Introduction to Healthcare Information Technology Chapter Two Healthcare Organizations and Operations

Objectives Identify various healthcare organizational structures and their different methods of operation Explain the use of codes of conduct Identify EHR/EMR access roles and responsibilities for using Protected Health Information (PHI) Describe the proper communication methods for use in the healthcare workplace List best practices in handling PHI in the healthcare setting

Healthcare IT: Challenges and Opportunities Delivery of health care to a large population Diverse and complex organizations First responders Police, firefighters, emergency medical technicians Operation of a hospital Numerous organizations play supporting roles

Healthcare Organizational Structures and Operation Framework through which a group of people work toward common goal Defines authority, responsibilities, communication methods, rights, and duties of the group Uniqueness of healthcare organizational structures Common goal to save lives, reduce suffering, and eliminate disease Stressful and demanding environments

Organizational Structures Hospitals Healthcare organizations treating patients for injury and disease Usually provide inpatient (long-term) care Patient resides in hospital one or more nights Also provide outpatient care Patient is not admitted and does not reside overnight

Organizational Structures (cont’d.) Types of hospitals General Contagious disease Nursing homes Psychiatric Orthopedic Pediatric Hospitals divide functionality into departments Departments depend on hospital type and size

Organizational Structures (cont’d.) Hospital departments Cardiac care unit (CCU) Emergency room (ER) Gynecology (GYN) Intensive care unit (ICU) Medical/Surgical (Med/Surg) Neurology Obstetrics (OB) Oncology Pediatrics (Peds)

Organizational Structures (cont’d.) Hospital departments (cont’d.) Physical therapy (PT) Psychiatry (Psych) Surgery (OR) Supporting departments Laboratory (Lab) Pathology (Path) Pharmacy Radiology (Xray)

Table 2-1 Selected departments typically found in hospitals © Cengage Learning 2013

Organizational Structures (cont’d.) Indirect support departments Health information management (medical records) Information technology (IT) Clinical (or biomedical) engineering Facilities management (maintenance/operations) Administration Food and nutrition services Security Material management

Organizational Structures (cont’d.) Physician Medical professional Licensed by a governing body Private practices Single physician provides care to individual patients Group of physicians working together Considered private practice if group is physician owned Non-physician owned healthcare group Not considered private practice

Organizational Structures (cont’d.) Nursing homes (convalescent hospitals) Equipped for patients with long-term diseases Address the needs of inpatients Generally not equipped for acute care Generally outsource support functions Skilled nursing facility (SNF) Requirement for facility to receive Medicare reimbursement Must employ skilled nursing staff

Organizational Structures (cont’d.) Requirements for Medicaid reimbursement of patient expenses Patient needs skilled nursing care Patient has income and assets below defined levels Patient must be a United States citizen Patient must reside in state in which nursing home is located

Organizational Structures (cont’d.) Assisted living facility Designed for elderly people who need some assistance with activities of daily living Has residents, not patients Generally do not have skilled nursing care staff No Medicare or Medicaid reimbursement

Organizational Structures (cont’d.) Home health care Treatment of disease or injury in patient’s home Staffed by nonmedical and/or skilled nursing professionals May be reimbursed depending on certain criteria

Organizational Structures (cont’d.) Hospice Care of terminally ill patients at home or in dedicated facilities Patients require palliative care Relief and prevention of suffering Hospice care may include: Skilled care on a 24-hour, 7 day per week basis Pharmaceuticals to provide patient comfort Necessary medical equipment Generally reimbursable by Medicare and Medicaid

Organizational Structures (cont’d.) Surgical centers and ASCs Specialize in outpatient surgical care Also called same-day surgery Less complex procedures than inpatient surgery Types of procedures Minor surgeries Pain management Diagnostic procedures

Methods of Operation Customs or practices used to achieve organization’s goal Scope of work Availability of resources Formality of procedures

Methods of Operation (cont’d.) Scope of work Refers to tasks involved in accomplishing a goal or objective Differences exist in scope of work among various types of medical facilities

Table 2-2 Scope of work for identified healthcare organizations © Cengage Learning 2013

Methods of Operation (cont’d.) Availability of resources Financial resources Economic and monetary resources needed for organization to function Human resources Staffing needs Physical resources Places and equipment Information

