The following are questions and answers regarding the actions taken to develop an HIT-GIS within a managed care system. This will be either edited or rewritten in more detail as time passes.
Question: What is the Gap? How do studies performed approach the gap?
Answer: Primary gap is leadership and potentials
- Lack of management knowledge base and awareness
- Lack of leadership with specific goals and processes in place proving their stake
- Lack of preliminary plan, due to lack of understanding of potential and possible end products
Q: What are the basic rules for constructing a theory for the project?
A: The Rules are
- Assume that Barriers related to the topic, in turn can be broken down into parts and used to define the hypotheses.
- Various methods of developing these barriers might exist (need a model, and perhaps a paradigm)
- Major concepts or variables are to be tested, based upon the model
Q: What is known about these relationships. Why study the relationship defined for this final PhD project?
A: Hypotheses define the expectations of researchers
- The inability of patients to use HIT (versus GIS-HIT), versus practitioners, versus administrators and technicians, versus managers relate to different models—barriers may differ considerably.
- Highly successful versus smaller institutions can differ, and may in fact experience greater barriers related to employee skills and knowledge base, regional familiarity with the technology, etc.
Q: What about selecting to GIS to use as an option?
A. The value and reason(s) for GIS:
- Location/Access improvements; redesigning plans and services
- Cost savings by redesigning facilities, determining needs
- Services — quality and adding new services, documenting this
- Future planning (projection of health and patients and costs; plans/goals)
- Standardized reporting of valuable QA information; meet ACO requirements
- Performance Improvement QI scores, documenting and reporting
- Ad hoc reporting per local needs
- Increase recognition and Support:
- Professional reputation
- Public Support and recognition
- Press related support and recognition
- Obtaining other institutional support (npos, clinics, allied health) and recognition
- Financier support and recognition (improve investments)
- Allied corporations support
- Federal or governmental support and recognition
Q: What are the Requirements?
A: The Requirements, Rules and Regulations for implementing a GIS at the Managed Care level needs to address HIPAA possible concerns. This means, an institution has to have a guidelines book in place for GIS, and/or a Policy defined that is reviewed annually and whenever a major technological change in GIS occurs, that is of interest to the insttitution. If the institution has a Committee or team directed to technological assessments and decision making regarding use, financing the new technology, etc., they must undergo a regular review of this policy as well. HIPAA related policy makers or overseers might also need to give a final approval on implementing, updating or modifying the HIT-GIS Policy.
Q: What steps do we go through to develop this policy?
A: Policy implementation steps (tentative, as of 10;25/15):
- Design an institutional GIS-HIT Policy
- Define metrics levels
- Define stages and order of development (see metrics list below, choose several projects to initiate with)
- Define stages and levels of reporting (direct/indirect; next level=clinical/clinical admin; next=upper level admin, public reporting (if any))
- Define the process of developing an HIT-GIS station; define tool or tools, correlate with projects/spatial analytic steps taken
- Set Goals for each stage in this process, define dates for those goals.
- Assign an overall goal of implementing fully functional workstation for certain parts of the HIT-GIS program, testing its performance. [Recommendation: 9 months for Level 1 reporting, 12 months for approval of statement that goal was met. 15 months=produce first report(s) or models for reports.
- Have a Management Report plan and format in place, in order to administer these reports
- Define the exact Metrics [34 types, about 1000-2000 metrics, depending upon reports/subgroupings)
- Initiate use either in sections, or as need requires.
- Produce chronology or GANTT on this
- Evaluate rate of development of the HIT-GIS work stations over time.
- Evaluate rate of documentation of critical events or improvements in HIT-GIS development
Q: What are examples of the metrics we have to consider?
A: You can design your metrics based upon the quality improvement, meaningful use, projects developed each year for annual reviews. Add to these some very generic reports pertaining to population age-gender-ethnicity-location information. Next, define two or more special topics to implement and apply to this program, preferably those reporting on quarterly to biannual rates, such as Emergency line use, case management activities, institutions and patients, smoking cessation calls, complaints lines use and reporting, changes in a standard care performance that could constitute a high risk patient indicator (quarterly blood tests, late visits or skipped appointments).
