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AIS Week 6 Final 3
- 1. Prepared by: Robin E. Corsetto, Shahzad Yusuf, Rude Del Valle, Lenice Lauderdale HCS 533 August 20, 2012 Michael Solomon Administrative Information System Structure
- 2. Introduction Importance of the use of electronic systems Benefits Privacy and Security System Development Evaluation Future Evolutions Special Considerations Source: www.grassvalley.com
- 3. Enhancing Patient Access Improved efficiency of scheduling and registration Decreased wait times Increased positive survey feedback Increased repeat business
- 4. Optimizing Payments Improves insurance verification and prior authorizations Improves clean claims Reduces denials Increases cash collections Faster revenue cycle Source: www.thebizcoachblog.com
- 5. Privacy and Security Ensure compliance to governance, regulations and privacy HIPAA Emergency Disaster Plan Security safeguards Data backup recovery Passwords and biometrics Virus protection and firewalls Internal and external threats Adopt network security
- 6. System Development Life Cycle Phase 1: planning and analysis Phase 2: design Phase 3: implementation Phase 4: training and support
- 7. Implementation Training Passive demonstrations Printed handouts Group classes run by trainers Hands-on training Computer-based tutorials Step-by-step guides Source: www.madisoncollege.edu
- 8. Implement…go LIVE! Conversion of patient demographic data from one system to another Begin daily use Moniter performance of staff to identify needs Adjust workflow as needed Recognize necessary system adjustments
- 9. Maintenance Components Software monitoring system Hardware / software upgrades Different requirements per vendor Source: www.copiersphoenix.com
- 10. Use of Data Quality in= Quality out=faster billing Billing Scrubber for clean claims Financial Statistics Avg days to final bill Days in accounts receivable # cash collections at time of visit Monitor wait times Lobby Registration
- 11. Evaluation of Effectiveness Strategies to improve relationship among the users Performance monitoring of the staff to ensure engagement process Conduct interviews with employees Prepare formal reports of completed assignments
- 12. Hardware Considerations Hardwired desktop computers Card scanners Self-service kiosks Mobile notebook or tablet Switches and wireless routers Limited battery life Cost Durability
- 13. Impact of Future Evolutions Self-service kiosks and online pre-registration Integrated systems equal better connectivity Population health statistics Real time insurance eligibility Patient identity solution across systems
- 14. The Future…continued Business intelligence from reporting capabilities Contract modeling system to help calculate expected payments Intelligent system alerts to proactively recognize missing information Paper checks to be eliminated in favor of electronic payments
- 16. References Chinnaiyan, R., & Somasundaram, S. (2011). An SMS based Failure Maintenance and Reliability Management ofComponent Based Software Systems. European Journal of Scientific Research, 59(1), 123-133. Eastaugh, S. R. (1995). Nationwide EDI system can trim administrative costs. hfm (Healthcare Financial Management, 49(6), 45. Retrieved from http://www.ehis.ebscohost.com Healthcare Information and Management Systems Society. (2008, December). A Call for Action Enabling Healthcare Reform Using Information Technology Recommendations for the Obama Administration and 111th Congress. Retrieved from http://www.himss.org/2009calltoaction/himsscalltoactiondec2008.pdf Krishnan, A., Nongkynrih, B., Yadav, K., Singh, S., & Gupta, V. (2010). Evaluation of computerized health management information system for primary health care in rural India. BMC Health Services Research, 10310-322. doi:10.1186/1472-6963-10-310 Lemmetty, K., Hayrinen, K., Sundgren, S., Ensio, A., Brennan, P. F., Park, H., Tallberg, M., & Saranto, K. (2009). The Impacts of Informatics Competencies and User Training on Patient Information System Implementation. Studies in Health Technology and Informatics, 146, 646-651. Nahm, E., Mills, M. E., & Feege, B. (2006, June). Long Term Care Information Systems: An Overview of the Selection Process. Journal of Gerontological Nursing, 32(6), 32-38. Needle, S. (2006, March). Electronic Medical Records: Helping Keep Disaster at Bay. Retrieved July 27, 2012, from Information Management: http://www.information-management.com Optimizing Patient Access. (2009). hfm (Healthcare Financial Management), 63(6), 1-8. Schoberle, C. (2007, June). «Personal Health Information: Privacy and Security Considerations in Outsourcing and Offshoring Decisions Creating Safeguards through Best Practices». Retrieved from http://www.tpi.net/pdf/papers/Personal%20Health%20Information.pdf Smith, E. M. (2006). Managing Health Information During disasters. Health Information Management Journal, 8-14. Wager, K. A., Lee, F. W., & Glaser, J. P. (2009). Healthcare Information Systems A Practical Approach for Healthcare Management (2nd ed.). San Francisco, CA: Jossey-Bass.
