Impact of Informatics
1998
1998
15th ISQua CONFERENCE ON QUALITY IN HEALTH CARE
BUDAPEST, HUNGARY, OCTOBER 7 – 10, 1998
THE MANAGEMENT OF
HEALTH CARE ORGANIZATION SYSTEMS
Authors:
Dr Oscar González Morán *
Dr Eduardo Rodas **
Dr Mario Vernengo Lima ***
Dr Angel Tonietto ****
Dr Roberto Gallino Fernández *****
Dr Pablo Morici ******
* College Degree in Public Health – Consultant
** Chief of Medical Informatics at the Manuel Belgrano Hospital. Province of Buenos Aires
*** Technical Assistant Director at the San Justo Children’s Hospital . Province of Buenos Aires
**** Executive Director at the Manuel Belgrano Hospital. Province of Buenos Aires
***** Associate Director at the Manuel Belgrano Hospital. Province of Buenos Aires
Correspondence to:
e-mail: edurodas@yahoo.com.ar
SUMMARY
Informatics brings about changes in the management of organizations financing and supplying health services, which we shall proceed to highlight according to our own experiences in public, private and social health care areas.
The historical transformation of information sources and systems have accompanied the technological progress of medicine and we currently feel the need for a profound updating to include users, institutional and central policies, human resources, software, hardware and humanware in the face of the progress and strong impact information management is causing on health care organizations.
Informatics systems can therefore interact with management levels to determine homogeneous groups of health care organizations, identifying those whose invoicing practices differ significantly from those of their colleagues; analyzing transactions carried out by organization members in addition to the broad range of information as regards percentages, averages and profiles based on mathematical models will enable us to prevent any future frauds and counteract the impact any control system may have on health organizations, thus achieving a homeostasis of the system for a balanced development based on equity, efficacy and efficiency.
Introduction
The process undergone by health care organizations with the advent of informatics is extremely complex. The impact of implementing any new technology leads to resistance, which may range from insecurity about losing one’s job to uncertainty because of lack of knowledge as regards the use of these new tools. We have noted that health care organizations, as part of the services sector, did not suffer the mass unemployment caused, for instance, by the incorporation of robotics in the industrial sector. Lack of knowledge of new tools has been handled using comprehensive ongoing training plans to prepare the members of the organization in the use of informatics tools.
When redefining the organizational structure for health service in an effort to serve the aims of the organization we must consider the incorporation of the informatics area.
With the help of adequate information about certain facts, decisions may be made using the deductive / analytical method to replace estimations and intuitive judgements, which are so frequent in this area. Transforming data into information involves a cost, and as such should be considered as important added value.
Information is classified according to the levels at which it is used:
a) Management level operation within the production process
b) Management level tactics within the health care organization
c) Management level strategy within the health care system
Information should adapt to the level at which it will be used, which is why it should be increasingly summarized as and when senior management levels require it.
Incorporating distributed systems contributes to a participative management. The multidirectional flow of information helps different members of the organization to have access to the information they require to make decisions in their corresponding sectors. Distributed informatics therefore generates and accompanies change dynamics, achieving an open, participative management.
With the generation of self-managed work groups, new teams evolve outside traditional health care organization structures, and can carry forward projects which coincide with the organization’s interests.
On analyzing the medical attention process, with the understanding that this includes any activity or action carried out on a person, both to prevent illness and to recover health, we note a permanent exchange of data between the patient and the person attending to him / her.
Data is understood as the set of unstructured facts and background material required to achieve exact knowledge of something; the exactness of this knowledge will enable an efficacious and efficient performance of the goals of medical attention.
The process of medical attention is essentially a permanent transfer of data, from the time the patient joins the health service, when he requires information as to where he must go for attention, when he first goes to see a doctor and is asked for data in his anamnesis, data obtained from laboratories, from radiology and scans, data which the doctor himself compiles with instruments such as a thermometer or a tensiometer, data acquired from his colleagues via cross-consultations, or from whatever literature he has at his disposal. All this data is registered in the patient’s case history and is processed by the doctor on the basis of information he can access, in order to reach a diagnosis and be able to indicate the course to be followed.
Historical transformation
Formerly little importance was given to health care information. It was only when great epidemics or catastrophes occurred that their impact was considered and the severity of their side-effects, i.e. death and illness, was measured.
In our early-century beneficent hospitals, just as in the rest of the world, medical aid was simple, and made little use of apparatus and only scarce use of medicinal remedies; health care teams adopted an attitude of paternalistic protection towards their patients.
Towards the mid 50’s and in the decades following, modern medicine suffered revolutionary changes with the appearance of apparatuses and the pharmaceutical industry. It was no longer the doctor who diagnosed, healed or relieved using his hands or his senses, but rather technology based on microelectronics with its multiple applications and advances. Data constitutes the input to an information system and this same data, organized and analyzed, constitutes the output of the system where the data is processed.
