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Health Information Technology and Management CHAPTER 8 Additional Health Information Systems Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pretest (True/False) • During clinical drug trials, phase II testing is performed on patients for whom the treatment is intended. • A transplant is a device intentionally put into the body to serve a particular purpose. Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pretest (True/False) (continued) • The ER typically has ready access to a patient’s records in the HIM department. • Speech recognition software can be taught to avoid past mistakes. • A glucose monitor is an example of an instrument that facilitates point-of-care testing. Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Departmental Information Systems • HIS is core system for hospital: – Includes both clinical and administrative systems – Consists of complex arrangement of multiple individual systems • Practice management system is principal system for medical office Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. EHR Interface • Health records originate from many separate systems: – Records imported into EHR – Records imported into central CDR – Records only retrieved and displayed from EHR; stored on own respective systems Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Why Multiple Information Systems? • IT department may follow two different approaches to information systems: – Integrated systems approach uses systems from one vendor – Best-of-breed approach chooses software based on departmental needs Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Why Multiple Information Systems? (continued) • Certain hospital departments may have more influence and select their own software • Some equipment may come with own software required for operation – CAT scan, MRIs, PET, biomedical devices Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Patient Registration System • Demographic information about patient • Guarantor and insurance information used for billing • Some clinical data (admitting and discharge diagnosis, LOS, and organ donor, DNR, consent, other forms) • Patient’s medical record number Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 8-1 Patient registration screen. (Courtesy of McKesson Corporation.) Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Master Patient Index (MPI) • Includes all previously registered patients – Contained in special database (large healthcare organization) or patient registration database (smaller facility) • Prevents duplicate entry of same patient • Provides quick universal lookup of patients for all systems interfaced to the HIS Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Master Patient Index (MPI) (continued) • Helps locate patient chart (paper-based system) • Often includes Soundex field to facilitate finding surnames when name’s spelling unclear Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 8-2 Master patient index. (Courtesy of McKesson Corporation.) Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Laboratory Information System (LIS) • Receives orders and sends results of medical tests performed by lab • Receives information directly from automated lab instruments via electronic interface • Sends information about equipment to LIS Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Laboratory Information System (LIS) (continued) • Uses HL7 interface standard to connect with HIS, CPOE, EHR, other healthcare systems Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Workflow of Electronic Lab Orders • Some clinical pathology tests performed with automated instruments receive orders from LIS; send results back to LIS • Anatomic pathology findings and nonautomated clinical pathology tests entered manually • LIS generates printed or faxed lab report; also sends to EHR if interfaced Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Workflow of Electronic Lab Orders (continued) • Digital pathology captures specimen images digitally, displays on computer monitor; images stored on PAC system Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Figure 8-5 Workflow of electronic lab orders and results. Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Radiology Information System (RIS) • Manages workflow in radiology departments • Communicates with PAC systems • Schedules and tracks radiologic studies • Posts charges • Communicates with other systems such as HIS, EHR, billing Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Examples of Images • Digital x-ray images – Computed radiography (CR) – Digital radiography (DR) • Computerized axial tomography (CAT) • Magnetic resonance imaging (MRI) • Positron emission tomography (PET) Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Dictation/Transcription Systems • Based on provider’s dictation, which may be recorded on microcassette tapes, digital voice files, or via telephone • Typed by transcriptionists using special equipment and word processor • Reviewed by provider for accuracy, then corrected as needed by transcriptionist Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. How Speech Recognition Software Works • Noise-canceling microphone sends speaker’s word sounds to computer, which converts into digital data • Software uses mathematical calculations to identify phonemes in digital data and compare to “language model” • Software then groups phonemes correctly into words displayed on screen as if keyed Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. How Speech Recognition Software Works (continued) • Errors may be corrected by user; software stores for future reference Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pharmacy Systems • Comprised of one or more computer systems for tracking, ordering, dispensing medications • Interfaced with registration, billing, CPOE, EHR systems Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Pharmacy Systems (continued) • Include decision support, patient medication administration reports, controlled substance tracking, intervention documentation, inventory control, pricing, purchasing, repackaging, distribution Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Emergency Department System Considerations • ER may use different software system than rest of hospital • ER may not have access to patient’s records (HIM or physician office) • ER patients may be unconscious and unidentified – Allergies or medical history information may be unknown Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Emergency Department System Considerations (continued) • Some patients without primary care physician may treat ER as walk-in clinic Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Perioperative Software • Records all aspects of presurgery, surgery, postsurgical recovery • Includes nonpatient functions such as management and scheduling of operating rooms, surgical supplies, equipment, personnel • May include software for anesthesiologist Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Implants and Transplants • Implants: device or substance intentionally put into the body to serve particular purpose – Examples: heart valves, pacemakers, breast implants, artificial joints • Transplants: organ or tissue from human donor – Examples: kidney, heart, liver, bone marrow Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Implant Registry Data • Facilitates study of performance and longevity of implants • Includes adverse events resulting from implant • Includes patient demographic data, facility, implant manufacturer, implant identification information Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Transplant Registry Data • Tracks potential recipients and includes clinical data about patient status and condition • Includes information on donors, such as cause of death, medical history, medications, procurement process, consent forms Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Transplant Registry Data (continued) • Communicates with international registries like UNOS and NMDP • Includes post-transplant records on recipient and on living donors Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Clinical Trial Phases • Phase I: Small groups of subjects tested in controlled setting to see if drug is safe, tolerated by healthy person • Phase II: Testing performed on patients for whom treatment intended; focuses on finding right dosage levels and proving drug works Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. Clinical Trial Phases (continued) • Phase III: Large patient groups undergo controlled studies; some patients receive drug, others receive placebo • Phase IV: Survey drug once approved and on market Health Information Technology and Management Richard Gartee Copyright ©2011 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved.