Chapter 1: Information System Fundamentals - Health Information Systems (HIS)

Health Information System (HIS) Fundamentals

Core Principles and Regulatory Compliance

• Fundamentals: Skills, training, methods, standards, and principles are crucial for guiding the planning, design, testing, implementation, and maintenance of any Health Information System (HIS).

• Regulatory Environment: The healthcare industry is heavily regulated. Consequently, regulatory compliance is an essential aspect of implementing and operating an HIS.

Key Acronyms in Health Information Systems

While often used interchangeably, these terms have distinct definitions:

• EMR (Electronic Medical Record): This refers specifically to a patient's medical record in a digital format.

• EHR (Electronic Health Record): This system facilitates the sharing of EMR data across various different sources (e.g., hospitals, clinics, labs).

• HIS (Health Information System): This is a broader computer system designed for the overall operation of hospitals and clinics, encompassing administrative, financial, and clinical functions.

• HMIS (Health Management Information System): This system integrates data from various HIS instances, analyzes it, and aims to generate new knowledge and support strategic decision-making.

HIS Strategic Planning and Governance

• Strategic Alignment: HIS strategic planning must be closely aligned with the organization's overarching strategic business goals and directions.

  • Long-Term View: Strategies typically encompass a long-term perspective, often 5 to 10 or 15 years, rather than short-term (e.g., one year or one month). They guide annual HIS and operating budgets.

• Governance: This involves the consistent application of management methods, policies, decision-making rights, and processes across all units and departments within an organization.

  • Steering Committee: A steering committee plays a vital role in establishing rules and making decisions critical for effective governance.

Managing HIS Activities

There are six key activities involved in managing an HIS:

1. Planning and Budgeting:

   • Must align with the organization's strategic business objectives. For instance, if the organizational strategy is to improve community health, the HIS planning should support that goal.

   • Annual HIS operating budgets are developed based on these long-term strategies.

2. System Selection:

   • Involves deciding whether to acquire new systems (e.g., new servers, operating systems, applications, technologies) or to reconfigure/optimize existing computer hardware and software.

   • Choices include selecting specific vendors, operating systems, and applications suitable for the organization's operations.

   • The HIS steering committee is responsible for overseeing the selection process and all related decision-making.

3. Implementation:

   • This can involve building the HIS in-house (using proprietary IT staff), outsourcing the development to external entities, or utilizing cloud service application providers via Internet connection.

   • Implementation extends beyond merely activating new software on new hardware or operating systems; it crucially includes providing comprehensive training programs for all end-users.

4. Managing Changes:

   • The healthcare industry operates in a dynamic environment, requiring HIS to continuously adapt to compliance regulations.

   • Crucially, any changes or maintenance efforts must involve collaboration with end-users (e.g., hospital staff, nurses, physicians). A technically sophisticated system is ineffective if it is not adopted or used by its intended users; consultation with end-users and customers is paramount.

5. Managing Vendors:

   • Hospitals and clinics increasingly rely on third-party vendors (for hardware, software, and services) because their core expertise lies in patient care, not in developing HIS.

   • It is important to be cautious and diligent when managing vendors, as their primary objective is to create their own value, which may not always align perfectly with the hospital's objectives.

Harvesting Yield and Value from HIS

• Data Production and Protection: HIS generates a significant volume of accurate patient data, which must be diligently protected.

• Analysis for Knowledge Generation: Collected HIS data should be analyzed using tools like business analytics, business intelligence, or clinical intelligence systems to produce new knowledge.

• Value Assessment: The value of an HIS project is often assessed using Return on Investment (ROI):
  ROI = \frac{\text{Return (Benefit)}}{\text{Investment (Cost)}}

• Industry Underachievement: Despite the potential, the value derived from HIS in the industry is often underachieved.

• Data Quality: Data consistency, accuracy, accessibility, and safety are critically important.

  • **