Introduction to Healthcare Information Technology Chapter Six Document Imaging and Problem Solving

Introduction to Healthcare Information Technology

Chapter SixDocument Imaging and Problem Solving


Objectives

• Describe frequently used healthcare image file types and their characteristics

• Identify medical interface components• Explain the interface diagnosis process• Describe the clinical software troubleshooting

process• Explain the need for and use of change control in

the clinical environment

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Healthcare IT: Challenges and Opportunities

• Recent study results:– Fewer than two percent of hospitals employ a

comprehensive EHR system • Challenges to integration of an EHR system

– Interfacing dissimilar systems• Example: x-rays produce images on cellulose or

polyester film– Film image must be digitized– Alternatively, x-ray machine modified to output digital

images

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Introduction to Healthcare Information Technology 4

Document Imaging

• Images must be organized into standardized format for storage

• Image files may be composed of:– Pixels (small picture elements)– Bitmap data– Vector (geometric) data– Combination of these data types


File Types

• Different applications for image files– Reason for existence of different file types

• Characteristics of image files– Quality– Size– Resolution– Compression

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Characteristics

• Image quality– Describes how well the image file maintains fidelity

of the source image– High-quality images appear more like the source

than low-quality• File size

– Described by number of bytes needed to store data• Compression

– Technique to reduce size of a digital image file

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Characteristics (cont’d.)

• Image resolution– Refers to the number of pixels in an image– Typically stated as number of pixels high by number

wide– Multiplying pixel counts gives a single resolution

number• Example: digital camera with resolution of 2048 x

1536 pixels– Said to have resolution of three megapixels

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Characteristics (cont’d.)

• Four image file types commonly used in health care– Graphics Interchange Format (GIF)– Joint Photographic Experts Group (JPG or JPEG)– Portable Document Format (PDF)– Tagged Image File Format (TIFF)

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Table 6-1 Image file formats and characteristics

© Cengage Learning 2013


Scanning and Indexing

• Storing image data in data files– Key part of creating an electronic document storage

and retrieval system• Typical hospital can create hundreds to thousands

of electronic images per day• Scanning

– Process of converting paper–based data into electronic format

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Figure 6-1 Desktop scanner

© Konstantin Shevtsov/www.Shutterstock.com


Scanning and Indexing (cont’d.)

• Electronic file considered protected health information

• Metadata– Data used to describe image attributes– Examples: creation date, patient ID– Data is included with the image file– Will vary greatly, depending on application, how data

is used, and applicable regulations

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Scanning and Indexing (cont’d.)

• Storage– Process of saving data for future retrieval and use

• Database– Structure used to store data

• Index– Data structure that allows for fast data retrieval

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Optical Character Recognition (OCR) and Structured Data

• Structured data– Data arranged in a defined manner

• Unstructured data– No predefined arrangement– Examples: bitmap images, audio files, most text files

• Optical character recognition– Process of converting scanned images of

handwritten or printed text into computer readable text

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Medical Interface Components

• Health Level Seven (HL7)– Nonprofit, accredited standards development

organization– Develops standard languages for formatting

electronic messages between healthcare providers• HL7 message components

– Segments presented in a defined sequence– Segments may be optional, required, and/or

repeatable

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Medical Interface Components (cont’d.)

• HL7 message segment example

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• HL7 message example

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• Commonly used HL7 message types– ACK: general acknowledgment– ADT: admit, discharge, transfer– BAR: add/change billing amount– DFT: detailed financial transaction

• Example ADT message subtypes– A01: patient admit– A02: patient transfer– A03: patient discharge– A04: patient registration

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• HL7 message segment standard contents– MSH: message header– SFT: software segment– EVN: event type– PID: patient identification

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Table 6-2 Common HL7 message segments



E-Prescribing

• Electronic transmission of a prescription to a pharmacy from the point of care

• Can lower the cost of medication transactions• Improves management of traditional medication

administration problems• Medication reconciliation

– Process of avoiding medication inconsistencies across care settings

– Can be accomplished with process integrated with an EMR

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E-Prescribing (cont’d.)

• Bedside medication verification (BMV)– Method of verifying correct medications are

administered to the right patient– Commonly accomplished with barcodes and barcode

scanner• Drug allergy interactions (DAI)

– Certain drugs or drug combinations can cause allergic reactions in some patients

– Helpful to maintain accurate database of patient allergy list• May be accomplished using CPOE system

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E-Prescribing (cont’d.)

• Formulary– List of medications covered by a third-party payer

• Formulary checking– Part of an e-prescribing process– Verifies prescribed medications are in the formulary

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Billing

• Medical information from the provider’s EMR/EHR system– Used to create an electronic version of the bill– Transmits to third-party payer (outbound

communication)• HL7 billing segments

– PID: patient information– PV1: visit information– FT1: financial transaction– IN1: insurance information

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Billing (cont’d.)

