Module 07 Assignment – Health Information Exchanges

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This assignment will result in two bulleted lists and a memo for patients. All can be placed into one Word Document for submission. In this assignment, imagine yourself in the role of a recently hired HIM Manager for LiveWell Hospital. You are the direct supervisor over Release of Information, Chart Completion and Clinical Documentation Improvement. You previously worked as an HIM coordinator and were on the front line when they adopted and deployed a Health Information Exchange (HIE), and this gave you a hiring advantage at LiveWell.

SCENE ONE: Ms. Clark, the HIM Director asks to see you in her office to review a possible project for you. LiveWell wants to adopt and roll-out an HIE with several facilities in the northern part of your state. She prefers that the Information Systems department oversee and manage the HIE project and indicates that she doesn’t believe that HIM professionals have the competency needed for an HIE roll-out. Your previous experience with HIE was very rewarding and successful – you interrupt Ms. Clark in your excitement and plead with her to let you oversee HIE at LiveWell. You explain that your previous experience convinced you that HIE belongs in the HIM department. Ms. Clark asks you to research and report back on the following two issues regarding HIE:

  1. Create a bulleted list that outlines HIM COMPETENCY to effectively manage an HIE roll-out.
  2. Prepare a 2nd bulleted list and ADVOCATE for HIE – she wants to better understand the benefits for the patient, the healthcare facility and the northern region of your state.

You leave Ms. Clark’s office and locate the following AHIMA article, HIE Management and Operational Considerations (Updated) and use it to respond to the above issues presented by Ms. Clark above.

SCENE TWO: The following month, Ms. Clark notifies you that based on your input and experience, the HIM department will oversee the roll-out of an HIE. She congratulates you and then indicates that she is concerned on how patients will accept an HIE – she feels that an HIE will scare patients and make them feel that their PHI (protected health information) is at risk. She asks you to:

  1. Create a one page memo to use with patients and their families which will explain
    1. How we participate in a regional medical records-sharing HIE.
    2. Why we participate in a regional medical records-sharing HIE
    3. Indicate how a patient’s information may be used and disclosed for the HIE.
    4. Include specific benefits to the patient of our clinic sharing their private health information with other health care providers.
    5. Include information on the privacy and security protections that are pertinent.
    6. The memo must be easy to read, well organized and proofed. This is a professional communication tool that will be seen by all of LiveWell’s patients.

Be sure to responsibly use citations for research sources and make sure your submission is free of spelling and grammar errors. Your completed submission will include:

  • two bulleted lists (#1 and #2 above)
  • a memo for patients (#3 above)

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Learning Objectives

Determine what administrative information system is needed for a particular task.

Differentiate among the administrative information systems.

Differentiate between a decision support system and an executive information system.

Describe how administrative systems impact health information management practices.

Key Terms

Administrative information systems

Algorithm

Chargemaster

Clinical documentation improvement (CDI)

Decision support system (DSS)

Enterprise master patient index (EMPI)

Executive information system (EIS)

Facilities management systems

Financial information system

Hospital information system

Human resources information system (HRIS)

Master patient index (MPI)

Materials management system

Patient registration system

Practice management system

Registration-admission, discharge, transfer (R-ADT)

Revenue cycle

Revenue cycle management

Scheduling system

Soundex

Administrative information systems, which manage the business of healthcare, were the first information systems to be used in healthcare. The data collected in administrative information systems are mainly financial or business-oriented in nature, rather than clinical. The administrative information systems perform many tasks throughout healthcare organizations. Some administrative systems, such as the master patient index (MPI), are used by many departments and employees throughout the organization. Other administrative information systems, like the decision support system, are utilized only by a select group of authorized users. The hospital information system, the major information system used by a healthcare facility, is made up of many administrative systems, such as the financial information system and the MPI. The main administrative information systems are summarized in the following list. Each of these components will be discussed separately:

The financial information system monitors and controls the financial aspects of the healthcare facility.

The human resources information system (HRIS) tracks and manages all employees and other contracted personnel within the organization.

The decision support system (DSS) gathers data from a variety of sources to assist management and staff in decision-making tasks associated with the nonroutine and nonrepetitive problems.

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Administrative Information Systems

The master patient index (MPI) provides a permanent record of patients treated at the healthcare facility.

The patient registration system collects information on patients receiving treatment.

The scheduling system allows the facility to make efficient use of resources such as operating rooms.

The practice management system combines a number of applications required to manage a physician practice.

The materials management system manages the supplies and equipment within the facility.

