This document discusses developments in hospital management and information systems over the past 20 years. It presents a framework to describe the relationship between types of hospital management and the use of hospital information systems over time. The framework identifies three eras of hospital management: capacity management, functional management, and network management. It also describes three corresponding eras in the use of hospital information systems: isolated individual systems, internal integration of systems, and interconnections of hospital systems through external networks. The framework is applied in a case study of a large hospital in the Netherlands to analyze how the use of information systems has developed in relation to changes in hospital organization and management over the past decade.
Naomi Fulop: Integrated care lessons from the researchNuffield Trust
1) The evidence on integrated care shows some improvements in care coordination and partnerships but mixed results on costs, utilization of services, and patient outcomes.
2) Successful integration requires focusing on clinical integration rather than just organizational integration and ensuring supportive local contexts.
3) Key challenges to integration include overcoming cultural differences between organizations, avoiding negative impacts on community services, providing the right incentives, and being patient as integration takes significant time.
Nursing informatics is a distinct specialty that combines nursing science, computer science, and information science. It supports nursing practice and care delivery by helping to integrate data, information, and knowledge for clinical decision making. As clinical information systems have become more common, nursing informatics has emerged to help nurses manage the large amount of information generated during practice. Nursing informaticists use their knowledge of nursing and information management to provide structure and support for managing clinical data across specialties.
Nursing informatics
What is nursing informatics?
Evolution of nursing informatics
Role of the Nurse as knowledge worker
Medical Informatics
Consumer Informatics
This document discusses nursing informatics, which integrates nursing science with information management and analytical sciences. It is the science of processing and managing nursing data, information, and knowledge to support various areas of nursing. The field has grown with the increasing use of technology in healthcare, such as the transition to electronic health records. The document outlines the history of computing in nursing and covers topics like clinical information systems and the nursing informatics model.
This is a PowerPoint that helps the students understand what is Nursing Informatics at a very basic level..Everyone who reads this will understand what is Nursing informatics
This document discusses several models and frameworks related to nursing informatics. It describes Graves and Corcoran's model which views nursing informatics as the linear progression from data to information to knowledge. It also outlines Schwirian's model focusing on identifying information needs and Turley's model defining nursing informatics at the intersection of nursing science, computer science, and information science. Additionally, it discusses the Data-Information-Knowledge model and Benner's Novice to Expert model as applied to nursing informatics. Finally, it introduces several specific models for the Philippine healthcare ecosystem, the patient medical record, and terminology standards.
Nursing informatics combines nursing science, computer science, and information science to support nursing practice, education, administration, research, and knowledge development. It involves the management and processing of nursing data and information through technologies like electronic health records and decision support systems. While technology offers benefits like reducing errors and improving data-driven decisions, it also faces challenges regarding usability issues, security concerns, and ensuring the humanistic aspects of care are not lost.
The document discusses hospital infrastructure and administration. It describes the key systems that modern hospitals require like backup power generators and priority access to utilities. It also discusses the shift from ward-based patient rooms to private rooms for privacy and comfort. The role of the hospital administrator is outlined, who is responsible for overseeing all hospital departments, budgets, policies, staffing and quality assurance to efficiently provide medical care.
Naomi Fulop: Integrated care lessons from the researchNuffield Trust
1) The evidence on integrated care shows some improvements in care coordination and partnerships but mixed results on costs, utilization of services, and patient outcomes.
2) Successful integration requires focusing on clinical integration rather than just organizational integration and ensuring supportive local contexts.
3) Key challenges to integration include overcoming cultural differences between organizations, avoiding negative impacts on community services, providing the right incentives, and being patient as integration takes significant time.
Nursing informatics is a distinct specialty that combines nursing science, computer science, and information science. It supports nursing practice and care delivery by helping to integrate data, information, and knowledge for clinical decision making. As clinical information systems have become more common, nursing informatics has emerged to help nurses manage the large amount of information generated during practice. Nursing informaticists use their knowledge of nursing and information management to provide structure and support for managing clinical data across specialties.
Nursing informatics
What is nursing informatics?
Evolution of nursing informatics
Role of the Nurse as knowledge worker
Medical Informatics
Consumer Informatics
This document discusses nursing informatics, which integrates nursing science with information management and analytical sciences. It is the science of processing and managing nursing data, information, and knowledge to support various areas of nursing. The field has grown with the increasing use of technology in healthcare, such as the transition to electronic health records. The document outlines the history of computing in nursing and covers topics like clinical information systems and the nursing informatics model.
This is a PowerPoint that helps the students understand what is Nursing Informatics at a very basic level..Everyone who reads this will understand what is Nursing informatics
This document discusses several models and frameworks related to nursing informatics. It describes Graves and Corcoran's model which views nursing informatics as the linear progression from data to information to knowledge. It also outlines Schwirian's model focusing on identifying information needs and Turley's model defining nursing informatics at the intersection of nursing science, computer science, and information science. Additionally, it discusses the Data-Information-Knowledge model and Benner's Novice to Expert model as applied to nursing informatics. Finally, it introduces several specific models for the Philippine healthcare ecosystem, the patient medical record, and terminology standards.
Nursing informatics combines nursing science, computer science, and information science to support nursing practice, education, administration, research, and knowledge development. It involves the management and processing of nursing data and information through technologies like electronic health records and decision support systems. While technology offers benefits like reducing errors and improving data-driven decisions, it also faces challenges regarding usability issues, security concerns, and ensuring the humanistic aspects of care are not lost.
The document discusses hospital infrastructure and administration. It describes the key systems that modern hospitals require like backup power generators and priority access to utilities. It also discusses the shift from ward-based patient rooms to private rooms for privacy and comfort. The role of the hospital administrator is outlined, who is responsible for overseeing all hospital departments, budgets, policies, staffing and quality assurance to efficiently provide medical care.
This document discusses the historical efforts of nursing informatics pioneers and current ways nurses are using informatics to transform healthcare. It describes a nursing informatics history project that interviewed 33 pioneers and identified common themes from their interviews. Examples are given of the 2011 Nursing Informatics Innovations Awards, which recognized projects at Carolinas Medical Center, Children's Hospital Colorado, and University of Wisconsin Hospitals that improved patient outcomes through nurse-led informatics initiatives. Tips are provided on promoting healthcare informatics through initiatives like the TIGER project.
Nursing informatics theories, models, and frameworksJoseph Lagod
Nursing informatics is an established and growing specialty area in nursing that employs information technologies. It combines nursing science, computer science, and information science. Nursing informatics helps manage and communicate data, information, and knowledge to support decision-making by patients, nurses, and other providers. The goal is to improve care through the effective use of information technology.
Nursing informatics is a relatively new specialty recognized by the American Nurses' Association in 1992 that has grown from a specialized field to one that now permeates all areas of nursing. Nursing informatics is especially important in critical care where fast decisions, monitoring systems, wireless communication and computerized documentation are now fundamental. While informatics was once highly specialized, it now requires a basic understanding across nursing practice and continues to expand as technology grows. Education for nursing informatics ranges from bachelor's to doctoral degrees and board certification, and works in diverse settings including hospitals, education, research and administration.
Here are the key points about standard terminologies/languages and nursing terminologies:
- Standard terminologies/languages allow for consistent representation of clinical data across systems and organizations. This supports aggregation and analysis of data.
- A data set is a collection of related data on a particular topic. In nursing, examples include patient demographics, assessments, interventions, and outcomes.
- The Nursing Minimum Data Set (NMDS) is a standardized set of core nursing data elements that can be shared across systems to support nursing practice, documentation, and research.
- ANA-recognized nursing terminologies include:
- NANDA-I (Nursing Diagnoses)
- NIC (Nursing Interventions Classification
Nursing informatics utilizes information technology to support nursing practice, research, and education. It aims to improve patient care and outcomes through the management and communication of nursing data, information, and knowledge. Emerging trends in nursing informatics include more ubiquitous and integrated technology solutions for clinical documentation, order management, and other areas of the nursing workflow.
This document discusses how sharing economy tools like social media and ICT can improve healthcare outcomes and reduce costs. It argues that connecting healthcare professionals through these tools allows for improved knowledge sharing, more rapid dissemination of best practices, and reduced errors and treatment times. The document reports that studies have found 30-40% reductions in healthcare costs when clinical pharmacists are integrated into care teams using sharing economy instruments like social media. It calls for incorporating sharing economy principles and management training into clinical pharmacist education to further optimize healthcare quality and costs.
