Other Hospital Information Systems CIS and RIS
Radiology Information Systems
Cardiology Information Systems
● For the storage and retrieval of
Cardiology-centric images.
● Communicates with other information systems to
retrieve orders with the patient demographics
and other information and subsequently profiles
it against the images and stored for further
distribution, viewing or long-term archive.
Relevant information for cardiologists
● Personal notes (history, physical exam)
● Signals (electrocardiograms)
● Images (echocardiograms, angiograms, CT,
MRI)
● Reports from investigations/procedure
HISTORY and EVOLUTION
● 1970S - AVAILABLE CARDIOLOGY
INFORMATION SYSTEM ORIGINATED FROM
A MAINFRAME ENVIRONMENT, THE
TECHNICAL SPECIFICS OF WHICH WOULD
BE CONSIDERED RIDICULOUS IN THE
PRESENT DAY SETTING.
● 1980S – MODULAR SYSTEMS BECAME A
TREND WHICH EMPHASIZED THE USE OF
REAL-TIME APPLICATIONS AND MINI
COMPUTERS
● INTERNET BECAME A TURNING POINT IN
THE CIS EVOLUTION
CIS now…
● Cardiology information systems nowadays have
unique features that enable remote access and
easy retrieval. Some CIS have also attempted to
integrate with a Radiology Information System to
create a Cardiovascular Information System that
is capable of more than just storage, particularly
involving more administrative processes
Functionalities
Editing, Viewing and Storing MultiModal Cardiology
Data - All data relevant to cardiology is consolidated
and managed on a single platform
Remote Access - Cardiology data anywhere you need
it.
Visualization and Reporting Capabilities - Ease and
consistency in reporting.
EHR Integration - Offers a more comprehensive view
of the patient care spectrum
.
Benefits and Features
● Ease of access while maintaining data
security - No need to seek multiple
departments, CIS consolidates all cardiology
data in one system
● Flexibility in the workflow - This allows doctors
to access cardiology data anywhere they go,
offering improved efficiency in their service
● Enhanced Comparability - Allows healthcare
professionals to make more informed decisions
for the benefit of their patient
● Tracks Radiology image orders in conjunction
with:
● PACS
- Picture Archive & Communicating System
- It is a healthcare technology for short and long
term storage, retrieval, management, distribution
and presentation of images.
● VNA
- Vendor Neutral Archive
- In a health information technology context, it is
as medical imaging used by the healthcare
professionals that stores images in a standard
format and interface, making medical imaging
data accessible through different picture
archiving and communication systems (PACS).
- Within a Hospital Information System
Advantages of RIS
● Better communication with referring doctors
● Faster payments
● Improved efficiency
Functions of RIS
Patient Management - An RIS can track a patient's
workflow within the radiology department.
Scheduling - The RIS allows staff to make
appointments for both inpatients and outpatients.
Patient Tracking - Using a RIS system, providers can
track a patients entire radiology history from admission
to discharge and coordinate the history with past,
present, and future appointments.
Result Reporting - A RIS can generate statistical
reports for a single patient, group of patients, or
particular procedures.
Image Tracking - Traditionally, radiology providers uses
RIS to track individual films and their associated data
Billing - RIS systems provide detailed financial
record-keeping and process electronic payments and
automated claims, though these functions are becoming
incorporated into medical organizations’ overall EHR
systems.
MATERIALS MANAGEMENT SYSTEM
making sure that services go successfully from one
source to an end user
lessens expenses and ensures adequate cash flow
MATERIALS MANAGEMENT INFORMATION SYSTEM
