Healthcare Information Systems

Health Information Systems Functions and Services

Unit-4

Sandeep Sahu
Assistant Professor,
VIT-Bhopal, University, Sihore
School of Computing Science & Engineering

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Health Information Systems
Functions
➢ A health information system (HIS) refers to a system designed to
manage healthcare data.
➢ This includes systems that collect, store, manage and transmit a
patient's electronic medical record (EMR), a hospital's operational
management or a system supporting healthcare policy decisions.
➢ Health information systems also include those systems that handle
data related to the activities of providers and health organizations.
➢ As an integrated effort, these may be leveraged to improve patient
outcomes, inform research, and influence policy-making and
decision-making.
➢ Because health information systems commonly access, process, or
maintain large volumes of sensitive data, security is a primary
concern.

Health Information Systems 2

Health Care Information System
and Information Processing
What is the significance of information systems for health care?

– Information processing is an important quality factor, but an enormous

cost factor as well. It is also becoming a productivity factor.

– Information processing should offer a holistic view of the patient and of

the hospital cum healthcare system.

– A hospital/healthcare information system can be regarded as the

memory and nervous system of a hospital

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EXAMPLES OF HEALTH INFORMATION SYSTEMS

➢ Health information systems can be used by everyone in healthcare

from patients to clinicians to public health officials.
➢ They collect data and compile it in a way that can be used to make
healthcare decisions.
➢ Examples of health information systems include:
➢ Electronic Medical Record (EMR) and Electronic Health Record
(EHR)
➢ These two terms are almost used interchangeably.
➢ The electronic medical record replaces the paper version of a
patient’s medical history.
➢ The electronic health record includes more health data, test results,
and treatments.
➢ It also is designed to share data with other electronic health records
so other healthcare providers can access a patient’s healthcare data.

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➢ A healthcare management information system (HMIS) collects,
stores, analyses, and evaluates health-related data from health
facility to district, regional and national administrative levels.
➢ It provides analytical reports and visualizations that facilitate
decision making at all these levels.
➢ HMIS are also referred to as routine healthcare information
systems.
➢ A HMIS derives much of its information from patient-provider
interactions in health facilities.
➢ Hospitals, health centers, and community outreach services
provide health care across preventive, promotive, medical and
surgical, rehabilitation, and palliative care interventions.
➢ The HMIS also collects data from beyond government-run
facilities including from non-profit, for-profit, faith-based
facilities and from service delivery sites such as prisons,
schools, workplaces and communities.
•Facilities collect data – which are integral to the services they provide – to ensure
good management of patients.
•Health managers aggregate and report the data to higher administrative levels,
for example district, regional and national levels.
•When aggregated, the data provide information for epidemiological surveillance
and for monitoring health services performance in terms of access, coverage,
quality, and equity at all levels of the health system.
•The information generated show the range and volume of services delivered to
the population, including: prevention such as immunization, antenatal, delivery
and postnatal care; treatment of acute conditions such as malaria, diarrhea, and
upper respiratory tract infections; chronic conditions such as HIV, tuberculosis,
high blood pressure; and management of surgery and trauma.
•In addition to generating information on interventions – admissions, treatments
administered and health outcomes – a HMIS also produces data on the availability
of services, infrastructure, equipment and supplies needed to deliver such
interventions.
➢ The HMIS provides information for local planning.
➢ It also contributes to country level monitoring and evaluation,
research, policy and planning and generates indicators about
outputs, outcomes and impact.
 Functions and Services, Interdepartmental Relationships
➢ Health care is conventionally regarded as an important determinant
in promoting the general physical, mental and social well-being of people
around the world and can contribute to a significant part of a country's
economy, development and industrialization when efficient.
➢ Health information management (HIM) is a set of practices to organize
medical data so that it can be effectively used for enhancing the quality of
care.
➢ It aims at making the right health content accessible whenever it’s required,
at the same time ensuring its high quality and security.
➢ The health care information system is an integral part of a social and medical
organization, the function of which is to provide for the population complete
health care, both curative and preventive and whose outpatient services reach
out to the family and its home environment; the hospital is also a center for the
training of health worker and for biosocial research (WHO).
➢ Healthcare Management is the process of designing and maintaining an
environment in which individuals, working together in groups, efficiently
accomplish selected aims.
➢ Management process in general: The functions of the management in all types
of the organization remains the same and revolves around the following
management functions:
Planning: Staffing:
Objectives of the individual Recruitment procedure
Objectives of the organization Developmental schemes of hospital in
Policy and strategy of the hospital relation to human resource
Rules and procedures of hospital Maintenance of staff
Various health programs of the hospital Utilization of staff
Priorities of the hospital
Patient Experience Controlling:
Organizing: Establishing standards of performance
Span of control Methods of measurement of
Delegation of authority performance
Use of staff and service groups Comparison of performance with
Informal groups of hospital standards
Integration of structural activities Improving rate of return on
Directing: investment
Leading the staff Developing effective budgeting
Motivating the staff Employing better cost control and
Communication channels and methods quality control
Job satisfaction Coordinating
Job enrichment and job enlargement Synergy among different units of the
schemes hospital
Supervising of staff The combined and coordinated efforts
make one plus one eleven
 ➢ The American Health Information Management Association (AHIMA) singles
out five functional areas covered by the HIM.

