Transcript Computer

Today's Medical Assistant
2nd edition
Chapter 38
Medical Office Computerization
Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved
1
Lesson 38.1
Computer Concepts
1.
2.
3.
4.
Explain the difference between data and a
program.
Explain the purpose of each of the following
parts of the data processing cycle: input,
processing, and output.
List examples of input and output devices.
Explain the difference between software and
hardware.
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2
Lesson 38.1
Computer Concepts (cont’d)
5.
6.
7.
8.
Explain the function of an operating system.
State the function of application software.
List and state the function of the following
components of the main computer unit:
mainboard, CPU, main computer memory, hard
drive, optical disc drive, and power supply.
Describe the care and maintenance of the main
computer unit.
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3
Introduction to Medical Office
Computerization

Computer


Most frequently used piece of equipment in
medical office
Medical assistant must be familiar with:
•
•
Computer system used in the office
Programs being run on that computer system: medical
practice management program; electronic medical record
program
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4
Computer Concepts

Computer: a device consisting of
electronic components


Has the ability to process data according to a
program in order to produce a desired result
Advantages of computers
•
•
•
Tasks are performed with greater speed and accuracy
Computers are versatile – can perform a wide variety
of administrative procedures
Same tasks can be performed repeatedly while
maintaining the same level of efficiency
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5
Computer Concepts

Computer: a device consisting of
electronic components

Microcomputer: also known as a personal
computer or a desktop computer
•

Used most often in medical office
Network: computers that are linked together
•
•
Computers can communicate with each other – share
data and resources
Number of computers in the network varies on the
basis of: size of the medical practice; type and
number of tasks performed on the computer
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6
Data Processing Cycle


Data processing: changing raw facts or
data into usable information
Data: raw, unorganized facts presented to
the computer for processing

Data frequently entered into the computer in the
medical office:
•

Name, address, and telephone number of patients
Program: a set of instructions organized in
a logical step-by-step sequence

Tells the computer how to perform a specific
function
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7
Data Processing Cycle

Data process cycle includes three phases:
input, processing, output

Input: the transfer of data to the computer for
processing – includes:
•
•

When a computer is finished working on “electronic”
data
•
•

Entering data into the computer
Converting them into an electronic form (code) that can be
understood by the computer
Must be converted back into a form that can be understood
by the user
User: the individual using the computer
Input device: device used to enter data into the
computer
•
Examples: computer keyboard, mouse, scanner,
microphone
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8
Data Processing Cycle

Data process cycle includes three phases:
input, processing, output

Processing: the computer’s handling and
arranging of the electronic data according to a
program
•
•

Data undergo some type of manipulation to produce
useful information
Processing may include: classifying; sorting;
calculating; summarizing; listing of the data
Output: the transfer of usable information back
to the user
•
Output device: converts the electronic code into a
form that can be understood by the user – examples:
monitor, printer
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9
Data Processing Cycle
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10
Components of the Computer System

Computer system: all of the components
making up the computer

Two major divisions
•
•
Software
Hardware
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11
Software

Software: programs or instructions that tell
a computer what to do



Tells the computer how to perform specific
tasks
Consists of a series of step-by-step instructions
organized in a logical sequence
Categories of software:
•
•
System software: assists the computer in carrying
out its tasks
Application software: assists the user in carrying out
computer tasks
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12
System Software


Group of special programs that control or
maintain the operations of a computer
Operating system: most common type of
system software




Automatically loaded into the computer’s main
memory (RAM) when the computer is turned on
Performs “housekeeping” chores required by
the computer system to operate itself
Serves as an intermediary to tell the hardware
how to run an application program
Example of an operating system: Windows
(Microsoft Corporation)
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13
Application Software



Software designed to allow a user to
accomplish a specific task
Also known as application program or
software program
Makes up the greatest proportion of the
software available for use with a computer
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14
Application Software

Application software included in a medical
practice management program:

Word processing
•
•

Used to enter, edit, format, and file (store) text
Used to produce letters (e.g., referral letter) and
reports (e.g., health history report)
Spreadsheet
•
•
An electronic ledger designed to perform mathematic
calculations quickly
Used to generate financial reports for the office
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15
Application Software

Application software included in a medical
practice management program:

Telecommunications
•
•

Allows one computer to “talk” with another computer
Used for the electronic submission of insurance
claims and electronic mail (e-mail)
Database management
•
•
•
•
The storing and retrieving of data in and from a
database
Used to store large amount of data on a storage
device (e.g., hard disk)
Provides the ability to: add new information; modify
existing information; delete unneeded information
Computer can cross-reference all the information in a
database
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16
Documentation



A written set of instructions
Designed to assist the user in
understanding how to operate an
application program
Includes:

Program user manual
•


Contains complete instructions for learning and using
the program
Online help screens displayed on the computer
monitor
Reference cards
•
Contains frequently needed details for quick reference
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17
Hardware


Hardware: the physical equipment making
up the computer system
Includes:





Main computer unit
Monitor
Computer keyboard
Mouse
Printer
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18
Hardware
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19
Main Computer Unit



Consists of a hard plastic case that is
usually rectangular in shape
Houses all the components that make the
computer work
Includes: mainboard, central processing
unit, main computer memory (RAM), video
card, sound card, hard disk, optical drive,
and power supply
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20
Mainboard



Also known as the motherboard
Primary circuit board of the main computer
unit
Each of other components of main unit
either:




Sit on the mainboard (e.g., CPU)
Connect to the mainboard (e.g., hard drive)
Provides a means for all the components to
communicate with each other
“Nervous system” of the computer
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21
Central Processing Unit


“Brain” of the computer
Most complex computer component



Consists of a microprocessor chip
Interprets and executes the instructions
that operate the computer
Resides on the mainboard
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22
Central Processing Unit

Determines how fast a computer can
process information

Speed of CPU: expressed in gigahertz (GHz)
•
•
The higher the value: the faster the computer
Example: 3-GHz computer can process information
twice as fast as a 1.5-GHz computer
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23
Central Processing Unit

CPU consists of:

Control unit: coordinates the entire computer
system – functions as a “traffic patrolman” to:
•
Direct the step-by-step operation of all the processing
functions: reads and interprets the preset instructions
of a program; tells the other components of the
system what to do
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24
Central Processing Unit

CPU consists of:

Control unit: coordinates the entire computer
system – functions as a “traffic patrolman” to:
•
•

