Quiz 4 Flashcards
Ch. 10, 11, 12
Licensure
The process that gives a facility legal approval to operate.
-Overseen by State government
Certification
Gives a health organization the authority to participate in the federal Medicare and Medicaid programs.
-CMS develops minimum standards and conditions of participation
Accreditation
A voluntary, external review process.
-Organizations receive financial and legal incentives for becoming accredited
The Joint Commission
An independent, not-for-profit organization
- Best-known health care accrediting agency in the U.S.
- Performs site surveys every 3 years (2 for Labs)
- Publish a standards manual annually
Deemed Status
Facilities that are accredited by an approved national accreditation organization (AO) are exempt from routine State surveys for Medicare conditions, under Section 1865 of the Social Security Act,
Categories of Accreditation: Preliminary Accreditation
For organizations that demonstrate compliance with select standards under the Early Survey Policy, which allows organizations to undergo a survey prior to having the ability to demonstrate full compliance.
-Required to undergo a second on-site survey.
Categories of Accreditation: Accreditation
For organizations that demonstrate compliance with all standards.
Categories of Accreditation: Accreditation with Follow-up Survey
For organizations that are not in compliance with specific standards and require a follow-up survey within thirty days to six months.
Categories of Accreditation: Contingent Accreditation
For organizations that fail to address all requirements in an accreditation with follow-up survey decision
OR
For organizations that do not have the proper license or other similar issue at the time of the initial survey
-Generally: A follow-up survey is required within 30 days.
Categories of Accreditation: Preliminary Denial of Accreditation
For organizations for which there is justification for denying accreditation.
-This decision is subject to appeal
Categories of Accreditation: Denial of Accreditation
For organizations that fail to meet standards and that have exhausted all appeals.
Joint Commission Standards: Record of Care (RC), Treatment, and Services Standard
Provide information about the requirements for the content of a complete health record, regardless of format.
Joint Commission Standards: Information Management Standards
J-CO’s belief that quality information influences quality care.
-Applies to non-computerized systems and systems with the latest technologies.
National Committee for Quality Assurance (NCQA)
Leading accrediting body for health plans.
2015 Health Plan includes:
- Quality Management and Improvement (QI)
- Utilization Management (UM)
- Credentialing and Re-credentialing (CR)
- Members’ Rights and Responsibilites (RR)
- Member Connections (MEM)
- Medicaid benefits and services (MED)
- Health Effectiveness Data and Information Set (HEDIS)
Crossing the Quality Chasm (2001)
A publication by the Institute of Medicine that outlines six aims for establishing quality health care:
1) Safe
2) Effective
3) Patient-centered
4) Timely
5) Efficient
6) Equitable
Quality Care - Data Sources for Measure
- Administrative: Claims databases
- Disease Registries: Data on patients with specific conditions
- Health Records: Detailed patient information
- Qualitative Data: Patient surveys or interviews
Quality Care Measures: Health Effectiveness Data and Information Set (HEDIS)
- Oldest and most widely used in the U.S.
- More than 90% of health plans collect and report HEDIS data.
Quality Care Measures: Clinical Quality Measures (CQM)
- Identified and updated annually by CMS
- Developed by private organizations, health care societies, collaboratives, alliances, and government agencies.
-Required for J-CO accreditation
Comparative Health Care Data Sets
Benchmarking to determine quality
Patient Satisfaction Data Sets
Reliance on survey data by third party surveyors.
-AHRQ’s Consumer Assessment of Healthcare Providers and Systems (CAPHS) program
Practice Patterns Data Sets
Dartmouth Atlas: Online, interactive tool funded by Dartmouth Institute for Health Policy and Clinical Practice
Clinical Data Sets
Quality Check:
-Introduced in 1994 by J-Co.
Hospital Compare:
-CMS-sponsored interactive, online comparative data sets.
Comparative Data for Health Plans
-NCQA health care report cards
Federal Quality Improvement Initiatives
Patient Safety Act:
-Patient Safety Organizations (PSO): responsible for the collection and analysis of health information that is referred to in the Final Rule as patient safety work product (PSWP)
- PSWP: Contains identifiable patient information covered by specific privilege and confidentiality protections
- –Incidents
- –Near Misses (close calls)
- –Unsafe conditions
-Common Formats: established by AHRQ to help providers uniformly report patient safety events.
