1. Introduction to Health Informatics I Chapters 1-3 of

2. .  Introductions  Syllabus Overview  Questions  Unit 1/Chapters 1-3/Overview  Problem Solving

3. .  Nathan Botts, PhD  California native  Health IT Researcher (Westat, Center for HealthIT)  CTO of HealthATM

4. .  Personal Health Information Systems  Design Science Research  Potential for Health Outcomes Impact within Underserved, Chronically Ill, Populations  Other Research  Public Health Informatics  Health Cyberinfrastructure  Health Information Exchange

5. .  PHR Integrated with Google Health platform  Focus on usability to address digital divide  Ability to affect Health Locus of Control

6. .  What work do you do or what work do you want to do?  What made you interested in Health Informatics?  Any other aspects of your life that you would like to share?

7. .  Seminars = Wednesday 9pm EST  Unit 1 – March 23- March 29  Projects are due Tuesday 11:59 pm EST of their assigned Unit.  All course projects submitted on time will be graded within five days of their due date (the Sunday of the following unit).

8. .  Seminars = Wednesday 9pm EST  DB – Introduction, Discussion 1 &2  Seminar Quiz  Homework Zero

9. .  Post a minimum of three posts per discussion question. One initial response and two replies to your classmates  Posting on a minimum of three different days, for example: Wednesday, Friday and Monday  The first post must be made by Saturday.

10. . Introduction to Health Care Information

11. .  Types of Health Care Information  Patient Encounter Data  Patient Specific Information  Clinical  Administrative  Combined  Aggregate Information  Clinical  Administrative  Combined  Comparative Information  Expert of Knowledge-based Information

12. . Research Perspective 1 Practice Perspective 2 2 http://www.sciensus.com/index.php?page=what-is-hi 1 http://www.ukchip.org/?q=page/Professionalism-Health-Informatics

13. .  Internal Data/Information ▪ Patient Encounter ▪ Patient specific ▪ Aggregate ▪ Comparative ▪ General Operations  External Data/Information ▪ Comparative ▪ Expert/Knowledge-based

14. . Primary Purpose Type ClinicalAdministrative Patient-Specific Those items generally included as a part of the patient medical record are in italics Identification Sheet Problem List Medication Record History Physical Progress Notes Consultations Physicians’ Orders Imaging and X-ray results Lab results Immunization Record Operative Report Pathology Report Discharge Summary Diagnoses Codes Procedure Codes Identification Sheet Consents Authorizations Pre-authorization Scheduling Admission/Registration Insurance Eligibility Billing Diagnoses Codes Procedure Codes Aggregate Disease Indexes Specialized Registers Outcomes Data Statistical Reports Trend Analysis Ad hoc Reports Cost Reports Claims Denial Analysis Staffing Analysis Referral Analysis Statistical Reports Trend Analysis Ad hoc Reports

15. .  Purpose of Patient Records  Patient care  Communication  Legal documentation  Billing and Reimbursement  Research and Quality Management

16. .  Content of Patient Records (myPHR, 2004)  Identification Sheet  Problem List  Medication Record  History and Physical  Progress Notes  Consultation

17. .  Overview of Inpatient Encounter  Scheduling  Preadmission  Admission/Registration  Treatment ▪ Medical ▪ Nursing ▪ Ancillary  Discharge

18. .  Outpatient/Ambulatory Encounter  Physician’s Office Patient Flow  Check In  Move to Exam Room  Examination  Check Out  Later activities

19. .  Data Needed for Reimbursement  UB 92  CMS 1500  Other Uniform Data Sets  ACDS  UHDDS

20. .  UHDDS elements as adopted in 1986 are: 1. Personal identification 2. Sex 3. Race 4. Ethnicity 5. Residence 6. Hospital identification 7-8. Admission and discharge dates 9-10. Attending physician and operating physician 11. Diagnoses: Principal diagnosis & Other diagnoses 12. Procedure and date 13. Disposition of patient 14. Expected payer

21. .  Coding Systems  ICD-9-CM ▪ National Center for Health Statistics ▪ Inpatient and Outpatient Diagnoses ▪ Inpatient Procedures  CPT ▪ American Medical Association ▪ Outpatient Procedures

22. .  Disease and Procedure Indexes  Specialized Registers  Emergency Room  Operating Room  Trauma  Tumor  Other  Ad hoc Reports

23. .  Limitless Ad hoc Reports  Specific Examples  Medicare Cost Reports  Health Care Statistics ▪ Census ▪ Discharge

24. .  Outcome Measures  Benchmarking  Balanced Scorecards  Clinical Value Compass

25. . Health Care Data Quality

26. .  Data vs. Information  Problems with poor quality data  Ensuring Data Quality  Data Errors

27. .  Information is processed data  Health care information is processed health care data  Knowledge is a “combination or rules, relationships, ideas, and experience” ( Johns, 1997 )

28. . Health Care Data Health Care Information Health Care Knowledge Processing

29. .  Diminished quality of Patient care data can lead to problems with  Patient care  Communication among providers & patients  Documentation  Reimbursement  Outcomes assessment  Research

30. .  Medical Record Institute Principles of Health Care Documentation (MRI, 2004)  Unique Patient Identification within and across systems  Health care documentation must be ▪ Accurate and consistent ▪ Complete ▪ Timely ▪ Interoperable across systems ▪ Accessible ▪ Auditable  Confidential and secure authentication and accountability must be provided

31. .  Accessibility  Consistency  Currency  Granularity  Precision  Accuracy  Comprehensiveness  Definition  Relevancy  Timeliness AHIMA Data Quality Management Model: Data Characteristics

32. .

