Health Care Domain

1. Health Care Domain • By: • RoomanaChanna • The City School, • Senior Branach. Sukkur

2. Overview • TSG-SSS Mission Statement • Health Care in USA • Health Care Institutions • Hospital Departments • Health Care Information System • Health Care Modules Integration • Patient Types And Status • Patient Flow • Important Health Care Modules In Detail • Health Care Standards

3. TSG-SSS Mission Statement • To introduce an array of healthcare software solutions and services with IT innovations that enhance patient safety, care process, data quality, enterprise-wide integration, and business intelligence • To introduce an array of business productivity software and solutions with innovations that provide workflow automation, back-end processing, outsourcing and business intelligence • To continue to expand our collaboration with academic institutions to help bring business intelligence and knowledge management to the forefront of businesses, professionals and management. • http://www.shamsgroup.com/Shamsgroup/GalaxyAcademicCollaboration/tabid/227/Default.aspx?PageContentID=278

4. Health Care In USA • Health care in the United States is provided by many separate legal entities. • The U.S. spends more on health care per capita (US$ 6096 in year 2007) than any other nation in the world. • Current estimates put U.S. health care spending at approximately 15.2% of GDP (The gross domestic product (GDP) or gross domestic income (GDI) is one of the measures of national income and output for a given country's economy), second only to the tiny Marshall Islands among all United Nations member nations. • The health share of GDP is expected to continue its historical upward trend, reaching 19.5 percent of GDP by 2017. In 2007, the U.S. spent a projected $2.26 trillion on health care, or $ 6096 per person.

5. International perspective Health Care Spending per Capita, 2005 Source: OECD Health Data 2007

6. Mortality rate in USA due to Iatrogenic • Following is a survey of deaths/year in US due to medical errors (iatrogenic); • The report apparently shows there are 2,000 deaths/year from unnecessary surgery • 7000 deaths/year from medication errors in hospitals • 20,000 deaths/year from other errors in hospitals • 80,000 deaths/year from infections in hospitals • 106,000 deaths/year from non-error, adverse effects of medications • These total up to 225,000 deaths per year in the US from iatrogenic causes which ranks these deaths as the # 3 killer. (1998) • Source: http://www.howtobefit.com/iatrogenic-death.htm • Due this US government has urged health care institutions to have at least some kind of automation in place for clinical systems by 2014.

7. Health Care Institutions • Hospital is an institution for health care providing treatment by specialized staff and equipment, and often but not always providing for longer-term patient stays. Hospital Facility is a geographically distinguished service location of a hospital. • Outreachis an effort by individuals in an organization or group to connect its ideas or practices to the efforts of other organizations, groups, specific audiences or the general public. Simply speaking they are remote offices of hospital with a predefined set of services provided to patients such as Collection points, Consulting clinics, Pharmacy etc. • Pharmacy is the health profession that links the health sciences with the chemical sciences, and it is charged with ensuring the safe and effective use of medication. The scope of pharmacy practice includes more traditional roles such as compounding and dispensing medications, and it also includes more modern services related to patient care, including clinical services, reviewing medications for safety and efficacy, and providing drug information.

8. Key Terms DRG (MediCare) Diagnosis-related group is a system to classify hospital cases into one of approximately 500 groups, also referred to as DRGs, expected to have similar hospital resource use. Revenue Cycle The revenue cycle starts from the time that a patient calls to schedule an appointment for a medical service to the time when the practice gets fully and sufficiently paid for that service. Plan of Care The overall approach to the assessment, management, and outcome measurement to address the expectations and needs prioritized as important by the patient and family. PACS Picture Archiving and Communication Systems are computers or networks dedicated to the storage, retrieval, distribution and presentation of images.

9. Key Terms (contd …) • CPT • CPT is a listing of descriptive terms and identifying codes for reporting medical services and procedures. • ICD9 • The ICD9 is an international classification system which groups related disease entities and procedures for the purpose of reporting statistical information. • HL7 • Health Level Seven is a series of communications protocol standards for various applications and medical devices to successfully interact and exchange information. • HIPPA • Health Insurance Portability and Accountability Act provides rights and protections for participants and beneficiaries in group health plans.

