A compilation of those areas of IPD which are usually not covered in classrooms. A greater emphasis on the management aspect with examples from existing hospitals in INDIA
A compilation of those areas of IPD which are usually not covered in classrooms. A greater emphasis on the management aspect with examples from existing hospitals in INDIA
OPD is the mirror of the hospital, which reflects the functioning of the hospital being the first point of contact between the patient and the hospital staff.
Patients visit the OPD for various purposes, like consultation, day care treatment, investigation, referral, admission and post discharge follow up. Not only for treatment but also for preventing and promotive services like, health check up, Immunisation, Physio-therapy and so on.
Emergency is the gateway to the hospital, patients with pain and agony, relative emotionally charged enter the emergency department at any hour of the day or night, expecting immediate treatment and solace.
Inpatient Department consists of a wards with Nursing Station,Beds, and all other facilities & services necessary for good patient care. It is one of the important aspects of hospital as every ratios and calculation for hospital planning and designing process.
A presentation in February 2011 presented at the Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. Presentation partly in English and partly in Thai.
OPD is the mirror of the hospital, which reflects the functioning of the hospital being the first point of contact between the patient and the hospital staff.
Patients visit the OPD for various purposes, like consultation, day care treatment, investigation, referral, admission and post discharge follow up. Not only for treatment but also for preventing and promotive services like, health check up, Immunisation, Physio-therapy and so on.
Emergency is the gateway to the hospital, patients with pain and agony, relative emotionally charged enter the emergency department at any hour of the day or night, expecting immediate treatment and solace.
Inpatient Department consists of a wards with Nursing Station,Beds, and all other facilities & services necessary for good patient care. It is one of the important aspects of hospital as every ratios and calculation for hospital planning and designing process.
A presentation in February 2011 presented at the Ramathibodi Hospital Administration School, Faculty of Medicine Ramathibodi Hospital, Mahidol University in Bangkok, Thailand. Presentation partly in English and partly in Thai.
Evolution of the healthcare industry in India and the potential impact of the...Harshit Jain
2014 looks to be a positive but challenging year for the Indian health care sector; one in which many historic business models and operating processes will no longer suffice amid rising demand, continued cost pressures, lack of or inadequate care facilities, and rapidly evolving market conditions. India, likely will be dominated by the “Modi-care” –Health assurance for all.
A presentation given by Cheryl McCullough at The Journey, CHA conference for 2012, in the 'Enhancing Outcomes Through Innovations in Technologies' stream.
Covered California Calls Collection of Patient Data a Good ThingFreeway Insurance
With 1.4 million people enrolled, Covered California is embarking on an ambitious effort to collect insurance company data on every patient pertaining to prescriptions, doctor visits and hospital stays .
Chart of Accounts, coding and description for the HIS. It would be very conducive to generate MIS reporting system to compare the cost as well as revenue of each department, sections, clinics, doctors, etc.
HOSPITAL MANAGEMENT SYSTEM SOFTWARE
There has been a significant change which has occurred in the past year or so. The healthcare industry, and particularly acute care facilities, in the midst of a flurry of merger and acquisition activity, has discovered as a whole they lack the ability to move quickly internally to assimilate new systems and to adapt to the changing environment. Quite inefficient and labor-intensive business processes are still being used.
We have seen a rapid advancement in application of information technology to almost every sector of industries. The explosion of Internet growth fuelled by the so-called killer application - the World Wide Web, further accelerates this advancement.
The Hospital Management System ultimately combine electronic copies of all documents created from admission to discharge with electronic reports, usually clinical testing or billing information, into a single electronic folder. They reduce labor, eliminate lost files and ‘loose sheets,’ improve access to authorized users, increase security and provide documentation for claims more quickly.
This scenario has rendered the almost impossible task of integrating and seamlessly managing patient’s record across hospitals, clinics and between countries or states.
Hospital Management System is a Medical office on-line. It is a custom web site for each physician’s office. Hospital Management System offers a web application that handles every task for a physician’s office. These tasks include billing, appointment scheduling, writing prescriptions, maintaining charts and notes, keeping lab results & X-rays, etc.
In addition to providing access to the office staff and the physician, Hospital Management System also offers controlled access to others. Patients, pharmacists, drug company representatives, and other people could access Hospital Management System to perform various tasks that would otherwise have to be performed by the physician’s office. MD Offices that subscribe to Hospital Management System would benefit from increased productivity.
