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Introduction to Healthcare Information Technology Chapter One Introduction to Healthcare IT.

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Presentation on theme: "Introduction to Healthcare Information Technology Chapter One Introduction to Healthcare IT."— Presentation transcript:

1 Introduction to Healthcare Information Technology Chapter One Introduction to Healthcare IT

2 About the Presentations The presentations cover the objectives found in the opening of each chapter. All chapter objectives are listed in the beginning of each presentation. You may customize the presentations to fit your class needs. Some figures from the chapters are included. A complete set of images from the book can be found on the Instructor Resources disc.

3 Introduction to Healthcare Information Technology Objectives Define healthcare information technology Recognize some of the benefits of healthcare IT Describe the CompTIA Healthcare IT Technician Certificate List major healthcare regulators Summarize the major healthcare regulations Describe typical healthcare legal practices 3

4 Introduction to Healthcare Information Technology Healthcare IT: Challenges and Opportunities Information technology adoption –Slower in healthcare industry compared with other industries Obstacles to adoption –Fragmented healthcare system –Many different systems among providers –Shortage of trained technology professionals –Highly regulated industry 4

5 Introduction to Healthcare Information Technology What Is Healthcare Information Technology? Framework for managing health information Mechanism to improve patient care Enables patient care coordination Application of information technology to the healthcare industry Hardware and software –Used to manipulate health data and information 5

6 Introduction to Healthcare Information Technology Benefits of HIT Healthcare costs continue to rise –5.2 percent of U.S. GDP spent on healthcare in 1960 –17 percent in 2007 Advances in technology account for about half of healthcare spending increases Efficiency benefits of electronic medical records –Eliminates medical transcription –Reduces need to physically retrieve charts –Reduces duplicate diagnostic tests 6

7 Introduction to Healthcare Information Technology The CompTIA Healthcare IT Technician Certificate CompTIA –Nonprofit trade organization –Advocate for the IT industry –Provides education and certification programs CompTIA healthcare IT technician certificate –Shows individual’s proficiency in certain areas of healthcare and information technology –Prepares students for jobs in software and technology support 7

8 Introduction to Healthcare Information Technology The CompTIA Healthcare IT Technician Certificate (cont’d.) CompTIA proficiency areas –HIT regulations –Healthcare organization and operations –Basic IT operations –Network IT operations –Document imaging –Basic and advanced healthcare security –Medical business operations This text book is to help prepare for the CompTIA IT Technician HIT-001 certification. 8

9 Introduction to Healthcare Information Technology Regulatory Compliance: Regulators Regulation –Something that constrains or controls Regulator –Governmental entity that mandates regulations Healthcare one of most heavily regulated industries Purpose of regulations –Ensure minimum standard of care –Provide broad patient access at reasonable cost 9

10 Introduction to Healthcare Information Technology Regulatory Compliance: Regulators (cont’d.) 10 Table 1-1 Primary U.S. healthcare regulatory agencies © Cengage Learning 2013

11 Introduction to Healthcare Information Technology Department of Health and Human Services Mission of HHS –Provide citizens access to high-quality health care –Help people find jobs and child care –Keep food safe –Manage infectious diseases –Extend the practice of diagnosis and treatment HHS represents 25 percent of U.S. federal budget 11

12 Introduction to Healthcare Information Technology Department of Health and Human Services (cont’d.) Operating divisions of HHS –Administration for Children and Families (ACF) –Administration on Aging (AoA) –Agency for Healthcare Research and Quality (AHRQ) –Agency for Toxic Substances and Disease Registry (ATSDR) –Center for Disease Control and Prevention (CDC) –Centers for Medicare and Medicaid Services (CMS) –Food and Drug Administration (FDA) 12

13 Introduction to Healthcare Information Technology Department of Health and Human Services (cont’d.) Operating divisions of HHS (cont’d.) –Health Resources and Services Administration (HRSA) –Indian Health Service (IHS) –National Institutes of Health (NIH) –Office of the Inspector General (OIG) –Substance Abuse and Mental Health Services Administration (SAMHSA) 13

14 Introduction to Healthcare Information Technology Department of Health and Human Services (cont’d.) Office of the National Coordinator for Health Information Technology (ONC) –Staff division within HHS –Responsible for coordinating use of advanced HIT practices at the national level 14

