Florida National University
HSA-6197 Health Information System and Electronic Health Records: Assignment Week 2
Student PowerPoint Presentation: Chapters 3 and 4
Objectives: The presentation assignment has several goals. It requires students to apply concepts
from Medisoft and scheduling. Medisoft Clinical is a practice management and electronic health
record program for physician practices, a skill they will be using as Healthcare Administrator.
Format and Guidelines: The student will create a Power Point Presentation from Chapter 3 and
4 of the Textbook related to Week 2 (Choose your desire topic form these chapters). The
Presentation should have a minimum of 12 slides, including Title Page, Introduction,
Conclusion, and References.
The student must use other textbooks, research papers, and articles as references (minimum 3).
EACH PAPER SHOULD INCLUDE THE FOLLOWING:
1. Title Page: Topic Name, Student Name
2. Introduction: Provide a brief synopsis of the meaning (not a description) of the topic you
choose, in your own words
3. Content Body: Progress your theme, provide Material, illustrations and Diagram to
explain, describe and clarify the Topic you choose.
4. Conclusion: Briefly summarize your thoughts & conclusion to your critique of the
Chapter you read.
5. References: The student must use other textbooks, research papers, and articles as
references (minimum 3)
Dr. Gisela Llamas
Florida National University
HSA-6197 Health Information System and Electronic Health Records: Assignment Week 2
Student PowerPoint Presentation: Chapter 3 and 4
Grading Sheet
Student Name __________________________________
Category
Possible Points
Presentation style and content.
3
Distributed bibliography w/ 3
additional readings
2
Inclusion of diversity content
Pictures, Graphic, etc.
2
Length: Minimum 12 slides
1
Required Format
2
TOTAL
10
Dr. Gisela Llamas
Date_____________________
Actual Points
ASSIGNMENT GRADING SYSTEM
A
90% – 100%
B+
85% – 89%
B
80% – 84%
C+
75% – 79%
C
70% – 74%
D
60% – 69%
F
50% – 59% Or less.
Dr. Gisela Llamas
Chapter 4:
HIS Strategic
Planning
Introduction
• HIS is a reflection of the organization’s character
and values
• HIS strategy and planning processes should
intertwine the organization and its HIS
capabilities
• The HIS Planning Framework provides a construct
for defining the HIS software portfolio
• The goal is a HIS Strategic Plan that reflects the
organization’s strategic business plan
HIS Planning Framework
• The four quadrants of the HIS Planning
Framework provide the conceptual structure
needed to conduct HIS planning discussions that
include all stakeholders
• “What do we want to do,” not “how” or “who”
• Supports the imperative that all disciplines of
health professionals become well versed in HIS
HIS Planning Framework
• Principles of planning
– Universal principles of planning should guide the HIS
planning process and strategy
– Rush to solve problems can spell disaster
– Most publicity and conference content focuses on
successes
– Vendor contracts constrain organizations’ ability to
be transparent about problems
– HIS are costly to acquire, implement, and maintain
– Careful planning is needed to avoid surprises
Case Example: No Decision Is a
Decision
• Background
• The challenges needing a solution
• The solution
• Anticipated outcomes of the new approaches
HIS Strategy: Using Organizational
Strategy as a Roadmap
• Strategies
– Directional statements or overarching aims directly
tied to mission and vision
– Mission: Organization’s reason to exist
– Vision: Long-term and evolving view of its place in
an environment or market in the future
– Mission, vision, and values are communicated
widely throughout the organization
– Every organizational action should be consistent
with these pillars
HIS Strategy: Using Organizational
Strategy as a Roadmap
Organizational Pillars
HIS Strategy: Using Organizational
Strategy as a Roadmap
• Steps in determining strategy
– First step is to define mission, vision, and values
– Next is to determine how the organization should go
about doing so and which activities will move it in
that direction
HIS Strategy: Using Organizational
Strategy as a Roadmap
• Steps in determining strategy
– Determining the course and criteria for decisions
involves
• Framing a vision for the organization
• Documenting all currently existing HIS and technology
• Designing a 10- to 15-year view of a desired vision
• Mapping out a migration path between the current state
and the desired vision or future state
Case Example: Hypothetical
Visioning for a Heart Healthcare
Provider
• Background
• The challenges needing a solution
• The solution
• Anticipated outcomes of the new approaches
HIS Strategy: Using Organizational
Strategy as a Roadmap
• Relationship between organizational strategy and
HIS strategy
– HIS strategy should be to build the IT capabilities and
systems necessary to enable the organization’s
strategies and support business and clinical goals and
objectives
– Systems and HIS infrastructure that do not align or run
counter hinder the forward movement of the entire
organization and threaten the trajectory toward its
vision state
HIS Strategy: Using Organizational
Strategy as a Roadmap
• Relationship between organizational strategy and
HIS strategy
• If the organization does not have a strategic plan
– Take charge and create the strategic organizational plan
before launching off to develop and implement HIS
strategy
– Seek input from employees at all levels
– Document everything
– Circulate documentation and get reactions
– Adjust documentation based on feedback
HIS Strategy: Where Do We Begin?