(MMIS) manage functions like purchasing, accounting,
inventory management, and patient supply charges
FUNCTIONS OF MMIS
• PURCHASING
WAYS TO MAKE PURCHASE QUOTATIONS:
Single quotations- manually or out of a purchase
requisition
Multiple quotations- the purchase quotation wizard
could be used
Quotation- created from sales orders by using the
procurement confirmation wizard
INVENTORY CONTROL
• Inventory is one of the biggest expenses for
most medical institutions (Johnston, 2014)
• Plays an important part in refining the quality of
healthcare services Lives of people are on the
line, as well as because medical costs are
increasing
STRATEGIES TO IMPROVE INVENTORY CONTROL:
Making Sure Shippers Are Accurate
• Most medical suppliers use third-party shippers,
and the tracking system must ensure that the
correct supplies were loaded at the warehouse
• Reveal whether medical supplies have been
properly handled in transit.
Alignment With Sales Projections
• Sales projections can be wildly inaccurate
difficult to predict disease and accident
patterns, and patients are notoriously
reluctant to switch doctors, hospitals, and
health insurance
• It prevents waste, frees up cash that would
have gone to excess inventory and helps
medical companies identify trends they
might not have seen before
Compliance With Regulations
• A company that routinely fails to serve the best
interests of patients can quickly find itself being
investigated, sued, or simply shunned by health-
care consumers
• Knowing what inventory is on hand and what
items are needed can keep a medical company
responsive and prevent closer scrutiny by
regulators.
Establishing Buying Cycles
• Instead of responding to needs for supplies and
equipment, inventory personnel can anticipate
needs based on previous cycles -> can eliminate
shortages and overages.
• Tracked to determine whether trends are
shifting and need to be adjusted.
ITEM MASTER MAINTENANCE- MEDICAL AND NON-
MEDICAL INVENTORY ITEMS
INVENTORY ITEM MAINTENANCE
• The upper portion contains master information
• “Item Tab” is used for maintenance of the
attributes of an inventory item, such as product
type, item class, item type, etc.
• “Item Availability” form specifies
inventory levels across all warehouses
ITEM INDENTS AND ISSUES • seller's point of view -> intention to sell and is
referred to as a sales order
• In some cases, items are damaged either upon
orders become a contract between the buyer
receiving from the supplier or during the move
and seller.
from the source to another location
• Some suppliers allow returns of the said goods
that have indents or the like, with a guarantee INVOICES
of replacement without any additional
• invoice or bill is a commercial document issued
payments
by a seller to the buyer, indicating the products,
• Damaged items are moved to another
quantities, and agreed prices for products or
warehouse for them to be monitored.
services the seller has provided the buyer
• indicates the sale transaction only.
RE-ORDER LEVEL, RE-ORDER QUANTITY, MINIMUM
AND MAXIMUM LEVELS FOR EACH STORE
DOCUMENTS
• Re-order level is the minimum quantity of an
• Documents need to be created in order to
item that a company has in stock, so when the
enable a quotation, order, invoice, tax forms etc.
stock reached the minimum quantity stated, the
to be used
item must then be re-ordered
• These documents are statutory requirements to
Min/Max inventory ordering method enable smooth transition of the processes
involved in successfully completing a sale /
• The ”Min” value is representative of a stock
purchase.
level that prompts a re-order, and the “Max”
value is representative of a new targeted stock
level that follows the re-order. COMPARISON OF QUOTATIONS AND PREFERRED
Economic Order Quantity (EOQ) -> main VEDNOR DOR EACH ITEM
difference of these two—Max and Min
PURCHASE QUOTATIONS

