Quiz 1 Flashcards
A
Institute of Medicine (IOM) [1991]
Published a report on the problems with paper-bases records and called for the creation of computer-based patient records (CPR).
Health Insurance Portability and Accountability Act (1996)
- Signed in by Bill Clinton
- Makes health insurance more affordable/accessible
- Simplifies administrative processes
- Protects security and confidentiality of personal health information
Institute of Medicine (IOM) [2000]
Published To Err Is Human: Building a Safer Health Care System. Estimated 44,000-98,000 patient deaths annually due to medical error.
Medicare Modernization Act (2003)
Expanded the Medicare program to include prescription drugs and mandated the use of electronic prescriptions.
Pay For Performance (P4P)
Program that reimbursed providers based on meeting predefined quality measures, thus promoting a quality-reward model.
Office of the National Coordinator for Health Information Technology (ONC) [2004]
- Established by President Bush
- Tasked with providing “leadership for the development and nationwide implementation of an interoperable health information technology infrastructure to improve the quality and efficiency of health care.”
Health Information Technology for Economic and Clinical Health (HITECH) Act [2009]
Expanded the role of ONC to provide leadership and oversight of the national efforts to support the adoption of electronic health records (EHR) and health information exchange (HIE).
Affordable Care Act [2010]
- Mandated individual health coverage
- Expanded Medicaid
- Created structure for health insurance exchange, including a greater role for states.
Affordable Care Act - Medicare Changes [2010]
-Reduced payments to hospitals in instances of hospital-acquired infections & excessive re-admissions.
Affordable Care Act - Private Insurance Changes [2010]
-Imposed changes, including: prohibition of preexisting conditions & lifetime limits on dollar value of coverage.
Affordable Care Act - Center for Medicare & Medicaid Services (CMS) [2010]
- Established innovation center to test, evaluate, and expand different payment structures & methodologies to reduce program expenditures while maintaining or improving quality of care.
- Pushing for value-based payment methods.
Medicare Access and CHIP Reauthorization Act (MACRA) [2015]
-Signed into law, outlining a 2019 timetable for the implementation of a merit-based incentive payment system (MIPS) to replace other value-based payment programs.
MACRA - Medicare Implications [2016]
-MACRA repeals Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a merit-based system, Quality Payment Program (QPP).
Quality Payment Program (QPP) [2016]
- Two Track system introduced
1) Merit-based Incentive Payment System (MIPS)
2) Advanced Alternative Payment Models (Advanced APMs)
-CMS predicts 566,000 Part B clinicians to adopt MIPS as the new default payment program.
Merit-based Incentive Payment System (MIPS) [2017]
- QPP combines Medicare Meaningful Use [MU], Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) into one program: MIPS
- MIPS payment adjustments are applied two years after the performance year (starting 2017)
Merit-based Incentive Payment System [MIPS] calculation
- MIPS uses 4 categories to determine performance score:
1) Quality [60%]
2) Advancing Care Information (formerly Meaningful Use) [25%]
3) Improvement Activities (IA) [15%]
4) Cost [0%]
-Final score published publicly by CMS.
Accountable Care Organization (ACO)
A network of providers that share responsibility for coordinating care and meeting health quality and cost metrics for a defined patient population.
Bundled Payments
Incentivize providers to improve coordination, promote teamwork, and lower costs; payers compensate providers with a single payment for an episode of care.
Patient Centered Medical Homes (PCMH)
- Private sector
- Focus on Physician-led coordination of care.
Interoperability
- The ability of a system to exchange health information with other systems without special effort on the user’s part
- For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.
Health Level Seven International (HL7)
-Devise technical standards for health information exchange
HL7 Fast Healthcare Interoperability Resources (FHIR)
- The present standards created by HL7
- In effect since 2012
Sequoia Project
Focused on legal and policy barriers associated with nationwide interoperability
Commonwell Health Alliance
Consortium of HIT vendors and organizations committed to achieving interoperability.
Health Information Blocking
Persons or entities knowingly or unreasonably interfering with the exchange or use of health care information.
Health Care Data
Raw health care facts, generally stored as characters, words, symbols, measurements, or statistics.
Health Care Information
Processed health care data, available for use,
Protected Health Information
Any information, oral or written, recorded through any medium, that is created/received by a health care provider, health plan, public health authority, employer, life insurer, school, or health care clearinghouse which relates to past/present/future physical/mental health/condition of an individual, the provision of their health care, or payment for the provision of health care
Electronic Medical Record (EMR)
A digital version of the paper charts containing medical & treatment history of a patient in one practice/organization.
