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- 1. Foundations of Health Information Management Health Care Systems
- 2. History of Health Care Delivery • Why is studying the history of healthcare delivery important? – To understand how healthcare improvements are based on previous developments – To understand the forces that affect the U.S. healthcare system – To understand how the current U.S. healthcare system evolved – To understand how changes in the healthcare system affect HIM practice • Source: AHIMA
- 3. Medical Associations • Standardization of medical practice – American Medical Association – American Association of Medical Colleges – Medical Education – State licensing of physicians and surgeons – Emergence of medical specialties and subspecialties
- 4. Hospital Standards • Standardization of hospital practice – American Hospital Association – American College of Surgeons (ACS) – Minimum Standards and Hospital Standardization Program – State licensing of hospitals
- 5. Medical Record Specifications 1919 by the ACS Patient identification data Complaint Personal and family history History of current illness Physical examination Special examinations Provisional or working diagnosis Medical and surgical treatments Progress notes Gross and microscopic findings Final diagnosis Condition on discharge Follow-up Autopsy findings in the event of death
- 6. Question • What organization was formed to develop standards for hospitals? A.American Medical Association B.American Hospital Association C.American College of Surgeons D.Joint Commission
- 7. Early Hospitals – the Boston House Picture: Courtesy of the U.S. Library of Medicine
- 8. Surgical Service – A Caesarian Operation Picture: Courtesy of the U.S. Library of Medicine
- 9. Influence of Federal Legislation Biologics Control Act of 1902 Social Security Act of 1935 Hospital Survey and Construction Act of 1946 Public Law 89-97 of 1965 Public Law 92-603 of 1972 Utilization Review Act of 1977 Peer Review Improvement Act of 1982 Tax Equity and Fiscal Responsibility Act of 1982 Public Law 98-21 of 1983 Consolidated Omnibus Budget Reconciliation Act of 1985 Omnibus Budget Reconciliation Act of 1986 Health Care Quality Improvement Act of 1986 Omnibus Budget Reconciliation Act of 1989 Omnibus Budget Reconciliation Act of 1990 Health Insurance Portability and Accountability Act of 1996
- 10. Department of Health and Human Services
- 11. Accreditation • The Joint Commission (formerly known as JCAHO) • American Osteopathic Association (AOA) • Commission on Accreditation of Rehabilitation Facilities (CARF) • Community Health Accreditation Program (CHAP) • National Committee for Quality Assurance (NCQA)
- 12. Question • Which federal branch of the government is charged with the health and welfare of the U.S. people, including numerous regulatory programs? (Enter the abbreviation only)
- 16. Essential Services Nursing Care Diagnostic radiology services Nuclear medicine Nutritional services Pathology and Clinical Laboratory Services Emergency services Pharmaceutical services Physical Rehabilitation services Respiratory care services Social Services HEALTH INFORMATION MANAGEMENT
- 17. Other Care Settings … • Subacute Care • Home Care • Long-term Care – Assisted Living – Residential care – Independent living – Retirement communities – Nursing facilities – Hospice and Respite care
- 19. Financing Health Care Third-party reimbursement Commercial insurance: employer-sponsored and individual Blue Cross/Blue Shield Types of commercial insurance – Major medical/Cash Payment Medicare Medicaid TRICARE Department of Veterans Affairs Indian Health Services State and local healthcare services Workers’ compensation Managed care prepaid health plans Investor-owned hospital chains Health maintenance organizations (HMOs) Preferred provider organizations (PPOs) Point-of-service (POS) plans
- 20. Future Trends • Point of Care Clinical Information Systems • Electronic Data Exchange • Decision Support Systems • Electronic Health Record • National Health Information Infrastructure • Privacy and Security Issues • Consumer Involvement
- 21. Question What is the name of the association for health information management professionals? A. Association of Health Information Management Agencies B. Association of Health Information Management Advocates C. American Health Information Management Association D.American Health Information Management Agencies
Editor's Notes
- #2: Welcome to the exciting field of Health Information Management! The Allen School is so glad that you have chosen this field! You are about to embark on an exciting journey! Before we begin, and I know you can’t wait to get started, it is important to learn where we as a country have come. It is said you don’t know where you are unless you know where you have come. So let’s begin.
