Introduction to Healthcare
Information Technology
Chapter One
Introduction to Healthcare IT
About the Presentations
• The presentations cover the objectives found in the
opening of each chapter.
• All chapter objectives are listed in the beginning of
each presentation.
• You may customize the presentations to fit your
class needs.
• Some figures from the chapters are included. A
complete set of images from the book can be found
on the Instructor Resources disc.
Objectives
• Define healthcare information technology
• Recognize some of the benefits of healthcare IT
• Describe the CompTIA Healthcare IT Technician
Certificate
• List major healthcare regulators
• Summarize the major healthcare regulations
• Describe typical healthcare legal practices
Introduction to Healthcare Information Technology
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Healthcare IT: Challenges and
Opportunities
• Information technology adoption
– Slower in healthcare industry compared with other
industries
• Obstacles to adoption
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Fragmented healthcare system
Many different systems among providers
Shortage of trained technology professionals
Highly regulated industry
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What Is Healthcare Information
Technology?
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Framework for managing health information
Mechanism to improve patient care
Enables patient care coordination
Application of information technology to the
healthcare industry
• Hardware and software
– Used to manipulate health data and information
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Benefits of HIT
• Healthcare costs continue to rise
– 5.2 percent of U.S. GDP spent on healthcare in 1960
– 17 percent in 2007
• Advances in technology account for about half of
healthcare spending increases
• Efficiency benefits of electronic medical records
– Eliminates medical transcription
– Reduces need to physically retrieve charts
– Reduces duplicate diagnostic tests
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The CompTIA Healthcare IT
Technician Certificate
• CompTIA
– Nonprofit trade organization
– Advocate for the IT industry
– Provides education and certification programs
• CompTIA healthcare IT technician certificate
– Shows individual’s proficiency in certain areas of
healthcare and information technology
– Prepares students for jobs in software and
technology support
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The CompTIA Healthcare IT
Technician Certificate (cont’d.)
• CompTIA proficiency areas
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HIT regulations
Healthcare organization and operations
Basic IT operations
Network IT operations
Document imaging
Basic and advanced healthcare security
Medical business operations
This text book is to help prepare for the CompTIA
IT Technician HIT-001 certification.
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Regulatory Compliance: Regulators
• Regulation
– Something that constrains or controls
• Regulator
– Governmental entity that mandates regulations
• Healthcare one of most heavily regulated industries
• Purpose of regulations
– Ensure minimum standard of care
– Provide broad patient access at reasonable cost
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Regulatory Compliance: Regulators
(cont’d.)
Table 1-1 Primary U.S. healthcare regulatory agencies
© Cengage Learning 2013
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Department of Health and Human
Services
• Mission of HHS
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Provide citizens access to high-quality health care
Help people find jobs and child care
Keep food safe
Manage infectious diseases
Extend the practice of diagnosis and treatment
• HHS represents 25 percent of U.S. federal budget
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Department of Health and Human
Services (cont’d.)
• Operating divisions of HHS
– Administration for Children and Families (ACF)
– Administration on Aging (AoA)
– Agency for Healthcare Research and Quality
(AHRQ)
– Agency for Toxic Substances and Disease Registry
(ATSDR)
– Center for Disease Control and Prevention (CDC)
– Centers for Medicare and Medicaid Services (CMS)
– Food and Drug Administration (FDA)
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Department of Health and Human
Services (cont’d.)
• Operating divisions of HHS (cont’d.)
– Health Resources and Services Administration
(HRSA)
– Indian Health Service (IHS)
– National Institutes of Health (NIH)
– Office of the Inspector General (OIG)
– Substance Abuse and Mental Health Services
Administration (SAMHSA)
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Department of Health and Human
Services (cont’d.)
