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Health Care Information Systems A Practical Approach for Health

Health Care Information Systems A Practical Approach for Health

Health Care Information Systems A Practical Approach for Health

Care Management

Fourth Edition

Karen A. Wager

Frances Wickham Lee

John P. Glaser

 

 

 

Cover design by Wiley

Copyright © 2017 by John Wiley & Sons, Inc. All rights reserved.

Published by Jossey-Bass A Wiley Brand One Montgomery Street, Suite 1000, San Francisco, CA 94104-4594—www.josseybass.com

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9781119337188 (paperback) 9781119337126 (ePDF) 9781119337089 (ePub)

Printed in the United States of America

FOURTH EDITION

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Contents

Tables, Figures, and Exhibits …………………………………………………………………….. xi Preface …………………………………………………………………………………………………. xv Acknowledgments ……………………………………………………………………………….. xxiii The Authors ………………………………………………………………………………………… xxv

Part 1 Major Environmental Forces That Shape the National Health Information System Landscape ………………………………………………. 1

1 The National Health Information Technology Landscape …………………………………………………………… 3 Learning Objectives 1990s: The Call for HIT 2000–2010: The Arrival of HIT 2010–Present: Health Care Reform and the Growth of HIT Summary Key Terms Learning Activities References

2 Health Care Data …………………………………………………………………. 21 Learning Objectives Health Care Data and Information Defi ned Health Care Data and Information Sources Health Care Data Uses Health Care Data Quality Summary Key Terms Learning Activities References

3 Health Care Information Systems …………………………………………. 65 Learning Objectives Review of Key Terms Major Health Care Information Systems History and Evolution Electronic Health Records Personal Health Records Key Issues and Challenges

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vi · C O N T E N T S

Summary Key Terms Learning Activities References

4 Information Systems to Support Population Health Management ……………………………………………………………. 99 Learning Objectives PHM: Key to Success Accountable Care Core Processes Data, Analytics, and Health IT Capabilities and Tools Transitioning from the Record to the Plan Summary Key Terms Learning Activities References

Part 2 Selection, Implementation, Evaluation, and Management of Health Care Information Systems ………………………………………………………….. 139 5 System Acquisition …………………………………………………………….. 141

Learning Objectives System Acquisition: A Defi nition Systems Development Life Cycle System Acquisition Process Project Management Tools Things That Can Go Wrong Information Technology Architecture Summary Key Terms Learning Activities References

6 System Implementation and Support …………………………………. 179 Learning Objectives System Implementation Process Managing Change and the Organizational Aspects System Support and Evaluation Summary Key Terms Learning Activities References

7 Assessing and Achieving Value in Health Care Information Systems ………………………………………………………….. 215 Learning Objectives Definition of IT-Enabled Value

 

 

 

 

 

 

 

C O N T E N T S · vii

The IT Project Proposal Ensuring the Delivery of Value Analyses of the IT Value Challenge Summary Key Terms Learning Activities References

8 Organizing Information Technology Services ………………………. 251 Learning Objectives Information Technology Functions Organizing IT Staff Members and Services In-House versus Outsourced IT Evaluating IT Effectiveness Summary Key Terms Learning Activities References

Part 3 Laws, Regulations, and Standards That Affect Health Care Information Systems ………….. 285

9 Privacy and Security …………………………………………………………… 287 Learning Objectives Privacy, Confidentiality, and Security Defi ned Legal Protection of Health Information Threats to Health Care Information The Health Care Organization’s Security Program Beyond HIPAA: Cybersecurity for Today’s Wired Environment Summary Key Terms Learning Activities References

10 Performance Standards and Measures ………………………………… 323 Learning Objectives Licensure, Certification, and Accreditation Measuring the Quality of Care Federal Quality Improvement Initiatives Summary Key Terms Learning Activities References

11 Health Care Information System Standards ………………………… 357 Learning Objectives HCIS Standards Overview Standards Development Process

 

 

 

 

viii · C O N T E N T S

Federal Initiatives Affecting Health Care IT Standards Other Organizations Influencing Health Care IT Standards Health IT Standards Vocabulary and Terminology Standards Data Exchange and Messaging Standards Health Record Content and Functional Standards Summary Key Terms Learning Activities References

