Health Information Systems Fundamentals

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Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
CHAPTER 1
Health Information Systems
Fundamentals
LEARNING OBJECTIVES
By the end of this chapter, the student will be able to:
Describe the importance of fundamentals in the Health
Information Systems (HIS) discipline and why
fundamentals exist.
Understand key HIS concepts and why they are
important.
Describe the HIS Model and its use in understanding
HIS.
Define key HIS terminology and how that term fits with
others in the HIS construct.
Explain the various categories and types of systems
used in HIS.
Describe players in HIS, including a variety of HIS end
users, customers, participants, and professionals
involved in HIS.
Illuminate the roles and responsibilities of HIS
professionals.
Describe the basics of HIS history to assist in
comprehending the unique development pathways that
have brought us to today’s state of HIS in the U.S.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
T
â–¶ Introduction
he topic of HIS is a vast, complex story involving technology,
data, people, and processes. A well-architected and
orchestrated HIS is a thing of beauty, helpful to those who use it to
do their work more effectively and capable of inspiring with new
capabilities to pull us forward into better ways of doing things and
improved outcomes. To even begin to tell this story, a common
lexicon and consistency in principles, terminology, and methods
are required. Often, professionals well versed in their respective
disciplines, such as clinical care, financial management, or
research, who are well-meaning in intent and committed to
collaboration, fail to understand one another as they discuss and
attempt to tackle HIS goals, issues, and projects. This struggle
plagues many HIS projects and initiatives, and the primary reason
why the dialogue gets off on the wrong foot is due to an inability to
truly communicate, since core principles and ideas are not shared
and agreed upon. Thus, this chapter is devoted to fundamentals
—those ideas, methods, practices, and principles that are so basic
to HIS that more advanced, elegant, and complex HIS initiatives
and capabilities cannot be imagined or discussed, let alone
achieved, without complete agreement on these basic building
blocks from the beginning.
An analogy that makes this point well is the game of baseball. Key
skills of throwing, catching, and hitting the baseball with a bat are
the first things a beginner is taught before trying to learn the rules
of the game, the various positions on a team, and certainly before
attempting to compete against other teams or manage a team and
a game, with winning and losing at stake. These fundamental skills
are not just taught to new learners of the game, but they are also
relentlessly and forever practiced for the entire career of any
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
player, whether that career ends after Little League or after a 20-
year professional baseball career. Those skills—throwing,
catching, and hitting—are excellent examples of fundamentals, the
essential building blocks of playing the game of baseball. Why are
they called the fundamentals? There are numerous reasons, but
here are a few. Can you imagine a baseball team in which every
player threw, caught, and hit the ball differently, using different
methods and random styles? I doubt the team would be very
good. Also, mistakes happen—in baseball, these are called errors.
When an otherwise talented player makes an error, the team fails
to get the out, make the base, or score the run. Or that player’s
team fails to defend and the other team scores, steals a base,
wins. So, errors are to be avoided at all cost. When this talented
player makes an error, another thing happens—the otherwise
successful player is stunned and loses confidence, and the entire
team can be thrown off kilter. For one error. How important it is to
remember that none of us is perfect, and life is not perfect. We all
must accept the fact that errors, mistakes, or random occurrences
will happen when we are not expecting them. So, what do we do?
Go back to fundamentals. Fundamentals are important because
when an error occurs, and everyone makes errors from time to
time, the way the player gets back on track, stems the problem for
the team, and regains their confidence is by going back to the
fundamentals—the specific proven ways, best practices,
standards, and time-honored, honed, and most basic skills
according to their training. Then, they can move forward again with
confidence.
In HIS, fundamentals are just as important. Key skills, training,
methods, standards, and principles must guide the planning,
design, testing, implementation, maintenance, and enhancement
of HIS and their architectures for healthcare organizations,
whether used for clinical, business, or analytical purposes. Let’s
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
get started with the fundamentals that all professionals involved in
HIS activities and initiatives must share.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
â–¶ HIS Fundamentals
This text is designed to walk through HIS principles and timehonored methods that yield predictable results. These areas of
knowledge cover HIS strategic planning, governance, and policies;
managing HIS including system selection and change;
implementing HIS; harvesting the yield from HIS including data
management, business and clinical intelligence (BI/CI), analytics,
and creating new knowledge; HIS regulatory compliance and risk
management; and HIS standards, governance, and policy. Let’s
take these one at a time.
HIS Strategic Planning
The business plan of a healthcare organization aligns the future
state of the healthcare organization to its market and external
environment, and adapts the organization to the complex changing
needs of the population it services and the providers who work
within it. The HIS Strategic Plan thus aligns the HIS and
technologies to these strategic business directions and initiatives
of the organization, not only to support, but in many cases also to
enable the strategies to be accomplished. A good HIS strategy
insists upon the definition of a desired future state of an
organization, 5, 10, 15, 20 years hence. This future template and
the roadmap that leads the organization along the way to it contain
the ingredients for defining and organizing the HIS strategies and
initiatives needed to motivate and propel the organization from
where it is to that desired future state as an organization. The HIS
Strategic Plan produces an actionable, balanced portfolio of
systems that support and enable the clinical, business and
administrative, and connectivity needs and activities of the
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
organization as it engages with its community of patients and
providers.
Trying to select software systems in the absence of a HIS
Strategic Plan is akin to shopping without a list—you tend to buy
things that might satisfy an impulse or a perceived need but may
not be affordable or meet your requirements once you get them
home. Buying HIS to fulfill a balanced HIS portfolio of systems for
your organization without an HIS Strategic Plan grounded in the
organization’s strategic business plan would be akin to attempting
to build a house without a plan, budget, or blueprint. Before any
activity regarding HIS takes place, the HIS Strategic Plan must be
developed for any type of healthcare organization—this principle
applies not just to hospitals or health systems but also to provider
practices of all types and sizes, to home health organizations,
hospice, community health centers, free clinics, imaging centers,
and outpatient surgery centers. To do otherwise is a recipe for
disappointment, if not disaster for the organization. Concepts,
Principles, and Methods for HIS strategic planning are covered in
detail in subsequent chapters (Chapters 2–4).