-Not portable outside of that one practice/organization.
Electronic Health Record (EHR)
Includes data within the scope of the EMR but also encompassing all health information pertaining to an individual across all medical visits.
-Designed to travel with a patient regardless of where they receive medical care.
Personal Health Records (PHR)
An electronic application used by patients to maintain and manage their health information in a private, secure, and confidential environment.
- Maintained by the individual.
- Can include information from multiple, varying health sources
- Features include: custom diet plans, data access from home monitoring systems, patient contact information, diagnosis lists, medication lists, allergy lists, immunization histories, etc
- Distinct from Portals
- NOT a legal document of care
Episode of Care
The service provided to a patient with a specific condition for a specific period of time
Continuum of Care
A concept involving a system that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity of care.
Population Health
The improvement of health outcomes within defined communities.
Patient Record Purposes: Patient Care
- Patient records provide documented basis for planning patient care & treatment, for a single episode of care & across the continuum of care.
- Considered #1 reason to maintain records
Patient Record Purposes: Communication
-Patient records are tools used by providers within a single facility or across organizations that can be used to communicate patient needs across the continuum of care.
Patient Record Purposes: Legal Documentation
Patient records are legal documents that can become primary forms of evidence in lawsuits or legal action.
Patient Record Purposes: Billing/Reimbursement
Patient records provide the necessary documentation that patients/payers need to verify billed services.
Patient Record Purposes: Research & Quality Management
Patient records serve as source documents from which information about certain diseases or procedures can be taken.
Patient Record Purposes: Population Health
Patient records are used to monitor population health, assess health status, measure utilization of services, track quality outcomes, and evaluate adherence to evidence-based practice guidelines.
-Focuses on prevention as a means of achieving cost-effective care.
Patient Record Purposes: Public Health
Patient records are used by state and federal agencies to inform policies and procedures in order to ensure the protection of citizens from unhealthy conditions.
Components of Patient Records: Identification Screen
- Data collected at the time of registration/admission including:patient name, address, phone #, insurance carrier & policy number, as well as diagnoses & disposition at discharge.
- Used as a clinical and administrative document for providing a quick view of diagnoses.
- Includes codes & demographic info necessary for reimbursement & planning purposes.
Components of Patient Records: Problem List
Comprehensive list identifying significant illnesses and operations experienced by the patient throughout their lifetime.
-Responsibility of all practitioners caring for the patient.
Components of Patient Records: Medication Record
Medication Administration Record (MAR):
-Lists medicines prescribed for and administered to patient as well as allergies to medications.
-Nurses’ responsibility.
Components of Patient Records: History and Physical
History includes: major illnesses & surgeries, family history of disease, health and dietary habits, and current medications. This information is provided by the patient at the beginning of a single episode of care.
Physical refers to the findings of the present physician during their hands-on examination.
Combined, these assessments provide the basis for the initial diagnosis and subsequent treatments. This is also the framework with which providers can document significant findings and should be regularly reassessed throughout the course of treatment.
Components of Patient Records: Progress Notes
Notations made by providers that documents the patient’s response to treatment and plan for continued care. Practicioner’s responsibility.
-A common format for progress notes is SOAP:
Subjective Findings
Objective Findings
Assessment
Plan
Components of Patient Records: Consultation
A record of medical opinions made by outside providers, upon request of the attending physician.
Components of Patient Records: Physician’s Orders
A practitioner’s directions, instructions, or prescriptions given to other members of the health care team regarding a patient’s medication, tests, diets, treatments, etc.
Components of Patient Records: Imaging & X-Ray Reports
A radiologist’s interpretation of a patient’s diagnostic test.
- Reports must be timely so as to assist in the course of treatment.
- Radiologist’s responsibility.
Components of Patient Records: Laboratory Reports
The result of tests conducted on body fluids, cells, and tissue.
- Reports must be timely so as to assist in the course of treatment.
- Lab tech’s responsibility.
Components of Patient Records: Consent & Authorization Forms
Copies of consents to admissions, treatments, surgeries, and release of that information are an important factor in the legality of the patient record.
-Physician must gain consent before treatment begins.
Components of Patient Records: Operative Report
A report describing any surgery performed, listing the names of surgeons and attending staff.
-Surgeon’s responsibility.
Components of Patient Records: Pathology Report
A report regarding the analysis of tissue removed during a surgical procedure and the diagnosis based on those samples.
-Pathologist’s responsibility.
