Today's Medical Assistant 2nd edition Chapter 38 Medical Office Computerization Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 1 Lesson 38.1 Computer Concepts 1. 2. 3. 4. Explain the difference between data and a program. Explain the purpose of each of the following parts of the data processing cycle: input, processing, and output. List examples of input and output devices. Explain the difference between software and hardware. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 2 Lesson 38.1 Computer Concepts (cont’d) 5. 6. 7. 8. Explain the function of an operating system. State the function of application software. List and state the function of the following components of the main computer unit: mainboard, CPU, main computer memory, hard drive, optical disc drive, and power supply. Describe the care and maintenance of the main computer unit. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 3 Introduction to Medical Office Computerization Computer Most frequently used piece of equipment in medical office Medical assistant must be familiar with: • • Computer system used in the office Programs being run on that computer system: medical practice management program; electronic medical record program Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 4 Computer Concepts Computer: a device consisting of electronic components Has the ability to process data according to a program in order to produce a desired result Advantages of computers • • • Tasks are performed with greater speed and accuracy Computers are versatile – can perform a wide variety of administrative procedures Same tasks can be performed repeatedly while maintaining the same level of efficiency Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 5 Computer Concepts Computer: a device consisting of electronic components Microcomputer: also known as a personal computer or a desktop computer • Used most often in medical office Network: computers that are linked together • • Computers can communicate with each other – share data and resources Number of computers in the network varies on the basis of: size of the medical practice; type and number of tasks performed on the computer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 6 Data Processing Cycle Data processing: changing raw facts or data into usable information Data: raw, unorganized facts presented to the computer for processing Data frequently entered into the computer in the medical office: • Name, address, and telephone number of patients Program: a set of instructions organized in a logical step-by-step sequence Tells the computer how to perform a specific function Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 7 Data Processing Cycle Data process cycle includes three phases: input, processing, output Input: the transfer of data to the computer for processing – includes: • • When a computer is finished working on “electronic” data • • Entering data into the computer Converting them into an electronic form (code) that can be understood by the computer Must be converted back into a form that can be understood by the user User: the individual using the computer Input device: device used to enter data into the computer • Examples: computer keyboard, mouse, scanner, microphone Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 8 Data Processing Cycle Data process cycle includes three phases: input, processing, output Processing: the computer’s handling and arranging of the electronic data according to a program • • Data undergo some type of manipulation to produce useful information Processing may include: classifying; sorting; calculating; summarizing; listing of the data Output: the transfer of usable information back to the user • Output device: converts the electronic code into a form that can be understood by the user – examples: monitor, printer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 9 Data Processing Cycle Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 10 Components of the Computer System Computer system: all of the components making up the computer Two major divisions • • Software Hardware Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 11 Software Software: programs or instructions that tell a computer what to do Tells the computer how to perform specific tasks Consists of a series of step-by-step instructions organized in a logical sequence Categories of software: • • System software: assists the computer in carrying out its tasks Application software: assists the user in carrying out computer tasks Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 12 System Software Group of special programs that control or maintain the operations of a computer Operating system: most common type of system software Automatically loaded into the computer’s main memory (RAM) when the computer is turned on Performs “housekeeping” chores required by the computer system to operate itself Serves as an intermediary to tell the hardware how to run an application program Example of an operating system: Windows (Microsoft Corporation) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 13 Application Software Software designed to allow a user to accomplish a specific task Also known as application program or software program Makes up the greatest proportion of the software available for use with a computer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 14 Application Software Application software included in a medical practice management program: Word processing • • Used to enter, edit, format, and file (store) text Used to produce letters (e.g., referral letter) and reports (e.g., health history