Governance
Governance in healthcare organizations includes the use of
consistent management methods, policies, decision rights, and
processes across all units and departments. For HIS, governance
often translates to structural methods including steering
committees, standards, auditability, and consistent policies and
processes for decision making and accountabilities for
expenditures. While these structural and oft-times top-down
methods are part of good governance, enlightened approaches
also include a culture of ethics, integrity, and personal
accountability, controls within which those purchasing, using, and
accessing technology do so within understood methods that allow
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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for greater accessibility to systems, technology, data, and
information (Meyer, 2005). Good HIS governance assures sound
guidance, interdisciplinary communication and collaboration,
oversight, accountability, and reinforcement of organizational HIS
policies and procedures. This includes detailing the rules and
practices regarding HIS strategic planning, decision making,
management, setting priorities, resource allocation, budgeting, key
performance indicator definition, dialogue, and other processes
intended to fairly and properly steward HIS resources in the
context of the overarching needs and capacity of the organization.
Good governance requires regular, face-to-face interaction,
grounded in the general policies and practices of the organization
and consistent with the organization’s overarching governance
philosophy, starting with the Board of Trustees on down. Many
organizations tend to avoid or isolate HIS policies, standards, and
decision making: this is a mistake. HIS must be mainstreamed
with the organization’s activities and oversight overall; in other
words, HIS governance should be integrated with organizational
governance. In 2013, HIS expenditures comprised 3.06 percent of
overall expenditures for healthcare organizations (leading up to
that, expenditures in 2012 had responded to the HITECH
Meaningful Use program, yielding an average of 2.74 percent of
the total operating expenses spent on information technology (IT)
in 2012, up from 2.39 percent in 2011 and 2.40 percent in 2010)
(Becker’s Hospital Review, 2014b).
In 2018, HIS expenditures rose to 3 percent of the gross revenues
of a healthcare organization, an increase of 8.8 percent in 2018
over 2017, compared to increases of about 6 percent in IT
expenditures in all industries in the U.S. during the same time
period (Kass & Bazzoli, 2017). So the stakes are high for making
sure these mission-critical expenditures are properly handled.
Governance of anything that is substantial or strategic is
everyone’s business in the organization, not just the concern of
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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the IT department or an isolated set of processes and policies.
Governed and managed well, HIS is essential to the organization
successfully navigating its future successes and challenges. This
paves the way for a bright and predictable future as the healthcare
organization adapts to market conditions over time, delivers
consistently high-quality care, and meets its business and fiduciary
responsibilities to its constituents. Good governance involves the
give-and-take of feedback and accountability, which requires the
efforts, education, awareness, and energies of all stakeholders
including professionals and patients. HIS governance establishes
and oversees the HIS Steering Committee for the organization,
establishing plans, priorities, policies, procedures, and key metrics
for measuring HIS activities and performance. Details and
methods for HIS governance are covered in Chapter 12.
Managing HIS
Managing HIS involves the techniques and activities deployed to
achieve HIS goals and objectives in a healthcare organization.
These HIS management methods include generally accepted
methods and standards for planning, implementing, supporting,
and managing core HIS (the foundational center of the HIS
Model). These activities involve an organization’s IT department
(e.g., information services, information resources, technology, and
information systems) responsible for planning and managing HIS
and infrastructure, data, analytics, people, operational support and
customer service, implementation of systems and managing
change, training technology staff and end users of systems, and
myriad other activities involved in providing excellent HIS for an
organization. Managing HIS is one of the essential functional
areas of a healthcare organization, along with clinical operations,
finance, human resources, strategic planning, marketing, and
overall leadership of the organization. HIS expenditures comprise
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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a significant portion of the organization’s capital and operating
budgets and provide the support systems and infrastructure
necessary for the organization to function efficiently and
effectively. This warrants attention from the highest levels of the
organization. Managing HIS includes key HIS activities such as
planning and budgeting, system selection, system implementation,
managing change, and managing vendors.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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HIS Planning and Budgeting
Using the organization’s strategic business plan as a guide, HIS
planning and budgeting should reflect exactly the forward
movement and enablement of the organization toward its business
and clinical strategies, and not stray one iota from efforts and
expenditures in those directions. From the 5- to 10- to 15-year
view of the HIS Strategic Plans, annual or near-term plans and
budgets must be established to fuel progress year by year. Annual
HIS plans often reflect a set of one- to five-year strategic HIS
initiatives, as significant HIS projects usually take more than one
year. HIS annual plans describe in detail the activities the HIS
function is accountable for accomplishing each year, and these
annual plans drive the annual HIS capital and operating budgets.
HIS plans and budgets must include everything needed and
feasible to accomplish in the coming fiscal year to meet the needs
of the organization as well as to live within the means of the
organization. The result is an HIS agenda for each year that is
planned in concert with the strategic and operational needs of the
organization, working with the percentage of capital and operating
funds agreed collectively to allocate to HIS. Annual HIS plans and
budgets must also stay in exact tune with the HIS Strategic Plan,
which is a direct reflection and interpretation of the organization’s
strategic business plan into HIS initiatives and terminology.
Deviations from the HIS Strategic Plan are dangerous, rendering
the HIS strategies impotent and diminishing their impact in moving
the organization toward its strategic future.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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HIS Selection
System selection is the process by which decisions are made
about which new software systems to bring into the organization.