During the processing phase keeps track of: which
steps of the program have been performed; which
steps remain
Collects the output and directs it to the designated
output device
Arithmetic/logic unit (ALU)
•
Executes the program’s instructions by performing
mathematic computations; logical operations
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25
Main Computer Memory

Consists of computer chips mounted on a
small board


Responsible for temporarily storing
information


Connected to mainboard
Until ready for use by the CPU
Items held in main memory




Operating system
Application program in current use
Data waiting to be processed
Information ready for output
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26
Main Computer Memory

RAM: random-access memory


Main memory of a microcomputer
Computer can get to any part of the information
directly
•

Less time involved in locating information
Provides only temporary storage
•
When computer is turned off – items stored in RAM
are dumped out
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27
Storage Capacity


The maximum amount of information that
RAM can hold
Measured in bytes

One byte equals one character (letter or
number)
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28
Storage Capacity

Kilobyte (KB): equal to 1024 bytes



Usually rounded off to 1000 bytes
Megabyte (MB): equal to 1 million bytes or
1000 KB
Gigabyte (GB): equal to 1 billion bytes or
1000 MB

Most computers come with a main memory of 1
GB or more
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29
Storage Capacity

Capacity of RAM


Correlates to the level of complexity of
programs it can run
Program takes up a certain amount of
space in RAM


Small program: takes up less space in RAM
Large complex program: takes up more space
in RAM
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30
Storage Capacity

Application program packaging

Labeled with information on its computer
system requirements
•
Indicates the requirements your computer system
must have to run the program – examples: type of
operating system, microprocessor speed, amount of
memory, hard disk space
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31
Sound Card and Video Card

Video Card


Also known as a graphics card
Converts video output into electronic signals
that are sent to the monitor
•
Signals are converted into text and images –
displayed on the screen of the monitor
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32
Sound Card and Video Card

Sound Card

Converts audio output into electronic signals
•
Signals are sent to speakers that convert them into
sound – examples: sound effects, music, and
narration
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33
Power Supply

Provides the power needed by the
computer to run itself
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34
Care and Maintenance of the Main
Computer Unit

Place on a flat, stable surface (e.g.,
computer desk)

Prevents excessive vibration during operation
•

Could loosen electronic circuit boards
Most main units are placed in a vertical position
(e.g., tower)
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35
Care and Maintenance of the Main
Computer Unit

Operate in a moderately cool temperature
environment

Extreme heat and inadequate ventilation:
increase chance of malfunction
•
•
Do not place near a window or other areas that
receive direct sunlight
Do not obstruct ventilation slots
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36
Care and Maintenance of the Main
Computer Unit

Rooms with computers should be kept
clean with no smoking permitted

Primary cause of improper functioning:
•
Exposure to environmental contaminants – examples:
dust, dirt, smoke
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37
Care and Maintenance of the Main
Computer Unit

Casing of the main unit

Wipe periodically with a slightly damp, lint-free
cloth
•

To remove dust and dirt
Do not clean with:
•
Aerosol sprays, solvents, and abrasives – can
damage the finish
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38
Care and Maintenance of the Main
Computer Unit

Interior of main unit


Clean (occasionally) according to instructions in
user manual
Keep liquids away from the computer

If liquid spills into main unit
•

Can damage electronic circuit boards
Check computer cables on a regular basis:
make sure they are secure

Loose or disengaged cable: can result in
temporary malfunctioning
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39
Lesson 38.2
Computer Accessories
9.
10.
11.
Describe the function, care, maintenance, and
ergonomics of the computer monitor.
List and describe the function of the special keys
on a computer keyboard.
Describe the care, maintenance, and
ergonomics of a computer keyboard.
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40
Lesson 38.2
Computer Accessories (cont’d)
12.
13.
14.
Identify the guidelines to follow in the care and
maintenance of a printer.
List and describe the storage devices used with
microcomputer systems.
Describe the method of organization that a hard
disk uses to store and retrieve information.
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41
Computer Monitor


Displays images generated by a computer
Permits user to view:



Input: data entered into the computer
Output: information produced by the computer
as a result of processing
Softcopy: the visual display of information
on the screen of the monitor

Useful when information is necessary and a
permanent copy is not required
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42
Types of Monitors

CRT monitor: big, bulky, and heavy visual
display device similar to most television
sets


CRT: abbreviation for cathode-ray tube
Sprays electrons onto a viewing screen under
the direction of a magnetic field
•

Forms characters on the screen
Previously: the type of monitor used most often
•
LCD monitors are increasing in popularity as cost is
decreasing
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43
Types of Monitors

LCD flat panel monitor: flat panel desktop
monitor



LCD: abbreviation for liquid crystal display
Small, lightweight, and compact
Consumes very little power
•

Creates a visual image by manipulating light
•

More energy-efficient than CRT monitors
Within a layer of liquid crystal cells
Sometimes difficult to view images from an
angle
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44
Types of Monitors

LCD Monitor
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45
Screen Size

Measurement of a computer screen


Typical desktop monitor used in medical
office:


From one corner of the screen diagonally
across to the opposite corner
Screen size: from 17 to 20 inches
Range of available screen sizes: between
14 and 23 inches
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46
Monitor Resolution


The sharpness of the image displayed on
the screen
High-resolution monitor: produces a sharp
image


Crisp, clear, easy-to-read characters
Works to prevent eyestrain and headaches
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47
Monitor Resolution

Measured in pixels (picture elements)

Pixels: “dot” locations on the screen
•

Can be lit up as needed to display characters and
other images – the more dots present: the sharper the
image
Resolution of 1280 × 1024

Displays 1280 pixels horizontally and 1024
pixels vertically
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48
Monitor Controls


Used to operate and adjust the display screen
On/off button



When monitor turned on: indicator light comes on
Brightness control: increases or decreases
the intensity of the images on the screen
Contrast control: adjusts screen for
comfortable viewing

Contrast: the degree of difference between the light
and dark areas on the screen
•

Too much contrast: makes it uncomfortable to look at the
characters
Not enough contrast: makes it difficult to view
characters
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49
Monitor Ergonomics

Place monitor directly in front of the user


At an arm’s length distance when sitting back in
a chair
Position of monitor:

Top of the monitor should be approximately
2 to 3 inches above eye level
•
Helps prevent back and neck tension
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50
Monitor Ergonomics