• Four essential themes feed into solid
understanding of HIS strategy
– Organizational strategy
– HIS Planning Framework
– HIS decision making processes
– Context of the changing national HIS strategy
HIS Strategy: Where Do We Begin?
• Organizational strategy provides the foundation
for HIS strategic planning
– Organization’s strategic planning process defines a
5- to 10- to 20-year desired future state based on
mission, vision, and values
– Next, it will select strategies that will move the
organization in this direction
– Then it will break multiyear goals into measurable
annual objectives
– HIS initiatives and projects should align
HIS Strategy: Where Do We Begin?
• Organizational strategy provides the foundation
for HIS strategic planning
– Many HIS strategies focus on selecting software
vendor
– Choosing vendors for software and hardware
products is important
– More important task is to determine whether the
implementation of that software will address the
right types of IT capabilities for the organization’s
current and future needs
HIS Strategy: Where Do We Begin?
• Organizational strategy provides the foundation
for HIS strategic planning
– Alignment with organizational strategy is the most
important criterion
– Software should be tailored to the needs and
preferences of your organization’s knowledge
workers
– Architecture: technology
HIS Strategy: Where Do We Begin?
• Organizational strategy provides the foundation
for HIS strategic planning
– Foundational IT should be in place before new
software systems
– Systematic implementation of new HIS should follow
roadmap laid out by the HIS Strategic Plan
– Enterprise systems vs. silos
– Implementation success lies in thoughtful planning;
collaborative, multidisciplinary groups;
documentation; and prioritization
– “Top-down” and “bottom-up” perspectives
HIS Planning Framework: An
Aligned, Architectural Approach
• HIS Planning Framework was developed
originally as a consulting tool
• Presents a way to visualize totality of application
systems needed in an organization’s application
portfolio
• Help with technical planning, budgeting,
staffing, sequencing of system introduction
HIS Planning Framework: An
Aligned, Architectural Approach
HIS Planning Framework: The Four Quadrants
HIS Planning Framework: An
Aligned, Architectural Approach
• The framework is intended to be used to
strategize and plan the balanced portfolio of
software application systems needed to support
clinical and business functions and capabilities
• Different business models can be planned using
the framework
– Accountable care organizations (ACOs), population
health management efforts, etc.