Nursing informatics professionals need to be aware of healthcare policy to effectively practice in today's changing healthcare environment. Healthcare policy is established at local, state, and national levels to guide solutions for population health needs. For nursing informatics to be recognized as a specialty, it had to demonstrate a differentiated practice, identify educational programs, develop a research agenda. Standards are critical for electronic health records and the effective exchange of health information. Adoption of technologies like computerized provider order entry and smart infusion pumps can help reduce errors and improve workflow.
This document discusses electronic health records (EHR) and related concepts. It provides information on what EHRs are, how they are accessed and integrated across hospital departments, the types of data they store, and issues related to EHR systems. Key benefits of EHRs include managing health information electronically and displaying data in useful formats. Challenges include completely converting paper records, maintaining data integrity and security, and costs of purchasing and maintaining computer systems. The document also examines nursing minimum data sets and the theories, models and frameworks that guide nursing informatics practice.
Nursing informatics is the use of computers and information technology to support nursing practice, education, administration, research, and clinical care. It involves managing nursing data, information, and knowledge through technologies like electronic health records. The goal is to improve patient health outcomes and support nurses' decision-making. While nursing informatics is still emerging, national nursing organizations recommend nurses become computer literate as healthcare increasingly relies on digital tools and data.
This document discusses nursing informatics as an established area of specialization in nursing. It provides background on the origins of the term "informatics" and defines it as a multidisciplinary field combining various sciences like computer science, information science, and cognitive science. The document then defines health informatics and its subdomains like medical informatics and nursing informatics. Nursing informatics is discussed as the application of information technologies to nursing practice, education, research, and administration. It became a recognized nursing specialty in 1992 with its own distinct body of knowledge. Nursing informatics specialists work in various roles applying their skills and knowledge to improve patient care and the nursing experience.
Read about some of the innovative solutions we offer for better healthcareCGI
Delivering healthcare is one of the most complex human activities. In recent decades, major transitions have taken place in diagnostics, pharmaceuticals and treatments resulting in shorter length of stay in healthcare facilities. The current transition to more personalised care and to longer term managed care pathways means that healthcare IT systems are changing direction. But this change may not happen smoothly.
This monograph provides an assessment of the current hospital-physician landscape and outlines an innovative vehicle for advancing hospital-physician relationships that has the potential to improve care delivery and coordination, clinical quality, and patient cost. Our findings and recommendations address:• Changes in the market place.• The concept of an integrated medical staff model.• The role of operational clinical integration, enabled by an Electronic Medical• Record, toward creating virtual medical staffs.• Benefits to the hospital, physicians, patients and community.• What boards and senior management can do to move toward the model.
Key Takeaways from the first IDC Pan European Healthcare Summit . Post event ...Silvia Piai
This slide deck summarizes the key takeaways from the first Pan European Healthcare Executive Event. Focused on the three themes of the Summit ( Personalization,Integration and Industrialization), the Summit has explored the different dimensions in which ICT is an enabler of a new business model for sustainable healthcare in Europe
SUMARIZE THE NEXT ARTICLE (250 words-APA format) Then respond to the.docxrafbolet0
SUMARIZE THE NEXT ARTICLE (250 words-APA format) Then respond to the 2 analysis at the end (150 words Each)
Geriatric care management reduces Medicare losses
Healthcare costs for the elderly are rising rapidly in the United States. One way for a hospital to control these rising costs is to implement a geriatric care management system. The goal of a system is to change the way the hospital treats medically complex Medicare patients and, thus, reduce unnecessary hospital costs. Such a system requires a process for identifying elderly patients in need of geriatric care management services, treating them efficiently, and assessing the system itself. An effective process usually results in significant cost savings for the hospital as well as improved patient care and satisfaction.
While people aged 65 and older make up 12 percent of the U.S. population, they account or 6 percent overall healthcare expenditures.(a) By the year 2000, the elderly population will be responsible for 58 percent of all hospital days and almost half of all healthcare expenditures.(b) Furthermore, fragmentation of services and funding sources makes it difficult for the elderly and their families to obtain appropriate care.
Thus, care management becomes extremely important in order to effectively address the increasing healthcare needs and costs of elderly Americans.
A geriatric care management system designed to restructure the delivery of care for Medicare patients is one way hospitals can control costs. Such a system is based on the concept that a relatively small proportion of Medicare patients must be targeted for focused care management in order for hospitals to increase the quality of care, avoid financial losses, and prevent poor clinical outcomes. The patients targeted are those who, without focused management, would account for the majority of hospital problems involving excessive resource use and long lengths of stay. Because these patients can be prospectively identified, focused care management techniques can be employed to ensure appropriate and efficient hospital care, thereby reducing lengths of stay and costs. The geriatric care management system thus provides hospitals with ways to reduce a patient's length of stay and to use hospital resources more effectively.
The system focuses on three functions: identification of patients needing care management, geriatric care management intervention, and program performance evaluation. The performance evaluation provides information a hospital can use to improve the use of its resources and reduce patients' lengths of stay.
IDENTIFICATION
The task of identifying Medicare patients who require geriatric care management starts with an analysis of hospital data related to discharge geriatric patients. This process involves analyzing hospital data to identify DRGs and admitting diagnoses as well as characteristics of patients and physicians associated with inappropriate lengths of stay; excessive resource use (such as l.
Rick MacCornack, PhD
Chief Systems Integration Officer
Northwest Physicians Network
CEO
Rainier Health Network
Closing Presentation "ACOs and Health IT: True Delivery System Reform or Another Round of Unintended Consequences?"
A fundamental component of the Affordable Care Act is support for the creation of so-called Accountable Care Organizations. Health care information technology will play a critical role in the reform process, perhaps in ways which are not yet well understood. Using the framework and early experience of a local CMS appointed ACO, this session is intended to ask questions and provide examples for how IT efforts might contribute to healthy, disruptive change in improving medical care delivery.
Learning Objectives:
∙ Consider the unintended consequences of the current IT trajectory in supporting medical care delivery in relation to the mandates of the
Affordable Care Act. Consider some opportunities for future IT contributions and what will need to occur for these opportunities to be tapped.
∙ Reflect on the historical contributions of IT in health and how there will necessarily be a shift in IT development in the future in support of
medical care delivery reform.
This document summarizes supply chain management practices in the healthcare industry. It discusses that healthcare supply chains involve various stakeholders like producers, purchasers, and providers. It also outlines different modes of integration in healthcare supply chains like integration of processes, information, planning, and markets. Some best practices discussed are use of RFID technology, inventory management, procurement processes, information sharing, and revenue cycle management systems. The conclusion states that while improvements have been made, areas like inventory control, procurement, and information sharing require more focus from managers.
Naomi Fulop: What can the evidence tell usNuffield Trust
1) The evidence suggests that integrated care can improve partnerships and focus on case management through increased information sharing, but the impact on costs, admissions, length of stay, and health outcomes is mixed.
2) Successful integration requires clear objectives, an emphasis on clinical rather than organizational integration, supportive local contexts, attention to cultural differences between organizations, and ensuring community services are not disadvantaged.
3) It takes time to fully implement integration and realize potential benefits due to challenges integrating cultures and incentives, and changes may not immediately lead to efficiencies or improved outcomes.
Design and Implementation of Hospital Management System Using JavaIOSR Journals
This document describes the design and implementation of a Hospital Management System (HMS) using Java. The HMS was developed to address challenges with manual hospital management processes and provide benefits like streamlined operations and enhanced patient care. It includes modules for patient management, services management, appointments, the pharmacy, admissions and accounting. The system uses a database to store patient and medical records and allows users to view records, diagnoses and drug prescriptions. Test results showed the HMS met user requirements and provided functionality like registering patients, viewing inpatient data and the drug database. It was concluded the HMS can help hospitals enhance patient care and increase organizational profitability by improving operational control and streamlining processes.
Role of Community Matrons in shifts in settings of care Care City
The document discusses the political context driving healthcare reforms in the UK and the expected shift toward more community-based care delivery away from hospitals. Community matrons and practice nurses can contribute to this shift by participating in whole-systems approaches, sharing knowledge and best practices, and participating in ongoing service redesign. The new model of care should focus on prevention, self-care, coordination, and consistent high-quality care both in specialist and community settings through greater integration between primary and secondary care teams.
IntroductionHealthcare Information Systems are defined as Comp.docxvrickens
Introduction:
Healthcare Information Systems are defined as “Computerized systems designed to facilitate the management and operation of all technical (biomedical) and administrative data for the entire healthcare system, for a number of its functional units, for a single healthcare institution, or even for an institutional department or unit” [9]. The employment of computers in the healthcare sector can be traced back to the 1960s. During the early 1970s, the first attempts to adopt HIS were made [10]. However, in the past, HIS initiatives were limited to the automation of business processes related to (a) administration and (b) healthcare tools and techniques related to various medical procedures as: diagnostic, therapeutic and surgical. During the 80s, innovative patterns in database designs and applications related to HIS, concluded to developments in planning and administration of the healthcare data. In parallel, HIS also introduced low cost financial systems for hospitals under 200 beds in size [11]. It should be noted that the early computerized systems were limited in big hospitals and government projects (military).
