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Reviewer in ICTM111 (Finals)

The document discusses various health information systems, including Cardiology Information Systems (CIS), Radiology Information Systems (RIS), and Materials Management Systems (MMS), highlighting their functionalities and benefits. Key features include data management, remote access, EHR integration, and improved efficiency in hospital operations. Additionally, it outlines the purchasing process, inventory control, and the importance of vendor management in healthcare settings.
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0% found this document useful (0 votes)
10 views15 pages

Reviewer in ICTM111 (Finals)

The document discusses various health information systems, including Cardiology Information Systems (CIS), Radiology Information Systems (RIS), and Materials Management Systems (MMS), highlighting their functionalities and benefits. Key features include data management, remote access, EHR integration, and improved efficiency in hospital operations. Additionally, it outlines the purchasing process, inventory control, and the importance of vendor management in healthcare settings.
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Reviewer in ICTM111 (Finals) However, the following are the most common

benefits they enumerate:


Lesson 1: Other Hospital Information 1. Ease of access while maintaining data
System security
2. Flexibility in the workflow
Cardiology Information System (CIS) 3. Enhanced Comparability
 Cardiology Information Systems (CIS) are
mainly focused on the storage and retrieval CIS Functionalities
of Cardiology-centric images. CIS usually
receive an order with patient demographics 1. Editing, Viewing and Storing Multi-Modal
from other information management Cardiology Data
systems, and once the images are acquired  different types of data, including computed
from imaging modalities, they are profiled tomography (CT), cardiac ultrasound
against the order and stored for further (echocardiography), magnetic resonance
distribution, viewing, and long-term archive imaging (MRI), nuclear imaging (PET and
(Katipula and Ireland, 2013). SPECT), and angiography, may be managed
on a single platform with the help of the
Evolution CIS.
 Decades ago, the requirements for an
electronic medical information were 2. Remote Access
restricted by the availability of equipment.  the use of networks and integrated
In the 1970s, available cardiology information systems, coupled with the
information system originated from a availability of the internet and tablets and
mainframe environment, the technical smart phones, offer flexibility to Cardiology
specifics of which would be considered Information Systems.
ridiculous in the present day setting.
 Modular systems became the trend in the 3. Visualization and Reporting Capabilities
80s, which emphasized the use of real-time  one of the main benefits of Cardiology
applications and mini computers (Turney Information Systems is the ease and
and Kohls, 1977). consistency of reporting. Virtually real-time
 Internet became a turning point that shifted information retrieval is possible with just a
the focus of most systems to creating couple of clicks and queries, and is possible
networks and facilitating integration. from multiple locations.

The information used by cardiologists for 4. EHR Integration


diagnosis and treatment of their patients varies  since a CIS may be integrated with existing
from Electronic Health Record Systems, it can
enhance the quality of services offered by
a. personal notes (history, physical examination), health professionals by offering a more
to signals (electrocardiograms), comprehensive view of the patient care
spectrum.
b. images (echocardiograms, angiograms, CT,
MRI) and Radiology Information System (RIS)
 A Radiology Information System (RIS) is a
c. reports from investigations and from networked software system for managing
procedures. All this information can currently medical imagery and associated data. An RIS
be provided in digital format, and Cardiology is especially useful for tracking radiology
Information Systems serve as a repository which imaging orders and billing information, and
houses these forms of imagery. Unfortunately, is often used in conjunction with Picture
most CIS are limited to their Archiving and Communication Systems
storage capabilities and do not include (PACS) and Vendor Neutral Archivals (VNA)
post-processing functions. to manage image archives, record-keeping
and billing within a Hospital Information
Benefits and Features System (HIS) (Rouse, 2017).
 Different vendors have varying degrees of
available features.

1
Hospital Information Systems (HIS) 2. Scheduling
 A hospital management information system  The RIS allows staff to make appointments
or hospital information system (HIS) is an for both inpatients and outpatients.
element of health informatics that focuses
mainly on the administrational needs of 3. Patient Tracking
hospitals. Using a RIS system, providers can track a patient's
entire radiology history from admission to
Picture Archiving and Communication System discharge and coordinate the history with past,
(PACS) present and future appointments.
 It is a healthcare technology for short and
long term storage, retrieval, management, 4. Results Reporting
distribution and presentation of images.  A RIS can generate statistical reports for a
single patient, group of patients or particular
Vendor Neutral Archival (VNA) procedures.
 In a health information technology context,
it is as medical imaging used by the 5. Image Tracking
healthcare professionals that stores images in  Traditionally, radiology providers use RIS to
a standard format and interface, making track individual films and their associated
medical imaging data accessible through data. But as EHRs have become standard
different picture archiving and across the healthcare industry and digitized
communication systems (PACS). images and PACS have been widely adopted,
radiology departments and their RIS-PACS
Advantages of Using an RIS systems have been more drawn into the
clinical workflow of the entire medical
1. Better communication with referring doctors enterprise.
 An RIS can integrate with the referring
doctor’s electronic health record or EHR 6. Billing
system, so you can access patient data easily  RIS systems provide detailed financial
and quickly. The result is a better experience record-keeping and process electronic
for referring doctors, which dramatically payments and automated claims, though
increases the likelihood they’ll refer more these functions are becoming incorporated
patients to you. into medical organizations' overall EHR
systems.
2. Faster Payments
 A chief benefit of a RIS is that you can use it Lesson 2: Material Management System
to verify insurance before a patient visit. The
electronic payments you are now capable of Materials Management System
receiving means that you get paid faster.  The management function of hospital
materials—making sure that services go
3. Improved Efficiency successfully from one source to an end user
 It’s much faster to find, input, and create —includes several areas of the hospital and
reports from patient data when the records could drastically affect medical institution
are computerized. With the information expenses.
digitized and no longer needing to be  Executing this function in a manner that
entered into records a second or third time.  lessens expenses and
 ensures adequate cash flow
Functionalities of RIS  requires effective management of a large
amount of information from several sources.
Rouse (2017) describes the following functions of
an RIS: Purchasing Process Overview