• document for requesting prices and delivery

ENQUIRIES AND QUOTATIONS FOR DRUGS,
CONSUMABLES, ASSETS AND GENERAL ITEMS
Enquiries - start point of a sale or purchase process
lead to getting information from a vendor/supplier for
the requirement at hand establishing a connection with
the right vendor/supplier in order to get a quotation,
place the order and receive the requirements.
Quotations- state important information such as price,
delivery times, delivery details, payment terms, taxation
etc.
ORDER
• stated intention, either spoken or written, to
engage in a commercial transaction for specific
products or services
• buyer's point of view -> expresses the intention
to buy and is called a purchase order
information from a vendor before the purchase
order.
• complete history of the sourcing process: create
a purchase quotation -> send the document to a
vendor when a response from the vendor is
received, with a list of prices and delivery dates,
one can enter the information in the purchase
quotation
• the information tracked enables one to choose
the right vendor for the purchase
• helps in lessening expenses, improving the
quality and increasing on-time delivery
• allows one to compare offers in order to pick
the appropriate vendor for the purchase
scenario
PREFERRED VENDORS
SEVERAL QUALITIES OF A PREFERRED VENDOR THAT A
COMPANY LOOKS FOR ARE:
• On-time performance
• Reasonable costs
• High quality of products and services
• Fully licensed, bonded, and insured
• Good Business practices
PURCHASE REQUESTS, ORDER CREATION AND
APPROVAL PROCESS
PURCHASE REQUEST
• Purchase Request or Purchase Requisition is a
document that notifies the purchasing
department that certain items or services need
to be replenished
• The document stipulates a timeframe and
required quantities for the items requested. In
certain instances, it also contains authorization
to acquire assets
• For enhanced accountability and documentation
purposes, some companies require a purchase
requisition for all purchases, but others only
require them for specific kinds of purchases,
such as those that would require greater capital
outlay.
PURCHASE ORDERS
• a document which records a business
transaction between the buyer and the seller
• buyer issues his order, and upon seller
acceptance of the order, a legally binding
contract is created between the parties
A simple Purchase Order will identify the following
basic elements:
Buyer: name, address, and contact info of party giving
money for goods
Seller: name, address, and contact info of party
receiving money for goods
Order Number: a unique ID number to track each
business transaction
Item Description: details, quantity of goods, cost per
unit, and total price of goods
Shipping Address: where the goods will be shipped
Shipping Date: when the goods will be delivered to the
final location
Billing Address: location of where the invoice should
be sent so the Buyer can pay
Signature: signature of Buyer offering to buy and
signature of Seller accepting
Order Date: when the business transaction occurred
APPROVAL PROCESS
• Originator- The person who creates the
document, either a purchase request or order
• An internal request is immediately sent to the
first approval stage when the approval process
is launched
• This request is received in the Messages/Alerts
Overview window, and the approver can access
the document
• Approval can be done through a mobile phone if
the devices are integrated
• Internal notification goes back to the originator
with a link to the rejected document should the
approver reject the document
• The originator can amend the document, and
the approval procedures will continue until the
approval conditions are adequately satisfied
RECEIPT AND INSPECTION OF GOODS:
Signing for Deliveries
• the person receiving the product should sign the
receiving documents provided by the supplier or
shipping company.
• inspect the items before signing the receipt and
should also initial the packing list.
• submit the packing list to the appropriate
person (Accounts Payable, Requester, Asset
Management) for financial reconciliation.
Refusing Delivery
• departments should refuse to accept shipments
if they are unable to confirm that the order was
placed by their department, or if the packing
appears sufficiently damaged to warrant
concern.
Record Retention
RETURNABLE GATE PASS
• The receiving Department takes physical
possession and legal ownership of the
shipment.
• provide the department with a packing list for
all shipments delivered to the
department.
• If the supplier fails to provide the packing list,
the department should contact the supplier to
request that copies be sent to the department
for its files.
• The need for saving receiving documents is
particularly important when accepting any
partial or staggered deliveries over a period of
time.
1. The products conform to the purchase order
requirements and other relevant
documents (for example: correct model
number, description, size, type, color, ratings,
etc.)
2. The quantity ordered against the quantity
shipped or delivered.
3. There is no damage or breakage.
CONSIGNMENT STOCK RECEIPT, CONSUMPTION, AND
4. The unit of measurement count is correct (e.g. if
REGULARIZATION
the unit of measurement on the purchase order
is one dozen, there should be 12 in the
package).
5. Delivery documentation (packing list,
certifications, etc.) is acceptable.
6. Perishable items are in good condition and
expiration dates have not been exceeded.
7. Products are operable or functional.
Partial Deliveries
• Departments should contact the appropriate
Purchasing Agent whenever a purchase is
