Week 4, Chapter 13
Transcript of Week 4, Chapter 13
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Chapter 13
Management of Information in
Healthcare Organizations
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Healthcare organizations (HCOs)
Any business organization, such as aphysicians practice, hospital, or health
maintenance organizations, that providescare to patients.
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Healthcare information system
(HCIS)An information system used within a
healthcare organization to facilitate
communication, to integrate information, todocument health care interventions, toperform record keeping, or otherwise tosupport the functions of the organization
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Challenges of Sharing data
components purchased from differentvendors
No national standards among products Systems created for specific users only
Different programming languages
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Development to improve sharing
data1. Development of the Interface Engine, acomputer system that translates andformats data for exchange between
independent (sending and receiving)computer systems.
2. Creation of the HL7, healthcare-based
initiative, to develop standards for thesharing of data among individualsystems.
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President ObamasSummary of American Recovery and
Reinvestment Plan
Scientific Research:
$2 billion in biomedical research, 1.5 million forexpanding good jobs involving biomedical
research to study Alzheimers, Parkinsons,cancer, and heart disease.
$900 million to prepare for pandemic influenza,support advanced development of medical
countermeasures for chemical, biological,radiological and nuclear threats and for cybersecurity protection at HHS.
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PRESIDENT OBAMASSUMMARY OF AMERICAN RECOVERY AND
REINVESTMENT PLAN
LOWER HEALTHCARE COSTS: TO SAVE NOT ONLY JOBS, BUTMONEY AND LIVES, WE WILL UPDATE AND COMPUTERIZEOUR HEALTHCARE SYSTEM TO CUT RED TAPE, PREVENT
MEDICAL MISTAKES, AND HELP REDUCE HEALTHCARECOSTS BY BILLIONS OF DOLLARS EACH YEAR
Health Information Technology: $20 billion to jumpstart efforts tocomputerize health records to cut costs and reduce medical errors.
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Regional Health Information
Network (RHIN)Also referred to sometimes as organization
rather than network (RHIN)
RHIN-A public-private alliance among healthcare providers, pharmacies, public healthdepartments, and payers, designed toshare health information among all health
participants thereby improvingcommunication health and health care.
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National Health Information
InfrastructureNHII- A comprehensive knowledge based
network of interoperable systems (RHIN)of clinical, public health, and personalhealth information that is intended toimprove decision making by making healthinformation available when and where it is
needed.
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Utahs RHIO: UHIN In operation since 1993
Governor Leavitts Health Print
Statewide value added network
Community-based; inclusive Community standards
Not-for-profit
Self-sustaining Began with what members thought would
bring the most value: Claims
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Clinics
UHIN today
DOH
Payers
Clearinghouse
Other orgs
Payers
Banks
CliniciansHospita
ls
Laboratories
Clinicians
ProviderBilling
Services
Payers
Clinicians
Clinics
Hospitals
Integrated health
care system
Clearinghouse
UHIN
Gateway
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UHINs RHIO Vision
Goal: Create a sustainable business
Begin with direct messages where thereceiver is known
Discharge
summary
Easier to bring value to end user
ADOPTION!
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Challenges with moving to EMR
within a facility Paper environment
Cost
Change/training requirement HIPAA
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Davis Hospital IASIS Challenge
1. ILE Component of the EMR
low-volume scanning application
Condition of admission HIPAA Privacy
Insurance card
Drivers license
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Davis Hospital IASIS Challenge
2. HED, component of the EMR
Nursing documentation
Patient history Flowsheets
Vitals
Medication record assessments
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Davis Hospital IASIS Challenge
3. DCS/QCI, component of the EMR
High-volume scanning application
All records that are not electronicallyentered (records from otherfacility,physician office)
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Davis Hospital IASIS Challenge
4. Dictaphone, component of the EMR
Transcription
Dictated reports
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Davis Hospital IASIS Challenge
5. STAR, component of EMR
Contains MPI
Ordering systems for labs/radiology Result systems for labs/radiology
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Davis Hospital IASIS Challenge
6. MD Portal, component of the EMR
Record viewing application
Web-based Clinical use
Current status of patient
Trending Completion of Charts (Physician use)
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Davis Hospital HIM function
How will components interface with the HPF,Component of the EMR
Record viewing application Queues
Deficiencies (HIM)
Adjust images
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Davis Hospital Challenge
ILE
STAR
DCS
MD Portal
HED
Dictaphone
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Mountainside Medical Center
See text on pg 493
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HCOs Operational Informationneeds
1. Operational requirements
2. Planning requirements
3. Communication requirements4. Documentation and reporting
requirements
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Operational requirements
Required detail and up-to-date factualinformation. (bread & butter of theinstitution)
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Planning Requirements
Short and long term decisions about patientcare. Clinical decision making. High-quality care.
