Introduction to Healthcare
Information Technology
Chapter Two
Healthcare Organizations and
Operations
Objectives
• Identify various healthcare organizational
structures and their different methods of operation
• Explain the use of codes of conduct
• Identify EHR/EMR access roles and responsibilities
for using Protected Health Information (PHI)
• Describe the proper communication methods for
use in the healthcare workplace
• List best practices in handling PHI in the healthcare
setting
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Healthcare IT: Challenges and
Opportunities
• Delivery of health care to a large population
– Diverse and complex organizations
• First responders
– Police, firefighters, emergency medical technicians
• Operation of a hospital
– Numerous organizations play supporting roles
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Healthcare Organizational Structures
and Operation
• Organizational structure
– Framework through which a group of people work
toward common goal
– Defines authority, responsibilities, communication
methods, rights, and duties of the group
• Uniqueness of healthcare organizational structures
– Common goal to save lives, reduce suffering, and
eliminate disease
– Stressful and demanding environments
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Organizational Structures
• Hospitals
– Healthcare organizations treating patients for injury
and disease
– Usually provide inpatient (long-term) care
• Patient resides in hospital one or more nights
– Also provide outpatient care
• Patient is not admitted and does not reside overnight
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Organizational Structures (cont’d.)
• Types of hospitals
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General
Contagious disease
Nursing homes
Psychiatric
Orthopedic
Pediatric
• Hospitals divide functionality into departments
– Departments depend on hospital type and size
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Organizational Structures (cont’d.)
• Hospital departments
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Cardiac care unit (CCU)
Emergency room (ER)
Gynecology (GYN)
Intensive care unit (ICU)
Medical/Surgical (Med/Surg)
Neurology
Obstetrics (OB)
Oncology
Pediatrics (Peds)
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Organizational Structures (cont’d.)
• Hospital departments (cont’d.)
– Physical therapy (PT)
– Psychiatry (Psych)
– Surgery (OR)
• Supporting departments
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Laboratory (Lab)
Pathology (Path)
Pharmacy
Radiology (Xray)
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Table 2-1 Selected departments typically found in hospitals
© Cengage Learning 2013
Organizational Structures (cont’d.)
• Indirect support departments
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Health information management (medical records)
Information technology (IT)
Clinical (or biomedical) engineering
Facilities management (maintenance/operations)
Administration
Food and nutrition services
Security
Material management
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Organizational Structures (cont’d.)
• Physician
– Medical professional
– Licensed by a governing body
• Private practices
– Single physician provides care to individual patients
• Group of physicians working together
– Considered private practice if group is physician
owned
• Non-physician owned healthcare group
– Not considered private practice
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Organizational Structures (cont’d.)
• Nursing homes (convalescent hospitals)
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Equipped for patients with long-term diseases
Address the needs of inpatients
Generally not equipped for acute care
Generally outsource support functions
• Skilled nursing facility (SNF)
– Requirement for facility to receive Medicare
reimbursement
– Must employ skilled nursing staff
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Organizational Structures (cont’d.)
• Requirements for Medicaid reimbursement of
patient expenses
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Patient needs skilled nursing care
Patient has income and assets below defined levels
Patient must be a United States citizen
Patient must reside in state in which nursing home is
located
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Organizational Structures (cont’d.)
• Assisted living facility
– Designed for elderly people who need some
assistance with activities of daily living
– Has residents, not patients
– Generally do not have skilled nursing care staff
– No Medicare or Medicaid reimbursement
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Organizational Structures (cont’d.)
• Home health care
– Treatment of disease or injury in patient’s home
– Staffed by nonmedical and/or skilled nursing
professionals
– May be reimbursed depending on certain criteria
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Organizational Structures (cont’d.)
• Hospice
– Care of terminally ill patients at home or in dedicated
facilities
• Patients require palliative care
– Relief and prevention of suffering
• Hospice care may include:
– Skilled care on a 24-hour, 7 day per week basis
– Pharmaceuticals to provide patient comfort
– Necessary medical equipment
• Generally reimbursable by Medicare and Medicaid
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Organizational Structures (cont’d.)
• Surgical centers and ASCs
– Specialize in outpatient surgical care
• Also called same-day surgery
• Less complex procedures than inpatient surgery
• Types of procedures
– Minor surgeries
– Pain management
– Diagnostic procedures
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Methods of Operation
• Customs or practices used to achieve
organization’s goal
– Scope of work
– Availability of resources
– Formality of procedures
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Methods of Operation (cont’d.)
• Scope of work
– Refers to tasks involved in accomplishing a goal or
objective
• Differences exist in scope of work among various
types of medical facilities
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Table 2-2 Scope of work for identified healthcare organizations
© Cengage Learning 2013
Methods of Operation (cont’d.)
• Availability of resources
– Financial resources
• Economic and monetary resources needed for
organization to function
– Human resources
• Staffing needs
– Physical resources
• Places and equipment
– Information
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Table 2-3 Availability of financial resources for identified healthcare organizations
© Cengage Learning 2013
Methods of Operation (cont’d.)