• HL7 billing segments (cont’d.)– IN2: additional insurance information– IN3: additional insurance information, certification– GT1: guarantor– AUT: authorization information

• Billing clearinghouse– Validates claims to ensure free of errors– Then transmits to specified payer over secure

connection

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Diagnosing Interface Problems

• Troubleshooting– Systematic approach to determine source of problem

• Four troubleshooting steps– Identification– Generation– Determination– Confirmation

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HL7 Message Problems

• Common problem with HL7 messages– Improperly formatted patient demographics– Example: patient’s SSN is 123-4T-5678 when it

should be 123-45-6789• Communication link errors

– Generated as a result of failure in a fax, network, or Internet connection

– Common in areas with aging communications infrastructure or frequent power interruptions

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E-Prescribing Problems

• Inaccurate patient demographics– Patient medical history may be inaccurate– Variety of causes

• National standard for e-prescribing– Developed by the National Council for Prescription

Drug Programs (NCPDP)• SCRIPT Standard Implementation

– E-prescribing messaging standard using segments and fields

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E-Prescribing Problems (cont’d.)

• SCRIPT message example

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Billing Problems

• Superbill– Form used by providers to quickly list patient’s

procedures and diagnosis for reimbursement– Commonly adapted for a specific provider– Includes patient demographic data, CPT procedure

codes, ICD diagnostic codes– May cause errors if data is inconsistent with other

data

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Billing Problems (cont’d.)

• Billing software configuration settings examples– Bill patient for missed copays?– Display diagnosis description?– Display procedure description?– Rendering provider?– Scheduling provider?– Service location?– Supervising provider?

• Some configuration settings are important for accurate data transmission

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Medical Device Problems

• Check for power first• Brownouts or voltage sags may cause medical

device interface issues• Less common power problems

– Blackouts– Spikes– Surges– Electrical noise

• Use an uninterruptible power supply (UPS) on the device or central power system

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Table 6-3 Less common power problems



Medical Device Problems (cont’d.)

• Network and communication problems– Network failure can cause data corruption

• Some devices can be configured to perform differently by adjusting configuration settings

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Troubleshooting Clinical Software Problems

• Types of clinical software – Auditing systems– Billing systems– Coding systems– CPOE systems– EMR/EHR systems– Lab information system (LIS)– Patient care planning systems

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Troubleshooting Clinical Software Problems (cont’d.)

• Types of clinical software (cont’d.)– Pharmacy information system (PIS)– Patient tracking systems– Patient scheduling systems– Radiology information system (RIS)– Workflow management systems

• Defined plan for troubleshooting integrated software systems– Imperative for the HIT professional

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Locate the Affected Modules or Fields

• Troubleshooting process steps– Identify system malfunctions or symptoms– List possible causes– Determine cause of the problem– Develop and test solution

• Confirm the problem has been solved

• Approach for first step– Divide the problem into smaller domains– Work backward in the system from where the

problem appears

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Determine Data Types

• Data type error– Data classified based on properties (text, numeric,

binary)• Database and software applications expect data to

be of a certain type• Check configuration to ensure user inputs have

been checked for correct data types– Manual configuration change may have allowed

errors to be introduced into the system

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Escalate When Necessary

• When software problem cannot be solved through normal troubleshooting methods:– May need to be escalated (reported) to another

technical support group• Problem escalation process

– Describes who should be contacted first• Technical support groups often organized into tiers

– Initial call to support group will encounter Tier 1 support

– Escalates to Tier 2 if problem cannot be resolved

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Table 6-4 Tiered technical support



Change Control

• Clinical software modules used together– Integrated system– Increases overall system complexity exponentially

• Software regularly changes over time– New requirements and regulations– Bug fixes or performance improvements

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Procedural Systematic Customization

• Change control system– Procedure for systematic software customization

• Specifics required for a change control system– Change compliance reporting– Defining specific change process activities– Delineating testing and cutover processes– Developing a change schedule– Identifying impacts of change– Specifying staff roles regarding change control

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Governance Board

• Risk and cost of failure with software change may be quite high

• Governance– Alignment around objectives, strategies, tools and

methods to minimize change failure• Change management governance board (CMGB)

– Group with responsibility to approve changes that may result in critical service interruption

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System Patching and Updates

• Types of software changes– Patch

• Fix for specific software problem– Update

• Includes larger changes than patches• Can add features or functionality• Issued less frequently than patches

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Change Scheduling

• Scheduling software changes– Challenging in a highly integrated environment

• Some clinical software systems are used around the clock, every day of the year


Change Scheduling (cont’d.)

• Change scheduling process questions – Is there a backup system?– Can collected data be recovered during the system

downtime?– Will the downtime impact any life support systems?– Were all impacted departments notified, and did they

approve the proposed schedule?– Can the old system be rolled back if the updates are

not functional?• Answers to above questions will affect the update

schedule


Change-Control Environments

• Four stages in software change process– Development

• Writing new program code to address need– Quality assurance (QA) test

• Ensures software meets functional requirements and defined performance behaviors

– User test• Assesses whether software meets user requirements

– Production (live)• Software is released to be used in a live environment

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Summary

• Images must be organized into a standard format for storage

• Scanning is the process of converting printed data into electronic format

• Data can be classified as structured or unstructured

• For information to be shared, a common language or format must be used

• Health Level 7 is a standards development organization

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Summary (cont’d.)

• An HL7 message is composed of groups of message segments presented in a predefined sequence

• Troubleshooting uses a systematic approach to determine the source of a problem

• Software regularly changes over time– Increases complexity of clinical software

management– Change control process is needed

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Documents

Introduction to Healthcare Information Technology Chapter Six Document Imaging and Problem Solving