Health Informatics (formerly Computers in Health Care)

Kathryn J. Hannah Marion J. Ball Series Editors

Springer Science+Business Media, L L C

Health Informatics (formerly Computers in Health Care)

Series Editors: Kathryn J. Hannah Marion J. Ball

Dental Informatics Integrating Technology into the Dental Environment L.M. Abbey and J. Zimmerman

Aspects of the Computer-based Patient Record M.J. Ball and M.F. Collen

Performance Improvement Through Information Management Health Care's Bridge to Success M.J. Ball and J.V. Douglas

Strategies and Technologies for Healthcare Information Theory into Practice M.J. Ball, J.V. Douglas, and D.E. Garets

Nursing Informatics Where Caring and Technology Meet, Second Edition M.J. Ball, K.J. Hannah, S.K. Newbold, and J.V. Douglas

Healthcare Information Management Systems A Practical Guide, Second Edition M.J. Ball, D.W. Simborg, J.W. Albright, and J.V. Douglas

Clinical Decision Support Systems Theory and Practice E.S. Berner

Strategy and Architecture of Health Care Information Systems M.K. Bourke

Information Networks for Community Health P.F. Brennan, S.J. Schneider, and E. Tornquist

Introduction to Clinical Informatics P. Degoulet and M. Fieschi

Patient Care Information Systems Successful Design and Implementation E.L. Drazen, J.B. Metzger, J.L. Ritter, and M.K. Schneider

Introduction to Nursing Informatics, Second Edition K.J. Hannah, M.J. Ball, and M.J.A. Edwards

Computerizing Large Integrated Health Networks The VA Success R.M. Kolodner

Organizational Aspects of Health Informatics Managing Technological Change N.M. Lorenzi and R.T. Riley

(continued after Index)

Marion J. Ball Judith V. Douglas Editors

Performance Improvement Through Information

Management Health Care's Bridge

to Success

With a Foreword by John G. King

With 14 Illustrations

Springer

Marion J. Ball, EdD Adjunct Professor Johns Hopkins University School

of Nursing Baltimore, MD 21205, USA

Judith V. Douglas, MA, MHS Adjunct Lecturer Johns Hopkins University School

of Nursing and Associate First Consulting Group Baltimore, MD 21210, USA

Series Editors:

Kathryn J. Hannah, PhD, RN Vice President, Health Informatics Sierra Systems Consultants, Inc. and Professor, Department of Community

Health Science Faculty of Medicine The University of Calgary Calgary, Alberta, Canada

Marion J. Ball, EdD Adjunct Professor Johns Hopkins University School

of Nursing Baltimore, MD, USA

Library of Congress Cataloging-in-Publication Data Performance improvement through information management : health care's

bridge to success / edited by Marion J. Ball, Judith V. Douglas, p. cm. — (Health informatics)

Includes bibliographical references and index. ISBN 978-1-4612-6800-0 ISBN 978-1-4612-0519-7 (eBook) DOI 10.1007/978-1-4612-0519-7

1. Medical informatics. 2. Health services administration. I. Ball, Marion J. II. Douglas, Judith V. III. Series. R858.P47 1999 362.1'068'4—dc21 98-24445

Printed on acid-free paper.

©1999 Springer Science+Business Media New York Originally published by Springer-Verlag New York, Inc. in 1999 Softcover reprint of the hardcover 1st edition 1999 All rights reserved. This work may not be translated or copied in whole or in part without the writ­ten permission of the publisher, Springer Science+Business Media, L L C except for brief excerpts in connection with reviews or scholarly analysis. Use in con­nection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the former are not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone. While the advice and information in this book are believed to be true and accurate at the date of go­ing to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein.

Production coordinated by WordCrafters Editorial Services, Inc., and managed by Francine McNeill; manufacturing supervised by Jeffrey Taub. Typeset by MATRIX Publishing Services, Inc., York, PA.