The facilities management system allows physical plant operations to control the automated systems within the facility for patient safety and comfort—that is, heating and air systems, automated key control, and preventive maintenance tasks such as testing fire extinguishers, elevator inspections, and the care of various equipment used in the healthcare facility.

Financial Information System

The financial information system is critical to the fiscal health of the healthcare facility. The healthcare facility must receive accurate financial information in a timely manner to monitor and manage the finances of the healthcare facility. This information can be used to plan and control the expenses of the day-to-day operations, as well as long-term investments.

The management of the accounts receivable and the accounts payable on a daily basis by the healthcare facility is known as revenue cycle management. The revenue cycle is a very complex process involving several departments and many employees who perform tasks of reviewing services provided for claims submitted as well as reviewing outstanding claims, returned claims, denials, missing accounts, bill holds, and other claims involving the revenue of the healthcare facility. Many health information management (HIM) professionals are involved in working with the revenue cycle in their facilities and some work for vendors who specialize in the area of revenue cycle management and clean-up as a business.

Financial Information System Functionality

The financial information system includes functions related to:

Patient accounting

Accounts receivable

Accounts payable

General ledger

Investment management

Contract management

Payroll

Billing and claims management

The patient accounting module collects all of the charges related to patient care. Some charges, such as the patient’s room charge, are automatically generated, but others are created when nurses, respiratory therapists, and other staff enter charge information either through the financial information system or through a clinical information system that captures the information automatically and then shares it with the patient accounting system. These charges come from the chargemaster, shown in figure 7.1. A chargemaster is a financial management form or software that contains information about the healthcare facility’s charges for the services it provides to patients (also called a charge description master [CDM]). The chargemaster automates the coding process for routine procedures such as laboratory tests and radiology examinations. Attached to each of these codes is the charge associated with the service. This amount and other charges recorded are used to determine the amount of money charged to the patient’s account. For example, a healthcare facility may charge $100 for a chest x-ray. The information system then generates the bill and submits it to the third-party payer. The patient accounting system also generates the discharged not final billed report, which lists the patient accounts that have not been billed.

Financial Information System

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Figure 7.1. Example of a chargemaster

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Source: Pilato 2013.

Because the chargemaster has such an impact on the healthcare facility, periodic updates are required. The classification system codes must be updated annually; HIM professionals must ensure that their respective chargemaster updates are completed annually by the healthcare facility’s information systems (IS) department when the software updates are received. Otherwise, charges billed can mean a loss of revenue to the healthcare facility. Once the updates are performed on schedule, the healthcare facility is reimbursed the amount they are owed based on their particular geographic region of the country.

Accounts payable records what the healthcare facility owes to others. This amount may be a refund to a patient or an insurance company, or it may be payment to companies that provide supplies and equipment to the healthcare facility.

The general ledger records debits and credits to the various accounts managed by the financial information system. All of the financial transactions are recorded for the time frame. These transactions include receipt of payment, payroll, and disbursements.

Healthcare facilities invest their excess cash. The investment management features of the financial information system track the investment accounts and analyze the return on the investments. Changes to the investment portfolio can be made according to the findings.

Healthcare facilities sign many contracts, including those with software vendors, insurance companies, businesses that purchase healthcare services, and many other companies. The contract management portion of the financial information system can track particulars such as who the contract is with and expiration dates. The information that comes from the financial information system is used to negotiate managed care contracts and monitor the impact of the contract based on information such as the number of patients, amount of revenue, cost of care, and whether or not the facility is making money on the contract.

The last module of the financial information system to be discussed is the payroll functions. Payroll functions include tracking employees, salaries, taxes to be deducted, taxes to be paid, health insurance deductions, life insurance deductions, and direct deposits. The payroll functions would need to track salary increases and changes in deduction from one year to another.

The information is also used to generate financial reports that are needed by the healthcare facility’s management staff. The financial information also provides the balance sheet, statement of revenue and

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expense, cost reports, and illustrates cash flow. These financial reports can assist in the pricing of services rendered, control inventory, analyses of productivity of staff, and other purposes.

