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HTH 1304, Health Information Technology and Systems 1

Course Learning Outcomes for Unit V Upon completion of this unit, students should be able to:

3. Summarize current issues related to health information systems. 3.1 Describe data collection issues that could arise in specific health information systems.

4. Differentiate various health information standards in terms of their ability to support the requirements

of a health care enterprise. 4.1 Describe a specialized health information system used in specific health care departments.

Course/Unit Learning Outcomes

Learning Activity

3.1 Unit Lesson Chapter 3 Unit V Research Paper

4.1 Unit Lesson Chapter 3 Unit V Research Paper

Required Unit Resources Chapter 3: Sources of Data

Unit Lesson Modern health care has vastly expanded and grown into a wide-ranging industry involving many different scopes of medical practice and expertise. This expansion of health care services has given birth to a variety of health care facilities and health care settings that specialize in certain areas of medicine. This unit will build on what you have learned about data sets, code sets, and data collection and provide a deeper insight on how specific care settings collect, transmit, and analyze health information. From outpatient care to inpatient care, there are dozens of care settings that use information differently and follow different regulations set by licensing entities. As a health information management (HIM) professional, it is important to be familiar with how different health care settings’ information systems operate and what potential issues could arise from those systems. Below are various health care settings and brief outlines of their functions and characteristics about their health information systems. Ambulatory Surgical Facilities The terms ambulatory care and outpatient care can be used synonymously as both of these terms refer to care where the patient is not admitted to a hospital and usually only receives care for a maximum of 24 hours. With this knowledge, ambulatory surgery is defined as an outpatient medical operation where the patient is released shortly after the procedure. These types of facilities are becoming more popular as they are often less expensive and lack other liabilities. One attractive feature of ambulatory surgical facilities is their separation from inpatient surgery centers where the risk for exposure to germs, viruses, and bacteria is higher. Patients in inpatient care are often admitted to recover from diseases and/or illnesses making the inpatient setting more susceptible to surgical infection. HIM professionals who code for ambulatory services use the procedural coding system health care common procedure coding/current procedure terminology (HCPCS/CPT) as there are no diagnostic services offered in this setting. Reimbursement professionals dealing with ambulatory surgeries use the UB-04 claim form to bill for services provided.

UNIT V STUDY GUIDE

Care Settings and Health Information Management

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Physician Office Doctor visits are another type of ambulatory service. These outpatient facilities vary in locale as some are adjacent to major hospitals while some are attached to the physician’s home (Davis & LaCour, 2017). In this care setting, the physician is usually the primary care provider, and physicians may partner with each other and operate with a shared interest in the facility. This is called a group practice. Physicians’ offices are a common and popular care setting with a familiar health care workflow. A patient sets an appointment with a physician, is then seen by the physician who conducts an examination on the patient, and finally, the physician makes a medical decision regarding a treatment plan. While these are the major workflow stages of a doctor’s visit, there are more intricate steps that take place in between them in which information is sent and received through many channels. This care setting uses the diagnostic tool ICD-10-CM, which stands for International Classification of Diseases, 10th revision, Clinical Modification, to code for diagnoses as well as HCPCS/CPT to code for supplies, procedures, and services. HIM professionals for this care setting uses the CMS-1500 health insurance claim form. Dialysis Centers

Dialysis centers are also considered ambulatory or outpatient settings. Dialysis is the removal of waste products from a patient’s bloodstream (Davis & LaCour, 2017). These types of facilities have become widespread, and the need for these facilities has grown as our country deals with increased health problems that require the purifying of blood. Kidney disease is a major cause for dialysis treatments, and the demand for this service is high, which is one reason why dialysis centers now have their own identity and have separated themselves from hospitals. Like other ambulatory services, coders in dialysis facilities use the procedural coding system HCPCS/CPT.