Editor's Notes
- According to the Healthcare Information Management Systems Society’s (HIMSS) recommendations to the President and Congress, healthcare reform initiatives have two distinct themes. Relevant to administrative information systems, the U.S. should “Apply health IT as a means of increasing consumer and provider access to healthcare services and information, optimizing the efficiency of care payments, and protecting the privacy and security of health information.” (HIMSS, 2008, p. 8) An administrative information system is primarily used for managerial functions, such as reporting, analyzing and planning for personnel, finances, payroll, accounts payable, and supplies and equipment management. There are many different areas within the healthcare spectrum that utilize administrative systems, including but not limited to: the human resource department, patient registration, staff scheduling, and the finance department. The use of these systems creates efficient data collection and helps to plan for improvements throughout the organization. (Wager, Lee, and Glaser, 2009) This presentation will discuss the importance and benefits of these systems, privacy and security challenges that must be overcome in the electronic arena, and how these systems go through planning, development and implementation. It wraps up with a focus on evaluating these systems continuously and preparing for future evolutions to come.
- The first benefit of an administrative information system in healthcare is that is enhances patient access. The more challenging it is for people to access healthcare, the less likely that they will make and keep regular appointments. An administrative information system that provides easy access for the consumer by improving the efficiency of scheduling and registration creates an environment that leads to better customer satisfaction and increased business. The business of healthcare is highly dependent on volume/census, therefore it is vital “that access be provided to our services in a timely and efficient way.” (Optimizing Patient Access, 2008, p. 2) This efficiency on the front end is likely to decrease wait times, which leads to higher customer satisfaction and ultimately increased repeat and new business. Word of mouth is one of the most effective marketing strategies and can be a great result of superb customer service.
- Turning from the patient to the benefits of the healthcare provider, an administrative information system is an absolute necessity nowadays. The U.S. healthcare insurance maze is extremely difficult to maneuver and the rules and requirements are constantly changing. A robust system can help the organization stay on path and follow the particular rules in a timely manner, ultimately creating a quicker and more efficient revenue cycle. Quality data on the front end improves clean claim, reduces denials, and increases cash collections (such as deductibles and co-pays). A well organized system can ultimately increase the organization’s bottom line; it is the finance department’s most important tool. (Optimizing Patient Access, 2009) The healthcare organization has to be careful with this system, though, as a lot of financial and personal information is housed within an administrative information system, which must be protected by law.
- Health care organizations must not forget the governing rules in regards to electronic health records: the Health Insurance Portability and Accountability Act (HIPAA), along with Cyber Security, and Privacy Awareness regulations. “For the most critical data, health care organizations should consider an EMR solution that offers replication and remote storage to ensure accessibility, faster recovery time and minimal risk of data loss. With data replication, information can be copied to a remote data storage system. Health Information Departments must consider a secondary data center to prevent data back up failures. Failover guarantees that information requests from the disabled primary data center are redirected to a secondary data center. Maintenance of a secondary data center will require additional hardware and software costs”. (sic) (Needle, 2006, p. 1) (Failover is a process that, when automatic data backup mechanism fails such as network hiccup or other connectivity issues, data is re-routed or remains in the queue until the data base administrator trouble shoots the problem. ) The Chief Security Officer must be responsible to evaluate and verify employees meet satisfactory measures related to HIPAA, Privacy Awareness, and Cyber Security. Administrative safeguards and physical safeguards of patient health records will be maintained in regulation with privacy and HIPAA guidelines. In order to plan for a disaster, the organization’s Chief Security Officer must evaluate the system security. The data backup and disaster recovery systems should be reviewed to test all functions to make sure that patient health information data is safe. “Chief security officers must periodically evaluate their organization’s health care information systems and network for proper technical controls and processes. Clearly an established set of health information technical standards for security would facilitate this evaluation process.” (Wager, Lee, & Glaser, 2009, p. 261) At the time of the registration process of a patient, staff must keep in mind the HIPAA laws and must follow procedures to prevent breach of privacy. During the collection of detailed patient data, one must explain that it is a confidential matter between patients and their healthcare providers. As an added layer of security, computer systems are set up to have unique usernames and passwords for individuals who are employed within the organization. Even though PIN, password and biometric protocols are the most universal forms of identification authentication methods, they also provide a feeble form of security. One reason for its weakness is the staff must be sure to remember his or her password and must not share their codes with others. Computers must also be protected from viruses. Hackers are very knowledgeable and can slip through the cracks and security loopholes to access protected information such as insurance identification and credit card information for fraudulent purposes. Surprisingly, this usually happens within co-workers of the organization who have access to the organizations’ database; this issue is a massive potential risk for every health