Health Information Systems and HPM 440A Instructor: Jean A., MPH, RHIA Phone: (619) 203-1687 (mobile) Mail: jbalgrosky@g.ucla.edu Class Time: day day 10:00am 11:50am Class Location: CHS 51-279 Introduction: The field of health care information systems and technology (HIS) has been evolving for many decades, however at the present time its level of activity has reached a fever-pitch. Numerous dynamics drive rapid HIS development in U.S. health care: modernization of our society and commerce; continuous innovation and advancements in technology; expansion of the internet and social networking; a health care system tangled between government programs and private enterprise; costs spiraling out of control, resistant to traditional containment measures; nationwide stimulus incentives for adoption of electronic health record (EHR) systems and their Meaningful Use; burgeoning HIS vendor and product markets; convergence of health care provider organizations, public health organizations and initiatives, biomedical devices, mobile computing, and advanced analytics (big data); and reports such as To Err Is Human (Institute of Medicine, 1997) presenting evidence that healthcare quality in the U.S. is seriously sub-par and recommending that HIS can help. This confluence of factors creates the exciting and challenging dynamics of HIS in the U.S. today. Within seemingly all types of healthcare organizations including community hospitals, complex health systems, physician practices, community clinics, payers, public health organizations, and the government, HIS is a critical priority. These organizations goals include becoming more efficient by streamlining processes and reducing waste, measuring and improving clinical and business outcomes, and engaging patients directly in the management of their health, all while enhancing patient and provider experiences. Laudable and lofty goals indeed! Over the developmental years of HIS, healthcare institutions and providers have historically invested in implementation of financial, human resource, material management, and other administrative systems; ancillary systems supporting laboratory, pharmacy and radiology; high-speed network infrastructure; patient accounting and billing systems; and early versions of clinical information systems. Although there are reports of recent progress in HIS adoption, the track record for implementing and adopting robust electronic medical records (EMRs) and 1
electronic health records (EHRs) into mainstream medicine and healthcare remains stubbornly difficult, far below expectations. It takes much longer to fully adopt EHR systems into healthcare organizations than any vendor would have one believe. Reality is healthcare organizations struggle to afford costly information technology; providers enjoy having the patient s records on-line, but are frustrated as they bear the brunt of manual data entry into EHR systems; siloed departments myopically value their own systems and niche processes without appreciation for integration and streamlining of workflow between historical departmental units. The talent pool necessary to design, build, implement, and support the myriad systems throughout the U.S. healthcare system is conservatively estimated to be 60,000 professionals fewer than those required to meet current HIS requirements. These factors add up to a very challenging situation, to be sure, but a situation that is also rife with opportunity for improvements and innovation in quality, efficiency, and outcomes. While the promise of HIS currently under-realized, progress is being made and the recognition of HIS and enabling technology to enable improved processes and outcomes in healthcare organizations increases. Thus in addition to significant HIS investments by healthcare providers, the federal government through the American Recovery and Reinvestment Act (ARRA) of 2009 and its Health Information for Economic and Clinical Health (HITECH) Act, is investing $36+ billion in HIS adoption. This investment comes largely in the form of incentives to stimulate adoption of EHRs by providers and healthcare institutions. The federal government requires EHR implementations meet certain standards (e.g., data and security standards) and certified thresholds for EHR functionality adoption (i.e., Meaningful Use criteria Stages 1, 2, and 3) including interoperability in order for providers and hospitals to qualify for HITECH incentive funds. HPM 440A provides a solid, introductory foundation of context, methods, and understanding of HIS systems and technology for those preparing to work in healthcare management, policy, clinical, operational, technical, legal, or other roles. Emphasis is placed on the student developing knowledge and skills necessary to participate in planning, managing, implementing, and using HIS systems and the data they create and capture. It delves into many facets of HIS in