PowerPoint Presentation

Where Are Ambulatory Patients Being Treated?

As a response to increasing costs of providing healthcare, the healthcare industryhas moved away from the expensive inpatient, acute care environment to caringfor patients in various ambulatory care settings.So just get your act together?

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)

AMBULATORY CARE SYSTEMS

GOOD JOB MURICA!

Ambulatory Care Information SystemsAmbulatory Care Physician Order Entry (ACPOE)e-PrescribingEvidence-Based MedicineRegulatory RequirementsKey wordsEHR: Honestly, if you dont know what this is Ill 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 galleryIssues for ambulatory careIncreased Accountability

Need for Continuous and Documented Service Improvements

Pressures to Control Utilization

Protection of Confidential Information

Effective Reimbursement of Services

WOWMUCH PROBLEMS!WOW!Ambulatory care information systems designed to:StoreManipulateRetrieve information for planning, organizing, directing, and controlling administrative and clinical activities associated with the provision and use of ambulatory care services and facilities.

Applications needed in the ambulatory environment:RegistrationBillingAccounts ReceivableAccounts PayablePatient and Staff SchedulingManaged Care FunctionalityIn the Ambulatory EnvironmentApplications necessaryCOST EFFECTIVE!!!(And timely bill submission process)Financial benefits

Reduction of Record Room SizeReduced Time Finding and Delivering Charts (ctrl+F)Increased Privacy of DataLegible and Legal FormatsPromotion of Quality AssuranceImproved Patient SatisfactionHome Access to Physicians and Nurse PractitionersAlerts for Incomplete DataIntegration of Clinical DataPatient scheduling systems must link together so activities can be coordinated.Appointment TimesProvidersResourcesLocations Throughout the HospitalPatient must be seen at the appropriate times with the proper personnel, equipment, supplies, and chart information.Physicians and nurse practitioners should also be credentialedAdministrative benefits to an automated information systemCLINICAL BENEFITSAutomated Healthcare Record can provide:Problem ListAutomated ACPOEMedication RecordVital SignsProgress NotesLab ResultsFlow SheetsClinical Decision Support Systeme-PrescribingEvidence-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.

Regulatory RequirementsSystems 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 physicians 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 systemRegulatory Requirements IIHealth 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 FDACode on Dental Procedures and Nomenclature

Regulatory Requirements IIIMedicares 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 1997All covered outpatient services are divided into 451 groups called APCsSoftware available to help ambulatory care organizations determine and verify paymentMakes it possible for outpatient managers to determine patterns, predict cost of resource use, and evaluate managed care and physician contractsRegulatory Requirements IVThere are a multitude of other federal, state, and local regulations:Centers for Medicare and Medicaid Services (CMS) AKA Healthcare Financing AdministrationHealth 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 patients level. It is also important to aggregate data to view patient care and payment trends.Based on 7,808 facilities in 2004:84% were not automated13% installed a system3% had a contract signed, but no software7% planned to purchase a software

Implementation Issues and Challenges

Using Informatics Concepts in the Ambulatory ArenaRole of a nurseI use an Ambulatory Care System because it helps me with my job!ExactlyWARNING!I suggest taking notes for this section!

MUCH LIST!

MUCH NOTES!

WOW!

American Academy of Ambulatory Care Nursing (AAACN)American Medical Informatics Association (AMIA)Medical Group Management Association (MGMA)Society for Ambulatory Care ProfessionalsFederated 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)

Member Associations Involved in Ambulatory CareAccreditation Association for Ambulatory Health Care (AAAHC)

COLA

National Committee for Quality Assurance (NCQA)

Joint Commission on Accreditation of Healthcare OrganizationsAccreditation OrganizationsJournal of Ambulatory Care ManagementThe Ambulatory PediatricsJournal for Healthcare QualityMedical Group Management Association (MGMA)American Medical Informatics Association (AMIA)Journals and ConferencesFUTURE DIRECTIONSThe 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 physicians offices and ambulatory care practices is a primary step in the goal of EHRs for all citizensTHANK YOU FOR LISTENING

CLICK HERE FOR MORE PICTURES!WELCOME TO ANDRES SUPER INFORMATION GALLERY!Ambulatory careis 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) preciselyGuardians of the galleryGuardians of the gallery

PRESIDENT GEORGE W. BUSHFour Major Goals of Ambulatory Care Systems:Inform Clinical PracticeInterconnect CliniciansPersonalize CareImprove Population HealthGuardians of the galleryVarious Ambulatory Care SettingsAmbulatory ClinicsSurgery CentersDiagnostic LaboratoriesHealth Maintenance OrganizationsIndependent Physician AssociationsBirthing CentersCollege/University Health ServicesFaculty Medical PracticesCommunity Health CentersPrison Health CentersIndian Health CentersHospital Sponsored Ambulatory Health ServicesUrgent and Immediate Care CentersOffice-Based Surgery CenterPain Management ClinicsPodiatry OfficeMRI CentersPlastic Surgery Centers

And a Whole Lot More!Guardians of the galleryDID I SCARE YOU?37Track 01artisttitle, track 1genre77426.68