This multidirectional flow of data which is processed and transformed into ‘information’ is the basis for the QUALITY of medical attention.
On analyzing the Health Service management process as that of a high contact service company, which is what it really is, it may be noted that data is also fundamental basis for efficient management, especially as regards making use of resources such as personnel, materials, instruments and financial resources, among others, which after being processed are transformed into information.
Given the concept that interaction of the medical care process and the availability of resources is the basis for the productive process in this kind of service companies, information management takes on a central role in Health Services management.
Information is a resource similar to any other (human, instrumental, building, etc.) in a healthcare system, and as such should be carefully administered. Second only to human resources, information should be recognized as the most important resource for whoever is managing a health service.
Current healthcare systems offer vitally important information at all levels of healthcare organizations: from the operative level of the production process, as regards control, to the highest management level for planning.
Having timely information at hand when required implies efficient management of available resources.
Computer processing of information is frequently carried out initially in a somewhat “disorganized” way, that is, it is done without any prior planning or organization, which will make it difficult to share it in future, much less integrate it in a single information network.
Information should ideally be precise, reliable, sufficient and timely. An information system required for managing a health service is essentially based on storing, organizing and recovering data on a correct and timely basis. Data constitutes access to an information system and information is defined as a set of interpreted and organized data which makes sense and has significance for the user of the system and is the output of this system.
The person responsible for managing a healthcare organization and who is unable to recognize that information is the key material / resource to be used as a basis for adequate decision-making as regards requirements is undoubtedly doomed to failure.
Proved knowledge of efficiency
We can define the management of a healthcare organization as the process of distributing and making use of resources by way of planning, organization, management, coordination and control, with the aim of offering the services patients require and complying with the organization’s mission.
Information is the basis for planning; it both determines and defines plans to be drawn up in the short, medium and long term to achieve the aims of the healthcare service.
The impact caused in areas such as Attention to Outside Users, Human Resources, Purchasing, Administration, Laboratory, Pathology, Image Scanning, is such that we would like to mention some of the benefits achieved.
When informatics was installed in the office where appointments are given for Out-patient attention, some patients were found to have up to seven different case history numbers. These numbers are currently given automatically and a patient data base has been set up. If the patient already has a case history number the computer will detect it and avoid duplication.
By filing data from the Out-patient, In-patient and Emergency departments control is kept on any patient entering or leaving the establishment.
Secretaries who formerly had to stand up and sit down over sixty times in one morning to hand out appointments can now work seated at their computer monitor.
During an interview carried out in the Purchasing Office, one employee said: “It’s an entire team which has become adapted to working in a certain way. Our work production in this office has increased. Purchase requests which formerly took 20 to 30 days to complete when done manually now take 24 to 48 hours. Learning is made easier for new employees. They adapt faster. Mistakes jump out at you. Overall work presentation is better, both in quality and quantity. There are no longer differences between the estimated budget and the final budget. I’m much less concerned about any possible mistakes in my work. It’s more difficult to go wrong.”
During the interview in the Human Resources Office we were told: “The computer improves the quality of our work; it’s neater, the information it processes is more accurate. Work times have improved notably.”
Towards system homeostasis
The high costs involved in healthcare systems, added to over-utilization of technological resources, excess medication and a lack of adequate management have made some healthcare organizations frankly unfeasible.
Globalized economy and new paradigms marking behaviors within companies make it necessary to implement information much faster and more efficiently.
Many healthcare organizations are suffering losses because there is no validation for the services they offer, and frequently when the analysis of this information is prepared it is not done systematically.
Current informatics systems can interact with management levels and, by making use of these modern tools, can determine routine behavioral groups, identify organizations whose invoicing practices differ significantly form those of their colleagues, analyze transactions carried out by organization members, enable a follow-up of healthcare organizations and avoid future misapplications. Thus information may be gathered as regards the average amount of appointments per patient, average number of patients per family, percentage of house-calls made on public holidays, average number of diagnosis per patient, percentage of teenage patients attended, percentage of senior citizens attended, average cost per call, average cost per patient, average duplicate appointment vouchers, percentage rate of calls vs. radiology, laboratory, physiotherapy, dentistry studies, etc.
Deviation detection is increased with the creation of profiles based on mathematical models and interactive tools are available for analyzing and graphically visualizing information.
Prevention is established by estimating future fraud and the effect any control system has on organizations offering services.
Application of these management tools will achieve homeostasis of the system and achieve a balanced development based on equity, efficacy, efficiency and quality.
It is frequently supposed that having the equipment (hardware) and a few programs (software) is enough to install informatics at a healthcare establishment, and that after a time and as the result of experience the human resource (humanware) will arise, as the most important resource, accompanied by institutional or centralized policies as the basis for any informatics development project.
We have observed individual attitudes which seek to conceal recently acquired know-how, and we feel this goes against the progress of different projects.
We also believe development should be tailor-made – to the extent possible – and carried out locally so as to avoid depending on outside decisions; this should favor growth and continuity of our work.
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