Chapters 11-12
Logical Observations, Identifiers, Names and Codes (LOINC)
A database protocol developed by the Regenstrief Institute for Health Care aimed at standardizing laboratory and clinical codes for use in clinical care, outcomes management, and research that enable exchange and aggregation of electronic health data from many independent systems
Meaningful Use
A regulation that was issued by CMS, outlining an incentive program for professionals (EPs), eligible hospitals, and CAHs participating in Medicare and Medicaid programs that adopt and successfully demonstrate ________________ of certified EHR technology.
Claim
A request for payment for services, benefits, or costs by a hospital, physician or other provider that is submitted for reimbursement to the healthcare insurance plan by either the insured party or by the provider
Perspective
A systems ________ (taking into account all systems) must be taken to achieve interoperability
Registration-Admission, Discharge, Transfer (R-ADT)
A type of administrative information system that stores demographic information and performs functionality related to registration, admission, discharge, and transfer of patients within the organization
Electronic Health Record (EHR)
An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and that can be created, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.
Meaningful Use (MU) program
An incentive program by the Health Information Technology for Economic and Clinical Health (HITECH) component of the American Recovery and Reinvestment Act (ARRA) of 2009 provided eligible hospitals and professionals with financial incentives, in terms of healthcare payment adjustments, to make meaningful use of EHRs.
-Laboratory information system (LIS) -Radiology information system (RIS) -Pharmacy information system -Others (dietary and nutrition, respiratory therapy)
Ancillary or clinical department applications include:
Value
Example of ________, when making a purchase it is desirable that what is purchased is of the highest possible quality at the lowest possible cost
Laboratory information system (LIS)
Health information system that includes hardware; software; communications and network technologies; operational and cultural adaptations that people must make to use the technologies in performing diagnostic studies on various specimens collected from patients and to apply professional judgement in evaluating the quality of the data representing the results; policies and standards from the local organization in which the system is housed as well as accrediting and licensing bodies that must be followed for design of the technology and its use; and workflow and process designs assure the most efficient and effective use of the technology
Prior approval (authorization)
Process of obtaining approval from a healthcare insurance company before receiving healthcare services
Revenue cycle management (RCM)
Refers to the entire process of creating, submitting, analyzing, and obtaining payment for healthcare services
Claim, charge capture, ancillary systems, encoder
_______ generation systems for reimbursement by a health plan (and patient) that relies on _______ to collect information about services performed from ___________________ and ____________ systems (ancillary systems support the department in which they exist
Sharing
_________ refers to the fact that the EHR, "has created a strong demand for the seamless sharing of information across technology systems, information platforms, location, provider, or other boundaries"
Value
___________ refers to the combination of quality and cost.
Knowledge
____________ is more than information.
Meaningful Use
_______________ is a term used by the federal government for the program designed to incentivize use of EHRs.
Template
a guide for documentation; a pattern used in computer-based patient records to capture data in a structured manner
Telehealth
a telecommunications system that links healthcare organizations and patients from diverse geographic locations and transmits text and images for (medical) consultation and treatment
Power users
are able to use technology to significantly improve their productivity
Administrative or financial applications
are usually managed by specific departments, such as admitting, patient financial services, and health information management
Telehealth
assist in providing remote diagnosis and treatment
Auto-analyzer
device that analyzes the specimen
Prior approval (authorization)
management systems where a health plan requires review and approval of a procedure prior to its performance
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
mandated standards for use for each transaction, such as eligibility verification, claims status inquiry, and so forth
Logical Observations, Identifiers, Names and Codes (LOINC)
mandated under the MU program to order and report lab results; as well as policy that patients may have direct access to their test results, even prior to review by their ordering provider
Unstructured data
narrative information not able to be uniquely processed by a computer; nonbinary, human-readable data
Health IT
provides the umbrella framework to describe the comprehensive management of health information and its secure exchange between consumers, providers, government and quality entities, and insurers
Data
raw facts and figures. The dates, numbers, images, symbols, letters, and words that represent basic facts and observations about people, processes, measurements, and conditions.
