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Introduction to Healthcare Information Technology
Chapter TwoHealthcare Organizations and
Operations
Introduction to Healthcare Information Technology
Objectives
• Identify various healthcare organizational structures and their different methods of operation
• Explain the use of codes of conduct• Identify EHR/EMR access roles and responsibilities
for using Protected Health Information (PHI)• Describe the proper communication methods for
use in the healthcare workplace• List best practices in handling PHI in the healthcare
setting
2
Introduction to Healthcare Information Technology 3
Healthcare IT: Challenges and Opportunities
• Delivery of health care to a large population– Diverse and complex organizations
• First responders– Police, firefighters, emergency medical technicians
• Operation of a hospital– Numerous organizations play supporting roles
Introduction to Healthcare Information Technology 4
Healthcare Organizational Structures and Operation
• Organizational structure– Framework through which a group of people work
toward common goal– Defines authority, responsibilities, communication
methods, rights, and duties of the group• Uniqueness of healthcare organizational structures
– Common goal to save lives, reduce suffering, and eliminate disease
– Stressful and demanding environments
Introduction to Healthcare Information Technology
Organizational Structures
• Hospitals– Healthcare organizations treating patients for injury
and disease– Usually provide inpatient (long-term) care
• Patient resides in hospital one or more nights– Also provide outpatient care
• Patient is not admitted and does not reside overnight
5
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Types of hospitals– General– Contagious disease– Nursing homes– Psychiatric– Orthopedic– Pediatric
• Hospitals divide functionality into departments– Departments depend on hospital type and size
6
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Hospital departments– Cardiac care unit (CCU)– Emergency room (ER)– Gynecology (GYN)– Intensive care unit (ICU)– Medical/Surgical (Med/Surg)– Neurology– Obstetrics (OB)– Oncology– Pediatrics (Peds)
7
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Hospital departments (cont’d.)– Physical therapy (PT)– Psychiatry (Psych)– Surgery (OR)
• Supporting departments– Laboratory (Lab)– Pathology (Path)– Pharmacy– Radiology (Xray)
8
Table 2-1 Selected departments typically found in hospitals
© Cengage Learning 2013
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Indirect support departments– Health information management (medical records)– Information technology (IT)– Clinical (or biomedical) engineering– Facilities management (maintenance/operations)– Administration– Food and nutrition services– Security– Material management
10
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Physician– Medical professional– Licensed by a governing body
• Private practices– Single physician provides care to individual patients
• Group of physicians working together– Considered private practice if group is physician
owned• Non-physician owned healthcare group
– Not considered private practice
11
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Nursing homes (convalescent hospitals)– Equipped for patients with long-term diseases– Address the needs of inpatients– Generally not equipped for acute care– Generally outsource support functions
• Skilled nursing facility (SNF)– Requirement for facility to receive Medicare
reimbursement– Must employ skilled nursing staff
12
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Requirements for Medicaid reimbursement of patient expenses– Patient needs skilled nursing care– Patient has income and assets below defined levels– Patient must be a United States citizen– Patient must reside in state in which nursing home is
located
13
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Assisted living facility– Designed for elderly people who need some
assistance with activities of daily living– Has residents, not patients– Generally do not have skilled nursing care staff– No Medicare or Medicaid reimbursement
14
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Home health care– Treatment of disease or injury in patient’s home– Staffed by nonmedical and/or skilled nursing
professionals– May be reimbursed depending on certain criteria
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Introduction to Healthcare Information Technology 16
Organizational Structures (cont’d.)
• Hospice– Care of terminally ill patients at home or in dedicated
facilities• Patients require palliative care
– Relief and prevention of suffering• Hospice care may include:
– Skilled care on a 24-hour, 7 day per week basis– Pharmaceuticals to provide patient comfort– Necessary medical equipment
• Generally reimbursable by Medicare and Medicaid
Introduction to Healthcare Information Technology
Organizational Structures (cont’d.)
• Surgical centers and ASCs– Specialize in outpatient surgical care
• Also called same-day surgery
• Less complex procedures than inpatient surgery• Types of procedures
– Minor surgeries– Pain management– Diagnostic procedures
17
Introduction to Healthcare Information Technology
Methods of Operation
• Customs or practices used to achieve organization’s goal– Scope of work– Availability of resources– Formality of procedures
18
Introduction to Healthcare Information Technology 19
Methods of Operation (cont’d.)
• Scope of work– Refers to tasks involved in accomplishing a goal or
objective• Differences exist in scope of work among various
types of medical facilities
Table 2-2 Scope of work for identified healthcare organizations
© Cengage Learning 2013
Introduction to Healthcare Information Technology 21
Methods of Operation (cont’d.)
• Availability of resources– Financial resources
• Economic and monetary resources needed for organization to function
– Human resources• Staffing needs
– Physical resources• Places and equipment
– Information
Table 2-3 Availability of financial resources for identified healthcare organizations
© Cengage Learning 2013
Introduction to Healthcare Information Technology 23
Methods of Operation (cont’d.)
