1. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Health Information Management Chapter 15

2. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 2 Introduction Health information management is a relatively new field that continues to grow in popularity among students of the health professions. The advent of computer-based medical records makes this a high-demand career opportunity.

3. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 3 This chapter will examine: How health information is used Characteristics of high-quality data Concerns of quality assurance Importance of HIPAA Functions of the NCHS Types of healthcare statistics kept Total quality management

4. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 4 Evolution of the Profession American Health Information Management Association (AHIMA) Began as the Association of Record Librarians of North America Changed name to American Medical Record Association in 1970 Evolved into AHIMA in 1991

5. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 5 Advances in technology have brought healthcare from a paper-based environment to a computer-based environment. Physicians and other healthcare providers can usually access patient and statistical information in a matter of seconds. Evolution of the Profession

6. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 6 Move toward Computer-Based Records In 2005, one quarter of the nation’s physicians used some form of computer-based medical records.

7. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 7 How Use of Electronic Records Reduces Medical Errors Keeps prescriptions organized Notes allergies clearly Reduces costs by avoiding duplicate tests Can reduce staffing needs Note: Information entered into the computer is only as reliable as the person who entered the data.

8. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 8 Characteristics of High-Quality Health Data Experts agree on nine characteristics of high-quality health data, which are: Validity Reliability Completeness Recognizability Timeliness Relevance Accessibility Security Legality

9. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 9 Characteristics of High-Quality Health Data Validity: synonymous with accuracy. Healthcare information must be accurate to be usable. Reliability: Healthcare professionals must be able to rely on the information presented.

10. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 10 Characteristics of High-Quality Health Data Completeness: Incomplete records may lack vital information needed to care for the patient. Recognizability: All users of health information must be able to interpret the data that are presented in the health record.

11. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 11 Characteristics of High-Quality Health Data Timeliness: Health information must be entered into the record as soon as it becomes available so that decisions made are supported by the latest information about the patient’s condition. Relevance: Information in the record must be relevant to be useful.

12. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 12 Characteristics of High-Quality Health Data Accessibility: Healthcare data must be accessible to multiple users at one time. Security: Precautions must be taken to prohibit intruders from accessing medical records. Legality: The record must be completely legible and properly authenticated.

13. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 13 Quality Assurance Activities designed to increase the quality of a product or service through process or system changes that increase efficiency or effectiveness. Many people assume that quality is only a result of patient satisfaction surveys. This is actually only a small part of the quality-assurance process.

14. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 14 Challenges of Quality-Assurance Problems Quality assurance is concerned with issues revolving around healthcare services, such as: Overuse Underuse Misuse

15. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 15 Some Overused Treatments Hysterectomies Tympanostomy tubes Antibiotics

16. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 16 Some Underused Treatments Mammograms Cervical cancer screenings Beta-blockers for heart patients Eye examinations for diabetic patients

17. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 17 Some Underused Treatments (cont’d)

18. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 18 Misuses of Healthcare Services Laboratory tests that provide erroneous results Medication errors Hospital injuries to patients Nosocomial infections

19. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 19 Discharge Rates Percentages of people who leave a hospital without dying. These rates are higher in some areas of the country than in others.

20. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 20 HIPAA Health Insurance Portability and Accountability Act (HIPAA) Became law in 1996 Became effective April 14, 2003 Applies to records that are created or maintained by healthcare providers, health plans, and healthcare clearinghouses that engage in electronic transactions

21. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 21 HIPAA Regulation HIPAA is regulated by the Office of Civil Rights (OCR), which is a division of the Department of Health and Human Services.

22. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 22 Provisions of HIPAA’s Privacy Rule Patients must give specific authorization before protected information can be disclosed. Covered entities must provide patients with a copy of their privacy practices.

23. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 23 Provisions of HIPAA’s Privacy Rule Pharmacies, health plans, and other covered entities must have specific patient permission before sending marketing materials. Covered entities cannot use business associate agreements to circumvent the rule’s marketing provisions.

24. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 24 Provisions of HIPAA’s Privacy Rule Patients generally can access their personal medical records and request changes to correct any errors. Patients can request an accounting of nonroutine uses and disclosures of their personal health information.

25. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 25 Patient Confidentiality Patients have the right to expect patient confidentiality with regard to their health records.

26. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 26 National Center for Health Statistics (NCHS) Division of the Centers for Disease Control and Prevention (CDC) Primary provider of health information statistics

27. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 27 NCHS Functions Documentation of health status of the population and its subgroups Identification of disparities in health status and use of healthcare by socioeconomic factors Description of experiences with the healthcare system Evaluation of the impact of health policies and programs

28. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 28 NCHS Functions Monitoring of trends in health status and healthcare delivery Identification of health problems Support for biomedical and health services research Provision of information for making changes in public policies and programs

29. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 29 Types of NCHS Statistics Teenage pregnancy Incidence of HIV infection Alcohol and drug use Births Deaths Communicable diseases Infant health and mortality Leading causes of death Life expectancy Sexually transmitted diseases Suicide

30. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 30 Total Quality Management (TQM) TQM consists of management and control activities designed to enhance the quality of services provided to patients.

31. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 31 Total Quality Management (TQM) (cont’d)

32. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 32 TQM Concept Much of today’s TQM concepts originated with W. Edwards Deming. Deming stressed an emphasis on quality rather than quantity, applying his principles to various types of businesses and managers.

33. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 33 Deming’s 14 Points for Management Create constancy of purpose toward improvement of product and service. Adopt the new philosophy. Cease dependence on inspection to achieve quality. End the practice of awarding business on the basis of price tag.

34. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 34 Deming’s 14 Points for Management Constantly improve the system of production and service. Institute training on the job. Institute leadership. Drive out fear so that everyone can work effectively for the company. Break down barriers between departments.

35. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 35 Deming’s 14 Points for Management Eliminate slogans, exhortations, and targets for the work force asking for zero defects and new levels of productivity. Remove barriers that rob the hourly worker of his right to pride of workmanship. Remove barriers that rob people in management and in engineering of their right to pride of workmanship.

36. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 36 Deming’s 14 Points for Management Institute a vigorous program of education and self- improvement. Make the company transformation everyone’s job.

37. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 37 The Joint Commission (TJC) Nonprofit organization Provides accreditation services to healthcare facilities Voluntary process, but vital to healthcare organizations

38. Copyright © 2007 by Saunders, Inc., an imprint of Elsevier Inc. Slide 38 Risk Management Any occurrence that could result in patient injury or any type of financial loss to the facility is called a risk. Risk management efforts focus on: Loss prevention Avoiding patient injury Avoiding any financial loss resulting from liability Avoidance of negative publicity resulting from sentinel events