Theera-Ampornpunt N. Departmental information systems and management information systems in healthcare organizations. Presented at: Faculty of ICT, Mahidol University; 2012 Feb 8; Bangkok, Thailand.

1. Departmental
Information
Systems &
Management
Nawanan Information
Theera-Ampornpunt Systems in
http://www.slideshare.net/nawanan
Healthcare
Organizations
Parts of this material were based on materials developed by Duke University, funded by the Office of the
National Coordinator for Health Information Technology, U.S. Department of Health and Human Services under
Award Number IU24OC000024 (Health IT Workforce Curriculum v.2.0, Component 6/Unit 9-1).

2. Outline
Departmental Information Systems
 Hospital departments
 Nature of enterprise information systems
 Departmental IS categories
 Integration & interfaces
 System acquisition decisions
Management Information Systems (MIS)
 Concepts of MIS
 Common MIS in healthcare organizations
2

3. Class Exercise 1
 Name some departments or
organizational units of a hospital that you
can think of.
3

4. Examples of Hospital Departments
 Clinical departments  Obstetrics/Gynecology -
 Pediatrics (children) OB/GYN (childbirth &
 Ophthalmology (eye)
woman’s health)
 Otolaryngology (Ear, nose,
 Psychiatry (mental health)
throat - ENT)
 Nursing
 Orthopedics (bone
 Pathology (lab)
diseases)
 Radiology (x-rays)
 Internal medicine
 Anesthesiology
 Emergency medicine
 Family medicine
 Community medicine
 Physical medicine &
 Pharmacy
rehabilitation
 Operating rooms
 Surgery
 Outpatient departments
 Inpatient wards
4

5. Examples of Hospital Departments
 Administrative departments
 General administration office
 Hospital director’s office
 Human resources
 Finance
 Procurement & material management department
 Public relations
 Policy & planning
 Medical education
 Graphics design & media
 Academic affairs
 Student affairs
 Library
 Quality improvement department
 IT/Informatics
 etc.
5

6. Health Care Information
System (HCIS)
 Information system used within a health care
organization
 Facilitates communication
 Integrates information
 Documents health care interventions
 Performs record keeping
 Otherwise supports the functions of the
organization
Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer
Applications in Health Care and Biomedicine. Third Edition. New
York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
6

7. Hospital Information System
 Information system used within a hospital
 Sometimes divided into
 Front Office (Clinical information systems)
 Back Office (Management information
systems)
7

8. Enterprise-wide Information Systems
Shortliffe, EH, Blois, MS., The Computer Meets Medicine and Biology: Emergency of a Discipline.
In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health
Care and Biomedicine. Third Edition. New York, NY: Springer; 2006. 8

9. Class Exercise 2
 Choose 3-5 hospital departments and
discuss their specific information needs
and circumstances
9

10. Hospital Information System (HIS)
 Information system used within a hospital
 Sometimes divided into
 Front Office (Clinical information systems)
 Back Office (Management information
systems)
10

11. Some characteristics
Front Office Back Office
 Focuses on patient  Performs
care administrative
 Patient records functions
should be  Some information is
accessible
hospital-wide to specific to the
clinical individual
departments department
 Time may be  Often is not very
critical time-dependent
11

12. HIS Components
 Patient management and billing
 Care delivery and clinical documentation
 Clinical decision support
 Department management
 Financial and resource management
Vogel, LH, Perreault, LE., Management of Information in
Healthcare Organizations. In: Shortliffe, E, Cimino J, eds:
Biomedical informatics: Computer Applications in Health Care
and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
12

13. Patient Management and Billing
 Systems that support patient
management functions
 Example
 Patient identification
 Supporting technology
 Master patient index
 Houses centralized database
 Patient financial, demographic, registration and
location data
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In:
Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health
Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
13

14. Care Delivery and Clinical
Documentation
 Systems that support the delivery of the care and
documentation of that care
 Example
 Clinical information systems, EHRs
 Supporting technology
 Electronic clinical order entry and results reporting
 Houses centralized database
 Patient clinical data
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In:
Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health
Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
14

15. Clinical Decision Support
 Systems that support the clinical staff with
data interpretation and decision-making
 Example
 Medication Administration System
 Supporting technology
 Bar-code medication administration (BCMA)
 Accesses patient and other databases
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations. In:
Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in Health
Care and Biomedicine. Third Edition. New York, NY: Springer; 2006
Health IT Workforce Curriculum Version
2.0/Spring 2011
15