received as a partial delivery without
acknowledgment or notification from the
EXPIRED STOCK AND QUARANTINE
supplier. This information is typically noted on
the packing list.
EXPIRED STOCK/INVENTORY
Tracking of Goods
• Goods can be easily tracked /traced when they
are managed by Serial or Batch.
Aging of products can also be done if the items
are slow moving/stay longer in the warehouse.
PURCHASE RETURNS ALONG WITH RETURNABLE/NON-
• Defective or substandard quality goods,
incorrect order delivery, and deterioration
among inventory purchased and sold are usually
common in business
• When purchased goods are returned, the
material management system updates inventory
levels to reflect the decrease in quantity.
• Supplies and equipment are also sometimes
required to be taken out of the department for
repairs or consignment
temporary movement Returnable Gate Pass is
issued
• Non-returnable Gate Pass permanent
movement.
• The material management system can be
configured to track returnable and non-
returnable items of inventory or equipment
monitor due dates for returnable items, and
provide detailed reports about the status of
different inventory items.
• Consignment- the vendor or consignor issues
materials to the receiver or consignee, and
these materials are stored on the consignee’s
premises.
• The vendor maintains legal ownership until such
materials are removed from consignment
stores.
• The invoice is due at predetermined intervals,
such as monthly.
• Customers can also arrange to take over
ownership of the remaining consignment
material after a certain period of time
• Upon reaching their expiration dates, some
goods, such as food and medicine, can no longer
be utilized.
 • It may be sold to other parties at a lower cost.
• inventory expires and its value falls below its
original cost this must be reflected in the
financial records so as not to misstate the
financial statements.
• The amount that reduces inventory in your
records is recognized as a loss that is a reduction
in profit
QUARANTINE STOCK/INVENTORY
• Inventory is put into quarantine if initially
rejected during -> Production, upon completion
of an operation, when specified as Move
Rejected End Item to Quarantine.
Inbound inspection upon receipt of:
➢ Manufactured end items Purchased items
➢ Sold items on sales return orders
➢ Enterprise Planning distribution orders
➢ Outbound inspection upon issue of:
Materials to production
DRUGS AND CONSUMABLE ISSUES AND RETURNS TO
PATIENTS
• 30 to 50% of hospital charges are actually
attributable to diagnostics, drugs, and
consumables, and doctors get only between 10
to 20%
• drugs and consumables take up the bulk of
expenditure
• Material Management Systems become
advantageous -> provides an overview of the
entire institution’s purchasing and inventory
control processes, decision- makers can have
more reliable information, and can monitor the
bigger picture
LIFO, FIFO, FEFO ISSUES METHODS
First In, First Out (FIFO) – Inventory items are sold in the
order they are purchased. This is the most common
technique.
Last In, First Out (LIFO) – The last to enter the system
are sold first. This is common among non-perishable
items like petroleum, minerals, and metals.
First Expired, First Out (FEFO) – Materials are sold
based on date they should be consumed, regardless of
when it was purchased.
GENERIC TAX FORMULA CONFIGURATIONS
• Material Management Systems usually allow tax
rates to be defined internally via tax codes, or
imported from an external source
-Tax on sales and purchases
-Additional taxes like VAT
-Sales and Use tax as in USA
-Withholding tax like income tax in India
PERIODIC PHYSICAL STOCK-TAKING AND
ADJUSTMENTS WITH TRACKING
• An inventory count is a process where a
business physically counts its entire inventory
- Inventory services provide labor and
automation to quickly count inventory and
minimize shutdown time.
- Inventory control system software can speed up
the physical inventory process.
- A perpetual inventory system tracks the receipt
and use of inventory and calculates the quantity
on hand.
- Cycle counting, an alternative to physical
inventory, may be less disruptive
• Barcode and RFID are supplementary
technologies that can be used in combination
with the Material Management System in order
to have more accurate and less burdensome
inventory counts
 Clinical Data Repositories
 Houses a multitude of laboratory results,
diagnostic reports, and various clinical
documentation
 Data are readily searchable and exportable,
often because the information is gathered from
standard clinical care procedures (Robertson
and Williams, 2016)
 Integrates physician-entered data with data
from different existing information systems
including laboratory, radiology, admission, and
pharmacy among others
 Location where both clinical data and other data
of interest, such as external data sources and
financial data, are assimilated
Common kinds of available information in the CDR:
 Patient Demographics
 Hospital Inpatient Visits
 Diagnoses
 Patient’s Primary Care Provider
 Emergency Department Encounters
 Procedures
 Medication List
 Outpatient Visits
 Laboratory Results
 Allergies
 Immunizations
 Social History
 Vitals
Types of Clinical Data Repository
Study - A database that collects observations for a
specific clinical research study.
Electronic Health Record - A database of observations
made as a result of direct health care.
Registry - Observations collected and organized for the
purpose of studying or guiding particular outcomes on a
defined population. Associated studies are either multiple
or long term and evolving over time.
