Transcript Document

University of Minnesota
Information Technology in
Healthcare
Medical Industry Leadership Institute
Course: MILI/PUBH 6562
Fall Semester B, 2014
Stephen T. Parente, Ph.D.
Carlson School of Management
Department of Finance
[email protected]
Health IT Overview
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Why a Course in Health IT?
Course Objectives
Health Information Systems Overview
Health IT Clients
Logistics: Readings, Labs, Exams & WWW
Small group discussion
Who is this course designed for?
• Future managers
– Provider
– Insurer
– Technology (medical & related)
– Consulting
• Clinicians intending to manage a health IT
system in the future.
New Market Forces in Play for
Health IT
• Emphasis on quality of care
– overuse
– misuse
– underuse
• The Internet & consumerism
• Managed care under attack
• Government price controls have outlived their
usefulness
Who cares about Health IT?
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Fortune 500 Businesses
Venture Capitalists
Managed care & insurers
Providers
Government
Researchers
Consumers (future patients)
Why a Course in Health IT?
World has changed in health care:
• Health reform (1993-94, version 6.0) gave
rise to accountability
• Emphasis on having the ‘right’ information
for informed decisions:
– consumers
– providers
– businesses & government
Wouldn’t a Management Information
System Course Do?
• Isn’t it just another application of computers?
• Can’t I just insert the word ‘patient’ instead of
‘customer’ and ‘physician’ instead of vendor in
a software package and be done with it?
• Aren’t there people I can just hire to do this
stuff?
No, No, Yes (but it will cost you)
• Health informatics is an interdisciplinary
product combining several fields:
– Computer Science
– Electrical Engineering
– Medicine, Nursing and Allied Health
– Management & finance
– Risk and insurance
– Economics, Epidemiology & Statistics
The Problems of ‘Cutting & Pasting’
MIS to Health Care - 1
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16,000+ unique diagnoses,
10,000+ unique procedures
and 20,000+ unique drugs
used in combination to produce one
‘widget’.
The Problems of ‘Cutting & Pasting’
MIS to Health Care - 2
• Clients (patients) without full information
about what they want to buy, why they want it
and how they will pay for it.
• Individual providers at the top of the social and
political spectrum able to ‘craft’ products
specific to each client.
So You Want to Just Buy a Health
MIS From a Vendor, Huh?
• How do you know what your buying?
• How will you know the importance of one
million dollar feature from another?
• How long will the technology meet your
needs?
• What are the indirect cost of transitioning to
the new system?
Health IT in 2014 Includes - 1
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Automated time & attendance/HR
Bar coding systems
Claims auditing/analysis software
Claims processors/clearinghouses
Clinical software
Computer-based patient records
Data repositories
Health IT in 2014 Includes - 2
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Data security
Decision support systems
Digital dictation/transcription systems
Documents management
Financial/billing/patient accounting systems
Hardware/peripheral devices
Home health care software
Hospital/health care information systems
Interface engines/integration tools
Health IT in 2014 Includes - 3
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Internet/e-commerce
Laboratory information systems
Meaningful Use Certification Vendors
Materials management/supply ordering software
Outcomes/utilization review software
Outsourcing services
Radiology systems
Patient ID/smart cards
Pharmacy information systems
Health IT in 2014 Includes - 4
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Practice management software
Scheduling software
Systems integrators
Telecommunications/networking
Telemedicine/teleradiology systems
Wireless devices/networks
Fundamental Aims of Course
• Know the Technology: Recognize the potential
and limitations of Health IT.
• Buy Smart: Make informed IT purchase and
development decisions
• Effectively Use & Systematically Evaluate:
Continuous planning, implementation,
evaluation of Health IT.
Primary Course Topics – 1
• Health IT Overview
– Systems & technology
– Health IT Demands of Managers
• Health IT architecture
– Hardware
– Data structure
– Life-support applications
– Decision-support applications
The Health IT Pyramid
Decision
Support Software
Life Support Software
Clinical & Financial Data
Hardware
Primary Course Topics – 2
• Health IT application case studies
• Design and evaluating heath IT
– Security
– Confidentiality
• Future health IT innovations
Skill Set Provided by Course -1
• Describe the basic the hardware of information
technology.
• Understand the basic data structures present in
heath care.
• Identify software applications used to manage
health care.
• Describe the principal clients of health
information systems.
Skill Set Provided by Course -2
• Evaluate an information system using basic
systems theory and evaluation skills.
• Communicate to a systems analyst ad-hoc
programming instructions.
• Discuss health information technology legal
and ethical issues.