10. Hospital Departments There are many departments of hospital like any other organization. Following is the detail of few major health care departments of a hospital: Patient Registration /Admission • Hospital Admission department is responsible to admit a patient in hospital. • Patient Registration collects admission and registration data on inpatients, outpatients, emergency room patients, surgical day care patients, observation patients, recurring patients, referred patients, and home health care patients throughout a health care network. The department ensures patient information is formatted uniformly, makes pre-certification and verification checks, communicates accurate data throughout the hospital and health care organization, eliminates duplication of effort among multiple departments and home care admissions. • Hospital Admission System is closely integrated with the other Hospital Modules like Medical Records, Laboratory, Radiology, Patient Billing, Pharmacy etc. • Medical Record (MR) • A medical records department is a department in a hospital or other health care facility that houses the records of patients who have been admitted to the hospital and subsequently have been discharged, transferred to ambulatory care services, left against medical advice, or expired. • A single source for viewing all relevant patient information from all aspects of clinical care throughout the health care delivery system. Complete visit histories are electronically stored for each patient over the course of an entire lifetime.

11. Hospital Departments (contd…) • Medical Billing • Department is responsible to submit and then follow up on claims to insurance companies in order to receive payment for services rendered by a healthcare provider. The same process is used for most insurance companies, whether they are private companies or government-owned. Patient Visit Patient has insurance Submit bills/ claims Insurance Company Health care provider Receive full/ part of payment • Pharmacy • Pharmacy department works closely with doctors and patients. Pharmacist are the persons who provide their expertise on the composition, use, and manufacturing of a drug, as well as its physiological and chemical interactions. • The scope of pharmacy department not only includes compounding and dispensing medications but it also includes more modern services related to patient care, including clinical services, reviewing medications for safety and efficacy, and providing drug information.

12. Hospital Departments (contd…) • Laboratory (LAB) • A clinical laboratory is a place where tests are done on clinical specimens in order to get information about the health of a patient. Lab tests constitute up to 80% of a physician's diagnosis and treatment choice.Lab medicine is generally divided into four sections, and each of which is further divided into a number of units. These four sections are: • Anatomic Pathology: Further divided into units, namely Histopathology, Cytopathology, and Electron Microscopy. • Clinical Microbiology: This is the largest section in laboratory medicine; as it encompasses five different sciences (units). These include Bacteriology, Virology, Parasitology, Immunology and Mycology. • Clinical Biochemistry: Units under this busy section are Instrumental Analysis, Enzymology, Toxicology and Endocrinology. • Hematology: This small, yet busy, section consists of two units, which are Coagulation and Blood Bank.

13. Hospital Departments (contd…) • Radiology • Is the medical specialty directing medical imaging technologies to diagnose and treat diseases. • Originally it was the aspect of medical science dealing with the medical use of electromagnetic energy emitted by X-ray machines or other such radiation devices for the purpose of obtaining visual information as part of medical imaging. • Modern day radiological imaging is no longer limited to the use of x-rays, and now includes technology-intensive imaging with high frequency sound waves, magnetic fields, and radioactivity. • Today, following extensive imaging technologies such as ultrasound, computed tomography (CT) nuclear medicine, and magnetic resonance imaging (MRI) are available to diagnose or treat disease.

14. Why HCIS…? • Health care information system allows comprehensive management of medical information and its secure exchange between health care consumers and providers. Broad use of HCIS will; • Improve health care quality • Prevent medical errors • Reduce health care costs • Increase administrative efficiencies • Decrease paperwork • Expand access to affordable care • Integrates hospital at all levels • Work processes • Functions & Services • Departments • Non-medical services like maintenance, security, etc.

15. Importance of HCIS • Easy Access To Information • Provide Integration • Help In Decision Making • Keep Records Electronically • Updated Info at all level • Document Imaging • Provide Nursing Assistance • Order Entry/Lab Result etc.

16. Highly flexible • Highly expandable • Cross platform compatible • Highly extendible HCIS General Architecture

17. WAN via Internet • No more geographical limitations to a hospital's operations HCIS General Architecture (contd…) • No more costly dedicated lines

18. Health Care Modules Integration LAB ADMISSION PHA RAD OE +++ ER AP BAR MM ITS MR MIS ABSTRACTING OUTREACH GL EIS PCI Health Care Information System

19. An Example of HCIS

20. Patient Type

21. Patient Status

22. Patient Flow • Patient oriented • Process oriented

23. Important Health Care Information Systems Modules & Processes in detail

24. Patient Registration Process • HIS Registration process collects admission and registration data on inpatients, outpatients, emergency room patients, surgical day care patients, observation patients, recurring patients, referred patients, and home health care patients throughout a health care network. • In addition to streamlining patient appointment scheduling, the application helps reduce scheduling errors and missed appointments. Furthermore, the application includes capabilities to manage resources efficiently and support managed care environments.

