Adaptive Health Management Information Systems:

Concepts, Cases, & Practical Applications: Concepts,

Cases, & Practical Applications

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Library of Congress Cataloging-in-Publication Data
Tan, Joseph K. H.
Adaptive health management information systems : concepts, cases, & practical applications / Joseph Tan with
Fay Cobb Payton.—3rd ed.
p. ; cm.
Rev. ed. of: Health management information systems. 2nd ed. Gaithersburg, Md. : Aspen Publishers, 2001.
Includes bibliographical references and index.
ISBN-13: 978-0-7637-5691-8 (pbk.)
ISBN-10: 0-7637-5691-1 (pbk.)
1. Information storage and retrieval systems—Health services administration. 2. Management information
systems. I. Payton, Fay Cobb. II. Tan, Joseph K. H. Health management information systems. III. Title.
[DNLM: 1. Management Information Systems. 2. Health Services Administration. W 26.5 T1608a 2009]
RA971.6.T36 2009
362.1068'4—dc22
2008054201
6048
Printed in the United States of America
13 12 11 10 09 10 9 8 7 6 5 4 3 2 1
56918_FMxx_Final_Tan 4/6/10 1:31 PM Page iii

New to This Edition

Adaptive Health Management Information Systems, Third Edition, is for instructors who want to
keep pace with rapid changes in the field of healthcare management information systems
(HMIS) and health informatics (HI). This new edition is not simply an update of the second
edition—it is a completely reorganized, expanded, and rewritten text containing all new con-
tributions, special sections, and streamlined discussions of more established as well as hot cur-
rent topics. These are spiced with motivating scenarios; real-world examples; mini-cases;
stimulating chapter questions; illustrative graphics, tables, and exhibits; and additional read-
ings. Significant updates and complete revisions have been integrated throughout the text—so
much so that readers familiar with the previous edition would not recognize this work as a de-
rivative of the other.

Specific updates
● Content. Rich, comprehensive topics covered range from HMIS history; chief executive

officer/chief information officer roles and responsibilities; health IT and Internet use;
HMIS enterprise software; virtual communities and networks; patient-centric manage-
ment systems; HMIS interoperability; HMIS strategic planning; HMIS developments;
HMIS project management; HMIS standards, governance, and international perspec-
tives; and HMIS innovation.
● Scenarios. Realistic and real-world scenarios set the stage for topic discussion and to moti-

vate the student readers; a short reflection is also given at the end of each scenario.
● Technology Briefs. Concise briefs cover specific HMIS knowledge domains such as the

Internet and associated technologies; hardware, software, and user interfaces; network
technologies; database concepts; and data mining and data warehousing.
● Research Brief. Brief extends reading and provides supplementary research data.

● Policy Brief. Brief covers key policy issues relating to the Health Insurance Portability and

Accountability Act (HIPAA), privacy, confidentiality, and security issues.

● Mini-Cases. Short cases illustrate concepts, and related mini-case questions promote class

discussions among students.

● Chapter Questions. Long- and short-answered questions stimulate classroom discussions

and promote learning of various topics and examples discussed in the text.
56918_FMxx_Final_Tan 4/6/10 1:31 PM Page iv

iv NEW TO THIS EDITION

● Editor’s Notes. Appended to chapters contributed by various authors, these notes bridge
the chapter contents with the other chapters and parts of the text, thereby providing read-
ers with an overview of the intended organization of the text.
● Major Cases. Part V provides a selection of major cases to enhance understanding of
teaching materials and promote further interactions between students and instructors.
56918_FMxx_Final_Tan 4/6/10 1:31 PM Page v

Dedication
To the memory of my parents, who brought me into this world;
to my students and colleagues, who have enjoyed my work and benefited
from my 20-year career of teaching and research in the fields of healthcare services
and administration, business information systems, and healthcare informatics;
and to my immediate family members, who have helped in every way
to mature my academic publishing and writing career.