an organized fashion and simplifies the basics of this complex topic for the student, regardless of the amount of familiarity she/he has with information technology. The course covers the background and evolution of HIS; definitions and clarity about software, technology and data and how these key elements can be architected to form a cohesive HIS architecture tuned to the specific needs of various types of healthcare organizations, providers, patients, and public health agencies; how HIS is planned, implemented and managed; key principles for managing vendor relationships and negotiating contracts for software, hardware, and IT-related services; and how HIS can be productively used by health care delivery organizations, external research organizations, regulatory organizations, providers, and 2
patients/consumers. Fundamentals of information technology, electronic medical records (EMRs), electronic health records (EHRs), personal health records (PHRs), Meaningful Use, interoperability and health information exchanges (HIE) will be covered. The scope of the course also includes: a conceptual HIS planning framework; high-level architectural design, implementation strategies and support processes for various types of HIS systems, including clinical, financial/administrative, and decision support systems; introduction to network and connectivity technologies such as health information exchanges (HIE); explanation of data management, analytics, and interoperability of systems. The impact and requirements associated with current healthcare legislation and stimulus support as they affect HIS will be explored, including the Health Information Portability and Accountability Act (HIPAA), Health Information for Economic and Clinical Health (HITECH), interoperability, health information exchange (HIE), and Regional Healthcare Information Organizations (RHIOs). In addition to lectures, the course includes assignment, team project, and take-home examination; guest lecturers will provide real-world examples of the use and challenges associated with HIS. By completing this course, students will gain necessary skills and knowledge to understand and apply HIS in their healthcare work, whether clinical, managerial, policy, HIS, or business-oriented. Students going into health care management, clinical care, public health, or policy work will gain needed understanding of HIS strategy and management, as well as perspective on how HIS works in concert with health care delivery organizations, the U.S. healthcare system, and the work of healthcare professionals. Objectives: This course teaches students key concepts, components and management skills in the areas of health information systems (HIS), HIS strategy and alignment with healthcare delivery organizations, underlying HIS technologies, importance of HIS to the current health care landscape, and emerging directions in HIS. Course objectives: students will develop knowledge, skills, and competencies in these areas: 1. Understanding health information systems and technology (HIS). a. Alignment of HIS with current challenges in health care; and b. HIS Scope, Definition, and a Conceptual Model for understanding the totality of HIS and it many facets; 2. Systems and their Management: a. HIS Strategic Planning and Architecture. This objective addresses the art and science of planning HIS for healthcare organizations including scope, architecture and investment in concert with the mission, goals, and services of the organization; architecting HIS to fit and properly support the organization; includes a conceptual framework for understanding HIS on an architectural level, so that HIS plans, budgets 3
and strategic initiatives can be aligned with and suitably developed for a health care delivery organization, its providers, and its workers; b. HIS Application Systems and. This objective addresses types of application software used in health care and the basics of HIS-related technology. Includes an overview of clinical, business/administrative, imaging and decision support/business and clinical intelligence systems; electronic medical records (EMRs), electronic health records (EHRs) and personal health records (PHRs); picture archive communication systems (PACS), and others. Reviews the basics of HIS technologies including definitions and descriptions of hardware, network infrastructure, technical standards, security, telecommunications, imaging, devices that support HIS, and other HIS-related technologies. c. Managing HIS and Services. This objective speaks to managing HISrelated processes and people. It introduces HIS product acquisition methods, including vendor management and contracting, and how to conduct a request-forproposal (RFP) process in the evaluation and procurement of software systems. d. Implementation. This objective addresses stages in implementation and reasons for implementation successes and