OUR LADY OF LOURDES COLLEGE FOUNDATION

COLLEGE OF MEDICAL LABORATORY SCIENCE

Vinzons Ave., Daet, Camarines Norte 4600

COURSE TITLE:
HEALTH INFORMATION SYSTEM
FOR
MEDICAL LABORATORY
SCIENCE STUDENTS

MODULE 15:
CHANGE MANAGEMENT
 MODULE OBJECTIVES
At the end of the lesson, the student shall be
able to:
1. discuss the significance of change
management in health informatics
2. 2. Identify common tools, techniques, and
practices during change initiative
3. Explain the role of health information
management professionals and of
telemedicine in the Philippines
 INTRODUCTION/OVERVIEW
OVERVIEW/INTRODUCTION
❖ Change occurs continuously around us. We may want to
support it, be indifferent to it, and be passive or participate
in it. The pace of change has increased dramatically.
❖ Managing change is about handling the complexity of the
process. It is about evaluating, planning and implementing
operations, tactics and strategies and making sure that the
change is worthwhile and relevant. Managing change is a
complex, dynamic and challenging process. It is never a
choice between technological or people-oriented solutions
but a combination of all.
❖ This module discusses change management in the
healthcare industry and its significance .
 INTRODUCTION/OVERVIEW
WHAT IS CHANGE MANAGEMENT?
❖ defined as the methods and manners in which a
company describes and implements change within
both its internal and external processes.
⚫Generally, there are four kinds of changes that all
kinds of organizations might encounter, with the
likelihood of overlap among the conceivable
outcomes.
⚫
1. Operational changes- involve the way
employees work and lead to changes in systems,
processes, or both. influence the way dynamic
business tasks are led, including the
computerization of a particular business segment. 
 INTRODUCTION/OVERVIEW
WHAT IS CHANGE MANAGEMENT?
2.  Strategic change
✔ the implementation of new strategies that involve
substantive changes beyond the normal routines of the
organization.
✔ occur when the business direction, in relation to its
vision, mission, and philosophy, is altered.
✔ For instance, changing the business technique from
business growth to increasing market share in the overall
industry is a case of strategic change.
 WHAT IS CHANGE MANAGEMENT?
INTRODUCTION/OVERVIEW
3.  Cultural Change- modification of a society
through innovation, invention, discovery, or
contact with other societies.
⚫ Cultural changes influence the internal
organizational culture, for example, the way the
business is conducted, such as actualizing a CQI
(continuous quality improvement) framework. 
 INTRODUCTION/OVERVIEW
WHAT IS CHANGE MANAGEMENT?
4.  Political changes
-occurs when there is alternation
in the way power and authority are
exercised in a particular state.
-several changes may happen
within social groups, classes and
political institutions and process.
-in human resources occur
primarily due to political reasons of
varying types, commonly, changes
that happen on top patronage levels
in the government agencies.
 INTRODUCTION/OVERVIEW
WHAT IS CHANGE MANAGEMENT?
4.  Political changes
-Different sorts of changes
typically have dissimilar impacts on
different organizational levels. For
instance, operational changes tend to
have the highest impact on the lower
organizational levels, and mostly
affect frontline employees. Employees
working at the upper levels might be
indifferent to the changes, which may
cause significant distress to those
attempting the implementation of
change.
 INTRODUCTION/OVERVIEW
WHAT IS CHANGE MANAGEMENT?
4.  Political changes
-Conversely, the effect of political
changes is more strongly felt on the
higher levels of the organization.
When changes occur relatively in a
bureaucratic organization, those
working on the bottom level often
notice the change at the top (Lorenzi
& Riley, 2000).
 INTRODUCTION/OVERVIEW
WHAT IS CHANGE MANAGEMENT?
❖ There is no denying that organizational
changes have varying degrees of impact on both
the organization, and in effect, its clientele. This
lesson discusses change management
contextualized in health informatics, which is
increasingly becoming a course of action that
health institutions avail in order to improve their
services.
❖Changes are inevitable especially in organizations
because they need to evolve to meet the demands
of the stakeholders which include global
competition, changes in customer demand,
technological advances, and new legislation.
 INTRODUCTION/OVERVIEW
WHAT IS CHANGE MANAGEMENT?
❖ Organizations may even change the way they operate in
order to cope with the demands. Redefining roles,
eliminating ineffective processes, or initiating new ways of
working are considered minor adjustments. Conversely,
there are times when pressures necessitate major
disruptions which transform the culture; re-organize people,
processes and systems; and change the organization's
strategy radically.
❖For more than 100 years, change management has been
evolving with its beginnings rooted in health and job-related
grief studies. Currently, most change management
processes which are designed to drive business
transformations draw their inspiration from behavioural and
social sciences and IT and business
 INTRODUCTION/OVERVIEW
REASONS BEHIND CHANGE MANAGEMENT

