Quality Data Comparison To Its Competitors In The Local Market Essay

Quality Data Comparison To Its Competitors In The Local Market Essay ORDER NOW FOR CUSTOMIZED AND ORIGINAL ESSAY PAPERS ON Quality Data Comparison To Its Competitors In The Local Market Essay First, review the case study that preceded Chapter 1 in the textbook. Then respond to the following: How does CMC’s quality data compare to its competitors in the local market? Should value-based purchasing (VBP) be incorporated into CMC’s strategic planning process? CSU CMC HCM 460 Quality Data Comparison To Its Competitors In The Local Market Essay ebook.pdf Quality Data Comparison To Its Competitors In The Local Market Essay. HEALTH CARE INFORMATION SYSTEMS A Practical Approach for Health Care Management Second Edition KAREN A. WAGER FRANCES WICKHAM LEE JOHN P. GLASER FOREWORD BY LAWTON ROBERT BURNS Copyright © 2009 John Wiley & Sons, Inc. Copyright © 2009 by John Wiley & Sons, Inc. All rights reserved. Published by Jossey-Bass A Wiley Imprint 989 Market Street, San Francisco, CA 94103-1741—www.josseybass.com The first edition of this book was previously published as Managing Health Care Information Systems: A Practical Approach for Health Care Executives. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, or on the Web at www.copyright.com. Requests to the publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, 201-748-6011, fax 201-748-6008, or online at www.wiley.com/go/permissions. Readers should be aware that Internet Web sites offered as citations and/or sources for further information may have changed or disappeared between the time this was written and when it is read. Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. 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Library of Congress Cataloging-in-Publication Data Wager, Karen A., 1961-Health care information systems : a practical approach for health care management / Karen A. Wager, Frances Wickham Lee, John P. Glaser ; foreword by Lawton Robert Burns. – 2nd ed. p. ; cm. Rev. ed. of: Managing health care information systems / Karen A. Wager, Frances Wickham Lee, John P. Glaser. 1st ed. c2005. Includes bibliographical references and index. ISBN 978-0-470-38780-1 (pbk.) 1. Medical informatics. 2. Health services administration. I. Lee, Frances Wickham, 1953- II. Glaser, John (John P.) III. Wager, Karen A., 1961- Managing health care information systems. IV. Title. [DNLM: 1. Medical Informatics–organization & administration. W 26.5 W131h 2009] R858.W34 2009 610.68–dc22 Printed in the United States of America second edition PB Printing 10 9 8 7 6 5 4 3 2 1 Copyright © 2009 John Wiley & Sons, Inc. TABLES, FIGURES, AND EXHIBITS TABLES 1.1 2.1 2.2 4.1 4.2 5.1 5.2 6.1 8.1 8.2 9.1 9.2 10.1 10.2 10.3 11.1 12.1 12.2 12.3 12.4 13.1 14.1 15.1 15.2 16.1 A.1 A.2 A.3 Examples of Types of Patient Encounter Data and Information AHIMA Data Quality Management Characteristics Some Causes of Poor Health Care Data Quality Common Types of Administrative and Clinical Information Systems Timeline of Major Events + Advances in Information Technology = HCIS Health Information Technology Definitions Functions of an EHR System as Defined by the IOM Sample Criteria for Evaluation of RFP Responses Differences Between OLTP Databases and Data Warehouses Seven-Layer OSI Model Organizations Responsible for Formal Standards Development X12 TG2 Work Groups CMS Recommendations for Accessing ePHI Remotely CMS Recommendations for Storing ePHI on Portable Devices CMS Recommendations for Transmitting ePHI from Remote Locations Managers’ Grades for Work Factors IT Support of Organizational Goals Summary of Scope of Outpatient Care Problems Potential Value Proposition for Wireless Technology Sample Synthesis of IT Strategic Planning Target Increases in an IT Operating Budget Project Resource Analysis Financial Analysis of a Patient Accounting Document Imaging System Requests for New Information System Projects List of Cases and Major Themes Typical Provider Distribution of IT Spending Health Care Vertical Market: NAICS Taxonomy Major Health Care IT Vendors: Ranked by Revenue Copyright © 2009 John Wiley & Sons, Inc. 7 49 55 90 91 111 112 159 201 204 236 242 275 276 277 298 317 322 335 336 385 402 424 426 446 474 476 478 ix x Tables, Figures, and Exhibits B.1 B.2 486 493 FIGURES 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 2.1 2.2 2.3 4.1 4.2 5.1 5.2 5.3 5.4 5.5 5.6 6.1 6.2 6.3 7.1 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11 8.12 CSU CMC HCM 460 Quality Data Comparison To Its Competitors In The Local Market Essay Quality Data Comparison To Its Competitors In The Local Market Essay. Types of Health Care Information Framework Sample EMR Screen Inpatient Encounter Flow Physician’s Office Visit Patient Flow Sample Diabetes Query Screen Example of Dartmouth Atlas Interactive Report Example of NCQA Report Card Sample