care organization. The Health Information Department (HIT) must be able to protect the data by deploying authentic data leak prevention tools to protect health related documents. Most of the data maintained in health care information systems are structured and unstructured in nature, (social security numbers and credit card numbers are considered structured data, whereas text material or paragraphs are considered unstructured data.) therefore in order to protect health care files and its sensitive data, IT departments must be equipped with advance levels of data leak prevention tools. In order to prevent security breaches IT department must be able to identify where these Data Leak Prevention (DLP) appliance need to be placed and must have clear understanding about what type of breaches they are protecting against. For instance, in order to prevent external threat Symantec technology is usually installed on the Network. Data security is a big problem for the health care industry. Health systems have lost their data due to unreliable employees, external hackers and substandard computer security measures. Protected health information is a serious matter for many patients. If not kept confidential, it breaches their privacy. For example, some patients do not want to disclose their health conditions to their relatives, friends or to the public. It is a very sensitive and personal situation for many patients, and if violated makes them very upset which can further negatively impact their health condition and as well as their personal life. This can adversely effect an organization’s reputation, potentially its accreditation, and definitely its legal stance. In such cases the organizations are held accountable for such neglect. Information and technology department must be ready at all times to prevent its database from unauthorized, malicious attacks. IT department must be able to secure large volume of database and deploy DLP tools to the location of data storage, such as its main servers. It is very important to plan for the privacy and security needs of the system during the planning stages of system’s life cycle and then to be sure to plan the design based on the needs identified.
- Phase 1: Planning & Analysis A Healthcare Administrative Information System is involved in various aspects of the facility’s operations and often is costly. Therefore, organizational strategic plans and expectations from new systems must be clear from the top level of management. Chief officers from financial, clinical, and information services should map out their strategic plans for each department, set organizational priorities, and propose goals for the new system. Current infrastructure of the institution, such as the type of network, specifications of current personal computers, and operating systems must also be analyzed. Based on this analysis and hardware specifications for the prospective system, the management can decide if it needs to upgrade its infrastructure. Identification of the challenges and opportunities for improving a current system requires collaboration between committee members and end-users. Each committee member should solicit as many comments as possible from the front-line staff. Methods for gathering information during this phase include brainstorming, user surveys, or user interviews. In addition, informal discussions with users can provide valuable information. A report from meetings, surveys, and user interviews needs to be compiled and reviewed by the committee. In this phase, current work processes and responsible parties for those processes need to be thoroughly analyzed. In particular, linkages among work processes in conjunction with state and federal regulations should be investigated (Nahm, Mills, & Feege, 2006). Phase 2: Design One of the most critical jobs is to analyze and understand every task that is accomplished on the paper-based system, as well as current work processes. It is vital for the success of any administrative information system to appoint a project team in order to get the job done successfully. The team works to find duplication of work processes as an opportunity to improve efficiency, by designing improved work flows within the capacity of registering patients, scheduling care, verification of insurance coverage, and collecting payment as required. This will facilitate new, modified workflows. A learning culture within the organization is key to accomplish their set goals. Decision makers of the organizations must negotiate with the vendors of the administrative system to ensure that training is available throughout the process and must be available in a very short notice. Communication between the programmers, managers, and administrative and front line staff is also a key to success for an efficient work flow process that would make the administrative system a dream come true for the users and organization as a whole. For example, elimination of paper based phone messages via administrative communication note directly into the system with alerts such as: ‘patient needs call back to reschedule the visit’, which adds the patient automatically to the rescheduling log for a call back. Hardware selection is very important aspect of EMR system. In order to prevent future potential disruptions in the work flow and keep the cost minimal we decided to purchase hardwired desktop computers due to their longer life as compared to portable and mobile devices. Phase 3: Implementation The implementation process of an administrative information system entails workflow mapping, hardware and software installation, as well as staff training. The very first step in this process is to understand what workflow we want to accomplish with the new system and take continual actions throughout the process until it goes live. Staff training is a vital aspect of the implementation phase and must be provided before, during and after implementation. Phase 4: Training and Support Technical support is very important to provide trouble shooting when issues arise in order to stay productive and continue day-to-day business. Over time, upgrades and patches are provided by vendors, and changes are made by regulatory bodies in the way healthcare data is collected. As the system changes, on-going training must be available in order to stay knowledgeable throughout the life of the system. Therefore, the importance of staff training of this new system and processes is vital.