National Quality Strategy
Outlines 3 broad aims used to guide and assess national efforts to improve health and the quality of health care.
-Established by the Affordable Care Act and published in 2011
National Quality Strategy’s 3 Broad Aims: Better Care
Improve the overall quality by making health care more patient-centered, reliable, accessible, and safe.
National Quality Strategy’s 3 Broad Aims: Healthy People/Healthy Communities
Improve the health of the US population by supporting proven interventions to address behavioral, social, and environmental determinants of health in addition to delivering higher-quality care.
National Quality Strategy’s 3 Broad Aims: Affordable Care
Reduces the cost of quality health care for individuals, families, employers, and government
Levers to Ensure Alignment with NQS: Measurement and Feedback
Provider performance feedback to plans and providers to improve care.
Levers to Ensure Alignment with NQS: Public Reporting
Compare treatment results, costs, and patient experience for consumers.
Levers to Ensure Alignment with NQS: Learning and Technical Assistance
Foster learning environments that offer training, resources, tools, and guidance to help organizations achieve quality improvement goals.
Levers to Ensure Alignment with NQS: Certification, Accreditation, and Regulation
Adopt or adhere to approaches to meet safety and quality standards.
Levers to Ensure Alignment with NQS: Consumer Incentives and Benefit Designs
Help consumers adopt health behaviors and make informed decisions
Levers to Ensure Alignment with NQS: Payment
Reward and incentivize providers to deliver high-quality, patient-centered care.
Levers to Ensure Alignment with NQS: Health Information Technology
Improve communication, transparency, and efficiency for better coordinated health and health care
Levers to Ensure Alignment with NQS: Innovation and Diffusion
Foster innovation in health care quality improvement and facilitate rapid adoption within and across organizations and communities.
Levers to Ensure Alignment with NQS: Workforce Development
Invest in people to prepare the next generation of health care professionals and support lifelong learning or providers
Quality Improvement: CMS Programs
Original, value-based programs were an attempt to link performance on endorsed quality measures to reimbursement.
CMS QI Programs: Hospital Value-Based Purchasing (HVBP)
Program rewards acute care hospitals for quality care using incentives
CMS QI Programs: Hospital Readmissions Reductions (HRR)
Program rewards acute care hospitals that reduce unnecessary hospital readmission for certain conditions.
CMS QI Programs: Hospital-Acquired Conditions (HAC)
Program determines whether or not an acute care hospital should be paid a reduced amount based on performance across health-acquired infections and unacceptable adverse events.
CMS QI Programs: Value Modifiers
Reward physicians for high-quality, lower-cost performance using an adjustment for each claim
CMS QI Programs: Medicare Access and CHIP Reauthorization Act (MACRA)
Streamlines quality programs under the Merit-based Incentive Payment Systems (MIPS)
-Enacted in 2015
Extensible Markup Language (XML)
Widely accepted as a standard for data sharing using web-based technologies in health care and other industries.
Standards Development Process: Ad Hoc
A group of interested people or organizations agree on a certain specification without any formal adoption process.
Standards Development Process: De Facto
A vendor or other commercial enterprise controls such a large segment of the market that its product becomes the recognized norm.
Standards Development Process: Government Mandate
Required by law to adopt the standards
Standards Development Process: Consensus
Representatives from various interested groups come together or reach a formal agreement on specifications
-This method is employed by the standards developing organization (SDO) accredited by the American National Standards Institute (ANSI)
Standards Developing Organizations (SDOs)
- Responsible for the creation of Health Level Seven (HL7) and Accredited Standards Committee (ASC) standard
- Accredited by ANSI
Standards Development: Profiling Bodies
Use existing standards to create comprehensive implementation guides.
- Examples:
- –Integrating the Healthcare Enterprise (IHE)
- –ONC
Health Care IT Standards: Federal Initiatives - HIPAA
- Designated Standard Maintenance Organizations (DSMOs)
- –Mandates certain standards for electronic transactions
- –Mandates standard code sets for transactions
- –Identifies the organization that oversees the adoption for HIPAA compliance.