—Joseph Tan
56918_FMxx_Final_Tan 4/6/10 1:31 PM Page vi
56918_FMxx_Final_Tan 4/6/10 1:31 PM Page vii

Acknowledgments
Above and beyond those to whom I am indebted while putting together the earlier editions of
this text, I would like to thank those newly added academic and professional contributors, in-
cluding those who were brought on board by co-editor, Dr. Fay Cobb Payton. Dr. Payton has
personally shared in parts of the writing of this revised edition and Mr. Joshia Tan helped
make this revised edition not only a completely different kind of text, but one much more ap-
pealing and valuable for instructors and students alike. Aside from contributing his very own
case as a closure to the text and spearheading the writing of several briefs and chapters, Mr.
Tan has contributed to the repackaging of the materials in this text in such a way as to help
student readers better digest those more complex and highly technical parts of the previous
editions by rearranging and rewriting key portions of previously published materials for lighter
and easier reading.
There are two other individuals whom I must especially thank: Dr. Kai Zheng, a professor at
the University of Michigan School of Public Health and School of Information, and Mr.
Jonathan Dunford, a graduate student studying in the joint MBA–Masters in Health Services
and Administration program at the University of Michigan. Dr. Zheng has kindly—and metic-
ulously—reviewed some of the more critical chapters of this revised edition, especially Chapter
1, while Mr. Dunford has generously assisted in summarizing several of the motivating scenar-
ios appearing at the beginning of the chapters. I am also indebted to numerous Wayne State
University students, whose names would fill countless pages if I were to list them one by one; I
will choose to keep this simple for fear of missing anyone important. To date, these students
have contributed to many repeated discussions, year after year, about where they felt changes
would have made previous editions of this text more valuable in classroom teaching and during
online discussion sessions. A good number of these students have enjoyed and greatly benefited
from my teaching and have also encouraged me to elaborate on new and emerging topics, most
of which, unfortunately, I can only incorporate briefly and sparingly due to space limitation;
otherwise, we would have ended up with a four-volume introductory text if all of the research
gathered by myself, my assistants, and my students were to be incorporated, in one way or an-
other, as different chapters, briefs, and cases. Indeed, I have also taken this opportunity, with
the help of Mr. Joshia Tan, to substantially reduce the volume of words to convey the same key
56918_FMxx_Final_Tan 4/6/10 1:31 PM Page viii

viii ACKNOWLEDGMENTS

messages contained in the previous editions through the innovative use of Technology, Research,
and Policy Briefs. In so doing, we have eliminated most of the dated materials.
I am grateful to all who have contributed, especially for their collaborative spirit and willing-
ness for me to revise and edit freely their submitted pieces throughout the lengthy duration of
this project. Their willingness for me to redirect their contributions to a common theme, to
conform to a set format or a particular layout, to confine and revise the writing to a particular
topic or area of research, to eliminate much of the overlapping information in earlier drafts, and
to make substantive changes when necessary—without the need to consult with them over and
over again—is highly admired because it has helped merge the different contributed pieces into
a unified whole. More importantly, a special acknowledgment is due to the generosity of the
publisher to extend the deadline for me to complete all of the revisions I wanted to see going
into this latest edition at a time when I was swamped with the parallel production of several
other major works. I would also like to take this opportunity to thank the three anonymous re-
viewers engaged by the publisher for going over the submitted drafts, pointing out any errors,
and providing various suggestions to improve the appeal of the different chapter layouts and
contents. Without the patience shown to me by key personnel at Jones & Bartlett Publishers, I
know the end product of this revised edition would have been vastly limited. I am also indebted
to Dean Homer Schmitz of St. Louis University, who kindly agreed to pen the Foreword for
this latest edition swiftly on a very tight time constraint. His mentorship and advice for advanc-
ing my academic career has always been one that I truly admire and enjoy.
All in all, I greatly appreciate and thankfully acknowledge all of the assistance, encourage-
ment, and understanding from each and every person who participated in any way, shape, or
form, in the various stages and processes involved in the production of this work, from begin-
ning to end. Once again, I am particularly grateful to my son, Joshia Tan, who took precious
time out of his extremely busy summer 2008 work schedule to help me prepare this third edi-
tion for publication. And I must certainly acknowledge the unceasing support, encouragement,
and understanding of my wife, Leonie Tan, throughout the duration of this project.
To all of these individuals and to my family members, friends, students, and relatives, I offer
my many thanks for the support provided to me. Much of the value of this work is due to their
contributions and assistance.

