Transcript Ambulatory care

AMBULATORY CARE SYSTEMS
Chapter 23
Andre Lim
BSN Jade
OBJECTIVES
 Understand information issues in ambulatory care including
regulatory requirements.
 Delineate the functions and benefits for information systems
and sources for further information.
 Describe the state of the art in using information systems in
ambulatory care.
 Describe further trends in ambulatory care information
systems.
 Define various roles for nurses.
Ambulatory Care
Information Systems
Ambulatory Care Physician
Order Entry (ACPOE)
e-Prescribing
Evidence-Based Medicine
Regulatory Requirements
KEY WORDS
On April 27, 2004, President George Bush announced a goal
to establish electronic health records (EHR) for all citizens
within a 10-year time frame.
He created the position of a National Health Information
Technology Coordinator to develop a nationwide interoperable
health information technology infrastructure.
One of the Responsibilities:
“The coordination of care and information among hospitals,
laboratories, physician offices, and other ambulatory care
providers through an effective infrastructure for the secure
and authorized exchange of health care information.”
(White House Executive Order, 2004)
So just get your act together?
GOOD JOB MURICA!
AMBULATORY
CARE
SYSTEMS
“DECADE OF HEALTHCARE INFORMATION
TECHNOLOGY”
What does this guy
even do?
Coined by Tommy G.
Thompson, the
Health and Human
Services Secretary.
Announced the
publication of a
report, in July 2004,
which identified four
major goals.
As a response to increasing costs of providing healthcare, the healthcare industry
has moved away from the expensive inpatient, acute care environment to caring
for patients in various ambulatory care settings.
Where Are Ambulatory Patients Being Treated?
ISSUES FOR AMBULATORY CARE
 Increased Accountability
 Need for Continuous and Documented Service
Improvements
 Pressures to Control Utilization
 Protection of Confidential Information
 Effective Reimbursement of Services
Ambulator y care information systems designed
to…:
 Store
 Manipulate
 Retrieve
… information for planning, organizing, directing,
and controlling administrative and clinical
activities associated with the provision and use of
ambulator y care ser vices and facilities.
Applications needed in the ambulator y
environment:
 Registration
 Billing
 Accounts Receivable
 Accounts Payable
 Patient and Staf f Scheduling
 Managed Care Functionality
APPLICATIONS
NECESSARY
In the
A m b ula to r y
E nv i ro n m e n t
FINANCIAL BENEFITS
COST EFFECTIVE!!!
(And timely bill submission process)
ADMINISTRATIVE BENEFITS TO AN AUTOMATED
INFORMATION SYSTEM
 Reduction of Record Room
Size
 Reduced Time Finding and
Delivering Char ts ( ctrl+F)
 Increased Privacy of Data
 Legible and Legal Formats
 Promotion of Quality
Assurance
 Improved Patient Satisfaction
 Home Access to Physicians
and Nur se Practitioners
 Aler ts for Incomplete Data
 Integration of Clinical Data
Patient scheduling systems
must link together so activities
can be coordinated.
 Appointment Times
 Providers
 Resources
 Locations Throughout the
Hospital
Patient must be seen at the
appropriate times with the
proper per sonnel, equipment,
supplies, and char t information.
Physicians and nur se
practitioners should also be
credentialed
Automated Healthcare Record can provide:
 Problem List
 Automated ACPOE
 Medication Record
 Vital Signs
 Progress Notes
 Lab Results
 Flow Sheets
 Clinical Decision Support System
 e-Prescribing
 Evidence-Based Medicine
Patient Master Index
Other functions of the ambulatory care environment can
be enhanced by electronic information technology for data
collection and management.
Automatic transfer requests for referrals will aid patient
care and bill payment.
Medical record location can be tracked automatically with
an automated system.
CLINICAL
BENEFITS
Systems must support the Resource-Based Relative
Value Scale (RBRVS) and the Relative Value Unit (RVU).
The RBRVS procedure fee pricing is a model designed
by the Department of Health and Human Services
(DHHS). Each physician’s Current Procedural
Terminology (CPT) code has a relative value associated
with it. The payer will pay the physician on the basis of
a monetary multiplier for the RVS system
Regulatory Requirements
Health Care Portability and Accountability Act of 1996 requires six code sets.
A database must be maintained of all the current coding schemes used in
ambulatory environments including:
 Current Procedural Terminology (CPT)
 Ninth Revision of the International Classification of Diseases (ICD-9-CM)
 Healthcare Common Practice Coding System (HCPCS)
 National Drug Code (NDC) managed by the FDA
 Code on Dental Procedures and Nomenclature
Regulatory Requirements II
Medicare’s Ambulatory Payment Classification (APC) system is a prospective
payment system for hospital outpatient services.
 Mandated by Congress as part of the Balanced Budget Act of 1997
 All covered outpatient services are divided into 451 groups called “APCs”
 Software available to help ambulatory care organizations determine and
verify payment
 Makes it possible for outpatient managers to determine patterns, predict
cost of resource use, and evaluate managed care and physician contracts
Regulatory Requirements III
There are a multitude of other federal, state, and local regulations:
 Centers for Medicare and Medicaid Services (CMS) AKA Healthcare
Financing Administration
 Health plan Employer Data and Information Set (HEDIS)
 Outcome and Assessment Information Set (OASIS)
In the ambulatory care environment, there is a lot of emphasis on data at
the individual patient’s level. It is also important to aggregate data to view
patient care and payment trends.
Regulatory Requirements IV
IMPLEMENTATION ISSUES AND CHALLENGES
Ambulatory Care Systems
Stone
Ages
Totally
2015
Signed,
but not in
the band
Far out
man!
Based on 7,808
facilities in 2004:
 84% were not
automated
 13% installed a
system
 3% had a contract
signed, but no
software
 7% planned to
purchase a software
I use an
Ambulatory Care
System because
it helps me with
my job!
Exactly
ROLE OF A
NURSE
Using
Informatics
Concepts in the
Ambulatory
Arena
WOW!
WARNING!
I suggest taking notes for this section!
MEMBER ASSOCIATIONS INVOLVED IN
AMBULATORY CARE
American Academy of Ambulatory Care Nursing (AAACN)
American Medical Informatics Association (AMIA)
Medical Group Management Association (MGMA)
Society for Ambulatory Care Professionals
Federated Ambulatory Surgery Association (FASA)
American Association of Ambulatory Surgery Centers (AAASC)
Association for Ambulatory Behavioral Healthcare (AABH)
American Health Information Management Association
(AHIMA)
 Healthcare Information Management Systems Society (HIMSS)