Occasionally focus your eyes on a distant
object (more than 20 feet away)

Prevents eye strain
•

Blink frequently: lubricates and moistens
eyes


Eye muscles must work harder to focus on near
objects
Prevents them from drying out
Position screen so that it does not reflect
bright light (glare)

Could result in eye strain
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51
Monitor Care and Maintenance


Place monitor on a flat, stable surface (e.g.,
computer desk)
Do not obstruct ventilation slots: allow heat
to escape


Do not stack items around the monitor
Never place anything on top of the monitor
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52
Monitor Care and Maintenance

Clean screen regularly with:


Microfiber cloths
Computer screen cleaner applied with a lint-free
cloth
•
Do not apply directly to the screen – may run down
inside of case and damage electrical circuits
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53
Monitor Care and Maintenance

Casing of the monitor

Wipe periodically with a damp, lint-free cloth to
remove dust and dirt
•

Dust and dirt act like insulation: heat builds up in
monitor – causes electronic components inside
monitor to wear out
Do not use aerosol sprays, solvents, and
abrasives to clean casing

Can damage finish
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54
Computer Keyboard





Most common input device
Contains keys that are pressed to enter
data and instructions into the computer
Includes all the keys normally found on a
typewriter keyboard
Composition is alphanumeric: alphabetic
and numeric keys
May have a numeric keypad on the right
side

Used for entering numbers quickly
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55
Computer Keyboard
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56
Computer Keyboard

Pressing a key on the keyboard

Generates an electronic code
•

Passed into the computer for processing
Types of keyboards


Attached to main unit by a cable
Wireless keyboard
•
Communicates with computer through radio waves or
infrared light waves
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57
Special Keys


Issue commands to the computer to
perform specific functions on the
information displayed on the screen
Pressing a special key

Does not cause a character to be typed on the
screen
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58
Special Keys

Allows user to perform certain tasks, such
as:






Saving text
Printing text
Capitalizing text
Deleting and inserting text
Moving the cursor
Example: “Enter” key (also called the return
key)


Most frequently used special key
Tells the computer to act on the instructions that
have been given to it
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59
Special Keys

Categories of special keys

Modifier keys: used in conjunction with another
key to enter commands into the computer
•
•
Include: control key, shift key, alternate key,
command key
Example: “Ctrl-P” can be used to print a document
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60
Special Keys

Categories of special keys

Lock keys: used to lock a key in position
•

Include: caps lock, numeric lock, scroll lock
Navigation keys: used to control the
movement of the cursor on the screen
•
Include: arrow keys, home/end key, page scroll key,
enter key, backspace key, insert key, delete key, tab
key
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61
Special Keys

Categories of special keys

Function keys: can be programmed to perform
certain tasks that will assist the user
•
•
•
•
•
Examples of tasks: saving text, printing a document
Number of F-keys varies: usually 12 or more
Located above the top row of alphanumeric keys
Usually preprogrammed by an application software
package
Some computers: permit F-keys to be user
programmed from the keyboard
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62
Mouse


A pointing device that fits comfortably
under the palm of the hand
Used to move the pointer on the screen to
an object on the screen


Examples of screen objects: menu item, icon,
line of text
Mouse must be “clicked” to perform a
certain action on the screen object
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63
Keyboard Ergonomics



Place keyboard at a level that is lower than
conventional desk
Feet should be flat on the floor
Hands should rest comfortably at the
keyboard with the shoulders relaxed


Elbows flexed at a 90-degree angle or tilted
slightly upward
Adjustable chair with good back support

To attain the proper typing height
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64
Keyboard Ergonomics





Use a light touch when entering data
Keep hands and fingers as relaxed as
possible
Position mouse at same height as
keyboard
Allow adequate working space
Position material being entered into the
computer


Lying flat on the work surface
Held vertically in a copy holder
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65
Keyboard Ergonomics
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66
Keyboard Care and Maintenance

Residue may build up on surface of
keyboard (grime)

Clean with an antiseptic wipe or a slightly damp,
lint-free cloth
•

Do not use aerosol sprays – liquid may drip down into
the keyboard: can damage electrical components
Dust interior of keyboard


Using compressed inert gas in a pressurized
can
Can also use a vacuum cleaner with a small
brush attachment
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67
Keyboard Care and Maintenance

Steps for cleaning computer keyboard



Shut down the computer
Disconnect keyboard cable
Hold keyboard upside down
•
Shake it to remove dust, dirt, or crumbs
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68
Keyboard Care and Maintenance

Steps for cleaning computer keyboard

Clean the keyboard using a can of compressed
air
•

Clean top and side of keys to remove grime
•
•

Following manufacturer’s instructions
With an antiseptic wipe or a damp, lint-free cloth
Can use a cotton swab moistened with alcohol to
clean between spaces of keys
Allow keyboard to dry completely (about 30
minutes)
•
Before reconnecting it to computer
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69
Keyboard Care and Maintenance

Liquids spilled into keyboard: can damage
it

Steps to take if liquid is thin and clear (e.g.,
water)
•
•
•
•
•
•
•

Turn off computer immediately
Unplug keyboard
Turn upside down and gently shake it
Keep inverted to allow additional fluid to drain out
Wipe with paper towel or clean cloth
Let dry in inverted position for 24 hours
If it doesn’t work after 24 hours: replace it
If liquid is greasy, sweet, or sticky:
•
•
Often causes permanent damage
Keyboard must be replaced
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70
Printer


An output device capable of printing text
and graphics on paper
Converts processed data from a
combination of electronic impulses into a
printed form

Hardcopy: printed form
•

Examples: patient reminders, patient receipts,
prescriptions, patient statements, office reports
Some printers: double as fax machines and
photocopiers

Only practical when there’s a small volume of
work
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71
Printer

Printer can be:



Printers most commonly used in medical
office:



Dedicated to one computer
Networked to a number of computers
Inkjet
Laser
Dot-matrix printer: impact printer that can
print multiple-copy documents

Not used as much as in the past
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72
Inkjet Printer


Uses droplets of ink to form text characters
and graphics
Contains nozzles



Spray tiny drops of ink onto the paper to create
an image
Lightweight and inexpensive
Can produce text and graphics

In black and white and in color
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73
Inkjet Printer
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74
Inkjet Printer

Printing speed: the number of pages per
minute (ppm) generated by the printer


Inkjet printer: ranges from 8 to 36 ppm
Pages that contain text print at a faster rate
than:
•
•
Pages that are in color
Graphics
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75
Inkjet Printer


