Introduction to Health Informatics

Health Health Informatics Informatics OverviewOverview IAKM 60401IAKM 60401 Health Informatics Health Informatics ManagementManagement Michael O. BiceMichael O. Bice

Health Informatics (HI)Health Informatics (HI)

Definition: Health Informatics (HI) is a Definition: Health Informatics (HI) is a science that defines how health science that defines how health information is technically captured, information is technically captured, transmitted and utilized. transmitted and utilized.

Health informatics can be considered Health informatics can be considered “trans-disciplinary” and focuses on “trans-disciplinary” and focuses on information systems, informatics information systems, informatics principles, and information technology principles, and information technology as it is applied to the continuum of as it is applied to the continuum of healthcare delivery. healthcare delivery.

Health Informatics Health Informatics (HI)(HI) Health Informatics is a discipline Health Informatics is a discipline

with with threethree domains. domains. – Information SystemsInformation Systems domain domain

focuses on such issues as focuses on such issues as information systems analysis, information systems analysis, design, implementation, design, implementation, management and leadership. management and leadership.

Health Informatics Health Informatics (HI)(HI)

– InformaticsInformatics domain is domain is concerned with the study of concerned with the study of structure, function and transfer structure, function and transfer of information, socio-technical of information, socio-technical aspects of health computing, aspects of health computing, and human-computer and human-computer interaction. interaction.

Health Informatics Health Informatics (HI) (HI)

– Information TechnologyInformation Technology domain focuses on:domain focuses on:Computer networks Computer networks Database and systems Database and systems administration,administration,

SecuritySecurityProgrammingProgramming

What We Need in What We Need in Plain English Plain English We need to turn paper processes in We need to turn paper processes in

hospitals, clinics, labs and physician hospitals, clinics, labs and physician offices into electronic transactionsoffices into electronic transactions

We need to be able to share medical We need to be able to share medical records when a patient travels outside of records when a patient travels outside of a region, while protecting patient privacya region, while protecting patient privacy

We need a web-based system for We need a web-based system for promulgating evidence-based medical promulgating evidence-based medical treatments into everyday clinical practicetreatments into everyday clinical practice

ObservationsObservations

Significant challenges to Significant challenges to longstanding assumptions, longstanding assumptions, practices, and vested interests. practices, and vested interests.

The transition from a paper The transition from a paper culture to a digital culture will be culture to a digital culture will be difficult, costly, and disruptive. difficult, costly, and disruptive.

The private healthcare sector, left The private healthcare sector, left to its own devices, will never fully to its own devices, will never fully embrace HIembrace HI


Large multi specialty physician Large multi specialty physician groups are more likely to pursue groups are more likely to pursue evidence, adopt guidelines and evidence, adopt guidelines and manage variation aggressively, than manage variation aggressively, than smaller groups or solo practitioners smaller groups or solo practitioners (Digital Divide)(Digital Divide)

The end game for HI is reduced The end game for HI is reduced costs, better care, better health, and costs, better care, better health, and improved accessimproved access


Frequency and Severity of HIT Frequency and Severity of HIT Related Risks are IncreasingRelated Risks are Increasing

IT Products and Services Have IT Products and Services Have been Oversold and Not Well been Oversold and Not Well UnderstoodUnderstood

When hospitals purchase a major When hospitals purchase a major IT solution, they are not merely IT solution, they are not merely buying technology. They are buying technology. They are buying buying clinical transformationclinical transformation. .


The U.S. lags other industrialized The U.S. lags other industrialized countries in IT adoptioncountries in IT adoption

A major barrier to widespread IT A major barrier to widespread IT adoption is that costs are adoption is that costs are generally incurred by a few generally incurred by a few entities, while benefits accrue to entities, while benefits accrue to many interested parties (Public many interested parties (Public versus Private Good?)versus Private Good?)


Connecting patients across a Connecting patients across a fragmented delivery system—from fragmented delivery system—from MD office to hospital to skilled nursing MD office to hospital to skilled nursing facility—seems desirable, but will it facility—seems desirable, but will it ever be realized?ever be realized?