1. Patient Management
 An RIS can track a patient's entire workflow
within the radiology department; radiology
providers can add images and reports to
EHRs, where they can be retrieved and
viewed by authorized radiology staff.

2
Purchase Request itself being investigated, sued or simply
 A purchase request could be used as a first shunned by health-care consumers.
step in the process of purchasing. This is used Tracking inventory can be extremely
internally to identify a need for an item. important in maintaining the
 A purchase request generally is a document responsiveness of a medical company.
which is made by a user to notify the This applies not only to front-line health
purchasing department regarding needed providers but also to the suppliers of those
items and services. providers. Knowing what inventory is on
 This document specifies… hand and what items are needed can keep a
a. quantities, as well as a medical company responsive and prevent
b. timeframe for the items requested. closer scrutiny by regulators.
c. authorization information needed to
proceed with the purchase. 5. Establishing Buying Cycles
 Inventory control helps medical companies
Things To Consider On Purchasing Items: understand buying cycles. Instead of
responding to needs for supplies and
1. Inventory Control equipment, inventory personnel can
 Johnston (2014) states that inventory is one anticipate needs based on previous cycles.
of the biggest expenses for most medical Smoothing ordering out to fit predictable
institutions. Inventory control plays an cycles can eliminate shortages and overages.
important part in refining the quality of Buying cycles can also be tracked to
healthcare services, since the lives of the determine whether trends are shifting and
people are on the line, as well as because need to be adjusted. In this way, tracking
medical costs are increasing. inventory can make inventory ordering into
 Moreover, Johnston details the strategies on a manageable process that is proactive
how to improve inventory control within instead of reactive.
healthcare facilities:
Item Master Maintenance - Medical And
2. Making Sure Shippers Are Accurate Non-Medical Inventory Items
 Tracking medical inventory must  Because the importance of inventory control
involve checking shipments for has been recognized, the usage of a
accuracy. Most medical suppliers use materials management system could bring
third-party shippers, and the tracking system an advantage.
must ensure that the correct supplies  In Material Management Systems, the
were loaded at the warehouse. “Inventory Item Maintenance” screen has
Even if items are ordered correctly, many sections. The upper portion contains
tracking can catch any errors in filling those master information. Additional options
orders. It can also reveal whether medical appear after the selection of an existing
supplies have been properly handled in item.
transit.

3. Alignment With Sales Projections


 In the field of medicine, sales projections can
be wildly inaccurate. It is difficult to predict
disease and accident patterns, and patients
are notoriously reluctant to switch doctors,
hospitals and health insurance. Tracking
inventory in comparison to actual sales is
essential. This prevents waste, frees up cash
that would have gone to excess inventory
and helps medical companies identify trends
they might not have seen before.

4. Compliance With Regulations


 The medical field is heavily regulated. A
company that routinely fails to serve the
best interests of patients can quickly find

3
 “Item Tab” is used for maintenance of the Min—is often interpreted as Economic
attributes of an inventory item, such as Order Quantity (EOQ). Although the
product type, item class, item type, etc. If Min/Max method is an unpolished method
the balance and order activity is zero (0), for inventory ordering, the Min/Max
items can be deleted using this option. settings could be adjusted to provide better
 Users could set the product type to group inventory performance (Vermorel, 2014).
similar items for sales analysis and inventory
reporting. Most of the inventory reports are Documentation Needed In MMS:
based on a certain product type.
 The “Item Availability” form specifies 1. Enquiries
inventory levels across all warehouses.  Enquiries are the start point of a sale or
purchase process. Enquiries lead to getting
information from a vendor / supplier for the
requirement at hand. Enquiries lead to
establishing a connection with the right
vendor / supplier in order to get a quotation,
place the order and receive the
requirements.

