History of Health Information Systems

History of Health Information Systems and Clinical Applications Order Instructions: Over the past several decades, health care and information technology have undergone a period of dramatic change caused by a multitude of pressures and opportunities, many of which continue to persist and evolve.

History of Health Information Systems
History of Health Information Systems

As we have moved into globalization of communication, technology, and information, Health Information Systems need to reflect what is happening to ensure optimal use of clinical information.
In 2-3 (full) pages, discuss key historical trends involving the evolution of Health Information System and respective health care environments. Describe how clinical information systems and applications can fit together to provide comprehensive care. In your discussion be sure to include both the benefits and challenges to the integration of information systems and exchange of health information. Include reference to literature, expert opinion and case examples from your research involving various health care disciplines to support your position, key points, and explanations.

Module 1 – Background of History of Health Information Systems

History of Health Information Systems and Clinical Applications
Although the use of healthcare-related electronic computer systems first emerged just 30 to 40 years ago, the origins of healthcare computing tools and information systems can be traced back several centuries. The earliest forms of computing and information systems were derived from Von Liebnitz’s views surrounding codification and classification of human behaviors.
Since the early 1960s, Health Information Systems have grown rapidly. They now touch essentially every aspect of healthcare and affect professionals from across all medical-related disciplines and areas of practice. For the past several decades, technology and computing systems have continued to evolve at astounding rates, followed closely by an abundance of complex medical data and information. With more computing power comes more data and information, along with new advancements in medical technology and procedures. Accordingly, we now face an ever-expanding body of medical knowledge that changes quickly; one where information and knowledge are generated and abandoned in continually shorter and shorter cycles.

History of Health Information Systems Additional Changes

Additional changes to the healthcare environment caused by market-driven healthcare reform during the 1990s have also fueled heavy demand for Health Information Systems. More specifically, the expansion of managed care, the development of integrated delivery systems by healthcare providers, and major changes to billing and insurance reimbursement processes require systems to integrate and exchange information and data efficiently and in like form.
It is from these growing information demands on the healthcare industry that the discipline of Health Informatics is born. As medical and patient-related information reaches deep across every healthcare discipline and health services provider, so too does the science of Health Informatics.
Health Informatics is defined as “an evolving scientific discipline that deals with the collection, storage, retrieval, communication and optimal use of health-related data, information and knowledge. The discipline utilizes the methods and technologies of the information sciences for the purposes of problem solving, decision making and assuring highest quality health care in all basic and applied areas of the biomedical sciences” (Graham, 1994).

History of Health Information Systems and the Data Collection

The substance of Health Informatics is data, information, and knowledge, and all that is done with it by healthcare professionals. Therefore, it is reasonable to think that the significance of Health Informatics will continue to increase as technology advances and the abundance of available information continues to grow. Indeed, the rapidly growing knowledge base in the medical field is vast and encompasses both scientific knowledge and the day-to-day business of providing healthcare. Accordingly, administrative processes are becoming increasingly augmented with systems that address the core of medicine in the clinical and research settings.
Clinical Applications
Health Information Systems can be divided into two areas: administrative and clinical. Administrative information systems support administrative tasks such as personnel, staffing, financing, resources, etc. Administrative information systems are concerned with improving the efficiency of human resources departments and healthcare executives. Clinical information systems collect information about patients and their healthcare.
As healthcare information technology emerges, information systems are being developed to work together across providers, agencies, and patients, thus transforming the system into patient-centered healthcare by managing medical information and providing a secure exchange of information. Utilizing technology can benefit the patient and provider by improving healthcare quality, reducing medical errors, increasing efficiency of care, reducing unnecessary healthcare costs, expanding access to affordable care, and improving population health.