Part 4 Senior-Level Management Issues Related to Health Care Information Systems Management ………………………………………………….. 393 12 IT Alignment and Strategic Planning ………………………………….. 395

Learning Objectives IT Planning Objectives Overview of Strategy The IT Assest A Normative Approach to Developing Alignment and IT Strategy IT Strategy and Alignment Challenges Summary Key Terms Learning Activities References

13 IT Governance and Management ……………………………………….. 427 Learning Objectives IT Governance IT Budget Management Role in Major IT Initiatives IT Effectiveness The Competitive Value of IT Summary Key Terms Learning Activities Notes References

14 Health IT Leadership Case Studies ………………………………………. 467 Case 1: Population Health Management in Action Case 2: Registries and Disease Management in the PCMH Case 3: Implementing a Capacity Management

Information System Case 4: Implementing a Telemedicine Solution Case 5: Selecting an EHR For Dermatology Practice Case 6: Watson’s Ambulatory EHR Transition

 

 

C O N T E N T S · ix

Case 7: Concerns and Workarounds with a Clinical Documentation System

Case 8: Conversion to an EHR Messaging System Case 9: Strategies for Implementing CPOE Case 10: Implementing a Syndromic Surveillance System Case 11: Planning an EHR Implementation Case 12: Replacing a Practice Management System Case 13: Implementing Tele-psychiatry in a Community Hospital

Emergency Department Case 14: Assessing the Value and Impact of CPOE Case 15: Assessing the Value of Health IT Investment Case 16: The Admitting System Crashes Case 17: Breaching The Security of an Internet Patient Portal Case 18: The Decision to Develop an IT Strategic Plan Case 19: Selection of a Patient Safety Strategy Case 20: Strategic IS Planning for the Hospital ED Case 21: Board Support for a Capital Project Supplemental Listing of Related Case Studies and Webinars

Appendixes A. Overview of the Health Care IT Industry …………………………….. 525

The Health Care IT Industry Sources of Industry Information Health Care IT Associations Summary Learning Activities References

B. Sample Project Charter, Sample Job Descriptions, and Sample User Satisfaction Survey ………………………………….. 539 Sample Project Charter Sample Job Descriptions Sample User Satisfaction Survey

Index ………………………………………………………………………………………………….. 559

 

 

 

 

 

 

 

 

 

 

 

 

Tables, Figures, and Exhibits

TABLES

1.1 Stages of Meaningful Use ……………………………………………………….. 9 1.2 Differences between Medicare and Medicaid EHR

incentive programs ……………………………………………………………….. 11 1.3 MIPS performance categories…………………………………………………..13 2.1 Ten common hospital statistical measures ………………………………….47 2.2 Terms used in the literature to describe the fi ve common

dimensions of data quality ……………………………………………………..52 2.3 Excerpt from data dictionary used by AHRQ surgical site infection

risk stratifi cation/outcome detection …………………………………………56 3.1 Common types of administrative and clinical information systems ….68

3.2 Functions defining the use of EHRs ………………………………………….76 3.3 Sociotechnical dimensions ………………………………………………………92 4.1 Key attributes and broad results of current ACO models …………….. 106 5.1 Sample criteria for evaluation of RFP responses ……………………….. 161 7.1 Financial analysis of a patient accounting document

imaging system …………………………………………………………………..227 7.2 Requests for new information system projects ………………………….. 230 9.1 HIPAA violation categories …………………………………………………… 302 9.2 Top ten largest fines levied for HIPAA violations as of

August 2016 ………………………………………………………………………. 303 9.3 Resources for conducting a comprehensive risk analysis …………….. 309 9.4 Common examples of vulnerabilities and mitigation strategies …….. 310

10.1 2015 approved CMS accrediting organizations …………………………..329 10.2 Major types of quality measures …………………………………………….336 10.3 Excerpt of CQMs for 2014 EHR Incentive Programs ……………………338 10.4 MIPS performance categories…………………………………………………349 11.1 Relationships among standards-setting organizations …………………. 361 11.2 Excerpt from CVX (clinical vaccines administered) …………………….374 11.3 Excerpt from NCPDP data dictionary ……………………………………… 380 11.4 X12 TG2 work groups …………………………………………………………. 381 11.5 Excerpt from the HL7 EHR-S Functional Model …………………………386