Components of Patient Records: Discharge Summary
Summarizes hospital stays, including information on: reason for admission, significant findings from tests, procedures performed, therapies provided, responses to treatments, condition at discharge, and instructions for medications, activity, diet, and follow-up care.
-Attending physician’s responsibility.
Healthcare Data Quality: Traditionally
- Patient’s Clinical/Claim Records
- Episodic
- Generated by a single organization
Healthcare Data Quality: Today
- EHR/Electronic Claims Records
- Continuous
- Quality factors now important
American Health Information Management Association (AHIMA)
A framework in the context of managing health care data quality across the enterprise
AHIMA - Accuracy
Ensure data are the correct values, valid, and attached to the correct patient record.
AHIMA - Accessibility
Data should be easily obtainable and legal to access with strong protections and controls in place.
AHIMA - Comprehensiveness
All required data is included. Ensure the entire scope of data is collected and document intentional limitations.
AHIMA - Consistency
The value of data should be reliable and the same across multiple applications.
AHIMA - Currency
Data should be up-to-date.
AHIMA - Definition
Each data element should have clear meaning and acceptable values that can be understood by present and future users.
AHIMA - Granularity
Attributes and values should be defined at the correct level of detail.
AHIMA - Precision
Data values should be just large enough to support the application/process.
AHIMA - Relevancy
Data should be meaningful to the performance of the application or process for which they are collected.
AHIMA - Timeliness
Data should be available in the time frame required for its usefulness.
Weiskopf and Weng Data Quality Dimensions
Derived a five dimension model for health data quality based on reviews of 95 articles examining EHRs.
Weiskopf and Weng - Completeness
Is a truth about a patient present?
Weiskopf and Weng - Correctness
Is an element that is in the EHR true?
Weiskopf and Weng - Concordance
Is there agreement between elements in the EHR or between the EHR and another data source?
Weiskopf and Weng - Plausibility
Does an element in the EHR make sense in light of other knowledge about what that element is measuring?
Weiskopf and Weng - Currency
Is an element in the EHR a relevant representation of the patient state at a given point in time?
Information System (IS)
An arrangement of data, processes, people, and information technology that interact to collect, process, store, and provide as output the information needed to support the organization.
Information Technology (IT)
The combination of computer technology with data and telecommunications tech.
Provider Organization
The hospital, health system, physician practice, integrated delivery system, nursing home, or rural health clinic.
Administrative Information System (Administrative Application)
Contains primarily administrative or financial data and is generally used to support the management functions and operations of the health care organization.
Clinical Information System
Systems used by individual departments within a healthcare system (e.g. radiology, pharmacy, or laboratory systems.)
Health Information Systems : 1960’s-1970’s
- Used in Admin & Finance
- Mainframe computing
- Designed primarily in-house at large hospitals
Health Information Systems: 1980’s
- Rise in the need for clinical & admin data for reimbursement purposes
- Advent of microcomputer
Health Information Systems: 1990’s
- Internet & e-mail
- IOM calls for widespread adoption of computerized patient records (CPR)
- Continued growth of clinical applications
Health Information Systems: 2000’s
- IOM reports on patient safety
- Leapfrog recommends computerized patient order entry (CPOE)
- E-prescribing expands
- Public Health Records available
Health Information Systems: 2010-Present
- ACA & HITECH emerge
- CMS EHR inventive programs & Meaningful Use
- Payment reform
- Population health management
- Big data & data analytics
- Cloud computing
- Mobile applications
Electronic Health Records: Features & Functions
- Electronically collect and store patient data
- Supply information to providers
- Allow direct input into a CPOE
- Advises health practitioners
Patient Portal
Secure website that offers patients quick access to features such as:
- Electronic record access
- Appointment scheduling
- Communication with providers
- Prescription refill requests
- Test results
- Bill payment
Person-Generated Health Data (PGHD)
Mobile applications & technologies to capture health and wellness.
e.g. Step trackers, food diaries, networked weight scales, blood pressure machines
EHR Benefits (Organizational)
- Adherence to evidence-based treatments
- Enhanced health monitoring
- Decreased medication errors
- Efficiency improvements
- Improved revenues
- Cost reductions
- Satisfaction for both provider and patient
ONC Roadmap to Interoperability
- Requiring standards
- Incentivizing the use of standards
- Creating a trusted environment for the exchange of electronic health information.
Usability
The effectiveness, efficacy, and satisfaction with which the intended users can achieve their tasks in the intended context of product use.
Health IT Patient Safety Concerns
- Adverse events that reached the patient.
- Near misses that did not reach the patient.
- Unsafe conditions that increased the likelihood of a safety event.
