Week 13....

tick....tick.....week 13 already! It is getting closer!!
This week we were sent to check out a website: http://www.isabelhealthcare.com/home/default

This website was a great thing to discover! I could see it be a great asset to a healthcare provider. this site has information to help make a diagnosis by entering in information about symptoms. There is no way a physician can remember every single diagnosis there is....especially with new diagnoses popping up continuously.

The thing I liked the most about this website is the symptom checker tool. This can be used by anyone. It is free and available, but you have to know it exists. I typed in some symptoms to see what would pop up so I typed in some symptoms my husband had....symptoms that had nothing to do with his GERD, but symptoms that were there when we went to the ED. The physicians came back to GERD both times....so I thought I would play and was floored when one of the possible diagnosis had something to do with the esophagus! This a a wonderful TOOL to use to check on what your doctor has already told you....sort of like a second opinion. This is not something to rely on, because going to the doctor is of utmost importance if you are ill. However, if you are not comfortable with the diagnosis you get, you can use this tool and maybe ask for a second opinion.

Health care fraud and abuse....wow. This happens so much more than I think any of us really know. This can be done by upcoding, unbundling, or outright identity theft. Any of these acts are illegal and can result in legal action if and when caught. Upcoding is done when something else is coded that will bring in a higher dollar amount for the provider. Unbundling is done when something is included in a procedure, but is charged as a separate code and billed separately. And identity theft can be done by using another doctors credentials for billing, or for a patient to say they are someone else to get medical care if they are uninsured.

Any of these acts are costly for the payers as they are paying more than they should.  It is like a snowball that is rolling downhill and sooner or later that escalated cost they are paying out will end up hurting the little guy by raising they out of pocket payments or monthly insurance premiums. There is nothing good that will ever come out of being dishonest in any situation.

The last topic for the week we discussed was knowledge. I didn't realize there were so many types of knowledge!

• Internal knowledge is knowledge that comes from within a person brain. It is knowledge we have within ourselves like how to get in our car and drive to the store and back.
• External knowledge is that which comes from outside our brain. As the example of driving to the store and back I gave above, external knowledge would require us to turn on a GPS to get from place to place….to someplace we have never been and do not have the internal knowledge to just drive there and back.
• Coded knowledge is a written step by step procedure to follow to complete a task. This type of knowledge is documented.
• Tacit knowledge is the knowledge an individual person has within themselves to complete a task. This is not written down anyplace; it is individual and needs no guidance to complete tasks at hand. A person with tacit knowledge may not even be able to write down steps to complete a task, they just do it.
• Active knowledge is knowledge that is actively used to do a job, as a nurse would do.
• Passive knowledge is a type that the person with the knowledge does not actually use what they know to complete tasks, but passes their knowledge on to others to use to complete tasks.
• Transmitted knowledge is taught or read, as we are all getting transmitted knowledge through our educational experiences.
• Experiential knowledge is learned through experience, or by doing tasks and learning from those tasks.
• Declarative knowledge is the properties between concepts. It is an expressed knowledge, like stated in a sentence.
• Procedural knowledge is a “how to” type of knowledge. The example given in our lecture was perfect; a recipe is a procedure that has to be followed in a certain order to bake something.

All types of knowledge are needed to make a facility a well-rounded facility. You need the people who "just know" things, the people who can follow step by step directions, the people who can write down those directions, and the people who have learned things through education or other means and can just do their tasks without asking or looking things up. 

Week 12....

Risk management is a very important topic. Risk management involves high quality patient care while having a safe environment for patients, employees, and visitors. Risk management also can minimize financial loss by reducing the chances of injuries through prevention.
Most places will have a risk management team that they may refer to as a safety team, a loss prevention team, or claims management. Call them what you want, they all do the same thing by trying to make the facility as safe a place as possible to reduce, or tyring to eliminate, accidents to prevent people from getting hurt and bringing suite against the facility by legal action. Although there are teams for risk management, it is every person job to reduce risk. This can be done as easily as picking up a piece of paper on the floor so no one slips on it, or calling someone to clean up a spill (which I do at Wal-Mart). I do not want to see someone get hurt by something I could have prevented so it is important for everyone to take a moment and think of someone else if they see something that could cause injury to someone else. This does not mean you need to shovel or throw salt down on a sidewalk if you slip, but let someone in the facility know so they can call someone to do it....it is that simple.

Week 11....

I will begin this weeks topics by chatting about accreditation, licensure, and standards.

Accreditation is actually a voluntary act performed by facilities to meet a certain set of standards. Once these standards are met, the facility is accredited by an independent accrediting agency, such as TJC (The Joint Commission) which is a common accrediting agency for healthcare facilities.

Getting licensed is usually achieved on a state or county level. This means the facility has reached a certain legal or formal permission to perform certain duties by meeting standards that are set by the entity that would grant them a license.

Standards are something in-house a facility would have to make sure the staff is performing their duties to a certain level of care. Employees know what those standards are by knowing the policies and procedures the facility has in place.

Anyone in the HIM department must abide by strict policies and procedures for the facility. I never realized how strict some of these policies were until we visited St. Rita's in Lima, OH. the HIM Manager, Lisa, told us that is the physician does not complete their record in a certain period of time, they will no longer be able to schedule surgeries, see patients, and will not be able to perform other duties within the facility until they are in compliance. This shocked me. I thought they would get to it when they get to it if it was not completed prior to the HIM department receiving the documents. I found out otherwise very quickly....physicians are help to a very strict time frame in order to stay compliant so the records can be completed and sent to billing in a timely manner.