Impact on HIM

The coding professional staff will populate the diagnosis and procedure codes either through direct data entry or from an interface to an encoder. HIM and coding staff have always played an integral part in the financial viability of the healthcare facility. This is particularly true with the completed transition to International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and International Classification of Diseases, Tenth Revision, Procedure Coding System (ICD-10-PCS). Extensive and continuous training is required to maintain optimal skill in identifying the correct and appropriate diagnostic and procedural codes. With the massive increase in the number of codes due to increased specificity in ICD-10, coders must be thoroughly trained in anatomy and pathophysiology to assign the precise codes. However, codes can only be as accurate as the documentation allows. Clinical documentation improvement (CDI) is the process an organization undertakes that will improve clinical specificity and documentation that will allow coding professionals to assign more concise disease and procedural classification codes. The quality of this documentation is vital in order to properly evaluate patient care, meet all regulatory requirements, and obtain the appropriate amount of reimbursement. Because quality documentation, whether it be paper or electronic, is one of the cornerstones of the HIM profession, it is essential for the HIM and coding staff to be integral in all phases of CDI.

HIM professionals should also be involved in the development and management of the chargemaster. Services are added to and removed from the chargemaster as the services provided by the facility change. Both ICD-10 and current procedural terminology (CPT) classification codes are updated on a regular basis. These changes must be implemented and verified within the facility’s chargemaster. In addition, the monetary value associated with each code must also be confirmed. Upwards of 700 new, revised, and deleted codes have been implemented for the 2018 fiscal year (CMS 2017).

Analysis of chargemaster data can indicate changes in billing time frames, productivity of coding submissions, reimbursement denials, diagnoses, and procedures that are most resource-intensive or cost-effective. The analysis of the billing and coding information and reports will help both HIM and finance departments to conduct performance improvement activities to become more efficient.

Human Resources Information System

A healthcare facility requires many staff members in order to operate. Many healthcare facilities operate 24 hours a day, 7 days a week. Because of staffing requirements, payroll expenses make up a large part of the operating budget. This large outlay of cash demands strong management of the human resources department within the organization.

Functionality

The HRIS tracks employees within the organization. This tracking includes promotions, transfers, terminations, performance appraisal due dates, and absenteeism. The individual data elements collected include:

Employee name

Employee number

Department

Title

Salary

Benefit information

Hire date

Results of performance appraisal

Previous titles

Termination date

Certifications

Disciplinary actions

Eligibility for rehire

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These elements and other data are used to create a permanent record for the healthcare facility. This information is used to manage current staff and to verify that past employees worked at the healthcare facility. The HRIS data will track the benefits that an employee has selected, such as family healthcare plan, dental insurance, long-term disability insurance, and retirement. The HRIS will be able to track the utilization of staff by department, job title, or other grouping. The human resources staff would have access to the records of all employees, whereas the various department directors should have access only to those employees reporting to that director.

Department managers may use an automated timekeeping system for their employees when staff members clock in and out. This HRIS tracks the hours per week worked by pay period. Human resources and managers can then use the HRIS to determine sick time, vacation time, and benefit time per employee.

The HRIS can also assist with the hiring process. For example, the HRIS can track résumés and applications submitted by potential employees. The information system can compare the skills and education of the candidate with those of the other applicants, thus speeding up the hiring process.

Reporting is important in the HRIS. Reporting features can be used to track items such as turnover rate, open positions, labor costs, benefits, budget, or overtime. The healthcare facility may also track employee satisfaction and report on the findings of the surveys. Many facilities offer in-house educational opportunities to employees and attendance at these events is tracked within the HRIS software. These might include optional educational seminars to advance managers with training and development skills. Other workshops might include cardiopulmonary resuscitation (CPR) training classes for staff. The HRIS software may also track mandated classes for all employees that require annual attendance such as fire and safety classes, OSHA standards, privacy and security training, and so forth. Department directors can then easily use the reporting function to assess the attendance within their own departments as well as results of these educational classes by their employees annually.

Impact on HIM

HIM department staff do not use the HRIS; however, the HIM director may use HRIS to generate reports, perform queries, review applications, and perform other tasks related to the HIM department staff.

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1. Which part of an administrative information system would be able to identify which surgeries are most profitable for the healthcare facility?

a. Encoder

b. Decision support

c. Financial management

d. Practice management

2. Which information system assists the coding professional in selecting the appropriate code?

a. Encoder

b. Decision support

c. Chargemaster

d. Practice management

3. Which information system would be able to identify employee turnover rates in all departments within the healthcare facility?

a. Decision support

b. Revenue cycle

c. Human resources information system

d. Materials management

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4. Typically, a chargemaster is updated from software on a(n) ______________ basis.

