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Given the disparate systems that must be considered in an HMIS (clinical, management, strategic decision support and eHealth applications), select two of the areas and address some of the specific issues that managers and HMIS developers should prepare to address? Please support your response with a supporting reference.

As a department manager you have been asked to identify areas within your organization in need of change, based on the implications of the new regulatory compliance issues. Describe your approach in selecting the HMIS area first prioritized for change (i.e., clinical, management, strategic decision support, or eHealth applications). Outline the considerations for identifying a potential vendor for these services. Please support your response with two references.

1. Adaptive Health Management Information Systems: Concepts, Cases, and Practical Applications Read chapters 1 and 2.
1. 2008 CIO Survey Results – CIOs Predict Future Trends Review the “2008 CIO Survey Results – CIOs Predict Future Trends,” located on the Health Data Management website for background and assistance in completing the assignment in this topic.
2. Optional: 2012 HIMSS Leadership Survey Senior IT Executive Results For additional historical context to assist you in completeing the assignment in this topic, the following is recommended:
“2012 HIMSS Leadership Survey Senior IT Executive Results,” located on the Healthcare Information and Management Systems Society website.

3. Optional: 25th Annual 2014 HIMSS Leadership Survey Results
For additional background and context to assist you in completing the assignment in this topic, the following is recommended:
“25th Annual 2014 HIMSS Leadership Survey Results,” located on the Healthcare Information and Management Systems Society website.

4. Optional: Survey: Healthcare Saw Budget Increase in First Quarter of 2009
For additional information, the following is recommended:
“Survey: Healthcare Saw Budget Increase in First Quarter of 2009,” by Merrill, located on the Healthcare IT News website.