Method of Evaluation
• Take-home Final exam:
45%
• Laboratory & class participation: 30%
• Mid-term examination (11/11)
25%
Course Labs
• #1: Identifying a vendor-supplied application
• #2: Communicating to a programmer
• #3: Build or buy a new health IT system
Office Hours
• Room 3-279, CSOM, 3pm to 5pm, Tuesday
• By appointment is best.
• Email [email protected] to schedule time
outside office hours.
• Phone & e-mail info:
– [email protected]
– 612-624-1391
The Course Readings
• Three sources for readings:
– The course web site:
• http://hsinetwork.ehealthecon.com/ithc2012.html
• Links to online articles are provided.
– Handouts
• Readings are vital to discussion and exams.
Online Modules
• Provides a Hybrid Online Course
• Goal is to describe key concepts at students on pace.
• Will reduce required class time and optimize guest
speaker / case examples.
• New for 2014, but based on 10 years of experience
from other courses.
• Feedback welcome
– Segments to add
– Segments to modify
– Awesome Videos to make a point punch. s.
Course Notes
• Also available from the course web site:
– http://hsinetwork.ehealthecon.com/ithc2014.html
• Click on lecture to download notes. I will try
to make notes available one day before lecture.
E-Mail Distribution List
• Distribution list will be generated to:
– Immerse you in the subject with health IT news
briefings, & webinars.
– Inform class guest speakers and scheduling
changes.
– Clarify assignments
– Introduce you to themorningconsult.com
Small Group Exercise
1. What types of health care organizations will
there be in 2019?
2. What types of information do their C-level
leadership need to make decisions?
3. How will the data/information be furnished?
Exercise from This
Week’s Readings
• Read tech trends article
• For each of your THREE FAVORITE trends,
identify a direct causal relationship between
the technology trend and:
– Improved productivity
• More services, holding constant resources.
• Better Health outcomes
– Improved financial performance
• More efficient
• New sources of revenue
Present Homework as an
Executive Memo
• Ideally one to two pages long with 5 paragraphs.
– Intro paragraph
• What are you looking at: State key question/issue or problem
• What’s the punch line
– Body
• What was your approach/process to answer the question.
• Describe your results in more detail.
– Concluding paragraph
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Restate punch line
Explain why it matters
What are the caveats/limitations of what you said
Talk about next steps or issues to follow-up
Health IT Online
Module 1.1
Fundamental Information
Systems Theory
• Data: raw facts and figures collected as part of
the normal functioning of a business, clinical
encounter or research experiment.
• Information: data processed in a formal,
intelligent way to obtain results directly useful
to managers and analysts.
Systems Theory Basics
• Objects: component parts of a system.
• Attributes: characteristics of an object.
See it in motion: INPUT to OUTPUT, through
a conversion process.
Input to Output
Health care examples???
Conversion Process
Input
Output
Management Decisions &
Information Systems
Two type of approaches:
Management Decisions & Information Systems
Two type of approaches:
• PURELY RATIONAL: All information must be
considered before a decision is made.
• NONRATIONAL: Every situation is different.
Must consider:
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Social
Political
Environment
“Feel people out”
What approach should managers use?
The Role of the Computer
• The computer is a tool.
• The computer is not a Health IT product.
• A Health IT Business Plan should NOT
specify the purchase of a computer as a key
goal (unless it is the foundation for the rest of
the plan).
Health IT Online
Module 1.2
The Management
Information Cycle
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Goals and Objectives
Estimate demand
Allocate resources to meet demand
Control Quality of Performance
Evaluate Results
Re-establish Goals and Objectives
Is This a Good Mantra for a
Health Data Manager?
• If it’s not measurable, it’s not manageable.
• If it’s not manageable, it’s not meaningful.
• If it’s not meaningful, don’t do it.
Health examples?? Health exceptions??
Three Types of Systems Relevant
to Health Care
• Mechanical
• Human Systems
• Human-machine systems
Health examples from each?
Systems Objectives in a Health
Care Setting
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Medical/health outcomes assessment
Cost control
Utilization analysis and demand estimation
Program planning & evaluation
Simplification of an external process
Clinical research
Education
Health IT Online
Module 1.3
Meet the Health IT Clients –1
• Providers: Physicians, hospitals, nurses and
allied health professionals who need
information to improve clinical quality, get
reimbursed and compete.
• Manufacturers: Pharmaceutical, biotechnology
and medical device manufacturers who need
need IT for clinical trials and well as costeffectiveness evaluations.
Meet the Health IT Clients –2
• Insurers & health plans: Public and private
insurers who need information to manage
providers, insure risk, and stay solvent.
• Government, researchers & consultants:
Building IT infrastructure for biomedical
research, health policy evaluation and
public health surveillance/response.
Health IT Online
Module 1.4
The Value Proposition of Health IT
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What is information demand?
How much information is needed?
Finding the value of information
Inventorying data resources
One-time health IT demand scenarios
On-going health IT demand scenarios
What are the Goals of Information Technology?
