Healthcare Data & Management PDF

03/17/2024 HCMT 2001 Hospital Functions and Management Topic 2: Healthcare data www.udst.edu.qa Lecture 3 2 First, understand that Health data extends life Where is your visit history? Doctor notes? Shared between doctors? Stats on your health development? Charts? Population stats? Disease outbreak?...

03/17/2024 HCMT 2001 Hospital Functions and Management Topic 2: Healthcare data www.udst.edu.qa Lecture 3 2 First, understand that Health data extends life Where is your visit history? Doctor notes? Shared between doctors? Stats on your health development? Charts? Population stats? Disease outbreak? Vaccination records? Allergies management? Lab results? Medications? 1 03/17/2024 Lecture 3 23 Goal Improve patient care Learning objectives Define health care data and information Understand the major purposes for maintaining patient records Discuss basic patient health record and claims content Discuss basic uses of health care data, including big and small data and analytics Identify common issues related to health care quality 12 03/17/2024 Outline Health Care Data and Information Defined Health Care Data and Information Sources What are health data and health information? Where does health data originate and why? How do health care organizations use data? When does health care data become health care information? What is the impact of the trend toward analytics and big data on health care data? Health Care Data Uses How does the quality of health data impact its use? Health Care Data Quality 25 What is the difference between healthcare data and healthcare information? 13 03/17/2024 Difference between healthcare data and healthcare information? Often used interchangeably but there is a distinction. Health information is processed health data. Health care data: raw health care facts, stored as characters, words, symbols, measurements or statistics. When unprocessed, they are generally not very useful for decision making. processing broadly covers everything from formal analysis to explanations supplied by the individual decision maker’s brain. knowledge is defined as “a combination of rules, relationships, ideas, and experience.” Discovering knowledge from healthcare data 28 14 03/17/2024 Difference between healthcare data and healthcare information? Health care information systems comes from entries in a patient’s health record and the information is readily matched to a specific patient. The Health Insurance Portability and Accountability Act (HIPAA) is the federal legislation that protects patient’s health information. Health information is information that: Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse Relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual. HIPAA refers to this type of information as Protected health information (PHI) What’s the difference between EMR vs. EHR? 15 03/17/2024 EMR vs. EHR The terms are often used interchangeably to describe a patient’s clinical record. Electronic medical records (EMRs) are digital versions of the paper charts. Contain medical and treatment history of the patients in one organization. some advantages over paper versions such as allowing clinicians to track patients over time, identify patients due for screenings and checkups, and check on patient progress on certain parameters. doesn’t travel easily out of the organization. Electronic Health Records (EHR) have: the same advantages of electronic medical record (EMR) and more. focus on the total health of the patient. designed to share information with other health care providers, such as laboratories, and specialists. include decision-support capabilities beyond those of electronic medical records (EMRs). 32 16 03/17/2024 What about personal health records? Maintained by the individual to track personal health care information. It is not the same as a health record maintained by a health care organization or provider and does not constitute a legal document of care. Differences in Scope of Care: Episode of Care: refers to the services provided to a patient with a specific condition for a specific period of time. Continuum of Care: a concept involving a system that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity of care. Population Health: the concept behind managing population health is to improve health outcomes within defined communities What are the purposed of patient records? 