ACCREDITATION ORGANIZATIONS
 Accreditation Association for Ambulatory Health Care (AAAHC)
 COLA
 National Committee for Quality Assurance (NCQA)
 Joint Commission on Accreditation of Healthcare
Organizations
JOURNALS AND CONFERENCES





Journal of Ambulator y Care Management
The Ambulator y Pediatrics
Journal for Healthcare Quality
Medical Group Management Association (MGMA)
American Medical Informatics Association (AMIA)
The goals set by President Bush and the appointment of
Dr. David J. Brailer as the national coordinator will inject
momentum into the adoption of automated systems into
ambulatory care. There is a move to use computerized provider
order entry (CPOE) systems in ambulatory care. The biggest area
of impact is that of medication safety where it is thought that
adverse drug events could be prevented. A major area of concern
is who should pay for the implementation of these systems.
Estimates for the use of electronic prescribing of medications is
now between only 5 and 18% of physicians and other clinicians.
Some ambulatory practices are using electronic mail, computer
interviewing, voice recognition, handwriting recognition, smart
card technology, wireless devices, and biometrics. Some seek
the goal of a paperless record. Automating the physician’s
offices and ambulatory care practices is a primary step in the
goal of EHRs for all citizens
FUTURE
DIRECTIONS
THANK YOU FOR LISTENING
CLICK HERE FOR MORE PICTURES!
WELCOME TO ANDRE’S SUPER INFORMATION
GALLERY!
GUARDIANS OF THE GALLERY
Ambulatory care is a patient focused service where some
conditions may be treated without the need for an overnight
stay in hospital. You will receive the same medical treatment
you would previously have received as an inpatient.
Delineate: describe or portray (something) precisely
GUARDIANS OF THE GALLERY
PRESIDENT GEORGE W. BUSH
GUARDIANS OF THE GALLERY
EHR: Honestly, if you don’t know what this is… I’ll be
disappointed in you
Interoperable: (of computer systems or software) able to
exchange and make use of information.
Infrastructure: the basic physical and organizational structures
and facilities (e.g., buildings, roads, and power supplies)
needed for the operation of a society or enterprise.
GUARDIANS OF THE GALLERY
Four Major Goals of Ambulatory Care
Systems:
 Inform Clinical Practice
 Interconnect Clinicians
 Personalize Care
 Improve Population Health
GUARDIANS OF THE GALLERY
 Hospital Sponsored Ambulator y
Health Ser vices
 Urgent and Immediate Care Center s
 Of fice-Based Surger y Center
Ambulator y Clinics
 Pain Management Clinics
Surger y Center s
 Podiatr y Of fice
Diagnostic Laboratories
 MRI Center s
Health Maintenance Organizations
Independent Physician Associati ons  Plastic Surger y Center s
Bir thing Center s
College/Univer sity Health Ser vices
Faculty Medical Practices
Community Health Center s
Prison Health Center s
Indian Health Center s
Various Ambulatory
Care Settings











And a Whole Lot More!
GUARDIANS OF THE GALLERY
Leads to decreased days in accounts receivable
The are ways to pay online or in person
depending on the system used
Depending on the system, credit cards can also
be used to pay.
GUARDIANS OF THE GALLERY
Patient Master Index
The basis for collection of all patient related
data. If the ambulatory care organization is a
part of a greater healthcare enterprise, then
the PMI must be integrated into an enterprise
wide index.
A master patient index is a cultural repository
for patient’s member information.
GUARDIANS OF THE GALLERY
CPT: Describes medical procedures performed
by physicians and other health workers. The
codes were developed my the AMA to assist in
the assignment of reimbursement amounts to
providers by Medicare carriers.
ICD-9-CM: Designed for the classification of
morbidity and mortality information for
statistical purposes.
GUARDIANS OF THE GALLERY
HCPCS: a collection of codes that represent
procedures, supplies, products, and services
NDC: identifies pharmaceuticals in detail. Used
by the FDA for reporting and it is used in many
healthcare information
GUARDIANS OF THE GALLERY
HEDIS: standardized, comprehensive set of
indicators used to measure the performance of a
health plan.
OASIS: for use in home health agencies and is an
initiative from the Health Care Financing
Administration. The purpose is to provide a
comprehensive assessment for an adult home care
patient and measure patient outcomes for
purposes of outcome-based quality improvement
TOTALLY A RELEVANT IMAGE…
DID I SCARE YOU?