Methodologies for HIS selection are widely known, repeatable
processes consistent with and essentially standardized throughout
well-run organizations. Methodologies for system selection include
project description and requirements definition, budgetary
requirements estimation (both capital and operating expenditures
over five years), documentation of how this new system will fit into
the HIS Strategic Plan and overall portfolio of applications,
justification of the new system (an analysis of why a new system is
proposed vs. not using something that already exists in the
organization’s HIS portfolio), as well as draft implementation plan
and timetable, staffing and other resource requirements, technical
underpinnings and specifications of the new system, interface and
integration requirements, data management plans, reporting
requirements and key performance indicators produced through
the use of the new system, system selection decision timing and
process, key contract guidelines and performance criteria for the
winning vendor, and other components, all documented in a
comprehensive HIS business plan. The HIS Steering Committee is
responsible for overseeing the process, and the rules of
engagement are published at the outset so that expectations are
clear and adhered to throughout the selection process.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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Implementing HIS
Implementing HIS is the set of activities that results in a software
system going from a business plan to a fully utilized HIS, usually
replacing a previous or legacy system that has limited functionality
and capabilities. The art and science of implementing new
systems challenge even the most sophisticated and wellresourced organizations. Like system selection, successful system
implementations follow a disciplined methodology that drives a
carefully executed and highly detailed project plan. Implementation
includes not only activating new software that runs on new
hardware, operating systems, programming languages, storage,
and other infrastructure, but also a carefully designed and timed
training program for preparing end users to use the new system,
then activating the new system in a stable, predictable manner,
transitioning all processes, systems, and end users away from the
old system to the new. HIS implementation also includes testing
and evaluating the new system once it is implemented to make
sure it is functioning as designed. Any issues are prioritized and
worked on until they are resolved, and the vendor is held
accountable for doing their part to make sure the new HIS works
as promised in the contract. The new HIS must meet the
requirements and definition as outlined in the business plan.
Successful system implementation is challenging, harrowing, and
rewarding work. The organization benefits greatly from a wellmanaged implementation that supports the full cooperation and
efforts of all disciplines involved.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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Managing Change
Managing change is the earthy reality of what happens when new
HIS are brought into use in the organization, from ideas expressed
in the HIS Strategic Plan all the way to changes in clinician or
administrative workflow. Even post-implementation issue
resolution may bring enhancements and additional functionality
into a successfully implemented HIS. Managing change
emphasizes communication, preparing the organization by
satisfying participants’ need for involvement, orientation, and
confidence in what’s about to happen. This happens by involving
interdisciplinary teams actively in the design, requirements
definition, training, testing, activation, and use of the new system.
Equally important is staying in close collaboration with end users,
management, clinical staff, and others throughout the processes of
planning, system selection, system build, implementation, and
post-implementation evaluation and enhancement. Also, those in
the organization who may not be as involved in the actual process
must be kept in the communication loop so that they are aware
and understand the changes that are to occur. All members of the
organization should know how a change in work for those directly
connected to the system connects to the work of those not directly
using the new system. They are connected to it through use of
data or process touch points throughout the organization.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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Managing Vendors
This is one of the most important areas in which to become
proficient when managing and implementing new HIS, since
organizations rely heavily on external companies (vendors) whose
business model is to produce, deliver, and support HIS software,
hardware, and services. It is essential to keep this in mind and
remember why these companies are called vendors. They are in
business to create value for their shareholders (if they are publicly
traded companies) or returns for their owners and investors (if they
are privately held companies) by creating and selling HIS
software, technology, and services to customers, usually
healthcare organizations of various types. They are for-profit
corporations that answer to their boards of directors and
shareholders on a quarterly basis about whether they have hit
their sales and financial earnings targets. Although these
companies are full of good people, most of whom care deeply
about health care and technology, they are measured not by the
well-being of their client organizations but by hitting their numbers.
In Chapters 5 and 7, we will discuss successful practices for
managing vendors.
Harvesting the Yield from HIS
HIS implemented to support the work of clinicians, business
people, and support staff within the organization have another
equally important role of creating and capturing data valuable to
improving patient care, organizational procedures, policy and
oversight, and best practices. Yet, with the massive undertaking of
creating and implementing an HIS Strategic Plan, the sheer
magnitude of the work often prevents an organization from taking
full advantage of the data and information resources it is creating.
By carefully stewarding these data resources produced and
captured as a result of core system efforts, precious information
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
resources become available to the organization for creation of new
knowledge, through analytics, business intelligence and clinical
intelligence (BI/CI), and research. This brings additional value and
returns on the investment in the core HIS. This is especially
important to emphasize, since many, if not most, of today’s
healthcare executives and managers were trained before these
types of analytical and intelligence systems were available or used
to actually manage an institution (Bresnick, 2017). This means
the value garnered from HIS is widely underachieved. These types
of analytics systems and activities are described as BI/CI,
outcomes analysis, data warehousing, and data management, and
knowledge management. Chapters 10 and 11 are devoted to the
areas of data and analytics, with descriptions of these types of
systems and data activities as follows.
Data Management and Stewardship
Perpetually growing troves of data are created and captured in the
core clinical and business workflow/transaction systems. In order
to gain further yield and value from these data, they must be
carefully and continuously tended. What does it mean to steward
these data resources? To steward means to manage, oversee,
and take care of a resource, such as property, finances, or other
assets. When we think of this in the context of data as an asset,
stewardship of data means to make sure the definition of each
data element is accurate and consistent in its use by those
interacting with it, take responsibility for ensuring it is managed
according to the goals of the organization, and take care of it by
regularly checking on consistency, accuracy, accessibility, and
safety of data. Data stewardship accompanies an overall data
management program, inserting into the fabric of the organization
the necessary leadership, roles, responsibilities, and education as
part of the organization’s data resource management.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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Business, Clinical, and Artificial Intelligence
BI/CI and artificial intelligence (AI) systems provide analytical
systems, resources, data management, and personnel capabilities
to support gaining insights, knowledge, and their application to
improving business and clinical processes and outcomes. Chapter
11 is devoted to these topics.
