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LDR 620 Class Discussions:Week #1We are surrounded by computers in almost every aspect of our lives.? Now computerization has come to healthcare.? Please discuss the following:Why has there been a movement toward computerization in?healthcare?What are?the major positive?and?negative aspects to computerization in healthcare?What has been done to encourage the?increase in the use of?computers in healthcare?There are core strategic issues in healthcare that must be addressed in order for healthcare organizations to achieve business success and compliance. The compliance is based on three laws the Healthcare Insurance Portability and Accountability Act of 1966 (HIPPA), the American Recovery and Reinvestment Act of 2009 (ARRA), and the Affordable Care of Act of 2010 (ACA)( Hoyt & Matthews, 2013). The goals of these laws are to make care more cost effective, improve quality, safety, and to allow access to healthcare information through an electronic exchange. Given these dramatic changes and the current state of healthcare we must move forward and incorporate information technology into our rmational technology has several positive aspects especially when it comes to patient care. According to Davis and colleagues (2004) report on the measurement of six domains of quality from the perspective of the patient; patient safety, patient-centerness, timeliness in care, efficiency, effectiveness and equity are major positive contributions in healthcare (Glandon, Smaltz, & Slovensky, 2011). It will also improve management systems and aid in cost containment. The negative aspects include protection of privacy of health care information, and the perceived cost associated with development, and up keep of informational systems.The movements to computerized systems are being encouraged throughout health care. Safety measures have been placed; the electronic medical records are security encrypted, the full-time web-enabled record gives the physician access to medical records regardless of patient location. It contains a pharmacy system, laboratory and radiology services can input data and images directly into the system (Glandon, Smaltz, & Slovensky, 2011, p. 17). Computerized systems assist management to control performance standards, monitor financial information, develop disease prevention programs and assist with strategic management; thus, providing standards that will meet the changes occurring in healthcare (Glandon, Smaltz, & Slovensky, 2011).American Hospital Association & American College of Healthcare Executives. (2013). Futurescan: Healthcare trends and implications, 2013-2018. Chicago, Illinois: Health Administration Press.Glandon, G. L., Smaltz, D. H., & Slovensky, D. J. (2011). Information systems for healthcare management (7th ed.). Chicago, Illinois: Health Administration Press.WEEK #2Data Standardization and Data Sharing In using computer systems, there are two inherent difficulties that?must be overcome, getting the information in to the computer system and getting the information out of the computer system in a usable format.Think about it. That is what we basically try to do when using computers for almost everything. Part of the task is inputting the appropriate information and the other part is getting the appropriate information out of the system.? In healthcare, we talk about "The 5 Rights of Healthcare Information":the right information at the right time on the right device in the right format in the right context in the right amount (this sixth right was added to meet HIPAA "minimum necessary" information requirements) When the data is well defined and limited to a few variables, the task can be easy. But what happens when the data is vast and the people who input the data do it in different ways?One of the difficulties in healthcare involves networked computers and disparate data. Let's take a hypothetical health system. The health system is comprised of five hospitals. There is a main, urban hospital, which is the largest in the system. There is also a medium sized community hospital about 30 miles from the main campus. In addition, there are three small, Critical Access Hospitals that are 25 beds each, in rural areas, about one hour outside of town. The health systems purchases an electronic medical record with a clinical data repository (CDR).All of the clinical information that goes in to the new EMR is available to all providers in all hospitals. What can be done to ensure that the information being input to the system uses a common language or that the computer translates it into a common language? How can we be sure that when one doctor writes that the patient is SOB, he intended to state that the patient was short of breath, not something else.Our topics for discussion:(1) Why is data standardization so important in healthcare?? (2) What can be done in the system design and / or the system implementation to help standardize the information so that it can be useful to all of the clinicians in the five different hospitals?