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

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Presentation on theme: "Introduction to Healthcare Information Technology Chapter Six Document Imaging and Problem Solving."— Presentation transcript:

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

2 Introduction to Healthcare Information Technology 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 2

3 Introduction to Healthcare Information Technology 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 3

4 Introduction to Healthcare Information Technology 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 4

5 Introduction to Healthcare Information Technology File Types Different applications for image files –Reason for existence of different file types Characteristics of image files –Quality –Size –Resolution –Compression 5

6 Introduction to Healthcare Information Technology Characteristics Image quality –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 6

7 Introduction to Healthcare Information Technology Characteristics (contd.) 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 7

8 Introduction to Healthcare Information Technology Characteristics (contd.) 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) 8

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

10 Introduction to Healthcare Information Technology 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 10

11 Figure 6-1 Desktop scanner © Konstantin Shevtsov/www.Shutterstock.com

12 Introduction to Healthcare Information Technology Scanning and Indexing (contd.) 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 12

13 Introduction to Healthcare Information Technology Scanning and Indexing (contd.) 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 13

14 Introduction to Healthcare Information Technology Optical Character Recognition (OCR) and Structured Data 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 14

15 Introduction to Healthcare Information Technology 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 15

16 Introduction to Healthcare Information Technology Medical Interface Components (contd.) HL7 message segment example 16

17 Introduction to Healthcare Information Technology Medical Interface Components (contd.) HL7 message example 17

18 Introduction to Healthcare Information Technology Medical Interface Components (contd.) 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 18

19 Introduction to Healthcare Information Technology Medical Interface Components (contd.) HL7 message segment standard contents –MSH: message header –SFT: software segment –EVN: event type –PID: patient identification 19

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

21 Introduction to Healthcare Information Technology 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 21

22 Introduction to Healthcare Information Technology E-Prescribing (contd.) 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 22

23 Introduction to Healthcare Information Technology E-Prescribing (contd.) 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 23

24 Introduction to Healthcare Information Technology Billing Medical information from the providers 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 24

25 Introduction to Healthcare Information Technology Billing (contd.) HL7 billing segments (contd.) –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 25

26 Introduction to Healthcare Information Technology Diagnosing Interface Problems Troubleshooting –Systematic approach to determine source of problem Four troubleshooting steps –Identification –Generation –Determination –Confirmation 26

27 Introduction to Healthcare Information Technology HL7 Message Problems Common problem with HL7 messages –Improperly formatted patient demographics –Example: patients SSN is 123-4T-5678 when it should be 123-45-6789 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 27

28 Introduction to Healthcare Information Technology 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 28

29 Introduction to Healthcare Information Technology E-Prescribing Problems (contd.) SCRIPT message example 29

30 Introduction to Healthcare Information Technology Billing Problems Superbill –Form used by providers to quickly list patients 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 30

31 Introduction to Healthcare Information Technology Billing Problems (contd.) 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 31

32 Introduction to Healthcare Information Technology 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 32

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

34 Introduction to Healthcare Information Technology Medical Device Problems (contd.) Network and communication problems –Network failure can cause data corruption Some devices can be configured to perform differently by adjusting configuration settings 34

35 Introduction to Healthcare Information Technology 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 35

36 Introduction to Healthcare Information Technology Troubleshooting Clinical Software Problems (contd.) Types of clinical software (contd.) –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 36

37 Introduction to Healthcare Information Technology 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 37

38 Introduction to Healthcare Information Technology 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 38

39 Introduction to Healthcare Information Technology 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 39

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

41 Introduction to Healthcare Information Technology 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 41

42 Introduction to Healthcare Information Technology 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 42

43 Introduction to Healthcare Information Technology 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 43

44 Introduction to Healthcare Information Technology 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 44

45 Introduction to Healthcare Information Technology 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 45

46 Introduction to Healthcare Information Technology Change Scheduling (contd.) 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 46

47 Introduction to Healthcare Information Technology 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 47

48 Introduction to Healthcare Information Technology 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 48

49 Introduction to Healthcare Information Technology Summary (contd.) 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 49


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