Introduction to Health Care Information

CHAPTER 1

INTRODUCTION TO HEALTH CARE INFORMATION

KEY TERMS

* Aggregate Data and Information - Data (Patient Records, Uniform Billing info, and discharge data sets) that go into literally hundreds of aggregate reports or queries that are developed and used by providers and executives in health care organizations to assist in their decision making needs.

* Clinical Reporting, disease indexes and specialized registers are often used.

i. Disease and Procedure Indexes - Users can search the disease and procedure database for statistics since it gives a summary information about a particular disease or treatment. Because of computers, it is handled as a component of the patient medical record system or the registration and discharge system. The retrieval of its information is based on the ICD-9-CM and CPT Codes.

ii. Specialized Registers - List that generally contain the names and sometimes other identifying information of patients seen in a particular area of the health care facility. Many registers can be created from using ad hoc queries.

* Administrative Reporting - Commonly used administrative reports include basic health care statistical reports, claims, denial reports, and cost reports. Two basic types are Medical Cost Reports and Basic Health Care Statistical Reports.

i. Medical Cost Reports - are filed annually by all health care facilities. They contain provider information such as utilization data, cost and charges, financial statement data, etc. The reports are mainly used by CMS (Center for Medicare Services) determine portions of a facility's reimbursement but also to determine Medicare's rate adjustment, cost limits, and various wage indexes. Their quality control programs are aimed at hospitals and other health facilities.

ii. Health Care Statistics - Statistics gathered from health care organizations include Census Statistics, Discharge Statistics. These statistics are used to provide a basis for planning and monitoring patient services.

There are some executives that utilize both clinical and administrative data sources. Reports are created to improve customer service, quality of patient care, and operational efficiency.

* American Health Information Management Association ( AHIMA) -

* American Hospital Association - formed the National Uniform Billing Committee

* American Medical Association

* Benchmarking - The process of comparing one or more outcome measure

* Centers for Disease Control and Prevention (CDC)

* Centers for Medicare and Medicaid (CMM) -

* Electronic Health Record- An electronic record of health-related information on an individual that conforms to nationally recognized interoperability standards and can be created, gathered, managed, and consulted by authorized clinicians and staff across more than one healthcare organization.

* Electronic Medical Record - An electronic record of health-related information on an individual that can be created, gathered, managed, and consulted by authorized clinicians and staff within on healthcare organization.

* Categories of data and information

* External data and information

i. Comparative data and information - Combine internal and external data to aid organizations in evaluating their performances

1. Outcome Measures - The measurable results of a process and can be applied to individuals or groups. An example of a clinical outcome measure is the percentage of similar lab results that occur within a month. An example of a administrative outcome measure the percentage of claims denied by Medicare during one month. The process of comparing one or more outcome measure is called Benchmarking.

2. Balanced Scorecards- examine multiple measures to ensure that the organization is performing well across the board....more detailed.

ii. Expert or Knowledge -based data and information - Data collected by experts that are not a part of the organization. Health care providers and executives use this type of info in decision making, both clinical and administrative. Ex is info found in a professional healthcare journal, national databases, or informational websites.

* Internal data and information

i. Focus is on clinical and administrative information directly related to the activities surrounding the (1)patient encounter, both clinical and administrative for categories patient specific and aggregate and (2) general operations of the organization.

1. Clinical - The majority of clinical, patient specific info can originate from the patient's medical record information.

2. Administrative-

* Health Care information

1. Health Information - Any information, whether oral or recorded that is created or received by a health care provider, health plan, employer, etc that relates to past, present, or future physical or mental health or condition of an individual, the provision of an individual, or the payment for the provision of health care to an individual. The importance of having an understanding of Health Care Data and information is needed to reach the goal of having effective health care information systems. Data quality is also important.

* Health Insurance Portability and Accountability Act (HIPAA) - the federal legislation that includes provisions to protect patients' health information (PHI) from unauthorized disclosures.

* Health Plan Employer Data and Information Set (HEIDIS)

* International Classification of Diseases, Clinical Modification, 9th Edition ICD-9-CM - Developed by the World Health Organization to capture disease data. It is used to code not only disease information but also procedure information. An update is published each year.

The ICD has become a major role in reimbursement to hospitals. Since 1983, it has been used for determining DRG's, which are the basis for determining appropriate inpatient reimbursements for Medicare.

The ICD-10 is the next edition and once it is released, all providers will have to adjust their systems to handle the conversion.

* The Joint Commission - The major accrediting agency for health care organizations. Offers a broader framework for examining health information than