Introduction to Health Informatics IChapters 1-3 of

. .

IntroductionsSyllabus OverviewQuestionsUnit 1/Chapters 1-3/OverviewProblem Solving

. .

Nathan Botts, PhDCalifornia nativeHealth IT Researcher (Westat, Center

for HealthIT)CTO of HealthATM

. .

Personal Health Information SystemsDesign Science ResearchPotential for Health Outcomes

Impact within Underserved, Chronically Ill, Populations

Other Research Public Health Informatics Health Cyberinfrastructure Health Information Exchange

. .

PHR Integrated with Google Health platform

Focus on usability to address digital divide

Ability to affect Health Locus of Control

. .

What work do you do or what work do you want to do?

What made you interested in Health Informatics?

Any other aspects of your life that you would like to share?

. .

Seminars = Wednesday 9pm ESTUnit 1 – March 23- March 29Projects are due Tuesday 11:59 pm

EST of their assigned Unit.All course projects submitted on time

will be graded within five days of their due date (the Sunday of the following unit).

. .

Seminars = Wednesday 9pm ESTDB – Introduction, Discussion 1 &2Seminar QuizHomework Zero

. .

Post a minimum of three posts per discussion question.  One initial response and two replies to your classmates

Posting on a minimum of three different days, for example: Wednesday, Friday and Monday

The first post must be made by Saturday.

. .

Introduction to Health Care Information

. .

Types of Health Care Information Patient Encounter Data Patient Specific Information

Clinical Administrative Combined

Aggregate Information Clinical Administrative Combined

Comparative Information Expert of Knowledge-based Information

. .

Research Perspective1 Practice Perspective2

2http://www.sciensus.com/index.php?page=what-is-hi1 http://www.ukchip.org/?q=page/Professionalism-Health-Informatics

. .

Internal Data/Information▪ Patient Encounter

▪ Patient specific▪ Aggregate▪ Comparative

▪ General Operations External Data/Information

▪ Comparative▪ Expert/Knowledge-based

. .

Primary PurposeType

Clinical Administrative

Patient-Specific

Those items generally included as a part of the patient medical record are in italics

Identification SheetProblem ListMedication RecordHistoryPhysicalProgress NotesConsultationsPhysicians’ OrdersImaging and X-ray resultsLab resultsImmunization RecordOperative ReportPathology ReportDischarge SummaryDiagnoses CodesProcedure Codes

Identification SheetConsentsAuthorizationsPre-authorization SchedulingAdmission/RegistrationInsurance EligibilityBillingDiagnoses CodesProcedure Codes

Aggregate Disease IndexesSpecialized RegistersOutcomes DataStatistical ReportsTrend AnalysisAd hoc Reports

Cost ReportsClaims Denial AnalysisStaffing AnalysisReferral AnalysisStatistical ReportsTrend AnalysisAd hoc Reports

. .

Purpose of Patient Records Patient care Communication Legal documentation Billing and Reimbursement Research and Quality Management

. .

Content of Patient Records (myPHR, 2004)

Identification Sheet Problem List Medication Record History and Physical Progress Notes Consultation

. .

Overview of Inpatient Encounter Scheduling Preadmission Admission/Registration Treatment

▪ Medical▪ Nursing▪ Ancillary

Discharge

. .

Outpatient/Ambulatory EncounterPhysician’s Office Patient Flow

Check In Move to Exam Room Examination Check Out Later activities

. .

Data Needed for Reimbursement UB 92 CMS 1500

Other Uniform Data Sets ACDS UHDDS

. .

UHDDS elements as adopted in 1986 are:1.    Personal identification2.    Sex3.    Race4.    Ethnicity5.    Residence6.    Hospital identification7-8.  Admission and discharge dates9-10.  Attending physician and operating physician11.    Diagnoses: Principal diagnosis & Other diagnoses 12.    Procedure and date13.    Disposition of patient14.    Expected payer

. .

Coding Systems ICD-9-CM

▪ National Center for Health Statistics▪ Inpatient and Outpatient Diagnoses▪ Inpatient Procedures

CPT▪ American Medical Association▪ Outpatient Procedures

. .

Disease and Procedure IndexesSpecialized Registers

Emergency Room Operating Room Trauma Tumor Other

Ad hoc Reports

. .

Limitless Ad hoc ReportsSpecific Examples

Medicare Cost Reports Health Care Statistics

▪ Census▪ Discharge

. .

Outcome Measures Benchmarking Balanced Scorecards Clinical Value Compass

. .

Health Care Data Quality

. .

Data vs. InformationProblems with poor quality dataEnsuring Data QualityData Errors

. .

Information is processed data Health care information is processed

health care dataKnowledge is a “combination or

rules, relationships, ideas, and experience” (Johns, 1997)

. .

Health Care Data

Health Care Information

Health Care

KnowledgeProcessing

. .

Diminished quality of Patient care data can lead to problems with Patient care Communication among providers &

patients Documentation Reimbursement Outcomes assessment Research

. .

Medical Record Institute Principles of Health Care Documentation (MRI, 2004) Unique Patient Identification within and across

systems Health care documentation must be

▪ Accurate and consistent▪ Complete▪ Timely▪ Interoperable across systems▪ Accessible▪ Auditable

Confidential and secure authentication and accountability must be provided

. .

Accessibility Consistency Currency Granularity Precision

Accuracy Comprehensiveness Definition Relevancy Timeliness

AHIMA Data Quality Management Model: AHIMA Data Quality Management Model: Data CharacteristicsData Characteristics

. .

