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9781133787778_PPT_ch011.pptx

Introduction to Healthcare Information Technology

Chapter One

Introduction to Healthcare IT

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About the Presentations

The presentations cover the objectives found in the opening of each chapter.

All chapter objectives are listed in the beginning of each presentation.

You may customize the presentations to fit your class needs.

Some figures from the chapters are included. A complete set of images from the book can be found on the Instructor Resources disc.

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Objectives

Define healthcare information technology

Recognize some of the benefits of healthcare IT

Describe the CompTIA Healthcare IT Technician Certificate

List major healthcare regulators

Summarize the major healthcare regulations

Describe typical healthcare legal practices

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Introduction to Healthcare Information Technology

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Healthcare IT: Challenges and Opportunities

Information technology adoption

Slower in healthcare industry compared with other industries

Obstacles to adoption

Fragmented healthcare system

Many different systems among providers

Shortage of trained technology professionals

Highly regulated industry

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Introduction to Healthcare Information Technology

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What Is Healthcare Information Technology?

Framework for managing health information

Mechanism to improve patient care

Enables patient care coordination

Application of information technology to the healthcare industry

Hardware and software

Used to manipulate health data and information

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Benefits of HIT

Healthcare costs continue to rise

5.2 percent of U.S. GDP spent on healthcare in 1960

17 percent in 2007

Advances in technology account for about half of healthcare spending increases

Efficiency benefits of electronic medical records

Eliminates medical transcription

Reduces need to physically retrieve charts

Reduces duplicate diagnostic tests

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Introduction to Healthcare Information Technology

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The CompTIA Healthcare IT Technician Certificate

CompTIA

Nonprofit trade organization

Advocate for the IT industry

Provides education and certification programs

CompTIA healthcare IT technician certificate

Shows individual’s proficiency in certain areas of healthcare and information technology

Prepares students for jobs in software and technology support

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Introduction to Healthcare Information Technology

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The CompTIA Healthcare IT Technician Certificate (cont’d.)

CompTIA proficiency areas

HIT regulations

Healthcare organization and operations

Basic IT operations

Network IT operations

Document imaging

Basic and advanced healthcare security

Medical business operations

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Regulatory Compliance: Regulators

Regulation

Something that constrains or controls

Regulator

Governmental entity that mandates regulations

Healthcare one of most heavily regulated industries

Purpose of regulations

Ensure minimum standard of care

Provide broad patient access at reasonable cost

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Regulatory Compliance: Regulators (cont’d.)

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Table 1-1 Primary U.S. healthcare regulatory agencies

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Department of Health and Human Services

Mission of HHS

Provide citizens access to high-quality health care

Help people find jobs and child care

Keep food safe

Manage infectious diseases

Extend the practice of diagnosis and treatment

HHS represents 25 percent of U.S. federal budget

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Department of Health and Human Services (cont’d.)

Operating divisions of HHS

Administration for Children and Families (ACF)

Administration on Aging (AoA)

Agency for Healthcare Research and Quality (AHRQ)

Agency for Toxic Substances and Disease Registry (ATSDR)

Center for Disease Control and Prevention (CDC)

Centers for Medicare and Medicaid Services (CMS)

Food and Drug Administration (FDA)

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Department of Health and Human Services (cont’d.)

Operating divisions of HHS (cont’d.)

Health Resources and Services Administration (HRSA)

Indian Health Service (IHS)

National Institutes of Health (NIH)

Office of the Inspector General (OIG)

Substance Abuse and Mental Health Services Administration (SAMHSA)

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Department of Health and Human Services (cont’d.)

Office of the National Coordinator for Health Information Technology (ONC)

Staff division within HHS

Responsible for coordinating use of advanced HIT practices at the national level

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Centers for Medicare and Medicaid Services Information Technology

CMS administers:

Medicare program

Federal portion of the Medicaid program

State Children’s Health Insurance Program (CHIP)

Parts of Medicare

Part A

Inpatient hospital stay insurance

Part B

Doctor’s services and outpatient care

Prescription drug coverage

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Centers for Medicare and Medicaid Services Information Technology (cont’d.)

Medicaid

Program for low-income people

Covers certain medical expenses

Jointly funded by federal government and the states

Medicare and Medicaid incentive programs

Cash incentives to providers for adopting electronic health record (EHR) technology

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The Office of the National Coordinator for Health Information Technology

Responsibilities

Coordinates use of advanced HIT practices at the national level

Certifies EHR systems and providers

Three aspects of certification

Standards and certification criteria for EHR

Certification programs

Metadata standards

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The National Institute of Standards and Technology

Federally sponsored physical science research laboratory

Sets standards for EHRs under the HITECH Act

Five goals of NIST’s role in health information technology

Coordinate standards

Coordinate infrastructure testing

Improve EHR usability

Extend healthcare’s reach through technology

Perform research and development

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The National Institute of Standards and Technology (cont’d.)

NIST and Healthcare Information Technology Standards Panel (HITSP)

Provide standards and specifications to ensure system interoperability

Example: specific data and communication format requirements

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The National Institute of Standards and Technology (cont’d.)

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Table 1-2 HIT standards implementation process

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Regulatory Compliance: Regulations

HIPAA privacy rule

Broad federal regulation

Adopted in 1996

HIPAA goals

Improve portability and continuity of health insurance

Manage waste, fraud, and abuse of health care delivery

Reduce costs and increase efficiency by standardizing the interchange of electronic data

Protect the privacy of personal health records

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Regulatory Compliance: Regulations (cont’d.)