Emergency Departments One of the more well-known outpatient facilities is known as the Emergency Department/EmergencyRoom or (ED/ER). EDs offer a wide range of services for issues

ranging from minor respiratory problems to heart attacks. Patients seen in the ED are often dealing with more serious or even life-threatening injuries, and during the registration process, the level of severity is determined. Trauma patients or patients at higher risk of severe morbidity or mortality are given priority. There is a great benefit provided if EDs are part of a hospital. If, after the ED examination, it is determined that the patient needs to be admitted to the hospital, the patient is easily transitioned into inpatient care. As you can imagine, data collection in EDs can be hectic if an effective system is not in place. EDs usually use multiple data sets as well as a combination of paper and electronic collection methods. HIM professionals who code for EDs use the procedural coding system HCPCS/CPT as well as ICD-10-CM. Reimbursement professionals working in EDs use the UB-04 claim form to bill for services provided. Urgent Care Facilities Urgent care centers provide services for medical needs that may not be serious enough to warrant a visit to the ED but cannot wait for a scheduled doctor visit. The operation of an urgent care is similar to an ED in that it is first come, first serve, but more severe cases are granted precedence over less severe cases. For example, someone experiencing chest pains would be seen before someone who has been under the weather with a cold. These facilities have also increased in number, helping with the volume of patients that would normally go to a hospital’s ED for urgent care needs. Like with EDs, if a patient has needs that are beyond the scope of care that the urgent care center can provide, an ambulance can be called to transport the patient to a hospital. Coding and reimbursement for urgent care facilities are similar to EDs.

(China, 2011; Sanchez, 2017; Davis, 2010;

Mondberg, 2012)

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Radiology Departments This care setting is very important in helping clinical professionals diagnose patients. Radiology departments services such as diagnostic imaging and scanning that can help care providers better visualize issues the patient may be experiencing. These departments serve both inpatient and outpatient care settings and are most of the time located in or near inpatient facilities such as hospitals. A few of the imaging services that radiology departments provide are magnetic resonance imaging (MRI) scans, computed tomography (CT) scans, and ultrasounds. One trend that is developing in radiology is the introduction of mobile imaging services, and its most important characteristic is convenience (Davis & LaCour, 2017). Now, for those patients who have to sacrifice a lot of time and effort to travel for these services, they can undergo testing closer to home or even at home in some cases. The use of information systems in radiology is vital. One system that is commonly used in radiology is picture archiving and communication system (PACS). This system allows many different images from various devices to be archived and accessed from any computer terminal in the network (Davis & LaCour, 2017). This is valuable when you have multiple stakeholders that need to have access to patient radiology images. HCPCS/CPT coding is used in radiology as well as ICD-10. Laboratory Departments Laboratory services are similar to radiology services in that they serve both inpatient and outpatient settings. The laboratory’s main task is to test human specimens for diagnostic and treatment purposes. Laboratories can test blood, urine, saliva, and other bodily secretions. An example of how the lab can be used to assist in diagnostics is the testing of a patient’s blood for iron deficiency. A patient comes into a doctor’s office complaining of symptoms that alerts the physician of a vitamin deficiency. To confirm, the doctor draws the patient’s blood, and it is taken to the lab for testing. The results of that test will help the physician determine a treatment plan. HCPCS/CPT coding is used in this department as well as ICD-10. Hospitals These facilities are a staple of traditional health care. Hospitals are inpatient facilities where patients must be admitted with the goal of nursing the patient back to health. Not only do hospitals serve patients with lifesaving services, they also serve other health care needs such as childbirth and routine surgeries. There are several other inpatient care settings that make up a hospital. Two major divisions within hospitals are the intensive care unit (ICU) and non-intensive care units, such as rehabilitation centers. Rehabilitation centers can serve as outpatient settings. Therefore, professionals in this field will use ICD-10-CM and ICD-10-PCS for inpatient coding and HCPCS/CPT for outpatient procedures. Reimbursement for inpatient services can be comprehensive and requires great attention to detail. Coders and reimbursement professionals in hospitals must become familiar with using all billing formats to include UB-04 and CMS 1500. Behavioral Health Facilities

This care setting provides services for a wide range of psychological and behavioral disorders (Davis & LaCour, 2017). Behavioral health facilities, like rehabilitation centers, can serve as both inpatient and outpatient settings. Professionals in this care setting utilize ICD-10-CM and ICD-10-PCS for inpatient coding and HCPCS/CPT for outpatient procedures. When you think about the problems facing our country with drug addiction and alcohol abuse, cognitive disorders, and psychiatric disorders, these facilities can become a beacon of hope for millions of Americans. Long-Term Care Facilities Long-term care (LTC) centers are inpatient facilities in which the patients are residents receiving a variety of services, depending on the patient’s condition. LTC facilities are often confused with nursing homes. Nursing home residents get assistance with daily life activities

