1. Clinical Health Information Systems Ch.3

2. P RETEST (T RUE /F ALSE ) A patient who has surgery at an ambulatory care facility is required to remain overnight. The emergency department is considered an outpatient service. The average length of stay in a long-term care facility is greater than 30 days.

3. P RETEST (T RUE /F ALSE ) ( CONTINUED ) If a patient is readmitted to a hospital, the hospital will use the same patient chart it used for that patient previously, rather than starting a new chart. The size of an outpatient facility is determined by the number of patients it sees each day.

4. H EALTH D ELIVERY F UNDAMENTALS

5. A MBULATORY C ARE F ACILITIES Also called outpatient care facilities Provide care to patients who do not require an overnight stay Privately or publicly owned

6. E XAMPLES OF A MBULATORY C ARE F ACILITIES Doctor’s offices Medical clinics Public health departments Walk-in clinics Urgent care centers Outpatient surgery centers Diagnostic centers

7. A CUTE C ARE F ACILITIES Treat patients (inpatients) with more serious illnesses or injuries Keep patients overnight or longer Owned by either for-profit corporations or not- for-profit organizations Typically called a hospital

8. E XAMPLES OF A CUTE C ARE F ACILITIES Acute care hospital Not-for-profit hospital For-profit hospital Long-term care facility Rehabilitation facility

9. H OSPITAL D EPARTMENTS Surgery Radiology Pediatrics Laboratory Emergency (ED or ER) Trauma centers Intensive care units (ICUs)

10. L ENGTH OF S TAY (LOS) Outpatient facility: Patients do not stay overnight Inpatient facility: ALOS less than 30 days (acute care) ALOS greater than 30 days (long-term care) Note: ALOS=Average LOS

11. D ETERMINING F ACILITY S IZE Outpatient facility: Number of patient encounters per day Inpatient facility: Number of licensed beds Bed count

12. A DMISSION /D ISCHARGE Outpatient facility: No formal process Inpatient facility: Formal process for both Doctor must perform physical exam within 24 hours of admission Discharge requires doctor’s order Date and time of both determine LOS and number of days for billing

13. O RGANIZATIONAL C HARTS Used in business and other organizations to illustrate managerial relationships Place most responsible position at top Place next management level below, and so forth

14. O RGANIZATIONAL C HARTS Use vertical lines to connect managers with subordinates Use horizontal lines to indicate equal jobs reporting to same manager

16. O RGANIZATIONAL C HARTS ( CONTINUED ) Inpatient care facilities generally have more complex organizational structures Outpatient care facilities generally have a simpler management structure

17. Note: LPN=Licensed Practical Nurse LVN= Licensed Vocational Nurse

18. S UBACUTE C ARE F ACILITIES Offer services appropriate for patients whose nursing care needs are less frequent and intensive Include physical rehabilitation facilities, long- term care facilities, home care

19. R EHABILITATION F ACILITIES Offer inpatient care Help patient return to maximum functionality possible Specialize in physical medicine, PT (PhysioTherapy), OT (Occupational Therapy), addiction recovery

20. L ONG - TERM C ARE F ACILITIES Offer inpatient care at less intense level than acute care facility Provide LOS greater than 30 days Include skilled nursing facilities, nursing homes, residential care facilities, rehabilitation hospitals

21. H OME C ARE Offered regularly in patient’s home, not in a facility Provided by home health agencies Includes the following healthcare providers: Nurses PTs OTs

22. O UTPATIENT C HART Single chart per patient Contains records of all visits, plus associated reports or results from other providers Focuses on longitudinal care of patient Used primarily used by physician, nurse, billing staff

23. O UTPATIENT C HART ( CONTINUED ) Includes detailed physician’s notes about each visit Has smaller quantity of data than inpatient chart

24. I NPATIENT C HART New chart started each time patient admitted Focuses on information related to current stay Used extensively by wide number of caregivers and administrative personnel Includes brief physician exam notes

25. I NPATIENT C HART ( CONTINUED ) Includes doctor’s orders and nurses’ notes as main elements Contains greater quantity of data than outpatient chart

26. Figure 1-10 Medical specialties and subspecialties

27. Figure 1-10 (continued) Medical specialties and subspecialties

29. D IRECT C ARE P ROVIDERS Provide healthcare services directly to patient Require state license to practice Actions regulated by professional or licensing boards

30. D IRECT C ARE P ROVIDERS ( CONTINUED ) Must document patient care, including time spent with, observations, actions Depend on accuracy and completeness of health record to make patient care decisions

31. D OCTORS Include several different types of healthcare professionals Require specialized training and licensing Oversee patient’s care Order medications, therapy, diagnostic tests, referrals, consults with other physicians

32. D OCTORS ( CONTINUED ) Authorize medical orders and patient documentation

33. E XAMPLES OF D OCTORS Chiropractors Dentists Psychologists Osteopaths Medical doctors American boards of specialties and subspecialties