Initial cost of printer: low
Ink cartridges: contain ink used by an inkjet
printer



Expensive
Must be replaced frequently
Most printers use at least 2 cartridges
•
•
1 black ink cartridge
1 or more colored ink cartridges
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76
Laser Printer

Produces text using:



Micro-thin beam of light (laser beam), electric
charges, and toner powder
To produce each page of text
Toner powder: housed in a plastic cartridge

Operating panel: displays level of toner
remaining
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77
Laser Printer
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78
Laser Printer

Initial cost of a laser printer: more than an
inkjet printer

Operating cost is less
•

Print quality of laser printers: superb


Cost of using toner powder is less than using ink
cartridges
Nearly attains the quality of typesetting
Available in black-and-white and color
models
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79
Laser Printer

Has a fast printing speed and quiet mode of
operation

Printing speed range: 12 to 35 or more ppm
•
•

Text: prints at a faster rate
Color and graphics: prints at a slower rate
Does not have as many mechanical moving
parts

Reduces frequency of repair
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80
Printer Care and Maintenance


Place printer on a flat, stable surface
Avoid placing printer in a location that
would expose it to:




Direct sunlight
Excessive heat
Moisture
Dust
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81
Printer Care and Maintenance

Sufficient room should be left around the
printer for:




Adding paper
Replacing ink or toner cartridges
Add paper when needed, following
manufacturer’s instructions
Replace ink cartridges (inkjet printers) and
toner cartridges (laser printers) as required,
following the manufacturer’s instructions
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82
Printer Care and Maintenance

After turning off the printer

Wait at least 5 seconds before turning back on
•

Rapid switching of the power off and on: can damage
printer
Clean regularly: to remove accumulated
dust and dirt

Outside case
•

Clean with a soft, clean cloth – dampened with a mild
detergent solution
Inside of printer
•
Clean according to instructions in user manual
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83
Storage Devices

Storage device: consists of a storage
medium that permanently stores
information for later retrieval by the
computer



Retains information after the power has been
removed
Used to store both programs and data
Examples:
•
•
•
•
Hard disks
CDs
DVDs
USB flash drives
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84
Storage Devices

Storage capacity of a storage device



Maximum amount of information the device can
hold
Measured in bytes (kilobytes, megabytes, and
gigabytes)
Varies widely on the basis of the type of storage
device
•
Example – typical hard disk: 250 GB
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85
Hard Disks


Consist of thin, rigid platters made of metal
or glass
Coated with a magnetically sensitive
material

Data are stored as magnetic particles
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86
Hard Disks
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87
Hard Disks

Method of organization used to store and
retrieve information

Disk surface is divided into concentric circles:
tracks
•


Data are stored on tracks in the form of magnetized
particles
Tracks are further divided into sectors
(resemble the wedge-shaped pieces of a pie)
Formatting: a process that numerically marks
tracks and sectors
•
Facilitates the location of information stored on the
disk
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88
Hard Disks
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89
Hard Disk Drive




Used to retrieve data from a hard disk
Consists of a mechanical device located
inside the main computer unit
Rotates a hard disk at a high rate of speed
Read/write head mounted on an arm


Floats on a layer of air above the spinning disk
Has instant access to all tracks and sectors on
disk
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90
Hard Disk Drive

Hard disk: sensitive to dirt, dust, smoke

Encased in a permanently sealed, airtight
container
•


Protects it from contaminants
Hard disk drive: consists of hard disks and
read/write heads
Purpose of read/write head

Stores information onto the hard disk: write
•

Information is transferred from RAM to the hard disk
Retrieves information from the hard disk: read
•
Information is transferred from the hard disk and into
RAM
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91
Hard Disk Drive
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92
Hard Disk Drive

Hard disk consists of two or more platters
stacked on top of one another


Increases storage capacity
Both sides of the disk: used to store information
•

Each side of disk: has a read/write head
Available in a variety of storage sizes
•
Begin at 80 GB and range up to 750 GB or more
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93
Optical Discs



Storage devices that store data using laser
technology
Used to store: system software, application
software, data, photographs, music, movies
Consists of a flat, round, portable disc
made of metal, plastic, and lacquer
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94
Optical Discs

May be read-only

Data can only be read (retrieved) from the disc
(using a laser beam of light)
•

Most application software today

Comes on CD-ROMs
•

Data cannot be written (saved) on the disc – example:
CD-ROM (holds 650 MB)
Installed onto a computer's hard drive to operate
May also be read/write

Data can be read from the disc and written onto
the disc
•
Example: CD-RW (compact disc rewritable)
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95
Optical Discs

DVD (digital versatile disc or digital video
disc)


Uses another type of optical disc technology
Can hold 6 times as much information as a CDROM
•

Used to store: music and movies
Optical drive: uses a laser to read an optical
disc or write onto an optical disc

Today’s computers: include one or more optical
drives
•

Installed in drive bays on the main unit
To use an optical drive:
•
•
Button is pushed to slide out a tray – optical disc is
inserted (label side up)
Same button is pushed to close tray
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96
USB Flash Drive




Portable storage device
Consists of a small circuit board in a plastic
case
Also known as a jump drive and a thumb
drive
Stores information using flash memory



Type of electrical computer memory
Inserted into a USB port on main unit
Storage capacity: up to 64 GB or more

Ranges between 1 GB and 64 GB or more
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97
Lesson 38.3
Medical Office Computerization
15.
16.
17.
Explain why it is important to have a foundation
in computer concepts before engaging in handson computer operations.
List and explain the advantages and
disadvantages of medical office
computerization.
List and describe measures that can be taken to
promote the efficient running of a computerized
medical office.
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98
Lesson 38.3
Medical Office Computerization (cont’d)
18.
19.
Explain the purpose of a medical practice
management software program.
Explain the function performed by each of the
following parts of the medical office computer
system: patient registration, appointments,
posting transactions, patient billing, insurance
billing, reports, file maintenance, and electronic
medical record.
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99
Medical Office Computerization


Use of computer to perform medical office
administrative procedures
Increased demand for qualified individuals
trained in medical office computerization
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100
Prerequisite Computer Concepts