❖ A study conducted in US among 400 HRs revealed the

reasons behind the organizations implementing or planning
change over the two previous years. These are:
❖New performance management process.
❖Relocation or facility closure
❖Organizational culture changes
❖New IT systems
❖Change of strategy
❖New financial/accounting systems
❖Downsizing, layoffs
❖Operational changes resulting from new legislation, economic
conditions, or national/international events
❖Product rebranding
❖Acquisition
❖Off shoring or outsourcing
❖Merger
 INTRODUCTION/OVERVIEW
3 FACTORS THAT CONTRIBUTE TO CHANGE IN
HEALTHCARE
1. Regulatory adjustments
2. Shifts in consumer behaviour patterns
3. Accelerated pace of IT development

❖Health care consumers want a more customized experience

and greater opportunity to participate in their health care
decisions. This means that health care institutions need to
adapt a more innovative technology, implement an informed
patient engagement strategy, and adjust their organizational
structures to drive better patient experiences which may result
in numerous and rapid changes (Quinn, 2017).
 INTRODUCTION/OVERVIEW
❖However, technology alone is not enough. The truth of the
matter is that no technology can be successfully implemented
without the human factor which intensifies the work processes
and gives the appropriate guidance. The need to find the right
balance between technology and human factor is necessary
in the roadmap for organizational changes.
❖Another vital element in change management initiatives is
communication. Information should be shared so the
stakeholders would be advised about the timing, nature, and
importance of changes in the business. Participation from
management is crucial to the successful implementation of
the planned changes. Any change can only be successful
when the employees are motivated towards the change and
are willing to accept the vision presented by the organization's
leadership (Aljohani, 2016).
 INTRODUCTION/OVERVIEW
❖Those organizations which are able to manage
change well will definitely survive and thrive. This is
basically the concept of change management. The
managers need to direct, control, and monitor
the changes to ensure that the objectives are
met. They must ensure that the employees adapt
the changes without disrupting the regular
operations (Downey, 2008).
❖Change management process has a wide range of
models with each model having its own strategic
approaches.
 INTRODUCTION/OVERVIEW
❖The more common change practice examples include:
1. Kurt Lewin's Unfreeze-Change-Refreeze model
❖This three-step model was proposed by Kurt Lewin, founder of social
psychology, in the 1950s. This is still widely used as the basis for many
change management strategies.
2. Proski's ADKAR® model
❖This acronym means “Awareness of the business reasons for change;
Desire to engage and participate in the change; Knowledge about how
to change; Ability to implement change; and Reinforcement to ensure
change sticks” (ADKAR).
3. Kotter's Change model
❖This eight-step model was developed by John Kotter of Harvard
Business School. Building a strong collaborative team by using a solid
strategy, creating effective communication channels, supporting staff
empowerment, using a phased and steady approach, and securing the
change within an organization's culture are the core concepts of this
method (QuickBase, 2017).
 INTRODUCTION/OVERVIEW
APPLICATION OF CHANGE MANAGEMENT

❖Change management is defined as a series of tools,

techniques, and processes aimed at successfully
effecting change. These tools support the application of
other initiatives such as Six Sigma, Customer
Relationship Management (CRM), Total Quality
Management (TQM), or Enterprise Resource Planning
(ERP), but can be implemented in a variety of contexts.

