Data quality in hospital strategic information systems: a summary of survey findings

Fundamental changes in health care financing and delivery have resulted in an unprecedented need for data and information. The application of computer technology to daily hospital operations has gone far toward aiding various kinds of organizational decision making. The quality of those decisions, however, is dependent upon the quality of the data delivered by the various information systems used in the course of health care delivery and management. What remains unknown is the extent to which poor data quality occurs and what actions are taken to measure and control data quality in information systems used for strategic decision making. This article summarizes the results of a survey that was conducted for the purpose of explaining what information systems are important to hospital administrators in their strategic decision making, the frequency with which strategic decision makers encounter data quality problems, and what, if any, actions are taken to prevent, control, or correct apparent data quality problems.     

The pillars of health management education: lessons from the CEE experience.

AUPHA faculty members have had the opportunity to provide health care executive training and to work in partnership with academic institutions in Central and Eastern Europe and in the New Independent States of the former Soviet Union. This article presents some observations on health management education that demonstrate the similarity in issues faced by programs in the U.S. and in CEE. The health management educational partnership program was designed to provide technical assistance to emerging health management programs in the CEE. The partnership program has been mutually beneficial for several reasons. The role of physicians in leadership and the management educational needs that result provide one example of an issue that health management educational programs must address. The emergence of the roles of other health professions and growing contribution that they will make has its parallel in the American ascendance of the role of interdisciplinary team in clinical decision making. The partnership and executive training experiences have caused U.S. partners to focus consciously on pedagogical methods. The nature of the issues faced by emerging CEE health management programs suggests that mutual support among programs in the region after the partnership program is necessary in order to provide a forum for debate. The focus of the debate should continue to be on the role of management in health reform, content of curriculum, research focus and pedagogical methods appropriate for health care management undergraduate and graduate programs. The result will be a strengthening of the health management academic discipline in the region. The future of the AUPHA should predicated on the same principles, the roots from which it has grown.     

卫勤优化决策模拟训练信息管理系统研发

针对信息化条件下某校卫勤指挥训练问题,以某校卫生事业管理专业生长型学员、研究生和继续教育学员为对象,依据全军信息化统一技术体制与数据要求,依托卫勤优化决策模拟训练系统,设计并研发了与之配套的信息管理系统,搜集、储存、分析和整理卫勤指挥决策所需要的各类信息资源,为优化决策方案的制定提供有力的数据支撑。     

Hospital administrator perceptions of health information managers as future leaders in health care reform

The article examines hospital administrators' perceptions of health information professionals moving into leadership positions within health care organizations. Data for this study were collected from a national random sample of hospital administrators (N = 62). Findings from the study suggest that, although health information managers are viewed as integral to the success of the health care organization, health information managers are perceived as lacking appropriate educational training to move into administrative or leadership positions. For the health information professional to move into a leadership position, educational training (at the master's level) must focus on quality management, statistical process control, and performance evaluation.     

Evidence-based management reconsidered

Reports of medical mistakes have splashed across newspapers and magazines in the United States. At the same time, instances of overuse, underuse, and misuse of management tactics and strategies receive far less attention. The sense of urgency associated with improving the quality of medical care does not exist with respect to improving the quality of management decision making. A more evidence-based approach would improve the competence of the decision-makers and their motivation to use more scientific methods when making a decision. The authors of this article consider a study of 68 U.S. health services managers that found a low level of evidence-based management behaviors. From the findings, four strategies are suggested to increase health systems managers' use of research evidence to improve decision making: focusing evidence-based decision making on strategically important issues, developing committees and other structures to diffuse management research throughout the organization, building a management culture that values research, and training managers in the competencies required to apply research evidence to health services management decisions. To aid the manager in understanding and applying an evidenced-based approach to decision making, the article provides practical tools, techniques, and resources for immediate use.     

