Chapter 13

Management of Information in Healthcare Organizations

Healthcare organizations (HCOs)

Any business organization, such as a physician’s practice, hospital, or health maintenance organizations, that provides care to patients.

Healthcare information system (HCIS)

An information system used within a healthcare organization to facilitate communication, to integrate information, to document health care interventions, to perform record keeping, or otherwise to support the functions of the organization

Challenges of Sharing data

• components purchased from different vendors

• No national standards among products

• Systems created for specific users only

• Different programming languages

Development to improve sharing data

1. Development of the Interface Engine, a computer system that translates and formats data for exchange between independent (sending and receiving) computer systems.

2. Creation of the HL7, healthcare-based initiative, to develop standards for the sharing of data among individual systems.

President Obama’s Summary of American Recovery and

Reinvestment Plan

Scientific Research:• $2 billion in biomedical research, 1.5 million for

expanding 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 cyber security protection at HHS.

PRESIDENT OBAMA’S SUMMARY OF AMERICAN RECOVERY AND

REINVESTMENT PLAN

LOWER HEALTHCARE COSTS: TO SAVE NOT ONLY JOBS, BUT MONEY AND LIVES, WE WILL UPDATE AND COMPUTERIZE OUR HEALTHCARE SYSTEM TO CUT RED TAPE, PREVENT MEDICAL MISTAKES, AND HELP REDUCE HEALTHCARE

COSTS BY BILLIONS OF DOLLARS EACH YEAR

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

Regional Health Information Network (RHIN)

Also referred to sometimes as organization rather than network (RHIN)

RHIN-A public-private alliance among health care providers, pharmacies, public health departments, and payers, designed to share health information among all health participants thereby improving communication health and health care.

National Health Information Infrastructure

NHII- A comprehensive knowledge based network of interoperable systems (RHIN) of clinical, public health, and personal health information that is intended to improve decision making by making health information available when and where it is needed.

Utah’s RHIO: UHIN• In operation since 1993

– Governor Leavitt’s 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

Clinics

UHIN today

DOH

Payers

Clearinghouse

Other orgs

Payers

Banks

Clinicians Hospitals

Laboratories

Clinicians

ProviderBilling Services

Payers

Clinicians Clinics

Hospitals

Integrated health care system

Clearinghouse

UHIN Gateway

UHIN Gateway

UHIN’s RHIO Vision• Goal: Create a sustainable business

• Begin with direct messages where the receiver is known

Discharge summary

• Easier to bring value to end user

• ADOPTION!

Clinics

One connection gets you all needed messages

DOH

Payers

Clearinghouse

Other orgs

PBM

Payers

Banks

Pharmacies

Providers Hospitals

Laboratories

Clinicians

RxHub

PBM

ProviderBilling Services

Pharmacies

Pharm Hub

Payers

Clinicians Clinics

Hospitals

Integrated health care system

NHIO

RHIO

RHIO

Clearinghouse

(UHINet)(UHINet)

Challenges with moving to EMR within a facility

• Paper environment

• Cost

• Change/training requirement

• HIPAA

Davis Hospital IASIS Challenge

1. ILE Component of the EMR

• low-volume scanning application

• Condition of admission

• HIPAA Privacy

• Insurance card

• Drivers license

Davis Hospital IASIS Challenge

2. HED, component of the EMR

• Nursing documentation

• Patient history

• Flowsheets

• Vitals

• Medication record

• assessments

Davis Hospital IASIS Challenge

3. DCS/QCI, component of the EMR

• High-volume scanning application

• All records that are not electronically entered (records from other facility,physician office)

Davis Hospital IASIS Challenge

4. Dictaphone, component of the EMR

• Transcription

• Dictated reports

Davis Hospital IASIS Challenge

5. STAR, component of EMR

• Contains MPI

• Ordering systems for labs/radiology

• Result systems for labs/radiology

Davis Hospital IASIS Challenge

6. MD Portal, component of the EMR

• Record viewing application

• Web-based

• Clinical use

• Current status of patient

• Trending

• Completion of Charts (Physician use)

Davis Hospital HIM function

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

• Record viewing application

• Queues

• Deficiencies (HIM)

• Adjust images

Davis Hospital Challenge

ILE

STAR

DCS

MD Portal

HED

Dictaphone

Mountainside Medical Center

See text on pg 493

HCO’s Operational Information needs

1. Operational requirements

2. Planning requirements

3. Communication requirements

4. Documentation and reporting requirements

Operational requirements

Required detail and up-to-date factual information. (bread & butter of the institution)

Planning Requirements

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

Communication requirements

• Communication among caregivers, multiple personnel, business units.

