Understanding Health Information Systems Chapter 3
Introduction to Health Information Systems (HIS)
Volatile and Dynamic Work Environment: Health Information Systems (HIS) function within an exceptionally dynamic and often volatile healthcare landscape.
Healthcare Industry Dynamics: Few industries experience as much rapid change and complexity as healthcare.
Transition to Value-Based Care: The U.S. healthcare system is currently undergoing a significant transition from a traditional fee-for-service model to a value-based care model.
This transition aims to provide cost-effective care for an aging population with a high prevalence of chronic illnesses.
Requirements for Successful Transition: A successful shift necessitates a combination of strong vision, effective leadership, and robust, functional HIS systems.
Health Care's Current State: Challenges and Drivers of Change
Three Major Issues Describing Current Healthcare:
Programs of care predominantly designed around fee-for-service reimbursement.
Untenable and unsustainably high healthcare costs.
Ineffective care delivery.
Drivers of Change and Challenges:
Inadequate Quality: Persistent issues with the quality of care provided.
Focus on Acute Care vs. Chronic Illness: A historical emphasis on acute care, despite the increasing incidence of chronic illnesses, leading to a mismatch in care models.
Aging Population: A growing demographic of older individuals requiring more complex and prolonged care.
High Variability in Processes: Significant inconsistencies in healthcare processes, contributing to inefficiencies and varying outcomes.
Increasing Cybersecurity Threats: Growing risks from cyberattacks, posing threats to patient data security and system integrity.
EHR System Perceptions: Electronic Health Record (EHR) systems have, in many instances, transformed healthcare knowledge-workers into data entry clerks, leading to frustration among providers.
Unsustainably High Cost: The exorbitant and ever-increasing cost of healthcare is a major concern.
The Problem of Untenable Healthcare Costs
Fee-for-Service Model's Role in Costs:
HIS systems were originally designed to support fee-for-service (FFS) reimbursement structures.
Billing and reimbursement for individual procedures under FFS is more straightforward than for holistic value and overall health outcomes, which complicates the transition to newer models.
U.S. Healthcare Spending:
The U.S. spends more on healthcare than other developed countries.
Despite higher spending, outcomes for most critical health measures are worse.
Healthcare is the largest single driver of government spending.
Statistical Data on U.S. Healthcare Expenditures (Peter G. Peterson Foundation, CMS, National Academies of Sciences, Engineering, and Medicine):
U.S. Health Spending as Percentage of GDP: Total U.S. health spending (public and private) reached one-fifth of the economy in 2020.
1980: 9\% of GDP
1990: 12\% of GDP
2000: 13\% of GDP
2010: 17\% of GDP
2020: 20\% of GDP
Federal Spending on Healthcare: Surged significantly in 2020.
Share of Federal Spending on Healthcare: Has steadily risen over recent decades.
1990: 17\% of Total Healthcare Spending (719 Billion)
2005: 23\% of Total Healthcare Spending (2,026 Billion)
2020: 36\% of Total Healthcare Spending (4,124 Billion)
Healthcare Waste Estimates: The Health and Medicine Division (HMD) estimates that 30\% of all healthcare dollars are wasted on services that are ineffective, overpriced, or simply unnecessary.
Ineffective Care and Quality Concerns
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Introduction to Health Information Systems (HIS)
Volatile and Dynamic Work Environment: Health Information Systems (HIS) function within an exceptionally dynamic and often volatile healthcare landscape.
Healthcare Industry Dynamics: Few industries experience as much rapid change and complexity as healthcare.
Transition to Value-Based Care: The U.S. healthcare system is currently undergoing a significant transition from a traditional fee-for-service model to a value-based care model.
This transition aims to provide cost-effective care for an aging population with a high prevalence of chronic illnesses.
Requirements for Successful Transition: A successful shift necessitates a combination of strong vision, effective leadership, and robust, functional HIS systems.
Health Care's Current State: Challenges and Drivers of Change
Three Major Issues Describing Current Healthcare:
Programs of care predominantly designed around fee-for-service reimbursement.
Untenable and unsustainably high healthcare costs.
Ineffective care delivery.
Drivers of Change and Challenges:
Inadequate Quality: Persistent issues with the quality of care provided.
Focus on Acute Care vs. Chronic Illness: A historical emphasis on acute care, despite the increasing incidence of chronic illnesses, leading to a mismatch in care models.
Aging Population: A growing demographic of older individuals requiring more complex and prolonged care.
High Variability in Processes: Significant inconsistencies in healthcare processes, contributing to inefficiencies and varying outcomes.
Increasing Cybersecurity Threats: Growing risks from cyberattacks, posing threats to patient data security and system integrity.
EHR System Perceptions: Electronic Health Record (EHR) systems have, in many instances, transformed healthcare knowledge-workers into data entry clerks, leading to frustration among providers.
Unsustainably High Cost: The exorbitant and ever-increasing cost of healthcare is a major concern.
The Problem of Untenable Healthcare Costs
Fee-for-Service Model's Role in Costs:
HIS systems were originally designed to support fee-for-service (FFS) reimbursement structures.
Billing and reimbursement for individual procedures under FFS is more straightforward than for holistic value and overall health outcomes, which complicates the transition to newer models.
U.S. Healthcare Spending:
The U.S. spends more on healthcare than other developed countries.
Despite higher spending, outcomes for most critical health measures are worse.
Healthcare is the largest single driver of government spending.
Statistical Data on U.S. Healthcare Expenditures (Peter G. Peterson Foundation, CMS, National Academies of Sciences, Engineering, and Medicine):
U.S. Health Spending as Percentage of GDP: Total U.S. health spending (public and private) reached one-fifth of the economy in 2020.
1980: 9\% of GDP
1990: 12\% of GDP
2000: 13\% of GDP
2010: 17\% of GDP
2020: 20\% of GDP
Federal Spending on Healthcare: Surged significantly in 2020.
Share of Federal Spending on Healthcare: Has steadily risen over recent decades.
1990: 17\% of Total Healthcare Spending (719 Billion)
2005: 23\% of Total Healthcare Spending (2,026 Billion)
2020: 36\% of Total Healthcare Spending (4,124 Billion)
Healthcare Waste Estimates: The Health and Medicine Division (HMD) estimates that 30\% of all healthcare dollars are wasted on services that are ineffective, overpriced, or simply unnecessary.
Ineffective Care and Quality Concerns
Medical Errors and Patient Safety: A significant portion of ineffective care stems from preventable medical errors, adverse events, and systemic issues related to patient safety.
Suboptimal Outcomes: Despite high spending, the U.S. often experiences suboptimal health outcomes compared to other developed nations, indicating that care is not always effective or efficient.
Variability in Quality: There is considerable variation in the quality of care patients receive, which can depend on factors such as geographic location, facility, or individual provider.
Lack of Coordination: Poor coordination among different healthcare providers and settings (e.g., primary care physicians, specialists, hospitals) leads to fragmented, inefficient, and often ineffective care delivery.
Access Disparities: Unequal access to timely and appropriate care for all populations further contributes to overall ineffective care metrics and exacerbates health inequities.
Technology Gaps and Usability Issues: While Electronic Health Records (EHR) systems are widely adopted, suboptimal design or implementation can hinder effective care, leading to issues like alert fatigue, excessive data entry burden for clinicians, and challenges with interoperability between systems.