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CPHIMS > Healthcare Environment > Flashcards

Healthcare Environment Flashcards

Recognize the impact of commonly accepted laws, regulations, accreditation and other state and local rules that govern critical healthcare information and systems management services, including privacy, safety and security (e.g., privacy regulations, pharmacy, environments of care, patient rights) on the healthcare industry • Evaluate trends in healthcare technology and implement strategies to improve patient outcomes (e.g., telemedicine, patient portals, wearable devices, population health)

1
Q

What is Health Information Technology?

A

Health Information Technology, or Health IT, is defined by the HHS Office of
the National Coordinator for Health IT (ONC) as, “the application of
information processing involving both computer hardware and software that
deals with the storage, retrieval, sharing, and use of health care information,
data, and knowledge for communication and decision making” in
healthcare.

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2
Q

The Quintuple Aim

A

Improved Patient Experience
Population Health
Lower Cost of Care
Advancing Health Equity
Improved Care Team Well-Being

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3
Q

Hospitals (inpatient care facilities) may be classified by

A

Type of services provided
* General hospitals
* Psychiatric hospitals
* Rehabilitation hospitals
* Children’s hospitals
* Long-term acute
* Teaching status
* Academic medical centers or university hospitals
* Geographic location
* Rural hospitals/Critical Access
* Urban hospitals
* Others

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4
Q

Continuum Of Care

A

A complete range of health care services and programs
* Primary
* Secondary
* Tertiary

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5
Q

The Roles of Government

A

Provider of Care
* Public ownership of hospitals and clinics
* US: Department of Veteran Affairs
* UK: National Health Service
Payer
* National Health Insurance
* US: Centers for Medicare and Medicaid Services
* Canada: Provincially-funded health insurance
Regulator
* Laws
* Regulations

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6
Q

Payers: Publicly Financed

A

Government-financed and managed programs
* National Health Service (United Kingdom)
* National Health Insurance (Canada)
* United States
* Medicare, Medicaid, SCHIP (State Children’s Health Insurance Program), TRICARE, VHA
(Veterans Health Administration), IHS (Indian Health Service)
* Medicare includes Part A, B, D, C (Medicare Advantage)

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7
Q

Payers: Privately Financed

A

Commercial insurance programs administered by private entities, generally
funded by
* Employers
* Citizens
* Combination of both

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8
Q

Interrelationships of Healthcare Organizations

A

Support such purposes as
* Enabling access to comprehensive care services
* Assuring effective transfers of care
* Ensuring the general portability of care
* Reporting public and population health information
* Obtaining appropriate reimbursement for quality care
* Supporting particular organization models of care

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9
Q

Senior Level Roles of Health IT and
Informatics Professionals

A

Senior IT roles
* Chief Information Officer: CIO
* Chief Technology Officer: CTO
* Chief Information Security Officer: CISO
* Privacy Officer (can be Chief Privacy Officer: CPO)
Senior Clinical Information Management Roles
* Chief Medical Information/Informatics Officer: CMIO
* Chief Nursing Information/Informatics Officer: CNIO

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10
Q

Common IT Positions in Larger Healthcare
Organizations

A

Desktop Support Specialist
* Database Administrator
* Network Engineer/Analyst
* Project Manager
* Programmer/Application Developer
* Systems Analyst/Administrator
* Security Analyst
* Web Developer
* Telecommunications Specialist
* Portal Administrators

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11
Q

Regulation

A

An interpretation of a law that is written by the responsible regulatory agency
* Federal and state laws are passed by legislative bodies and then are
implemented as regulations
* Required, NOT voluntary

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12
Q

Licensure

A
  • Legal authority granted to a person or facility to perform specific acts or
    provide specific services
  • Granted by governmental agencies – most often at the state level
  • Example-physicians and nurses must hold licenses
  • Approval requirements and guidelines typically vary
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13
Q

Accreditation

A

Process of granting recognition to an institution after it has met predetermined
standards and qualifications
* Accrediting organizations perform a semi-regulatory role
* Voluntary process, yet highly recommended
* Examples:
* Joint Commission
* URAC
* NCQA
* CARF
* COA

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14
Q

What is Health Informatics?

A

As defined by the U.S. National Library of Medicine, health informatics is, “the
interdisciplinary study of the design, development, adoption, and application
of IT-based innovations in healthcare services delivery, management, and
planning

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15
Q

What is Health?

