Introduction to Healthcare Information Technology Chapter Five Medical Business Operations

Introduction to Healthcare Information Technology

Chapter FiveMedical Business Operations


Objectives

• Define frequently used healthcare terms• Identify and describe the functions of certain

healthcare departments• Describe the uses for clinical software• List and describe the steps in the clinical process

or environment• Identify and describe the functions of various

medical devices

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Healthcare IT: Challenges and Opportunities

• Health care is one of the largest industries in the US– 14.2 million workers

• Bureau of Labor Statistics forecast:– Over 3 million new jobs in healthcare between 2008

and 2018• Home healthcare services

– One of the fastest growing areas until 2018

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Introduction to Healthcare Information Technology 4

Medical Terminology

• Healthcare– Specialized terminology– Numerous acronyms

• Imaging– Often called radiology– Use of technologies to provide visual representation

of internal body structures– Can eliminate the need for biopsies or surgery in

some cases


Medical Terminology (cont’d.)

• Major types of imaging technologies– X-ray– CT scan– Fluoroscopy– Magnetic resonance imaging (MRI)– Ultrasound– Nuclear medicine

• Newer techniques– Capsule endoscopy


Figure 5-1 Modern x-ray machine© Tyler Olson/www.Shutterstock.com


Primary Care Physician

• Over 20 physician specialties in medicine• Primary care physician specialties

– Family or general practice• Broad range of ailments and chronic disorders

– Internal medicine• Adult diseases and chronic disorders

– Pediatrics• Diagnosis and treatment of children

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Stat

• Term meaning “immediately”• Derived from Latin word statim

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Acuity

• Measure of the degree of patient disease or injury• Can refer to:

– Severity– Time sensitivity– Physical effects– Psychological suffering

• High-acuity patient less healthy than low-acuity patient, in general

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Code Blue

• Emergency code• Indicates patient needs immediate help• Can be announced over the public address system• Expedites correct staff moving to location where

patient needs help

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Trauma Levels

• Trauma– Physical wound or injury to the body– May be caused by accident or violence– Commonly treated at hospital ERs

• Trauma center– Centers classified according to their ability to handle

different types of trauma

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Table 5-1 Trauma center levels and resources

© Cengage Learning 2013


Controlled Substances

• Controlled Substances Act of 1970– Established government control of certain drugs and

chemicals known as controlled substances• Classification scheme with five levels• Schedule 1 substances

– High abuse potential– No currently accepted medical use

• Schedule 2 substances– Can cause dependence– High abuse potential

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Controlled Substances (cont’d.)

• Schedule 3 substances– Lower abuse potential than schedule 1 and 2– Example: drugs containing less than 15mg

hydrocodone per dosage• Schedule 4 substances

– Lower abuse potential than schedule 3– Examples: diazepam, alprazolam, propoxyphene

• Schedule 5 substances– Cough and cold preparations with limited quantities

of certain narcotics

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Controlled Substances (cont’d.)

• Healthcare providers that use controlled substances:– Have well-defined policies and procedures for use

• Example controlled substance policy components– Locked storage– Staff authorization to access– Substance abuse protocol– Substance audits

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Electronic Medical Record

• Medical record (chart)– Location where provider records aspects of

diagnosis and treatment• Electronic medical record

– Can be viewed by authorized individuals anywhere in the world

– Can be interfaced to other electronic systems• Lab or radiology results can be instantly updated

– Controlling access can be more difficult than with paper record

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Electronic Health Record

• Broader than an EMR• Includes demographics, billing, and all historical

medical information• Gives providers the widest possible perspective on

a patient• Potential for abuse of information exists

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Medical Departments

• Ambulatory/day surgery– Provides surgery on an outpatient basis

• Behavioral health– Provides care for mental disorders

• Cardiac care units– Treat patients requiring specialized cardiac

monitoring

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Medical Departments (cont’d.)

• Cardiovascular– Includes advanced cardiac specialties

• Electrophysiology• Heart failure• Heart transplantation

• Dermatology– Treats skin diseases:

• Usually on an outpatient basis

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• Ear, nose, and throat– Also called otolaryngology– Facial plastic surgery– Laryngology (voice)– Neuro-otology (middle/inner ear, base of skull)– Otology (ear)– Rhinology (sinuses)

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• Emergency room– Treats patients with life-threatening condition or

immediate need– Certified to a specific trauma level

• Intensive care unit– Treats patients needing high level of specialized care– Can include intensive monitoring with electronic

equipment– Patient may need ventilator, feeding tubes, etc.

