Transcript Clinical Health Information Systems

Ch.3
Clinical Health Information Systems
PRETEST (TRUE/FALSE)
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.
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PRETEST (TRUE/FALSE) (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.

HEALTH DELIVERY FUNDAMENTALS
AMBULATORY CARE FACILITIES
Also called outpatient care facilities
 Provide care to patients who do not require an
overnight stay
 Privately or publicly owned
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EXAMPLES OF
AMBULATORY CARE FACILITIES
Doctor’s offices
 Medical clinics
 Public health departments
 Walk-in clinics
 Urgent care centers
 Outpatient surgery centers
 Diagnostic centers
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ACUTE CARE FACILITIES
Treat patients (inpatients) with more serious
illnesses or injuries
 Keep patients overnight or longer
 Owned by either for-profit corporations or notfor-profit organizations
 Typically called a hospital
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EXAMPLES OF
ACUTE CARE FACILITIES
Acute care hospital
 Not-for-profit hospital
 For-profit hospital
 Long-term care facility
 Rehabilitation facility
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HOSPITAL DEPARTMENTS
Surgery
 Radiology
 Pediatrics
 Laboratory
 Emergency (ED or ER)
 Trauma centers
 Intensive care units (ICUs)
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LENGTH OF STAY (LOS)
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Outpatient facility:
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Patients do not stay overnight
Inpatient facility:
ALOS less than 30 days (acute care)
 ALOS greater than 30 days (long-term care)
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Note: ALOS=Average LOS
DETERMINING FACILITY SIZE
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Outpatient facility:
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Number of patient encounters per day
Inpatient facility:
Number of licensed beds
 Bed count
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ADMISSION/DISCHARGE
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Outpatient facility:
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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
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ORGANIZATIONAL CHARTS
Used in business and other organizations to
illustrate managerial relationships
 Place most responsible position at top
 Place next management level below, and so forth
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ORGANIZATIONAL CHARTS
Use vertical lines to connect managers with
subordinates
 Use horizontal lines to indicate equal jobs
reporting to same manager
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ORGANIZATIONAL CHARTS (CONTINUED)
Inpatient care facilities generally have more
complex organizational structures
 Outpatient care facilities generally have a
simpler management structure
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Note:
LPN=Licensed Practical Nurse
LVN= Licensed Vocational Nurse
SUBACUTE CARE FACILITIES
Offer services appropriate for patients whose
nursing care needs are less frequent and
intensive
 Include physical rehabilitation facilities, longterm care facilities, home care
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REHABILITATION FACILITIES
Offer inpatient care
 Help patient return to maximum functionality
possible
 Specialize in physical medicine, PT
(PhysioTherapy), OT (Occupational Therapy),
addiction recovery
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LONG-TERM CARE FACILITIES
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
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HOME CARE
Offered regularly in patient’s home, not in a
facility
 Provided by home health agencies
 Includes the following healthcare providers:

Nurses
 PTs
 OTs
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OUTPATIENT CHART
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
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OUTPATIENT CHART (CONTINUED)
Includes detailed physician’s notes about each
visit
 Has smaller quantity of data than inpatient
chart
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INPATIENT CHART
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
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INPATIENT CHART (CONTINUED)
Includes doctor’s orders and nurses’ notes as
main elements
 Contains greater quantity of data than
outpatient chart
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Figure 1-10 Medical specialties and subspecialties
Figure 1-10 (continued) Medical specialties and subspecialties
Figure 1-10 (continued) Medical specialties and subspecialties
DIRECT CARE PROVIDERS
Provide healthcare services directly to patient
 Require state license to practice
 Actions regulated by professional or licensing
boards
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DIRECT CARE PROVIDERS (CONTINUED)
Must document patient care, including time
spent with, observations, actions
 Depend on accuracy and completeness of health
record to make patient care decisions
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DOCTORS
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
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DOCTORS (CONTINUED)
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Authorize medical orders and patient
documentation
EXAMPLES OF DOCTORS
Chiropractors
 Dentists
 Psychologists
 Osteopaths
 Medical doctors
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American boards of specialties and subspecialties
NURSES
Spend largest amount of time in direct patient care
 Several levels of nursing licensure:
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LPN (Licensed Practical Nurse)
RN (ADN= Associate Degree in Nursing, BSN= Bachelor of
Science Nursing )
CRNA(Certified Registered Nurse Anesthetists )
Nurse midwives
Nurse practitioners
PHYSICIAN ASSISTANTS
Work under supervision of physicians
 Conduct physical exams
 Diagnose and treat illnesses
 Order and interpret tests
 Counsel patients
 Assist in surgery
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ALLIED HEALTHCARE PROFESSIONALS
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)
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ALLIED HEALTHCARE PROFESSIONALS
(CONTINUED)
Clinical laboratory technicians
 Diagnostic technologists
 Pharmacists
 Registered dietitians (RDs)
 Audiologists
 Speech pathologists
 Clinical medical assistants
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CLINICAL PROFESSIONAL ORGANIZATIONS
American Medical Association (AMA)
 American Nurses Association (ANA)
 American Hospital Association (ANA)
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OUTLINE
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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
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CLINICAL INFORMATION
SYSTEMS
VARIOUS TERMS USED OVER TIME
CPR
ComputerBased
Patient
Record
EMR
PHR
EHR
Electronic
Medical
Record
Personal
Health
Record
Electronic
Health
Record
DEFINITIONS
CORE FUNCTIONS
WHERE ARE WE TODAY?
Broad Spectrum
EHR ADOPTION IN US HOSPITALS
2012 PHYSICIAN ADOPTION OF EHRS
EHR USE IN OTHER POST ACUTE
AND LTC SETTINGS
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Extremely low
6%--Long term care
 4%--Rehabilitation
 2%--Psychiatric
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Source: Health
Affairs, 2012
VALUE OF EHR
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Improved quality, outcomes and safety
Computerized reminders and alerts
 Improved compliance with practice guidelines
 Reduction in medical errors
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Improved efficiency, productivity, and cost
reduction
 Improved service and satisfaction
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OTHER 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
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CPOE
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Driven by need to
improve patient
safety
Automates the
ordering process
Accepts orders
electronically,
provides decision
support, may aid in
diagnosis and
treatment
USE AND STATUS 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
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HISTORICAL BARRIERS TO CPOE USE
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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?
MEDICATION ADMINISTRATION
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Use of barcoding
becoming more
widespread
Aids in correctly
identifying patient,
drug, dose, etc.
HIMSS
implementation
guide—good resource
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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…
TELEMEDICINE
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Use of
telecommunciations
for the direct
provision of care to
patients at a distance
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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
TELEHEALTH
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Using telecommunications to communicate with
patients and deliver services
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Electronic consultations (e-consultations)
Patient portals
Refilling prescriptions
Registering patient
Scheduling appointments
TELEHEALTH
 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
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PERSONAL HEALTH RECORD &
PATIENT PORTALS
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
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FITTING PIECES TOGETHER
BARRIERS TO ADOPTION & STRATEGIES
FOR OVERCOMING THEM
Financial
 Organizational or Behavioral
 Technical Barriers
 Privacy and Security Barriers
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STRATEGIES FOR OVERCOMING BARRIERS
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What strategies are being employed to help
overcome—
Financial barriers?
 Behavioral barriers?
 Technical barriers?
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SUMMARY
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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