Chapter 9

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Chapter 9
2011-04-05 14:14:32

Basics of the U.S Health Care System
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  1. artificial intelligence
    Computerized techniques that imitate human decision making.
  2. chief information officer
    This person in the organization is responsible for managing the organization's information systems.
  3. clinical decision support systems
    Systems that are designed to integrate medical information, patient information, and a decision making tool to generate information to assist with cases.
  4. computerized physician order entry
    Electronic system that enables a physician to order prescriptions, lab tests, etc.
  5. DDI
    This software program alerts physicians and clinicians about potential drug-drug interactions.
  6. dxplain
    A decision support system that uses lab data and symptoms to produce a ranked list of diagnoses.
  7. ehealth
    Use of information technology to deliver education, research, and clinical care.
  8. electronic medical record
    Electronic patient medical information that is accumulated in one health system and is used by the providers who treat the patient.
  9. enterprise data warehouse
    An integration of data from several different sources that supports strategic decision making.
  10. eprescribing
    Physicians electronically prescribe medicine for their patients.
  11. health vault
    Microsoft Web site that enables patients to maintain their medical information and access health education.
  12. imaging informatics
    Computer application to tissues and organs.
  13. informatics
    • -Science of computer application to data in different industries.
    • -Refers to the scicence of computer application to data in different industries.
  14. information technology
    Systems that electronically transforms data that can be used in organizations to be used for decision making.
  15. legacy systems
    These are older systems in an organization.
  16. medical informatics
    • -Science of computer application that supports clinical and research data in different areas of health care.
    • - Health or medical informatics.
  17. telemedicine
    Use of information technology to enable healthcare providers to communicate with patients that may not be able to visit them physically because they are in a rural area.
  18. Health Information system
    are system that store, transmit, collect, and retrieve these data
  19. Health information technology's (HIT)
    goal is to manage the health data that can be used by patients/consumers, insurance companies, healthcare providers, healthcare administrators, and any stakeholder that has an interest in health care.
  20. HIT
    • - impacts every aspect of the healthcare industry.
    • -All stakeholders in the healthcare industry use HIT
  21. Information Technology (IT)
    • -has had a tremendous impact on the healthcare industry because it allows documentation of every trasaction to be more quickly documented.
    • When an industry focuses on saving lives, it is important that all activty has a written document that describes the activity
  22. The main focus of HIT is record
    • -Both President Bush and Obama have supported this intiative.
    • - This is the foundation of many IT system because it will enable different system to share the patients information which will increase the quality and efficiency of health care.
  23. History of IT in Health Care
    Computers’ first widespread use was in the 1960s as a result of the implementation of Medicaid and Medicare.
    • -Health care providers were inundated with forms to complete for both programs. In order to receive reimbursement from both programs, services needed to be tracked, forms needed to be completed and submitted to these programs.
    • -As a result, computers were used to assist with the financial management of these programs.
    • -As a result of computer integration, more health care providers recognized the efficiency of computers to manage programs. Hospitals particularly recognized the efficiency of electronic billing
  24. -During the 19060s, hospitals developed their own computer system that housed their financial information.
    -the hospital were responsible for the maintenance of these system.
    • -these system, which were large mainframe system, required a large staff to maintain their operations.
    • -All of the hospitals' data was stored on these mainframe computers
  25. -Computer programs were developed by the hosptial to extract data reports. these mainframe computers were very expensive.
    • -they were eventually replaced in 1970s with minicomputers which were more efficent, more cost-effective and easier to maintain.
    • -these minicomputers were connected to main computers that stored all of the data.
    • -these minicomputers were also used to enter information
    • -Eventually, specific computer system were developed for laboratory and clinics.
  26. the 1980-1990s, the development and widespread use of personal computers (PCs) revolutionized information systems and technology.
    -PCs were not reliant on a main computer for analyses. they were able to generate more sophisticated reports.
    • -PCs were often linked as a network to share information among different departments in hospitals.
    • -The development of a PC also enabled more computerization of physician practices.