5. Optional: Transforming IT – The CIO as Clinical Transformation Champion For additional information, the following is recommended:
“Transforming IT – The CIO as Clinical Transformation Champion,” by Arlotto, from Healthcare Information and Management Systems (2006). CA 360 Lecture 1
1. Adaptive Health Management Information Systems: Concepts, Cases, and Practical Applications
Read chapters 1 and 2.
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What is a health care management information system (HMIS)? Simply put, a health care management information system integrates and distributes vital information from individual health information systems across an organization, or across organizations, to be used for improving patient care and services; evaluating and controlling costs; planning; and monitoring and controlling resources, to name a few. Typical health care information systems that are harnessed by an HMIS to distribute information are clinical, management, strategic decision support, and e-health applications (Austin & Boxerman, 2003).
Components and Functions of HMIS
Our text identifies five major components and interrelationships of an integrated HMIS as “data/information/knowledge; hardware/software/network; process/ task/system; integration/interoperability; and use/administration/management” (Tan & Payton, 2010, p. 8). While the attributes, uses, systems interdependence, scope, and scale of HMIS are far more complex than are required by most businesses, in the interests of simplicity, let’s approach these components and interrelationship with a short discussion of the information needs that are common to most business entities.
We all know that computerization brings the advantages of data collection and manipulation, but taking a step back to review what underlies the true value of computerization is important. It is commonly said that health care organizations “drown in data, but starve for information.” Austin & Boxerman summarize this notion succinctly:
Careful distinction should be drawn between data and information. Data are raw facts and figures collected by the organization. Information, on the other hand, is defined as data that have been processed and analyzed in a formal, intelligent way so that the results are directly useful… (2003, p. 4).
In other words, data in and of itself does not have value unless it can be put to use; that is, when it becomes information. Knowledge, of course, is the practical, tested interpretation of information that informs judgment and decision making.
Selection of hardware, software, and networks first and foremost involves clear needs identification to ensure that chosen technologies are capable of meeting and supporting operating goals.A great deal of information (and vision) is required to ensure that selected technologies will also be able to adapt to future organizational needs with the fewest possible disruptions in operations and in services delivery.
Process, tasks, and systems define critical areas of any business’s operations. For example, most businesses have an accounting department, perhaps a separate finance department, a human relations department, marketing department, etc. Within each department, processes and tasks are determined, routinized, and automated through the application of an administrative-based information system. The data needs of these departments may be different, but often the data collected by each are useful, if not essential, to other departments to accomplish certain tasks.
Consider the following example of the interrelationships and data sharing that are typical in business. An organization’s accounting/finance is dependent on data that is collected by its human resources department, such as payroll and benefits costs. Marketing budgets need to be contemplated within the organization’s financial planning systems to determine if projected expenses are affordable. Vital questions such as, “Will we be likely to realize gains that will justify the expenditures?” must be asked. To enable departments to share necessary information, increase efficiencies, and produce better decision making, these systems must be able, if not to “talk” to one another, to reliably exchange data. This often becomes problematic when crucial legacy systems are involved. Note that there are many legacy systems in service in health care organizations.
What is a legacy system? A legacy system is an older system that has become essential to business operations. While a legacy system may be capable of meeting business needs, it may be incompatible with other systems. When this is the case, the legacy system needs to be reengineered or interfaced with other systems to serve new or emerging needs.
Let’s take a moment to consider a statement made by Tan and Payton: “System integration and data interoperability have, therefore, been an enduring challenge for HMIS researchers and practitioners” (2010, p.16). What do you think might be some of the issues to consider in integrating systems in a health care organization or across medical enterprises? Several considerations are listed after the conclusion to this Reading.
The Roles of Senior Executives in HMIS
In the evolution of health care management information systems, financial systems were the first to be developed because CFOs were held responsible for the information technology that was required to generate financial reporting. The impetus for the creation of financial information systems was the need to equate resources consumed by patients (medical services, drugs, equipment, etc.) with expenses incurred by the health care organization to deliver those resources.
Today, a new role, the chief information officer (CIO), is present in most of the larger health care organizations. The CIO reports to the CEO. These two individuals, along with the governing board and support provided by the chief financial officer (CFO), are responsible for HMIS. According to Austin and Boxerman (2003), the principal attributes that health care CIOs bring to the job are “leadership ability, vision/imagination, and business acumen” (p. 342). Chief information officers do not need to possess technical backgrounds, and, in fact, most do not. Instead, they should have strong business résumés that demonstrate strategic acumen and success in accomplishing goals.
In today’s health care environment, the issues are far more complex than merely what the patient should be billed or when inventory should be restocked. When considering current and future HMIS needs, a thorough understanding of the health care organization’s operations, business needs, issues of care, commitment to reduction of medical errors, and ethical responsibilities to patient privacy and confidentiality, are critical. As you will see in the modules that follow, being aware that health care is far more dynamic than most other industries is important in that it is subject to frequent changes in governmental regulations, multiplicities of payors (many with varying contracts), rapidly advancing medical technologies and clinical developments, staffing shortages, and a highly competitive landscape. All of these considerations present ongoing challenges to senior managers who must be vigilant to new trends and threats in the environment that may be addressed through HMIS, as well as having final responsibility for budgets, contracts, vendor selection, etc.
Finally, how much is at stake in these days of shrinking resources should not be underestimated. The commitment to HMIS, if not risky, is certainly lacking absolute guarantees. The cost of an HMIS initiative (or series of initiatives) can easily exceed the multi-million dollar mark, and it is exceedingly difficult for senior executives to project HMIS return on investment.
By the conclusion of this module, we will have become familiar with the basic components, systems integration, and functions of a health management information system. However, before embarking on an HMIS plan, it is critical that management has a deep understanding of the health organization’s disparate cultures, systems, and processes. The CEO and the CIO are responsible for managing the process of system development and implementation. They are also responsible for continually scanning the environment to identify emerging threats and trends that will impact the organization, and, in turn, may affect HMIS developments. Financial constraints are often limiting factors in HMIS adoption because returns on investment are difficult to estimate reliably. Senior management must supply and apply “vision” as well as strategic direction and ongoing commitment to establish, formalize, and support HMIS initiatives through to implementation and beyond. Thus, a thorough assessment of expected costs, risks, impacts, etc. throughout the entire organizational structure must be made in order to ensure that the “right fit” HMIS is selected and implemented.
Examples of considerations when integrating systems in a health care organization include:
•          What are the IT development costs of interfacing between the legacy and new systems?
•          How is data input affected? Will new data need to be collected? Will new forms be needed? How will this affect current workloads?
•          What gains (monetary, legal, operational, etc.) are anticipated vs. the projected return on investment (ROI)?
Austin, C. J. & Boxerman, S. B. (2003). Information systems for healthcare management (6th ed.). Chicago, IL: AUPHA/Health Administration Press.
Tan, J. & Payton F. C. (2010). Adaptive Health Management Information Systems: Concepts, Cases, and Practical Applications (3rd ed.). Sudbury, MA: Jones and Bartlett Publishers, LLC.


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