2. Quotations
 Quotations consist of various pieces of vital
information of a requirement towards a sale
/purchase. Quotations state important
Item Indents And Issues information such as price, delivery times,
 In some cases, there are instances delivery details, payment terms, taxation etc.
where items are damaged either On a quotation being accepted an order is
upon receiving from the supplier or during placed for the requirements.
the move from the source to another
location. 3. Orders
 Some suppliers allow returns of the said  In business or commerce, an Order is a
goods that have indents or the like, with a stated intention, either spoken or written, to
guarantee of replacement without engage in a commercial transaction for
any additional payments. This applies specific products or services. From a buyer's
to distribution and retail industries point of view it expresses the intention to
where the goods for sale are buy and is called a purchase order. From a
fast-moving. Normally, damaged items seller's point of view it expresses the
are moved to another warehouse intention to sell and is referred to as a sales
for them to be monitored. order. When the purchase order of the
buyer and the sales order of the seller agree,
Re-Order Level, Re-Order Quantity, Minimum the orders become a contract between the
buyer and seller.
And Maximum Levels For Each Store
 In a typical material management system,
Re-order level is the minimum quantity of 4. Invoices
an item that a company has in stock, so  An invoice or bill is a commercial document
when the stock reached the minimum issued by a seller to the buyer, indicating the
quantity stated, the item must then be products, quantities, and agreed prices for
re-ordered (Purchase Order/Production products or services the seller has provided
Order). the buyer. An invoice indicates the sale
 A basic re-ordering method transaction only.
implemented in many ERPs and
other inventory management software is Comparison Of Quotations And Preferred
the Min/Max inventory ordering method. Vendor For Each Item
The “Min” value is representative of a stock
level that prompts a re-order, and the 1. Purchase Quotations
“Max” value is representative of a new  A purchase quotation is a document for
targeted stock level that follows the re-order. requesting prices and delivery information
The main difference of these two—Max and from a vendor before the purchase order.

4
 One could create a purchase quotation, then f. Shipping Date: when the goods will be
send the document to a vendor; when a delivered to the final location
response from the vendor is received, with a g. Billing Address: location of where the
list of prices and delivery dates, one can invoice should be sent so the Buyer can pay
enter the information in the purchase h. Signature: signature of Buyer offering to buy
quotation. This way, one can store in the and signature of Seller accepting
system the complete history of the sourcing i. Order Date: when the business transaction
process. occurred
 From the quotation, the information
tracked enables one to choose the right Approval Process
vendor for the purchase. Using the  The person who creates the document,
quotation helps in lessening expenses, either a purchase request or order, is the
improving the quality and increasing originator. Upon adding documents to the
on-time delivery. A purchase quotation material management system, the system
report allows one to compare offers in checks for any approval requirements.
order to pick the appropriate vendor for the If the document fails to meet the requisites
purchase scenario. Afterwards, one can for an approval, the originator is
create the purchase order from the selected notified that the document needs
quotation. approval. The document is temporarily
saved as a draft.
2. Preferred Vendors  An internal request is immediately sent to
 Companies typically maintain a list of the first approval stage when the approval
preferred vendors, from which inventory process is launched. This request is received
items are usually purchased. Several qualities in the Messages/Alerts Overview
of a preferred vendor that a company looks window, and the approver can access
for are: the document. Approval can be
done through a mobile phone if the
 On-time performance devices are integrated. A internal
 Reasonable costs notification goes back to the originator with
 High quality of products and services a link to the rejected document should the
 Fully licensed, bonded, and insured approver reject the document. The
 Good Business practices originator can amend the document, and
the approval procedures will
Purchase Requests, Orders Creation And continue until the approval conditions
Approval Process are adequately satisfied (SAP, 2012).

Purchase Orders Inspecting a Shipment


 A Purchase Order, on the other hand, is a  Persons receiving shipments should, upon
document which records a business acknowledging receipt of an order, conduct
transaction between the buyer and the seller. an inspection to verify the following
A buyer issues his order, and upon seller minimum conditions:
acceptance of order, a legally binding 1. The products conform to the purchase order
contract is created between the parties (SAP, requirements and other relevant documents
2012). (for example: correct model number,
description, size, type, color, ratings, etc.)
 A simple Purchase Order will identify the 2. The quantity ordered against the quantity
following basic elements: shipped or delivered.
a. Buyer: name, address, and contact info of 3. There is no damage or breakage.
party giving money for goods 4. The unit of measurement count is correct
b. Seller: name, address, and contact info of (e.g. if the unit of measurement on the
party receiving money for goods purchase order one dozen, there should be
c. Order Number: a unique ID number to track 12 in the package).
each business transaction 5. Delivery documentation (packing list,
d. Item Description: details, quantity of goods, certifications, etc.) is acceptable.
cost per unit, and total price of goods 6. Perishable items are in good condition and
e. Shipping Address: where the goods will be expiration dates have not been exceeded.
shipped 7. Products are operable or functional.

5
Partial Deliveries 1. First In, First Out (FIFO) – Inventory items are
 Departments should contact the appropriate sold in the order they are purchased. This is the
Purchasing Agent whenever a purchase is most common technique.
received a a partial delivery without 2. Last In, First Out (LIFO) – Last to enter the
acknowledgement or notification from the system are sold first. This is common among
supplier. This information is typically noted non-perishable items like petroleum, minerals,
on the packing list. and metals.
3. First Expired, First Out (FEFO) – Materials are
Tracking of Goods sold based on date they should be consumed,
 Goods can be easily tracked /traced when regardless of when it was purchased.
they are managed by Serial or Batch. Aging
of products can also be done if the items are Periodic Physical Stock Taking And Adjustments
slow moving/stay longer in the warehouse. With Tracking