15 Introduction to Healthcare Information Technology Centers for Medicare and Medicaid Services Information Technology CMS administers: –Medicare program –Federal portion of the Medicaid program –State Children’s Health Insurance Program (CHIP) Parts of Medicare –Part A Inpatient hospital stay insurance –Part B Doctor’s services and outpatient care –Prescription drug coverage 15

16 Introduction to Healthcare Information Technology Centers for Medicare and Medicaid Services Information Technology (cont’d.) Medicaid –Program for low-income people –Covers certain medical expenses –Jointly funded by federal government and the states Medicare and Medicaid incentive programs –Cash incentives to providers for adopting electronic health record (EHR) technology 16

17 Introduction to Healthcare Information Technology The Office of the National Coordinator for Health Information Technology Responsibilities –Coordinates use of advanced HIT practices at the national level –Certifies EHR systems and providers Three aspects of certification –Standards and certification criteria for EHR –Certification programs –Metadata standards 17

18 Introduction to Healthcare Information Technology The National Institute of Standards and Technology Federally sponsored physical science research laboratory Sets standards for EHRs under the HITECH Act Five goals of NIST’s role in health information technology –Coordinate standards –Coordinate infrastructure testing –Improve EHR usability –Extend healthcare’s reach through technology –Perform research and development 18

19 Introduction to Healthcare Information Technology The National Institute of Standards and Technology (cont’d.) NIST and Healthcare Information Technology Standards Panel (HITSP) –Provide standards and specifications to ensure system interoperability –Example: specific data and communication format requirements 19

20 Introduction to Healthcare Information Technology The National Institute of Standards and Technology (cont’d.) 20 Table 1-2 HIT standards implementation process © Cengage Learning 2013

21 Introduction to Healthcare Information Technology Regulatory Compliance: Regulations HIPPA: Health Insurance Portability Accountability Act of HIPAA privacy rule –Broad federal regulation –Adopted in 1996 HIPAA goals –Improve portability and continuity of health insurance –Manage waste, fraud, and abuse of health care delivery –Reduce costs and increase efficiency by standardizing the interchange of electronic data –Protect the privacy of personal health records 21

22 Introduction to Healthcare Information Technology Regulatory Compliance: Regulations (cont’d.) HIPAA privacy rule regulates: –Health care providers –Health plans –Health care clearinghouses –Collectively called Covered Entities (CE) Rule extends to Business Associates (BAs) of Covered Entities Business Associate Agreements –Contracts between CEs and BAs ensuring HIPAA is followed 22

23 Introduction to Healthcare Information Technology Regulatory Compliance: Regulations (cont’d.) Protected Health Information (PHI) –Individually identifiable health information –Created or received by CE or BA –Can exist in various forms (verbal, paper, electronic) De-identified information –Cannot be traced back to the individual –Must remove 18 specific identifiers or be certified by a statistician (name, small geographic, vital stat, tel., , SS, Med. record number, IP address, address, license plate, biometric, etc.) 23

24 Introduction to Healthcare Information Technology Regulatory Compliance: Regulations (cont’d.) Data use agreement –Permits researchers to use PHI under specific conditions Office for Civil Rights (OCR) –Responsible for enforcement of HIPAA 24

25 Introduction to Healthcare Information Technology25 Table 1-3 HIPAA Privacy Rule safeguards and requirements © Cengage Learning 2013

26 Introduction to Healthcare Information Technology HIPAA Security Rule Focuses on electronically transmitted or stored PHI –Known as ePHI Narrower focus than the privacy rule Seeks to ensure Covered Entities provide certain administrative, physical, and technical safeguards for data 26

27 Introduction to Healthcare Information Technology27 Table 1-4 HIPAA Security Rule categories, safeguards, and requirements © Cengage Learning 2013

28 Introduction to Healthcare Information Technology HIPAA Identifier Rule Mandates all Covered Entities storing or transmitting ePHI have a National Provider Identifier (NPI) –Replaces all other identification from Medicare, Medicaid, and other government programs 28

29 Introduction to Healthcare Information Technology HIPAA Transaction and Code Sets Rule (TCS) Mandates consistent electronic interchange of PHI Electronic data interchange for health care Technology is tested and proven from use in other industries Several standards exist –ANSI X.12 standard 29