Creating New Knowledge
Health care is a function of information and knowledge workers
coming together to help patients, healthcare organizations, patient
populations, and communities overall. The learning organization
creates and manages information in ways that enable it to learn
from experiences through data analysis and evidence, information
and data-driven processes. The needs of patients evolve over time
and healthcare organizations must continuously adapt to these
changing needs. The ability to be data driven and put new
knowledge into practice relies on an organizational culture that
embraces this adaptation and thirst for new knowledge, as well as
implementing it into clinical and administrative processes.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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HIS Regulatory Compliance and Risk
Management
Each of the areas described requires significant know-how,
attention, organizational commitment, and expertise—but those
alone are not enough. Actions, systems, policies, and
management techniques used to accomplish these initiatives must
be done in compliance with regulations that govern health care
and systems. These regulations include the Health Information
Portability and Accountability Act (HIPAA), Medicare Access and
CHIP Reauthorization Act (MACRA) of 2015, the Center for
Medicare and Medicaid Services (CMS) Quality Payment Program
including Merit-based Incentive Payment System (MIPS) and
Advanced Alternative Payment Models (APMs), Department of
Health Services (DHS) regulations, the quasi-regulatory program
of the Joint Commission on Accreditation of Healthcare
Organizations (Joint Commission), and other regulatory programs
and requirements (Centers for Medicare & Medicaid Services,
n.d.; Quality Payment Program, n.d.). Health care is highly
regulated for several reasons. Health care is paid for by
government and third-party insurance programs; fraud comprises
about 10 percent of the total cost of health care in the U.S.; and
patient safety, data, and privacy must be protected. Clinical care,
regulatory compliance, and policy enforcement require the full
attention of management at technical, business, and clinical
leadership levels (Schulte, 2017).
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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HIS Security
The security of HIS, data, and protected health information (PHI)
has always been a primary goal in health care, but threats and
damage to security are increasing, as hackers, black market, and
ransomware experts are unfortunately succeeding in threatening
HIS. Preventing hacking and ransoming healthcare data, system
shutdowns, and general havoc on health data systems are
amongst the highest priorities on any HIS agenda (Yaraghi, 2016).
HIS Standards
To communicate across providers, insurers, and users of health
care, HIS technical and data standards must be in place. The
importance of common protocols and terminology cannot be
overstated. These standards are critical for goals of
interoperability, quality, and cost-effective care, to name a few. If
HIS at the radiology facility in Utah where one’s leg was broken
doesn’t communicate to the physical therapist’s HIS in New
Jersey, technology is no better than paper.
However, health care has been reluctant and slow to develop and
adopt standards in technical and data management arenas. For
many years, vendors have developed proprietary software
systems to strategically withhold opportunity and flexibility for
healthcare organizations to blend and access multiple software
products from different vendor products simultaneously. Some
progress is being made in the development of technical, data, and
reporting standards, but the road ahead in this effort is long.
Clearly this is an area that needs improvement, to facilitate
interoperability as well as analytics across multiple data sources.
This text emphasizes key concepts as well as specific information
about HIS, data, and technology. The ability to conceptualize
something in HIS is essential to becoming proficient in this
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
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discipline, superseding knowledge or expertise in any particular
type of technology. Technologies are constantly advancing and
changing, and will continue to do so for as long as any of us can
imagine (Dovey, 2018). How those various technologies are used,
however, in concert with people and process, tells the real story.
Think about the number of different vendors that supply software
for electronic health record (EHR) systems, enterprise resource
planning (ERP) systems, analytical databases, network
infrastructure, and other HIS. Every one of those software systems
provided by competing vendors that do the same types of things,
differently, have shining successes and abysmal failures. There
are successful, mediocre, and failed implementations of every one
of the leading EHR system vendors in healthcare organizations
(Green, 2017).
CASE EXAMPLE: COMMON FUNDAMENTAL
FAILURES
Often, the same software, implemented and managed differently,
yields very different results. Common mistakes in HIS are
usually connected to a lack of access to or a dismissal of HIS
fundamentals. Examples of these include the following:
New HIS introduced into the organization without the new
system being rooted in the strategic plan of the organization
Inadequate funding of an HIS initiative or project
Poorly or randomly designed HIS without input and regular
collaboration with key stakeholders and subject matter
experts (SMEs) who understand necessary workflows
HIS built by programmers who are neither cohesively
managed nor following an overall development plan
according to good methodology, including thorough testing
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HIS implemented without adequate communication, relevant
training, and support for all end users
HIS not consistently maintained and kept up-to-date with new
releases, versions, and enhancements from the software or
technology vendor
Lack of efficient support for end users from a well-trained,
customer service-oriented technology department
Success depends upon fundamentals. Sometimes people think
that because fundamentals are basic, they are elementary,
simple, and boring. But the fact is that for something as complex
as HIS planning, development, and implementation in diverse
settings called healthcare organizations—with their many layers,
specialties, and nuances—fundamentals are the tools that help
us through the maze of complexity inherent in HIS.
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â–¶ HIS Model
The HIS Model provides a visual representation of the overall
scope of HIS and the gradual layers that build upon one another to
create a comprehensive HIS arena. This visual model will be
referenced throughout the text to help readers contextualize and
connect the subject matter (FIGURE 1.1).
FIGURE 1.1 HIS Model for the health professions.
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â–¶ HIS Terminology
This text relies on consistent terminology to convey the ideas and
instruction contained within. For purposes of this text, the following
definitions and terminology will be used.
Health Information Systems (HIS): HIS comprise an organized
combination of system components, including infrastructure,
hardware, middleware, application software, devices, and other
technologies intended to support an organization or key processes
in health care.
Technology Infrastructure: Elements of infrastructure include
technology and network components such as fiber optics, routers,
and switches; bandwidth connectivity; middleware; intranet;
Internet; and extranet capabilities.
Hardware: Hardware comprises the backbone of computing
environments, whether in an organization’s data center or
provided by a vendor for cloud-based services, providing the
technology upon which software operates, accessed by end users.
Hardware also consists of the physical computing equipment and
devices such as personal computers, laptops, tablets, and other
components used by those accessing and using the software
supporting their work.
Software: HIS requires computer programs written to support
knowledge workers, patients, and providers in health care.
Software applications can be clinical, administrative, analytic, or
business-oriented in functionality. Types of core software
programs in the clinical arena include EHR systems, the scope of
which includes patient access systems such as registration,
admissions, emergency medicine, orders management, results
reporting, clinical documentation, laboratory, radiology/imaging,
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pharmacy management and other clinical processes, functions,
reporting, and departments. Key administrative software programs
include ERP systems, including general ledger, accounts payable,
fixed assets management, supply chain management, human
resources and payroll, reporting, and other business functions.
(See Chapter 6 for in-depth software information.)