failures. Implementing new HIS systems is disruptive to organizations and the people working in them, requiring careful planning, management, interdisciplinary teamwork, and on-going systems support. e. Leadership and Adoption of HIS and. This objective covers HIS leadership from an organizational perspective; realizing the value from HIS and technology investments; presidential/political/national leadership perspective in HIS and technology; leadership from public health researchers and scientists; leadership of professional organizations in HIS and technology; and adoption of HIS. 3. Health Informatics. This objective defines and describes the purpose of health informatics; additional motivations to pursue health informatics; relationship of health informatics to Donabedian s Healthcare Quality Framework; health informatics capabilities and disciplines; and unintended consequences of the uses of HIS and technology. 4. Data, Analytics, and Business Intelligence/Clinical Intelligence: a. Data. This objective addresses data sources; velocity, volume, and variety of data (three V s) and Big Data; data challenges; and data security and protection. b. Data, Analytics, and Business Intelligence/Clinical Intelligence (BI/CI): Business Intelligence and Clinical Intelligence. This objective spans healthcare business and 4
clinical intelligence; history of BI and CI; current challenges for analytics; models for data architecture and strategy; examples of BI/CI at work; the future of BI/CI. 5. Research, Policy, and Public Health: HIS and research, policy, and public health. This objective discusses HIS Model: research, policy, and public health relationships to HIS; types of research and sources of data from HIS; and areas deserving special attention that rely on HIS management. 6. New Directions for HIS and : what lies beyond the current state of HIS and technology? This objective provides understanding of the future of HIS and technology; ehealth, mhealth, social media uses, and telemedicine; emerging HIS technologies and the human-machine relationship; future directions in informatics, data, and analytics; the effect of new technologies on public health; alignment between future HIS and technologies and future challenges in health care and public health; issues and ethics to consider as the future of HIS and technology unfolds; and future impact of HIS and technology on research, policy, and public health. 7. Communication Skills: How to communicate about HIS with technical and non-technical audiences. Competencies students will develop include: Domain Competencies Measurement Tools Program and Project Planning, Management, Evaluation, and Implementation: Design, develop, implement, and evaluate projects and programs to improve individual and community health. Financial Analysis: Understand and explain financial and accounting information. 1. Develops a detailed project scope of work or plan 2. Manages team meetings with effective team and group facilitation skills 3. Tracks plan budget and time against plan specifications 4. Coordinates work of diverse individuals with different tasks for the project Develops and justifies operating and capital budgets; estimates project expense and develops cost pro forma; explains budget. 1. EHR Evaluation Team Project 2. HIS Strategy and High-level Architectural Design Project 5
Information Management: Understand the use of electronic clinical and management information systems and decision support tools. Organization Development and Change: The process of recognizing the need to change; determining what and how to change; and managing and leading the change process in order to improve organizational effectiveness. Strategic Orientation: Consider the business, financial, demographic, ethnocultural, political, and regulatory implications of decisions and develop strategies that ensure the viability and long-term success of the organization. 1. Identifies and discuss major trends in healthcare information technology. 2. Is familiar with current information technology for patient tracking including clinical, financial, reimbursement, and records management 3. Describes the framework of IT systems and identify components and functionality of the generic concept of systems 4. Identifies ways in which healthcare businesses and services use IT to develop a strategic competitive advantage. 5. Specifies how information technology tools can be used in a clinical setting to streamline and improve healthcare and decision-making. 6. Identifies and discuss the ethical issues relating to the use of health care information technology, including HIPAA requirements for privacy and security. 1. Identifies area for change diagnoses and defines problem. 2. Can distinguish between cause and effect symptoms. 3. Expresses vision for change, identifies viable solutions, defines critical success factors, and analyzes (cost-benefit) viable solutions to select best change solution. 