AMBULATORY CARE SYSTEM

HISTORY
April 27, 2004, President George W. Bush establishes ELECTRONIC HEALTH RECORDS (EHRS). This is to develop a nationwide interoperable health information technology infrastructure. July 2004, Tommy G. Thompson then Health and Human Services Secretary announced the Decade of Healthcare Information Technology

GOALS

GOALS

Inform Clinical Practice

Bringing information tools to the point of care, especially by investing in EZHR system in physician offices and hospitals.

GOALS
Interconnect Clinicians
building an interoperable health information infrastructure, so that records follow the patient and clinicians have access to critical health care information when treatment decisions are being made.

GOALS..
using health information technology to give consumers more access and involvement in health decisions.

Personalized Care

GOALS..
expanding capacity for public health monitoring, quality-ofcare measures, bringing research advances more Improve population quickly into medical Health practice.

ORGANIZATIONS UNDER AMBULATORY HEALTHCARE

ORGANIZATIONS UNDER AMBULATORY HEALTHCARE

Ambulatory clinics and surgery centers Single and multispecialty group practices Diagnostic laboratories Health maintenance organization Independent physician organization Birthing centers College and university health services

OTHER ORGANIZATIONS THAT SERVE AMBULATORY POPULATION

Faculty medical practices Community health centers Prison health centers Hospital-sponsored ambulatory health services Urgent and immediate care centers Office-based surgery centers Groups of ambulatory care organization

OTHER ORGANIZATIONS THAT SERVE AMBULATORY POPULATION

Specialty providers such as:
Birthing centers Cardiac catheterization centers Imaging centers Dental clinics Dialysis centers Endoscopy centers Infusion therapy services Laser centers

OTHER ORGANIZATIONS THAT SERVE AMBULATORY POPULATION

Specialty providers such as:
Lithotripsy services MRI centers Ophthalmology practices Oral and maxillofacial surgery centers Pain management center Plastic surgery centers Pediatric clinics

OTHER ORGANIZATIONS THAT SERVE AMBULATORY POPULATION

Specialty providers such as:
Radiation/oncology clinics Rehabilitation centers Sleep centers Urgent/emergency care centers Womens health centers

ISSUES FOR AMBULATORY CARE

ISSUES FOR AMBULATORY CARE

Increase accountability Need for continuous and documented service improvements Pressure to control utilization Protection of confidential information

MAJOR APPLICATIONS NECESSARY IN THE AMBULATORY ENVIRONMENT

MAJOR APPLICATIONS NECESSARY IN THE AMBULATORY ENVIRONMENT

Registration Billing Accounts receivable Accounts payable Patient and staff scheduling Managed care functionality Automated clinical application

FINANCIAL BENEFITS OF AUTOMATED INFORMATION SYSTEM

FINANCIAL BENEFITS OF AUTOMATED INFORMATION SYSTEM

Cost effective and timely bill submission decreases days in accounts receivable and the reduction of rejected claims. Larger ambulatory care organization use Electronic Data interchange (EDI) to automate the exchange of data between providers and payors such as claims, submittals and remittances, health plan eligibility information.

FINANCIAL BENEFITS OF AUTOMATED INFORMATION SYSTEM

Some organizations provide integrated credit card payment applications for credit card payments.

ADMINISTRATIVE BENEFITS FOR AUTOMATED INFORMATION SYSTEM

Reduction in the size of the record room Reduced time spent finding and delivering charts Increase in the privacy of a data Formats that are legible and comply with legal regulations Promotion of quality assurance and improved patient satisfaction

ADDITIONAL BENEFITS FOR AMBULATORY CARE RECORDS

Ability for home access by physicians and nurse practitioner Alerts for incomplete data Integration of clinical data Patient scheduling system must link existing scheduling systems so that scheduled activities are coordinated across locations to schedule appointment times, providers, resources and location throughout the hospital or organization.

ADDITIONAL BENEFITS FOR AMBULATORY CARE RECORDS

The automated system can also enhance lookup and maintenance of credentialing physicians and nurse practitioners in order to provide service.

CLINICAL BENEFITS OF AUTOMATED HEALTHCARE RECORDS

Problem list Automated Ambulatory Care Provider Order Entry (ACPOE) Medication record Vital signs Progress notes Flow sheets Growth charts Immunization records Medication allergies Profile Alerts and reminders And follow up system

OTHER APPLICATIONS:
Clinical decision support system E-prescribing Evidence-based medicine In AHR, there is a patient master index which is the basis for collection of all patient-related data. It is integrated into an eEnterprise wide index Master patient index Medical record location can be tracked automatically with an automated system

REGULATORY REQUIREMENT
Systems must support the Resource Based Relative Value Scale (RBRVS) and the Relative Value Unit (RVU) RBRVS procedure fee pricing is a model designed by Department of Health and Human Services (DHHS). In this system, each physicians current procedural terminology (CPT) code has a relative value associated with it. The payor will pay the physician on the basis of a monetary multiplier for the RVS value.

REGULATORY REQUIREMENT
The Health Care Portability and Accountability Act of 1996 require six code sets. The database must be maintained of all the current coding schemes. These include: Current Procedural Terminology, 4th (CPT) describes medical procedures performed by physicians and other health providers.

REGULATORY REQUIREMENT
Ninth revision of the International Classification of Diseases (ICD-9-CM) it is designed for the classification of morbidity and mortality information for statistical purposes, for the indexing of hospital records by disease and operations, and for data storage and retrieval.

REGULATORY REQUIREMENT
It also determine diagnosis-related group (DRG) that control reimbursement by Centers for Medicare and Medicaid services (CMS) programs and most other payors

REGULATORY REQUIREMENT
Healthcare Common Procedure Coding System (HCPCS) collection of codes that represents procedures, supplies, products, and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. The codes are programmed to promote uniform reporting and statistical data collection of medical procedures, supplies, products and services.

REGULATORY REQUIREMENT
National Drug Code (NDC) identifies pharmaceuticals in detail including packaging. It is required by the FDA for reporting and it is used in many healthcare information systems to aid in reimbursement. Code of Dental Procedures and Nomenclature

 Medicares Ambulatory Payment Classification (APC) is a prospective payment system for hospital out-patient services. It is mandated by Congress as part of the Balanced Budget Act of 1997.

OTHER FEDERAL, STATE AND LOCAL REGULATIONS

Centers for Medicare and Medicaid Services (CMS) Health Plan Employer Data and Information Sets (HEDIS) Outcome and Assessment Information Set (OASIS)

THE ROLE OF THE NURSE USING INFORMATICS CONCEPT IN THE AMBULATORY ARENA
The nurse is the user of data contained in automated systems. May be involved in the selection of an automated system based on a needs assessment of the environment May be instrumental in the implementation of an automated system whether the emphasis be administration, financial, or clinical.

THE ROLE OF THE NURSE USING INFORMATICS CONCEPT IN THE AMBULATORY ARENA
Note: all nurses must be mindful of the impact of the information system on the confidentiality and security of information

THANK YOU!
EN D OF PR ESEN T AT I ON