Chapter 12

Integrated Information Systems for Chronic Care: A Model Linking

Acute and Long Term Care

Integrated Information System

Multiple information sets linked together in an organized way– information sets

groups of similar items often collected together e.g., participant characteristics, health and

functional assessments, service use, service billing info

information sets can be collected at different points in time by different members of the service agency

Integrated Information System

Information system links or connects information collected by different units in the agency and makes it available to everyone who needs it

Organized means there is a well-defined plan for collecting and linking information sets to meet multiple information needs In the most efficient and effective manner

Integrated Information System

IIS Advantages– more efficient

eliminates need for duplicate data collection since one entry serves all

– makes more information available to all users improves service quality; increases efficiency

– links information across services provides a comprehensive picture of the participants

– a description of health needs and conditions; services they receive; cost of care; outcomes of treatment

– links summary information across IHDS

Integrated Information System

Primary Components:– Information– Computer Hardware– Computer Software– Communications– Peripherals

Information

Groups of similar information items collected together.

Important to analyze work process and information being used prior to implementing the integrated system.

Determine how information is shared: cross-departmentally or cross-organizationally.

Computer Hardware

Processing power quadruples every 2 1/2 years (Moore’s Law) making it less expensive and more feasible for organizations to process vast amounts of information.

Inexpensive automation replacing human labor. Client servers manage the information

network.

Computer Software

Operating systems Applications Operating system and applications must be

compatible. “Make”- you develop and build your

software in-house. “Buy”- you contract with a vendor to develop

the software. Better approach.

Communications

Communication devices allow sharing of information between two or more parties.

The linking of computers allows asynchronous communication (e.g. e-mail) so different data sets can be added at different times and places by different people.

Networks

Allow organizations/departments to share information. It is the linking of one or more computers through network cabling.

Types of Computer Networks:

- LAN/WAN- Internet/ Intranet/ Extranet

Peripherals

All the other items necessary to process, store, convert, and transmit information (e.g printers, scanners).

Organizations must consider compatibility and costs when purchasing peripherals.

Hospital Information Systems

Accounting System, DRG Billing System Specialized Systems Focus on short term acute care rather than

chronic care so the hospital system would not be useful as a model for chronic care information systems.

HMO Information Systems

Integrated HMO systems maintain membership information, scheduling, accounting, cost tracking

Designed for managing traditional health services for a generally healthy population

Would be applicable to chronic care but many HMOs are not organized to manage the ongoing information needs of chronic care

Long Term Care Information Systems Mostly focuses on billing and external

reporting. Few are integrated into useful systems so

could not be applied to chronic care information systems.

Chronic Care InformationSystems Currently no system fully meets the needs

of chronic care management. Requires a system that can process large

volumes of information because of the long length of care and the various types of information .

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

Chronic Care IS ModelPatient/Client Information

Identification and description – Master Participant Record would include:

identifying information demographic information program status information

– Data collection frequency recorded at time of enrollment information relatively stable; updated as changes

occur

Chronic Care IS ModelPatient/Client Information Assessment information

– Participant Assessment Record would include: health status information functional status information cognitive status information environmental information informal support information

– Data collection frequency information changes over time needs to be assessed at regular intervals

Chronic Care IS ModelPatient/Client Information Service/Treatment Plan

– Service/Treatment Plan Record would include: service goal information service orders

– Data collection frequency: information changes constantly as client needs

change initial plan development at time of assessment and

stored with assessment record

Chronic Care IS ModelPatient/Client Information Service Use

– Participant’s Service Record would include: delivered services information IHDS service information

– Data collection frequency: ongoing basis summarized and reported for specified time periods

–

Chronic Care IS ModelFiscal Information Service Revenues

– billing various insurance companies for multiple types of services with multiple forms of payment

Service costs– expenses

Chronic Care IS ModelFiscal Information Service Revenue

– Service Revenue Record would include: service charge information reimbursement information

– Data collection frequency: ongoing basis total service charge information by participants on a

monthly basis revenue reported by funding source

Chronic Care IS ModelFiscal Information Service costs

– Program Cost Record would include: personnel cost information materials and supplies information facility cost information

– Data collection frequency: reported on a regular basis

Non-automated Integration

Manual integration of client level data. – identification, assessment, service use, cost information– problem with the logistics of information placement

Integrating summary data. – Manual counts from existing participant records to

prepare summary data sets reports for each information set

– does not allow participant specific comparisons

Automated Information Integration Periodic Data Sharing

– Simplest form is periodic sharing of data files among participating agencies

Stand-alone System– Integrated information system developed for the

integrated health care delivery system Integrated Data System

– Build integrated delivery information into the existing information system

Benefits of Integrated Information Systems Reduction in time required for recording

information Service planning is enhanced Allows for automated scheduling Facilitates long-term study of care outcomes Reduce duplication of effort/information Monitor quality

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