Middleware: Middleware is software that connects software
applications to the data and technology supporting the application.
As a transaction layer, it enables communications and data
management for multiple or distributed software applications.
Networks: In HIS, as in other computerized industries, computers
linked together exchange data with each other using technical and
data connections, forming a network via linkages, which are
enabled through fiber optics, cables, wires, routers, switches, WiFi, and other technologies; these enable data communications and
resource sharing among a wide variety of users.
End Users: Variety abounds among users of HIS, or end users:
they include clinical professionals, business people, and analysts
using systems and information to meet their professional goals
and obligations. These knowledge workers and professionals are
experts performing work in areas of clinical, business,
informatics/analytics, and patients, both within organizations and
at external third parties. Users of HIS are those who rely on its
capabilities, reporting capabilities, and connectivity to perform the
work of the organization. Users drive workflow, processes, and
data creation and capture as a byproduct of their use of HIS—they
are the human part of the computer-human interface, connecting
workflows and processes with technology. Their workflow and
information needs drive the types of features and functions that
HIS are programmed to perform. Typically, the “user interface”
(UI) is activated through typing on a keypad, speaking into a voiceactivated device, or by other means of connecting the user to the
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HIS or computer. Quantitatively, there are myriad features and
functions in HIS that users interact with to do their work.
Qualitatively, the “user-experience,” or UX, is the ease or difficulty
with which the user is able to use the HIS. An easy, delightful,
energizing UX is the goal and sets one HIS apart from others in
not only what features and functions exist in the system but also
how those features and functions operate in relation to the end
user.
Roles: Roles in HIS cover a wide array of responsibilities in
planning, governance, management, design, development,
activation/implementation, and ongoing maintenance of HIS
products and services. In fact, this text is designed to provide the
fundamental understanding of these roles for health professionals
so that they are prepared to participate in HIS activities such as
HIS planning and governance. HIS planning directly ties the
investment in and prioritization of HIS resources and systems to
the strategic plan of the organization. Professionals participating in
this work have training and education in IT, management,
planning, and health care. HIS governance is the proper,
interdisciplinary oversight, policy-setting, fiduciary and regulatory
assurance, and strategic alignment of the HIS function and
portfolio of systems. Individuals performing HIS governance
comprise leaders from all key disciplines and stakeholders in the
organization, who hopefully have a combination of subject matter
expertise in their clinical or business discipline, as well as a
foundation of fundamentals of health IT, data, analytics, and other
essential HIS-related elements. Proper HIS management includes
day-to-day oversight, controls, and quality assurance of systems
planning, people, process, and technology. HIS professionals with
years of experience of increasing complexity and scope are
capable of leading HIS professionals, with excellent verbal and
written communication skills, healthcare knowledge, and
multidisciplinary HIS acumen in order to plan, manage, and
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oversee the activities of technology professionals. HIS design
connects the content and framework of systems to the workflow of
the organization’s knowledge workers. HIS design also takes the
human-computer interface into account, achieving qualitative as
well as quantitative aspects of workflows, features, and functions
of each software system. We’ve all experienced the difference
between a well-designed car, appliance, or process with those that
do essentially the same things but are poorly designed. Design is
essential to the quality of architecture, engineering, art, and
computer systems, among many other endeavors. HIS
professionals involved in systems design are the most
experienced, talented software planners, engineers, and technical
experts the organization can acquire, with skills specific to the type
and purpose of system being developed. HIS development
includes user and system/workflow planning, design, building or
programming the system, testing, documentation, deployment,
and maintenance according to the steps of the process called
software/systems development life cycle (SDLC), discussed in
Chapter 6. Development is the creation by software engineers
and other technical staff of programs and interfaces needed to
construct a software system. The professionals doing the
development work include programmers, analysts, and those
managing and overseeing their work. Activation/implementation
includes putting the new software system into use to do real work
of the organization or putting the system “into production.” Types
of professionals involved in activation/implementation are a
multidisciplinary, technology-proficient team including HIS
management, project managers, training professionals who
provide training curricula, a comprehensive training plan including
train-the-trainers, and ongoing training for the organization; a
variety of software engineers who support the software programs
and technology that comprise the system; technical support staff
for devices and printers and other access points; and superusers
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who are both SMEs and HIS proficient, often including
informaticists in their particular arena, such as nursing, medical,
and business informaticists. Ongoing maintenance includes
training, updates and fixes to programs and equipment that break,
answering end-user questions, updates and upgrades to the
system software, hardware, and access points, and providing
these services on a measured, timely basis usually through a help
desk system. The roles and processes employed to plan, design,
build, test, implement, evaluate, and support systems on an
ongoing basis are many. Successful systems initiatives are
dependent upon interdisciplinary cooperation and collaboration,
with a wide variety of experts in clinical, business, technology, and
management domains. Thus begins the life and journey of a
software system, a life that contains continuous effort—you are
never finished.
Communication: The importance of communication (including
active listening skills) cannot be overemphasized. It is key to
sincere, relevant participation of all parties, bringing to bear the
needed interaction and dialogue to foster collaboration, and
eventual acceptance of change associated with the introduction of
new HIS that enable new ways of doing work.
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â–¶ Vendor and Provider Relations
HIS development began in the 1960s in the U.S. HIS beginnings
were local, humble, and generally rooted in the data processing
departments of hospitals. Technology was in such a different place
than it is now. It is difficult to imagine computerizing these
processes so much more simply than they are configured today,
since we are so accustomed to today’s massive and complex
enterprise systems. The early systems did not have the advantage
of the use of the Internet to connect capabilities inside and outside
organizations, nor did they have ubiquitous availability of
infrastructure in the form of smartphones, wireless, high-speed
networks, and cloud computing. This now-huge market brings
along with it numerous unintended consequences compared to the
straightforward, ground-breaking, purposeful efforts of early HIS
development pioneers. Some of the long list of unintended
consequences include the collision of business interests of
wealthy publicly traded or private vendor corporations vs. health
provider, community and patient interests: a David vs. Goliath
situation. Examples of these issues include ethical problems
regarding use of data for monetary gain vs. patient health;
protection of vendor problems and failings vs. transparency on
behalf of patients and providers; undercutting and overwhelming
the efforts of those who work in not-for-profit community, safety
net, religious, and research organization as well as teaching
hospitals and health systems. The literature abounds with stories
referencing hospitals suffering financial hardship, even going
bankrupt trying to implement expensive vendor systems such as
Epic EHR (Becker’s Hospital Review, 2013; Jayanthi & Ellison,
2016; Moukheiber, 2012). When community hospitals are going
bankrupt due to software implementations, it is urgent for those
working in HIS and HIS-adjacent fields to strengthen our
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understanding of the dynamic vendor marketplace and business
aspects of HIS in order to protect the mission and vision of
healthcare provider organizations and the professionals who
practice within them. The topic of untoward effects on the very
institutions intended to be “helped” with HIS will be covered in
detail in Chapter 8.
The contrast between the early days of HIS and today’s massive,
ubiquitous HIS capabilities couldn’t be greater. Typically, those
early projects focused on automation of the accounting functions,
with a few rare clinical specialty or research niche initiatives as
exceptions. HIS got its start with the health-minded professionals
who wanted to improve the care and business processes of the
places they worked—hospitals, clinics, and physician practices.
The following section describes the history of HIS in the U.S.
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â–¶ History of HIS
The Early Days
Amid the sense of urgency and recent major legislative and
regulatory thrusts to stimulate the adoption of HIS and technology
in the U.S., one might think this was a brand-new idea, an
innovation just emerging from the laboratories of Silicon Valley
technology firms and Cambridge software development start-ups.
The early beginnings of HIS and technology of the 1960s closely
followed the advent of computerization of U.S. society in general.
The few hospitals that were able to afford expensive mainframe
hardware and programmers to write software developed the first
healthcare computer application software systems. These
mainframe computers were so large and generated so much heat
that they had to be cooled by water, which required a significant
investment in this infrastructure and the data centers that housed
them. Early software applications focused primarily on accounting
and financial applications, with rare instances of specialty clinical
research applications being developed by these hospitals’ data
processing departments. Clinical applications were few and far
between, predominantly isolated in single research departments or
siloed specialty areas.
Early HIS began largely as support for hospital finance and
accounting departments because finance departments controlled
budgets and accounting information, and their processes followed
Generally Accepted Accounting Principles (GAAP) rules. Plus, the
“data” of finance and accounting involved dollars and cents, data
elements long standardized and universally understood. Thus,
these departments and processes adhered to well-known
accounting standards, which made computerization easier:
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accounting functions represented repeatable, consistent functions
and tasks that lent themselves to being programmed into
computer systems.
In the 1970s, with the advent of air-cooled minicomputers, things
began to change. Companies that distributed and supported
hospital financial software applications emerged. These were the
early HIS and technology vendors. One example of such a vendor
was Shared Medical Systems (SMS), an early version of today’s
application services provider or software as a service (e.g., “the
cloud”) provisioning method. SMS, which was acquired by the
German company, Siemens, in the late 1990s, and then acquired
by Cerner in 2015, remains a very viable competitor in the
financial and patient accounting HIS software market, supporting
many hospital systems remotely from its data centers in Malvern,
Pennsylvania (Becker’s Hospital Review, 2014a). Financial
patient accounting systems have always been the roots and
mainstay products of SMS, throughout its journey through
Siemens and now subsumed within Cerner.
In the meantime, the hospitals that made the early decision to
independently invest in hardware, programmers, and data centers
developed much of their own software for financial, patient
accounting, and order communications systems. This early HIS
work gave rise to the first HIS professional organizations: Hospital
Information Systems Sharing Group (HISSG) and Electronic
Computing Hospital Organization (ECHO). Each of these
professional organizations consisted of hospital members who
developed software and collaborated on the further development
of software for use in their hospitals. In addition to sharing ideas
and functionality definitions for these software systems, the
members actually “shared” or exchanged software programs and
applications with one another. For example, if one hospital had
developed (programmed) a successful patient accounting software
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system and another had developed a successful software system
for laboratory, personnel from the two hospitals could meet one
another and establish a collaborative relationship through which
they would exchange copies of the software programs for use in
their respective institutions. ECHO was the organization for the
hospitals using IBM hardware, and HISSG served the same
purpose for the hospitals using non-IBM hardware. In those days,
it was all about which type of “iron” (hardware) was used in the
data center of the hospital: “Big Blue” (IBM) mainframes or nonIBM minicomputers (e.g., Digital Equipment Corporation and
eventually Hewlett-Packard).
The first HIS were really extensions of charge-capture systems for
patient billing system purposes. The first comprehensive medical
information system (akin to today’s EHR systems) was designed
and built through a federal grant to Lockheed Martin; it was
eventually commercialized and named Technicon, and initially
implemented at El Camino Hospital in Mountain View, California,
in 1971. The people who developed this software came out of the
aerospace industry and worked with those who understood
hospitals and health care. Also, in the 1970s, Science Applications
International Corporation (SAIC)—a large, successful employeeowned company with expertise in information systems work for the
defense industry and federal government—developed an early
clinical information system for VA hospitals. (This system was
replaced in 1982 with a newer version system called Veterans
Health Information Systems and Technology Architecture [VistA],
an integrated EHR that is currently in use in more than 1,400 VA
hospitals and ambulatory clinics across the U.S. (World VistA,
n.d.).)
The 1980s ushered in the era of the minicomputer, which offered
fierce competition to the expensive, water-cooled mainframes of
the 1960s and 1970s; the “minis” were smaller, generated less
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heat than the big mainframes, and were more affordable and
easier to support because they could be cooled with less
expensive air conditioning rather than water systems. HewlettPackard, Digital Equipment Corporation, and eventually even IBM
developed highly competitive air-cooled minicomputers. Not only
were these minicomputers more efficient and less expensive to
buy and operate, but fewer and less expensive personnel were
also needed to operate the computers and keep them up and
running compared to the systems engineers and other highly
technical professionals required for mainframe support. This trend
made automation more affordable for hospitals, large clinics, and
even large physician practices, which in turn stimulated the
development of clinical applications as well as more widespread
adoption of the typical financial accounting systems.