A

The World Health Organization (WHO) defines health as:
* “a state of complete physical, mental and social well-being and not merely the
absence of disease or infirmity.”

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16
Q

Healthcare Organizations - Hospitals

A

Hospitals (inpatient/acute care facilities) may be classified by:
* Ownership
* Public (government-managed)
* Private
* Private hospitals may be further classified by
* Non-profit
* For-profit (Investor-owned)

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17
Q

Healthcare Organizations - Outpatient or Ambulatory
Care

A

Physicians’ Offices
* Ambulatory Surgery Centers (ASC)
* Emergency Department (ED)
* Urgent Care
* Outpatient Specialty Medicine
* Prison Systems
* Retail Clinics
* Diagnostic Services
* Diagnostic Imaging Facilities
* Medical Laboratories
* Specialized Medical Laboratories

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18
Q

Integrated Delivery Network (IDN)

A

A healthcare organization with a variety of providers offering services across
the continuum of care and integrated in administration and information
sharing
* Formed through
* Merger and acquisition
* Joint venture
* Alliance
* Network
30

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19
Q

Goals

A

Coordinated care across the continuum
* Better care
* Safer care
* Less costly care
* HIT Enablers
* EMR
* Patient portals
* Health information exchanges
* Interoperability and data sharing
* Data analytics

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20
Q

Payers: Financing and Reimbursement

A

Financing
* Private financing
* Commercial private insurance
* Self-Pay
* Public financing
* National health insurance
* National health system
* Reimbursement models
* Fee for service (FFS)
* Prospective payment (DRGs-Diagnosis Related Groups)
* Pay for Performance and Value-Based
* Patient Centered Medical Home
* Accountable Care Organization (ACO)

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21
Q

Healthcare Workforce Members

A

Physicians / Providers
* Primary Care
* Surgery
* Specialists
* Hospitalists
* Physician Assistants
* Nurse Practitioners
* Residents and Interns
* Nursing – CNA, LPN, RN, NP
* Pharmacists
* Therapists – Respiratory, Physical, Behavioral, etc.
* Dieticians and Dietary Staff
* Diagnostic Imaging Staff
* Laboratory Staff
* Clinical Support (Infection Control, QAPI, UR, Social
Services, Spiritual Care, etc.)
* Clinical Support Staff
* Registration and Scheduling
* Clerical
* Facilities & Maintenance
* Environmental Services
* Materials Management/Inventory
* Administrative (C-Suite Leadership)
* Privacy and Legal
* HIM
* Information Technology
* Informatics
* Teaching and Research

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22
Q

IT Department Responsibilities

A

Operations and technical support
* Application management, development, and support
* Information security
* Network/Data Center operations
* Database administration
* Website development
* Telecommunications
* Desktop support

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23
Q

Common IT Positions in Larger Healthcare
Organizations

A

Desktop Support Specialist
* Database Administrator
* Network Engineer/Analyst
* Project Manager
* Programmer/Application Developer
* Systems Analyst/Administrator
* Security Analyst
* Web Developer
* Telecommunications Specialist
* Portal Administrators

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24
Q

Regulatory Agencies

A

Implement and Administer Healthcare Law
* Licensure
* Health Insurance Portability and Accountability Act (HIPAA)
* Emergency Medical Treatment and Labor Act (EMTALA)
* UK Data Protection Act of 1998
* European Union General Data Protection Regulation (EUGDPR)

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25
Q

Credentialing and Privileges

A

Credentialing is the process of verifying qualifications to ensure current
competence to grant privileges. The term credentialing involves verification
of education, training, experience, and licensure to provide services.
* Privileging is the process of authorizing a specific scope of practice for
patient care based on credentials and performance.
46

26
Q

Hospitals

A

Hospitals can be categorized in various ways, including by ownership, types of services provided, teaching status, and geographic location:

Ownership: Public (government-managed) vs. private hospitals. Private hospitals can be for-profit or nonprofit.
Types of Services Provided: General hospitals, psychiatric hospitals, rehabilitation hospitals, and children’s hospitals.
Teaching Status: Teaching hospitals train future healthcare providers and are often associated with academic institutions.
Geographic Location: Urban hospitals vs. rural hospitals, with different challenges and resources.

27
Q

Outpatient or Ambulatory Care

A

Outpatient care is provided when a patient’s condition does not require intensive management in a hospital setting. This includes primary care provided by general practitioners and specialist referrals. There has been a shift towards less expensive and more patient-friendly outpatient settings, including ambulatory surgery centers and urgent care clinics.