- As stated within the SDLC, user training of information systems is crucial for the success of the organization and its’ employees. However, it is not only the basic skills of information technology that determines what kind of training is required for the implementation. The implementation of a health information system requires extensive support and training in order to achieve user acceptance. The training plan must be completed before the initial implementation, and it should also include intensive support during the implementation. (Saranto, 2009) All users do not learn alike and represent a wide variety of educational levels. Therefore, multiple learning methods must be considered and utilized. An overall basic classroom course to explain the new system to the group would be helpful to prepare the staff for the upcoming changes, with an opportunity to ask questions to relieve stressors involved with change. Traditional teaching methods, such as written material and lectures, may not prove to be the best solution. More attention should be paid to setting up the goals for training based on the competence level of the staff. Information system training should be offered in small groups with as much hands-on training as possible, possible via computer-based tutorials. This, combined with personal guidance as necessary and studying independently in one’s own work unit can all be helpful to be a successful implementation. (Saranto, 2009)
- Within the planning stages of the project, the team needs to understand that the conversion aspect from one system to another is time consuming and may not be effectively done during regular business hours (or when the busiest times of registration are). The time to go live with the new system should not be rushed and should be delayed if all of the pieces are not in place. Going live with the new system is when it begins to be used as the primary system on a daily basis. While staff begin the use the system in this manner, it is important to monitor their performance and recognize learning needs. As stated earlier, not everyone learns the same, or picks up new processes as quickly as others. During this orientation of the new system, the organization needs to continue to support the staff and adjust workflow and workloads as necessary, while keeping in mind that sometimes some issues do end up being system adjustment needs and to plan for that as a potential bump in the road ahead. Maintaining the staff competence, as well as the system itself are both equally as important.
- Maintenance is required for almost all types of software systems. The type of maintenance that is performed can be defined as either preventive or corrective maintenance. Preventive maintenance is carried out at predetermined intervals or according to prescribed criteria and is intended to reduce the probability of a failure. Corrective maintenance is carried out after a failure and is intended to repair the system. In other words, preventive maintenance is performed before a failure and the corrective is preformed after the failure occurs (Chinnaiyan, 2011). The technical availability of software is high, around 98%, but this is due to fast and frequent service and not just because of good reliability or maintenance management. The problem area for the proposed work is focused on the reliability for the software components of the component based software system. If the most critical software components for the software system can be identified, it will show in what areas to focus when planning the maintenance for the software system (Chinnaiyan, 2011). A State Monitoring System (SMS), is a tool for informing about the state of the software components in a component based software system. SMS are used today in many other applications but in the software industry the SMS is relatively new. With SMS a prediction of impending failure is given for each software component, and therefore maintenance and repairing can then be better scheduled. The SMS used today are capable of detecting failures well in time prior to a failure and they are even able to predict which software component inside the software is defective (Chinnaiyan, 2011).
- With the use of an administrative information system, the demographic data is entered into a centralized electronic system. The elimination of handwritten information in some ways eliminates poor quality of information gathered. Within the administrative system can be found components for demographic patient data such as phone number and address, appointment scheduling, and financial/billing information. Different data can be compiled from this information and analyzed for trends and accuracies. As for the finance department, they may use a billing scrubber to run edits on claims to assure accuracy of data input. When sending claims to insurance companies it is vital to send a clean claim to create an efficient reimbursement. Finance officers collect data such as number of clean claims, average days to final bill, days in accounts receivable, and total of cash collections at time of visit. As for the statistics, the data can be compared not only within a timeframe, but also from one registrar to another in order to recognize weakness and work to correct them. (Optimizing Patient Access, 2009)
- The staff engagement is key to success of the program. If the staff do not accept the new system, they will never use it to its fullest potential. As the implementation is underway, the project team needs to check in with the users and their managers to discuss system issues that have arisen, as well as user differences and suggestions. In order to evaluate the effectiveness of the administrative system, the data for evaluation needs to be collected by in-depth interviews of the program managers and healthcare workers. An in depth interview method should be chosen because, unlike focus group discussions, it gives the opportunity for one-to-one interaction, and individual opinions can be elicited. (Krishan, 2010)The collection of data should include a descriptive study and a semi-structured in-depth interview guide that is used as a study instrument. This instrument lists questions under different domains such as record keeping, data quality, supervision and feedback and overall usefulness of the computerization of the administrative systems structure. The results of this data collection should be presented to the key players in the project team to discuss potential changes to the processes. (Krishan, 2010) Customer satisfaction surveys should reflect the better wait times and more efficient registration process. The finance department should see improvements in their data as well. If the expected benefits are not seen, then the team should consider where in the workflow barriers may exist.