report) Spreadsheet • • An electronic ledger designed to perform mathematic calculations quickly Used to generate financial reports for the office Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 15 Application Software Application software included in a medical practice management program: Telecommunications • • Allows one computer to “talk” with another computer Used for the electronic submission of insurance claims and electronic mail (e-mail) Database management • • • • The storing and retrieving of data in and from a database Used to store large amount of data on a storage device (e.g., hard disk) Provides the ability to: add new information; modify existing information; delete unneeded information Computer can cross-reference all the information in a database Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 16 Documentation A written set of instructions Designed to assist the user in understanding how to operate an application program Includes: Program user manual • Contains complete instructions for learning and using the program Online help screens displayed on the computer monitor Reference cards • Contains frequently needed details for quick reference Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 17 Hardware Hardware: the physical equipment making up the computer system Includes: Main computer unit Monitor Computer keyboard Mouse Printer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 18 Hardware Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 19 Main Computer Unit Consists of a hard plastic case that is usually rectangular in shape Houses all the components that make the computer work Includes: mainboard, central processing unit, main computer memory (RAM), video card, sound card, hard disk, optical drive, and power supply Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 20 Mainboard Also known as the motherboard Primary circuit board of the main computer unit Each of other components of main unit either: Sit on the mainboard (e.g., CPU) Connect to the mainboard (e.g., hard drive) Provides a means for all the components to communicate with each other “Nervous system” of the computer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 21 Central Processing Unit “Brain” of the computer Most complex computer component Consists of a microprocessor chip Interprets and executes the instructions that operate the computer Resides on the mainboard Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 22 Central Processing Unit Determines how fast a computer can process information Speed of CPU: expressed in gigahertz (GHz) • • The higher the value: the faster the computer Example: 3-GHz computer can process information twice as fast as a 1.5-GHz computer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 23 Central Processing Unit CPU consists of: Control unit: coordinates the entire computer system – functions as a “traffic patrolman” to: • Direct the step-by-step operation of all the processing functions: reads and interprets the preset instructions of a program; tells the other components of the system what to do Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 24 Central Processing Unit CPU consists of: Control unit: coordinates the entire computer system – functions as a “traffic patrolman” to: • • During the processing phase keeps track of: which steps of the program have been performed; which steps remain Collects the output and directs it to the designated output device Arithmetic/logic unit (ALU) • Executes the program’s instructions by performing mathematic computations; logical operations Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 25 Main Computer Memory Consists of computer chips mounted on a small board Responsible for temporarily storing information Connected to mainboard Until ready for use by the CPU Items held in main memory Operating system Application program in current use Data waiting to be processed Information ready for output Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 26 Main Computer Memory RAM: random-access memory Main memory of a microcomputer Computer can get to any part of the information directly • Less time involved in locating information Provides only temporary storage • When computer is turned off – items stored in RAM are dumped out Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 27 Storage Capacity The maximum amount of information that RAM can hold Measured in bytes One byte equals one character (letter or number) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 28 Storage Capacity Kilobyte (KB): equal to 1024 bytes Usually rounded off to 1000 bytes Megabyte (MB): equal to 1 million bytes or 1000 KB Gigabyte (GB): equal to 1 billion bytes or 1000 MB Most computers come with a main memory of 1 GB or more Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 29 Storage Capacity Capacity of RAM Correlates to the level of complexity of programs it can run Program takes up a certain amount of space in RAM Small program: takes up less space in RAM Large complex program: takes up more space in RAM Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 30 Storage Capacity Application program packaging Labeled with information on its computer system requirements • Indicates the requirements your computer system must have to run the program – examples: type of operating system, microprocessor speed, amount of memory, hard disk space Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 31 Sound Card and Video Card Video Card Also known as a graphics card Converts video output into electronic signals that are sent to the monitor • Signals are converted into text