(3) What is a common medical vocabulary or common medical terminology?The future trends in health care in relation to quality care are based on best practices. These practices are developed from research and supports what processes should be used to treat disease conditions. This standard of care allows clinicians to provide coordination of care, meet performance benchmarks for quality and manage cost for the community. But most importantly it assists the healthcare organization with data standardization. According to De Vries (2006), through research one is able to describe the processes needed for developing and implementing a company standard and once best practices are established the criterion will contribute to the company’s success; if this is not done it will result unconformity. This step is detrimental to the changes that are occurring in healthcare, according to the article Crossing the Quality Chasm, a health care quality innovation fund needs to be established to assist a committee in developing care processes for common health conditions and that it should be guided by the IOM (p. 4). These types of innovations would standardize treatment modalities leading to standardized data and a common language.During the initial design of the system all five organizations need to participate in the development of the system. They need to work together with the system specialists to establish the directives of the system, standardize information and understand the implementation process (Glandon, Smaltz and Slovensky, 2001). The clinicians have to be in agreement with the format because if the process is not being used it will have no value. A learning process must also be established so that potential direct users are willing to use the standard and be capable of understanding and using it ( De Vires, 2006, p. 65). An evaluation process or monitoring group needs to be established so that the objectives established are being met and utilized correctly. These processes would assist in standardizing the information in all five hospitals. Common medical terminology is a language that is used by clinicians and coders to explain health conditions. It is an informational tool that is used to educate the reader and allow for transparency in clinical information, administrative processes and increased clinician productivity (Health Language Technology Translates Medical Terminology and Administrative Billing Codes into Consumer-Friendly Terms, 2008). If a common language is not used it will result in misperception which will effect coordination of care, misdiagnosis and patient safety.Anonymous. (2008). Health Language Technology Translates Medical Terminology and Administrative Billing Codes into Consumer-Friendly Terms. Business Wire, 1-4.Glandon, G. L., Smaltz, D. H., & Slovensky, D. J. (2011). Information systems for healthcare management (7th ed.). Chicago, Illinois: Health Administration Press.Crossing The Quality Chasm: A New Health System For The 21st Century. (2001)Week #3International Classification of DiseasesThe coding system that is used for the identification of diagnoses is called the International Classification of Diseases (ICD).? The ICD is the international standard diagnostic classification for all general epidemiological, many health management purposes and clinical use. ICD is used extensively for billing purposed in the United States.ICD-10 was approved by the World Health Organization (WHO) in May 1990 and came into use by WHO Member States in 1994. Although it has been used throughout the world for many years, the United States is still using ICD-9.? ICD-10 will be mandated for use in the US as of October 2014.Our topics for discussion:(1) Why the US has postponed the implementation of ICD-10 for so long? The International Classification Of Disease (ICD) has been in use for several years; specifically ICD-9 has been in use for 30 years. In 1990 it was decided to change the classification system so that it would be able to support the changes occurring in the delivery and reimbursement of the healthcare field (WHO, n.d.). The ICD-10 was postponed for several reasons. According to Commis, the fiscal intermediaries for Centers for Medicare and Medicaid Services many organizations are not even ready for 5010 and have seen the impact of hospital cash because of delays and payers being unable to accept those federally mandated transaction standards and if they had kept the date it would have been worst (p.2). Payers are also having problems with meeting deadlines; reimbursement is complex and not tied to diagnostic codes, so if you change the codes you impact the whole reimbursement cycle; this would create a challenge for healthcare providers and insurance companies (Commis, 2012). It was also noted that there could be no easy transition for the organizations involved. It would have to be an instantaneous move and all the organizations involved would have to use it at once. (2) From the?information systems perspective, what issues does the implementation of ICD-10 present? In the article ICD-10 Compliance it states that the informational system would require replacement, remediation, upgrading, or outsourcing of legacy information systems. It would also require a process of re-engineering, creation or modification of input and code driven or code dependent clinical and business processes. There is also a lack of long-term “workarounds”; they cannot map/translate from ICD-9 to ICD-10. (3)? What are the advantages of ICD-10? There have been numerous advantages associated with the use of the ICD-10 initiation. It improves specificity because of the increase in number of codes; it enables the comparison of data for clinical, research and payment purposes. It enables creation of new diagnosis codes from advances in medicine and technology. It will allow for a high degree of automated claims adjudication and more accurate payments (ICD-9 Compliance, n.d.). The advantages that have been noted will represent significant improvement in the hospital setting. Healthcare organizations have been challenged with pairing codes with the correct diagnosis and having the documentation to support the criteria. Our case managers are always challenged with ensuring the codes are appropriate. The ICD-10 will have its challenges but it will support our current healthcare trends. ICD-10 Deadline Postponed, Sebelius Confirms. (February 17, 2012). Retrieved September 10, 2013, from Compliance.