Comprehensive Guide to Health Information Systems (HIS) and Data Management

Health Information Systems (HIS)

Systems that manage health data and information to support healthcare operations and decision-making.

HIS Strategic Plan

Aligns HIS and technologies to strategic business directions and initiatives.

Governance

Use of consistent management methods, policies, decision rights, and processes across all units and departments.

Managing HIS

Key activities include Planning, Budgeting, System Selection, System Implementation, Managing Changes, and Managing Vendors.

HIS Planning and Budgeting

Uses the organization's strategic business plan as a guide and establishes annual or near-term plans/budgets based on a $5$-$10$-$15$-year view.

HIS Selection

Process for decisions about which new software systems to bring into the organization, overseen by the HIS Steering Committee.

Implementing HIS

Activities to move from a business plan to a fully utilized HIS, including activating new software and training end users.

Managing Change

Involves working with interdisciplinary teams on design, requirements, training, testing, activation, and use of HIS.

Managing Vendors

Organizations rely on external companies that produce, deliver, and support HIS software, hardware, and services.

Harvesting the Yield from HIS

The process of leveraging data resources to create new knowledge through analytics and business intelligence.

Data Management and Stewardship

Definition of each data element must be accurate and used consistently, managed according to organizational goals.

Data, Information, Knowledge (D-I-K)

Data: Elementary description of things, Information: Data organized to have meaning, Knowledge: Accumulated learning and expertise.

Information Overload

In 2023, the average internet user created about $1.7$ MB of data per second, leading to around $120$ zettabytes of world data creation.

Business, Clinical, and Artificial Intelligence

Provide analytical systems, resources, data management, and personnel capabilities.

Health Informatics

Uses biomedical data, information, and knowledge for scientific inquiry and decision making to improve human health.

HIS Regulatory Compliance

Key regulations include Health Insurance Portability and Accountability Act (HIPAA) and Medicare Access and CHIP Reauthorization Act (MACRA).

Risk Management

The process of identifying, assessing, and controlling threats to an organization's capital and earnings.

Clinical Intelligence (CI)

The use of data analytics to improve clinical outcomes and decision-making in healthcare.

Business Intelligence (BI)

Technologies and strategies for analyzing business data to support decision-making.

Regulatory Compliance

Ensuring that an organization follows relevant laws, regulations, and guidelines.

Interdisciplinary Teams

Groups composed of members from different disciplines working together towards a common goal.

Steering Committees

Groups that provide direction and oversight for projects within an organization.

Healthcare Regulation

Healthcare is highly regulated because it is paid for by government/third-party insurance; fraud constitutes roughly $10 ext{%}$ of healthcare costs.

Patient Safety

Patient safety, data, and privacy must be protected.

HIS Security

Security of HIS, data, and Protected Health Information (PHI) is a primary goal.

HIS Threats

Threats include hackers, black market activity, and ransomware.

HIS Prevention

Prevention is among the highest priorities for any HIS agenda.

HIS Model

A holistic model that includes: Global HIS, policy, and research; Analytics, BI/CI, and AI; Data and informatics; People and processes; Systems and management; Technology and infrastructure; Central HIS.

Technology Infrastructure

Elements include fiber optics, routers, switches; bandwidth connectivity; middleware; intranet; Internet; extranet capabilities.

Hardware

The backbone of computing environments, whether in a data center or cloud-based; provides the technology upon which software operates; accessed by end users.

Software

Applications can be clinical, administrative, analytic, or business-oriented. Core clinical programs include EHR systems, etc.

Middleware

Software that connects software applications to the data and technology supporting the application.

Networks

Computers linked to exchange data using technical and data connections; linkages enabled through fiber optics, cables, wires, routers, switches, Wi-Fi, etc.

End-users

Include clinical professionals, business people, and analysts using systems and information to meet professional goals.

User Interface (UI)

UI is activated through typing on a keypad, speaking into a device, or other means of connecting the user to the HIS or computer.

Middleware (Q&A)

M_ is software that connects software applications to the data and technology supporting the application.

Health Information Systems (Q&A)

H_ I S___ comprise an organized combination of system components, including infrastructure, hardware, middleware, application software, intended to support an organization or key processes in health care.

Bytes in 1 TB

How many bytes in 1 TB? billion bytes. Answer: 1000.

HIS Planning Horizons

Planning horizons mentioned for HIS planning: $5$-$10$-$15$ year view.

Regulatory Emphasis

Regulatory emphasis includes HIPAA, MACRA, and DHS regulations, with an estimated fraud burden around $10 ext{%}$ of healthcare costs.

Data Scale Figures

Data scale figures cited: $1.7$ MB/s, $147$ GB/day, $120$ ZB/year (2023 context), $337{,}080$ PB/day.

Scope of HIS

The scope of HIS comprises three interrelated components: Health informatics, Data and analytics, Research, policy, and public health uses of HIS.

HIS Foundation

These components rely on the fundamental capabilities and data provided by HIS; without a solid foundation, higher-level uses cannot exist.

HIS Model Positioning

The model positions HIS as the footing for broader health informatics activities and data-driven decision-making.

