How do you acquire information?
Introduction to Information Systems Consider the following scenario: You have just been hired by a large healthcare facil ity. You enter the personnel office and are told that you must learn a new language to work on the unit where you have been assigned. This language is used just on this unit. If you had been assigned to a different unit, you would have to learn another language that is specific to that unit, and so on. Because of the differences in various units’ languages, interdepartmental sharing and information exchange (known as interoperability) are severely hindered.
This scenario might seem farfetched, but it is actually how workers once operated in health care—in silos. There was a system for the laboratory, one for finance, one for clinical departments, and so on. As healthcare organizations have come to appreciate the importance of communication, tracking, and research, however, they have devel oped integrated information systems that can handle the needs of the entire organization.
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Information and IT have become major resources for all types of organizations, and health care is no exception (see Box 2-1). Information technologies help to shape a healthcare organization, in conjunction with personnel, money, materials, and equipment. Many healthcare facilities have hired chief information officers (CIOs) or chief technical officers (CTOs), also known as chief technology officers. The CIO is in volved with the IT infrastructure, and this role is sometimes expanded to include the position of chief knowledge officer. The CTO is focused on organizationally based scientific and technical issues and is responsible for technological research and devel opment as part of the organization’s products and services. The CTO and CIO must be visionary leaders for the organization, because so much of the business of health care relies on solid infrastructures that generate potent and timely information and
BOX 2-1 EXAMPLES OF INFORMATION SYSTEMS
Information System How It Is Used
Clinical Information System (CIS) Comprehensive and integrative system that manages the administrative, financial, and clinical aspects of a clinical facility; a CIS should help to link financial and clinical outcomes. An example is the EHR.
Decision Support System (DSS) Organizes and analyzes information to help decision makers formulate decisions when they are unsure of their decision’s possible outcomes. After gathering relevant and useful information, develops “what if” models to analyze the options or choices and alternatives.
Executive Support System Collects, organizes, analyzes, and summarizes vital information to help executives or senior management with strategic decision making. Provides a quick view of all strategic business activities.
Geographic Information System (GIS) Collects, manipulates, analyzes, and generates information related to geographic locations or the surface of the earth; provides output in the form of virtual models, maps, or lists.
Management Information Systems (MIS) Provides summaries of internal sources of information, such as information from the transaction processing system, and develops a series of routine reports for decision making.
Office Systems Facilitates communication and enhances the productivity of users needing to process data and information.
Transaction Processing System (TPS) Processes and records routine business transactions, such as billing systems that create and send invoices to customers, and payroll systems that generate employees’ pay stubs and wage checks and calculate tax payments.
Hospital Information System (HIS) Manages the administrative, financial, and clinical aspects of a hospital enterprise. It should help to link financial and clinical outcomes.
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knowledge. The CTO and CIO are sometimes interchangeable positions, but in some organizations the CTO reports to the CIO. These positions will become critical roles as companies continue to shift from being product oriented to knowledge oriented, and as they begin emphasizing the production process itself rather than the product. In health care, ISs must be able to handle the volume of data and information neces sary to generate the needed information and knowledge for best practices, because the goal is to provide the highest quality of patient care.
Information Systems ISs can be manually based, but for the purposes of this text, the term refers to computer-based information systems (CBISs). According to Jessup and Valacich (2008), CBISs “are combinations of hardware, software and telecommunications networks that people build and use to collect, create, and distribute useful data, typically in organizational settings” (p. 10). Along the same lines, ISs are also defined as “a col lection of interconnected elements that gather, process, store and distribute data and information while providing a feedback structure to meet an objective” (Stair & Reynolds, 2016, p. 4). ISs are designed for specific purposes within organizations. They are only as functional as the decisionmaking capabilities, problemsolving skills, and programming potency built in and the quality of the data and information input into them. The capability of the IS to disseminate, provide feedback, and adjust the data and information based on these dynamic processes is what sets them apart. The IS should be a userfriendly entity that provides the right information at the right time and in the right place.
