Module 1
The Healthcare
Environment
Learning Objectives
• Articulate the characteristics and services of different types of
healthcare organizations
• Identify the characteristics of interrelationships within and across
healthcare organizations
• Differentiate the roles and responsibilities of healthcare information
and management systems professionals
• Describe the roles of governmental, regulatory, professional, and
accreditation agencies in the healthcare environment
What is Health?
• The World Health Organization (WHO) defines health as:
“a state of complete physical, mental and social well-being and
not merely the absence of disease or infirmity.”
Key Issues in Healthcare
• High, rapidly rising costs
• Highly variable clinical quality
• Patient safety issues
• Need for evidence-based decision making
• Complex administrative processes
• Increasing consumerism and heightened expectations
• Research and technology advances
Providers of Care
• Hospitals
• Ambulatory Care Centers
• Physician Practices / Clinics
• Long-term Care Providers
• Public Health Agencies
• Community Health Organizations
• Diagnostic and Pharmaceutical Services
Healthcare Organizations
Hospitals
Total Number of All U.S. Registered Hospitals
Number of U.S. Community Hospitals
5,724
4,973
Number of Nongovernment Not-for-Profit Community Hospitals
2,903
Number of Investor-Owned (For-Profit) Community Hospitals
1,025
Number of State and Local Government Community Hospitals
1,045
Number of Federal Government Hospitals
208
Number of Nonfederal Psychiatric Hospitals
421
Number of Nonfederal Long Term Care Hospitals
112
Number of Hospital Units of Institutions (Prison Hospitals, College Infirmaries, Etc.)
10
AHA Hospital Statistics, 2013 edition
Healthcare Organizations
Hospitals
Hospitals (inpatient care facilities) may be classified by:
• Ownership
 Public (government-owned & managed)
 Private
• Private hospitals may be further classified by
 Non-profit
 For-profit (Investor-owned)
Public Hospitals
http://www.commonwealthhealth.net
http://www.caph.org/content/
Private Hospitals
http://www.hopkinsmedicine.org/the_johns_hopkins_hospital/
http://www.mountsinai.org/
Hospitals: For-Profit
http://hcahealthcare.com/home/index.dot
http://medicalcenter.osu.edu/Pages/index.aspx
Hospitals: Non-Profit
http://www.berkshirehealthsystems.org/body_bmc.cfm?id=43
http://www.stormontvail.org/
Healthcare Organizations
- Hospitals • By type of services provided
 General hospitals
 Psychiatric hospitals
 Rehabilitation hospitals
 Children’s hospitals
• By teaching status
 Academic medical centers or university hospitals
• By geographic location
 Rural hospitals
 Urban hospitals
Healthcare Organizations
- Hospitals Number of Rural Community Hospitals
1,984
Number of Urban Community Hospitals
2,989
AHA Hospital Statistics, 2013 edition
Psychiatric
http://www.fbh.com/
Children’s Hospitals
http://www.chop.edu/
Long-term Care Providers
• Nursing Home – skilled nursing and intermediate care facilities
• Rehabilitation
• Mental Health
• Home Healthcare Agencies
Rehabilitation
http://rehabhospitalwi.com
/
Knowledge Check
1. Which of the following is a characteristic of a
hospital categorized as privately-owned?
a. They are always organized on a for-profit model
b. They are generally staffed by government
employees
c. They may not be classified by geographic location
d. They may be classified into more than one
category. For example, they may also be a
general hospital and an urban hospital.
Healthcare Organizations
- Outpatient or Ambulatory Care Outpatient care services may be provided in a number of settings including:
• Independent provider offices
• Multi-provider group practices
• Emergency departments
• Ambulatory surgery centers
Independent
http://www.dh.org/
Multi-Provider
http://www.northshorephysicians.org/
Emergency/Urgent Care
http://www.concentra.com/urgent-carecenters/texas/dallas-urgent-care.aspx
Ambulatory Surgery Centers
http://www.canyonsurgerycenter.com/
Healthcare Organizations
Other healthcare delivery organizations include:
• Community health organizations
 Community-centered hospitals and clinics
 Simply a geographic construct
• Public Health Agencies and Programs
• Diagnostic and pharmaceutical services
 Laboratory services
 Radiological services
 Pharmacies
Community Health Organizations
http://portlandcommunityhealthcenter.org/
Diagnostic Services
http://www.healthfirst.org/outpatient/diagnostics/index.cfm
Integrated Delivery Network (IDN)
• A healthcare organization with a variety of
providers offering services across the continuum
of care and integrated in administration and
information sharing.
• Formed through:
– Merger and acquisition
– Joint venture
– Alliance
– Network
Knowledge Check
2.
Which of the following is NOT a type of Outpatient or Ambulatory
Care?
a.
Ambulatory Surgery Centers
b.
Academic Hospitals
c.
Emergency Departments
d.
Multi-provider group practices
Healthcare Organizations: Payers
Beyond healthcare delivery organizations, many
other types of organizations are part of the
healthcare process, including payers which may be
classified as:
• Publically financed
• Privately financed
Payers: Publically Financed
• Government-financed and managed programs
 National Health Service (United Kingdom)
 National Health Insurance (Canada)
 Multi-payer system (United States)
National Health Service: United
Kingdom
http://www.nhs.uk/aboutNHSChoices/Page
s/NHSChoicesintroduction.aspx
National Health Insurance: Canada
http://www.disabledworld.com/medical/healthcare/canadamedicare/
Multi-Payer System: United States
http://www.uhfnyc.org/publications/880709
Payers: Privately Financed
• Insurance programs administered by private entities, generally funded by
 Employers
 Citizens themselves
 Some combination of both
Payers: Privately Financed
Healthcare Cost 101, 2013 Edition
California HealthCare Foundation
Private Health Insurance
http://www.ehealthinsurance.com/
Knowledge Check
3.