34. N URSES Spend largest amount of time in direct patient care Several levels of nursing licensure: LPN ( Licensed Practical Nurse ) RN (ADN= Associate Degree in Nursing, BSN= Bachelor of Science Nursing ) CRNA( Certified Registered Nurse Anesthetists ) Nurse midwives Nurse practitioners

35. P HYSICIAN A SSISTANTS Work under supervision of physicians Conduct physical exams Diagnose and treat illnesses Order and interpret tests Counsel patients Assist in surgery

36. A LLIED H EALTHCARE P ROFESSIONALS Provide care directly to patient Operate based on orders of licensed provider (doctor, nurse practitioner, PA) Examples include: Physical therapists (PTs) Occupational therapists (OTs) Respiratory therapists (RTs)

37. A LLIED H EALTHCARE P ROFESSIONALS ( CONTINUED ) Clinical laboratory technicians Diagnostic technologists Pharmacists Registered dietitians (RDs) Audiologists Speech pathologists Clinical medical assistants

38. C LINICAL P ROFESSIONAL O RGANIZATIONS American Medical Association (AMA) American Nurses Association (ANA) American Hospital Association (ANA)

39. O UTLINE Clinical Information Systems— adoption, use, value – Electronic Health Record – Computerized Provider Order Entry (CPOE) – Medication Administration – Telemedicine/Telehealth – Personal Health Record Fitting Applications Together Information Exchange Across Boundaries Overcoming Barriers to Adoption

40. C LINICAL I NFORMATION S YSTEMS

41. V ARIOUS TERMS USED OVER TIME CPR Computer- Based Patient Record EMR Electronic Medical Record PHR Personal Health Record EHR Electronic Health Record

42. D EFINITIONS

43. C ORE F UNCTIONS

44. W HERE ARE WE TODAY ? Broad Spectrum

45. EHR A DOPTION IN US H OSPITALS

47. 2012 P HYSICIAN A DOPTION OF EHR S

48. EHR U SE IN O THER P OST A CUTE AND LTC S ETTINGS Extremely low 6%--Long term care 4%--Rehabilitation 2%--Psychiatric Source: Health Affairs, 2012

49. V ALUE OF EHR Improved quality, outcomes and safety Computerized reminders and alerts Improved compliance with practice guidelines Reduction in medical errors Improved efficiency, productivity, and cost reduction Improved service and satisfaction

50. O THER MAJOR TYPES OF CIS Computerized provider order entry (CPOE) Medication administration using barcoding Telemedicine Telehealth—for our purposes, we will focus on online communication (e.g. email) between patients and providers Personal health record

51. CPOE Driven by need to improve patient safety Automates the ordering process Accepts orders electronically, provides decision support, may aid in diagnosis and treatment

52. U SE AND S TATUS OF CPOE Estimates vary from 8-20% Historically teaching hospitals more likely to use Many organizations are in various stages of implementation Required for achieving meaningful use

53. H ISTORICAL B ARRIERS TO CPOE U SE Complexity of ordering process Physician entry an issue Takes longer to place order; many systems are ‘cumbersome’, take too many steps Incentives may not be aligned with use Lack of confidence in system reliability Insufficient training Mandating use – should you?

54. M EDICATION ADMINISTRATION Use of barcoding becoming more widespread Aids in correctly identifying patient, drug, dose, etc. HIMSS implementation guide—good resource More widely accepted Has been used successfully by many health care organizations Again, has potential to aid in making sure the right meds, get to the right patient, at the right dose…

55. T ELEMEDICINE Use of telecommunciations for the direct provision of care to patients at a distance – Over 200 telemedicine programs involving over 3500 health care institutions – Store and forward – Two-way interactive TV Funding an issue Cost effectiveness not fully known

56. T ELEHEALTH Using telecommunications to communicate with patients and deliver services Electronic consultations (e-consultations) Patient portals Refilling prescriptions Registering patient Scheduling appointments

57. T ELEHEALTH Current use of email communication between patients and physicians Value to patients and providers Issues Complexity of infrastructure Degree of integration Message structure Cost Security Reimbursement

58. P ERSONAL H EALTH R ECORD & P ATIENT P ORTALS Managed by consumer May include both health and wellness information Patient portal—secure web site through which patients can access PHR or EHR Approximately 7% of consumers have PHR

59. F ITTING P IECES T OGETHER

60. B ARRIERS TO A DOPTION & S TRATEGIES FOR O VERCOMING T HEM Financial Organizational or Behavioral Technical Barriers Privacy and Security Barriers

61. S TRATEGIES FOR O VERCOMING B ARRIERS What strategies are being employed to help overcome— Financial barriers? Behavioral barriers? Technical barriers?

62. S UMMARY Examined five clinical information systems— their current use, status, and value & their relationship to each other Discussed the value of sharing health information across organizations Discussed the three major barriers to adoption of these systems—financial, behavioral and technical and strategies to overcome them