Week 4, Chapter 13

8/8/2019 Week 4, Chapter 13

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Chapter 13

Management of Information in

Healthcare Organizations


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Healthcare organizations (HCOs)

Any business organization, such as aphysicians practice, hospital, or health

maintenance organizations, that providescare to patients.


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Healthcare information system

(HCIS)An information system used within a

healthcare organization to facilitate

communication, to integrate information, todocument health care interventions, toperform record keeping, or otherwise tosupport the functions of the organization


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Challenges of Sharing data

components purchased from differentvendors

No national standards among products Systems created for specific users only

Different programming languages


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Development to improve sharing

data1. Development of the Interface Engine, acomputer system that translates andformats data for exchange between

independent (sending and receiving)computer systems.

2. Creation of the HL7, healthcare-based

initiative, to develop standards for thesharing of data among individualsystems.


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President ObamasSummary of American Recovery and

Reinvestment Plan

Scientific Research:

$2 billion in biomedical research, 1.5 million forexpanding good jobs involving biomedical

research to study Alzheimers, Parkinsons,cancer, and heart disease.

$900 million to prepare for pandemic influenza,support advanced development of medical

countermeasures for chemical, biological,radiological and nuclear threats and for cybersecurity protection at HHS.


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PRESIDENT OBAMASSUMMARY OF AMERICAN RECOVERY AND

REINVESTMENT PLAN

LOWER HEALTHCARE COSTS: TO SAVE NOT ONLY JOBS, BUTMONEY AND LIVES, WE WILL UPDATE AND COMPUTERIZEOUR HEALTHCARE SYSTEM TO CUT RED TAPE, PREVENT

MEDICAL MISTAKES, AND HELP REDUCE HEALTHCARECOSTS BY BILLIONS OF DOLLARS EACH YEAR

Health Information Technology: $20 billion to jumpstart efforts tocomputerize health records to cut costs and reduce medical errors.


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Regional Health Information

Network (RHIN)Also referred to sometimes as organization

rather than network (RHIN)

RHIN-A public-private alliance among healthcare providers, pharmacies, public healthdepartments, and payers, designed toshare health information among all health

participants thereby improvingcommunication health and health care.


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National Health Information

InfrastructureNHII- A comprehensive knowledge based

network of interoperable systems (RHIN)of clinical, public health, and personalhealth information that is intended toimprove decision making by making healthinformation available when and where it is

needed.


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Utahs RHIO: UHIN In operation since 1993

Governor Leavitts Health Print

Statewide value added network

Community-based; inclusive Community standards

Not-for-profit

Self-sustaining Began with what members thought would

bring the most value: Claims


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Clinics

UHIN today

DOH

Payers

Clearinghouse

Other orgs

Payers

Banks

CliniciansHospita

ls

Laboratories

Clinicians

ProviderBilling

Services

Payers

Clinicians

Clinics

Hospitals

Integrated health

care system

Clearinghouse

UHIN

Gateway


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UHINs RHIO Vision

Goal: Create a sustainable business

Begin with direct messages where thereceiver is known

Discharge

summary

Easier to bring value to end user

ADOPTION!


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Challenges with moving to EMR

within a facility Paper environment

Cost

Change/training requirement HIPAA


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Davis Hospital IASIS Challenge

1. ILE Component of the EMR

low-volume scanning application

Condition of admission HIPAA Privacy

Insurance card

Drivers license


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2. HED, component of the EMR

Nursing documentation

Patient history Flowsheets

Vitals

Medication record assessments


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3. DCS/QCI, component of the EMR

High-volume scanning application

All records that are not electronicallyentered (records from otherfacility,physician office)


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4. Dictaphone, component of the EMR

Transcription

Dictated reports


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5. STAR, component of EMR

Contains MPI

Ordering systems for labs/radiology Result systems for labs/radiology


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6. MD Portal, component of the EMR

Record viewing application

Web-based Clinical use

Current status of patient

Trending Completion of Charts (Physician use)


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Davis Hospital HIM function

How will components interface with the HPF,Component of the EMR

Record viewing application Queues

Deficiencies (HIM)

Adjust images


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Davis Hospital Challenge

ILE

STAR

DCS

MD Portal

HED

Dictaphone


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Mountainside Medical Center

See text on pg 493


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HCOs Operational Informationneeds

1. Operational requirements

2. Planning requirements

3. Communication requirements4. Documentation and reporting

requirements


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Operational requirements

Required detail and up-to-date factualinformation. (bread & butter of theinstitution)


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Planning Requirements

Short and long term decisions about patientcare. Clinical decision making. High-quality care.