Modern technology isn’t foolproof. It Modern technology isn’t foolproof. It can magnify privacy problems, can magnify privacy problems, thereby weakening the case for public thereby weakening the case for public support.support.


Seemingly intractable problems of Seemingly intractable problems of privacy, security, and interoperabilityprivacy, security, and interoperability

HIT is a “free for all” in which every HIT is a “free for all” in which every participant – health plan, provider, participant – health plan, provider, vendor - is pursuing their own agendavendor - is pursuing their own agenda

Healthcare is a complex, fragmented, Healthcare is a complex, fragmented, information-dependent industry that information-dependent industry that lacks a unifying technologylacks a unifying technology

What Are The Business What Are The Business Risks of HI?Risks of HI? The Open Nature of Internet The Open Nature of Internet

Technologies Increases Technologies Increases Vulnerability to:Vulnerability to:– Web Outages and DisruptionsWeb Outages and Disruptions– Security BreachesSecurity Breaches– Introduction of Computer VirusesIntroduction of Computer Viruses– Privacy Violations Privacy Violations – Content and Advertising OffensesContent and Advertising Offenses

What Are The Business What Are The Business Risks of HI? Risks of HI?

– Intellectual Property InfringementIntellectual Property Infringement– Programming ErrorsProgramming Errors– Electronic Information Theft, Electronic Information Theft,

Damage, or DisclosureDamage, or Disclosure All Indications are These Incidents All Indications are These Incidents

and the Resultant Tangible and and the Resultant Tangible and Intangible Losses are on the RiseIntangible Losses are on the Rise

Pause and ReflectPause and Reflect

If you were a senior healthcare If you were a senior healthcare executive, what would be your executive, what would be your primary concerns about installing primary concerns about installing and maintaining expensive and and maintaining expensive and sophisticated IT systems?sophisticated IT systems?

As a healthcare consumer, what As a healthcare consumer, what are your primary concerns about are your primary concerns about electronic health records?electronic health records?

Federal Government Federal Government Strategy (2004-2014)Strategy (2004-2014)

The Decade of Health Information The Decade of Health Information Technology: Delivering Consumer-Technology: Delivering Consumer-centric and Information-rich Health Carecentric and Information-rich Health Care

Private Sector Certification of E H R: Private Sector Certification of E H R: Commission for Certification of HIT Commission for Certification of HIT (CCHIT)(CCHIT)– FunctionalityFunctionality– InteroperabilityInteroperability– SecuritySecurity

Federal Government Federal Government Strategy (2004-2014)Strategy (2004-2014) Four Strategic GoalsFour Strategic Goals

– Inform Clinical PracticeInform Clinical Practice– Interconnect PhysiciansInterconnect Physicians– Personalize CarePersonalize Care– Improve Population HealthImprove Population Health

Federal HIT Strategic Federal HIT Strategic Plan 2008 - 2012Plan 2008 - 2012

Two GoalsTwo Goals–Patient-focused Health Care

–Population Health

Federal HIT Strategic Federal HIT Strategic Plan 2008 - 2012Plan 2008 - 2012 Four Cross Cutting ThemesFour Cross Cutting Themes

– Privacy and SecurityPrivacy and Security– InteroperabilityInteroperability– AdoptionAdoption– Collaborative GovernanceCollaborative Governance

Federal HIT Strategic Federal HIT Strategic Plan 2008 - 2012Plan 2008 - 2012 Success MeasuresSuccess Measures

– Health IT becomes common and expected in health care delivery nationwide for all communities

– Your health information is available to you and those caring for you so that you receive safe, high quality, and efficient care

– You will be able to use information to better determine what choices are right for you with respect to your health and care

– You trust your health information can be used, in a secure environment, without compromising your privacy

Costs & Benefits of HIT Costs & Benefits of HIT (CBO July ’08)(CBO July ’08) HIT is necessary but not sufficient to HIT is necessary but not sufficient to

improve quality and control costsimprove quality and control costs Challenges to Rand and CITL Studies of Challenges to Rand and CITL Studies of

HIT savings (Possible, but not probable)HIT savings (Possible, but not probable) Can the federal government, short of Can the federal government, short of

major reform to the healthcare system, major reform to the healthcare system, provide incentives, penalties or provide incentives, penalties or mandates that will substantially mandates that will substantially increase the rate of HIT adoption?increase the rate of HIT adoption?

