Applied Informatics

1
Applied Informatics

• History of Health IT
• Unit 3 Lesson 1

2
Lesson Objectives

• At the end of this lesson, you will be able to
• Describe the history and evolution of health care
  information systems
• Trace the development of IT systems in health
  care and public health
• Discuss the experiments of the 1950s and 1960s
• Discuss the dynamics of incentives and health
  care IT adoption and use

3
Definition of Terms

• Health Care Information System (HCIS)
• An arrangement of information and data
• Interacts to collect, process, store, and provide
  output information
• Information system and information technology are
  interchangeable
• Recommended to support a health care organization

4
Definition of Terms Cont.

• Two types of HCIS
• Administrative information system
• Contains primarily administrative or financial
  data
• Used to support the management functions and
  general operations of the health care
  organization
• Clinical information system
• Also known as departmental systems such as
  radiology or pharmacy
• May be clinical decision support such as
  medication administration computerized provider
  order entry, or electronic medical record systems

5
History and Evolution

• The 1960s Health Care Environment
• President Lyndon B. Johnson signed Medicare and
  Medicaid into law.
• 1960s Information Technology
• Large mainframe computers
• Centralized processing
• Few vendor-developed products

6
History and Evolution Cont.

• 1960s Uses of Health Care Information Systems
• Administrative or financial information systems
  were used primarily in large hospitals and
  academic medical centers
• Developed and maintained in house
• Shared systems available to smaller hospitals
• Centralized data processing

7
History and Evolution Cont.

• 1970s Health Care Environment
• Health care costs escalating due to high
  Medicare/Medicaid expenditures
• Economic inflation
• Expansion of hospital expenses and profits
• Increased need for better access to clinical
  information
• Emergence of departmental systems to improve
  productivity and capture charges to maximize
  revenues

8
History and Evolution Cont.

• 1970s Information Technology
• Mainframes still utilized
• Minicomputers debut
• Handling of clinical data becomes more efficient
• 1970s Use of Information Technology
• Vendor Relationships
• Direct result of increased demand for patient
  specific data
• Low cost microcomputers contribute to opening
  vendor market
• Vendors developed applications for clinical
  departments
• Turnkey systems created

9
History and Evolution Cont.

• 1970s Use of Information Technology cont.
• Health Care Executive Interaction
• Involvement limited to securing funds
• System Limitations
• Most systems were stand alone
• Did not interface well with other administrative
  or clinical information systems within
  organizations

10
History and Evolution Cont.

• 1980s Health Care Environment
• Changes to Medicare/Medicaid
• Medicare introduces prospective payment systems
  for hospitals
• Medicare shifts from a cost-based reimbursement
  to a prospective payment system
• Medicaid and private insurers follow suit
• Need for financial and clinical information

11
History and Evolution Cont.

• Other Impacts
• Health care cost rose by double the rate of
  inflation
• Providers argued that fee-for-service payment
  failed to promote cost containment
• Emergence of Managed Care Plans
• HMOs reimburse physicians based on fixed rates

12
History and Evolution Cont.

• Impact to Big Business
• Integration of organizations making up the
  hospital system
• Enter many other health care-related businesses
• Consolidated control
• Overall shift toward privatization and
  corporatization of health care
• Integrated delivery system begins to emerge

13
History and Evolution Cont.

• 1980s Information Technology
• Microcomputer or personal computer (PC) becomes
  available
• Far more powerful
• Brings computing to desktops
• Revolutionizes data processing
• Changes how companies do business
• Computer market opened among different types of
  health care organizations
• Advent of local area networks (LANs)

14
History and Evolution Cont.

• 1980s Use of Health Care Information Systems
• Advancements resulted in
• Distributed data processing
• Expansion of clinical information systems in
  hospitals
• Physician practices introduce billing systems
• Integrating financial and administrative
  information becomes important

15
History and Evolution Cont.

• 1990s Health Care Environment
• Medicare changes physician reimbursement to a
  resource-based relative value scale (RBRVS)
• Health care reform efforts initiated by the
  Clinton administration (HIPAA)
• Growth of managed care and integrated delivery
  systems
• Institute of Medicine calls for computer-base
  patient record (CPR) adoption

16
History and Evolution Cont.

• 1990s Information Technology
• The Internet and World Wide Web arrives
• 1990s Uses of Health Care Information Systems
• Growth of the Internet has profound effect on
  health care organization business
• Vendor community growth explodes
• Products more widely available and affordable
• Enterprise wide systems
• Increased interest in clinical application
• Relatively small percentage of health care
  organizations adopt CPR

17
History and Evolution Cont.

• 2000 to Today
• Health care environment
• IOM reports on patient safety and medical errors
• Bush and Obama call for electronic health record
  (EHR) adoption
• HIPAA privacy and security regulations in effect
• Medicare Modernization Act

18
History and Evolution Cont.

• Information Technology
• Internet expansion continues
• Broadband access in rural areas
• Portable devices become more widespread
• Bar codes
• Use of Health Care Information Systems
• Focus on EHR systems
• Vendors promote CCHIT certification
• Health care organization invest in information
  systems

19
Summary

• Types of HCIS Administrative Clinical
• Started in mid60s with Johnson - Medicare
  Medicaid
• 1960s birth of technology
• 1970s - health care costs high IT more
  efficient vendors developed clinical systems
• 1980s 90s Medicare changes generate changes
  in technology, Internet
• 2000 HIT CCHIT certification of EHR