a. Annual

b. Quarterly

c. Monthly

d. Weekly

5. Which classification system updates must be implemented and evaluated annually in a facility’s chargemaster?

a. ICD-10-CM

b. ICD-10-PCS

c. CPT

d. All of the above

Decision Support System

The DSS, as defined earlier, is an information system that gathers data from a variety of sources and assists in providing structure to the data by using various analytical models and visual tools in order to facilitate and improve the ultimate outcome in decision-making tasks associated with the nonroutine and nonrepetitive problems. It is also used to solve structured problems. This means that the DSS is not used to schedule staff, determine inventory levels, or perform other routine decisions, but rather to make decisions about whether to open a new women’s health center or a geriatric center. Other decisions that may be candidates for the DSS are whether or not to add new examination rooms in the emergency department or to open new operating rooms. To make these decisions, the DSS utilizes the data in the data repositories and data warehouses. The DSS uses models to run analyses such as “what if” to determine what would happen if certain decisions were made or to forecast the future. For example, the DSS would evaluate the profit or loss that would occur if a hospital added an extra patient room in the emergency department. It would take into consideration extra costs, extra patients, reduced wait times, extra staff, and more.

Executive Information System

The executive information system (EIS) is a type of decision support system that is designed to be used by healthcare administrators. As such, it must be easy to use and have access to a wide range of data. With the EIS, a lot of graphs and charts generally are used as part of the results. Advantages of the EIS include:

Improved competitiveness of the healthcare facility

Knowledge of the healthcare facility

Making information available to authorized users throughout the healthcare facility

Assistance in making strategic decisions about the healthcare facility

The EIS assists the administrator and other top administration staff in making quick decisions. To generate the data manually that the EIS generates with a few clicks of the mouse would take days.

A dashboard report gives administration-structured information to make intelligent decisions for the future. In this example, administration can view the dashboard report and see from the diagnostic-related groups (DRGs) and the length of stay (LOS) what the facility was actually reimbursed and what it actually cost the facility to treat the patient. The last columns give administration an idea of the profit that was expected versus the actual profit made. This type of report is useful to administration in planning for the future to make decisions.

Figure 7.2 shows an example of an EIS dashboard report. Administrators can view detailed data by types of graphs that are selected, depending on the software used. For this example, several bar charts and graphics are used. Administrators can easily view an EIS dashboard report and see the practice performance activity of the physician highlighted. In this case, performance is evaluated by identifying patient load, wait

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times for the patients, satisfaction survey results, and general patient demographic information. The same measures can be used to evaluate and compare all the other physicians listed across the top of the screen. Administrators must focus on the fluctuating monthly patient load and the differences in monthly wait times for various physicians. The data from this EIS planning tool is a visual representation to administration of where the problem is greatest and where the priority should be focused. The HIM department may or may not use the DSS depending on the type of DSS and the data stored within it.

Figure 7.2. EIS dashboard showing physician practice performance with bar charts

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Source: iDashboards n.d. Reprinted with permission.

Master Patient Index

The MPI is part of the hospital information system. It is a patient-identifying directory, referencing all patients related to a healthcare facility, that also serves as a link to the patient health record or information, facilitates patient identification, and assists in maintaining a longitudinal patient record from birth to death. The MPI identifies every patient who has been admitted to the healthcare facility, and it is the key to locating all patient health records. The MPI lists patient names and health record numbers and cross-references them. An MPI is to be kept permanently as mandated by legal statutes. The information contained within the MPI was originally limited to demographics that could readily distinguish between any two patients as not having the same health record. These data include both demographic data and visit-specific information. The demographic information will include data such as the patient name. The visit information will include items such as discharge date. The data contained in the MPI include:

Internal patient identification (that is, health record number)

Person name (legal name with given name, surname, initial, suffixes, and prefixes)

Date of birth

Gender

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Administrative Information Systems

Race

Ethnicity

Address

Telephone number (where patient can be reached)

Alias, previous, or maiden names

Social security number

Universal patient identifier (not yet established)

Account or visit number

Admission, encounter, or visit date

Discharge or departure date

Encounter or service type

Encounter or service location

Encounter primary physician

Patient disposition (Reynolds and Sharp 2016, 130)

Other data may be collected depending on the needs of the healthcare facility.

The person who collects the data in the MPI is frequently an admissions staff member who interviews the patient upon entering the facility at the time of the visit encounter. Once data are entered into the MPI, data are easily transferable into other screens and other information systems within the software for other users.

Functionality

Information about patients can generally be retrieved using many of the previously mentioned data elements. The most commonly used are patient name and health record number. The MPI usually has soundex capabilities, which allow the user to retrieve patients based on the sound of the name. Soundex is a phonetic-based indexing system that is easily incorporated into computer software for searching surnames that sound alike but are spelled differently. The soundex search is useful when there are multiple ways to spell a last name, such as Burger, Burgur, Berger, and Burgher.

