Chapter 12

1. Chapter 12 Integrated Information Systems for Chronic Care: A Model Linking Acute and Long Term Care

2. Integrated Information System • Multiple information sets linked together in an organized way • information sets • groups of similar items often collected together • e.g., participant characteristics, health and functional assessments, service use, service billing info • information sets can be collected at different points in time by different members of the service agency

3. Integrated Information System • Information system links or connects information collected by different units in the agency and makes it available to everyone who needs it • Organized means there is a well-defined plan for collecting and linking information sets to meet multiple information needs In the most efficient and effective manner

4. Integrated Information System • IIS Advantages • more efficient • eliminates need for duplicate data collection since one entry serves all • makes more information available to all users • improves service quality; increases efficiency • links information across services • provides a comprehensive picture of the participants • a description of health needs and conditions; services they receive; cost of care; outcomes of treatment • links summary information across IHDS

5. Integrated Information System • Primary Components: • Information • Computer Hardware • Computer Software • Communications • Peripherals

6. Information • Groups of similar information items collected together. • Important to analyze work process and information being used prior to implementing the integrated system. • Determine how information is shared: cross-departmentally or cross-organizationally.

7. Computer Hardware • Processing power quadruples every 2 1/2 years (Moore’s Law) making it less expensive and more feasible for organizations to process vast amounts of information. • Inexpensive automation replacing human labor. • Client servers manage the information network.

8. Computer Software • Operating systems • Applications • Operating system and applications must be compatible. • “Make”- you develop and build your software in-house. • “Buy”- you contract with a vendor to develop the software. Better approach.

9. Communications • Communication devices allow sharing of information between two or more parties. • The linking of computers allows asynchronous communication (e.g. e-mail) so different data sets can be added at different times and places by different people.

10. Networks • Allow organizations/departments to share information. It is the linking of one or more computers through network cabling. • Types of Computer Networks: - LAN/WAN - Internet/ Intranet/ Extranet

11. Peripherals • All the other items necessary to process, store, convert, and transmit information (e.g printers, scanners). • Organizations must consider compatibility and costs when purchasing peripherals.

12. Hospital Information Systems • Accounting System, DRG Billing System • Specialized Systems • Focus on short term acute care rather than chronic care so the hospital system would not be useful as a model for chronic care information systems.

13. HMO Information Systems • Integrated HMO systems maintain membership information, scheduling, accounting, cost tracking • Designed for managing traditional health services for a generally healthy population • Would be applicable to chronic care but many HMOs are not organized to manage the ongoing information needs of chronic care

14. Long Term Care Information Systems • Mostly focuses on billing and external reporting. • Few are integrated into useful systems so could not be applied to chronic care information systems.

15. Chronic Care InformationSystems • Currently no system fully meets the needs of chronic care management. • Requires a system that can process large volumes of information because of the long length of care and the various types of information .

16. Chronic Care IS ModelPatient/Client Information • Identification and description • Assessment information • Treatment Plan • Service Use

17. Chronic Care IS ModelPatient/Client Information • Identification and description • Master Participant Record would include: • identifying information • demographic information • program status information • Data collection frequency • recorded at time of enrollment • information relatively stable; updated as changes occur

18. Chronic Care IS ModelPatient/Client Information • Assessment information • Participant Assessment Record would include: • health status information • functional status information • cognitive status information • environmental information • informal support information • Data collection frequency • information changes over time • needs to be assessed at regular intervals

19. Chronic Care IS ModelPatient/Client Information • Service/Treatment Plan • Service/Treatment Plan Record would include: • service goal information • service orders • Data collection frequency: • information changes constantly as client needs change • initial plan development at time of assessment and stored with assessment record

20. Chronic Care IS ModelPatient/Client Information • Service Use • Participant’s Service Record would include: • delivered services information • IHDS service information • Data collection frequency: • ongoing basis • summarized and reported for specified time periods

21. Chronic Care IS ModelFiscal Information • Service Revenues • billing various insurance companies for multiple types of services with multiple forms of payment • Service costs • expenses

22. Chronic Care IS ModelFiscal Information • Service Revenue • Service Revenue Record would include: • service charge information • reimbursement information • Data collection frequency: • ongoing basis • total service charge information by participants on a monthly basis • revenue reported by funding source

23. Chronic Care IS ModelFiscal Information • Service costs • Program Cost Record would include: • personnel cost information • materials and supplies information • facility cost information • Data collection frequency: • reported on a regular basis

24. Non-automated Integration • Manual integration of client level data. • identification, assessment, service use, cost information • problem with the logistics of information placement • Integrating summary data. • Manual counts from existing participant records to prepare summary data sets reports for each information set • does not allow participant specific comparisons

25. Automated Information Integration • Periodic Data Sharing • Simplest form is periodic sharing of data files among participating agencies • Stand-alone System • Integrated information system developed for the integrated health care delivery system • Integrated Data System • Build integrated delivery information into the existing information system

26. Benefits of Integrated Information Systems • Reduction in time required for recording information • Service planning is enhanced • Allows for automated scheduling • Facilitates long-term study of care outcomes • Reduce duplication of effort/information • Monitor quality

27. Barriers to Integrated Information Systems • Lack of management commitment to integration • Lack of shared corporate directive • Unwillingness to change • Lack of available resources • Belief that technology is a barrier • Confidentiality concerns • Interagency cooperation