—Joseph Tan
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Contents
About the Editors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxiii
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxv
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xxxvii

PART I Foundation Concepts of Health Management

Information Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Chapter 1
Health Management Information Systems: A Managerial Perspective . . 3
Joseph Tan
Scenario: Key Trends Contributing to the Merging of Enterprise and
Health Information Exchange Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
II. Evolution of HMIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
III. HMIS Components and Basic Functions . . . . . . . . . . . . . . . . . . . . 8
● HMIS Components . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

● HMIS Basic Functions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

IV. HMIS Cultures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

V. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

Mini-Case: MinuteClinic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21

ix
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x CONTENTS

Chapter 2
Health Management Information System Executives: Roles and
Responsibilities of Chief Executive Officers and Chief Information
Officers in Healthcare Services Organizations . . . . . . . . . . . . . . . . . . . 23
Joseph Tan
Scenario: Managing Waiting Time in Emergency Rooms . . . . . . . . . . . . . . . 24
I.Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
II.Vision . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
III.Strategy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
IV. Execution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
V. Senior Executives in Healthcare Services Organizations . . . . . . . . 33
● A Trustworthy Leader . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

● An Inspirational Manager and Motivator of Others . . . . . . . . . 36

● An Effective Communicator . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

VI. Specific CIO Role and Responsibilities . . . . . . . . . . . . . . . . . . . . . 37

VII. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Additional Readings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Mini-Case: Predicting Future HMIS Trends by Chief Information

Officers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Research Brief I: Personal Digital Assistants Enhance Data

Collection Efficiency during a Study of Waiting Times in an
Emergency Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
N. Elkum, W. Greer, and A. Al-Madouj

Chapter 3
Online Health Information Seeking: Access and Digital
Equity Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Fay Cobb Payton and Joseph Tan
Scenario: A New RHIO in DC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
II. Emotional Support and Empowerment of Health
Information Seekers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52
III. Profiling Health Information Seekers . . . . . . . . . . . . . . . . . . . . . . 54
IV. Accessing Health Information beyond the Internet . . . . . . . . . . . . 57
V. Alternative Means of Accessing Health Information . . . . . . . . . . . 57
VI. Future Directions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
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CONTENTS xi

Technology Brief I: Fundamentals of Internet and Associated

Technologies for Healthcare Services Organizations . . . . . . . . . . . . . . . 61
Joshia Tan

PART II Health Management Information System Technology

and Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67

Chapter 4
Health Management Information System Enterprise Software:
The New Generation of HMIS Administrative Applications . . . . . . . . 69
Joshia Tan with Joseph Tan
Scenario: Customer Relations Management with Blue Cross Blue
Shield of Minnesota . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
II. Supply Chain Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
III. Customer Relationship Management . . . . . . . . . . . . . . . . . . . . . . 75
IV. Enterprise Resource Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
V. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Technology Brief II: Basic Hardware, Software, and

Interface Concepts for Healthcare Services Organizations . . . . . . . . . . 86
Joshia Tan and Joseph Tan

Chapter 5
Community Health Information Networks: Building Virtual
Communities and Networking Health Provider Organizations . . . . . . 95
Jayfus T. Doswell, SherRhonda R. Gibbs, and Kelley M. Duncanson
Scenario: Designing an Intelligent Community Health
Information Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96

I.Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
II.Previous Community Health Information Networks . . . . . . . . . . 98
III.From CHIN to RHINO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
IV. Prospects for RHINO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100
V. HL7 Standard Health Data Exchange . . . . . . . . . . . . . . . . . . . . . 101
● Community Management Systems . . . . . . . . . . . . . . . . . . . . . 102

VI. Mayo Clinic CASE Study . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104

VII. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
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xii CONTENTS

Technology Brief III: Telecommunications and Network

Concepts for Healthcare Services Organizations . . . . . . . . . . . . . . . . . 109
Joseph Tan

Chapter 6
Trending toward Patient-Centric Management Systems . . . . . . . . . . . 117
Joseph Tan with Joshia Tan
Scenario: Google Health, a Portal for Personal Health Records
and Health Decision Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
I.Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120
II.Definitions of EHR, CPOE, and CDSS . . . . . . . . . . . . . . . . . . . 120
III.Historical Evolution of EHR, CPOE, and CDSS . . . . . . . . . . . . 121
IV. Electronic Health Records . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
V. Computerized Physician Order Entry . . . . . . . . . . . . . . . . . . . . . 125
VI. Clinical Decision Support Systems . . . . . . . . . . . . . . . . . . . . . . . 125
VII. Benefits and Challenges of EHR, CPOE, and CDSS . . . . . . . . . 126
● Benefits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

