Chapter 11 - Health Information Systems
An EHR application that enables diagnostic study results (primarily lab results) to be both reviewed in a report format and the data within the reports to be processed - users can compare, trend, and graph results - all data to be processed must be in structured format and ideally stored in a clinical data repository - important because 70% of ability to reach a diagnosis is based on lab results
1. results management
systems can be used for entering all orders (patient admission, laboratory tests, x-rays and other diagnostic studies, dietary and nutrition, therapies, nursing services, consults, discharge of patient, referrals, and even building personal task lists, entering orders for meds) CDS in CPOE systems initially provided many alerts that may not have been specific or relevant to a given patient, resulting in alert fatigue, or the ignoring of alerts due to volume and irrelevancy appropriate alerting to drug-allergy and drug-drug contraindications (situations that should be avoided as potentially harmful to the patient) is a complex process that requires not only accurate data from patient and throughout the patient's care, but an up-to-date drug-knowledge database (subscription service that provides current info about drugs and is accessible to users and the CDS) - a cause for concern because most often based on standard order sets (common orders for patients with certain conditions) and are based on research, experts, and other sources of evidence-based medicine (EBM) - accepting standard order sets in haste without being modified for each patient can result in unintended consequences (unanticipated and undesired effect of implementing and using an EHR) - generates patient's med list (required under MU program to be coded using one of the code sets standardized under RxNorm (system maintained by National Library of Medicine to normalize drug names across disparate vocabularies)
3. CPOE Systems - part of med management
refers to the use of certain information systems that help ensure patient safety (preventing harm to patients), learning from errors, and building a culture for safety - often referred to as closed-loop medication management systems (automate processes from the point that drug is ordered to point of administration) systems include - e-prescribing (e-Rx) (special type of CPOE) - BC-MAR - Medication reconciliation systems (compare drugs ordered against drugs dispensed and administered) - automated drug dispensing machines - policies, procedures, and workflows associated with ensuring proper drug ordering, dispensing, administrating, and monitoring of reactions CPOE implemented last usually because of difficulty to get physicians to use ISs, but MU requires it first
3. medication management
new technologies that have an IS component to them include - new medical procedures - prosthetics - machine learning new medical procedures include technologies like liquid biopsies to monitor tumors noninvasively ____ is creating new prosthetics and ways to improve organ and tissue repairs extending beyond AI is ___, in which AI applications adjust algorithms supplied in software based on additional data, providing more sophisticated clinical decision support
3D printing machine learning
the integration of financial and clinical data provides ____ that helps support business decisions by both the administrative and clinical leadership of HCOs
BI (Business intelligence)
EHRs did not become a primary focus for healthcare providers until 2009 with the passage of the _____ - provided eligible hospitals and professionals with financial incentives, in terms of payment adjustments, to make meaningful use of EHRs incentive program is known as the Meaningful Use (MU) program (now promoting interoperability)
Health Information Technology for Economic and Clinical Health (HITECH) Act legislation
application of algorithms that analyze data and make applicable recommendations
artificial intelligence (AI)
often, it is necessary to move data from the CDR to a separate database that has been optimized to perform analytics and reporting (online analytical processing (OLAP) - this type of database is referred to as a ______ - integrates at least some of the data from the CDR and performs analytics
clinical data warehouse (CDW)
serve primarily to manage the department in which they exist, which at the same time provides key clinical data for the EHR 3 main systems 1. laboratory information system (LIS) 2. radiology information system (RIS) 3. pharmacy information system
clinical departmental applications, also called ancillary systems
help support the exchange of data across separate information systems within a healthcare organization and across organizations, and also with individuals - to exchange data among health information systems, computers must be networked together when exchanging data within the organization, the network is referred to as a local area network (LAN) when exchanging data across organizations, such as from a provider to a pater, the network is referred to as a wide area network (WAN) - WANs need a secure connection, which is often a virtual private network (VPN) (an encrypted connection over the internet)
connectivity systems
lists all data elements used in a health information system with their definitions and characteristics - specifies that term temperature must be documented in centigrade - improves data quality information systems
data dictionary
