Running head: HEALTH INFORMATION SYSTEMS IN CAHs
Health Information Systems in CAHs
Nicole Smith
Siena Heights University
LDR620 Information Systems Management
Dr. Barry Schoenbart
November 2, 2015
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Introduction
Healthcare organizations face the critical need for managing and integrating the
information systems with an aim of enhanced management. Statistics shows that almost 60
million Americans reside in rural areas and face the common challenge of accessing quality care.
The number represents a huge majority of Americans that live in areas that have acute shortages
of primary care providers. The use of health information technology is essential to the success of
Critical Access Hospitals (CAH). CAHs are rural and small hospitals located 35 miles apart or
rather 15 miles in areas that have mountainous topography. CAHs are normally state-certified
and have a maximum of 25-bed capacity. Nevertheless, they must contain an annual average of
96 hours for patients admitted due to acute health conditions (Gibbons, 2008). Health
information systems play a supportive role in augmenting the normal hospital processes such as
billing, accounting, and patient registration among others. Adoption of HIT applications is a key
priority for successful operations of CAHs. Understandably, Medicare cost-based reimbursement
has played a critical role in permitting the CAHs to make an initial investment in HIT
infrastructure. HIT application in CAHs presents multiple opportunities that will end up
improving the population health and enhancing the access of basic care.
Organizational and Clinical Leadership
In organizations that perform exceptionally well, focused and collaborative leaders set
goals with an aim of achieving them. Health information in CAHs provides hospital managers
with informatics that are critical in decision-making. Organizational leadership aided by the
health information technology focuses on the needs of the patients while at the same time
encouraging continuous learning and innovation. Importantly, this encourages continuous
innovating approaches while at the same time demonstrating the ability to adapt the much-
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needed change (Green, Bowie, & McGraw, 2011). Adoption of IT solutions enables physicians
to demonstrate key interventions that improve care delivery. Health IT application in CAHs
enables these organizations to optimize clinical, administrative as well as operational data
including the patient and the overall community information. Evaluation of this data is essential
to set up goals and identifying the opportunities that will lead to improvement while at the same
time monitors the progress. Some of the health IT capabilities that support both organizational
and clinical leadership in CAHs include:
1. Providing access to clinical and administrative generated electronic data to set goals that
will fast track the performance
2. Normalizing and analyzing data under diverse settings and across a span of time with an
aim of assessing the performance of quality, cost and overall patient experience. This
aspect helps in identifying the necessary opportunities for improvement while at the same
time monitor the overall progress
3. One of the main reasons why the health care quality is clouded by high costs entails the
typical fragmented delivery. Health IT applications help the CAHs to coordinate care
across different providers and settings. Engaging the multidisciplinary team is critical to
improving the quality of care.
4. Accessing the patient records from different settings helps the organizational managers of
CAHs to come up with decisions that support tools and help the clinicians to offer
integrated and evidence-based patient care. Nevertheless, information will enable the
health organizational leaders to advise the patient accordingly with respect to the adopted
regimen.
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5. Health IT and overall information exchange enable the care providers as well as the
patients to access information at the appropriate time. Most of the information is derived
from different patient records, physician practices, laboratories and health plans. This
information is essential in the management of the care in CAHs.
Timely Access to Healthcare
One of the commonly cited advantages of Health IT in CAHs involves enhancement of
timely access to health care. One of the challenge healthcare provider’s face in the rural areas
entails serving the approximately 60 million Americans residing in these areas. The realities of
distance, constricted resources and isolation complicate rural health care delivery. Health IT
serves as a way of ameliorating these problems. Health IT does so by providing the patients with
multiple avenues in ensuring that there are timely care and consultations under appropriate
conditions. Both online and electronic patient tools including the patient portals (applications
enabling secure communication between the health care organization and the patients) facilitate
information exchange between the patients and care teams (Sarnikar, Bennett, & Gaynor, 2013).