16. Financial and Resource
Management
 Systemsthat support business
functions
 Example
 Accounts Payable System
 Supporting technology
 Claims administration
 Houses centralized database
 Financial and employee data
Health IT Workforce Curriculum Version
2.0/Spring 2011
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17. 4 Ways IT Can Help Health Care
Strategic
• Business
Intelligence • CDSS
• Data Mining/ • HIE
Utilization • CPOE
• MIS • PACS
• Research
Informatics • EHRs
• E-learning
Administrative Clinical
Enterprise
Resource • ADT
Planning • HIS
(ERP) • LIS
• Finance • RIS
• Materials
• HR
Operational
Position may vary based on local context 17

18. Department Management
 Systems that support a department’s information
needs
 Example
 Health Information Management Department systems
 Supporting technology
 Electronic Document Management Systems
 Supplies data to patient databases
Vogel, LH, Perreault, LE., Management of Information in Healthcare
Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer
Applications in Health Care and Biomedicine. Third Edition. New York, NY:
Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
18

19. Departmental information system
 Supports specific needs of each
department
 Often designed to fit best with each
department’s unique workflows &
circumstances
 Usually a small system used by a few users
of one or two small departments
19

20. Class Exercise 3
 What are some issues you can think of
when developing an information system
for a specific department
20

21. Issues of Departmental IS
 Data integration (data sharing)
 Silos of information
 Process (workflow) integration
 In other words, standardization vs.
customization
 Implementation strategies (build or buy)
 Sustainability & system maintenance
21

22. Integration
 Arrangement of an organization’s
information systems
 Efficient and effective communication
 Bring together related parts into a single
system
Health IT Workforce Curriculum Version
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23. Application Integration
 Patient management and billing
 Patient tracking
 Department management
 Electronic document management
 Care delivery and clinical documentation
 Order entry and results reporting
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations.
In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications
in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
23

24. Application Integration
 Clinical decision support
 Computer-based physician order-entry
 Financial and resource management
 Provider profiling
Vogel, LH, Perreault, LE., Management of Information in Healthcare
Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics:
Computer Applications in Health Care and Biomedicine. Third Edition.
New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
24

25. Systems Integration Strategies
 Data preservation
 Separate information management plan
components for
 Data management
 Applications and business logic
 User interface
Vogel, LH, Perreault, LE., Management of Information in Healthcare
Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics:
Computer Applications in Health Care and Biomedicine. Third
Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
25

26. Key Components of Enterprise
Integration
 Master person index
 Single sign-on
 Context management
 Common code sets
 Data warehouse
Health IT Workforce Curriculum Version
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27. Critical Integration Elements
 Information is available when and where it is
needed
 Users must have an integrated view
 Data must have a consistent interpretation
 Adequate security must be in place
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations.
In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications in
Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
27

28. Data and Process Integration
 Data integration
 Interface engine
 Process integration
 Operational workflow
 Human organizational systems
Vogel, LH, Perreault, LE., Management of Information in Healthcare
Organizations. In: Shortliffe, E, Cimino J, eds: Biomedical informatics:
Computer Applications in Health Care and Biomedicine. Third
Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
28

29. Interface Engine
 Translates and formats data for exchange
 Controls data flows between applications
 Central connecting point for all interfaces
Vogel, LH, Perreault, LE., Management of Information in Healthcare Organizations.
In: Shortliffe, E, Cimino J, eds: Biomedical informatics: Computer Applications
in Health Care and Biomedicine. Third Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
29

30. HL7 Messaging Standard
Health Level Seven (HL7)
Message standard
Supports clinical practice
Move data in standard
formats
Health IT Workforce Curriculum Version
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31. From Islands of Information to
Meaningful Use
Health IT Workforce Curriculum Version
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32. System Acquisition Decisions
for Departmental Information
Systems
 Build (in-house development)
 Buy (outsourcing)
 Combination (e.g. buy then maintain/customize
in house)
32

33. Build or Buy
Build/Homegrown Buy/Outsource
 Full control of software &  Less control of software
data & data
 Requires local expertise  Requires vendor
 Expertise competence
retention/knowledge  Vendor relationship
management is vital management is vital
 Maybe cost-effective if  Maybe cost-effective
high degree of local if economies of scale
customizations or long-
term projection
33