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Figure 5-3 Intensive care monitoring

© Edwin Verin/www.Shutterstock.com



• Laboratory– Provides chemical, microbial, microscopic, and other

studies to diagnose and treat injury• Medical/surgical

– Care for adult patients before and after surgery• Nuclear medicine

– Uses radioactive decay of radiopharmaceuticals to diagnose and treat disease

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• Obstetrics/gynecology– Provides care for the female reproductive system– Obstetrics provides care surrounding childbirth

• OB/GYN related departments– Family birth center– Labor and delivery– Neonatal intensive unit

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• Occupational therapy– Care for patients recovering from injury to regain

work-related skills– Helping people with disabilities accomplish self-care

tasks• Oncology

– Care for cancer patients• Operating room

– Department where surgical operations are conducted

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• Ophthalmology– Diagnose and treat various eye conditions

• Pediatrics– Specialized treatment for children– Patients may be medium or high acuity

• Physical therapy– Assists patients to regain lost range of motion

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• Plastic surgery– Provides reconstruction of the human body

• Post-anesthesia care unit– Provides care during recovery from anesthesia

• Radiology– Provides imaging equipment using x-ray, ultrasound,

or nuclear isotopes to diagnose disease or injury

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• Respiratory– Provides breathing treatments for inpatients or

outpatients• Bronchodilators• Pulmonary rehabilitation• Mechanical ventilation

• Transitional/progressive care unit– Provides transitional care between CCU/ICU and

standard care unit

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Clinical Software

• Software– Set of instructions that helps hardware process data

into information• Clinical software

– Used to manage data and information in a clinical environment

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Patient Tracking

• Patient tracking software benefits– Tracks services provided– Manages patient demographics– Manages patient visit history– Tracks time-specific illnesses like allergies

• Many patient tracking systems can interface with scheduling, medical records, and lab software packages

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Scheduling

• Scheduling software manages patient scheduling process

• Capabilities– Quickly scan for open appointments– Track patient cancellations, no-shows, and

reschedules– Track patient visits by time of check-in and departure


Order Entry

• Computerized physician order entry (CPOE)– Electronic systems transmit physician’s orders to

other healthcare professionals• Advantages of CPOE

– Instant availability of patient’s medical history– Current information helps prevent unwanted drug

interactions– Statistical reports improve resource management– Linking diagnoses to the order improves billing

management


Billing/Coding/Auditing

• Billing software helps manage billing process– Software decision engines can validate claims– Submits claims to appropriate payer

• International Statistical Classification of Diseases and Related Health Problems Codes (ICD-9)– List of over 13,000 codes used in billing

• ICD-10– Complete revision of the diagnosis code set– Includes about 68,000 codes

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Table 5-2 ICD-9 and ICD-10 code examples

© Cengage Learning 2013


Billing/Coding/Auditing (cont’d.)

• Audit software– Computer algorithms determine whether correct CPT

and ICD codes are used– Can use historical data for trending and analysis to

predict and improve performance

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Practice Management

• Practice management software (PMS) functions– Patient tracking– Scheduling– Computerized physician order entry– Billing– Coding– Audit

• PMS can be interfaced with EMR systems


The Clinical Environment

• Clinical process (clinical environment)– Sequence of operations that must occur for the

patient to be examined, diagnosed, and treated– May vary by environment

• Common features of the clinical environment– Registration, consultation, examination, CPOE,

dictation/transcription, referrals

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Registration

• Patient must be registered or admitted:– Prior to being seen by medical staff

• Examples of patient data collected during registration– Contact information– Billing information– Next of kin– Current medications– Other pertinent information

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Consultation

• Also known as medical history• Questions about pain levels, location, and intensity• Brief history of activity:

– To determine if behavior or actions contributed to the illness

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Examination

• Checking the patient’s physical status• Vital signs

– Body temperature– Blood pressure– Pulse rate– Respiratory rate

• Initial examination normally performed by nurse or other medical professional– Patient examined in more detail by a physician