and images – displayed on the screen of the monitor Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 32 Sound Card and Video Card Sound Card Converts audio output into electronic signals • Signals are sent to speakers that convert them into sound – examples: sound effects, music, and narration Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 33 Power Supply Provides the power needed by the computer to run itself Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 34 Care and Maintenance of the Main Computer Unit Place on a flat, stable surface (e.g., computer desk) Prevents excessive vibration during operation • Could loosen electronic circuit boards Most main units are placed in a vertical position (e.g., tower) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 35 Care and Maintenance of the Main Computer Unit Operate in a moderately cool temperature environment Extreme heat and inadequate ventilation: increase chance of malfunction • • Do not place near a window or other areas that receive direct sunlight Do not obstruct ventilation slots Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 36 Care and Maintenance of the Main Computer Unit Rooms with computers should be kept clean with no smoking permitted Primary cause of improper functioning: • Exposure to environmental contaminants – examples: dust, dirt, smoke Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 37 Care and Maintenance of the Main Computer Unit Casing of the main unit Wipe periodically with a slightly damp, lint-free cloth • To remove dust and dirt Do not clean with: • Aerosol sprays, solvents, and abrasives – can damage the finish Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 38 Care and Maintenance of the Main Computer Unit Interior of main unit Clean (occasionally) according to instructions in user manual Keep liquids away from the computer If liquid spills into main unit • Can damage electronic circuit boards Check computer cables on a regular basis: make sure they are secure Loose or disengaged cable: can result in temporary malfunctioning Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 39 Lesson 38.2 Computer Accessories 9. 10. 11. Describe the function, care, maintenance, and ergonomics of the computer monitor. List and describe the function of the special keys on a computer keyboard. Describe the care, maintenance, and ergonomics of a computer keyboard. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 40 Lesson 38.2 Computer Accessories (cont’d) 12. 13. 14. Identify the guidelines to follow in the care and maintenance of a printer. List and describe the storage devices used with microcomputer systems. Describe the method of organization that a hard disk uses to store and retrieve information. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 41 Computer Monitor Displays images generated by a computer Permits user to view: Input: data entered into the computer Output: information produced by the computer as a result of processing Softcopy: the visual display of information on the screen of the monitor Useful when information is necessary and a permanent copy is not required Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 42 Types of Monitors CRT monitor: big, bulky, and heavy visual display device similar to most television sets CRT: abbreviation for cathode-ray tube Sprays electrons onto a viewing screen under the direction of a magnetic field • Forms characters on the screen Previously: the type of monitor used most often • LCD monitors are increasing in popularity as cost is decreasing Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 43 Types of Monitors LCD flat panel monitor: flat panel desktop monitor LCD: abbreviation for liquid crystal display Small, lightweight, and compact Consumes very little power • Creates a visual image by manipulating light • More energy-efficient than CRT monitors Within a layer of liquid crystal cells Sometimes difficult to view images from an angle Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 44 Types of Monitors LCD Monitor Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 45 Screen Size Measurement of a computer screen Typical desktop monitor used in medical office: From one corner of the screen diagonally across to the opposite corner Screen size: from 17 to 20 inches Range of available screen sizes: between 14 and 23 inches Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 46 Monitor Resolution The sharpness of the image displayed on the screen High-resolution monitor: produces a sharp image Crisp, clear, easy-to-read characters Works to prevent eyestrain and headaches Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 47 Monitor Resolution Measured in pixels (picture elements) Pixels: “dot” locations on the screen • Can be lit up as needed to display characters and other images – the more dots present: the sharper the image Resolution of 1280 × 1024 Displays 1280 pixels horizontally and 1024 pixels vertically Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 48 Monitor Controls Used to operate and adjust the display screen On/off button When monitor turned on: indicator light comes on Brightness control: increases or decreases the intensity of the images on the screen Contrast control: adjusts screen for comfortable viewing Contrast: the degree of difference between the light and dark areas on the screen • Too much contrast: makes it uncomfortable to look at the characters Not enough contrast: makes it difficult to view characters Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 49 Monitor Ergonomics Place monitor directly in front of the user At an arm’s length distance