There are times when a patient is issued one or more duplicate health record numbers. When the duplication is identified, the MPI must have the capability to combine these health records under one health record number and keep a record of the health record number eliminated. The MPI must also be able to address overlays. Overlays occur when two patients are assigned the same health record number because of the incorrect assumption that they were the same patient. Duplicate health record numbers and overlays cause problems with data quality and ultimately can create a quality of care risk because either the patient’s information is fragmented or two patients’ records are intertwined.

As mentioned earlier, the MPI is the data storehouse of patient information, which by legal statutes must be maintained permanently. The information stored in the MPI is also vital to the administrative functions of the healthcare facility’s database system. When a patient is admitted, discharged, or transferred, the registration—admission, discharge, transfer (R-ADT) application is updated with the demographic information and serves as the foundation for the MPI.

Enterprise Master Patient Index

Integrated delivery systems (IDSs) typically have an enterprise master patient index (EMPI), which provides access to multiple repositories of information from overlapping patient populations that are maintained in separate information systems and databases. An IDS is an organizational arrangement of a network of health providers that may include hospitals, physicians, and health maintenance organizations (HMOs) that provide coordinated services along the continuum of care from ambulatory, acute, and long-term care and may extend across a geographical region.

An EMPI allows all of the components of the IDS to share information about the patient. The health record number assigned may be the same for all hospitals, ambulatory settings, and other components of the healthcare system. There may also be an enterprise health record number, with each component issuing its own health record number to the patient. The EMPI would identify all patient visits to the IDS and the data stored would include the facility that the patient visited.

Patient Registration (Registration—Admission, Discharge, Transfer)

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Impact on HIM

The HIM department is a key user of the MPI. The HIM staff is responsible for the data quality of the MPI, so they perform the various tasks to maintain quality, such as combining duplicate health records and correcting overlays, along with other data quality issues. The HIM staff also uses the MPI to:

Look up health record numbers

Identify discharge dates

Confirm that the health record contains all patient visits

Look up when the patient was last seen in the healthcare facility

Merge duplicate health record numbers

Correct errors in data entry

Unmerge overlays when one patient’s record is overwritten by another patient record; these records must then be separated into their original files (Reynolds and Sharp 2016, 130)

Although this list of activities is not long, the amount of time HIM staff spend using the MPI is significant. For example, the release of information staff must look up the health record number on every authorization to release information that comes into the department. Depending on the number of requests, this could take hours.

An MPI can link to other databases within the facility and, as a result, duplicate health record numbers can easily be assigned by other departments such as admissions, clinics, and the emergency department. It is extremely important that the MPI be routinely maintained and updated for accuracy and data control.

Patient Registration (Registration—Admission, Discharge, Transfer)

Patient registration systems are frequently known as R-ADT. The R-ADT is defined as a type of administrative information system that stores demographic information and performs functionality related to registration, admission, discharge, and transfer of patients within the organization. The data collected include:

Basic demographic information such as name, address, and gender

Insurance information such as insurance company, policy number, and group number

Information about the stay such as the admission date, discharge date, and attending physician

Functionality

The information collected in the R-ADT is transferred to other information systems. This transfer of data ensures that the demographic information is consistent and prevents data from being entered over and over again. If a patient needs multiple tests or services performed on the same day, such as laboratory, physical therapy, and x-ray, the registration system should be able to schedule all of these tests with one phone call. The R-ADT system issues the health record number assignment to the patient folder.

Because the MPI and R-ADT systems are both parts of the hospital information system, sophisticated algorithms can be used to help prevent duplicate health record numbers when admitting a patient. Algorithms are relatively short computer programs of rules or procedures containing conditional logic for solving a problem or accomplishing a task. When the user enters a patient’s name and other identifying information into the R-ADT and there is a patient with the same or similar information, the R-ADT notifies the user. Essentially, the R-ADT asks the user if the patient being admitted is one of the patients listed. If so, duplication of the health record number can be avoided. Not only can algorithms identify exact matches based on name, social security number, and other identifying information, but they can also identify patients whose information is nearly identical, such as a patient whose social security number or date of birth is one digit off from an existing entry or whose last name has changed because of marriage or divorce since the last visit. Many MPIs utilize a ranking system to identify the amount of confidence that the MPI system has in the match. Exact information would receive the maximum score. A potential match with almost everything identical would be a high score but not a perfect score. A potential match with very little, if anything, matching will be a low score.