HIS Planning Framework: An
Aligned, Architectural Approach
• Donabedian’s Health Care Quality Framework
identifies three areas for evaluating quality of
health care
– Structure
– Process
– Outcomes
HIS Planning Framework: An
Aligned, Architectural Approach
Donabedian’s Healthcare Quality Framework and HIS
HIS Planning Framework in Practice
• The framework is oriented towards
– Information requirements
– Functionality
– Identification of software systems
HIS Planning Framework in Practice
HIS Planning Framework: Scope of Quadrants
HIS Planning Framework in Practice
HIS Planning Framework: Software Applications
HIS Planning Framework in Practice
HIS Planning Hierarchy
HIS Planning Framework in Practice
• HIS strategic planning process
– Begins with documentation of current state of HIS,
clinical and administrative workflows, and
information processes
– This “current state analysis” is a set of baseline HIS
capabilities the organization sets out to replace or
integrate into more expansive and capable
enterprise-wide systems
HIS Planning Framework in Practice
• Migration plan
– Connects the current state to the future state
– Needs a chief information office who thinks in terms
of overarching strategic terms
– Once HIS and technology strategic plans are in place,
HIS and technology tactical must be developed
• Capital and operating budgets for each project
• Project teams and specialized task forces
• Teams consist of IT staff, clinical and administrative
knowledge workers, and external resources
HIS Planning Framework in Practice
• Migration plan
– Once requirements for a new system are developed,
a business plan is prepared for preliminary approval
and committee presentations
– When the project is approved internally it moves
through more detailed, tactical planning phase
• Request for Information (RFI)
• Request for Proposal (RFP)
– Disciplined, carefully orchestrated RFI and RFP
activities lay groundwork for future decisions
HIS Planning Framework in Practice
• Business plans
– Must accompany each project that accomplishes
each step that build the portfolio of HIS
– Prepared in collaboration with and signed off by
others in the organization whose buy-in, input,
cooperation, and resources must be sought,
available, and used
– Standard outline
– Guided by interdisciplinary steering committees
HIS Planning Framework in Practice
• HIS strategic initiatives
– Next step is to span the HIS planning portfolio out
over the next 5 to 10 years
– Quadrants of the HIS Planning Framework are a
useful tool for organizing the global HIS Strategic
Plan into Strategic Initiatives
– Each quadrant represents unique categories of
systems
HIS Alignment and Strategic
Planning
• All business strategies and clinical initiatives
must be addressed from an HIS perspective
• HIS sometimes operates in support/processimprovement mode and at other times as
enabler
• All strategic discussions should include an HIS
element, and vice versa
• Aligned organizational and HIS strategies can be
developed into detailed tactical HIS plans
HIS and Technology Strategy;
Advancing Public Health
• Uses of HIS and technology can have a
remarkable effect on public health
• Care-providing entities are striving to reach
patients as closely as possible to their homes
and places of work
• HIS planned and designed in support of public
health means building awareness and providing
access to information about health-related
issues
Summary
• Effective HIS strategy and planning rely on and
require linkage to overall strategies and activities
of the healthcare organization
• The HIS Planning Framework provides a template
for engaging in meaningful dialogue about how
to create a balanced application architecture and
HIS portfolio
• The HIS strategic planning process begins with
documentation of the organization’s current
state, then defines a 5- to 10- to 15 year desired
state of HIS
Summary
• The migration plan provides a roadmap for
moving from current to future state
• The migration plan can then be developed,
articulating the roadmap for moving from current
to future state
• Donabedian’s Framework of Health Care Quality
is an important aid to planning and implementing
HIS and technology to improve healthcare quality
• HIS in organizations and those providing for the
public’s health are converging
Chapter 3:
Aligning HIS in the
Dynamic
Healthcare
Environment
Introduction
• HIS play their part in a volatile and dynamic
work environment
• Few industries are as dynamic as health care
• U.S. fee-for-service health system is trying to
transition to value-based care while caring for
aging, chronically ill population costeffectively
• Strong vision and leadership combined with
functional HIS systems are needed to make
this transition successfully
Health Care’s Current State
• Drivers of change and challenges
– Inadequate quality
– Historical focus on acute care with increasing
incidence of chronic illness
– Aging population
– High degrees of variabilities in health care processes
– Increasing cybersecurity threats
– EHR systems that have turned health care
knowledge-workers into data entry clerks
– Unsustainably high cost of health care
Health Care’s Current State
• Three major issues that describe health care
today and face the most significant change
– Programs of care designed around fee-for-service
– Untenable health care costs
– Ineffective care
Health Care’s Current State
• Fee-for-service
– HIS systems were designed to support fee-forservice reimbursement
– Bill and reimbursement for procedures is more
straightforward than for value and health outcomes
• Healthcare costs
– U.S. spends more than other developed countries
– Outcomes are worse for most important measures
– Health care is the largest driver of government
spending
Health Care’s Current State
The Rising Cost of Health Care
Data from the National Academies of Sciences, Engineering, and Medicine: Health and Medicine Division. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series
Summary. Washington, DC: The National Academies Press. https://doi.org/10.17226/12750. Retrieved from http://resources.nationalacademies.org/widgets/vsrt/healthcare-waste.html
Health Care’s Current State
• Healthcare quality and effectiveness
– HMD estimates 30% of healthcare dollars are
wasted, ineffective, overpriced, or unnecessary
services
– To Err Is Human (HMD, 1999)
• Studied 33.6 million hospitalizations in the U.S.
