PD IV Final Cards Flashcards
Passive and Active Health IT
Passive - Information storage
Active - Reminders
Foundational interoperability
Allows data exchange with no interpretation or assignment to a patient
Structural interoperability
Data is exchanged with purpose and meaning of data intact
Semantic interoperability
Ability to exchange data, interpret it, and use the information that has been exchanged
Used in contiguous healthcare settings
Barriers to IT in healthcare
Cost
Complexity
Question of finincial return
Increased time to use IT
No streamlining between organizations
Components of an EHR
Demographics
Contact info
Communication
Encounters & Procedures
Testing
Advance directives
EHR templates
Template
Structured
OR
Unstructured
CPOE
Computerized Provider Order Entry
Allows for electronic ordering - can see what other people have ordered, no handwritten errors
Lets you know what is on the formulary
Clinical Decision Support System
Enhances ability to do what needs to be done
Reminders for routine testing
Tx suggestions for disease
Guidelines for abberant labs
Trend labs
Suggest diagnoses
PACS
Picture archiving/communication system
Helps with storage and access of imaging
Better access and use of images
Bar coding in medicine
Tracks what is given, etc.
Does not prevent wrong prescribing, etc.
RFID in medicine
Anti-elopement/Abduction
Inventory control
Equipment tracking
Tells where a patient is in the hospital
Automated medication dispensing machine
AMDS
Pyxis
Secures medication and ensures that medications are not duplicated
Can cause alarm fatigue
Electronic Materials Management
Make sure that supplies stay in stock
Prevent delays and false charges
Telemedicine structure
Distant/Hub sites with ongoing/spoke sites where the patient is
Asynchronous data collection
Remote patient monitoring devices
Teleradiologist
Interpret images remotely - must be done by a radiologist in the US
3 steps for provider reimbursement
Appropriate coding for diagnosis
Appropriate coding of services
Insurance determines appropriate fee
CPT
Current Procedural Coding
Quantifies complexities of an encounter
ICD-10
Billing codes for diagnosis
HIPAA required
Problem focused hx
CC,
Brief HPI w/ 1-3 elements,
no ROS or PFSH
Expanded Problem Focused Hx
CC,
Brief HPI 1-3 elements,
Problem pertinent ROS -one system,
No PFSH
Detailed Hx
CC, Extended
HPI 4+ elements or status of 3+ chronic conditions,
Extended ROS 2-9 systems,
Pertinent PFSH at least 1
Comprehensive Hx
CC,
Extended HPI 4+ elements or status of 3+ chronic conditions,
Complete ROS 10+ systems,
Complete PFSH two areas for established or 3 for new
How to implement non-provider info into an HPI
Make sure you go over it with the patient so that you can document it
Problem focused PE
1+ organ systems with 1-5 elements
Expanded problem focused PE
1+ organ systems with 6+ elements
Detailed PE
6+ organ systems with 2+ elements each
OR
2+ with 12+ elements in total
Comprehensive PE
9+ organ systems with 2+ elements each
Single system problem focused exam
1 to 5 elements in that system
Expanded problem focused single system exam
6+ elements in that system
Detailed single system exam
12+ elements
OR
9+ in eye/psych
Comprehensive single system exam
Look at all possible elements
Straightforward decision making level
Minimal Dx or Management options
Minimal/No Compleixty of data reviewed
Minimal risk of significant complications
Low complexity medical decision making
Limited number of dx or mgmt options
Limited data reviewed
Low risk of significant complications
Moderate complexity medical decision making
Multiple tx or mgmt options
Moderate amount/complexity of data reviewed
Moderate risk of significant complications
High complexity medical decision making
Extensive number of tx mgmt options
Extensive amount/complexity of data reviewed
High risk of significant complications
Example of a straightforward MDM case
Self limiting minor problem
Order of non-invasive ordinary labs
Simple tx options
Sprained ankle
Example of a low complexity MDM case
2+ minor problems, 1 stable chronic problem, or Acute uncomplicated illness
Moderately invasive tests and imaging
Various interventions such as minor surgery, OT or IV hydration
BPH
Moderate MDM example
1+ chronic illness w/ exacerbation
2+ stable chronic illnesses
New problems with uncertainty
Complicated or systemic illness
Cardio imaging and more invasive testing
Major surgery w/ risk
High MDM level
1+ chronic illness with acute axacerbation
Emergencies
Most invasive dx
Major or emergent surgeries
2019 Changes to coding
Don’t need to document necessity of home visit
Less emphasis on H&P
Similar changes in 2021:
Merging higher complexities
When was ICD-10 implemented
2015
ICD-10 code format
3 for category: Alpha, Number, Alpha
3 for etiology, site, severity: 3 alpha OR numeric
Extension: #
Ex. A1A.123 4 OR A11.ABC 4
Not all codes are 7 characters - I10 is Essential HTN
Symptom as a code
Oaky if you don’t have the dx yet - dx preferred
NCCPA
Certifying body for PAs
Initial certification for PAs
Graduate ARC-PA certified program
Pass the PANCE
PA recertification
100hrs of CME every 2 years
$150 maintainence fee every 2 years
Pass recertification exam every 10 years
PANCE exam taking requirements
$550 registration fee
Apply 90 days before expected completion date
PANCE exam time and questions
Five 60 minute blocks w/ 45 minute break
300 questions total
Time to take the pance
180 days to take after graduating
How often can you take the PANCE
Once every 90 days
3 times per year
6 times total
6 year, 6 attempt rule
Passing and highest possible PANCE score
800 = top score
350 = Passing
Panre cost and structure
$350 - Apply 9th or tenth year of recert cycle
6 months to schedule
240 questions in four hours
Can choose practice focus
PANRE-LA alternative
350 dollar registration fee
Completed in years 7-9
3 month blocks of 25 questions
Complete 8 quarters of blocks - can skip up to four
Open book
Categories of CME
Category 1 - Formally planned activities - have to be documented
Category 2 - Does not require documentation - can be like talking to a doctor
Active learning!!