Electronic Knowledge-Based Information Resources From Data to Knowledge AHIMA Data Quality Management Model Activities for Improving Data Quality Typical Mainframe Computer Physician Using a PDA Sample Drug Alert Screen Sample EMR Screen Percentage of Hospitals Reporting EMR Use, by Bed Size Percentage of Physician Practices Reporting EMR Use, by Size Sample CPOE Screen Clinical Information Schematic Systems Development Life Cycle Cost-Benefit Analysis Example of a Simple Gantt Chart Sample Composition of Implementation Team Common Interface Engine Operation Relational Database Management System Layers Entity Relationship Diagram Partial Attribute Lists for Patient, Clinic, and Visit Data Flow in the OSI Model OSI Model Compared to the Internet Model Ethernet Network in a Physical Star XML and HTML Code URL Components Touch Screen Thumb Drive Laptop Computer Copyright © 2009 John Wiley & Sons, Inc. 6 12 15 16 29 35 36 37 43 48 57 94 104 113 113 114 115 122 136 146 161 163 169 194 196 197 198 205 205 207 213 213 219 222 223 Tables, Figures, and Exhibits 8.13 9.1 9.2 9.3 10.1 11.1 11.2 11.3 12.1 12.2 12.3 12.4 13.1 14.1 15.1 15.2 Tablet Computer HL7 Encoded Message HL7 EHR Functional Model Outline Nationwide Health Information Network Encryption Procedure Typical IT Organizational Chart IT Department Organized by Function and Geography IT Department Organized by Function and Process Overview of IT Strategy Development IT Initiative Priorities Plan Timelines and Budget Singles and Grand Slams IT Budget Decision-Making Process Project Timeline with Project Phases IT Investment Portfolio Days in Accounts Receivable Before and After Implementation of Practice Management System xi 224 240 243 248 270 285 300 300 320 337 338 356 386 401 432 438 EXHIBITS 1.1 1.2 1.3 1.4 1.5 1.6 1.7 3.1 3.2 3.3 3.4 3.5 6.1 11.1 11.2 11.3 14.1 Uniform Bill: UB-04 Claim Form: CMS-1500 UHDDS Elements and Definitions Excerpt from the ICD-9-CM Disease Index Patient Encounter Form Section of a Medicare Cost Report for a Skilled Nursing Facility Sources of Comparative Data for Health Care Managers Medical Record Content: Excerpt from South Carolina Standards for Licensing Hospitals and Institutional General Infirmaries Medical Record Content: Excerpt from the Conditions of Participation for Hospitals Management of Information Standards AHIMA Guidelines for Defining the Health Record for Legal Purposes Sample Release of Information Form Overview of System Acquisition Process Sample CIO Job Description Sample CMIO Job Description Sample User Satisfaction Survey Sample Project Status Report Copyright © 2009 John Wiley & Sons, Inc. 19 21 24 26 28 31 34 63 65 67 71 81 148 290 292 309 404 To our students Copyright © 2009 John Wiley & Sons, Inc. FOREWORD Information systems (IS) constitute the source of many of the problems in the health care industry. Health care is one of the most transaction-intensive industries (estimated at thirty billion transactions annually), given all the encounters between patients and providers, providers and other providers, providers and insurers, suppliers and providers, and so on. Yet compared to other industries, health care has historically underinvested in IS—and it shows. CSU CMC HCM 460 Quality Data Comparison To Its Competitors In The Local Market Essay The transactions between parties in health care take place not so much electronically as through a mixture of telephone, paper, fax, and EDI media. The result is that much information is never captured, is captured incorrectly, is captured inefficiently, or is difficult to retrieve and use. Moreover, the industry relies heavily on legacy systems that cannot communicate with one another, not only between organizations but often within the same organization. What is required to fix this messy situation? To paraphrase an old adage, the system may be the solution. The U.S. health care industry is in need of a massive infusion of capital to fund the adoption of new information technology (IT). Kaiser Permanente is well into the implementation of a paperless system that has already cost $5 billion, which provides a glimpse of the scale involved. Who will offer providers (where much of the IS help is needed) the financial assistance to underwrite these investments? Physicians are now getting help from their hospitals, thanks to a ruling by the Internal Revenue Service that allows hospitals to foot 85 percent of the costs of an EMR in doctor offices. Both hospitals and physicians will need support from their trading partners (for example, manufacturers who sell them products) and a big nudge from private sector insurers and (especially) the federal government in terms of how they pay for health care. Private payers are linking reimbursement to performance metrics via pay-for-performance (P4P) programs. The federal government is also linking reimbursement to e-prescribing and quality data