provides a logical structure for managing all the healthcare organization's data - addresses data governance and data stewardship, data quality management, specifications of terminologies of data, roles and responsibilities for collection and use of data, metadata management, data storage and warehousing, and data security
data governance framework (DGF)
organize data to depict relationships among the data to help ensure the quality of data collected by health information systems
data models
refers to adherence to standard data definitions and metadata (data about data) requirements
data quality
another term for health information and technology used by ONC because of its focus on information technology for healthcare - computer hardware and software enabling collection and processing of data into useful info - includes communication and network technologies that enable data and information to be exchanged across various computers
health IT
enables sharing of health information across disparate entities Primary Purpose: - supports authorized exchange of health data across entities that subscribe to the service goal: - support sharing of health info to achieve best possible healthcare and experience of care at a reasonable cost data sharing narrow in scope and can only share where EHR for a patient is located or maintain a repository of limited data like lab results and med lists by subscribers
health information exchange (HIE)
the term ___ may be considered to include technical components and people, policy, and process components that work together to support the goal of improving the health and well-being of the nation
health information system
used to describe the full scope of adopting health information technology
health information system
departments similar to HIM departments with respect to not necessarily having departmental management systems but having responsibility for supporting the information technology infrastructure and connectivity systems to enable effective use of all of an entity's information systems
health information technology
diagnostic study results data, POC documentation, medication management data, and other clinical documentation are exchanged among applications using similar standards from the _____ standards development organization - not-for profit, standards-developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing, and retrieval of electronic health information that supports clinical practice and the management, delivery, and evaluation of health services
health level seven (HL7)
hardware includes _____, which are any form of input device used by humans (monitors, keyboards, printers, scanners) - enable human interaction with computing technology - includes all computer servers and associated cabling and other tools for processing and storage
human computer interfaces (HCI)
refers to technology having been installed and configured to meet the basic requirements of the HCO. - demonstration to end users took place (persons who will use the information system in the course of their daily processes and procedures)
implementation
data that have been processed in a useful and meaningful manner
information
process that can be automated, but not as easily as other elements of medication management - each time patient is transferred across levels of care, such as admission, transferring to intensive care unit, or sent to surgery, medication that the patient should be administered need to be reviewed (meds discontinued, dose altered) - connecting systems at different levels of care has been a challenge and only few hospitals have been successful
medication reconciliation
before the internet, application software was written using _____ to structure the format of data that are processed by the applications and which could only support point-to-point communications Ex: - ASC X12 standard for exchanging claims and other administrative and financial data - NCPDP standard for exchanging prescriptions between an e-prescribing system and a retail pharmacy
message format standards
refers to the technology that allows the various applications to work - includes hardware and software of various forms and sophistication
supporting infrastructure
refers to components that work together to accomplish a goals
system
the most basic form of interoperability - refers to exchange of any data element across information systems
technical interoperability
alternative payment models are being used in what is now being referred to as _____ strategies to improve the quality of care drive down its cost
value-based care
5 core clinical EHR systems
1. results management 2. point of care (POC) clinical documentation 3. medication management encompassing CPOE and bar code medication administration recording (BC-MAR) systems 4. Clinical decision support (CDS) systems (CDSS) 5. analytics and reporting
intent of applications is to inform user what data needs to be recorded for patient and to use data to supply clinic decision support (CDS), including alerts and reminders, at the time when the clinician is able to be most responsible to alerts and reminders - documentation systems supply templates to the user to be complete primarily via point-and-click, drop-down, type-ahead, etc. - structured data that the computer processes into clinical info - documentation systems include support for documentation of all patient care administered by healthcare professionals
2. point-of-care (POC) documentation