An IS acquires data or inputs; processes data through the retrieval, analysis, or synthesis of those data; disseminates or outputs information in the form of reports, documents, summaries, alerts, prompts, or outcomes; and provides for responses or feedback. Input or data acquisition is the activity of collecting and acquiring raw data. Input devices include combinations of hardware, software, and telecommunications, including keyboards, light pens, touch screens, mice or other pointing devices, automatic scanners, and machines that can read magnetic ink characters or lettering. To watch a payperview movie, for example, the viewer must first input the chosen movie, verify the purchase, and have a payment method approved by the vendor. The IS must acquire this information before the viewer can receive the movie.
Processing—the retrieval, analysis, or synthesis of data—refers to the alteration and transformation of the data into helpful or useful information and outputs. The processing of data can range from storing it for future use; to comparing the data, making calculations, or applying formulas; to taking selective actions. Processing devices consist of combinations of hardware, software, and telecommunications and include processing chips where the central processing unit (CPU) and main memory are housed. Some of these chips are quite ingenious. According to Schupak (2005), the bunny chip could save the pharmaceutical industry money while sparing “millions of furry creatures, with a chip that mimics a living organism” (para. 1). The HµREL Corporation has developed environments or biologic ISs that reside on chips and actually mimic the functioning of the human body. Researchers can use these environ ments to test for both the harmful and beneficial effects of drugs, including those that
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are considered experimental and that could be harmful if used in human and animal testing. Such chips also allow researchers to monitor a drug’s toxicity in the liver and other organs.
One patented HµREL microfluidic “biochip” comprises an arrangement of sepa rate but fluidically interconnected “organ” or “tissue” compartments. Each com partment contains a culture of living cells drawn from, or engineered to mimic the primary functions of, the respective organ or tissue of a living animal. Microfluidic channels permit a culture medium that serves as a “blood surrogate” to recirculate just as in a living system, driven by a microfluidic pump. The geometry and fluidics of the device are fashioned to simulate the values of certain related physiologic parameters found in the living creature. Drug candidates or other substrates of interest are added to the culture medium and allowed to recirculate through the device. The effects of drug compounds and their metabolites on the cells within each respective organ compartment are then detected by measuring or monitoring key physiologic events. The cell types used may be derived from either standard cell culture lines or primary tissues (HµREL Corporation, 2010, para. 2–3). As new technologies such as the HµREL chips continue to evolve, more and more robust ISs that can handle a variety of biological and clinical applications will be seen.
Returning to the movie rental example, the IS must verify the data entered by the viewer and then process the request by following the steps necessary to provide ac cess to the movie that was ordered. This processing must be instantaneous in today’s world, where everyone wants everything now. After the data are processed, they are stored. In this case, the rental must also be processed so the vendor receives payment for the movie, whether electronically, via a credit card or checking account with drawal, or by generating a bill for payment.
Output or dissemination produces helpful or useful information that can be in the form of reports, documents, summaries, alerts, or outcomes. A report is designed to inform and is generally tailored to the context of a given situation or user or user group. Reports may include charts, figures, tables, graphics, pictures, hyperlinks, ref erences, or other documentation necessary to meet the needs of the user. A document represents information that can be printed, saved, emailed, or otherwise shared, or displayed. Summaries are condensed versions of the original information designed to highlight the major points. An alert is comprised of warnings, feedback, or additional information necessary to assist the user in interacting with the system. An outcome is the expected result of input and processing. Output devices are combinations of hardware, software, and telecommunications and include sound and speech synthesis outputs, printers, and monitors.
Continuing with the movie rental example, the IS must be able to provide the con sumer with the movie ordered when it is wanted and somehow notify the purchaser that he or she has, indeed, purchased the movie and is granted access. The IS must also be able to generate payment either electronically or by generating a bill, while storing the transactional record for future use.
