Clinical Health Information Systems

Ch.3

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.

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

EXAMPLES OF AMBULATORY CARE FACILITIES

Doctor’s offices Medical clinics Public health departments Walk-in clinics Urgent care centers Outpatient surgery centers Diagnostic centers

ACUTE CARE FACILITIES

Treat patients (inpatients) with more serious illnesses or injuries

Keep patients overnight or longer Owned by either for-profit corporations or

not-for-profit organizations Typically called a hospital

EXAMPLES OF ACUTE CARE FACILITIES

Acute care hospital Not-for-profit hospital For-profit hospital Long-term care facility Rehabilitation facility

HOSPITAL DEPARTMENTS

Surgery Radiology Pediatrics Laboratory Emergency (ED or ER) Trauma centers Intensive care units (ICUs)

LENGTH OF STAY (LOS)

Outpatient facility: Patients do not stay overnight

Inpatient facility: ALOS less than 30 days (acute care) ALOS greater than 30 days (long-term care)

Note: ALOS=Average LOS

DETERMINING FACILITY SIZE

Outpatient facility: Number of patient encounters per day

Inpatient facility: Number of licensed beds Bed count

ADMISSION/DISCHARGE

Outpatient facility: 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

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

ORGANIZATIONAL CHARTS

Use vertical lines to connect managers with subordinates

Use horizontal lines to indicate equal jobs reporting to same manager

ORGANIZATIONAL CHARTS (CONTINUED)

Inpatient care facilities generally have more complex organizational structures

Outpatient care facilities generally have a simpler management structure

Note: LPN=Licensed Practical NurseLVN= Licensed Vocational Nurse

SUBACUTE CARE FACILITIES

Offer services appropriate for patients whose nursing care needs are less frequent and intensive

Include physical rehabilitation facilities, long-term care facilities, home care

REHABILITATION FACILITIES

Offer inpatient care Help patient return to maximum functionality

possible Specialize in physical medicine, PT

(PhysioTherapy), OT (Occupational Therapy), addiction recovery

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

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

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

OUTPATIENT CHART (CONTINUED)

Includes detailed physician’s notes about each visit

Has smaller quantity of data than inpatient chart

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

INPATIENT CHART (CONTINUED)

Includes doctor’s orders and nurses’ notes as main elements

Contains greater quantity of data than outpatient chart

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

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

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

DOCTORS (CONTINUED)

Authorize medical orders and patient documentation

EXAMPLES OF DOCTORS

Chiropractors Dentists Psychologists Osteopaths Medical doctors

American boards of specialties and subspecialties

NURSES

Spend largest amount of time in direct patient care Several levels of nursing licensure:

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

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)

ALLIED HEALTHCARE PROFESSIONALS (CONTINUED)

Clinical laboratory technicians Diagnostic technologists Pharmacists Registered dietitians (RDs) Audiologists Speech pathologists Clinical medical assistants

CLINICAL PROFESSIONAL ORGANIZATIONS

American Medical Association (AMA) American Nurses Association (ANA) American Hospital Association (ANA)

OUTLINE

• 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

CLINICAL INFORMATION SYSTEMS

VARIOUS TERMS USED OVER TIME

CPRCompu

ter-Based Patient Record

EMRElectro

nic Medica

l Record

PHRPerson

al Health Recor

d

EHR Electronic

Health Recor

d

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

Extremely low 6%--Long term care 4%--Rehabilitation 2%--Psychiatric

Source: Health Affairs, 2012

VALUE OF EHR

Improved quality, outcomes and safety Computerized reminders and alerts Improved compliance with practice guidelines Reduction in medical errors

Improved efficiency, productivity, and cost reduction

Improved service and satisfaction

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

CPOE• 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

HISTORICAL BARRIERS TO CPOE USE

• 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

• Use of barcoding becoming more widespread

• Aids in correctly identifying patient, drug, dose, etc.

• HIMSS implementation guide—good resource

• 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

• Use of telecommunciations for the direct provision of care to patients at a distance– 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

Using telecommunications to communicate with patients and deliver services 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 infrastructureDegree of integrationMessage structureCostSecurityReimbursement

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

FITTING PIECES TOGETHER

BARRIERS TO ADOPTION & STRATEGIES FOR OVERCOMING THEM

Financial Organizational or Behavioral Technical Barriers Privacy and Security Barriers

STRATEGIES FOR OVERCOMING BARRIERS

What strategies are being employed to help overcome— Financial barriers? Behavioral barriers? Technical barriers?

SUMMARY

• 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