HCS/533

Julie Bentley

July 20, 2015

Jane Ferraris

Administrative Structure For Clinical

Documentation- How Data is Captured

Impact on the Delivery of Health Care

• Helps the initiative of the National Health Service to be “paperless before 2018 (Carlisle, 2013).

• Allows the administrative data to be used for benchmarking and used as Evidence based decision strategic support for competitive comparison among health care facilities and outpatient health care needs (Wager, 2013).

• ICD-10-CM and ICD-10-PCS codes are captured and then sent to Accounting and Billing using new innovative “Accu-Sure” technology using accurate billing for accurate disease process captured in clinical documentation.

• Reimbursement approvals and denials evaluated with administration.

• Quality and value measurement assessment for improved patient care.

1. Sets Vision and Strategy

2. Integrates information technology for business success.

3. Makes change happen

4. Builds technological confidence.

5. Partners with customers.

6. Ensures information technology talent.

7. Builds networks and community (CHIME, 2008)

Impact of Future Evolutions

The Administrative Safeguards section of The Final Rule of HIPAA Security Rule has nine (9) standards which are listed below and will have implications on the data capturing of Shaw Heart Center.1. Security Management Functions - (Risk Analysis, Risk

Management, Sanction Policies, Information System Activity Reviews by IT and Security Department)

2. Assigned Security Responsibility – The Chief Engineer identifies individual responsible for overseeing security policies and procedures.

3. Workforce Security – employee’s have access and non-employee’s have no access (Authorization and/or supervision, workforce clearance procedure, termination procedure for loss of job) (Wager, 2013).

Implications of Privacy and Security Management on Administrative Structures

4. Information Access Management – authorizes access to health care clearinghouses, and health care organizations (Access organization, Access establishment and modification).

5. Security awareness and training – implementation of awareness and training programs for all members of workforce.

6. Security Incident Reporting – implementation of policies and procedures to address security incidents.

7. Contingency Plans – Data Backup, Disaster Recovery Plan, Emergency Mode Operational Plan, Testing and Revision Procedures, Applications and data criticality analysis.

8. Evaluation – Periodic performance of technical and nontechnical evaluations in response to changes.

9. Business Associate Contracts and other Arrangements – formal agreement needed.

Implications of Privacy and Security Management on Administrative Structures - Part 2

1. Planning and Analysis - exam current problems, organizational strategy, identify opportunity for improvement (Wager, 2013).

2. Design - evaluation of alternative solutions to address what is needed, cost-benefit analysis done, system is selected, vendor negotiations finalized, built-in-house system plans finalized (Wager, 2013).

3. Implementation – significant allocation of resources for training of staff, converting data, preparation for go-live date (Wager, 2013).

4. Support and Evaluate - longest phase of life cycle. Sufficient resources needed, glitches fixed, and upgrades determined (Wager, 2013).

Steps in the System Development Life Cycle of the Administrative Structure (SDLC)

• Training will occur with 2-3 Super-Users per Department which will happen 6 months prior to Go-live date of February 2016. These Super-Users will be staff from the Department that has expressed an interest in learning the new administrative information technology system, and who wish to be a resource for staff in the department. Suggestion is a 1.0 FTE employee.

• Training will then be provided at the facility with a training pool. Page for access before, during, and after Go-Live Date of February 1, 2016.

• Training Dates: September 1-30, 2015 – 6 months prior

October 1-20, 2015 – 5 months prior

December 1-17, 2015 – 3 months prior

January 10, 20, 2016 - 1 month prior

February – all month long – Go-Live Date -everyday

assistance. (ext.4500)

Training of the Staff

1. Information Technology Department and IT Staff – weekly, monthly, then progressing to every 3-6 months, then yearly.

2. Software Updates and Upgrades – monthly, and every 6 months.

3. Hardware Upgrades – Price allotment per Department on yearly report. Upgrades and purchase from this yearly Department allotment.

4. Personnel and Staff - maintenance and continued IT training for staff when issues arise for 100% use for Departments on weekly and monthly reports.

Maintenance Components

The Data from the Administrative Structure is used for:

• Evidence Based Research for continued improvement.

• Administrative Structure Progression

• Creation and Innovation of proper ICD-10 coding and reimbursement for Health Care Facility.

• Creation of Decision Support for Clinicians at Point-of-care.

• Research and Development at Educational Medical Facilities.

How Is the Data Used ?

• Reimbursement is within 30-60 days of receipt of bill.

• Parameters chosen that reflect the measure of the customer encounter and value of care (on-line or mail questionairre).

• Provision of electronic copy of health information to patient.

• CPOE (Computer Physician Order Entry) is established and integrated inpatient and outpatient.

• Ensuring privacy and security of personal health information.

• Improvement of population and public health in city where health services are rendered.

• Clinical diagnosis is within 12 hours of inpatient admission and within 18 hours of outpatient visits. (This will allow automatic billing and reimbursement to fit ICD-10 codes)

How Can the Quality Be Assured

Four measurement tools to evaluate Administrative Structure Analysis:

1. Net Present Value – cash generated or saved in next 3 years over initial IT investment (Wager, 2013).

2. Internal Rate of Return – At present value of IT system investment what percentage am I receiving back? (Wager, 2013)

3. Reimbursement denials decreased by 90%.

4. 100% compliance on CPOE diagnosis entries from all providers.

Evaluation of Effectiveness

Currently at this time Hardware is being changed and updated to accommodate the new Administrative Structure Data Capturing Tool for the capture of the Clinical Documentation Diagnosis. These will continue to be evaluated so the hardware is compatible and updated.

Please contact the IT department at ext. 8600 for hardware and software updates. Email’s will be sent to the unit managers for continued communication.

Hardware Issues

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Questions?

Carlisle, D. (2013). Time for Tech to Grow Up. The Health Service Journal. 123(6368) Suppl. 6-7. Retrieved from http://

search.proquest.com/docview/1492870405?accountid=35812

Mihalas, G. I. (2014, February). Evolution of Trends in European Medical Informatics.  ACTA INFORM MED, 22(1), 37-43.

10.5455/aim2014.22.37-43

Reddy, M., Pratt, W., & Dourish, M. (2011, May). Special Issue on Supporting Collaboration in Healthcare Settings: The

Role of Informatics. International Journal of Medical Informatics, 42(80), 541-543. Retrieved from http://www.ijmijornal.

com

Wager, K.A., Lee, F.W., & Glaser, J.P. (2013) Health Care Information Systems: A Practical Approach for Health Care

Management (3ed ed.). San Francisco, CA: Jossey-Bass.

References