HCS 533 Week 6 Administrative Structure Power Point
1. HCS/533
Julie Bentley
July 20, 2015
Jane Ferraris
Administrative Structure For
Clinical Documentation- How
Data is Captured
2. Impact on the Delivery of Health
Care
• Helps the initiative of the National Health Service to be
“paperless before 2018 (Carlisle, 2013).
• Allows the administrative data to be used for benchmarking
and used as Evidence based decision strategic support for
competitive comparison among health care facilities and
outpatient health care needs (Wager, 2013).
• ICD-10-CM and ICD-10-PCS codes are captured and then sent to
Accounting and Billing using new innovative “Accu-Sure”
technology using accurate billing for accurate disease process
captured in clinical documentation.
• Reimbursement approvals and denials evaluated with
administration.
• Quality and value measurement assessment for improved
patient care.
3. 1. Sets Vision and Strategy
2. Integrates information technology for business success.
3. Makes change happen
4. Builds technological confidence.
5. Partners with customers.
6. Ensures information technology talent.
7. Builds networks and community (CHIME, 2008)
Impact of Future Evolutions
4. The Administrative Safeguards section of The Final Rule of HIPAA
Security Rule has nine (9) standards which are listed below and will have
implications on the data capturing of Shaw Heart Center.
1. Security Management Functions - (Risk Analysis, Risk Management,
Sanction Policies, Information System Activity Reviews by IT and
Security Department)
2. Assigned Security Responsibility – The Chief Engineer identifies
individual responsible for overseeing security policies and procedures.
3. Workforce Security – employee’s have access and non-employee’s
have no access (Authorization and/or supervision, workforce
clearance procedure, termination procedure for loss of job) (Wager,
2013).
Implications of Privacy and Security
Management on Administrative Structures
5. 4. Information Access Management – authorizes access to health care
clearinghouses, and health care organizations (Access organization, Access
establishment and modification).
5. Security awareness and training – implementation of awareness and
training programs for all members of workforce.
6. Security Incident Reporting – implementation of policies and procedures
to address security incidents.
7. Contingency Plans – Data Backup, Disaster Recovery Plan, Emergency
Mode Operational Plan, Testing and Revision Procedures, Applications
and data criticality analysis.
8. Evaluation – Periodic performance of technical and nontechnical
evaluations in response to changes.
9. Business Associate Contracts and other Arrangements – formal
agreement needed.
Implications of Privacy and Security Management on
Administrative Structures - Part 2
6. 1. Planning and Analysis - exam current problems, organizational
strategy, identify opportunity for improvement (Wager, 2013).
2. Design - evaluation of alternative solutions to address what is
needed, cost-benefit analysis done, system is selected, vendor
negotiations finalized, built-in-house system plans finalized
(Wager, 2013).
3. Implementation – significant allocation of resources for training of
staff, converting data, preparation for go-live date (Wager, 2013).
4. Support and Evaluate - longest phase of life cycle. Sufficient
resources needed, glitches fixed, and upgrades determined (Wager,
2013).
Steps in the System Development Life Cycle of
the Administrative Structure (SDLC)
7. • Training will occur with 2-3 Super-Users per Department which will
happen 6 months prior to Go-live date of February 2016. These Super-
Users will be staff from the Department that has expressed an interest
in learning the new administrative information technology system, and
who wish to be a resource for staff in the department. Suggestion is a
1.0 FTE employee.
• Training will then be provided at the facility with a training pool. Page
for access before, during, and after Go-Live Date of February 1, 2016.
• Training Dates: September 1-30, 2015 – 6 months prior
October 1-20, 2015 – 5 months prior
December 1-17, 2015 – 3 months prior
January 10, 20, 2016 - 1 month prior
February – all month long – Go-Live Date -everyday
assistance. (ext.4500)
Training of the Staff
8. 1. Information Technology Department and IT Staff – weekly, monthly,
then progressing to every 3-6 months, then yearly.
2. Software Updates and Upgrades – monthly, and every 6 months.
3. Hardware Upgrades – Price allotment per Department on yearly
report. Upgrades and purchase from this yearly Department
allotment.
4. Personnel and Staff - maintenance and continued IT training for staff
when issues arise for 100% use for Departments on weekly and
monthly reports.
Maintenance Components
9. The Data from the Administrative Structure is used for:
• Evidence Based Research for continued improvement.
• Administrative Structure Progression
• Creation and Innovation of proper ICD-10 coding and
reimbursement for Health Care Facility.
• Creation of Decision Support for Clinicians at Point-of-care.
• Research and Development at Educational Medical Facilities.
How Is the Data Used ?
10. • Reimbursement is within 30-60 days of receipt of bill.
• Parameters chosen that reflect the measure of the customer
encounter and value of care (on-line or mail questionairre).
• Provision of electronic copy of health information to patient.