- Electronic Data Interchange (EDI)
- –ICD-10-CM
Health Care IT Standards: Federal Initiatives - CMS
- E-Prescribing
- –Provides standards for compliance for electronic RX
- –No requirement for providers to write e-scripts
- EHR Incentive Programs
- Office of the National Coordinator Information Technology (ONC
- –Interoperability Standards Advisory: outlines the ONC-identified “best available” standards and implementation specifications for clinical IT interoperability
Health Care IT Standards: ASTM International
Focused on the development of standards help doctors and health care practitioners transfer and preserve patient information using EHR technologies.
Health Care IT Standards: HL7 International - Version 2 and 3 HL7 Messaging standards
Interoperability specifications for health and medical transactions; commonly referred to as HL7
Health Care IT Standards: HL7 International - Clinical Document Architecture (CDA)
A document markup standard for clinical information exchange among providers based on version 3 of HL7.
Health Care IT Standards: HL7 International - Continuity of Care Document (CCD)
A joint effort with ASTM, providing complete guidance for implementation of CDA in the U.S.
Health Care IT Standards: HL7 International - Clinical Context Object Workgroup (CCOW)
Interoperability standards for visually integrating applications at the “point of use.”
Health Care IT Standards: Integrating Healthcare Enterprise (IHE)
Developed a series of profiles to guide health care documentation sharing.
Vocabulary and Terminology Standards
- Create a common language that enables different information systems or vendor products to communicate unambiguously with each other.
- No single vocabulary has emerged to meet all information exchange needs.
Vocabulary and Terminology Standards: National Drug Code (NDC)
The universal product identifier for all human drugs
Vocabulary and Terminology Standards: Systemized Nomenclature of Medicine - Clinical Terms (SNOMED-CT)
A comprehensive clinical terminology developed to facilitate the electronic storage and retrieval of detailed clinical information.
Vocabulary and Terminology Standards: Logical Observation Identifies Names and Codes (LOINC)
Facilitates the electronic transmission of lab results to hospitals, physicians, third-party payers, and other uses
Vocabulary and Terminology Standards: Clinical Vaccines Administered (CVX)
Developed by the CDC as standard code and terminology for use with HL7 messaging standards.
Vocabulary and Terminology Standards: RxNorm
- Normalized naming system for generic and name brand drugs
- Supports semantic inter-operation between drug terminologies and pharmacy knowledge-based systems
Vocabulary and Terminology Standards: Unified Medical Language System (UMLS)
Facilitates the development of computer systems that behave as if they “understand” the meaning of language of biomedicine and health.
-Created by the National Library of Medicine in 1986
UMLS: Metathesaurus
Compiles concepts from more than 100 vocabularies in order to map and incorporate them into a single system
UMLS: Semantic Network
Defines broad categories and relationships between categories for labeling the biomedical domain.
UMLS: SPECIALIST Lexicon and Lexicon Tools
A dictionary of English words, common and medical, which exist to supportal natural language processing.
Data Exchange and Messaging Standards: HL7
Version 2 and Version 3 are among the most commonly used internationally.
Data Exchange and Messaging Standards: Digital Imaging and Communications in Medicine Standards (DICOM)
Used by all major diagnostic medical imaging vendors
Data Exchange and Messaging Standards: National Council for Prescription Drugs Program (NCPDP)
Standards for the electronic submission of third-party drug claims
-SDO accredited by ANSI
Data Exchange and Messaging Standards: ANSI ASC X12N
Develops standards for the electronic exchange of business information.
Data Exchange and Messaging Standards: Continuity of Care Document (CCD)
Standard for the electronic exchange of patient summary information
Data Exchange and Messaging Standards: Fast Health Interoperability Resources (FHIR)
- Includes modern web services to exchange clinical information.
- Offers easy-to-use tools
- –Build faster and more efficient data exchange mechanisms
- –Use personal health information to create innovative new apps
-STILL UNDER TESTING
HL7 Health Record-System (EHR-S) Functional Model
Outlines what should be included in an EHR or other clinical record
1) Overarching (OV)
2) Care Provision (CP)
3) Care Provision Support (CPS)
4) Population Health Support (POP)
5) Administrative Support (AS)
6) Record Infrastructure (RI)
7) Trust Infrastructure (TI)
Strategy: Formulation
Making decisions about the mission and goals of the organization and the activities and initiatives it will undertake to achieve them.