医院信息系统数据质量现况分析

数据质量存在的问题严重影响信息系统在医院日常事务处理、统计分析和预测决策等方面的准确性和可靠性。影响数据质量的因素主要有:长期以来缺乏足够的重视;数据监管制度不健全;基础数据录入缺乏统一标准及规范;人员素质培训力度欠缺;医院信息系统本身的问题,等等。     

Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making

This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.     

Information in medical decision making: how consistent is our management?

BACKGROUND: The use of outcomes data in clinical environments requires a correspondingly greater variety of information used in decision making, the measurement of quality, and clinical performance. As information becomes integral in the decision-making process, trustworthy decision support data are required. METHODS: Using data from a national census of certified health information managers, variation in automated data quality management practices was examined. RESULTS: Relatively low overall adoption of automated data management exists in health care organizations, with significant geographic and practice setting variation. Nonuniform regional adoption of computerized data management exists, despite national mandates that promote and in some cases require uniform adoption. Overall, a significant number of respondents (42.7%) indicated that they had not adopted policies and procedures to direct the timeliness of data capture, with 57.3% having adopted such practices. CONCLUSIONS: The inconsistency of patient data policy suggests that provider organizations do not use uniform information management methods, despite growing federal mandates to do so.     

Strategic information systems: can you support your decisions?

Information technology will continue to have a profound effect on decision analysis. Clinicians and technologists must continue to work together to achieve systems that enhance patient quality and managerial decision making. Users will continue to grow more sophisticated in using information systems for patient care and organizational analyses. Strategic information systems will not solve all problems that health care professionals may face. However, better decisions will result from improved availability of information. The acceptance, support, and imagination of power users will enhance and drive information system development and design. Strategic information systems will provide opportunities for data analysis enabling health care professionals to better support decisions.     

关于开展医学信息学教育的思考和建议

当前，医疗卫生专业人员对现代数据处理、信息处理和知识处理技术及其在医疗决策中的作用还普遍缺乏深入了解。为有效利用信息资源，提高医疗水平，要求他们应用信息技术，但知识有限。有鉴于此，迫切需要大量训练有素的医学信息学专业人才。欲达此目的，只有通过改进医学教育，使更多的医疗卫生专业人员接受医学信息学培训。     

Creating a culture for health care quality and safety

Approximately 67% of hospital quality indicators require some type of laboratory testing to monitor compliance. Unfortunately, in many hospitals, laboratory data information systems remain an untapped resource in eliminating medical errors and improving patient safety. Using case scenarios, this article demonstrates potential consequences for patient safety and quality of care when information sharing between medical technologists and nurses is not a part of a hospital's culture. The outcome for this patient could have been avoided if a more inclusive health care quality and safety culture existed. Creating a culture for health care quality and safety requires consensus building by clinical and administrative leaders. Consensus building occurs by managing relationships among and between a team of independent, autonomous physicians, nurses, allied health professionals, and health care administrators. These relationships are built on mutual respect and effective communication. Creating a quality culture is a challenging but necessary prerequisite for eliminating medical errors and ensuring patient safety. Physician leaders promoting and advancing cultural change in clinical care from one of exclusive decision making authority to a culture that is based on shared decision making are a necessary first step. Shared decision making requires mutual respect, trust, confidentiality, responsiveness, empathy, effective listening, and communication among all clinical team members. Physician and administrative leaders with a focus on patient safety and a willingness to change will ensure a culture of health care quality and safety.     

突发公共卫生事件预警决策分析能力现状调查

目的分析“提高预警决策分析能力试点研究”试点省一湖北省各级疾病预防控制中心突发公共卫生事件预警决策分析能力的现状，为制定合理的培训方案提供科学建议。方法对湖北市、县两级疾病预防控制中心从事突发公共卫生事件预警决策分析的专业人员进行半结构化访谈，了解其工作现状、人员状况、监测的内容和报告管理方式、监测数据的利用情况、提高决策分析能力的途径等内容。结果市级疾病预防控制中心监测资料的内容未整合、资料质量和管理尚可，但分析利用的能力不足，难以完成突发公共卫生事件预测、预警的工作。县级疾病预防控制中心仅能完成监测系统的报告任务，基本不具备对突发公共卫生事件进行预测、预警的能力。结论应当对市级、县级疾病预防控制中心专业人员进行分级培训，培训内容和方式上应各有侧重。培训的内容应包括基础理论知识的巩固和更新，典型案例分析等内容。     

Improving the quality of decision-making in health care management: a project report from the Nevada/Bohemia health management education partnership.

