Q# 2.  True or False.  Implementation managers provide on-site management of mobile adoption support teams for the period of time before and during implementation of health IT systems in clinical settings. 

Answer-True (eHIST p. 104)

Initiating phase

planning phase

executing phase

monitoring & controlling phase

closing phase

1.  kick-off & project planning

2.  system selection

3.  contract negotiation

4.  design

5.  development

6.  testing

7.  training

8.  deployment

9.  evaluation

HIS - core

systems & management

health informatics

data & analytics

research, policy, & public health; global HIS & technology

layer of the HIS model that includes activities directed toward managing data & harvesting the value from the secondary use of data created & captured in HIS as a by-product of patient care & business processes.

Includes analysis of data stored in databases & data warehouses & made available thru analytics platforms

bioinformatics

imaging informatics

clinical informatics

public health informatics

1.  right information

2.  right person

3.  right format

4.  right medium or channel

5.  right place

Information technology infrastructure library

transition

design

operation

Change management

configuration management system

service training & validation

release & deployment management

knowledge management

incident management

problem management

event management

supplier management

service level management

availability management

service catalog management

IT service support

IT service delivery

10% - contract signing

10% - hardware & software installation

10% - project plan development, IT staff training

15% system design & build

10% - interface development & system testing

20% - activation/go-live

25% - final integrated system test

technology (hardware & software)

process

organizaton

external environment

people

                Multiple choice: Which of the following is NOT one of the Six Aims of Crossing the Quality Chasm:

1. Safe
2. Timely
3. Patient Centered
4. Strategic Planning

Answer: D, Strategic Planning (eHIST pg. 153)

The phrase used by NIH to encompass informatics in health medical science

biomedical informatics (eHIST pg. 164)

each data element actually representing what its definition says it is

Validity

founded in patient-provider interactions & the ancillary clinical & administrative activities to support them

Process

A key indicator of the effectiveness of an HIS program

the amount of unplanned work needed to mitigate major system “crashes” or other adverse events that cause systems to become unstable, unresponsive, or unavailable compared to the amount of planned work.

a businessinvestment decision-making & oversight process by which healthcare organizations effictively evaluate, select, priortize, & fund their HIS investment, including overseeing their implementations & tangibly measuring the organizational benefits achieved.

What IT should be working on

The IT service delivery process areas in the context of HIS services include

Service desk

incident management

problem management

change management

release management

configuration management

the process by which recurring incidents are analyzed to determine their root causes & provide permanent solutions for the problem at hand.

root cause analyses are performed and documented after HIS application outages or other unplanned server downtimes

nine stages in the implementation process

Kick off & planning

requirements definition & system selection

negotiate agreement

design

develop/build

test

go-live/activate

evaluate

The physician who fills the physician leadership role and becomes a member of the HIS department

The physician who fills the physician leadership role and becomes a member of the HIS department

innovators

early adopters

early majority

late majority

laggards

Primary uses of an Electronic Health Record System

supports delivery & management of patient care

supports administrative activities & transactions

connects patients, providers, & data

the second core process area that is important for the proper implementation and support of HIS applications

IT service delivery

Q#3 Public health informatics includes information capabilities that:

1. identify & understand health trends, health statuys, & the incidence of illnesses across populations or segments of population locally, regionally, nationally, & globally
2. monitor & survey disease & conditions across a broad geographic & population scope
3. detect, prevent, intervene, & monitor in the event of an outbreak of a disease, a natural disaster, or bioterrorism
4. promote health & prevention
5. provide for preparedness through means such as biosurveillance, illness, notification, & education

the catchy layman’s slogan for activation of a new HIS application or system

“Go-live!”

fully engate physicians & nurses

the CEO.  It is unrealistic for the CIO to support all functions in an organization in a balanced fashion working within one of those functions, just as it is infeasible for other functions or disciplines to have adequate input into the HIS agenda if the CIO reports to only one of those departments or functions.

biomedical informatics

Data plus meaning

The science and art of biomedical informatics includes

making sure the HER presents the right data content in the right layout, format, and timing to best support clinician workflow.

a hacking malware that appears to perform a desirable function yet, after it gains access to system, causes system harm or steals unauthorized data.  Often appears as an email attachment.