History of Health Information Systems and Medical Information Collection Tools

Some tools that are used to collect medical information are the following:
Electronic Medical Record (EMR) – “Electronic medical record systems lie at the center of any computerised health information system. Without them other modern technologies such as decision support systems cannot be effectively integrated into routine clinical workflow. The paperless, interoperable, multi-provider, multi-specialty, multi-discipline computerised medical record, which has been a goal for many researchers, healthcare professionals, administrators and politicians for the past 20+ years, is however about to become reality in many western countries.” http://www.openclinical.org/emr.html
Computerized Provider Order Entry (CPOE) – “Computerized provider order entry (CPOE) refers to any system in which clinicians directly enter medication orders (and, increasingly, tests and procedures) into a computer system, which then transmits the order directly to the pharmacy. These systems have become increasingly common in the inpatient setting as a strategy to reduce medication errors. A CPOE system, at a minimum, ensures standardized, legible, and complete orders and thus has the potential to greatly reduce errors at the ordering and transcribing stages.” (AHQR.com, 2009) http://www.psnet.ahrq.gov/primer.aspx?primerID=6
Telehealth – “…[T]he delivery of healthcare from a distance. Modern technology has made it possible for patients to receive healthcare in many different ways. Technologies such as telephones, email, computers, interactive video, digital imaging, and healthcare monitoring devices, make it possible for clinicians to monitor, diagnose and treat patients without having to physically be with them. Telehealth is a broad term that covers any type of healthcare that is delivered remotely. Surfing the Internet for information about cancer, telephoning a nurse hotline, emailing a physician, sending data from a heart monitor via the telephone to a cardiologist—all of these things are applications of telehealth.” www.telemed.org/consumer/whatis.asp
Telemedicine – “…[A] subset of telehealth. It includes many medical subspecialties, such as telepediatrics, telepsychiatry, teleradiology and telecardiology. Specialties such as telepediatrics and telepsychiatry are practiced by using live videoconferencing systems. A pediatric or psychiatry visit would be conducted exactly the same as if the patient and provider were in the same room, but the videoconferencing units allow them to be thousands of miles apart.” www.telemed.org/consumer/whatis.asp
Personal Health Record (PHR) – A record detailing an individual’s health and healthcare across providers. It is owned and managed by the patient, allowing “people to access and coordinate their lifelong health information and make appropriate parts of it available to those who need it—in essence, a ‘communications hub’ controlled by the patient. Offering patient-empowering features such as online appointment calendars, patient-provider messaging, and the capability for patients to view and annotate their health records, the PHR has the potential of leveraging information to provide new avenues for measuring health and service outcomes over time. Conceivably, PHRs will also help to forge the important link between the provision of information and improved health.” http://www.connectingforhealth.nhs.uk/newsroom/worldview/protti7

Presentations of the History of Health Information Systems

•Health Care Technology: A History of Clinical Care Innovation examines the evolution of Health Information within the context of clinical care.1
•In the John Paul Chakackal article Health Information Systems 2, he defines Health Informatics and describes its various applications.
•Dr. William Hersh provides a good overview of Health Informatics and its contribution to improving healthcare in Medical Informatics 3.
•Integration and Beyond4 from the Journal of the American Medical Informatics Association provides a more technical inspection of the successive generations of work related to Health Informatics and integration between healthcare disciplines.
•Michael Herrick and Andrew Patterson discuss the changing landscape and trends surrounding healthcare in Trends in Health Information Management 5.
•Mullner and Chung discuss Current Issues in Health Care Informatics6.

History of Health Information Systems Sources of References and Materials

Sources For Presentation Material Referenced Above
1.Johnson, R. (2003). Health Care Technology: A History of Clinical Care Innovation. Retrieved from http://www.hctproject.com/documents.asp?grID=321&d_ID=1687
2.Chakalackal, J. P. (2001). Health informatics. Retrieved on May from http://www.ihsnet.org.in/HealthInformatics/HealthInformatics.htm
3.Hersh, W. R. (2002). Improving health care through information. Journal of the American Medical Association, 288(16), 1955-1958.
4.Stead, W. W., Miller, R. A., Musen, M. A., & Hersh, W. R. (2000). Integration and beyond. Journal of the American Medical Informatics Association, 7, 135-145.
5.Herrick, M. W. & Patterson, A. (2000). Megatrends you need to know about (Healthcare trends special report). Journal of AHIMA, 71(5), 26-31.
6.Mullner, R. M. & Chung, K (2006). Current Issues in Health Care Informatics. Journal of Medical Systems, 30(1), 1-2

