Topics in health information management最新文献

Telemedicine is rapidly evolving into a viable method of delivering health care. As programs become more active, healthcare organizations must examine policies and procedures to assure they meet the needs of the changing complexities of healthcare delivery. Telemedicine, or providing health care from a distance, brings with it a new dimension that complicates a number of unresolved issues. Reimbursement and telemedicolegal concerns particularly bring into focus the need for quality documentation for telemedicine. A proposed telemedical record model provides guidelines to ensure consistent, accurate, timely, and nonduplicative documentation of teleconsultations in any telehealth scenario.

DOOR Online began as a collaborative effort between a number of agencies and people from the disabled community in Colorado. The shared goal was to develop an accessible, searchable resource listing for people with disabilities, their families, and community supports. DOOR Online, the result of this effort, is a database of local, state, and national resources that can be accessed directly through the Internet or the statewide library network.

This article examines the effect of the Balanced Budget Act of 1997 on current treatment and reimbursement practices in rehabilitation services. Specifically, we focus on the integration of HIM and therapy skills and practices in providing quality patient care. In this article we present two models that represent possible scenarios defining the interaction between the HIM and rehabilitation professionals that could occur as a result of this legislation.

Telemedicine involves the use of rapidly evolving technology that carries enormous promise to improve the current level of medical care. In order to achieve these expectations, some barriers beyond its technological development must be overcome. These are primarily legal and regulatory issues that must be resolved by the current stakeholders. These barriers arise from the fact that a newly developing telemedicine technology changes the way clinical care is delivered to the population and documented.

The quality movement has gone through three phases in this century. The first, quality assurance, emphasized reacting to problems and identifying "bad apples." The second, quality improvement, shifted the focus from individuals to processes but still retained a reactive problem-solving approach to improving the quality of products and services. The third phase, quality management, has gained strength in other industries over the years. The article presents a quality management, or "next generation quality," model for health care centered on clinical pathways as core clinical processes that are continuously improved and monitored through an improved version of variance management systems called the gateway model.

Part 1 of this two-part series defined a new quality paradigm called the next generation quality model. This model applies the principles of the Malcolm Baldrige Criteria for Performance Excellence to clinical processes. The model's components are clinical pathways, variance management systems, stream-lined patient documentation, and continuous improvement. Part 2 extends the next generation quality model, describes the principles and applications of integrated performance measurement systems, and explains how measurement systems are adapted to different levels of an organization to effect change.

Information management is critical in today's health care environment. Traditional paper-based medical records are inadequate information management tools. Electronic medical records (EMRs) overcome many problems with paper records and are ideally suited to help physicians increase productivity and improve the quality of care they provide. The Department of Family Medicine at the Medical University of South Carolina uses the Practice Partner Patient Record EMR system. Department members have developed a quality improvement model based on this EMR system. The model has been used to improve care for acute bronchitis, diabetes mellitus, tobacco abuse, asthma, and postmenopausal osteoporosis.

Quantifying quality and marketing care delivery have been long-term challenges in the health care market. Insurers, employers, other purchasers of care, and providers face a constant challenge in positioning their organizations in a proactive, competitive niche. Tools that measure patient's self-reported perception of health care needs and expectations have increased the ability to quantify quality of care delivery. When integrated with case management and disease management strategies, outcomes reporting and variance analysis tracking can be packaged to position a provider in a competitive niche.

The development and implementation of clinical pathways at New York University Medical Center and the transition to a computerized multidisciplinary documentation system took place between 1995 and 1998. Both the computerized system and the pathway program evolved simultaneously over this 3-year period. The article describes the process of creating the clinical pathways and the automated documentation system to support the clinical pathways. Migration from the paper pathway to the automated system required the efforts of an interdisciplinary team, which focused on issues such as translation of written pathway detail into language that could be loaded into the automated system. The advantages, pitfalls, and lessons learned in this integration experience are also described.

Case managers armed with timely, organized, accurate, and meaningful data are powerful influencers and key decision makers. Case managers are in a unique position to use data to shape health care services, systems, and organizational strategy. They know the customers (internally and externally). They know why the organization gets and loses business. They know what the organization does well and what could use improvement. Most important, they know how well the organization is doing in managing the daily flow of financial resources. Case managers, coupled with health information support personnel, are exceptionally valuable corporate assets.