Health Information Systems: Benefits, Challenges & HIS

Advantages and Disadvantages of Health Information Systems

All health information systems (HIS) come with significant advantages and some disadvantages that must be considered in order to keep patients safe. A HIS is a system that captures and retains information and helps manage it. It can be used to send health information within an organization and outside of it. Several items within a healthcare organization have interoperability with the HIS, including but not limited to x-rays, IV pumps, laboratory data, and vital sign machines, all of which can be directly linked to the HIS. A major advantage of the HIS is that it makes patient information easy to find from multiple locations. Interoperability refers to the ability of various systems within the healthcare organization to share information and work together. For example, a patient's blood work results can be viewed inside the hospital and can also be accessed by a healthcare provider working remotely.

Another advantage of the HIS is that some documentation can be completed in real time, depending on how the system is configured. Providers can view a patient's medical records remotely rather than carrying a paper chart. Additionally, the ability to exchange patient information increases patient safety. For instance, a healthcare provider can review an abnormal x-ray from home and place orders to begin the needed treatment. Without the HIS, that provider would have to travel to the hospital and physically locate the x-ray, causing a delay in treatment.

There are six primary categories used to evaluate HIT usability:

1. Satisfaction
2. Errors
3. Memorability
4. Utility
5. Efficiency
6. Learnability

Whenever the HIS lacks in any of these six categories, the system will experience some form of disruption. In extreme cases, the system may be rejected altogether. To fully understand usability, it is essential to understand the working environment of healthcare clinicians. Clinicians interact with HIS in ways that are fundamentally different from how information workers use such systems.

HIS is designed to enhance the safety and efficiency of healthcare processes. Systems such as pervasive computing devices and electronic records have a demonstrated record of improving safety in the healthcare environment. However, research reveals that the design of such systems—especially user interface design—may be linked to increases in certain types of errors (Minshall, 2013). The main disadvantage with respect to usability is the time spent training clinicians to use the new system. Challenges associated with Complex Adaptive Systems may also contribute to resistance to change.

HIS Interoperability, Usability, and Scalability

HIMSS (Healthcare Information and Management Systems Society) defines interoperability as describing the extent to which devices and systems can exchange data and interpret that shared data (HIMSS, 2018; HIMSS, 2018b). For systems to become interoperable, they must be capable of exchanging data and presenting it in a manner that is understandable to the user.

In the healthcare industry, interoperability means the capacity for computer systems and software to share and transmit data from essential sources such as clinics, laboratories, medical practices, hospitals, and pharmacies. Data exchange standards and schemas should enable data sharing among clinicians, pharmacies, hospitals, patients, and labs regardless of application vendor. The collaborative functioning of HIS across and within organizational boundaries, with the objective of advancing efficiency in healthcare delivery, defines interoperability. HIS interoperability has three essential levels:

Foundation level: Through HIS interoperability, the exchange of data from one IT system to another receiving IT system is made possible, regardless of whether the receiving system can interpret the transmitted data.

Semantic: At this level, more than one system can exchange and apply information. Semantic interoperability makes use of structured data exchange and data codification, including vocabulary standards, so that the receiving IT system can interpret the information. This level enables electronic exchange of summarized patient information among clinicians and other authorized parties through EHR systems and related platforms, thereby improving efficacy, efficiency, safety, and quality of care.

Structural: Interoperability at this level defines the format or structure of exchanged data so that healthcare data moves uniformly from one system to another while preserving operational and clinical meaning. Structural interoperability defines data exchange syntax and ensures that data exchanged between IT systems is interpretable at the data field level.

Safety in healthcare transitions: Healthcare continuity is fundamental for patients, whether they have chronic conditions or acute situations involving multiple providers. Through interoperability, safety in healthcare transitions is enhanced, contributing to improved patient outcomes for all.

Enhanced efficiency: Healthcare interoperability is designed to help improve efficiency. When data is presented consistently regardless of its source, it becomes much easier for clinicians to quickly assess a situation and make treatment decisions.

The key disadvantage of HIS interoperability is the unwillingness of healthcare practitioners to adopt the systems. Quinn (2015) references research conducted in the United States in which 33% of healthcare practitioners reported using electronic health records to share patient information, while 40% used EHRs but did not transmit patient information through them. It appears that, despite recommendations, many healthcare practitioners are not yet ready to accept this change.