Paperless Hospitals Dr Dev Taneja 3rd June2012DrDevTaneja
The Indian Hospital industry is growing at 15% per annum.Due to Low industry maturity, the Health IT applications are still at basal level. Though there is lot of hype around Paperless hospitals, the presentation attempts to understand challenges of implenting a True Paperless Hospital
This whitepaper is written by Pieter Rahusen, Clara Aguilo and Lydia Goerig Market Development
Managers Healthcare, from Ricoh Europe. This document is meant for colleagues, prospects,
customers and relations from Ricoh. This whitepaper shows Ricoh’s vision about a paperless hospital
via digitalization and management of patient/client and company records in healthcare. Ricoh’s vision
is based on years of experience with information processes in European healthcare institutions. It has
led to a modular solution that consists of several building blocks. These blocks guarantee a seamless
integration of several processes. The solution also uses the standards from existing infrastructures and
work methods.
The existing primary business and care applications, the IT environment and the work methods are
therefore the starting point for change management. Ricoh’s healthcare specialists have a broad
understanding and knowledge of the procedures and laws within healthcare. This makes Ricoh
an excellent and reliable partner that can guide and support healthcare organizations with issues
regarding a paperless office.
This whitepaper describes the building blocks of the complete solution for Smart Document
Management from Ricoh. It enables healthcare institutions to gradually switch to a paper less hospital
(step-by-step). The goal of this whitepaper is to offer objective and relevant information that supports
the decision making process about the implementation of a paperless office.
Laboratory Services provides a comprehensive range of diagnostic testing and clinical and consultative services .
Medicare Part B (Medical Insurance) covers medically necessary clinical diagnostic laboratory services that are ordered by your doctor or practitioner.
Laboratory tests include certain blood tests, urinalysis, tests on tissue specimens, and some screening tests. They must be provided by a laboratory that meets Medicare requirements.
Information Technology and Information Technology Enabled Services SectorVibrant Gujarat
Highlighting the value proposition of the ever growing IT-ITes Sector in India, this presentation gives an overall idea about the future of the sector in India as well as Gujarat. It mentions the various initiatives, incentives and schemes launched by the Government of India and the Government of Gujarat to promote business and investment in the sector.
Overview of Meaningful Use, Stage One. Presented to Georgetown's Health Information System's class on 4/14//11. Only difference from previous lectures is the addition of slides on adoption sentiment.
Meaningful Use Stage One, with CertificationJess Jacobs
Overview of Meaningful Use, Stage One. Presented to Georgetown's Undergraduate Health Information System's class on 12/8/10. Only difference from 1/8/10 lecture is the addition of slides on certification.
Slides used to deliver presentation on Korean healthcare system overview. Main topics are: payer, healthcare delivery system, regulation, stakeholders.
Hospital management system is a computer system that helps manage the information related to health care and aids in the job completion of health care providers effectively.
Hospital Management System brings together all the information and processes of a hospital, in a single platform.
It presents you with a unified 360-degree view for managing patients, doctors, inventory, appointments, billing information, finances and much more.
The system automatically generates a highly-efficient process and makes it quick. Thereby, allowing hospitals to provide quality service in addition to professional medical care.
In a nutshell, Hospital Management System (HMS) creates a frictionless approach towards managing the entire hospital and solves all complexities in the process
Workflow & Business Process Automation Opportunities in the Healthcare MarketY Soft Corporation
Wouter Koelewijn, Y Soft Vice President and Managing Director of Y Soft Scanning Division, talked about opportunities in workflow and business process automation for healthcare market in USA.
YSoft SafeQ is a leading print management and document capture solution currently uses by more than 14 000 companies in more than 100 countries.
If you want to find out more about YSoft SafeQ, contact us at www.ysoft.com/contact-us or schedule your Live Demo at www.ysoft.com/demo.
Presented at the BDMS Golden Jubilee Scientific Conference 2022 "BDMS Beyond 50 years: Looking towards the centennial," Bangkok Dusit Medical Services Public Company Limited (BDMS), Bangkok, Thailand on October 19, 2022
Presented at The Thai Medical Informatics Association Annual Conference and The National Conference on Medical Informatics (TMI-NCMedInfo) 2021, Bangkok, Thailand on November 26, 2021
Presented at the Master of Science Program in Medical Epidemiology and the Doctor of Philosophy Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 25, 2021
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 15, 2021
Consumer Health Informatics, Mobile Health, and Social Media for Health: Part...Nawanan Theera-Ampornpunt
Presented at the Master of Science and Doctor of Philosophy Programs in Data Science for Healthcare and Clinical Informatics, Department of Clinical Epidemiology and Biostatistics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand on November 10, 2021
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Couples presenting to the infertility clinic- Do they really have infertility...