Costs & Benefits of HIT Costs & Benefits of HIT (CBO July ’08)(CBO July ’08) Total Costs for a HIT SystemTotal Costs for a HIT System

– The initial fixed cost of the hardware, software, and technical assistance necessary to install the system

– Licensing fees– Expense of maintaining the system– Opportunity costs

Costs & Benefits of HIT Costs & Benefits of HIT (CBO July ’08)(CBO July ’08) Evidence on Improvements in

Efficiency from Adoption of HIT– Eliminating Paper Medical Records– Avoiding Duplicated or Inappropriate

Diagnostic Tests– Promoting the Cost-Effective Use of

Prescription Drugs– Improving the Productivity of Nurses

and Physicians

Costs & Benefits of HIT Costs & Benefits of HIT (CBO July ’08)(CBO July ’08) Low Rates of Adoption of HIT:

Why?– Challenges in Implementing Health

IT Systems– Providers’ Inability to Capture

Financial Returns from Health IT– Competition Among Health

Insurance Plans– Regulatory Impediments


As a healthcare executive, what As a healthcare executive, what set of arguments would you put set of arguments would you put forth to your Board of Directors to forth to your Board of Directors to have them endorse a major, have them endorse a major, multiple year investment in multiple year investment in Health IT? Health IT?

Seven Durable Ideas Seven Durable Ideas (Glaser ’08)(Glaser ’08) Centrality of ProcessesCentrality of Processes

– Application Project and SupportApplication Project and Support– IntelligenceIntelligence– Assessment and Measurement of Assessment and Measurement of

ProcessesProcesses Organizational PartnershipOrganizational Partnership

– Agenda DevelopmentAgenda Development– Project ManagementProject Management

Seven Durable Ideas Seven Durable Ideas (Glaser ’08)(Glaser ’08) Progressive IncrementalismProgressive Incrementalism

– Break It Into PiecesBreak It Into Pieces– Identifying ReadinessIdentifying Readiness

AgilityAgility– Infrastructure AgilityInfrastructure Agility

Leverage StandardsLeverage Standards Core Technology AssessmentCore Technology Assessment

Seven Durable Ideas Seven Durable Ideas (Glaser ’08)(Glaser ’08) AgilityAgility

– Application AgilityApplication Agility Internal DevelopmentInternal Development Rapid FeedbackRapid Feedback Service-oriented ArchitectureService-oriented Architecture

– Organizational AgilityOrganizational Agility Streamline Decision ProcessStreamline Decision Process ChunksChunks

Seven Durable Ideas Seven Durable Ideas (Glaser ’08)(Glaser ’08) ArchitectureArchitecture

– Great ArchitectsGreat Architects– Processes, Rules, and StandardsProcesses, Rules, and Standards– Ability to Recognize and Leverage Ability to Recognize and Leverage

Major Technology AdvancesMajor Technology Advances Embedded ResearchEmbedded Research

– Physician LeadershipPhysician Leadership– Embedding Research in OperationsEmbedding Research in Operations

Seven Durable Ideas Seven Durable Ideas (Glaser ’08)(Glaser ’08) Engage the Broader Health Care Engage the Broader Health Care

IndustryIndustry– Create Capacity/Time for External Create Capacity/Time for External

PursuitsPursuits– Incentives for Academic or Incentives for Academic or

Management PromotionManagement Promotion

What IT Leadership What IT Leadership NeedsNeeds(Glaser ’08)(Glaser ’08) Value and Limitations of Durable Value and Limitations of Durable

IdeasIdeas VisionVision EngineeringEngineering StaffStaff


Assume that you are a hospital Assume that you are a hospital CEO about to launch a search for CEO about to launch a search for a new CIO. What will be the a new CIO. What will be the critical competencies that will you critical competencies that will you be looking for in the successful be looking for in the successful CIO candidate?CIO candidate?