-Understanding competing ideas and choosing between them
Strategy: Implementation
Making decisions about how we structure ourselves, acquire skills, establish organizational capabilities, and alter organizational processes to achieve the goals and carry out the activities defined during formulation.
Four Vectors of IT Strategy: Organizational Strategies
Directly from the organization’s goals and plans
Four Vectors of IT Strategy: Continuous Improvement of Core Processes and Information Management
Measures the performance of core processes and uses the resulting data to develop plans to improve performance.
Four Vectors of IT Strategy: Examination of the Role of New Information Technologies
How new IT capabilities enable a new IT agenda or alter the current agenda
Four Vectors of IT Strategy: Assessment of Strategic Trajectories
Highly speculative; what happens after a fixed time horizon?
IT Asset
Composed of IT resources that the organization has or can obtain and are applied to further the goals, plans, and initiatives of the organization.
IT Asset: Applications
Systems that users interact with.
- Strategies focus on:
- –Sourcing
- –Application Uniformity
- –Application Acquisition
IT Asset: Infrastructure
-Capabilities: What can it do?
- Characteristics: Broad properties, such as:
- –Reliability, security, agility, supportability, intergatability, potency
IT Asset: Data
Focus on acquiring new types of data
- Defining the meaning of data
- Determining the organizational function responsible
- Integrating existing data sets
- Obtaining technologies used to manage, analyze and report data.
IT Asset: IT Staff Members
Analysts, programmers, and computer operators who manage and advance information systems in an organization on a daily basis.
A Normative Approach to Developing Alignment and IT Strategy
There is no single right way to develop an IT strategy and to ensure alignment
A Normative Approach to Developing Alignment and IT Strategy: Strategy Discussion Linkage
- Should be a regular agenda at senor leadership meetings
- CIO should develop an assessment of IT ramifications of strategic options
A Normative Approach to Developing Alignment and IT Strategy: IT Liaisons
Each major department should have a senior IT staff person who serves as the department’s point of contact.
A Normative Approach to Developing Alignment and IT Strategy: New Technology Review
CIO should periodically present new technologies and their possible contributions to the goals of the organization
A Normative Approach to Developing Alignment and IT Strategy: Synthesis of Discussions
- Needed during development of the annual budget
- Requires debate and discussion
- Involves prioritizing recommendations
IT Strategy Challenges: Persistence of the Alignment Process
- Business strategies are not clear or are volatile
- IT opportunities are poorly understood and new technologies emerge constantly
- The organization is unable to resolve the different priorities of different parts of the organization
- Effective alignment requires the leadership to understand:
- –Organization’s strategic context
- –Organization’s environment
- –IT strategy
- –IT portfolio
IT Strategy Challenges: Limitations of Alignment
- Does not guarantee effective application of IT
- Cannot overcome unclear overall strategies
- Cannot compensate for material competitive weaknesses
IT Strategy Challenges: Emerging Technology
- When does current technology need to be upgraded?
- Which technologies are likely to survive and become industry standards?
IT Strategy Challenges: Alignment at Maturity
Earl studied organizations in the UK with a history of IT excellence and found these characteristics present:
- IT Planning was not a separate process
- IT Planning had neither a beginning or an end
- IT Planning involved shared decision making and shared learning
- IT Plan emphasized themes
Gartner’s Hype Cycle: Technology Trigger
A potential technology breakthrough kicks things off.
-Early proof-of-concept stories and media interest trigger significant publicity.
Gartner’s Hype Cycle: Peak of Inflated Expectations
Early publicity by proponents of the technology reaches a crescendo; often with little practical experience using the tech.
-Some companies react, others do not.
Gartner’s Hype Cycle: Trough of Disillusionment
Interest wanes as experiments and implementations fail to deliver on the hype of the peak.
-Tech is too immature and users are just beginning to learn how to utilize it.
Gartner’s Hype Cycle: Slope of Enlightenment
More instances of how the technology may benefit the enterprise start to crystallize and become more widely understood
- 2nd and 3rd generation products appear.
- The real value of the technology emerges.
Gartner’s Hype Cycle: Plateau of Productivity
Mainstream adoption starts to take off.
-Criteria for assessing vendor and product viability are more clearly defined.