● Challenges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128

VIII. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132

Technology Brief IV: Database, Data-Mining, and

Data-Warehousing Concepts for Healthcare Services Organizations . . 133
Joshia Tan and Joseph Tan

Chapter 7
Health Management Information System Integration: Achieving
Systems Interoperability with Web Services . . . . . . . . . . . . . . . . . . . . 143
J. K. Zhang and Joseph Tan
Scenario: The SAPHIRE Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
II. Current HMIS Interoperability Issue . . . . . . . . . . . . . . . . . . . . . 148
III. Web Services: The Interoperability Solution . . . . . . . . . . . . . . . . 150
IV. WSIHIS Case . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
● Background of WSIHIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153

● WSIHIS Interoperability . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154

● Web Service–Based Solution for WSIHIS Interoperability . . . 154

● System Assessment on WSIHIS Interoperability . . . . . . . . . . . 157

V. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
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CONTENTS xiii

PART III Health Management Information System

Planning and Management . . . . . . . . . . . . . . . . . . . . . . . 163

Chapter 8
Health Management Strategic Information System Planning/
Information Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Jon Blue and Joseph Tan
Scenario: Open Health Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166

I.Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
II.The Essence of Management . . . . . . . . . . . . . . . . . . . . . . . . . . . 168
III.The PODC Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
IV. HMSISP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176
V. Information Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178
● Information Sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

● Business Systems Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . 179

● Critical Success Factors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182

● In-Depth Interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183

VI. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188

Chapter Appendix: Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . 189

Chapter 9
System Development: Health Management Information
System Analysis and Developmental Methodologies . . . . . . . . . . . . . . 191
Joseph Tan
Scenario: Richmond Township . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192

I.Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196
II.HMIS Analysis and Development Methodologies . . . . . . . . . . . . 196
III.SDLC-Based Methodologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
IV. Structured Methodologies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203
V. Prototyping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
VI. Contemporary Models . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206
● Computer-Assisted Software Engineering

(CASE) Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207

● Multiview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208

● Open-Source Software . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211

VII. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214
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xiv CONTENTS

Chapter 10
Data Stewardship: Foundation for Health Management Information
System Design, Implementation, and Evaluation . . . . . . . . . . . . . . . . 217
Bryan Bennett
Scenario: The Metropolitan Medical Group . . . . . . . . . . . . . . . . . . . . . . . 218
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
II. The Change Continuums . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220
● Technology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

● Processes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

● People . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 221

III. Data Stewardship . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222

● Data Quality Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . 222

● Data Management Implications . . . . . . . . . . . . . . . . . . . . . . . 223

● Data Security Implications . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

● Business Intelligence Implications . . . . . . . . . . . . . . . . . . . . . . 224

IV. Implementation Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

● Step 1: Assessing the Available Resources . . . . . . . . . . . . . . . . 225

● Step 2: Assessing Data and Data Inventory . . . . . . . . . . . . . . . 226

● Step 3: Profiling Data and Determining the Valid Values

for Each Attribute . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226

● Step 4: Reviewing Processes . . . . . . . . . . . . . . . . . . . . . . . . . . 226

● Step 5: Reviewing Personnel Responsibilities . . . . . . . . . . . . . . 228

● Post-Implementation Review . . . . . . . . . . . . . . . . . . . . . . . . . 229

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229
Mini-Case: The Metropolitan Medical Group (MMG) . . . . . . . . . . . . . . 230

Chapter 11
Managing Health Management Information System Projects:
System Implementation and Information Technology
Services Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Joseph Tan
Scenario: Louisiana Rural Health Information Exchange . . . . . . . . . . . . . 232
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
II. Critical Success Factors for Systems Implementation . . . . . . . . . . 234
● User Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235

● Systems Design Characteristics . . . . . . . . . . . . . . . . . . . . . . . . 236

● Organizational Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 237

III. Strategic Planning and Management Issues . . . . . . . . . . . . . . . . . 238

● Staffing Issues . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238

● Organizational Project Management . . . . . . . . . . . . . . . . . . . . 240

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CONTENTS xv

Reengineering Considerations . . . . . . . . . . . . . . . . . . . . . . . . . 242