A patient who becomes ill while on vacation may not have all of their medical history available. Through ICT and HIS, it is possible to access patient information and provide care appropriately. ICT is an essential component of healthcare today, as HIS improve interoperability for clinicians by facilitating meaningful and seamless information exchange across and within diverse healthcare institutions at the point of care (Olaronke et al., 2014). As a result, healthcare providers gain timely access to appropriate patient information, enabling efficient management of patient health.

Interoperability in electronic HIS has remained a challenge. Among the major barriers to adoption and effective use of electronic HIS for information exchange is user interface design (Olaronke et al., 2014). Poorly designed interfaces, missing essential functional qualities, or mismatches between interface features and clinical tasks can propagate medical errors. This may also lead to declines in user satisfaction, reduced system performance, and inefficiencies in care, such as missing critical patient diagnosis details, making it harder for practitioners to effectively use EHR systems for patient care and information exchange (Olaronke et al., 2014).

A recent report stated that nearly half of medical practitioners using EHRs do not receive the patient information needed for care coordination. According to Quinn (2015), research led by Professor Chun-Ju Hsiao for the U.S. Department of Health and Human Services found that only 33% of healthcare practitioners use EHRs to electronically share patient information, and close to 40% use EHRs but fail to share patient information.

All of this relates to the Continuity of Care Document (CCD). Meaningful use is central to the issue: the CCD document must remain uniform throughout the entire EHR process (Quinn, 2015). Compatibility should be demonstrated throughout the system, although this is frequently not the case.

A substantial number of existing HIS involve heterogeneous systems and contend with scalability challenges. From a scalability perspective, cost is a pronounced barrier. Attempting to integrate many components incrementally can result in duplicated efforts, higher costs, and slower-than-needed progress toward the desired level of interoperability. This is why seamless data exchange across the healthcare HIS landscape remains a significant challenge today.

Gaining clinician acceptance and active use of the system presents many challenges as well. Incentive issues remain highly significant when it comes to HIS implementation and physician use. Wireless connectivity in hospital networks has become a fundamental part of the network environment. IT leaders at HIMSS indicate that current HIS demands are manageable; however, coming years will bring enhanced mobile devices and growth in the size of healthcare organizations. Managing and supporting environments that extend beyond the hospital compound is difficult. It is important to ensure that, as mobility grows, hospitals are also empowered to manage physical structures in their environment and the surrounding community.

The major drawback of HIS with respect to interoperability, scalability, compatibility, and usability is the unwillingness of practitioners to accept and actively use new HIS and EHR systems. For full integration to occur, healthcare practitioners must be willing to accept change and learn to apply complex adaptive systems (CAS) in their daily activities. Hospitals such as Johns Hopkins have rolled out a HIS Capacity Command Center (CCC), and early evaluation of the system is quite positive. However, the risk of technology and management errors can fundamentally disrupt hospital activities.

Despite these challenges, HIS offer many advantages. They help reduce human error, increase hospital efficiency, alleviate fatalities related to inefficiencies, and improve coordination and capacity. Some specific disadvantages include interoperability issues when different programs do not work well with each other, connectivity problems in areas with weak Wi-Fi, the risk of team members becoming more focused on the technology than on patient well-being, and medication errors caused by malfunctioning barcode scanners. Many of the advantages of a HIS can become disadvantages if the system is not functioning properly. A proper education plan is also essential for preventing HIS advantages from turning into liabilities.

Patient Care, Documentation, and Nursing Quality

All healthcare organizations aim to provide safe, high-quality patient care. Despite its disadvantages, the HIS greatly increases patient safety and care quality. Error reductions are achieved through a properly functioning HIS. One example is the scanning of patient and medication barcodes, which ensures the right medication, the right dose, the right route, and the right patient at the right time. Barcode scanning also ensures that medication administration is recorded in the patient's documentation. When working with any component of the HIS, nurses must be careful not to become so focused on the technology that they lose engagement with the patient.

A HIS can support high-quality nursing care by serving as a centralized, easily accessible repository of patient information. Nurses working with a HIS gain a clearer view of a patient's medical history rather than relying solely on patient-reported history, which is often incomplete. For example, a patient may not know when they had an EKG or recall the accurate results. With access to a HIS, a nurse can review past EKG records without waiting for medical records to be sent from another organization. HIS also makes it easy to trend blood sugar results and other lab values over time. If nurses did not have access to a HIS, they would have to wait for records to be located and transmitted, causing delays and reducing the quality of patient care.