Health Information Management Technology PDF

Health Information Management Technology: An Applied Approach, Sixth Edition Chapter 11: Health Information Systems ahima.org ahima.org © 2020 AHIMA Health Information Systems Office of the National Coordinator for Health Information Technology (ONC) Vision: high-quality care, lower costs, healthy p...

Health Information Management Technology: An Applied Approach, Sixth Edition Chapter 11: Health Information Systems ahima.org ahima.org © 2020 AHIMA Health Information Systems Office of the National Coordinator for Health Information Technology (ONC) Vision: high-quality care, lower costs, healthy population, and engaged people. Mission: improve the health and well-being of individuals and communities through the use of technology and health information that is accessible when and where it matters most. ahima.org © 2020 AHIMA Federal Health IT Plan 2015–2020 ahima.org © 2020 AHIMA Federal Health IT Goal 4: Enhance Health IT Collect data and information Share knowledge through interoperable systems Use knowledge to support a learning health system that achieves value (such as, improves the quality and reduces the cost of health care) ahima.org © 2020 AHIMA Health Information Systems Components of a system: Hardware Software Communications and network technologies People (operational and cultural adaptations) Policies (and standards) Process (workflow for efficient and effective use) ahima.org © 2020 AHIMA Work together to support the goal of improving the health and well-being of the nation Current State of Health Information Systems Regulation Actual Practice HITECH: MU Program Implementation CMS Quality Payment Programs: Promoting Interoperability ahima.org © 2020 AHIMA Use/MU Adoption Optimization Scope of Health IT ahima.org © 2020 AHIMA Remember concept for TEST Source Systems Supply the EHR and other broad health information systems with data Administrative and Financial Registration, Admission, Discharge, Transfer (R-ADT) Physician Practice Management (PMS) ahima.org © 2020 AHIMA Master Person Index (MPI) Patient Financial Systems (PFS)/Billing System Revenue Cycle Management (RCM) Quality Measurement, Reporting, and Improvement Systems Business Intelligence (BI) Health Information Management (HIM) Source Systems (continued) Ancillary/Clinical Departmental Laboratory information system (LIS) Radiology information system (RIS)/Picture archiving & communications system (PACS) Pharmacy information system Others Specialty Clinical Systems Intensive Care Other Specialties Perioperative/Surgical Long Term & Post-Acute Care Labor & Delivery Behavioral Health Emergency Therapies Population Health Management “Smart” Peripherals Monitoring Equipment Robotics ahima.org © 2020 AHIMA Infusion Pumps Dispensing Devices HIPAA Transactions and Clinical Data ahima.org © 2020 AHIMA Revenue Cycle Management Contract negotiation Patient demographics & insurance capture Eligibility & benefits verification Co-pay collection Patient financial counseling Prior approval for certain service coverage Case management Utilization management Charge capture & chargemaster maintenance Coding & clinical documentation integrity Source: Amatayakul. M. 2017a ahima.org © 2020 AHIMA Claims review & edits (“cleaning”/ scrubbing”) Claim submission Filing for contractual payments & shared risk arrangements Claim status determination Claims attachments Remittance advice & payment posted to accounts receivables Audits, denials, & appeals Accounts receivables follow-up & collections Bad debt/charity management Analytics & reports HIM Systems Master patient index Coding Clinical documentation integrity Document imaging systems (EDMS, ED/CM) Speech dictation/discrete reportable transcription Consent management and release of information Chart tracking ahima.org © 2020 AHIMA Core Clinical EHR Systems Results management Results in structured format, available for subsequent processing Ability to compare, trend, graph results ahima.org © 2020 AHIMA Core Clinical EHR Systems (continued) POC documentation Point-of-care (POC) charting for all clinicians Informs user what documentation is needed Supports structured data collection Provides documentary evidence of patient care actions Affords timely communications across care team Structured data used to Provide clinical decision support (alerts and reminders) (see later slide) Support coding for reimbursement Support clinical quality measurement Support other analytics ahima.org © 2020 AHIMA Core Clinical EHR Systems (continued) Medication management Systems work together to achieve closed-loop medication management for patient safety Computerized provider order entry (CPOE) E-prescribing, special case for prescriptions filled at retail/mail order pharmacies Barcode medication administration record (BC-MAR) Medication reconciliation ahima.org © 2020 AHIMA Core Clinical EHR, Ordering ahima.org © 2020 AHIMA Core Clinical EHR, Med Admin ahima.org © 2020 AHIMA Core Clinical EHR, CDS Alerts? Many types of clinical decision support (CDS): Active (such as, alerts) vs. passive (such as, reminders, infobutton) Integrated within EHR or standalone Offered at many points in use of EHR: ahima.org © 2020 AHIMA Data display Workflow Data retrieval Data entry Core Clinical EHR, Reporting & Analytics Reporting is the Analytics is the statistical processing supplying of results (of analytics) to the of data (from EHR intended recipient (via and other sources) EHR or other means) to reveal new information OLTP OLAP Copyright © Margret\A Consulting, LLC. Reprinted with permission ahima.org © 2020 AHIMA Data Quality “Good” data is essential for accurate reporting Well planned Data model Metadata Data dictionaries Adheres to standard vocabularies for semantic interoperability Monitored for attributes of data quality ahima.org © 2020 AHIMA Supporting Infrastructure Skipped Human computer interfaces Interface engine Clinical data repository vs. clinical data warehouse vs. registries Inference engine & knowledge sources Enterprise architecture Data