17 03/17/2024 Purpose of Patient Records Patient care: The number one reason for maintaining patient records. Patient records provide the documented basis for planning patient care and treatment for a single episode of care and for care continuum. Communication: health care professionals within an organization and across different organizations use patient records to communicate with one another about patient needs. Legal documentation: patient records are legal documents because they describe and document care and treatment. The record is considered the primary evidence in the event of a law suit or other legal action involving patient care. Purpose of Patient Records Billing and reimbursement: patients and payers use patient records to verify billed services. Research and quality management: patient records are used in research in order to monitor the quality of care provided in large academic medical centers as well as other health care organizations. Population health: health record information is used to monitor population health, assess health status, measure utilization of services, track quality outcomes and monitor adherence to evidencebased practice guidelines. Public health: patient records are used by federal and state public health agencies to inform policies and procedures to ensure they protect citizens from unhealthy conditions.. 18 03/17/2024 Components Patient Records ▸ ▸ ▸ ▸ Identification screen: information originates at the time of admission. Contains the patient’s main identification data. Recorded by the physician and coded by administrative personnel. Problem list: identifies significant illnesses and operations the patient has experienced. The list is generally maintained over time. Medication record: also called a medication administration record. It lists medicines prescribed for and subsequently administered to the patient as well as medication allergies. Physician’s orders: directions, instructions or prescriptions given to other members of the health care team regarding the patient’s medication, tests, diets, procedures and treatments. 37 Components Patient Records as Legal Documents ▸ ▸ ▸ History and physical: The history component consists of any major illnesses and surgeries the patient has had, significant family history, health habits, and current medication. The history is reported by the patient. The physical component is recorded by the physician upon hands-on examination. Progress notes (SOAP): made by different staff members caring for the patient. They reflect the patient’s response to treatment along with the provider observation and plans for continued treatment. Consultation: opinions about the patient’s condition made by another health care provider inside or outside a particular health organization at the request of the attending physician or primary care provider 38 19 03/17/2024 Components Patient Records ▸ ▸ ▸ ▸ Imaging and x-ray reports: the radiologist interprets the radiology images and the interpretations or findings are documented in the patient’s record. Laboratory reports: contain results of tests conducted on body fluids, cells and tissues. Lab personnel document the lab results into the patient record. Consent & authorization forms: consent forms are signed by the patient before treatment takes place are an important aspect of the use of patient records as a legal documents. Patient Records ▸ ▸ Pathology reports: documented by the pathologist, describe tissue removed during any surgical procedure and the diagnosis based on examination of that tissue. Discharge summary: summarizes the hospital stay, including the reason for admission, significant findings from tests, procedures performed, therapies provided, responses to treatments, condition at discharge, and instructions for medications, activity, diet, and follow-up care. Operative reports: documented by the surgeon, it describe any surgery performed and lists the names of surgeons and assistants. 39 AI monitoring patients What do you think? AI and monitoring of patients? https://www.youtube.com/ watch?v=qetKUFDDF4A Maybe we should do like China for patients: https://www.youtube.com/ watch?v=JMLsHI8aV0g 40 20 03/17/2024 Components of Patient Records 41 Components Claims ▸ ▸ Health care information is stored as part of the patient record, and is used by health care organizations for billing. Accounting/Billing departments are responsible for: ▹ ▹ ▹ Verify insurance coverage Bill third party payers (private insurance companies, QLM, Alkoot, Medicare, or Medicaid). Payments are processed upon receipt. 42 21 03/17/2024 EHR Information Screen 43 EHR Problem List 44 22 03/17/2024 EHR Progress Notes 45 EHR Lab Report 46 23 03/17/2024 Codes Diagnostic and Procedural ▸ Diagnostic and procedural codes are captured during the patient encounter for tracking clinical progress but also for billing, reimbursement and other administrative purposes. ▸ Two major coding systems are employed: ▹ ICD-10 (International Classification of Diseases) ▹ CPT (Current Procedural Terminology) 47 Codes Diagnostic and Procedural ▸ ICD-10 (International Classification of Diseases) ▹ ▹ ▹ ▹ Derived from the International Classification of Diseases, Tenth Revision, which was developed by the World Health Organization (WHO). The precursors to the current International Classification of Diseases (ICD) systems were developed to enable comparison of morbidity and mortality statistics across nations. Over the years this coding evolved to ICD-10-CM (Clinical Modification) which plays a major role in reimbursement to health care institutions. Accurate ICD10 coding is vital to accurate institutional reimbursement. Procedure information is similarly coded using the ICD-10-PCS (Procedural Coding System). 