As the IT industry flourish the HIS technology was populated with various network applications. The ‘net period with the internet, intranet and extranet affected the communication of data in hospitals especially in the 1990's. In the middle of the same decade the interface engine emerged as a product to support the integration of applications, as best-of-breed applications became harder to manage [12]. New experience and knowledge in applications such as Internet-based telemedicine, personal health records, asynchronous healthcare communication systems, m-health and picture archiving communication systems (PACS) have been applied in the healthcare sector [13]. The growth of the aforementioned applications has lead to the development of healthcare services that have been characterized as complex, redundant and transcriptive [14].
In shedding some light on the underlined services that exist in healthcare organizations, we reviewed the normative on HIS classification. Based on the services that HIS support, Mantzana [7] categorized them into: (a) clinical, (b) non-clinical, (c) pharmaceutical and (d) laboratory. The authors adopt this classification and extend it, by proposing that the patient record category should be added, as it refers to medical records that can be maintained by the citizen or the health professional. This category can be further broken down into (a) Electronic Patient Records Systems (EPR), which are detailed records of encounters between patients and their healthcare providers and (b) Electronic Personal Health Records (ePHR) that are citizen self-maintained health and healthcare records
Extensive and serious quality problems exist in health care delivery processes, resulting in tremendous harms and losses to stakeholders. An increasing concern for improving health care quality has been expressed fro ...
Hospital administration role in quality patient careShaharul Sohan
Hospital administration ensures that hospitals run efficiently and provide quality patient care. Key responsibilities of hospital administrators include overseeing departments, recruiting and managing staff, ensuring compliance with policies and regulations, and coordinating efforts to achieve common goals like quality care. Effective hospital administration requires planning, organizing, staffing, directing, coordinating, reporting, budgeting, supervising, and evaluating all hospital activities and processes. The role of the administrator is crucial to the success of the hospital organization and the care provided to patients.
This document discusses the historical efforts of nursing informatics pioneers and current ways nurses are using informatics to transform healthcare. It describes a nursing informatics history project that interviewed 33 pioneers and identified common themes from their interviews. Examples are given of the 2011 Nursing Informatics Innovations Awards, which recognized projects at Carolinas Medical Center, Children's Hospital Colorado, and University of Wisconsin Hospitals that improved patient outcomes through nurse-led informatics initiatives. Tips are provided on promoting healthcare informatics through initiatives like the TIGER project.
Nursing informatics theories, models, and frameworksJoseph Lagod
Nursing informatics is an established and growing specialty area in nursing that employs information technologies. It combines nursing science, computer science, and information science. Nursing informatics helps manage and communicate data, information, and knowledge to support decision-making by patients, nurses, and other providers. The goal is to improve care through the effective use of information technology.
Nursing informatics is a relatively new specialty recognized by the American Nurses' Association in 1992 that has grown from a specialized field to one that now permeates all areas of nursing. Nursing informatics is especially important in critical care where fast decisions, monitoring systems, wireless communication and computerized documentation are now fundamental. While informatics was once highly specialized, it now requires a basic understanding across nursing practice and continues to expand as technology grows. Education for nursing informatics ranges from bachelor's to doctoral degrees and board certification, and works in diverse settings including hospitals, education, research and administration.
Here are the key points about standard terminologies/languages and nursing terminologies:
- Standard terminologies/languages allow for consistent representation of clinical data across systems and organizations. This supports aggregation and analysis of data.
- A data set is a collection of related data on a particular topic. In nursing, examples include patient demographics, assessments, interventions, and outcomes.
- The Nursing Minimum Data Set (NMDS) is a standardized set of core nursing data elements that can be shared across systems to support nursing practice, documentation, and research.
- ANA-recognized nursing terminologies include:
- NANDA-I (Nursing Diagnoses)
- NIC (Nursing Interventions Classification
Nursing informatics utilizes information technology to support nursing practice, research, and education. It aims to improve patient care and outcomes through the management and communication of nursing data, information, and knowledge. Emerging trends in nursing informatics include more ubiquitous and integrated technology solutions for clinical documentation, order management, and other areas of the nursing workflow.
This document discusses how sharing economy tools like social media and ICT can improve healthcare outcomes and reduce costs. It argues that connecting healthcare professionals through these tools allows for improved knowledge sharing, more rapid dissemination of best practices, and reduced errors and treatment times. The document reports that studies have found 30-40% reductions in healthcare costs when clinical pharmacists are integrated into care teams using sharing economy instruments like social media. It calls for incorporating sharing economy principles and management training into clinical pharmacist education to further optimize healthcare quality and costs.
Nursing informatics professionals need to be aware of healthcare policy to effectively practice in today's changing healthcare environment. Healthcare policy is established at local, state, and national levels to guide solutions for population health needs. For nursing informatics to be recognized as a specialty, it had to demonstrate a differentiated practice, identify educational programs, develop a research agenda. Standards are critical for electronic health records and the effective exchange of health information. Adoption of technologies like computerized provider order entry and smart infusion pumps can help reduce errors and improve workflow.
This document discusses electronic health records (EHR) and related concepts. It provides information on what EHRs are, how they are accessed and integrated across hospital departments, the types of data they store, and issues related to EHR systems. Key benefits of EHRs include managing health information electronically and displaying data in useful formats. Challenges include completely converting paper records, maintaining data integrity and security, and costs of purchasing and maintaining computer systems. The document also examines nursing minimum data sets and the theories, models and frameworks that guide nursing informatics practice.
Nursing informatics is the use of computers and information technology to support nursing practice, education, administration, research, and clinical care. It involves managing nursing data, information, and knowledge through technologies like electronic health records. The goal is to improve patient health outcomes and support nurses' decision-making. While nursing informatics is still emerging, national nursing organizations recommend nurses become computer literate as healthcare increasingly relies on digital tools and data.
This document discusses nursing informatics as an established area of specialization in nursing. It provides background on the origins of the term "informatics" and defines it as a multidisciplinary field combining various sciences like computer science, information science, and cognitive science. The document then defines health informatics and its subdomains like medical informatics and nursing informatics. Nursing informatics is discussed as the application of information technologies to nursing practice, education, research, and administration. It became a recognized nursing specialty in 1992 with its own distinct body of knowledge. Nursing informatics specialists work in various roles applying their skills and knowledge to improve patient care and the nursing experience.
Read about some of the innovative solutions we offer for better healthcareCGI
Delivering healthcare is one of the most complex human activities. In recent decades, major transitions have taken place in diagnostics, pharmaceuticals and treatments resulting in shorter length of stay in healthcare facilities. The current transition to more personalised care and to longer term managed care pathways means that healthcare IT systems are changing direction. But this change may not happen smoothly.
This monograph provides an assessment of the current hospital-physician landscape and outlines an innovative vehicle for advancing hospital-physician relationships that has the potential to improve care delivery and coordination, clinical quality, and patient cost. Our findings and recommendations address:• Changes in the market place.• The concept of an integrated medical staff model.• The role of operational clinical integration, enabled by an Electronic Medical• Record, toward creating virtual medical staffs.• Benefits to the hospital, physicians, patients and community.• What boards and senior management can do to move toward the model.
Key Takeaways from the first IDC Pan European Healthcare Summit . Post event ...Silvia Piai
This slide deck summarizes the key takeaways from the first Pan European Healthcare Executive Event. Focused on the three themes of the Summit ( Personalization,Integration and Industrialization), the Summit has explored the different dimensions in which ICT is an enabler of a new business model for sustainable healthcare in Europe
SUMARIZE THE NEXT ARTICLE (250 words-APA format) Then respond to the.docxrafbolet0
SUMARIZE THE NEXT ARTICLE (250 words-APA format) Then respond to the 2 analysis at the end (150 words Each)
Geriatric care management reduces Medicare losses
Healthcare costs for the elderly are rising rapidly in the United States. One way for a hospital to control these rising costs is to implement a geriatric care management system. The goal of a system is to change the way the hospital treats medically complex Medicare patients and, thus, reduce unnecessary hospital costs. Such a system requires a process for identifying elderly patients in need of geriatric care management services, treating them efficiently, and assessing the system itself. An effective process usually results in significant cost savings for the hospital as well as improved patient care and satisfaction.