  27. The establishment of a Chief Information Officer (CIO) in health care organizations emphasized the importance information systems and technology had become to health care organizations
    • -the US healthcare system has been the world leader for developing cutting-edge technology in healht care.
    • -it has impacted how diagnostic procedures are performed, how data is collected and disseminated, how medicine is delivered, how providers treat their pateients, and how sugeries are performed.
  28. -there are several healthcare stakeholders that impacted by technology.
    -Comsumers, providers, employers, researchers all governmental levels, nonprofit and forprofit healthcare organization and insurance payers have all been impacted by technology.
    -Technological advances have been blamed, in part for the continued rise of healthcare expenditures, but the results of technological advances cannot be disputed.
  29. The Institute of Medicine has published a series of reports over the past several years that focus on improving the quality of health care in the United States.
    -In 2001, they published the report “Crossing the Quality Chasm: A New Health System for the 21stCentury”, which stresses the importance of improving the information technology infrastructure.
    They emphasize the importance of an electronic health record (EHR), an electronic record of patient’s medical history. They also discuss the importance of patient safety by establishing data standards for collecting patient information
  30. -In 2004, President Bush established within the Department of Health and Human Services, the Office of the National Coordinator for Information Technology.
    -In 2005, the American Health InformationCommunity (AHIC) was chartered to develop recommendations on how to increase health information technology use in our health care system.
    They focused on surveillance, consumer awareness, chronic health care and electronic health care records
  31. In 2008, this initiative was renamed the National eHealth Collaborative.
    • this organization has already met with president obama regarding HIT.
    • - During his tenure, President Bush indicated that most U.S. citizens should have an electronic patient record by 2014.
    • - President Obama has also supported this issue. Obama has budgeted $19 billion to accelerate the use of computerized medical records in physicians’ office by creating regional health IT extension centers.
  32. Electronic Patient Record
    -In 1991 and 1997, the Institute of Medicine issued reports that focused on the impact of computerbased patients’ records as important technology for improving health care .
    -There are two concepts in electronic patient records that are used interchangeably yet are different—the electronic medical record (EMR/EHR) and the electronic health record.
    • According to the National alliance for Health Information Technology:
    • The electronic health record (EHR ) is the electronic record of health-related information on an individual that is accumulated from one health system and is utilized by the health organization that is providing patient care.
    • - Simply, the EHR is an EMR that can be integrated with other systems
  33. The Institute of medicine has been urging the healthcare industry to adopt the electronic patient record but initially cost were too high and the health community did not embrace the recommendation.
    • As software cost have declined, more healthcare providers have adopted the use of the EHR system.
    • -In 2003 HHS began to promote the use of HIT including the use of EHR.
    • - the IOM was asked to identify essential elements for the establishment of an EHR.
  34. The IOM broadly defined the definition of EHR to include:
    • -the collection of longitudinal data on a person's health.
    • -Immediate electronic access to this information.
    • -Establish of a system that provides decision support to ensure the quality, safety, and efficiency of patient care.
  35. Benefits of Electronic Patient Records
    Many administrators cited the capability of more comprehensive reporting that integrated both clinical and administrative data.
    -It also provided an opportunity to analyze and review patient outcomes because of the standardization of the clinical assessments.
    -Also noted was the development of electronic automated reports that improved the discharge of a patient. The reports also provided an opportunity for the administrator to assess the workload of a department.
    • -The EHR also improved operational efficiency and had excellent capabilities to process and store data.
    • - Administrators also reported that the computerized documentation took 30% less time than the previous handwritten notes
  36. However it is difficult to develop an electonical record that can integrate with other medical systems.
    -It is important that standards are developed for EHR to ensure standard data elements are collected and to ensure that the software will be integrated into other others system
    -Several studies indicated there was an improvement in interdepartmental communication.
  37. -Several studies indicated there was an improvement in interdepartmental communication.
    -The EHR provided aggregate data in the patient records to other departments and the information about the patient was legible.
    - The EHR allowed accessibility by many departments regarding integrated care.