34. Build or Buy
 No universal right or wrong answer
 Depends on local contexts
 Strategic positioning
 Internal IT capability
 Existing environments
 Level of complexity/customization needed
 Market factors: market maturity, vendor choices,
competence, willingness to customize/learn
 Pricing arrangements
 Purchasing power
 Sustainability
34

35. Outsourcing Decision Tree
Keep Internal
No
Is external delivery
No reliable and lower cost?
Does service offer Yes OUTSOURCE!
competitive advantage?
Yes Keep Internal
From a teaching slide by Nelson F. Granados, 2006 35

36. Outsourcing Dilemmas
Doig et al, “Has Outsourcing gone too far,”
McKinsey Quarterly, 2001
• “One of the challenges Ford has is that it has outsourced so
much of its process, it no longer has the expertise to
understand how it all comes together” Marco Iansiti, CIO, 2003
From a teaching slide by Nelson F. Granados, 2006 36

37. IT Outsourcing: Ramathibodi’s Case
External delivery unreliable
• Non-Core HIS
External delivery higher cost
• ERP, IT Support?
Keep Internal
No
Is external delivery
No reliable and lower cost?
Does service offer Yes OUTSOURCE!
competitive advantage?
PACS, RIS,
Departmental
Yes Keep Internal
systems
Core HIS, CPOE
Strategic advantages
• Agility due to local workflow accommodations
• Secondary data utilization (research, QI)
• Roadmap to national leader in informatics
From a teaching slide by Nelson F. Granados, 2006 37

38. If Decision = Build
Challenges
 Recruitment & retention
 Keeping up with new technologies & requirements
 The “legacy systems” trap
 Justifying “slow” implementation
38

39. If Decision = Build
Suggestions
 Recruitment & retention
 Knowledge management: Tacit -> Explicit
 Have long-term vision/strategies
 Aim for system evolution
 New requirements
 New technologies/best practices
 Refactoring
 Prioritize
 Reevaluate build/buy decision every 5 years
39

40. If Decision = Buy
Challenges
 Vendor selection
 Justifying long-term costs
 Managing risks
 The “vendor lock-in” problem
 Sharing data with other systems
40

41. If Decision = Buy
Suggestions
 Take time & effort in knowing your potential vendors
 Be flexible in requirements, project delivery
 Look at vendor as partner, not contractor
 Avoid “us-versus-them” mentality
 Understand “learning curves”
 Be less bureaucratic, more collaborative
 Be specific in SLAs, MAs, IP, data ownership
 Choose technologies wisely, with rooms for later
migration if possible
 Knowledge transfer
 Always have a Plan B (Alternative vendors, internal workforce)
41

42. Management Information
Systems (MIS)
 Provides information needed to manage an
organization (e.g. a hospital) effectively and
efficiently
 A broad category of information systems
 Administrative reports
 Enterprise resource planning (ERP)
 Supply Chain Management (SCM)
 Customer Relationship Management (CRM)
 Project management tools
 Knowledge management tools
 Business intelligence (BI)
42

43. Business Intelligence
Applications
 Allows for
 Data analysis
 Correlation
 Trending
 Reporting of data across multiple sources
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44. Business Intelligence
Applications
 Examples
 Clinical and Financial Analytics and Decision
Support
 Query and Reporting Tools
 Data Mining
 Online Scoreboards and Dashboards
Business Intelligence & Data Warehousing for Healthcare. Clinical Informatics
Wiki. 2008. Available from: http://www.informatics-
review.com/wiki/index.php/Business_Intelligence_&_Data_Warehousing_f
or_Healthcare
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45. Summary
 Various departments and their information
needs in hospitals/healthcare organizations
 Applications that need to be integrated in
health care information systems
 Strategies to ensure integration of front-end
clinical data collection and back-end billing
functions
 Critical integration elements
 Information systems for organizational
management (MIS)
 Data analysis and trending (BI)
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46. References
 Vogel, LH, Perreault, LE., Management of
Information in Healthcare Organizations.
In: Shortliffe, E, Cimino J, eds: Biomedical
informatics: Computer Applications in
Health Care and Biomedicine. Third
Edition. New York, NY: Springer; 2006.
Health IT Workforce Curriculum Version
2.0/Spring 2011
46