HIPAA privacy rule regulates:

Health care providers

Health plans

Health care clearinghouses

Collectively called Covered Entities (CE)

Rule extends to Business Associates (BAs) of Covered Entities

Business Associate Agreements

Contracts between CEs and BAs ensuring HIPAA is followed

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Regulatory Compliance: Regulations (cont’d.)

Protected Health Information (PHI)

Individually identifiable health information

Created or received by CE or BA

Can exist in various forms (verbal, paper, electronic)

De-identified information

Cannot be traced back to the individual

Must lack 18 specific identifiers or be certified by a statistician

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Regulatory Compliance: Regulations (cont’d.)

Data use agreement

Permits researchers to use PHI under specific conditions

Office for Civil Rights (OCR)

Responsible for enforcement of HIPAA

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Table 1-3 HIPAA Privacy Rule safeguards and requirements

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HIPAA Security Rule

Focuses on electronically transmitted or stored PHI

Known as ePHI

Narrower focus than the privacy rule

Seeks to ensure Covered Entities provide certain administrative, physical, and technical safeguards for data

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Table 1-4 HIPAA Security Rule categories, safeguards, and requirements

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HIPAA Identifier Rule

Mandates all Covered Entities storing or transmitting ePHI have a National Provider Identifier (NPI)

Replaces all other identification from Medicare, Medicaid, and other government programs

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HIPAA Transaction and Code Sets Rule (TCS)

Mandates consistent electronic interchange of PHI

Electronic data interchange for health care

Technology is tested and proven from use in other industries

Several standards exist

ANSI X.12 standard

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HITECH Act

Creations of the Health Information Technology for Economic and Clinical Health (HITECH) Act

HIT Standard Committee

HIT Policy Committee

Process to adopt standards and procedures

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HITECH Act (cont’d.)

HITECH Act more stringent than HIPAA

Increased resources for enforcement

Increased penalties for violation

Health providers cannot use patient health information without expressed permission

Sale of private health information must be authorized by the patient

Patients may audit their electronic patient records

Act extends to future unanticipated entities

Mandates encryption of ePHI

Requires patients be notified of any breach

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HITECH Act (cont’d.)

HITECH act and Business Associates

HITECH Act encompasses both Covered Entities and Business Associates

HITECH Act and PHI breach

Covered Entity required to report the breach to each individual affected

Business Associate breaches reported to Covered Entity first

HHS must be contacted if more than 500 patients affected

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HITECH Act (cont’d.)

HITECH act enforcement

Four levels of enforcement

Lowest level of enforcement: unknown violations despite due diligence

Penalties: $100-$25,000 per violation

Next level: reasonable cause and not willful neglect

Penalties: $1000 to $100,000 per violation

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HITECH Act (cont’d.)

Level 3: willful neglect corrected within 30 days of knowledge of violation

Penalties: $10,000 to $250,000 per violation

Level 4: willful neglect that is not corrected

Penalties: $50,000 to $1,500,000 per violation

Penalties are for a given calendar year

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HITECH Act (cont’d.)

HITECH act and EHRs

Majority of funding for HITECH used for provider incentives to adopt EHRs

Entities that provide assistance, best practices, and grants under HITECH Act

Workforce investments

HIT extension program

HIT research center

HIT regional extension centers

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HITECH Act (cont’d.)

Certified EHR

Tested by an ONC Authorized Testing and Certification Body (ATCB)

HITECH act and meaningful use

EHR must be used in a meaningful manner

EHR must be used for submission of quality data and other measures

EHR must be used for exchange of health information that improves health care quality

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HITECH Act (cont’d.)

Eligible Provider (EP)

Provider qualifying for financial incentives under HITECH Act

Incentives for both Medicare and Medicaid exist

EPs may participate in multiple programs

Certain restrictions apply

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Table 1-5 Maximum Medicare EHR incentive payments

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Legal Practices

Legal practices outside the scope of traditional regulatory environment

Liability waivers

EHR service level agreements

Memoranda of understanding

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Liability Waivers

Used by hospitals and physicians to protect them against legal liability

Documents signed by the patient

Specify provider responsibility in case of treatment failure or injury

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Service Level Agreements

Frequently used in technology applications

Define level of service user can expect from technology provider

Examples of SLA performance measures

Downtime

Downtime period

Monthly uptime percentage

Scheduled downtime

Service credit

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Memorandum of Understanding

Also called memorandum of agreement (MOA)

Voluntary agreement between health providers

Specifies some mutually beneficial arrangement

Example: natural disaster recovery

Agreement would specify responsibilities of each entity

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Memorandum of Understanding (cont’d.)

Four elements of a legally binding contract

Payment or consideration

No illegal activities

Actions of parties must be described

Agreed upon without threat or duress

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Summary

Healthcare costs keep increasing

Healthcare industry has been slow to adopt use of information technology

HIT: the use of hardware and software to manage and manipulate health information

Regulation provides constraints or controls

HIPAA protects privacy and security of patient health data

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Summary (cont’d.)

Parts of HIPAA

Privacy rule

Security rule

Identifier rule

Transaction and Code Sets rule

HITECH Act increases protections of HIPAA

Certain legal practices exist outside the regulatory environment

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