CHANGE MANAGEMENT IN HEALTH INFORMATICS
 There are generally four kinds of changes
that all kinds of organizations might
encounter, with the likelihood of overlap
among the conceivable outcomes:
 Operational Changes – it can
influence the way dynamic
business tasks are led, including
the computerization of a particular
business segment
 Strategic Changes – it occurs
when the business direction, in
relation to its vision, mission, and
philosophy, is altered. For
instance, changing the business
technique from business growth
to increasing market share in the
overall industry is a case of
strategic change
 Cultural Changes – it influences
the internal organizational culture,
for example, the way the
business is conducted, such as
actualizing a CQI (continuous
quality improvement) framework
 Political changes – in human
resources occur primarily due to
political reasons of varying types,
commonly changes that happen
on top patronage levels in the
government agencies
 The different sorts of changes typically
have dissimilar impacts on different
organizational levels. For instance, the
operational changes tend to have the
highest impacts on the lower
organizational levels, because the frontline
employees are mostly affected. Employees
working at the upper levels might be
indifferent as to the changes, which may
cause significant distress to those
attempting the implementation of change
 Conversely, the effect of the political
changes is more strongly felt on the higher
levels of the organization. When change
occurs relatively in a bureaucratic
organization, those working on the bottom
level often notice the change at the top
(Lorenzi and Riley, 2000)
 There is no denying that organizational
changes have varying degrees of impact
on both the organization, and in effect, its
clientele. This chapter discusses Change
Management contextualized in Health
Informatics, which is increasingly
becoming a course of action that health
institutions avail of in order to improve their
services
 There are a wide range of change
management process models to explore
and consider—each with their own
strategic approaches based on the
expertise and experiences of their
developers. A few of the more common
change practice examples include:
 Kurt Lewin’s Three-Step
“Unfreeze-Change-Refreeze”
Model – it is proposed by the
universally recognized founder of
social psychology in the 1950s. It
is still highly relevant today and
often used as the basis for many
changes management strategies
 Proski’s ADKAR® Model – it is
an acronym for a strategy that
encompasses: “awareness of the
business reasons for change;
desire to engage and participate
in the change; knowledge about
how to change, ability to
implement change, and
reinforcement to ensure change
sticks”.
 Kotter’s 8-Step Model of
Change – it is developed by
Harvard Business School’s John
Kotter, focuses on efficient and
effective change management in
a competitive world. Highlights
include building a strong,
collaborative team and a solid
strategy; creating effective
communication channels;
supporting staff empowerment;
using a phased and steady
approach; and securing the
change within an organization’s
culture (QuickBase, 2017)
Application of Change Management
 Th change management is a series of
tools, techniques and processes aimed at
successfully effecting change. These tools
and techniques can be implemented in a
variety of contexts, but often they support
the application of other initiatives such as
Six Sigma, CRM, Total Quality
Management, or enterprise applications
such as SAP
 Downey (2008) describes common tools
and techniques that a change
management practitioner might use during
a change initiative, which include:
 Questioning skills to gather
information about the ‘as is’ and
‘to be’ status of the business
process
 CHANGE MANAGEMENT IN HEALTH INFORMATICS

 Process mapping for both ‘as is’ requirements for status problem-solving teams
and ‘to be’ processes reporting in order to to address critical and
keep projects moving complex issues
 Gap analysis forward
Empowering staff and
 Business case development Manage users’ end-users to change
expectations; prepare things, by removing
 Project management them for casualties, barriers and obstacles
stress, and general
 Problem solving sense of ambiguity Adoption makes the
change stick by
 Requirement’s elicitation reinforcement, until old
techniques traditions are replaced
with new
 Negotiation skills
Frequently celebrate
 In addition to these techniques, Downey success by honouring
also mentions that it is crucial that contributors to keep the
progress of the change initiative can be motivation and
quantified against the objectives set by the momentum
organization. For this to be successful, the
organization needs to set clear objectives Monitor and measure
and settle on key performance indicators key indicators (e.g.,
(KPIs) that can be used to track and using a dashboard to
evaluate the change initiative against its report progress and
objectives. These KPIs might include: benchmarks)
 Reducing rework by x%
Involve those affected by
the change in decision-
 Improvement in stakeholder
making (e.g., choice of
satisfaction, for example,
computer carts, COW)
customer/employee surveys

 Reduced time to market Other creative actions

e.g., monthly prizes for
 Enhanced speed of delivery high performing teams,
provide snacks & drinks
 The return on investment, that is,
The Role of Health Information Management
the total cost to implement the
Professionals
initiative versus total savings
gained from the initiative per
period  The Health Information Management (HIM)
professionals, credentialed with their
Key Success Factors academic preparation, work experience,
commitment to patient advocacy, and
Key success factors at Key success factors at professional code of ethics, have a
specialized skill set that uniquely qualifies
the leadership level in the program level
healthcare them to assume the role both of privacy
official and/or security officials who store,
organizations
protect, and transmit information in all
Setting vision and Clear and frequent
media and formats (May 2014). A Health
strategy roadmap dissemination of
Information Management professional:
information
Formation of governance  Collects, aggregates, analyzes,
board to set direction, to Building a strong project and disseminates patient health
prioritize work, and to leadership team/steering information
allocate resources team and other
action/functional teams  Committed to the timely and
Designate an executive accurate collection of health
sponsor, departmental Providing education and information and its maintenance,
champions, and program training on the new storage, retentions, and
manager changes – workflow and disclosure
technology