28
Q

Community Health Organizations

A

Community health organizations serve local populations and provide comprehensive care, including health promotion and illness prevention. In the U.S., community health centers (CHCs) serve medically underserved areas and vulnerable populations.

29
Q

Diagnostic and Pharmaceutical Services

A

These services support healthcare delivery by providing laboratory and pathology services, diagnostic imaging, and pharmacies. Larger hospitals may have these capabilities in-house, while smaller facilities may rely on external providers.

30
Q

Healthcare Payers

A

Healthcare payers include government-financed programs, private insurance programs, and personal funds. Government programs may be single-payer systems or multipayer systems, such as Medicare and Medicaid in the U.S. Private insurance is often employer-based or purchased directly by individuals.

31
Q

Interrelations Within and Across Healthcare Organizations

A

Healthcare organizations interact to enable comprehensive care, assure effective transfers of care, ensure the portability of care, report public health information, obtain reimbursement for care, and support organizational models of care. This includes health information exchanges (HIEs) and integrated delivery systems (IDSs).

32
Q

Roles and Responsibilities of Healthcare Information and Management Systems Professionals

A

Healthcare information and management systems professionals play various roles, including chief information officer (CIO), chief security officer (CSO), privacy officer, chief technology officer (CTO), and clinical informatics professionals. They ensure the effective use of information technology in healthcare settings.

33
Q

Government, Regulatory, Professional, and Accreditation Agencies

A

Governments play a significant role in healthcare through regulation and funding. Regulatory agencies implement health laws, while professional associations advocate for their members. Accreditation organizations, such as The Joint Commission, ensure healthcare organizations meet specific standards.

34
Q

Enabling Access to Comprehensive Care Services

A

Healthcare organizations rely on various partners to deliver comprehensive care. For example, outpatient providers often depend on external laboratory and radiology services for accurate diagnoses and pharmacies for medication fulfillment. Effective communication, often electronic, is essential to ensure seamless care delivery

35
Q

Assuring Effective Transfers of Care

A

When a patient’s care needs exceed a provider’s capabilities, care is transferred to another provider or organization. Effective communication during these transfers is vital to ensure that all relevant patient information, such as medical history, diagnostic test results, and medications, is shared. This prevents delays and redundant tests, improving patient outcomes

36
Q

Ensuring the General Portability of Care

A

Patients may need care from different providers, especially when traveling. National health information exchanges (HIEs) and initiatives like Canada’s Health Infoway and the UK’s NHS Digital facilitate the sharing of patient health information across different healthcare settings. This ensures that providers have access to critical patient information, such as medication allergies, regardless of location

37
Q

Reporting Public and Population Health Information

A

Healthcare organizations collect and report health information to public health entities to monitor and respond to disease outbreaks and promote preventive care. For example, the UK’s NHS Digital and the U.S. Centers for Disease Control and Prevention (CDC) use health information to support public health activities and research

38
Q

Obtaining Appropriate Reimbursement for Quality Care

A

Healthcare organizations must submit claims to be reimbursed for services provided. This process can be complex, especially in multipayer systems like the U.S., where claims are submitted to various government programs and private insurers. Effective communication and data sharing are essential to ensure accurate and timely reimbursement

39
Q

Supporting Particular Organizational Models of Care

A

Integrated delivery systems (IDS) and accountable care organizations (ACO) are examples of organizational models that rely on interrelationships among healthcare providers. These models aim to provide coordinated, high-quality care while reducing costs. They require close integration of healthcare providers and effective information sharing to achieve their goals.

In summary, interrelationships within and across healthcare organizations are essential for enabling comprehensive care, ensuring effective transfers of care, maintaining the portability of care, reporting public health information, obtaining reimbursement, and supporting organizational models of care. These interrelationships rely heavily on effective communication and information sharing to improve patient outcomes and healthcare efficiency.

40
Q

Chief Information Officer (CIO)

A

The CIO is typically the top IT position in a healthcare organization. The CIO is responsible for the overall management of the organization’s IT strategy, including the development, implementation, and maintenance of IT systems. This role involves overseeing the IT department, ensuring that IT initiatives align with the organization’s goals, and managing the IT budget.