System
refers to all the components (technology, standards, people, policy, and process) that must work together to achieve a desired goal (interoperability)
Ancillary or clinical department applications
serve primarily to manage the department in which they exist
Barcode medication administration record (BC-MAR)
system that uses barcoding technology for positive patient identification and drug information
Form creation
systems automate some of the authorization, consent, advance directive, and other administrative forms used to manage healthcare administrative processes
Registration-Admission, Discharge, Transfer (R-ADT)
systems in hospitals that register patients for inpatient admission or outpatient services
Eligibility verification
systems to determine if a patient's health plan will provide reimbursement for services to be performed, and sometimes prior-authorization management systems where a health plan requires review and approval of a procedure (or referral) prior to performing the service
Claim attachment
systems where additional information required by the health plan to pay the claim can be sent electronically
Business intelligence (BI)
the end product or goal of knowledge management
Shared Nationwide Interoperability Roadmap
132. Shared Nationwide Interoperability Roadmap- ONC's three stage vision for interoperability; 2015-2017: Nationwide ability to send, receive, find, and use a common clinical data set; 2018-2020; Expand interoperable data, users, sophistication, and scale; 2021-2024: Broad-scale learning health system
Laboratory information system (LIS)
A _____________________ would be one that includes: Hardware, Software, Computerized provider order entry system (CPOE), diagnostic studies, Logical Observations Identifiers Names and Codes (LOINC), and workflow/process designs.
Accredited Standards Committee X12 (ASC X12)
A committee accredited by ANSI responsible for the development and maintenance of EDI standards for many industries.
Hospital Information System (HIS)
Administrative and financial systems, collectively and especially in the past when they were standalone systems, may be called __________________ and include registration-admission, discharge transfer (R-ADT) systems, patient financial systems (PFS), and form creation systems.
-Registration, admission, discharge, transfer (R-ADT) -Patient financial (PFSs) -Form creation
Administrative or financial applications are usually managed by specific departments
Operating rules
Affordable Care Act (ACA) also requires standard __________________ that further explain the standards so their use is consistent across health plan.
Diagnostic studies
All diagnostic services of any type, including history, physical examination, laboratory, x-ray or radiography, and others that are performed or ordered pertinent to the patient's reasons for the encounter
Computerized provider order entry (CPOE)
Communications and network technologies (connections between a _______________________________________, used by providers to enter orders for medications, lab tests, and other procedures, and the destination systems, such us pharmacy for medications, LIS for lab tests, billing system to capture charges for the medications and lab tests)
Information
Data processed into usable form
-Health Insurance Portability and Accountability Act (HIPAA) -Accredited Standards Committee (ASC) X12
Each transaction, such as eligibility verification, claims status inquiry, and so forth have mandated standards for use under the ___________________________________. The standards specify in what format the data should be compiled and what data should be exchanged with payers. These standards are developed by the American National Standards Institute ___________________________________.
-Person-Centered, Self-Managed -Health Care Delivery, Community Health -Research, knowledge, innovation -Health IT
Federal Health IT Strategic Plan goals: Goal 1. Advance _________ _______ and _____ ______ Health Goal 2. Transform _____ ____ _____ and _____ _____ Goal 3. Foster ______, scientific ____ and _____. Goal 4. Enhance Nations's ___________ Infrastructure
Shared Nationwide Interoperability Roadmap
Following the release of the Federal Health IT Strategic Plan, the ONC published its ______________________________________, laying out a three stage vision for interoperability
-claims data -clinical data -health reform
Increasingly there is the need to integrate ______ (that is, data documented for reimbursement purposes) with ________________ (namely, the data documented about a patient's health status and treatment) for __________________ initiatives or steps taken to make major policy changes in how providers are reimbursed for healthcare services
Claims data
Information required to be reported on a healthcare claim for service reimbursement
Billing systems
Information system that generates a bill for healthcare services performed
Patient financial system (PFS)
Information system that manages patient accounts; billing systems, eligibility verification, claims
Health Information Technology for Economic and Clinical Health (HITECH)
Legislation created to promote the adoption and meaningful use of health information technology in the United States. Subtitle D of the Act provides for additional privacy and security requirements that will develop and support electronica health information, facilitate information exchange, and strengthen monetary penalties. Signed into law on February 17, 2009, as part of ARRA.
Health IT, health information system, health IT system
Many use the term _____________ to refer to the people, policy, and process elements that must be in place for healthcare professionals to learn how to use and make the most effective use of the hardware, software, communications, and network technologies. This may also be referred to as a ______________ or ___________________.
Template, use
Nurses may enter data into nurse assessment _________ and document medication administration using the technology. This is an example of _____
Use
Often "_____" has not addressed workflow and process changes that enable intended users to seamlessly incorporate the technology into their everyday operations
Diagnostic studies
Operational and cultural adaptations necessary to use the technologies in performing ____________ on various specimens collected from patients and applying professional judgement in evaluating the quality of the data representing the results
Provider
Physician, clinic, hospital, nursing home, or other healthcare entity (second party) that delivers healthcare services
Electronic Health Record (EHR)
Prior to completion of the Federal Health IT Strategic Plan, the focus of federal government efforts in health IT was promoting use of the _______________ by organizations and providers.
Operating rules
Rules that further explain the business requirements so their use is consistent across health plans
Encoder
Specialty software used to facilitate the assignment of diagnostic and procedural codes according to the rules of the coding system
Ancillary systems
Systems that serve primarily to manage the department in which they exist, while at the same time providing key clinical data for the EHR.
