Medical informatics report

Running head: MEDICAL INFORMATICS REPORT 1

Medical Informatics Report

Cynthia Brown

April 10, 2012

MEDICAL INFORMATICS REPORT 2

Abstract

This report discusses Health Information Technology (HIT), specifically medical informatics and

the challenges and benefits of its use at Nazarene Community Health Clinic (NCHC). The report

touches on the fact that the underutilization of HIT in the health care industry has played a

significant role in the poor quality of health care delivery. In this report, medical informatics is

defined as how certain components of medical informatics can assist the NCHC in providing and

sustaining quality health care. The analysis, interpretation, and management of data are essential

components in improving the health care delivery system. The importance of the medical

informatics program’s alignment with NCHCs core objectives is discussed along with using a

systems development cycle (SDLC) to ensure successful implementation of the program. The

implementation process is outlined capturing the role of key senior managers in ensuring a

smooth transition from our current infrastructure to one of a technology driven quality

management infrastructure. Cross-functional teams and an organizational culture of teamwork is

necessary to successfully make the transition is also be discussed. The perceived challenges

along with the benefits of implementing a medical informatics program are argued. Three legal,

ethical, and regulatory safeguards are suggested to improve the patient safety and the quality of

care at NCHC.

Keywords: medical informatics, health information technology, electronic health record,

health information exchange, personal health record, systems development life cycle


Medical Informatics Report

Information Technology (IT) and management have been directly linked to quality in

other industries. The Health Care Industry however has failed to see the correlation between

quality and IT for many years. The Health Care Industry has been known to be one of the lowest

investors in IT at an annual percentage rate of 3.5; while similar industries invest at a 9 to 10

percent rate (Gupta, Harrington, Pexton & Trusko, 2007). This lack of attention to IT has been

stated as one of the major reasons health care has the poorest quality of any other industry in the

world (Gupta et al., 2007).

Recently, the rate of IT investment among health care organizations has risen to 4.5

(Gupta et al., 2007). The Federal government along with many of today’s health care providers

is in agreement that medical informatics will play an essential role in improving the quality and

safety of our fragmented health care delivery system. This strong conviction has been shown in

Nazarene Community Health Clinic (NCHC) receiving a Federal grant to develop and put into

action an organization-wide medical informatics program. This report will cover key topics

concerning a medical informatics program at NCHC along with the barriers of implementation

and the role medical informatics will play in improving quality at NCHC. Legal, regulatory, and

ethical topics will be covered that will promote patient safety as well as quality.

Topics

The Role of Medical Informatics in Quality Improvement and Two-Three Anticipated

Benefits of Health Information Technology for the NCHC

The overall strategic plan of NCHC for the 21st century is to provide health care that is

safe, efficient, cost-effective, and of the highest quality. To remain in alignment with this

strategic plan, it is imperative that NCHC take the opportunity afforded by the Federal grant to


improve its health information infrastructure through the use of medical informatics. A medical

informatics programs allows the clinic to improve clinical efficiency, accuracy, and reliability

through the effective use of medical data (Shi & Singh, 2010). Clinical efficiency, accuracy, and

reliability are all contributing factors to improved, quality health care and a medical informatics

program will assist NCHC in these areas.

Medical informatics’ role in achieving quality health care can be attributed to its purpose

of examining the structure, the acquisition, and the use of health care information at NCHC

(Varkey, 2010). Some very distinct areas medical informatics can be used to improve health care

quality and quality measurements are (Varkey, 2010): 1) In increased access to pertinent

medical information; 2) In real time evidence and decision support systems used at the time of

care; 3) In improved synchronization of information among health care providers and between

patients and health care providers; 4) In augmented ability to collect and report information on

performance; 5) In promoted practice of evidence-based medicine through access of the

electronic health record (EHR) and electronic medical literature; and 6) In aided decision-making

through the use of “alert systems”.

Health Information Technology (HIT) is an integral part of the overall health care

delivery system and can be described in a wide range of technologies for transmitting and

managing health information for use by consumers, providers, payers, insurers, and other

interested in health care (Blumenthal and Glaser, 2007). One of the benefits of HIT for the

NCHC can be seen in the use of the EHR. The EHR can electronically collect and store data

about patients, supply that information to providers upon request, permit providers to directly

enter orders into the computer, provide health care professionals with advice in making decisions

about the patient’s care (e.g., alerts, reminders, clinical decision support) (Blumenthal and


Glaser, 2007). The EHR can also allow health information exchange (HIE) across organizational

boundaries; allow prior authorizations along with benefits/insurance verification in more than

half the time; and finally allow for uniform public and private health reporting (Bradley, Burns &

Weiner, 2012). The ability to share information across organizational boundaries in itself greatly

increases the perception of higher quality in health care delivery; because it supports continuity

of care among providers.