(Guinazu, 2014; agilemktg1, 2016; Ybarbo,

2011; Sunkel, 2017)

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such as bathing, transferring from beds to chairs, and eating. Other types of LTC facilities include assisted living homes and skilled nursing centers. Skilled nursing care is directed at those LTC patients that have an illness that requires advanced care from a clinical professional. Skilled nursing care centers, like nursing homes, assist with daily life activities but on a more intensive basis. LTC facilities also provide their residents with recreational services as comfortability is a focus of this care setting. Payment for LTC services can come from various payers to include private insurance plans and Medicare. LTC facilities do not administer many procedures, so professionals in that field work limitedly with ICD-10-PCS. However, they do need to be familiar with ICD-10-CM. Billing is done using the UB-04. Home Health Care One of the fastest growing sectors in the health care industry is an outpatient care setting called home health care. As mentioned in previous units, the Baby Boomer population is approaching Medicare age, and that is one major reason for the growth in this sector. This population can now use Medicare funds to receive health services in the comfort of their homes. As stated above, when discussing ambulatory care, health care services that are offered outside of a hospital decrease the risk for infection. Along with convenience, this is another notable feature of home health care. Depending on the services provided, many different health care professionals can administer care in this setting. In some circumstances, home health care can be ordered in the event that a patient is unable to perform household tasks due to their medical condition. The home health caregiver can shop, cook, wash laundry, and in some cases, just spend time and converse with the patient. This type of care could be life-changing for some individuals who may not be able to afford their desired long- term care setting. The Outcome and Assessment Information Set (OASIS) is the predominant data set used in home health care to monitor and transmit patient information. Home health care is billed using the UB-04. The common bond of all the health care settings described in this unit is the ability to collect, store, and transmit information using data sets. Interoperability, or the ability of systems to be able to exchange information without human interaction, is vital when one is working in the health industry as there are many stakeholders that need access to patient information. Although information systems need to work together, there is also a need for those systems to be specific to the care setting. For example, a data set that is used in the ED is The Data Elements for Emergency Department Systems (DEEDS). This system is specific to emergency departments, but the data set contains information that may have been collected previously or will need to be sent to another department, such as reimbursement. All of these settings use some type of information system in the collection and dissemination of information, and each one is important in its own right.

References Agilemktg1. (2016). Nurse measuring blood pressure of senior woman at home. Looking at camera, smiling

[Photograph]. Flickr. https://www.flickr.com/photos/68716695@N06/29609189672 China, H. (2011). Wilford Hall now an ambulatory surgical center [Photograph]. 59th Medical Wing.

http://www.59mdw.af.mil/News/Photos/igphoto/2000218940/ Davis, B. J. (2010). David Grant USAF Medical Center [Image]. 59th Medical Wing.

http://www.af.mil/News/Photos/igphoto/2000316503/ Davis, N., & LaCour, M. (2017). Foundations of health information management (4th ed.). Elsevier. Guinazu, C. (2014). UCC; Caring for the body and soul [Image]. Mountain Home Air Force Base.

http://www.mountainhome.af.mil/News/Photos/igphoto/2000811575 Mondberg. (2012). Entrance of the Emergency Department of the Cairns Base Hospital, Cairns, Queensland,

Australia [Image]. Wikimedia. https://commons.wikimedia.org/wiki/File:Cbh_emergencydepartment1.jpg

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Sanchez, M. (2017). Army Lt. Col. Owen Johnson III, a plastic surgeon at William Beaumont Army Medical Center at Fort Bliss, Texas, discusses options available for reconstructive surgery with a patient [Image]. Military Health System. https://health.mil/News/Articles/2017/10/30/Breast-reconstruction- can-aidpsychological-healing

Sunkel, P. (2017). Lab tech draws CPI to reduce steps, improve process [Image]. U.S. Air Force.

http://www.airforcemedicine.af.mil/Media-Center/Art/igphoto/2001779067/ Ybarbo, B. (2011). MRI [Photograph]. Air Combat Command.

http://www.acc.af.mil/News/Photos/igphoto/2000294045/

Learning Activities (Nongraded) Nongraded Learning Activities are provided to aid students in their course of study. You do not have to submit them. If you have questions, contact your instructor for further guidance and information.

• Chapter 3: Competency Milestone and Critical Thinking Questions, pp. 113–114