    • -The actual design and implementation of an EHR system developed a more interdisciplinary approach to patient care. The implementation of an EHR system led to improved data accuracy because it reduced the need to replicate data.
    • -EHR system provides an opportunity for future research. The data captured in the database could be used to analyze outcomes and develop baseline data for future research
  38. Barriers to Electronic Patient Records
    -A major issue with any national implementation of an electronic heath record system is the development of data standards that should be used nationally.
    -From a user perspective such as a physician’s office, a major issue with EHR implementation was the cost of the implementation of the system.
    -Software purchases, hardware, network upgrades, training and computer personnel must be considered in the purchase of the system.
    • -Estimates vary from $15,000-$30,000 per physician which can be amortized over a period of 5 years.
    • -Estimates should also include annual costs of $5,000-$15,000 over the first 5 years.
  39. Microsoft
    -In 2008, Microsoft announced their Health-Vault website ( that enables patients to develop electronic health records free of charge.
    - It is up to the individual as to how much medical information the person wants to store online with this website.
    • -The website also has links to several health websites that can assist with exercise programs, heart issues, drug reactions, software that allows users to share their medical information with their providers, etc.
    • -In November 2008, the Cleveland Clinic agreed to pilot data exchanges between HealthVault and the Cleveland Clinic’s personal health record system. The Clinic has enrolled 400 patients in the areas of diabetes, hypertension and heart disease to test the system.
  40. Legal and Ethical Issues of Electronic Patient Records
    -However, legal and ethical issues are also a concern. As with any technological development, regulations often lag behind its’ implementation.
    • -A major legal barrier is the sharing of the patient information electronically with other providers. Does this violate any HIPAA regulations pertaining to privacy and confidentiality? Does the patient have to consent this sharing of information each time their information is electronically shared with other providers.
    • - Recent surveys have indicated that nearly 50 percent of U.S. adults polled indicated they had concerns about privacy and security of their information but felt that a computerized system like EHRs would outweigh the risks.
    • - The remaining 50 percent of those polled indicated that the EHR systems do not outweigh the risks of privacy and security
  41. Clinical Decision Support Systems (CDSS)
    -Artificial intelligence (AI) is a field of computerized methods and technologies to imitate human decision making
    -A technique of AI is expert systems (EI) which were developed to imitate expert’s knowledge in decision making .
    • -Electronic clinical decision support systems are systems that are designed to integrate medical information, patient information and a decision making tool to generate information to assist with cases. They are a type of knowledge-based system. The key functions of a CDSS are:
    • 1) administrative,
    • 2) case management,
    • 3) cost control
    • 4) decision support.
  42. -Specifically, expert systems can be used to alert and remind health care providers of a patient’s condition change, or to have a laboratory test performed or have an intervention performed.
    - An expert system can also assist with a diagnosis using the system’s database. The system can expose any weaknesses in a treatment plan or check for drug interactions and allergies.
    - A system can also interpret imaging tests routinely to flag any abnormalities. It is important to note that the more complex duties of a system require the integration of an EMR/EHR system so the system can interface with the patient dat
  43. research over the past several years indicated that CDSSs have many potential benefits that can be classified into three categories:
    1. improved patient safety
    2. improve quality of care
    3 improved efficiency in healthcare delivery
    • -although the barriers to implementation were identified previously the benefits for many institutions have outweighed those barriers so they have found ways to utilize these CDSSs.
    • - more CDSSs are being developed to provide information for various type of diseases.
  44. Computerized Physician Order Entry (CPOE)
    -Computerized Physician Order Entry (CPOE) are clinical decision support systems that enable a patient’s provider to enter a prescription order, order for a lab or diagnostic test into a computer system. The order entry has four components:
    • 1) information can be entered from a handheld device, laptop or desktop computer,
    • 2) it enables the provider to order a test or prescription, or procedure,
    • 3) it is connected to a decision support system that alerts the provider to any problems with their orders, and
    • 4) it can be integrated into the overall computer system of the organization.