➢ Data capture, validation, and maintenance calls for the introduction of policies and
procedures to get reliable data.
➢ This results in fewer claim denials, decreased operational costs, improved patient
safety, and better research outcomes.
➢ The stage involves activities related to data quality management, data integration,
support for healthcare data standards, and optimum information flow design.
➢ Data analysis, transformation, and decision support revolve
around deriving knowledge and insights critical for enhancing
patient care.
➢ Information dissemination and liaison are about effective
sharing of health records, reports, and research findings.
➢ Health information resource management and innovation
take care of health documents across their life cycle.
➢ Health information governance and stewardship ensure
compliance of data use with regulations, standards, ethical
norms, and internal organizational policies.
➢ HIM practices are applicable wherever health information
exists, from private physician’s offices to large hospital
chains. But for ultimate clarity, we need to answer the
question: What exactly is health information?
 Health information vs health data
➢ The terms data and information are often used interchangeably but HIM
strictly differentiates them.
➢ Data refers to raw facts and figures.
➢ By contrast, health information (HI) means knowledge obtained after data
is processed and structured into a meaningful form.
➢ Health information systems or HISs capture, store, and manage medical
information.
➢ The heart of the entire HI infrastructure is an electronic health record
(EHR) system that handles vital information about patients and their
course of treatment.
➢ The list of other widely-spread HISs includes but is by far not limited
to:
➢ radiology information systems (RISs), laboratory information systems
(LISs), pharmacy management systems, practice management
software, patient portals, medical billing software, and remote patient
monitoring systems.
➢ To make health systems share information smoothly — and thus enable
physicians to build a complete picture of a patient’s health — special
exchange standards were developed.
 Management of Health Record Content and
Processes
➢ Health IT (health information technology) is the area of IT involving the design, development,
creation, use and maintenance of information systems for the healthcare industry.
➢ Automated and interoperable healthcare information systems will continue to improve medical
care and public health, lower costs, increase efficiency, reduce errors and improve patient
satisfaction, while also optimizing reimbursement for ambulatory and inpatient healthcare
providers.
➢ Medical records are the document that explains all detail about the patient’s history, clinical
findings, diagnostic test results, pre and postoperative care, patient’s progress and medication.
➢ If written correctly, notes will support the doctor about the correctness of treatment.
➢ In spite of knowing the importance of proper record keeping in India, it is still in the initial stages.
➢ Medical records are the one of the most important aspect on which practically almost every
medico-legal battle is won or lost.
➢ A good medical record serves the interest of the medical practitioner as well as his patients.
➢ It is very important for the treating doctor to properly document the management of the patient
under his care.
➢ Medical record keeping has evolved into a science.
➢ The key to dispensability of most of the medical negligence claim rest with the quality of the
medical records.
➢ Record maintenance is the only way for the doctor to prove that the treatment was carried out
properly.
➢ Medical records are often the only source of the truth.
➢ They are likely to be far more reliable than memory.
➢ The management and preservation of the hospital records in Indian context
present a very gloomy picture.

