Ebook: Health Information Management: Empowering Public Health

Effective and efficient management of health institutions is a key prerequisite to enabling the dynamic and sustainable development of national health systems. In an increasingly digital society, the human capacity for knowledge and skills in health information management becomes the primary factor in ensuring the sustainable development of healthcare institutions. Therefore, health institutions are showing great interest in hiring experts in the field of health information management. According to a prediction by the U.S. Bureau of Labor Statistics “students with a master’s degree in health information management, will have good perspective with 18% growing employment between 2018 and 2028”. Employment in European healthcare systems is projected to grow in all healthcare occupations, but especially in those related to information management such as applied informatics professional, public health informatics professional, and chief medical information officer.

The main goal of the Health Information Management: Empowering Public Health is to provide a comprehensive introduction to the study and development of health information management in a clear and understandable manner. The textbook is designed to be used by university and vocational school programs to train allied health professionals. Furthermore, it can be used as an in-service training tool for new healthcare-facility personnel, government healthcare institutions, independent billing and health assurance services, or individually by health information specialists. Students and professionals can learn more about what health information management is and how it merges the fields of healthcare and information technology before pursuing a degree in the field. Readers will learn how to organize and analyze healthcare data; accurately record, store and assess health data; use an electronic patient record system; provide statistical analysis and interpret the results; as well as logical thinking, communications, and organizational processes in healthcare institutions.

This textbook has been produced within the Erasmus+ project “Enhancement of study programs in Public Health Law, Health Management, Health Economics and Health Informatics in Montenegro (PH-ELIM)”, Ref.No: 573997-EPP-1-2016-1-ME-EPPKA2-CBHE-JP, funded with support from the European Commission. This publication reflects the views of the authors only, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

The Editors would like thank the authors and co-authors for their efforts in providing their chapter contributions in their fields of expertise in a didactic and pedagogical manner, with exercises and problems fostering and challenging the knowledge and skills of the readers to pursue further and fathom the field of Health Information Management.

Finally, we would like to thank both Arie Hasman and John Mantas for their diligent reviewing of the entire book and for providing advice to the authors. We are also thankful to Dr. Emmanouil Zoulias and Ms. Marianna Isaakidou, colleagues at the Health Informatics Laboratory of the National and Kapodistrian University of Athens, for their additional editing in refining each chapter according to the template.

The Editors

August 2020

This chapter aims at providing the student with a general overview of the Health and Health Determinantsbasic concepts. More precisely, this chapter provides a definition and explanation of health and health determinants and presents an overview of measures in epidemiology.

In early February of 2020, attention was drawn to the increased number of deaths and the new cases of coronavirus infection. The epicentre of the outbreak was Wuhan in the People’s Republic of China. In order to control the outbreak, Chinese leaders called on the city authorities in Wuhan to set up mass quarantine centres for infected people. The Chinese government took this step to protect the public against infectious disease. This is an example of the conflicts between public health and civil liberties/individual rights. Government authority is the pillar of the public health law. The government retains the power to achieve and maintain common good by restricting – within solid international and national limits – individual rights concerning autonomy, privacy, association, and liberty. Public health agencies have the right to collect, use, and disclose a considerable amount of personal health information and to enforce certain vaccinations, medical examinations, and treatments. In addition to the power to isolate individuals to protect the public against the spread of infectious disease, their powers can be used to control businesses and professions. There are several legal interventions to prevent injury and disease and promote the public’s health. Among these tools are taxing policies, which encourage engaging in beneficial behaviour (fruit consumption) and disincentives to engage in high-risk activities (smoking).

This chapter aims at providing the student with a general overview of the appropriate structure and ethics healthcare organizations are based on, the concept of ethical leadership, the importance of having clear statements of mission, vision and value in healthcare organizations and the Health Promotion Charters implemented in a Globalized World.

This chapter aims at providing the student with a general overview of the Health Organization Development and Design basic concepts. More precisely, this chapter outlines the origins and the future of Health services planning and development and the structure of health organizations. The typology of different international healthcare systems implemented in United Kingdom, United States of America, Greece, Serbia and Germany is also presented.

This chapter is written in order to provide the student with a general overview of communication and public relations in healthcare. All healthcare institutions have a need for adequate and successful communication with their external and internal stakeholders. Every contact of a particular healthcare organization with the public represents a unique interface, as an important part of the communication strategy. Therefore, it is very important to create strategic consistency among all the messages that stakeholders need to receive. The chapter will discuss the relationships between the various components of integrated marketing communications in healthcare, crisis management in the communications sphere and ethics and social responsibility issues.

Application of economics in the healthcare area is relatively new. Until recently, the public health scene has not understood the importance that the application of well-established economic concepts could have in this field. Fortunately, it is now well recognized that the introduction of economics in health (health economics) is of great importance. While other disciplines contribute to the understanding of factors that determine the health of an individual, health economics contributes to a better understanding of an individual’s behavior that would ultimately have a strong influence on his health condition. A health economist explains individual behavior as a process in which an individual makes decisions by comparing current health condition, time and financial costs on one side and future health contributions such as a decrease of the probability of getting a disease or death, on the other side. Clarification of this issue, as well as numerous other issues concerning health economics applications are the central challenges for this field of research.

This chapter deals with financial management in healthcare institutions. Topics which will be covered in this chapter include the function of financial management in a company and elements of financial management. We also discuss types of ownership and related organizational forms of healthcare institutions, which influence financial functions. We are trying to identify the general role and objectives of financial management in healthcare institutions. Having in mind the fact that financial management is based on the information provided through company’s accounting we will give an overview of basic accounting concepts. They influence financial reporting, which is also covered in the chapter through a presentation of different types of financial statements and their content.

