Chapter 4 The Enterprise Solution : A Modern Model of HIM Practice EIM Team Questions How is the management of digital data different from the management of paper records? What are differences and similarities? What is traditional HIM practice? What type of practices are needed to manage information in a digital era? Traditional him practice Traditional HIM Practice Departmental focus Synergy among people, processes, and documents Management of physical records (objects) Concerned with tracking, filing, and retrieving records, not information Contemporary Model of Enterprise Health Information Management (EHIM) Practice Focus on enterprise management Synergy among people, processes, content, and technology Data management functions across many domains Ehim domains Data Life Cycle Management Managing data from beginning to end points Establishes: What data are collected Standards for data capture Standards for data storage and retention Processes for data access and distribution Standards for data archival and disposal Data Architecture Management Integrated specification artifacts Establishes: Standards, policies, procedures for data collection, storage, and integration Standards for information storage (IS) design Identifying and documenting requirements Developing and maintaining data models Metadata Management Structured information that describes, explains, locates, or helps retrieve, use, or manage an information resource Manage data dictionaries Establish enterprise metadata strategy Develop policies and procedures for metadata identification, management and use Establish standards for metadata schemas Establish and implement metadata metrics Monitor policy implementation Master Data Management Management of key business entity data Identifying reference data sources (databases, files) Maintaining authoritative value lists and metadata Establishing organization data sets Defining and maintaining match rules Reconciling system of record Master Data Patients Vendors Employees Providers Products Location Reference Data Business Units Content and Record Management Management of unstructured data Developing and implementing policies and procedures for the organization and categorization of unstructured data (content) in electronic, paper, image, and audio files for its delivery, use, reuse, and preservation Developing and adopting taxonomic systems Developing and maintaining an information architecture and metadata schema that identify links and relationships among documents and defines the content within a document Data Security Management Protection measures and safeguards for data Data security planning and organization Developing, implementing and enforcing data security policies and procedures Risk management Business continuity Audit trails Information Intelligence and Big Data Management of applications and technologies for gathering, storing, analyzing, and providing data for d ...

1. Chapter 4
The Enterprise
Solution
:
A Modern Model of HIM Practice
EIM Team Questions
How is the management of digital data different from the
management of paper records?
What are differences and similarities?
What is traditional HIM practice?
What type of practices are needed to manage information in a
digital era?
Traditional him practice

2. Traditional HIM Practice
Departmental focus
Synergy among people, processes, and documents
Management of physical records (objects)
Concerned with tracking, filing, and retrieving records, not
information
Contemporary Model of Enterprise Health Information
Management (EHIM) Practice
Focus on enterprise management
Synergy among people, processes, content, and technology
Data management functions across many domains
Ehim domains
Data Life Cycle Management
Managing data from beginning to end points
Establishes:
What data are collected

3. Standards for data capture
Standards for data storage and retention
Processes for data access and distribution
Standards for data archival and disposal
Data Architecture Management
Integrated specification artifacts
Establishes:
Standards, policies, procedures for data collection, storage, and
integration
Standards for information storage (IS) design
Identifying and documenting requirements
Developing and maintaining data models
Metadata Management
Structured information that describes, explains, locates, or helps
retrieve, use, or manage an information resource
Manage data dictionaries
Establish enterprise metadata strategy
Develop policies and procedures for metadata identification,

4. management and use
Establish standards for metadata schemas
Establish and implement metadata metrics
Monitor policy implementation
Master Data Management
Management of key business entity data
Identifying reference data sources (databases, files)
Maintaining authoritative value lists and metadata
Establishing organization data sets
Defining and maintaining match rules
Reconciling system of record
Master Data
Patients
Vendors

5. Employees
Providers
Products
Location
Reference Data
Business Units
Content and Record Management
Management of unstructured data
Developing and implementing policies and procedures for the
organization and categorization of unstructured data (content) in
electronic, paper, image, and audio files for its delivery, use,
reuse, and preservation

6. Developing and adopting taxonomic systems
Developing and maintaining an information architecture and
metadata schema that identify links and relationships among
documents and defines the content within a document
Data Security Management
Protection measures and safeguards for data
Data security planning and organization
Developing, implementing and enforcing data security policies
and procedures
Risk management
Business continuity
Audit trails
Information Intelligence and Big Data
Management of applications and technologies for gathering,
storing, analyzing, and providing data for decisions
Assessing current intelligence needs, resources, and use
Determining scope, requirements, and architecture for