Table 2-3 Availability of financial resources for identified healthcare organizations © Cengage Learning 2013

Methods of Operation (cont’d.) Formality of procedures Set of established behaviors for collectively achieving an organization’s goal High formality: little deviation from set procedures Low formality: higher deviation from set procedures Formality typically increases as risk to patient increases

Table 2-4 Formality of procedures for identified healthcare organizations © Cengage Learning 2013

Codes of Conduct Rules for behavior to which a group of people adhere May be specific and written Likely to be similar for similar groups of people or facilities Frequently address communication, procedural behavior, social behavior, and sanitation

Communication Professional communication Style of communication Use of written, oral, or other exchange methods Style of communication How something is said Content of communication What is said High-formality healthcare setting Use formal communication style Inappropriate to discuss outside activities, relationships, or other staff members in front of patient

Adapting Procedural Behavior Level of procedural formality based on type of treatment or diagnostics Examples of locations where procedural behavior is important Imaging room Procedure room Recovery room Examination room Emergency room

Sanitation Physical hazards due to close proximity to biological or chemical disease components Sanitation methods Sterilization of facilities and instruments Proper disposal of contaminated wastes Infection control procedures Hand washing Cleaning and sterilization Use of antimicrobials Use of protective equipment

Social Behavior and Sensitivity of the Environment Conduct toward other people Example: inappropriate for emergency room staff to act shy around unclothed patient May be appropriate behavior for maintenance worker

Conforming to Management Requirements Main responsibility is the patient Managerial operating procedures Address business needs of the organization May sometimes conflict with patient care Example: private hospitals may turn away patient without insurance or means to pay

Protecting Healthcare Information HIPAA privacy rule protects individually identifiable health information Includes verbal, paper, and electronic forms Relates to past, present, and future health of an individual PHI is protected as long as retained by Covered Entity: Even if individual is deceased

Access Roles and Responsibilities Healthcare team access Each member of healthcare team has roles and responsibilities pertaining to PHI

Table 2-5 Protected health information access roles (continues) © Cengage Learning 2013

Table 2-5 Protected health information access roles (cont’d.) © Cengage Learning 2013

Access Roles and Responsibilities (cont’d.) Business Associate access HITECH Act encompasses Business Associates in same manner as Covered Entities Examples of Business Associate functions Claims processing Accounting Data aggregation Accreditation

Access Limitations Based on Role and Exceptions Certain times when traditional access roles need to be superseded Example: emergency situation when database administrator may read PHI

Access to Sensitive Patient Data Some information may have more stringent guidelines Individuals may ask a Covered Entity to restrict use and disclosure of their PHI Roles must be modified appropriately

Proper Communication Procedures must be followed for various types of communication Backups A permanent copy of all ePHI is maintained Unique identifiers Username and password for each distinct user account Emergency access Procedures for obtaining necessary ePHI during an emergency

Proper Communication (cont’d.) Timeout Terminating an electronic communication session after a period of inactivity Encryption ePHI must be encrypted Audit trails Mechanism to record activity in information systems

Proper Communication (cont’d.) Integrity Mechanisms to prevent unauthorized destruction or alteration of ePHI Authentication Procedures to ensure those seeking access to ePHI are authentic Disposal Procedures to ensure final disposition of ePHI

Proper Communication (cont’d.) Safeguards must apply to all forms of communication E-mail Instant messaging Fax File transfer protocol Telephone Voice over IP

Table 2-6 Safeguards for various electronic communication methods © Cengage Learning 2013

Data Handling Procedures Best practices for general technology use Help ensure PHI is protected Access to network devices should be controlled Access methods Physical Electronic Managing physical access Location of physical device chosen to minimize access

Data Handling Procedures (cont’d.) Privacy screens Prevents anyone not sitting in front of screen from reading its contents Screensavers Lock out computer screens after specified time period Time lockouts Program locks out users after specific period of time Password must be entered to regain access

Summary Various healthcare organizational structures exist Code of conduct refers to behavior rules to which a group of people adhere PHI includes information in verbal, paper, or electronic form Includes past, present, and future health information Various roles and responsibilities exist for using PHI

Summary (cont’d.) Safeguarding communication methods is one facet of protecting PHI Best practices in handling PHI in a healthcare setting involve controlling physical and electronic access to PCs, printers, and other equipment