Important to acquire a thorough knowledge
of computer concepts
Benefits



Increased confidence and ease when working
on a computer
Ability to understand computer terminology
Helps in communicating with computer software
specialists
•
Technical support staff for your medical practice
management program – necessary when first learning
the program or when a problem is encountered
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101
Impact of Medical Office
Computerization


Sometimes considered to be the solution to
all medical office management problems
However, there are some disadvantages:
can lead to difficulties

Must be aware of these problems
•
Take steps to prevent them or be prepared to deal
with them
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102
Advantages of Computerization

Speed and productivity

Large amount of data can be processed quickly
•

Example: inquiry search for patients with hypertension
Billing and health insurance
•
Can prepare and process these items in a short
period of time
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103
Advantages of Computerization

Efficiency

Computer can perform repetitive tasks in which
information is used again but in a different
format
•
Example: once a patient’s name and address have
been entered – can be used on a number of different
forms; do not need to reenter them
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104
Advantages of Computerization

Efficiency

Computer can automatically transfer information
where needed
•

Based on the task being performed – example:
patient’s name and address can be transferred to
patient statement, insurance form, mailing label
Computer keeps track of the status of functions
that have been executed in the office
•
Example: submission of insurance claims
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105
Advantages of Computerization

Accessibility

Data are easy to retrieve when needed
•
Example: patient registration record – do not need to
manually hunt through a filing system for record
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106
Advantages of Computerization

Audit trail

Computer can keep track of data entry
•
•
•

When new information entered or existing information
is changed, log is created and stored
Log includes time and date of entry; name of
computer operator
Log can be retrieved by practice manager to detect
irregularities
Reduced costs

Decreases operating costs by:
•
Reducing amount of time required to perform front
office procedures
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107
Disadvantages of Computerization

Initial cost

Initial investment is required
•
•
Hardware: physical devices making up a computer
system – cost depends on the number of computers
and printers needed
Software: programs that tell a computer what to do –
may need to periodically upgrade
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108
Disadvantages of Computerization

Time investment

Can take considerable time to learn a program
and use it with ease
•

May take a month or more
Software vendors provide:
•
•
On-site training
Technical support for problems
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109
Disadvantages of Computerization

Start-up tasks


Certain tasks must be performed before the
program becomes operational
Most offices are already computerized
•

These tasks have previously been performed
If office has just opened or purchased a new
program:
•
Start-up tasks are required
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110
Disadvantages of Computerization

Start-up tasks

Examples of start-up tasks:
•
•

Start-up tasks must be performed:
•

Entering diagnoses and procedures
Setting up patient registration records
Before program can be used to operate the front
office
Start-up data: only need to be entered once
•
Additional information can be added as needed
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111
Computer System Malfunction

Hardware and software systems
occasionally fail


One or more front office procedures come to a
halt
Cause of malfunctions:



Operator error
Software “bug”
Hardware malfunction
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112
Measures to Promote Efficient
Computer Operation

Selection of hardware and software


Should be selected from experienced and
established vendors
Some offices use a consultant to assist with this
process
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113
Measures to Promote Efficient
Computer Operation

Qualified personnel

Should be well-trained in:
•
•

Computer concepts
Hands-on computer operation
Office should:
•
•
Employ graduates of a formal education program
Have staff attend computer workshops and seminars
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114
Measures to Promote Efficient
Computer Operation

Qualified personnel

Untrained staff:
•

Can adversely affect efficient operation of a computer
system
Proper care and maintenance of the
computer system


Directly related to reliable operation of the
system
Less likely to malfunction
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115
Medical Practice Management Program




Provides instructions to the computer for
performing front office procedures
Consists of a number of areas of
specialization
Each area of specialization: system
Each system performs procedures related
to its particular area of specialization
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116
Medical Practice Management Program

Systems included in a practice
management program:







Patient registration system
Posting transactions system
Appointment system
Patient billing system
Insurance billing system
Reports system
File maintenance system
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117
Patient Registration System

Used to set up a registration record

For each patient in the medical practice
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118
Patient Registration System

Includes demographic and medical
insurance information:






Patient’s name and address
Telephone number
Gender
Date of birth
Social Security number
Insurance carrier, policy number, group number
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119
Patient Registration System

Also used to review and update information


Example: change of patient’s address
Use of information in patient registration
records:




Preparing new patient’s chart
Posting transactions
Processing patient statements
Processing insurance claims
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120
Appointment System

Handles all procedures related to
appointment scheduling:






Making an appointment
Canceling an appointment
Rescheduling an appointment
Finding an appointment
Printing an appointment log
Printing a patient reminder card
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121
Appointment System

Occasionally: medical office uses an
appointment book

When written record is preferred
•
In the event of a computer breakdown: written record
is still accessible
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122
Appointment System

Advantages of a computer scheduling
program:


Easier to change an appointment on a
computer than with pencil and paper
Appointment schedule can be printed out
•

Does not have to be generated manually from the
appointment book
Easier to schedule patients who need regular
weekly or monthly visits
•
Computer automatically records the patient's name in
that time slot – for as many visits as needed
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123
Posting Transactions System

Used to post charges for all the services
and procedures performed on a patient

MA enters the services and procedures
provided to the patient
•

From the encounter form – lists all services and
procedures performed during the visit
Computer has codes for all services and
procedures in its database
•
Automatically posts charge for each service or
procedure
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124
Posting Transactions System

Used to post payments made by:



Patient (e.g., copayment)
Third-party payer
Used to print out a patient receipt

Time-of-service (TOS) charges and payments
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125
Patient Billing System


Prepares bills and prints billing statements
Patient charges, payments, and
adjustments are posted



Stored in computer
Available when needed by patient billing system
Searches database to obtain information to
generate bills
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126
Insurance Billing System


Prepares and generates insurance claims
Procedures and diagnoses are entered into
computer (posting transactions)


Stored in medical practice database
Available when needed to prepare insurance
claims
•

Computer automatically fills out every portion of
insurance claim
Insurance claims submitted to insurance
companies


Mailing paper claim forms
Sending them electronically
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127
Insurance Billing System

Electronic filing of insurance claims


Becoming more widespread
Sent using electronic data interchange
•


Type of computer protocol
Biggest barrier: data security
Allows electronic payment of claims
•
Insurance company transfers payment electronically
to medical practice bank account
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128
Reports System


SUsed to generate a variety of reports for
the medical practice
Information in reports


Accessed by the computer from the medical
practice database
Allows physician to review and analyze
business and practice activities
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129
File Maintenance System

