Ambulatory Care Systems Ambulatory Care  as a response to increasing costs of providing health care, the healthcare industry has

moved away from the expensive in patient acute care environment to caring for clients in various ambulatory care settings. Covers a wide range of health care services that are provided for patients who are not admitted overnight to a hospital. These services are performed at:  outpatient clinics  urgent care centers  emergency rooms  ambulatory or same-day surgery centers  diagnostic and imaging centers  primary care centers  community health centers  occupational health centers  mental health clinics Financial Benefit(s):  Cost effective and timely bill submission process  decreased days in accounts receivable and the reduction of rejected claims.        Administrative Benefits: Reduction in the size of the record room Reduced to time spent finding and delivering charts Increase in the privacy of data Formats that are legible and comply with legal regulations Promotion of quality assurance and improved patient satisfaction. Administrative Benefits:

  

Ability for home access by physicians and nurse practitioners Alerts for incomplete data Integration of clinical data.

Clinical Benefits:  Provides automated:  Problem list  automated ambulatory care provider order entry(ACPOE)  a medication record  vital signs  progress notes  results from the laboratory and radiology dept  Clinical Benefits:  Provides automated:  Profiles  alerts and reminders  a follow-up system  flow sheets  growth charts  immunization records  medication allergies Patient Master Index:  A central repository for patient/member across the enterprise including sophisticated tools for querying, updating and managing the index Basis for collection of all patient-related data

Regular Requirements:  systems must support the resource based relative value scale (RBVS) and the relative value unit(RVU). The Health Care Portability and Accountability Act of 1996 requires code sets.

Code sets:  Current Procedural Terminology(CPT), 4th ed.   describe medical procedures performed by the physicians and other health providers.

The 9th Revision of the International Classification of Diseases (ICD-9-CM)  Designed for the classification of morbidity and mortality information for statistical purposes, for indexing of hospital records by disease and operations, and for data storage and retrieval.

The Healthcare Common Procedure Coding System (HCPCS)  a collection codes that represents procedures , supplies, products, and services w/c may be provided to medicare beneficiaries and to individual enrolled in private health insurance programs.

The National Drug Code (NDC) managed by FDA  identifies pharmaceuticals in details including the packaging. Its use is required by the FDA for reporting and it is used in many healthcare information systems to aid in reimbursement.

 Health Plan Employer Data and Information Set(HEDIS)  is a standardized, comprehensive set of indicators used to measure the performance of a health plan

Outcome and Assessment Information Sheet(OASIS)  a data set for use in home health agencies and is an initiative from the health care financing administration.

The Role of the nurse using informatics in the Ambulatory arena  user of the data contained in automated systems   to take the data and put it together in meaningfulways, making information

nurse may be involved in the selection of automated systems

the ambulatory nurse can be instrumental in the implementation of an automated system whether administrative, financial or clinical

Ambulatory Care Information System  Provides automated processing of  data and information such as allergies medical alerts  patients accounting system such as charging billing discounts and concessions diagnostics imaging treatments  It involves one-time registration required per visit. It also facilitates the management of doctors schedule.

Advantages:   Real-time and easy access to patient s medical records by healthcare providers. Improved workflow  allows more time for comprehensive patient counseling and review.  Reduced errors with the availability of various automation engines drug interaction engine; medical alert engine; patient billing engine, etc. Automated and integrated back-end process such as pharmacy, billing, purchasing, inventory management, etc. Improved clinical outcome analysis Better monitoring and management of costs Improvement in hospital inventory management.

  

Issues in Ambulatory Care Information System  Increased accountability

   

The need for continuous support Privacy and confidentiality of information Accessibility and security of data and information Integration and support to the other system