Hospital Services & Management
1. Hospital Services and Management
Nawanan Theera-Ampornpunt, MD, PhD
Faculty of Medicine Ramathibodi Hospital, Mahidol University, Thailand
Modified from slides of Assoc.Prof. Artit Ungkanont
Parts of this material were based on materials developed by Johns Hopkins University, funded by the Office of the
National Coordinator for Health Information Technology, U.S. Department of Health and Human Services under Award
Number IU24OC000013 (Health IT Workforce Curriculum v.2.0, Component 7/Units 2-3).
2. A Bit About Myself
2003 M.D. (Ramathibodi)
2009 M.S. in Health Informatics (U of MN)
2011 Ph.D. in Health Informatics (U of MN)
Medical Systems Analyst
Health Informatics Division
Faculty of Medicine Ramathibodi Hospital
Mahidol University
ranta@mahidol.ac.th
www.SlideShare.net/Nawanan
Research interests:
• Health IT applications in clinical settings (including EHRs)
• Health IT “adoption”
• Health informatics education
3. Outline
• Overview of the healthcare system
• Hospitals as a key component
• Nature of hospital services
• Contrast with ambulatory & emergency settings
• Management of hospital operations
• Needs for health IT in hospitals
• Conclusion
5. Stakeholders in Health Care
• Want to deliver the best
• Want a high-quality care and outcomes to patients with limited
satisfactory service resources
experience for an acceptable Providers
• Needs to satisfy many “bosses”
cost
• Want data for
• High bargaining policy-making and
power Policy- management
• Want to pay less Payers Patients Makers • Limited budget
money for more • Often face
quality bureaucracies
• Highly political
Public • Concerns about resource allocation &
community’s well-being, but not
necessarily individual patients
6. Providers
• Provide health care services to patients
• Hire or employ health care professionals, including
physicians, nurses, pharmacists, etc.
• Receive payment from patients or third-party
payers
– National Health Security Office
– Social Security Office
– Comptroller-General Department
– Private insurance companies
7. Providers in Thailand’s Various Settings
• Ambulatory Setting
– Private clinics (sometimes called physician’s offices)
– Outpatient departments of hospitals
– Private pharmacies
– Dental clinics
– MOPH’s community health centers
• Currently called “health promotion hospitals”
• They are not really hospitals!! Just a political marketing tool!
8. Providers in Thailand’s Various Settings
• Emergency Setting
– Emergency rooms of hospitals
– Ambulances and pre-hospital care
– Incident management and command
9. Providers in Thailand’s Various Settings
• Inpatient Setting
– Inpatient wards for
• Acute care hospitals
• Nursing homes (for the elderly and chronic patients)
• Hospice (for the terminally ills)
– Special cases
• Delivery room
• Patients being observed in emergency rooms
• Short stay services
11. Hospital Services in Thailand
Inpatient Care
Ambulatory
Emergency
(Outpatient)
Care
Care
Surgery
(Operating
Rooms)
12. Why We Need To Hospitalize (Admit) Patients
• Serious illness or injury
• Need to monitor patient status closely
• Need to observe progression of illness
• Need to administer intravenous drugs or fluids
• Need extensive/ongoing investigations
• Need to observe response to treatment and adjust
plans, or because of potential treatment side effects
• Before and after major surgery or procedures
• Etc.
13. Importance of Hospital Services
• Sophisticated capabilities & technologies
– Labs
– X-rays
– Surgeries
– Other treatments and technologies
• Integrated services by multiple specialties
• Ability to provide level of care needed by each patient
– General wards for different specialties (medicine, surgery, OB-GYN,
pediatrics, orthopedics, eye, ENT, etc.)
– Intensive Care Units (ICUs), Cardiac Care Units (CCU)
– Public (shared) wards vs. private rooms
• Referral systems of increasing capabilities
14. Class Discussion #1
• What are some different types of hospitals you can
think of?
• What characteristics do you think make these
hospitals different?
15. Types of Hospitals in Thailand
Hospital Category Number of Percentage of All
Hospitals Hospitals
District hospitals (MOPH) 737 56.4%
General hospitals (MOPH) 68 5.2%
Regional hospitals (MOPH) 26 2.0%
Other hospitals under MOPH* 50 3.8%
Other public hospitals 111 8.5%
outside MOPH†
Private hospitals 315 24.1%
Total 1307 100.0%
*Including general and specialty hospitals under other departments within the Ministry of Public Health.
