration between communities to understand the capabilities and needs of other subcultures. The transformation of healthcare practices using IT is a complex process that requires clear goals, multidimensional organization thinking through strategy, attention to detail and a great deal of discipline. The role of the CIO is creating an environment that ensures successful implementation and has the capability to expand technology. The CIO must be the leader throughout the organization and be effective at succession planning which prepares for problems and changes. One- on-one planning is a necessity for mentoring and developing successors and this leader makes sure the team behind them can succeed and support sudden changes.
References:
Ball, M. J., Weaver, C. A., and Kiel, J.M. (Eds). (2010). Healthcare Information Management Systems: Cases, Strategies and Solutions (3rd ed.) New York , NY: Springer-Verlag.

TCO G:
Have an understanding of the major issues associated with technology solutions for consumer health information. Be prepared to discuss solutions to those issues.

Given the current issues of confidentiality, privacy and quality of health information, examine and explain the ethical issues surrounding the use of health care information and application systems for health care delivery. Providing quality health information to consumers will be analyzed.
HIPAA at its core is a law that helps and protect the information that is collected and transmited by provides and institutions (Ball, Weaver, & Kiel, 2004). This law was set up to provide security to patients that their medical information will not fall in to the wrong hands. The focus of the law gave direct understanding of who could get information about a patient and how it could be used. The biggest issue with this law is fear that the basic healthcare worker has about it. There is a fear around the law and healthcare workers can be miss informed around the usage of this law. Along with this misinformation is the update to the law that started back in March of 2013. The new update deals with privet practices and deals with what is considered business associates (BA) (Shay, & Gosfield, 2013). The update provides stricter definitions of what is a BA and the heightened penalties that come with a breach of the law. For the update to the law it gives a better understanding of what a BA is and how information can be transferred or used by a BA. For the change BA are initiates that may not be directly employed or working under the practice but has access to the information examples are temporary workers such as agency or contracted workers (Shay, & Gosfield, 2013). This finer definition provides a better understanding so private practices can gain understanding that an outside institution such as a radiology servers provider is not considered a BA so the issue of HIPAA breaches would fall on that group under the change of the law.
Ball, M., Weaver, C., & Kiel, J. (2004). Healthcare information management systems: Cases, strategies, and solutions. (3rd ed.). New York City: Springer Science Business Media., LLC.
Shay, D. F., & Gosfield, A. G. (2013). HIPPA AGAIN: Confronting the Updated Privacy and Security Rules. Family Practice Management, 20(3), 18-22.
Professor and class, HIPPA stands for the Health Insurance Portability and Accountability Act (1996). The intent of this act is to protect clients, reduce fraud, improve quality of health care, and set strict standards for how private information about clients is transmitted, although EMR are a faster way of getting information,it comes with the risk of security violations. HIPAA was presented to ensure that health providers have common standards of practice, legitimacy, and to protect our clients (Kiel, 2010).

The Privacy Rule: The privacy rule established regulations for the use and disclosure of protected health information. PHI (protected health information) is any information about health status, provision of health care, payment, & medical records; basically anything that identifies an individual. PHI could be : patient 's name, address, date of birth, telephone number, email address, social security number etc... A common concern for providers is the terms in which information can, should or must be disclosed. If a patient requests their information you have 30 days to provide it. Also, by law a provider can be required to disclose information. For example, if child abuse is a concern with a client then your state child welfare agency requires some identifiable information. Give it to them, but limit what you provide to the minimal amount that still allows you to achieve your intended purpose.

The Security Rule is broken into three specific types of security safeguards: administrative, physical, and technical. For each of the three types the rule identifies security standards and both required & addressable implementation specifications (HIPPA, 1996).

Administrative safeguards are policies and procedures designed to clearly show how your practice will comply with HIPPA. Make sure the procedures address how security breaches that are discovered will be addressed.