- #3: In the United States, the first school of medicine was founded in 1763 in Philadelphia. This was the first school to formalize training for physicians. As the United State’s population grew, more hospitals and physicians were needed. Thus, the growth continued and by the end of the nineteenth century, 400 medical schools had been established. However, the quality of many of these schools was in question.
- #4: In 1847, a group of physicians established the American Medical Association for the primary purpose of establishing and supporting a code of ethics for physicians. First, the AMA focused on the quality of medical education and the ethics of practicing physicians. Continuing today the AMA is dedicated to promoting the science and art of medicine, improving public health, making health care policy, and serving its membership.
- #5: Shortly thereafter in 1948, the American Hospital Association was born. The AHA was founded for the purpose of promoting public welfare by providing better health care in the hospitals. Today the AHA supports research and educational programs, maintains data on hospitals, and represents in legal and legislative matters. The American College of Surgeons was founded in 1913 to develop a system of hospital standardization that would improve patient care and recognize hospitals that had the highest ideals. To begin, they collected information from medical records. At that time they realized that the medical documentation was lacking and identified the minimum standards for medical record specifications.
- #6: Because of the work of the ACS, we have the beginnings of a standardized medical record … and the beginning of our role in the delivery of health care! These specifications will be important to remember as we move along.
- #7: Answer: C Feedback: This organization also sets standards for cancer registries…we will discuss the registries in a few weeks! Try Again…
- #8: As hard as it is to believe, in the early 1900’s most hospitals were viewed as boarding homes for the poor and sick. Physicians did not even take physical exams on admission to the hospital! Can you imagine that? However, by the 1920’s there were over 6000 hospitals across the country mostly funded by private benefactors!
- #9: In 1910, Abraham Flexner started the path toward twentieth century reforms with his study, the Flexner Report, which revealed serious problems that existed in medical education. This spurred on the accreditation of medical schools by the American Medical Association.
- #10: Since the early 1900’s, many reforms have taken place. The most significant changes occurred with passage of the Social Security Act of 1933 amendment which established the Medicare and Medicaid programs, the Patient Self-Determination Act of 1990, and the Health insurance Portability and Accountability Act, HIPAA, of 1996. Most recently, a significant change is due to the establishment of the Healthy People 2010 Report whose primary goals are to increase the quality and years of healthy life and to eliminate health disparities.
- #11: Speaking of the many reforms we have reviewed, mostly undertaken by the United States government, it is important for you to have an understanding of the government as the regulator of health care from the local health department to the U.S. Department of Health and Human Services. This chart outlines the many agencies, centers and offices of the DHHS. Whereas the federal government grants accreditation/certification to health care providers/facilities, states grant licensure. It is important to recognize your state’s involvement with the regulation of health care. Typically, most states grant licensure to health care providers and to health care facilities.
- #12: Next, let’s discuss accreditation, the process in which an outside, non-government agency conducts an external review to determine if a facility or agency has met predetermined standards of care. Although this is a voluntary process, the benefits are many for a health care organization: required for reimbursement for certain patient groups such as hospitals, validation of the quality of care, and a competitive edge over non-accredited facilities. The HIM department plays a vital role in this process as the review of health information data is an integral part of the process. The Joint Commission is the most recognized of the accrediting agencies. This organization establishes guidelines and standards for the operation and management of health care facilities with an emphasis of the health care functions critical to patient care. The standards are based on the health care organization being responsible for providing a high quality of health care to the people they serve while efficiently using resources. The American Osteopathic Association likewise accredits osteopathic medical colleges and health care facilities. Osteopathic medicine is based on the theory that all body systems are interconnected and therefore the focus of health care is directed at the whole person. CARF is responsible for accrediting rehabilitation facilities. Rehabilitation is the process of treatment and education that leads the disabled person to the achievement of maximum independence and function and a personal sense of well-being. CHAP accredits community-based agencies such as home health agencies and hospice agencies. It’s primary focus is patient-centered versus the clinical aspect of care. And finally, the NCQA is responsible for accrediting managed care organizations in order to improve the quality of health care and health plan performance in conjunction with managed care plans, purchasers, consumers, and the public.