While people aged 65 and older make up 12 percent of the U.S. population, they account or 6 percent overall healthcare expenditures.(a) By the year 2000, the elderly population will be responsible for 58 percent of all hospital days and almost half of all healthcare expenditures.(b) Furthermore, fragmentation of services and funding sources makes it difficult for the elderly and their families to obtain appropriate care.
Thus, care management becomes extremely important in order to effectively address the increasing healthcare needs and costs of elderly Americans.
A geriatric care management system designed to restructure the delivery of care for Medicare patients is one way hospitals can control costs. Such a system is based on the concept that a relatively small proportion of Medicare patients must be targeted for focused care management in order for hospitals to increase the quality of care, avoid financial losses, and prevent poor clinical outcomes. The patients targeted are those who, without focused management, would account for the majority of hospital problems involving excessive resource use and long lengths of stay. Because these patients can be prospectively identified, focused care management techniques can be employed to ensure appropriate and efficient hospital care, thereby reducing lengths of stay and costs. The geriatric care management system thus provides hospitals with ways to reduce a patient's length of stay and to use hospital resources more effectively.
The system focuses on three functions: identification of patients needing care management, geriatric care management intervention, and program performance evaluation. The performance evaluation provides information a hospital can use to improve the use of its resources and reduce patients' lengths of stay.
IDENTIFICATION
The task of identifying Medicare patients who require geriatric care management starts with an analysis of hospital data related to discharge geriatric patients. This process involves analyzing hospital data to identify DRGs and admitting diagnoses as well as characteristics of patients and physicians associated with inappropriate lengths of stay; excessive resource use (such as l.
Rick MacCornack, PhD
Chief Systems Integration Officer
Northwest Physicians Network
CEO
Rainier Health Network
Closing Presentation "ACOs and Health IT: True Delivery System Reform or Another Round of Unintended Consequences?"
A fundamental component of the Affordable Care Act is support for the creation of so-called Accountable Care Organizations. Health care information technology will play a critical role in the reform process, perhaps in ways which are not yet well understood. Using the framework and early experience of a local CMS appointed ACO, this session is intended to ask questions and provide examples for how IT efforts might contribute to healthy, disruptive change in improving medical care delivery.
Learning Objectives:
∙ Consider the unintended consequences of the current IT trajectory in supporting medical care delivery in relation to the mandates of the
Affordable Care Act. Consider some opportunities for future IT contributions and what will need to occur for these opportunities to be tapped.
∙ Reflect on the historical contributions of IT in health and how there will necessarily be a shift in IT development in the future in support of
medical care delivery reform.
This document summarizes supply chain management practices in the healthcare industry. It discusses that healthcare supply chains involve various stakeholders like producers, purchasers, and providers. It also outlines different modes of integration in healthcare supply chains like integration of processes, information, planning, and markets. Some best practices discussed are use of RFID technology, inventory management, procurement processes, information sharing, and revenue cycle management systems. The conclusion states that while improvements have been made, areas like inventory control, procurement, and information sharing require more focus from managers.
Naomi Fulop: What can the evidence tell usNuffield Trust
1) The evidence suggests that integrated care can improve partnerships and focus on case management through increased information sharing, but the impact on costs, admissions, length of stay, and health outcomes is mixed.
2) Successful integration requires clear objectives, an emphasis on clinical rather than organizational integration, supportive local contexts, attention to cultural differences between organizations, and ensuring community services are not disadvantaged.
3) It takes time to fully implement integration and realize potential benefits due to challenges integrating cultures and incentives, and changes may not immediately lead to efficiencies or improved outcomes.
Design and Implementation of Hospital Management System Using JavaIOSR Journals
This document describes the design and implementation of a Hospital Management System (HMS) using Java. The HMS was developed to address challenges with manual hospital management processes and provide benefits like streamlined operations and enhanced patient care. It includes modules for patient management, services management, appointments, the pharmacy, admissions and accounting. The system uses a database to store patient and medical records and allows users to view records, diagnoses and drug prescriptions. Test results showed the HMS met user requirements and provided functionality like registering patients, viewing inpatient data and the drug database. It was concluded the HMS can help hospitals enhance patient care and increase organizational profitability by improving operational control and streamlining processes.
Role of Community Matrons in shifts in settings of care Care City
The document discusses the political context driving healthcare reforms in the UK and the expected shift toward more community-based care delivery away from hospitals. Community matrons and practice nurses can contribute to this shift by participating in whole-systems approaches, sharing knowledge and best practices, and participating in ongoing service redesign. The new model of care should focus on prevention, self-care, coordination, and consistent high-quality care both in specialist and community settings through greater integration between primary and secondary care teams.
IntroductionHealthcare Information Systems are defined as Comp.docxvrickens
Introduction:
Healthcare Information Systems are defined as “Computerized systems designed to facilitate the management and operation of all technical (biomedical) and administrative data for the entire healthcare system, for a number of its functional units, for a single healthcare institution, or even for an institutional department or unit” [9]. The employment of computers in the healthcare sector can be traced back to the 1960s. During the early 1970s, the first attempts to adopt HIS were made [10]. However, in the past, HIS initiatives were limited to the automation of business processes related to (a) administration and (b) healthcare tools and techniques related to various medical procedures as: diagnostic, therapeutic and surgical. During the 80s, innovative patterns in database designs and applications related to HIS, concluded to developments in planning and administration of the healthcare data. In parallel, HIS also introduced low cost financial systems for hospitals under 200 beds in size [11]. It should be noted that the early computerized systems were limited in big hospitals and government projects (military).
As the IT industry flourish the HIS technology was populated with various network applications. The ‘net period with the internet, intranet and extranet affected the communication of data in hospitals especially in the 1990's. In the middle of the same decade the interface engine emerged as a product to support the integration of applications, as best-of-breed applications became harder to manage [12]. New experience and knowledge in applications such as Internet-based telemedicine, personal health records, asynchronous healthcare communication systems, m-health and picture archiving communication systems (PACS) have been applied in the healthcare sector [13]. The growth of the aforementioned applications has lead to the development of healthcare services that have been characterized as complex, redundant and transcriptive [14].
In shedding some light on the underlined services that exist in healthcare organizations, we reviewed the normative on HIS classification. Based on the services that HIS support, Mantzana [7] categorized them into: (a) clinical, (b) non-clinical, (c) pharmaceutical and (d) laboratory. The authors adopt this classification and extend it, by proposing that the patient record category should be added, as it refers to medical records that can be maintained by the citizen or the health professional. This category can be further broken down into (a) Electronic Patient Records Systems (EPR), which are detailed records of encounters between patients and their healthcare providers and (b) Electronic Personal Health Records (ePHR) that are citizen self-maintained health and healthcare records
Extensive and serious quality problems exist in health care delivery processes, resulting in tremendous harms and losses to stakeholders. An increasing concern for improving health care quality has been expressed fro ...
Hospital administration role in quality patient careShaharul Sohan
Hospital administration ensures that hospitals run efficiently and provide quality patient care. Key responsibilities of hospital administrators include overseeing departments, recruiting and managing staff, ensuring compliance with policies and regulations, and coordinating efforts to achieve common goals like quality care. Effective hospital administration requires planning, organizing, staffing, directing, coordinating, reporting, budgeting, supervising, and evaluating all hospital activities and processes. The role of the administrator is crucial to the success of the hospital organization and the care provided to patients.
Exploring the Impact of Information System IntroductionSuelette Dreyfus
This document summarizes a study that explored the impact of introducing an information system at an Australian hospital emergency department. The study conducted a 9-month longitudinal case study at a major trauma center that recently introduced a large-scale IS. Through observations and interviews, the study identified both positive and negative consequences of the IS introduction on key work routines. The findings provide insights for both research and practice on understanding the impacts of implementing new information systems in healthcare settings.
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THIS IS THE FEEDBACK I RECEEIVED. Only one patient responded to my post. Hope this helps
Ryan,
Inadequate levels of nursing professionals were first discussed more than 80 years ago (Whelan, n.d.). Recently, scholars have opined many reasons for the shortage of nurses. Factors such as work stress, burnout, violence against healthcare professionals, a lack of qualified nursing instructors, and nurses unable to adapt to changing technology or clinical environments have been addressed (Haddad & Toney-Butler, 2019). As many nurses may attest, doing more with less can lead to mistakes and dissatisfaction with a nursing career. Ultimately, patient care suffers.