Which of the following types of payers are common in the
healthcare environment?
a.
Government-financed and managed programs
b.
Insurance programs administered by private entities
c.
Personally funded plans
d.
Health Insurance Marketplaces
Organizational Interrelationships
Support such purposes as:
• Enabling access to comprehensive care services
• Assuring effective transfers of care
• Ensuring the general portability of care
Organizational Interrelationships
• Reporting public and population health information
• Obtaining appropriate reimbursement for care
• Supporting particular models of care
Comprehensive Care
Transfers of Care
Medication Reconciliation:
CMS defines Medication Reconciliation as
“the process of identifying the most accurate
list of all medications that the patient is
taking by comparing the medical record to an
external list of medications obtained from a
patient, hospital or other provider.”
Health Information Exchange
http://www.camdenhealth.org/programs/he
alth-information-exchange/
Public and Population Health
• UK: Secondary Use Services (SUS)
• US:
– Centers for Disease Control and Prevention
– Immunization Registries
Healthcare Workforce
• Physicians / Providers
– Primary Care
– Specialists
– Hospitalists
• Other Roles:
– Administrative
– Clinical Support Staff / Services
– Clerical
– IT / HIT
Roles and Responsibilities
of Health IT Professionals
• Senior IT roles
 Chief Information Officer: CIO
 Chief Technology Officer: CTO
 Chief Security Officer: CSO
• Senior Clinical Information Management Roles
 Chief Medical Information Officer: CMIO
 Chief Nursing Informatics Officer: CNIO
CIO Responsibilities
Chief Medical Information
Officer
Chief Security Officer
http://www.ejanco.com/Job_Book_CSO.html
Chief Nursing Informatics
Officer
Common IT Positions in Larger
Healthcare Organizations
• Desktop Support
Specialist
• Systems Analyst
• Database Administrator
• Web Developer
• Network Engineer/Analyst
• Telecommunications
Specialist
• Project Manager
• Programmer/ Application
Developer
• Security Analyst
IT Department Responsibilities
• Operations and technical support
• Application management
• Information security
• Network / Data Center operations
• Database administration
• Website development
• Telecommunications
Health IT Job Descriptions
Knowledge Check
5.
Regarding roles of healthcare information and management
systems professionals, which of the following is true?
a.
b.
c.
d.
The Privacy Officer is responsible for securing the healthcare
organization’s computing and communications assets from
either intentional or unintentional security breaches from inside
or outside the organization.
With the increasing use of IT in healthcare processes, effective
integration of clinical insights into systems solutions is of great
importance. These clinical insights are provided by positions
such as the Chief Medical Information Officer and the Chief
Nursing Informatics Officer.
CIO is the acronym for the Chief Informatics Officer and is
generally the top IT position in healthcare organizations.
The Chief Technology Officer or CTO is generally focused on
managing medical devices in the hospital environment.
The Roles of Government
• Provider of Care
– Public ownership of hospitals and clinics
• US: Department of Veteran Affairs
• UK: National Health Service
• Payor
– National Health Insurance
• US: Centers for Medicare and Medicaid Services
• Canada: Provincially-funded health insurance
• Regulator
– Laws
– Regulations
The Roles of Governmental and
Regulatory Agencies in Healthcare
• Government
 Annual growth in healthcare expenses of OECD* countries has
averaged 4%, while annual GDP growth has only averaged 1.6%
 Governments must balance the cost of care with the quality,
access, and safety of that care
• Regulatory agencies
 Implement the provisions of a nation’s health laws through a more
explicit system of regulations
* OECD - The Organisation for Economic Co-operation and Development (OECD)
Government Agencies
http://www.who.int/about/brochure_en.pdf
Regulatory Agencies
http://www.hpc-uk.org/aboutus/
Regulatory Agencies
•Licensure
•HIPAA and EMTALA
•UK Data Protection Act of 1998
•European Union Data Protection
Directive (EUDPD)
The Role of Professional
Associations in Healthcare
• Generally determine entrance requirements to professions
by determining examination requirements
• Exist for most professions
• UK - Total Professions:
– Set and assess professional examinations
– Publish professional journals
– Provide expertise networking and learning opportunities
– Handle complaints and disciplinary procedures
– Establish code of conduct
Professional Associations
http://apps.himss.org/HIMSSorg/nonProfit_membe
rs.asp
The Role of Accreditation
Agencies in Healthcare
• Typically serve in a semi-regulatory role on behalf of the government
– Joint Commission International
– US: CMS Approved AO’s
• The Joint Commission
• AAAHC
• ACHC
Accreditation Agencies
http://www.hmeaccreditationresource.com/
pages/accreditation-agencies.html
The Roles of Governmental,
Regulatory, Professional, and
Accreditation Agencies in Becoming a
Physician Assistant
Module Summary
• Articulate the characteristics and services of different
types of healthcare organizations
• Identify the characteristics of interrelationships within
and across healthcare organizations
• Differentiate the roles and responsibilities of healthcare
information and management systems professionals
• Describe the roles of governmental, regulatory,
professional, and accreditation agencies in the
healthcare environment