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IntroductionI offer feel the need to express my views (which I have done throughout this web site) on something that I have recently read or heard concerning any of a number of topics. These pages...until I have time to turn this into a real Blog...will be my platform...and I am not always current with what everyone else is thinking...In fact, people tell me that I am very opinionated....and this is a long section. This page will present the general philosophy of this site. InHCc feels that it is important to give a hint of the direction that we are going. This project will be developed with the philosophy that without a good Integrated Health Care Management and Information systems (HMIS) that is capable of operating at all levels of service; no other objectives can be met. Complex health services and solutions can only be provided to clients who need them at the time they need them if those managing and delivering the services have access to reliable, well-structured and timely information. In all areas of Health Care Policy Reform, the attention is on the measurability and comparability of results. Administrators have become more aware of the need for information for policy formulation, implementation and management. Without sufficient and quality data, without effective and proper use of data, and without properly trained personnel, this measurability and comparability cannot be implemented…and…without the measurability and comparability of results, management cannot take place. The growing complexity of healthcare services means that managers need greater access to information and better decision-making tools.
Surveys have shown that existing management solutions do not completely address the issues of the accuracy and reliable of data, its time-variant nature, its usefulness to management, its security, or its cost. Providing information and collaboration are core values in Health Care Services. Health care organizations at all levels need the means to manage their resources and put the right information in the hands of the right decision maker at the right time so that they can make informed decisions quickly and act promptly. Without information, indicators can not be measured, targeted population can not be identified, health care services can not be evaluated, and processes can not be made more efficient. From the viewpoint of the increasing healthcare costs, the introduction of computer systems is looked to as the "salvation of the health care system." However, it must be remember that the computer system is only the tool. If we do not learn how to use that tool, we could cause more damage than good. What do we mean by Healthcare?It is easy to define what is the "best" health care (usually the most expensive) but it is a political decision based on social values that ultimately determines what is delivered. The Declaration of Alma-Ata was adopted at the International Conference on Primary Health Care, Alma-Ata, 6-12 September 1978. It was the first international declaration underlining the importance of primary care The primary health care approach has since then been accepted by member countries of WHO as the key to achieving the goal of ‘Health for All’. The Conference strongly reaffirms that health, is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector In 1977, the World Health Assembly decided that the major social goal of governments and WHO should be the attainment by all people of the world, "Health for All" by the year 2000 of a level of health that would permit them to lead a socially and economically productive life. In 1981, the Assembly unanimously adopted a Global Strategy for by the Year 2000. This was the birth of the "Health for All" movement. According to WHO, "'Health for All' does not mean an end to disease and disability, or that doctors and nurses will care for everyone. It means that resources for health are evenly distributed and that essential health care is accessible to everyone. It means that health begins at home, in schools, and at the workplace, and that people use better approaches for preventing illness and alleviating unavoidable disease and disability. It means that people recognize that ill-health is not inevitable and that they can shape their own lives and the lives of their families, free from the avoidable burden of disease." Let us look at this a little closer...What this clearly says is that "Health" is more than just an end to disease and disability. A level of Health should lead to a health of "health" that would permit them to lead a socially and economically productive life. It also clearly says that it should be the goal of governments. A very big mandate. But what it does not say is:
From our analysis, people in emerging and developing countries have different healthcare issues than those of the more advance countries. We feel that approximately 70% of the illnesses/problems come from social issues...sufficient quality food, clean water, sanitation, wars, and just plain bad government. Our InHCc HMIS is heavily focused on the social and economic aspects of the client and his family. The InHCc HMIS places each individual into his family unit. All data is available both on the individual and the Household.
Healthcare is a Complicated BusinessThe descriptions and definitions given above makes healthcare one of the most complex businesses. It deals with everything that the human is...or can be. While it may be impossible to descript the totally of this complex business, parts of it is can be descript and events are not entirely unpredictable. In fact, many events of humans are totally predictable such as when the birth of a baby will occurred and the pathway of many diseases. While procedures use to treat an individual's problems are constantly changing, the types of problems themselves change only very slowly. Computers and Information systems can provide data....but these devices are "Tools"...it is the people that must make use of the data. Over and Over again in this web site will we stress the need for good managers...
We at InHCc believe that Healthcare Delivery is not any different that the delivery of any of goods and services (it requires good "business" procedures and monitoring and control) we are not going to step into the discussion of wither Healthcare is or is not a basic human right or wither it should be delivered by the Government or Privately or who should pay for it....No matter who is responsible for delivering health care or paying for it....the process of Delivering Healthcare is the same...You deliver it in the most efficient and effective way possible. Today in all areas of health care applications the attention is on the measurability and comparability of results. Administrators have become more aware of the need for information for policy formulation, implementation and monitoring (WHO 1996). Without sufficient and quality data, without effective and proper use of data, and without the properly trained personnel, this measurability and comparability cannot be implemented.
Surveys
have shown that Management Information Systems (MIS) in vary considerably from one country to another. Most of these countries had to start from the very beginning or, worst
yet, piece together parts of what they already had. Systems have tended to grow
independently, on a small scale and not according to any plan. No one knew what
the other departments were doing. This has led to costly and time-consuming
duplication of work and redundancy of data. In many cases each department had
its own “IS” personnel. In the past, each data piece was collected, summarized
and passed up the hierarchy to the next level. In this hierarchical
system each unit, department, or division had his or her special information
needs. This lead to separate data files, separate programs, separate personnel
and separate “systems” and only what summary information was passed up the
system was available to the next level. In many incidents, personnel “made
up” the data just to please the higher authorities. This leads to
inappropriate allocation due to incorrect and misleading data supplied for use.
Even when a particular “piece” of the MIS was developed, it was almost
impossible to integrate it with other parts developed elsewhere independent of
the others. Absence of standards
made it impossible to compare information within an organization much less
across national or international boundaries.
As health planning develops from a single purpose entity towards an integrated organization, information systems need to be developed so managers can have the flexibility they need to make informed decisions. Healthcare Information System (HIS) Requirements
Sometimes it does pay to "reinvent the wheel." Most standards and procedures where developed many years ago (ICD-6 codes were first published in 1949). A electronic record is as different as the horse and buggy to that of the car. They just do not work the same. In many cases, it may be helpful to go outside the healthcare industry to discover new items and workflows. Using the "same people" to "come up with new ideas" usually does not work. Attempting to consolidate all existing codes, use the previous codes to make it easy to earn...just will not work. Standards have been developed by individuals with no knowledge of electronic technology or what can be accomplished. Even SNOMED started by combining every code set they could. Combining many bad code sets makes it even worse. Again, these standards are trying to duplicate what exists and not create something new and better. Duplication of notes (such as physicians and nursing notes) is a waste of time and is dangerous in the since that physicians and nurses fail to read each others notes. Instead of "improving on" and "correcting"...these groups carry on like the other groups do not exist. 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 There is never a need to "Search" for the correct term! Items of InterestTraining Training is the most important aspect of any new adventure. Try to save on training because they are "too busy" will lead in the long run to increase costs and minimum results. The important point in training is not "how to do it" but rather "why they need to do it." Teach them "why" and they will easily learn the "how".
References and Links
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