Information Systems for Health Care Enterprises

No other book on the market covers both the broad, practical scope of information systems applications in health care and at the same time brings the latest advances in administrative simplification and fraud control to the forefront. While the focus is on provider organizations, and particularly hospital information systems, fair attention is given to health insurance operations and other components of the health care enterprise. The book is used in teaching university students and includes numerous tools for facilitating instruction. Audience and Related Work This book Information Systems for Health Care Enterprises is an introduction to health care information systems for people with some background in health care and information systems. While no particular knowledge of the reader is expected, the book does not comprehensively define the most basic concepts of either health care or information systems. Instead, the reader can expect to become immersed quickly into the challenging issues of getting information systems to work in health care organizations. Many books have been written about health information systems with usually a distinct audience in mind each time. For instance, one can find books for * physicians with practical tips on how to use computers in the private office. * Chief Information Officers on strategies for implementing enterprise-wide systems * nursing students on support systems in the hospital that nurses use to help patient care, and * medical students on computer-supported diagnosis. This book is for students of information systems and of health care administration and for professionals responsible for decisions about information systems in health care enterprises. Content The book has twelve chapters. These are grouped into five main parts as follows: * Requirements and Design * Providers and Payers * Regulation * Personnel and Vendors * Integration and Diffusion The reader is asked to address the issues that should lead to the ability to do the following as regards health information systems: 1. identify needs for development of health information systems, 2. design the high-level structures and functions needed for a health information system, 3. delineate the typical components of a health information system and how they are integrated in new systems spanning diverse organizations, 4. identify the people who create and use information systems, and 5. anticipate the factors that determine whether or not a system will be adopted by its users and thus diffuse through the target population. The book goes into detail about the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act. These provisions have been deemed the most important influence on information systems in American health care. They require standardization of provider-payer transactions and privacy of protected health information. The book also explains how fraud occurs and the role of information systems in fighting fraud. Most books on health information systems focus on providers to the exclusion of health plans or payers. This book has a separate chapter on health plans that examines their function and sample applications. While many books examine the staff involved in health care information systems, few consider in detail the role of information technology vendors and consultants, as this book does. This book focuses on the United States health care system. Health care systems vary around the world with many systems being more government-owned than the American system. Ownership naturally has major ramifications for finance and policy. Nationalization of health care leads to greater uniformity of health practice and creates a foundation for certain computerization. At the same time, nationalization removes free-market competition and thus also the incentive to improve market competitiveness by computerization. Despite its great, unruly diversity, the American health care system is in many ways at the forefront in computerization. Style Every chapter begins with a Main Points list and ends with Questions. The ‘Questions’ are divided into ‘Reading Questions’ and ‘Doing Questions’. ‘Reading Questions’ only ask the reader to reflect on what was presented in this book. The ‘Doing Questions’ challenge the reader to go beyond the book to present new information and insights. The book includes over one hundred references.