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American Health Information Management Association. Position statement. Issue: Educational clinical affiliations.

In the realm of health information management, the clinical affiliation refers to the course(s) in which the student reports to a healthcare facility and experiences planned activities in the environment of the actual workplace. The provision for technical and managerial experiences is an integral component of the curricula. The importance of the clinical affiliation to health information management education is immeasurable. Through the application of didactic learning, the theories of health information management are reinforced, the dynamics of the workplace are observed, and the realistic dimension of the profession is added. No amount of classroom simulation can replace it. Objectives of an affiliation should include but are not limited to: 1) development of the student as a person responsible for actions and outcomes, 2) acquisition of the knowledge and skills needed for entry level competency, 3) recognition of the needs of patients and clients, and 4) adherence to the mission, policies, and procedures of an organization.

Clinical Clerkship↗

A review of information management practices for health ministries.

This is a review paper on best practices in information management for health ministries in governments. It is based on a recent study in which we examined information management (IM) and information technology (IT) functions inside a provincial health ministry. In order to foster best IM practices we offer five key guiding principles followed by five recommendations for action. We urge governments to consider these principles and recommendations when planning the IM function for their health ministries.

Benchmarking↗

A cognitive task analysis of information management strategies in a computerized provider order entry environment.

OBJECTIVE: Computerized Provider Order Entry (CPOE) with electronic documentation, and computerized decision support dramatically changes the information environment of the practicing clinician. Prior work patterns based on paper, verbal exchange, and manual methods are replaced with automated, computerized, and potentially less flexible systems. The objective of this study is to explore the information management strategies that clinicians use in the process of adapting to a CPOE system using cognitive task analysis techniques. DESIGN: Observation and semi-structured interviews were conducted with 88 primary-care clinicians at 10 Veterans Administration Medical Centers. MEASUREMENTS: Interviews were taped, transcribed, and extensively analyzed to identify key information management goals, strategies, and tasks. Tasks were aggregated into groups, common components across tasks were clarified, and underlying goals and strategies identified. RESULTS: Nearly half of the identified tasks were not fully supported by the available technology. Six core components of tasks were identified. Four meta-cognitive information management goals emerged: 1) Relevance Screening; 2) Ensuring Accuracy; 3) Minimizing memory load; and 4) Negotiating Responsibility. Strategies used to support these goals are presented. CONCLUSION: Users develop a wide array of information management strategies that allow them to successfully adapt to new technology. Supporting the ability of users to develop adaptive strategies to support meta-cognitive goals is a key component of a successful system.

Cognition↗

A national comparison of health information management students' career expectations and anticipated involvement in professional activities.

The aim of this paper is to present the results of a survey of Australian health information management students relating to their career aspirations and expectations and anticipated involvement in professional activities following graduation. To explain reasons for the differences in results between states and student years, interviews were conducted with academic staff and other health information management educators. Three hundred and sixty three students completed the questionnaire in 1996, which represented a response rate of 86%. It was found that the majority of students thought they had made the correct career choice and were confident they would find full-time employment within six months of graduation. A high percentage of students also indicated that they would undertake continuing education after graduation. There was less support for involvement in the activities of their professional association, particularly at a national level. Students in New South Wales and Queensland indicated that they would be significantly less likely to work in the field of health information management for the rest of their careers. They also reported they would be significantly less likely to conduct research in an area related to health information management. Victorian students were significantly more likely to present a paper at a conference than students from Queensland, New South Wales or Western Australia. Western Australian students were significantly more likely to report that they would undertake postgraduate studies compared to students from the other three states.

Australia↗

Nurses' information management across complex health care organizations.

UNLABELLED: The purpose of this study was to describe the information management used by hospital and home care nurses for patients in need of continuing care after an episode of hospitalization. METHOD: A prospective descriptive design was used. In total 287 hospital nurses and 220 home care nurses were asked to complete a questionnaire before and after the hospital implemented nursing documentation integrated in the electronic patient record (EPR). RESULTS: Discrepancies between the policies expressed by the health care organizations and the authorities in formal documents and the information management used by the nurses were identified. Differences were also found between nurses in hospital and home care with regard to how they assessed the information management during patient admission, throughout the patient's hospital stay and at the patient's discharge. The perceived differences decreased, however, after the hospital introduced electronic nursing documentation. The study shows a need to contextualize and customize the information that nurses exchange. In addition technological problems with the lack of integrated EPR systems between the hospital and the home health care as well as different practice models in the two organizations entail complex information handling during a patient's trajectory through the health system.

