HIS Scope, Model, and Maturation

HIS Overview

General Information

  • Course Title: Health Information Systems I (HIM72060)

  • Week: 2A

  • Topic: HIS Scope, Model, and Maturation

  • Instructor: Laurie Lafleur

Supply Chain Analogy

  • Supply Chain Elements:

    • Consumer

    • Retailer

    • Supplier

    • Manufacturer

    • Distributor

    • Logistics (for each group; emphasizes the interconnected nature of supply chains)

The Scope of the HIS Model

  • Definition: The scope of the Health Information Systems (HIS) model encompasses all computer systems (software, hardware, operating systems, and end-user devices), networks, and data.

  • Goal: Support the delivery of health information (the product) to the consumer (healthcare professional, patient, researcher, etc.).

HIS Foundations According to Balgrosky

  • Quotations: "The access devices and networks do not actually create data; instead, data are created and captured in painstakingly and properly implemented HIS…" - Balgrosky, p.22

  • His view emphasizes comprehensive HIS implementations supporting healthcare workflows.

HIS Model Breakdown

  • Components of HIS Maturation:

    • Global HIS, policy, and research

    • Analytics, Business Intelligence (BI)/Clinical Intelligence (CI), and Artificial Intelligence (AI)

    • Data & informatics

    • People & processes

    • Systems & management

    • Technology & infrastructure

  • Source Reference: Jean A. Balgrosky (2020), Understanding Health Information Systems for the Health Professions.

Learning Objectives

  • Discuss the scope of HIS and elements of HIS maturation.

  • Explore various clinical settings and usage patterns.

  • Understand the significance of HIS data collection and sharing for research, policy, and public health applications.

Definition of Health Informatics

  • Definition by Balgrosky: "Health Informatics is the use of information systems and technology to redesign, improve, and recreate the way work is done in disciplines such as medicine, nursing, medical imaging, and public health." - Balgrosky, p.22

  • Key Focus: Aimed at quality or process improvement across various healthcare sectors, including emergency care and pandemic preparation.

HIS Maturation Phases

  • Foundation: Strong foundational components are necessary for effective HIS before implementation.

  • Key Questions:

    • What foundational components are needed for HIS?

    • What foundational components are required for an Amazon order?

Critical Components of HIS

Infrastructure

  • Essential components include:

    • Network: Connectivity tools (routers, switches, gateways, etc.)

    • Storage: On-premises or cloud storage solutions

    • Servers: Physical or virtual servers

    • Business Continuity: Load balancing, replication efforts for disaster recovery

Core Systems

  • Operating Systems: Security features, firewalls, VPNs, and user management tools

  • Monitoring Tools: Infrastructure monitoring and application usage

End-User Devices

  • Examples Include:

    • Desktop workstations

    • Imaging modalities (e.g., X-ray, CT, MRI, ultrasound)

    • IoT and point-of-care devices (e.g., wearable monitors and handheld ultrasounds)

    • Mobile applications.

HIS Maturation: Use and Data Utility

  • Key Components:

    • People & Processes

    • Data & Informatics

    • Foundation (Technology & Infrastructure)

    • Systems & Management

Processes, Workflows, and Data

  • Importance of HIS: Provides meaningful healthcare information rooted in the technical foundation that supports processes and workflows.

  • Key Terms Defined:

    • Processes: End-to-end methods for healthcare delivery

    • Workflows: Sequences of tasks

    • Data: Information captured by HIS supporting healthcare operations.

Example ER Visit Workflow

  1. Visit Triage Nurse

  2. Provide Personal Information

  3. Arrive in ER

  4. Nurse Takes Vitals

  5. Nurse Registers Patient in HIS/EMR

Process Activities in ER

  • Activities Involved in Visit:

    • Registration

    • See Doctor

    • Get X-Rays

    • Get Cast

    • Discharge

  • Collecting Data in Workflow:

    • Sample data includes: Birthdate, Health Card Number, Vitals, Medications, Comorbidities, etc.

Understanding HIS Use Cases

  • Stakeholder Categories:

    • Who: Patients, Administrators, Physicians, Researchers, Nurses, etc.

    • Where: Care Settings (Hospitals, Ambulatory Centers, Family Physician Offices, etc.)

    • Purpose: Utilized for health system planning, operations management, diagnosis, treatment planning, preventative care, policy-making, and research.

Clinical vs. Administrative Applications

  • Clinical Applications: Direct care-related tools for diagnosing or treating conditions.

  • Administrative Applications: Support and backend tools for HIS management such as security, technical infrastructure, and workflow processes.

Primary vs. Secondary Use of Data

  • Primary Uses: Supports patient care and administrative activities.

  • Secondary Uses: Encompasses research, policy, public health analytics, and reporting to third parties.

Stakeholder Discussion Question

  • Comparative Analysis: Discussion on differences in the information use or data collection of lab techs versus public health administrators or specialist physicians.

  • Inquiry into the attribution of the term 'patients' becoming 'consumers' in healthcare:

    • Why this change?

Patient Engagement

  • Higher patient engagement leads to improved health outcomes.

  • Statistics on Patient Change:

    • Less Activated Patient: 28% readmission rate w/in 30 days

    • More Activated Patient: 13% readmission rate

    • Increased activation levels correlate with better adherence to treatment and health-related behavior changes (e.g., exercise).

HIS Maturation Focus on Learning & Knowledge

  • Key components include:

    • People & Processes

    • Data & Informatics

    • Technology & Infrastructure

    • Systems & Management

Data Elements Appearing in HIS

Discrete Data Elements:

  • Physician visit notes, family history, prescriptions, immunizations, health risks, and conditions—including social determinants of health, etc.

HIS Analytics Components

Similarities and Differences:

  • Similarities: Creation of information from data, supports evidence-based decision making, importance of solid foundational HIS.

  • Differences:

    • Business Intelligence (BI): Focused on business metrics like performance, planning, budgeting.

    • Clinical Intelligence (CI): Concerned with clinical decisions and outcomes.

    • Artificial Intelligence (AI): Focused on predictive analytics and complex modeling in both BI and CI contexts.

Examples of Analytics in HIS

  • Business Intelligence Example: Reports on exam volumes segmented by inpatient and outpatient, analyzed by modality over time.

  • Clinical Intelligence Example: Patient cohort details, including study dates and statistical analysis of medical conditions and treatments.

Artificial Intelligence Application in HIS

  • Use of AI in managing follow-up recommendations and patient data analysis based on condition status.

Research, Policy & Public Health

  • Importance of HIS foundations in understanding challenges within various HIS use frameworks.

  • Examples to consider: Application of data in healthcare settings for broader public health implications.

Breakout Room Activity

  • Task: Identify examples of challenges related to assigned HIS layers within groups.

  • Duration: 5 minutes.

Key Takeaways

  1. Describe the four stages of HIS maturation.

  2. Differentiate clinical from administrative applications and respective use cases.

  3. Understand primary vs. secondary use cases of HIS.

  4. Compare HIS needs across various care settings and stakeholders.

  5. Importance of HIS data collection and sharing for research, policy, and public health.

Homework

  • None assigned for this week.