Dissertations / Theses on the topic 'HEALTH INFORMATION MANAGEMENT'

This dissertation examines several key aspects regarding health insurance policies in the United States. The development of the United States health insurance market began in the 1920s with life insurance companies selling traditional indemnity health insurance plans and hospitals offering hospital care plans on a pre-paid basis. This market has evolved over the last century into a heavily regulated market dominated by employer-sponsored, managed-care plans. Reviews in the introduction of this dissertation include the overall market, health insurer evolution, the history of managed care operations, the progression of employer-sponsored health insurance plans and regulation specific to health insurance. Analysis of health insurance market evolution can offer a better understanding of how past developments in U.S. health care can inform and shape future policy.

The second chapter of this dissertation provides an analysis of adverse selection in the U.S. health insurance market. Adverse selection is a phenomenon inherent in insurance contracting. Using a rich, unique dataset consisting of multiple insurers, across states for the years 2013–2015, I document a correlation between coverage and risk. Results show that adverse selection is present both in the individual and group markets. Additionally, I test for the presence of adverse selection by state and by insurer. I find that factors such as the health of the state population, regulatory environment, insurer competition and insurer size are not associated with the likelihood that a state or and insurer experiences the presence of adverse selection.

The third chapter of this dissertation relates adverse selection and consumer satisfaction in health insurance plans. I exploit a dataset rich with respondent demographics and health insurance plan information to evaluate the relationship between adverse selection and health insurance plan satisfaction. I find that respondents who are more likely to have adversely selected into the health insurance plan are more satisfied with their plan. This is evidence that respondents may use private information on their risk level to choose plans to their advantage.

The dynamics and progress of the integration of the electronic health record (EHR) into health-care disciplines have been described and examined using theories related to technology adoption. Previous studies have examined health-care clinician resistance to the EHR in primary care, hospital, and urgent care medical settings, but few studies have been completed that pertain specifically to behavioral health-care clinicians. The study purpose was to examine the relationships that may exist between behavioral health-care clinician perceptions of usefulness and ease of use and demographic variables on adoption of the EHR. Regression analyses were performed to test the relationship between behavioral health-care clinician personal characteristics, their perceived ease of use and usefulness of EHR, and their attitudes toward adoption of the EHR. The study utilized licensed marriage and family therapists as participants. The Physician’s Survey Questionnaire Form was adapted to the needs of this study and utilized as the survey instrument. The study was embedded within the frame of Roger’s diffusion of innovations theory and the technology acceptance model. The findings of the study suggest that older clinicians are less likely to perceive the EHR as useful in their professional practice. The results also demonstrate that behavioral health clinician perceived ease of use and usefulness of EHR is positively associated with attitude toward adoption of the EHR. The findings indicate that to improve the adoption of the EHR for behavioral health clinicians, the EHR needs to be viewed as useful. Interpretation of the results and suggestions for future research are offered.

A major initiative in the U.S. healthcare care industry is to establish a nationwide health information network securing the sharing of information between all involved U.S. healthcare stakeholders. However, implementing an interoperability solution is a massive, complex, and enduring effort with significant challenges such as inconsistent technology and data standards, as well as complex privacy and security issues. The purpose of this qualitative, case study is to examine the impacts of interoperability initiatives involving the U.S. government and to provide an understanding of the information governance and security risk as standards that are vendor-neutral and trustworthy. This qualitative case study was conducted using federal participants who are health information management (HIM) and health information technology (HIT) professionals working in the Washington DC metropolitan area. The participants' interview data revealed nine major themes; patient identification matching, payment claims and auditing, information sharing, data stewardship, regulatory compliance, technology enhancements, training and certification, standards optimization, and value-based care. The implication of the study's themes showed interoperability is beneficial to the healthcare industry, but there is a greater need for technology and data standardization, information governance, data stewardship, and a greater understanding of federal and state data privacy and security laws. Future recommendation for practices discussed; policy and regulatory adjustments to enhance auditing and compliance, establish a healthcare data ecosystem to improve data and information governance, and technology alternatives such as master data management and white space data. Recommendation for further research included expanding the sample population to compare other federal organizations or the United Kingdom's HIT interoperability project initiative.

The infusion of information and communication technology (ICT) as the electronic health record (EHR) requires a significant increase in the knowledge and skills of the current Canadian health information management (HIM) workforce (Prism Economics and Analysis [Prism], 2009). However, there exists a shortfall in the capacity of the Canadian Health Information Management Association (CHIMA) to provide the required training and development to the organization’s membership (Prism, 2009). This study is an exploratory qualitative case study to examine the reasons for the CHIMA’s capacity shortfall and whether or not the use of a virtual community of practice (vCoP) might be effective to address the need. Three one-hour teleconference interviews were conducted with the CHIMA leadership. Data were analyzed using the work of Senge (1990a), Rogers (2003), and Wenger (1998) as a theoretical lens, which implies that leadership has a responsibility to provide a strategy and communication channels for organizational learning and development. The study findings provide implications for the CHIMA, its membership, and related educational stakeholder organizations to make firm determinations of their role in continuing professional education (CPE) for Canadian HIM professionals. The study is significant in its contribution to understanding the CPE challenges and opportunities resultant from the EHR implementation. Future research areas include (a) engagement of the CHIMA membership in the association, (b) awareness of Canadian HIM professionals of the changing profession (c) visibility of the Canadian HIM profession, and (d) the role of vCoPs in the Canadian HIM setting.