Transactions
The Revenue Cycle Management (RCM) functions that exchange data between providers and health plans are referred to as _________________.
-Health Information Technology for Economic and Clinical Health (HITECH) -American Recovery and Reinvestment Act (ARRA)
The ____________________ component of the _________________ of 2009 provided eligible hospitals and professionals with financial incentives, in terms of healthcare payment adjustments, to make meaningful use of EHRs.
Learning health system
The alignment of science, informatics, incentives, and culture for continuous improvement and innovation, with best practices seamlessly embedded in the delivery process and new knowledge captured as an integral by-product of the delivery experience
Hospital Information System (HIS)
The comprehensive database containing all the clinical, administrative, financial, and demographic information about each patient served by a hospital.
Charge capture
The process of collecting all services, procedures, and supplies provided during patient care
Vision, Mission
The strategic plan consists of: -Has a _______ of high quality care, lower costs, healthy populations, and engaged people. -Has a ______ to 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.
Meaningful
The term ____________ was chosen to reflect the purposeful desire to get to the next stage of use beyond simply using the EHR as a search tool.
Power users
The user who optimizes health IT has fully embraced the standard vocabularies supported by the technology, pays attention to alerts and reminders, is able to generate various reports that meet unique needs, frequently tailors the system to further take advantage of documentation aids, and may be considered a _______________.
Business intelligence (BI)
This integration of financial and clinical data provides __________________________ that helps support business decisions by both the administrative and clinical leadership of healthcare organizations
American Recovery and Reinvestment Act (ARRA)
To assist those most impacted by the recession.
American Recovery and Reinvestment Act (ARRA)
To invest in transportation, environmental protection, and other infrastructure that will provide long-term economic benefits.
American Recovery and Reinvestment Act (ARRA)
To preserve and create jobs and promote economic recovery.
American Recovery and Reinvestment Act (ARRA)
To provide investments needed to increase economic efficiency by spurring technological advances in science and health.
American Recovery and Reinvestment Act (ARRA)
To stabilize state and local government budgets, in order to minimize and avoid reductions in essential services and counterproductive state and local tax increases.
Collection, data, information
_______ emphasizes the importance of EHRs as a primary source of ____ (raw facts and figures) and ___________ (facts and figures processed into usable form).
Office of the National Coordinator (ONC) for Health Information Technology
agency within the federal government tasked to be a resource to the nation, describes a vision and mission for US use of health information technology; The principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information. was created in 2004, through an Executive Order, and legislatively mandated in the HITECH Act of 2009
Remittance advice
an explanation of payments (for example, claim denials) made by third-party payers
Claim attachment
any of a variety of hardcopy or electronic forms needed to process a claim in addition to the claim itself, such as a copy of the emergency department
Computerized provider order entry (CPOE)
electronic prescribing systems that allow physicians to write prescriptions and transmit them electronically. These systems usually contain error prevention software that provides the user with prompts that warn against the possibility of drug interaction, allergy, or overdose and other relevant information
Knowledge
is the application of experience to information and provides value to information beyond only serving as evidence of actions taken
Optimization
is the final state that demonstrates not only effective adoption for all routine operations, but also an understanding and appropriate use of the technology's features
Health IT
refers to computer hardware, software, integrated technologies or related licenses, intellectual property, upgrades, or packaged solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or exchange of health information
Implementation
refers to technology having been installed, configured to meet the basic requirements of the healthcare organization, and demonstrated to users.
Use
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
Adoption
reflects that the organization has implemented all of the major components of technology, although there may be some available technology that is more specialized, costly, and time-consuming to implement that has not yet been implemented.
Interoperability
sharing information across EHRs and other health IT systems and the capability of different information systems and software applications to communicate and exchange data
Health reform
steps taken to make major policy changes in how providers are reimbursed for healthcare services
Source systems
supply the EHR and other applications with data -may include administrative, financial, ancillary, or departmental systems
Knowledge
the information, understanding, and experience that give individuals the power to make informed decisions
Transactions
the transmission of information between two parties to carry out financial or administrative activities related to health care
End user
those persons who will use the systems for their daily processes
Claims status inquiry and response
to determine if a health plan has a claim pending for additional information or is processing the claim
Health IT
to enable collection and processing of data into useful information; as well as the communication and network technologies that enable data and information to be exchanged across various computers
Barcode medication administration record (BC-MAR)
used by nurses to manage drug administration for patients and other procedures performed on the patient
Claims status inquiry and response
used to determine if a health plan has ended a claim for additional information or is processing the claim
Portals
windows into information systems
Use
with respect to individually identifiable health information, the sharing, employment, application, utilization, examination, or analysis of such information within an entity that maintains such information