41
Q

Chief Security Officer (CSO)

A

The CSO is responsible for securing the organization’s computing and communications assets from both internal and external threats. This includes implementing security policies, conducting risk assessments, and ensuring compliance with relevant regulations. The CSO works closely with other IT and security professionals to protect sensitive patient information and maintain the integrity of IT systems.

42
Q

Privacy Officer

A

The Privacy Officer ensures that the organization complies with privacy laws and regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States. This role involves developing and implementing privacy policies, conducting privacy audits, and training staff on privacy practices. The Privacy Officer also handles privacy-related incidents and ensures that patient information is accessed and used appropriately.

43
Q

Chief Technology Officer (CTO)

A

The CTO is responsible for the technical architecture of the organization’s IT systems. This role involves staying up-to-date with emerging technologies, evaluating new IT solutions, and ensuring that the organization’s IT infrastructure supports its strategic goals. The CTO works closely with other IT leaders to implement and maintain technology solutions that enhance patient care and operational efficiency.

44
Q

Health Information Managers

A

Health Information Managers oversee the management of patient health records and ensure that they are accurate, complete, and accessible. This role involves implementing and maintaining electronic health record (EHR) systems, ensuring compliance with health information management standards, and training staff on proper documentation practices. Health Information Managers also play a key role in data governance and quality assurance.

45
Q

Clinical Informatics Professionals

A

Clinical Informatics Professionals bridge the gap between clinical practice and IT. They work to optimize the use of EHRs and other clinical systems to improve patient care and outcomes. This role involves analyzing clinical workflows, developing and implementing clinical decision support tools, and training clinical staff on the use of IT systems. Clinical Informatics Professionals also collaborate with other healthcare professionals to ensure that IT solutions meet the needs of clinicians and patients.

46
Q

IT Support Staff

A

IT Support Staff provide technical support to end-users, ensuring that IT systems are functioning properly and addressing any issues that arise. This role involves troubleshooting hardware and software problems, providing training and assistance to users, and maintaining IT infrastructure. IT Support Staff play a critical role in ensuring that healthcare professionals can effectively use IT systems to deliver patient care.

47
Q

Project Managers

A

Project Managers oversee the planning, execution, and completion of IT projects within the organization. This role involves coordinating with various stakeholders, managing project timelines and budgets, and ensuring that projects are completed on time and within scope. Project Managers play a key role in implementing new IT systems and ensuring that they meet the organization’s needs.

48
Q

Data Analysts

A

Data Analysts collect, analyze, and interpret healthcare data to support decision-making and improve patient care. This role involves working with large datasets, developing reports and dashboards, and identifying trends and patterns in the data. Data Analysts collaborate with other healthcare professionals to ensure that data is used effectively to inform clinical and operational decisions.

These roles and responsibilities highlight the diverse and critical functions that healthcare information and management systems professionals perform within healthcare organizations. Their work ensures that IT systems are effectively utilized to enhance patient care, improve operational efficiency, and support strategic decision-making

49
Q

The impact of commonly accepted laws, regulations, accreditation, and other state and local rules on healthcare information and systems management services is profound and multifaceted. These regulations ensure that healthcare organizations maintain high standards of privacy, safety, and security, which are crucial for protecting patient rights and ensuring the quality of care. Here are some key areas where these regulations have a significant impact

A

Privacy Regulations
Safety and Security
Accreditation Standards
Pharmacy Regulations
Environments of Care
Patient Rights

50
Q

Privacy Regulations

A

Privacy regulations, such as the Health Insurance Portability and Accountability Act (HIPAA) in the United States, are designed to protect patients’ personal health information (PHI). These regulations require healthcare organizations to implement strict safeguards to ensure the confidentiality, integrity, and availability of PHI. Compliance with privacy regulations helps prevent unauthorized access to patient data, reduces the risk of data breaches, and ensures that patients’ rights to privacy are upheld.

51
Q

Safety and Security

A

Safety and Security
Safety and security regulations mandate that healthcare organizations implement measures to protect patients and staff from harm. This includes physical security measures, such as secure access to facilities, and cybersecurity measures, such as firewalls, encryption, and regular security audits. These regulations help prevent incidents that could compromise patient safety, such as unauthorized access to medical devices or systems, and ensure that healthcare organizations are prepared to respond to security threats.

52
Q

Accreditation Standards

A

Accreditation Standards
Accreditation organizations, such as The Joint Commission in the United States, set standards for healthcare organizations to ensure they provide high-quality care. These standards cover various aspects of healthcare, including patient safety, infection control, medication management, and emergency preparedness. Accreditation helps healthcare organizations identify areas for improvement, implement best practices, and demonstrate their commitment to quality care.

