Healthcare Informatics

Healthcare

Informatics

Improving Efficiency

and Productivity

Healthcare

Informatics

Improving Efficiency

and Productivity

Edited by

Stephan P. Kudyba

CRC Press

Taylor & Francis Group

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Dedication

To my family for their unending support over the years,

especially to my wife, Cherryl, whose unyielding passion to care for patients provided an essential inspiration to produce this work.

vii

Contents

Foreword ...ix

James H. GoodniGHt

Preface ... xiii about the editor...xvii Contributors ...xix

1

technology, and informatics ...1

stePHan KUdyba and RiCHaRd temPle

2

Goals for meaningful Use of Health information technology ...19

miCHael H. ZaRoUKian and PeteR basCH

3

initiatives...43

CHRisti RUsHnell and maRy beattie

4

systems ...85

teRRy mooRe

5

optimAl utilizAtion ...105 James F. Keel and d. aRlo JenninGs

6

ann mCKibbon

7

tomas GReGoRio

viii  ◾  Contents

8

Jason bURKe

9

Healthcare ...181

stePHan KUdyba and maRK RadeR

10

trinity Health ...195

RaJiv KoHli, FRanK PionteK, laRRy selleRs, tom mineR, and PaUl Conlon

11

WUllianallUR RaGHUPatHi

12

support in Healthcare ...225

billie andeRson, Cali m. davis, and J. miCHael HaRdin

13

optimization of Care enhancement services...239

tHeodoRe l. PeRRy, JoHnny e. GoRe, JeFFRey W. eRdley, and JeRemy d. loWeRy

index ...255

ix

Foreword

James H. Goodnight, PhD, CEO of SAS

To anyone who works in the information technology industry, the contrast is quite stark: How is it possible that one of the largest economic forces and ethical priorities on the planet—healthcare—is not a leading example of using information technolog y? On the one hand, we have sequenced the human genome—an unparalleled achieve-ment that would not have been possible without leading-edge technology. And yet, on the other hand, when you go to your doctor for a simple physical examination, chances are that your critical health information is recorded on paper and put on a shelf, inaccessible to you, your other care providers, or researchers trying to find better treatments.

So it may be with some trepidation that you pick up a book about health infor-matics. It seems almost impossible that an industry so mired in paper can use some-thing as computer oriented as analytical software. Where can you even start?

The first step is recognizing a truth that exists in every modern organization. There is not a lack of information; rather, there is a lack of usability of already existing infor-mation. In 2008, the analyst firm IDC released a document called The Diverse and Exploding Digital Universe. The report, which focused on the ever-growing volumes of electronic information around the world, drew the following comparison:

The number of digital ‘atoms’ (1s and 0s) in the digital universe is already bigger than the number of stars in the universe. And, because the digital universe is expanding by a factor of 10 every five years, in 15 years it will surpass Avogadro’s number (6.022 × 1023_).

By any measure, those are large numbers. And despite the lack of progress in adopting electronic medical records, the data mountain in healthcare is large and growing. Every new drug brought to market in the United States is supported by years of research stored in databases. Every major health institution has reposi-tories of patient data waiting to be analyzed. Every care provider and payer has financial and operational data sitting inside its enterprise. We are limited only in our creativity and commitment to find needed improvements.

x  ◾  Foreword

Barriers to technology adoption—accessibility, usability, data standards, com-puter fluency, physical distance among stakeholders, data privacy, and others—have had a long-standing impact on healthcare. But over the past 10 years, many of these perceived and actual barriers have slowly collapsed. The “consumerization” of tech-nology brought about through home computers, portable music players, digital photography, cell phones, and many other innovations has produced an indus-try of healthcare practitioners with a much greater technology comfort level, and much higher expectations of “the world of the possible.” As computer processor and network bandwidth capacities have grown exponentially, the opportunity to bring powerful, user-friendly software to the practice of medicine has been unlocked. And concerns over patient safety and the escalating costs of care have produced clear demands from consumers and regulators: find smarter ways of working and produce better health outcomes for patients.