Attitude of Health Personnel↗

Medical informatics in healthcare organizations: A survey of healthcare information managers

Objective: To assess the medical informatics needs of healthcare organizations and the work roles for informaticists in those organizations. Methods: A 128-item survey was developed and administered as a structured interview to thirty-two information managers in eighteen organizations. The survey included items about medical informatics training, prior work experience, skills for informaticists, and programming proficiency. Results: There was a strong preference for informaticists with prior clinical work experience and an understanding of healthcare. Project management and data warehousing were highly rated skills. Informaticists were expected to know about healthcare processes, clinical guidelines, and outcome management. They were not expected to be expert programmers. Conclusion: There is a role in healthcare organizations for interdisciplinary workers who understand clinical medicine, healthcare management, information technology, and who can communicate and work effectively across these organizational boundaries.

Journal Article↗

Medical informatics in healthcare organizations: a survey of healthcare information managers.

OBJECTIVE: To assess the medical informatics needs of healthcare organizations and the work roles for informaticists in those organizations. METHODS: A 128-item survey was developed and administered as a structured interview to thirty-two information managers in eighteen organizations. The survey included items about medical informatics training, prior work experience, skills for informaticists, and programming proficiency. RESULTS: There was a strong preference for informaticists with prior clinical work experience and an understanding of healthcare. Project management and data warehousing were highly rated skills. Informaticists were expected to know about healthcare processes, clinical guidelines, and outcome management. They were not expected to be expert programmers. CONCLUSION: There is a role in healthcare organizations for interdisciplinary workers who understand clinical medicine, healthcare management, information technology, and who can communicate and work effectively across these organizational boundaries.

Administrative Personnel↗

Information management: a long-term investment.

Conventional information processes are inadequate to meet today's health care demands. To allocate scarce resources, new approaches to information management are needed. This article explains how tapping the horizontal flow of information--across departments, services and programs--presents the greatest opportunities and challenges for health care management. New information infrastructures can integrate the entire health care system, and ultimately lead to enhanced affordability.

Canada↗

The quality information management program database in South Carolina.

BACKGROUND: The Quality Information Management (QIM) Program was initiated in 1987 on the basis of the decision of the South Carolina Hospital Association's Subcommittee on Quality Assurance to develop a statewide database that could provide member hospitals with comparative quality indicator data. There are ten indicators for acute care and seven for psychiatry and substance abuse. Thirty-seven acute care hospitals participate in the QIM program, as do 7 specialty hospitals. For each three-month period, participant hospitals complete a computerized software report from their data sources specifying summary-level and patient-level data elements. REPORTING OF DATA: Participating hospitals are provided detailed, quantitative statistical reports to help them identify variations for further investigation. Risk adjustment is accomplished by peer grouping. Each hospital receives summary data for the peer groups to which it is assigned. During the quarterly users group meetings, participants discuss their successes and failures in collecting, reporting, and presenting indicator data. DISCUSSION: Involvement in the QIM program has educated participants in the use of comparative databases for quality improvement activities. It is a challenge to help providers and practitioners, in the face of increasing demands for dissemination, become more comfortable with the release of data to the public, while still preserving some degree of confidentiality.

Computer Communication Networks↗

Management information system ensures maintenance coordination.

The computer-based management information system implemented at Massachusetts General Hospital has proved to be an effective system for ensuring better coordination of maintenance activities in the hospital's maintenance department. The system provides accurate, up-to-date information that managers can use to make decisions concerning allocation of manpower, employee performance, and utilization of resources.

Computers↗

Materials management information systems.

