To do this assignment you'll need: The project instruction sheetThe Access database file (file will download as a Zip) When you've completed the assignment, zip the Access database and submit to the d

A first step in assessing vendor capabilities is to determine how long they have been in business, and whether they plan to continue working in health care. Unless a vendor has substantial health care experience it may be wise to keep searching.

Having developed the information plan and associated priorities orients the organization in the right direction.

The Certification Commission for Healthcare Information Technology (CCHIT) is an organization that tests for basic functionality of an electronic health record. Certification of a system by the CCHIT is not sufficient to know if that system will meet the needs for particular specialties, however. Each type of medical care can be so specialized that the vendor system was not customized to that application. Take ophthalmology, for instance. The body system covered is the eye and associated optic nerves. However, certain conditions are covered in so much more depth in the ophthalmology department, that it is unlikely a general medical system adopted for EHR could be adequate for ophthalmological care documentation. A requirement to allow substantial free-form text entry may be necessary.

A vendor that offers Software as a Service (SaaS) solutions reduces the requirements for local support, such as local servers and backups of the server data, as well as maintenance and updates. This approach is also known as an Application Services Provider (ASP). This is in contrast to a localized client-server approach. If the medical practice or hospital hosts its own server computer, a local (on-site) computer serves as the repository of the program. A localized approach may seem more accessible but will involve more maintenance and upkeep.

 Physical Hardware Devices and Storage

A health information system comprises many pieces of hardware. It is not necessary for you, as a member of the HIM project team, to be an expert on every piece of hardware in the system, but it is helpful to have an understanding of how each piece functions and how it contributes to the system. Let's explore the basics of system hardware.

CPU

The Central Processing Unit of the computer is known as the CPU. This unit reads instructions, interprets, and uses internal language understandable to the computer, and sends instructions to other parts of the computer. When enabled by an operating system such as Microsoft Windows, the CPU executes the instructions provided from a computer program. You may have heard of the term “bus” in relation to a computer. The bus connections transfer data to and from the CPU to other units of the computer, such as storage units and inputs. The CPU is doing the difficult computational work of the computer. The information will not “go” anywhere without the bus connections.

Input Devices

Keyboard

A keyboard allows entry of text and numeric data, and also includes function keys and key combinations to give shortcuts to various system functions. For example, “Control-C” key combination allows text copying in most word processing programs. “Control-V” allows for pasting text. Directional arrow keys, or “navigation keys” on the keyboard allow movement around the page whether or not a mouse is being used. “Control-enter” is another function enabled within word processing programs to allow entering a page break.

Mouse

The Mouse allows for efficient movement around the desktop, among other functions. “Click and drag” is a commonly used mouse function when working with drawing programs. As you know, placing the cursor on a position on the page, then left clicking, makes this the new position for the cursor. This feature of the mouse provides efficiency, in comparison with having to use the keyboard arrow keys which move one space at a time.

Scanner

This also functions as an input device. The scanner produces a “bit-map” or picture of whatever is scanned. These bitmaps can be interpreted by various visualization programs. The bitmap can’t ordinarily be searched for terms or types of data.

Connections

Do you know what USB stands for? Universal Serial Bus. We use one each time we plug in a “flash” or “jump” drive or when we connect a printer. It is universal because it has been adopted as a standard way for connecting outside devices, or peripherals, to main computer drives and CPU.

Prior to developing USB ports each type of peripheral had its own type of connector device. The older parallel printer connections had large, pinned connectors. The mouse, too, had a special cable. Now that these are “universal”, life has been greatly simplified.

Storage Devices

Storage can be primary or secondary.

Primary Storage

Primary storage refers to the Random Access Memory (RAM) and the Read Only Memory contained adjacent to the CPU. RAM and ROM are the working areas for software applications to hold their instructions, and the documents on which a user is working. When you write a new document it is contained within RAM until instructed to “save”. RAM is not stable in that each time the computer is turned off, data contained within vanishes. If the computer starts to run very slowly, chances are the RAM could be working at or near capacity.

Secondary Storage

Secondary storage can continue to retain data even after the computer is turned off. Secondary storage includes hard drives, “floppy” drives, and optical disk storage including CD-ROM and DVDs. The floppy drive and CD drive are often referred to as removable drives. The hard drive is not intended to be removed from the computer housing, though it is possible to buy external peripheral “hard drives”, convenient for backup purposes.