➢ Despite the intensive effort at national and international level, the

fundamental health care needs of the population of the developing countries
are still unmet.

➢ The lack of basic health data renders difficulties in formulating and applying a
rational for the allocation of limited resources that are available for patient
care and disease prevention.

➢ It is recommended that more efforts should be made by the

institutions/hospital managements, all clinicians and medical record officer
to improve the standard of maintenance and preservation of medical records.
➢ There are many problems faced by institution/hospital for the proper
maintenance of the records.

➢ 1. Constant revision of the outdated form is needed.

➢ 2. Always trained personnel are needed for the maintenance.

➢ 3. Inactive records need storage at appropriate place.

➢ 4. There must be a need of determination of record retention.

➢ 5. Unwanted records must be destroyed.

➢ 6. Record storage entail into 2 stages. A. Moving the records from active to
inactive file and from there to storage room. B. Destruction and disposal of the
unimportant records.
Objectives of Maintaining Medical Records:

1. Monitoring of the actual patient

2. Medical research

3. Medical/dental or paramedical education

4. For insurance cases, personal injury suits, workmen’s

compensation case, criminal cases, and will cases

5. For malpractice suits

6. For medical audit and statistical studies

 Quality Control and Monitoring for Health
Record Systems
➢ Health data is not the same as information.
➢ But the better the quality of the former the higher the value of the latter.
➢ Conversely, missing and inaccurate details disrupt the validity of HI, contribute to
wrong diagnoses, and lead to incorrect research findings.

➢ To avoid errors that may threaten patient safety, AHIMA introduced the data quality
management model which covers:

✓ Application, or the reason for data collection,

✓ Collection, or the process of data gathering,
✓ Warehousing, or systems and activities related to data storage and archiving, and
✓ Analysis, or translating data into meaningful information.
✓ The model also defines ten quality attributes to be applied across all the above-
mentioned dimensions.
 ➢ Data quality attributes

