1. Introduction to Healthcare Information Technology
Chapter Two
Healthcare Organizations and Operations

2. 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

3. 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

4. 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

5. 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

6. 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

7. 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)

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

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. 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

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

19. 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

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

21. 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

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

23. 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

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

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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

31. 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

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

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

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

35. 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

36. 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

37. 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

38. 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

39. 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

40. 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

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

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

43. 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

44. 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

45. 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

46. 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