Table Of ContentHealth Informatics
(formerly Computers in Health Care)
Kathryn J. Hannah Marion J. Ball
Series Editors
Springer Science+Business Media, LLC
Health Informatics
(formerly Computers in Health Care)
Series Editors:
Kathryn J. Hannah Marion J. Ball
Dental Informatics
Integrating Technology into the Dental Environment
L.M. Abbey and J. Zimmerman
Aspects of the Computer-based Patient Record
M.J. Ball and M.F. Collen
Performance Improvement Through Information Management
Health Care's Bridge to Success
M.J. Ball and J.V. Douglas
Strategies and Technologies for Healthcare Information
Theory into Practice
M.J. Ball, J.V. Douglas, and D.E. Garets
Nursing Informatics
Where Caring and Technology Meet, Second Edition
M.J. Ball, K.J. Hannah, S.K. Newbold, and J.V. Douglas
Healthcare Information Management Systems
A Practical Guide, Second Edition
M.J. Ball, D.W. Simborg, J.W. Albright, and J.V. Douglas
Clinical Decision Support Systems
Theory and Practice
E.S. Berner
Strategy and Architecture of Health Care Information Systems
M.K. Bourke
Information Networks for Community Health
P.F. Brennan, S.J. Schneider, and E. Tornquist
Introduction to Clinical Informatics
P. Degoulet and M. Fieschi
Patient Care Information Systems
Successful Design and Implementation
E.L. Drazen, J.B. Metzger, J.L. Ritter, and M.K. Schneider
Introduction to Nursing Informatics, Second Edition
K.J. Hannah, M.J. Ball, and M.J.A. Edwards
Computerizing Large Integrated Health Networks
The VA Success
R.M. Kolodner
Organizational Aspects of Health Informatics
Managing Technological Change
N.M. Lorenzi and R.T. Riley
(continued after Index)
Marion J. Ball Judith V. Douglas
Editors
Performance Improvement
Through Information
Management
Health Care's Bridge
to Success
With a Foreword by John G. King
With 14 Illustrations
Springer
Marion J. Ball, EdD Judith V. Douglas, MA, MHS
Adjunct Professor Adjunct Lecturer
Johns Hopkins University School Johns Hopkins University School
of Nursing of Nursing
Baltimore, MD 21205, USA and
Associate
First Consulting Group
Baltimore, MD 21210, USA
Series Editors:
Kathryn J. Hannah, PhD, RN Marion J. Ball, EdD
Vice President, Health Informatics Adjunct Professor
Sierra Systems Consultants, Inc. Johns Hopkins University School
and of Nursing
Professor, Department of Community Baltimore, MD, USA
Health Science
Faculty of Medicine
The University of Calgary
Calgary, Alberta, Canada
Library of Congress Cataloging-in-Publication Data
Performance improvement through information management : health care's
bridge to success / edited by Marion J. Ball, Judith V. Douglas,
p. cm. — (Health informatics)
Includes bibliographical references and index.
ISBN 978-1-4612-6800-0 ISBN 978-1-4612-0519-7 (eBook)
DOI 10.1007/978-1-4612-0519-7
1. Medical informatics. 2. Health services administration.
I. Ball, Marion J. II. Douglas, Judith V. III. Series.
R858.P47 1999
362.1'068'4—dc21 98-24445
Printed on acid-free paper.
©1999 Springer Science+Business Media New York
Originally published by Springer-Verlag New York, Inc. in 1999
Softcover reprint of the hardcover 1st edition 1999
All rights reserved. This work may not be translated or copied in whole or in part without the writ
ten permission of the publisher, Springer Science+Business Media, LLC
except for brief excerpts in connection with reviews or scholarly analysis. Use in con
nection with any form of information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed is forbidden.
The use of general descriptive names, trade names, trademarks, etc., in this publication, even if the
former are not especially identified, is not to be taken as a sign that such names, as understood by
the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone.