The R-ADT system generates some key reports used by many departments within the facility. These include the daily admission list, discharge list, census report, transfer list, and bed utilization reports. The facility may also generate monthly, quarterly, yearly, and ad hoc reports to show type of patient treated,

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number of discharges, number of admissions, occupancy rates, and other information needed. The R-ADT system may also print out routine documents, such as general consent form, notice of privacy practices acknowledgment, and advance directives that the patient needs to sign.

Impact on HIM

Although the HIM department does not generally register patients, the HIM department utilizes the reports that come from the R-ADT. For example, the discharge list is often used to confirm that all discharged health records arrive in the HIM department after discharge.

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1. Which of the following would not be done with an MPI system?

a. Merging duplicate health record numbers

b. Identifying discharge dates

c. Printing out patient general consent forms

d. Looking up health record numbers

2. What type of report would give administrators structured information in a variety of graphs to better plan facility operations?

a. EMPI

b. IDS

c. R-ADT

d. EIS Dashboard

3. Algorithms are used to match duplicate patients in which of the following information systems?

a. Decision support system

b. Executive information system

c. Master patient index

d. Enterprise master patient index

4. What type of information system would be beneficial when developing 10- and 20-year strategic plans for the healthcare facility?

a. Decision support system

b. Executive information system

c. Master patient index

d. Enterprise master patient index

5. What is an IDS?

a. A network of coordinated healthcare providers under the umbrella of a single HCO

b. A database of all patients who have received services at an HCO

c. A short computer program of rules and procedures to solve problems

d. A type of decision support used by executive management in an HCO

Scheduling System

Scheduling systems are used to control the use of resources throughout the healthcare facility. These resources can include staff, equipment, rooms, and more. Scheduling systems may be centralized or independent. Centralized scheduling allows the scheduling of all services of the healthcare facility so that one call can make multiple appointments. The decentralized system utilizes the scheduling features of individual systems in use in each department, so calls would have to be made to more than one location to schedule multiple tests.

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Functionality

Healthcare facilities need to keep expensive equipment and other resources generating revenue rather than allowing them to remain idle. The scheduling system can help with this by scheduling tests, beds, operating rooms, staff, and other resources wisely. For example, a subsystem of the main scheduler is used for scheduling surgeries. If Dr. Smith needs to perform an appendectomy on a patient, the scheduling system knows what operating rooms are available, how long the operating room will be needed, the staff required, and what equipment will be required. This scheduling of the patient and resources ensures that everything is available when needed, thus preventing unnecessary cancellation of surgeries.

To schedule a patient for admission, tests, or other services, the physician office may call the hospital or other healthcare facility to make the necessary reservations or the information system may be available for direct access by the healthcare provider.

In a typical appointment book scheduling system, a patient appointment can be made by the month and date by clicking on the month and date that is desired for the next appointment follow-up.

The patient’s name is then entered into the timeline of the hour that the appointment time is made. Physician offices use these types of appointment books for routine patient visits in their offices. Clinics and ambulatory surgical facilities may also use these software applications. In some cases, the patient is able to log in and schedule routine tests, such as an annual mammogram.

The scheduling system can assist with many management functions. The reporting capabilities of the scheduling system can track cancellations, resource utilization, patient volume, and other topics important to management. The reservations can also be used as part of the preadmission process to collect data such as insurance information and precertification.

Impact on HIM

The HIM department does not use the scheduling system.

Practice Management

Practice management systems are used by physician practices. Scheduling, patient accounting, patient collections, claims submission, appointment scheduling, human resources, and other functions all are built into this single information system.

Functionality

The practice management system may be fully functional information systems, or the physician practices can select from a variety of modules as needed by the practice.

The practice management system can automate prescription renewals and other routine tasks. The practice management system may also connect to administrative information systems at the healthcare facility. One of the major functions of the practice management system is billing. The practice management system will capture the necessary data, review the claim to determine if all the necessary data are available, and then submit the data either to the insurance company or to a healthcare clearinghouse. The practice management system is able to generate reports. Sample reports include number of patients, profit or loss, most common services, and much more.

Impact on HIM

The HIM professional who works in the physician office manager role will utilize the practice management information system in many of the same ways as the financial information system, master patient index, and other administrative systems. These tasks include chargemaster management, entering codes for billing, reporting, and tracking patient visits.

Materials Management System

Healthcare facilities must manage a large amount of equipment and supplies. The typical materials management system automates the:

Purchasing process

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Inventory control

Menu planning

Food service

Materials management personnel would work with the dietary or food service personnel to order and track various food stuffs and supplies for patients and staff. The materials management staff would work with clinical personnel to track and order bandages, blood pressure cuffs, thermometers, and other patient-centered resources.

