Optimizing Health Information Systems

Optimizing Merged Health Information Systems
Although the merger of two comparably sized companies competing in the same industry is a relatively commonplace business strategy, the process is fraught with obstacles and challenges and a significant percentage of merged entities fail outright because of these problems (Murphy, 2019). These types of problems are further compounded when there are sophisticated information systems involved that must also be merged successfully. The purpose of this paper is to explicate the responsibilities involved in implementing a health information system (HIS) that meets current Health Information Technology for Economic and Clinical Health (HITECH) Act and the Health Insurance Portability and Accountability Act (HIPAA) Security and Privacy regulatory requirements. To this end, a discussion and analysis of health information systems, a description concerning how a system will affect patient care and documentation and an explanation concerning how using a system to access information will affect the quality and delivery of nursing care and patient outcomes are followed by a discuss about how a system will benefit the merged organization. Finally, a description of four essential stakeholder roles needed to form an interdisciplinary team to work on a system implementation is followed by a discussion concerning the plan for evaluating the success of the implementation of a system by incorporating two professional organization standards are followed by a summary of the research and important findings about the challenges and issues involved are presented in the paper’s conclusion..
A. Discussion and analysis of health information systems
1. Summary of advantages and disadvantages of a system.
A health information system is defined by Abouzhar (2009) as an "integrated effort to collect, process, report and use health information and knowledge to influence policy-making, program action and research" (p. 578). Although health information systems may differ significantly in terms of configurations and capabilities, they typically share some common features that are related to improving the ability of health care organizations to more effectively manage patient-related data to identify problem areas and opportunities for improvement. For instance, according to Shahmoradi and Habibi-Koolaee (2016), the primary advantages of health information systems relate to their ability to “provide assembly, analysis, and dissemination of data necessary to guide, promote and evaluate the disease prevention and health promotion programs” (p. 1096).
Conversely, the main disadvantages of health information system include their complexity and the piecemeal fashion in which they are frequently developed (Creswell & Aziz, 2013). Moreover, there is no conceptual framework available for the implementation of health information systems and the process can be extremely difficult as a result of a broad array of technical, social, and organizational factors that tend to be inter-related (Cresswell & Aziz, 2013). In this regard, Cresswell and Azis (2013) emphasize that, “The evidence indicates that there are a range of technical, social and organizational considerations that need to be deliberated when attempting to ensure that technological innovations are useful for both individuals and organizational processes” (p. 73). Because these factors are typically inter-related, though, the decision-making process for implementing health information systems must apply a holistic approach so that there are no unintended outcomes or adverse effects on patient care (Cresswell & Aziz, 2013)
The full range of the advantages that accrue to the use of health information systems can only be achieved by ensuring they are usable, scalable, interoperable and compatible. For example, effective health information systems are characterized by a high degree of usability. In this context, “usability” refers to the effectiveness, efficiency and satisfaction with which specific users can achieve a specific set of tasks in a particular environment” (Usability, 2019). Moreover, it requires a significant amount of time to realize these advantages and organizational leaders should be prepared for some setbacks and mistakes.
At present, the usability of many health information systems remains suboptimal due to the manner in which data is stored and the difficulties that are frequency experienced in attempting to access it (Abouzhar, 2009). Likewise, the term “interoperability” refers to “the ability of different information systems, devices or applications to connect, in a coordinated manner, within and across organizational boundaries to access, exchange and cooperatively use data amongst stakeholders, with the goal of optimizing the health of individuals and populations” (What is interoperability?, 2019, para. 2).
Effective health information systems are also characterized by a high level of scalability so that they can accommodate ongoing increases in data and user demand (Zhou & Watzlaf, 2017). In addition, it will be vitally important to ensure the compatibility of the two merged health information systems in order to optimize their operations. In the past, compatibility between disparate health information systems was somewhat easier to achieve because the data typically consisted of alpha-numeric data only; however, in recent years, the transition from paper-based documentation to digital storage has also be marked by the addition of graphic images and other types of data that may not be easily shared between these systems (Reichertz, 2009), making the need for compatibility a fundamental requirement for success.
One strategy that can be used to help ensure the interoperability and compatibility of disparate health information systems is the use of middleware. For example, Shahmoradi and Habibi-Koolaee (2016) report that:
Standards on terminology, security and data exchange play a critical role to integrate health information systems and provide interoperability across heterogeneous systems. Middleware is a tool to facilitate the integration of health information systems, so that, in the interaction between the systems there is no need to reproduce the same component of them. (p. 1098)
Taken together, it is clear that there are a number of advantages and corresponding disadvantages related to health information systems, and these systems also have a profound effect of patient care and documentation as discussed further below.