Healthcare institutions are business systems that provide different medical products and services to improve the health and quality of life of users of products and services. First of all, this is reflected in the differing complexities of the business, but also of the products and services they offer, as well as the different costs they cause. Thus, some products or services cause high indirect costs, while others require higher direct costs. For health care managers to make the right business decisions, they must continually have timely, quality and truthful information at their disposal. This information is provided by the management accounting of the institutions. This paper aims to present management accounting activities that enable the acquisition of information necessary for decision making.

In the last decades radical changes in the health care market have happened. Customers continuously require a higher level of quality of service and they become more careful and demanding in the decision process, market intelligence is continuously growing, competition and quality of services are dramatically increasing, as well as the external influences of various lobbyists in many parts of the world. Also, it is important to mention the fact that there are many initiatives for change in many branches of health care delivery, as well as many innovative models for providing health services that change the traditional role of healthcare institutions. In these conditions in order to be competitive on the global market and to create satisfied and loyal consumers of health services, health institutions need to introduce a marketing management concept which is completely in accordance with actual trends on the global market as well as needs and demands of services consumers.

This chapter is written in order to give students general summary of basic statistical methods, techniques, indicators and procedures. However emphasis is on the application of those that are frequently used in biomedical research. Statistics is science about data, but data that represent numbers with their context. Therefore, in this chapter the topics of population, samples, types of variables, descriptive statistics and statistical inference will be briefly covered. At the end, correlation and regression analysis will be briefly presented. The aim of this chapter is to give a very short overview of the main principles; techniques and procedures that should be used in order to obtain and understand analyzed biomedical data.

Health analytics is a branch of analysis that focuses on the analysis of complex and large amounts of health data that are characterized by high dimensionality, irregularities and rarities. Their aim is to improve and increase the efficiency of the process of healthcare providers, working with patients, managing costs and resources, improve diagnostic procedures and treatments, etc. The prime focus is investigating historical data and finding templates for different scenarios. As a final product, usually different visualisation tools are produced to support practitioners in patient care to provide better services, and to improve existing procedures.

Recent decades made a change in health care by putting health information as a core asset for effective management and improved quality of care. That is a reason why applications of information technology in health and healthcare attract more attention by healthcare organisations with highly skilled health information management professionals having an active role in the effective maintenance of organized and accurate electronic healthcare data. Also, widely adopted standards and principles of healthcare information governance are essential in efforts to reach a compromise of shared data, information and knowledge in the interoperable, electronic healthcare information sharing environment.

Hospital information systems (HIS) have to be considered as socio-technical systems, which consist of technical components as well as of the human aspect like hospital staff and patients. HIS strive for the optimization of information logistics, to support tasks like patient care and administration of a hospital. To systematically manage such complex systems, HIS can be analyzed on three layers: First, tasks and entity types should be considered. Entity types represent information which is used and updated by tasks like ‘Patient Admission’ or ‘Decision Making’. Second, application components of a HIS should be analyzed, they can be either computer-based or paper-based; both of them support tasks from the first layer. Therefore, they store and exchange information. The third layer analyzes physical data processing components of a HIS, like servers, workstations or networks. The three-layered view can be used for the systematic information management of HIS on three perspectives: strategic information management plans the development of the whole HIS for the next 5 years and longer. Measures from strategic information management are implemented as projects, coordinated by the tactical information management. The operational information management ensures a continuous and reliable operation of the HIS.

eHealth is the use of modern information and communication technology (ICT) for trans-institutional healthcare purposes. Important subtopics of eHealth are health data sharing and telemedicine. Most of the clinical documentation to be shared is collected in patient records to support patient care. More sophisticated approaches to electronic patient records are trans-institutional or (inter-)national. Other aims for clinical documentation are quality management, reimbursement, legal issues, and medical research. Basic prerequisite for eHealth is interoperability, which can be divided into technical, semantic and process interoperability. There is a variety of international standards to support interoperability. Telemedicine is a subtopic of eHealth, which bridges spatial distance by using ICT for medical (inter-)actions. We distinguish telemedicine among healthcare professionals and telemedicine between health care professionals and patients. Both have a great potential to face the challenges of aging societies, the increasing number of chronically ill patients, multimorbidity and low number of physicians in remote areas. With ongoing digitalization more and more data are available digitally. Clinical documentation is an important source for big data analysis and artificial intelligence. The patient has an important role: Telemonitoring, wearable technologies, and smart home devices provide digital health data from daily life. These are high-quality data which can be used for medical decisions.

Modern technology development created significant innovations in delivery of healthcare. Artificial intelligence as “a branch of computer science dealing with the simulation of intelligent behaviour in computers” when applied in health care resulted in intelligent support to decision-making, optimised business processes, increased quality, monitoring and delivering of personalised treatment plans and many other applications. Even though the benefits are clear and numerous, there are still open issues in creating automation of healthcare processes, ensuring data protection and integrity, reduction of medical waste etc. However, due to rapid development of AI techniques, more advances and improvements are still expected.

Clinical processes need to be well understood before a new health IT tool can be introduced. Observations, interviews, surveys, or documentation analysis are carried out to systematically collect information to better understand a clinical process. To aggregate and visualize the collected information about a clinical process, use case diagrams can build a basis. Formal process models such as process chain diagrams or BPMN diagrams are well suited to model the process in detail. The objective of this chapter is to discuss these methods for analyzing and modeling clinical processes, as this is an important precondition for systematic process management in health care.