9 8 7 6 5 4 3 2 1

ISBN 978-1-4612-6800-0

To Jim Reep, for his vision, professionalism,integrity, energy, and warmth

Foreword

Recent national surveys suggest an upturn in spending on information technol­ogy in health care and throughout corporate America. As senior healthcare ex­ecutives, we cannot make these investments without justifying them in terms ofwhat they will yield. We are charged with improving performance and deliver­ing top-quality care. For us, buying and managing technology are only means toan end. Clearly, we have a difficult task, and we need the help of other practi­tioners in health care in understanding how to proceed.

To begin, performance improvement requires that we understand the forces,structures, and strategies that shape the healthcare marketplace. It demands thatwe change how we deliver care-that we redefine our mission and goals to pre­pare for the future. To achieve what we envision, we must deliberately and me­thodically redefine processes, restructure information, and redesign work flow.

Traditionally, efforts to improve care focus on operations at hospitals and clin­ics. These functions are basic to health care and assume added significance inthe current environment, with its emphasis on integrating care delivery networks.Areas of fragmentation persist in health care, as do pressures to increase pro­ductivity and improve financials. Information management systems can supplycritically needed linkages; increasingly robust infrastructure and applications cansupport integration efforts. In addition, new technologies like call centers offerinnovative solutions. Clearly, we can do much to improve operational effective­ness.

The most remarkable gains in performance improvement will come from ar­eas we are only now beginning to explore--clinical decision making for care­givers and patients alike. Today we are putting into place computerized patientrecords, clinical data repositories, and web-based applications. Physicians andphysician managers becoming more comfortable with the technologies give themthe information they need for decisions, even supply them with clinical remindersand alerts. Tomorrow, when the repositories are well populated and patientrecords can be confidentially shared on the web, physicians will be able to de­liver care that is evidence-based, linked to the best medical knowledge.

Today, healthcare organizations are beginning to pay attention to customer sat­isfaction. They are collecting data, surveying patients, and offering 24-hour dial-

vii

Vlll Foreword

a-nurse services. Real customer service offers great opportunities, largely un­tapped to date. For example, interactive videos can help patients share in mak­ing decisions about their treatment, and web-based modules can make patientsactive partners in managing their own health. For healthcare organizations, thesenew uses of information technology will transform health care, just as the com­puterized reservations process altered the airlines.

As always, the future holds risks. Fortunately, it also offers opportunities tothose of us who understand the forces of change and seize upon transformationalprocesses and enabling technologies to reinvent our world. To the authors of thisbook, who have helped us do all of these things, we offer our thanks. They havemade our tasks easier.

John G. KingChief Executive Officer

Legacy Health SystemPortland, Oregon

Series Preface

This series is directed to healthcare professionals who are leading the transfor­mation of health care by using information and knowledge. Launched in 1988 asComputers in Health Care, the series offers a broad range of titles-some ad­dressed to specific professions such as nursing, medicine, or health administra­tion; others to special areas of practice such as trauma or radiology. Still otherbooks in the series focus on interdisciplinary issues such as the computer-basedpatient record, electronic health records, or networked healthcare systems.

Renamed Health Informatics in 1998 to reflect the rapid evolution in the dis­cipline now known as health informatics, the series will continue to add titlesthat contribute to the evolution of the field. In the series, eminent experts serv­ing as editors or authors offer their accounts of innovations in health informat­ics. Increasingly, these accounts go beyond hardware and software to address therole of information in influencing the transformation of healthcare delivery sys­tems around the world. The series also will increasingly focus on "peopleware"and the organizational, behavioral, and societal changes that accompany the dif­fusion of information technology in health services environments.

These changes will shape health services in the next millennium. By makingfull and creative use of the technology to tame data and to transform informa­tion, health informatics will foster the development of the knowledge age in healthcare. As coeditors, we pledge to support our professional colleagues and the se­ries readers as they share advances in the emerging and exciting field of healthinformatics.

Kathryn 1. HannahMarion J. Ball

ix

Preface

We have long believed that infonnation technology, used wisely, can transfonnhealth care. To help make this happen, we left academia and joined the world ofhealthcare consulting, where we have been privileged to work with the peoplewho effect real changes in how care is delivered. They have generously con­tributed their expertise to this book and to its companion volume, Strategies andTechnologies for Healthcare Information: Theory into Practice.