●

End-User Involvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

●

● Vendor Involvement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

● Additional Considerations . . . . . . . . . . . . . . . . . . . . . . . . . . . 244

IV. Systems Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245

● Pre-Implementation Preparation . . . . . . . . . . . . . . . . . . . . . . . 245

● Proposal Evaluation and Selection . . . . . . . . . . . . . . . . . . . . . . 246

● Physical Implementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249

● Post-Implementation Upkeep . . . . . . . . . . . . . . . . . . . . . . . . . 251

V. IT Services Management Concepts . . . . . . . . . . . . . . . . . . . . . . . 253

VI. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257

PART IV Health Management Information System

Standards, Policy, Governance, and Future . . . . . . . . . . . . 259

Chapter 12
Health Management Information System Standards:
Standards Adoption in Healthcare Information Technologies . . . . . . . 261
Sanjay P. Sood, Sandhya Keeroo, Victor W. A. Mbarika, Nupur Prakash,
and Joseph Tan
Scenario: HHS to Form Standards, Operability Group to Spur
Health IT Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262

I.Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
II.HMIS Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
III.HIPAA to Spur Data Standards Adoption . . . . . . . . . . . . . . . . . . 266
IV. HL7: Health Level Seven . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270
● The Vocabulary Problem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270

● HL7 Development . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

● HL7 Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272

V. DICOM: Digital Imaging and Communication

in Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272
● Purpose of DICOM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273

● Adoption of DICOM Standards . . . . . . . . . . . . . . . . . . . . . . . 274

VI. Web Standards . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275

VII. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
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xvi CONTENTS

Policy Brief I: HIPAA, Privacy, and Security Issues for

Healthcare Services Organizations . . . . . . . . . . . . . . . . . . . . . . . . . . . 280
Joseph Tan and Fay Cobb Payton

Chapter 13
Health Management Information System Governance, Policy, and
International Perspectives: HMIS Globalization through E-Health . . 291
Anantachai Panjamapirom and Philip F. Musa
Scenario: TriZetto and TeleDoc Alliance . . . . . . . . . . . . . . . . . . . . . . . . . 292
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293
II. Tele-Care, Telemedicine, Tele-Health, and E-Health . . . . . . . . . . 295
III. Types of Telemedicine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296
IV. The Economic Perspectives of ICT and E-Health . . . . . . . . . . . . 298
● Production Possibility Frontier . . . . . . . . . . . . . . . . . . . . . . . . 300

● Positive Externality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301

V. Factors Influencing the Adoption of E-Health . . . . . . . . . . . . . . 302

● Technology Acceptance Model . . . . . . . . . . . . . . . . . . . . . . . . 302

● Theory of Planned Behavior . . . . . . . . . . . . . . . . . . . . . . . . . . 303

● Diffusion of Innovation Theory . . . . . . . . . . . . . . . . . . . . . . . 303

● Technology-Organization-Environment Model . . . . . . . . . . . . 304

VI. Barriers to E-Health Adoption . . . . . . . . . . . . . . . . . . . . . . . . . . 304

VII. Stakeholder Analysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306
VIII. WHO’s Strategic Framework for E-Health Development . . . . . . 308
IX. Flow of Resources between Developed and
Developing Countries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 310
X. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316
Mini-Case: M&P Cardiovascular Center Inc. . . . . . . . . . . . . . . . . . . . . . 316
Chapter Appendix: Glossary of Terms . . . . . . . . . . . . . . . . . . . . . . . . . . 317

Chapter 14
Health Management Information System Innovation: Managing
Innovation Diffusion in Healthcare Services Organizations . . . . . . . . 319
Tugrul U. Daim, Nuri Basoglu, and Joseph Tan
Scenario: MedeFile International . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 320
I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 321
II. Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 322
III. Complex Adaptive Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
● General Systems Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327

● Complex Adaptive Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . 327

● Handling Complexity in Healthcare Services Organizations . . 328

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CONTENTS xvii

IV. Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329

V. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333

Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334
Chapter Questions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 336

PART V Health Management Information Systems

Practices and Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 337

Case 1
Emergency Medical Transportation Resource Deployment . . . . . . . . . 339
Homer H. Schmitz

