An information technology influence will strongly affect the future of our healthcare system as federal regulators attempt to reduce costs. Federal regulations are requiring quality reporting measures relating to patient care assessments and outcomes, meaning a revamping of our healthcare system. This translates into providers being dependent on better and faster information in order to survive.
Healthcare providers perform many tasks. Many of those tasks are delegated to other healthcare professionals to provide certain treatments such as screening and diagnostic procedures, administration of vaccines and other medications, and even the transfer of a patient from a hospital to a nursing home.
Clinical policies as well as state, and hospital rules define the requirements within the scope of medical orders. For example, in an ambulatory setting, orders are typically for referrals to other specialists, or for radiology and diagnosis imaging tests, blood work, and durable medical equipment, various therapies such as physical, occupational, and respiratory therapy, as well as rehabilitation. Medication prescriptions are also ordered through an ambulatory setting.
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In a hospital setting, a clipboard chart will show all services related to the patient during his hospital stay. Some of the information that you would find on a clipboard chart would be medications the patient is taking with dosage amounts, as well as whether or not the patient is receiving the medication orally, intravenously, via injection or rectally, and the times they are scheduled to receive such doses and the time that they did. Ordered laboratory tests, radiology and imaging tests and blood transfusions, as well as all findings, are also filed in the chart. If the patient has received dialysis, or had any providers consulted for their involvement in the care of the patient, this information would be included in the chart along with specific surgical preparations, if applicable. There are also certain protocols to be followed for recovery room patients. You will find recorded vital signs and last of all, when a patient is either transferred to another facility or discharged from the hospital, that information would be the final piece concerning the patient to complete the discharge.
CPOE stands for computerized physician order entry systems. CPOE is a medical order that is communicated electronically as opposed to being recorded on paper and placed in a folder.
A key factor of the HITECH ACT within the American Recovery and Reinvestment Act (ARRA) of 2009 is to improve the quality, safety, and inefficiency of patient care while reducing any inconsistencies.
Plans are now in place for using Stage 1 electronic health record (EHR) meaningful use reporting and requirements. For example, physicians are required to order at least one medication through CPOE for at least 30% of their patients who are taking meds, in order to qualify for any incentive payments. The CPOE system transmits the order to the proper department so that individuals can carry out the order. This reduces errors related to the interpretation of hand written prescription orders, a common problem that affects patient care. The electronic recording method produces real-time clinical decision-making as well as support. With real-time ordering of medication, alternative medication suggestions are readily available, duplicate therapy warnings and toxic drug interactions are presented immediately.
There’s a lot of time and effort put into setting up a CPOE in an ambulatory setting. The CPOE includes patient prescriptions as well as diagnostic radiology workups and lab orders providing quick results. In order to train the provider, prepare them for the change, and formulate standards of protocol, a lot of time must be invested.
One of the most common concerns with implementing a CPOE system is aligning the ambulatory setting with providers and facilities.
When all processes are in sync, results of tests are realized in real time.
The HITECH ACT provides incentives to those who adopt EHR and are fully compliant with meaningful use. For providers who do not adopt the meaningful use protocol, financial penalties will be implemented in 2015.
There are three uses for the HITECH ACT and certified EHR:
2. Electronic exchange of health information to improve quality of care
3. Submitting clinical quality and other measures
CMS Medicare and Medicaid have incentive payments that are available for eligible professionals when they adopt a certified EHR and can successfully demonstrate meaningful use in ways that improve the quality, safety, and effectiveness of patient care. To meet the requirements, an eligible professional must participate in either a Medicare or Medicaid EHR incentive program and must utilize a certified EHR. If an eligible professional does not have a certified EHR, he must upgrade to one in order to qualify for the EHR Incentive Program.
E prescribing is a process where new and refill prescriptions are electronically transmitted to a local pharmacy or through mail order. It can be accomplished is part of an EMR or EHR or through as ASP, an application service provider, where data is stored off-site. Providers must use a certified EHR that includes e-prescribing to collect incentive payments under ARRA.