  45. E-Prescribing
    -E-prescribing, a form of CPOE, focuses on electronic prescription ordering by a provider for their patient.
    - It also focuses on improving patient safety.
    • -Medication ordering and the administration of these medications can be incorrectly given to a patient because of similar sound names, similar dosages, similar labeling.
    • -E-prescribing can be performed on a desk computer, laptop or hand-held device that will records physicians’ prescription orders which eliminates having an individual reading a hand written prescription.
    -E-prescribing will become more commonplace with the mandates of Medicare. In order to manage this technology effectively and efficiently, a Pharmacy Benefit Manager(PBM) uses technology based tools to assess and evaluate the management of the prescription component so it can be customized to address the needs of the organization
    - PBMs are companies that administer drug benefits for employers and health insurance carriers.
    -They contract with managed care organizations, self insured employers, Medicaid and Medicare managed care plans, federal health insurance programs and local government organizations
    Approximately 95% of all patients with drug coverage received benefits through a PBM
  47. Drug-Drug Interactions (DDIs)
    -Drug-Drug Interactions (DDIs) are used by software programs to alter pharmacists and clinicians about potential drug-drug interactions.
    - These alerts can be notifying the provider that two drugs may interact or there may be management strategies provided regarding the DDIs
    • -In a January 2009 article entitled” Development of computerized alerts with management strategies for 25 serious drug-drug interactions”, a group of experts developed a list of 25 important DDIs and management strategies that should be used in when prescribing in an ambulatory setting.
    • -Alert messaging was developed for these 25 DDIs for eRx and pharmacy systems. This type of additional information will educate providers regarding potential issues while prescribing
  48. Telehealt
    -Telehealth is the broad term that encompasses the use of information technology to deliver education, research and clinical care.
    -An important activity of telehealth is the use of email as a communication between providers and their patients.
    -In an American Medical Association 2004 survey, approximately 25% of physicians reported they communicated with their patients via e-mail.
    -Telehealth also includes communication between health care providers
  49. E-health
    E-health refers to the use of the Internet by both individuals and health care professionals to access education, research and products and services. There are several online websites such as and that provide consumers general health care information
  50. Telemedicine
    -Telemedicine refers to the use of information technology to enable health care providers to communicate with rural care providers regarding patient care or to communicate directly with patients regarding treatment.
    -The basic form of telemedicine is a telephone consultation.
    • Telemedicine is most frequently used in pathology and radiology because images can be transmitted to a distant location where a specialist will read the results.
    • - Telemedicine is becoming more common because it increases health care access to remote locations such as rural areas. It also is a cost effective mode of treatment
  51. Chief Information office
    -As more health care services are delivered electronically, many health care organizations have designated a Chief Information officer (CIO) to manage the organization’s information systems.
    -Some organizations may also refer this position as a Chief Technology Officer (CTO) or they may have both.
    -Normally, the CIO is a vice president of the organization and the CTO reports to that position. The CIO also integrates HIT into the organization’s strategic plan
  52. -The CIO must have knowledge of current information technologies as they apply to the healthcare industry and how new techology can apply to the organization
    -the CIO is also responsible for motivating employees whenever there is any technological change.
    -(CAQH)This nonprofit organization consists of alliances of health plans and trade associations to discuss efficiency initiatives to exchange patient information.
    -As part of their initiative, they have created a Committee on Operating Rules for Information Exchange (CORE) which is borrowing from the banking industry who has set up standards for one of the largest electronic payment systems in the world.
  54. Other Applications
    Enterprise Data Warehouse
    -An Enterprise Data Warehouse is developed to provide information to aid enterprises in making decisions from a strategic perspective. Data warehousing requires an integration of many computer systems across an organization.
    -One of the first health care systems to utilize an EDW is the Veteran’s Health Administration.
    • -The VHA’s Enterprise Data Warehouse (EDW)
    • -It uses an IT-based system which is used for clinical management, e-prescriptions, patient and drug information and decision support. This system is in use at VA hospitals and clinics.
