Optimizing Merged Health Information Systems: HIS Guide

Introduction

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 difficulties are further compounded when sophisticated information systems are 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 Health Insurance Portability and Accountability Act (HIPAA) security and privacy regulatory requirements.

To this end, the paper provides a discussion and analysis of health information systems, a description of how a system will affect patient care and documentation, and an explanation of how using a system to access information will affect the quality and delivery of nursing care and patient outcomes. This is followed by a discussion of how a system will benefit the merged organization. Finally, four essential stakeholder roles needed to form an interdisciplinary team for system implementation are described, and a plan for evaluating implementation success incorporating two professional organization standards is presented.

Analysis of Health Information Systems

Advantages and Disadvantages

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 common features related to improving the ability of healthcare organizations to more effectively manage patient-related data, identify problem areas, and pursue opportunities for improvement. 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 systems include their complexity and the piecemeal fashion in which they are frequently developed (Cresswell & Aziz, 2013). Moreover, no conceptual framework is universally 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 interrelated. In this regard, Cresswell and Aziz (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 interrelated, 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).

Usability, Interoperability, Scalability, and Compatibility

The full range of advantages that accrue from health information systems can only be achieved by ensuring they are usable, scalable, interoperable, and compatible. 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). It requires a significant amount of time to realize these advantages, and organizational leaders should be prepared for setbacks and mistakes along the way.

At present, the usability of many health information systems remains suboptimal due to the manner in which data is stored and the difficulties frequently experienced in attempting to access it (Abouzhar, 2009). Similarly, 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, ensuring the compatibility of two merged health information systems is vitally important in order to optimize their combined operations. In the past, compatibility between disparate systems was somewhat easier to achieve because data typically consisted of alphanumeric entries only; however, the transition from paper-based documentation to digital storage has been marked by the addition of graphic images and other data types that may not be easily shared between systems (Reichertz, 2009), making compatibility a fundamental requirement for success.

One strategy that can help ensure the interoperability and compatibility of disparate health information systems is the use of middleware. 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 on patient care and documentation.

Impact on Patient Care, Documentation, and Nursing Outcomes

Effect on Patient Care and Documentation

Properly implemented and administered, health information systems affect patient care in a number of positive ways. 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 paper-based documentation through the use of electronic medical records and electronic health records (Kumar, 2010).

Effect on Quality and Delivery of Nursing Care and Patient Outcomes

The main advantages of health information systems are only achievable when these systems are properly implemented and administered. When this has been accomplished, 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 nursing care delivery naturally have a corresponding positive impact on patient outcomes, but the process is not automatic and requires careful planning and diligent oversight to ensure optimal results (Drazen, 2006).

It is also important to note that there are significant operational and organizational issues involved in the efficient access to healthcare data that can adversely affect the quality and delivery of nursing care and patient outcomes. 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 healthcare organizations is involved, since there may be conflicting procedures and protocols inherent in their respective health information systems. Consequently, the merged organization must work to minimize the constraints involved in merging disparate systems while simultaneously 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, health information systems affect the quality of nursing care and patient outcomes in additional ways. Although there have been some trends toward including qualitative data in health information systems, the vast majority of data used by these systems are quantitative. These aggregated quantitative data can help nursing professionals discern trends and patterns efficiently. 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).

Achieving 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 can access data in an intuitive rather than arcane fashion. 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 that data are unavailable or nonexistent, but rather that the interface with the health information system may be sufficiently complex as to require an inordinate amount of familiarity and training. This constraint not only adversely affects the delivery of timely, high-quality nursing care—it can also be highly costly for healthcare organizations in terms of overall system 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, health information systems can benefit organizations in a number of specific ways.

Conclusion

The research was consistent in showing that mergers between two comparably sized organizations frequently fail due to a lack of planning and follow-up oversight. Moreover, these challenges are exacerbated when disparate information systems are involved. 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 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 the achievement of optimal patient outcomes do not occur automatically when health information systems are adopted, but are rather the direct result of careful planning, implementation, and administration of these systems.

References

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