Expired Stock And Quarantine  An inventory count is a process where a


business physically counts its entire
Expired Stock/Inventory inventory. A physical inventory may be
 Upon reaching their expiration dates, some mandated by financial accounting rules or
goods, such as food and medicine, can no the tax regulations to place an accurate
longer be utilized. In rare instances, it may value on the inventory, or the business may
be sold to other parties at a lower cost. need to count inventory so component
However, as soon as inventory expires and parts or raw materials can be restocked.
its value falls below its original cost, this Businesses may use several different tactics to
must be reflected in the financial records so minimize the disruption caused by physical
as not to misstate the financial statements. inventory:
The amount that reduces inventory in your  Inventory services provide labor and
records is recognized as a loss that is a automation to quickly count inventory
reduction in profit (Keythman, 2017). and minimize shutdown time.
 Inventory control system software can
Quarantine Stock/Inventory speed the physical inventory process.
 When undecided about how to handle  A perpetual inventory system tracks the
defective goods, whether to be sold as scrap, receipt and use of inventory, and
reworked, returned, or used as it is, a calculates the quantity on hand.
quarantine location or warehouse can be  Cycle counting, an alternative to
used to temporarily house them until a final physical inventory, may be less
decision has been reached. disruptive (CTI Reviews, 2016).
 Inventory is put into quarantine if initially  Fortunately, these are all features and
rejected during: benefits offered by the Material
a. Production, upon completion of an Management System. Barcode and RFID are
operation, when specified as Move Rejected supplementary technologies that can be
End Item to Quarantine. used in combination with the Material
b. Inbound inspection upon receipt of: Management System in
 Manufactured end items
 Purchased items Lesson 3: Clinical Data Repositories
 Sold items on sales return orders
 Enterprise Planning distribution orders Clinical Data Repositories (CDR)
c. Outbound inspection upon issue of:  in electronic or written format
 Materials to production (Infor LN  to represent an aggregated database of
Warehousing, 2018). clinical information
 It usually houses a multitude of
LIFO, FIFO, FEFO Issues Methods: laboratory results, diagnostic reports, and
 Inventory management is a crucial function various clinical documentations.
for any product-oriented business. Common  The data are readily searchable and
inventory handling methods include: exportable, often because the information
is gathered from standard clinical care
procedures

6
 The CDR integrates physician-entered data than a warehouse or more
with data from different existing sources than a registry.
information systems including laboratory, Organized to help users find a
radiology, admission, and pharmacy among particular data set, but not to
others. query for data combined across
 It is a location where both clinical data and data sets.
other data of interest, such as external data Federation A repository distributed across
sources and financial data, are assimilated. multiple locations, where each
location retains control over
Clinical Data Repositories access to its own data, and is
 A clinical data repository can successfully responsible for making the data
depict the same sample across different comparable with the data of
points in time, from varying sources both other locations.
within and outside the health institution.
Common kinds of available information in Multiple Views For Patient Medical Record
the CDR are listed below:  Information for patients is typically scattered
across multiple subsystems. A clinical
 Patient Demographics data repository standardizes data from
 Patient’s Primary Care Provider disparate sources into a cohesive
 Medication List format. It comprises numerous tables, each
 Allergies offering a partial view of patient
 Hospital Inpatient Visits information.
 Emergency Department Encounters  The structure of clinical data repositories
 Outpatient Practice Visits allows data to be extracted along
 Immunizations dimensions such as time (by year, month,
 Diagnoses week, or day), location, or
 Procedures diagnosis among many others. This data can
 Lab Results often be accessed in smaller units
 Social History within the same dimension. For
 Vitals instance, a user can view the number of
patients with having a certain type of
Types Of Clinical Data Repositories diagnosis, lab result, or prescription
within a year, then a month in that year,
Repository Definition and further into a day in that month.
Type
Study A database that collects Graphical Representation Of Lab Results And
observations for a specific Vitals
clinical research study.
Electronic A database of observations  Data collected through an electronic health
Health Record made as a result of direct health record system may be retrieved at the
care request of an authorized user, whether a
Registry Observations collected and physician, medical technologist, nurse or
organized for the purpose of radiologist. The electronic health record
studying or guiding particular may present patient care information as text,
outcomes on a defined tables, graphs, sounds, images,
population. Associated studies full-motion video, or signals on an
are either multiple or long-term electronic screen, phone, pager, or paper
and evolving over time. (Bronzino and Peterson, 2014).
Warehouse A repository that adds levels of  Unfortunately, analyzing trends and
integration and quality to the patterns from large data sets can be a
primary (research or clinical) challenging process. This is where data
data of a single institution, to visualization, the art of representing data in
support flexible queries for a pictorial or graphical format, becomes
multiple uses. Is broader in useful.
application than a registry.  Data visualization helps in simplifying
Collection A library of heterogeneous data a wide array of information, and it
sets from more organizations allows decision-makers to derive analytical

7
results from information presented 1. A computer program should be used in
visually. Correlations, patterns, and clinical practice only after appropriate
trends which might be undetected from evaluation of its efficacy and the
text-based clinical data can be documentation that it performs its intended
revealed and recognized with more task at an acceptable cost in time and
ease because of data visualization. money.
 Visualization is increasingly becoming an 2. All uses of informatics tools, especially in
important tool in decision making. The patient care, should be preceded by
graphical representation feature of most adequate training and instruction, which
clinical data repositories enable scenario should include review of applicable
analysis, which helps users use different product evaluations.
kinds of filters in order to change the level of 3. Users of most clinical systems should be
information that may be seen. Common health professionals who are qualified
filters include age and gender, in order to to address the question at hand on
assess how the outcomes of a certain the basis of their licensure, clinical
intervention will be based on isolating training, and experience.
certain factors.