functionality in the EHR helps physicians, nurses, and other clinical professionals - collectively referred as clinicians - as well as patients themselves to make decisions about patient care Ex: - alerts about potential drug contraindications - out-of-range lab results - standard order sets in CPOE - CDS templates can help determine what documentation of clinical findings is necessary - provide suggestions to prescribe less expensive but equally effective drugs - supply protocols (specification of appropriate processes based on expert processes and clinical research findings) for certain health maintenance procedures - alert that a duplicate lab test is being ordered may be built into each core EHR application or acquired as separate information systems that work in conjunction with EHR applications (separate clinical decision support system) ex of separate CDSs integrated into EHR: - templates used in clinical documentation -standard order sets used in CPOE - clinical pathways guiding nursing services CDSs used in standalone fashion (those specific to unique function) - IS to alert infection control nurses of a potential hospital-acquired infection - provides advice on which med is most effective in combating infection given causative agent (compiles data from clinical documentation, lab results, x-ray results, etc.) Ex: - differential diagnosis system (compare diagnostic images against a library of images and their known conditions - useful for radiologists, dermatologists, pathologists, etc.) (compare data from clinical documentation, especially the history of present illness with a ROS, with a library of known signs and symptoms for a specific diagnosis CDS is an increasingly important tool in value-based care, as it helps healthcare professionals encourage healthy lifestyles - improving overall health of individual and lowering costs
4. Clinical decision support
the final core EHR application analytics (refers to statistical processing of data to reveal new information) - answers questions like how many patients were seen for a specific condition - involves data mining, forecasting, neural networks) - produced many clinical benefits for healthcare industry (genomic research and personalized medicine (also known as precision medicine that tailors treatment to the individual, given not only comorbidities but genomic characteristics and predispositions) - used to created BI, such as predicting prescribing patterns of physicians or the impact of a disaster on local emergency services reporting (supplying the results of analytics to intended recipient)
5. analytics and reporting
a special type of CPOE used exclusively to write a prescription and transmit it electronically to retail pharmacies - format and content of prescription transmitted is standardized by the National Council for Prescription Drug Programs (NCPDP) - standards development organization setting standards for pharmacy industry - NCPDP SCRIPT standard (standard for electronically transmitting a prescription) (used in ambulatory setting - includes medication alerts and reminders like CPOE, but also has formulary info identifying whether a patient's health plan covers drug and what co-pay may be required - in 2010, the drug enforcement administration (DEA) previously banned the use of e-prescribing for controlled substances (EPCS), such as narcotics, set special requirements allowing its use Requirements for EPCS include - identity proofing (authentication credentials used to electronically sign such prescriptions) - two-factor authentication (signature type including two of three following elements: something known [password], something held [token or digital certificate (issued by a certificate authority, like an organization verifying a person's credentials and can be revoked)], something personal [biometrics] - fingerprints, retinal scan, to enable use)
E-Rx
In 2015, ONC issued the ____, in which it describes a vision and mission for the United States' use of health information technology 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 Four overarching goals for health IT: 1. Advance person-centered and self-managed health 2. Transform healthcare delivery and community health 3. Foster research, scientific knowledge, and innovation 4. Enhance the nation's health IT infrastructure
Federal Health IT Strategic Plan 2015-2020
___ and ___ generally perform quality data capture
HIM and nursing professionals
may manage some RCM functions such as coding of diagnoses, procedures, and professional services and clinical documentation integrity to ensure documentation in the EHR supports the diagnoses, procedures, and professionals services identified support complementary systems - document imaging systems (used only to scan paper forms) - electronic document management systems (EDMS) (scanning is coupled with workflow tools) - electronic document/content management (ED/CM) systems (both documents and the data in the document have XML [eXtensive markup language] tags applied for ease of searching for content) - speech dictation systems (enable speech to be translated directly into a narrative document) - discrete reportable transcription (DRT) systems ( combine speech dictation with natural language processing [ability of computer to not only convert words, but apply sophisticated computer processes to put words into appropriate context] and can populate predefined templates with structured data - consent management systems (maintain patient preferences about who may have access to their health information) - chart tracking system (manage location of paper records)