Using mobile applications and secure messaging is critical to ensuring that the patients are
served even when they are dispersed in expansive rural areas. This application saves the patients
a huge deal of time in getting the necessary consultation. Online scheduling and other reminders
have improved the overall operations of CAHs since they enable the patients to have care access
that suits their overall needs and flexibility. Importantly, virtual consultations have been
revolutionary in helping and guiding specialists despite their physical location (Zieliński,
Duplaga, & Ingram, 2006). This is vital since it gives the patients with access to the same
quality of care similar to that of individuals visiting the physical location. Convenient as well as
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cost effectiveness of electronic visits have been important in situations when face-face visits
become compromised.
Emphasis on Wellness and Healthy Behaviors
Health IT has been crucial in offering the necessary knowledge transfer, especially in
CAHs. Disease prevention and improving the wellness of the public is the main aim of Health
Organizations. High-performing organizations provide a chance to the patients by helping them
understand matters affecting their health through educational resources tailored to meet their
current health needs. CAHs can use the electronic educational resources as well as other
interactive tools that can enable the patients to understand as well as manage their overall
wellness and health (Zieliński, Duplaga, & Ingram, 2006). Some of the health IT capabilities
adopted by the most health organization entails information exchange. Some of the adopted
health IT approaches used by the CAHs include:
1. Online educational resources that will end up in supporting the awareness on the
prevention of disease and the overall wellness
2. Tracking and other self-monitoring tools offered online through a plethora of mobile
applications have helped the patients adhere to various treatment regimens
3. The connection between the self-monitoring tools as well as the EHR has been critical in
improving the communication between individuals and other care teams.
4. Constant reminders as well as alerts through emails and secure text messaging identified
earlier provide both preventive and follow-up actions that require adoption. For instance,
the reminders, as well as alerts, play a critical role in ensuring the patient stick to a laid
out immunization and routine screening.
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5. The social media platforms have played a crucial role in supporting dialogue among
different individuals facing common conditions and the needs of interests.
Interoperability and Information Exchange
CAHs face the challenge of information dissemination especially due to barriers in the
distance. Information exchange in diverse and multiple entities is central in offering coordinated
and accountable models in care delivery. Within the hospital setting, the information associated
with patient health resides in different settings that include offices of physicians and specialist,
laboratories, and radiology departments. Some of this information is dispersed in other areas
such as health plans enrolled by the patients, pharmacies as well as nursing homes (Yih, 2011).
Without robustness in health information exchange, it is impossible for the CAHs to spread the
attributes leading to high performance and clinical decision support. Understandably, it will
become impossible to support the outcomes leading to accountability and overall improvement.
CAHs adopting health information exchange have attained positive impact on both costs as well
as the quality of care. Most physicians working in CAHs believe that health information
exchange is critical in reducing costs of health care thus increasing the amount of time saved.
Information exchange facilitated by the Health IT has been critical in enhancing the quality of
care given to the patients (Tan, 2013). Health IT systems meeting the interoperability standards
have streamlined the overall services offered while at the same time enhancing the delivery of
care. Providers and other key players in the in rural health settings have listed the key programs
that will work together with the support of the strategy. HITECH has set out clear process that
advocates for the adoption of health IT standards leading to interoperability. Health information
exchange has played a great role in ensuring that the physicians in the hospitals prioritize in areas
that require implementation of certain specifications.
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Visioning and Strategic Planning
Health information technology has helped healthcare organizations to achieve both
efficient and effective care delivery. HIT processes encompass various software applications as
well as requisite policies. HIT provides a roadmap that enables the CAHs come up with a long
range of goals that entail stakeholder engagement in enhancing the delivery of care. Clinical
information systems support the professions in direct delivery of care. When a collaborative
effort has been established the clinical systems, they are called electronic health records. These
clinical information systems have contributed towards automation that includes retrieval and
imaging (Tan, 2013). In situations involving ambulatory care, information technology has
helped the CAHs in various functions that include data capture, documentation, prescribing and
offering clinical decision support systems for overall care management. Since the legislations
were passed, EHR has played a critical role in the integration of practice management such as
patient registration, billing, and scheduling. Some of the CAH have chosen to use the standalone
electronic prescribing systems while at the same time using the registries for care management.