2. Description concerning how a system will affect patient care and documentation
Properly implemented and administered, health information systems affect patient care in a number of positive ways. For instance, according to Shahmoradi and Habibi-Koolaee (2016), “[Health information systems] have been developed in order to integrate health information to meet consumer requirements, contribute to epidemiological research, enhance care quality, reduce expenses and facilitate information management” (p. 1097). A concomitant effect of health information systems is the reduction and even outright elimination of in paper-based documentation through the use of electronic medical records and electronic health records (Kumar, 2010).
3. Explanation concerning how using a system to access information will affect the quality and delivery of nursing care and patient outcomes
As noted above, the main advantages of health information systems are only achievable when these systems are properly implemented and administered. Assuming this has been accomplished, though, health information systems have the ability to “improve cost control, increase the timeliness and accuracy of patient care and administration information, increase service capacity, reduce personnel costs and inventory levels, and improve the quality of patient care” (Drazen, 2006, p. 51). These improvements in facilitating the delivery of nursing care naturally have a corresponding positive impact on patient outcomes, but the process is not automatic and requires careful planning and diligence in oversight to ensure optimal outcomes (Drazen, 2006).
It is also important to note, however, there are also some significant operational and organizational issues that are involved in the efficient access to health care data stored in health information systems that can adversely affect the quality and delivery of nursing care and patient outcomes. In this regard, Drazen (2016) adds that, “Operational problems may exist that diminish information timeliness, accessibility, and accuracy; policies and procedures may not have been sufficiently tailored to reflect the realities and intents of the systems; and personnel tasks may not have been adequately restructured” (p. 52).
These are especially salient issues when a merger of two health care organizations is involved since there may be conflicting procedures and protocols involved in their respective health information systems. Consequently, the merged organization must make minimizing the constraints that are involved in merging disparate health information systems while simultaneously strategically optimizing their advantages. As Drazen (2006) concludes, “In order to realize the full potential of information systems, health care organizations must plan for and implement strategies that are designed to maximize such benefits” (p. 53).
Beyond the foregoing improvements, there are some other ways that health information systems can affect the quality and delivery of nursing care and patient outcomes. Although there have been some trends towards including qualitative data in health information systems in recent years, the vast majority of data that are used by these systems are quantitative. These aggregated quantitative data can help nursing professionals discern trends and patterns in a highly efficient fashion. For example, according to Abouzhar and Boerma (2009), “The health information system is heavily biased towards quantitative data [such as] analysis of causation of health problems, quantification of associations between health outcomes and risk or protective factors, and assessment of the effectiveness of health interventions” (p. 579).
Here again, though, achieving the optimal results from health information systems also requires consideration of the potential future uses of the data collected as well as ensuring that nursing personnel are able to access the data in an intuitive rather than arcane fashion. In this regard, McGrail and Black (2009) emphasize that, “The lack of explicit consideration of future uses of data in the planning stages of collection has resulted in a fragmented world of data where some decision-makers and researchers are able to find and use information and others are not” (p. 564).
This observation does not mean, of course, that the data are unavailable or nonexistent, but rather the interface with the health information system is sufficiently esoteric that it requires an inordinate amount of familiarity and training with a given system. This constraint not only adversely affects the delivery of timely and high quality nursing care, it can also be highly costly health care organizations in terms of the system’s usability. As McGrail and Black (2009) point out, “The data exist, but they are not easily accessible. Limited access diminishes their value and means that the sunk costs of data collection are just that--sunk. The lack of foresight in creating data access policies poses a problem that now demands a solution” (p. 565). Notwithstanding these constraints, however, health information systems can benefit organizations in a number of specific ways as discussed below.
B. Discuss how a health information system will benefit the organization
1. Provide two ways that quality improvement (QI) data collected from a system can lead to measurable improvement in health care services and the health status of targeted patient groups.
There are several ways that health information systems can benefit organizations and their ability to provide optimal patient care by using the collected quantitative QI data to identify opportunities for improvement. One such way is the ability of health information systems to integrate existing data from various sources. This means that organizations can not only target those patient care areas in need of improvement, they can do so in a highly cost efficient manner. For example, Williams (2009) cites the need for “a wide range of statistics to inform sound decision-making on health policy and its execution” (p. 564). This attribute represents a valuable function of health information systems, and the quantitative nature of the vast majority of the health data collected for these systems facilitates its analyses.
Moreover, Williams (2009) also notes that in many cases this type of information already exists in other health information systems. In this regard, Williams points out that,”[These data] go far beyond information from, and on, the health system itself, including information on the socioeconomic, demographic, environmental and behavioral determinants of health outcomes, taken from vital registration systems, household surveys and population and housing censuses” (p. 564). The analysis of this type of integrated health data available from health information systems can help nursing researchers identify problems areas in need to resolution as well as provide them with the ability to measure the effectiveness of any interventions that are implemented in response (Williams, 2009).
