Health Informatics Week 1 Critical Reflection Paper: Chapters 1 and 2 Objective: To critically reflect your understanding of the readings and your ability to apply them to your Health care Setting.  A

CHAPTER © 2012 The McGraw -Hill Companies, Inc. All rights reserved. McGraw -Hill 1 A Total Patient Encounter © 2012 The McGraw -Hill Companies, Inc. All rights reserved. Learning Outcomes When you finish this chapter, you will be able to:

1.1 Compare practice management (PM) programs and electronic health records (EHRs). 1.2 Discuss the government health information technology (HIT) initiatives that have led to integrated PM/EHR programs. 1.3 List the eight facts that are documented in the medical record for an ambulatory patient encounter. 1.4 Identify the additional uses of clinical information gathered in patient encounters. 1.5 Compare electronic medical records, electronic health records, and personal health records. 1 -2 © 2012 The McGraw -Hill Companies, Inc. All rights reserved. Learning Outcomes (Continued) When you finish this chapter, you will be able to:

1.6 Describe the four functions of a practice management program that relate to managing claims. 1.7 List the steps in the medical documentation and billing cycle. 1.8 Compare the roles and responsibilities of clinical and administrative personnel on the physician practice health care team. 1.9 Explain how professional certification and lifelong learning contribute to career advancement in medical administration. 1 -3 © 2012 The McGraw -Hill Companies, Inc. All rights reserved. Key Terms • accounts receivable (A/R) • American Recovery and Reinvestment Act of 2009 (ARRA) • cash flow • certification • continuity of care • data mining • data warehouse • diagnosis code 1 -4 • documentation • electronic health record (EHR) • electronic medical record (EMR) • electronic prescribing • encounter • health informatics • health information exchange (HIE) © 2012 The McGraw -Hill Companies, Inc. All rights reserved. Key Terms (Continued) • Health Insurance Portability and Accountability Act of 1996 (HIPAA) • health information technology (HIT) • integrated PM/EHR program • meaningful use • medical assistant (MA) • medical biller • medical coder 1 -5 • medical documentation and billing cycle • medical malpractice • medical necessity • medical record • National Health Information Network (NHIN) • patient examination • pay for performance (P4P) © 2012 The McGraw -Hill Companies, Inc. All rights reserved. Key Terms (Continued) • personal health record (PHR) • Physician Quality Reporting Initiative (PQRI) • practice management (PM) program • procedure code • records retention schedule • regional extension centers (RECs) 1 -6 • revenue cycle management (RCM) • standards © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.1 Health Information Technology: Tools for a Total Patient Encounter 1 -7 • Health information technology (HIT) — use of computers and electronic communications to manage medical information and its secure exchange • Practice management (PM) programs — used to perform administrative and financial functions in a medical office • Electronic health record (EHR) — computerized lifelong health care record for an individual that incorporates data from all sources that provide treatment for the individual © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.1 Health Information Technology: Tools for a Total Patient Encounter (Cont.) 1 -8 • Health informatics — knowledge required to optimize the acquisition, storage, retrieval, and use of information in health and biomedicine © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.2 Major Government HIT Initiatives 1 -9 • Health Insurance Portability and Accountability Act of 1996 (HIPAA) — legislation that protects patients’ private health information, ensures health care coverage when workers change or lose jobs, and uncovers fraud and abuse in the health care system – Standards — technical specifications for the electronic exchange of information • Electronic prescribing (e -prescribing) — technology that enables a physician to transmit a prescription electronically to a patient’s pharmacy © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.2 Major Government HIT Initiatives (Continued) 1 -10 • Physician Quality Reporting Initiative (PQRI) — Medicare program that gives bonuses to physicians when they use treatment plans and clinical guidelines that are based on scientific evidence • American Recovery and Reinvestment Act of 2009 (ARRA) — $787 billion economic stimulus bill passed in 2009 that allocates $19.2 billion to promote the use of HIT © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.2 Major Government HIT Initiatives (Continued) 1 -12 • Health information exchange (HIE) — network that enables the sharing of health -related information among provider organizations according to nationally recognized standards • National Health Information Network (NHIN) — common platform for health information exchange across the country • Integrated PM/EHR programs — programs that share and exchange demographic information, appointment schedules, and clinical data © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.2 Major Government HIT Initiatives (Continued) 1 -11 • Meaningful use — utilization of certified EHR technology to improve quality, efficiency, and patient safety in the health care system • Regional extension centers (RECs) — centers that offer information, guidance, training, and support services to primary care providers who are in the process of making the transition to an EHR system © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.3 Documenting the Patient Encounter 1 -13 • Encounter (or visit) — meeting of a patient with a physician or other medical professional for the purpose of providing health care • Patient examination — examination of a person’s body in order to determine his or her state of health © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.3 Documenting the Patient Encounter (Continued) 1 -14 • Documentation — record created when a physician provides treatment to a patient • Medical record — chronological health care record that includes information that the patient provides, such as medical history and the physician’s assessment, diagnosis, and treatment plan • Continuity of care — coordination of care received by a patient over time and across multiple health care providers © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.3 Documenting the Patient Encounter (Continued) 1 -15 Eight data points included in an ambulatory care medical record:

