Unlike many other industries that have already entered the Information Age, many unique situations have either delayed or, until now, discouraged a similar move by the healthcare industry. Possibly the greatest discouragement to greater information use and integration is the expensive investment made by many healthcare providers in their existing information systems. For many the need to integrate information, at least initially, appears to place this investment in jeopardy.
The primary focus of most information systems used in either clinic or hospital environments are the financial and billing activities of the provider. Consequently, to protect the information within these systems and to insure the integrity of the information, these systems were constructed as "closed" systems. Generally, closed systems make it difficult for the user to extract information. Consequently, the user cannot share information or retrieve information addressing the dynamic nature of their profession. If these information systems displayed any "openness" it occurred when allowing the electronic submission of billing information to a payer. Many users of these hospital information systems find it difficult to search out desired information, even if that information is financial in nature.
A tour of almost any clinic or hospital would quickly illustrate how many users resolve this dilemma. Microcomputer software, like electronic spreadsheets and word processing, is being used to produce information users are unable to receive from their hospital information system. By itself this is not a problem. A potential problem occurs because users have to reenter data already contained in their information system. Users risk incorrect data from mistaken data entry or simply the age of the data. The inability to get to data so it can be used in another system or the inability to produce information in a system in a flexible, user determined form illustrates a closed system.
The closed nature of these base systems encouraged the proliferation of other, special purpose systems throughout the clinical areas of the healthcare delivery system. Again, a tour through any hospital presented an interesting array of technologies, many with unique and limited roles. For example, hospital labs include various technologies to do a variety of tests, including chemistries, blood analysis and more. Some of these technologies store results for later recall, but even these seem to severely limit the depth of this history. Beyond these technologies, many labs make use of separate systems to manage the history of laboratory tests for a patient. For some this system is a card index. The patient is uniquely described by some identifier on a card, such as patient name, with a unique number entered on the card for each lab test. For others, there may be a microcomputer available where the same information is stored in a simple file management system. Still for others, there has been a conscious effort to connect the lab environment into the overall information system infrastructure. Here, lab orders and results are available within the system and a common identifier, such as medical record number, is used throughout the institution. These multiple approaches to identifying data and the use of multiple technology vendors has proven to exacerbate the problem of integrating information.
The problem, though, is not simply related to the interconnection of various computer systems. Instead the problem is more fundamental. For example, in many clinic and hospital information systems the basic information source is an admission and the corresponding billing event. In the clinic area, such as laboratory systems, the basic information source is a patient. Creating a complete picture of a patient within this environment is, at times, a complex problem. In approximately eighty percent (80%) of the hospital, clinic or long term care facilities included in the case studies, at least four different identifiers were used to describe the same patient. These identifiers ranged from medical record number, usually uniquely created for an individual and retained over time, to birth date as the identifier used within a lab. The variety of choices for identifying a patient were not unique to any specific type of provider. Consequently, whether it was a hospital or a clinic, small or large, the ability to collect and present information about a patient from all areas of the institution is limited.
One interesting aspect of any tour through a healthcare provider's facility is the volume of data maintained and stored by the provider. Whether it's medical records, bills, radiology procedures or medical transcripts, a provider has accumulated large quantities of data.
Several issues arise regarding this data. First, much of the data is not managed or stored using information technologies. While it may be true that some hospitals, like Emory in Atlanta, are moving rapidly toward the "paperless" hospital, most, especially in rural areas, are fighting an ongoing battle to simply store their paper. As a result, new technologies are not quickly accepted because of concerns over how to get this information into an available, automated form and because of the dramatic change caused by these technologies.
The second issue is related. Information, as envisioned by the declaration of the Information Age, places a premium on "currency" or the current value of the data that produces the information. Much of the volume of data maintained by a provider does not satisfy the test of "currency." For example, at one stop during the case studies the pages for the medical record for the first patient admitted to a hospital built in the 1950s was reviewed. These medical record pages were not displayed in a prominent place of "honor," but were still considered an important "current" description of this patient.
The last issue regarding the data maintained by a provider concern the variety of data. Some data is textual, some a fixed image (i.e., an X-ray), and some data is a dynamic image, such as that provided through Telemedicine. Technologies capable of integrating these various, multi-media forms of data are only recently available and at a level of quality that justifies their investigation.
The final major impediment faced by the health care profession in a pursuit of greater information sharing is related to the experience these professionals have at sharing information. The past has shown only limited sharing actually occurs. Because of concerns over legal issues, the working relationship among professionals, and providing the best healthcare to a patient, each provider was a major independent contributor to the entirety of a patient's medical record. Changes in the expectations for healthcare are just now causing the various professionals to wonder if they can share more information. While technology, even at a low cost, exists to facilitate this exchange, there is limited experience on which to base this exchange.
The situation uncovered in the process of assessing the opportunities for further technology integration might initially present itself as an overwhelming problem. But as the NISAPP Workbooks will illustrate, these impediments present a wide range of opportunities with relatively quick resolutions. Accomplishing information integration and increased information use, as long as it is planned and begins at a fundamental level, should not require a complete reinvestment in technology. It may require additional investments. The purpose of the workbooks is to guide those interested in greater information integration and use through the process of recognizing the technology opportunities.
The following table is intended to focus your needs on
the specific workbook that will be most helpful.
|
An Individual's Focus on Integration |
Description |
|---|---|
|
Institutional uses of information |
Individuals that encompass the organization's major creators and users of information, such as administrators, office managers, and department managers |
|
Technology issues relating to institutional sharing of data and information. |
Individuals that encompass the organization's major users of information technology and that have sufficient background to assess their technologies. |
|
NISAPP Workbook on Hospital Network Integration of Information |
|
|
Sharing of information and resources in a hospital network |
Individuals that represent each hospital's major creators and users of information and interested in finding ways that shared technologies can be employed to enhance patient care and reduce the cost of providing care. |
|
Technology issues relating to the sharing of information or developing shared resources |
Individuals that encompass the hospitals that make up a hospital network integrating data and information technology and that have sufficient background to assess their technologies. |
|
Sharing of information and resources within a community |
Individuals that represent each of the community organizations interested in information integration and/or use. |
|
Technology issues relating to the sharing of information among community organizations |
Individuals that encompass the community organizations interested in information integration and/or use and that have sufficient background to assess their technologies. |
For additional information contact Kelli Schneider @
(970) 207-9798 or