2. Explain how a system will meet HITECH and HIPAA security standards and regulations:
Health information systems help organizations conform to the security standards and regulations of HITECH and HIPPA by ensuring the integrity of the data contained in these systems (Shahmoradi & Habibi-Koolaee, 2016). It is important to note, though, that health information systems must also routinely backup their data and have data recovery methods in place to ensure that no data is lost or compromised as a result of natural or manmade disasters (Kruse & Smith, 2017).
3. Explain how a system will protect patient privacy.
The protection of patient privacy in line with the requirements of HITECH and HIPPA is an overarching responsibility of any organization maintaining a health information system (Kruse & Smith, 2017). For instance, Kruse and Smith (2017) advise that, “Confidentiality and security of protected health information which is included in a patient’s electronic health record, is addressed in HIPAA” (p. 127). The three pillars of security outlined in HIPAA, for instance, include (1) administrative safeguards, (2) physical safeguards, and (3) technical safeguards (Kruse & Smith,2017). According to Kruse and Smith (2017), “These three pillars are also known as the three security safeguard themes for healthcare. These themes range from techniques regarding the location of computers to the usage of firewall software to protect health information” (p. 127).
Some relevant examples of these types of safeguards that organizations can take to protect patient data stored in health information systems in ways that conform to the provisions of HITECH and HIPPA are set forth in Table 1 below.
Table 1
Safeguards for protecting patient data in health information systems
Safeguard type
Description
Access control
This is a technical safeguard that prevents or limits access to an electronic resource. The intent behind access control techniques is to limit access to only authorized parties. The healthcare facility collects, stores, and secures patients’ data, which is very sensitive. This safeguard can take the form of role-based access control, attribute-based access control, and identity-based access control. Role-based refers to a person’s role in the healthcare facility. For instance, when a provider begins working at a healthcare facility, he/she has access to patient data, but only the patient data for his/her patients. If this provider also serves on a certain committee in the hospital, then another set of privileges is created to enable access to committee resources. When other data is accessed, a log is created that is periodically audited. When a front-desk clerk begins working in a facility, he/she has no reason to access clinical data, but may need access to the administrative data such as address and phone number, depending on the role that the person plays in the organization. Other names for this are media controls, entity authentication, encryption, firewall, audit trails, virus checking, and packet filtering.
Physical access control
This is a technique that prevents or limits physical access to resources. The intent of this control is similar to the technical safeguard: It limits access to only authorized parties. A patient in a facility will not have access to any clinic or ward except the one he/she is seen in. A front-desk clerk in the optometry clinic will not typically need access to the emergency room, so his/her access card will not open those doors. A provider in a facility will not typically need access to the server room, so his/her access card will not unlock those doors. Other names for this are physical security, (some) workstation security, assigned security responsibility, media controls (access cards), and physical access control.
Administrative safeguards
These are techniques that are not entirely technical or physical, but may contain a piece of each. These safeguards typically take the form of policies, practices, and procedures in the facility to regularly check for vulnerabilities and continually improve the security posture of the organization. Other names for this control are risk analysis and management, system security evaluation, personnel chosen for certain roles, contingency, business continuity, and disaster recovery planning.
Source: Adapted from Kruse & Smith, 2017, p. 127
4. Description concerning how adopting a system will improve organizational efficiency and productivity by addressing the following factors to the organization
The standardized documentation that is used in health information systems improves efficiency and productivity for organizations in a number of ways, including (a) supporting more efficient work practices, (b) streamlining work processes, and (c) providing point-of-care decision support to promote better patient outcomes (Noah, 2017). In addition, health information systems have been shown to reduce waste of valuable organizational resources including human and capital resources (Shahmoradi & Habibi-Koolaee, 2016).
C. Description of four essential stakeholder roles needed to form an interdisciplinary team to work on a system implementation
An interdisciplinary team will be needed to encourage the adoption, acceptance, and usability of the health information system (Zhou & Watzlaf, 2017). The respective titles, roles and expertise of the four team members that will be used for this purpose and how their expertise will contribute to the success of the project are set forth in Table 2 below.
Table 2
Description of interdisciplinary team members’ title, role, expertise and how they will contribute to the success of the project
Title
Role
Expertise
Contribution
Project leader
Oversee and coordinate efforts by other team members
? Human resource management and compliance with HIPPA and HITECH
? Information technology background
Ensure that schedules and timelines are followed and collaboration between team members.
