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IntroductionI get a little upset when I see in articles that a particular individual/Organization has not been able to cost justify the implementation of a Healthcare Information System (HIS). This actually tells me more about that Individual and the Organization than it does the Healthcare Information System (HIS). Surveys of individuals with no or little experience in using electronic applications mean very little. Recently, "PriceWaterhouseCoopers" published an article "Will an investment in healthcare IT really pay off?" and added the question "how long will it take to realize a return." Well, it will not return any part of the investment if you only buy the "tool." The best "tool" in the world will not do anything unless you know how to use it.We are NOT trying to duplicate the "paper based system" or the current work flow. We are trying to make it more efficient and effective.
While it is acknowledged that clinicians may have difficulty in evaluating an individual HIS system's usability because they lack the skills, And we also cannot say that the clinician is any less intelligence than individuals in other industries that have been using Computer Applications for a good 20 years. It doesn't take a genius to recognized the benefits of a HIS concept. The HIS both helps to provide the ability to prevent bad care AND provide the ability to detect bad care. Return on Investments (ROI) have been low (reported) for the simple reason, Healthcare Organizations do not know how to use information. A car is little use to someone that does not know how to use it. It is not the technology; it is the use of the technology that is important. The benefits/Costs of a HIS should be defined as "potential" and be evaluated under ideal conditions and be evaluated at a defined levels of usage by professionals that know what they are doing. The fact that an individual provider does not "benefits" from a HIS means nothing if that provider does not know what they are doing. However, in most cases, this may not be the fault of the Provider but rather that of the Software company selling them the Healthcare Information System (HIS). From looking at the brochures that are available it does appear that many healthcare software vendors do not push the "real" advantages of their products in real terms.The evaluation of a HIS requires more than just keeping data on the patient (order entry, warnings and alerts or error prevention. The healthcare organization is a business and data is require to manage this organization. Investment payoff does not begin until the data is used to define, monitor and improvement the processes of the organization. You cannot separate the delivering of the product (providing healthcare) from the business processes. They are one and the same. A poorly ran organization will provide bad care! Data must be collected on every aspect of the organization and "managed." Many examples are given through this web site. Another problem with the evaluation of any healthcare process is that there are no good measures of the benefit/cost of an individual's health. As an example, what is the cost of a medication error? How do we measure it? What if the medication errors kills the patient? There is NO clear way to do a Cost-Benefit analysis in Healthcare because there is no way to measure the benefits/costs...But...it is not necessary...a true Healthcare Professional "knows" when it is the right thing to do... Even when a HIS system is evaluated it seems that almost never is the ability to "Analysis" patient care included as a benefit. The potential for data analysis and data mining is one of the most important benefits of the HIS. If no other benefit was listed, this one benefit would justly the cost of the HIS. This paper will not try to be an essay on "Management" but hopefully it will give the reader ideas that they can use to "follow-up" on the suggestions made in this web site.... Groups have attempted to “Justify Electronic medical” technology based on “improved outcomes.” Identifiable outcomes are only a small part of the benefits of an Electronic medical record. (2006 HIMSS Analytics, EMR Sophistication Correlates to Hospital Quality Data) General Benefits of a HIS You only have to read the article: Diagnosing Diagnosis Errors: Lessons from a Multi-institutional Collaborative Project to understand how important it is to have a good HIS. Medicine has become too complex to be practiced in isolation. Medicine no longer is limited to the practitioner who only reads his own notes (and he could be just as "natural" as he wanted to be. Medicine now depends on a number of stakeholders working in association or combining their efforts and knowledge. These stakeholders must be able to share their data and more importantly, the data must be capable of being analyzed. The goal is to improve the healthcare of the population. A good electronic medical record will improve healthcare, but not without imposing a certain number of standards and not without come controversy. The greatest advantage to an electronic system is the ability to organize data in any format that is desired, for any individual. Information can be immediately accessed, in any format, and only what is required. There is no need to "organize" data chronologically, by subject, even by patient. The user can select and sort in any way he needs the information presented. Information information can be tagged and much of the information can be automatically "audited" and warnings and alerts issued. What is important is that data is collected not how it is displayed on the screen. Screen views can easily be created for each individual user and his role in the organization....but all healthcare team members see the "same data". The "Individual Medical Health Record" is not one record but may consist of 1000's of individual records that can be selected, sorted, and viewed in any format that is beneficial to the user. Each Data "value" is related to every other data value. Administrative costs are related the amount of time spend in an encounter and related to the procedure that is performed. The number of terms will depend on what is require. Terms are presented to the use as "data-sets" that can be selected by clicking In the InHCc System there are limited "concepts" or "attributes" that can be selected for any "input" field. These data sets are normalized and do not contain synonyms nor values that are outside the limited domain. You cannot communicate between healthcare professionals, analysis data or perform data-mining on data-sets that contain synonyms...or use free text.