HIM departments
a healthcare information system for a hospital laboratory includes
Hardware (computers, printers, laboratory devices) Software (computer programs designed to process lab test orders, produce specimen collection lists for hospitalized patients, produce labels for specimen containers, produce test results, conduct quality assurance on lab testing processes) Communications and network technologies (computerized provider order entry [CPOE] system - (used by providers to enter orders for lab tests, medications, procedures, lab testing devices, pharmacy systems for drug info that may impact results, destination systems like the EHR to convey results to providers and billing for charging of lab tests Operational and cultural adaptations necessary to use the technologies in performing diagnostic studies on various specimens collected from patient and applying professional judgement in evaluating quality of data representing results Policies and standards from local healthcare organization and accrediting and licensing bodies (Logical Observations, Identifiers, Names, and Codes (LOINC) [federally mandated for ordering and reporting lab results] Clinical Laboratory Improvement Amendments (CLIA) of 1988 [federal regulatory standards that ensure quality lab testing] Workflow and process designs (ensure most efficient and effective use of technology)
system will: - receive an order for a lab test - generate a work list for specimen collection - labels for specimen containers - accession numbers to track specimens - retrieve results from an auto-analyzer - perform quality control - maintain an inventory of equipment and supplies needed for lab tests - manage information on departmental staffing and costs - supplies lab results wither as a paper copy printout or an electronic print file, which is structured data (data able to be processed by the computer) to an EHR
Laboratory Information System (LIS)
term used by the federal government for the program designed to incentivize use of EHRs - meaningful = go beyond using EHR just as a search tool 2 components: - specified functionality an EHR must have in order for a provider to qualify to earn incentives (managed by ONC) - the degree of use providers should make of the qualified EHR as specified by CMS
Meaningful Use
the agency within the federal government tasked to be the health information technology (health IT) resource to the nation
Office of the National Coordinator for Health Information Technology (ONC)
system that - receives an order for a drug in a hospital - aids hospital pharmacist in checking for contraindications (situations that should be avoided as potentially harmful to a patient) - directs staff in compounding any drugs requiring special preparation - assists in dispensing the drug in appropriate dose and for appropriate route of administration - maintains inventory (documenting meds in stock using National Drug Codes (NDC), terminology maintained by FDA to use in identification FDA approved drug) - supports staffing and budgeting - performs other departmental operations
Pharmacy information system
system performing functions similar to LIS - receiving an order for a procedure - scheduling procedure - notifying hospital personnel or the patient if performed as an outpatient - tracking the performance of the procedure and its output - tracking preparation of the report - performing quality control - maintaining an inventory of equipment and supplies - managing departmental staffing and budget departments obtain picture archiving and communication systems (PACS) (digitalize results of radiological modalities such as CTs and x-rays and provide special viewing capabilities of these images on a computer - standardization for PACS established by Digital Imaging and Communications in Medicine (DICOM) organization
Radiology information system (RIS)
Which factor in a BC-MAR system supports medication five rights? a. Bar code reading b. Documentation of medication administered c. List of medications to be administered to the patient d. Reports of accuracy of medication administration
a. Bar code reading
Dr. Smith always orders the same 10 things when a new patient is admitted to the hospital in addition to some patient-specific orders. What would assist in assuring that the specific patient is not allergic to a drug being ordered? a. clinical decision support b. pharmacy information system c. electronic medication administration record system d. standard order set
a. clinical decision support
what provides alerts and reminders to clinicians? a. clinical decision support system b. electronic data interchange c. point-of-care charting system d. workflow system
a. clinical decision support system
a _____ is considered a core clinical EHR component a. computerized provider order entry system b. pharmacy information system c. document imaging d. registration-admission, discharge, transfer system
a. computerized provider order entry system
term frequently associated with the intent of MU and reflects that the HCO has implemented all the major components of the technology, although there may be some tech available that is more specialized, costly and time consuming to implement that is not yet implemented -requires users to rely on tech to enter and retrieve most info and where decision support is included to use when appropriate - demonstrates effective integration into the daily routines of healthcare - less or equivalence of time as using paper records and have greater value