Start-up tasks must be performed: before
program becomes operational

Customizes program
•
To meet the specific requirements of a medical office
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130
File Maintenance System

Start-up tasks include:







Entering practice information
Assigning user passwords
Entering provider information
Entering diagnosis and procedure codes
Entering insurance carriers
Entering place of service information
Entering referring physicians
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131
File Maintenance System

Most offices are already computerized


Start-up tasks required:



Start-up tasks have previously been performed
Office is just opening
Office has purchased a new practice
management program
Once program is operational

File maintenance is used to:
•
•
Add information
Review, edit, delete information previously entered
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132
Lesson 38.4
Electronic Medical Record, Computer
Maintenance, and Computer Security
20.
21.
22.
List the general functions of electronic medical
record (EMR) software.
Explain the advantages and disadvantages of
EMRs.
Describe the processes required to produce or
convert each administrative and clinical
document in a medical record into a digital
format.
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133
Lesson 38.4
Electronic Medical Record, Computer
Maintenance, and Computer Security
(cont’d)
23.
24.
25.
Discuss concepts of networking and electronic
transfer of information.
List the procedures performed by the physician
and medical assistant using an EMR.
Describe the methods used to maintain security
of the medical office computer system.
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134
Lesson 38.4
Electronic Medical Record, Computer
Maintenance, and Computer Security
(cont’d)
26.
27.
28.
List and describe methods used to back up
computer data in the medical office.
State the various types of system maintenance
that should be performed on a computer system.
List the various types of service agreements
available for a computer system.
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135
Electronic Medical Record


Also known as electronic health record
(EHR)
Consists of a computerized record of the
important health information regarding a
patient

Includes:
•
•
Care of the individual
Progress of the patient’s condition
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136
Electronic Medical Record

Major undertaking to convert to an EMR

Deterrents:
•
•

Financial investment
Time investment
EMR software can perform following
medical record functions:





Creation
Storage
Organization
Editing
Retrieval
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137
Electronic Medical Record

Usually linked to the practice management
software

Allows the EMR to facilitate certain administrative
tasks
•

Examples: billing and insurance
Each document in the medical record has a
specific function

PPR: some documents consist of preprinted forms
•

Information is entered on a form
EMR: forms (templates) are displayed on computer
screen
•
Information completed in same way as paper form –
field: space on the form for entering information
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138
Advantages of the Electronic Medical
Record

Often leads to better quality care due to:



Improved communication
Faster access to data
Clearer and better documentation
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139
Advantages of the Electronic Medical
Record

Speed and productivity

Can retrieve requested documents from a
patient’s record very quickly
•

Documents from outside facilities can be stored
very quickly
•

Avoids having to manually hunt through the record
Example: laboratory reports
Records do not need to be filed
•
•
•
Saves time
Frees up office space needed to store records
Paper costs are reduced
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140
Advantages of the Electronic Medical
Record

Efficiency

Facilitates the entry of data into the patient’s
medical record
•


Point and click technology is used to enter data
(check-boxes; drop-down lists)
Prints customized patient education instructions
and handouts
Generates prescriptions
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141
Advantages of the Electronic Medical
Record

Accessibility

Provides ready access to patient’s medical
record
•


Available at any EMR computer workstation
More than one person can view chart at the
same time
Readily accessible if patient telephones office
•
Avoids having to find record and call patient back
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142
Disadvantages of the Electronic
Medical Record

Initial cost


Initial investment required for the purchase of
hardware and EMR software
Office must have a sufficient number of
computers
•


To accommodate the number of health care providers
in the office
Expense can easily fall into thousands of dollars
Must periodically upgrade the EMR software
•
Leads to further expenses
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143
Disadvantages of the Electronic
Medical Record

Time investment

Takes considerable time to learn an EMR
program
•

Up to several months or more
Most software vendors provide:
•
•
On-site training
Technical support for problems
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144
Disadvantages of the Electronic
Medical Record

Operational tasks

Certain tasks must be performed
•

Before EMR program becomes operational
Scanner
•
Used to scan older records into the computer (paper
records may be shredded)
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145
Disadvantages of the Electronic
Medical Record

What Would You Do? What Would You
Not Do?
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146
Disadvantages of the Electronic
Medical Record

What Would You Do? What Would You
Not Do?
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147
Electronic Medical Record Documents

EMR documents


Come from many locations and sources
Two categories:
•
•

Administrative documents
Clinical documents
EMR documents must be in a digital format

Modifications are needed to:
•
•
Produce them in a digital format
Convert them into a digital format
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148
Electronic Medical Record
Administrative Documents


Information necessary for efficient
management of the medical office
Patient registration record


Consists of demographic and billing information
In most EMR offices:
•
•
•
Patient completes a paper/pencil registration form
Data entered into a patient registration “computer”
form
Paper form may be shredded (based on medical
office policy)
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149
Electronic Medical Record
Administrative Documents

Patient registration record

Patient may be asked to enter this information
directly into the computer
•
•
Provide a private area for this task
MA must be available to answer patient questions
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150
Electronic Medical Record
Administrative Documents

NPP Acknowledgement Form

Notice of privacy practices (NPP): written
document – explains to patients:
•


How their protected health information will be used
and protected by the medical office
Patient signs a form: acknowledgement of
receiving a NPP
NPP form is scanned into the computer
•
Filed in the patient’s EMR
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151
Electronic Medical Record
Administrative Documents

Correspondence

Correspondence received from a number of
individuals or facilities – examples:
•
•
•
Patient’s insurance company
Patient’s attorney
Patient himself
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152
Electronic Medical Record
Administrative Documents

Correspondence

Correspondence transmitted electronically to
office
•

Already in a digital format – transferred to patient’s
EMR (example: letter from an insurance company
sent as an attachment to an email)
Correspondence received in a paper form
•
MA must convert to a digital format (scan it into
computer; file in patient’s EMR)
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153
Electronic Medical Record
Administrative Documents
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154
Electronic Medical Record
Administrative Documents

Correspondence

Copy of correspondence sent out of the office
•
•
Examples: referral letter, collection letter
Generated in an electronic format (word processing) –
can easily be transferred to the patient’s EMR
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155
Emergency Medical Record Clinical
Documents


Records and reports that assist physician in
the care and treatment of the patient
Health History Report


Collection of subjective data about the patient
Patient may complete paper/pencil health
history
•
MA enters data into the computer
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156
Emergency Medical Record Clinical
Documents

