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Introduction to Healthcare Information Technology

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Presentation on theme: "Introduction to Healthcare Information Technology"— Presentation transcript:

1 Introduction to Healthcare Information Technology
Chapter Six Document Imaging and Problem Solving

2 Objectives Describe frequently used healthcare image file types and their characteristics Identify medical interface components Explain the interface diagnosis process Describe the clinical software troubleshooting process Explain the need for and use of change control in the clinical environment

3 Healthcare IT: Challenges and Opportunities
Recent study results: Fewer than two percent of hospitals employ a comprehensive EHR system Challenges to integration of an EHR system Interfacing dissimilar systems Example: x-rays produce images on cellulose or polyester film Film image must be digitized Alternatively, x-ray machine modified to output digital images

4 Document Imaging Images must be organized into standardized format for storage Image files may be composed of: Pixels (small picture elements) Bitmap data Vector (geometric) data Combination of these data types

5 File Types Different applications for image files
Reason for existence of different file types Characteristics of image files Quality Size Resolution Compression

6 Characteristics Image quality File size Compression
Describes how well the image file maintains fidelity of the source image High-quality images appear more like the source than low-quality File size Described by number of bytes needed to store data Compression Technique to reduce size of a digital image file

7 Characteristics (cont’d.)
Image resolution Refers to the number of pixels in an image Typically stated as number of pixels high by number wide Multiplying pixel counts gives a single resolution number Example: digital camera with resolution of 2048 x 1536 pixels Said to have resolution of three megapixels

8 Characteristics (cont’d.)
Four image file types commonly used in health care Graphics Interchange Format (GIF) Joint Photographic Experts Group (JPG or JPEG) Portable Document Format (PDF) Tagged Image File Format (TIFF)

9 Table 6-1 Image file formats and characteristics
© Cengage Learning 2013

10 Scanning and Indexing Storing image data in data files
Key part of creating an electronic document storage and retrieval system Typical hospital can create hundreds to thousands of electronic images per day Scanning Process of converting paper–based data into electronic format

11 Figure 6-1 Desktop scanner
© Konstantin Shevtsov/

12 Scanning and Indexing (cont’d.)
Electronic file considered protected health information Metadata Data used to describe image attributes Examples: creation date, patient ID Data is included with the image file Will vary greatly, depending on application, how data is used, and applicable regulations

13 Scanning and Indexing (cont’d.)
Storage Process of saving data for future retrieval and use Database Structure used to store data Index Data structure that allows for fast data retrieval

14 Optical Character Recognition (OCR) and Structured Data
Data arranged in a defined manner Unstructured data No predefined arrangement Examples: bitmap images, audio files, most text files Optical character recognition Process of converting scanned images of handwritten or printed text into computer readable text

15 Medical Interface Components
Health Level Seven (HL7) Nonprofit, accredited standards development organization Develops standard languages for formatting electronic messages between healthcare providers HL7 message components Segments presented in a defined sequence Segments may be optional, required, and/or repeatable

16 Medical Interface Components (cont’d.)
HL7 message segment example

17 Medical Interface Components (cont’d.)
HL7 message example

18 Medical Interface Components (cont’d.)
Commonly used HL7 message types ACK: general acknowledgment ADT: admit, discharge, transfer BAR: add/change billing amount DFT: detailed financial transaction Example ADT message subtypes A01: patient admit A02: patient transfer A03: patient discharge A04: patient registration

19 Medical Interface Components (cont’d.)
HL7 message segment standard contents MSH: message header SFT: software segment EVN: event type PID: patient identification

20 Table 6-2 Common HL7 message segments
© Cengage Learning 2013

21 E-Prescribing Electronic transmission of a prescription to a pharmacy from the point of care Can lower the cost of medication transactions Improves management of traditional medication administration problems Medication reconciliation Process of avoiding medication inconsistencies across care settings Can be accomplished with process integrated with an EMR

22 E-Prescribing (cont’d.)
Bedside medication verification (BMV) Method of verifying correct medications are administered to the right patient Commonly accomplished with barcodes and barcode scanner Drug allergy interactions (DAI) Certain drugs or drug combinations can cause allergic reactions in some patients Helpful to maintain accurate database of patient allergy list May be accomplished using CPOE system

23 E-Prescribing (cont’d.)
Formulary List of medications covered by a third-party payer Formulary checking Part of an e-prescribing process Verifies prescribed medications are in the formulary

24 Billing Medical information from the provider’s EMR/EHR system
Used to create an electronic version of the bill Transmits to third-party payer (outbound communication) HL7 billing segments PID: patient information PV1: visit information FT1: financial transaction IN1: insurance information

25 Billing (cont’d.) HL7 billing segments (cont’d.) Billing clearinghouse
IN2: additional insurance information IN3: additional insurance information, certification GT1: guarantor AUT: authorization information Billing clearinghouse Validates claims to ensure free of errors Then transmits to specified payer over secure connection