• An estimated 44,000 – 98,000 patients deaths occur
because of hospital mistakes
• Sheds light on whole U.S. healthcare system rather than
focusing on any one caregiver/provider
Health Care’s Current State
Healthcare Spending: 30% Is Waste
Data from the National Academies of Sciences, Engineering, and Medicine: Health and Medicine Division. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series
Summary. Washington, DC: The National Academies Press. https://doi.org/10.17226/12750. Retrieved from http://resources.nationalacademies.org/widgets/vsrt/healthcare-waste.html
Health Care’s Current State
• Healthcare quality and effectiveness
– Crossing the Quality Chasm (HDM, 2001): Outlines
six key aims necessary to improve quality of care
• Safe
• Effective
• Patient centered
• Timely
• Efficient
• Equitable
Health Care’s Current State
• Healthcare quality and effectiveness
– Crossing the Quality Chasm identified four key
reasons for significant gap in U.S. health system
between reality and ideal quality
• Growing complexity of science and technology, with
delays between innovation and implementation
• Increase in chronic disease burden with a system centered
on acute illness
• Inadequate use of information technology
• A payment system that provides conflicting incentives and
does not reward quality improvement
Health Care’s Current State
• The state of health care as it relates to HIS
– As of 2015, 75% of hospitals and 86.9% of officebased physicians used at least a basic EHR system
(Adler-Milstein and DesRoches; CDC)
– Basic system includes
• Patient history and demographics
• Patient problem lists
• Physician clinical notes
• Comprehensive list of patient medications/allergies
• Computerized orders for prescriptions
• Ability to view lab and imaging results electronically
Health Care’s Current State
• The state of health care as it related to HIS
– Interoperability: Sharing patient data between
practices electronically
• Far more difficult and often less achievable than originally
imagined
• Highly variable capability
• Current approaches are vendor driven
• Effectiveness is questionable
• To be helpful, must be widespread
Case Example: Interoperability
• Background
• The challenges needing a solution
• The solution
Case Example: Interoperability
Percent of physicians who have demonstrated MU and/or
adopted, implemented, or upgraded and EHR
Reproduced from Office of the National Coordinator for Health Information Technology. ‘Office-based Health Care Professionals Participating
in the CMS EHR Incentive Programs,’ Health IT Quick-Stat #44. dashboard.healthit.gov/quickstats/pages/FIG-Health-Care-ProfessionalsEHR-Incentive-Programs.php. August 2017.