• Formality of procedures– Set of established behaviors for collectively
achieving an organization’s goal– High formality: little deviation from set procedures– Low formality: higher deviation from set procedures
• Formality typically increases as risk to patient increases
Table 2-4 Formality of procedures for identified healthcare organizations
© Cengage Learning 2013
Introduction to Healthcare Information Technology 25
Codes of Conduct
• Rules for behavior to which a group of people adhere
• May be specific and written• Likely to be similar for similar groups of people or
facilities• Frequently address communication, procedural
behavior, social behavior, and sanitation
Introduction to Healthcare Information Technology
Communication
• Professional communication– Use of written, oral, or other exchange methods
• Style of communication– How something is said
• Content of communication– What is said
• High-formality healthcare setting– Use formal communication style– Inappropriate to discuss outside activities,
relationships, or other staff members in front of patient
26
Introduction to Healthcare Information Technology
Adapting Procedural Behavior
• Procedural behavior– Level of procedural formality based on type of
treatment or diagnostics• Examples of locations where procedural behavior
is important– Imaging room– Procedure room– Recovery room– Examination room– Emergency room
27
Introduction to Healthcare Information Technology
Sanitation
• Physical hazards due to close proximity to biological or chemical disease components
• Sanitation methods– Sterilization of facilities and instruments– Proper disposal of contaminated wastes
• Infection control procedures– Hand washing– Cleaning and sterilization– Use of antimicrobials– Use of protective equipment
28
Introduction to Healthcare Information Technology
Social Behavior and Sensitivity of the Environment
• Social behavior– Conduct toward other people
• Example: inappropriate for emergency room staff to act shy around unclothed patient– May be appropriate behavior for maintenance worker
29
Introduction to Healthcare Information Technology
Conforming to Management Requirements
• Main responsibility is the patient• Managerial operating procedures
– Address business needs of the organization– May sometimes conflict with patient care– Example: private hospitals may turn away patient
without insurance or means to pay
30
Introduction to Healthcare Information Technology
Protecting Healthcare Information
• HIPAA privacy rule protects individually identifiable health information– Includes verbal, paper, and electronic forms– Relates to past, present, and future health of an
individual• PHI is protected as long as retained by Covered
Entity:– Even if individual is deceased
31
Introduction to Healthcare Information Technology
Access Roles and Responsibilities
• Healthcare team access– Each member of healthcare team has roles and
responsibilities pertaining to PHI
32
Table 2-5 Protected health information access roles (continues)© Cengage Learning 2013
Table 2-5 Protected health information access roles (cont’d.)
© Cengage Learning 2013
Introduction to Healthcare Information Technology
Access Roles and Responsibilities (cont’d.)
• Business Associate access– HITECH Act encompasses Business Associates in
same manner as Covered Entities• Examples of Business Associate functions
– Claims processing– Accounting– Data aggregation– Accreditation
35
Introduction to Healthcare Information Technology
Access Limitations Based on Role and Exceptions
• Certain times when traditional access roles need to be superseded
• Example: emergency situation when database administrator may read PHI
36
Introduction to Healthcare Information Technology 37
Access to Sensitive Patient Data
• Some information may have more stringent guidelines
• Individuals may ask a Covered Entity to restrict use and disclosure of their PHI
• Roles must be modified appropriately
Introduction to Healthcare Information Technology 38
Proper Communication
• Procedures must be followed for various types of communication
• Backups– A permanent copy of all ePHI is maintained
• Unique identifiers– Username and password for each distinct user
account• Emergency access
– Procedures for obtaining necessary ePHI during an emergency
Introduction to Healthcare Information Technology 39
Proper Communication (cont’d.)
• Timeout– Terminating an electronic communication session
after a period of inactivity• Encryption
– ePHI must be encrypted• Audit trails
– Mechanism to record activity in information systems
Introduction to Healthcare Information Technology 40
Proper Communication (cont’d.)
• Integrity– Mechanisms to prevent unauthorized destruction or
alteration of ePHI• Authentication
– Procedures to ensure those seeking access to ePHI are authentic
• Disposal– Procedures to ensure final disposition of ePHI
Introduction to Healthcare Information Technology 41
Proper Communication (cont’d.)
• Safeguards must apply to all forms of communication– E-mail– Instant messaging– Fax– File transfer protocol– Telephone– Voice over IP
Table 2-6 Safeguards for various electronic communication methods
© Cengage Learning 2013
Introduction to Healthcare Information Technology 43
Data Handling Procedures
• Best practices for general technology use– Help ensure PHI is protected
• Access to network devices should be controlled• Access methods
– Physical– Electronic
• Managing physical access– Location of physical device chosen to minimize
access
Introduction to Healthcare Information Technology 44
Data Handling Procedures (cont’d.)
• Privacy screens– Prevents anyone not sitting in front of screen from
reading its contents• Screensavers
– Lock out computer screens after specified time period
• Time lockouts– Program locks out users after specific period of time– Password must be entered to regain access
Introduction to Healthcare Information Technology
Summary
• Various healthcare organizational structures exist• Code of conduct refers to behavior rules to which a
group of people adhere• PHI includes information in verbal, paper, or
electronic form– Includes past, present, and future health information
• Various roles and responsibilities exist for using PHI
45
Introduction to Healthcare Information Technology
Summary (cont’d.)
• Safeguarding communication methods is one facet of protecting PHI
• Best practices in handling PHI in a healthcare setting involve controlling physical and electronic access to PCs, printers, and other equipment
46