Feedback or responses are reactions to the inputting, processing, and outputs. In ISs, feedback refers to information from the system that is used to make modifica tions in the input, processing actions, or outputs. In the movie rental example, what if the consumer accidentally entered the same movie order three times, but really
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wanted to order the movie only once? The IS would determine that more than one movie order is out of range for the same movie order at the same time and provide feedback. Such feedback is used to verify and correct the input. If undetected, the viewer’s error would result in an erroneous bill and decreased customer satisfaction while creating more work for the vendor, which would have to engage in additional transactions with the customer to resolve this problem. The Nursing Informatics Practice Applications: Care Delivery section of this text provides detailed descriptions of clinical ISs that operate on these same principles to support healthcare delivery.
Summary Information systems deal with the development, use, and management of an organi zation’s IT infrastructure. An IS acquires data or inputs; processes data through the retrieval, analysis, or synthesis of those data; disseminates or outputs in the form of reports, documents, summaries, alerts, or outcomes; and provides for responses or feedback. Quality decisionmaking and problemsolving skills are vital to the develop ment of effective, valuable ISs. Today’s organizations now recognize that their most precious asset is their information, as represented by their employees, experience, competence or knowhow, and innovative or novel approaches, all of which are de pendent on a robust information network that encompasses the information technol ogy infrastructure.
In an ideal world, all ISs would be fluid in their ability to adapt to any and all users’ needs. They would be Internet oriented and global, where resources are avail able to everyone. Think of cloud computing—it is just the beginning point from which ISs will expand and grow in their ability to provide meaningful information to their users. As technologies advance, so will the skills and capabilities to compre hend and realize what ISs can become. As wearable tracking technologies and other healthrelated mobile applications expand, more robust and timely health data will be generated, and this data will need to be processed into meaningful information. “Practitioners and medical researchers can look forward to technologies that enable them to apply data analysis to develop new insights into finding cures for difficult diseases. Healthcare CIOs and other IT leaders can expect to be called upon to man age all the new data and devices that will be transforming healthcare as we know it” (Schindler, 2015, para. 2). Devices with sensors communicating with each other is known as the Internet of Things (IoT) and the future possibilities for health care are tremendous. “The IoT raises the bar—enabling connection and communication from anywhere to anywhere—and allows analytics to replace the human decisionmaker” (Glasser, 2015, para. 3). Essentially, the sensorcollected data are transmitted to another technology, triggering an action or an alert that prompts feedback for an action. For example, “imagine a miniaturized, implanted device or skin patch that monitors a diabetic’s blood sugar, movement, skin temperature and more, and informs an insulin pump to adjust the dosage” (para. 8).
It is important to continue to develop and refine functional, robust, visionary ISs that meet the current meaningful information needs while evolving systems that are even better prepared to handle future information and knowledge needs of the health care industry.
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References Cornell University. (2010). Information science. Retrieved from http://www.infosci.cornell.edu Goldstein, D., Groen, P., Ponkshe, S., & Wine, M. (2007). Medical informatics 20/20. Sudbury,
MA: Jones and Bartlett. Glasser, J. (2015). How the Internet of Things will affect health care. Hospitals and Health
Networks. Retrieved from http://www.hhnmag.com/articles/3438howtheinternetof thingswillaffecthealthcare
HµREL Corporation. (2010). Humanrelevant: HµREL. Technology overview. Retrieved from http://www.hurelcorp.com/overview.php
Jessup, L., & Valacich, J. (2008). Information systems today (3rd ed.). Upper Saddle River, NJ: Pearson Prentice Hall.
Schindler, E. (2015). Healthcare IT: Hot Trends for 2016, Part 1. InformationWeek. Retrieved from http://www.informationweek.com/healthcare/leadership/healthcareithottrendsfor 2016part1/d/did/1323722
Schupak, A. (2005). Technology: The bunny chip. Forbes. Retrieved from http://www.forbes .com/forbes/2005/0815/053.html
Stair, R., & Reynolds, G. (2016). Principles of information systems (12th ed.). Boston, MA: Cengage Learning.
Web Dictionary of Cybernetics and Systems. (2007). Technological determinism. Retrieved from http://pespmc1.vub.ac.be/ASC/TECHNO_DETER.html
THOUGHT-PROVOKING QUESTIONS
1. How do you acquire information?