❖Downey (2008) enumerates the common tools and

techniques that can be used during a change initiative:
❖Gathering information about the 'as is' and to be status of
the current process
❖Mapping of the process for both 'as is' and to be status
 INTRODUCTION/OVERVIEW
APPLICATION OF CHANGE MANAGEMENT
❖Gap Analysis
❖Business case development
❖Project Management
❖Problem Solving
❖Requirements elicitation techniques
❖Negotiation Skills
❖ In addition, the progress of the change initiative can be measured
against the objectives set by the organization(Downey, 2008). The
said objectives will be measured by the key performance indicators
which include reducing rework by x%, improving in stakeholder
satisfaction, for example, customer/employee surveys, reducing
time to market, enhanced speed of delivery, and having good return
vestment (ROI) which is the total cost to implement the initiative
versus total savings gained from the initiative per period.
 INTRODUCTION/OVERVIEW
APPLICATION OF CHANGE MANAGEMENT

❖In the world of health care, some hospitals are reluctant

and indignant towards the idea of change, and find it
difficult to adjust. Thus, health informatics hopes to
change the way health care institutions conduct their
business on a daily basis. Health care providers need to
welcome change and approach information technology
with an open mind. Aziz (2007) emphasizes that a
mechanism for the transformation of business and
clinical processes should be in place. By encouraging
the adoption of innovation in health care information
technology by clinicians, therapists, nurses, and
physicians, health care providers can achieve key
success factors.
INTRODUCTION/OVERVIEW
 INTRODUCTION/OVERVIEW
WORKING WITH PHYSICIANS
❖Most physicians have patients in multiple hospitals since they
are non-hospital employees. Systems of health institutions
may differ from each other which complicates the situation.
Thus, they should have clear-cut adoption methods to avoid
any issues. Aziz (2007) lists some ideas for the success of the
transformation:
❖Communicate patiently the benefits of the changes in terms of
patient care and safety.
❖Nominate physician leaders at the start of the program.
❖Use web, CBT, and other multi-channel learning and training
opportunities.
❖Be ready and available to answer questions and clarifications.
❖Make sure that there is a process in place in handling
enhancement requests and developments.
 INTRODUCTION/OVERVIEW
TRAINING AND EDUCATION IN HEALTH
INFORMATICS
❖Below is a list of practices that emphasize life-long
learning in support of the change management that must
be initiated by the leaders of the organization (Aziz,
2007).
1. Provide instructor-led training classes to cover different shifts.
2. Present contemporary models of training.
3. Make computer laboratories available for practice (24/7).
4. Roll out accompanied by on-the-job/real-time training.
5. Summarize the steps and make cheat sheets handy.
6. Print easy to carry colorful booklets in a pocket.
7. Provide a short manual with key facts and how-to-tips.
8. Have well equipped training rooms.
9. Schedule train-the-trainer program to give enough time to practice.
10. Assign a super-user to keep people involved.
 INTRODUCTION/OVERVIEW
TRAINING AND EDUCATION IN HEALTH
INFORMATICS
11. Provide the business process maps and process
workflows.
12. Prepare a day-in-the-life scenario for the simulation.
13. Walk them through the flow several times until they are
able to adapt.
14. Entertain and answer questions clearly and provide
details.
15. Prepare the users by discussing some of the challenges
and frustrations they might encounter in the early stages of
the rollout.
 INTRODUCTION/OVERVIEW
TRAINING AND EDUCATION IN HEALTH
INFORMATICS
Enumerated are the fundamental practices that management needs to
embrace as its well-rounded strategy (Aziz, 2007).
❖ Align business leaders with clinical leaders by creating a governance structure.
❖ Focus on the process design and map the workflow clearly.
❖ Have due diligence to ensure a thorough organizational and business impact
analysis.
❖ Encourage the involvement of clinicians at various levels at the start of the
project
❖ Show commitment by staying on the course and communicating the objectives
clearly.
❖ Have a strong program customized to address differential needs
❖ Get feedback into the loop and work on it
❖ Have a 24 x 7 help desk to ensure that the program is well-structured and has
ample support.
❖ Select a couple of measurement criteria for benchmarking and system
evaluation.
 INTRODUCTION/OVERVIEW
HEALTH INFORMATION PROFESSION