when sitting back in a chair Position of monitor: Top of the monitor should be approximately 2 to 3 inches above eye level • Helps prevent back and neck tension Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 50 Monitor Ergonomics Occasionally focus your eyes on a distant object (more than 20 feet away) Prevents eye strain • Blink frequently: lubricates and moistens eyes Eye muscles must work harder to focus on near objects Prevents them from drying out Position screen so that it does not reflect bright light (glare) Could result in eye strain Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 51 Monitor Care and Maintenance Place monitor on a flat, stable surface (e.g., computer desk) Do not obstruct ventilation slots: allow heat to escape Do not stack items around the monitor Never place anything on top of the monitor Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 52 Monitor Care and Maintenance Clean screen regularly with: Microfiber cloths Computer screen cleaner applied with a lint-free cloth • Do not apply directly to the screen – may run down inside of case and damage electrical circuits Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 53 Monitor Care and Maintenance Casing of the monitor Wipe periodically with a damp, lint-free cloth to remove dust and dirt • Dust and dirt act like insulation: heat builds up in monitor – causes electronic components inside monitor to wear out Do not use aerosol sprays, solvents, and abrasives to clean casing Can damage finish Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 54 Computer Keyboard Most common input device Contains keys that are pressed to enter data and instructions into the computer Includes all the keys normally found on a typewriter keyboard Composition is alphanumeric: alphabetic and numeric keys May have a numeric keypad on the right side Used for entering numbers quickly Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 55 Computer Keyboard Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 56 Computer Keyboard Pressing a key on the keyboard Generates an electronic code • Passed into the computer for processing Types of keyboards Attached to main unit by a cable Wireless keyboard • Communicates with computer through radio waves or infrared light waves Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 57 Special Keys Issue commands to the computer to perform specific functions on the information displayed on the screen Pressing a special key Does not cause a character to be typed on the screen Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 58 Special Keys Allows user to perform certain tasks, such as: Saving text Printing text Capitalizing text Deleting and inserting text Moving the cursor Example: “Enter” key (also called the return key) Most frequently used special key Tells the computer to act on the instructions that have been given to it Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 59 Special Keys Categories of special keys Modifier keys: used in conjunction with another key to enter commands into the computer • • Include: control key, shift key, alternate key, command key Example: “Ctrl-P” can be used to print a document Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 60 Special Keys Categories of special keys Lock keys: used to lock a key in position • Include: caps lock, numeric lock, scroll lock Navigation keys: used to control the movement of the cursor on the screen • Include: arrow keys, home/end key, page scroll key, enter key, backspace key, insert key, delete key, tab key Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 61 Special Keys Categories of special keys Function keys: can be programmed to perform certain tasks that will assist the user • • • • • Examples of tasks: saving text, printing a document Number of F-keys varies: usually 12 or more Located above the top row of alphanumeric keys Usually preprogrammed by an application software package Some computers: permit F-keys to be user programmed from the keyboard Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 62 Mouse A pointing device that fits comfortably under the palm of the hand Used to move the pointer on the screen to an object on the screen Examples of screen objects: menu item, icon, line of text Mouse must be “clicked” to perform a certain action on the screen object Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 63 Keyboard Ergonomics Place keyboard at a level that is lower than conventional desk Feet should be flat on the floor Hands should rest comfortably at the keyboard with the shoulders relaxed Elbows flexed at a 90-degree angle or tilted slightly upward Adjustable chair with good back support To attain the proper typing height Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 64 Keyboard Ergonomics Use a light touch when entering data Keep hands and fingers as relaxed as possible Position mouse at same height as keyboard Allow adequate working space Position material being entered into the computer Lying flat on the work surface Held vertically in a copy holder Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 65 Keyboard Ergonomics Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 66 Keyboard Care and Maintenance Residue may build up on surface of keyboard (grime) Clean with an antiseptic wipe or a slightly damp, lint-free cloth • Do not use aerosol sprays – liquid may drip down into the keyboard: can damage electrical components Dust interior of keyboard Using compressed inert gas in a pressurized can Can also use a vacuum cleaner with a small brush attachment Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 67 Keyboard Care and