Meaningful health information

Data that is only as good as the HIS platform and the technical foundation that serves as the data source.

Workflows

Sequences of common tasks used by health professionals and organizations.

Processes

End-to-end methods used by healthcare providers, organizations, patients, and public health professionals.

Pharma-to-Patient value chain

Illustrates the broad ecosystem involved in health care, including Pharma, Biotechnology, Medical Equipment, and more.

Core Building Blocks

Essential components for advanced data uses, including Clinical decision support (CDS) and Artificial intelligence (AI).

Quality- or process-improvement objectives

Objectives that vary by setting and constitute the practical use of HIS capabilities by end users.

Health Information Technology (HIT)

A domain represented in health informatics alongside Health Information Management (HIM).

Data creation settings

Occurs across multiple settings such as physician practices, clinics, and hospitals.

Data aggregation

The process of compiling data for research, analysis, and policy.

Electronic Health Records (EHRs)

Data captured in EHRs are aggregated into databases for research and policy analysis.

Polystore

Diverse data architectures where EHR data can be stored, including column stores and relational databases.

Population query

A query type for aggregate/population-level analysis.

Single patient query

A query type for case-level clinical detail.

Primary clinical use

One of the two primary uses of EHR data.

Research use

The second primary use of EHR data.

Micro-level data collection

Feeds macro-level insights in health data analysis.

Data flow and interoperability

The needs across manufacturers, providers, payers, regulators, and patients to support care delivery.

Critical requirement for data

Data must emanate from real healthcare processes to be credible and useful.

Health Information Management (HIM)

A domain that focuses on managing health information systems and data.

Big data

Large and complex data sets that require advanced methods to process and analyze.

Public health purposes

Personal data used for improving community health outcomes.

Figure reference note

Illustrates data store concepts and query types.

Data collection

Data input by physicians and other users via user interfaces to central databases.

Data processing

Data are reviewed and validated; quality-based registries (examples: PQRS, society-based registries) support quality measurement and reporting.

Data analysis

Downstream analysis supports clinical decision making, quality improvement, and research.

DBMS role

Database management systems manage data input, central storage, and data review.

Organizational Data and IT Infrastructure

Database management systems example domains within organizations: Registrar's offices, class programs, academic information, team data, employee data, tuition data, accounting data, financial data, student data, course data, athletics data, registration data.

Core IT components

Typically mapped in diagrams include: Hardware, Software, Database, Network, Procedures, People.

HIT/Informatic Landscape

An integrated view of HIS infrastructure includes: Hardware, Software, Database, Network, Procedures, People.

Balanced integration

Emphasis on balanced integration of technology with human processes and organizational procedures to achieve effective HIS performance.

Maturation of HIS

Maturation occurs through the progression of the HIS Conceptual Model.

Core pillars of HIS

Success is the result of balanced involvement of people, processes, and technology.

HIS Uses in Organizational and Community Settings

Mission, vision, and goals drive the core systems used by an organization.

Stakeholders/users of HIS

Include various payers, patients/consumers, public health agencies, and research organizations; different needs across these groups inform HIS deployment.

Settings for HIS Uses

Inpatient, outpatient, and ambulatory care organizations; Patients'/consumers' homes; Payers, insurance companies, and government programs/agencies; Public health organizations.

Health Information Exchanges (HIEs)

Collaborative arrangements aimed at sharing patient-related health information.

Health Information Exchange (HIE)

HIEs enable sharing of patient-related health information across organizations and settings.

Goal of HIEs

To facilitate timely, accurate, and interoperable data sharing to improve care coordination and population health.

Business Intelligence

A term for value realized by flexibly analyzing comprehensive stores of data representing the totality of an organization's/provider's scope of activity.

Workflows and processes in HIS

Transform raw data into actionable information within HIS.

Distinction between BI and CI

Be able to distinguish between BI and CI (Clinical Intelligence) and why clinical data analysis is central to patient care.

Roles of CDS and AI

Foundational building blocks in modern HIS applications.

EHR data architectures

Polystore concepts and the difference between primary clinical use and research use.

Purpose of Health Information Exchanges (HIEs)

Support public health and patient care.

HIS standards and governance frameworks

Guide the operational integrity and strategic alignment of health information systems.

Governance structures

Such as steering committees, are essential for overseeing HIS planning and ensuring consistent management across departments.

Key activities in HIS Management

Include planning, budgeting, system selection, implementation, change management, and vendor management.

System selection

Requires justification for new software systems, overseen by the HIS Steering Committee to ensure strategic fit.

Implementation in HIS

Involves transitioning from a business plan to a fully operational HIS, including software activation and user training.

Change management

Requires collaboration with interdisciplinary teams to address design, requirements, and user training effectively.

Data Management in HIS

Crucial for transforming raw data into actionable insights that drive organizational success.

Data

Refers to elementary descriptions of events and transactions, serving as the foundational element of HIS.

Information

Data that has been organized and processed to provide meaning and context.

Knowledge

The accumulation of information and experience that informs decision-making and problem-solving in health contexts.

HIPAA

A key regulation that governs the management of health information.

MACRA

A key regulation that governs the management of health information.