4. Understands change implementation process; conceptualizes and can develop change implementation strategy. 5. Understands how to mobilize others to change; addresses (potential or actual) resistance to change. 1. Conducts internal and external environmental and competitive scanning such as a SWOT analysis to ascertain forces that currently impact the organization. 2. Develop strategies that address the environmental analysis to position the organization for survival and success and to take advantage of its strengths while developing methods to compensate for its weaknesses. 1. Midterm Examination 2. HIS Strategy and High-level Architectural Design Project 3. EHR Evaluation Team Project 1. Midterm Examination 2. HIS Strategy and High-level Architectural Design Project 3. EHR Evaluation Team Project 1. HIS Strategy and High-level Architectural Design Project 2. Midterm Examination 3. EHR Evaluation Team Project 6
Leadership Skills: Ability to inspire individual and organizational excellence; advocate the organization s vision; and energize commitment to strategic and successful performance of the organization. 1. Express and apply the organization s mission, set of core values and vision to work group; 2. Articulate the principles of leading organizational change, including development of organizational change efforts; 3. Apply evidence-based principles to strategic and operational decision-making and performance management. 1. HIS Strategy and High-level Architectural Design Project 2. Midterm Examination 3. EHR Evaluation Team Project Domain: Communication and Interpersonal Skills: The ability to communicate effectively, orally, and in writing to diverse audiences and settings, establish and maintain relationships, and facilitate constructive interactions with individuals and groups. Competencies Sub Competencies/Examples Measures Prepares well-written, effective, convincing managerial and policy reports, including brief and precise executive summaries. Prepares and delivers logical, concise, persuasive oral presentations that can convince, influence or impress others to agree with your preferences. 1. Uses proper subject-verb agreement and parallel structure, rules of punctuation and sentence and paragraph construction, and concise thematic construction. 2. Uses accurate and complete presentation of facts. 3. Uses logical presentation of arguments pro and con. 4. Develops well-reasoned, evidence-based recommendations. 5. Prepares concise executive summary. 1. Prepares cogent business presentations. Stays on topic. 2. Makes persuasive oral presentations or arguments. 3. Uses clear and understandable voice that is free of extraneous phrases ( um, you know ). 4. Uses effective audio visual media (presentation software, exhibits). 5. Engages in non-defensive Q&A, stays within time allotment. 1. EHR Evaluation Team Project 2. HIS Strategy and High-level Architectural Design Project 1. EHR Evaluation Team Project 2. In-class Discussion of Chapter Questions 7
Work effectively in teams. 1. Works collaboratively with team members in open and transparent manner 2. Contributes ideas and non-judgmental evaluation of team options and decisions. 3. Helps build team commitment and good morale 4. Helps to facilitate resolution of conflict or resistance. 1. EHR Evaluation Team Project Grading: Student grades will be based on: student performance of the following assignments and examination; class participation; and attendance. Letter grades will be assigned as follows: 98-100=A+, 92-97=A, 90-91=A-, 88-89=B+, 82-87=B, 80-81=B-, 78-79=C+, 72-77=C, 70-71=C-, below 70=F. Late assignments will be penalized at a rate of 5% per day. Academic Integrity: In line with University policy, the guidelines and policy for academic integrity will be enforced. Please see the policy found at the following link for the policy provisions: http://www.deanofstudents.ucla.edu/studentguide.pdf Assignments and Class Participation: 1. Students will design and describe business rationale for a high-level HIS architecture for a hypothetical organization. Students will provide written report and oral presentation formats. (20 points=15 points written report + 5 points presentation) 2. Students will actively participate in in-class discussion based on questions posed during the quarter as part of the lecture sessions. Students are expected to engage in class discussions on a regular basis throughout the quarter as part of their contribution to the success of the class. (10 points) 3. Final Project: Electronic Health Record (EHR) System evaluation: students will work in teams to conduct in-depth evaluations of commercially available EHR systems and present the results in a written report (including a 5-year cost estimate pro forma) and to the class in an oral presentation. (30 points total=20 points written report, 10 points team presentation). 4. Attendance, participation and EHR Project peer evaluations (combined 15 points) Examination: 1. Student will complete a take-home midterm examination to assess their knowledge of the HIS concepts and information presented in foundational portions of the book and class. (25 points) 8