- Implementing an administrative information system can create great efficiencies if the right equipment is placed and provided for the needed workflow. Cost and durability are certainly specifications that must be considered when purchasing a desktop versus a portable tablet. Also, touch screen self service stations can help with busy environments and offers the patient a lot of confidentiality to complete much of the registration process on their own. When a patient presents their health insurance card, rather than making a copy for a paper record and being sure the finance department has access to it, the electronic systems allow for the cards to be run through a simple card reader that scans the information directly into the system. This is also a good time to scan an identification card to assure that the person is not using another person’s insurance to pay for their care. Portable tablets are now economical and are proving to be a useful component for most data collection systems. In the case that a registration specialist needs to go to the emergency department to speak to families and patients to gather demographic information, they can bring the system with them and eliminate duplication of documentation later on in the workflow process. There are more and more tablets being used in patients rooms, but there are concerns with privacy if one leaves a tablet behind in a room with the screen letting patient have access to tablets. Tablets need to be treated like all other computers within the hospital with security settings that will not allow access to personal health information.
- The future is now. Organizations that have a more forward thinking culture along with strong information technical support, are developing and trialing systems now that may become commonplace in healthcare in the future. Some systems allow for on-line scheduling and registration, which can decrease the data input needs of the organization and also secures accurate data from the onset. Patients do not appreciate being asked the same information over and over again while accessing healthcare. A system that eliminates duplication provides a seamless transfer of demographic data to other systems throughout the providers locations, like from the emergency room to the patient care unit. “Improved patient access often means taking advantage of effective technology, designing organizational structures for greater efficiencies, focusing on staff training and development needs, and staying nimble enough to address evolving challenges.” (Optimizing Patient Access, 2009, p. 2) Another evolution of the health information system are the use of health information exchange (HIE). A HIE “consists of the technology, standards, and governance that enable the exchange of data between the information systems of various health care stakeholders.” (Wager, Lee, and Glaser, 2009, p. 137) HIEs are currently being developed on a regional and national level. Once of the challenges of integrating all healthcare entities within a single system is the ability to identify the patient because there is no uniformity across systems and levels of care of what is used to identify the patient. One facility may use name and date of birth, another may use the four digits of the social security number and the name, while another may use medical record number and name. Pulling the same patient’s health information from all of these sources is challenging because of the differences in identification. (HIMSS, 2008) A benefit of creating these HIEs is that there not only would be connectivity of a patient’s overall record of care across organizations, but it also allows for more accessibility of health information research. A HIE allows for population health statistics analysis; it allows for real time data of particular health care needs and medical conditions to be able to complete research and focus healthcare spending where it would be best utilized.
- The more sophisticated healthcare information technology gets, the more benefits of automation can be realized. Insurance companies and healthcare vendors are also becoming more automated on their administrative side. Their participation and integration can realize costs of care real time. The systems are also starting to be able to recognize deficiencies and inaccuracies. “Intelligent system alerts, proactively notifying staff of outstanding tasks or missing information prior to the visit while, at the same time, helping ensure complete claims go out the door.” (Optimizing Patient Access, p. 7, 2008) The federal government began the standard requirement that all claims be submitted electronically; this has saved a lot of healthcare spending dollars. In the future, this practice will become the standard for all healthcare third party payers, as well as the practice of electronic payments. Paper checks will be a thing of the past. (HIMSS, 2008)
- In tying it all together, administrative information systems within healthcare are the gold standard. The more integration and connectivity that is happening with other applications, the more useful the systems will be in creating personal health records and gathering population health statistics. The decision to upgrade or change current systems altogether should not be taken lightly, but rather needs to happen in a logical pattern and follow the SDLC to maximize successful implementation. A solid team effort can create amazing results.