Health History Report

Alternatives:
•
•
MA enters information directly into computer – asks
patient questions related to his or her health status
Patient completes health history on a computer –
using a computer-guided questionnaire (private area
must be provided for patient; MA must be available to
answer questions)
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157
Emergency Medical Record Clinical
Documents

Physical Examination Report


An assessment by the physician of each part of
the patient’s body
Physician records findings on a computer
screen using:
•
•
•
Free-text entry
Drop-down lists
Check-boxes
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158
Emergency Medical Record Clinical
Documents

Physical Examination Report

EMR uses this information
•

To generate the PE report
At the end of the examination
•
•
PE report is complete
Physician does not need to dictate findings –
alleviates need for transcribing
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159
Emergency Medical Record Clinical
Documents

Progress Notes

Update the medical record with new information
•

Each time the patient visits or telephones the medical
office
Information is entered directly into the computer
using:
•
•
•
Free-text entry
Drop-down lists
Check-boxes
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160
Emergency Medical Record Clinical
Documents

Medication Record


Consists of detailed information related to the
patient’s medications
MA enters information into the computer using:
•
•
•
•
Free-text entry
Drop-down lists
Fill-in boxes
Check-boxes
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161
Emergency Medical Record Clinical
Documents

Medication Record – prescription program


Reduces amount of time needed to prescribe
and refill medication
Generates and prints prescriptions
•
•

Signed by the physician
Given to the patient
Transmits prescriptions electronically to
pharmacy
•
•
E-fax
E-mail
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162
Emergency Medical Record Clinical
Documents

Medication Record – prescription program

Advantages
•
•
•
•
•
Eliminate need for pharmacist to decipher physician’s
handwriting
Can compare prescription to list of drugs covered by
patient’s insurance plan
Program provides access to product information
Can quickly refill a prescription
Can print a list of prescriptions being taken by the
patient
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163
Emergency Medical Record Clinical
Documents

Medication Record – prescription program

Using an EMR prescription program:
•
•
•
Program displays list of available dosage strength and
preparation forms
Physician highlights dosage, strength, and
preparation desired – enters information into
computer
Physician selects additional information required
(dosage frequency; number of refills)
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164
Emergency Medical Record Clinical
Documents

Medication Record – prescription program

Using an EMR prescription program:
•
•
•
•
•
Program automatically checks prescription against
drug allergies and potential interactions with other
medications taken by patient
Once prescription entered into the computer,
medication recorded in the patient’s medication list
Prescription is printed out
Signed by physician
Given to patient or sent electronically to pharmacy
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165
Emergency Medical Record Clinical
Documents

What Would You Do? What Would You
Not Do?
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166
Emergency Medical Record Clinical
Documents

What Would You Do? What Would You
Not Do?
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167
Emergency Medical Record Clinical
Documents

Consultation Report


A narrative report of a clinical opinion about a
patient’s condition other than the primary
physician
If received as an electronic report:
•

MA transfers to patient's EMR
If received in paper format:
•
•
MA must scan letter into computer
Transfer report to patient's EMR
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168
Emergency Medical Record Clinical
Documents

Home Health Care Report


Home health care: the provisions of medical
and nonmedical care in a patient’s home or
place of residence
Most home health care reports: in paper format
•
•
Must be scanned into the computer
Transfer report to patient's EMR
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169
Emergency Medical Record Clinical
Documents

Laboratory Documents


A report of the analysis or examination of body
specimens
Office may communicate electronically with
outside laboratory – Request form:
•
•
Completed on a form displayed on the screen
Transmitted electronically to medical laboratory
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170
Emergency Medical Record Clinical
Documents

Laboratory Documents

Once patient’s tests have been completed:
•
•
•
Results are sent electronically to office – EMR files
report in patient’s EMR
Copy of report placed in physician’s “electronic review
bin” – for review and electronic signature
Abnormal values are highlighted on the report
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171
Emergency Medical Record Clinical
Documents

Laboratory Documents

Advantages
•
•

Can quickly view laboratory results in chronological
order
Results performed on a routine basis can be graphed
(e.g., blood glucose) – permits abnormal trend to be
identified early
If medical office is not networked by computers
to outside laboratory:
•
Laboratory reports must be scanned into computer
and filed in patient’s EMR
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172
Emergency Medical Record Clinical
Documents

Diagnostic Procedure Documents


Consist of a narrative description and
interpretation of a diagnostic procedure
Reports may be sent electronically to office
•
Easy to store report in patient's EMR
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173
Emergency Medical Record Clinical
Documents

Diagnostic Procedure Documents

Paper report
•
•

MA must scan into computer
File report in patient's record
Image of diagnostic procedure (x-ray, CAT
scan, MRI, ECG)
•
•
Can be stored as a digital image
Can be displayed on a computer screen
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174
Emergency Medical Record Clinical
Documents

Therapeutic Service Documents


Document the assessments and treatments
designed to restore a patient’s ability to function
Include:
•
•
•

Physical therapy report
Occupational therapy report
Speech therapy report
Most reports are in paper format
•
•
MA must scan into computer
File report in patient's EMR
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175
Emergency Medical Record Clinical
Documents

Hospital Documents



Prepared by the physician responsible for the
care of a patient while at the hospital
Include a history and physical report, operative
reports, discharge summary report, pathology
report, emergency department report
If hospital documents received in electronic
format:
•

MA files in patient's record
If hospital documents received in paper format:
•
•
MA must scan into computer
File document in patient's EMR
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176
Emergency Medical Record Clinical
Documents

Consent Forms

Legal documents required to:
•
•

Perform certain procedures
Release information contained in the patient’s medical
record
Most consent forms are in paper format that
patient signs
•
•
MA must scan into computer
File form in patient's EMR
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177
Internet


Global system of interconnected computer
networks
Connected by routers



Broadband router
Digital subscriber line (DSL)
Cable modem
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178
Internet

World Wide Web

Webpages can be accessed by a Web browser
•
•

Internet Explorer
Firefox
Input URL
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179
E-mail



Messages sent over the Internet
Files can be attached
Security and confidentiality are issues


MA should assume email may be read by
someone else
E-mail should not be used for private messages
or information in the medical office
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180
Clinical Messaging



E-mail within the EMR
Links directly to clinical and laboratory data
regarding patients
Physician can identify which medications a
patient’s insurance will cover.
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181
Electronic Transmission of Billing and
Insurance Information


