Principles of Health Informatics

Abstract

This chapter provides an overview of Health Informatics’ evolution as a discipline and specialty within the healthcare industry. It describes basic informatics definitions, the history of the field, the different types of informatics and informatics theories, health information exchange and interoperability, and the different categories of health information systems. The authors discuss the key players and the Health Informatics professional/Health Informaticians’ role as part of the healthcare team and the importance of the multidisciplinary educational background and collaborations in implementing successful Health IT initiatives. The final section describes the role and challenges of emerging technologies and their potential to play a transformative role in the healthcare system, with a final discussion on the importance of interprofessional training for sustainable change.

Appendix: Answers to Review Questions

• 1. What is the major characteristic of Biomedical and Health Informatics?

  Biomedical and Health Informatics are interdisciplinary, scientific fields that study and pursue the practical uses of biomedical data, information, and knowledge for scientific inquiry, problem-solving, and decision making, motivated by efforts to improve human health. Biomedical and Health Informatics apply computer and information science principles to the advancement of life sciences research, health professions education, public health, and patient care. They build bridges to healthy communities by establishing informatics as a bridge to accelerate the translation of discoveries to improve individual patients’ health and translate the science of healthcare delivery for better population health.

• 2. How health informaticians use information technology to process data into information and knowledge?

  Health Informaticians use information technology, such as computers, to retrieve information from the data and then generate knowledge. While computers are used to store data, health informaticians find meaning in the data by using methods and computer-generated models to extract the knowledge from information.

• 3. Use each stage of Lewin’s Change Theory to explain the transition from paper-based records to an EMR in a small dental clinic.

  The three stages of Lewin’s Change Theory are Unfreezing, Cognitive, and Refreezing.

  Unfreezing : During this stage, the benefits that a basic digital charting program can provide to the dental practice should be highlighted (Examples: Improved quality and patient safety; Increased security; Reduced paperwork and storage issues; Increased efficiency and productivity; Reduced operational costs such as transcription services and overtime labor; E-prescribing and clinical documentation capabilities; More efficient patient billing process; Increased accuracy, etc.).

  Cognitive : The users would need to be convinced that the new approach is safer and better than the old and have a change in behavior to give space for the new process, which is evident by learning how to use the EMR.

  Refreezing : The leadership and implementation team should offer rewards and support to those transitioning from the paper-based system to the EMR.

• 4. Which type of health information exchange should be used to send data to public health organizations? Directed Exchange or Consumer-Mediated Exchange?

  Directed Exchange is being used to send immunization data to public health organizations or report quality measures to The Centers for Medicare & Medicaid Services (CMS).

• 5. What are the ethical concerns associated with the use of wearable devices?

  The ethical concerns associated with the use of wearable devices include disclosure of data collection, the selling of data, manipulation of insurance premiums, different ways of interpreting data, and worries about data loss due to poor cybersecurity.

Case Study: Electronic Medical Record Implementation at Liberty Health

(Conceptualized by graduate-level Health Informatics students at the University of Southern Indiana)

Liberty Health was lagging in technological advances. The not-for-profit business model was not structured to purchase new technology or software programs and had no workforce or time to implement an EMR system. The practice sees about 30 patients a day from ages 2 to 75. The majority of patients live below the poverty level. These patients consume a large share of American health care services, which has increased the demand on the healthcare system for this population. One of the significant issues Liberty Healthcare is experiencing is providing a wide range of skills and services to meet this population’s future needs.

Manual record keeping has caused significant problems and threatened to decrease the clinic’s efficiency in healthcare delivery and compromise care delivery. In the past, Liberty Health performed all documentation on paper, including patient information, details of each patient’s visit, vitals, and patient history. The practice also utilized other billing services from private insurers. The practice began seeing a trend of mistakes in the paperwork as well as inefficient work practices. Also, patients wanted easier access to their health information, and this became time-consuming for employees. Duplication of procedures to replace lost or missing test results jeopardized patients’ health and left the practice at risk of adverse medical events. Duplication of unnecessary procedures also contributed to delayed results and created potentially harmful situations for patients; it was also a needless expense. Liberty Health attempted numerous ways to improve its workflow process, but unfortunately, the efforts were not successful, and the problems were multiplying. YourCare Consulting was asked to help Liberty Health address the following:

• Internal assessment of the current workflow of the practice

• Recommend an EMR that best suits the needs of the healthcare facility

• Develop best practices and plans on how to implement the EMR in the most efficient way

Workflow Requirements

Patient Appointment Workflow

It is crucial to have an effective workflow process to increase productivity and understand protocols and tactical procedures. This allows team members involved to quickly comprehend what is expected and needed to complete a job successfully. Figure 2.6 illustrates the workflow process that will be utilized with the implementation of the new EMR. This workflow, consisting of approximately ten steps in the process, would benefit from checking-in a patient and placing them in an exam room because it records every step and saves documentation for future appointments. A nurse or doctor can recall the patient’s medical history with a few clicks. This improves patients’ flow during the day and, if used correctly, could increase the number of patients seen daily.