 Represents patients’ interest in

Forming integrated matters of privacy and security,
Define reporting
 CHANGE MANAGEMENT IN HEALTH INFORMATICS
information release, and issues
and guidelines regarding record
access
 Certified by the American Health
Information Management
Association
 Ensures confidential patient
information is kept private,
secure, and in accordance with
federal and state laws
 The Health Information Management
professionals are the stewards and
guardians of patient health information.
They represent the patient’s interests in
matters of privacy and security, information
release, issues and guidelines regarding
record access, and general consumer
education about personal health records
 They specialize in managing patient health
information and medical records,
administering computer information
systems, and classifying using standard
coding systems, the diagnoses, and
procedures for health care services
provided to patients
 Those with health information
management and health information
technology careers manage all aspects of
the content of patient medical records and
patient information systems. Job
responsibilities can include aspects of
clinical information documentation capture
and maintenance, data analytics and
interpretation, as well as designing,
implementing, and maintaining health
information technology systems
The Philippine Health Information Profession
 The advancements in ICT (information and
communication technology) are upsetting
not only traditional businesses, but even
those not immediately thought of as
probable beneficiaries—such as the
healthcare sector
 From electronic patient records to the
wireless transmittal of patient files for
remote diagnosis, improvements in
communication and technology will lead to
better delivery of healthcare services.
Telemedicine, or the use of electronic
communications to transmit and exchange
medical information and data to provide
patient treatment, is quickly gaining
momentum within the country and the rest
of the ASEAN region
Telemedicine in the Philippines
 With the increasing popularity of smart
phones, wireless tools and other
comparable technology, primary care, and
specialist referral services, as well as
remote patient monitoring and patient
medical health information are undeniably
improved with the help of telemedicine
 Thailand, Singapore, and Malaysia have
started adopting healthcare IT solutions to
bring the sector to the next level. In 2009,
Singapore developed its National
Electronic Health Record initiative, which
permitted healthcare practitioners in the
island state access to a patient’s records
across the healthcare continuum
 Malaysia initiated a Hospital
Implementation System in 1993, with its
first telemedicine project in 1996, and
Thailand created its National Health
Information Committee in 2010
 Likewise, the Philippines has developed an
e-Health Strategic Framework and Plan for
2014 to 2020, whose objective is to utilize
information and communication
technologies in the health sector. This will
assist in the delivery of health services and
manage health systems for greater
efficacy, with the ultimate goal of providing
universal healthcare for the Filipinos
 One of the strategic goals of this
framework is to establish unified and
coherent health and management
information systems, and also to take
advantage of ICT to reach and provide
better health services and support the
attainment of the UN’s Sustainable
Development Goals
 In line with this, the Department of Health
(DOH) in region 4B has launched the first
interactive telemedicine system in
Marinduque, and seemingly the entire
country, at the Dr. Damian J. Reyes
Provincial Hospital. The system currently
provides medical consultations and
diagnostics through video calls (De Dios,
2016)
 For an archipelago such as the
Philippines, the delivery of healthcare
services might prove to be challenging.
 CHANGE MANAGEMENT IN HEALTH INFORMATICS
Fortunately, the rise of Telemedicine within
the region, as discussed above, has been
a beneficial turn of events for the
Philippine Healthcare sector
 The multiple players in the Telemedicine
scene in the Philippines currently exist,
ranging from mobile apps to call center
services
 Some providers of over-the-phone
telemedicine services are Medgate and
Lifeline. Common features include 24/7
call centers, diagnosis using images sent
via email, medical certificates, and
treatment plan summaries. These kinds of
telemedicine centers usually have a
corresponding mobile app to facilitate
easier access. Unique to Lifeline, however,
is video consultation with doctors, patient
education, free doctor or nurse home
visits, and delivery of medication and
prescriptions in exchange for a fixed
monthly subscription fee
 The Mobile App-based Telemedicine
centers, on the other hand, include
MyPocketDoctor and MyDocNow. These
providers are usually in partnership with
other international telemedicine centers
 The Medway Healthcare Inc., by far, offers
the most comprehensive set of
telemedicine services, being the first
medical clinic in the Philippines to mobilize
its Pre-Employment Medical Examination
(PEME) arm into the path of delivering
interactive healthcare. They offer
Telefollow-up and Teleconsultation
procedures which are accessible online
and through a specially designed computer
program
 In Telefollow-up, patients are notified of
the medical evaluation results via text
messages on their individual cell phones.
Within 24 hours of PEME, patients will
already know if they are fit to work, unfit to
work or still with pending workups. Follow-
up visit to the clinic is then advised.
Follow-up of results using traditional
landline call is also accommodated
 Telemedicine efforts from the government
and other non-profit organizations have
also ensued. The National Telehealth
Center is the leading research unit in the
University of the Philippines responsible
for developing cost effective tools and
innovations in the realm of information and
communications technology (ICT) for
improving health care. NTHC experienced
a breakthrough, when it first conducted
telemedicine research-cum-service in
remote and undeserved areas from
Batanes to Zamboanga through partners in
the then Commission on Information and
Communications Technology’s (CICT,
2004-2008) and Department of Science
and Technology – Philippine Council for
Health Research and Development
(DOST-PCHRD, 2008-2011). Today, the
center partners with various government
and non-government institutions, engaging
them on eHealth research, 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
 The 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)