33. . SystematicRandom Unclear data definitions Unclear data collection guidelines Poor interface design Programming errors Incomplete data source Unsuitable data format in the source Data dictionary is lacking or not available Data dictionary is not adhered to Guidelines or protocols are not adhered to Lack of insufficient data checks No system for correcting detected data errors No control over adherence to guidelines and data definitions Illegible handwriting in data source Typing errors Lack of motivation Frequent personnel turnover Calculation errors (not built into the system)

34. .  Data Error Prevention  Compose a minimum set of necessary data items  Define data and data characteristics in a data dictionary  Develop a data collection protocol  Create user friendly data entry forms or interface  Compose data checks  Create a quality assurance plan  Train and motivate users  Data Error Detection  Perform automatic data checks  Perform data quality audits  Review data collection protocols and procedures  Check inter- and intraobserver varability (if appropropriate)  Visually inspect completed forms (online or otherwise)  Routinely check completeness of data entry

35. .  Actions for Data Quality Improvement  Provided data quality reports to users  Correct inaccurate data and fill in incomplete data detected  Control user correction of data errors  Give feedback of data quality results and recommendations  Resolve identified causes of data errors  Implement identified system changes  Communicate with users

36. . Health Care Information Regulations, Laws and Standards The current draft of the PHR Certification Criteria specifies use of theHL7 Continuity of Care Document (CCD) as the only endorsed standard for interoperable exchange of information to and from PHRs. This is extremely short-sighted.HL7 Continuity of Care Document (CCD) The current draft of the PHR Certification Criteria specifies use of theHL7 Continuity of Care Document (CCD) as the only endorsed standard for interoperable exchange of information to and from PHRs. This is extremely short-sighted.HL7 Continuity of Care Document (CCD) “The current draft of the PHR Certification Criteria specifies use of theHL7 Continuity of Care Document (CCD) as the only endorsed standard for interoperable exchange of information to and from PHRs. This is extremely short-sighted.” 1HL7 Continuity of Care Document (CCD) - Vince Kuraitis Principal, Better Health Technologies, LLC Member, ASTM CCR Steering Committee 1 http://e-caremanagement.com/cchit-should-support-both-the-hl7-ccd-and-the-astm-ccr-for-phrs/

37. .  Accreditation, Licensure & Certification  Facility Licensure  Certification  Joint Commission on Accreditation of Healthcare Organizations (JCAHO)  Other Accrediting Organizations

38. .  Legal Aspects of Health Care Information  Health Record as a Legal Document ▪ Definition ▪ Retention of Health Records ▪ Authentication  Privacy and Confidentiality ▪ Pre-HIPAA ▪ HIPAA ▪ Release of Information

39. .  How do government policies affect health care information requirements?

40. .  States oversee facility licensure  Facilities must have a license to operate  Emphasis is on standards for physical plant, safety, etc.  Minimum standards for patient records

41. .  Gives authority to participate in Medicare and Medicaid  Standards were established in 1970’s  Hospitals with JCAHO Accreditation have “deemed” status

42. .  Voluntary external review  Well known agencies  JCAHO—hosptials and other health care facilities  NCQA—managed care plans  AOA—Osteopathic health care organizations  CARF—Rehabilitation facilities  AAAHC—Ambulatory care facilities

43. .  Possible Benefits  Deemed status for CMS programs and some state licensure  Required for reimbursement from some payers  Validates quality of care  May influence liability insurance  May enhance managed care contracts  Gives competitive edge over non-accredited

44. .  What is the legal Health Record?  No simple answer in the electronic environment  State and Federal laws are being modified

45. .  AHIMA define Legal Health Record (LHR) “the documentation of the healthcare services provided to an individual in any aspect of healthcare delivery by a healthcare provider organization.” (Amatayakul, 2001)

46. .  AHIMA defines four categories of patient data  Legal Health Record  Patient-Identifiable Source Data  Administrative Data  Derived Data

47. .  JCAHO defines authentication as (JCAHO, 2004) “the validation of correctness for both the information itself and for the person who is the author or the user of the information”

48. .  Forms of Authentication  Handwritten signature  Electronic signature ▪ Most states allow or are silent on electronic signatures ▪ Policies and procedures are needed to insure that electronic signature codes, etc are not shared

49. .  Privacy—individual's right to be left alone  In health care—the right to limit access to health care information  Confidentiality—the expectation that information will only be used for its intended purpose  Confidentiality relies on trust

50. .  Pre-HIPAA  A few federal and state laws, but no comprehensive federal regulation to protect private health information  HIPAA  Multiple Sections, including  Privacy Rule  HIPAA=Health Insurance Portability and Accountability Act

51. .  Key definitions  Covered Entities ▪ Health plans ▪ Health care clearinghouses ▪ Health care providers  Key consumer facets  Limits exposure of unnecessary data  Covered entities must disclose PHI to the individual within 30 days upon request  The right to request that a covered entity correct any inaccurate PHI.

52. .  Key definitions  Protected Health Information (PHI) ▪ Relates to physical or mental health, provision of or payment for health care ▪ Identifies the person ▪ Created or received by a covered entity ▪ Transmitted or maintained in any form

53. .  Five major components  Boundaries  Security  Consumer control  Accountability  Public Responsibility

54. .  Health care organizations need comprehensive policies and procedures for releasing patient information  Routine Use –requires consent  Non-routine Use—requires authorization

55. .  Chp1= Intro to domain of Health Information  Chp2=Health Care Data Quality  Chp3=Regulations, Laws and Standards