26 Diagnosing Interface Problems
Troubleshooting Systematic approach to determine source of problem Four troubleshooting steps Identification Generation Determination Confirmation

27 HL7 Message Problems Common problem with HL7 messages
Improperly formatted patient demographics Example: patient’s SSN is 123-4T-5678 when it should be Communication link errors Generated as a result of failure in a fax, network, or Internet connection Common in areas with aging communications infrastructure or frequent power interruptions

28 E-Prescribing Problems
Inaccurate patient demographics Patient medical history may be inaccurate Variety of causes National standard for e-prescribing Developed by the National Council for Prescription Drug Programs (NCPDP) SCRIPT Standard Implementation E-prescribing messaging standard using segments and fields

29 E-Prescribing Problems (cont’d.)
SCRIPT message example

30 Billing Problems Superbill
Form used by providers to quickly list patient’s procedures and diagnosis for reimbursement Commonly adapted for a specific provider Includes patient demographic data, CPT procedure codes, ICD diagnostic codes May cause errors if data is inconsistent with other data

31 Billing Problems (cont’d.)
Billing software configuration settings examples Bill patient for missed copays? Display diagnosis description? Display procedure description? Rendering provider? Scheduling provider? Service location? Supervising provider? Some configuration settings are important for accurate data transmission

32 Medical Device Problems
Check for power first Brownouts or voltage sags may cause medical device interface issues Less common power problems Blackouts Spikes Surges Electrical noise Use an uninterruptible power supply (UPS) on the device or central power system

33 Table 6-3 Less common power problems
© Cengage Learning 2013

34 Medical Device Problems (cont’d.)
Network and communication problems Network failure can cause data corruption Some devices can be configured to perform differently by adjusting configuration settings

35 Troubleshooting Clinical Software Problems
Types of clinical software Auditing systems Billing systems Coding systems CPOE systems EMR/EHR systems Lab information system (LIS) Patient care planning systems

36 Troubleshooting Clinical Software Problems (cont’d.)
Types of clinical software (cont’d.) Pharmacy information system (PIS) Patient tracking systems Patient scheduling systems Radiology information system (RIS) Workflow management systems Defined plan for troubleshooting integrated software systems Imperative for the HIT professional

37 Locate the Affected Modules or Fields
Troubleshooting process steps Identify system malfunctions or symptoms List possible causes Determine cause of the problem Develop and test solution Confirm the problem has been solved Approach for first step Divide the problem into smaller domains Work backward in the system from where the problem appears

38 Determine Data Types Data type error
Data classified based on properties (text, numeric, binary) Database and software applications expect data to be of a certain type Check configuration to ensure user inputs have been checked for correct data types Manual configuration change may have allowed errors to be introduced into the system

39 Escalate When Necessary
When software problem cannot be solved through normal troubleshooting methods: May need to be escalated (reported) to another technical support group Problem escalation process Describes who should be contacted first Technical support groups often organized into tiers Initial call to support group will encounter Tier 1 support Escalates to Tier 2 if problem cannot be resolved

40 Table 6-4 Tiered technical support
© Cengage Learning 2013

41 Change Control Clinical software modules used together
Integrated system Increases overall system complexity exponentially Software regularly changes over time New requirements and regulations Bug fixes or performance improvements

42 Procedural Systematic Customization
Change control system Procedure for systematic software customization Specifics required for a change control system Change compliance reporting Defining specific change process activities Delineating testing and cutover processes Developing a change schedule Identifying impacts of change Specifying staff roles regarding change control

43 Governance Board Risk and cost of failure with software change may be quite high Governance Alignment around objectives, strategies, tools and methods to minimize change failure Change management governance board (CMGB) Group with responsibility to approve changes that may result in critical service interruption

44 System Patching and Updates
Types of software changes Patch Fix for specific software problem Update Includes larger changes than patches Can add features or functionality Issued less frequently than patches

45 Change Scheduling Scheduling software changes
Challenging in a highly integrated environment Some clinical software systems are used around the clock, every day of the year

46 Change Scheduling (cont’d.)
Change scheduling process questions Is there a backup system? Can collected data be recovered during the system downtime? Will the downtime impact any life support systems? Were all impacted departments notified, and did they approve the proposed schedule? Can the old system be rolled back if the updates are not functional? Answers to above questions will affect the update schedule

47 Change-Control Environments
Four stages in software change process Development Writing new program code to address need Quality assurance (QA) test Ensures software meets functional requirements and defined performance behaviors User test Assesses whether software meets user requirements Production (live) Software is released to be used in a live environment

48 Summary Images must be organized into a standard format for storage
Scanning is the process of converting printed data into electronic format Data can be classified as structured or unstructured For information to be shared, a common language or format must be used Health Level 7 is a standards development organization

49 Summary (cont’d.) An HL7 message is composed of groups of message segments presented in a predefined sequence Troubleshooting uses a systematic approach to determine the source of a problem Software regularly changes over time Increases complexity of clinical software management Change control process is needed

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