Why not use hard drives for all data, instead of RAM? The reason is that it is inefficient to access the hard drive. For the CPU to access RAM is like going to the next town, versus “going to Tokyo” for hard drive access. However, the space on a hard drive is much less expensive than RAM.

In short, RAM is very fast and accessible.
Hard drives and optical drives are very stable, but less efficient.

Output Devices

A video display terminal is commonly used in conjunction with the processing unit. Using various types of computer “monitors” we see a visual depiction of information. When using a tablet computer it appears that the monitor may be all we have, but the CPU is still working behind the scenes and requires inputs. Touch screens are a common way to provide a combination display device and input device. Information can also be output to a printer, or to audio devices. As technology advances the lines between input and output devices are merging.

Servers

A server is simply a computer that has dedicated tasks and does it well. It processes much data, refers that data out to other computers, and stores information. We usually do not connect peripheral devices to a server. That is because it is constantly communicating with other computers connecting via a local network or remote network. How do you get to a website like Google? Your computer connected over the Internet, eventually contacting one of Google’s servers. If you went into a server room, you would be rather bored and possibly chilly. The room is kept cool to keep temperature-sensitive CPUs running at their best. There are not normally display monitors attached to the server.

Application Software Concepts

Because of applications software, we are able to put computers to use for our purposes. For example, consumer software is commonly used for:

• Word processing

• Spreadsheets

• Databases

• Statistical analysis (SAS, SPSS)

• Graphic representation and design

• Voice Transcription

• Audio editing

Did you check out of a grocery store recently? The store used POS (Point of Sale) software to scan and compute your purchases and simultaneously update the store's inventory records.

Filled the gas tank? Credit card information was scanned and sent to the bank using a magnetic card reader and associated applications software.

Got lost and checked a GPS or map application? Geographic information system (GIS) software was used.

In many areas of life today, we barely notice as applications software is used.

Applications in Health Care

Hospitals and health care organizations have used software applications for quite a while for billing, coding, and inventory control. It is reasonable that these business office purposes were the first ones applied. This is the case in that financial software was developed earlier than most other software types for nearly all industries. As the efficiency and quality of computerized data processes become evident, more applications have been devised.

Pharmacies were among earlier health applications software users. This is because pharmacies have extensive needs to track inventory and make sure the right medication is prepared for the right patient. Processes are also very definable for a pharmacy. The NDC (National Drug Code) is a 12-digit code, which identifies each manufacturer, product, dosage type, strength and package size of medications recognized by the FDA, the U. S. Food and Drug Administration. Pharmacies are paid by the type of drug dispensed plus a fee for pharmacists time.

The health information management department of a hospital or health care facility commonly uses a master patient index (MPI), encoders, electronic document management systems (EDMS), and transcription facilities.

Laboratories have also used information systems on a legacy basis. Most lab tests can be well-specified and the results presented in printout format. One little-known fact is that values presented as normal ranges can vary from system to system! Thus, while one system may represent total cholesterol of 220 as high, in another system the patient with total cholesterol of 195 may be designated as having high cholesterol.

HIPAA

Congress passed the Health Insurance Portability and Accountability Act in 1996 (HIPAA), which specified certain types of organizations as covered entities, including health plans and certain health providers. Coding standards were specified by HIPAA. These included the ICD-9 code set for diagnoses and CPT codes. These codes were in wide use prior to HIPAA, but the act cemented their use. Standardizing billing codes helped promote inter-provider communications.

However, ICD-9 and CPT systems lacked the specificity and granularity to be of greatest use in clinical health records applications.

HIPAA also specified communications and security standards for exchange of information among health care entities.

More specific nomenclatures including SNOMED and others have become the backbone for a variety of electronic health record (EHR) systems. The development and adoption processes for these systems have been lengthy.

 Enterprise-wide Resource Planning

Developing systems that can communicate within a health care organization is the concept behind enterprise-wide resources planning. It is promoted as a way to have data entered at one point, but be available at any number of service or delivery points within the organization.

Newer initiatives of the federal government to promote more comprehensive use of health information systems have led to the HITECH Act of 2009 (as part of the ARRA legislation), and the Meaningful Use Criteria of 2010.

Meaningful Use designations by the federal government include requirements for health care facilities to analyze care comprehensively in several areas. These include: emergency department throughput time from patient arrival to departure, specific treatment elements for stroke, and blood clot (venous thromboembolism) care.

The health care facility will need to examine processes cross-departmentally to achieve these goals