In HIT 2000 we discussed mandated reporting in Ohio. There are also very strict guidelines for mandated reporting of various situations: WHO must report, WHEN (time frame) they must report, TO WHOM they must report, and the situation involved that must be reported.
This is what I came across while researching mandated reporting:

• Health care providers must include the following information upon reporting:
  

  • Name of patient
  • Diagnoses or suspected diagnoses
  • Date of birth
  • Sex
  • Telephone number of pt.
  • Street address, city, state and zip
  • Supplemental surveillance information
  • Health care provider name, telephone number, and street address with city, state, and zip code

  A laboratorian must report the following information:
  

  • Name of pt.
  • Date of birth of pt.
  • Sex of pt.
  • Street address of pt. with city, state, and zip code
  • Laboratory test information
    • Specimen identification number
    • Specimen collection date
    • Specimen type
    • Test name
    • Test result
    • Organism and serotype, as applicable
    • Health care provider name, telephone number and street address with city, state, and zip code.

  A report must be made for a class A disease-disease of major public health concerns because of severity or potential for an epidemic (includes anthrax, diphtheria, smallpox, and SARS)-must be reported immediately by phone; class B1 disease-diseases of a public health concern that could potentially become an epidemic (includes malaria, meningitis, west Nile virus, and hepatitis A)-must be reported by the end of next business day; class B2 disease-diseases of significant public health concern (includes chlamydia, gonococcal infections, hepatitis C, and typhus fever)-must be reported by the end of the business week; and class C disease-outbreaks, unusual incidences, or epidemic (includes pediculosis, scabies, histoplasmosis, and staphylococcal infections)-must be reported by the end of the next business day.
  
  
  

  • 
    http://www.odh.ohio.gov/pdf/idcm/intro1.pdf.
    
    
    

The implementation of EHRs have  greatly increased the workflow within facilities. Prior to EHRs, everything had to be done be hand. Charts were all written out by hand and put into files one paper at a time after they papers were punched so they could be affixed in the files. Not only the documentation aspect, but charts had to be pulled for patients, and re-filed after the patient care was completed. This all took a great deal of time.....which cost a great deal of money. EHRs are instant once signed onto a computer and the patient records are requested. No more running to records or anyplace else to get files. Not to mention the completeness of EHRs. When lab tests are done, the results are there in the record immediately upon completion.
With EHRs nurses document on a computer which goes directly into the patients healthcare record. Nurses used to sit at the end of their shifts and catch up on all the paper work and files that needed completed. EHRs also save space as paper records took up a great deal of space within facilities.

Week 10....

Ok, finally past the halfway mark on the semester. I really didn't think switching from quarters to semesters was going to be that much of a difference, but it really is. It just seems to be dragging out forever with the semester. But....we are over halfway done now and I am sure the end of the quarter will actually get here to quickly for me because then I have finals and the course projects due and all that good stuff...lol.

During week 10 we discussed things such as  CAC and NLP. CAC, or computer-aided coding, is an asset in many different areas. It will help the physician with selecting a proper code by the use of drop down boxes or touch screen terminals. NLP, or natural language processing, is a type of CAC. When using NLP, it enables the program to pick words our and match codes up to the infromation that is being typed in. This could help in many ways. A coder would have to physically scan the document and try to pick out the words needed to code for the documetn. By doing this, a coder has to read the entire document which is time consuming and costly since it takes more time. It would be much easier to have a program read the data input and pick out "key" words and suggest codes. The coder would then review the codes selected by the software and verify everything before sending on to the billing department.

We also discussed why patient safety is so important. I think that is pretty obvious, but to some it may not be. Patients go into a facility to be taken care of, not to be injured and catch some illness they didn't have when being admitted. They is more that goes into patient safety than just taking care of the patient. It also involves cleaning rooms, bathrooms, counters, floors, beds, and very importantly the health care workers hands.

Julie listed this in one of her replies and it is definitely worth sharing and repeating:

• 1. Hand hygiene – wash your hands!
  2. Safe surgery checklists – these are often met with resistance by healthcare staff because they feel the information is already listed in the patients’ charts.
  3. Patient selection criteria – choosing the appropriate surgery center to prevent transfers.
  4. Surface disinfectant – areas that are not visibly soiled are often overlooked.
  5. Wrong-site procedures – the prevention of wrong-site procedures needs to be improved, according to the source.
  6. Dependence on safety tools – staff often forget to think outside of the box.
  7. Burns - from electrosurgical equipment, defibrillators, etc.
  8. Distractions in the operating room – physicians answer phone calls, watch movies, do not participate in “time-outs”.
  9. Housekeeping – staff are not trained on how to properly clean
  10. Properly trained staff – unqualified and untrained staff members

  10 top patient safety issues in 2012. (2011, December 19). Retrieved October 28, 2012, from http://www.beckersasc.com/asc-accreditation-and-patient-safety/10-top-patient-safety-issues-in-2012.html.

The other topic we discussed for this week was social media usage in healthcare. Although I could see some benefits to social media in healthcare, such as pharmaceutical companies sharing new drugs they have released for certain conditions, a doctor really could not use this due to all of the HIPAA laws and the potential for violation of these privacy laws. They also could not really discuss ailments in general as people could take it to heart, maybe not go to the doctor, becaome very ill, then try to come back on the doctor that may have posted something on Facebook or Twitter.