Additional Required Reading History of Health Information Systems

The First Consulting Group (2003). Online Patient Provider Communication Tools: An Overview.
George Marshalek, & Steve Casey. (2003, February). Pain-Free CPOE. Health Management Technology, 24(2), 25-27. Retrieved from ABI/INFORM Global. (Document ID: 282605201).
Ross, C., & Banchy, P. (2007, November). The Key to CPOE. Health Management Technology, 28(11), 22, 24. Retrieved from ABI/INFORM Global. (Document ID: 1380726941).
Paul C. Tang, & David Lansky. (2005). The Missing Link: Bridging The Patient-Provider Health Information Gap. Health Affairs, 24(5), 1290-1295. Retrieved from ABI/INFORM Global. (Document ID: 899710641).
Hillestad R., Bigelow J., Bower A., Girosi F., Meili R., Scoville R., Taylor R. (2005). Can Electronic Medical Systems Transform Health Care? Potential Health Benefits, Savings and Costs. Health Affairs, 24 (5): 1103-1117. http://content.healthaffairs.org/cgi/content/full/24/5/1103
Open Clinical (n.d.). Electronic Medical Records, Electronic Health Records. http://www.openclinical.org/emr.html
AHQR (n.d.). Computerized Provider Order Entry. Retrieved from http://www.psnet.ahrq.gov/primer.aspx?primerID=6
medic exchange.com (n.d.) Improvement in Telemedicine has great impact. Retrieved May 15, 2010.
Module Overview
Computers in healthcare are recognized and accepted worldwide. Their use and application in areas such as clinical care, administration, and research, and as diagnostic aids for improving overall patient care, is well steeped in history.
Health information technology allows healthcare organizations to comprehensively manage medical information securely so it can be used by various organizations, providers, and consumers. The broad use of health information technology makes health organizations more efficient and provides better care for the patient. As technology is evolving, the management of health records is also evolving to respond to the needs of the consumer, provider, and organization.
As technology has continued to advance, new and more specialized healthcare disciplines and areas of medical science emerge. Likewise, medical data, information, and knowledge have grown exponentially in terms of both abundance and complexity; so has the need for a discipline and profession to manage them—Health Informatics.
Health Informatics is concerned primarily with the processing of data, information, and knowledge across all areas of healthcare. It is a rapidly growing medical discipline and profession that has profound implications for the future and quality of patient care.
In this module, we will examine the history of healthcare information systems and Health Informatics as an emerging profession, along with internal and external forces affecting its evolution. We will also identify various healthcare disciplines and examine their connection to Health Informatics. We will also explore current and emerging tools that are used in healthcare.

Health info systems
During the previous few decades, there have been dramatic changes in information technology and healthcare as a result of a multitude of opportunities and pressures. These changes continue evolving and persisting. Since there is globalization of information, technology, and communication, there is a need of the Health Information Systems to reflect the occurrences so that clinical information is used optimally. The aim of this paper is exploring the historical trends of Health Information System in the respective healthcare environment.