Lesson 4: Ethics, Privacy, and Security

Introduction
 Modernization in healthcare has led
to the tendency of most practitioners
to rely on the use of mechanical aids
throughout the process of providing patient Guiding Principles of General Ethics:
treatment. However, the fact remains that
human values should continue to 1. Autonomy
govern research and practice in the  Autonomy is defined as either allowing
healthcare profession. individuals to make their own decisions in
 Healthcare informatics encompasses response to a particular societal context, or
issues of proper and improper as the idea that no one human person does
behaviour, honourable actions, and of right not have the authority nor should have
and wrong. power over another human person.
 Ethical questions in medicine, nursing,  Electronic health records (EHR) must
human subject research, psychology, and maintain respect for patient autonomy, and
other related fields continue to become this entails certain restrictions about the
more twisted and complex, but some access, content, and ownership of records.
overarching issues are common among  Limiting patient access and control over
them. patient records improves document quality
 Ethical issues in health informatics, on the because they can become proofreaders of
other hand, are less familiar, even if their own patient history (Mercuri, 2010).
some of them have been
controversial for decades. 2. Beneficence and Non-maleficence
 Informatics also raises questions  These two principles are respectively
about various legal and regulatory defined as “do good” and “do no harm.” In
requirements. health informatics, beneficence relates most

8
significantly with the use of the stored data 4. Principle of Access
in the EHR system, and non-maleficence  The subjects of electronic health records
with data protection. have the right of access to those records and
 Deeply-integrated EHR systems will contain the right to correct them with respect to its
substantial amounts of raw data, and great accurateness, completeness and relevance.
potential exists for the conduction of
groundbreaking biomedical and public 5. Principle of Legitimate Infringement
health research. These kinds of research will  The fundamental right of privacy and of
be beneficial to both the individual patient, control over the collection, storage, access,
and to the entirety of society. use, manipulation, linkage, communication
 With this in mind, new EHR systems should and disposition of personal data is
be developed with the capacity to allow conditioned only by the legitimate,
patients to release information from appropriate and relevant data-needs of a
their EHRs which can be valuable to free, responsible and democratic society,
researchers and scientists. Similarly, and by the equal and competing rights of
the available consolidated from clinical data others.
repositories will be able to allow healthcare
professionals to provide the best possible 6. Principle of the Least Intrusive Alternative
treatments for their patients, further  Any infringement of the privacy rights of a
upholding the principle of beneficence. person or group of persons, and of their
right of control over data about them, may
Informatics Ethics only occur in the least intrusive fashion and
 Informatics ethics, on the other hand, with a minimum of interference with the
involves the ethical behaviour required of rights of the affected parties.
anyone handling data and information, as
prescribed by the International Medical 7. Principle of Accountability
Informatics Association (2016). It covers  Any infringement of the privacy rights of a
seven principles: privacy, openness, security, person or group of persons, and of the right
access, legitimate infringement, least to control over data about them, must be
intrusive alternatives, and accountability. justified to the latter in good time and in an
appropriate fashion.
1. Principle of Information-Privacy and
Disposition Software Ethics
 All persons and group of persons have a  Health informatics ethics heavily relies on
fundamental right to privacy, and hence to use of software to store and process
control over the collection, storage, access, information. As a result, activities carried out
use, communication, manipulation, linkage by software developers might significantly
and disposition of data about themselves. affect end-users. The software developer has
ethical duties and responsibilities to the
2. Principle of Openness following stakeholders: society, institution
 The collection, storage, access, use, and employees, and the profession.
communication, manipulation, linkage and  Activities should be carried out with the best
disposition of personal data must be interest of the society in mind. Developers
disclosed in an appropriate and timely should be mindful of social impacts of
fashion to the subject or subjects of those software systems. This includes disclosing
data. any threats or known defects in software.

3. Principle of Security Privacy, Confidentiality And Security


 Data that have been legitimately collected  Privacy generally applies to individuals and
about persons or groups of persons should their aversion to eavesdropping, whereas
be protected by all reasonable and confidentiality is more closely related to
appropriate measures against loss unintended disclosure of information.
degradation, unauthorized destruction,  There are numerous significant reasons to
access, use, manipulation, linkage, protect privacy and confidentiality. One is
modification or communication. that privacy and confidentiality are widely
regarded as rights of all people which merits
respect without need to be earned, argued,