Integration of Administrative and Medical Data The Healthcare Information Management System should have the Administrative and Medical Modules Integration. You CANNOT MANAGEMENT if you do not know what are the costs of each medical process, and/or if you cannot monitor the staff. Short List The following are a short list of benefits from a good Healthcare Information System (HIS)
InHCc Specific
Common Reasons given not to use a HIS Responses here are based on using a "good" HIS, not one created at the local computer store. It also appears that organizations report a higher level of satisfaction when a "fully integrated" system is used.
"All primary care physicians in Sweden use electronic health records, while the rate is 99 percent in Finland and 95 percent in Denmark. Only 28 percent of primary care physicians in the United States use electronic health records." Now, the assumption would be that if physicians in these countries (which also have better healthcare statistics than the US) can use HIT, then why not the US? A more meaningful act by the government would be…”if you do not use it, you will not be reimbursed” I first want to discussion the reasons that providers commonly give for not using a HIS. Selection of System. As a sign of "good practice" [sic], one hospital let their staffers “vote for the winning company.” Unless these staffers knew a lot about Health Information Systems (HIS) (Technology, Design, etc.), I am not sure letting a group of individuals vote on a system was the way to do this! It has been standard practice for IT professionals to ask the user “what do you need,” again assuming that the users knew what was available and how to use the system. Since it is very likely that the potential users have never used a "real HIS, just what do you think they are going to say. It did not reduce my practice cost nor increase my revenue. But what about giving better healthcare to the patients. (see Physicians and other stakeholders) Who is going to pay for it? It seems that the provider has no problem with finding the money to buy new technology that he thinks will increase his revenues through marketing. However, when it comes to giving better care "he has a problem?" All businesses purchases tools to be used in their profession. What makes a healthcare professional think that he should be any different? Based on this report, a HIS system can return the investment within a very short period of time (if the user knows how to use it). And what about "better quality health care"... it that factored into the "cost saving" of the system? It takes to long or EHRs will slow me down: The attitude from many Physicians that it "takes too long" to enter the data, serves to tell me, that the physician is only thinking about himself....there are many other stakeholders in the Health Care Workflow and the benefits to these stakeholders must also be considered. Research also shows that while it may slow down the user in the beginning, in the long run, a HIS significantly reduces the total time of "paper" work. IT systems has failed in other communities. The Healthcare information system (HIS) is used by over 95 percent of the providers in the Nordic countries and patients will not attend a provider that does not make use of the HIS. Communities that have failed is an indication of management and not the system. A "Popularity Contest" is also no way to judge the "Success" of a HIS. A "low coverage and is less popular among staff" again tells me more about the Management's ability to bring about change than how good the HIS is. If good Change Management techniques are not in place, then NO system will be electronic system will be implemented. And generally, this is not dependent on how much money is spent for the system, or if their is participatory development process (which in many cases will lead to a worse system), or software appropriately tailored to the workflow. We must understand that Changes must come about and what was done in the past, is usually NOT a good reason to do them in the future. Change is hard. People do not want to make them! The Question ask of the employees "what you really liked or dislike about a HIM" assumes that they have the knowledge to compare "their" system with that of another. If the employee has only experiences with one system it is highly unlikely for them to make any type of comparisons. In is our experience, that the "better" the system, the more the employees complain. The reason is that a good HIS will force the healthcare professionals to do what they are supposed to do and many employees do not like being forced to perform any action in which they are not use to performing. Using a HIS makes me change the way I provide care. Yes, it does and in almost every case it is for the better. This is an argument for a HIS, not against. Many "New" HIS attempts to duplicate "exactly" the way things were done before. No information system has paid for themselves by "duplication of what exists." An electronic system" makes it possible to completely change the work patterns to provide better healthcare more efficiently. It is less "personal." It is our research results that patients want the provider to know about them and their history. They want the provider to be able to pull up information that they need instead of "guessing." In ever case, providers have been rated higher when they use a HIS. I can see less patients in a day. What is this a "speed contest?" I though the purpose was to give the patient good health care no matter how long it took and not to see how many patients could be seen in a day. This statement really worries me. However, if this statement refers to the fact that he actually has to examine a patient fully and ask the correct and full set or required questions so be it. Believe it or not, a patient has a perception of what is the "correct" care. Having a healthcare professional run into the room, ask a few questions, and then run out after writing a prescription is not the way to built up their