Health care is a data-sensitive and data-rich industry. Designers of health administration curricula recognize that future health care providers and managers must be trained to use available analytical and database information technology (IT) to transform these data into information helpful to the decision-maker. However, as the data available to administrators and clinicians proliferates, additional skills are needed to select data that is pertinent and useful. This paper presents the results of the collaboration of partners from Bohemia and University of Nevada and focuses on three areas: threats to the effective use of data to support health care decision-making;. health care decision support research and training strategies; future cross-disciplinary collaboration in health care decision support. Advanced IT methods have the potential to assist clinical and managerial decision-making. If further discussion is stimulated about the introduction of advanced IT methods into the health care management curriculum and research agenda, this paper will achieve its goal.     

Education in the workplace for the physician: clinical management states as an organizing framework

Medical educators are interested in approaches to making selected relevant knowledge available in the context of problem-based care. This is of value both during the process of care and as a means of organizing information for offline self-study. Four trends in health information technology are relevant to achieving the goal and can be expected to play a growing role in the future. First, health care enterprises are developing approaches for access to information resources related to the care of a patient, including clinical data and images but also communication tools, referral and other logistic tools, decision support, and educational materials. Second, information for patients and methods for patient-doctor interaction and decision making are becoming available. Third, computer-based methods for representation of practice guidelines are being developed to support applications that can incorporate their logic. Finally, considering patients as being in particular "clinical management states" (or CMSs) for specific problems, approaches are being developed to use guidelines as a kind of "predictive" framework to enable development of interfaces for problem-based clinical encounters. The guidelines for a CMS can be used to identify the kinds of resources specifically needed for clinical encounters of that type. As the above trends converge to produce problem-specific environments, professional specialty organizations and continuing medical education course designers will need to focus energies on organizing and updating medical knowledge to make it available in CMS-specific contexts.     

Health-related quality-of-life data should be regarded as a vital sign

ObjectivesThe health care system systematically collects data on risk factors, processes of care, and the amount and type of services provided; in short, it mainly measures inputs. The system only sporadically collects data on the health status and health-related quality of life (HRQL) of those served. What does the system actually produce? It produces quality-adjusted survival; yet, there is little systematic effort to collect such outcome–output data.Study Design and SettingSystematic routine use of HRQL instruments to assess the health of all patients is one step toward filling this void.ResultsAssessing the HRQL on all patients provides the information needed to create a report card on the system. Furthermore, the routine use in the context of chronic care management has the potential to improve patient–clinician communication, provider and patient satisfaction, shared decision making, and health outcomes.ConclusionOver five decades of methodological development have provided a rich array of HRQL instruments. A plethora of technologies facilitate the collection, transmission, and storing of information. What is needed is training to assist patients and providers in the meaning and use of such information and the will to use it to improve performance, accountability, and patient care. Administrative support is also necessary.     

HIV-related knowledge, attitudes, and stress among health care providers: a literature review and research agenda

The role of health services administrators in assuring high quality care for HIV-positive individuals and a physically safe, psychologically comfortable work environment for providers is an important one. Administrators need sound information on which to base policy and operational decisions about treatment of infected individuals. While the current literature provides some information in this regard, significant limitations and gaps remain. We have reviewed this literature and suggested a number of research issues that are relevant to administrative decision making. As the epidemic grows and changes in geographic diffusion and patient populations affected, empirical information to inform decision making will become even more critical. In addition, this information and the methods developed for data collection and interpretation in this area may be applicable to providers caring for a broader range of chronic conditions.     