†Including university hospitals, military hospitals, autonomous public hospitals, prison hospitals, hospitals of state enterprises, and public
hospitals under local governments.
MOPH = Ministry of Public Health
Source: Bureau of Policy and Strategy, Ministry of Public Health (November 2010).
17. Hospital Characteristics
• Level of services
– Primary care
– Secondary care
– Tertiary care
– Supertertiary care
• Ownership
– Public/private status
– Parent organization
– Being in a multi-hospital system
18. Hospital Characteristics
• Teaching status
– Non-teaching hospitals
– Teaching hospitals
• Budget
• Service capabilities
– Medical technologies available
– Medical specialties available
• etc.
19. Class Discussion #2
• How many of you have had an experience being
admitted to a hospital or had a relative who was
admitted?
• Can you share some non-confidential parts of the
story?
– Describe what happened.
– What did the providers do to you/your relative in the
hospital?
– How was the experience (your feeling of the
experience)?
20. An Overview of Hospital Services
Information
Services
From Dr. Artit Ungkanont’s slide
23. Ambulatory Processes
• Check-in
– Verify Appointment; Update Info; Pull Medical Record
• Move to exam room
– Vital Signs; Review Reason for Visit; Document
– Examination; Discussion of Findings; Plan; Order; Documents
• Check-out
– Schedule appointment
– Payment
• After the fact
– Complete Documentation/Dictate
– Code Visit & File Insurance Claim
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture a
24. A Typical Process for Outpatient Care
OPD nurse performs
Verify appointment,
Registration (New brief history taking,
OPD Check-in insurance eligibility,
patients only) vital signs
pull medical records
measurement
Doctor orders Doctor takes history
Doctor writes
Doctor reviews results investigations (lab, x- and physical
documentation
rays, etc.) examination
OPD Check-out
OPD nurse reviews Patient receives
Doctor writes Patient makes
order, educates medications and go
prescription payment
patient, makes home
appointment (if any)
27. A Typical Process for Inpatient Care
Admission processing
(verify admission
Entry Point Patient registration Patient stays in a ward
paperwork, insurance
eligibility)
Doctor writes order for
Doctor takes history &
Doctor reviews Nurse reviews and investigations (lab, x-
physical examination
investigation results processes orders rays, etc.) and
in an admission note
treatment
Nurse measures vital Patient makes
Hospital makes claims
signs every 6 hours or payment, receives
Discharge planning and receives
as ordered, writes home medications &
reimbursements
nurse’s notes education, discharged
28. Inpatient Processes
1. Register
2. Review Patient Info
3. Talk, Observe, Examine
4. Document
*H&P, PMH, Signs/Symptoms, etc.
5. Take Actions “Orders”
*Meds, Labs, Procedures, Consults, Admit, Next Appt.
6. Discharge
7. Patient Education (could occur anywhere in the process)
8. Health Data Reporting
9. Link to Reimbursement
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture a
29. Entry Point for Inpatient Admissions
• From outpatient visits
• From emergency room
• Referred from another facility
• Scheduled inpatient appointment
– Pre-operative (before surgery) admissions
– Chemotherapy
– Other procedures that require hospitalization
• Operating room
– Post-operative (after surgery) care
– One-day surgery with unexpected complications requiring admission
30. Routine Ward Work for Physicians
• Morning Ward Rounds
– Check patient’s illness progression, changes from previous rounds, lab/x-ray
results, response to treatment
– Plan next steps
• Ordering investigations and treatments
– Lab tests
– X-rays
– Medications and IV fluids
– Surgeries & bed-side procedures
– Nursing procedures
– Diet
– Patient activity
• (Optional) Afternoon Ward Rounds
• Progress notes & other documentation
• Providing treatments during the day as necessary (e.g. CPR)
31. Routine Ward Work for Nurses
• Typically an 8-hour shift
• Observe and document patient status, illness progression, and changes
• Measure routine vital signs and intake/output
• Review and process doctor’s orders
• If patient condition is serious or urgent, inform physicians
• Perform nursing interventions as ordered
• Coordinate with other departments and staff
• Assist physicians in bed-side procedures
• Documentation
– Nurse’s notes
– Medication administration records (MARs)
– Vital sign
– Kardex (for within-shift communications and between-shift hand-over)
– Other administrative documents
32. Discharge Status
• Discharged home with approval
• Left against medical advice
• Escape
• Referred to another facility
• Expired (Dead)
33. What Is Different?
• Access to systems & data
• Challenges of geography
• Patient Load
• Episode of Care
• Facilities and technologies available
• Level of monitoring and control of environment
• Coordination, Communication, Consultation
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Modified from “Working with Health IT Systems, Under the Hood, Lecture a”
34. Inpatient vs. Ambulatory Processes:
Comparing and Contrasting
How do they differ?