Physical Safeguards are those expectations to physically monitor any inappropriate access to protected data. This part of the rule states that hardware and software must be introduced to your area safely and be removed properly. For example, if you hire a technician to come into your clinical area to add new technology, make sure the can not access clients ' information. If you get a new computer in your office, make sure the old one is completely cleared out before you donate it.

Technical safeguards speck to your responsibility to govern your computer systems and people you deal with through technological means via fax, email, & phone. Think to yourself, "How will I ensure the person I intend to receive this material actually receives it?"

In my opinion, as a health care provider it is our job to value our clients and not compromise their privacy whether inadvertently or with intent for personal gain. HIPPA is good because it holds everyone to s standard of practice and compliance is taken seriously. Compliance violations stare with $100 fines and can go all the way up to $250,000 and 10 years in prison.

Kiel, J. M. (2010). The health insurance portability and accountability act: Confidentiality, privacy, and security. In Bell, M. J., Weaver, C.A., Kiel, J. M., (Eds.). Healthcare Informatics Management Systems: Cases, Strategies, and Solutions, (pp. 53-62). New York: Springer-Verlag.

Heath Insurance Portability and Accoutability Act (HIPPA) of 1996.

Http://www.hhs.gov/hippa

TCO H:
Have an understanding of the major issues associated with the HCIS and the EMR implementation challenges. Be familiar with Clouding computing and its role in Health IT.

Given the evolving needs of health care organizations, evaluate the potential for emerging information technologies to improve the quality and cost-efficiencies of health care delivery systems.
When we talk about the “Future of Health Informatics”, we must first understand was informatics does. “Informatics is a key enabler both for addressing availability, access, quality, and cost, and also for supporting the work of health policy, finance, and management experts. Informatics provides the necessary information technology (IT) infrastructure, standards, tools, and data to be able to address these key topics and for carrying out the work of the experts” (Greenes, 2009, pp. 21). It is sad to learn that the U.S. health care “system” is ailing due to a multiplicity failures, documented in countless studies. Key among these failures being;
• Spiraling costs.
• Disparities of access and large numbers of uninsured.
• Errors and unevenness of quality, and slow dissemination of advances.
• Inefficiencies and waste.
• Fragmentation and poor communication.
If we look at all these failures, we can both agree that the health care system itself can be considered to be a patient, one that is critically ill, if not actually on life support! Despite the ills of the U.S. system, its entrepreneurial system still currently leads the world in scientific and technical advances in health care. With respect to health care in particular, the advantage of the U.S. economy in the global market is counterbalanced by the concern that under-rationalized adoption of technological advances also contributes to the spiraling costs we are experiencing. It is therefore essential that we both preserve the ethos that fosters health care innovations and advances as well as seek ways to deploy them more effectively.
There is need in developing new technologies and therapies that will have potential for improving health. There is a tension between our capacity for innovation and development, and our inability to do systematic planning and execution that reflect a mistrust or fear of central planning, management, or control. The other issue is the fear for invasion of privacy or reduction of personal rights, while at the same time such large scale resources can be major enablers of discovery, validation, and dissemination of advances. Ideas have been pursued to address these issues by re-engineering the health care system to improve workflow and efficiency;
• by using informatics to reduce errors and improve quality
• by developing more efficient and effective organizational structures.
• by improving communication, and reducing administrative costs.
• by introducing systems, procedures, and regulations to protect the rights and privacy of individuals
• by modifying incentives to encourage cost-effective pursuit of best practices, and
• by other approaches.
This is a multi-faceted challenge that needs a large-scale multi-disciplinary, multi-stakeholder, long-term effort. We need to have an environment where we can develop projects, expand promising approaches on a large scale, and use them as a basis for innovation and development of a reinvigorated, even redesigned, healthcare system.
Greenes, R. (2009). Strategy for the future of health. Informatics and a health care strategy for the future—general directions. Studies I Health Technology & Informatics, 21-28.