There are many advantages to e-prescribing. For example, there is less drug error from deciphering poorly handwritten prescriptions. One of the biggest advantages to e-prescribing is the avoidance of human error. How many times do telephone miscommunications occur between pharmacies and the doctor’s office? How often do patients misplace prescriptions?
Having immediate access to a patient’s medication history can alert the pharmacist to potential drug interactions or any type of error.
Automation streamlines the routine tasks in a medical practice, improves turnaround time for getting important information to other providers and their billing department, which is basically more cost-effective.
Scanning insurance cards into the medical record is one of the most important features of electronic medical records. In the past, the front desk would write down insurance information incorrectly slowing down the billing and collection process. Registrations can be done online via a patient portal and eligibility can be checked in batches. Appointment reminders are performed through texting, e-mail or automatic messaging. Providers can enter charges and automatically capture the information to be submitted to payers in real time. However, having a certified coder on staff would eliminate denied claims since most providers are focused on patient care and not coding and billing regulations. Patients can even pay their bills online.
Telehealth and Telemedicine
Telehealth and telemedicine are process by which medical care can be provided remotely through the Internet that does not include having a healthcare provider physically present during the evaluation.
Only a handful of states will reimburse for telemedicine or telehealth services. Some states require a separate license to practice telemedicine.
A few examples of telemedicine would be medical education, diagnostic image transfers, remote monitoring of vital signs, telecardiology, and teledermatology.
Telehealth networks provide the infrastructure that enables Internet access and drives health information exchange in areas where commercial broadband is deficient and unaffordable.
Email is an accepted means of telemedicine communication. Telehealth can also include technologies such as the telephone, fax machines, electronic mail systems, and remote patient monitoring devices. Smart phones are also another means of telehealth using a mobile OS platform. Four out of five doctors use iPhones and iPads in medical applications in everyday practice management.
ICD-9-CM Vols. 1-2 is used solely for physician coding.
The international classification of diseases, ninth revision, clinical modifications Volumes One and Two represent diagnosis codes. ICD-9 CM codes are alphanumeric codes that stand for diseases, conditions, or circumstances that could cause a person’s illness injury or death. These codes are a HIPAA code set and represent the diagnosis or reason a procedure is done. The format for diagnosis codes is a decimal place after the first three characters in one of two possible additional add-on characters following. (For example, 250.02.)
ICD-9 CM Volume Three represents procedures provided in an inpatient hospital facility to treat diseases.
CPT codes, Current Procedural Terminology published by the American Medical Association represents procedures performed and billed by physicians. These codes are a HIPAA code set. The format of the CPT code is five characters.
HCPCS Level II, Healthcare Common Procedure Coding System Level Two are codes used to identify medications, medical supplies, and some medical procedures. These codes are also a HIPAA code set used primarily in billing to represent the services performed or supplies used by the provider.
Enterprise architecture (EA) is strategic business planning which requires goal setting and project planning. It typically integrates the use of technical road maps, reference models, and blueprints. Healthcare Organizations have outdated systems, called legacy systems, and through the use of EA, they can update and connect their systems to achieve interoperability.
Clinical Data Repositories
A Clinical Data Repository (CDR) is a database that gathers patient information from a variety of clinical sources so that all providers and facilities can pull selected elements of a patient record. Data is stored in a secure location identified by a Patient Record Locator.
Health Information Exchange (HIE)
HIE is the evolving process of moving and sharing HIPAA protected health information. (PHI) This exchange of data can occur at a local or national level. A few examples of shared data would be:
• Lab test orders and results
• Sharing patient information between physicians
An HIE is protected by a firewall and is the portal for patients, providers, pharmacies, clinics, public health facilities, insurance carriers, and more. All tied into the HIE mutually benefit from the exchanged data.
More Information about Modern Health IT
Medical Practice Management – Quality in Health Care
AAPC – PPM