Warehouse - A repository that adds level of integration
and quality to the primary (research or clinical) data of
single institution, to support flexible queries for multiple
uses. Is broader in application than a registry.
Collection - A library of heterogeneous data sets from
more organizations than a warehouse or more sources
than a registry. Organized to help users find a particular
data set, but not to query for data combined across data
sets.
Federation - A repository distributed across multiple
locations, where each location retains control over access
to its own data, and is responsible for making the data
comparable with the data of other locations.
MULTIPLE VIEWS FOR PATIENT MEDICAL RECORD
 Structure of clinical data repositories allows
data to be extracted along dimensions such as
time (by year, month, week, or day), location, or
diagnosis among many others
 User can view the number of patients with
having a certain type of diagnosis, lab result, or
prescription within a year, then a month in that
year, and further into a day in that month
 Allows clinicians to trend and chart results
independent of the visits and test panel
organization.
 Provide access to information where it is
needed. Creates a “one-stop shopping”
environment
 GUI access can be deployed through hand-held
devices, bedside computing devices, computers
in physician offices, or computing devices
deployed at nursing stations
 Cross-continuum view of information, since they
allow information to be gathered and viewed
from sources other than an acute setting.
GRAPHICAL REPRESENTATION OF LAB RESULTS AND
VITALS
 The electronic health record may present
patient care information as text, tables, graphs,
sounds, images, full-motion video, or signals on
an electronic screen, phone, pager, or
paper (Bronzino and Peterson, 2014)
ETHICS, PRIVACY, AND SECURITY
Content
 Ethics in Health Informatics
-General Ethics
-Informatics Ethics
-Software Ethics
 Privacy, Confidentiality and Security
-Levels of Security in HIS
-Levels of Security in LIS
-Data Privacy Act
Health informatics Ethics
 Application of the principles of ethics to the
domain of health informatics
Ethics in Health Informatics
General Ethics
Autonomy
 Defined as either allowing individuals to make
their own decisions in response to a particular
societal context, or as the idea that no one
human person does not have the authority nor
should have power over another human person
 Electronic health records (EHR) must maintain
respect for patient autonomy, and this entails
certain restrictions about the access, content,
and ownership of records
 Limiting patient access and control over patient
records improves document quality because
they can become proofreaders of their own
patient history (Mercuri, 2010).
 Beneficence and Non- maleficence
Defined as “do good” and “do no harm”,
respectively.
 Beneficence relates most significantly with the
use of the stored data in the EHR system
 Non-maleficence with data protection
Principle of Beneficence in Health Informatics
 Conduction of groundbreaking biomedical and
public health research
Principle of Non- maleficence in Health Informatics
 Temporary Outage
 Total System Failure
 Data Security
Informatics Ethics
 Principle of Information-Privacy and Disposition
– All have fundamental right to privacy
– Thus the control over the collection, storage,
access, use, communication, manipulation,
linkage and disposition of data about
themselves
 Principle of Openness
– The collection, storage, access, use,
communication, manipulation, linkage and
disposition of personal data must be disclosed
in an appropriate and timely fashion to the
subject or subjects of those data
 Principle of Security
– Data that have been legitimately collected
about persons or groups of persons should be
protected by all reasonable and appropriate
measures against loss degradation,
unauthorized destruction, access, use,
manipulation, linkage, modification or
communication.
 Principle of Access
– The subjects of electronic health records have
the right of access to those records and the
right to correct them with respect to its
accurateness, completeness and relevance.
  Principle of Legitimate Infringement
– The fundamental right of privacy and of
control is conditioned only by the legitimate,
appropriate and relevant data-needs of a free,
responsible and democratic society, and by the
equal and competing rights of others
 Principle of the Least Intrusive Alternative
– Any infringement of the privacy rights of a
person or group of persons, and of their right of
control over data about them, may only occur in
the least intrusive fashion and with a minimum
of interference with the rights of the affected
parties.
 Principle of Accountability
– Any infringement of the privacy rights of a
person or group of persons, and of the right to
control over data about them, must be justified
to the latter in good time and in an appropriate
fashion.
Software Ethics
 The software developer has ethical duties and
responsibilities to the following stakeholders:
Society
 Best interest of the society. Developers should
be mindful of social impacts of software
systems.
Includes disclosing any threats or known defects
in software
Institution and employees
 Best interests of the institution and its
employees, while balancing their duties to the
public, including being straightforward about
personal limitations and qualifications
 The software developer has ethical duties and
responsibilities to the following stakeholders:
Professional Standards
 Software products should meet expected
professional standards.
 Developers should strive to build products that