Organizations employ various tactics to help strengthen nurse retention. Halter et al. (2017) suggest strong nursing leadership and assigning preceptors to new nurses can help minimize nursing resignation rates. At the writer’s employment, hospital administrators use several ways to retain nurses. Each quarter, a nurse is recognized for outstanding achievement by receiving a certificate, gift card, and editorial mention on the hospital’s intranet. Moreover, the hospital caters lunch for all employees, dayside and nighttime staff, twice a year for meeting quality targets. Also, the hospital uses various national celebration days such as ice cream, donuts, coffee, bagels, and candy to reward all employees. Creating a level of goodwill and institutional collaboration can help retain nurses and improve job satisfaction (Kurnat-Thoma et al., 2017).
Reference
Haddad, L.M., & Toney-Butler, T.J. (2019). Nursing shortage. StatPearls Publishing.
Halter, M., Pelone, F., Boiko, O., Beighton, C., Harris, R., Gale, J., Gourlay, S., & Drennan, V. (2017). Interventions to reduce adult nursing turnover: A systematic review of systematic reviews. The Open Nursing Journal, 11, 108-123. https://doi.org/10.2174/1874434601711010108
Kurnat-Thoma, E., Ganger, M., Peterson, K., & Channell, L. (2017). Reducing annual hospital and registered nurse staff turnover: A 10-element onboarding program intervention. SAGE Open Nursing, 3. https://doi.org/10.1177/2377960817697712
Whelan, J.C. (n.d.). Where did all the nurses go? Retrieved from https://www.nursing.upenn.edu/nhhc/workforce-issues/where-did-all-the-nurses-go/
By Thomas C. Ricketts and Erin P. Fraher
Reconfiguring Health Workforce
Policy So That Education,
Training, And Actual Delivery
Of Care Are Closely Connected
ABSTRACT There is growing consensus that the health care workforce in
the United States needs to be reconfigured to meet the needs of a health
care system that is being rapidly and permanently redesigned.
Accountable care organizations and patient-centered medical homes, for
instance, will greatly alter the mix of caregivers needed and create new
roles for existing health care workers. The focus of health system
innovation, however, has largely been on reorganizing care delivery
processes, reengineering workflows, and adopting electronic technolo ...
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A2EVIDENCE- BASED PR.docxSANSKAR20
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:2
EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:7
Running head: EVIDENCE- BASED PRACTICE PROPOSAL SECTION A:1
Evidence- Based Practice Proposal- Section A: Organizational Culture and Readiness Assessment
Evidence based practice (EBP) should be fundamental in every healthcare setting in the sense that it ensures decisions based on the best evidence integrated with clinical experience and the various expectations of patients within the healthcare setting (Gale & Schaffer, 2009). The main objective and aim in evidence-based practice protocols are to integrate the clinical expertise with the patient’s perspective and the scientific evidence in a bid to provide efficient and high quality healthcare services which are based on the needs, values, interests and culture of the patients served by the healthcare organization in question. It should be noted that evidence- based practice is essential as it does integrate the perspective of the patient, including values and culture in providing higher quality healthcare supported by research and scientific evidence (Gale & Schaffer, 2009). In essence it ensures the provision of quality and reliability of the healthcare services provided within the healthcare setting.
In regards to the healthcare organization I am currently employed by, and would opt for the implementation of EBP in, the organization is ready for the implementation of EBP in the sense that all stakeholders are in support of implementation of EBP protocols in the various units. Considering the fact that my organization is a very small critical access hospital in rural Georgia, with very limited resources, the organization is ready to fully adopt EBP. All stakeholders believe that such implementation is critical and vital for ensuring quality, and reliable healthcare service that is comprehensive and not only meets but exceeds the needs and expectations of our clients.
According to the survey, some respondents were in full support of the implantation of EBP, while others were not. It should be noted that the category scores for the survey varied due to the fact that respondents had a varied degree of preference when it comes to the implementation of EBP, and changes to practice within the facility. Most respondents responded higher in areas pertaining to changes in providing educational strategies according to EBP guidelines (Melnyk & Fineout-Overholt, 2015). Incorporating EBP within the facility basically requires all the organizational stakeholders to develop a culture of openness and inquiry since such implementation provides very clear parameters for quality and efficient care (Melnyk & Fineout-Overholt, 2015). Some of the notable barriers to the full implementation of EBP include lack of managerial commitment to the full implementation, lack of resources due to the size and financial situation of the facility. Above all lack of interest of upper management to assist staff in ...
This document summarizes a research paper on developing a web-based health care management system. It discusses the need for digitizing hospital management processes to increase efficiency. The proposed system would allow patients to book appointments online, give doctors access to patient records and histories, and help hospital administrators manage daily operations and record keeping in a centralized digital manner. It outlines the objectives, research gaps, literature review on similar systems, proposed system methodology using web technologies, and expected features and results of the new management system. The system aims to streamline hospital management through a unified digital platform.
This document provides an overview of a study on implementing total quality management (TQM) in the healthcare sector in India. It includes an abstract that describes the rising costs and pressures in healthcare that have led organizations to adopt quality management approaches like TQM. The introduction discusses issues in healthcare quality and the need for reforms. The document then proposes a model for TQM implementation that identifies key factors like leadership, momentum, teamwork, training, focus on core processes, and measures.
The document provides a case study report on Alexandra Hospital and how they have leveraged experience design to transform healthcare services and provide quality and affordable care. It discusses how the hospital implemented an enterprise system by integrating different departments and technologies like the Clinical Digital Dashboard and Bed Management System. The integration allowed for real-time sharing of patient information and bed availability across departments, improving workflow and reducing waiting times. The implementation involved selecting appropriate package software, addressing critical success factors like user inclusion and identifying key performance metrics to measure benefits. The successful transformation demonstrates how technology can be used to improve healthcare processes and the patient experience.
Future of hospital design initial perspective - sept 2020Future Agenda
Hospitals of the Future
In partnership with Mott MacDonald we are exploring how hospital design will change in the next decade. Building on insights gained from multiple healthcare expert workshops around the world, this is an initial perspective that share some key thoughts on how and where we may see most change. Starting with context on shifts in healthcare more generally, from slide 28 onwards it includes 22 proposals for future design focus. These range from hub and spoke ecosystems and post-Covid reconfiguration to more flexible spaces and the impact of digital theatres.
As part of a global Open Foresight programme, we are now sharing these views to gain feedback for inclusion in a more detailed point of view that will be published later in the year. If you would like to add in your opinions on which issues will be driving most change in hospitals of the future, we would welcome input either directly to us by email (tim.jones@futureagenda.rg) or via this short survey: https://www.surveymonkey.co.uk/r/J9S8SB6
Many thanks in advance for your collaboration on another key topic for future change.
The document discusses the history and evolution of nursing informatics from Florence Nightingale's time to the present. It covers key topics like the development of hospital information systems in the 1950s-1960s, the definition and purpose of nursing informatics according to the ANA, general and specialist informatics competencies, nursing informatics specialties, the importance of informatics in healthcare delivery, and various informatics applications in areas like critical care, community health, and ambulatory care.
Case study 7 chapter 141. 2. Answer the Case Study Questions (.docxwendolynhalbert
Case study 7 chapter 14
1.
2. Answer the Case Study Questions (found at the end of each case study) in 500-750 words total (not including reference list).
3. Include at least one additional, external reference to sources such as an article or video. Cite the reference(s) in your study.
Your case study will be graded on the following:
Grading: 20 points
Content 80% (how thoroughly and logically you answer the questions, how well you incorporate your reference(s), how well you make arguments and state facts to support your answers).
Spelling/Grammar/Punctuation 20%
14-4 What are the principal risk factors in information systems projects, and how can they be managed?
We have already introduced the topic of information system risks and risk assessment in Chapter 8. In this chapter, we describe the specific risks to information systems projects and show what can be done to manage them effectively.Dimensions of Project Risk
Systems differ dramatically in their size, scope, level of complexity, and organizational and technical components. Some systems development projects are more likely to create the problems we have described earlier or to suffer delays because they carry a much higher level of risk than others. The level of project risk is influenced by project size, project structure, and the level of technical expertise of the information systems staff and project team.
· Project size. The larger the project—as indicated by the dollars spent, the size of the implementation staff, the time allocated for implementation, and the number of organizational units affected—the greater the risk. Very large-scale systems projects have a failure rate that is 50 to 75 percent higher than that for other projects because such projects are complex and difficult to control. The organizational complexity of the system—how many units and groups use it and how much it influences business processes—contributes to the complexity of large-scale systems projects just as much as technical characteristics, such as the number of lines of program code, length of project, and budget. In addition, there are few reliable techniques for estimating the time and cost to develop large-scale information systems.