Health information management (HIM) professionals have

a special skill set that qualifies them to assume the role of
privacy and security officers who take care of the storage,
protection, and maintenance of the information in the
health care institution. This is coupled with their academic
preparations, experiences in the health sector, and
commitment to the advocacy of patient care and
professional code of ethics (May, 2014)
 INTRODUCTION/OVERVIEW
HEALTH INFORMATION PROFESSION

❖HIM professionals should be committed to the timely and accurate

collection and management of data which cover the aggregation,
analysis, and dissemination of patient health information. They
manage the said information and medical records, administer the
computer information systems, and standardize the coding
systems for the diagnoses and procedures of the services
provided to patients. Such information is kept secure and private
in accordance with state laws.
 INTRODUCTION/OVERVIEW
HEALTH INFORMATION PROFESSION

❖A career in health information management and health

information technology is not limited to data capture,
documentation, and maintenance of clinical information
but also includes data analytics and interpretation, and
management of the health information technology
systems.
 INTRODUCTION/OVERVIEW
HEALTH INFORMATION PROFESSION

❖A career in health information management and health

information technology is not limited to data capture,
documentation, and maintenance of clinical information
but also includes data analytics and interpretation, and
management of the health information technology
systems.
 HEALTH INFORMATION PROFESSION
INTRODUCTION/OVERVIEW

❖HIM professionals may fall into various job categories with varied
titles, including:
❖ Health information management department director
❖ Health information management system manager
❖ Information security officer
❖ Chief privacy officer to
❖ Health data analyst
❖ Health record technician specialist
❖ Clinical coding specialist
❖ Patient information coordinator
❖ Physician practice manager
❖ Health information administrator
PHILIPPINE HEALTH INFORMATION PROFESSION
INTRODUCTION/OVERVIEW
 INTRODUCTION/OVERVIEW
❖ For an archipelago such as the
Philippines, the delivery of health care
services might be proven to be
challenging. Fortunately, the rise of
telemedicine within the region has
been a beneficial turn of events for the
Philippine health care sector.
❖ Multiple players in the telemedicine
scene currently exist, ranging from
mobile apps to call center. Some
providers of over-the-phone
telemedicine services are Medgate
and Lifeline. Common features include
24/7 call centers, diagnosis using
images sent via email, medical
certificates, and treatment plan
summaries.
 INTRODUCTION/OVERVIEW
❖ Telemedicine centers usually have a
corresponding mobile app to facilitate
easier access. Unique to Lifeline,
however, is video consultation with
doctors, patient education, free doctor
or use me visits, and delivery of
medication and prescriptions in
exchange for a fixed monthly
subscription fee.
INTRODUCTION/OVERVIEW
 INTRODUCTION/OVERVIEW

❖ Mobile app-based telemedicine centers, on the other hand,

include MyPocketDoctor and MyDocNow. These providers
are usually in partnership with other international
telemedicine centers. Medway Healthcare Inc. offers the most
comprehensive telemedicine services by using telefollow-up
and teleconsultation procedures. These applications are
accessible online. It is the first medical clinic in the Philippines
which mobilized the pre-employment medical examination
(PEME).
 INTRODUCTION/OVERVIEW