• Make life easier
– Easier to obtain products & services
• Improve quality of life
• Save Money
– Labor-savings $$$
– Less costly mistakes
• Make Money
– Focused Marketing
Economics as an IT Lense
• Definition of Economics:
– The study of the allocation of scarce resources
among competing ends.
• Tools of Economists:
– Theory
– Econometrics & data
– Institutional Knowledge
Economic Theory of IT
• Good work by: Erik Brynjolfsson and Lorin
Hitt (2000) from MIT Sloan School
• Three Different Measure’s of IT Value:
– Productivity
– Profit
– Consumer Welfare
Unique Features of Health IT Economics
• Standard assumption is that IT can not yield
profits only reduce costs.
• Assumption is not true if an industry has high
barriers to entry.
• Health care has many barriers to entry, so
providers & insurers should buy IT not just as
a tool to control cost but to profit as well.
Econometric Application - 1
Productivity
• Define an output in health care:
– Mortality is crude but undisputed.
– Improved health outcomes (can be highly
subjective in health care)
• Define an input:
– Health IT Investment (# of workstations)
– Labor (# of FTEs)
Econometric Application - 2
Profitability
• Measure profits & IT investment and analyze.
• Some early results:
– Hospital’s who invested in IT can have improve
their profit margins by about 40%.
– Study is being refined to identify whether IT drives
the profits, or profits motivate IT investment.
Impact of IT on Hospital Profits
Over Time
H o s p it a ls W it h o u t In fo rm a t io n S y s t e m s
H o s p it a ls W it h In fo rm a t io n S y s t e m s
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T ota l M a r g in
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Econometric Application - 3
Consumer Surplus
• Consumer surplus is derived from consumers
purchasing a good at a market price lower than
what they would have been willing to pay.
• IT is full of these examples in the PC market
today. What about Health IT?
• Want to plot a demand curve to measure CS:
– Could obtain data from insurers and providers to see
whether consumer surplus exists.
– May need a patient survey for Internet applications
related to health.
Evaluation of Individual IT Systems
• Examples:
– Hospital ER
– Managed care plan disease management system
– Distance learning services for continuing medical
education.
– OTHERS?
• Which economic goals are they systems
seeking to fulfill?
Health IT Online
Module 1.5
What is the ‘Value’ of Information?
• Hard to Express…….
• A proxy valuation is the ‘opportunity cost’ of not
having the information.
• Opportunity cost is defined as the cost you would pay
to obtain one unit of information in exchange for one
unit of another good.
• Health example: An insurer not having a diabetes care
tracking system by 2014 will lead to employer with
5,000 beneficiaries to leave the plan, which would
decrease profits/surplus by $25 million.
• What can you do with different databases with
the same unit of observation?
• ‘Merge’ them to create combined information
and possibly calculate new information.
Lessons Learned by Redesigning -1
• Organize around outcomes, not tasks.
• Have those who use the output of the process
perform the process.
• Subsume information-processing work into the
real work that produces information.
Lessons Learned by Redesigning -2
• Treat geographically dispersed resources as
though they were centralized
• Link parallel activities instead of integrating
their results.
• Put the decision point where the work is
performed and build control in the process.
• Capture information once at the source.
Principals of Information
Resource Management
• Information is an essential organizational
resource.
• Obtain top executive support for information
systems planning and management.
• Develop a strategic vision and plan.
Health IS Categories
Health IT Online
Module 1.6
Inventorying Data Resources - 1
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Internal to the Organization (see previous).
Available from partner organizations.
Available from government agencies.
Available from the private sector.
Data needs to be collected
Primary vs. Secondary Data
What are the Data Elements of Interest?
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Charges
Payment
Cost
Service use
Vital statistic
Diagnosis
Outcomes
Demographics
Provider of Service
Treatment Used
What is the Unit of Observation?
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State
County
Health plan
Group Practice
Hospital
Physician
Patient
Second x, seen by Patient Smith
Work Through Ongoing Scenarios
• An health insurer wants to aggressively
manage diabetic enrollees with a phone
tracking system.
• A hospital wants to implement a new human
resource management system to integrate
residents with hospitalists to reduce ‘July
errors”.
Work Through Ongoing Scenarios
• A pharmaceutical company needs to evaluate
the cost-effectiveness of their existing
products.
• A patient with moderate to severe asthma
wants to improve the quality of their care.
• A large group practice wants to reward its most
productive members.
Work Through One-Time
Only Scenarios
• Two hospitals want to merge.
• A Medicare Part D carrier needs to identify
which regions to possibly exit in two years of
poor profits.
• A managed care plan needs a new panel of
exclusive low cost/high performance
physicians to establish contracts with.