9
or defended. Secondly, protection of 3. Perimeter identification — knowing and
privacy and confidentiality is ultimately controlling the boundaries of trusted access
advantageous for both individuals and to the information system, both physically
society. Patients are more likely to be and logically;
comfortable to share sensitive health care 4. Controlling access — enabling access for
data when they believe this information health care providers only to information
would not be shared inappropriately. essential to the performance of their jobs
 This kind of trust is essential in establishing a and limiting the real or perceived
successful physician- patient or nurse-patient temptation to access information beyond a
relationship, and it enabled practitioners to legitimate need; and
perform their jobs better. 5. Comprehensibility and control — ensuring
 Privacy and confidentiality protection also that record owners, data stewards, and
benefits public health. When people are not patients understand and have effective
afraid to disclose personal information, they control over appropriate aspects of
are more inclined to seek out professional information privacy and access.
assistance, and it will diminish the risk of
increasing untreated illnesses and spreading Philippine Data Privacy Act of 2012
infectious diseases (Goodman, 2016).  Business Process Management, particularly
involving Health Information Technology, is
Levels of Security in the Hospital Information an increasingly growing industry within the
System Philippine economy. With total IT
 It is important to note that the types of expenditure reaching $4.4 Billion in 2016,
safeguards you choose may be prescribed or the industry is forecasted to more than
restricted by law. Another important double itself by the year 2020. In addition,
consideration is the cost-benefit principle. If Filipinos utilize social media heavily, with a
it is not cost effective for your practice to whopping 3.5 Million users on LinkedIn, 13
avail of an expensive technology to mitigate Million on Twitter, and 42.1 on Facebook
a risk to electronic health information, an (Wall, 2017).
alternative may be requiring your staff to  Given the rapid evolution of the digital
follow a new administrative procedure that economy and heightened international data
equally reduces that risk. trading, the Philippines has decided to
 Conversely, if you cannot afford to place strengthen its privacy and security
additional burden on your staff due to protection by passing the Data Privacy Act
possibilities of human error, you may of 2012, with an aim “to protect the
choose to purchase a technology that fundamental human right of privacy, of
automates the procedure in order to communication while ensuring free flow of
minimize the risk. information to promote innovation and
 Regardless of the type of safeguard your growth.” (Republic Act. No. 10173, Ch. 1,
practice chooses to implement, it is Sec. 2).
important to monitor its effectiveness and  The Data Privacy Act applies to individuals
regularly assess your health IT environment and legal entities that are in the business of
to determine if new risks are present. processing personal information. The law
applies extraterritorially, applying both to
The National Research Council (1997) companies with offices in the Philippines,
emphasizes that technological security tools are and even those located outside, but which
essential components of modern distributed use equipment based in the Philippines. It
health care information systems, and that they covers personal information of Filipino
serve five key functions: citizens regardless of the place of residence.

1. Availability — ensuring that accurate and The Main Principles That Govern The Approach
up-to-date information is available when For The Data Privacy Act Include:
needed at appropriate places;  Transparency;
2. Accountability — helping to ensure that  Legitimacy of purpose; and
health care providers are responsible for  Proportionality.
their access to and use of information, based  Consent is one of the major elements
on a legitimate need and right to know; highly-valued by the Data Privacy Act. The
act provides that consent must be

10
documented and given prior to the include imprisonment. These violations
collection of all forms of personal data, and include:
the collection must be declared, specified, a. Unauthorized processing
and for a legitimate purpose. b. Processing for unauthorized purposes
 Furthermore, the subject must be notified c. Negligent access
about the purpose and extent of data d. Improper disposal
processing, with details specifying the need e. Unauthorized access or intentional breach
for automated processing, profiling, direct f. Concealment of breach involving sensitive
marketing, or sharing. These factors ensure personal information
that consent is freely-given, specific, and g. Unauthorized disclosure; and
informed. h. Malicious disclosure.
 However, an exception to the requirement i. Any combination or series of acts
of consent is allowed in cases of contractual enumerated above shall make the person
agreements where processing is essential to subject to imprisonment ranging from three
pursue the legitimate interests of the parties, (3) years to six (6) years, and a fine of not
except when overridden by fundamental less than One million pesos
rights and freedom. Such is also the case in (Php1,000,000.00) but not more than Five
responding to national emergencies. million pesos (Php5,000,000.00) (Republic
 Processing of sensitive and personal Act. No. 10173, Ch. 8, Sec. 33).
information is also forbidden, except in
particular circumstances enumerated below. Lesson 5: Change Management in Health
The Data Privacy Act describes sensitive Informatics
personal information as those being:
 About an individual’s race, ethnic origin, Change Management In Health Informatics
marital status, age, color, and religious,
philosophical or political affiliations; Introduction
 About an individual’s health, education,  There are generally four kinds of changes
genetic or sexual life of a person, or to that all kinds of organizations might
any proceeding or any offense encounter, with the likelihood of overlap
committed or alleged to have among the conceivable outcomes:
committed;
 Issued by government agencies 1. Operational Changes
“peculiar” (unique) to an individual,  can influence the way dynamic business tasks
such as social security number; are led, including the computerization of a
 Marked as classified by executive order particular business segment.
or act of Congress.
 The exceptions are: 2. Strategic Changes
 Consent of the data subject;  occur when the business direction, in
 Pursuant to law that does not require relation to its vision, mission, and
consent; philosophy, is altered. For instance,
 Necessity to protect life and health of a changing the business technique from
person; business growth to increasing market share
 Necessity for medical treatment; in the overall industry is a case of strategic
 Necessity to protect the lawful rights of change.
data subjects in court proceedings, legal
proceedings, or regulation. 3. Cultural Changes
 The provisions of the law necessitate  influence the internal organizational culture,
covered entities to create privacy and for example, the way the business is
security program to improve the collection conducted, such as actualizing a CQI
of data, limit processing to legitimate (continuous quality improvement)
purposes, manage access, and implement framework.
data retention procedures.
4. Political Changes
Penalties  in human resources occur primarily due to
 The act provides for different penalties for political reasons of varying types,
varying violations, majority of which commonly changes that happen on top