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xii · T A B L E S , F I G U R E S , A N D E X H I B I T S

12.1 IT initiatives linked to organizational goals ………………………………397 12.2 Summary of the scope of outpatient care problems …………………… 402 12.3 Assessment of telehealth strategic opportunities ……………………….. 413 12.4 Summary of IT strategic planning ………………………………………….. 414 13.1 Target increases in an IT operating budget ……………………………….442 14.1 List of cases and corresponding chapters …………………………………469 A.1 IT interests of different health care organizations ………………………526 A.2 Health care provider market: NAICS taxonomy …………………………527 A.3 Changes in application focus resulting from changes

in the health care business model ………………………………………….528 A.4 Major health care IT vendors, ranked by revenue ……………………… 530 B.1 Revision history …………………………………………………………………. 541 B.2 Issue management ………………………………………………………………549

FIGURES

1.1 Milestones for a supportive payment and regulatory environment ….15 2.1 Health care data to health care knowledge …………………………………23 2.2 Sample EHR information screen ………………………………………………33 2.3 Sample EHR problem list ……………………………………………………….34 2.4 Sample EHR progress notes …………………………………………………….34

2.5 Sample EHR lab report …………………………………………………………..35 2.6 Sample heart failure and hypertension query screen …………………….45

3.1 History and evolution of health care information systems (1960s to today) …………………………………………………………………..70

3.2 Sample drug alert screen ………………………………………………………..73 3.3 Sample patient portal …………………………………………………………….74 3.4 Percent of non-federal acute care hospitals with adoption of at

least a basic EHR with notes system and position of a certifi ed EHR: 2008–2015 ……………………………………………………………………75

3.5 Office-based physician practice EHR adoption since 2004 ……………..77 3.6 The ONC’s roadmap to interoperability ……………………………………..84 4.1 Percent of nonfederal acute care hospitals that electronically

exchanged laboratory results, radiology reports, clinical care summaries, or medication lists with ambulatory care providers or hospitals outside their organization: 2008–2015 ……………………. 118

5.1 Systems development life cycle ………………………………………………144 5.2 System usability scale questionnaire ……………………………………….163

5.3 Cost-benefi t analysis ……………………………………………………………164 5.4 Example of a simple Gantt chart ……………………………………………167

 

 

 

 

 

 

 

 

 

T A B L E S , F I G U R E S , A N D E X H I B I T S · xiii

6.1 Project timeline with project phases ……………………………………….189 7.1 IT investment portfolio …………………………………………………………237 7.2 Days in accounts receivable ………………………………………………….239 7.3 Digital intensity versus transformation intensity ………………………..246 8.1 IT organizational chart: Large health system …………………………….257

10.1 Screenshot from NQF ………………………………………………………….. 341 10.2 Projected timetable for implementation of MACRA ……………………. 350 12.1 Overview of IT strategy development ……………………………………… 400 12.2 IT initiative priorities ………………………………………………………….. 415 12.3 IT plan timetable and budget ……………………………………………….. 416 12.4 Hype cycle for emerging technologies, 2014 …………………………….. 422 13.1 IT budget decision-making process …………………………………………443 13.2 Gross margin performance differences in high IT–use industries ….. 461 13.3 Singles and grand slams ……………………………………………………….463

EXHIBITS

2.1 Excerpt from ICD-10-CM 2016 ………………………………………………….38 2.2 Excerpt from ICD-10 PCS 2017 OCW …………………………………………40 2.3 Patient encounter form coding standards …………………………………..41 5.1 Overview of System Acquisition Process …………………………………. 147 9.1 Sample release of information form ………………………………………..294 9.2 Cybersecurity framework core ………………………………………………. 318

10.1 Medical Record Content: Excerpt from South Carolina Standards for Licensing Hospitals and Institutional General Infi rmaries ……….326

10.2 Medical Record Content: Excerpt from the Conditions of Participation for Hospitals …………………………………………………….328

11.1 Excerpt from ONC 2016 Interoperability Standards Advisory ………..366 11.2 X12 5010 professional claim standard……………………………………… 382 12.1 IT initiatives necessary to support a strategic goal for a provider …. 410 12.2 IT initiatives necessary to support a strategic goal for a

health plan ……………………………………………………………………….. 411 12.3 System support of nursing documentation ………………………………. 412

 

 

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