– Inpatient 4 phases
• Initial evaluation
• Ongoing Management
• Pre-discharge
• Discharge
– Ambulatory
• Episodic
• Coordination across providers and locations
• Monitoring/treatment chronic & acute
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture a
35. Managing Hospital Operations
• Typical Organizational Structure
– Hospital Director as top executive
– Various clinical departments depending on medical
specialties and services available
– Nursing Department
• Important Administrative Departments
– Director’s Office
– Quality improvement, Risk management
– IT
– Finance, Human Resource (HR), Procurement
– Academic/Education/Research
36. Supporting Care Processes with HIT
• Facilitate filtering, organizing, & access
• Thoroughness and currency imperative
• Reviewing & Documenting
• Planning
• “Doing” – ordering
• Educating
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture a
37. Supporting Care Processes with HIT
• Communicating
– High risk, high stress
– Teams – working independently but
with constant information exchange
– Moving patients, moving providers, rapidly changing
situations
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture a
38. IT Management in Hospitals
• Front Office
– Hospital Information Systems (or Clinical Information Systems)
• Back Office
– Management Information Systems
– Including Enterprise Resource Planning (ERP) systems
– Research and Education
– Office Automation Tools
• Data Warehouse, Data Analysis & Reporting
• IT Infrastructure
– Systems & Network Administration, including Security
– Web Sites
39. Hospital Information System
Clinical
Medical ADT Notes
Records
Workflow
Pharmacy IS
Operation Master
Patient LIS
Theatre
Index (MPI)
Order
CCIS
RIS
Scheduling
Portals Billing
PACS
Modified from Dr. Artit Ungkanont’s slide
40. Clinical Decision Support:
“Any system designed to
HIT Systems (Inpatient) improve clinical decision making
related to diagnostic or
therapeutic processes of care.”
From Dr. Artit Ungkanont’s slide
41. Care Processes: HIT Support
• Registration
– Admission, Discharge Transfer Systems (ADT)
– Bed Management Systems (BMS)
– Unique Identifier – i.e. Hospital Number (HN),
sometimes called Medical Record Number (MRN)
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture b
42. Care Processes: HIT Support
• Reviewing Patient Information
– Retrieve patient record
• Verifying demographics, etc.
• Past medical history, etc.
• Talking, Observing, Examining
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture b
43. Care Processes: HIT Support
Documentation
– Copious
• Pick lists, Voice Recognition, Structured Notes, Integrated
Records, Patient-Centered, Kiosks, PHRs …
– Knowledge Resources & Decision Support
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture b
44. Care Processes: HIT Support
Taking Action Performing/Ordering/Reviewing
– CPOE – Computerized Prescriber Order Entry
• E-prescribing, Consults, Treatments, Diets, Labs, Tests…
– Guideline-based Care http://www.guideline.gov/
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Modified from Working with Health IT Systems, Under the Hood, Lecture b
46. Care Processes: HIT Support
• Pre-Discharge/Discharge
– Ties into ADT, bed management, discharge planning
…
• Education
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture b
47. Care Processes: HIT Support
• Reporting & Reimbursement
– External (Disease Control & Prevention, Immunization
Registries, Payers for reimbursement, etc.) & Internal
(Practice Improvement, Trending, etc.)
– $$$
Health IT Workforce Curriculum
Version 3.0/Spring 2012 Working with Health IT Systems, Under the Hood, Lecture b
48. Summary
• Hospitals are an important setting in health care
• Nature and work processes in the inpatient,
outpatient, and emergency settings are quite
different
• These settings have some common needs for
health IT, but each also has unique needs
• Hospitals are just one part of the whole
healthcare system
Health IT Workforce Curriculum Working with Health IT Systems
Version 3.0/Spring 2012 Under the Hood
Lecture b
49. Healthcare System: The Big Picture
Government
Hospital A Hospital B
Clinic C
Lab Patient at Home