PM Stage & Knowledge Area Overview

Projects Aspects

communication

time

scope

risk

procurement

human resources

integration

quality

cost

PM Stage & Knowledge Area Overview

Project Life Cycle

initiating

planning

executing

controlling

closing

Managing financial risk

risk domains

identification

quantification

risk response

monitoring

managing financial risk

identification

managing financial risk

quantification

managing financial risk

risk response

managing financial risk

monitoring

a professional who brings departmental or functional expertise to bear in the project planning and implementation processes.

Six Aims of Crossing the Quality Chasm care states

safe

effecive

patient centered

timely

efficient

equitable

the act of extracting information from a data set for use in data analytics

IT service support

. A comprehensive EHR system, includes the basic functionality plus how many other clinical functions?

A. 8

B. 14

C. 9

D. 12

Answer:  B - 14.  eHIST, pg 112

1. begins with the foundational infrastructure
2. thorough analysis & documentation of the current state of how all key processes are performed before designing any new workflow to be built into a new system
3. development of the master patient index

1. implementing the basic elements of the EHR
2. helping stakeholders see the migration path

1. more advanced initiatives, typically involving
1.  quality management,
2. outcomes analysis and reporting,
3. business intelligence,
4. clinical intelligence,
5. CPOE

the carefully planned move from a current way of doing work to new ways; it requires involvement of the involved disciplines in the planning of these new methods, followed by the systematic introduction of these methods supported by HIS and technology

group represents more than 2000 nurses and brings together 18 independent nursing informatic groups?

Answer: D - ANI, the Alliance for Nursing Informatics;  eHIST pg 149

The term "health informatics" can NOT be used interchangeably with the term "health information technology".

True or False

Answer:  False, eHIST pg 166

IT demand governance

IT supply-side goverance

information technology infrastructure library

control objectives for information and related technology

international organization for standardization

the international electrotechnical commission

it service support

it service delivery

• there are it issues to solve
• staff training is needed
• it requests must be managed

• service desk
• incident management
• problem management
• change management
• release management
• configuration management

• service level management
• availability management
• capacity management
• financial management
• service continuity management

**itg frameworks

ISO/IEC 38500

ISO/IEC 27001

COBIT

• increasing medicare rate cuts
• pricing pressures from commercial payers
• "bad debt" based on higher co-payments & affordability challenges
• healthcare reform changes
• ehr implementations & ongoing support
• shortage of health IT talent
• ration of unplanned work to planned work

1. budgeting & planninng
2. purchasing options (capitalized & depreciated assets)
3. operating expenses, basic accounting principles, & standards
4. financial models & methods
5. compliance regulations

**managing budget risk

1. plan budgets using best estimates carefully at outset of project
2. include contingency funds in project budget
3. collaborate with other department in annual budget process
4. manage budgets closely
5. understand the significant components of the budget

• formally submit a project request
• analyze their business requirements
• conduct a 3-layer HIS vendor evaluation search
• select the winning candidate & successfully negotiate a contract

• submit project
• define requirements
• conduct structured evaluation
• negotiate the agreement

**structured vendor selection flow

submit project

• follow consistent process for all new HIS project requests
• HIS planners create initial project/business plan
• involve all necessary parties
• create project charter
• establish project team & steering committee

**structured vendor selection flow

define requirements

• include system scope & feature & functions
• include integration & technical requirements
• include reporting/analytical requirements
• issue RFI/RFP to appropriate vendors
• include contracting guidelines in RFP

**structured vendor selection flow

conduct structured evaluation

• usability:  features & functions, workflows, test scenarios
• technology:  technical architecture & specifications
• business relationship & contract:  company characteristics, business relationship, trust, adherence to contract guidelines

**structured vendor selection flow

negotiate agreement

• narrow vendors to 2 finalists
• cio & legal counsel collaborate
• follow contracting guidelines
• update project business plan w/actual plan
• seek funhding, including both capital costs & ongoing operating expenses
• select vendor after negotiation of key points so terms & conditions are known

technical components

technical architecture

technology standards

1. does the product have the generally available features & functions
2. what are the development pipeline & timeline dates
3. does the product perform the tasks required by the end users
4. does it integrate well into the existing workflow & improve it
5. are the modules or applications integrated or interfaced
6. is the end-user interface easy to understand
7. is training easily accomplished
8. does the product support an efficient workflow for the users
9. will the workflow need to change with the product's implementation
10. does it permit efficiencies & savings in time/money or both
11. can the system support specialty departments, such as cardiology, nuclear medicine, dietary, & oncology

• standardized processes & procedures
• expenditure visibility
• improved compliance management
• enhanced spending & performance analysis
• reduced uncontrolled spending
• evergreen contract elimination