· Project structure. Some projects are more highly structured than others. Their requirements are clear and straightforward, so outputs and processes can be easily defined. Users know exactly what they want and what the system should do; there is almost no possibility of the users changing their minds. Such projects run a much lower risk than those with relatively undefined, fluid, and constantly changing requirements; with outputs that cannot be fixed easily because they are subject to users’ changing ideas; or with users who cannot agree on what they want.
· Experience with technology. The project risk rises if the project team and the information system staff lack the required technical expertise. If the team is unfamiliar with the hardware, system software, applica ...
Case study 7 chapter 141. 2. Answer the Case Study Questions (.docx
Show
1. Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Developments in Hospital Management and Information Systems
Martin Smits and Gert van der Pijl
Tilburg University, School of Economics
PO Box 90153, 5000 LE Tilburg, The Netherlands
Phone: +31 13 4662188, Fax: +31 13 4663377
m.t.smits@kub.nl, vdrpijl@tref.nl
Abstract changes over the last 20 years, and how this related to
Hospital management and business processes in changes in hospital information systems (IS).
An interesting question is how organisational,
hospitals have changed considerably over the past
managerial and IT developments take place in hospitals,
twenty years, as did the use of hospital information and how these developments influence each other, in terms
systems. In this paper a ‘stages of growth’ of impact, alignment, and reinforcement. For instance,
framework is developed and used to describe the hospital management can focus on centralised financial
relations between types of hospital management and control, on decentralisation of budgets, on co-ordination of
the use of hospital information systems over time. In the primary medical processes, or on external networking
this paper the framework is applied in a case study with other hospitals or medical services. The latter often
of a large general hospital in the Netherlands. It occurs in combination with a focus on control of the total
costs of medical services and health care for specific
was found that the use of IS in this hospital did not
groups of patient, often indicated as clients.
develop according to the needs and developments in Recently several hospitals in the Netherlands have
the hospital organisation over the past decade. reorganised by combining different cure and care processes
Key words: health care, hospital management, hospital into patient oriented clusters. In this paper an overview is
information systems, stages of growth given of recent developments in hospital management and a
framework is presented to relate three types of hospital
1. Introduction. management to the use of IT in a hospital. In doing so, a
Health care in the Netherlands, as in many other ‘stages of growth model’ [Nolan, 1992] is created,
countries, is confronted with a growing demand for medical resembling the model presented by Galliers and Sutherland
treatments and services, due to factors such as a ‘greying’ [1991], but tailored to the developments in hospital
population, and higher individual standards for the quality organisation and use of IT in hospitals. The framework is
of life [Fellegi, 1988; Dekker, 1988; Mooney and Salmons, applied in a case study of a hospital in the Netherlands.
1994]. Health care has been an issue of growing importance Ultimately the framework is aimed (i) to provide guidelines
for national governments [Miller, 1994]. Many national and for transforming information systems while transforming
regional health care plans have been developed in the past hospital management, and (ii) to compare hospitals
decades, in order to control the costs, the quality, and the management and the use of hospital information systems in
availability of health care for all citizens. These plans have practice.
created a complex environment for local health care First, the developments in hospital management in the
institutions. This paper is focused on the way hospital past decade are described in section 2., and the
management has coped with the various environmental developments in hospital information systems in section 3.
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2. Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Table 1. Management actions to improve quality and cost effectiveness of care services in European
hospitals by 1998 (Andersen Consulting, 1993)
actions agree %
implement IT to support administrative tasks 88
conduct efficiency drives in service departments 86
implement IT to support patient care activities 80
introduce revised procedures for determining nursing staff requirements 75
redesign patient care procedures 75
redesign administrative procedures 75
use documented care plans and treatment protocols 74
establish multi-disciplinary care teams 71
The conceptual framework to describe relations between The responses to the challenges facing national health
hospital management and hospital information systems is care systems have wide ranging implications. Hospital
presented in section 4, and applied to describe a hospital managers respond to falling revenues by re-organising and
case situation in section 5. redesigning the structure and processes in their hospitals, to
improve the cost and quality of the care they provide. It is
2. Developments in hospital management expected for the coming years that the number of inpatient
beds will continue to decrease and resources will continue
2.1. National health care. to shift from hospitals to primary care. Hospitals will strive
Traditionally, health care in the Netherlands is supplied to offer more outpatient and ambulatory services, and the
by privately run institutions. Health care in the Netherlands operational management will be more and more
consists of primary care (provided by general practitioners, decentralised. Hospitals consider co-operating with other
dentists etc.) and hospital and specialist care provided by care organisations. A survey, held under 2752 European
hospitals and medical specialists. The government influence hospital managers, identified a range of actions which were
and interference in public health care was formalised by an most likely to take place by 1998 (table 1) [Andersen
amendment to the constitution in 1983 “the government shall Consulting, 1993].
take measures to promote public health”. It is the task of the These changes may challenge many of the traditional
government to ensure that the health care system is roles in a hospital, including those of doctors, nurses, and
accessible to all. other disciplines. This will consequently require
In 1983 the system of budget financing for hospitals was management to work closely with health care professionals
introduced, based on cost without regard to effectiveness. resulting in an effective institution.
Since that point institutions have, periodically and in Modern hospitals nowadays supply professional
advance, been assigned a budget to finance the services and services, in stead of products. Until the 1980's a patient
facilities they provide. In the years after 1983, cuts have actually purchased production capacity of the hospital
been made, squeezing the budgets. organisation, often through an insurance scheme. Hospitals
Under a budget system the expansion of medical had a high quality technological infrastructure in order to
activities imposes a heavy burden on the manpower and sell medical capacities. This organisational type is now
material resources of an institution, so that priorities have to under pressure, including decreasing financial budgets, due
be set. On account of the fact that hospitals may in many to the changes in society, politics, and population. Hospitals
ways be regarded as a business that makes facilities move in the direction of a social market organisation
available to specialists as independent practitioners, [Wulff, 1996]. In the near future, traditional hospitals in the
hospital management is generally not well equipped to set Netherlands will be replaced by day care, home care, and
priorities. This resulted in an enormous workload for short stay facilities. Home care services are provided to
nursing staff, further increased by the reduction in the patients requiring basic care. Hospitals will continue to
average term of nursing and substantial increases each year focus on specialised services for specific groups, requiring
in the total volume of treatment provided to patients. high technology facilities. Until now hospitals do not use
[Dekker, 1988] quality measurements nor performance results.
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3. Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
medical specialists cure processes
policlinical diagnosis and
policlinical surgery and/or
consult planning of
treatment clinical treatment
and diagnosis clinical treatment
ambulant care
and
first aid
policlinical clinical patient
patient registration registration clinical patient planning of
and and care planning surgery facilities
appointment planning waiting lists
hospital care and support processes
yearly evaluation
budgetting of budgetted
per dept. activities
Figure 1. Relations between the two primary processes in hospitals.
management plays an important -intermediate- role in the
2.2. Core processes in a general hospital national health care management network [Van der Zwan,
Most employees in a hospital work in the primary care 1993; CMCZ, 1994].
processes. Due to the health care laws in the Netherlands up On a national level, the government aims to control the
to 1997 most medical specialists are not employees of a costs of health care by taking relatively detailed budgetary
hospital, but work as private practitioners, making use of measures, by drastic cuts in specific budgets, limiting
hospital facilities. Figure 1 gives an overview of relations numbers of specific treatments, and introducing out of
between the two primary processes in hospitals: the pocket payments by patients. In stead of these detailed
specialist cure process, and the care and support process. measures, hospitals prefer more global and long term
The figure demonstrates that patients and information about governmental measures, in order to be more able to adjust
patients are exchanged between the two primary processes. hospital planning to the national and environmental rules.