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Communication requirements

Communication among caregivers,multiple personnel, business units.


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Security & ConfidentialityRequirements

1. Designated Security officer

2. Train employees so they understand theappropriate uses of patient-identifiable

information and the consequences of violations3. Use electronic tools such as access controls

and information audit trails not only todiscourage misuse of information, but to teach

employees and patients that people whoaccess confidential information can and will betracked and held accountable.


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HIPAA Security standards &Implementation Specifications

Pg 488 of text

1. Administrative safeguards

-security management process (riskanalysis)

-Assigned security responsibility

-workforce security (authorization)-security awareness and training


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Administrative safeguards cont.

-Security Incident Procedures

-Contingency plan

-EvaluationBusiness Associate Contracts &Arrangements


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2. Physical Safeguards

-Facility Access Controls (Access controls& validation procedures)

-Workstation use-workstation security

-Device and media controls


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Intranet vs Internet

Intranet is a private corporate network that

uses the same structures as the Internet.Internet a global network of networks,

connecting innumerable smaller networks,computers, and users.

How do we protect our intranet?


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Ways of Protecting Information

A firewall is either the program or thecomputer it runs on, usually an Internetgateway server, that protects the

resources of one network from users fromother networks. Typically, an enterprisewith an intranet that allows its workersaccess to the Internet will want a firewall to

prevent outsiders from accessing its ownprivate data resources.


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Firewall example

internet firewallHome network

blocker


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EncryptionEncryption is the process of encoding information in such a way that only theperson (or computer) with the key can decode it.

What would you want encrypted? NameAddress

Credit card numberSocial security numberBank account informationHealth information

Computer encryption is based on the science ofcryptography, which has beenused throughout history. Before the digital age, the biggest users ofcryptography were governments, particularly for military purposes. Theexistence of coded messages has been verified as far back as the RomanEmpire. But most forms of cryptography in use these days rely on computers,simply because a human-based code is too easy for a computer to crack. Mostcomputer encryption systems belong in one of two categories:Symmetric-key encryption

Public-key encryption


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F ti & C t f th


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Functions & Components of theHealthcare Information System

(HCIS)

Patient Management & Billing

-Master patient index (MPI)-the module of ahealth care information system used to identify apatient uniquely within a system. The MPIstores patient identification information, basicdemographic data, and basic encounter-leveldata such as dates and locations of service.


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Functions & Components of theHealthcare Information System

Admission-discharge-transfer: Onecomponent of a hospital informationsystem that maintains and updates thehospital census, including bedassignments of patients.


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Functions & Components of the

Healthcare Information System

Care DeliveryOrder Entry: online entry of orders for drugs,

laboratory tests, and procedures, usually bynurse or physician.

Results reporting: online access to results oflaboratory tests and other procedures.

ClinicalPathways: Disease-specific plan thatidentifies clinical goals, interventions, andexpected outcomes by time period.


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Functions & Components of the HealthcareInformation System

Financial & Resource Management

Electronic data interchange (EDI): Electronicexchange of standard data transactions, such asclaims submissions and electronic funds

transfer.Contract-management system: A computer

system used to support managed carecontracting by estimating the costs and

payments associated with potential contractterms and by comparing actual with expectedpayments based on contract terms.


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Functions & Components of the HealthcareInformation System

Financial & Resource Management

Provider-profiling systems: computer systemused to manage utilization of health resourcesby tracking and comparing physicians resource

utilization (e.g. cost of drugs prescribed, labtests ordered) compared to severity-adjustedoutcomes

Patient triage: A computer system that helps

health professionals to classify new patients anddirect them to appropriate health resources

Week 4, Chapter 13

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