❖ Telefollow-up is a specialized application which notifies

patients of the medical evaluations results via text
messages. Patients will know the status if they are fit to
work or still have pending workups within 24 hours of
PEME. On the other hand, follow-up teleconsultation
takes care of the online communication between the
patient and the physician regarding the follow-up of
medical results when the patient is up visit. unavailable
to get the results personally. The physician gives the
necessary advice and schedules the follow up visit.
 TELEMEDICINE IN THE PHILLIPINES
INTRODUCTION/OVERVIEW

❖ The specialist teleconsultation is also available which gives way to

consultation despite distance barrier. This application enables real-
time consultation with a physician with the assistance of a nurse
and utilization of the appropriate telemedicine equipment. If the
specialist needs to listen to the patient's breathing, the nurse would
place the telephonic stethoscope on the appropriate areas of the
patient's body and the sound would then be transmitted back to the
specialist. The equipment uses high-definition cameras to focus on
lesions or specific body parts. As for the test results, they are
transmitted by using a store-and-forward technology if real time
option is not available. (Medway Health Inc., 2012).
 TELEMEDICINE IN THE PHILLIPINES
INTRODUCTION/OVERVIEW
❖ The government pioneered nationwide telemedicine efforts, through
research and service work of the National Telehealth Center (UP-
NTHC) of the University of the Philippines Manila and funding from
the Commission on Information and Communications Technology
(CICT). It implemented the Buddyworks Telehealth project from
2004 to 2007. This uses a web-based and SMS-based telehealth
platform. Subsequently, the Department of Health (DOH, funding
from 2011 to 2013) and Department of Science and Technology
(DOST, 2007 to present) supported the UP-NTHC's continuing
telehealth program expanding its geographic scope and telehealth
innovations. From an initial 10 isolated and disadvantaged sites, it
grew to link over a thousand young doctors with clinical specialists
based in the UP-Philippine General Hospital and regional hospitals
of the Cordillera Administrative Region and Eastern Visayas to
support them in their clinical decision making. Other DOH regional
hospitals are being prepared by the UP-NTHC to become telehealth
hubs in the locale.
 TELEMEDICINE IN THE PHILLIPINES
INTRODUCTION/OVERVIEW
❖ RxBOx diagnostic telemedicine device was incorporated in the
government telehealth program through DOST’s support. The first
version was developed in 2007 by Dr. Alvin Marcelo and Dr. Luis
Sison of OP-NTHC and UP Engineering in Diliman, respectively.
❖ The RxBox device included sensors that can measure blood
pressure, pulse rate, temperature, and even an electrocardiogram.
Dr. Marcela Wauma surgeon, envisioned that the RxBox would be
used in ambulances transmitting a patient's clinical parameters via
telehealth to prepare better the emergency room clinicians to
receive these critical patients.
❖ Dr. Sison continued to develop the second version beginning 2012,
this time with Dr. Portia Fernandez Marcelo*. They added sensors
that will detect fetal heart beats and the pregnant woman's uterine
contractions, and envisioned its use in rural health units. The
objective was to equip these rural centers with lifesaving diagnostic
tools and better manage health information.
 TELEMEDICINE IN THE PHILLIPINES
INTRODUCTION/OVERVIEW
❖ Clinical data gathered by the RxBox is exchanged with
the community health information tracking system
(CHITS) electronic medical records system; in the event
of clinical dilemma, data can be pulled from CHITS and
transmitted to specialists for teleconsultation. In the
latter part of 2018, the seamlessly linked systems of
RxBox, CHITS, and telehealth will be implemented in
1,000 rural municipalities and with medical specialists in
all regions nationwide.
 SUPPLEMENTARY AID:
INTRODUCTION/OVERVIEW
✔ https://www.who.int/goe/publications/goe_telemedicine_
2010.pdf
✔ https://evisit.com/resources/10-pros-and-cons-of-teleme
dicine/
✔ https://academic.oup.com/jamia/article/7/2/116/940838
✔ https://pubmed.ncbi.nlm.nih.gov/18510142/