clientele. Research has shown time and time again, that the provider that spends the most time with their patients is rated higher by their patients and is more like to return. I am not being paid to be a data entry clerk. The fact that the physician has to entry data is a fact....but then someone has to do it! Instead of a "data entry clerk" or a "coder" trying to guess what the physician intends (and making a mistake) it is faster, safer and more effective and efficient to have the physician record their own data if it must be recorded at all. I feel like I am being told what to do. Yes...and in most cases, following evidence based medicine will produce better outcomes than the physician doing what he wants to do. The flip side of this and is the "unstated" reason that most physicians do not want to use a HIS, is that their practices can be "monitored." Wither it is the fear of being sued for bad practices, losing patients, or losing their revenue. Starting in 2009, Medicare will not cover the costs of "preventable" conditions, mistakes and infections resulting from a hospital stay. It will not be too long before other payers follow. Many Current system allows for “entering of information that the healthcare professions "think is important" and not what is required base on base practices. If the Healthcare professional is wrong, then he has prejudice all future care for the individual. It is ok, for a Healthcare professional to say what he "thinks" (and noted that this is his subjective thoughts) but this does not imply that he should "delete" information because he doesn't think it is important. Patients are already learning a lot "before they see a physician" from the Internet. The physician is at a disadvantage. The physician cannot know or remember everything...and with a HIS, they have the opportunity to do their reference work immediately. I do not use all the "gadgets" that are offered. More HIS systems have implemented the requirements as outlined by the Certification Commission for Health Information Technology (CCHIT®)....and there is a reason. These "Gadgets" have proven to provide better health care and have created a more efficient and effective work flow. Our practice is still training our physicians or "getting physicians to attend training sessions scheduled outside of office hours is a challege. Many organizations comment that they had not reached 100 percent usage because they were still training and bringing physicians on board. It takes about 4 hours to train a physician to use a good system. Not attending classes that would help them give better care, tells me more about the physician than the HIS. “It's difficult to train personnel and still keep our clinic open and running.” No better time to learn the system than actually having to use it. Refer to the complaint above. "Loss of physician productivity after the EHR transition period. ah! but does it matter that the physician gives better healthcare and that there are other stakeholders involved that uses the system. "Already invested in powerful billing and practice management system" If the new system can improve healthcare and save money in management....it doesn't matter what the old system cost....dump it. "It is not Intuitive" Intuitive is what is learned…not what is right…
T The Medical Group Management Association
has recently reported "Electronic Health Records: Status, Needs and Lessons –
2011 Report Based on 2010 Data" results from a survey from which
suggested that some physician practices that have historically operated in a
fee-for-service environment are not yet convinced that adoption of EHRs makes
sense from a business perspective. This study found that 67.4 percent of medical
practices that currently use paper medical records feel that the expected loss
of productivity after the transition to an EHR system is a ‘significant’ or
‘very significant’ barrier to EHR implementation. | Looks like to me that the only thing these physicians are interested in is making money! Without being able to be monitored, they can "charge" what ever fee they want. I would think that these physicians are the first ones that need to be audited! What is also interesting about this survey, is not one single question was asked to determine if the physicians thought that a EHR system Improved Healthcare! Also See the following detail sections: Physicians and other stakeholders Benefits that are not real benefits Ok...we will now take a different approach and "disagree" with some of the stated benefits. Accumulates a large amount of data. Accumulating a "large amount of data" also is not a valid benefit unless that data is "clean." Research has shown that "diagnoses" may be wrong in as many as 65% of the cases. In one recent study in Hermosillo, Mexico, it was stated that only 23% of the death certificates were correct for infants (and this should be really easy!). A CEO of one of the largest Healthcare organizations in the US stated that their research showed that over 67% of diagnoses made by their doctors were "wrong". Now if the data is not correct going into the database how can we say either that any aggregation or analysis is correct? While having real-time data is a benefit, if that data is not used then that benefit goes to waste. Hospitals systems are complex but a HIS does not have to address every process that a hospital performs. The evaluation of an HIS system in a Hospital should be based on the applications that Are implemented. Trying to evaluate a HIS against "Everything" a organization performs is not practical and is just stupid. Also many systems are not designed for Health care but rather are "financial systems" with a few applications that collect visits, diagnoses, medications, and little else. Now these systems really do Not give any "Healthcare" benefits. So...in Summary...benefits are "Potential". Wither they occur or not is really dependent on "Management." We have seen many good HIS fail, not because the HIS was bad but because the Implementation and Management was bad!