48 24 03/17/2024 Codes Diagnostic and Procedural ▸ ICD-10 (International Classification of Diseases) 49 Codes Diagnostic and Procedural CPT (Current Procedural Terminology) First developed and published in 1966 to provide a uniform language for describing medical and surgical services. In 1983, however, the government adopted Current Procedural Terminology (CPT), in its entirety, as the major component of the Healthcare Common Procedure Coding System (HCPCS) There are official guidelines and facilities that do not adhere to these guidelines are liable to charges of fraudulent coding practices. 25 03/17/2024 Data Analysis Databases and Data Warehouses 51 Data Analysis Patient records are a rich source of health care data. Before health care data can be used it must be stored and retrieved. Health care data must be processed to become information. The level of required processing differs based on the application. 52 26 03/17/2024 Data Analysis Four basic elements of data analysis ▸ Source of data ▸ Data must be stored in a retrievable manner ▸ Analytical tool applied to the stored data ▹ ▹ ▹ ▸ EHR, claims data, laboratory data, etc. Database or data warehouse Mathematical statistics, probability models, predictive models, etc. Reported in a usable manner 53 Databases and Data Warehouses ▸ ▸ A database refers to any structured, accessible set of data stored electronically. A data warehouse differs from a database in its structure and function. In health care data warehouses derived from health care information are called clinical data repositories ▹ ▹ ▹ The data from a data warehouse comes from a variety of sources. The data from the sources are extracted, “cleaned,” and stored in a structure that enables the data to be accessed along multiple dimensions, such as time (e.g., day, month, year); location; or diagnosis. Data warehouses help organizations transform large quantities of data from separate transactional files or other applications into a single decision-support database. 54 27 03/17/2024 Small v. Big Data ▸ ▸ ▸ Data stores and data analytics are not new to health care, but the speed by which the data is analysed and new information is discovered increased tremendously. Small Data ▹ Comparable to a filing cabinet ▹ Static Big Data characterized by the three Vs (Volume, Variety, Velocity) ▹ Comparable to a conveyor belt ▹ Volume ▹ Variety ▹ Velocity ▹ Veracity (accuracy) Sacristan, Jose & Dilla, Tatiana. (2015). No big data without small data: Learning health care systems begin and end with the individual patient. Journal of Evaluation in Clinical Practice. 10.1111/jep.12350. 55 Small data ▹ ▹ Disease and Procedure Indexes: contained summary information about a particular disease or treatment. Prior to EHR were card catalogues or books that kept track of disease and treatment counts. Now the disease and procedure index is handled as a EHR component. The retrieval information is based on ICD and CPT codes. Health Care Statistics: Utilization and performance statistics are routinely gathered for health care executives. Two types of statistics related to patient stay are routinely captured and reported: ▹ ▹ Census statistics: reveal the number of patients present in a facility at any time. Discharge statistics: calculated from fata accumulated when patients are discharged. 56 28 03/17/2024 Big data ▹ ▹ ▹ collected from a variety of sources (EHRs, internal databases, data warehouses, as well as the availability of data from the growing volume of other health-related sources, such as diagnostic imaging equipment, aggregated pharmaceutical research, social media, and personal devices such as Fitbits and other wearable technologies) ▹ Novel analytics that are being developed to analyze this data: The focused is no longer primarily on inpatient care, which resulted in data accumulating from hospitals, physician practices, long-term care facilities, the patient, and so on. Wide range of uses across multiple industries and efforts. For example, data on online social sites provides support communities, and contains knowledge that can be mined for research and other health-related activities. ▹ Post-market surveillance of medication and device safety ▹ Comparative effectiveness research (CER) ▹ Assignment of risk, for example, readmissions ▹ ▹ ▹ ▹ Novel diagnostic and therapeutic algorithms in areas such as oncology Real-time status and process surveillance to determine, for example, abnormal test follow-up performance and patient compliance with treatment regimes Determination of structure including intent, for example, identifying treatment patterns using a range of structured and unstructured and EHR and non-EHR data Machine correction of data-quality problems 57 Big data Impact of applying analysis to big data: ▹ Big data initiatives ->$300 to $450 billion in reduced health care spending, or 12 to 17 percent of the $2.6 trillion baseline in US health care costs. 