IT specialist
? Ensuring data quality; information assurance constructs of confidentiality, integrity, and data availability
? Design of mobile app, database, and web portal
Data integration and analysis
? Customization of the open-source electronic health record
Health information system design, development and management
Provides effective management of the health information system
Advanced practice nurses (two)
? Designing of well-being assessments
? Personalized interventions
? Providing feedback on electronic health records, mobile app, and web portal
Specialty expertise in various areas of clinical medicine
Provides clinical information and feedback needed by the IT specialist to optimize the health information system
Source: Adapted from Kruse & Smith, 2017
D. Discussion of plan for evaluating the success of the implementation of a system by incorporating two professional organization standards
Besides using aggregated data concerning the effectiveness of the interventions that are developed for the health information system , two relevant professional organization standards published by the National Association of Healthcare Quality (NAHQ) that can be used to evaluate the success of the implementation of a health information system are as follows:
1. Healthcare quality professionals understand that recipients of healthcare services are the most vulnerable stakeholders in the system. They treat recipients with empathy and respect, honoring their autonomy and privacy. They support positive health outcomes for healthcare recipients.
2. Healthcare quality professionals advocate for quality and safety regardless of healthcare setting. They facilitate seamless transitions of care among providers and provider groups. They support approaches to care that promote the right intervention to the right person at the right time and in the right setting (NAHQ code of ethics for healthcare quality, 2019).
In order to apply these professional organization standards in ways that can accurately evaluate the effectiveness of the health information system, it will be necessary to develop appropriate quantifiable metrics concerning the extent to which these standards are followed. Weights can be assigned along a range from 1 to 10 for any identified violations, with 1 representing the least serious and 10 the most serious violations. This data will be analyzed to determine where problems areas exist and what steps need to be taken in response.
Conclusion
The research was consistent in showing that mergers between two comparably sized organizations frequently fail to a lack of planning and follow-up oversight. Moreover, these challenges are exacerbated when there are disparate information systems involved. Further, organizations that maintain health information systems have a legal responsibility to comply with the provisions of the Health Information Technology for Economic and Clinical Health Act and the Health Insurance Portability and Accountability Act. Compliance with these laws and professional organization standards can be achieved by ensuring that there are appropriate and adequate administrative, physical and technical safeguards are in place. Finally, the research was also consistent in emphasizing that the improved delivery of nursing services and achieving optimal patient outcomes does not just happen when health information systems are used, but are rather the direct result of careful planning, implementation and administration of these systems.
References
Abouzhar, C. & Boerma, T. (2009, August). Health information systems: The foundations of public health. Bulletin of the World Health Organization, 83(8), 578-583.
Cresswell, K. & Aziz, S. (2013, May). Organizational issues in the implementation and adoption of health information technology innovations: An interpretative review. International Journal of Medical Informatics, 87(5), 73-86.
Drazen, E. L. (2006, February). Maximizing the benefits of health care information systems. Journal of Medical Systems, 10(1), 51-56.
Kruse, C. S. & Smith, D. (2017, July). Security techniques for the electronic health records. Journal of Medical Systems, 41(8), 127.
Kumar, V. (2011). Impact of health information systems on organizational health communication and behavior. The Internet Journal of Allied Health Sciences and Practice, 9(2), 37-44.
McGrail, K. M. & Black, C. (2009, August). Access to data in health information systems. Bulletin of the World Health Organization, 83(8), 563-569.
Murphy, M. L. (2019, March). Mastering accounting for business combinations: Mergers and acquisitions present challenges that finance can overcome by staying involved with the deal and preparing in advance of the closing. Journal of Accountancy, 227(3), 24-27.
NAHQ code of ethics for healthcare quality. (2019). National Association for Healthcare Quality. Retrieved from https://nahq.org/about/code-of-ethics.
Noah, C. (2017, Winter). Using an electronic health record to standardize documentation in an emergency observation unit. OJNI, 21, 37-39.
Nolen, L. B. & Braveman, P. (2009, August). Strengthening health information systems to address health equity challenges. Bulletin of the World Health Organization, 83(8), 597-602.
Reichertz, R. (2009, March-April). Health information systems: past, present and future. International Journal of Medical Informatics, 75(3-4), 268-281.
Shahmoradi, L. & Habibi-Koolaee, M. (2016, August). Integration of health information systems to promote health. Iranian Journal of Public Health, 45(8), 1096-1099.
Usability. (2019). HiMiss. Retrieved from https://www.himss.org/what-ehr-usability.
What is interoperability? (2019). HiMiss. Retrieved from https://www.himss.org/library/ interoperability-standards/what-is-interoperability.
Williams, T. (20090, August). Building health information systems in the context of national strategies for the development of statistics. Bulletin of the World Health Organization, 83(8), 564.
Zhou, L. & Watzlaf, V. (2017, Summer). A health information system for scalable and comprehensive assessment of well-being: A multidisciplinary team solution. Perspectives in Health Management. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/ PMC5559692/.