adoption
MU program began winding down in 2016, and since then, requirements for using an EHR have been incorporated into ____, which are new ways the federal government is paying for care
alternative payment models (APMs)
these are technically smart peripherals that are available to secure and make drugs more readily available to nursing staff - machines typically filled by pharmacy department staff based on physician orders
automated drug dispensing machines
What stage describes when users are not yet using all the available EHR functionality? a. Adoption b. Implementation c. Optimization d. Meaningful use
b. Implementation
Templates are intended to: a. Afford free text entry of narrative information b. Provide data entry support consistent with patient type c. Require use of a standard set of orders for every patient d. Support copy and paste of content from one record to another
b. Provide data entry support consistent with patient type
identify a source system a. clinical decision support system b. laboratory information system c. results management system d. medication reconciliation system
b. laboratory information system
why is medication reconciliation the most difficult function of closed-loop medication management systems to implement? a. bar code systems contain only limited information b. multiple systems, potentially across healthcare settings, must be connected c. nurses do not have sufficient time to obtain a medication history d. vendors are reluctant to design such systems due to cost
b. multiple systems, potentially across healthcare settings, must be connected
the documentation of administering medication to a patient and is a function performed by nurses in a hospital - bar code reader to positively ID patients and meds to be administered to them bar codes - bars = dark elements - spaces = light elements frequency and care taken by nurse to follow medication five rights 1. right drug 2. right dose 3. right route 4. right time 5. right patient systems require: - each patient to be identified with a bar code (wrist band) - to package (or buy pre-packaged drugs) in unit dose form, each with a bar code or radio-frequency identification (RFID) tag - wireless transmission of data with same function as barcode (identifies drug, dose, and intended route of administration) provides additional links about drugs and generates reports on timely administration of drugs Issues - bags specifically compounded with multiple drugs adminstered intravenously require labels to reflect all drugs in compound - brining computer, barcode wand, and meds to patient beside addressed using workstation on wheels (WOWs) or a tablet with wand device in a sling
bar code medication administration recording (BC-MAR) - part of medication management
most HCOs are now outsourcing analytics to vendors and they aggregate data from many customers to enlarge the pool of data, making the results of an analysis of the data more valid and reliable - when the data pool has a large volume of data, it is referred to as ____ (offers greater reliability and validity) ____ ____ analytics implies massive amounts of data that can be analyzed quickly in near teal time to return new info to users at the POC (data does not have to be structured)
big data
systems that integrate, analyze, and supply financial and clinical data to support both administrative/financial and clinical decision making
business intelligence systems
which of the following characterizes the current state of EHRs? a. EHRs aid in comparing the quality of care rendered across healthcare organizations b. EHRs enable complex analysis of all patient data for the healthcare organization c. EHRs provide data and support for data collection about one patient at a time d. EHRs support the ability to generate lists of patients with similar characteristics
c. EHRs provide data and support for data collection about one patient at a time
e-prescribing systems are used to a. inventory and dispense drugs in retail pharmacies b. write orders for drugs to be administered in hospitals c. send prescriptions to retail pharmacies d. report adverse drug reactions
c. send prescriptions to retail pharmacies
to earn MU incentives and to participate in alternative payment models, an EHR application must have ____ from an ONC-designated certifying body that indicating that the EHR meets all of the required functionality criteria for the program
certification
increasingly, ____ are being integrated with clinical data (namely, the data documented about a patient's health status and treatment) for alternative payment incentives and to aid in strategic planning for the overall HCO
claims data
a quicker and more efficient way to exchange data across many different organizations that is a go-between (a vendor) is known as a
clearinghouse
the nature of the database required for POC documentation and CDS is referred to as - purpose is primarily online transaction processing (OLTP) (each access, entry, or other process performed on data is a transaction) - typically used to house and process the broader range of LIS, RIS, EDMS, EHR, and many other applications being brought together
clinical data repository (CDR)
raw facts and figures without context or meaning
data
what is the goal of the Federal Health IT Strategic Plan?