Functionality

The materials management system can create requisitions, which use workflow in order to gain the necessary approvals for the purchases. Part of the process can be comparing the purchase to the budget to ensure that the necessary funds are available.

This functionality helps control costs in the healthcare facility. The materials management system can be set up to automatically order supplies and equipment based on predetermined thresholds for inventory supplies, allowing for just-in-time inventory controls. For example, if the healthcare facility wants to keep at least 200 suture kits in stock, the materials management system automatically triggers an order for suture kits with the preferred vendor when the inventory drops to 250 suture kits. The materials management system can notify the financial information system when the supplies arrive so that the vendor can be paid, thus increasing the efficiency of the healthcare facility.

The materials management system can generate bar codes to be applied toward supplies to be used and charged to the patient correctly. The use of materials management systems include cost savings through improved efficiencies, better knowledge of the supplies in stock, reductions in the amount of supplies retained in inventory, and reduced lost charges.

The dietary component of the materials management system tracks the patient’s dietary needs, the healthcare facility’s food inventory, and food costs. A number of menus can be entered into the information system from which the dietary management and dietitians can work. The materials management system should have a variety of menus available from which to choose.

Impact on HIM

The HIM department is not a frequent user of the materials management system. However, purchase requisitions may be used to order office supplies and other supplies for the HIM departments. This is dependent on the setup of the materials management and ordering system of each healthcare facility.

Facilities Management

The physical plant will require maintenance and upgrades over the years. The physical plant refers to the building structure, surrounding grounds, parking lots or decks, and various building equipment such as elevators. A facilities management system is used by a healthcare facility to manage the physical plant. A facilities management system will track routine maintenance such as elevator inspections, fire extinguisher inspections, and equipment preventive maintenance. Preventive maintenance will enable the equipment to last longer, so tasks such as filter changes, inspection of electrical cables, and other tasks will save the healthcare facility money. The facilities management system will track the preventive maintenance tasks and other inspections that can be used in risk management investigations as well as inspections from outside sources, such as accreditation and state licensing. With the focus by the Joint Commission on patient safety, the physical plant is focused on providing equipment and a healthcare environment that is vital to the well-being of the guests, staff, and ultimately the patients within the healthcare facility.

Functionality

The facilities management software can control various features of the healthcare facility, such as the thermostat, automatic locks, and key cards. For example, the temperature provided by the air conditioner and heating systems can be controlled, making the healthcare facility more energy efficient. Doors can be locked and unlocked automatically at a prescheduled time, and employees can be given access to or denied access to restricted areas.

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Facilities management software can also track preventive management tasks, such as testing fire extinguishers, elevator inspections, and the care of various equipment used in the healthcare facility. It keeps track of when repairs and maintenance are performed, such as when a roof was put on a building or when filters are changed in the air conditioning system.

From time to time, major renovations or new construction is necessary. The facilities management system can track and plan the project through the use of project management tools such as project evaluation and review technique (PERT) charts and Gantt charts (refer to chapter 4).

Impact on HIM

The HIM department is not a direct user of the facility management information system. Indirectly, the HIM department may use key cards for entry into locked areas or doorways or use the automated HVAC (heating, ventilation, and air conditioning) system from the physical plant. The HVAC system is set by the physical plant staff, usually in zones for larger buildings, to run at set temperatures during various seasons to make operating costs of heating and cooling more economical.

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1. Which of the following information systems would coordinate the schedules of five physicians and seven nurse practitioners based upon the needs of the patients within an internal medicine group practice?

a. Materials management

b. Practice management

c. Facilities management

d. Scheduling

2. Routine reports, such as number of admissions and discharges per month or per year, are generated by which information system?

a. Materials management

b. Registration

c. Facilities management

d. Scheduling

3. The scheduling system knows which of the following ______________.

a. Amount of time needed to perform colonoscopy

b. Physicians who are up for reappointment to the medical staff

c. Census report

d. The latest version of the notice of privacy practice

4. The area most closely aligned with meeting the Joint Commission’s focus on patient safety would be ______________.

a. Facilities management

b. Practice management

c. Registration

d. Scheduling

5. Which information system typically assigns the patient’s health record number to the patient?

a. Scheduling

b. Materials management

c. Facilities management

d. Registration

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Administrative Information Systems

Real-World Case

The cardiology department of Smithville Community Hospital wants to expand the cardiovascular lab to include additional procedure rooms and equipment. Several cardiologists have mentioned that there seems to be an increase in the number of patients and number of cardiac procedures performed. The hospital CIO was asked to evaluate the request and provide an initial report to the Board of Directors. The CIO worked with the VP of clinical operations to write the report. Using the physician and procedure indices within EHR, the CIO and VP completed a 10-year historical analysis of all cardiac patients and procedures. They identified inpatient and outpatient procedures, documented the number of outpatients who were also cardiac inpatients at some point, and reviewed wait times for scheduling of procedures. Four years of historical data was available in the current EHR for wait-time analysis. The previous system was not able to track wait times for scheduling.

