1. Running head: EVOLUTION OF HEALTH CARE INFORMATION SYSTEMS 1
Evolution of Health Care Information Systems
Debbie Fernando
HCS/533
April 29, 2013
Jacqueline Sommerville

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Evolution of Health Care Information Systems
This paper will discuss the evolution of health care information systems and how they
affect the day to day operations in hospitals today compared to years ago. It will discuss the
effect it has on patient care and reimbursement. It will compare the collection of data today,
using technology, and how data was collected years ago.
Past Health Care Information Systems
Health Care Information Systems have been a part of health care since patient care
became a business. Twenty years ago, the majority of charting and documentation was all hand
written. From the physician writing the admitting orders to the nurse charting the care given and
the patient’s condition, ink was the method of choice. At one time, the ink used was a different
color depending on the time of day. The 7-3 shift used black ink. The 3-11 shifts used green ink,
and the 11-7 shifts used red ink. At the time, this seemed to be a fast way to determine an
approximate time as to what was happening with the patient. A care giver could just look at the
color and know if an event occurred during the day, evening, or night. Eventually, the only color
ink allowed was black or maybe blue. It turned out that green and red ink did not show up well
when a document was copied on a copy machine. In a way, the copy machine was the beginning
of a whole new era in health care information systems.
Past Health Care Information Systems
In the past, when a patient came into the hospital, the physician would locate in a filing
cabinet the document labeled “physician orders”. He would then take this sheet, which was in
usually in triplicate, and handwrite orders for the patient. The very first order was usually the
diagnosis. He might write something like “Admit pt (patient) to 5413 – Dx (diagnosis) of CHF
(congestive heart failure). The importance of the diagnosis was apparent. This is the main way

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the person doing the coding could find the diagnosis. The rest of the physician orders would
follow which he would hand write. Included would be the type of diet the patient could have, any
medications, IV (intravenous) fluids, activity, lab work, etc… He would then “flag” the chart so
the nurse would know there were new orders. The nurse would then read the orders, sign them
off, (to let others know she had read and implemented them) and tear off the remaining 2 parts of
the triplicate and send them to their destination, whether it is pharmacy, lab, or wherever it
should be sent. The physician did this for every patient that was admitted. Today, the physician
sits at the computer and prints out a copy of his orders for a particular disease. These are orders
that he and his partners had previously agreed upon for this particular diagnosis. Barring any
would be complications, all patients with the same diagnosis would receive the same orders.
There are usually only slight variations. This saves time for all heath care providers. The
physician doesn’t have to hand write everything; and the nurse already knows (with minimal
possibility of change) whether to get her supplies to start and IV, or what diet to order for the
patient. When the pharmacy receives its copy of the orders, the staff doesn’t have to decipher any
illegible handwriting or check drug dosages. They will, however, still have to check for patient
allergies.
Data Use
According to “American Hospital Association” (2013), “Adding new technology can reduce
health care costs by minimizing complications, reducing duplicative tests and improving
outcomes” (Adopting technological innovation in hospitals). The community as a whole benefits
by disease surveillance and health care information exchange. If there is a communicable disease
outbreak, it can be monitoring and contained much faster with the proper technology. The data
collected today is gathered and shared so quickly, it is an asset to health care. A patient can be

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seen by his physician, get lab work completed, x-rays completed, and the results can be sent to a
specialist, if needed. His information can already be in the hands of the specialist before his
appointment. The data gathered in regards to the population can watch patterns emerge whether
good or bad, and the people can be better informed. In the past, the patient would not have his
results ready before his appointment with the specialist. Also, in the past, the gathering of
population data would probably take too long to be of any help to the majority of people.
Two major technological advantages that influenced HCIS
One major technological advantage that influenced HCIS is Health Information
Exchanges (HIEs). HIEs are entities that bring together health care stakeholders within a defined
geographic area and govern the electronic sharing of health information among them for the
purpose of improving health care in that community. The main reason for creating HIEs is that
the ability to exchange health care information electronically plays a large part in the efforts to
improve health care delivery in the nation (“American Medical Association”, 2013). The speed
and accuracy in which HIEs allow the necessary information to be gathered and exchanged make
a considerable difference in the health of the communities. In the past, there could be an outbreak
of a disease in several neighboring counties. With the patients going to different hospitals, it
could take days for someone to realize that many counties were involved in having patients
present with the same symptoms. For example, a new famous restaurant opens and people from
miles away come for dinner. One employee fails to wash his hands properly and all the salads
become contaminated with e-coli. After the patrons go home, they become ill, and go in various
hospital ER’s in their own counties. Today, that information would be gathered and shared in a
matter of hours. In the past, it could take days for the same information to be gathered. The speed

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of which this information is gathered can allow the proper authorities to investigate the restaurant
thus causing any further contaminated salads being served.
Health Information Technology is a second technological advance that has influenced HCIS
practices. With the introduction of health information technology, patients can go from the
physician’s office to the hospital and their orders can be there waiting. Any tests or procedures
ordered can be scheduled sooner, results obtained sooner, the patient treated, health improved,
discharged, third party billed, and reimbursement collected sooner.
Conclusion
EHRs focus on the total patient. They go beyond clinical data and include a broader view
of the patient’s care. They are designed to reach beyond the original collectors of the information
and to share the information with other providers. The biggest benefit is that all this sharing
results in more open communication and patient involvement ("Health Care IT News", 2013) .
The evolution of health care information systems has made a huge difference in the way patients
receive care and the hospitals reimbursed. The new technology makes the gathering of health
care information fast and simple thus possibly preventing epidemics or pandemics across our
states. The information gathered can also predict health problems that can be prevented if the
patients listen and heed the warnings of the ill effects certain habits can have on the health of a
person. Health care information systems will continue to evolve as technology advances as we,
as health care providers and patients, attempt to keep up with the amount of information
provided.

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References:
American medical association. (2013). Retrieved from http://www.ama-
assn.org/ama/pub/physician-resources/practice-management-center/practice-
operations/health-information-technology/hie.page
American hospital association. (2013). Retrieved from
http://www.aha.org/search?q=evolution+of+health+information+systems&site=redesign_
aha_org
Health care IT news. (2013). Retrieved from
http://www.healthcareitnews.com/directory/electronic-health-record-ehr