11
patronage levels in the government 3. Kotter’s 8-Step Model of Change
agencies.  developed by Harvard Business School’s
 Different sorts of changes typically have John Kotter, focuses on efficient and
dissimilar impacts on different effective change management in a
organizational levels. For instance, the competitive world. Highlights include
operational changes tend to have the building a strong, collaborative team and a
highest impacts on the lower organizational solid strategy; creating effective
levels, because the frontline employees are communication channels; supporting staff
mostly affected. Employees working at the empowerment; using a phased and steady
upper-levels might be indifferent as to the approach; and securing the change within an
changes, which may cause significant distress organization’s culture (QuickBase, 2017).
to those attempting the implementation of
change. Application Of Change Management
 Conversely, the effect of the political
changes is more strongly felt on the higher Change Management
levels of the organization. When change  is a series of tools, techniques and processes
occurs relatively in a bureaucratic aimed at successfully effecting change. These
organization, those working on the bottom tools and techniques can be implemented in
level often notice the change at the top a variety of contexts, but often they support
(Lorenzi & Riley, 2000). the application of other initiatives such as Six
Sigma, CRM, Total Quality Management or
 There is no denying that organizational enterprise applications such as SAP.
changes have varying degrees of impact on
both the organization, and in effect, its Downey (2008)
clientele. This chapter discusses Change  describes common tools and techniques that
Management contextualized in Health a change management practitioner might
Informatics, which is increasingly becoming use during a change initiative, which
a course of action that health institutions include:
avail of in order to improve their services.
 Questioning skills to gather information
Change Management Process Models about the ‘as is’ and ‘to be’ status of the
 There are a wide range of change business process
management process models to explore and  Process mapping for both ‘as is’ and ‘to be’
consider—each with their own strategic processes
approaches based on the expertise and  Gap analysis
experiences of their developers. A few of the  Business case development
more common change practice examples  Project management
include:  Problem solving
 Requirements elicitation techniques
1. Kurt Lewin’s three-step  Negotiation skills.
“Unfreeze-Change-Refreeze” model
 proposed by the universally recognized In addition to these techniques, Downey
founder of social psychology in the 1950s. It also mentions that it is crucial that progress of the
is still highly relevant today and often used change initiative can be quantified against the
as the basis for many change management objectives set by the organization. For this to be
strategies. successful, the organization needs to set clear
objectives and settle on key performance
2. Proski’s ADKAR® Model indicators (KPIs) that can be used to track and
 an acronym for a strategy that encompasses: evaluate the change initiative against its
“Awareness of the business reasons for objectives. These KPIs might include:
change; Desire to engage and participate in
the change; Knowledge about how to  Reducing rework by x%
change, Ability to implement change, and  Improvement in stakeholder satisfaction, for
Reinforcement to ensure change sticks”. example, customer/employee surveys
 Reduced time to market
 Enhanced speed of delivery

12
 The return on investment, that is, the total them to assume the role both of privacy
cost to implement the initiative versus total official and/or security officials who store,
savings gained protect, and transmit information in all
media and formats (May, 2014). A Health
Table 15.1: Key Success Factors Information Management professional:

Key success factors at the Key success factors at the  Collects, aggregates, analyzes, and
leadership level in program level disseminates patient health information.
healthcare organizations  Committed to the timely and accurate
1. Setting vision and 1. Clear and frequent collection of health information and its
strategy roadmap dissemination of
maintenance, storage, retentions, and
2. Formation of information
governance board to set 2. Building a strong
disclosure.
direction, to prioritize project leadership  Represents patients’ interest in matters of
work, and to allocate team/steering team privacy and security, information release,
resources and other and issues and guidelines regarding record
3. Designate an executive action/functional teams access.
sponsor, departmental 3. Providing education  Certified by the American Health
champions, and and training on the Information Management Association.
program manager new changes – workflow  Ensures confidential patient information is
4. Define reporting and technology
kept private, secure, and in accordance with
requirements for status 4. Forming integrated
reporting in order to keep problem-solving teams
federal and state laws.
projects moving forward to address critical
5. Manage users’ and complex issues Health Information Management Professionals
expectations; prepare 5. Empowering staff and  are the stewards and guardians of patient
them for casualties, stress, end-users to change health information. They represent the
and general sense of things, by removing patient’s interests in matters of privacy and
ambiguity barriers and obstacles security, information release, issues and
6. Adoption - make the guidelines regarding record access, and
change stick by
general consumer education about personal
reinforcement, until old
traditions are replaced
health records.
with new  They specialize in managing patient health
7. Frequently celebrate information and medical records,
success by honoring administering computer information systems,
contributors to keep the and classifying using standard coding systems,
motivation and the diagnoses, and procedures for health
momentum care services provided to patients.
8. Monitor and measure  Those with health information management
key indicators (e.g. using
and health information technology careers
a dashboard to report
progress and benchmarks)
manage all aspects of the content of patient
9. Involve those medical records and patient information
affected by the change systems. Job responsibilities can include
in decision-making aspects of clinical information
(e.g. choice of computer documentation capture and maintenance,
carts, COW) HI data analytics and interpretation, as well as
10. Other creative actions designing, implementing, and maintaining
e.g. monthly prizes for health information technology systems.
high performing teams,
provide snacks & drinks
The Philippine Health Information Profession
The Role of Health Information Management
Advancements in ICT (information and
Professionals
communication technology) are upsetting not
only traditional businesses, but even those not
Health Information Management (HIM)
immediately thought of as probable
 professionals, credentialed with their
beneficiaries—such as the healthcare sector.
academic preparation, work experience,
From electronic patient records to the
commitment to patient advocacy, and
wireless transmittal of patient files for remote
professional code of ethics, have a
diagnosis, improvements in communication and
specialized skill set that uniquely qualifies