• CPOE (Computer Physician Order Entry) is established and integrated
inpatient and outpatient.
• Ensuring privacy and security of personal health information.
• Improvement of population and public health in city where health
services are rendered.
• Clinical diagnosis is within 12 hours of inpatient admission and within
18 hours of outpatient visits. (This will allow automatic billing and
reimbursement to fit ICD-10 codes)
How Can the Quality Be Assured
11. Four measurement tools to evaluate Administrative
Structure Analysis:
1. Net Present Value – cash generated or saved in next
3 years over initial IT investment (Wager, 2013).
2. Internal Rate of Return – At present value of IT
system investment what percentage am I receiving
back? (Wager, 2013)
3. Reimbursement denials decreased by 90%.
4. 100% compliance on CPOE diagnosis entries from
all providers.
Evaluation of Effectiveness
12. Currently at this time Hardware is being changed
and updated to accommodate the new
Administrative Structure Data Capturing Tool for
the capture of the Clinical Documentation
Diagnosis. These will continue to be evaluated so
the hardware is compatible and updated.
Please contact the IT department at ext. 8600 for
hardware and software updates. Email’s will be
sent to the unit managers for continued
communication.
Hardware Issues
14. Carlisle, D. (2013). Time for Tech to Grow Up. The Health Service Journal. 123(6368) Suppl. 6-7. Retrieved from http://
search.proquest.com/docview/1492870405?accountid=35812
Mihalas, G. I. (2014, February). Evolution of Trends in European Medical Informatics. ACTA INFORM MED, 22(1), 37-43.
10.5455/aim2014.22.37-43
Reddy, M., Pratt, W., & Dourish, M. (2011, May). Special Issue on Supporting Collaboration in Healthcare Settings: The
Role of Informatics. International Journal of Medical Informatics, 42(80), 541-543. Retrieved from http://www.ijmijornal.
com
Wager, K.A., Lee, F.W., & Glaser, J.P. (2013) Health Care Information Systems: A Practical Approach for Health Care
Management (3ed ed.). San Francisco, CA: Jossey-Bass.
References
Editor's Notes
Speaker Notes:
When speaking look at Board and Director, introduce with a smile on your face while saying the topic “Administrative Structure for Clinical Documentation – How Data is captured.” The opening slide shows two individuals as they are working hard to build and implement something that will work well for the hospital or outpatient setting that the customer desires to implement. While looking at the Board and the Director, each member individually, state the following from HCS/533 Week 3 Individual Paper which states – “as technology changes occur on a daily basis, and clinical technology advances as implemented in health care domestically and internationally, administrative structures that work well for both outpatient and inpatient are important for the quality and value associated with health care today. Clinical coordination of the administrative structures and the analysis of the usage patterns are a way for the administrative strategic team to choose what works best in their health care culture and the environment. The Power Point presentation looks at the impact on the delivery of health care, future evolutions of administrative structure for clinical documentation, implications of privacy and security management, identification of the steps in the system development life cycle as pictured above, training that will be provided for the administrative structure to be implemented, maintenance components that are necessary, how can the quality of data be assured, and evaluation of effectiveness and hardware issues. We will start as we look at the next slide that discusses the impact of the administrative structure for clinical documentation.
Speaker Notes: The impact on the delivery of Health Care using the administrative structure for clinical coordination and analysis of usage patterns are seen with the national statement that Carlisle (2013) stated when National Health Service stated that they desired to be “paperless” by the year 2018. When the data storage is deposited at midnight every night at the data repository for easy retrieval, it allows administration to obtain at any time with the proper security and maintenance the data they need for continued evidence-based support for organization decisions and strategic management for implementation of newer software, or more efficiency with the workflow process inpatient or outpatient (Wager, 2013).
Also, direct capture of data through the electronic documentation of the disease process is done through the newly bought “Accu-Sure” technology program that captures data, sends it to the Accounting and Billing Departments, and then processed through automatic mailing to Medicare, Medicaid, or private insurer. This new innovative software called “Accu-Sure” has enable quick turn around times for receipt, and reimbursement from Medicare, Medicaid, or private health care insurer.
Reimbursement approvals and denials are evaluated and reported to administration every 30 days. Quality and value measurement evaluation is monitored and reported to the appropriate inpatient and outpatient areas.
With the higher cost of the “Accu-Sure” technology and the maintenance and updates, the cost will be made within 3-5 years with projected numbers that the Chief Financial Officer will supply at the end of the presentation.
