EHR: Electronic Health Record
An electronic health record (EHR) (also electronic patient record (EPR) or computerised patient record) is an evolving concept defined as a systematic collection of electronic health information about individual patients or populations[1]. It is a record in digital format that is capable of being shared across different health care settings, by being embedded in network-connected enterprise-wide information systems. Such records may include a whole range of data in comprehensive or summary form, including demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, and billing information.
Its purpose can be understood as a complete record of patient encounters that allows the automation and streamlining of the workflow in health care settings and increases safety through evidence-based decision support, quality management, and outcomes reporting.[2]
http://en.wikipedia.org/wiki/Electronic_health_record
Thursday, July 22, 2010
What is an Achoring Error?
Anchoring Error (or Bias)
Refers to the common cognitive trap of allowing first impressions to exert undue influence on the diagnostic process. Clinicians often latch on to features of a patient's presentation that suggest a specific diagnosis. Often, this initial diagnostic impression will prove correct, hence the use of the phrase "anchoring heuristic" in some contexts, as it can be a useful rule of thumb to "always trust your first impressions." However, in some cases, subsequent developments in the patient's course will prove inconsistent with the first impression. Anchoring bias refers to the tendency to hold on to the initial diagnosis, even in the face of disconfirming evidence.
1. Redelmeier DA. Improving patient care. The cognitive psychology of missed diagnoses. Ann Intern Med. 2005;142:115-120. [go to PubMed]
2. Croskerry P. Cognitive forcing strategies in clinical decisionmaking. Ann Emerg Med. 2003;41:110-120. [go to PubMed]
3. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78:775-780. [go to PubMed]
http://www.psnet.ahrq.gov/glossary.aspx#F
Refers to the common cognitive trap of allowing first impressions to exert undue influence on the diagnostic process. Clinicians often latch on to features of a patient's presentation that suggest a specific diagnosis. Often, this initial diagnostic impression will prove correct, hence the use of the phrase "anchoring heuristic" in some contexts, as it can be a useful rule of thumb to "always trust your first impressions." However, in some cases, subsequent developments in the patient's course will prove inconsistent with the first impression. Anchoring bias refers to the tendency to hold on to the initial diagnosis, even in the face of disconfirming evidence.
1. Redelmeier DA. Improving patient care. The cognitive psychology of missed diagnoses. Ann Intern Med. 2005;142:115-120. [go to PubMed]
2. Croskerry P. Cognitive forcing strategies in clinical decisionmaking. Ann Emerg Med. 2003;41:110-120. [go to PubMed]
3. Croskerry P. The importance of cognitive errors in diagnosis and strategies to minimize them. Acad Med. 2003;78:775-780. [go to PubMed]
http://www.psnet.ahrq.gov/glossary.aspx#F
Wednesday, July 21, 2010
Acronym(s) of the Day: HAC and OIG
HAC: Hospital Acquired Conditions
Section 5001(c) of Deficit Reduction Act of 2005 requires the Secretary to identify conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence‑based guidelines.
On July 31, 2008, in the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule, CMS included 10 categories of conditions that were selected for the HAC payment provision. The IPPS FY 2009 Final Rule is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.
Section 5001(c) of Deficit Reduction Act of 2005 requires the Secretary to identify conditions that are: (a) high cost or high volume or both, (b) result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and (c) could reasonably have been prevented through the application of evidence‑based guidelines.
On July 31, 2008, in the Inpatient Prospective Payment System (IPPS) Fiscal Year (FY) 2009 Final Rule, CMS included 10 categories of conditions that were selected for the HAC payment provision. The IPPS FY 2009 Final Rule is available in the Statute/Regulations/Program Instructions section, accessible through the navigation menu at left.
The 10 categories of HACs include:
- Foreign Object Retained After Surgery
- Air Embolism
- Blood Incompatibility
- Stage III and IV Pressure Ulcers
- Falls and Trauma
-Fractures
-Dislocations
-Intracranial Injuries
-Crushing Injuries
-Burns
-Electric Shock - Manifestations of Poor Glycemic Control
-Diabetic Ketoacidosis
-Nonketotic Hyperosmolar Coma
-Hypoglycemic Coma
-Secondary Diabetes with Ketoacidosis
-Secondary Diabetes with Hyperosmolarity - Catheter-Associated Urinary Tract Infection (UTI)
- Vascular Catheter-Associated Infection
- Surgical Site Infection Following:
- Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE)
Payment implications will begin October 1, 2008, for these 10 categories of HACs.
https://www.cms.gov/HospitalAcqCond/06_Hospital-Acquired_Conditions.asp
OIG: Office of the Inspector General
Office of the Inspector General (OIG) is an office that is part of Cabinet departments and independent agencies of the United States federal government as well as some state and local governments. Each office includes an Inspector General and employees charged with identifying, auditing, and investigating fraud, waste, abuse, and mismanagement within the parent agency.
