Computers in
the Medical Office
Chapter 2:
Information
Technology and HIPAA
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-2
Information Technology
in the Medical Office
Medical practices are using
information technology to accomplish
many administrative tasks
Three major areas affected by
technology are
 Electronic medical records
 Electronic prescribing
 Practice management
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-3
Electronic Medical Records
An electronic medical records (EMR)
contains clinical information about a
patient, such as:




Physicians’ notes
Test results
Surgical reports
X-rays
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-4
Electronic Medical Records
Benefits of EMR systems include:




Immediate access to health information
Everything located in one place
More than one person can access at a time
Access to latest research for clinical
decision-making
 Automated alerts and reminders
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-5
Electronic Medical Records
Benefits of EMR systems include:
 Secure and fast communication among
physicians and staff
 Patient education and support
 Administrative and reporting tools
 Reduction in medical errors
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-6
Electronic Medical Records
Obstacles to EMR implementation:
 Startup costs
 Learning curve
 Confidentiality and security
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-7
Electronic Prescribing
The use of computers or hand-held
devices to create and transmit
prescriptions to pharmacies in a secure
manner
 Reduces medication errors
 Eliminates problem of illegible
prescriptions
 Provides physician with information about
effectiveness, interactions, and standard
dosage
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-8
Practice Management Programs
Used to complete administrative tasks,
such as:






Scheduling
Recording patient information
Creating and transmitting claims
Billing patients
Creating financial reports
Collecting on overdue accounts
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-9
Practice Management Programs
Used to complete administrative tasks,
such as:






Scheduling appointments
Recording patient information
Creating and transmitting claims
Billing patients
Creating financial reports
Collecting on overdue accounts
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-10
Practice Management Programs
Appointments
Computerized scheduling makes it
easy to locate, schedule, and change
patient appointments
Electronic insurance claims result in
fewer errors, faster payment
 Clearinghouses check claims for errors
before transmitting to third-party payers
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-11
Practice Management Programs
Claims and Billing
Some medical practices use
clearinghouses to prepare electronic
claims in HIPAA standard format
A clearinghouse receives claims from a
physician practice, checks claims for
accuracy and completeness, and
transmits the claims to insurance
carriers in HIPAA format
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-12
Practice Management Programs
Claims and Billing
Some medical practices hire billing
services to prepare claims
When clearinghouses or billing
services are used, HIPAA requires the
practice have a contract with the
outside service
The service company must meet and
follow all HIPAA rules
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-13
Practice Management Programs
Reimbursement
Patients who make payments at the
time of an office visit are given a
walkout statement
Payments from insurance plans are
entered in the medical billing program
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-14
Practice Management Programs
Electronic Medical Records
Some PMPs are able to exchange data
with EMRs
Saves time and money, no re-entering
of data
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-15
Advantages of Computer Use
in Medical Offices
Information can be accessed by more
than one person at a time
Information is easy to find
Less storage space is required
Increased efficiency
Fewer errors
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-16
HIPAA and Electronic
Exchange of Information
Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
intended to:
 Ensure portability of health insurance
when employees change jobs
 Increase accountability and decrease
fraud and abuse in health care
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-17
HIPAA and Electronic
Exchange of Information
Health Insurance Portability and
Accountability Act of 1996 (HIPAA)
intended to:
 Improve the efficiency of health care
transactions and mandate standards
 Ensure the security and privacy of health
information
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-18
HIPAA Electronic Transaction
and Code Sets Standards
Electronic Data Interchange (EDI) is the
electronic transmission of data from
one computer to another
In the past, many different EDI systems
were used, which created the need for
many software programs to translate
the data from one format to another
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-19
HIPAA Electronic Transaction
and Code Sets Standards
Regulations that specify a standardized
format for health care transactions
 X12-837P Health Care Claim for
professional claims
Regulations that require the use of
specific code sets, such as CPT-4 for
procedures and ICD for diagnoses.
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-20
HIPAA Electronic Transaction
and Code Sets Standards
National Provider Identifier (NPI)
 Unique ten-digit number assigned to each
health care provider
 Effective May 23, 2007, all but small health
care plans must use NPI; small plans have
one additional year to comply
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-21
HIPAA Privacy Rule
Protects individually identifiable health
information
Protected Health Information (PHI)
Notice of Privacy Practices
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.
2-22
HIPAA Security Rule
Storing and transmitting patient health
care information on the computer
raises significant security concerns
Administrative, technical, and physical
safeguards required to prevent
unauthorized access to protected
health care information
McGraw-Hill Career Education
© 2009 by The McGraw-Hill Companies, Inc. All rights reserved.