HIMS Midterm

What are the 3 alternate payment methods (APMs)?

1) Accountable care organizations (ACO) 2) bundled payments 3) patient-centered medical homes (PCMH)

Name some unintended problems that arise from having regulations like HIPAA that require good information privacy practices.

1) Increased paperwork due to authorization and transfer documentation 2) Providers are overly cautious about transferring information due to all the potential consequences 3) Patients must fill out paper work and not call their providers which is more of a hassle and time consuming for both parties

Name some benefits from having regulations like HIPAA that require good information privacy practices.

1) Patients trust their providers more 2) Patients can legally modify their records so they can ensure their providers are documenting correctly 3) Outside sources can not get a hold of personal information

What are the barriers to interoperability?

1) States have different laws and regulations 2) health information is not standardized 3) payment incentives are not aligned to support interoperability 4) privacy laws differ and are misinterpreted 5) lacj of trust among health care providers and consumers

Weiskopf & Weng EHR data quality demensions

1) completeness 2) correctness 3) concordance 4) plausibility 5) currency

What are the barriers to usabilty with the EHR?

1) confusing displays 2) iconography that lacks consistency and intuitive meaning 3) do not support clinician's cognitive workflow 4) data entry is time-consuming

Data quality characteristics

1) data accuracy 2) data accessibility 3) data comprehensiveness 4) data consistency 5) data currency 6) data definition 7) data granularity 8) data precision 9) data relevancy 10) data timeliness

What are the two main sources of missing EHR data?

1) data were not collected 2) documentation was not complete

Common patient record content

1) identification screen 2) problem list 3) medication record 4) history and physical 5) progress notes 6) consultation 7) physician's orders 8) imaging and x-ray reports 9) lab results 10) consent and authorization forms 11) operative report 12) pathology report 13) discharge summary

What are the core PHM core processes?

1) identifying, assessing, stratifying, and selecting target populations 2) providing high-quality care and care management interventions across a continuum 3) managing contracts and financial performance 4) measuring, predicting, and improving performance 5) preparation and automation

What are the "triple aims" to help create healthcare reform as stated in the ACA 2010?

1) improve the patient experience of care 2) improve the health of populations 3) reduce per capita cost of health care

The transformation of healthcare business model and payment mechanisms (volume to quality) is causing what types of challenges for health leaders?

1) keeping patients well and managing and preventing disease 2) establishing more efficient organziation and utilization of care teams and venues of care 3) creating a culture that is comfortable with change and ongoing automation 4) engaging patients in managing their care and overall health 5) ensuring the most cost-effective care is provided and clinical processes are streamlined and follow the best evidence

What should organizations minimially include to build a PHM strategy?

1) know, characterize, and predict the health trajectory that will happen within a population 2) engage members, families, and care providers to take action 3) manage outcomes to improve health and care

What are types of clinical information systems?

1) lab information 2) radiology information 3) pharmacy information 4) nursing documentation 5) EHR 6) CPOE 7) Telemedicine 8) rehabilitation service documentation 9) medication administration

What are the benefits of implementing patient-centered medical homes (PCMH)?

1) lower Medicare spending 20 more effective care management and optimized use of healthcare services 3) improved care management and preventative screenings for cardiovascular and diabetes patients 4) reduced socioeconomic disparities in cancer screening

Five areas of analysis where providers are being held more accountable for the care deliver to a patient/population

1) population management analytics 2) provider profiling/physician performance analytics 3) point of care health gap analytics 4) disease management 5) cost modeling

Q2 What are the major benefits of EHR systems?

1) quality, outcomes, and safety 2) efficiency, improved revenues, and cost reduction 3) proivder and patient satisfaction

Three major benefits/impacts of EHR systems

1) quality, outcomes, and safety 2) efficiency, improved revenues, and cost reduction 3) provider and patient satisfcation

ONC Roadmap to Interoperability states the following work needs to be done for interoperability success:

1) requiring standards 2) motivating the use of those standards through appropriate incentives 3) creating a trust environment for collecting, sharing, and using electronic health information

Advantages of EMRs

1) track data over time 2) easily identify which patients are due for preventive screenings or checkups 3) check how patients are doing on certain parameters 4) monitor and improve overall quality of care within the practice

Health IT safety framework states that the major categories of safety error are the result of:

1) unmet display needs 2) software modifications 3) system-to-system interfacing 4) hidden dependencies on distributed systems

Data warehouse

Also called clinical repositories. Data comes from a variety of sources, extracted and cleaned, then stored in a structure that enables data to be accessed along multiple dimensions.