Speaker Notes:
Look at the Board and say “with the administrative structure for clinical coordination and analysis of the usage patterns at Shaw Heart Hospital, we see that with the capturing of data that there will be impact of future evolutions inpatient and outpatient. In 1998, and 2008, the College of Healthcare Information Management chronicled the evolution of health care and how information technology and having expertise in the IT Department leads to the above mentioned impacts on the organization internally and externally (CHIMA, 2008, Reddy, 2011)
Speaker Notes:
The implications of privacy and security management on Administrative Structures starts with threats that include human, natural and environmental, and technology threats. The HIPAA Security Rule from 2003 instructs security and Information Technology Departments about the nine different standards how the security should look and work in administrative structures. Let us review each of the nine standards with an update on HITECH expansion and ending with administrative safeguards for the information technology security system (Wager, 2013). We will read them on the slide for your individual understanding. A printout will be at the back table at the end of the presentation for you to take to your departments and offices.
Speaker Notes:
This is the continued list of the nine standards of the HIPAA Security Rule of 2003 (Wager, 2013). Administrative Safeguards listed in the nine HIPAA Security Rule Standards are 1) risk analysis and management, 2) Chief Security Officer, 3) System Security Evaluation, and 4) Contingency, Business Continuity, and disaster recovery planning (Wager, 2013, p. 363).
Speaker Notes:
Many of the system development life cycle depends on the four stages listed above with variations of this life cycle found in other diagrams, books, and literature. The first phase is called Planning and Analysis and is the primary focus of system development. During this phase it is important to examine current systems and problems in order to identify opportunities for improvement of the administrative structure system (Wager, 2013). Assessment of the feasibility of the new system with analysis of technology, financially, and operation base is important to see if this is the direction that the inpatient or outpatient facility wishes to pursue.
The second step is Design – whether by Vendor or built-in-house. This will help the facility achieve it’s needs for the workflow process and will encourage adoption once the go-live date happens. Happy users make for good profitability and building of a value system that all people can see.
The third step is called implementation. The implementation phase requires significant allocation of resources in completing tasks such as conducting work-flow and process analysis, installing the new system, testing the system, training staff, converting data, and preparation of staff and facility for the go-live date of the new system (Wager, 2013, p. 213).
The fourth step is support and evaluation phase. This is the longest step and constant. This is the step when sufficient resources which includes people, technology, infrastructure, and upgrades need to be allocated to maintain and support the new system. Support costs during this phase vary widely from system to system, but in most industries up to 80% of the information system budget is spent on maintanance of the system (Wager, 2013, p. 213).
“Health care executives and boards want to know the value of the IT investment, thus the degree to which the new system has achieved its goals and objectives should be assessed because the system will be replaced and the SDLC process begins again.
Speaker Notes:
We will review the Dates on the slide that show how the training process will proceed during the implementation/transition phase to Go-Live Date of February 1, 2016. Information Technology Department will be contacting the managers of the different departments for staff learning in the computer lab, and will have test patients for clinical documentation and how to adjust the records with automatic downloading to billing and ICD-10 coding accounting departments.
Speaker Notes:
Maintenance Components are needed for any information technology system especially when the automatic downloading of patient diagnosis whether inpatient or outpatient is needed for accounting and billing purposes. European medical informatics has published a report internationally that with the new telemedicine and “telematics” as was coined in Europe that there is a strong synergy between telecommunication and informatics (Mihalas, 2014). The upgrades and constant daily and weekly maintenance of these systems uses expertise, scientists, engineers, and physicists to get what the health care industry wants and needs making it something that is of value in the domestic and International world today. Maintenance components are a huge resource for the information system department and making sure that the equipment used at the facility is in top-notch shape makes investment worth the time and effort to ensure it’s continued survival.
Speaker Notes:
The data is used for evidence based research for continued improvement for goals and strategic management of the health care facility, administrative structure progression as technological advances continue, creation and innovation of proper ICD-10 coding for reimbursement issues for health care facility to meet standards of Centers for Medicare and Medicaid and private insurers, and creates a decision support for clinicians at the point-of-care, and for educational medical facilities, it continues research and development of advanced technology initiatives that may be used in the next 5-10 years (Carlisle, 2013, Reddy, 2011)
Speaker Notes:
Quality is what is needed in today’s health care environment world. Domestically and internationally quality is foremost in health care users minds. Quality of information systems and administrative structures is of upmost importance because of reimbursement for health services in the United States, and in Europe (Mihalas, 2014). Let us look at what is listed above as we established how quality can be assured at Shaw Heart Center and at the health care service providers in the world.
Speaker Notes:
The evaluation of effectiveness is calculated by the four measures above for this year. These will be re-evaluated with the yearly Board meeting in compliance with the IT department and Security Department. Let us look at each one written above, and talk about what this means in your facilities for this year. Look at Board.
I will read this slide to the Board and presentation committee. Printed handouts of the presentation slides will be available at the table at the exits after the conclusion of the meeting with contact names and numbers.
Ask the Board if there are any questions and remind them that there are hand-outs as they leave to take back to their desks and departments. Emails will follow the presentation and questions can be answered there also.