➢By checking your data against these ten traits, you can assess its quality.
➢Accuracy means that the data is correct and reproduces facts from the source
without bias. Say, lab tests must precisely represent results generated by lab
equipment.
➢Accessibility is about the ability of authorized users to easily review medical
records whenever required while sticking to privacy regulations.
➢Comprehensiveness guarantees that the information is complete and the
document contains all required data elements. Data can be missed at the
collection stage — say, as a result of a data entry error, lack of standardization, or
because not all details were taken into consideration during visits. Such gaps may
lead to wrong conclusions and lower reliability of insights.
➢Consistency relates to keeping data uniform and reliable as it moves across
applications. For this, all attributes — say, the patient name, age, date of birth,
study details, diagnoses, and so on — should be presented in the same format,
with the same terminology used.
➢For example, the date of birth of a particular patient may be registered as 06-11-
1982 in one database and as 11-06-1982 in the other. Though this format
inconsistency doesn’t pose direct health risks, it can cause doubt about whether
both records are related to the same person.
➢Definition supports data consistency, requiring elements in medical
documents to be well-defined and have a range of acceptable values. In other
words, users must clearly understand what a particular piece of information
describes.
➢Precision defines a range of values for each attribute. For instance,
acceptable values for gender may be F (female), M (male), and U (unknown).
➢Granularity mirrors the level of detail required for the intended use.
Rounding done for numerical values (like body temperature or drug dosage)
or peculiarities omitted in the clinical documentation may impact the course
of treatment. However, the sufficient granularity level for running
administrative tasks can be lower than for diagnostics or research purposes.
➢Currency ensures that all data is up-to-date and there are no obsolete
elements.
➢Timeliness reflects whether patient information is recorded within a relevant
timeframe. Ideally, all important details must be captured at the time of the
first visit to a clinic or hospital. New findings, lab results, and other updates
are to be added as they become available and as soon as possible.
➢Relevancy is the term describing the usefulness of data collected. Too
lengthy records are often no lesser evil than incomplete documents.
 Indexes and Registries, Management and
Supervisory Processes
➢ Indexes and registers (or registries) allow health information to be
maintained and retrieved by health care facilities for the purpose of
education, planning, and research.
➢ The American Heritage Dictionary of the English Language provides the
following definition for an index “an index serves to guide, point out, or
otherwise facilitate reference, especially an alphabetized list of names,
places, and subjects treated in a print work, giving the page or pages on
which the items is mentioned.”
➢ The American Heritage Dictionary of the English Language provides the
following definition for a register “a formal or official recording of items,
names or actions.”
➢ Whereas, a registry is an organized system for the collection, storage,
retrieval, analysis, and dissemination of information on individuals who
have either a particular disease, a condition that predisposes to the
occurrence of a health related event, or prior exposure to substance or
circumstances known or suspect to cause adverse health effects.
➢ As we previously noted in a prior unit, indexes, registers, and registries are
considered secondary sources of patient information.
➢ We will now discuss a very important index that is used in the health
care setting.
➢ This index is referred to as the Master Patient Index. Rather than
saying Master Patient Index, most health care professionals will refer
to it as the “MPI.”
➢ The Master Patient Index is also referred to as the Master Person
Index.
➢ The MPI is the key to locating patient records.
➢ The MPI is retained permanently and filed alphabetically by the
patient’s last name. The demographic data that should be included on
each patient’s MPI include the following:
❑ The patient’s name (their last name, first name, middle initial)
❑ The patient’s address (to include street, city, and zip code)
❑ Social Security number
❑ Their date of birth (make sure to use the mm/dd/yyyy format)
❑ The medical record number (this is assigned by the facility)
❑ The name of the facility and/or provider
❑ The type of care received (such as inpatient, outpatient, emergency,
or physician’s office)
➢ The main purpose of the MPI is to provide continuity of care.
➢ As previously mentioned, it is important to link the patient to
their established medical record.
➢ The admission specialist needs to make sure to ask the
patient if they have previously been seen in the facility.
➢ This process prevents the duplication of multiple medical
record numbers for one patient.
➢ For the facility the MPI provides a customer database.
 Future Directions in Health Information
Management Technology
➢ Currently, information technology is considered an important tool to
improve healthcare services.
➢ To adopt the right technologies, policy makers should have adequate
information about present and future advances.
➢ It is divided into two groups: those forecasting the future of health
information technology and those providing health information
technology foresight.
➢ In the health information technology foresight group, most of the studies
used a combination of techniques, such as scenario building and Delphi
methods, and had long-term objectives.
➢ Conclusion: To make the most of an investment and to improve
planning and successful implementation of health information
management technology, a strategic plan for the future needs to be set.
➢ To achieve this aim, methods such as forecasting the future of health
information management technology and offering health information
management technology foresight can be applied.
➢ Information and communication technology (ICT) is a broad term that covers any
product that stores, retrieves, manipulates, transmits, or receives information
electronically and in a digital form.
➢ The application of ICT in healthcare, which is known as health information
management technology (HIMT), includes a variety of technologies that are used to
collect, transmit, display, or store patients’ data electronically.
➢ HIMT is also a concept that describes the application of computerized systems to
access healthcare information by patients, healthcare providers, insurance
companies, and other government agencies.
➢ The use of HIMT helps to reduce medical errors, costs, and paperwork; increases the
efficiency and quality of healthcare; and empowers patients and clinicians.
➢ HIMT includes a wide range of products, technologies, and services, such as remote
and mobile health technology, cloud-based services, medical devices, telemonitoring
tools, assistant and sensor technologies, electronic health records (EHRs), and other
applications of information technology in healthcare.
➢ These technologies can help users to collect, share, and use health information for
different purposes.
➢ The application of future studies in HIMT was proposed by Englebardt and Nelson
in Health Care Informatics: An Interdisciplinary Approach in 2002.
➢ In 2013, another book, titled Health Informatics: An Interprofessional
Approach, emphasized the use of future studies to analyze the future of health
information systems.
➢ These books emphasized the necessity of using foresight to provide a basis for
designing and constructing future health information systems.