• contract milestones
• ownership of data
• change of control
• maintenance costs
• terms & conditions

1. initiating phase
2. planning phase
3. executing phase
4. monitoring & controlling phase
5. closing phase

1. project scope management
2. project time management
3. project cost management
4. project human resource management
5. project procurement management

• project risk management
• project quality management - scope, time, & cost impact quality management
• project integration management
• project communication management
• project stakeholder management

project scope

time

cost

• managing project personnel to meet project goals
• delivering project objectives within budget & on schedule
• controlling project resources to meeto the project objectives
• managing project scope, schedule, & cost
• reporting on project progress
• resolving project-related issues, conflict, & risks

• select a unique name for the committee
• develop a committee charter
• broaden the scope of the committee
• create optimal decision-making process
• choose someone other than the CIO as the chair
• keep the steering committee small & meet on a monthly basis

• basic ehr system:  uses ehr functionality on at least 1 clinical unit & includes basic clinical functionality
• comprehensive EHR systems:  includes basic functionality plus 14 other clinical functionalities & is used throughout entire hospital

• implementation planning
• system design
• application programming
• system development
• testing
• roll-out or deployment
• evaluation

1. kick-off & project planning:  create project planning team & task forces
2. system selection:  using disciplined methodology
3. contract negotiation:  negotiate agreement for all necessary system components
4. design:  perform system design in concert with process redesign efforts, icluding interfaces
5. development:  program/"build" the system
6. Testing:  perform for each module & application
7. training:  all IT staff & project participants/users
8. deployment:  prepare system site, go-live, roll-out system into production environment for users
9. evaluation:  test & validate systems once live, create feedback loop

• network infrastructure
• document current state of systems & processes
• design approach to master patient index

• development begins where you are
• do not begin until you know the whole plan
• break strategic initiatives into recognizable projects to organize
• do not underestimate importance of training
• carefully document the "current state"
• software systems "out of the box" include thousands of raw capabilities, which must be painstakingly shaped to meet needs of the organization
• a new system should be implemented in a basic way first, with more advanced functionality added only after some experience with the basics
• at every turn, take the opportunity to standardize the computing & data enviroment
• initiate each HIS project through the organization's formal governance processes

• Usability
• technology
• business relationship

• develop & commujnicate approved business plan for the project
• establish selection committee
• define system requirements
• develop selection criteria
• identify potential vendors
• develop request for information & send to potential vendors
• develop RFP & send to field of vendors narrowed through RFI
• evaluate RFP responses, narrow vendors, hold scripted demos, conduct site visits
• conduct detailed due diligence of finalists
• negotiate agreement
• once vendor chosen, finalize project business plan & budget (5-year cost spreadsheet)
• launch project once contract signed

• link vendor payemnts to key milestones, not dates
• negotiate expectations for system support & maintenance, including escalation processes
• include all releases/updates as part of software license
• include all applications offered by vendor in a site or enterprise license
• include promises ade during sales cycle in writing in the contract

• 1st layer, foundation sphere in HIS model
• consists of core healthcare transaction systems
• other layers require these well-managed, comprehensive systems in place for informatics, data & analytics, & research, policy, public health layers to gain foothold & data sources needed for their conduct.

• dynamic discipline that includes clinical & business domains & expertise
• interaction between knowledge workers & computers
• development of new automated workflows
• improvement in processes & outcomes through use of computers & information
• includes IT professionals teamig with informaticists to create advances in linkage between computers, people, & processes

• analyzes & harvests value via secondary use of data created & captured in systems
• analysis of data stored in data warehouses
• available through analytics platforms
• business intelligence/clinical intelligence terms encompass many varied secondary uses of data
• within healthcare, research, policy, public health
• measuring & evaluate quality, cost, performance improvement, & public's health

• government organizations, universities, global organizations
• WHO
• commonwealth fund
• institute for health care improvement
• institute of medicine
• organization & individuals devoted to development of actionable knowledge, methods, & insights regarding healthcare quality, cost, population health.