7. enterprise intelligence
Developing and implementing policies and procedures for
enterprise information intelligence
Data Quality Management
Ensure data are meeting quality characteristics
Identifying data quality requirements and establishing data
quality metrics
Identifying and carrying out data quality projects
Profiling data and measuring conformance to established quality
metrics and business rules
Identifying data quality problems and assessing their root cause
Managing data quality issues
Implementing data quality improvement measures
Providing training for ensuring data quality
Terminology and Classification Management
Provide a central terminology authority for the enterprise

8. Ensuring appropriate adoption, maintenance, dissemination, and
accessibility of vocabularies, terminologies, classification
systems, and code sets for semantic interoperability and data
integrity
Developing algorithmic translations, concept representations,
and mapping among clinical nomenclatures
Providing oversight for clinical and diagnostic coding to ensure
compliance with established standards
Data Governance
Overarching authority ensuring cohesive operation and
integration of the EIM domains
Advocating for the data asset
Establishing data strategy
Establishing data policies
Approving data procedures and standards
Communicating, monitoring, and enforcing data policy and
standards
Ensuring regulatory compliance
Resolving data issues
Approving data management projects

9. Coordinating data management organization
EIM Organization and Structure
EIM Structure
No one structure
Usually includes:
Executive steering committee
DG board or advisory or coordinating group
Tactical teams
Network of data stewards
EIM or DG office
EIM Benefits
EIM Benefits
Making information management a key organizational initiative
Increasing organizational awareness of the importance of

10. information management
Promoting collaboration and cooperation to create a single
enterprise view of an organization’s information asset
Establishing formal organizational structure tasked with
authority and responsibility for EIM
EIM Benefits
Improving data quality by consolidating data sources,
establishing consistent business rules for managing data,
developing guidelines for data quality, and establishing
authority for data ownership
Increasing efficiency and effectiveness of data used for business
planning, operations, and patient care by an integrated, cross
program view of enterprise data, providing an information
delivery framework that accommodates easy access to data by
all users
EIM Benefits
Optimizing enterprise information delivery, reducing the
amount of time stakeholders spend trying to obtain data
Safeguarding data from misuse

11. Improving organization flexibility and agility by providing an
organizational data model, improving processes and procedures,
and supporting unstructured data
St. rita’s eim team Conclusions and next steps
St. Rita’s EIM Team Conclusions
EIM involves coordination of multiple domains
EIM is cross-functional and requires collaboration rather than a
command and control structure
EIM requires establishing a vision and mission, and developing
a strategy and goals
EIM can provide organization effectiveness and efficiency and
can solve many of St. Rita’s data problems
EIM Team Next Steps
Investigate the purpose, scope, and functions of each of the EIM
domains:
Data architecture management
Metadata management

12. Master data management
Content and record management
Data security management
Information intelligence and big data
Data quality management
Terminology and classification management
Data governance
Chapter 3
Electronic Health Information Systems
EIM Team Questions
How do we investigate St. Rita’s applications?
Does St. Rita’s have an application inventory?
Where do we start?
St. Rita’s has hundreds of applications
Narrow scope to most commonly used
Clinical applications
Administrative applications

13. Clinical information systems
Clinical Information Systems (CIS)
Definition
Information systems dedicated to collecting, storing,
manipulating, and making available clinical information
important to the delivery of patient care
There is no one specified inventory of a CIS that fits all
organizations
Clinical Information Systems (CIS)
CIS benefits
Providing access to organized, complete, and legible patient
information in a timely way
Improves patient safety and outcomes
Can reduce costs
Improves operations and efficiency
Anesthesia Information Management System (AIMS)
Purpose and functions
Automate the capture, storage, and presentation of data during

14. the intraoperative period
Functions may include
Electronic history taking
Intraoperative charting including manual input and output from
monitoring devices
Decision support capabilities
Automated Patient Identification and Bar Coding
Purpose and functions
Also referred to as bar code point of care (BPOC)
Enables use of bar code technology for identifying any
individual or object
Used for medication administration, transfusions, specimen
collection and diagnostics, point-of-care testing, and patient
charges
Clinical Data Repository (CDR)
Purpose and functions
Consolidates data from different clinical source systems (for
example, laboratory, pharmacy, and radiology) within an
organization to present a unified view of a single patient’s data
Real-time database that updates data immediately when it is
entered by a person, directly from a device, or in another

15. manner
Backbone of the electronic medical record (EMR)
Computerized Physician/Provider Order Entry (CPOE)
Purpose and functions
Allows those with ordering privileges to directly enter medical
orders such as medications, tests, and treatment
Routes orders to the appropriate departments and individuals for
completion
Includes decision support capabilities such as alerts for drug-
drug contraindications, drug overdoses, or patient allergies
Critical Care Information System (CCIS)
Purpose and functions
Provides intensive care units (ICU) with automated
documentation for collection, management, and display of
patient information
Integrates with monitoring
Decision support capabilities
Dietary Department and Management System