Maintenance Steps for cleaning computer keyboard Shut down the computer Disconnect keyboard cable Hold keyboard upside down • Shake it to remove dust, dirt, or crumbs Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 68 Keyboard Care and Maintenance Steps for cleaning computer keyboard Clean the keyboard using a can of compressed air • Clean top and side of keys to remove grime • • Following manufacturer’s instructions With an antiseptic wipe or a damp, lint-free cloth Can use a cotton swab moistened with alcohol to clean between spaces of keys Allow keyboard to dry completely (about 30 minutes) • Before reconnecting it to computer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 69 Keyboard Care and Maintenance Liquids spilled into keyboard: can damage it Steps to take if liquid is thin and clear (e.g., water) • • • • • • • Turn off computer immediately Unplug keyboard Turn upside down and gently shake it Keep inverted to allow additional fluid to drain out Wipe with paper towel or clean cloth Let dry in inverted position for 24 hours If it doesn’t work after 24 hours: replace it If liquid is greasy, sweet, or sticky: • • Often causes permanent damage Keyboard must be replaced Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 70 Printer An output device capable of printing text and graphics on paper Converts processed data from a combination of electronic impulses into a printed form Hardcopy: printed form • Examples: patient reminders, patient receipts, prescriptions, patient statements, office reports Some printers: double as fax machines and photocopiers Only practical when there’s a small volume of work Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 71 Printer Printer can be: Printers most commonly used in medical office: Dedicated to one computer Networked to a number of computers Inkjet Laser Dot-matrix printer: impact printer that can print multiple-copy documents Not used as much as in the past Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 72 Inkjet Printer Uses droplets of ink to form text characters and graphics Contains nozzles Spray tiny drops of ink onto the paper to create an image Lightweight and inexpensive Can produce text and graphics In black and white and in color Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 73 Inkjet Printer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 74 Inkjet Printer Printing speed: the number of pages per minute (ppm) generated by the printer Inkjet printer: ranges from 8 to 36 ppm Pages that contain text print at a faster rate than: • • Pages that are in color Graphics Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 75 Inkjet Printer Initial cost of printer: low Ink cartridges: contain ink used by an inkjet printer Expensive Must be replaced frequently Most printers use at least 2 cartridges • • 1 black ink cartridge 1 or more colored ink cartridges Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 76 Laser Printer Produces text using: Micro-thin beam of light (laser beam), electric charges, and toner powder To produce each page of text Toner powder: housed in a plastic cartridge Operating panel: displays level of toner remaining Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 77 Laser Printer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 78 Laser Printer Initial cost of a laser printer: more than an inkjet printer Operating cost is less • Print quality of laser printers: superb Cost of using toner powder is less than using ink cartridges Nearly attains the quality of typesetting Available in black-and-white and color models Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 79 Laser Printer Has a fast printing speed and quiet mode of operation Printing speed range: 12 to 35 or more ppm • • Text: prints at a faster rate Color and graphics: prints at a slower rate Does not have as many mechanical moving parts Reduces frequency of repair Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 80 Printer Care and Maintenance Place printer on a flat, stable surface Avoid placing printer in a location that would expose it to: Direct sunlight Excessive heat Moisture Dust Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 81 Printer Care and Maintenance Sufficient room should be left around the printer for: Adding paper Replacing ink or toner cartridges Add paper when needed, following manufacturer’s instructions Replace ink cartridges (inkjet printers) and toner cartridges (laser printers) as required, following the manufacturer’s instructions Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 82 Printer Care and Maintenance After turning off the printer Wait at least 5 seconds before turning back on • Rapid switching of the power off and on: can damage printer Clean regularly: to remove accumulated dust and dirt Outside case • Clean with a soft, clean cloth – dampened with a mild detergent solution Inside of printer • Clean according to instructions in user manual Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 83 Storage Devices Storage device: consists of a storage medium that permanently stores information for later retrieval by the computer Retains information after the power has been removed Used to store both programs and data Examples: • • • • Hard disks CDs DVDs USB flash drives Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 84 Storage Devices Storage capacity of a storage device Maximum amount of information the device can hold Measured in bytes (kilobytes, megabytes, and gigabytes) Varies widely on the basis of the type of storage device • Example – typical hard disk: 250 GB Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 85 Hard