Unfortunately, even with a new generation of systems and devices collecting healthcare data, there is only a small correlation between data, information, and knowledge. Our efforts to use modern, web-based technologies to collect better information faster serve the need of adding to our data mountains, but do little to increase human knowledge of health and disease. The key to crossing that knowl-edge chasm is analytics. To build better treatments, we need to analyze the factors that affect treatment efficacy. To lower administrative costs, we need to identify where and why we are incurring unnecessary costs and how we should focus our improvements. To prevent medical errors, we need a deeper understanding of the causes and proven interventions. Healthcare not only has a plethora of problems that can be solved with analytics, but the most important questions we currently face in healthcare can only be addressed with analytics.

Other industries have already found ways to use the power of analytics to dramatically improve their businesses. For example, if you have ever received a phone call from your credit card company asking about charges to your credit card that you know you did not make, you have seen one of the many applica-tions of advanced analytics. In a fraction of a second, credit card analytical systems are able to assess the probability of a given transaction being fraudulent and take corrective measures to prevent the payment from actually occurring in the first place. This approach saves millions in fraudulent claims as well as their subsequent recovery costs. Could we be doing the same with healthcare claims?

Another area where other industries are reaping the rewards of advanced analytics is customer intelligence. Retail organizations are using advanced analytics to better understand their customers—who they are, what they do, what they like, and how best to interact with them. Retailers want to know more than just the name, address, and phone number of the people they serve. They want to know how to be a better provider of goods and services to each individual consumer—creating compelling offers for things that are most likely to resonate with each individual consumer, delivered in a way that each specific consumer prefers, and avoiding inundating them with things that do not really matter to them as individuals. Campaign

Foreword  ◾  xi

management, marketing optimization, and similar analytical solutions give these companies the ability to grow their relationships with their customers. Could we use a similar approach to proactively build better doctor-patient relationships?

There are still plenty of challenges in our health technology evolution. But there has never been a more important time to look to analytics. We owe it to ourselves and future generations to do all we can to make our healthcare systems work smarter, be more effective, and reach more people. The power to know is at our fingertips; we need only embrace it.

xiii

Preface

Healthcare informatics, increasing productivity and efficiency, addresses the critical issue regarding the ongoing debate over rising costs in the healthcare industry, namely: Can the incorporation of information technologies drive efficiencies to help reduce costs and enhance the quality of care for patients? The answer is a resound-ing yes. Technologies that facilitate the input, storage, access, analysis, and com-munication of data and information for practitioners, administrators, researchers, and regulators can help identify inefficiencies in procedures across the spectrum of healthcare services. The application of knowledge generated from the availability of information should ultimately result in enhanced resource allocations, reduce costs, and promote the pipeline for new innovations.

This book is comprised of two major sections that address these concepts. The first part of the work provides an introduction and background to the state of affairs in our current healthcare system and describes the theoretical under-pinnings, such as information and knowledge management, project management, and strategic initiatives essential to achieving successful informatics-based imple-mentations within healthcare organizations. Some example project implementa-tions are included in the early chapters as well. The latter half of the book focuses on actual applications that have been incorporated by various healthcare organiza-tions along with corresponding strategic management issues that were involved for successful project rollouts. These applications include e-commerce, the creation of digital data, business intelligence, and high-end analytics initiatives.

Section 1: An Introduction to Informatics,

the State of Our Current Healthcare System,

and Critical Strategic Initiatives to Consider

in Achieving Effective Informatics-Based Projects

Chapter 1 provides an introduction to the complexities involved in managing resources in our current healthcare system and how management theory and informatics applications can increase efficiencies in the various functional areas

xiv  ◾  Preface

in healthcare services. Chapter 2 extends the description of problematic areas in healthcare and provides extensive background on current initiatives that are under way in the promotion and investment in informatics in the industry. It then pro-vides strategic concepts that are critical to achieving successful healthcare informa-tion technology (HIT) and electronic health record (EHR) applicainforma-tions.

Chapter 3 provides a robust description of project management issues that are essential in the implementation process of various informatics projects, and Chapter 4 adds a complementary focus of best practices in informatics imple-mentations and includes a detailed description of a successful computer physi-cian order entry (CPOE) system project at Mission Hospital in Asheville, North Carolina. Chapter 5 addresses the area of project management in informatics and stresses the importance of involving the skills of nursing staff to achieve successful technology rollouts. A brief case study describing this concept is included. The final chapter in this first section of the book stresses the importance of knowl-edge management and provides strategic insights in achieving knowlknowl-edge transfer among healthcare service personnel in the dissemination of information made available from various informatics platforms such as EHRs and clinical decision support systems (CDSSs). Effective knowledge transfer should ultimately enhance the quality of care for patients.