This volume, Performance Improvement Through Information Management,presents key concepts clearly and forcefully, beginning with an insightful lookat the current market environment. Subsequent chapters discuss transfonnationalprocesses and enabling technologies. Throughout the volume, the focus is onmaking health care operationally effective by improving the processes involvedin providing care and services. Infonnation technology, our contributing authorsunderstand, plays the role of enabler-a critical role to be sure, but always a sup­porting role, never the lead.

Weare convinced that this new title will be an invaluable resource for chiefexecutive officers and the entire healthcare team working to improve health carefor patients worldwide. We are proud to offer this volume to our readers, newand old alike.

Marion J. BallJudith V. Douglas

xi

Acknowledgments

This volume reflects the commitment and the expertise of those who contributedto it, most notably the chapter authors. Their work was supported throughout byJim Reep, Luther Nussbaum, Philip Lohman, and Carol Moore, who helped de­velop the conceptual framework for the book, and Jennifer Lillis, who helpededit the pages that follow.

Other colleagues, who gave of their time to review the chapters and suggestimprovements, have added richness and value to the content. Our thanks to allof the experts who serve on our review board: Horni Arabshahi, Dean Arnold,Dave Beaulieu, Marion Ball, Ray Bell, Bob Bonstein, Jim Burke, Joe Casper,Dave Chennisi, Mike Cornick, John Conway, Jerry Davis, Dave Dimond, SteveDitto, Erica Drazen, Jim Edgemon, Jim Gaddis, Hal Gilreath, Mike Gorsage,Sharon Graugnard, Kent Gray, Steve Heck, Gordon Heinrich, Barbara Hoehn,Todd Hollowell, Tom Hurley, Beth Ireton, Anna Kanski, Tom Kelly, PeterKilbridge, Rick Kramer, Christi Liebe, Bill Looney, John Manson, KeithMacDonald, Scot McConkey, Marcia McCoy, Jim McPhail, Jane Metzger, JeffMiller, Jerry Mourey, Mychelle Mowry, John Odden, Dave Pedersen, LesliePerreault, Briggs Pille, Jim Porter, Nabil Qawasrni, Ted Reynolds, Keith Ryan,Debra Slye, John Stanley, Paul Steinichen, Don Tompkins, Pankaj Vashi, TimWebb, Dale Will, Dave Williams, Roy Ziegler, and others.

Marion J. BallJudith V. Douglas

xiii

Contents

Foreword vii

Series Preface ix

Preface xi

Acknowledgments xiii

Part I-Market Environment

CHAPTER I-Market Forces and the Environment 3

James Reep and Philip Lohman

CHAPTER 2-Market Structure 21

Roice D. Luke and Ramesh K. Shukla

CHAPTER 3-Strategy Analyses and Implications for Information Systems 43

Roice D. Luke and Ramesh K. Shukla

Part 2-Transformational Processes

CHAPTER 4-Planning for Performance 65

Richard N. Kramer and Judith V. Douglas

CHAPTER 5-Enterprise Information Architecture 75

Tom Hurley and Donald Tompkins

CHAPTER 6--Process Design 84

David Beaulieu

CHAPTER 7-Care Delivery and Care Management 98

Barbara Hoehn and Leslie Perreault

CHAPTER 8-Health Plan Operations and Marketing:

The Emerging Network Manager Role 110

James R. McPhail and Robert G. Bonstein, Jr.

xv

xvi Contents

Part 3-Enabling Technologies

CHAPTER 9-Information Integration 121

Tim Webb and Dale Will

CHAPTER lD-Application Development 134

Tom Hurley and Michael Feyen

CHAPTER 1I-Performance Improvement Application Integration 144

Briggs T. Pille and Robert K. Antczak

CHAPTER 12-Technical Infrastructure: Power for the Enterprise 153

David Dimond, Michael Gorsage, Joseph Casper,

and Judith V. Douglas

CHAPTER 13-Emerging Technologies 162

Gordon Heinrich and Gail Hinte

CHAPTER 14-Implications and Direction 173

James Reep and Philip Lohman

Index 189

Contributors 201