(n.d.). Retrieved September 10, 2013, from Classification of Disease. (n.d.). Retrieved September 11, 2013, from #4Electronic Medical Records / Electronic Health Records While hospital information systems have been in existence for a number of years, Electronic Medical Records (EMR) and Electronic Health Records (EHR) are relatively new concepts.Please discuss:What is an Electronic Medical Record?The American Recovery and Reinvestment Act (ARRA), specifically the portion of the ARRA known as the HITECH (Health Information Technology for Economics and Clinical Health) Act and the Affordable Care Act (ACA) contain congressional directives to improve the quality, safety, and cost-effectiveness of, and access to, healthcare through the secure, appropriate electronic exchange of health information (Smith, Hoyt, Matthews, 2013,p. 26). The electronic medical record and the electronic health record are just two processes designed to accomplish these directives. An electronic medical record is a digital record of the patient’s medical history and contains information used at one practice (HealthIt,n.d.) Hospitals and private care physician’s use this technology for diagnosis and treatment of the patient and allows providers to track data over time, identify patients who are due for preventive visits and screenings, monitor how patients measure up to certain parameters and treatments, and improve overall quality of care in a practice ( HealthIt, n.d.,p.1). The EMR was developed as a tool for tracking physicians referrals, engaging both staff and non- staff physicians, sharing clinical data, connecting business partners, supporting care delivery, paying for services and decreasing patient errors but several challenges have been identified (Smith, Hoyt, Matthews, 2013).What is an Electronic Health Record?Currently, the term electronic health record (HER) is widely used. It describes the concept of a comprehensive, cross-institutional, and longitudinal collection of a patient’s health and healthcare data. It, therefore, includes data that is not only particularly relevant to a subject’s medical treatment but also to a subject’s health in general; the patient is regarded as an active partner in his/her treatment by accessing, adding, and managing health-related data, thereby supporting care (Hoebst, & Ammenwerth, 2010,p.2). EHRs can:Contain a patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory and test resultsAllow access to evidence-based tools that providers can use to make decisions about a patient’s careAutomate and streamline provider workflow(3) What is the difference between the two? Both the EMR and EHR are classified as digital charts used in primary care of patients but there are some key differences. One of the main features of an EHR is that health information can be created and managed by authorized providers in a digital format capable of being shared with other providers across more than one health care organization; EHRs are built to share information with other health care providers and organizations – such as laboratories, specialists, medical imaging facilities, pharmacies, emergency facilities, and school and workplace clinics – so they contain information from all clinicians involved in patients care. The information stored in EMRs is not easily shared with providers outside of a practice. A patient’s record might even have to be printed out and delivered by mail to specialists and other members of the care team. (Healthit, n.d.)(4) How can they help improve healthcare quality?In 2000, the Institute of Medicine's (IOM) Committee on Quality of Health Care in America released a seminal report titled To Err is Human: Building a Safer Health System that estimated that more than a million injuries and nearly 100,000 deaths each year in the United States are attributable to medical errors(Harrington, Kennerly, Johnson & Snyder, 2011,p. 33). These medial errors are a result of diagnostic, treatment, preventive, communication gaps, equipment failure and other system failures. So, one of the reasons that the EMR and EHR were developed was to decrease medial errors. A second IOM report, Crossing the Quality Chasm, identified challenges associated with use of information technology in healthcare to improve quality of care (Committee on Quality of Health Care in America 2001). The authors called healthcare the most complex sector of the economy because of numerous and complicated transactions that require many behavioral changes by patients, clinicians, and provider organizations. Underinvestment in clinical information systems by provider organizations is compounded by difficulties in demonstrating the benefit of clinical information systems. Healthcare providers are also challenged in securely maintaining patient health information and creating an infrastructure that enables exchange of data and information across diverse settings (Harrington, Kennerly, Johnson & Snyder, 2011,p. 34).Harrington, L., Kennerly,D., Johnson, C., & Synder, D. (2011). Safety Issues Related to the Electronic Medical (EMR): Synthesis of the Literature from the Last…Journal of Healthcare Management. (56) 1, p. 31-43.HealthIT. (n.d.). What is an Electronic Medical Record (EMR)? Retrieved on September 18, 2013 from, , A. & Ammenwerth, E. (2010). Electronic Health Records: A System Review on Quality Requirements. Research Division eHealth. Retrieved from, ., Hoyt,P.,H., & Matthews, P. (2013). Futurescan: Information Technology, 2013-2018. Chicago, Illinois: Health Administration Press, p. 26-33.Week #5Privacy in Healthcare Originally called the Kennedy-Kassebaum Act, the Health Insurance Portability and Accountability Act (HIPAA)?was signed into law by?President Clinton in 1996.This law had a major effect on the practice of healthcare in all venues.? HIPAA is a very broad law that addresses many?factors within the?healthcare industry.Our topics for discussion:What are the fundamental principles of HIPAA?The Health Insurance Portability and Accountability Act (HIPPA) provides for portability of health insurance from employer to employer, standards for transmitting health information in writing, orally and electronically, and methods for assuring the security, confidentiality, and privacy of personal health information (Asfaw, 2008,p. 1). Each of HIPPA’s titles identifies the requirements and are the standards established to accomplish these objectives.The first is the principle of Boundaries: With very few exceptions, health care information about a consumer should be disclosed for health purposes and health purposes only. It should be easy to use it for those purposes, and very difficult to use it for other purposes.The second principle is Security. Americans need to feel secure that when they give out personal health care information, they are leaving it in good hands. Information should not be used or given out unless either the patient authorizes it or there is a clear legal basis for doing so.The third principle is Consumer Control. Americans should not have to trade in their privacy rights to get quality health care.The fourth principle is Accountability. If you're using information improperly, you should be severely punished. This flows from the second principle of security. The requirement to safeguard information must be followed by real and severe penalties for violations. When someone's health care privacy has been violated, it's not enough to say it's wrong. We need to show it's wrong. We need to send the message that protecting the confidentiality of peoples' medical information is vitally important, and that people who violate that confidence will be held accountable.The fifth principle is just like our free speech rights; privacy rights can never be absolute. We have other critical--yet often competing-- interests and goals. We must balance our protections of privacy with our public responsibility to support national priorities-- public health, research, quality care, and our fight against health care fraud and abuse (Shalala, 1977).How has HIPAA affected healthcare and the healthcare industry?HIPAA compliance has had a dramatic effect on healthcare and the healthcare industry. Although the implementation of HIPPA legislation may or may not reduce health care cost in the long run, it mandates health care providers and researchers to make significant adjustments in the way they practice and advance knowledge in the field (Frimpong, & Rivers, 2006.p. 37). HIPAA has affected healthcare in some of the following ways:Several studies show a decline in participation rates in clinical trials and human research as a result of regulationsInformed consent processes has become complicatedThe privacy rule component of HIPAA requires providers, health care organizations, and health care entities to operate by minimum set of privacy regulations (Adopted National Provider Identifier).Electronic health transactions are used for health claims, health plan enrollment, and payments for care and health plan premiums.HIPPA provides a uniform level of protection of all health information that is stored or transmitted electronically.The most challenging obstacle facing healthcare organizations is the accurate assessment of the cost required to update current IT systems in order to become HIPPA compliant(Frimpong, & Rivers, 2008).(3) How has ARRA affected privacy?HHS issued regulations requiring health care providers, health plans, and other entities covered by the Health Insurance Portability and Accountability Act (HIPAA) to notify individuals when their health information is breached (U.S Department of Health & Humans Services, n.d.).These “breach notification” regulations implement provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act, passed as part of American Recovery and Reinvestment Act of 2009 (ARRA)(p.1). The regulations, developed by OCR, require health care providers and other HIPAA covered entities to promptly notify affected individuals of a breach, as well as the HHS Secretary and the media in cases where a breach affects more than 500 individuals.? Breaches affecting fewer than 500 individuals will be reported to the HHS Secretary on an annual basis. The regulations also require business associates of covered entities to notify the covered entity of breaches at or by the business associate (p.1).Asfaw, E. (2008). Health Insurance portability and Accountability Act (HIPPA): Confidentiality and