58 29 03/17/2024 Big data: Five areas of analytics that will be crucial: ▹ ▹ ▹ ▹ ▹ Population management analytics. Producing a variety of clinical indicator and quality measure dashboards and reports to help improve the health of a whole community, as well as help identify and manage at-risk populations Provider profiling/physician performance analytics. Normalizing (severity and case mix–adjusted profiling), evaluating, and reporting the performance of individual providers (PCPs and specialists) compared to established measures and goals Point of care (POC) health gap analytics. Identifying patient specific health care gaps and issuing a specific set of actionable recommendations and notifications either to physicians at the point of care or to patients via a patient portal or PHR Disease management. Defining best practice care protocols over multiple care settings, enhancing the coordination of care, and monitoring and improving adherence to best practice care protocols Cost modeling/performance risk management/comparative effectiveness. Managing aggregated costs and performance risk and integrating clinical information and clinical quality measures 59 Vioxx example An analysis of the cumulative sum of monthly hospitalizations because of myocardial infarction, among other clinical and cost data, led to the discovery of arthritis drug Vioxx’s adverse effects and its subsequent withdrawal from the market in 2004 https://www.youtube.com/watch?v=SpT7g3lk5BI 60 30 03/17/2024 Healthcare Data Quality ▸ Depends on the use of the data ▹ Traditionally: ▹ ▹ Patient Clinical/Claim Records were used primarily for ▹ Document episodic care ▹ Generally from a single organization Today: ▹ ▹ ▹ Care providers, care coordinators, analysts, and researchers are all looking to EHR/Electronic Claims Record as a continuous source of data instead of episodic. Criteria for quality has shifted the criteria against which quality is measured will change depending on the product, service, or use. 61 Healthcare Data Quality ▸ ▸ ▸ ▸ EHRs were mainly developed as patient records whose purpose was to document and communicate episodes of patient care. Today they are evaluated as a source of data for complex data analytics and clinical research. Clinicians prefer entering unstructured data to the system (write notes), while structured data is better for research purposes. The discussion on which type to adopt will likely continue. Missing EHR data are problematic and are due to one of two reasons: ▹ Data was not collected ▹ Documentation was not complete or was not done properly. Two frameworks for evaluating health care data quality. The first was developed by the American Health Information Management Association (AHIMA) and the second is the Weiskopf and Weng framework. 62 31 03/17/2024 American Health Information Management Association (AHIMA) ▸ Developed and published as set of health care data quality characteristics: ▹ Accuracy: reflected values are correct and valid ▹ Accessibility: data must be available to the decision makers needing them ▹ Comprehensiveness: all required data must be present and available to the user ▹ Consistency: data must be consistent, an example is the use of abbreviations ▹ Currency: most data becomes obsolete after a period of time ▹ Definition: a clear definition of data elements must be provided ▹ Granularity: individual data elements are atomic (cannot be divided) ▹ Precision: relates to numeric data: closeness to the actual value ▹ Relevancy: data must be relevant to the purpose for which they were collected. ▹ Timeliness: lab results for example, must be present to the physician in a timely manner 63 Weiskopf and Weng Definition ▸ Identifies five dimensions of Electronic health record (EHR) data quality: ▹ Completeness: Is the truth about a patient present? ▹ Correctness: Is an element that is in the EHR true? ▹ ▹ ▹ ▸ Concordance: Is there agreement between elements in the EHR or between the EHR and another data source? Plausibility: Does an element in the EHR make sense in light of other knowledge about what that element is measuring? Currency: Is an element in the EHR a relevant representation of the patient state at a given point in time? The authors further identified completeness, correctness and currency as “fundamental”, while concordance and plausibility and proxies. 64 32 03/17/2024 Healthcare Data Quality Strategies for Minimizing Data Quality Issues 65 Videos Resources AMIA Video: The Promise of Reducing Medical Errors https://www.amia.org/why-informatics/promise-reducingmedical-errors AMIA Video: Why Informatics: https://www.amia.org/why-informatics2 1 3 2 AMIA Video: The Art and Science to Transform Care https://www.amia.org/why-informatics/art-andscience-transform-care 66 33 03/17/2024 Conclusion Value of Health Care Data and Information Importance of Health Care Data and Information Sources Uses and Analysis of Health Care Data Assurance of Health Care Data Quality 34