reporting. Linking IT use to reimbursement is a further step in the right direction. In addition, provider organizations will need to provide incentives to their own physicians to employ IT—for example, by linking IT use to credentialing decisions. Finally, to convince all parties to adopt the necessary IT systems, we will need rigorous studies that document the cost and quality returns from these investments and the parties to which these returns accrue. This is not a small task; the value of IT investments still remains a messy discussion. This book provides an incredibly thorough overview of information systems and their importance in the health care industry. It provides an overview of the health care IT industry; a history of health care IS in the United States; a review of the fundamental characteristics of information, the uses to which it is put, and the processes it supports; and a highly detailed discussion of the primary clinical and managerial applications of information (including electronic medical records), the value of information and IS to multiple stakeholders, and most important, the management of information and IS.CSU CMC HCM 460 Quality Data Comparison To Its Competitors In The Local Market Essay This approach is particularly helpful when one considers that the vast majority of health system executives underwent their graduate training at a time when information systems Copyright © 2009 John Wiley & Sons, Inc. xiii xiv Foreword were in their infancy and thus when no such text existed. The second edition now also includes a dozen mini-cases documenting the challenges of IT implementation. This is incredibly valuable, since the technology costs are usually outweighed by the process costs of installation and achieving adoption by end users. This volume is thus a great primer, offering a systematic presentation of a complex, important topic. The reader will benefit from the collaborative effort that went into this volume. The first two authors are academics with considerable experience in teaching health care information management; the third is the chief information officer at one of the most prominent hospital (and integrated) systems in the United States. The combined talents of these two academics and one practitioner (all of whom have doctoral degrees) are reflected in the scope and depth presented here. This book is both systematic and practical, serving the needs of graduate students and current executives in the industry. What I have found particularly helpful is its ability to show how information and IS integrate with the other functions of the health care provider organization. The reader comes away from this book with a more profound understanding of how information serves as the lifeblood of the institution and as the real glue that can cement together professionals and departments within a health care organization and that can also tie the organization more closely to its upstream trading partners (manufacturers, wholesalers, and group purchasing organizations) and downstream trading partners (insurers and managed care organizations). At the end of the day, information and IS construct the real pathway to the utopia sought by providers during the past decade: integrated health care. This book is required reading for all those who toil in the field of health care management— whether as managers, professionals, consultants, suppliers and customers, students, or scholars. The topic of IS in health care is simply too important, and until recently too often ignored, to be left to haphazard learning. I commend the authors for their great contribution to the field of health care management and information management. March 2009 Lawton Robert Burns The James Joo-Jin Kim Professor The Wharton School Copyright © 2009 John Wiley & Sons, Inc. ACKNOWLEDGMENTS We wish to thank Amanda Price, a student in the master’s degree program in health administration at the Medical University of South Carolina (MUSC), for her assistance in preparing the final manuscript for this book. We also wish to thank the following MUSC students in the doctoral degree program in health administration, who contributed their information systems management stories and experiences to us so we could use them as case studies: Penney Burlingame, Barbara Chelton, Stuart Fine, David Freed, David Gehant, Patricia Givens, Victoria Harkins, Randall Jones, Catrin Jones-Nazar, Ronald Kintz, James Kirby, George Mikatarian, Lorie Shoemaker, and Gary Wilde. Copyright © 2009 John Wiley & Sons, Inc. xv Copyright © 2009 John Wiley & Sons, Inc. THE AUTHORS Karen A. Wager is associate professor and executive director for student affairs in the College of Health Professions at the Medical University of South Carolina (MUSC), where she teaches management and health information system courses to graduate students. She has over twenty-five years of