53
Q

Pharmacy Regulations

A

Pharmacy regulations govern the safe and effective use of medications within healthcare organizations. These regulations ensure that medications are stored, dispensed, and administered correctly, reducing the risk of medication errors and adverse drug events. Compliance with pharmacy regulations helps healthcare organizations maintain accurate medication records, implement effective medication management systems, and ensure that patients receive the correct medications at the right dosages.

54
Q

Environments of Care

A

Regulations related to the environments of care focus on creating safe and therapeutic environments for patients. This includes standards for facility design, maintenance, and cleanliness, as well as guidelines for managing environmental hazards, such as hazardous materials and waste. Compliance with these regulations helps healthcare organizations create environments that promote healing, reduce the risk of infections, and ensure the safety and well-being of patients and staff.

55
Q

Patient Rights

A

Regulations that protect patient rights ensure that patients are treated with dignity and respect and have access to information about their care. These regulations include the right to informed consent, the right to access medical records, and the right to privacy. Compliance with patient rights regulations helps healthcare organizations build trust with patients, improve patient satisfaction, and ensure that patients are actively involved in their care decisions.

In summary, commonly accepted laws, regulations, accreditation, and other state and local rules play a critical role in governing healthcare information and systems management services. They ensure that healthcare organizations maintain high standards of privacy, safety, and security, protect patient rights, and provide high-quality care. Compliance with these regulations is essential for healthcare organizations to operate effectively and maintain the trust of their patients and the public

56
Q

Telemedicine

A

Telemedicine has become increasingly popular, especially during the COVID-19 pandemic. It allows healthcare providers to offer remote consultations, reducing the need for in-person visits. This technology improves access to care, especially for patients in rural or underserved areas. To implement telemedicine effectively, healthcare organizations should invest in robust telehealth platforms, ensure compliance with privacy regulations, and provide training for both providers and patients

57
Q

Patient Portals

A

Patient portals are secure online platforms that allow patients to access their health information, schedule appointments, request prescription refills, and communicate with their healthcare providers. These portals empower patients to take an active role in their healthcare, leading to better health outcomes. To maximize the benefits of patient portals, healthcare organizations should ensure that the portals are user-friendly, promote their use to patients, and integrate them with electronic health records (EHRs)

58
Q

Wearable Devices

A

Wearable devices, such as fitness trackers and smartwatches, can monitor various health metrics, including heart rate, physical activity, and sleep patterns. These devices provide real-time data that can help patients manage chronic conditions and improve their overall health. Healthcare organizations can leverage wearable devices by integrating their data into EHRs, using the data for remote patient monitoring, and encouraging patients to use wearables as part of their health management plans

59
Q

Population Health Management

A

Population health management involves analyzing health data to identify trends and improve the health outcomes of specific populations. This approach can help healthcare organizations address social determinants of health, reduce health disparities, and implement targeted interventions. To implement population health management strategies, organizations should invest in data analytics tools, collaborate with community organizations, and develop programs that address the unique needs of their patient populations

60
Q

Artificial Intelligence (AI) and Machine Learning

A

AI and machine learning are transforming healthcare by enabling predictive analytics, personalized medicine, and improved diagnostic accuracy. These technologies can analyze large datasets to identify patterns and predict patient outcomes. Healthcare organizations can implement AI and machine learning by investing in advanced analytics platforms, training staff to use these tools, and integrating AI-driven insights into clinical workflows

61
Q

Cloud Computing

A

Cloud computing offers scalable and cost-effective solutions for storing and managing healthcare data. It enables healthcare organizations to access data from anywhere, facilitating collaboration and improving data security. To implement cloud computing, organizations should choose reputable cloud service providers, ensure compliance with data privacy regulations, and develop a robust data governance framework

62
Q

Blockchain Technology

A

Blockchain technology can enhance data security and interoperability in healthcare. It provides a decentralized and tamper-proof system for storing and sharing health information. Healthcare organizations can implement blockchain by exploring pilot projects, collaborating with technology partners, and developing use cases that demonstrate the value of blockchain in healthcare.

By staying abreast of these trends and implementing strategies that leverage these technologies, healthcare organizations can improve patient outcomes, enhance operational efficiency, and provide high-quality care

CPHIMS (8 decks)

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