    • -The EDW has been instrumental in providing effective services to over 5 million veterans on an annual basis
  55. The CMS Enterprise Data Warehouse
    -In 2006, CMMS, as a pilot study, developed the largest data enterprise warehouse in history to gather hospital, prescription, physician data to analyze the claims data for Medicare and Medicaid.
    They initially are going to integrate claims from 2005-2006. They feel that the integration of their data will enable them to analyze claims by provider
  56. Radio frequency identification (RFID)
    -Radio frequency identification (RFID) chips transmit data to receivers. Each of these chips is uniquely identified by a signal indicating where it is located.
    -RFID can be used for the following:
    - Tracking of pharmaceuticals as they are shipped from the manufacturer to the customer;
    - Tracking costly medical equipment to ensure easy access;
    • -Identifying providers in hospitals to ensure efficiency in care;
    • -Identifying laboratory specimens to reduce medical errors;
    • -Tracking patients including infants while they are hospitals;
    • -Tracking hazardous materials that pose a public health threat
  57. - Currently, approximately 25% of health care RFID tags are used to identify people to ensure they are given the appropriate medication and interventions.
    -Approximately 16% of RFID tags are used for expensive equipment; 13% are used for pharmaceuticals and 4% are used for blood identification to reduce medical errors.
    -It is anticipated that over the next 10 years, RFID will be used primarily on labels of drugs to eliminate any drug counterfeiting by providing the full custody information on the RFID tag of the drug.
    -PhreesiaPad, a wireless digital device with a touch screen keyboard allows a patient to enter their demographic information and the reason they are visiting the doctor
    • This new technology eliminates the patient’s need to replicate their information each time they pay a visit to the doctor.
    • -The system is currently being used in 49 states and thousands of doctors’ offices.
  59. The Healthy Advice Network
    -The Healthy Advice Network provides education to patients electronically while in the waiting room or an exam room.
    • Health education information is customized with brand advertising messages displayed on digital flat screens in the physicians’ waiting rooms. • There are 25 minute loops of brand materials that focus on prevention and management of disease.
    • - In 2009, this information was provided to 118.4 million annual patient visits.
  60. IntelliFinger
    -Developed by eMedicalFiles, the IntelliFinger is biometric authentication technology which authenticates the identification of a patient by their fingerprint which is scanned when they enter an office for a medical visit, pre-surgery visit, at check out and at the pharmacy.
    -The technology translates the fingerprint into a numeric combination that is matched with the patient’s medical information.
    -This prevents fraudulent use of insurance cards and should reduce Medicaid and Medicare fraud. The Intellifinger can be added to any electronic health record system
  61. DocketPort Scanner
    In 2002, the innovative Card Scanning, Inc. was started by a physician because he wanted to develop a user friendly scanner--the DocketPort Scanner, which uses an imaging software that would scan a patient’s insurance card and transfer the information to the patient form within 30 seconds.
    It eliminates copying costs and staff time that would normally copy the card and put it in the patient file.
  62. Acuson P10
    - Siemens has introduced a pocket sized ultrasound, Accuson P210 that can be used for traditional applications of diagnostic and screening tests
    -It can be used in outpatient areas, intensive care units, and rescue helicopters to provide instant information to make a diagnosis.
  63. Picclo Xpress Chemistry Analyzer
    -The size of a shoebox, the Piccolo Xpress is a compact portable chemistry analyzer that delivers blood test results quickly.
    - The provider places blood, etc. on a small disc and slides the disc into the Piccolo Express.
    • -The provider requests tests to be performed using its touch screen display which prints out a report in approximately 12 minutes or the information can be electronically transferred
    • -This technology expedites the provider’s ability to diagnose a patient.
    -A recent study focused on the implementation and management of IT in the hospital setting.
    - Six hospital CIOs or their equivalents and nurse managers were surveyed to assess why they used HIT.
    - The CIOs indicated they used HIT to streamline administrative processes in the organization.
    • -The nurse managers focused on the ability to reduce medical errors as a result of HIT.
    • -They also indicated that having electronic patient data ultimately contributed to more efficient and effective clinical decision making.