Documentation and reporting requirements

Need/requirement to maintain records for future reference or analysis and reporting. Legal health record

HIPAA Acronyms

HIPAA: Health Insurance Portability and Accountability Act

TPO: Treatment, payment, and operations

PHI: Protected health information

Security & Confidentiality Requirements

1. Designated Security officer2. Train employees so they understand the

appropriate uses of patient-identifiable information and the consequences of violations

3. Use electronic tools such as access controls and information audit trails not only to discourage misuse of information, but to teach employees and patients that people who access confidential information can and will be tracked and held accountable.

HIPAA Security standards & Implementation Specifications

Pg 488 of text

1. Administrative safeguards

-security management process (risk analysis)

-Assigned security responsibility

-workforce security (authorization)

-security awareness and training

Administrative safeguards cont.

-Security Incident Procedures

-Contingency plan

-Evaluation

Business Associate Contracts & Arrangements

2. Physical Safeguards

-Facility Access Controls (Access controls & validation procedures)

-Workstation use

-workstation security

-Device and media controls

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?

Ways of Protecting Information

A firewall is either the program or the computer it runs on, usually an Internet gateway server, that protects the resources of one network from users from other networks. Typically, an enterprise with an intranet that allows its workers access to the Internet will want a firewall to prevent outsiders from accessing its own private data resources.

Firewall example

internet firewall Home network

blocker

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

What would you want encrypted?• Name•Address•Credit card number•Social security number•Bank account information•Health information

Computer encryption is based on the science of cryptography, which has been used throughout history. Before the digital age, the biggest users of cryptography were governments, particularly for military purposes. The existence of coded messages has been verified as far back as the Roman Empire. 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. Most computer encryption systems belong in one of two categories: Symmetric-key encryption Public-key encryption

Understand your Threat & Risk Assessment at your facility

3. Technical Safeguards

-Access controls (audit trails)

-Integrity

-Personal authentication

-Transmission Security (integrity controls, encryption)

Functions & Components of the Healthcare Information System

(HCIS)

Patient Management & Billing

-Master patient index (MPI)-the module of a health care information system used to identify a patient uniquely within a system. The MPI stores patient identification information, basic demographic data, and basic encounter-level data such as dates and locations of service.

Functions & Components of the Healthcare Information System

Admission-discharge-transfer: One component of a hospital information system that maintains and updates the hospital census, including bed assignments of patients.

Functions & Components of the Healthcare Information System

Care DeliveryOrder Entry: online entry of orders for drugs,

laboratory tests, and procedures, usually by nurse or physician.

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

Clinical Pathways: Disease-specific plan that identifies clinical goals, interventions, and expected outcomes by time period.

Functions & Components of the Healthcare Information System

Care DeliveryClinical decision-support system: a computer-

based system that assists physicians in making decision about patient care.

Computer based physician order entry: A clinical information system that allows physicians and other clinicians to record patient-specific orders for communication to other patient care team members and to other information systems (such as test orders to lab systems or medication orders to pharmacy systems).

Functions & Components of the Healthcare Information System

Financial & Resource Management

Electronic data interchange (EDI): Electronic exchange of standard data transactions, such as claims submissions and electronic funds transfer.

Contract-management system: A computer system used to support managed care contracting by estimating the costs and payments associated with potential contract terms and by comparing actual with expected payments based on contract terms.

Functions & Components of the Healthcare Information System

Financial & Resource Management

Provider-profiling systems: computer system used to manage utilization of health resources by tracking and comparing physicians’ resource utilization (e.g. cost of drugs prescribed, lab tests ordered) compared to severity-adjusted outcomes

Patient triage: A computer system that helps health professionals to classify new patients and direct them to appropriate health resources