Case Example: The Ethos of
U.S.-Based HIS
• Background
• The challenges needing a solution
• The solution
Case Example: Putting Clinical
Processes First
• Background
• The challenges needing a solution
• The solution
Case Example: The Cripplingly High
Cost of Software
• Background
• The challenges needing a solution
• The solution
Health Care’s Current State
• Government
– History of health services modalities is driven by
types of funding available
– Complexity of U.S. regulatory and reimbursement
processes adds cost and has created negative effects
on quality
– Adding to the challenge are volatility due to politics,
regulatory adjustments, government contracts, and
uncertainty in large programs such as Medicare
Health Care’s Current State
• The Health Insurance Portability and
Accountability Act
– Designed to ensure individuals’ insurance would be
portable across states and jobs
– Far more impact through “administrative
simplification” (Title II) elements
– Requirements for electronic data interchange (EDI)
anticipated need for data standards for electronic
claims
Health Care’s Current State
• The Health Insurance Portability and
Accountability Act
– Administration simplification attributes
• Electronic HIS standards for data transmission protocols
• Requirement that Medicare providers and health plans
participate
• Privacy and security of protected health information
(PHI)
• Preempted state laws
• Imposed penalties for noncompliance
Health Care’s Current State
• Title II Administrative Simplification Act
– Aimed to improve U.S. health system’s efficiency by
introducing standards governing use and
communication of healthcare information
– Protect identifiable PHI
– Apply to all provider and payer organizations
(“covered entities”)
• Health plans, and healthcare billing services and providers
that transmit healthcare data, submit claims, and receive
reimbursements from Medicare
Health Care’s Current State
• Title II Administrative Simplification Act
– Privacy Rule
– Transactions and Code Sets Rule
– Security Rule
– Unique Identifiers Rule
Health Care’s Current State
• ARRA and HITECH
– National and presidential initiatives to improve
quality and health care were priorities under
Presidents George W. Bush and Barack Obama
– ARRA has had the greatest impact
• Includes the HITECH Act, which requires the government
to lead the development of standards that allow for
nationwide electronic exchange and use of health
information
• Meaningful Use (MU) criteria
• Diagnosis related groups (DRGs)
Health Care’s Current State
MU Stages 1, 2, and 3
Health Care’s Current State
• Security
– Issue reaches into realms of AI and monetary
capitalization of data by insurance companies
– Security of EHR systems goes beyond HIPAA
– AI is being used by insurance agencies to predict risk
and raise rates, exclude, and restrict access to care
– This puts patients and providers at a disadvantage
HIS: A Key for Change?
• HIS is both a collection of technologies and a
transformative force that can radically alter and
improve healthcare delivery work processes
• As we computerize we must always ask what we
are trying to accomplish and why
• Evaluate whether goals have been achieved
• Make adjustments
• Shift focus to value-based reimbursement, patient
engagement, other means of improving cost-quality
ratio
HIS: A Key for Change?
• Alleviating clerical work
– Computerization of clinical tasks relieves health
professionals of mundane manual tasks and
improves efficiencies and documentation
• For reimbursement
• For analytics
– Providers are frustrated
– Providers and patients feel the value of EHR systems
do not outweigh the detractors
• Additional two hours of documentation for one hour of
patient contact
Population Health Management
and HIS
• Population health management
– Takes a holistic view of health and care
– Provides needed health services for defined group o
population of patients
– Includes acceptance of financial risk and clinical
responsibility by a health system/group of providers
– HIS plays key role in enabling successful population
health management
Population Health Management
and HIS
• Value-based care
– Term is needed because many in health care have
lost sight of the core of what health care is about:
the interaction and relationship between patient
and provider
– Dollars are great in health care and adjacent markets
– Value equals ratio of quality/benefits to cost
– Cost is far less to keep a person healthy than to cure
or manage long-term illness
Population Health Management
and HIS
• Value-based care in action
– Goal is to provide proactive, comprehensive medical
and behavioral care managed in a way that
enhances the overall outcomes and wellness for the
patient
– Requires thinking differently and orienting thoughts
and actions to focus on care and interventions that
bring improvement in outcomes
– Must proactively gather data, information, and
evidence; involve patients and families in
management of their health
Population Health Management
and HIS
• Emphasizing prevention and care management
– Mature use of HIS will help move from focus on
acute episodic care to prevention of disease and
care management
– Requires shift away from vertical (silos of
information) to horizontal integration
– Administrative processes and business systems
must evolve to anticipate risk and provide incentives
Challenges for HIS and Health
Professionals Using Them
• Challenges for HIS and health professionals
using them
– Legacy HIS systems
– Aging technology
– Workflows, incentives, and organizational cultures
built around fee-for-service market
– Massive industry consolidation
Summary
• The evidence against fee-for-service is
mounting
• Healthcare industry is proving to be more
dynamic and volatile than ever
• Health care must become more affordable,
higher quality, and sustainable
• Shift toward value-based will depend on HIS
that can support new processes
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