Nevertheless, the approach entails obtaining continuity of care document application that plays a
critical role in the management of referrals.
The data warehouse in the CAH plays an important role in providing the necessary
support for decision-making. Some of the portals availed through Health IT have been essential
in the transfer of important information (Kudyba, 2010). Using the available information, health
care providers can make important decisions that will offer transformative functions. Transfer of
information from one of the CAH to another has been important in forming an intricate network
of information that is crucial for successful running of the health care organizations. Using the
information repositories, CAH have been in a position to restructure and improve the overall care
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given. Telehealth and other important health information exchange have been under constant
evolution. Personal health records stored in these hospitals provide an insight on the overall
enhancement of quality of care.
HIT and Care Management
Health information technology has been critical in aiding management of chronic
conditions for patients enrolled to CAHs. This helps the patient with support systems that help in
managing both medical and behavioral conditions (Sarnikar, Bennett, & Gaynor, 2013). Care
delivery is possible at various levels of management including population and patient level. The
burden of diseases has gone overboard to include the chronic illnesses. The role of Health IT in
care management is crucial in supporting the care management functions that include capturing
the patient data, aggregation and reporting. Primary care providers in the CAH have been in a
position of grouping the patients using their health conditions thus identifying the unmet needs.
Importantly, this approach enables the provider to tailor all the care plans depending on the
condition. Nevertheless, they are capable of filling the gaps in disease-specific populations.
Patient having complex chronic conditions can manage their conditions by accessing the
integrated health information. As noted earlier, secure messaging functions enable the patients to
interact with the care team making the communication efficient and timely. The remote
monitoring devices used provide enabling environments that provide alerts to care managers
about the problematic health issues (Zieliński, Duplaga, & Ingram, 2006). Devices at home can
add value to the quality of care given to the patients.
Information systems
Some of the health information systems that have been adopted by the CAHs include
EHRs. This is an electronic file cabinet that stores patient data from various sources. This cabinet
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integrates all data from text, voice, notes and even images. CAHs have been able to utilize EHRs
to achieve automated order entry as well as to track their patients. This has been enabled due to
the ability to access patient data more readily at the same time maintaining a continuous
longitudinal care or their care (Vincent, 2010).
CAHs have also adopted the use of computerized provider order entry commonly referred
to as the CPOE. Essentially, this is an automated medication ordering and fulfillment system.
Further attempts have been made to include lab orders, discharges and even referrals of serious
cases. Clinicians in CAHs have also benefited from the integration of health information systems
in CAHs. Clinical decision support systems have provided physicians and nurses in CAHs with
treatment and diagnostic recommendations. This technology provides health care practitioners
with simple alerts and warnings of dangerous drug interactions upon prescription. Clinical
pathways and protocols of the drugs are made available to the physicians and pharmacists hence
improving the quality of healthcare provided (Fonkych, Taylor, & Rand Corporation, 2005). The
result is that medical errors have been reduced, and even complications arising from these errors
have been on the decline. CAHs can now boast of improved and more efficient healthcare.
Another critical health information system that has been adopted by CAHs is the picture
archiving and communication system. This technology has allowed the capturing and integration
of diagnostic as well as well as radiological images from various devices. The information is
then stored and disseminated into a medical record or a clinical data repository. In the event that
a patient relocates to another place, this information can be in turn accessed by the nearest CAH
and the patient can still enjoy quality service with ease and convenience (Girosi, Meili, &
Scoville, 2005).