FROM THE EDITORS

Abstract

Better informed and educated consumers can improve the patient/health care professional communication process and allow full participation in decision making about one's own health. Web sites have become the popular means of obtaining consumer health information. Consumers, however, face the task of selecting from thousands of choices over the World Wide Web (WWW). The purpose of this article is to collect quality WWW sites focusing on Alzheimer's disease. Accepted evaluation criteria were used to select each WWW site. These selected Web sites are provided to help increase the users' awareness of Alzheimer's disease and to help consumers understand what to expect and where to find information. All Web sites included are for informational and educational purposes only. They will never replace visits to physicians. Consumers and patients will always have to consult with physicians and other health professionals for their health care.     

Community-based integrated care: myth or must?

ISSUE: In spite of the many efforts that have been made to rationalize and improve the functioning and the quality of health care delivery in industrialized countries, too limited a degree of success has been achieved so far. This paper argues that this limited success originates from a lack of coherence among the various strategies and instruments developed to rationalize and improve the delivery of health care. ADDRESSING THE ISSUE: This fact can be shown by reducing the complexity of today's health care into three levels of decision making: the primary process of patient care, the organizational context, and the financing and policy context of health care systems. Distinct rationales exist on each of these three levels of decision making as actors have their own perspectives, cultures, disciplines, and traditions concerning the delivery of health care. These differences can often result in ambiguity of goals, conflicting interests between decision makers, bureaucracy, poor information transfer, and limited use of the available scientific knowledge on all three levels. In such a context, rationalization and quality-improvement efforts are frustrated and will have limited effectiveness. Therefore, the various rationalization strategies and instruments on all three levels of decision making should be embedded in our health care systems in a synergistic way. DEMONSTRATING THE PROPOSED SOLUTION: Community-based integrated care is a promising approach to addressing this issue successfully. How this concept might function as a unifying concept for quality improvement will be illustrated by relevant developments in the Academic Medical Center, University of Amsterdam in The Netherlands.     

Analysis of economic management as an aid for directing and planning health care facilities

Analyses of hospital processes are of vital importance to management decisions in health facilities. The number of indicators to provide a meaningful analytical basis for decision making should be kept as small as possible. An increased use of modern electronic data processing systems will result in a qualitative improvement of facility-related information systems for managing and planning purposes. The example of an internal department of a district hospital shows that a small number of basic indicators is sufficient for facilitating efficiency and capacity analyses in in-patient units.     

Health literacy in health systems: perspectives on patient self-management in Israel

Health systems will face new challenges in this millennium. Striking the balance between the best quality of care and optimal use of dwindling resources will challenge health policy makers, managers and practitioners. Increasingly, improvements in the outcomes of interventions for both acute and chronic patients will depend on partnerships between health service providers, the individual and their family. Patient education that incorporates self-management and empowerment has proven to be cost-effective. It is essential that health care providers promote informed decision making, and facilitate actions designed to improve personal capacity to exert control over factors that determine health and improve health outcomes. It is for these reasons that promoting health literacy is a central strategy for improving self-management in health. The different types of health literacy--functional, interactive and critical health literacy--are considered. The potential to improve health literacy at each of these levels has been demonstrated in practice among diabetics and other chronic disease patients in Clalit Health Services (CHS) in Israel is used as an example to demonstrate possibilities. The application of all three types of health literacy is expressed in: (i) developing appropriate health information tools for the public to be applied in primary, secondary and tertiary care settings, and in online and media information accessibility and appropriateness using culturally relevant participatory methods; (ii) training of health professionals at all levels, including undergraduate and in-service training; and (iii) developing and applying appropriate assessment and monitoring tools which include public/patient participatory methods. Health care providers need to consider where their patients are getting information on disease and self-management, whether or not that information is reliable, and inform their patients of the best sources of information and its use. The improved collaboration with patient and consumer groups, whose goals are to promote rights and self-management capabilities and advocate for improved health services, can be very beneficial.