- #13: Answer: DHHS Feedback: The abbreviation is four initials…a huge organization – its important that you know the purpose of this federal government agency!
- #14: The continuum of care is another important concept for HIM students to understand. Please familiarize yourself with these types of settings. Be thinking about which type of setting interests you the most as your first application paper will require you to select one and then profile that facility or agency. As you can tell from this chart, there are a variety of health care settings in which health care is delivered. You are probably most familiar with the physician’s office and the hospital but as you can see, there are many other areas as well. Most of your studies in the days ahead will be focused on the physician’s office but do not let that stop you from thinking of other areas to take your career.
- #15: The number of medical specialties are as varied as health care settings. The most common specialties are listed in this table and are common to most hospital settings. There are numerous opportunities for the HIM professional in these specialties.
- #16: The members of the hospital medical staff are organized into areas of clinical services and departments that are usually representative of the medical specialties. Each service or department has an appointed director, department head or chairperson.
- #17: The Joint Commission has identified hospital services that must be provided on a regular basis and that are necessary for patient assessment and care. Of note, each of these essential services is also provided in the other continuum of care health care settings. You will note that the HIM department is a vital part of the organization!
- #18: In addition to these other health care settings, we need to keep in mind complementary and alternative medicine as well as emerging E-Health technologies where health care is provided remotely. There are also Adult Day Care centers, mobile diagnostic services and contract services. Keep in mind too that there are Integrated Delivery Systems which are organizations that provide the continuum of care under one organizational name. it is defined as a network of health care organizations that provide a continuum of care to a population.
- #19: Believe it or not, there are over 200 different health care professionals and practitioners! The places of employment are just as varied. Wilson and Neuhauser defined health care professionals as having the following attributes: Certification or licensure is required for membership in the profession A national or regional professional association exists A defined body of scientific knowledge and certain technical skills are required to practice A code of ethics exist Members of the profession practice with a degree of authority and have expertise for decision making in their area of competence. As you can see, you are on your way to becoming a health care professional and practitioner!! Congratulations on choosing such a vital part of the health care delivery system in our country as well as an international community of health information management professionals.
- #20: We cannot finish up this section without talking a little about how health care is financed, which is a complex system that involves multiple payers and numerous mechanisms of payment. Payment methods may be direct or indirect. Payment made by the patient is considered direct pay. Indirect pay involves payment by a third-party payer such as the government, insurance companies, and managed care programs. Insurance is a purchased contract … a policy in which the purchaser …. the insured … is protected from loss by the insurer’s agreeing to reimburse for that loss. Think of your car insurance … health insurance works roughly the same way. Reimbursement is critical to the livelihood of every health care facility and provider in the country. Without being reimbursed for the services delivered, there would be no health care. This is where you come in as a medical billing and coding specialist. Without your expertise, providers would not be reimbursed appropriately. Quite a responsibility indeed!
- #21: The General Accounting Office has identified ways that in which the EHR can improve health care delivery: 1.) provide data that are more accessible, of better quality, versatile for display, and easier to retrieve which will support better decision making for practitioners 2.) enhance outcomes research by capturing clinical data from large databases 3.) improve hospitals’ efficiency by reducing cost and enhancing staff productivity So what does the future hold for the health care delivery system in the United States and for Health Information Management professionals? The information needs that are created by the EHR and other technologies present unique opportunities and challenges for the HIM practitioner such as regulatory issues, privacy and security standards, integrity and ownership. I see a world of opportunities for the health information management professional, which we will continue discussing in the next section.
- #22: Answer: C Feedback: This association is one of the most important organizations in advocating for health information management practices and professionals.