• Office of the National Coordinator for Health
Information Technology (ONC)
– Staff division within HHS
– Responsible for coordinating use of advanced HIT
practices at the national level
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Centers for Medicare and Medicaid
Services Information Technology
• CMS administers:
– Medicare program
– Federal portion of the Medicaid program
– State Children’s Health Insurance Program (CHIP)
• Parts of Medicare
– Part A
• Inpatient hospital stay insurance
– Part B
• Doctor’s services and outpatient care
– Prescription drug coverage
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Centers for Medicare and Medicaid
Services Information Technology
(cont’d.)
• Medicaid
– Program for low-income people
– Covers certain medical expenses
– Jointly funded by federal government and the states
• Medicare and Medicaid incentive programs
– Cash incentives to providers for adopting electronic
health record (EHR) technology
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The Office of the National Coordinator
for Health Information Technology
• Responsibilities
– Coordinates use of advanced HIT practices at the
national level
– Certifies EHR systems and providers
• Three aspects of certification
– Standards and certification criteria for EHR
– Certification programs
– Metadata standards
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The National Institute of Standards
and Technology
• Federally sponsored physical science research
laboratory
• Sets standards for EHRs under the HITECH Act
• Five goals of NIST’s role in health information
technology
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Coordinate standards
Coordinate infrastructure testing
Improve EHR usability
Extend healthcare’s reach through technology
Perform research and development
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The National Institute of Standards
and Technology (cont’d.)
• NIST and Healthcare Information Technology
Standards Panel (HITSP)
– Provide standards and specifications to ensure
system interoperability
– Example: specific data and communication format
requirements
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The National Institute of Standards
and Technology (cont’d.)
Table 1-2 HIT standards implementation process
© Cengage Learning 2013
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Regulatory Compliance: Regulations
• HIPPA: Health Insurance Portability Accountability Act of 1996.
• HIPAA privacy rule
– Broad federal regulation
– Adopted in 1996
• HIPAA goals
– Improve portability and continuity of health insurance
– Manage waste, fraud, and abuse of health care delivery
– Reduce costs and increase efficiency by standardizing the
interchange of electronic data
– Protect the privacy of personal health records
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Regulatory Compliance: Regulations
(cont’d.)
• HIPAA privacy rule regulates:
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Health care providers
Health plans
Health care clearinghouses
Collectively called Covered Entities (CE)
• Rule extends to Business Associates (BAs) of
Covered Entities
• Business Associate Agreements
– Contracts between CEs and BAs ensuring HIPAA is
followed
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Regulatory Compliance: Regulations
(cont’d.)
• Protected Health Information (PHI)
– Individually identifiable health information
– Created or received by CE or BA
– Can exist in various forms (verbal, paper, electronic)
• De-identified information
– Cannot be traced back to the individual
– Must remove 18 specific identifiers or be certified by
a statistician (name, small geographic, vital stat,
tel.,email, SS, Med. record number, IP address,
email address, license plate, biometric, etc.)
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Regulatory Compliance: Regulations
(cont’d.)
• Data use agreement
– Permits researchers to use PHI under specific
conditions
• Office for Civil Rights (OCR)
– Responsible for enforcement of HIPAA
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Table 1-3 HIPAA Privacy Rule safeguards and requirements
© Cengage Learning 2013
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HIPAA Security Rule
• Focuses on electronically transmitted or stored PHI
– Known as ePHI
• Narrower focus than the privacy rule
• Seeks to ensure Covered Entities provide certain
administrative, physical, and technical safeguards
for data
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Table 1-4 HIPAA Security
Rule categories,
safeguards, and
requirements
© Cengage Learning 2013
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HIPAA Identifier Rule
• Mandates all Covered Entities storing or
transmitting ePHI have a National Provider
Identifier (NPI)
– Replaces all other identification from Medicare,
Medicaid, and other government programs
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HIPAA Transaction and Code Sets
Rule (TCS)
• Mandates consistent electronic interchange of PHI
• Electronic data interchange for health care
• Technology is tested and proven from use in other
industries
• Several standards exist
– ANSI X.12 standard
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HITECH Act
• Creations of the Health Information Technology for
Economic and Clinical Health (HITECH) Act
– HIT Standard Committee
– HIT Policy Committee
– Process to adopt standards and procedures
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HITECH Act (cont’d.)