While the advice and information in this book are believed to be true and accurate at the date of go
ing to press, neither the authors nor the editors nor the publisher can accept any legal responsibility
for any errors or omissions that may be made. The publisher makes no warranty, express or implied,
with respect to the material contained herein.
Production coordinated by WordCrafters Editorial Services, Inc., and managed by Francine McNeill;
manufacturing supervised by Jeffrey Taub.
Typeset by MATRIX Publishing Services, Inc., York, PA.
987654321
ISBN 978-1-4612-6800-0
To Jim Reep, for his vision, professionalism,
integrity, energy, and warmth
Foreword
Recent national surveys suggest an upturn in spending on information technol
ogy in health care and throughout corporate America. As senior healthcare ex
ecutives, we cannotmake these investments withoutjustifying them in terms of
what they will yield. We are charged with improving performance and deliver
ing top-quality care. Forus, buying and managing technology are onlymeans to
an end. Clearly, we have a difficult task, and we need the help ofother practi
tioners in health care in understanding how to proceed.
To begin, performance improvement requires that we understand the forces,
structures, and strategies that shape the healthcare marketplace. Itdemands that
we changehow wedelivercare-thatwe redefine ourmission and goals to pre
pare for the future. To achieve what weenvision, we mustdeliberately and me
thodically redefine processes, restructure information, and redesign work flow.
Traditionally,effortstoimprovecarefocusonoperationsathospitalsandclin
ics. These functions are basic to health care and assume added significance in
thecurrentenvironment,withitsemphasisonintegratingcaredeliverynetworks.
Areas of fragmentation persist in health care, as do pressures to increase pro
ductivity and improve financials. Information management systems can supply
criticallyneededlinkages;increasinglyrobustinfrastructureandapplicationscan
support integration efforts. In addition, new technologies like call centers offer
innovative solutions. Clearly, we can do much to improveoperational effective
ness.
The most remarkable gains in performance improvement will come from ar
eas we are only now beginning to explore--clinical decision making for care
givers and patients alike. Today we are putting into place computerizedpatient
records, clinical data repositories, and web-based applications. Physicians and
physicianmanagersbecomingmorecomfortablewiththetechnologiesgivethem
theinformationtheyneedfordecisions,evensupplythemwithclinicalreminders
and alerts. Tomorrow, when the repositories are well populated and patient
records can be confidentially shared on the web, physicians will be able to de
livercare that is evidence-based, linked to the best medical knowledge.
Today,healthcareorganizationsarebeginningtopayattentiontocustomersat
isfaction. Theyare collectingdata, surveying patients, and offering24-hourdial-
vii
Vlll Foreword
a-nurse services. Real customer service offers great opportunities, largely un
tapped to date. For example, interactive videos can help patients share in mak
ing decisions about their treatment, and web-based modules can make patients
active partners in managing theirownhealth. Forhealthcareorganizations, these
new uses ofinformation technology will transform health care,justas the com
puterized reservations process altered the airlines.
As always, the future holds risks. Fortunately, it also offers opportunities to
thoseofus whounderstand theforces ofchangeandseize upontransformational
processes andenablingtechnologies toreinventourworld. Totheauthorsofthis
book, who have helped us do allofthese things, weofferourthanks. They have
made our tasks easier.
John G. King
ChiefExecutive Officer
Legacy Health System
Portland, Oregon
Series Preface
This series is directed to healthcare professionals who are leading the transfor
mationofhealthcare by using informationandknowledge. Launchedin 1988 as
Computers in Health Care, the series offers a broad range of titles-some ad
dressed to specific professions such as nursing, medicine, orhealth administra
tion; others to special areas of practice such as trauma or radiology. Still other
books in the series focus on interdisciplinary issues such as the computer-based
patient record, electronic health records, or networked healthcare systems.
