Monday, February 29, 2016

Why is Health Information Management so Important?

The Health Information Management (HIM) professional is an expert in managing all aspects of patient health information. The comprehensive knowledge that the HIM associate possesses assists in all aspects of this position, including managing that health information through health records, administering computer information systems, and collecting and analyzing patient data. Also very important is the ability to comfortably and accurately use classification systems and medical terminologies.

The HIM associate must have the ability to document clearly and support an accurate diagnosis that confirms the patient’s clinical findings, progress, and finally, discharge planning. A clear understanding of the medical foundations of patient care includes basic pathophysiology, abnormal clinical findings, and anatomy and physiology. Understanding this information is paramount to the successful HIM associate’s assurance that coding is precise, and diagnoses and outcomes are exact.

Two courses in an HIM program of study include Pathophysiology and Anatomy and Physiology. An understanding of anatomy (what’s in the body) and physiology (how it works) is the basis of all medicine. If we know how the body works, how it is put together, and what can go wrong, we can then understand the treatments and interventions that are the basis of medical treatment. The study of Anatomy and Physiology bridges the knowledge of the intricacies of the human body to the complexities of managing the data and information to medically manage a patient.

The study of Pathophysiology examines the alterations in the normal functions of the body that affects individuals across the lifespan. Understanding the mechanisms of disease processes essentially give a HIM associate the ability to recognize abnormalities and alterations in function and enable him or her to identify code-able diagnoses and/or procedures. This must be supported by a strong working knowledge of anatomy, physiology, clinical disease processes, medical terminology and even pharmacology. 

It becomes very clear with the study of anatomy and physiology that the body works in a collaborative manner to maintain balance and equilibrium. Understanding the basic knowledge of the components of the body then allows us to recognize in more detail the processes that interrupt that balance and equilibrium. A strong understanding of pathophysiology means having that ability to recognize those interruptions of the normal physiologic processes.

Consider the role of a documentation specialist in an acute care hospital. This professional is considered an HIM associate, and reviews all physician documentation in the medical record on a daily basis while the patient is in the hospital. This review ensures that treatment regimens, diagnosis and plan of care are clearly and consistently present in the record. Upon discharge, this record is then reviewed by another HIM specialist to code, or assign very specific alphanumeric numbers that are tied to how much reimbursement is realized. Everything that happens to that patient must be present and detailed clearly in the medical record. A history and physical, the first time a medical diagnosis is identified in the record, every lab value, x-ray result and treatment plan and regimen must be coded. The HIM associate has skills to not only recognize abnormal lab values and the intricacies of medical intervention, they also begin to anticipate and investigate nuances of care that may lead to even more accurate management of the medical record that results in quality data administration.

Understanding the body in as many ways as possible gives the HIM associate the skills and competencies to become an essential part of a health care team. Never has the management of patient information and data been more crucial. Not only does the HIM professional offer skills that manage the medical record, but is instrumental in ensuring that information is complete, documentation is timely, and the information that is tied to reimbursement for services rendered is accurate. Having an understanding of how the body works, and then recognizing the intricacies of disease processes assists the HIM associate in assuring quality patient care.

 Submitted by Katie Cross, MSN, RNC-OB, Adjunct  Faculty BS HIM Program

Friday, February 12, 2016

Health Technologies & Elder Care

 GeroTechnology: An Introduction

As settings for long-term care become increasingly diversified, it is projected that there will be an increased reliance on family caregivers and technology within one’s home setting, especially during health status changes requiring extended care services.  A relatively new field, GeroTechnology (or GeronTechnology) engages technology companies, engineering and architectural firms, private entrepreneurial enterprises, research universities, governmental representatives, and members of the aging network – all working together to provide services that people need, when they need them, in the place they call HOME (Leading Age, 2016).   Rather than having to bear the expense of a nursing home, technology is being built into housing and products to improve person-environment congruence for older adults experiencing health status changes

As our senior population doubles over the next two decades, we face a daunting mission:  increasing the quality of care for a record number of elders while also striving to reduce the nation’s health care economic woes.  Many professionals argue that if we are to deliver quality care now and in the future, we must embrace the philosophy of a wellness revolution.  In other words, we will need to apply American innovation to wellness technologies that enable prevention, early detection, increased compliance, and new modes of remote caregiving and family support (Eldercare, 2015).

Home Care Technology and Aging-in-Place

By its very definition, home care helps people age-in-place.  In addition, home care technology provides essential tools to individuals on a widespread, cost-effective scale.   Telehealth or remote monitoring, an all-inclusive term, encompasses a range of high-tech applications that involve caring for patients remotely.  For example:

·               Monitoring an individual’s heart rate while that person is working out on a treadmill.

·               Transmitting a patient’s telemetry readings to a nurse via the Internet.

·               Virtually bringing a health care provider into a patient’s home via the digital use of a high-resolution camera.
(Hfaging, 2016).

As hospital stays have been shortened and more home care technology has become available, caregiving at home has come to take on many aspects of a mini intensive-care unit.  One interesting example is the MEDCOTTAGE – a mobile, modular medical home designed to be temporarily placed on a caregiver’s property for rehabilitation and extended care.  As noted on their Web page, the MEDCOTTAGE is a state-of-the-art hospital room with remote monitoring so caregivers can provide quality care and participate directly in their family member’s recovery (MedCottage, 2016).

