comp6 unit9a lecture slides

Health Management Information Systems

Administrative, Billing, and Financial Systems

Lecture aThis material Comp6_Unit9a was developed by Duke University, funded by the Department of Health and Human Services,

Office of the National Coordinator for Health Information Technology under Award Number IU24OC000024.


Learning Objectives

1. Explain applications that need to be integrated in health care information systems (Lecture a)

2. Describe the strategies used by health care organizations to ensure integration of functions (Lecture a)

3. Discuss the critical elements needed to integrate billing, financial, and clinical systems (Lecture a)

2Health IT Workforce Curriculum Version 3.0/Spring 2012

Health Management Information Systems Administrative, Billing, and Financial Systems

Lecture a


Learning Objectives

4. Discuss the core elements of a Master Patient Index (MPI) (Lecture b)

5. Describe current trends to establish a Unique Patient Identifier (UPI) (Lecture b)



Lecture a

Information System• Automated system

– Computer hardware and software• Receives data• Processes data• Outputs data

– Supports the functions of the organization


Health Management Information Systems

Administrative, Billing, and Financial SystemsLecture a

HCIS Components

• Patient management and billing• Department management• Care delivery and clinical documentation• Clinical decision support • Financial and resource management



Lecture a

Patient Management and Billing• Systems that support the management of the patient

– Example Patient identification

– Supporting technology Master patient index

▪ Patient-identifying directory▪ Links to the patient record▪ Facilitates patient identification▪ Assists in maintaining a longitudinal patient record



Lecture a

Admission-Discharge-Transfer (ADT)

“The name given to software systems used in healthcare facilities that register and track patients from admission through discharge including transfers; usually interfaced with other systems used throughout a facility such as an electronic health record or lab information system.” (AHIMA, 2012)



Lecture a

Financial and Resource Management

• Systems that support business functions– Example

• Accounts Payable System– Supporting technology

• Claims administration• Houses financial and employee data



Lecture a

Practice Management

• Practice management system (PMS)– Combination of financial and administrative

functions– Patient appointment, scheduling, registration,

billing, and payroll functions• PMS and electronic medical records integration



Lecture a

Integration

Arrangement of an organization’s information systems

• Efficient and effective communication• Bring together related parts into a single

system



Lecture a

Application Integration

• Patient management and billing– Patient tracking

• Department management– Electronic document management

• Care delivery and clinical documentation– Order entry and results reporting



Lecture a

Application Integration

• Clinical decision support– Computerized provider order entry

• Financial and resource management– Patient profiling



Lecture a

Systems Integration Strategies

• Data preservation• Separate information management plan

components for– Data management– Applications and business logic– User interface



Lecture a

Key Components of Enterprise Integration

• Master person index• Single sign-on with context management• Data warehouse



Lecture a

Key Components of Enterprise Integration

• Standards– Structure and content

• Identifier – Vocabulary

• SNOMED CT– Content exchange

• HL7 Clinical Document Architecture– Privacy and security

• NIST encryption algorithm



Lecture a

Standards for Certification of EHR Technology

• Content exchange standards– NCPDP SCRIPT Standard – HL7 Clinical Document Architecture (CDA), CCD

• Vocabulary standards– SNOMED CT– LOINC

• Privacy and security standards– NIST encryption algorithm– NIST hashing algorithm



Lecture a

Critical Integration Elements

• Information is available when and where it is needed

• Users must have an integrated view • Data must have a consistent interpretation• Adequate security must be in place



Lecture a

Data and Process Integration

• Data integration– Interface engine

• Process integration– Operational workflow– Human organizational systems



Lecture a

Interface Engine

• Translates functions from different systems and protocols

• Outcome is a common format• Facilitates information sharing• Controls data flow between applications• Central connecting point for all interfaces



Lecture a

HL7 Messaging Standard

Health Level Seven (HL7)• Content exchange (messaging)

standard• Supports clinical practice• Move data in standard formats



Lecture a

System Integration Example

• Revenue cycle– Administrative functions– Clinical functions

• Revenue cycle management



Lecture a

From Islands of Information to Meaningful Use

(Agosta, 2010)Image courtesy of Dr. Agosta



Lecture a

Business Intelligence Applications

Allow for • Data analysis• Correlation• Trending• Reporting of data across multiple sources



Lecture a

Business Intelligence Applications

Examples• Clinical and Financial Analytics and Decision

Support • Query and Reporting Tools • Data Mining • Online Scoreboards and Dashboards



Lecture a


Summary – Lecture a

• Administrative, billing, and financial systems integrated in health care information systems

• Health care organizations’ strategies to ensure integration of front-end clinical data collection and back-end billing functions

• Critical integration elements• Data analysis and trending



Lecture a


References – Lecture aReferences • Agosta, L. (2010, June 1). Data integration delivers healthcare meaningful use. Alleingang Research. Retrieved

from http://www.pervasiveintegration.com/dcontent/Collateral/PervasiveHITR.pdf• American Health Information Management Association (AHIMA). (2012). Pocket glossary for health information

management and technology (3rd ed.). Chicago, IL: Author.• Clinfowiki. (2011). Business intelligence. Available from:

http://www.informatics-review.com/wiki/index.php/Business_Intelligence_&_Data_Warehousing_for_Healthcare• Healthcare Financial Management Association. (n.d.). HFMA glossary. Retrieved from

http://www.hfma.org/forms/glossary/search.aspx/search.aspx• Healthcare Information and Management Systems Society (HIMSS). (n.d.a). About HIMSS.

http://www.himss.org/ASP/aboutHimssHome.asp• Healthcare Information and Management Systems Society (HIMSS). (n.d.b). Interoperability & standards.

Retrieved from http://www.himss.org/ASP/topics_integration.asp• Healthcare Information and Management Systems Society (HIMSS). (2007). Enterprise integration: Defining the

landscape. Retrieved from http://www.himss.org/content/files/Ent_Integr_whitepaper_030807.pdf• Health Level Seven International. (2011). About HL7. Retrieved from http://www.hl7.org/about/index.cfm?ref=nav• Healthcare Information and Management Systems Society (HIMSS). (2010). HIMSS dictionary of healthcare

information technology terms, acronyms and organizations (2rd ed.). Chicago, IL: Author.



Lecture a


References – Lecture aReferences • Loshin, D. (2003). Business Intelligence: The Savvy Manager's Guide, Addison Wesley, 2003• Office of the National Coordinator for Health Information Technology. (July 28, 2010). Health Information

Technology: Initial Set of Standards, Implementation Specifications, and Certification Criteria for Electronic Health Record Technology; Final Rule, 45 CFR Part 170. Retrieved from http://edocket.access.gpo.gov/2010/pdf/2010-17210.pdf

• The Data Warehousing Institute Faculty Newsletter. (2002, Fall). • Vogel, L.H., & Perreault, L.E., (2006). Management of information in healthcare organizations. In Shortliffe. E. H.,

& Cimino, J. J. (Eds.), Biomedical informatics: Computer applications in health care and biomedicine (3rd ed) (pp. 476-510). New York, NY: Springer Science + Business Media.

ImageSlide 22: Agosta, L. (2010). From islands of information to meaningful use [image on the Internet]. Available from:

http://www.pervasiveintegration.com/dcontent/Collateral/PervasiveHITR.pdf



Lecture a

comp6 unit9a lecture slides

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