Introduction to Healthcare Information Technology Chapter Two Healthcare Organizations and...

Introduction to Healthcare Information Technology

Chapter TwoHealthcare Organizations and

Operations


Objectives

• Identify various healthcare organizational structures and their different methods of operation

• Explain the use of codes of conduct• Identify EHR/EMR access roles and responsibilities

for using Protected Health Information (PHI)• Describe the proper communication methods for

use in the healthcare workplace• List best practices in handling PHI in the healthcare

setting

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Introduction to Healthcare Information Technology 3

Healthcare IT: Challenges and Opportunities

• Delivery of health care to a large population– Diverse and complex organizations

• First responders– Police, firefighters, emergency medical technicians

• Operation of a hospital– Numerous organizations play supporting roles


Healthcare Organizational Structures and Operation

• Organizational structure– Framework through which a group of people work

toward common goal– Defines authority, responsibilities, communication

methods, rights, and duties of the group• Uniqueness of healthcare organizational structures

– Common goal to save lives, reduce suffering, and eliminate disease

– Stressful and demanding environments


Organizational Structures

• Hospitals– Healthcare organizations treating patients for injury

and disease– Usually provide inpatient (long-term) care

• Patient resides in hospital one or more nights– Also provide outpatient care

• Patient is not admitted and does not reside overnight

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Organizational Structures (cont’d.)

• Types of hospitals– General– Contagious disease– Nursing homes– Psychiatric– Orthopedic– Pediatric

• Hospitals divide functionality into departments– Departments depend on hospital type and size

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• Hospital departments– Cardiac care unit (CCU)– Emergency room (ER)– Gynecology (GYN)– Intensive care unit (ICU)– Medical/Surgical (Med/Surg)– Neurology– Obstetrics (OB)– Oncology– Pediatrics (Peds)

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• Hospital departments (cont’d.)– Physical therapy (PT)– Psychiatry (Psych)– Surgery (OR)

• Supporting departments– Laboratory (Lab)– Pathology (Path)– Pharmacy– Radiology (Xray)

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Table 2-1 Selected departments typically found in hospitals

© Cengage Learning 2013



• Indirect support departments– Health information management (medical records)– Information technology (IT)– Clinical (or biomedical) engineering– Facilities management (maintenance/operations)– Administration– Food and nutrition services– Security– Material management

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• Physician– Medical professional– Licensed by a governing body

• Private practices– Single physician provides care to individual patients

• Group of physicians working together– Considered private practice if group is physician

owned• Non-physician owned healthcare group

– Not considered private practice

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• Nursing homes (convalescent hospitals)– Equipped for patients with long-term diseases– Address the needs of inpatients– Generally not equipped for acute care– Generally outsource support functions

• Skilled nursing facility (SNF)– Requirement for facility to receive Medicare

reimbursement– Must employ skilled nursing staff

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• Requirements for Medicaid reimbursement of patient expenses– Patient needs skilled nursing care– Patient has income and assets below defined levels– Patient must be a United States citizen– Patient must reside in state in which nursing home is

located

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• Assisted living facility– Designed for elderly people who need some

assistance with activities of daily living– Has residents, not patients– Generally do not have skilled nursing care staff– No Medicare or Medicaid reimbursement

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• Home health care– Treatment of disease or injury in patient’s home– Staffed by nonmedical and/or skilled nursing

professionals– May be reimbursed depending on certain criteria

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• Hospice– Care of terminally ill patients at home or in dedicated

facilities• Patients require palliative care

– Relief and prevention of suffering• Hospice care may include:

– Skilled care on a 24-hour, 7 day per week basis– Pharmaceuticals to provide patient comfort– Necessary medical equipment

• Generally reimbursable by Medicare and Medicaid



• Surgical centers and ASCs– Specialize in outpatient surgical care

• Also called same-day surgery

• Less complex procedures than inpatient surgery• Types of procedures

– Minor surgeries– Pain management– Diagnostic procedures

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Methods of Operation

• Customs or practices used to achieve organization’s goal– Scope of work– Availability of resources– Formality of procedures

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Methods of Operation (cont’d.)