professional and academic experience in the health information management field and has published numerous articles, case studies, and book chapters. Recognized for her excellence in interprofessional education and bringing practical research to the classroom, Wager received the 2008 MUSC outstanding teaching award in the educator-lecturer category. CSU CMC HCM 460 Quality Data Comparison To Its Competitors In The Local Market Essay She is past president of the South Carolina chapter of the Healthcare Information and Management Systems Society (HIMSS) and past president of the South Carolina Health Information Management Association. In her current position Wager spends part of her time working with the clinical leadership team at the MUSC Medical Center to assess the impact of clinical information systems on quality, safety, and staff efficiency. She holds a DBA degree with an emphasis in information systems from the University of Sarasota. Frances Wickham Lee is director of instructional operations for the Clinical Effectiveness and Patient Safety Center, a statewide organization dedicated to improving patient safety and clinical education through the use of health care simulation, and associate professor in the College of Health Professions at the Medical University of South Carolina (MUSC) in Charleston. Prior to joining the MUSC faculty in 1991, she served on the faculty at Western Carolina University. Her academic career spans thirty years, and she has taught courses related to health information management and information technology to both undergraduate and graduate students. She has published a variety of articles and has been a contributing author for several health information management books. She received her undergraduate degree from the University of Tennessee Center for the Health Sciences, her MBA degree from Western Carolina University, and her DBA degree from the University of Sarasota. John P. Glaser is vice president and chief information officer at Partners HealthCare, Inc. Previously, he was vice president, information systems, at Brigham and Women’s Hospital, and before that he managed the health care information systems consulting practice at Arthur D. Little. He was the founding chairman of the College of Healthcare Information Management Executives (CHIME), is a past president of the Healthcare Information and Management Systems Society (HIMSS) and of the eHealth Initiative, and has been a member of the board of the American Medical Informatics Association (AMIA). He is a senior adviser to the Deloitte Center for Health Solutions and a fellow of HIMSS, CHIME, and AMIA. CHIME has established a scholarship in his name. He has been awarded the John Gall award for health care CIO of the year and has been elected to CIO magazine’s CIO Hall of Fame. Partners HealthCare has received several industry awards for its effective and innovative use of information Copyright © 2009 John Wiley & Sons, Inc. xvii xviii The Authors technology. Glaser has published over one hundred fifty articles and three books on the strategic application of information technology in health care. He holds a PhD degree in health care information systems from the University of Minnesota. CSU CMC HCM 460 Quality Data Comparison To Its Competitors In The Local Market Essay Copyright © 2009 John Wiley & Sons, Inc. CONTENTS Tables, Figures, and Exhibits Foreword Acknowledgments The Authors Preface ix xiii xv xvii xix PART 1 HEALTH CARE INFORMATION 1 2 INTRODUCTION TO HEALTH CARE INFORMATION Learning Objectives Types of Health Care Information Internal Data and Information: Patient Specific—Clinical Internal Data and Information: Patient Specific—Administrative Internal Data and Information: Patient Specific—Combining Clinical and Administrative Internal Data and Information: Aggregate—Clinical Internal Data and Information: Aggregate—Administrative Internal Data and Information: Aggregate—Combining Clinical and Administrative External Data and Information: Comparative External Data and Information: Expert or Knowledge Based Summary Key Terms Learning Activities 23 27 30 HEALTH CARE DATA QUALITY Learning Objectives Data Versus Information Problems with Poor-Quality Data Documentation Ensuring Data and Information Quality Data Definitions Testing the Use of IT Summary Key Terms Learning Activities 41 41 42 43 44 46 53 56 58 58 58 Copyright © 2009 John Wiley & Sons, Inc. 3 3 4 8 17 32 32 36 38 38 39 iii iv Contents 3 HEALTH CARE INFORMATION REGULATIONS, LAWS, AND STANDARDS Learning Objectives Licensure, Certification, and Accreditation Legal Aspects of Managing Health Information Recent Health Care Privacy Violations Summary Key Terms Learning Activities 61 61 62 69 77 82 82 83 PART 2 HEALTH CARE INFORM … Get a 10 % discount on an order above $ 100 Use the following coupon code : NURSING10

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