Vendors of software packages also started to emerge from
entrepreneurial communities in great numbers in the 1980s. This
trend occurred in part because a huge market was budding: the
improved affordability of systems for more hospitals and some
large, multispecialty physician practices (think Mayo or Scripps
Clinics). Because valuable software had been developed by
hospitals for their own use in the 1970s, vendor companies could
be formed to commercialize these software developments as
“software packages.” During the 1980s, many hospitals and a
number of larger physician practices began to buy and implement
computer systems to support their financial systems, and
increasingly ancillary clinical (e.g., laboratory, radiology, and
pharmacy) and practice management (e.g., registration,
scheduling, and billing) systems. Numerous entrepreneurs sought
to acquire software from hospitals that had developed such
programs in-house; these entrepreneurs then relicensed the
software to other hospitals—and the hospital information system
software industry was born. Occasionally, these entrepreneurs
would develop software from scratch within their companies’
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development teams as well but did so less frequently than
commercializing the already-developed software that had been
built within healthcare organizations. As a result, the roots of very
few vendor software systems today were actually developed by
vendor companies; rather, many of the early software systems
sold by vendors were originally developed in hospital data
processing departments for the sponsoring hospital organization.
Notable exceptions to this model exist, including the HIS vendors
Technicon, Cerner, Meditech, and Epic, although each of these
companies needed a brave hospital or clinic to be willing to step
forward for the “alpha” implementation project to get started and
establish a toehold in the emerging HIS industry.
Evolution of Clinical Systems and the EHR
The first-generation HIS clinical order entry systems were really
extensions of charge-capture systems for patient billing system
purposes, rather than systems with functionality truly grounded in
clinical care processes. The ethos of the financial underpinnings
and motivations of hospital information systems were reflected in
the early clinical systems built and implemented primarily to
capture charges to feed billing and claims processes. As noted
earlier, Technicon developed the first comprehensive medical
information system—a system focused on clinical care—in the
mid-1970s. The requirements document for this system reads very
much like the requirements documentation for one of today’s
modern EHR systems. This was truly an innovation that disrupted
the healthcare industry. The VistA system, also described earlier,
was another early HIS that—in a continually more advanced
version—is still in use today in VA hospitals across the U.S.
Specialized, niche ancillary clinical systems began to emerge
especially in the 1980s, seeking to provide automation of profitable
hospital departments such as laboratory, radiology, and pharmacy
management. These niche systems often competed to be
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recognized as “best-of-breed” systems. Also blossoming were
physician practice management systems for large medical
practices.
At this point, hospitals still developed much of their own software
in-house and used their IT staff to interface a growing number of
vendor-supplied systems with their in-house developed systems.
To do so, they would build a data center, buy hardware, hire
programmers and systems analysts, contract with SMEs who are
knowledgeable about the processes being automated, and create
data processing departments to work with clinicians and
administrators to design and develop systems internally.
Universities developed some software, usually oriented to
specialized clinical departments or siloed functions. Initial clinical
information systems included “order entry” systems, early versions
of computerized provider order entry (CPOE), one of the core
capabilities of EHR systems. For some functions, these software
applications were modeled after hotel software; think about the
similarities in workflow between checking in and out of a hotel and
being admitted, transferred, and discharged from a hospital. In the
outpatient arena, only very large medical practices could afford
computer systems and data processing departments during this
time period.
From then through the 1990s, the number and types of healthcare
organizations implementing computer systems expanded
vigorously. The advent of the Internet transformed healthcare
computing, just as it transformed computing and
telecommunications in all industries. In lockstep with this disruptive
innovation, the federal government enacted HIPAA to protect the
security and privacy of citizens’ data in anticipation of the
significant increase in use of the Internet along with an increasing
scope of electronic systems and technology in healthcare
processes (U.S. Department of Health and Human Services, n.d.).
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While HIPAA was intended to ensure the security and privacy of
PHI, as that information was transferred from one insurance plan
to another (thus the “insurance portability and accountability”
language in the title of the legislation), this legislation has had
sweeping effects regarding the privacy and security of all PHI: (1)
for patient care purposes as data are created and captured in EHR
systems that share data across multiple organizational settings
involved in a patient’s care and (2) as information is created via
secondary uses of those data for analytics and data sharing
among providers. Since 1999 and 2001, when the Health and
Medicine Division (HMD) of the National Academies of Sciences,
Engineering, and Medicine published its watershed reports To Err
Is Human: Building a Safer Health Care System and Crossing the
Quality Chasm, respectively, healthcare organizations have been
building comprehensive HIS and technology architectures in
earnest, with the intent of improving quality and efficiency of care
as summarized in the Six Aims of Crossing the Quality Chasm
(described in Chapter 3).
The implications of these HMD reports—and the outright shock at
their revelations about the preventable problems occurring in
healthcare quality in U.S. hospitals—have driven the HIS and
technology and regulatory agenda for the decade of the 2000s, as
a potential means of improving the dire statistics published by the
HMD.
The Current Climate
As we proceed through the decade of the 2010s, in the aftermath
of the HMD reports and the recent update of the To Err Is Human
study, as well as in the face of unsustainably high levels of
healthcare expenditures, we are compelled to improve the quality
and efficiency of health care in the U.S.—and HIS and technology
are essential tools in that process. Significant governmental
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federal legislation on this front has included the American
Recovery and Reinvestment Act (Public Law 111-5) that includes
the HITECH Act of 2009. Under Title XIII of this $787 billion
economic stimulus bill, the U.S. Department of Health and Human
Services has invested $36 billion since 2009, providing incentives
and technical support for the adoption of EHRs among hospitals
and physician practices; in addition, it hopes to generate savings
of about $10 billion through the application of Meaningful Use
criteria as part of that incentive program, through adoption of
technical and data standards to facilitate the secure sharing of
data between clinicians through system interoperability
(athenahealth, Inc., 2009). HITECH funding also provides training
grants to colleges and universities to prepare the estimated 57,000
health IT workers needed to accomplish widespread EHR
adoption. These criteria and standards are being designed to
improve patient safety, reduce instances of repeated diagnostic
tests and other medical processes, increase timeliness of care by
speeding transmission of information to clinicians, and bring
greater overall efficiency to the U.S. healthcare system.
