History of Health ITUnit 3 Lesson 1

Lesson ObjectivesAt 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 healthDiscuss the experiments of the 1950s and

1960sDiscuss the dynamics of incentives and health

care IT adoption and use

Definition of TermsHealth Care Information System (HCIS)

An arrangement of information and dataInteracts to collect, process, store, and provide

output informationInformation system and information technology

are interchangeableRecommended to support a health care

organization

Definition of Terms Cont.Two types of HCIS

Administrative information systemContains primarily administrative or financial dataUsed to support the management functions and

general operations of the health care organizationClinical 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

History and EvolutionThe 1960s Health Care Environment

President Lyndon B. Johnson signed Medicare and Medicaid into law.

1960s Information TechnologyLarge mainframe computersCentralized processingFew vendor-developed products

History and Evolution Cont.1960s Uses of Health Care Information

SystemsAdministrative 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

History and Evolution Cont.1970s Health Care Environment

Health care costs escalating due to high Medicare/Medicaid expenditures

Economic inflationExpansion of hospital expenses and profitsIncreased need for better access to clinical

informationEmergence of departmental systems to

improve productivity and capture charges to maximize revenues

History and Evolution Cont.1970s Information Technology

Mainframes still utilizedMinicomputers debutHandling of clinical data becomes more efficient

1970s Use of Information TechnologyVendor 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

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

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

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 PlansHMOs reimburse physicians based on fixed

rates

History and Evolution Cont.Impact to Big Business

Integration of organizations making up the hospital system

Enter many other health care-related businesses

Consolidated controlOverall shift toward privatization and

corporatization of health careIntegrated delivery system begins to emerge

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 organizationsAdvent of local area networks (LANs)

History and Evolution Cont. 1980s Use of Health Care Information SystemsAdvancements resulted in

Distributed data processingExpansion of clinical information systems in

hospitalsPhysician practices introduce billing systemsIntegrating financial and administrative

information becomes important

History and Evolution Cont. 1990s Health Care EnvironmentMedicare 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

History and Evolution Cont. 1990s Information TechnologyThe Internet and World Wide Web arrives1990s Uses of Health Care Information SystemsGrowth of the Internet has profound effect on

health care organization businessVendor community growth explodesProducts more widely available and affordableEnterprise wide systemsIncreased interest in clinical applicationRelatively small percentage of health care

organizations adopt CPR

History and Evolution Cont. 2000 to TodayHealth care environment

IOM reports on patient safety and medical errorsBush and Obama call for electronic health record

(EHR) adoptionHIPAA privacy and security regulations in effectMedicare Modernization Act

History and Evolution Cont. Information TechnologyInternet expansion continuesBroadband access in rural areasPortable devices become more widespreadBar codesUse of Health Care Information SystemsFocus on EHR systemsVendors promote CCHIT certificationHealth care organization invest in information

systems

SummaryTypes of HCIS – Administrative & ClinicalStarted in mid’60s with Johnson - Medicare &

Medicaid1960s – ‘birth’ of technology1970s - health care costs high; IT more

efficient; vendors developed clinical systems1980s & 90s – Medicare changes generate

changes in technology, Internet2000 –HIT; CCHIT certification of EHR