Case 2
The Clinical Reminder System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351
Kai Zheng

Case 3
Integrating Electronic Medical Records and Disease
Management at Dryden Family Medicine . . . . . . . . . . . . . . . . . . . . . . 359
Liam O’Neill and William Klepack

Case 4
Delivering Enterprisewide Decision Support through
E-Business Applications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Rajiv Kohli and Henry J. Groot

Case 5
Mapping the Road to the Fountain of Youth . . . . . . . . . . . . . . . . . . . 385
Joshia Tan

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391
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About the Editors

Primary author and editor Joseph Tan, PhD, is a professor of business information systems/
information technologies (IS/IT) and healthcare informatics. He is the editor-in-chief of
International Journal of Healthcare Information Systems & Informatics (IJHISI). He has served as
acting director for the master’s of health administration program at the Faculty of Medicine,
University of British Columbia; as chair of the Information Systems and Manufacturing
Department of Wayne State University’s School of Business Administration; as consultant to
the Ontario Council of Graduate Studies; as well as a research fellow and advisor to various
professional research institutes and nonprofit and for-profit organizations. His professional
background spans a broad spectrum of disciplinary expertise and research interests, with a
demonstrated ability to serve in both academia and industry. He is the lead investigator in re-
defining the frontiers of interdisciplinary and translational business and health IT knowledge
development and expansion, including active involvement in collaborative research and multi-
disciplinary joint-grant submissions. He has achieved recognized scholarship in teaching and
learning with students’ nominations for teaching excellence awards, and he networks widely
with key decision and policy makers as well as academic scholars and practitioners at local,
provincial/state, national, and international levels, including private, public, and nongovern-
mental organizations and universities.
Dr. Tan has been asked to provide keynote speeches at doctoral seminars and conferences
and has been invited to conduct research seminars and/or make appearances at numerous ma-
jor universities around the world. His work is widely cited, and he has more than 100 academic
publications, including a four-volume encyclopedia and numerous research monographs and
teaching textbooks. He has taken leadership roles in team-based research, curriculum and pro-
gram development and accreditation, peer-reviewed journal publications and book reviews,
online education and programming, planning and organization of symposiums and confer-
ences, development of book series, special issue journals, and federal grant proposals. His past
20-year academic experience includes full-time employment in academia, private and nonprofit

xix
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xx ABOUT THE EDITORS

sector organizations, as well as consulting and engaging in executive program development ac-
tivities catering to executives and foreign delegation. His overall career focus is on reshaping the
landscape of IS/IT applications and promotion in e-healthcare informatics through cross-
disciplinary thinking/project partnering with diverse practitioners, clinicians, researchers, and a
variety of user communities.

Co-editor Fay Cobb Payton, PhD, is an associate professor of IS/IT at North Carolina State
University (NCSU), where she serves as the IS area coordinator. She is the vice chair of the AIS
SIG-Health International group and is an active member of the Institute of Electrical and
Electronics Engineers (IEEE) medical technology policy group. She is currently serving as a
member of the NCSU Advisory Board for the Women in Science and Engineering Program.
She has worked on consulting and/or research projects with Ernst & Young/CAP Gemini
Health Care IT Practice, IBM, Blue Cross Blue Shield of Ohio and North Carolina, Duke
Medical Center, the North Carolina Medical Society, Quintiles Transnational, and Time-
Warner. Her research interests include healthcare informatics (AIDS/HIV among African
American and sub-Saharan African populations; health disparities), data management (data an-
alytics and quality), and social exclusion (including the digital divide/equity and STEM
[Science, Technology, Engineering, and Mathematics] pathways). She has published in many
peer-reviewed publications, including Journal of the AIS; The Information Society; Journal of
Organizational Computing and EC; IEEE Transactions; Communications of the ACM; Health
Care Management Review; Computer Personnel, Information and Management; Decision Sciences
Journal on Innovative Education; Computers and Society; and International Journal of Technology
Management.
Dr. Payton served on the editorial board of ITProfessional—an IEEE computer society
journal—for four years and is the co-editor of the Health Care section for the National Science
Foundation (NSF)-sponsored African Journal of Information Systems. She is also the co-editor of
a Journal of the AIS special issue—“Healthcare: People and Processes.” She is part of a research
team that received an NSF ADVANCE grant. She has actively served in an advisory role for
The PhD Project and the project’s IS Doctoral Student Association.