Benefits This section is a compilation of the many benefits of a HIS system.
This site will have several sections of the Benefits of an Healthcare Information System. This section, the first section, will discuss the functions/benefits of any system and in general are derived from good Business practices. We continuously stress in this site that anything done with a computer can be done manually...it just takes a lot longer. It is how you use Information that is important. The Benefit section under our InHCc Healthcare Management Information System (InHCc HMIS) discus additional issues that the "InHCc HMIS" has that make our system unique...in today's market. We tried to avoid duplication. We have set our HMIS apart from the competition by emphasizing that it is a "Management" System. Not only is it an Information systems that collects and manipulate Data...but also we provide the Management. Information TechnologyInformation technology (IT) can transform how an organization achieves its mission. Moreover, it can enable radical and fundamental change in business processes. It is these changes that provide the benefits...not the duplication of existing processes. IT provides the tools to collect and manipulate data for the management of information, knowledge and processes. Public Health is also being reinvented with new challenges and opportunities in the core functions of assessment, policy development, and assurance of health services and protection of health for all. Detecting health events and assessing health status trends in populations in a timely, comprehensive, reliable, and cost-effective manner is only possible through IT. While we talk about Public Health as distinct from "Hospital" care...they are the same. A good healthcare organization should know their community in order to better market their product. InterestingHave you ever notices when reading the brochures of Healthcare IT companies that they seen to list the benefits of “their system” as
But then they never get around to telling you how their system does it! Looking at many of the "benefits" that are promulgated by healthcare information system vendors for their system makes you wonder why bother...and people wonder why they are not being used more in the Healthcare Industry? First, Health Information systems (HIS) have with rare exceptions paid for themselves by duplicating existing manual procedures....and as far as "communication" between healthcare professions...have these vendors really forgotten about the telephone, fax or email. And I have even seen one vendor list "save paper" as a reason to use their system! I will assume that this vendor does not consider the cost of IT equipment and training very important...and "greater safety"...If the healthcare worker did what they were suppose to do, there would be no need for emphasis on "greater safety".
Again, Information Systems are being used for the duplication of processes...not that it is not needed...but what we really need is the development of new processes. Important BenefitsThis section will analyze both the good and not so good benefits of a "Good" Health Information System. In addition, many of the benefits have their own complete section. A good EHR properly "designed" and "used" can transform healthcare processes in many ways. Data collected from many encounters with the client constitute the raw material of research and otherwise unattainable intelligence about the health status of large groups of people and what's succeeding or failing in efforts to deliver care more effectively (CCHIT)
Not So Important BenefitsIf we are going to discuss the Benefits in this section, it is also important to discuss what are NOT important Benefits...actually there are too many to discuss!Do things the way that Physicians are use to doing them. The first of these "NOT so Important Benefits" is the designing of a HIS system in order to "Do things the way the Physicians are use to doing". First, there are no two physicians that practice the same way...and Secondly, from examining the processes of Physicians...they certain are not efficient or effective when it comes to providing for good healthcare for their clients... No two physicians think the same way and what doctors think depends on where they went to school, who their professors were, the culture where they first practices, and how lazy they are. And it is especially true that the way physician practice in the US is different that England and different than in Cuba. It is also true that most physicians today have never used an Health management system and an electronic system is NOT a paper based system. Doing things the way they have always been done is not a good use to any IT system. What is important is designing "Efficient" and "Effective" process. Change. The greatest Barrier to the Adoption of a IT system, is NOT the costs of the system but rather the challenge of Change. People do not like doing things differently, making changes, and they certainly do not like being "Monitored and Evaluated"! "It is disruptive"....Well, maybe it should be disruptive if the current processes need to be changed to make them more efficient and effective. Being disruptive is NEVER a reason not to make changes. Physician Order Entry (CPOE). The Physician Order Entry (CPOE) system is described as improving the accuracy of orders and provides clinical decision support so that most common medical errors are avoided. Let up look at this closely...."the accuracy of orders"...now just exactly what does this mean..."accurate" ...Does it mean "better" or "efficient or effective"...Yes, giving the order as prescribed by the physician is important, but also having the physician order the right treatments. Unless Protocols are used, this cannot be assured. |
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