Health Care Information Systems

Module 11: Strategic Decision-Support Applications

The following objectives should be met by the end of this module:

These notes are intended only to supplement your readings. The best way to ensure each module is absorbed is to complete all the readings prior to reviewing these lecture notes. I will try to highlight what I believe to be the most important topics from your module readings. If you have any questions or concerns or there is something you do not understand, please ask me. You can either post on the webboard the question you have (that way others can benefit from the response), or you can e-mail me if you want a more private response. Either way it is extremely important that you have a complete and thorough understanding of the material for the module.

Healthcare executives who have traditionally relied upon experience and judgment to make business decisions are now using more sophisticated techniques. These techniques are based upon mathematical models and real time data and are used to assist in the decision making process. Information systems are available that support data retrieval, modeling, and reporting of results for decisions that are needed at a moment's notice. These are preferred by healthcare administrators as opposed to separate models being prepared for each individual issue. These preferred systems are referred to as decision-support systems (DSSs).

Decision support can be defined as "using an organization's data to aid in management decisions and efficient operations". This is an approach to problem solving that is based upon the use of data. The implementation of this approach can range from manually compiling and analyzing data to a fully automated system. A manual approach could be overwhelming due to the rapid turnaround time need for decisions and the volume of data that needs to be analyzed. Executives are realizing the need for IS in the decision support arena that is:

  1. user friendly
  2. relatively easy to interact with
  3. able to summarize data and be displayed in a meaningful format
  4. capable of modeling to allow for alternative decisions to be evaluated
  5. able to present results of the analysis in a easy to understand report

The concept of DSS came about in the late 1970s due to the need for analysis of data needed in a prospective payment system. A modeling technique was developed that combined industrial productivity systems engineering with units of hospital production. This technology has rapidly progressed and is now used by executives to examine performance indicators, and analyze data along clinical, operational, and strategic lines.

Components of a DSS include (see figure 13.3 in text):

Uses for DSS were first proposed by Alter in 1976. His listing of uses is described on page 316 of your text. Today DSSs have advanced to being primarily focused on the last three of these uses as described by Alter. These include (1) estimating consequences of a proposed decision (2) proposing decisions to management (2) making decisions according to predetermined algorithms. The other three uses can be performed by simpler technology such as a single database or statistical program. The final use is the only one that is capable of making independent decisions (the other uses only supplement the decision made by the manager). This is often called an expert system and utilizes the science of artificial intelligence or "fuzzy logic".

In the search for data needed by the DSS to evaluate decisions, we must decide on where to obtain the data and then what data is needed. There are three sources for information needed in healthcare, these include internal transaction processing systems, specially constructed databases, and external data sources. The information that is gathered from these sources can be categorized as follows:

Many applications of DSSs have been successfully developed and used by HSOs. These applications include financial modeling, planning and marketing, resource allocation, improving operations, expert systems, and executive information systems. Expert systems are active systems that are capable of "reproducing the reasoning process a human decision maker would go through in reaching a decision, diagnosing a problem, or suggesting a course of action. Expert systems originated in the 1970s in healthcare and primarily only in clinical applications. Recent applications in healthcare for management have been focused on solving recurring, tactical, structured types of problems. Remember, these decisions are made in the absence of a human, thus adoption of this technology has been slow. But, there are areas in health care where they can be used and are used effectively. For example, in the detection of fraud and abuse in insurance claims and in a bed assignment system.

Successful implementation and use of a DSS can only be achieved when executives take ownership of this project. This should not be delegated to IS staff, but rather controlled by the executive as the consultant with the IS designer.

That is it for notes for module #14! Let me know if you have any questions.
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