ABSTRACT Electronic medical record (EMR) use has improved significantly in health care organizations. However, many barriers and factors influence the success of EMR implementation and adoption. The purpose of the descriptive qualitative single-case study was to explore health care professionals? perceptions of the use of EMRs at a hospital division of a major medical center. The study findings highlighted the challenges in transitioning from paper records to EMR despite the many benefits and potential improvement in health care. A description of the 16 health care professionals? perceptions of EMR use emerged by adopting the unified theory of acceptance and use of technology (UTAUT) model and NVivo 10 computer software to aid with the analysis of semi-structured, recorded, and transcribed interviews. Themes emerging from the analysis were in five categories: (a) Experience of health care professionals with a subtheme of workflow, (b) Challenges in transition from paper to EMR, (c) Barriers to EMR acceptance, with a subtheme of privacy, confidentiality, and security, (d) Leadership support, and (d) Success of EMR. The findings of the case study may inform health care industry decision makers of additional social and behavioral factors needed for successful EMR strategic planning, implementation, and maintenance.

Alternative healthcare programs have been steadily flooding the health care market, with the most notable being mobile health. Mobile health, more popularly known as mHealth, is expected to generate upward of $59 billion dollars. This is astonishing, considering the mHealth market is still in its infancy as an alternative healthcare model. Still, there are over 100,000 mHealth smartphone applications and platforms on the market. The concept of offering affordable medical services that are accessible to anyone, at any time and in any place appeals to the mission and purpose of healthcare organizations. However, a large number of the studies and publications on mHealth are associated with the technologies behind mHealth and provide very little information on the practices and challenges associated with implementing mHealth, especially within a medical facility. For this reason, it was important to learn from executive health IT professionals who have successfully implemented mHealth services within the US healthcare system. Accordingly, the purpose of this study was to identify the practices used and challenges faced by CIOs in implementing mHealth technologies. The study also obtained recommendations CIOs believe are associated with successful mHealth services.

This was a qualitative study that used a phenomenology lens focused on the viewpoint of CIOs and the growing phenomenon of mHealth as a part of the U.S. healthcare system. This approach allowed the research to obtain data on the lived experiences of seven CIOs through semi-structured interviews who were identified as top experts by Becker Hospital Review publications. The analysis of their experiences revealed 13 best practices for mobile health implementation. The findings in this study aimed to identify how mHealth services could expand access to medical services by outlining key considerations and resources required for successful implementation.

In 2009 the American Recovery and Reinvestment Act (ARRA) was signed into law. As part of ARRA, the HITECH Act set aside $29 billion in Medicare and Medicaid incentives for healthcare organizations. To collect these incentives, healthcare organizations must install an electronic health record (EHR) system and achieve meaningful use. Implementation of an EHR must be completed by 2015 in order to acquire any of the incentives available. Small medical practices consisting of one to five physicians are finding it easier to implement a cloud-based EHR system due to minimal upfront costs and no need for technical capabilities within the medical practice. This study was done using a modified Delphi technique developed by Roy Schmidt to find critical success factors for the implementation of electronic health record systems within a centralized computing services structure. For purposes of this study a centralized computing services structure was considered a cloud or cloud-based environment.

This study found that the top five critical success factors for the implementation were the following: (1) EHR Training – implementing a strong training / education process for EHR users; (2) Usability – practical application of EHR features in a real medical office setting; (3) Reliability – Specifically high levels of redundancy and system availability. If the system is down, patient safety is a risk, and that is an unacceptable norm; (4) Strong clinical representation in the project to ensure workflows, processes and education needs are met; (5) Support services such as deployment / implementation services, help desk, and online support. Of these five factors, four are actually related to usability of the system, and not necessarily strictly based on implementation. This leads us to believe that the success of an implementation is reliant upon user perception based on system usage.

One of the core strategies to transform the United States national healthcare system is the implementation of key technologies such as the electronic patient medical record. Such key technologies improve patient care and help the organization gain competitive advantage. With a high demand for strategic and operational change, healthcare providers are turning to their own internal Healthcare Information Technology (HIT) for integrated technology solutions (e.g., clinical systems, robotics, infrastructure) in order to reduce costs, improve patient care, and unlock new value through innovation. Due to the overreliance on advanced technology solutions for revamping the US Healthcare System, the role of internal HIT needs to evolve into that of an effective strategic business change partner. As such, the purpose of this study was to test an a priori conceptual model of five competencies that would enable HIT to be an effective strategic business change partner. An on-line survey instrument was used to collect data from hospitals across the country and the data was analyzed through quantitative methods. Results suggest that the perception of internal healthcare information technology (HIT) organizations as an effective strategic business change partner is determined by its competence as a Healthcare Strategists, Change Driver, Collaborator, Agile Leader, and Technology Service Provider.