Privacy from the Perspectives of the Consumer and the Physician. Capella University.Frimpong, J. (2006). Health Insurance Portability and Accountability Act: Blessing or Curse? Journal of Healthcare Finance, (33)1, p. 31-39.U.S. Department of Health & Human Services (1997). Testimony on the Health Insurance portability and Accountability Act By The Honorable Donna E. Shala. Retrieved on September 25, 2013 from, http//:asl/testify/t970911/a.htmU.S Department of Health & Human Services (n.d.). Health Information Privacy. Retrieved on September 25, 2013 from, ’gov/ocr/privacy/hipaa/understanding/coveredentities/breachnotificationinf.htmlWeek 6Clinical Information ExchangeA major goal of healthcare information systems technology is the sharing of clinical information.? Many health information exchanges and regional health information organizations have been developed at a significant cost.? However, one of the most famous and successful health information exchanges closed after years of development.Discuss the Santa Barbara County Care Data Exchange (SBCCDE).(1) What was the Santa Barbara County Care Data Exchange? The Santa Barbara County Care Data Exchange was once considered one of the most ambitious and best-publicized health information exchange (HIE) efforts in the United States and a model for emerging regional health information organizations (RHIOs) elsewhere (Miller, & Miller, p. w 568). It was launched in 1999 to enable the exchange of medical data among hospitals, physicians and other health care organizations. HIE proponents argued that communitywide electronic HIE could improve quality if a health care provider could go to one local Web portal, with one user sign-on, password, and uniform graphical user interface (GUI), to obtain all health care data for a patient across all community health care facilities and providers. HIE could provide more patient data that were more timely, legible, organized, and accessible, which could improve electronic lab and prescription ordering, reminders, lists of patients needing services, and performance reporting. HIE could reduce costs if it could eliminate paper results distribution; reduce duplicate lab tests; and help provide more appropriate primary, specialty, and emergency room care—and thus reduce use of health care services (Miller, & Miller, p. w 568).(2) How much money was invested in the Santa Barbara County Care Data Exchange? The California HealthCare Foundation invested $10 million in the project. The five-year, $10 million investment in late 1999 was the largest single grant made by the CHCF and, admittedly, one of its riskiest investments. Eight years after that investment decision, it is important to understand what actually happened (Havenstein, 2007,p. 1). (3) Why did the Santa Barbara County Care Data Exchange close? Santa Barbara County Care Data Exchange shut down operations in December 2006; eight years after its development began. The board of the Santa Barbara Project (as it was commonly called) voted to shut down operations, even though the project had built a basic HIE infrastructure and started to provide data to clinical users (Miller & Miller, 2007). The foundations view is that the project died from:The design of the project.The group made an error in opting to try to build the entire infrastructure at once instead of taking an incremental approach.The RHID faced concerns from potential customers about whether it could adequately protect the privacy of patient data flowing through the system.Some of the organizations had serious concerns about liability for privacy breaches.The potential members balked at helping to fund the system; even after the first two participating organizations began exchanging data.Several area hospitals had set up their own electronic feeds, limiting the need for the RHIO.In the end the value proposition of the exchange, given the cost to operate it wasn’t there for the providers.(Havenstein, 2007)What lessons can we learn from the Santa Barbara County Care Data Exchange? There were several lessons learned from the project some include:Alternative approach to all at once design:The best way to drive major change is through a series of smaller, successful waves. Each success represents a small step in the right direction (p.590).Model would have allowed organizations full control over their data; addressing ownership issues:The project demonstrated the viability of a managed peer-to-peer model for HIE. The CDE architecture enabled data from each source to be stored in separate databases that could be managed independently and locally by each participating organization (p.590)Safe Harbor provisions would foster HIE while protecting providers from liability exposure:Privacy and liability issues need to be addressed up front. RHIOs should start with local policies as a base (for example, those established by the local hospital), understand federal and state regulations, and engage relevant stakeholders, including consumers, from the onset (p.590)Better mechanisms would allot for faster development and adaptation:The project underscored the need for more widely adopted data-exchange standards this added greatly to the complexity and cost of regional HIEs, in both initial implementation and ongoing maintenance. A better mechanism is needed to encourage or force the faster development, adoption, and use of exchange standards (p.590)(Frohlich, Karp, Smith & Sujansky, 2007)Frohlick,J.,Karp,S., & Smith, D.,M. (2007). Retrospective: Lesson Learned From The Santa Barbara Project And Their Implications For Health Information Exchange. Health Affairs, (25) 5, p. w589-w591.Havenstein, H. (2007). Funding, Tech Woes Shut Down Longtime Health Data Exchange. Computerworld, (41) 13, p.1-7.Miller, R., & Miller, S.,B. (2007). The Santa Barbara Country Care Data Exchange: What happened? Health Affairs, (26) 5, p. w568-w580.Week #7Natural DisastersHurricane Katrina of 2005 was the costliest natural disaster? in the history of the United States.? Damage caused by the hurricane was valued at $108 billion (in 2005 US dollars) and there were 1,836 confirmed deaths as a result of the hurricane, with 1,577 deaths in Louisiana alone.From a healthcare information systems perspective, what problems did the hurricane cause?Hurricane Katrina displaced about 1 million people from the Gulf Coast area, and most of them were separated from their medical records. Both immediately after the storm and in the weeks to follow, medical providers had no way to know about or track patients’ pre-existing medical conditions, medications, or allergies, and many times patients themselves were unable to provide accurate medical histories for a variety of reasons (Franco, Toner, Waldhorn, Maldin, OToole, & Inglesby, 2006, p.1). Patients were evacuated from hospitals, shuttled between multiple temporary medical shelters, and often were relocated to out-of-state healthcare facilities, all without any form of durable medical records (p.1). The evacuees were also unable to obtain prescriptions for needed medications; they were without medications for weeks which put their health at risk. Later an electronic system was developed to authorize health professionals and pharmacist; a private and public sector coalition created a new, secure online service which gathered databases from commercial pharmacies, government health insurance programs such as Medicaid, and private insurers, and pharmacy benefits managers in states affected by the storm (Elsevier, 2005, p. 1). This system assisted with gathering medical information stored 90 days prior to the day Katrina landed. What healthcare information systems technology lessons can be learned from Hurricane Katrina?Congressman Leavitt commented that the disaster had made the case for a national system of electronic health records (EHR), noting that such a system would be useful in general as well as for other emergencies such as pandemic influenza (Lister, n.d.). There were several evacuees that did not receive adequate care because the physicians did not know their history. In sharp contrast, the Veterans Administration (VA), which has an extensive national electronic health records system, was able to provide care for its patients in the Gulf Coast with fewer logistical complications because all of its patients’ medical records were electronic (Franco, et al, 2006,p.1). Several hundred veterans were evacuated from VA medical centers in Biloxi, Mississippi, and New Orleans. While this system was most likely not accessible from the heart of New Orleans, where basic infrastructure was down, VA patients could be tracked as they moved around the country, and their care (including histories of chronic conditions) could be maintained despite their changing locations(p.1).Elsevier, R. (2006). Informed Decisions Recognized for Unprecedented Health Resource Instated Following Hurricane Katrina. Business Wire, p. 1-4.Franco, C., Toner, E., Waldhorn, R., Maldin, B., Otoole, T., & Inglesby,T. (2006). Systemic Collapse: Medical Care in The Aftermath of Hurricane Katrina. Retrieved on October 8, 2013 from, , S. (2005). CRS Report for Congress Hurricane Katrina: The Public Health and Medical Response. Retrieve on October 8, 2013 from, Week 8QualityQuality means different things in different fields.? For example, the best hitter in the history of baseball, was Ty Cobb, who had a batting average of .366 over his career (1905-1928). ?That means that he got a hit in just over one third of his times at bat (36.6% success).? That also means that he was unsuccessful at almost two thirds (63.4%) of his attempts to hit.In fields such as vehicular traffic control, aviation or healthcare, this would not be an acceptable statistic.? Even at a rate of 95% accuracy or success, there would be 50,000 errors per 1 million attempts (5% of 1,000,000).By the nature of what is done in healthcare, there is little room for error.? What can be done to minimize errors in healthcare?Please discuss:(1) How can healthcare information systems minimize or reduce the number of errors in healthcare?Clinical errors cause at least 44,000 deaths annually in the United States; these deaths largely result from process errors, or the failure to provide recommendation treatments for patients with certain medical conditions (McCullough, Casey, Moscovice & Prasad, 2010, p. 647). Other factors have also contributed to the nations epidemic of medical errors; some include patients seeing multiple providers in different settings, adverse drug events, and mediation errors but with information technology organizations and providers can reduce these medical events by having a system were important healthcare information is stored and retrieved.Health information technology (IT) systems such as electronic health records and computerized physician order entry hold the potential to improve quality while reducing cost, improve communication, implementation of care guidelines and decision-support