Section 2: Information Management and

Increased Healthcare Efficiency through

E-commerce, Business Intelligence,

and Advanced Analytic Applications

Chapter 7 begins this section describing an e-commerce self-service patient check-in application at New Jersey’s Newark Beth Israel Hospital. The steps to achieving the successful implementation along with the productivity-improving results are included as well. Chapter 8 provides an introductory section addressing the realm of informatics analytics and the significant impact areas such as business intelligence and quantitative-based methods of data mining can have on improv-ing efficiencies in a variety of healthcare applications.

Chapter 9 describes a successful informatics project that focuses on the creation of digital assets from paper-based resources at New Jersey’s Saint Clare’s Health System. It then includes an introduction to business intelligence, describing how this concept can drive efficiencies regarding regulatory issues, hospital workflow activi-ties, and others. Chapter 10 describes three different successful informatics projects at Trinity Health. The first illustrates how informatics helped reduce excesses in length of stay (LOS); the second involves a web-based clinical indicator system that improved patient safety; and the third involves efficiency gains resulting from an ADE alert system. ADE systems refer to computerized adverse drug event initiatives.

Preface  ◾  xv

Chapter 11 delves into the realm of advanced analytics and describes how various data mining methods can be used to drive efficiencies across a variety of healthcare applications. Chapter 12 extends the discussion on data mining and illustrates how these quantitative-based methods enhance decision support activities in the area of colorectal cancer. Finally, the book ends with Chapter 13, which provides insights on the utilization of data mining to identify problem areas in healthcare billing and financial activities. It also illustrates how advanced algorithms can help identify patient populations at risk for hepatitis.

xvii

About the Editor

stephan Kudyba (MBA, PhD) is a faculty member in the management department at NJIT, where he teaches courses in the gradu-ate and executive MBA curriculum addressing the utilization of information technologies, business intelligence, and information and knowledge management to enhance organiza-tional efficiency. He has published numerous books, journal articles, and magazine articles on strategic utilization of data, information, and technologies to enhance organizational and macro productivity. Dr. Kudyba has been interviewed by prominent magazines and speaks at university symposiums, academic conferences, and corporate events. He has over twenty years of private sector expe-rience in the United States and Europe, having held management and executive positions at prominent companies, and maintains consulting relations with orga-nizations across industry sectors with his company Null Sigma, Inc. He holds an MBA from Lehigh University and a PhD in economics with a focus on the infor-mation economy from Rensselaer Polytechnic Institute.

xix

Contributors

billie anderson

SAS Institute

Carey, North Carolina

Peter basch MedStar Health Washington, D.C. mary beattie Health First Rockledge, Florida Jason burke SAS Institute

Carey, North Carolina

Paul Conlon Trinity Health Novi, Michigan Cali m. davis University of Alabama Tuscaloosa, Alabama Jeffrey W. erdley

Health Research Insights, Inc. Franklin, Tennessee

Johnny e. Gore

Health Research Insights, Inc. Franklin, Tennessee

tomas Gregorio

Newark Beth Israel Medical Center Newark, New Jersey

J. michael Hardin

University of Alabama Tuscaloosa, Alabama

d. arlo Jennings

Mission Health System Asheville, North Carolina

James F. Keel iii

Mission Health System Asheville, North Carolina

Rajiv Kohli

William and Mary College Williamsburg, Virginia

stephan P. Kudyba

New Jersey Institute of Technology Newark, New Jersey

Jeremy d. lowery

Health Research Insights, Inc. Franklin, Tennessee

ann mcKibbon

McMaster University Hamilton, Ontario, Canada

xx  ◾  Contributors

Thomas miner

Trinity Health Novi, Michigan

terry moore

Hackensack University Medical Center Hackensack, New Jersey

Theodore l. Perry

Health Research Insights, Inc. Franklin, Tennessee

Frank Piontek

Trinity Health South Bend, Indiana

marc Rader

AristaCare Health Services South Plainfield, New Jersey

Wullianallur Raghupathi

Fordham University New York, New York

Christi Rushnell

Health First Rockledge, Florida

larry sellers

Mercy Medical Center Sioux City, Iowa

Richard temple

AristaCare Health Services South Plainfield, New Jersey

michael H. Zaroukian

Michigan State University/Sparrow Health System

Lansing, Michigan