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Lecture: Competencies of Health Information System Managers
This course teaches managers to plan, implement and use information technology
to improve efficiency and quality of health care services.
It is written for managers and not computer programmers.
It focuses on use of information systems in health care settings and not
other types of organizations.
Most of the time the course focuses on electronic health records, but we adopt a
very broad definition of what is an electronic health record.
Obviously an electronic health record is a system organized to maintain
patient information; to store data and to retrieve it when needed.
An electronic health record also includes numerous other systems.
It includes systems organized for decision support, e.g. drug-drug
interactions. It includes systems
for data entry such as Computerized Physician Order Entry and system for seeing
lab results such as radiological reports.
It includes billing as well as clinical systems.
It includes systems designed to manage inventory or schedule appointments
or to benchmark clinicians’ performance.
In a sense, when we talk of electronic health record we have in mind any
system you can find in a modern hospital.
Figure 1 provides a sample of systems that were part of a hospital’s
electronic health record. Note how
many different components are considered to be part of electronic health
records. The definition of terms
such as electronic health record and health information systems are so broad
that we use these terms interchangeably.
In a sense, an electronic health record is a set of health information
systems that are useful in managing patients and delivery systems.
Figure 1: Claudine Baron’s
Descriptions of Various Health Information Systems in One Organization’s
Electronic Health Record
Figure 1 also shows the complexity of health information systems.
Each one of the boxes in Figure 1 refers to a large stand alone system
that has its own components. There
are many vendors and data communication is a problem.
At any one time some systems are being purchased and others are being
cycled out. A great deal of money
is spent on maintaining electronic health records.
Furthermore, many governments are pushing for additional spending in this
area in hopes of improving quality of care and reducing costs.
Given this complexity, it is natural to train and hire professionals to
manage health information systems.
This course prepares managers of health information systems.
What do information technology managers need to know?
Employers who hire technology managers have dissimilar tasks that require
different skills. Professors who
train health care administrators have different ideas of what is necessary for
success of technology managers. A well defined set of skills for training of
technology managers does not exist.
One purpose of this note is to suggest a clear set of competencies that any
manager of health information systems should have.
Recently, the accreditation organization for programs in health care
administration has emphasized that training of health administrators should
cover specific competencies.
They do not specify what these competencies are but they challenge programs to
define the competencies they address.
The competencies and skills that managers of health information systems need are
many. This course categorizes the
needed competencies into three broad areas:
plan, implement, manage/use of information systems.
IT managers need to plan well because they face large scale multi-year
multi-unit complex capital projects.
The competencies needed in this area include how to assess information
needs of the organization. They
need to have skills that can help them interact with clinicians and understand
their needs. They need to examine
“use-cases” and various scenarios of how information systems affect work
processes. They need to be able to
write system specifications, listing tables and fields where data will be
stored. IT managers need to learn
how to evaluate cost and benefits of possible technologies.
They need skills in analysis of return on investments.
They need to select vendors and this means they need skills in creating
consensus around large scale organization-wide efforts.
They need to understand process improvement and how electronic health
records help organizations change for the better.
This course teaches project managers to have financial, group
facilitation and system analysis skills necessary for planning large scale
technology projects.
Implementing information systems requires a specific set of competencies.
The skill that is most needed for implementing information systems is
project management. Students in this course will learn how to schedule tasks,
how to anticipate delays and what to do to finish projects on time and under
budget. They learn to assess
project risks and put together effective communication plans.
They learn to manage scope of information technology projects.
In short, they learn project management as it applies to information
technology.
When it comes to management of information systems, a separate set of skills are
needed. Now the manager needs to
worry about impact on productivity and quality of care.
They need to worry about security and privacy of information.
Technology managers do not need to open information systems and tinker
with its programs; no one wants the manager to become a computer programmer.
Yet, understanding the impact of information systems is a management
responsibility. Many organizations
use electronic health records as they had used paper record, a place for storage
and retrieval of data. They fail to
examine the utility of the data in the electronic health record.
Technology managers need to make sure that the full potential of the
benefits of technology are actualized.
This means that they need skills in evaluating the performance of
information systems. It means that
technology managers must have an ability to retrieve and analyze data to examine
patterns across clinical visits and to see if the information system is
responsible for improvements.
Managers need to check that the promise of technology is realized.
This course should provide the managers with skills for using the data in
electronic health records to analyze process improvement but we will not get a
chance to cover this topic.
Many health administration programs teach courses in management of information
systems, they focus on history of IT, types of IT, problems with IT and so on.
Most of these courses do not cover the tools of the trade.
Our course is different. It
is all about how to do things. The
focus is on analytical skills and not merely general advice.
Students are expected to learn skills and not just knowledge.
This course helps the student become a proficient financial analyst,
competent project manager, an effective database manager, and an insightful
security analyst -- all in the context of electronic health records.
These analytical skills are taught in sufficient depth so that they can
be carried out by the students.
Students are expected to gain confidence about what they can do on their own,
without hiring consultants.
It is frustrating to see students taught ideas but not the analytical skills to
carry out the work themselves. It
seems like a curse to know something but not in sufficient detail to carry the
tasks out -- remaining always in need of others to do the work for you.
In these situations, one remains a permanent customer of consultants.