30 Introduction to Healthcare Information Technology HITECH Act Creations of the Health Information Technology for Economic and Clinical Health (HITECH) Act –HIT Standard Committee –HIT Policy Committee –Process to adopt standards and procedures 30

31 Introduction to Healthcare Information Technology HITECH Act (cont’d.) HITECH Act more stringent than HIPAA –Increased resources for enforcement –Increased penalties for violation –Health providers cannot use patient health information without expressed permission –Sale of private health information must be authorized by the patient –Patients may audit their electronic patient records –Act extends to future unanticipated entities –Mandates encryption of ePHI –Requires patients be notified of any breach 31

32 Introduction to Healthcare Information Technology HITECH Act (cont’d.) HITECH act and Business Associates –HITECH Act encompasses both Covered Entities and Business Associates HITECH Act and PHI breach –Covered Entity required to report the breach to each individual affected –Business Associate breaches reported to Covered Entity first –HHS must be contacted if more than 500 patients affected 32

33 Introduction to Healthcare Information Technology HITECH Act (cont’d.) HITECH act enforcement –Four levels of enforcement Lowest level of enforcement: unknown violations despite due diligence –Penalties: $100-$25,000 per violation Next level: reasonable cause and not willful neglect –Penalties: $1000 to $100,000 per violation 33

34 Introduction to Healthcare Information Technology HITECH Act (cont’d.) Level 3: willful neglect corrected within 30 days of knowledge of violation –Penalties: $10,000 to $250,000 per violation Level 4: willful neglect that is not corrected –Penalties: $50,000 to $1,500,000 per violation Penalties are for a given calendar year 34

35 Introduction to Healthcare Information Technology HITECH Act (cont’d.) HITECH act and EHRs –Majority of funding for HITECH used for provider incentives to adopt EHRs Entities that provide assistance, best practices, and grants under HITECH Act –Workforce investments –HIT extension program –HIT research center –HIT regional extension centers 35

36 Introduction to Healthcare Information Technology HITECH Act (cont’d.) Certified EHR –Tested by an ONC Authorized Testing and Certification Body (ATCB) HITECH act and meaningful use –EHR must be used in a meaningful manner –EHR must be used for submission of quality data and other measures –EHR must be used for exchange of health information that improves health care quality 36

37 Introduction to Healthcare Information Technology HITECH Act (cont’d.) Eligible Provider (EP) –Provider qualifying for financial incentives under HITECH Act Incentives for both Medicare and Medicaid exist –EPs may participate in multiple programs –Certain restrictions apply 37

38 Introduction to Healthcare Information Technology38 Table 1-5 Maximum Medicare EHR incentive payments © Cengage Learning 2013

39 Introduction to Healthcare Information Technology Legal Practices Legal practices outside the scope of traditional regulatory environment –Liability waivers –EHR service level agreements –Memoranda of understanding 39

40 Introduction to Healthcare Information Technology Liability Waivers Used by hospitals and physicians to protect them against legal liability Documents signed by the patient Specify provider responsibility in case of treatment failure or injury 40

41 Introduction to Healthcare Information Technology Service Level Agreements Frequently used in technology applications Define level of service user can expect from technology provider Examples of SLA performance measures –Downtime –Downtime period –Monthly uptime percentage –Scheduled downtime –Service credit 41

42 Introduction to Healthcare Information Technology Memorandum of Understanding Also called memorandum of agreement (MOA) Voluntary agreement between health providers Specifies some mutually beneficial arrangement Example: natural disaster recovery –Agreement would specify responsibilities of each entity 42

43 Introduction to Healthcare Information Technology Memorandum of Understanding (cont’d.) Four elements of a legally binding contract –Payment or consideration –No illegal activities –Actions of parties must be described –Agreed upon without threat or duress 43

44 Introduction to Healthcare Information Technology Summary Healthcare costs keep increasing Healthcare industry has been slow to adopt use of information technology HIT: the use of hardware and software to manage and manipulate health information Regulation provides constraints or controls HIPAA protects privacy and security of patient health data 44

45 Introduction to Healthcare Information Technology Summary (cont’d.) Parts of HIPAA –Privacy rule –Security rule –Identifier rule –Transaction and Code Sets rule HITECH Act increases protections of HIPAA Certain legal practices exist outside the regulatory environment 45


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