Enabling Technologies and Chronic Care Management

A growing body of research indicates that care technologies can prevent premature institutionalization (and its related costs) while also giving older adults more control over their own health and living conditions.   The Center for Aging Services Technologies outlined several platforms that have demonstrated value for older Americans coping with chronic conditions.  Some of these include the following:

1.            Medication Optimization 

These platforms address medication non-adherence – a serious problem which is responsible for 33-69% of medication-related hospital admissions and 23% of all nursing home admissions. 

2.            Remembering to Take Medications

Many older adults have problems remembering to take their medications as well as remembering their timing and sequencing.  Medication reminder systems fall into several categories – passive organizers, commercial medication reminder services via phone or e-mail, and software for personal data assistance.

3.            Remote Patient Monitoring

These may include communication devices as well as weight scales, blood pressure monitors, assessment algorithms, and “clinician alerts” by remotely located health care professionals.  These are especially important in rural and medically underserved communities. 

4.            Assistive Technologies and Home Modifications

Videophone products, for example, offer family caregivers the advantage of being able to see and hear their relatives.  Observing an elder performing basic tasks, such as sitting down and getting into bed, can provide important information about strength and balance.  Additionally, if an individual has changed or stopped routine grooming and self-care habits, it will be more apparent via video.  

5.            Remote Training and Supervision

For family caregivers who have to learn how to perform long-term care tasks and who also feel isolated, remote training has become increasingly beneficial, e.g., online tutorials, coaching sessions, and family support groups.

6.            Cognitive Fitness: Training and Assessment

Designed for working with cognitively impaired older adults with chronic illness, some of the available tools include counseling support instruments, electronic health records, and point-of-care computers.

7.            Social Networking and Loneliness:  Social Connectedness

Although not typically categorized as an illness, loneliness is a problem faced by many older adults in poor health who may live alone.  As research indicates, they have a very different experience of aging than those with family and social supports.

In such cases, technology can help elders feel more connected to those outside their homes.  As just mentioned, videophones can be a tremendous asset.  In addition, computer networks, such as the Internet, offer many opportunities for communicating with others.  Some services are designed specifically for people aged 65+.  They may offer social activities as well as host a variety of online discussion and enrichment topics, such as book clubs and virtual travel excursions.

8.            Social Media

Most health experts agree that the future of medicine will incorporate social media – Internet-based tools used for sharing and discussing information.  Such social media might include social networking sites, news and bookmarking, blogs, video sharing, photo sharing, and virtual reality.

For example, according to nation-wide survey findings of The Pew Social Research Center,  once someone is online, living with a chronic disease is associated with a greater likelihood of accessing user-generated health content, such as blog posts, hospital and physician reviews, and podcasts.  In general, it seems that older adults believe that others with the same condition are more likely to understand, be supportive, and offer wise advice (Pew Research Center, 2010).

An aging population and a growing number of individuals living with chronic conditions mean, in turn, an increased reliance upon family caregivers to provide front-line health care. Recent national reports indicate that these caregivers are becoming health information specialists – thanks to the internet, used in researching health conditions and treatments.  (Pew Research Center, 2013). 

Health Technologies in Nursing Facility Settings
          While this discussion has primarily focused on home-based care, I also want to add a few    comments about those technologies that are being implemented within nursing home settings.

·               Advanced Total Quality Systems – integrate several basic components such as nurse calls, wandering management, fall prevention, resident tracking, resident assessment, and electronic medication administration.

·               Advanced Bedding Systems – have embedded sensors for monitoring vital signs and sleep quality.

·               Comprehensive, Interoperable Electronic Health Records (EHRs) – allow security in sharing health information across various settings. 

As noted by many nursing home administrators, resistance to change remains one of the biggest obstacles to technology integration within a facility’s environment.  Having a long history of being manual and paper-based, it will require a cultural shift to a technology base. Education and communication are essential in addressing this challenge (Eldercare, 2015).  

The Future of GeroTechnology

While it is clear that future cohorts of older adults will have more options in health care, much will depend upon their financial resources. It seems clear that consumers who do not have adequate income will have fewer choices in the type or quality of services received.  It must also be recognized that use of these technologies (low-tech and high-tech) assumes a level of health literacy, as well as a willingness to embrace the required new learning.  Others caution us to be mindful of potential negatives, such as patients’ privacy / confidentiality issues and dissemination/access to personal information. 

Most agree that those health technologies that connect elders (in a long-term care facility or home) and their respective families will continue to experience increased demand.   However, among the challenges we face will be the ability to make these innovations seamless, easy to use, respectful, and affordable. 
Health Technologies & Elder Care

  • Eldercare (2015). Assistive Technology, Eldercare: Connecting you to Community Services. 

  • Georgia Institute of Technology.  Human Factors & Aging Laboratory (2016).     

  • The American Elder Care Research Organization (2014). Technologies to reduce care costs and allow safe aging at home.  Paying for Senior Care.

Blog Author:  Dr. Donnelle Eargle

With a background in geriatric rehabilitation psychology, Dr. Eargle teaches gerontology-related courses at Saint Joseph’s College. Standish, Maine.