The hospital materials management function--ensuring that goods and services get from a source to an end user--encompasses many areas of the hospital and can significantly affect hospital costs. Performing this function in a manner that will keep costs down and ensure adequate cash flow requires effective management of a large amount of information from a variety of sources. To effectively coordinate such information, most hospitals have implemented some form of materials management information system (MMIS). These systems can be used to automate or facilitate functions such as purchasing, accounting, inventory management, and patient supply charges. In this study, we evaluated seven MMISs from seven vendors, focusing on the functional capabilities of each system and the quality of the service and support provided by the vendor. This Evaluation is intended to (1) assist hospitals purchasing an MMIS by educating materials managers about the capabilities, benefits, and limitations of MMISs and (2) educate clinical engineers and information system managers about the scope of materials management within a healthcare facility. Because software products cannot be evaluated in the same manner as most devices typically included in Health Devices Evaluations, our standard Evaluation protocol was not applicable for this technology. Instead, we based our ratings on our observations (e.g., during site visits), interviews we conducted with current users of each system, and information provided by the vendor (e.g., in response to a request for information [RFI]). We divided the Evaluation into the following sections: Section 1. Responsibilities and Information Requirements of Materials Management: Provides an overview of typical materials management functions and describes the capabilities, benefits, and limitations of MMISs. Also includes the supplementary article, "Inventory Cost and Reimbursement Issues" and the glossary, "Materials Management Terminology." Section 2. The MMIS Selection Process: Outlines steps to follow and describes factors to consider when selecting an MMIS. Also includes our Materials Management Process Evaluation and Needs Assessment Worksheet (which is also available online through ECRInet(TM)) and a list of suggested interview questions to be used when gathering user experience information for systems under consideration. Section 3A. MMIS Vendor Profiles: Presents information for the evaluated systems in a standardized, easy-to-compare format. Profiles include an Executive Summary describing our findings, a discussion of user comments, a listing of MMIS specifications, and information on the vendor's business background. Section 3B. Discussion of Vendor Profile Conclusions and Ratings: Presents our ratings and summarizes our rationale for all evaluated systems. Also includes a blank Vendor Profile Template to be used when gathering information on other vendors and systems. We found that, in general, all of the evaluated systems are able to meet most of the functional needs of a materials management department. However, we did uncover significant differences in the quality of service and support provided by each vendor, and our ratings reflect these differences: we rated two of the systems Acceptable--Preferred and four of the systems Acceptable. We have not yet rated the seventh system because our user experience information may not reflect the vendor's new ownership and management. When this vendor provides the references we requested, we will interview users and supply a rating. We caution readers against basing purchasing decisions solely on our ratings. Each hospital must consider the unique needs of its users and its overall strategic plans--a process that can be aided by using our Process Evaluation and Needs Assessment Worksheet. Our conclusions can then be used to narrow down the number of vendors under consideration...

Computer Security↗

Information management through integration of distributed resources.

Duke University Medical Center conducted a strategic planning process focused on information management needs beginning in 1983 and ending in 1985. That effort concluded that the institution was ready to establish an Integrated Academic Information Management System (IAIMS). A model was proposed in which information management was to be achieved through integrated distributed resources. The elements of the IAIMS model are ongoing policy development and planning; communications; an electronic library or resource inventory; coordination of the development or selection of the end-user function; user support; and ongoing evaluation. This model is being tested to determine its effectiveness in meeting the administrative, patient care, research, and educational needs of a basic science department and a clinical science department at Duke University.

Academic Medical Centers↗

Information management in nursing.

The information technology environment is here to stay. Computers are the devices being used to manage the extension of care out of hospitals and into the community. Nurses are the focal point of clinical documentation because they access patient data most often. Nurses know what information is needed and seek ways to collect that information. Nurses can dictate the type of data collected and how that data is presented to allow the most appropriate, well-informed decisions possible. Nurses have the knowledge to make decisions, and with information management skills, we will have the means to communicate that knowledge to others.

Computer Communication Networks↗

Clinical vocabularies and terminologies: impact on the future of health information management.

As standardized clinical vocabularies and terminologies are being developed, Health Information Management (HIM) practitioners must increase their knowledge of nomenclature and coding systems beyond the traditional ICD-9-CM and CPT. The limited scope of these classifications prevents them from serving as the standard vocabulary for the computer-based patient record. The American Health Information Management Association (AHIMA) Coding Futures Task Force provided insights into the knowledge and skills that HIM professionals will need as clinical vocabularies and terminologies become more integrated into health care systems. Certain characteristics are important in a clinical vocabulary and several clinical vocabularies are in use today.

Abstracting and Indexing↗