Need 50 hours of each in 2 years
Minimum passing score for PANRE
Changes over time
Four parameters that define scope of practice
Education and experience
State law
Facility policy
Needs of the practice
Changes in scope of practice
Supervising/Collaborating physician needs to sign off on new skills, etc.
Who is covered by HIPAA
Health plans
Health care providers
Health care clearinghouses
Business associates
Protected information under HIPAA
Any information that is personally identifiable - including billing and payment info
Non-protected information under HIPAA
De-identified health information
When can information be released under HIPAA
As privacy rule permits or with written patient permission
When must we release information
When individuals or their designated representative requests it
To Health and Human Services HIPAA investigators
When can info be released without authorization
To the individual
For tx, payment and healthcare ops
When individual has opportunity to object
Incidental disclosures
Public interest
Limited data sets
Psychotherapy notes and authorization
Often need specific clearance
How much info to disclose
The minimum amount necessary -Not as heavily enforced
What type of disclosure notice is provided
Notice of Privacy Practices
Patient control over own health record
Amendment request if the feel it is incorrect
Statement of disagreement if ammendment denied
RIght to a statement of disclosures
Can request limitation of disclosure
Requirements for individuals covered by HIPAA
Have privacy policy
Have training and enforcement
Mitigate harmful effects of mistakes
Data safeguards
No retaliation against patients exercising rights
No requirement to waive
Civil HIPAA penalty
Non-malicious violation
100-50,000 dollars
3 types of HIPAA criminal violations
Knowingly obtains or discloses
Obtains under false pretenses
Sell transfer or use information maliciously
Tier 1,2, or 3 respectively
MCCs of nosocomial infections
Pneumonia
GI
UTI
Surgical wound
Risk factors for nosocomial infections
Indwelling devices
Skin breaks
Contamination
Abx misuse
Improper sterilization
Hospital never events - 8
Object left in patient after surgery
Hospital acquired UTI
Hospital acquired bloodstream infections
Administration of incompatible blood products
Air Embolism
Patient falls
Pressure ulcers
Certain surgical site infections
Standard precautions
Baseline for all patients
Hand hygeine
Safe injection practice
PPE use as needed
Safe handling of fluids
Cough etiquette
Garbage and Laundry
When must soap and water be used for hand hygeine
Visibly soiled hands or patients with infectious diarrhea -surgery
Otherwise alcohol based rub even if wearing gloves
Use of gloves
Contact with blood or body fluids or potentially infectious materials
Use of gowns
Contact precautions
May get body fluids on you
Surgery
Facial PPE
Masks and Goggles
Procedures that cause splashes and sprays
Protect patients from anything you may have as well
Injection safety
Clean vial septum
Don’t reenter a vial
Give patient own multidose vial if possible
Keep sharps nearby
Critical items
ALWAYS have to be sterile - IV catheters or surgical tools
Semi-critical items
Touch mucous membranes or non intact skin - Colonoscope
Noncritical items
Touch intact skin only
BP Cuff
Environmental surfaces
Generally do not contact patient
Routine cleaning and disinfection
Reusable equipment
Clean and sterilize appropriately as needed
Contact precautions
Spread by contact and fomites
Gown and gloves and patient dedicated equipment - may need special cleaning instructions
Droplet precautions
Spread through respiratory contact
No gown but mask and goggles maybe
May consider gown or gloves
Airborne precautions
Spread through air
Mask or respirator
Isolation with negative pressure ventilation - private room with door closed if not available