are of high standard, by thoroughly testing and
detailing unresolved issues.
Privacy, Confidentiality and Security
 Privacy generally applies to individuals and their
aversion to eavesdropping
 Confidentiality is more closely related to
unintended disclosure of information
 Privacy and confidentiality are widely regarded
as rights of all people which merits respect
without need to be earned, argued, or defended
 Protection of privacy and confidentiality is
ultimately advantageous for both individuals
and society
 Privacy and confidentiality protection also
benefits public health.
 When people are not afraid to disclose personal
information, they are more inclined to seek out
professional assistance, and it will diminish the
risk of increasing untreated illnesses and
spreading infectious diseases (Goodman, 2016).
 When breaches of privacy and confidentiality
occur -> serious consequences for your
organization, such as reputational and financial
harm, or harm to your patients
 Poor privacy and security practices heighten the
vulnerability of patient information and
increases the risk of successful cyber-attacks
(USA Department of Health and Human
Services, 2015).
Obligations to protect privacy and to keep confidences
fall on:
–System designers
–Maintenance personnel
–Administrators
and, ultimately, to the:
–Physicians
–Nurses
 –Other frontline users of the information
Levels of Security in the Hospital Information
System
Administrative Safeguards
 Continual risk assessment of your health IT
environment
 Continual assessment of the effectiveness of
safeguards for electronic health information
 Detailed processes for viewing and administering
electronic health information
 Employee training on the use of Health IT to
appropriately protect electronic health information
 Appropriately reporting security breaches (eg. To
those enteties required by law ir contract) and
ensuring continued health IT operations.
Physical Safeguards
 Office alarm systems
 Locked offices containing computing equipment that
store electronic health information
 Security guards
Technical Safeguards
 Securely configured computing equipment (eg. Virus
checking, firewalls)
 Certified applications and technologies that store or
exchange electronic health information
 Access controls to health IT and electronic health
information (eg. Authorized computer accounts)
 Encryption of electronic health information
 Auditing of Health IT operations
 Health IT backup capabilities (eg. Regular backups of
electronic health information to another computer
file server)
5 Key Function
Availability: ensuring that accurate and up-to- date
information is available when needed at appropriate
places;
Accountability: helping to ensure that health care
providers are responsible for their access to and use of
information, based on a legitimate need and right to
know;
Perimeter identification: knowing and controlling the
boundaries of trusted access to the information system,
both physically and logically;
Controlling access: enabling access for health care
providers only to information essential to the
performance of their jobs and limiting the real or
perceived temptation to access information beyond a
legitimate need; and
Comprehensibility and control: ensuring that record
owners, data stewards, and patients understand and have
effective control over appropriate aspects of information
privacy and access.
Levels of Security in the Laboratory Information
System
Register Patient - Patient record (eg. ID number, name,
sex, age, location) must be created in the LIS before tests
can be ordered. LIS usually automatically receives these
data from a hospital registration system when a patient is
admitted.
Order test - Physician orders tests on a patient to be
draw as part of the laboratory's morning blood collection
rounds. The order is entered into the CIS and
electronically sent to the LIS.
Collect sample - Before morning blood collection, the LIS
prints a list of all patients who have to be drawn and the
appropriate number of sample bar-code labels for each
patient order. Each barcode has a patient ID, sample
contained, and laboratory workstation that can be used
to sort the tube once it reaches the laboratory. Another
increasingly popular approach is for patient caregivers or
nurses to collect the blood sample. Immediately prior to
collection, sample barcode labels can be printed (on
demand) at the nursing station on an LIS printer or
portable bedside printer.
Receive Sample - When the samples arrive in the
laboratory, their status has to be updated in the LIS from
"collected" to "received." This can be done by scanning
each sample container's barcode ID into the LIS. Once the
sample is "received," the LIS transmits the test order to
the analyser who will perform the test.
Run sample - The sample is loaded onto the analyser,
and the bar code is read. Having already received the test
order from the LIS, the analyser knows which tests to
perform on the patient. No work list is needed. For
manually performed tests, the technologist prints a work
list from the LIS. The work list contains the names of the
patients and the tests ordered on each. Next to each test
is a space to record the result.
Levels of Security in the Laboratory Information System
Review Result - The analyser produces the results and
sends them to the LIS. These results are only viewable to
technologists because they have not been released for
general viewing. The LIS can be programmed to flag
certain results —for example, critical values so the
technologist can easily identify what needs to be repeated
or further evaluated.