16. Purpose and functions
Supports patient nutritional assessment and management,
processing diet meal orders, cancellations and reorders, menu
development, patient menu choice, and meal tracking and
delivery
Integrates with other systems such as Registration-Admission,
Discharge, Transfer (R-ADT) System
Supports departmental administrative functions
Electronic Document Management Systems (EDM)
Purpose and functions
Often called an EHR bridge technology
Electronically scans paper documents, creating a digital image
which can be indexed and stored by the system for retrieval and
viewing by end users
May include workflow technology that automatically identifies
tasks to be performed for preparing and scanning documents
Emergency Department
Information System (EDIS)
Purpose and functions
Provides management and operational tools to improve
emergency department (ED) performance

17. May include patient registration, central visualization screen for
patient management, management of patient flow, monitoring
patient movement throughout the ED, reporting ED room status,
managing requests, and notifications for patient beds and
resources
Laboratory Information System (LIS)
Purpose and functions
Support administrative and operational functions of anatomical
pathology and clinical laboratory
Provides workflow automation, financial and manage ment
reporting, and quality assurance
Supports patient and specimen identification, specimen
tracking, results reporting, quality control, and inventory
control
Includes instrument interfaces
Medication Administration System (MAS)
Purpose and functions
Supports administration of medication to patients
Uses bar code technology
Provides decision support features checking for patient
allergies, drug-drug, and drug-lab interactions

18. Automatically documents medication administration
Interfaces with CPOE, MPI, and other subsystems
Medication Reconciliation Systems
Purpose and functions
Helps manage the coordination of drugs for a patient across the
continuum of care to avoid medication discrepancies
May incorporate e-prescribing systems so post-discharge
medications orders are electronically transferred to a pharmacy
of the patient’s choice
Monitoring Systems
Purpose and functions
Provide periodic or continuous observation of the patient or
physiological functions in guiding decisions of therapeutic
interventions
Store patient data, provide data electronically to life-support
equipment, perform complex data analysis, and provide noise
and text alerts to potentially life-threatening conditions to
caregivers
Usually associated with critical care units

19. Nursing Information System
Purpose and functions
Supports nursing documentation for patient assessment,
development of patient care plans, and documenting patient care
delivery
May include decision support such as prompts and reminders,
guides to disease linkages between signs or symptoms, and
access to online medical resources
Usually interface with CPOE and other subsystems
Operating Room Management System
Purpose and functions
Provide coordination of human and material resources during
pre-operative, intra-operative, and post-operative phases of care
Support clinical documentation, tracking patient status, staffing
management, equipment allocation and tracking, scheduling
operating room suites, and coordinating patient flow during
perioperative period
Usually interface with other subsystems
Patient Care Pathways
Purpose and functions

20. Multidisciplinary structured care plans that healthcare
professionals use to implement clinical guidelines and protocols
for a specific patient group, usually based on diagnosis or
surgical procedure
Pharmacy Information System
Purpose and functions
Provide verification work lists allowing pharmacists to review,
verify, and fill incoming drug orders
Decision support capabilities for contraindication information
May integrate with automated dispensing stations
Perform administrative functions such as inventory management
and stock requisition
Real Time Locator System
Purpose and functions
Identifies, determines, and tracks the location of equipment,
materials, and personnel, and in the case of healthcare patients,
throughout a building or healthcare complex using wireless
technology

21. Radiology Information System (RIS)
Purpose and functions
Support workflow of departmental functions and communication
within and outside the radiology department
Includes patient scheduling, patient tracking, and results
reporting, digital transcription
May include materials management, charge capture, and
management reporting
Interfaces with other subsystems such as CPOE, MPI
Radiology Picture Archiving and Communication System
(PACS)
Purpose and functions
Provides storage and access to images from various modalities
such as x-ray computed tomography (CT), magnetic resonance
imaging (MRI), positron emission tomography (PET),
mammograms, and digital radiography
Usually integrates with other subsystems such as MPI
Results Reporting, Retrieval, and Management
Purpose and functions
Provides the functionality to retrieve patient data such as

22. laboratory reports and diagnostic studies such as radiology
reports
May allow results management which is manipulation of data
for graphing or comparison purposes of data from multiple
source systems
Administrative
information systems
Administrative Information Systems
A suite of applications that support organizational strategic and
operational management
Many of these systems could be referred to as dual purpose
because they provide support for both administrative and
clinical functions
Registration-Admission, Discharge, Transfer (R-ADT) Systems
Purpose and functions
One of the backbone applications of a health information system
Captures patient demographic, insurance, and other
administrative data at registration or admission