Key historical trends- Health Information System evolution and the respective healthcare environmentsHealthcare information systems and computing tools emerged several centuries back. However, healthcare electronic computer systems began being used only about forty years ago. The earlier information and computing systems emerged from the views of Von Liebnitz on the classification and codification of human behavior. During the 1990s, there were market-driven healthcare reforms in the healthcare environment, and these fueled the Health Information Systems’ demand. Managed care expansion, integrated delivery systems’ development, and the insurance reimbursement and billing processes’ major changes have prompted the exchange and integration of data and information, leading to development of the relevant information technologies health informatics. Health informatics’ significance in healthcare has been increasing as technology advances and as the available information’s abundance continues growing (Tang & Lansky, 2005).
Electronic medical records are the basis for decision support systems. It evolved about twenty years ago, and its uptake is increasing in the western countries. It is a health information system that is computerized, and is used in the entire healthcare setting. The real history of EMS started during the 1960s with the problem-oriented medical records. These were a breakthrough in the medical recording. Until, now, doctors record the treatment and diagnosis they provide.
The CPOE (Computerized Provider Order Entry) is a system used by clinicians for entering medication orders into the computer system. The order is then transmitted to the pharmacy directly. In inpatient settings, medication errors are reduced significantly. Lockheed Martin developed the pioneer CPOE in 1971 at El Camino hospital (Mountain View, Califonia). It enabled the physicians to order medications quickly with just some few clicks. The commercial CPOE grew fundamentally between 1994 and 2004. In 2009, less than ten percent of the US hospitals had CPOE systems that were fully operational.
Telemedicine involves telecardiology, teleradiology, telepsychiaty, and telepediatrics, and there is videoconferencing use. This technology is not new as its use started in the 1920s. Therefore, the resent rapid growth period started about one decade ago. Hillestad et al. (2005) noted that although there is still no detailed telemedicine evaluation and research, the current history has a lot to tell, particularly in relation to the improvements needed.
Personal Health Record is a record that details the healthcare of an individual across providers. It enables the coordination of lifelong health information. This technology has patient-provider messaging, online appointment calendars, and patients can annotate and view their health records (Ross & Banchy, 2007). PHR first appeared in 1969 in some academic journal in Germany. In the historical context in PHR represents notes in a very simple form containing information needed so as to acquire information about the health of a person.
Telehealth involves healthcare delivery from a distance. Telehealth’s history can be traced back to 1977. During this time, high-priced broadband systems transmitting the two-way video/ audio communication between doctors and patients were assessed for quality.
How clinical information applications and systems can fit together for the provision of comprehensive care
Since the beginning of 1960s, Health Information Systems have rose rapidly. Presently, the applications and systems touch on every healthcare aspect, affecting professionals from different medical-related practice areas and disciplines. This means that the professionals from these departments are able to use their various technologies when collaboration to offer care, which would definitely translate to high quality, safe, and competent care. With the emergence of the healthcare information technology, information systems are being developed so as to work in union across patients, agencies, and providers (Herrick & Patterson, 2000). With this diversity, it has been possible to enhance the patient-centered healthcare since there is better management of medical information and information is being exchanged more securely.
Pros and cons of integrating information systems
The need to have the information systems integrated in turn leads to more information and power, in addition to novel medical procedures and technology advancement. As a result to the integration, there is an ever-expanding medical knowledge body, which changes quickly. At the same time, knowledge and information are abandoned and generated in continually shorter cycles. The implication of this is that there is ever new information in the healthcare sector, an indication that the state-of-the-art is known, promoting more appropriate solutions to the challenges being faced (Stead et al., 2000).
The integration of the information systems has also played a cardinal role in ensuring that there is an improved relationship between providers and patients, as the quality of care improves. Other benefits that have been realized with this integration includes medical errors reduction, increased care efficiency, expanding affordable care access, minimizing unnecessary healthcare costs, and improving the population health (Herrick & Patterson, 2000).
A disadvantage of integrating the information systems is that at times, the result might be an abundance of complex medical information and data, emerging from various departments. As a result, it becomes too difficult to make sense of the information, meaning that it might not be useful at the end. If the healthcare institution decides to amply a data analyst, then this becomes an extra cost.
Pros and cons of health information exchange
One of the benefits of health information exchange is that care can be coordinated in a better way, as every member of the interdisciplinary team is able to access and analyze the information. As a result, the patients are able to benefit from the most appropriate evidence-based care. Exchange of the health information has been very essential in ensuring that the different departments increase their collaboration and teamwork in applying the information. As a result, the general healthcare environment improves, there are better patient outcomes and satisfaction, low turnover rates, and the employees’ satisfaction levels improve. Information exchange helps in minimizing medication and other errors in the healthcare setting (Stead et al., 2000). Exchanging the healthcare information has greatly ensured that efficiency is increased and better care offered to patients. Needs of patients and the organization are also being met more efficiently.
If the healthcare information is exchanged, it would be equally necessary to ensure that it is being applied in the healthcare settings as intended. Failure to do this would make the information and data useless, implying that all the efforts taken and resources used previously would be wasted.

References for History of Health Information Systems

Herrick, M. W. & Patterson, A. (2000). Megatrends you need to know about (Healthcare trends special report). Journal of AHIMA, 71(5), 26-31.
Hillestad R., Bigelow J., Bower A., Girosi F., Meili R., Scoville R., Taylor R. (2005). Can Electronic Medical Systems Transform Health Care? Potential Health Benefits, Savings and Costs. Health Affairs, 24 (5): 1103-1117.
Tang, P. C. & Lansky, D. (2005). The Missing Link: Bridging The Patient-Provider Health Information Gap. Health Affairs, 24(5), 1290-1295.
Ross, C., & Banchy, P. (2007). The Key to CPOE. Health Management Technology, 28(11), 22, 24.
Stead, W. W., Miller, R. A., Musen, M. A., & Hersh, W. R. (2000). Integration and beyond. Journal of the American Medical Informatics Association, 7, 135-145.


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