A second benefit of Health Information Technology at NCHC focuses on the patient’s

participation and managing of their own health care through the access of their personal health

record (PHR). A PHR although electronic and accessed via the Internet is quite different from

the EHR. It is usually managed and controlled by the patient. The patient is able to access their

PHR to include both health and wellness information pertaining to their diet, medications,

exercise and daily routines, and future appointments (Bradley et al., 2012). Some organizations

are combining PHR data with EHR data to have a complete representation of the patient’s health

information (Halamka, Mandl & Tang, 2008). The patient can perceive a sense of partnership

with the provider through the use of the PHR; which in turns heightens the patient’s perception

of quality health care. The PHR is also a useful tool to promote the patient’s management of

chronic illnesses such as diabetes, hypertension, and chronic renal failure.

Two-Three Organizational Factors Essential to Successful Implementation of a Medical

Informatics Program

The first and foremost organizational factor essential to successful implementation of a

Medical Informatics Program at NCHC is that of strategic alignment. It is imperative that the

program is parallel to NCHC’s organizational strategies. For instance, one of the strategies of

NCHC is to improve organizational performances. The EHR component of the Medical


Informatics Program can improve adherence to evidence-based practice guidelines, enhance

surveillance and monitoring, and decrease medical errors each of which are related to the

organization’s strategy to improve performance (Bradley et al., 2012). Long and short term

goals/objectives must be identified in relation to the Medical Informatics Program.

The second factor essential to successful implementation of a Medical Informatics

program at NCHC is in choosing a customized systems development life cycle (SDLC)

methodology (Bradley et al., 2012). SDLC is a methodology which can be used to select,

acquire, implement, and maintain NCHCs health information system (Bradley et al., 2012). The

SDLC includes the following (Bradley et al., 2012): 1) Defining (planning), 2) Construction

(analysis, design, and testing), 3) Implementation, and 4) Maintenance phases. Using a

customized SDLC methodology helps to improve the chances that NCHC selects the correct

application or system for its particular needs and increases the probability of successful

implementation.

T he Role of the Senior Management Team and One-Two Functional Benefits the

Program’s Implementation will provide for each Team Member Category

The role of the senior management team comprised of chief executive officer, chief

information officer, chief financial officer, chief nursing officer, and the chief of the medical

staff should be that of assisting in the implementation of the medical informatics program at

NCHC (Bradley et al., 2012). Each of the roles of the senior management team is outlined

below.

Chief Executive Officer. The Chief Executive Officer’s (CEO) role in implementing the

Medical Informatics Program is that of transformational leader. The CEO is the visionary and

communicator of the organization’s core values and how they relate to the organization’s goal of


transitioning from its current information system to a medical informatics system. The CEO

should take the following steps to ensure acceptance of the strategic plan to incorporate medical

informatics into the practices at NCHC (Hofmann & Nelson, 2007): 1) Point out inefficient

business and work practices. 2) Ensure that NCHC’s mission, vision, and value statements are

fully understood by all staff, and that decisions and actions made are consistent with these

statements. 3) Involve physician, board, management, and staff in significant change efforts. 4)

Assess all positive and negative effects on the organization, staff, patient, community, and other

key stakeholders.

Chief Information Officer. The role of the Chief information Officer (CIO) is to ensure

that the information systems plans are aligned with the overall strategic plan of the organization

of upgrading to a medical informatics system. The CIO should make recommendations about

the implementation approach and the types of applications needed for the project (Bradley et al.,

2012). The CIO defines the as-is system; provides end-user feedback on screen designs or

prototypes of the new system, coordinates training, and monitors system testing (Bradley et al.,

2012).

Chief Financial Officer. The Chief Financial Officer’s (CFO) role is that of managing

the financial aspect of developing a medical informatics program. The CFO is responsible for

program proposal and the feasibility analysis (Bradley et al., 2012). The CFO also provides the

funds for the program, develops the budget, and oversees the program to ensure the benefits are

realized (Bradley et al., 2012).

Chief Nursing Officer and Chief of the Medical Staff. The main role of these two

individuals would be that of advocating health information technology for the organization, as

well as, further communication of the vision and its benefits within the organization; making


sure adequate training is provided; and making sure incentives for adopting and using the new

system are provided (Bradley et al., 2012). These two roles can also encourage input from their

respective staff allowing them to voice their concerns and later disseminating them to the senior

management team.