23. Tracks a patient when there is an intra-facility transfer from
one care area to another and identifies the date and time the
physician discharges the patient
Automated Diagnostic Coding
Purpose and functions
Automated tools to help assign diagnostic and procedures codes
such as ICD codes
May included a series of edit checks based on classification
rules to help ensure that code assignment is correct
Use heuristic logic to assign a diagnostic-related-group (DRG)
May include national language processing to interpret digital
reports
Bed Management System
Purpose and functions
Automates the process of assigning a patient to a specific
hospital care unit
Includes tracking bed inventory, categorizing bed requests,
managing patient queues, and managing environmental services
for room preparation

24. Business Intelligence (BI) Management
Purpose and functions
Collects data from various subsystems, both clinical and
administrative, and uses sophisticated analysis programs to
analyze performance against key indicators or measures
Used for clinical performance management, financial anal ysis,
cost accounting and budgeting, and process performance
management
Data warehouse used for data storage and retrieval
Financial Information Systems
Purpose and functions
An umbrella of financial systems that rely on data from both
clinical and administrative information systems
Includes patient and payer billing, claims management, accounts
payable and receivable, collection monitoring, staff scheduling,
budgeting, accounting, revenue cycle management, and facility
maintenance
Inpatient Scheduling Systems
Purpose and functions
Support care coordination and manage inpatient scheduling for

25. diagnostic exams, tests, and treatments
Sometimes referred to as inpatient flow management systems
Master Patient Index
Purpose and functions
Automatically assigns a unique patient identifier (medical or
health record number) to a patient and is a permanent identifier
for each patient who receives services at a healthcare facility
Contains a subset of information that identifies the patient such
as name, date of birth, gender, and address, and is considered
the “ system of record” for patient identification
Master Patient Index (MPI)
Purpose and functions
The unique identifier maps to other source systems and is a key
to identifying data about a patient’s multiple hospitalizations or
encounters
When an MPI is developed for an entire enterprise that has
multiple facilities or groups, it is usually referred to an
enterprise master patient index (EMPI)

26. Example of MPI Screen
Record Completion Management System
Purpose and functions
Automates managing workflow for documentation deficiency
analysis, routing deficiency notices to the correct clinician for
completion, and tracking record deficiencies and their
completion
Data from the system supports administrative analysis of record
deficiencies and workflow
Request for and Release of Health Information Management
System
Purpose and functions
Supports the capture of data that tracks disclosure of health
information and monitors and tracks requests from patients for
their own information
May integrate with a document management system so scanned
copies of requests and other correspondence can be captured
and stored within the system
Workforce Management System

27. Purpose and functions
Support staffing needs assessments and workforce balance,
capacity planning, and clinical staff scheduling
Generates various administrative reports to determine future
appropriate staffing levels
System interoperability
Interoperability
Definition
The ability of different information technology systems to
exchange data with each other and to use that data
Difference between data exchange and interoperability
Essential for EHRs and HIEs
Levels of Interoperability
Foundational interoperability
Lowest level of interoperability
Allows one system to exchange data with another
The target system cannot interpret the data

28. Levels of Interoperability
Structural interoperability
Intermediate level of interoperability
Allows one system to exchange data with another system in a
common data format and structure
Retains the identification of the data
Levels of Interoperability
Semantic interoperability
Highest level of interoperability
Exchanges data in standard format and preserves its meaning
by adding metadata and linking each data element to a
controlled vocabulary
Allows target system to interpret and use the exchanged data
Computer Interfaces
Specialized software that allows computer systems to
communicate with each other
Required to achieve interoperability
Point-to-point interface development
Interface engine

29. Computer Networks
A communication network consisting of
A transmitter that sends data,
A receiver that receives data, and
A medium that connects the transmitter and receiver and
provides the pathway for the transmissio n of the data
Essential for interoperability
Computer Networks
Network computers
Client computer accesses shared resources
Server computer provides a variety of shared resources
Computer Networks
Network types
Bus topology
Star topology
Ring topology
Mesh topology
St. rita’s EIM team Conclusions and Next Steps

30. EIM Team Conclusions
The variety of clinical and administrative applications required
for organization operations makes management of these
complex
There is interdependency among clinical and administrative
applications
Lack of standards makes interoperability among systems
difficult
An inventory of applications should be a top priority for St.
Rita’s
EIM Team Next Steps
Armed with knowledge about the history of information systems
development in healthcare and an understanding of the clinical
and administrative applications that make these systems, the
team is ready to explore the components and what constitutes an
EIM program.