Health Information Technology and Management

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Kristian Cannon
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1 Health Information Technology and Management CHAPTER 12 Management and Decision Support Systems

2 Pretest (True/False) Integrated systems require HL7 to exchange information with other healthcare systems. The ADT system registers patients before they are treated or scheduled for treatment. In a general ledger that uses a double-entry bookkeeping system, expenses are amounts that are owed, but not yet paid. Accounts payable systems control the outflow of money from a healthcare facility for all expenses except payroll. Rent, insurance, and utilities are all examples of direct costs a department must pay.

In a general ledger that uses a double-entry bookkeeping system, expenses are amounts that are owed, but not yet paid.

3 Interfaced vs. Integrated Systems Support healthcare operations but are not clinical records Interfaced systems: Hospitals Consist of separate software and databases linked into computer network Exchange information with other healthcare systems using HL7 or proprietary transaction standard Software may be from same or different vendor Integrated systems: Medical offices (practice management systems) Share common database Data records read and updated without need for HL7 Same vendor also supplies software programs such as registration and billing to work together seamlessly

databases linked into computer network Exchange information with other healthcare systems using HL7 or proprietary transaction standard Software

4 Administrative Systems Include (1) financial, (2) human resource, (3) scheduling, (4) facility and equipment maintenance, and (5) quality management systems Include hospital registration system (ADT system) and billing system (A/R system) Two systems on either end of patient care Provide secondary data that may be used for various purposes

hospital registration system (ADT system) and billing system (A/R system) Two systems

5 Eight Financial Systems Financial information systems Track income, expenses, assets, and liabilities 1. General ledger Overall accounting system used to produce financial statements and monitor organization s overall financial health Income, expenses, assets, and liabilities 2. Accounts receivable Money owed to the business Main source of revenue for healthcare organizations is patient and insurance billing

organization s overall financial health Income, expenses, assets, and liabilities 2.

6 Eight Financial Systems 3. Purchasing (continued) Used to order supplies and services 4. Accounts payable Manages payments for facility: purchases, recurring expenses (rent, utilities, insurance), and nonrecurring expenses (maintenance, repairs) 5. Inventory and materials management Works with purchasing, deducting from quantity on hand supplies used and adding to quantity on hand supplies received

insurance), and nonrecurring expenses (maintenance, repairs) 5.

7 Eight Financial Systems (continued) 6. Payroll Administration of employee payroll information and payment of wages, employer taxes, benefits 7. Budgeting Used to predict annual expected income and expenses 8. Cost accounting Used to attribute direct and indirect costs to various departments Direct and indirect costs

8 Human Resource Management Systems Maintain personnel records and create management reports Track productivity, absenteeism, and vacation time Monitor turnover Analyze labor expenses Functions: Employee evaluations Training Education and continuing education Employee health

vacation time Monitor turnover Analyze labor expenses Functions:

9 Patient Scheduling Systems Outpatient Scheduling Allows for orderly examination and treatment of patients Predicts labor and resource needs based on volume and type of patients Involves making appointments for length of time appropriate to reason for appointment Relies on schedule templates

based on volume and type of patients Involves making appointments for

11 Patient Scheduling Systems Inpatient scheduling (continued) Includes processing doctors orders for tests or services, coordinating with respective department, arranging for assistant to transport patient within hospital Requires schedule coordinator who handles several different departments

respective department, arranging for assistant to transport patient

12 Staff Scheduling Systems Employee scheduling systems used to determine which employees are working when Human resources tracks and manages vacation schedules, employee sick days, holidays Provider scheduling includes blocking doctors appointment schedule when doctors are not in the office and arranging for another doctor to cover patients; maintains on-call schedule Surgery scheduling includes pre-op, surgery, and post-op, plus cleaning of operating room

blocking doctors appointment schedule when doctors are not in the office and arranging for another doctor to cover

13 Facility and Equipment Maintenance Systems Systems to maintain facilities and equipment, including: Systems to track requests for repairs and upgrades to building, rooms, or departments Systems to control heat, air, and energy usage Systems for fire control, security, employee tracking, and timekeeping Repair orders for systems that require outside service are tracked and reported to purchasing and accounts payable Biomedical, surgical, radiological, laboratory, and other medical equipment must be serviced and tested regularly Joint Commission, CAP, other regulatory agencies require facilities to keep testing maintenance records

orders for systems that require outside service are tracked and reported to purchasing and accounts payable Biomedical, surgical, radiological, laboratory,

14 Quality Management (QM) Systems Covers many areas related to hospital operation and patient care provided to patients Produces data and reports used for risk analysis and decision support that allow facilities to evaluate appropriateness and effectiveness of medical care Tracks and maintains data entered by QM department Uses and analyzes data abstracted from patient health records and other departmental systems

facilities to evaluate appropriateness and effectiveness of medical care Tracks and maintains data

15 QM Data Includes Case management and utilization management Tracks certification, authorization, concurrent review of the case, avoidable days, denials, appeals Infection control Tracks and reports communicable diseases, hospital-acquired infections, and diagnoses that must be reported to CDC Incident tracking Tracks both patient and nonpatient incidents Patient relations Handles patient complaints to improve care and patient satisfaction, or reduce risk to patient or hospital

infections, and diagnoses that must be reported to CDC Incident tracking Tracks both patient and nonpatient incidents

16 Figure 12-8 MIDAS risk management screen records a patient fall. (Courtesy of MidasPlus, Inc.)

17 QM Data Includes (continued) Risk management Minimizes loss by reducing risk through preventive policies and measures Peer review Involves patient, employee, or audit that calls attention to issue relevant to patient care Other providers review to determine appropriateness, make recommendations Comparative performance measure systems Compares performance measures to those of other similar facilities May use NHQM and CMI information available from Medicare, or download data from vendors

to determine appropriateness, make recommendations Comparative performance measure systems Compares performance measures

18 Risk Assessment Versus Risk Management Risk assessment involves analyzing processes and measuring statistical data to identify preventable losses and minimizing their occurrences Example: assessing computer security to minimize security risks to EPHI data Risk management provides organizations with information needed to improve performance and processes and provide safer environment for employees, patients, volunteers, and visitors Basic functions: risk identification, risk analysis, loss prevention/reduction, and claims management

management provides organizations with information needed to improve performance and processes and provide safer environment for

19 QM: CMS RAC (Recovery Audit Contractor) Program Identifies improper payments made on healthcare claims provided for Medicare beneficiaries and obtaining repayment to Medicare Affects healthcare providers including: hospitals, physician practices, nursing homes, home health agencies, durable medical equipment suppliers, and any provider/supplier that bills Medicare Parts A and B Reviews handled by private companies with financial incentives to identify and recoup overpayments

practices, nursing homes, home health agencies, durable medical equipment suppliers, and any provider/supplier that

20 Role of HIM Department in RAC Program Ensure claims are as accurate as possible when first submitted Ensure requests from recovery audit contractor are handled efficiently, effectively, and according to existing procedures and policies

from recovery audit contractor are handled efficiently,

Jane Snecinski, FACHE Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com

Jane Snecinski, FACHE Post Acute Advisors, LLC P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com Jane Snecinski, FACHE P.O. Box 12078 Atlanta, GA 30355 www.postacuteadvisors.com RAC Demonstration Project 3 year demonstration project Greatest impact to IRF from California Issue with greatest impact