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A breakthrough system in CAHs has been bar coding. In remote areas where the number
of medical personnel is limited, bar coding has come as a Messiah. Here, an optical scanner
captures the information that has been encoded on a given medical product. Bar coding is used in
CAHs for medication. How is this done? Bar coding allows for the matching of drugs to patients
by using bar codes that have been placed on patients arms. Essentially, this allows even
untrained personnel or people with little knowledge about medication to dispense drugs utilizing
this technology. Barcoding has helped cover for the small number of trained medical personnel
in CAHs that are located in remote areas (Girosi, Meili, & Scoville, 2005).
Quality and health information technology in CAHs
A major motivator of using health information systems in CAHs has been the belief that
they will improve the quality of patient care. However, better research needs to be conducted to
help ascertain the relationship that exists between IT and quality. Aspects like quality problems
that information systems can be used to solve the need to be identified. Essentially, in any
healthcare setting, quality health care is dependent on the physicians, nurses and the patients
possessing the correct and relevant information at the right time (In Hoyt & In Yoshihashi,
2014). This information is what guides them to make the right decisions.
Health information systems have improved the ability of CAHs to address the problems
that are experienced in healthcare settings. Many patients tend to receive healthcare from many
different healthcare providers. This is influenced by their location of even convenience. The
primary means of coordinating the services that the patients have received, for a long time has
been through discussions with the patients. This has not been an effective approach because,
many times the patient forgets some aspects that he or she needs to mention. In other cases, the
patients are brought to the CAHs in critical conditions that they cannot discuss with the
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physicians their medical history (In Hoyt & In Yoshihashi, 2014). Health information systems
have thus stepped in to help solve this dilemma. Information systems used across the healthcare
setting has helped to create a virtual integrated delivery system that ensures all relevant
information is accessible by healthcare providers at any location.
A few examples of how health information systems have managed to improve health care in
CAHs include:
i.
Reduction in the number of medical errors that may lead to adverse drug reactions
and events
ii.
A decrease in the number of errors that occurs as a result of wrong dosages
iii.
Prescription of certain drugs more accurately
iv.
An overall improvement by the CAHs in accurate prescription of drugs and provision
of health services
Current status of use of health information systems in CAHs
The degree in which health information systems have been adopted varies with the
healthcare setting. Pharmacies have been reported to be the most advanced users. CAHs are
much further behind in terms of utilizing health information systems (Khosrowpour, 2002).
However, it is important to mention that both IT and internet have had a significant impact on the
consumers. Numerous CAHs have created websites that make healthcare information more
readily available to the public. Consequently, strengthening their role in healthcare decisions.
This has also allowed various insurers to post information on the premiums they offer,
consequently, enabling patients to choose the best options available.
Very little is known about the level of adoption of IT in CAHs and the strategies utilized
by the CAHs when making IT investment decisions. Much of the information regarding health
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information systems in CAHs has come from voluntary surveys, some of which are usually
conducted on the internet. As a result, the results may be biased towards the most advanced users
of IT in the healthcare setting.
Costs and benefits
The use of health care information systems in CAHs has a variety of benefits. The
efficiency in which health care is made available is improved including the health of the practice.
Computerized scheduling and financial systems have allowed the tracking of practice
productivity in healthcare. CAHs have been able to utilize EHRs to monitor and improve the
quality of healthcare by rendering relevant information available and reducing duplicative
documentation. The widespread adoption of HIT has allowed CAHs to achieve system
connectivity and information exchange between themselves and other healthcare providers
regionally and nationally (Khosrowpour, 2002).
As pointed out earlier, a majority of health care providers including CAHs have been
slow in adopting health information systems. A recent survey shows that only a meager 9.6% of
the CAHs have CPOE completely and readily available for use. The use of Electronic Health
Records is placed at 15%. In the wake of the adoption of healthcare systems by the various
health institutions, more costs have been incurred. More money has been pumped into the
purchase of various infrastructure needed to implement and adopt HIT.
Disadvantages of the use of healthcare information systems in CAHs
i.
Expensive
The increased use of sophisticated technology in healthcare has not come cheap. It is crucial
to understanding that all first world countries face a variety of problems and challenges in terms
of their health care systems. A major challenge is the aging population (Khosrowpour, 2002).