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Physician Order Entry

• Process of storing and transmitting orders to other healthcare providers

• Types of order entry– Handwritten or typed paper orders– Verbal orders– CPOE

• Digital signatures– Encrypted messages similar to handwritten

signatures– Allow for electronic transmission and storage

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Dictation/Transcription

• Used with verbal orders• Centralized voice-recording system shared among

physicians• Transcriptionist transcribes orders to electronic,

paper, or film format

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Referrals/Consults

• Physician may refer (send) patient to another professional for further diagnosis

• Consult– Communication between physicians or specialists

regarding a patient’s diagnosis or treatment

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Medical Devices

• FDA regulates the manufacture and distribution of medical devices in the US

• Definition of medical device– Recognized in the official National Formulary or the

United States Pharmacopoeia– Intended for use in the diagnosis or prevention of

disease– Intended to affect the structure or function of the

body without chemical action

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Computerized Axial Tomography Scanner

• Tomography– Imaging technique in which sections are created by

a penetrating wave• Computerized axial tomography (CAT or CT)

– X-ray system in which the tomography is created by computer processing

• Advantages of CAT scans– High contrast resolution– Tissues that differ in density may be distinguished


Electrocardiogram Machine

• Electrocardiogram (EKG or ECG)– Two-dimensional representation of electrical heart

activity– Read by trained professionals to detect heart

disease or abnormality• EKG machines

– Commonly transported by hand or small cart


Electroencephalograph Machine

• Measures ionic current flows within the brain’s neurons

• Usually portable and transported by utility cart• Trained professionals can read EEG:

– To determine disorders such as coma, epilepsy, and brain death

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Glucose Monitor

• Portable electronic device that directly reads level of glucose in the blood

• Results available in seconds• Used in diagnosis of diabetes mellitus

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Magnetic Resonance Imaging

• Uses very strong magnetic fields to create image of internal body structures

• Certain viewpoints more easily obtained than with other imaging techniques

• Greater detail of internal body structures compared with traditional techniques

• MRI machines– Large (room-size)– Complex

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Figure 5-6 Human brain scan from an MRI

© Donna Beeler/www.Shutterstock.com


Portable X-Ray Machine

• X-ray machine– Uses x-rays to cast static shadows of internal body

structures on film or image sensor– Large devices (typically room-size)

• Portable x-ray machine– Can be transported to the patient:

• In cases where patient cannot be easily transported to a traditional x-ray machine

– Machines are portable yet heavy

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Positron Emission Tomography

• Positronic emission tomography (PET) scans– Certain radiopharmaceuticals behave in different

ways in different body organs– Radiopharmaceutical administered to a patient emits

gamma rays– PET scanner creates 3D image of tracer

concentration• Scanners are large and complex

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Ultrasound

• Uses high-frequency sound waves to image soft tissue structures

• Image quality less detailed than x-ray or other technologies

• Ultrasound uses– Evaluating fetal health during pregnancy– Evaluating blood flow to the brain– Diagnosis of heart abnormalities

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Vascular/Nuclear Stress Test

• Cardiac stress test– Used to determine the heart’s response to physical

stress • Vascular or nuclear stress test

– Uses radiopharmaceuticals that emit gamma rays– Gamma camera captures detailed images of blood

flow in the heart

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Vitals Cuff

• Standard baseline measurements– Body temperature– Blood pressure– Pulse rate– Respiratory rate

• Vitals cuff – Device that integrates the entire vital sign

measurement process

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Medical Interfaces

• Standards for exchange of health information– Health Level Seven– e-prescribing– Continuity of Care Document (CCD)– Continuity of Care Record (CCR)– International Statistical Classification of Diseases

and Related Health Problems, 10th Revision (ICD-10)– Current Procedural Terminology (CPT)


Medical Interfaces (cont’d.)

• Standards for exchange of health information (cont’d.)– Systematized Nomenclature of Medicine (Snomed)– National Drug Code ID (NDCID)– Picture archiving and communication system (PACS)– Evaluation and Management Coding (E/M codes)


Summary

• Health care has specialized terminology and numerous acronyms

• Hospitals have different medical departments that provide different types of patient care

• Clinical software is used to manage and manipulate data and information in the clinical environment

• The healthcare environment workflow may include registration, consultation, examination, physician order entry, dictation/transcription, and referrals or consults

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Summary (cont’d.)

• Medical devices are used to diagnose and treat patients and are regulated by the FDA

• There are many interfaces and standards that support information sharing between devices and systems

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Documents

Introduction to Healthcare Information Technology Chapter Five Medical Business Operations