13
technology will lead to better delivery of in the Telemedicine scene in the Philippines
healthcare services. Telemedicine, or the use of currently exist, ranging from mobile apps to call
electronic communications to transmit and center services.
exchange medical information and data to Some providers of over-the-phone
provide patient treatment, is quickly gaining telemedicine services are Medgate and Lifeline.
momentum within the country and the rest of Common features include 24/7 call centers,
the ASEAN region. diagnosis using images sent via email, medical
With the increasing popularity of smart certificates, and treatment plan summaries. These
phones, wireless tools and other comparable kinds of telemedicine centers usually have a
technology, primary care and specialist referral corresponding mobile app to facilitate easier
services, as well as remote patient monitoring access. Unique to Lifeline, however, is video
and patient medical health information are consultation with doctors, patient education, free
undeniably improved with the help of doctor or nurse home visits, and delivery of
telemedicine. medication and prescriptions in exchange for a
Thailand, Singapore, and Malaysia have fixed monthly subscription fee.
started adopting healthcare IT solutions to bring Mobile App-based Telemedicine centers, on
the sector to the next level. In 2009, Singapore the other hand, include MyPocketDoctor and
developed its National Electronic Health Record MyDocNow. These providers are usually in
initiative, which permitted healthcare partnership with other international telemedicine
practitioners in the island state access to a centers.
patient’s records across the healthcare Medway Healthcare Inc., by far, offers the
continuum. most comprehensive set of telemedicine services,
Malaysia initiated a Hospital being the first medical clinic in the Philippines to
Implementation System in 1993, with its first mobilize its Pre-Employment Medical
telemedicine project in 1996, and Thailand Examination (PEME) arm into the path of
created its National Health Information delivering interactive healthcare. They offer
Committee in 2010. Telefollow-up and Teleconsultation procedures
Likewise, the Philippines has developed an which are accessible online and through a
e-Health Strategic Framework and Plan for 2014 specially-designed computer program. P
to 2020, whose objective is to utilize information In Telefollow-up, patients are notified of the
and communication technologies in the health medical evaluation results via text messages on
sector. This will assist in the delivery of health their individual cell phones. Within 24 hours of
services and manage health systems for greater PEME, patients will already know if they are fit
efficacy, with the ultimate goal of providing to work, unfit to work or still with pending
universal healthcare for the Filipinos. workups. Follow-up visit to the clinic is then
One of the strategic goals of this framework advised. Follow-up of results using traditional
is to establish unified and coherent health and landline call is also accommodated.
management information systems, and also to Telemedicine efforts from the government
take advantage of ICT to reach and provide and other non-profit organizations have also
better health services and support the attainment ensued. The National Telehealth Center is the
of the UN’s Sustainable Development Goals. leading research unit in the University of the
In line with this, the Department of Health Philippines responsible for developing cost
(DOH) in Region 4Bhas launched the first effective tools and innovations in the realm of
interactive telemedicine system in Marinduque, information and communications technology
and seemingly the entire country, at the Dr. (ICT) for improving health care. NTHC
Damian J. Reyes Provincial Hospital. The system experienced a breakthrough, when it first
currently provides medical consultations and conducted telemedicine research-cum-service in
diagnostics through video calls (De Dios, 2016). remote and undeserved areas from Batanes to
Zamboanga through partners in the then
Telemedicine In The Philippines Commission on Information and
Communications Technology’s (CICT,
For an archipelago such as the Philippines, 2004-2008) and Department of Science and
the delivery of healthcare services might prove to Technology - Philippine Council for Health
be challenging. Fortunately, the rise of Research and Development (DOST-PCHRD,
Telemedicine within the region, as discussed 2008-2011). Today, the center partners with
above, has been a beneficial turn of events for various government and non-government
the Philippine Healthcare sector. Multiple players institutions, engaging them on eHealth research,

14
training, and service activities (National
Telehealth Center, n.d.).
The Department of Science & Technology
(DOST) has also begun distributing the
breakthrough “RXBox” telemedicine device
developed by engineers and researchers from
University of the Philippines (UP) Diliman and
UP Manila to 1,000 far-flung municipalities in the
country, focusing on disadvantaged
municipalities to benefit from having affordable
health care in their respective communities.
The RXBox was collaboration between a
team of engineers, doctors and researchers from
UP Diliman and UP Manila, led by electronics
and communication engineer Nathaniel Cruz,
who is currently with the National Telehealth
Center.
RXBox has features that enable
teleconsultations via email, video call, or SMS. It
has sensors that can measure a patient’s blood
pressure, temperature, oxygen saturation rate,
pulse rate, and even the electrocardiogram rate,
and this information may all be sent to the
specialist doctor via email or SMS, aiding in
patient care. Afterwards, the RXBox stores and
files data into a community health information
system (Ronda, 2016).

15

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