Renamed Health Informatics in 1998 to reflect the rapid evolution in the dis
cipline now known as health informatics, the series will continue to add titles
that contribute to the evolution ofthe field. In the series, eminent experts serv
ing as editors or authors offer their accounts ofinnovations in health informat
ics. Increasingly,theseaccountsgobeyondhardwareandsoftwareto addressthe
role ofinformation in influencing the transformation ofhealthcare delivery sys
tems around the world. The series also will increasingly focus on "peopleware"
and the organizational, behavioral, andsocietal changes thataccompany thedif
fusion ofinformation technology in health services environments.
These changes will shape health services in the next millennium. By making
full and creative use of the technology to tame data and to transform informa
tion,healthinformaticswillfosterthedevelopmentoftheknowledgeageinhealth
care. As coeditors, we pledge to supportour professional colleagues and the se
ries readers as they share advances in the emerging and exciting field ofhealth
informatics.
Kathryn 1. Hannah
Marion J. Ball
ix
Preface
We have long believed that infonnation technology, used wisely, can transfonn
health care. To help make this happen, we leftacademiaandjoinedthe worldof
healthcare consulting, where we have been privileged to work with the people
who effect real changes in how care is delivered. They have generously con
tributed theirexpertiseto this bookand to itscompanionvolume, Strategiesand
Technologiesfor Healthcare Information: Theory into Practice.
This volume, Performance Improvement Through Information Management,
presents key concepts clearly and forcefully, beginning with an insightful look
atthecurrentmarketenvironment. Subsequentchaptersdiscuss transfonnational
processes and enabling technologies. Throughout the volume, the focus is on
making healthcare operationally effective by improving the processes involved
inprovidingcare and services. Infonnationtechnology, ourcontributing authors
understand, playstheroleofenabler-acriticalroletobesure,butalwaysasup
porting role, never the lead.
Weare convinced that this new title will be an invaluable resource for chief
executiveofficers andthe entirehealthcareteam working to improvehealthcare
for patients worldwide. We are proud to offer this volume to our readers, new
and old alike.
Marion J. Ball
Judith V. Douglas
xi
Acknowledgments
This volumereflects the commitmentandthe expertiseofthosewhocontributed
to it, most notably the chapter authors. Theirwork was supportedthroughout by
Jim Reep, Luther Nussbaum, Philip Lohman, and Carol Moore, who helpedde
velop the conceptual framework for the book, and Jennifer Lillis, who helped
edit the pages that follow.
Other colleagues, who gave of their time to review the chapters and suggest
improvements, have added richness and value to the content. Our thanks to all
ofthe experts who serve on our review board: Horni Arabshahi, Dean Arnold,
Dave Beaulieu, Marion Ball, Ray Bell, Bob Bonstein, Jim Burke, Joe Casper,
Dave Chennisi, Mike Cornick, John Conway, Jerry Davis, Dave Dimond, Steve
Ditto, Erica Drazen, Jim Edgemon, Jim Gaddis, Hal Gilreath, Mike Gorsage,
Sharon Graugnard, Kent Gray, Steve Heck, Gordon Heinrich, Barbara Hoehn,
Todd Hollowell, Tom Hurley, Beth Ireton, Anna Kanski, Tom Kelly, Peter
Kilbridge, Rick Kramer, Christi Liebe, Bill Looney, John Manson, Keith
MacDonald, Scot McConkey, Marcia McCoy, Jim McPhail, Jane Metzger, Jeff
Miller, Jerry Mourey, Mychelle Mowry, John Odden, Dave Pedersen, Leslie
Perreault, Briggs Pille, Jim Porter, Nabil Qawasrni, Ted Reynolds, Keith Ryan,
Debra Slye, John Stanley, Paul Steinichen, Don Tompkins, Pankaj Vashi, Tim
Webb, Dale Will, Dave Williams, Roy Ziegler, and others.
Marion J. Ball
Judith V. Douglas
xiii