dissemination of knowledge
new form of healthcare delivery that is very "low tech" - keeps people outside of physician offices, waiting rooms, or hospital beds, promote happiness and comfortable
e-visits (telephone communications between patient and provider) hospital-in-the-home (where the new connectivity mechanisms help monitor patients at home)
quality measure reporting required by Medicare is aided by CMS providing ____ specifications
electronic Clinical Quality Measure (eCQM)
to manage infrastructure, a plan describing what technology will be adopted, how the technology will be procured, and how the technology will work together is needed - plan is often in form of _____ (needed because large hospitals may have nearly a thousand applications) - helps keep track of all the applications and how they work together
enterprise architecture (EA)
a special server that supplies the rules that govern clinical decision support - if a patient is allergic to penicillin, generate an alert when a physician orders a med with penicillin in it - needs access to knowledge sources (provide information about the properties of drugs, the latest research about new surgical procedures, and other needed info for clinical decision making) - must be kept up to date, so vendors usually do this through subscription service
inference engine (rules engine)
as a result of the early development of health information systems software, most technical interoperability today requires an _____ (software that serves as a translator between different applications which may have different structure for data or may use different vocabularies to encode data) Ex: interface detects what data should be sent from what fields in R-ADT system to fields in LIS - every exchange between two applications requires an ____ - each application is unique to that entity and as a result, interface engines are often required to manage all the interfaced for a given entity, and with a very limited number of external entities
interface
a key component of supporting infrastructure is the need to provide _____ - term used to describe the ability of one information system to exchange data with another information system in a way that the data exchanged are usable to each part of the exchange - semantic (terminology carries same meaning to all parties to an exchange)
interoperability
special form of input device geared to people less familiar with computers - in provider waiting room to access health info and services
kiosk
____ is more than information, ____ is the application of experience to information that provides value to the information beyond only serving as evidence of actions taken
knowledge
IS managing the nursing department, including staffing, credentialing, training, budgeting, and other managerial functions - clinical data may be combined with department operations data in a nursing IS to provide patient acuity staffing levels (number of staff needed for any shift or day is determined by how acutely ill the current patients are)
nursing information system
state that demonstrates not only effective adoption of health information systems for routine operations, but also an understanding and appropriate use of technology's features with workflow and process improvements that can improve clinical efficiency - HCO implements all or almost all tech - Power users (expertise in IS is above others, are able to use tech to significantly improve their productivity and will likely see healthcare quality and cost benefits
optimization
systems serving to check patient insurance eligibility, capture charges for services (codes for office visits), compile and send claims to payers, receive payment and remittance advice, and identify unpaid or denied claims for which other collections efforts must be made
patient financial systems (PFSs) or billing systems
a special software that enables patients to log onto a website from home - used primarily for administrative functions: - request an appointment - directly schedule an appointment - pay bills - obtain patient educational material - sign informed consents - exchange email with provider - request release of information - some are summaries of info, but other portals view parts of EHR or whole EHR - access personal health record supplied from provider - patients enter own health history in portal using templates - e-visits through portals
patient portal
defined as the science and art of preventing disease, prolonging life, and promoting health through the organized efforts and informed choices of society, organizations, public and private communities, and individuals
population health
the aggregation of data across multiple health information system resources and the analysis of that data into actions providers can use to improve both clinical and financial outcomes Functions: - support care coordination - care transformation - patient engagement - care analytics to reduce practice variation while account for social determinants of health which are believed to account for 80% of what affects health outcomes outside of the traditional boundaries of healthcare delivery
population health management (PHM)
EHRs can be used to connect with patients through
portals (windows into information systems) - personal health records - personal medical devices - apps on smart phones - telehealth (assist in providing remote diagnosis and treatment through telecommunications technology)
infrastructure must also consider the processes and policies for using applications - increasingly being referred to as process interoperability and policy interoperability _____ refers to the use of workflows and procedures that best support use of technology - some aided by software - if there are a series of steps to be taken by different people, in different departments and in different systems with different information systems, software can be supplied to the direct sharing of data in the appropriate sequence as each person, department, and system completes its work ____ refers to the rules that govern exchange of data - incorporated into software development - access controls are security rules built into ISs to ensure only the appropriate access is afforded
process interoperability policy interoperability
a _____ (in a larger healthcare organization) or project manager aids in compiling a project's budget, allocating resources, maintaining a task list, identifying dependencies among tasks, establishing timelines, and managing a schedule - the ___ may only focus on health information systems or be broader in scope to encompass major projects, such as building construction and mergers and acquisitions
project management office (PMO)
includes a hospital, physician, nursing home, etc.