The program’s implementation is expected to benefit each team member category by

improving “the efficiency, cost-effectiveness, quality, and safety of medical care delivery by

making best practices guidelines and evidence databases immediately available to clinicians, and

by making computerized patient records available throughout NCHCs health care network”

(AHRQ, n.d., page 10). For example, reduction in patient errors, redundant tests ordering; and

efficient job performance can be realized as a result of using decision support systems,

computerized alerts, computerized performance measurements, and electronic orders; thereby

generating cost-savings that can be passed along throughout the entire organization. Cost-

savings can be transformed into dollars for additional staff, professional training, new

equipment, and future expansion all of which benefit each team member category.

One-Two Perceived Organizational Challenges Regarding such an Implementation and

One-Two Recommendations to Manage those Challenges

Albeit there are many benefits to the implementation of a medical informatics system for

NCHC; there are also challenges regarding such an implementation that must be considered

before moving forward. One is that of cost. The costs for developing, implementing,

maintaining, and supporting the program can be substantial. The resources needed both

financially and in human resources to sustain the system must be analyzed carefully. The

organization may find it difficult to come up with the capital necessary to invest in a medical

informatics program, especially since the break-even points range from 3-13 years (AHRQ, n.d.).


A solution to this concern is for there to be a total evaluation of the organization’s annual

reports which will provide an overview of the company’s financial position. Along with the

financial evaluation the costs of the project must be evaluated to see if the tangible benefits (i.e.,

improved quality, lower costs in providing services, increased patient load, pay for performance

incentives, return on investments) and intangible benefits (i.e., patient/employee satisfaction,

better market positioning, community image, provider relations) are worth the costs. Other

intangible benefits that should be considered are higher productivity, improved documentation

quality, and guideline compliance management. Another way to control the costs of

implementing the program is to the research programs of similar providers so as to afford costly

mistakes. It is prudent to learn from others mistakes. NCHC can also look into making cost

sharing alliances with local hospitals where their patients are typically referred or seen for

additional services or treatment. Finally, NCHC can take advantage of the American Recovery

and Reinvestment Act (ARRA) of 2009. Subtitles A and B of Title IV in Division B of ARRA

authorize incentive payments for eligible Medicare and Medicaid providers’, such as NCHC, for

the adoption and meaningful use of certified EHR technology (CMS, 2012).

A second barrier to the medical informatics program’s implementation is people and task

oriented resistances to change from the current information system to a medical informatics

system. The probability of resistance to change is high and should be faced head on; therefore it

is the responsibility of the transformational leader to eliminate the resistance. The resistance can

be due to several reasons (Gavin & Quick, 2000): 1) threat to one’s self-interest; 2) lack of

conviction that change is necessary; 3) fear of being manipulated; 4) threat to personal values; 5)

lack of confidence that change will succeed; 5) distrust of leadership; and 6) uncertainty. There


are two types of change resistance, namely people-oriented and task-oriented. A new medical

informatics program will evoke both.

To eliminate and/or reduce resistance to people-oriented change, leaders should (Mourier

& Smith, 2001): 1) Show relentless support and unquestionable commitment to the change

process. 2) Communicate the need and urgency for change to everyone. 3) Maintain ongoing

communication about the progress of change. 4) Avoid micromanaging and empower people to

implement change. Ensure change efforts are adequately staffed and funded. 5) Anticipate and

prepare people for the necessary adjustments that change will trigger, such as career counseling

and/or training.

To eliminate and/or reduce resistance to task-oriented change, leaders should (Kanter,

2000): 1) Assemble a coalition of supporters inside and outside the organization. 2) Align

organizational structure with a new strategy for consistency. 3) Transfer the implementation

process to a working team. 4) Recruit and fill key positions with competent and committed

supporters. 5) Know when and how to use ad hoc committees or task forces to shape

implementation activities. 6) Recognize and reward the contributions of others to the change

process.

The Role of Cross-functional Teams and the Type of Organization Culture that will

support a Successful Informatics Program Implementation

The role of a cross-functional team in implementing the medical informatics program is

that of understanding the goals and objectives of developing the program. Cross-functional

teams should make the objective of the teams clear to all members as well as their part in helping

the organization meet its objective. Cross-functional teams ensure that everyone buys in to the

objective. It also relies upon the expertise and skill set of a group of people rather than


individuals. Cross-functional teams must understand its interrelationship and interconnectivity

association with other members and other cross-functional teams. Each member of the

organization must work cooperatively and interpersonally as a team.

