Health Informatics

1. From your personal experiences with healthcare workflows as a professional (if possible, else as a patient) and from the lessons you have been learning from this course, do you see the adoption of information technology as having been a smooth and graceful experience or a turbulent and sometimes painful one? Dig more deeply into your experiences and point to what you believe were the most critical contributors to the success or the causes of problems with the adoption. Be specific and support your position with references.

Adoption of Health information technology (HIT) in healthcare facilities is experiencing more turbulence than a smooth flow. Some of the challenges that the industry is facing in the adoption of HIT includes costs (for systems purchase and implementation), technical issues, confidentiality and privacy concerns, interoperability of the system and lack of clinical informatics workforce that has been trained well. One problem I have experienced when working in the health care system involves the challenges experienced by clinical staff and physicians.

HIT implementation is an arduous undertaking for both smaller practices and large organizations. According to experience, HIT adoption requires more finances and acceptance by the healthcare workers. Adoption of HIT means that physicians and clinicians have to be on computer screens to fill in information or to check particular patient information. I believe that individuals resisted the change because of the few complications that were brought by the technology. For instance, some clinicians could complain of stiffness or pain in legs or arms or back pain. Due to such complications, those individuals preferred the traditional ways of using paper work.

According to Agno and Guo (2013), the two major challenges that face HIT adoption are clinical and administrative influences. Administrative influences include ensuring systems such as electronic health records (EHRs) meet accreditation, legal and regulatory standards. HIT systems are also supposed to establish efficiency in infrastructure and contain or reduce health care costs. The focus of clinical influences is to increase patient’s quality care, increase access to patient records and clinical data, reduce errors and satisfy both patients and employees. Since there are many challenges associated with the adoption, most physicians resist the change because they argue that they would be able to maintain quality care without the technology. The attitudes of physicians need to be attended to so that they embrace the changes, and start contributing to make the adoption succeed.

2. Based on your reflective analysis in question 1, which do you believe is a larger problem, lack of enough information or information overload? What evidence do you have to support your position?

Most of the challenges that health care systems face originate from lack of adequate information. Apart from finance problems experienced in the initial purchase and implementation of HIT, all the other challenges are caused by lacking information in one way or another. Adopting HIT would better the information systems, and quality of health care delivery would be improved. Health care providers experience technical challenges in HIT adoption because the information on how to implement and operate the new technological systems is inadequate. For instance, most health care organizations purchase and install electronic health record systems before they train their workforce on how to work with the systems. The untrained individuals operate the systems without the knowledge to do so and cause the systems to technically breakdown.

In addition, HIT systems face resistance from patients because of privacy and confidentiality issues. This resistance results from lack of enough information. Patients should be educated on the legislations that have been put in place to ensure that their private information is secure. HIT systems are designed in such a manner that their usage only allows the appropriate individuals to access the most critical patient information. The national Institute of Standards and Technology (NIST) is a federal agency that ensures that there are guidelines for securing information. Apart from NIST, there are other legislations that provide guidance on how patient information needs to be protected. The legislations include the Health Information Technology for Economic and Clinical Health (HITECH) Act and the Health Insurance Portability and Accountability Act (HIPAA) (Harman, Flite and Bond, 2012). Patients should understand that if privacy regulations are violated, the organizations and clinicians face civil and criminal penalties.

3. Attack or defend the following assertion: “While it is true that a very small fraction of the population accounts for a significantly large fraction of total costs (e.g. “hot spots”), many of the root causes for these conditions have taken years if not decades to develop and to eliminate these hot spots will require significant life style changes, some with strong cultural reinforcements, long before the symptoms appear.” Support your position with solid evidence.

I would defend this assertion and make the argument that it is true for small fractions of populations cause large losses in terms of costs. If for instance, a health care organization supports a certain small population, it is expected that the quality of care that they get is high. However, if new information technology systems are introduced in the organization, there are high chances that a dislike by certain people would cause high losses (Jamoom et al, 2014). Also, if a person warns patients that the new system will not protect patient information, they might fear providing the correct information that is necessary for quality care. Since the population is small, the rumor is likely to spread very fast within the whole population and might make the organization undergo cost losses for the installations.

In order to eliminate such “hot spots” the organization would have to design strategies on how to convince the small population that the adoption of new information technology will help to improve the quality of health care delivered to them. If they turn away from the health care system, the population will have to adopt certain lifestyle changes that will keep them away from health conditions. Lifestyle changes require individuals to undergo strong cultural reinforcements. The communities would be encouraged to embrace cultures that protect them and keep them safe from disease.

4. You have been brought in to help a regional hospital implement a major informatics upgrade that promises to significantly improve efficiency and patient outcomes. Leadership is nervous due to concerns that many of the “older” professionals will resist these changes. What strategy would you employ to maximize the probability of success with this new adoption effort? Explain the underlying rationale and support your position with evidence.

Resistance from ‘old professionals’ and other individuals on the adoption and implementation of HIT in the health care facilities originate from lack of adequate information. The most important thing I would do to maximize the probability of success would be to ensure that every member in the organization has adequate information on the importance of the new technology and on how to operate it (Schwamm, 2014). In relation to this, I would advocate for policies that see training programs created and implemented before the new technological systems are installed in the organization. The training programs will enlighten the ‘old professionals’ on the benefits they would get by using electronic health record systems, electronic medical records and other HIT systems. The training programs will also provide the professionals with skills that will enable them make their work easy using HIT. All professionals will contribute to the adoption of the HIT systems when they understand that they would be the ones to greatly benefit from them.

The other strategy would be to create super-users or a collaborative implementation team of the new HIT systems. The team would consist billing, HIM, coding, IT and other professionals who would be in charge of leading the implementation and providing a safe transition from the previous systems (Agno and Guo, 2013). Health information technology systems are used across departments. It is for this reason that the team should include individuals from all departments within the organization. Such a team would maximize the probability of successful implementation because it would be in charge of a smooth transition before, during and after the systems are adopted. Creation of a team would make the task successful if they understand the roles of each other and are able to discuss issues together. The additional strategy here would be to introduce review sessions, back-up meetings for super-users, biweekly newsletters and ongoing training for transferred or new employees.

References

Agno, C. & Guo, K. (2013). Electronic Health Systems. The Health Care Manager, 32(3), 246-252. http://dx.doi.org/10.1097/hcm.0b013e31829d76a4

Harman, L., Flite, C., & Bond, K. (2012). Electronic Health Records: Privacy, Confidentiality, and Security. Virtual Mentor, 14(9), 712-719. http://dx.doi.org/10.1001/virtualmentor.2012.14.9.stas1-1209

Jamoom, E., Patel, V., Furukawa, M., & King, J. (2014). EHR adopters vs. non-adopters: Impacts of, barriers to, and federal initiatives for EHR adoption. Healthcare, 2(1), 33-39. http://dx.doi.org/10.1016/j.hjdsi.2013.12.004

Schwamm, L. (2014). Telehealth: Seven Strategies to Successfully Implement Disruptive Technology and Transform Health Care. Health Affairs, 33(2), 200-206. http://dx.doi.org/10.1377/hlthaff.2013.1021