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Communication requirements
Communication among caregivers,multiple personnel, business units.
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Security & ConfidentialityRequirements
1. Designated Security officer
2. Train employees so they understand theappropriate uses of patient-identifiable
information and the consequences of violations3. Use electronic tools such as access controls
and information audit trails not only todiscourage misuse of information, but to teach
employees and patients that people whoaccess confidential information can and will betracked and held accountable.
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HIPAA Security standards &Implementation Specifications
Pg 488 of text
1. Administrative safeguards
-security management process (riskanalysis)
-Assigned security responsibility
-workforce security (authorization)-security awareness and training
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Administrative safeguards cont.
-Security Incident Procedures
-Contingency plan
-EvaluationBusiness Associate Contracts &Arrangements
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2. Physical Safeguards
-Facility Access Controls (Access controls& validation procedures)
-Workstation use-workstation security
-Device and media controls
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Intranet vs Internet
Intranet is a private corporate network that
uses the same structures as the Internet.Internet a global network of networks,
connecting innumerable smaller networks,computers, and users.
How do we protect our intranet?
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Ways of Protecting Information
A firewall is either the program or thecomputer it runs on, usually an Internetgateway server, that protects the
resources of one network from users fromother networks. Typically, an enterprisewith an intranet that allows its workersaccess to the Internet will want a firewall to
prevent outsiders from accessing its ownprivate data resources.
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Firewall example
internet firewallHome network
blocker
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EncryptionEncryption is the process of encoding information in such a way that only theperson (or computer) with the key can decode it.
What would you want encrypted? NameAddress
Credit card numberSocial security numberBank account informationHealth information
Computer encryption is based on the science ofcryptography, which has beenused throughout history. Before the digital age, the biggest users ofcryptography were governments, particularly for military purposes. Theexistence of coded messages has been verified as far back as the RomanEmpire. But most forms of cryptography in use these days rely on computers,simply because a human-based code is too easy for a computer to crack. Mostcomputer encryption systems belong in one of two categories:Symmetric-key encryption
Public-key encryption
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F ti & C t f th
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Functions & Components of theHealthcare Information System
(HCIS)
Patient Management & Billing
-Master patient index (MPI)-the module of ahealth care information system used to identify apatient uniquely within a system. The MPIstores patient identification information, basicdemographic data, and basic encounter-leveldata such as dates and locations of service.
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Functions & Components of theHealthcare Information System
Admission-discharge-transfer: Onecomponent of a hospital informationsystem that maintains and updates thehospital census, including bedassignments of patients.
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Functions & Components of the
Healthcare Information System
Care DeliveryOrder Entry: online entry of orders for drugs,
laboratory tests, and procedures, usually bynurse or physician.
Results reporting: online access to results oflaboratory tests and other procedures.
ClinicalPathways: Disease-specific plan thatidentifies clinical goals, interventions, andexpected outcomes by time period.
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Functions & Components of the HealthcareInformation System
Financial & Resource Management
Electronic data interchange (EDI): Electronicexchange of standard data transactions, such asclaims submissions and electronic funds
transfer.Contract-management system: A computer
system used to support managed carecontracting by estimating the costs and
payments associated with potential contractterms and by comparing actual with expectedpayments based on contract terms.
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Functions & Components of the HealthcareInformation System
Financial & Resource Management
Provider-profiling systems: computer systemused to manage utilization of health resourcesby tracking and comparing physicians resource
utilization (e.g. cost of drugs prescribed, labtests ordered) compared to severity-adjustedoutcomes
Patient triage: A computer system that helps
health professionals to classify new patients anddirect them to appropriate health resources