. .

Systematic Random

Unclear data definitionsUnclear data collection guidelinesPoor interface designProgramming errorsIncomplete data sourceUnsuitable data format in the sourceData dictionary is lacking or not

availableData dictionary is not adhered toGuidelines or protocols are not

adhered toLack of insufficient data checksNo system for correcting detected

data errorsNo control over adherence to

guidelines and data definitions

Illegible handwriting in data sourceTyping errorsLack of motivationFrequent personnel turnoverCalculation errors (not built into the

system)

. .

Data Error Prevention Compose a minimum set of

necessary data items Define data and data

characteristics in a data dictionary

Develop a data collection protocol

Create user friendly data entry forms or interface

Compose data checks Create a quality assurance

plan Train and motivate users

Data Error Detection Perform automatic data checks Perform data quality audits Review data collection protocols

and procedures Check inter- and intraobserver

varability (if appropropriate) Visually inspect completed forms

(online or otherwise) Routinely check completeness of

data entry

. .

Actions for Data Quality Improvement Provided data quality reports to users Correct inaccurate data and fill in incomplete

data detected Control user correction of data errors Give feedback of data quality results and

recommendations Resolve identified causes of data errors Implement identified system changes Communicate with users

. .

Health Care Information Regulations, Laws and Standards

The current draft of the PHR Certification Criteria specifies use of theHL7 Continuity of Care Document (CCD)  as the only endorsed standard for interoperable exchange of information to and from PHRs.  This is extremely short-sighted. The current draft of the PHR Certification Criteria specifies use of theHL7 Continuity of Care Document (CCD)  as the only endorsed standard for interoperable exchange of information to and from PHRs.  This is extremely short-sighted.

“The current draft of the PHR Certification Criteria specifies use of theHL7 Continuity of Care Document (CCD) as the only endorsed standard for interoperable exchange of information to and from PHRs.  This is extremely short-sighted.” 1

- Vince KuraitisPrincipal, Better Health Technologies, LLCMember, ASTM CCR Steering Committee

1http://e-caremanagement.com/cchit-should-support-both-the-hl7-ccd-and-the-astm-ccr-for-phrs/

. .

Accreditation, Licensure & Certification Facility Licensure Certification Joint Commission on Accreditation of

Healthcare Organizations (JCAHO) Other Accrediting Organizations

. .

Legal Aspects of Health Care Information Health Record as a Legal Document

▪ Definition▪ Retention of Health Records▪ Authentication

Privacy and Confidentiality▪ Pre-HIPAA▪ HIPAA▪ Release of Information

. .

How do government policies affect health care information requirements?

. .

States oversee facility licensureFacilities must have a license to

operateEmphasis is on standards for

physical plant, safety, etc. Minimum standards for patient

records

. .

Gives authority to participate in Medicare and Medicaid

Standards were established in 1970’s

Hospitals with JCAHO Accreditation have “deemed” status

. .

Voluntary external reviewWell known agencies

JCAHO—hosptials and other health care facilities

NCQA—managed care plans AOA—Osteopathic health care

organizations CARF—Rehabilitation facilities AAAHC—Ambulatory care facilities

. .

Possible Benefits Deemed status for CMS programs and some

state licensure Required for reimbursement from some payers Validates quality of care May influence liability insurance May enhance managed care contracts Gives competitive edge over non-accredited

. .

What is the legal Health Record? No simple answer in the electronic

environment State and Federal laws are being

modified

. .

AHIMA define Legal Health Record (LHR)

“the documentation of the healthcare services provided to an individual in any aspect of healthcare delivery by a healthcare provider organization.”

(Amatayakul, 2001)

. .

AHIMA defines four categories of patient data Legal Health Record Patient-Identifiable Source Data Administrative Data Derived Data

. .

JCAHO defines authentication as (JCAHO, 2004)

“the validation of correctness for both the information itself and for the person who is the author or the user of the information”

. .

Forms of Authentication Handwritten signature Electronic signature

▪ Most states allow or are silent on electronic signatures

▪ Policies and procedures are needed to insure that electronic signature codes, etc are not shared

. .

Privacy—individual's right to be left alone In health care—the right to limit access

to health care informationConfidentiality—the expectation that

information will only be used for its intended purpose Confidentiality relies on trust

. .

Pre-HIPAA A few federal and state laws, but no

comprehensive federal regulation to protect private health information

HIPAA Multiple Sections, including Privacy Rule HIPAA=Health Insurance Portability and

Accountability Act

. .

Key definitions Covered Entities

▪ Health plans▪ Health care clearinghouses▪ Health care providers

Key consumer facets Limits exposure of unnecessary data Covered entities must disclose PHI to the

individual within 30 days upon request  The right to request that a covered entity

correct any inaccurate PHI.

. .

Key definitions Protected Health Information (PHI)

▪ Relates to physical or mental health, provision of or payment for health care

▪ Identifies the person▪ Created or received by a covered entity▪ Transmitted or maintained in any form

. .

Five major components Boundaries Security Consumer control Accountability Public Responsibility

. .

Health care organizations need comprehensive policies and procedures for releasing patient information Routine Use –requires consent Non-routine Use—requires authorization

. .

Chp1= Intro to domain of Health Information

Chp2=Health Care Data QualityChp3=Regulations, Laws and

Standards