As hospitals and physician practices persevere through the
challenges of implementing EHR systems and meeting Meaningful
Use criteria, the shape and texture of healthcare delivery are
changing on a widespread basis. Will this massive effort and
investment in HIS and technology bridge the chasm between early
systems and later adopters? Between regulators and vendors?
Between vendors and patients? These questions are the agenda
of today’s HIS efforts in healthcare organizations. The answers are
up to all of us to figure out from here.
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Summary
In summary, as health professionals who are involved in HIS
development every step of the way, the task at hand is to provide
the education and support to create the kinds of systems we need
in today’s challenging and rapidly changing healthcare
environment. Also, each and every health profession now uses
HIS in order to perform its work. So clinical, business, and
technology health professions now can only be done proficiently
with HIS knowledge, ability, and activity. The U.S. health system
and healthcare organizations have perhaps some of the greatest
challenges to overcome due to historical reliance on the fee-forservice reimbursement methodology now attempting to evolve to a
value-based reimbursement system. Reliance by healthcare
organizations on the vendor marketplace as the source of
solutions complicates and increases the cost of automation of
health care. Added to this challenge is the fact that acute care can
no longer be the complete focus of hospitals and health systems—
prevention, wellness, chronic care management, and care
coordination now dominate the scene, all of which happen outside
institutions while current structures and systems and professionals
are set for an acute, medical, sickness-based, institutional
scenario.
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
Key Terms
Activation/implementation
Communication
Electronic health record (EHR)
End users
Hardware
Health Information Systems (HIS)
HIS design
HIS development
HIS fundamentals
HIS governance
HIS management
HIS planning
HIS Strategic Plan
Infrastructure
Middleware
Network
Ongoing maintenance
Roles
Software
Users
User interface (UI)
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
Discussion Questions
1. Describe why a basic understanding of the fundamentals of
HIS is important for any healthcare provider, support staff,
or leader.
2. How might the work of launching an implementation differ
from that of HIS ongoing maintenance?
3. What kind of new knowledge does HIS help create?
4. Name one organization or governmental department that
oversees HIS-related regulation.
5. Describe the beginnings of HIS. What functions did the first
HIS support?
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
References
athenahealth, Inc. (2009). A summary of the HITECH Act:
Whitepaper. Retrieved from
http://athenaheath.com/_doc/pdf/HITECH_Fact_Sheet_Whitepaper.pdf
Becker’s Hospital Review. (2013, December 19). St. Francis
bankruptcy partially due to IT upgrade. Becker’s Hospital
Review. Retrieved from
https://www.beckershospitalreview.com/healthcareinformation-technology/st-francis-bankruptcy-partiallydue-to-it-upgrade.html
Becker’s Hospital Review. (2014a, August). 10 things to know
about Cerner’s acquisition of Siemens Health Services.
Becker’s Hospital Review. Retrieved from
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Becker’s Hospital Review. (2014b, August). 25 things to know
about hospitals, health systems’ investments in IT. Becker’s
Hospital Review. Retrieved from
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Bresnick, J. (2017, November 20). 47% of IT professionals say
their executives are big data illiterate. HealthIT Analytics.
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Centers for Medicare & Medicaid Services. (n.d.). MACRA.
Retrieved from https://www.cms.gov/Medicare/QualityInitiatives-Patient-Assessment-Instruments/Value-BasedBalgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-andAPMs.html
Dovey, D. (2018, February 15). The future of technology is
uncertain as Moore’s Law comes to an end. Newsweek.
Retrieved from https://www.newsweek.com/futuretechnology-uncertain-moores-law-comes-end-807546
Green, J. (2017, October 31). 10 EHR failure statistics: Why you
need to get it right first time. EHR in Practice. Retrieved from
https://www.ehrinpractice.com/ehr-failure-statistics.html
Jayanthi, A., & Ellison, A. (2016, May 23). 8 hospitals’ finances
hurt by EHR costs. Becker’s Hospital Review. Retrieved from
https://www.beckershospitalreview.com/finance/8-
hospitals-finances-hurt-by-ehr-costs.html
Kass, E. M., & Bazzoli, F. (2017, December 27). 2018 tech
budgets to rise about 8.8% for healthcare organizations.
Health Data Management. Retrieved from
https://www.healthdatamanagement.com/news/2018-
tech-budgets-to-rise-about-88-for-healthcareorganizations
Meyer, N. D. (2005, February 28). What is governance and what
should IT leaders be doing about it? CIO from IDG. Retrieved
from
https://www.cio.com/article/2448788/governance/governancewhat-does-governance-mean.html
Moukheiber, Z. (2012, June 18). The staggering cost of an Epic
electronic health record might not be worth it. Forbes.
Retrieved from
https://www.forbes.com/sites/zinamoukheiber/2012/06/18/thestaggering-cost-of-an-epic-electronic-health-recordmight-not-be-worth-it/#602fa01146d3
Quality Payment Program. (n.d.). MIPS overview. Retrieved from
https://qpp.cms.gov/mips/overview
Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.
Schulte, F. (2017, July 19). Fraud and billing mistakes cost
Medicare—And taxpayers—Tens of billions last year. The
Center for Public Integrity. Retrieved from
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U.S. Department of Health and Human Services. (n.d.). Health
information privacy. Retrieved from
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World VistA. (n.d.). VistA history. Retrieved from
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Yaraghi, N. (2016, April 1). A health hack wake-up call. U.S. News
and World Report. Retrieved from
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Balgrosky, Jean A.. Understanding Health Information Systems for the Health Professions, Jones & Bartlett Learning, LLC, 2019. ProQuest Ebook Central,
http://ebookcentral.proquest.com/lib/fiu/detail.action?docID=5723520.
Created from fiu on 2021-01-25 16:01:45. Copyright © 2019. Jones & Bartlett Learning, LLC. All rights reserved.

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