Release Results - The technologist releases the results.
Unflagged results are usually reviewed and released at
the same time. The LIS can also be programmed to
automatically review and release normal results or
results that fall within a certain range. The latter
approach reduces the number of tests that a technologist
has to review. Upon release, the results are automatically
transmitted to the CIS.
Report Results - The physician can view the results on
the CIS screen. Reports are printed when needed from the
LIS.
Safeguards for the Laboratory Information System
Administrative Safeguards
 Continuous employee training on the use of the LIS
 Periodic review of standards in identifying which
results should be flagged
 Strengthen laboratory authorization and supervision
policies
 Implement strict rules and regulations regarding the
testing procedures
 Release guidelines on proper disposal of laboratory
specimen
 Enforce policies on the proper use of laboratory
workstations Impose disciplinary measures as
needed
Physical Safeguards
 Periodic maintenance of laboratory equipment
 Biometrics or other security protocol for
laboratory access
 Controlled temperature both for equipment and
specimen
 Contingency operations plan
 Use of appropriate personal laboratory safety
equipment
Technical Safeguards
 Automated identity confirmation procedures for
users requesting access
 Regular change of username and password
 Different access capabilities based on user position
 Automatic log-off after long periods of inactivity
Data Privacy Act of 2012
 Aim “to protect the fundamental human right of
privacy, of communication while ensuring free
flow of information to promote innovation and
growth.” (Republic Act. No. 10173, Ch. 1,
Sec. 2)
 Data Privacy Act applies to individuals and legal
entities that are in the business of processing
personal information.
 The law applies extraterritorially
 It covers the personal information of Filipino
citizens regardless of the place of residence.
 The main principles that govern the approach
for the Data Privacy act include:
– Transparency;
– Legitimacy of purpose; and
– Proportionality
 Consent is one of the major elements highly-
valued by the Data Privacy Act.
 The act provides that consent must be
documented and given prior to the collection of
all forms of personal data, and the collection
must be declared, specified, and for a legitimate
purpose.
 Furthermore, the subject must be notified
about the purpose and extent of data
processing, with details specifying the need for
automated processing, profiling, direct marketing,
or sharing.
 These factors ensure that consent is freely-
given, specific, and informed.
 However, an exception to the requirement of
consent is allowed in cases of contractual
agreements where processing is essential to
pursue the legitimate interests of the parties,
except when overridden by fundamental rights
and freedom.
 Such is also the case in responding to national
emergencies.
Data Privacy Act describes sensitive personal
information as those being:
– About an individual’s race, ethnic origin, marital
status, age, color, and religious, philosophical or political
affiliations;
– About an individual’s health, education, genetic or
sexual life of a person, or to any proceeding or any
offense committed or alleged to have committed;
– Issued by government agencies “peculiar” (unique) to
an individual, such as social security number;
- Marked as classified by executiv