Information system (IS)

An arrangement of data (information), processes, people, and information technology that interact to collect, process, and provide as output the information needed to support the organization

Health Information blocking

Biggest barrier to interoperability. When persons or entities knowingly and unreasonably interfere with the exchange or use of electronic health information

Knowledge

Combination of rules, relationships, and experiences that can be used for decision making

Minicomputers

Computers that came from the first HIT vendors. Smaller, more powerful than the mainframe computers and available at a cost that could be justified.

Q1 Which of the following is the biggest barrier to health information technology? -Technology -Incentive programs -Health information blocking -None of the above

Health information blocking

HCPCS

Healthcare common procedure coding system. Codes used for ambulances and DME.

Health information

Processed health data

Interoperability

The ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user

Health data

The raw health care facts, stored as characters, words, symbols, statistics, etc. that are not useful in decision making

Q1 Which of the following is NOT considered one of the "three Vs" of big data? -Validity -Volume -Variety -Velocity

Validity

What are the types of administrative information systems?

1) admission, discharge, transfer (ADT) 2) registration 3) staff scheduling 4) patient billing 5) utilization management 6) accounts payable 7) general ledger 8) personnel managment 9) materials management 10) payroll 11) staff and time attendance 12) revenue cycle management

AMA suggests that health IT safety requires the following:

1) building systems using-centered design principles with adequate testing and stimulation 2) embedding safety considerations throughout the implementation process 3) developing and publishing best practices 4) having accreditation agencies assume a significant role in testing as part of their accreditation criteria 5) focusing on shared learning and transparency 6) creating a nonpunitive environment for reporting

Accountable care and the move to population health management will require industry perspectives and health care delivery practices to shift from:

1) care providers working independently to collaborative teams of providers 2) treating individuals when they get sick to keeping groups of people healthy 3) emphasizing volumes to emphasizing outcomes 4) maximizing resources to applying appropriate levels of care at the right place 5) offering care at centralized facilities to providing care at sites convenient to patients 6) treating all patients the same 7) avoiding the sickest chronically ill patients to providing special chronic care services 8) being responsible for those who seek services to be responsible for the needs to of the community 9) putting forth best efforts to becoming high-reliability organizations

What are the 4 basic functionalities of a consumer-managed PHR? (by Ford and colleagues)

1) communicate electronically using secure messaging 2) access patient education materials on the internet 3) generate health data into their providers' EHRs 4) view, download, and transmit their provider-managed EHRs

Q2 What are the features of a patient portal?

1) complete forms online 2) schedule appointments 3) communicate with providers 4) request refills on prescriptions 5) review test results 6) pay bills

Meaningful use was created to use EHRs as a strategy to improve the nation's health outcome polity priorities:

1) improve health care quality, safety, and efficiency, and reduce health disparities 2) engage patients and families in their health care 3) improve care coordination 4) improve populations and public helath 5) ensure adequate privacy and security of PHI

Q2 The 1990s technological advances include:

1) internet and WWW 2) email

Q2 Despite proliferation in the adoption and use of EHR systems, health care providers and organizations still face what critical issues?

1) interoperability 2) usability 3) health IT safety

What are the key issues in the adoption and use of EHR systems?

1) interoperability 2) usability 3) health IT safety

HIPAA defines health information as an information that...

1) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school, or health care clearinghouse 2) relates to the past, present, or future physical or mental health condition of an individual, the provision of care to the individual, or the past/present/future payment of health care

AMA key recommendations of enhancing usbaility:

1) usability and human factor research 2) policy recommendations 3) industry recommendations 4) clinical end user recommendations

What are some ACO challenges?