Fig. 2.6

Workflow for patient appointment—Liberty Health

The main goal of implementing new technology in a small to medium size practice is to provide complete and accurate records of patient information. This ensures the quality and safety of patient care. Nevertheless, providers may have concerns about how computer-driven systems will affect their role as caregivers or if using such a system will impact the patient-provider relationship. Providers may also be concerned about challenges while adapting to new technology. One of the most significant concerns surrounding the EMR is whether it will positively or negatively affect patient satisfaction. Patients may be hesitant at the beginning of the transition due to data confidentiality. However, formal evaluations of EMR rarely address patients’ views of the quality of care after implementation. Measurement of patient satisfaction is an essential tool for research for any size organization. Administration and planning to ensure the practice receive the best feedback after implementation is vital.

Providers and healthcare professionals will need time to become familiar with the selected EMR system properly. The extent to which the chosen EMR system can operate, exchange, and interpret healthcare data is critical for successful implementation. Liberty Health desires an EMR system that can work within and across the boundaries of the healthcare organization. Adopting an EMR system could reduce rework by healthcare professionals and improve the exchange of new medical knowledge among physicians throughout the practice and other entities. Interoperability is essential because it decreases the cost of electronic medical records and makes it feasible for an individual or small group of providers to acquire and adopt these systems.

Implementing an EMR Solution

The implementation of an EMR solution will enable clinical staff to conduct cost/benefit analyses, trend clinical information to improve care and financial information to contain costs, target clinical quality indicators, and retrospectively analyze information for strategic and tactical decision making [42, 43]. The EMR will generate a unique patient identifier, thereby reducing the potential for duplicate patient records. Care coordination has improved as a result of the EMR system. Legible, accurate, timely information that can be simultaneously accessed allows the clinicians to work more efficiently as a team.

Liberty Health’s implementation of an EMR system would potentially solve the major issues with their paper system. These issues have impacted the practice’s ability to bill for services properly and therefore, has impeded its revenue stream. The proper EMR will increase revenue and decrease billing time. Reducing medical errors will help the practice provide better care to patients and decrease the risk of a serious complication due to a medical error. Also, with the implementation of the EMR system, patients will be able to look at their medical history and current course of treatment online. Overall, the implementation of an EMR system will significantly benefit Liberty Health and the benefits listed below will far outweigh the cost.

As a health care practice, it is crucial to manage risks and stay ahead of unexpected challenges that might arise; the recommended EMR solution provides those tools. Managing patient and staff risk is an important aspect of quality care and the recommended EMR solution will continuously allow focus on quality improvements. It will also provide management of incident reports by collecting information and records data for analysis. Having access to such reports will allow for high compliance monitoring resulting in improved quality care. To ensure that the practice is compliant, the staff and care team need to be informed regularly. By implementing the recommended EMR solution, the practice will have access to various learning and teaching resources.

Documentation is vital but often a demanding task when managing patient risk. There are specific documentation requirements that must be followed. Accurate filing, documenting, and collecting patient information is more straightforward with the proposed EMR solution.

EMR Vendor Selection

An EMR that is user friendly and has the ability to operate efficiently and effectively is vital. Usability can pose a barrier toward implementation; thus, all staff must learn how to use EMR effectively. Lack of technical training and support from vendors has been reported as a barrier to the adoption of EMRs in the past by providers; therefore, it is vital to choose a vendor that offers outstanding, extensive training programs and allows for a pilot demonstration before implementation. To prevent gaps in data transfers and losses, all systems should be password-protected and connected to a secure server that can protect and improve the organization’s internal processes.

The following questions can be used to identify the desired characteristics of vendors

• What is the market share this vendor maintains?

• What is the vendor’s reputation?

• How long has the vendor been around?

• Does the vendor have CCHIT certification?

• Does the vendor offer any additional services (i.e., web design)?

• Does the vendor provide functionality updates for each stage of meaningful use?

• Does the vendor provide support in helping to obtain the maximum incentive payment?

In conclusion, YourCare Consulting recommends that Liberty Health purchase an EMR system that aligns with the practice needs, which will result in raising revenues, improving patient care, enhancing documentation, and providing easier access to data. Usability is a critical factor, and choosing an EMR system that is integrated with a practice management system made by the same vendor would be most beneficial.

The most important benefit Liberty Health would see after the implementation of an EMR would be the reduction of errors in the workplace. Issues with misplaced records, errors because of illegible handwriting, and other staff mistakes would be eliminated with an Electronic Medical Records program. EMR would also expedite testing processes, reduce the number of errors in diagnostic testing, and eliminate duplicate testing. The need for staff to assemble, file, and retrieve charts would also be eliminated, creating a more efficient use of staff time.

Another issue EMR would address is low patient satisfaction scores in terms of patients accessing medical information. Currently, patients call the practice to request information, and a staff member searches through paper records for that information. Staff is pulled away from other tasks to retrieve the information; also, the information may not even be current because of the time it takes to add information to paper files. After implementing the EMR system, patients will be able to seamlessly access their medical records online or via an app on mobile phones, recent lab tests, and prescriptions. Liberty Health should expect to see an increase in patient satisfaction scores. Because patients will feel more involved in their own care, overall, patients’ health will likely improve and reduce readmissions or repeat visits to the healthcare facility.