Topics in health information management最新文献

To prepare graduates for the new roles envisioned in the American Health Information Management Association's Vision 2006, which places emphasis on information technology and the management of health information, a model curriculum has been developed for health information administration and health information technology programs in which information technology and information systems have been strengthened. With these new directions come the expense and problems of purchasing and maintaining computer systems necessitated by these changes. There can be great resistance on the part of deans and other individuals to authorize the procurement of the hardware and software needed to establish a computer laboratory. The article describes a cost-effective alternative.

A provider must demonstrate superior performance in several areas, such as cost, utilization, and clinical outcomes, to obtain designation as a Center of Excellence. A comprehensive orthopedic strategy was designed for use by Good Samaritan Health Systems to obtain this designation. The strategy included the development of clinical pathways and a profiling system. Acute, subacute, home care, and patient/family pathways were developed for diagnosis-related group 209: total joint replacement. Six months after implementation, a profile was developed using the Dartmouth Clinical Value Compass. Dimensions profiled included patient satisfaction, clinical variance data, functional status, and cost/utilization data. Improvements were identified in patient satisfaction, cost/utilization, and patient care.

The article describes a successful model for clinical integration that has improved utilization rates, service levels, physician and staff satisfaction, and the financial performance of physician groups and health plans. The model for clinical integration provides processes of medical management, care management, and patient management that are designed to transform a traditionally fragmented delivery system into a more cohesive system where everyone is working toward a common objective with aligned incentives. Links are established among primary care physicians, specialists, and hospitals to create synergistic relationships and seamless, accessible care for members.

Health care providers and payers are faced with ever-increasing pressures to lower costs, improve quality, and maximize profits. As medical information technology evolves, more medically related data are being collected, stored electronically within a data warehouse, and made available for decision support in the pursuit of lower costs and higher quality in health care. The article describes how medical expertise can be captured and integrated into decision support systems to improve awareness and predictability of disease and disease-associated financial risk within a population of patients, ultimately providing patient-centric and provider-centric opportunities to improve health and decrease costs. The concept of medical logic engineering is introduced.

Two academic medical centers in a newly integrated structure joined to understand better their patients' experience with care processes and to promote increased patient involvement in the plan of care. Through a team approach, a patient pathway was developed using graphic and text elements to illustrate the normal sequence of critical activities and care processes for established clinical pathways at these medical centers. A focus group was held to achieve a higher level of patient input into care coordination issues. Through the integration of the patient's voice into the plan of care, priorities for improvement can be identified.

The article highlights the importance of an object-oriented analysis and design (OOAD) methodology for the computer-based patient record (CPR) in the military environment. Many OOAD methodologies do not adequately scale up, allow for efficient reuse of their products, or accommodate legacy systems. A methodology that addresses these issues is formulated and used to demonstrate its applicability in a large-scale health care service system. During a period of 6 months, a team of object modelers and domain experts formulated an OOAD methodology tailored to the Department of Defense Military Health System and used it to produce components of an object model for simple order processing. This methodology and the lessons learned during its implementation are described. This approach is necessary to achieve broad interoperability among heterogeneous automated information systems.

The development and implementation of the information systems necessary to support an effective and efficient continuum of care and to measure the quality and cost of that care present complex information systems integration challenges. The article discusses the integration challenges and concludes with a review of strategies that an integrated delivery system can adopt to begin to address them.

To ensure success in building an enterprise master patient index (MPI), an understanding of the complexities of the internal duplicate files and the overlap population is essential. Merging multiple MPIs is complicated and requires time and a commitment to accuracy. Most organizations underestimate the importance of the following ground rules for building an enterprise MPI: Internal duplicates need to be corrected; linking patient files with a statistical weighting algorithm is far superior to using rigid criteria; there are more overlap patient files than an organization usually perceives; an imprecise and incomplete base of demographic data will multiply the error rate for the enterprise; preliminary data analysis is critical to avoid linkage problems during conversion; and accurate data collection and monitoring are imperative for ongoing data integrity. The article discusses the major steps involved in creating an enterprise MPI and recommends solutions to common problems encountered during conversion.

The evolving health care industry is placing new demands on its participants. Traditional institutional boundaries are being replaced by the need to cooperate, collaborate, and share increasingly scarce resources to provide high-quality care to patients. Information, which historically was coveted and protected, must now be shared by the multiple providers and organizations that together provide services. This need to share information has brought on the need for organizations to build common databases from which reports can be run, trends can be noted, and patient information can be drawn. Data warehouses and clinical data repositories are being recognized as solutions to issues of segregation of information. Both solutions are relatively new to health care, and there is acknowledgment that neither is simple to implement and that both represent new challenges to health care organizations. The article provides working definitions of the two solutions, describes at a high level some of the challenges associated with their implementation, and provides some of the key steps required to develop, implement, and realize the benefits of the clinical data repository or data warehouse.

The adoption of any information system should be justified by an economic analysis demonstrating that its projected benefits outweigh its projected costs. Analysis differ, however, on which methods to employ for such a justification. Accountants prefer cost-volume-profit analysis, and economists prefer net present value analysis. The article explains the strengths and weaknesses of each method and shows how they can be used together so that well-informed investments in information systems can be made.