HHS-OIG investigates tens of millions of dollars in Medicare fraud each year. In addition, OIG will continue its coverage of all 50 States and the District of Columbia by its multi-agency task forces (PSOC Task Forces) that identify, investigate, and prosecute individuals who willfully avoid payment of their child support obligations under the Child Support Recovery Act.
http://en.wikipedia.org/wiki/United_States_Department_of_Justice_Office_of_the_Inspector_General
Tuesday, July 20, 2010
Acronym of the Day: EMTALA
EMTALA: Emergency Medical Treatment and Active Labor Act
U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.
EMTALA applies to "participating hospitals", i.e., those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program. However, in practical terms, EMTALA applies to virtually all hospitals in the U.S., with the exception of the Shriners Hospitals for Children, Indian Health Service hospitals, and Veterans Affairs hospitals[citation needed]. The combined payments of Medicare and Medicaid, $602 billion in 2004,[2] or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, and not just to Medicare patients.[3][4]
The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate.[5] Similarly, it has attracted controversy for its impacts on hospitals, and in particular, for its possible contributions to an emergency medical system that is "overburdened, underfunded and highly fragmented."[6] More than half of all emergency room care in the U.S. now goes uncompensated. Hospitals write off such care as charity or bad debt for tax purposes. Increasing financial pressures on hospitals in the period since EMTALA's passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care.[7] There is also debate about the extent to which EMTALA has led to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.
http://en.wikipedia.org/wiki/EMTALA
U.S. Act of Congress passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA). It requires hospitals and ambulance services to provide care to anyone needing emergency healthcare treatment regardless of citizenship, legal status or ability to pay. There are no reimbursement provisions. As a result of the act, patients needing emergency treatment can be discharged only under their own informed consent or when their condition requires transfer to a hospital better equipped to administer the treatment.
EMTALA applies to "participating hospitals", i.e., those that accept payment from the Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS) under the Medicare program. However, in practical terms, EMTALA applies to virtually all hospitals in the U.S., with the exception of the Shriners Hospitals for Children, Indian Health Service hospitals, and Veterans Affairs hospitals[citation needed]. The combined payments of Medicare and Medicaid, $602 billion in 2004,[2] or roughly 44% of all medical expenditures in the U.S., make not participating in EMTALA impractical for nearly all hospitals. EMTALA's provisions apply to all patients, and not just to Medicare patients.[3][4]
The cost of emergency care required by EMTALA is not directly covered by the federal government. Because of this, the law has been criticized by some as an unfunded mandate.[5] Similarly, it has attracted controversy for its impacts on hospitals, and in particular, for its possible contributions to an emergency medical system that is "overburdened, underfunded and highly fragmented."[6] More than half of all emergency room care in the U.S. now goes uncompensated. Hospitals write off such care as charity or bad debt for tax purposes. Increasing financial pressures on hospitals in the period since EMTALA's passage have caused consolidations and closures, so the number of emergency rooms is decreasing despite increasing demand for emergency care.[7] There is also debate about the extent to which EMTALA has led to cost-shifting and higher rates for insured or paying hospital patients, thereby contributing to the high overall rate of medical inflation in the U.S.
http://en.wikipedia.org/wiki/EMTALA
Acronym of the Day: TJC
TJC : The Joint Commission
Formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a private sector United States-based not-for-profit organization. The Joint Commission operates accreditation programs for a fee to subscriber hospitals and other health care organizations. The Joint Commission accredits over 17,000 health care organizations and programs in the United States.[1] A majority of state governments have come to recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement. Surveys (inspections) typically follow a triennial cycle, with findings made available to the public in an accreditation quality report on the Quality Check Web site.
http://en.wikipedia.org/wiki/Joint_Commission
Formerly the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), is a private sector United States-based not-for-profit organization. The Joint Commission operates accreditation programs for a fee to subscriber hospitals and other health care organizations. The Joint Commission accredits over 17,000 health care organizations and programs in the United States.[1] A majority of state governments have come to recognize Joint Commission accreditation as a condition of licensure and the receipt of Medicaid reimbursement. Surveys (inspections) typically follow a triennial cycle, with findings made available to the public in an accreditation quality report on the Quality Check Web site.
http://en.wikipedia.org/wiki/Joint_Commission
Monday, January 4, 2010
Let’s pretend for a minute that healthcare is like a real business. That we define our objectives based on outcomes both financially and qualitatively. That we make decisions that give us a competitive advantage and position our organization as innovators and thought leaders.
Just imagine if we did this as opposed to the current model: waiting for the government to figure out what’s wrong so they can regulate us out of our self created mess. We need to start with the end. How do we define and demonstrate success as it pertains to HIT?
Until it is more than “I have it and it is compliant” we will continue to struggle.
Happy New Year. :-)
Thursday, October 22, 2009
What was it like being a nurse in the olden days?
Back when I first became a nurse and I thought it was fun to wear a little white hat and white hose, things were different. I had spent my childhood walking 20 miles to and from school and as the mores of the time dictated; it was always through 5 feet of snow and uphill, of course, both ways. I didn’t expect my life or job to be easy.
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