governance framework Project management office Big data & artificial intelligence Security ahima.org © 2020 AHIMA Connectivity Systems System A Data exchange System B Internally (such as R-ADT to LIS) or externally (such as between hospital and physician office, physician and patient) Near (via dedicated cabling) or far (via VPN, cloud computing) Without provision of healthcare services (such as to a SAN), or with provision of services (such as telehealth, e-visits) Requires use of standard interfaces (such as, ASC X12, DICOM, SCRIPT, HL7) or using web-based interfaces (such as XML structures, HL7 FHIR APIs) Interoperability is the ability to connect in a way that enables data to be shared accurately and in a usable manner ahima.org © 2020 AHIMA Telehealth and More Telehealth Technology Overcoming challenges Low tech: E-visits Hospital in the home High tech: 3D printing Artificial intelligence Machine learning ahima.org © 2020 AHIMA Patient-Exchanged Health Information Portal is specialized software that enables access to specific, predetermined data or applications Provider portals are often used for physicians to access their patients’ EHR, schedule admissions, and so on Patient portals often support patient appointment making, email with provider, and sometimes a PHR; they may be accessible via a kiosk at provider or via a personal computing device Personal health record may be: Standalone (paper or electronic maintained solely by the patient) Tethered to a provider (health plan, employer, other) Combination of many of standalone and multiple tethered PHRs ahima.org © 2020 AHIMA Clinical Document Architecture skipped Supplying a standard set of data is desirable for exchanging data between referring providers and between providers and patients Continuity of Care Document (CCD) required for earning incentives in MU program Clinical Document Architecture (CDA) used to transmit data among providers/patients when the CCR is rendered in XML. Consolidated Clinical Document Architecture (C-CDA) provides templates for multiple different documents, including the CCD ahima.org © 2020 AHIMA HIE and HIO Not On Test HIE is a process, but is also sometimes used to refer to an organization (HIO) that aids HIE HIOs provide HIE governance, policies and procedures, and often charges fees for HIE services HIOs may exchange a limited scope of data (such as, lab results, ED data) or the full scope of the EHR HIOs provide several key services: Patient identification, using an identity matching algorithm Directory services to identify patients and find their records Identity management (IdM) services to authenticate users, provide access to data, and other security measures Consent management which supports patients’ ability to opt in or opt out of HIE, often with a formal consent directive for this purpose ahima.org © 2020 AHIMA eHealth Exchange Skipped Current name for a nationwide system of HIOs in the support of HIE. It is a framework for trusted exchange of data Providers enter into a data sharing agreement HIPAA business associate agreement Data Use and Reciprocal Support Agreement (DURSA) There are two ways to connect using eHealth Exchange: Direct exchange is a secure form of email, enabling patient data to be pushed from one entity to another CONNECT is software that enables querying for data and pulling it into one system from another ahima.org © 2020 AHIMA Systems Development Life Cycle A system is a set of components that work together to achieve a common purpose Hardware, software, people, policies, and process components Systems have a formal, logical life cycle A need is identified, defined, and steps taken to build or acquire components to fulfill the need How well the components of the system work together is continuously monitored If it is found that needs are not being met, steps of refining the definition of the need and rebuilding or acquiring new components are taken ahima.org © 2020 AHIMA Applications for SDLC Strategic planning Clinical quality improvement Health information system selection (as illustrated on subsequent slides) Optimizing use of health IT ahima.org © 2020 AHIMA SDLC for System Selection 1. Identifying Need Needs are best expressed as goals that are (SMART): Specific Measurable Attainable Relevant Time-based ahima.org © 2020 AHIMA 2. Specify Requirements Once a goal is clearly expressed, the specific components and their attributes can be described in a requirements specification Hospital will provide telehealth services that are Medicare reimbursable to patients in rural communities in the state so that within two years of initiating the program quality of life for these patients will be improved by 20% as measured by Health People’s Health-Related Quality of Life and Well-Being (HRQoL) measures, and healthcare costs will be reduced by 10%. Specifications would include, for example: Store and forward telehealth technology (which is the only kind Medicare reimburses) Education campaign for staff participants and rural patients Survey process and database for collecting and analyzing results ahima.org © 2020 AHIMA 3. Design or Acquire 1. Request for proposal (RFP) and analysis of results 2. Due diligence, including product demonstration, reference checks, site visits 3. Contract negotiation ahima.org © 2020 AHIMA 4. Develop or Implement Using Project Management Principles Installation of hardware and software Software configuration (system build) Data and chart conversion Workflow and process redesign Software testing User training Go-live ahima.org © 2020 AHIMA 5. Maintain & 6. Monitor IT and Informatics Professionals Maintenance tasks to ensure technology works as intended Change control program to support authorization, testing, rollout, training, and documentation of all changes over time Monitoring tasks to support end users in following policies and processes to achieve successful adoption and optimization Close SDLC loop to identify need to be changes to the overall system to achieve current and new goals as they arise ahima.org © 2020 AHIMA