• primary HIS & IT leadership role
• can be called director of information technology, IT lead, HIS manager
• requirements similar, scaled to size & type of organization
• broad range of responsibilities
• HIS management & governance
• strategic & tactical HIS planning
• assuring value from HIS investments
• providing HIS support services
• collaborating w/stakeholders

• leadership role to fully engage physicians, other clinical it stakeholders
• supports design, implementation, & use of HIS within a healthcare organization
• physician w/affinity/training in informatics
• part of HIS organization
• often continue to practice medicine part-time
• key player in presentation of new ideas & HIS initiatives to other clinicians

• leads collaboration among nurses for HIS implementations
• essential to EHR design & implementation for nursing & patient care workflows
• nursing drives many important aspects of EHR
• documentation methods
• nurses must support EHR implementation or it will never extend beyond "basic" functionality
• nursing informatics graduate degrees

• along with the CIO, have a key connection in leading organization & resources
• working partnership key to HIS success
• most important role:  actively participate in HIS planning & place HIS on executive management agenda
• embracing HIS directly related to future of organization

• clinical & medical staff departments necessary to deliver healthcare processes
• must reach large majority of medical staff
• medical staff leadership plays key role
• avoid only working through medical staff leadership for HIS implementations
• EHR project team should reach total medical staff
• chooses to use EHR

• play key role in design & implementation of HIS
• definition of quality metrics
• definition of data elements to populate those measures
• build these data elements into clinical workflow
• ensure quality & performance measures woven into fabric of workflows & systems

accurate, timely, available information

improved access to information

empowered & engaged patients

strategic alignment

architectural excellence

realization of intended benefits

HIS services delivery

American reinvestment & recovery act

2009

included major incentives totaling about $25 billion for EHR implementations in HITECH

innovators (2.5%)

early adoptors (13.5%)

Early majority (34%)

late majority (34%)

laggards (16%)

• if errors occur, how does one determine cause of errors?
• study reported of total errors studied, 56% computer system related, 44% attributable to human error
• workflows that use both paper-based & electronic records particularly problematic

**HIS leadership takes several forms

• organizational
• government/presidential
• professional organizations

• reshapes how we work in health care using HIS & technology
• harvests insights, encourages knowledge to improve:
• health outcomes
• organizational effectiveness
• health status of populations

clinical informatics

public health information

primary - for patient care

secondary - for analytics, research, population health management, external reporting

1. informatics for designing & improving clinical workflows & processes (primary)
2. informatics for improving efficiency of administrative transactions (primary)
3. informatics for outcomes analysis, data mining, algorithm development, & clinical intelligence (secondary)
4. informatics for business intelligence & analytics (secondary uses of administrative data)

• clinical- transaction/functional support systems
• clinical workflow & process design
• clinical decision support systems
• data definition/standardization
• patient engatement
• mHealth
• clinical data exchange

• administrative - transaction/functional support systems
• operational workflow & process design
• service & process improvement

• clinical - management/decision support systems (BI/CI)
• data analytics & mining
• algorithm development
• quality analysis & reporting
• outcomes analysis
• clinical intelligence

• administrative - management/decision support systems (BI/CI)
• business intelligence, analytics
• data mining, reporting, & analytics

• evaluates how information presented right time, right format can improve decision abilities
• more information not necessarily better
• more complex alternatives often push decision maker to prefer status quo option, paradoxically
• dynamic tension between policy or group-level considerations & decision making of physician treating an individual

1. right information
2. to the right person
3. in the right format
4. through right channel or medium
5. at the right place

• develop adequate data defionitions
• train end users of systems of importance of careful attention to data quality
• establish data ownership roles
• establish groups to analyze data accuracy

• clinicians & IT staff collaborate in design & implementation of EHR clinical decision support capabilities
• supports work of physicians, nurses, laboratory & other clinical professionals, therapists
• algorithms programmed into ehr system to drive clinical rules & alerts of patient risk factors
• draws attention to need for complete, accurate data in ehr

• clinical decision support part of the nurses information needs
• nursing involves "whole" person, & continuous monitoring of patient's care, plus social & emotional elements
• signficant role of nursing in communication & documentation
• requires in-depth, inclusive, integrated view of aptient, thus is challenging

• identify health trends, health status, incidence of illnesses across populations or groups
• monitor & survey disease across broad geographic & population scopes
• detect, prevent, & monitor disease, natural disaster, & bioterrorism
• promote health & prevention
• conduct biosurveillance, illness notification, education
• public & private sectors beginning to share data

• incomplete data in ehrs
• persistent "slices" of information
• data codified first for billing, then for patient care, public health, or research uses
• difficulties capturing data contained within narrative documentation & free-form notes
• lack of granularity in EHR data for public health & research
• data needs vary in patient care vs. public health

• good data
• information
• a culture devoted to process & quality improvement

• analytics
• data mining
• business/clinical intelligence