provider
systems in hospitals that register patients for inpatient admission or outpatient services captures - demographic data - insurance data - when patients are admitted to hospital and opens an account - patient transfers such as moving from intensive care to cardiac unit - closes account when patient is discharged, transferred to another HCO, or dies
registration-admission, discharge, transfer (R-ADT) systems
another type of application that typically houses and performs analysis and data reporting on a subset of clinical data - tumor registry
registry
a term often referring to the broader process of not only creating, submitting, analyzing, and obtaining payment for healthcare services, but also negotiating contracts with health plans, coding and clinical documentation integrity, conducting utilization review, etc. includes: •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 •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
revenue cycle management (RCM) system
a medical ____ is an individual who enters clinical documentation into the EHR to reduce administrative burden - may assist providers in navigating EHRs, respond to messages on behalf of a physician as directed, locate information, or perform research - cut physician documentation time in half
scribe
supporting infrastructure must address _____ - healthcare is facing increased security threats - both internally and externally
security
standard vocabularies (compilation of terms formally adopted for use in the healthcare information systems) are used for data exchange across different health information systems exchange capability is known as ______, or the ability to share common meanings for data across systems
semantic interoperabiltiy
automated medical devices that have not generally been considered as ISs until recently, even though they have generated data as well as information - measurement of BP on screen - continuous feed of data such as a fetal monitoring strip or blood sugar level - vital sign monitors - cardiac output monitors - defibrillators - electrocardiographs - infusion pumps - physiologic monitors - ventilators -used to provide smart services - monitoring response to meds and making adjustments - alerting nursing staff
smart peripherals
capture and supply the EHR and other broad health information systems with data include - administrative and financial applications, ancillary/clinical departmental applications, specialty clinical systems, "smart" peripherals
source systems
systems acquired to support the unique needs of specialty services - cardiology, nephrology) some clinical systems are unique to services provided and are often stand-alone systems - long-term and post-acute care (LTPAC), dentistry, behavioral health (BH), therapy (physical, respiratory, occupational)
specialty clinical systems
in addition to exchanging info among providers and patient for treatment and payment, data is moved for operational functions, such as for supplying quality data to a registry and to store data various data ______ (archiving data organized for retrieval) techniques exist - storage area network (SAN) (supports ability to retrieve data from any storage location for use in EHR) (some are local to HCO and other use cloud computing - using computing services remotely over the internet often through a vendor or vendors to achieve data and in some cases to provide application software, including an EHR)
storage management
in physician practices, physicians and nurses often enter clinical documentation directly into the EHR as ____ - refer to data elements that are uniquely captured by the computer in fields that can then be processed (drug-lab checking - performed in a CDS system - determines drugs ordered against lab values to determine contraindications)
structured data
the oldest form of exchanging health information is ____ (process uses telecommunication to send voice, still pictures, and video between a remote location (where the patient is) and a base location (such as a hospital) for the purpose of diagnosis, and in some cases, treatment Challenges - connectivity (remote parts of country, battlefields, across the world, not always available in some areas) - broadband not available in all parts of US - physicians may not be licensed to practice in another state - reimbursement not always covered by health plans - specialized equipment must be brought to patient
telehealth
RCM functions that exchange data between providers and health plans are referred to as _____. - each ____, such as eligibility verification and claims status inquiry have mandated standards for use under HIPAA (specify in what format the data should be compiled and what data should be exchanged with payers) - standards developed by the American National Standards Institute Accredited Standards Committee X12 (ASC X12) - standard operating rules further explain the standards to ensure consistent use across health plans
transactions
structured data is contrasted with _____, or narrative information not able to be uniquely processed by a computer - lab values documented in notes, comments, or scanned images cannot be processed by the computer in the same way structured data can
unstructured data
refers to the fact that those who are supposed to apply the technology to their daily work have been trained and are starting to apply the technology at a simple level - nurses entering data into nurse assessment templates (guide for documentation) and med administration using the technology
use
refers to improving the quality of care to achieve a healthier nation, which can result in reducing the cost of care overall
value
utilizes tools to aid in exchanging data in a one-to-many (rather than point-to-point) manner - refers to use of web-based forms of interfaces - such as XML structures - to enable sharing across multiple parties
web services architectures (WSA)