25. How to Identify Patients Through HIS

26. Enterprise Medical Record • Enterprise Medical Record (EMR) represents a single source for viewing all relevant patient information — from all aspects of clinical care — throughout the health care delivery system. Complete visit histories are electronically stored for each patient over the course of an entire lifetime. • The EMR contains information from visits conducted anywhere along the continuum of care — ambulatory centers, hospitals, physicians’ offices, home health agencies, long term care facilities, and satellite laboratories. The information contained in the EMR is updated on a real-time basis. Whenever an order is placed or a test is conducted, the patient’s record of care is automatically updated. • An EMR accepts data from all sources throughout the enterprise, including both the Health Care Information System and other vendors’ systems. This data is collected in the EMR and displayed in one consistent, easily readable format. • An EMR provides highly accessible patient data and features:    • Current care/clinical information   • Historical patient data   • Outpatient information   • Current administrative data   • Graphical display of data   • Electronic order placement and signature   • Confidential records of care.

27. Order Entry Module • The Order Entry functionality provides clinicians fast, accurate entry of orders along with immediate access topatient information and test results. The functionality links patients’ locations to clinical departments in a powerful information network by reducing the time required to; • Identify a patient • Enter, edit, and cancel patient orders • Enter groups of orders from multiple departments as a set with one entry • Enter and track the status, request date, and service date of an order • Capture costs and charges of procedures • Generate reports and statistics for nursing areas and ancillary departments

28. Imaging and Therapeutic Services (ITS) • Imaging and Therapeutic Services (ITS) application expedites information capture and communication throughout the enterprise. • Radiology, Mammography, and other departments that use textual result reporting methods benefit from streamlined routines and robust reporting capabilities. • The application helps clinicians; • Ensure patient safety with help from flags, warnings, and rules-based conflict checking • Enhance communication with on-line schematics, digital pictures, and scanned images • Enter reports faster with rapid access to voice recognition • Expedite access to exam images via integration with PACS or other digital image system of the end user's choice.

29. Laboratory • Laboratory functionality in brief; • Laboratory and Microbiology products improve the speed and accuracy of lab work - from requisitioning through final reporting - by eliminating time-consuming paperwork and delivering information to physicians quickly and efficiently. • As caregivers gain easier access to lab results and reports, patient safety is improved and costs are reduced. • A standard Laboratory Application includes following features: • Accurate, up-to-the-minute patient data and charge information • Expert systems with rules-based logic • Ability to perform statistical analysis and compare test results • On-line patient inquiries, reports, and summaries • Integrated inventory management and maintenance scheduling for laboratory instruments • Advanced telecommunications capabilities using system modems, network printers, fax machines, pagers, and handheld devices • Laboratory functionality streamlines the specimen collection and verification process with: • User-definable barcode collection labels and Automated specimen storage • Efficient specimen processing by receipt of individual specimens or of an entire batch • Specimen collection time and user automatically captured from Order Entry when "Collected by Nurse" (CBN).

30. Laboratory (contd…) • Laboratory is divided into following sections; • Laboratory Chemistry Orders • Blood Bank • Micro Biology • Pathology test • Result Entry and Verification • Group and Series Orders • Integration with 3rd Party • Blood Bank Order • Out Reach Functionality

31. Abstracting • The Abstracting functionality in Health Information Management product collects and reports various patient information, such as prospective payment and Peer Review Organization (PRO) data, as well as data for state and federal reporting requirements. • The functionality helps health care organizations to calculate DRGs accurately, monitor charges as patients approach reimbursement limits, ensure that patient abstracts are completed in a timely manner, and analyze case mix management at the hospital. Integrated with HCIS Revenue Cycle application, the functionality provides an easy method of capturing and reporting patient and financial data. Nursing Module • Nursing application allows both multiple and single facility health care organizations to accurately measure patientcare needs, create standard patient care plans, document assessments on-line, and use nursing resources more effectively. Following are the salient feature of the module; • Automate the creation of a patient's plan of care • Associate each intervention with acuity values to permit accurate costing of patient care • Record on-line notes about a patient's progress • Print profiles that show patient conditions, diagnoses and treatments • Calculate the number of staff and the skillsrequired at each care area • Pull lab results from electronic medical records while viewing patient profiles • Use an MIS report schedule to print patient profiles.

