HISTORY AND EVOLUTION

OF HEALTH CARE
INFORMATION SYSTEMS
By Group B4
• Septianingtyas Risti A. (G41161049)
• Finno Harta D. (G41161074)
• Ika Rahmadhani (G41161296)
• Astrid Kartika D.A. (G41161311)
• Ines Meiyola P. (G41161526)
DEFINITION OF TERMS
There are two primary classes of health care information systems

administrative clinical
information information
system system

Common Types of Administrative and Clinical Information

Systems

Administrative Applications Clinical Applications

•Patient administration systems •Ancillary information systems

•Admission, discharge, transfer (ADT): •Laboratory information
•Registration •Radiology information
•Scheduling: •Pharmacy information
•Patient billing or accounts receivable
•Utilization management
 1960s: Billing Is the Center of the Universe;
Managing the Money; Mainframes Roam the Planet
• The administrative applications that existed in the 1960s
were generally found in large hospitals, such as those
affiliated with academic medical centers. These larger
facilities were often the only ones with the resources and
staff available to develop, implement, and support such
systems.
• These early administrative and financial applications ran on
large mainframe computers which had to be housed in large
rooms, with sufficient environmental controls and staff to
support them. Because the IS focus at the time was on
automating manual administrative processes and computers
were so expensive, only the largest, most complex tasks were
candidates for mainframe computing.

Typical Mainframe Computer

1970s: Clinical Departments Wake Up;
Debut of the Minicomputer

By the 1970s, health care costs were escalating rapidly, partially

due to high Medi- care and Medicaid expenditures. Rapid inflation in
the economy, expansion of hospital expenses and profits, and
changes in medical care, including greater use of technology,
medications, and conservative approaches to treatment also
contributed to the spiral- ing health care costs. Health care
organizations began to recognize the need for better access to
clinical information for specific departments and for the facility as a
whole.
• The development of departmental systems coincided with the availability of mini-
computers. Minicomputers were smaller and also more powerful than some
mainframe computers and available at a cost that could be justified by a clinical
department such as laboratory or pharmacy. At the same time, improvements in
handling clinical data and specimens often showed a direct impact on the quality of
patient care because of faster turnaround of tests, more accurate results, and a
reduction in the number of repeat procedures (Kennedy & Davis, 1992)
• As in the 1960s, the health care executive’s involvement in information system–
related decisions was generally limited to working to secure the funds needed to
acquire new information systems, now executives were working with individual
clinical as well as adminisalthough trative departments on this issue. Most systems
were still stand-alone and did not interface well with other administrative or clinical
information systems in the organization.
 Decade 1980
Computers for the masses; Age of the Cheap Machine; Arrival of the Computer Utility

Health Care State of Informationt Use Of Health Care

Environment Technology Information System
1. Medicare
1. Microcomputer or personal 1. Distributed data
introduces
computer (PC) becomes processing
prospective
available—far more 2. Expansion of clinical
payment system
powerful, affordable; information systems in
for hospitals
brings computing power to hospitals
2. Medicaid and
desktop; revolutionizes 3. Physician practices
private insurers
how companies process introduce billing systems
follow suit
data and do business 4. Integrating financial and
3. Need for financial
2. Advent of local area administrative information
and clinical
networks becomes important
information
• In 1982, Medicare shifted from a cost-based reimbursement system for hospitals to a
prospective payment system based on diagnosis related groups (DRGs).
• As Medicare and many state Medicaid programs began to reimburse hospitals under the
DRG-based system, many private insurance plans quickly followed suit.
• With these environmental changes happening in health care, the development of the
microcomputer in the mid-1980s could not have been more timely. The microcomputer
(PC), was smaller, often as or more powerful, and far more affordable than a
mainframe computer.
• A local area network (LAN) is a group of computers and associated devices that are
controlled by a single organization.
 Decade 1990
Health Care Reform Initiatives; Advent of the Internet

In 1990, marked as a Focus on electronic In 1991, the Institute of

great change in health medical records. Medicine (IOM) is
care. published its report
The Computer-
In 1990, marked as
Based Patient Record.
a great change in
health care.

Five years after the IOM The use of telemedicine

report. President
Clinton signed into law the
Health Insurance Portability
and Accountability
Act(HIPAA) of 1996.
and telehealth has also
become more
prevalen,particularly
during the 1990.
2000 to Today: Health Care IT Arrives;
Patients Take Center Stage
IOM report on
HIPAA privacy and
patient Broadband access in
safety and medical Adoption EHR security regulations in
rural areas
effect
errors

Health care
Transparency on
Adoption Medicare organizations
quality and price;
PHR Modernization Act invest in
Consumer EHR information
empowerment
systems

Health information
exchange activities
promulgated
WHY HEALTH CARE LAGS IN IT

Health care information is complex and it can be difficult to structure.

There is no simple standard operating procedure

health information is highly sensitive and personal

There were no federal laws that protected the confidentiality of all patient health
information, and the state laws varied considerably

Health care IT is expensive