tools, which may be particularly valuable in preventing process errors (McCullough, Casey, Moscovice & Prasad, 2010). (2)What is “Clinical Transformation” and how does it impact quality?Clinical transformation initiatives offer healthcare organizations improvements in patient care and financial performance, and greater physician and patient satisfaction but before this process is initiated the organization has to decide what it wants to accomplish by automating its clinical systems ( Krizner, 2004,p. 54). This is a difficult process and the staff, physicians and organization must be able to adapt to the automated solution by changing the way they perform their work. Quality and cost outcome issues made clinical transformation an imperative in today’s healthcare market; it is believed and there is significant evidence that information technology, along with clinical process change can have a dramatic impact on these issues (NewsRx, 2005,p.247). In addition to the gains in staff efficiency, the ultimate benefits of transforming clinical systems are improved patient safety and satisfaction; the true purpose of the system is patient centered and anything that allows healthcare to provide better, safer and quality care for our patient’s is a greatly needed (Krizner, 2004).(3)What is “Continuous Quality Improvement” (CQI) and how can CQI interact with healthcare IT projects?Continuous Quality Improvement is quality applied to health care means providing the best possible care through continuously improving service to meet or exceed the needs and expectations of patients, physicians, staff and the community served by the hospital; CQI is a process for achieving quality care that requires the institutionalization of several essential characteristics within a planned implementation framework (Hassen, 1998,p. 35). These characteristics include:Quality is consistent conformance to customers’ expectationsMeasurements of quality are through indicators of customer satisfaction, rather than indicators of self- gratification.The objective is conformance to expectations 100% of the timeQuality is attained through prevention and specific improvement projectsManagement commitment leads the quality process. Clinical outcomes in healthcare are tied to fitting a treatment strategy to a particular patient’s needs; IT projects could provide standards of care for patients hence quality outcomes. CQI could also enhance and assist healthcare workers with workflow so that CQI processes can be established and maintained.Hassen, P. (1998). Continuous Quality Improvement in Health Care: An Example. Business Quarterly, 56(2), p. 34-39.Krizner, K. (2004). Clinical Transformation Initiative Starts With A Total Vision. Managed Healthcare Executive, 14(10), p. 54-55.McCullough, S.,J., Casey, M., Moscovice, I., & Prasad, S. (2010). The Effect of Health Information Technology On Quality In U.S. Hospitals. Health Affairs, 29(4),p. 547-554.NewsRx. (2005). Information Technology: Center formed to help healthcare providers achieve clinical transformation. Biotech Business Week, p. 247-249.Week 9What is Biosurveillance? Biosurveillance is the practice of monitoring data to detect, investigate, and respond to disease outbreaks; traditional biosurveillance has focused on the collection and monitoring of diagnostic medical and public health data retrospectively to determine the existence of disease outbreaks (Shmueli, and Burkom, 2010,p. 39). Examples of traditional data are cause-specific mortality rates and daily or weekly counts of selected laboratory results; although such data are the most direct indicators of the current burden of a disease of interest, in most situations they are collected, delivered, and analyzed in days, weeks or even months after the outbreak (p. 39). By the time the data reaches decision makers it may be too late for public health interventions such as prevention of increased cases, dispensing vaccinations, or other forms of medication (Shmueli, and Burkom, 2010). In the 1900’s disease surveillance research shifted toward systems that would result in early detection of diseases stemming from bioterrorist attacks or natural causes (p. 39).How have advances in biosurveillance been incorporated into healthcare? Public health officials are seeking to mitigate the impact of health-related events through early detection and rapid response, by contrast, contemporary biosurveillance seeks to accelerate their process through automation, integration, and analysis ( Greenspun, and Cothren, 2008). EHR’s are a vital source of information for active biosurveillance; they hold the potential to provide real time data from hospitals, emergency rooms, physician practices and home health care providers (p. 35). When recorded in a standardized form, data can be extracted directly or, such as with text-based systems, run through natural language processes for analysis; in this manner, a comprehensive view of background health conditions can be established with rapid detection of anomalous events or patterns (p. 36). To protect confidentiality, records can also be identified at the source and, if required, re-identified later.Greenspun, G.,H., & Cothren, M., R. (2008). Achieving Effective Biosurvellance. Health Management Technology, 29(3), p. 35-37.Shmueli, G., & Burkom, H. (2010). Statisical Challenges Facing Early Outbreak Detection in Biosurveillance. Technometrics, 52(1), p. 39-46. ................
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