There was a day and an age when managers supervised others to do the
analytical work. But those days
have passed and managers, especially new starting managers, are repeatedly asked
to analyze return on investment, plan complicated multi-task projects, or
analyze data within the electronic health records.
This course gives students a set of skills and tools that could help
their careers.
Some senior managers may point out that they tell others to do the work.
They may claim that they do not need to be proficient in project
management or database management in order to carry out their duties.
They can manage people who do the work.
These senior managers are correct that managers do not need to become
analyst in order to succeed. They
are right to delegate the activities to others -- as their role requires them to
do so. But they are wrong that they
do not need to know how the work is done.
Without insights into the process, these managers cannot imagine what can
be done, they cannot see through defensive budgets and conservative time
projections for completion of the task.
They cannot understand the risks they face.
Senior managers do not need to become analysts but they need to
understand what it takes to complete the work.
This course helps them understand the tasks that they may delegate to
others.
This course is built on the principle of “learn one, do on, and teach one.”
Like medical interns, the student is introduced to a concept, then asked
to actually do the proposed steps, and finally to teach the ideas to others
through effective presentation of the material.
To help students do what they have learned we rely on a number of
software tools. The financial
analysis relies on Microsoft Excel software.
The project planning relies on Microsoft Project software and the data
analysis component relies on Microsoft Access database.
While we rely on Microsoft software to demonstrate analytical procedures,
we also recognize that there are other software in the field and provide videos
of MAC-based software tools that could replace Microsoft tools.
In the end, the software is a means to an end.
It helps the student practice what is taught.
We show videos and pictures of the software tool and help the students to
take the steps necessary to complete the analytical procedures.
This course is organized in three broad areas:
planning for, implementing, and using electronic health records.
You might have heard of the Plan, Do, Check and Act (PDCA) cycle.
One could imagine the sequence of course as a grand multi-year
multi-course PDCA, where an electronic health record is planned, implemented
(the Do section) and checked to see if it has produced the desired effects.
The first section of the course is on planning for electronic health records.
This includes chapters on the components of electronic health records,
establishing the business case for the electronic health record, and selecting
vendors. The chapter on components
of electronic health record shows the VISTA electronic health record developed
by the United States Veterans Administration.
Students will examine the content of an actual medical record and
familiarize themselves with the process of template design, data entry and data
retrieval. The section on financial
analysis covers basic tools of financial analysis like calculating present value
of future returns or calculating return on investments.
The section titled “Assessing information needs” discusses how to
distinguish what people want from what they need.
It helps the analyst to focus on upcoming decision and evaluate the need
for information in the context of upcoming decision.
The last section in the planning part of the course is titled
“Participatory vendor selection” and shows how to engage a large number of
clinicians in selection of specific systems so that they are excited and engaged
in upcoming change to an electronic health record. It helps the students forge a
consensus among clinicians with differing views and priorities.
The third part of this course is on retrieving data from electronic health
records and preparing the data for analysis.
We will not get a chance to cover the topics in this section.
This section starts with “Evaluation of Impact of Electronic Health
Records.” This lecture shows how to
audit if planned clinical improvements have actually occurred.
Has there been a reduction in cost of delivery of care?
Has there been a reduction in adverse sentinel events such as medication
errors? The next two lectures are
on retrieval of data from and analysis of data in electronic health records.
Data in electronic health records are distributed in a large number of
tables. One table may describe the
patient another table may describe the provider and yet a third table may
describe the encounter between the patient and the provider.
To analyze this data, Standard Query Language must be used to search
across tables and pull together information from various locations.
Another lecture in part three of the course is on matching patients
across databases – a problem that occurs often as health care providers have
multiple systems that do not typically talk to each other.
This lecture shows how to merge data across electronic health records or
merge data from legacy systems into modern electronic health records.
The last lecture in the third part of the course focuses on security of
electronic health records, which has mistakenly been identified with a series of
technical interventions (e.g. encryption, password protection) as opposed to the
more common problem of improper use of the system.
The lecture shows how to detect problems in use of the system and where
to focus limited training funds.
The following shows the three parts of the course and lectures within each part:
Part I: Planning for Electronic
Health Records
·
Component of electronic health records
·
Introduction to financial analysis of return on investment
·
Business case for electronic health records
·
Assessing information needs · Participatory vendor selection Part II: Implementation of Electronic Health Records
·
Introduction to project management
·
Project initiation and planning
·
Project execution, control and closure · Project risk management tools Part III: Using Electronic Health Records (not all topics are covered)
·
Evaluation of impact of electronic health records
·
Database management
a.
Evolution of databases
b.
Design of databases in Tables and Primary Keys
c.
Data modeling and Entity Relationship diagrams
d.
Normalization of databases
·
Analyzing databases
a.
Measuring severity of illness through database commands
b.
Benchmarking performance of clinicians
c.
Preparing clinical reminders and decision aids
d.
Data mining and personalized care
·
Matching patients across databases: Master list of patient IDs
·
Security of electronic health records
PresentationsFor an overview of competencies needed for management of health information systems, see some of these resources: Slides► You Tube► Narrated slides and videos require Flash. Download► This page is part of the course on Information Systems. This page was edited by Farrokh Alemi, Ph.D. ©Copyright protected. |