Editorial assistant Joshia Tan is a sophomore (and on the Dean’s List) at the Olin Business
School, Washington University, in St. Louis, Missouri. Even at an early age, Mr. Tan displayed
an affection for and interest in a vast range of pursuits, so it comes as no surprise that, years
later, he is involved in an incredible variety of activities. He serves as a college council represen-
tative, writes and distributes for Eleven Music Magazine, and works at the WashU Law School.
A National Merit Scholar and Washington University in St. Louis Book Award recipient, Mr.
Tan has also received numerous other awards, including graduating cum laude, the AP Scholar
with Distinction award, Cranbrook Prize Papers, Michigan Math Prize Competition Finalist,
and Brook Film Festival’s 3rd place award as lead actor and co-director of The Broken Silence. In
addition, one of Mr. Tan’s most recognized film productions, Tao Te Cranbrook, has been pre-
sented at a number of classes and seminars in the Business Department, School of Business
Administration, Wayne State University, Michigan. He has also brought his activities to new
levels by sharing them with others; for example, he volunteered for two years as a snowboarding
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ABOUT THE EDITORS xxi

counselor for Bloomfield Hills Ski & Snowboard club in Michigan. He also played violin with
various schools’ orchestras and served as assembly pianist for one his schools.
The literary world plays a large role in Mr. Tan’s life, as he has co-authored “The Oliver
Home Case” (with J. Tan/G. Demiris) and “CyberAngel: The Robin Hood Case” (with J. Tan),
both appearing in J. Tan (Ed.) E-Health Care Information Systems: An Introduction for Students
& Professionals (San Francisco: Jossey-Bass, 2005): 52–55 and 290–294, respectively. In 2008,
Mr. Tan self-published The Apprentice Bistro: A Feast for Amateur Writers, an adaptation of his
2007 Davidson Fellows entry—for which he received an honorable mention. More recently, he
has completed another major work, Concord in Calamity: Taming the Awakening Armageddon.
Mr. Tan is also an avid traveler with numerous countries under his belt; he keeps a steadfast
hold on his life dream of seeing the world—and changing it for the better. True to this vision,
he has studied various languages, including English, French, and two different dialects of
Chinese. Moreover, to better appreciate the Chinese language and culture, he spent an entire se-
mester fulfilling the challenge of his dream by accepting an invitation to work as an intern in
Shanghai, China. Furthermore, he incorporates this dream into his hobbies, such as drawing
from international influences for his dabbles in the musical and culinary arts. Ultimately, it is
this vision that continues to drive him; it is this dream that he works toward; and it is this
dream that may, years later, very well become reality.
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Contributors
Amal Al-Madouj
Clinical Research Assistant, Epidemiology Research Unit
Biostatistics, Epidemiology, and Scientific Computing
King Faisal Specialist Hospital and Research Centre
Riyadh, Kingdom of Saudi Arabia
Amal Al-Madouj is a clinical research assistant at the Biostatistics, Epidemiology, and
Scientific Computing Department, King Faisal Specialist Hospital and Research Centre,
Riyadh, Kingdom of Saudi Arabia (KSA). She graduated from the Health Sciences College and
has been awarded an associate degree in the field of health record administration.
In 2001, she joined the Epidemiology Research Unit (ERU) at King Faisal Hospital and
Research Centre, Riyadh, KSA. She has been involved in various projects as co-principal inves-
tigator and co-investigator.

Nuri Basoglu, PhD

Associate Professor
Department of Management Information Systems
Bogazici University
Istanbul, Turkey
Dr. Nuri Basoglu is an associate professor in the Department of Management Information
Systems, Bogazici University, Istanbul, Turkey. His research interests are sociotechnical aspects
of information systems, customer-focused product development, information technology
adaptation and wireless service design, intelligent adaptive human computer interfaces, and in-
formation systems strategies. He has published articles in journals such as Technology
Forecasting and Social Change, Journal of High Technology Management and Technology in
Society, and International Journal of Services Sciences.
Dr. Basoglu received his BS in industrial engineering from Bogazici University in Turkey,
and his MS and PhD in business administration from Istanbul University.

xxiii