32. Pharmacy • Pharmacy application enables pharmacists across the health care enterprise to perform their daily activities efficiently and effectively. • The various tools and routines simplify and expedite processes while ensuring safe, quality care for patients. The Pharmacy software helps pharmacists: • Reduce clinical errors with intelligent warnings, messages, and rejection notices • Gain immediate access to clinical information from throughout the enterprise • Maintain proper inventory levels by linking to dispensing machines.

33. Pharmacy (contd...) Dispensing Machine Compatibility Linking Pharmacy software with dispensing machines helps to support medication tracking management. Benefits include: • A dynamic, two-way flow of real-time patient and medication information • Notifications sent to the Pharmacy system regarding medication dispensed, medication returned, machine load/unload, and inventory count • Notifications sent to the dispensing machine regarding medications ordered for the patient, and new/deleted drug dictionary entries • Tight inventory control due to a link between medication administration and dispensing • Ability to manage inventories on the location, site, facility, and enterprise level.

34. Health Care Standards • CPT: Current Procedural Terminology • CPT is a listing of descriptive terms and identifying codes for reporting medical services and procedures. The purpose of CPT is to provide a uniform language that accurately describes medical, surgical, and diagnostic services, and thereby serves as an effective means for reliable nationwide communication among physicians, and other healthcare providers, patients, and third parties. • ICD9: International Classification of Diseases, 9th Revision • The ICD is published by the WHO. The ICD is used world-wide for morbidity and mortality statistics, reimbursement systems and automated decision support in medicine. This system is designed to promote international comparability in the collection, processing, classification, and presentation of these statistics. The ICD is a core classification of the WHO Family of International Classifications (WHO-FIC). • Currently, two standards are in use at the national level for diagnosis classification: the ICD-9 and the ICD-9-CM. • As a member state of WHO, Canada is governed by its nomenclature regulations, which make ICD-10 the international standard for reporting of illness and death. • For ICD-9 listing:ICD9_Coding.docx • HL7: Health Level 7 • HL7’s purpose is to facilitate communication in healthcare settings. The primary goal is to provide standards for the exchange of data among healthcare computer applications that eliminate or substantially reduce the custom interface programming and program maintenance that may otherwise be required. • HIPPA: Health Insurance Portability and Accountability Act • HIPAA, which stands for the American Health Insurance Portability and Accountability Act of 1996, is a set of rules to be followed by doctors, hospitals and other health care providers. HIPAA ensure that all medical records, medical billing, and patient accounts meet certain consistent standards with regard to documentation, handling and privacy

35. HL7 • Health Level Seven is one of several American National Standards Institute (ANSI) - accredited Standards Developing Organizations (SDOs) operating in the healthcare arena. Most SDOs produce standards (sometimes called specifications or protocols) for a particular healthcare domain such as pharmacy, medical devices, imaging or insurance (claims processing) transactions. • Health Level Seven’s domain is clinical and administrative data. • Why embrace HL7? • There are several health care standards development efforts currently underway throughout the world. Most of which focus on the requirements of a particular department. • On the contrary HL7 is singular as it focuses on the interface requirements of the entire health care organization, . • Moreover, on an ongoing basis, HL7 develops a set of protocols on the fastest possible track that is both responsive and responsible to its members. The group addresses the unique requirements of already installed hospital and departmental systems, some of which use mature technologies.

36. What is protected information – HIPAA • According to the regulations any information that can lead to the disclosure of a patient's identity, is considered protected information. • Individually identifiable health information are data element which need to be secured, few examples are as follows: • Name / Relative’s names • Address • Employer • DOB • SSN • Medical Record Number • Patient Account Number • Telephone, fax and e-mail addresses • E-mail, tickets, status report, faxes or a print out that contains personal patient information are all covered by HIPAA Act.

37. WHY HIPAA APPLIES TO US? • TSG / SHS/SSS has a Business Associate agreements with it’s customers “hospitals” under which all TSG / SHS employees will provide software support and development services. • This requires TSG/SHS/SSS and its employee to comply with HIPAA regulations to ensure patient confidentiality. Therefore, all employees at TSG/SHS/SSS are required to sign employee confidentiality agreement.