follow up on the posts of your classmates and faculty and responses to your own posts. The grading rubric calls for you to post a total of 3 times per week (1 initial post +  2 discussion participation posts).

– Add new information or viewpoints

– Provide context by example, inference, explanation, or comparison

– Critically evaluate discussion content

– Challenge, question, or refute discussion content or accepted knowledge

The development of early computerized billing systems was modeled after the electronic data interchange systems started by the steamship and railroad industries as described in the article by Reza et al (2020). From 1960 to 1980, these systems were rudimentary to say the least. They were not connected even in the same hospital as outlined in Wager (2022). I will illustrate an example of how fragmented the process was early in my career. The different hospital departments acted like separate units with different programs and even hardware. All of this was independent from the paper charting done at bedside by nurses and doctors. In the mid-nineties, as a resident I would handwrite orders. The chart would then be handed to the unit secretary. That person would have to tell the charge nurse to read it. If it were a nursing commination order such as “give a stool softener,”  the charge would then tell the bedside nurse. If it were a blood draw order, the unit secretary would input it on an old-fashioned IBM computer. The lab would then print the order and manually input it into another system. Then they would send someone to draw the blood from the patient’s arm. The next day at the printer, I would collect those paper results. This process was error prone, time consuming, inefficient, and costly. What I saw and experienced on the ground was reaffirmed by the second Institute of Medicine report To err is Human: Building a safer health care system (Kohn, Corrigan, & Donaldson, 2000) as cited in Wagner (2020).

Now I can dictate on my EPIC driven electronic health platform, order a test and send a copy of my note to the patient portal and to the family clinician. Then I can bill for the encounter, all from my iPhone. There were various laws and acts by the government to drive us to this point. Three to four fundamental pieces of US (United States) government legislation really impacted me as a clinician. First in 1996 was the passage of the Health Insurance Portability and Accountability Act (HIPPA) setting the standards for privacy and codifying them. Next was the passage of Health Information Technology for Economic and Clinical Health Act in 2009 that gave monies in incentives to Medicaid providers and hospitals as per Reza et al. (2020). The Affordable Care Act and 21st Century Cures Act are the other two subsequent pieces of legislation that took us to the next level, Wagner (2020). I believe that the last two really propelled us to wider adoption of equipment, platforms, programs that now are the norm.

In this journey I have had to develop various levels of health literacy and data literacy. I can only imagine what other consumers such as patients have had to do to assimilate the massive amounts of information now available. There are many other players that have a role in this process certainly not everyone has the same background or experience. I will focus on the physician – patient role. As the TEDx Morrow (2019) video discusses, I certainly had to develop a skill set of how to read, work, analyze, and argue/decipher information just to get through my EPIC electronic workflow every day. It is certainly different from when I started back as a medical student. That process took time, but it was more in physical terms. Now I must sift through layers of windows to get the right information. It is still not easy but certainly light years advanced than before. For patients, the central hub of dissemination of information was the physician. They had to trust the doctor, period. He or she was the central gospel of information. To many individuals this is still true. Now with Goggle and MedlinePlus any person has near complete access to up-to-date health information. This may “level the playing field ” to a point. It may also lead them to life saving treatment that their physician may not even know about. The outcome of their health depends on the level of health literacy. They must develop a robust skill set to dig through the information explosion. The better people can understand and manage their health information the healthier they can become, Netemeyer et al. (2020).

References 

Dixon B., Rahurkar S., Apathy N.C. (2020). Interoperability and health information exchange for public health. In Magnuson J.A., Dixon B. (Ed), Public health informatics and information systems. (3rd ed., pp. 307-321). Switzerland: Springer Nature.

Hersh W. (2020). Public health informatics in the larger context of biomedical and health informatics. In Magnuson J.A., Dixon B. (Ed), Public health informatics and information systems. (3rd ed., pp. 31- 41). Switzerland: Springer Nature.