1) working across organizational boundaries 2) building requisite infrastructure for effective data sharing 3) engaging patient in the care process 4) alignment and consolidation of all the various quality measures 5) measurement fatigue 6) increasing administrative burden 7) quality metrics not accurately measuring the overall health of the patient

ONC Nationwide Interoperability Roadmap

10-year plan for achieving HIT interoperability in the US. The ultimate goal is in 2024 stating "a learning health system enabled by nationwide interoperability"

Q2 In which decade did Medicare shift from a cost-based reimbursement system to a prospective payment system based on DRGs?

1980s

Q2 Which type of information system is used to manage personnel, finances, materials, supploes, or equipment?

Administrative information system

Q1 HIPAA, signed into law in 1996, was designed primarily to: -Make health insurance more affordable -Simplify administrative processes -Protect the security and confidentiality of personal health information -All of the above

All of the above

Q1 Which of the following describes protected heath information? -Oral or recorded in any form or medium -Created or received by a health care provider, health plan, public health authority, employer, life insurer, school/university, or health care clearinghouse -Related to past, present, or future physical or mental health or condition of an individual -All of the above

All of the above

Q1 Which of the following is one of the five areas of analysis that is crucial for holding providers accountable for the care delivered to patients? -Population management -Disease management -Cost modeling -All of the above

All of the above

Q1 Which of the following would help reduce errors during data collection and processing? -Standardize data entry fields -Institution real-time quality checking -Building human capacity -All of the above

All of the above

Q1 Using an abbreviation that has two different meanings is an example of a lack of: -Data comprehensiveness -Data definition -Data consistency -Data precision

Data consistency

Information technology (IT)

Describes the combination of computer technology (hardware and software) with data and telecommunications technology (data, image, voice networks)

Data dictionary

Descriptive list of names, definitions, and attributes of data elements to be collected in an information system or database

Electronic medical records (EMR)

Digital version of paper charts. Contains medical and treatment history of the patients in one practice.

Computer-based patient record (CPR)

Electronic patient record that resides in a system specifically designed to support users by providing accessibility to complete and accurate data, alerts, reminders, clinical decision support systems, links to medical knowledge, and other aids

Computerized provider order entry (CPOE)

Electronic prescription orders in the EHR that provide decision-level support tools, such as reminders, alerts, and access to evidence-based guidelines

Care management systems

Enable proactive surveillance, automation, coordination, and facilitation of services for many different subpopulations across the continuum of care

Q1 Health care data and health care information are synonymous and can be used interchangeably. T/F

False

National center of health statistics (NVHS)

Federal agency responsible for publishing ICD-10-CM codes

Health Information Technology for Economic and Clinical Health (HITECH) 2009

Federal support of the adoption and meaningful use of EHRs and other HIT to improve health care

Mainframe computers

First information systems in that were created in-house in large hospitals.

Key difference between a basic EHR system and a fully functional EHR system?

Full EHRs provide order entry capabilities and decision-support capabilities

Q1 Which of the following NOT a component of the HITECH Act? -Establishing Medicare and Medicaid EHR Incentive Programs -Establishing value-based incentive programs -Funding regional extensions centers to support providers in adopting and becoming meaningful users of EHRs -Funding for workforce training programs to support the education of HIT professionals

Funding for workforce training programs to support the education of HIT professionals

Q2 Which law made incentive money available for eligible professionals and hospitals to adopt and become "meaningful users"?

HITECH Act of 2009

Patient health information (PHI)

Identifiable health information

Q1 Which of the following is NOT one of the "triple aims" for the US health care delivery system? -Improve the patient experience of care -Improve the health of populations -Improve communication between providers -Reduce per capita cost of health care

Improve communication between providers

Administrative information system

Information system that contains administrative or financial data and is used to support the management functions and general operations

Clinical information system

Information system that contains clinical or health-related information used by providers in diagnosing and treating a patient and monitoring that patient's care

ICD-10-CM

International classification of diseases. Codes diseases and health statuses. Used to determine DRGs.