Must maintain a secure network and use an
encryption system
Facilitate transition to ICD-10-CM in 2014
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182
E-Prescribing


Either a stand-alone program or a function
of an EMR
Computer program can access






Drug information
Information about patient’s insurance coverage
Information about patient history and allergies
Information about drug interactions
Penalties for physicians who do not use
this method
E-prescribing controlled substances will
soon be reality
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183
Medical Assistant’s Use of the
Electronic Medical Record

EMR programs include an index


Allow MA to access the various areas of
information
MA first selects the patient who is being
seen

Enters information about the visit
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184
Medical Assistant’s Use of the
Electronic Medical Record
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185
Medical Assistant’s Use of the
Electronic Medical Record

Once MA begins working with the patient:

Mechanism within the EMR program to select
an activity or topic – selection made through:
•
•

Set of tabs on the screen
Drop-down list
Example: selecting the “Medical History” tab
•
•
Moves user to a screen containing information about
patient’s medical history
Ability to move to other screens with more specific
information
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186
Functions Performed by the Medical
Assistant




Access the daily schedule
Select a patient
Enter the time that the patient has checked
in
Enter the examination room number
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187
Functions Performed by the Medical
Assistant
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188
Functions Performed by the Medical
Assistant








Enter the patient’s chief complaint
Enter or review the patient history
Enter or review patient allergies
Enter or review the patient’s current
medications
Enter vital signs
Enter measurements, such as height and
weight
Enter results of tests, such as vision screening
or hearing screening
Enter results of laboratory tests performed at
the office (e.g., urinalysis, hemoglobin, strep
testing)
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189
Functions Performed by the Medical
Assistant
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190
Physician’s Use of the Electronic
Medical Record

Physician enters data into the EMR about:




Examination of patient
Assessments
Plan for the patient
Physician can review and update all
information entered by MA
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191
Physician’s Use of the Electronic
Medical Record

If EMR program is linked to the practice
management software

Physician is able to specify type of visit and
patient diagnosis
•

Assists in billing as part of check-out procedure
Physician can print a summary of the visit
for the patient

By selecting information from a list on the
screen – examples:
•
•
•
•
Physical examination findings
Laboratory test results
Vital signs
Treatment recommendations
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192
Physician’s Use of the Electronic
Medical Record


Physician can enter notes or reminders
EMR provides ability to send electronic
messages

To other physicians/staff members in the
system – similar to e-mail
•
Example: message to MA to schedule a patient for a
test/procedure
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193
Computer Network Security


All HIPAA regulations apply to the EMR
Medical office must provide secure access
to patient health information

Stored in the computer's database
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194
Authentification

Each health care worker with permission to
use the computer network



Must have a password
Must log in to access the network
Passwords should be changed at regular
intervals

May be a system function that requires this
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195
Authentification


MA should not share password with anyone
else
Effective passwords include:

Random series of digits, letters, and symbols
•
Rather than English words, telephone numbers, or
other combinations that have meaning
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196
Levels of Authorization


Specific levels of authorization within the
computer network
Certain screens and certain functions


Only available to users with the correct level of
authorization
Example: at the end of a patient visit:

Physician must electronically sign the record
•

Closes the visit: information cannot be changed
Only the physician has this level of authority
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197
Automatic Logoff

All users should log out of the computer
network

When their workstations are unattended
•
If user forgets to do this: program automatically logs
off a user after a predetermined period of inactivity
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198
Audit Controls

Practice management programs and EMR
programs


Have the ability to track the activity of
individuals using the system
Used to:


Determine if security violations have occurred
Identify the individuals with whom those
violations may be associated
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199
Antivirus Software


Type of system software known as a utility
program
Installed on the computer system to scan
for computer viruses

Computer virus: software designed to
penetrate a computer or network without
consent
•
Can access information and/or cause damage
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200
Antivirus Software



Operates in the background
Monitors all files for viruses
Updates itself regularly

New computer viruses are developed constantly
•
Can be spread quickly through the Internet
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201
Firewall

A system that protects a computer network
from unauthorized access by



Users on its own network
Users on another network (e.g., Internet)
May be in the form of:


A utility software program
A firewall hardware device that connects to the
computer
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202
Firewall

All inquiries and messages entering or
leaving the computer system

Must pass through the firewall
•
•
Examines each inquiry or message – blocks those
that do not meet firewall’s security criteria
If firewall unsure about whether or not to grant access
– displays a screen message: user decides whether
or not to grant access
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203
Firewall

What Would You Do? What Would You
Not Do?
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204
Firewall

What Would You Do? What Would You
Not Do?
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205
Backups

Backup: a duplicate copy of a program or
data kept for reference


In case the original is damaged, lost, or
destroyed
Many medical offices contract with an
online backup service

Provides secure backups of all files used in the
office for a monthly fee
•
•
May be performed every few hours or at scheduled
times
Information is encrypted
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206
Backups

Large health care facilities

May back up information from individual
computers
•

Using their own network system
External hard drives, CD-RWs, and DVDRWs

Can be used to create physical backup copies
•
Must be stored in a safe place: physically remote from
computer system – example: physician or MA takes
backup home
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207
System Maintenance


System maintenance: involves setting up
and overseeing the computer system
Three aspects of system maintenance:



Disk cleanup
Disk defragmentation
System administration
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208
Disk Cleanup

Unneeded files stored on the hard drive



Slow down system performance
Accomplished by a utility program: usually
comes with the computer
Frees up significant amounts of hard drive
space and can significantly improve system
performance
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209
Disk Defragmentation

Rearranges information on the hard disk


Files and programs are stored closer together
Allows the computer to locate information
on the hard disk in a shorter period of time

Results in improved system performance
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210
System Administration

System administrator: person designated to
maintain the computer system



Usually a computer specialist: known as an
information technologist (IT)
Small offices: often use a consultant
Practices with several sites, health
maintenance organizations, and community
health centers

Often have an IT specialist, or even an IT
department
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211
Service Agreements

MA usually responsible for maintaining the
service agreements


For the office's computer systems
Types of service agreements



Maintenance agreements for the hardware
System support agreements for the software
Training of personnel on the software
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212
Service Agreements

Should designate an area in the medical
office

For the storage of user manuals for:
•
•
•
•
Computers
Printers
Scanners
Application programs
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213