Netemeyer, Dobolyi, D. G., Abbasi, A., Clifford, G., & Taylor, H. (2020). Health literacy, health numeracy, and trust in doctor: Effects on key patient health outcomes. The Journal of Consumer Affairs, 54(1), 3–42.  https://doi.org/10.1111/joca.12267

Reza F., Prieto J.T, Julien S.P. (2020). Electronic health records: Origination, adoption, and progression. In Magnuson J.A., Dixon B. (Ed), Public health informatics and information systems. (3rd ed., pp. 183-200). Switzerland: Springer Nature.

TEDx Talks Morrow J. (2019, June 3rd) Why everyone should be data literate [Video File]. YouTube https://youtu.be/8ovyQZ_Z8Xs

Wager, K. A., Glaser, J., & Lee, F. W. (2022). Evolution of health care information systems in the United States. In Wager, K. A., Glaser, J., & Lee, F. W. (Ed.), Health care information systems a practical approach for health care management (5th ed., pp 3-38.). San Francisco: Jossey-Bass

Types, Purpose and Use of HIS

Health information systems provide various uses depending on the stakeholders involved: this can range from the healthcare professional, patients and the administration staff who work tirelessly behind the scenes. In a generalized sense the purpose of health information systems is to reduce costs, manage populations, and improve quality care and outcomes (Wagner et al., 2022). Examples of healthcare information systems (HCIS) are electronic health records (EHR), personal health record (PHR), and telehealth and telemedicine systems.

Health systems within the last decades have shifted their focus to become more patient-centered. This has proven to be the exemplary model of care. When holding patients at the center of all decision and treatment plans it allows for optimal outcomes at reduced costs. Use of applications such as patient portals allow patients to feel more involved in their care which promotes compliance as they feel as though they are being heard and become empowered to make decisions and then are more likely to follow through with care as they were involved in the decision-making process (Jung, 2016). Telehealth medicine has exploded over the last few years with the progression of the Covid pandemic. Consumers of telemedicine were able to have the ease and convenience of these visits providing an immense advantage to those struggling with mobility, financial burden of leaving the home or mental health disabilities that prove it difficult to interact with large populations. Remote monitoring for consumers allows trained professionals to view vital signs and weight and assist with disease monitoring or decompensation.

The foundation of HIS is the EHR. Healthcare professionals and administration staff all with various needs ranging from scheduling, billing, orders, or prescribing medications can be completed within the EHR system. Key functions of the EHR are health information and data, results management, order entry, decision support, communication, patient support, administrative process, and reporting for population health management (Wagner, 2022). Interoperability within the EHR works cohesively with the health data to be collected and transcribed and transferred from provider to payee or to the patient themselves. Results management collects diagnostic data and houses this for all patients applying analytics, trends, and algorithms regarding value ranges for additional patient safety and tracking. Order entry and decision support coincide jointly for the best patient outcomes. Order entry houses a location for historical tracking if multiple specialists are involved, prevents medication errors by alerting of possible allergies or interactions, and improves workflows as standardization is created. Clinical support tools assist to prevent medication errors from integrated algorithms. They remind providers of upcoming or overdue prevention screenings and predict disease process in certain populations. (Wagner, 2022). Communication with the EHR allows the interdisciplinary care team to collaborate amongst themselves through visibility into other discipline’s documentation. Communication within the platform also provides secure formatting complying with HIPPA regulations. Administrative process for billing and prior insurance authorization can be submitted and obtained with EHR systems. Other administrative personnel can also schedule appointments for other specialists or testing within the facility as ordered. Alerts can then be forwarded to the patient to ensure compliance with the plan of care. Reporting data within the EHR allows for monitoring and transmission of data at state and federal levels to comply with reportable infections or report increases in disease processes among a certain population.

The various capabilities of the EHR system are profound within the healthcare practice. They range from assisting the patient and provider relationship to a high level of reporting to assist the entire nation with disease management outcomes. This focus on prevention and minimization of error not only ensures the optimal outcome but also decreases the overall healthcare cost.

Resources

Jung, M. (2016). Consumer health informatics. The Health Care Manager, 35 (4), 312-320. https://doi.org/10.1097/HCM.0000000000000130

Wager, K. A., Glaser, J., & Lee, F. W. (2022). Health care information systems (5^th ed.).  Jossey-Bass.