Q1 ____ is defined as the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user. -Coordination of Care -Meaningful Use -Integration -Interoperability

Interoperability

History of HIT during the 1960s and 1970s

Investments were primarily made in administrative and financial information systems that could automate patient billing and facilitate accurate Medicare cost reporting

Medicare Modernization Act 2003

Law that added to the legal adoption of CPRs, by mandating the use of e-prescribing in health plans

What organization has to accredit primary care practices to be titled a PCMH?

National Committee for Quality Assurance (NCQA)

Accountable care organization (ACO)

Networks of health care providers that share responsibility for coordinating care and meeting health care quality and cost metrics for a defined patient population

Q1 Which entity was charged with providing leadership for the development and nationwide implementation of an interoperable health information technology infrastructure? -ONC -CMS -IOM -None of the above

ONC

Microcomputer

Or the personal computer (PC). Helped smaller hospitals have the same computing capabilities as large hospitals. Allowed the sharing of information between other microcomputers. Turning point in the use of health care information systems. Effected reimbursement practices.

Pay-for-performance (P4P)

Or value-based care, that reimburses providers based on meeting predefined quality measures

Office of the National Coordinator for Health Information Technology (ONC) 2004

Organization charged with providing leadership for the development and nationwide implementation of interoperable HIT infrastructure to improve the quality and efficiency of health care, by giving oversight to EHR adoption and health information exchanges

Current procedural terminology (CPT)

Procedure codes. Published and maintained by the AMA. Used in the physician office, outpatient, and ambulatory care coding.

Office of Inspector General (OIG)

Publishes compliance guidelines to ensure healthcare entities adhere to ethical and legal coding procedures. Investigates fraud.

Electronic health records (EHR)

Record that focuses on the total health of the patient, beyond the clinical data collected by the provider. Built to share info with other heath care providers.

IOM report: The computer-based patient record: An Essential Technology for Health Care

Report that brought international attention to problems in the paper-based medical record and called for CPR adoption by 2001

Patient portal

Secure website through which patients may communicate, review test results, or pay bills

Episode of care

Services provided to a patient with a specific condition for a specific period of time

Database

Structured, accessible set of data stored electronically in one place

Continuum of care

System that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity of care

Workflow and rules engines

Technology that presents clinicians with alerts and reminders, but also encourages teamwork in clinical decisions, assisting with the time management and task allocation in process delivery, stating changes in patient or operational conditions, and creating behind-the-scenes automation or process steps

Stratification

The ability to identify a patient or cohort at risk for a negative health event or preventable health care utilization. Identifying subpopulations of patients who might benefit from additional services.

Data quality management

The business processes that ensure the integrity of an organization's data during collection, application, warehousing, and analysis

Patient-centered medical home (PCMH)

The central role of primary care and care coordination, with the vision that every person should have the opportunity to easily access high-quality primary care in a place that is familar and knowledgeable about his or her health care needs and choices

Usability

The effectiveness, efficiency, and satisfaction with which the intended users can acheive their tasks in the intended context to produce use

Care management

The patient-centered management and coordination of care events and activities in multiple care settings by one or more providers. The aim is to manage the most complex patients through the health care system, as well as managing the overall health of a select population.

Population health management (PHM)

The proactive application of strategies and interventions to defined groups of individuals to improve the health of individuals within the group at the lowest cost

Personal health record (PHR)

Tool to collect, track, and share past and current information about your health or the health of someone in your care. Not the same as a health record and is not a legal document of care.

Q1 Which of the following best defines continuum of care? -Services provided for a specific condition for a specific period of time -Tracks patients over time through a comprehensive array of health services -Improves health outcomes within defined communities -None of the above

Tracks patients over time through a comprehensive array of health services

Q1 A database refers to only large structured, accessible data sets that are stored electronically. T/F

True

Q1 Electronic medical records (EMRs) are a digital version of the paper charts within one practice whereas electronic health records (EHRs) have all those capabilities but are equipped to communicate and share information with other providers. T/F

True

Q2 In the 1960s and 1970s, health care executives invested primarily in administrative and financial systems. T/F

True

What are the "three V's" of big data?

Volume, variety, velocity