• Scope of work– Refers to tasks involved in accomplishing a goal or

objective• Differences exist in scope of work among various

types of medical facilities

Table 2-2 Scope of work for identified healthcare organizations




• Availability of resources– Financial resources

• Economic and monetary resources needed for organization to function

– Human resources• Staffing needs

– Physical resources• Places and equipment

– Information

Table 2-3 Availability of financial resources for identified healthcare organizations




• Formality of procedures– Set of established behaviors for collectively

achieving an organization’s goal– High formality: little deviation from set procedures– Low formality: higher deviation from set procedures

• Formality typically increases as risk to patient increases

Table 2-4 Formality of procedures for identified healthcare organizations



Codes of Conduct

• Rules for behavior to which a group of people adhere

• May be specific and written• Likely to be similar for similar groups of people or

facilities• Frequently address communication, procedural

behavior, social behavior, and sanitation


Communication

• Professional communication– Use of written, oral, or other exchange methods

• Style of communication– How something is said

• Content of communication– What is said

• High-formality healthcare setting– Use formal communication style– Inappropriate to discuss outside activities,

relationships, or other staff members in front of patient

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Adapting Procedural Behavior

• Procedural behavior– Level of procedural formality based on type of

treatment or diagnostics• Examples of locations where procedural behavior

is important– Imaging room– Procedure room– Recovery room– Examination room– Emergency room

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Sanitation

• Physical hazards due to close proximity to biological or chemical disease components

• Sanitation methods– Sterilization of facilities and instruments– Proper disposal of contaminated wastes

• Infection control procedures– Hand washing– Cleaning and sterilization– Use of antimicrobials– Use of protective equipment

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Social Behavior and Sensitivity of the Environment

• Social behavior– Conduct toward other people

• Example: inappropriate for emergency room staff to act shy around unclothed patient– May be appropriate behavior for maintenance worker

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Conforming to Management Requirements

• Main responsibility is the patient• Managerial operating procedures

– Address business needs of the organization– May sometimes conflict with patient care– Example: private hospitals may turn away patient

without insurance or means to pay

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Protecting Healthcare Information

• HIPAA privacy rule protects individually identifiable health information– Includes verbal, paper, and electronic forms– Relates to past, present, and future health of an

individual• PHI is protected as long as retained by Covered

Entity:– Even if individual is deceased

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Access Roles and Responsibilities

• Healthcare team access– Each member of healthcare team has roles and

responsibilities pertaining to PHI

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Table 2-5 Protected health information access roles (cont’d.)



Access Roles and Responsibilities (cont’d.)

• Business Associate access– HITECH Act encompasses Business Associates in

same manner as Covered Entities• Examples of Business Associate functions

– Claims processing– Accounting– Data aggregation– Accreditation

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Access Limitations Based on Role and Exceptions

• Certain times when traditional access roles need to be superseded

• Example: emergency situation when database administrator may read PHI

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Access to Sensitive Patient Data

• Some information may have more stringent guidelines

• Individuals may ask a Covered Entity to restrict use and disclosure of their PHI

• Roles must be modified appropriately


Proper Communication

• Procedures must be followed for various types of communication

• Backups– A permanent copy of all ePHI is maintained

• Unique identifiers– Username and password for each distinct user

account• Emergency access

– Procedures for obtaining necessary ePHI during an emergency


Proper Communication (cont’d.)

• Timeout– Terminating an electronic communication session

after a period of inactivity• Encryption

– ePHI must be encrypted• Audit trails

– Mechanism to record activity in information systems



• Integrity– Mechanisms to prevent unauthorized destruction or

alteration of ePHI• Authentication

– Procedures to ensure those seeking access to ePHI are authentic

• Disposal– Procedures to ensure final disposition of ePHI



• Safeguards must apply to all forms of communication– E-mail– Instant messaging– Fax– File transfer protocol– Telephone– Voice over IP

Table 2-6 Safeguards for various electronic communication methods



Data Handling Procedures

• Best practices for general technology use– Help ensure PHI is protected

• Access to network devices should be controlled• Access methods

– Physical– Electronic

• Managing physical access– Location of physical device chosen to minimize

access


Data Handling Procedures (cont’d.)

• Privacy screens– Prevents anyone not sitting in front of screen from

reading its contents• Screensavers

– Lock out computer screens after specified time period

• Time lockouts– Program locks out users after specific period of time– Password must be entered to regain access


Summary

• Various healthcare organizational structures exist• Code of conduct refers to behavior rules to which a

group of people adhere• PHI includes information in verbal, paper, or

electronic form– Includes past, present, and future health information

• Various roles and responsibilities exist for using PHI

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Summary (cont’d.)

• Safeguarding communication methods is one facet of protecting PHI

• Best practices in handling PHI in a healthcare setting involve controlling physical and electronic access to PCs, printers, and other equipment

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Introduction to Healthcare Information Technology Chapter Two Healthcare Organizations and...

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