Cross-functional teams must also have an organizational culture that values and

emphasizes teamwork and participation (Bonache & Zarraga, 2003). Senior management must

encourage the concept of a team culture and be aware how a team culture is consistent with and

conducive to the organization’s overall objective of creating a medical informatics program

(Bradley et al., 2012). This can be accomplished by doing the following (Moorhead & Griffin,

1998): 1) Believe employees want to be held accountable for their jobs. 2) Exhibit the team

philosophy. 3) Have resourcefulness and power to overcome obstacles as they present

themselves.

The complexity of the task calls for team interaction and team cohesiveness among its

members. The diagram below illustrates the interaction between the senior management team

members as a continuous flow in implementing the medical informatics program.

CFO

CNO

CMO CIO

CEO

Medical

Informatics

Program

P


Three Legal, Regulatory, and/or Ethical Safeguards that NCHC should have in Place to

Assure Quality and Patient Safety

One of the goals seen throughout the existence of NCHC is that of providing a quality,

safe patient encounter. One of the ways in which NCHC will safeguard quality, safe health care

is to motivate our physicians and local hospitals to collaborate in areas of patient care (Bradley et

al., 2012). The Medicare Payment Advisory Commission discussed how the lack of integration

between hospitals and clinical physicians converts into a health care system that is more apt to

have errors, inefficiency, and poor quality (Bradley et al., 2012). NCHC will develop policies

and procedures for ensuring continuity of care across its clinical settings by passing along

medical information to local hospitals regarding patients seen in the clinic. This can be

accomplished through the use of an EHR that is accessible and linked to area hospitals so that in

the event of emergency treatments, referrals, and surgical interventions the patient does not lose

the efficacy of the treatment. NCHC can also benefit financially from this safeguard in that

certain policy initiatives have been implemented which provide financial incentives and other

incentives designed to encourage hospitals and physicians to work more collaboratively to

enhance patient care (Bradley et al., 2012).

Another way in which NCHC can have safeguards in place that promote quality, safe

health care is to strengthen its peer review processes. The Health Care Quality Improvement Act

(HCQIA) of 1986 reflects on issues of poor peer review processes and the identification of

physicians who are deemed incompetent or who are involved in unprofessional, unethical

behavior (Bradley et al., 2012). This safeguard is aimed at improving both the safety of the

patient through error reduction and the quality of the health care being delivered. The HCQIA

limits the immunity of physicians who are involved in the peer review process, greatly


diminishing the risk of lawsuits from physicians who face dismissal or loss of privileges

(Bradley et al., 2012). HCQIA provides legal exception of the clinic if the peer review actions

were taken (Bradley et al., 2012): 1) in the reasonable belief that the action taken was done so to

improve the quality of health care; 2) after a reasonable attempt to get the facts of the matter; 3)

after sufficient notice and hearing procedures were made known to the physician; and 4) in the

reasonable assumption that the action was deemed necessary by the facts and after meeting the

criterion of (3) above.

The third safeguard NCHC can put in place to ensure safe, quality health care is to

appoint a Regulatory Compliance Officer (RGO). NCHCs noncompliance to legal, regulatory,

and ethical standards can lead to serious consequences resulting in fines, loss of accreditation,

and loss of licensure. The role of the RCO consists of the following (Bradley et al., 2012): 1)

Educating staff on regulatory compliance protocols through training programs. 2) Monitoring

compliance. 3) Implementing enforcement policies; responding to compliance violations; and

seeking out opportunities to prevent future violations. 4) Acting as liaisons between NCHC and

appropriate regulatory agencies. 5) Collaborating with Risk Management, Internal Audit,

Employee Services, and Human Resources. 6) Conducting internal audits in search of violations.

In conclusion, the transition of NCHC from our current information systems to a medical

informatics system can only solidify our goals of safe, effective, efficient, affordable health care.

The medical informatics system will assist the clinic in developing and monitoring performance

measurements which will increase productivity and streamline clinical processes. The EHR and

the PHR will benefit the patient and the clinic in working together to achieve continuous, quality

care. The alignment of the medical informatics system with the organizational goals/objectives

is imperative to its success. A customized SDLC will assist NCHC in selecting, acquiring,


implementing, and maintaining the medical informatics system. The implementation of the

system will require the collaborative efforts of the senior management team comprised of the

CEO, CIO, CFO, CNO, and the CMO. Although there will be challenges the clinic must work

through to have successful implementation, the benefits of the system are felt to outweigh the

challenges. A cross-functional team approach is necessary to pull off the development,

implementation, and maintenance phases of the project. An organizational culture of teamwork

must be evident and emphasized throughout the process of change. Lastly, the legal, regulatory,

and ethical standards mentioned in this report should help to assure quality, safe health care.


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Health & Medicine

Medical informatics report