The following is an initial list of the kinds of metrics to consider:
- QA – missing data [unk, total ICD? Region, facility?]
- Standard metrics – population data on ICDs, plus demographics/area [2-16]
- Standard metrics – IH LOS, OP, LOS [7-10],
- Standard ICD QOC metrics – Ch Well Visits; CDM Yrly visits; 2MoFU for MH [10-15]
- Standard Rx Compliance Measures – Refill rates [2-3]
- Ethnicity measure for overall [2-16]
- Basic Foreign Language requirement, documentation metric; external use metric? [8,14]
- Specific Ethnic ICD/place measures (2 levels) – AfrAm or Hisp, other, Asian, AI/NA [5 each, incl W]
- ACOs [45-60]
- Other than ACO/QOC-S, simple basic QIA/PIP metrics (defined elsewhere) [15-20]
- HEDIS Admin metrics focused on facilities 
- Institutional 300+ Disease reporting tool (set for monthly or bimonthly use) [repeats above, 1 report, 300+ metrics]
- Ethnic-focused ICD reporting tool/report [40-100, x 4-5, x 8 or 11]
- SES-focused reporting tool, with special topics: poverty groups and areas [ditto]
- Age-subgroups tools: suicide, epilepsy SUNDS etc. [5-7]
- V-codes: ch/adult abuse, abandonment, refusal of care for religious reason, immunization refusal [socially meaningful, 12-15]
- ICD codes: suicide risk, special cultural/region risks, ID risks [age/gender related, 7 x 12 = 94]
- 65+ yo ICDs report [dupl. above but with different ages, ca. 20-100]
- Congenital Diseases report [20-45]
- Genetic Diseases report [1-4, or up to 100+ ICDs]
- Pregnancy/Child-bearing report (Chlamydia and non-chlamydia, age) 
- Comprehensive Chronic Disease Mgmt report (2-4 levels) [n cd, 4 grps, 8 regions, 11 facilities, 4-5 ethn]
- Charlson Disease list and scores report (totals, levels 1, 4, 6+) [ditto]
- Prediction modeling formula/reports (regionally, institutionally, by boroughs; SES-PH, BCBS and OptumHealth “black box” tools) [2 formulas, x 8, 11]]
- Newborn/Infant Care (3 or 4 years), risk levels (prediction tool) [25-40 icds, x 8,11]
- Young:Old Childcare (0-8, 9-17) (tic, beh h, ep, pulm, drug, smoking, alc ab, drug ab, suicide, fx, disl, tc.) (prediction tool) 25-40 icds, x 2 age groups, compared x 8, 11]
- Child Schooling (4-17), (Beh H, Nutr, CD, BMI, Injuries, Fx/Disl, ED use) [1 group, ditto]
- Mother:Child relationship (families, unmarr. vs married?; 10-45 yo) [1 group, ditto]
- Childhd:Adult [changing coverage] QOC conversion rates (asthma, CD, MH), 10-30, 12-26, 15-25/27) [25-40 icds, 8, 11]
- Pre-post 65+/- [changing coverage] QOC relationship (55-64, 65-74) [15-40 icds, 2 groups]
- SNGs reports: IDs, Autism, EP, MS, PTSD, Specific Drug Abuse hxs, Bullying, Ch Viol. Ch Sx Ab, Age-Fxs, BioT [15-25 icd small groups, 8, 11]
- Special reports, Risk Areas: Child Abuse indicators combination ICDs and V-codes, Suicide, Adult Abuse, Gender specifics; Infib, Violence indicators 6-12 icd subgroups]
- Special reports, cultural: culturally-bound indicators, culturally-linked indicators, cultural QOC comparisons (B vs W, H vs W, A vs W) [3 x 40 = 120, starting]
- Standardized Special reports: Diabetes, asthma, MS, epilepsy [3-7]
- Design modules, major beneficiaries
- Define and contact internal Gatekeepers for other options
- Document reporting requirements
- Fit requirements into HIT-GIS plan
- Establish IRB engagement process
Note: a fully developed HIT-GIS will be capable of reporting on nearly all of these, and then some.