Both in the field of quality assurance in the cure process and Hospitals can be regarded as professional bureaucracies
the care and support process and in the field of management [Mintzberg, 1989]. Hospitals can also be regarded as
information this gives rise to specific problems of co- organisations based on high technology and information
ordination. These are enhanced by the fact that the medical intensive processes. According to Lawrence and Dyer
specialists act as private entrepreneurs in the hospital [1982] such organisations are not hierarchically structured
environment [Postma, 1989]. bureaucracies, but are often based on democratic control
mechanisms with institutionalised stakeholder influence in
2.3. Hospital management decision processes. It is interesting to investigate if
Within the rules of national legislation and regulations, hospitals nowadays have a bureaucratic or a democratic
hospitals in the Netherlands are responsible for internal control structure. To support this investigation we have
hospital management. Long and medium term hospital defined three types of hospital management: capacity
planning is adjusted to regional and local developments, management, functional management, and network
and hospital budgets are allocated to resources. Hospitals management, as given in table 2.
negotiate with local government and insurance companies In the ‘capacity management’ category a patient actually
for the planning of clinical and outdoor services. Hospital purchases production capacity of the hospital organisation,
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4. Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Table 2. Identification of three types of hospital management
Capacity management functional management network management
(process management)
services to customers broad specialists sub specialists networked specialists
success factors availability and reli- correct diagnosis and quality of life and well
ability treatment being
knowledge owners medical specialists medical sub-specialists networks of medical
professionals
knowledge sources clinical training and scientific approach, knowledge networks,
experience academic training and electronic networks
journals
management control and financial (internal) functional (external) process
orientation reporting management management and mar-
keting
co-ordination mecha- top down, centralised decentralised clusters standardisation and
nisms communication
often through an insurance scheme. Hospitals maintain a management [Juran, Demming] are used in this type of
high quality technical infrastructure in order to sell medical organization. So called ‘Diagnosis Treatment
capacities, and support medical specialists. This Combinations’ [Baas, 1996] (resembling Diagnosis
organisational type is now under pressure, because of Related Groups) describe medical hospital products that
decreasing financial budgets and changes in society, can be ‘purchased’ by patients. Cost of care can be
politics, and patient expectations. calculated in terms of ‘production units’ [NZI 1994]
Hospitals can respond to these pressures by transforming Hospital structures tend to change nowadays from
into ‘functional specialisation’ In this way the organisation ‘capacity ’ to ‘network management’, or in terms of
tries to reduce costs and to improve the quality of Minzberg from ‘management by hierarchy and formal
specialised medical services. control’ to ‘management by network and collective
A more recent response of hospitals is to move into control’[Mintzberg and Glauberman, 1995].
‘network management’. In this organizational type a hospital
is seen as only one piece of a more elaborate network of 3. Developments in hospital information
medical care [Wulff,1996]. A networked hospital tries to systems.
improve it's 'input-output' or 'market' relations with primary
care physicians and for instance 'elderly care and home care 3.1 Actual situation
institutes'. Also internally the hospital is run more like a
networked organization in which coordination between A survey under 2752 European hospital managers
internal and external processes is the main focus of indicates that technology can substantially influence hospital
management. In this type of organization business process activities and services, as shown in table 3 [Anderson,
redesign [Hammer and Champy] and supply chain 1993]. It is also expected that health care budgets and
management [Venkatraman, 1997] can be used to improve funding will depend significantly on sophisticated patient
the efficiency and effectiveness of hospital services. The and diagnosis classifications. The use of IT in diagnostic
effectiveness of the services is measured in terms of the and treatment processes will add to the development of
well being of the patients. Well known principles of quality networks of clinical, hospital and health care processes.
Table 3 . Preferred IT implementation in European hospitals by 1998 (Andersen, 1993).
IT implementation preference %
computerised reimbursement procedures 86
executive information systems 79
communication between hospital departments 74
computerised medical records 68
library information directly available to doctors 65
electronically stored radiology images 64
computerised medical and nursing plans 63
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5. Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
The communication processes are critical for improving the administrative, the medical technical- and the cure and care
links between health care demands and providers. processes were isolated individual systems supporting
Until recently, in the Netherlands, the focus of IT in isolated parts of the business processes. Computer
health care was on personnel, logistics, and finance. It is technology mainly existed of mainframes and of intelligence
expected that in the coming years the focus will be on the built into individual medical systems.
care process, including electronic medical files, and quality In the second era, mainly due to the enormous costs of
measurements. It is also expected that the older information investment in IT, hospital management felt more and more
systems will become more integrated with the new, primary responsible for investments in IT and important IT
process oriented applications of IT. Of major concern at decisions were centralised. The IT function was separated
this moment is the financing of the development and the from the business function, either in the form of separate
governance of the new hospital information systems [Wulff, profit centres or even in the form of independent external IT
1996]. suppliers. Internal integration of systems started in all
sectors. IT technology started to be distributed in internally
3.2. Technological developments over 30 years linked administrative and primary applications.The third
In this paragraph a framework is presented to classify era, emerging nowadays in the Netherlands, shows
the use of IT in hospitals. The framework is based on the interconnections of hospital information systems through
‘stages of growth model’ [Nolan, 1992]. The framework external networks, with systems of other medical
uses three main eras or stages described by Nolan, without organisations like insurance companies, general
going into detailed sub-stages in each era. Another practitioners, pharmacists, etc. Because business unit (or
difference with the Nolan model is that the criteria and cluster) oriented systems can be superimposed on the
properties of each era are specific for the hospital situation general IT infrastructure of the hospital, some investment
and the national health care network. As a result we arrive decisions are taken by the hospital management, and others
at the stages of development of IT as described in table 4. by cluster management. Often decisions on IT are made in
The original hospital information systems were designed close co-operation with external IT providers. Also in this
and constructed by internal IT departments often supported era integration of IT in medical systems and in cure and
by external software houses. Primary responsibility for care systems reaches the full extend of its possibilities. In
design, deployment control and maintenance of IT were this third era, provision to IT to hospitals is client oriented,
with the IT department. Hospital applications, both in the process oriented, integrating applications along the lines of
Table 4 developments of IS in hospitals (based on Nolan, 1992)
DP era IT era network era
role of transaction pro- information processing information delivery
administrative IT cessing
value of IT data information knowledge
responsibility head of IT depart- hospital management heads of product-oriented clusters
ment top and BU management
infrastructure monolithic main- distributed 3 layer architecture
frame
users not involved observer participant
systems design in-house design and many suppliers with limited number of suppliers with
development many independent limited number of integrated
products hospital information systems
organisation IT department privatised IT function co-sourcing
role of IT in none isolated applications integrated applications supporting
primary cure and all cure and care
care processes
role of IT in IT embedded in interconnected equipment and
medical equipment stand-alone medical interconnected IT,
equipment
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6. Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
business processes and integrating administrative, medical analysing (i) the hospital management style, by identifying
and cure and care systems. Further more the technology the properties listed in table 2, and (ii) the information
enables flat internal organisation structures and integration systems approach, by using the properties in table 4.
of the hospitals activities in local, regional and national Position A indicates a hospital showing the capacity
healthcare systems. management style, combined with the computer management
style. B, C, and D show other possible combinations.
4. Conceptual framework Drawing the positions of a hospital at various moments
In this paper we use the framework only to describe in figure 1 can indicate situations of impact and alignment of
hospital management and information systems. Thus our IT [Henderson and Venkatraman, 1993; Smits and Van der
criterion for success is the degree to which we are able to Poel, 1996]. A hospital that moves from position [A] to [B]
classify actual hospital situations in term of the descriptions and then to [C] shows alignment of IS to hospital
the axes of the framework prescribe. By doing this we management. Impact of IS has occurred with a move from
analyze combinations of management and IS that are found [A] to [D] to [C]. Alignment starts from the existing
in the real world. In later parts of the research we can try to business organisation, and its needs, generating the
describe costs and benefits of the different situations and supporting IT services. Impact starts from IT opportunities
possible paths of growth and change. The approach taken is and generates changes to the overall business plan and the
similar to the one presented in Galliers and Sutherland hospital processes.
[1991]. The main difference being that our framework and In this way the grid can be used to follow the
analysis are dedicated to the use of IT in hospital developments in a hospital over time. Obviously, the grid
organizations. The advantage of this approach is that can also be used to compare several hospitals at a given
developments in IT and developments in organization are moment. In the next section we use the framework to analyse
brought together in one general framework. This is in line the situation a specific hospital in the Netherlands in 1987,
with recent publications on IS strategy that argue that 1990, 1993 and 1997.
changes in IT and changes in organization should go hand in
hand (Feeny; Earl). 5. The case: maasland hospital.
A hospital can be positioned in the grid in figure 1 by A case study was done in 1997 by analyzing a selection
network
focus
IS approach [D] [C]
IT focus (1993)
(1997)
(1990)
[A] [B]
data processing
(1987)
capacity functional network
management management management
hospital management style
Figure 2. Grid showing the relations between hospital management and information systems (the
numbers between brackets refer to section 5).
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7. Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
of the hospital documents and reports over the past 20 in 1993, the senior manager of the IS department mentioned
years, and by interviewing several managers and medical repeatedly the growing problems with the integrated
specialists involved. The changes in hospital management hospital information system. In his view the system would
and IS are given in sections 5.1 and 5.2.Then the Maasland not be able to deliver the information services needed by
hospital is positioned in the framework in 5.3. The final the new hospital management structure. Hospital general
section 5.4 presents the findings of a second round of management decided not to focus on information services,
interviews focusing on the actual problems in hospital and made the IS department, including further development
management, primary processes, and information systems. of the integrated hospital information system, a sub-unit of
the facilities department.