• HITECH Act more stringent than HIPAA
– Increased resources for enforcement
– Increased penalties for violation
– Health providers cannot use patient health
information without expressed permission
– Sale of private health information must be authorized
by the patient
– Patients may audit their electronic patient records
– Act extends to future unanticipated entities
– Mandates encryption of ePHI
– Requires patients be notified of any breach
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HITECH Act (cont’d.)
• HITECH act and Business Associates
– HITECH Act encompasses both Covered Entities
and Business Associates
• HITECH Act and PHI breach
– Covered Entity required to report the breach to each
individual affected
– Business Associate breaches reported to Covered
Entity first
– HHS must be contacted if more than 500 patients
affected
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HITECH Act (cont’d.)
• HITECH act enforcement
– Four levels of enforcement
• Lowest level of enforcement: unknown violations
despite due diligence
– Penalties: $100-$25,000 per violation
• Next level: reasonable cause and not willful neglect
– Penalties: $1000 to $100,000 per violation
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HITECH Act (cont’d.)
• Level 3: willful neglect corrected within 30 days of
knowledge of violation
– Penalties: $10,000 to $250,000 per violation
• Level 4: willful neglect that is not corrected
– Penalties: $50,000 to $1,500,000 per violation
• Penalties are for a given calendar year
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HITECH Act (cont’d.)
• HITECH act and EHRs
– Majority of funding for HITECH used for provider
incentives to adopt EHRs
• Entities that provide assistance, best practices, and
grants under HITECH Act
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Workforce investments
HIT extension program
HIT research center
HIT regional extension centers
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HITECH Act (cont’d.)
• Certified EHR
– Tested by an ONC Authorized Testing and
Certification Body (ATCB)
• HITECH act and meaningful use
– EHR must be used in a meaningful manner
– EHR must be used for submission of quality data
and other measures
– EHR must be used for exchange of health
information that improves health care quality
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HITECH Act (cont’d.)
• Eligible Provider (EP)
– Provider qualifying for financial incentives under
HITECH Act
• Incentives for both Medicare and Medicaid exist
– EPs may participate in multiple programs
– Certain restrictions apply
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Table 1-5 Maximum Medicare EHR incentive payments
© Cengage Learning 2013
Introduction to Healthcare Information Technology
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Legal Practices
• Legal practices outside the scope of traditional
regulatory environment
– Liability waivers
– EHR service level agreements
– Memoranda of understanding
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Liability Waivers
• Used by hospitals and physicians to protect them
against legal liability
• Documents signed by the patient
• Specify provider responsibility in case of treatment
failure or injury
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Service Level Agreements
• Frequently used in technology applications
• Define level of service user can expect from
technology provider
• Examples of SLA performance measures
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Downtime
Downtime period
Monthly uptime percentage
Scheduled downtime
Service credit
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Memorandum of Understanding
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Also called memorandum of agreement (MOA)
Voluntary agreement between health providers
Specifies some mutually beneficial arrangement
Example: natural disaster recovery
– Agreement would specify responsibilities of each
entity
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Memorandum of Understanding
(cont’d.)
• Four elements of a legally binding contract
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Payment or consideration
No illegal activities
Actions of parties must be described
Agreed upon without threat or duress
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Summary
• Healthcare costs keep increasing
• Healthcare industry has been slow to adopt use of
information technology
• HIT: the use of hardware and software to manage
and manipulate health information
• Regulation provides constraints or controls
• HIPAA protects privacy and security of patient
health data
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Summary (cont’d.)
• Parts of HIPAA
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Privacy rule
Security rule
Identifier rule
Transaction and Code Sets rule
• HITECH Act increases protections of HIPAA
• Certain legal practices exist outside the regulatory
environment
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