The CIO and VP identified financial data, including cost analysis of each procedure, how reimbursement of procedure varied by type of insurance, average length of stay (if inpatient), profit margins of each procedure, and MS-DRG analysis performed on inpatient cases. They performed physician profiles to identify which and how many procedures were performed by each cardiologist. Using external data provided by the city government and local economic development council, the CIO and VP made population projections for the next 20 years and found an increase in the local population of the over-50 age group. They generated anticipated cardiac services and procedures using predictive statistical modeling.

Based on the information the CIO and VP collected, they projected how many additional staff members and physicians might be needed and made space allocations for the increased number of procedure rooms. They are currently investigating the cost of additional equipment needed and completing a renovation budget and timeline. They expect to present their findings to the board by the end of the first quarter, and a final decision should be reached by the end of July.

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1. What term is used to describe the process of submitting claims for reimbursement, denials, billing matters, accounting, and any other issues or follow-up on claims?

a. Deterministic algorithm

b. Revenue cycle

c. R-ADT

d. Chargemaster

2. What is the name of the financial management software that contains information about the healthcare facility’s charges for the services it provides to patients?

a. Deterministic algorithm

b. Revenue cycle

c. R-ADT

d. Chargemaster

3. The HRIS would track which of the following?

a. Employee certification status

b. Reimbursements received from CMS

c. Inventory supplies

d. R-ADT

4. Which information system can the HIM director use to determine salaries, assist in hiring new staff, evaluate turnover rates, and track training sessions?

a. Practice management

b. Materials management

c. Facilities management

d. Human resources

Real-World Case

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5. Dr. Smith treats highly unusual medical cases requiring many laboratory, radiology, and other diagnostic tests. Hospital administration wants to determine if additional facilities, personnel, and equipment are needed to meet current and future community demands. Which information system would be helpful in this scenario?

a. DSS

b. R-ADT

c. HRIS

d. EIS

6. Every October, the CEO and other members of the upper administrative staff have strategic planning meetings to address the upcoming year’s goals and objectives. What information system would assist them in this process?

a. DSS

b. R-ADT

c. HRIS

d. EIS

7. During a disaster, which information system would help track the patients’ movements through the hospital as they go through triage, surgery, intensive care unit (ICU), regular patient care floor, and finally discharge to a rehabilitation facility?

a. DSS

b. R-ADT

c. HRIS

d. EIS

8. Which information system is the gateway into a healthcare facility to identify if a patient has been treated there, contains demographic information to confirm patient identity, and shows if the patient has been treated at other facilities within an IDS?

a. EMPI

b. EIS

c. HRIS

d. R-ADT

9. If the CFO wanted to evaluate the supply shipping schedule, storage costs for supplies and equipment, timeframes for ordering supplies, and the distribution of equipment and supplies to the correct departments, which information system would facilitate this process?

a. Materials management

b. Practice management

c. Facilities management

d. EIS

10. If the medical office manager wanted to compare the amount of time it takes for a patient to be seen by a physician versus a nurse practitioner, which information system would be helpful in this analysis?

a. Materials management

b. Practice management

c. Facilities management

d. EIS

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Administrative Information Systems

References

Centers for Medicare and Medicaid Services (CMS). 2017. 2018 ICD-10 CM and GEMs. https://www.cms.gov/Medicare/Coding/ICD10/2018-ICD-10-CM-and-GEMs.html.

iDashboards. n.d. Healthcare—Doctor’s Scorecard. Accessed February 10, 2018. https://www.idashboards.com/dashboard-examples/healthcare-dashboards-doctors-scorecard/.

Reynolds, R. B. and M. Sharp. 2016. Health Record Content and Documentation. Chapter 4 in Health Information Management: Concepts, Principles, and Practice, 5th ed. Edited by P. Oachs and A. Watters. Chicago: AHIMA.

Pilato, J. 2013. Charging vs. coding: Untangling the relationship for ICD-10. Journal of AHIMA 84(2): 58–60. http://library.ahima.org/doc?oid=106071#.Wn271KinFRY.

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