Activity Points HIS Strategy and High-level Architectural Design Assignment 20 In-class Discussions 10 Midterm Examination 25 Participation (including attendance and peer evaluation for EHR 10 Evaluation project Final Project EHR Evaluation: team project, written report, and 35 oral presentation Total 100 Prerequisites: Summer internship or equivalent work experience. Textbooks and Readings: 1., J.A. () Systems and. 1st ed. Jones & Bartlett Learning. http://www.jblearning.com/catalog/9781284036114/. 2. Readings: (Additional supplemental handouts, readings or download sites will be posted or communicated). a. Blumenthal, D. (2009). Stimulating the Adoption of Health Information N Engl J Med April 9, 2009, 360(15):1477-9. b. Hillestad, R. et al, (2005) Can Electronic Medical Record Systems Transform Health Care? Potential Health Benefits, Savings, And Costs. Health Affairs, 24(5):1103-1117. c. Health Research Institute-Health Information, Price Waterhouse Coopers (2009). Rock and a Hard Place. Meaningful Use of Health IT. April, 2009. d. Jha, A.K., et al. (2009). Use of Electronic Health Records in U.S. Hospitals. N Engl J Med 2009;360. e. Miller, R.H. & Sim, I. (2004). Physicians Use Of Electronic Medical Records: Barriers And Solutions. Health Affairs, 23(2):116-126. f. Other readings as posted 3. Materials should be read before class so that students can participate fully in the discussions. 9
CLASS CALENDAR Week/ Session Intro Session 1 Oct 2 Week 1 Session 2 Oct 7 Week 1 Session 3 Oct 9 Topics Reading/Assignments Instructor/G uest Introductions. Syllabus review. Review of class schedule, assignments, and activities. Understanding Health Information Systems and Systems and (HIS): Alignment: Health Chapter 1 - Alignment: Health Information Systems and Information Systems and Current Challenges in Health Care HIS Scope, Definition, and Conceptual Model Systems and Chapter 2 - HIS Scope, Definition, and Conceptual Model. Week 2 Session 4 Oct 14 Section II: Systems and Management HIS Strategic Planning Class discussion DO: Review discussion questions for Chapters 1 and 2 Distribute and Review Assignment #1 Week 2 Session 5 Oct 16 HIS Application Systems and Systems and Chapter 3: HIS Strategic Planning Week 3 Session 6 Oct 21 Week 3 Session 7 Oct 23 Discussion: Chapter 3 Questions Discussion: Chapter 3 Questions Implementation Assignment Workshop Participate: Workshop for Assignment #1 Systems and Chapter 4: HIS Application Systems and 10
Week 4 Session 8 Oct 28 Week 4 Session 9 Oct 30 Week 5 Session 10 Nov 4 Presentations by each team for Assignment #1: Developing a High-level HIS Architecture Implementation Leadership and Adoption of HIS and Due: Assignment #1 Report and copy of PowerPoint slides Due in hard copy at beginning of class. Systems and Chapter 6: Implementation Distribute: take-home midterm examination Systems and Chapter 7: Leadership and Adoption of HIS and Week 5 Session 11 Nov 6 Managing HIS and : Delivering the Goods Systems and Chapter 5: Managing HIS and : Delivering the Goods Jim Brady, PhD Week 6 Nov 11 Week 6 Session 12 Nov 13 Week 7 Session 13 Nov 18 Veterans Day Holiday Section III: Health Informatics Business and Clinical Intelligence EHR Project Kick-off Midterm Due in hard copy, stapled with names plus post on CCLE (at 10:00am beginning of class) Systems and Chapter 8 - Health Informatics Systems and Chapter 9: Data EHR Project kick-off Guest Speaker Project Teams 11
Distribute EHR Evaluation Project, form teams, initial team meetings. Week 7 Session 14 Nov 20 Week 8 Session 15 Nov 25 Health Informatics Discussion: Chapters 9 & 10 questions EHR Project Workshops Systems and Chapter 10: Business and Clinical Intelligence Do: Prepare discussion questions Chapters 9 and 10 Prepare questions about EHR project and cost spreadsheet Week 8 Nov 27 Week 9 Session 16 Dec 2 Thanksgiving Holiday! Section V: Research, Policy, and Public Health HIS and Research, Policy, and Public Health Systems and Chapter 11: HIS and Research, Policy, and Public Health EHR Project Workshop Class Project Teams Week 9 Session 17 Dec 4 Week 10 Session 18 Dec 9 Week 10 Session 19 Dec 11 EHR Project Workshop Section VI: New Directions for HIS and What Lies Beyond the Current State of HIS and? EHR Project Presentations EHR Project Presentations Systems and Chapter 12: What Lies Beyond the Current State of HIS and? PowerPoint presentations due in hard copy at beginning of class day December 9 for ALL TEAMS Written report for EHR project due day December 16 Guest Lecturer Class Project Teams Class Project Teams 12
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