5.1. Changes in hospital management.
5.3. Positioning Maasland hospital in the
The Maasland hospital was founded around 1900 in
Limburg in the south of the Netherlands. Until 1993 the framework
hospital management style was the classical model of The developments in the Maasland hospital can be
capacity management, primarily based on financial control. visualised in figure 1 as follows.
Hospital activities such as nursing care, catering, cleaning, 1987: the hospital is organised according to a
administration, and laboratories, were all managed bureaucratic structure, aiming at control of capacities and
separately, in different operational units with many facilities to support medical specialists. IT is dispersed and
hierarchical levels. Communication in the hospital was focused on administration. The IT department is part of the
complex, including complex regulations, and extensive use financial department. The hospital information system was
of standards and paper work. built by an external supplier. Operations, control and
By the end of the 1980s the hospital refocused on its maintenance are done internally.
core activities. Next to the existing classical departments, 1990: the hospital focused on core activities
new departments were formed, such as the unit for Clinical and functional management by creating different
Treatment, and the unit for Outpatient Treatment. In 1993, departments for clinical and outdoor treatments. IS gets
the new general manager of the hospital reorganised the attention of general hospital management, aiming to develop
hospital into new ‘product oriented’ departments or an integrated hospital system, with still a focus on financial
clusters. Each cluster has units for cure, care, and and administrative functions. IT management reports
management having shared responsibility for a set of health directly to general management. Again an external supplier
care services and budgets. was invited to build the system. IT operations are still
executed, controlled and maintained internally. IT
5.2. Changes in information systems processing power is still centralised
Automated information systems were used in the hospital 1993: medical cure and care functions have
since the 1970s in the financial department. In the hospital representatives in the hospital board. Friction occurs
laboratory a stand alone system was installed for between capacity management (1987) and the functionally
administrative purposes in the beginning of the 1980s. In organised cure and care (1990). IT supports various
1987 the first ‘integrated hospital information system’ was medical activities, and almost each administrative process.
installed, based on a turn key contract with a supplier. The Incidentally, IT is used as a change agent: the use of EDI to
supplier went bankrupt in 1989. In 1990 the hospital communicate with general practitioners, and the
decided to develop it’s own hospital wide information development of electronic medical files to support the
system, including the support of various medical and primary processes. The hospital is reorganised. IT
paramedical activities in the hospital. In 1993 a large management now reports to the head of the ‘facilities’
number of medical support activities were supported by the management and thus at greater distance from general
new system. Over 200 application modules were used in a management. IT systems are still operated, controlled and
network of 750 workstations. IS was heading for the maintained internally. Information systems are obtained
development of ‘integrated hospital wide information from many different suppliers. IT processing power is
systems’. The hospital has never had a (large) record of distributed now.
outsourcing IT activities. 1997: the hospital is now a ‘cluster
Organisationally, the IS department had been part of the organisation’, with only three hierarchical layers. Budgets
financial department in the 1970s. In the 1980s the IS and responsibilities are decentralised and delegated to
department became a department, reporting directly to the management teams. Each team consists of cure, care, and
hospital board. During the hospital reorganisation process administrative functions. Sometimes attention is given to co-
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8. Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
operation with local partners and health care providers. IT The general conclusion is that information systems have
is slightly changed since 1993: management requests have changed insufficiently to follow the organisational
lead to new ‘island’ applications, stand alone, and developments in the Maasland hospital, as well as the
uncontrolled. This shows that some IT decisions are taken developments in the national health care system.
on the level of cluster management while a general
supporting IT structure is lacking. This hampers the 6. Conclusions
integration of the separate systems. IT systems are still In this paper relations were described between changes
operated, controlled and maintained internally. Even more in hospital management and the use of hospital information
external suppliers are involved in the delivery of systems between 1980 and 1995.
information systems. IT processing power is highly The case of the Maasland Hospital shows that
decentralised. reorganisation processes occurred without management
The hospital management and IT situations in the years awareness for information systems. Hospital management,
1987, 1990, 1993, 1997 are drawn in figure 1. organisational structure, and primary processes have been
changed in several steps in the last two decades. Hospital
5.4. Actual problems in the maasland hospital
information systems could not provide the information
Having positioned the Maasland Hospital in the services that were needed, neither in the actual situation,
framework, new interviews were held to asses managers nor in previous situations.
opinions regarding the quality of information services. A framework was used to evaluate management and IS
Based on growing complaints from various departments and developments in hospitals. In the Maasland Hospital case
clusters, the hospital board decided to investigate the study the framework provides an overview of impact and
information services in the hospital. The aim was to make alignment over time; and gives an overview of the actual
an inventory of complaints and needs. Twenty five situation and discrepancies between hospital management
interviews were held with 13 medical specialists and 12 and IS. Further research and application of the framework
senior managers. It was found that: in other hospitals must be done to provide guidelines for
the respondents don’t see any coherence in information planning and prioritisation processes for IS in hospitals.
services provided. The reorganisation in 1993 was not
followed by a change of administrative processes, nor Acknowledgements
information systems. The management structure is based on The authors want to thank W.A.M. van Es and J.A.M.
decentralised control, while the administrative processes van Vlodrop for their work and contribution to the
and IS are still based on centralisation. The board appears investigations.
to be focused on administrative processes in stead of care
and cure. Literature
there is a lack of information to support the primary Anderson Consulting (1993): the future of European health
processes. Medical specialists have a need for electronic care. Report for the European Community (HCEC).
medical files to reduce the paper work involved in the Benson, Parker and Trainor (1989): information strategy and
hospital administrative processes, to reduce duplication of economics. Prentice Hall.
patients medical files as well as the care and administrative Dekker, W. (1988): Changing health care in the Netherlands.
files, and to fasten the treatment processes. The respondents Report of the Committee on the Structure and Financing of
suggest data management and files to be patient oriented in Health Care. Report of the Ministry of Health Care (ISBN 90 346
stead of specialist or departmental orientation. 18757), The Hague
management information is not adequately combined Fellegi, I.P. (1988): can we afford an ageing society ?
Canadian economic observer. October 1988, 4.1-4.34.
with the administrative processes. Paper based information
Galliers, R.D.; Sutherland, A.R. (1991): information systems
processing is too slow, and goes through too many steps. IT management and strategy formulation: the ‘stages of growth’
support for operational planning in clusters and departments model revisited. J. of IS (1): 89-114.
is lacking. Groenendal, Ingenhoest, Jansen, Keijzer (1997): Strategy and
no explicit contracts exist between central hospital management of organisations in health care. Tilburg Institute of
management and the decentralised medical clusters and Advanced Studies in Management, Tilburg University.
departments. There is no explicit agreement between Grossman (1994): Finding a lasting cure for US health care:
management levels on the performance measures of clusters Harvard Business Review, Sept 45-
and department. Budgets form the basis for cure and care,
and are adjusted yearly in an incremental way.
0-7695-0001-3/99 $10.00 (c) 1999 IEEE 8
9. Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Proceedings of the 32nd Hawaii International Conference on System Sciences - 1999
Henderson, J.C., Venkatraman, N. (1993): Strategic Mooney, G.; Salmond, G. (1994): A reflection on the New
alignment: leveraging information technology for transforming Zealand health care reforms. Health Policy (29): 173-182
organisations. IBM systems journal32 (1) 4-16. Nolan, Norton & CO (1992): ondernemingsstrategie en
Kim K. Kyu, Michelman, J.E. (1990): an examination of informatie technologie. (NNC & VSB), The Hague, the
factors for the strategic use of hospital information systems. MIS Netherlands.
Quarterly, June, 200-215. Postma (1989): Strategic decision making in hospitals (in
Lawrence, P., Dyer, D. (1982): Renewing Dutch). Thesis, University of Groningen, Wolters Noordhof,
American industry. The free press, New York. Groningen.
Miller R.H. (1994) Managed care plan performance since Smits, M.T., Van der Poel K.G. (1996): the practice of
1980. Journal of the American Medical Association (271) no 19. information strategy in six information intensive organisations in
May 18, pp 1512-1519 the Netherlands. Journal of Strategic Information Systems 5
Mintzberg (1989): Mintzberg on Management. The Free (1996) 93-110.
Press. Van der Zwan (1993): Health care in focus. (in Dutch)
Mintzberg and Glauberman (1995): managing the care of Nationaal Ziekenhuis Instituut 193.890.
health and the cure of disease. In: proceedings of ‘Managing Wulff (1996): Design of hospital organisations. Thesis,
Health Care’, Amsterdam. Eindhoven Technical University.
0-7695-0001-3/99 $10.00 (c) 1999 IEEE 9