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People are living longer, and the result of this is that there is an increase in the number of people
who need healthcare. However, the population that is working to support the healthcare system is
reducing. Many CAHs have been unable to adopt fully health information systems due to the
limitations coming in the form of funds. A major consideration they make is that, whether the
cost that comes with the use of technology is economically viable for the health institution?
ii.
Requires a long duration to adapt fast
A major challenge is that technology is constantly evolving. There are new software,
upgrades which offer a new way of doing things. The problem here is that the hospital staff in
CAHs has to keep up with the changes in the industry to maintain a competitive edge. This has
been a struggle for some of the staff especially the older staff.
iii.
Staff over dependency on technology
After the staff has adopted the new way of doing things, another problem arises. Many times
computers experience technical errors. The health information systems are not exempted from
these challenge. This problem is especially critical in Emergency departments. Various
departments within the CAHs are interconnected using a common information system. Whenever
one department experiences problems, then the rest tend to be affected (Preparing for success in
healthcare information and management systems: The CPHIMS review guide, 2013). For
example, if a patient is taken to the Emergency Department and there is an error in retrieving the
GXM results, and then the following procedures are automatically delayed. This sometimes
causes huge inconveniences or even worse. The patient may develop adverse complications as a
result of the delayed procedures. Fatalities have been reported in some instances.
iv.
Susceptibility to hackers
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Cybercrime has been a problem of the 21st century, and it tends to affect the quality of our
lives and well-being. Patient privacy is no longer guaranteed given that information stored can be
accessed by unauthorized personnel. CAHs that have not invested in securing their systems tend
to be easy targets of hackers, resulting in irreversible loss of crucial patient information.
Past and present
With the advancements in technology and informatics, it has helped lighten the workload
of various medical personnel like radiographers at the same time saving their time. In the past,
there was just simple radiography that involved processing and the printing of films that took a
lot of time. CAHs have adopted the use of computed radiography that has allowed the images to
be transmitted via radiological systems. In turn, doctors and radiologists can be able to access
this information when they need it (Trotter & Uhlman, 2013).
Initially, cases of lost patient file were very high. Physicians were in turn forced to attend
to patients with incomplete medical charts. This resulted in a large number of medical errors in
the form of patients being given drugs they no longer require or termination of treatment before a
given infection has been eliminated completely (Vincent, 2010). However, health information
systems like the HER have allowed for the digital storage of patient information which has in
turn reduced the risk of patient files being lost. Consequently, better quality health care has been
achieved.
Previously, there were limited employees in the field of IT in CAHs. With the adoption
of health information systems has opened a new door for IT experts. The sophisticated
connections, integrations and operations of health information systems require trained personnel.
Today, the number of IT personnel present in CAHs has increased due to the need for these
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institutions to maintain a competitive edge over their rivals by offering the best quality
healthcare service. The best way to achieve this is through the adoption of IT in healthcare.
Recommendations
Both the private and public sectors should adopt health plans and take steps that tend to
increase the incentives for facilitating information exchange that is crucial in achieving new
support models of healthcare. The entire health system should develop long-term data strategy
for allowing interoperability. This will in turn help align health and health care with the major
priorities. Existing policies should be clarified to ensure that Bi-directional exchange is realized.
By building upon previous policies, Health IT policy committee should continue gathering input
from the various stakeholders to develop policies that support a robust health information
exchange between the CAHs and other health providers (Vincent, 2010). The administration
should constantly offer clear guidelines on federal privacy and the security policies that cover
patient health information.
Conclusion
CAHs have ensured that health care is available to those that are in the most remote
areas. The adoption of healthcare information systems by CAHs has made this more efficient and
has in turn improved health of many individuals in the remote areas (Vincent, 2010). By
borrowing a leaf from the CAHs, other health institutions can be able to apply the same model
embraced by CAHs to ensure that they achieve efficiency, quality and accuracy in healthcare.
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