order or act of Congress.

Data Privacy Act of 2012

Exceptions

 Consent of the data subject;

 Pursuant to law that does not require consent;
 Necessity to protect life and health of a person;
 Necessity for medical treatment;
 Necessity to protect the lawful rights of data
subjects in court proceedings, legal
proceedings, or regulation

The act provides for different penalties for varying

violations, majority of which include imprisonment.
These violations include:

 Unauthorized processing
 Processing for unauthorized purposes
 Negligent access
 Improper disposal
 Unauthorized access or intentional breach
 Concealment of breach involving
sensitive personal information
 Unauthorized disclosure; and
 Malicious disclosure

Penalty

 Any combination or series of acts

enumerated above shall make the person
subject to
imprisonment ranging from three (3) years to six
(6) years, and a fine of not less than One million
pesos (Php1,000,000.00) but not more than Five
million pesos (Php5,000,000.00) (Republic Act.
No. 10173, Ch. 8, Sec. 33).
CHANGE IN HEALTH INFORMATICS
4 TYPES OF CHANGE
• Operational changes can influence the way
dynamic business tasks are led, including the
computerization of a particular business
segment.
• Strategic changes occur when the business
direction, in relation to its vision, mission, and
philosophy, is altered.
• Cultural changes influence the internal
organizational culture
• Political changes in human resources occur
primarily due to political reasons of varying
types
OVERVIEW OF CHANGE MANAGEMENT
• Organizations are driven to change in order to
respond to the many pressures they encounter
from their environment.
• These pressures usually include:
-Global competition;
-Changes in customer demand;
-Technological advances;
-New legislation
CHANGE MANAGEMENT PROCESS MODELS
Kurt Lewin’s three-step “Unfreeze- Change-Refreeze”
model
• Proposed by the universally recognized founder
of social psychology in the 1950s.
• Highly relevant today and often used as the
basis for many change management strategies.
Proski’s ADKAR® Model
• “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
• Developed by Harvard Business School’s John
Kotter
• Focuses on efficient and effective change
management in a competitive world.
• 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
APPLICATION OF CHANGE MANAGEMENT
Change management is a series of tools, techniques and
processes aimed at successfully effecting change.
Downey (2008) described 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
• Process mapping for both ‘as is’ and ‘to be’
processes
• Gap analysis
• Business case development
• Project management
• Problem solving
 • Requirements elicitation techniques
Negotiation skills
It is crucial that progress of the change initiative can be
quantified against the objectives set by the
organization. These KPIs might include:
• Reducing rework by x%
• Improvement in stakeholder satisfaction, for
example, customer/employee surveys
• Reduced time to market
• Enhanced speed of delivery
• The return on investment, that is, the total cost
to implement the initiative versus total savings
gained from the initiative per period.
Key success factors at the leadership level in healthcare
organizations
• Setting vision and strategy roadmap
• Formation of governance board to set direction,
to prioritize work, and to allocate resources
• Designate an executive sponsor, departmental
champions, and program manager
• Define reporting requirements for status
reporting in order to keep projects moving
forward
• Manage users’ expectations; prepare them for
casualties, stress, and general sense of
ambiguity
Key success factors at the program level
• Clear and frequent dissemination of information
• Building a strong project leadership
team/steering team and other action/functional
teams
• Providing education and training on the new
changes – workflow and technology
• Forming integrated problem-solving teams to
address critical and complex issues
• Empowering staff and end-users to change
things, by removing barriers and obstacles
• Adoption - make the change stick by
reinforcement, until old traditions are replaced
with new
• Frequently celebrate success by honoring
contributors to keep the motivation and
momentum
• Monitor and measure key indicators (e.g. using
a dashboard to report progress and
benchmarks)
• Involve those affected by the change in
decision- making (e.g. choice of computer carts,
COW)
• Other creative actions e.g. monthly prizes for
high performing teams, provide snacks & drinks
HEALTH INFORMATION PROFESSION
• Health Information Management (HIM)
professionals, credentialed with their academic
preparation, work experience, commitment to
patient advocacy, and professional code of
ethics, have a specialized skill set that uniquely
qualifies them to assume the role both of
privacy official and/or security officials who
store, protect, and transmit information in all
media and formats
• 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.
• Committed to the timely and accurate collection
of health information and its maintenance,
storage, retention, and disclosure, Health
Information Management Professionals ensure
that such information is kept private, secure,
and in accordance with federal and state laws.
A Health Information Management Professional:
• Collects, aggregates, analyzes, and disseminates
patient health information.
• Committed to the timely and accurate collection
of health information and its maintenance,
storage, retentions, and disclosure.
• Represents patients’ interest in matters of
privacy and security, information release, and
issues and guidelines regarding record access.
A Health Information Management Professional:
• Certified by the American Health Information
Management Association
• Ensures confidential patient information is kept
private, secure, and in accordance with federal
and state laws
Health Information Management Professionals fall into
many job categories with varied titles, including:
• Health Information Management Department
Director
• Health Information Management System
Manager
• Information Security Officer
• Chief Privacy Officer
• Health Data Analyst
• Health Record Technician Specialist
• Clinical Coding Specialist
• Patient Information Coordinator
• Physician Practice Manager
• Health Information Administrator
• Revenue Cycle Specialist
• Director of Quality Management
• Health Information Manager
• Health Information Technologist/Technician
The typical day-to-day activities of a Health
Information Management Professional include:
• collecting, aggregating, analyzing, and
disseminating patient health information for
doctors’ offices, hospitals, managed care
organizations, insurance companies, research
and policy agencies, and other health care
facilities and related industries
• providing accurate coding of diagnoses and
procedures from patient visits with health care
providers, ensuring accurate patient billing and
proper reimbursement to health care providers
• compiling and analyzing health care data from
patients, assisting with the identification of
ways to better utilize health care resources,
uncovering public health patterns, improving
patient care, and providing critical information
for health care research
• developing policies to support the delivery of
high quality health care by ensuring the
availability of quality information for accurate
health care decision making.
TELEMEDICINE IN THE PHILIPPINES
• 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.
• Some may have 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.
• Over-the-phone telemedicine providers:
- Medgate
- Lifeline
• Mobile App-based Telemedicine centers:
- MyPocketDoctor
- MyDocNow
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.
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

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).