• Formality of procedures
– Set of established behaviors for collectively
achieving an organization’s goal
– High formality: little deviation from set procedures
– Low formality: higher deviation from set procedures
• Formality typically increases as risk to patient
increases
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Table 2-4 Formality of procedures for identified healthcare organizations
© Cengage Learning 2013
Codes of Conduct
• Rules for behavior to which a group of people
adhere
• May be specific and written
• Likely to be similar for similar groups of people or
facilities
• Frequently address communication, procedural
behavior, social behavior, and sanitation
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Communication
• Professional communication
– Use of written, oral, or other exchange methods
• Style of communication
– How something is said
• Content of communication
– What is said
• High-formality healthcare setting
– Use formal communication style
– Inappropriate to discuss outside activities,
relationships, or other staff members in front of patient
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Adapting Procedural Behavior
• Procedural behavior
– Level of procedural formality based on type of
treatment or diagnostics
• Examples of locations where procedural behavior
is important
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Imaging room
Procedure room
Recovery room
Examination room
Emergency room
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Sanitation
• Physical hazards due to close proximity to
biological or chemical disease components
• Sanitation methods
– Sterilization of facilities and instruments
– Proper disposal of contaminated wastes
• Infection control procedures
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Hand washing
Cleaning and sterilization
Use of antimicrobials
Use of protective equipment
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Social Behavior and Sensitivity of the
Environment
• Social behavior
– Conduct toward other people
• Example: inappropriate for emergency room staff to
act shy around unclothed patient
– May be appropriate behavior for maintenance
worker
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Conforming to Management
Requirements
• Main responsibility is the patient
• Managerial operating procedures
– Address business needs of the organization
– May sometimes conflict with patient care
– Example: private hospitals may turn away patient
without insurance or means to pay
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Protecting Healthcare Information
• HIPAA privacy rule protects individually identifiable
health information
– Includes verbal, paper, and electronic forms
– Relates to past, present, and future health of an
individual
• PHI is protected as long as retained by Covered
Entity:
– Even if individual is deceased
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Access Roles and Responsibilities
• Healthcare team access
– Each member of healthcare team has roles and
responsibilities pertaining to PHI
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Table 2-5 Protected health information access roles (continues)
© Cengage Learning 2013
Table 2-5 Protected health information access roles (cont’d.)
© Cengage Learning 2013
Access Roles and Responsibilities
(cont’d.)
• Business Associate access
– HITECH Act encompasses Business Associates in
same manner as Covered Entities
• Examples of Business Associate functions
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Claims processing
Accounting
Data aggregation
Accreditation
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Access Limitations Based on Role and
Exceptions
• Certain times when traditional access roles need to
be superseded
• Example: emergency situation when database
administrator may read PHI
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Access to Sensitive Patient Data
• Some information may have more stringent
guidelines
• Individuals may ask a Covered Entity to restrict use
and disclosure of their PHI
• Roles must be modified appropriately
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Proper Communication
• Procedures must be followed for various types of
communication
• Backups
– A permanent copy of all ePHI is maintained
• Unique identifiers
– Username and password for each distinct user
account
• Emergency access
– Procedures for obtaining necessary ePHI during an
emergency
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Proper Communication (cont’d.)
• Timeout
– Terminating an electronic communication session
after a period of inactivity
• Encryption
– ePHI must be encrypted
• Audit trails
– Mechanism to record activity in information systems
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Proper Communication (cont’d.)
• Integrity
– Mechanisms to prevent unauthorized destruction or
alteration of ePHI
• Authentication
– Procedures to ensure those seeking access to ePHI
are authentic
• Disposal
– Procedures to ensure final disposition of ePHI
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Proper Communication (cont’d.)
• Safeguards must apply to all forms of
communication
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E-mail
Instant messaging
Fax
File transfer protocol
Telephone
Voice over IP
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Table 2-6 Safeguards for various electronic communication methods
© Cengage Learning 2013
Data Handling Procedures
• Best practices for general technology use
– Help ensure PHI is protected
• Access to network devices should be controlled
• Access methods
– Physical
– Electronic
• Managing physical access
– Location of physical device chosen to minimize
access
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Data Handling Procedures (cont’d.)
• Privacy screens
– Prevents anyone not sitting in front of screen from
reading its contents
• Screensavers
– Lock out computer screens after specified time
period
• Time lockouts
– Program locks out users after specific period of time
– Password must be entered to regain access
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Summary
• Various healthcare organizational structures exist
• Code of conduct refers to behavior rules to which a
group of people adhere
• PHI includes information in verbal, paper, or
electronic form
– Includes past, present, and future health information
• Various roles and responsibilities exist for using
PHI
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Summary (cont’d.)
• Safeguarding communication methods is one facet
of protecting PHI
• Best practices in handling PHI in a healthcare
setting involve controlling physical and electronic
access to PCs, printers, and other equipment
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