1. Patient’s name 2. Encounter date and reason 3. Appropriate history and physical examination 4. Review of all tests that were ordered 5. Diagnosis 6. Plan of care, or notes on procedures or treatments that were given 7. Instructions or recommendations that were given to the patient 8. Signature of the provider who saw the patient © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.4 Other Uses of Clinical Information 1 -16 Clinical information has several important secondary uses that involve:

– Legal issues – Quality review – Research – Education – Public health and homeland security – Billing and reimbursement © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.4 Other Uses of Clinical Information (Continued) 1 -17 • Medical malpractice — provision of medical services at a less -than -acceptable level of professional skill that results in injury or harm to a patient • Pay for performance (P4P) — provision of financial incentives to physicians who provide evidence -based treatments to their patients © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.5 Functions of an Electronic Health Record Program 1 -18 • Electronic medical record (EMR) — computerized record of one physician’s encounters with a patient over time – EHRs, on the other hand, can include information from the EMRs of a number of different sources. • Personal health records (PHRs) — private, secure electronic health care files that are created, maintained, and owned by the patient © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.5 Functions of an Electronic Health Record Program (Continued) 1 -19 EHRs have eight core functions: 1. Health information and data element maintenance 2. Results management 3. Order management 4. Decision support 5. Electronic communication and connectivity 6. Patient support 7. Administrative support 8. Reporting and population management Advantages of EHRs include safety, quality, and efficiency. © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.6 Functions of a Practice Management Program 1 -20 Practice management (PM) programs have functions related to managing claims, including:

– Creating electronic claims – Electronically monitoring claim status – Receiving electronic payment notification – Handling electronic payments © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.7 The Medical Documentation and Billing Cycle 1 -21 • Cash flow — movement of monies into and out of a business • Medical documentation and billing cycle — ten -step process that results in timely payment for medical services © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.7 The Medical Documentation and Billing Cycle (Continued) 1 -22 The Medical Documentation and Billing Cycle: – Step 1: Preregister patients – Step 2: Establish financial responsibility for visit – Step 3: Check in patients – Step 4: Review coding compliance – Step 5: Review billing compliance – Step 6: Check out patients – Step 7: Prepare and transmit claims – Step 8: Monitor payer adjudication – Step 9: Generate patient statements – Step 10: Follow up patient payments and collections © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.7 The Medical Documentation and Billing Cycle (Continued) 1 -23 • Diagnosis code — code that represents the physician’s determination of a patient’s primary illness • Procedure code — code that represents the particular service, treatment, or test provided by a physician • Medical necessity — treatment that is in accordance with generally accepted medical practice © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.7 The Medical Documentation and Billing Cycle (Continued) 1 -24 • Accounts receivable (A/R) — monies that are coming into a practice • Revenue cycle management (RCM) — management of the activities associated with a patient encounter to ensure that the provider receives full payment for services © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.7 The Medical Documentation and Billing Cycle (Continued) 1 -25 • Data warehouse — collection of data that includes all areas of an organization’s operations • Data mining — process of analyzing large amounts of data to discover patterns or knowledge • Record retention schedule — plan for the management of records that lists types of records and indicates how long they should be kept © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.8 The Physician Practice Health Care Team: Roles and Responsibilities 1 -26 • Physicians — primary clinicians in the practice • Physicians’ assistants (PAs) — health care professionals who treat minor injuries and assist with many aspects of an encounter • Nurses — health care professionals who perform a wide range of clinical and nonclinical duties • Medical assistants (MAs) — health care professionals who perform both administrative and certain clinical tasks in physician offices © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.8 The Physician Practice Health Care Team: Roles and Responsibilities (Cont.) 1 -27 • Medical billers — health care professionals who perform administrative tasks throughout the medical billing cycle • Medical coders — medical office staff members with specialized training who handle the diagnostic and procedural coding of medical records • Practice or office managers — individuals who direct the business operations of physician practices • Compliance officers — individuals who investigate and resolve all compliance issues relating to coding, billing, documentation, and reimbursement © 2012 The McGraw -Hill Companies, Inc. All rights reserved. 1.9 Administrative Careers Working with Integrated PM/EHR Programs 1 -28 • Certification — nationally recognized designation that acknowledges that an individual has mastered a standard body of knowledge and meets certain competencies • Education in the health care field is a lifelong commitment.