Disks Consist of thin, rigid platters made of metal or glass Coated with a magnetically sensitive material Data are stored as magnetic particles Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 86 Hard Disks Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 87 Hard Disks Method of organization used to store and retrieve information Disk surface is divided into concentric circles: tracks • Data are stored on tracks in the form of magnetized particles Tracks are further divided into sectors (resemble the wedge-shaped pieces of a pie) Formatting: a process that numerically marks tracks and sectors • Facilitates the location of information stored on the disk Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 88 Hard Disks Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 89 Hard Disk Drive Used to retrieve data from a hard disk Consists of a mechanical device located inside the main computer unit Rotates a hard disk at a high rate of speed Read/write head mounted on an arm Floats on a layer of air above the spinning disk Has instant access to all tracks and sectors on disk Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 90 Hard Disk Drive Hard disk: sensitive to dirt, dust, smoke Encased in a permanently sealed, airtight container • Protects it from contaminants Hard disk drive: consists of hard disks and read/write heads Purpose of read/write head Stores information onto the hard disk: write • Information is transferred from RAM to the hard disk Retrieves information from the hard disk: read • Information is transferred from the hard disk and into RAM Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 91 Hard Disk Drive Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 92 Hard Disk Drive Hard disk consists of two or more platters stacked on top of one another Increases storage capacity Both sides of the disk: used to store information • Each side of disk: has a read/write head Available in a variety of storage sizes • Begin at 80 GB and range up to 750 GB or more Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 93 Optical Discs Storage devices that store data using laser technology Used to store: system software, application software, data, photographs, music, movies Consists of a flat, round, portable disc made of metal, plastic, and lacquer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 94 Optical Discs May be read-only Data can only be read (retrieved) from the disc (using a laser beam of light) • Most application software today Comes on CD-ROMs • Data cannot be written (saved) on the disc – example: CD-ROM (holds 650 MB) Installed onto a computer's hard drive to operate May also be read/write Data can be read from the disc and written onto the disc • Example: CD-RW (compact disc rewritable) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 95 Optical Discs DVD (digital versatile disc or digital video disc) Uses another type of optical disc technology Can hold 6 times as much information as a CDROM • Used to store: music and movies Optical drive: uses a laser to read an optical disc or write onto an optical disc Today’s computers: include one or more optical drives • Installed in drive bays on the main unit To use an optical drive: • • Button is pushed to slide out a tray – optical disc is inserted (label side up) Same button is pushed to close tray Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 96 USB Flash Drive Portable storage device Consists of a small circuit board in a plastic case Also known as a jump drive and a thumb drive Stores information using flash memory Type of electrical computer memory Inserted into a USB port on main unit Storage capacity: up to 64 GB or more Ranges between 1 GB and 64 GB or more Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 97 Lesson 38.3 Medical Office Computerization 15. 16. 17. Explain why it is important to have a foundation in computer concepts before engaging in handson computer operations. List and explain the advantages and disadvantages of medical office computerization. List and describe measures that can be taken to promote the efficient running of a computerized medical office. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 98 Lesson 38.3 Medical Office Computerization (cont’d) 18. 19. Explain the purpose of a medical practice management software program. Explain the function performed by each of the following parts of the medical office computer system: patient registration, appointments, posting transactions, patient billing, insurance billing, reports, file maintenance, and electronic medical record. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 99 Medical Office Computerization Use of computer to perform medical office administrative procedures Increased demand for qualified individuals trained in medical office computerization Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 100 Prerequisite Computer Concepts Important to acquire a thorough knowledge of computer concepts Benefits Increased confidence and ease when working on a computer Ability to understand computer terminology Helps in communicating with computer software specialists • Technical support staff for your medical practice management program – necessary when first learning the program or when a problem is encountered Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 101 Impact of Medical Office Computerization Sometimes considered to be the solution to all medical office management problems However, there are some disadvantages: can lead to difficulties Must be aware of these problems • Take steps to prevent them or be prepared to deal with them Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 102 Advantages of Computerization Speed and productivity Large amount of data can be processed quickly • Example: inquiry search for patients with hypertension Billing and health insurance • Can prepare and process these items in a short period of time Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 103 Advantages of Computerization Efficiency Computer can perform repetitive tasks in which information is used again but in a different format • Example: once a patient’s name and address have been entered – can be used on a number of different forms; do not need to reenter them Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 104 Advantages of Computerization Efficiency Computer can automatically transfer information where needed • Based on the task being performed – example: patient’s name and address can be transferred to patient statement, insurance form, mailing label Computer keeps track of the status of functions that have been executed in the office • Example: submission of insurance claims Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 105 Advantages of Computerization Accessibility Data are easy to retrieve when needed • Example: patient registration record – do not need to manually hunt through a filing system for record Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 106 Advantages of Computerization Audit trail Computer can keep track of data entry • • • When new information entered or existing information is changed, log is created and stored Log includes time and date of entry; name of computer operator Log can be retrieved by practice manager to detect irregularities Reduced costs Decreases operating costs by: • Reducing amount of time required to perform front office procedures Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 107 Disadvantages of Computerization Initial cost Initial investment is required • • Hardware: physical devices making up a computer system – cost depends on the number of computers and printers needed Software: programs that tell a computer what to do – may need to periodically upgrade Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 108 Disadvantages of Computerization Time investment Can take considerable time to learn a program and use it with ease • May take a month or more Software vendors provide: • • On-site training Technical support for problems Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 109 Disadvantages of Computerization Start-up tasks Certain tasks must be performed before the program becomes operational Most offices are already computerized • These tasks have previously been performed If office has just opened or purchased a new program: • Start-up tasks are required Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 110 Disadvantages of Computerization Start-up tasks Examples of start-up tasks: • • Start-up tasks must be performed: • Entering diagnoses and procedures Setting up patient registration records Before program can be used to operate the front office Start-up data: only need to be entered once • Additional information can be added as needed Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 111 Computer System Malfunction Hardware and software systems occasionally fail One or more front office procedures come to a halt Cause of malfunctions: Operator error Software “bug” Hardware malfunction Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 112 Measures to Promote Efficient Computer Operation Selection of hardware and software Should be selected from experienced and established vendors Some offices use a consultant to assist with this process Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 113 Measures to Promote Efficient Computer Operation Qualified personnel Should be well-trained in: • • Computer concepts Hands-on computer operation Office should: • • Employ graduates of a formal education program Have staff attend computer workshops and seminars Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 114 Measures to Promote Efficient Computer Operation Qualified personnel Untrained staff: • Can adversely affect efficient operation of a computer system Proper care and maintenance of the computer system Directly related to reliable operation of the system Less likely to malfunction Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 115 Medical Practice Management Program Provides instructions to the computer for performing front office procedures Consists of a number of areas of specialization Each area of specialization: system Each system performs procedures related to its particular area of specialization Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 116 Medical Practice Management Program Systems included in a practice management program: Patient registration system Posting transactions system Appointment system Patient billing system Insurance billing system Reports system File maintenance system Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 117 Patient Registration System Used to set up a registration record For each patient in the medical practice Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 118 Patient Registration System Includes demographic and medical insurance information: Patient’s name and address Telephone number Gender Date of birth Social Security number Insurance carrier, policy number, group number Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 119 Patient Registration System Also used to review and update information Example: change of patient’s address Use of information in patient registration records: Preparing new patient’s chart Posting transactions Processing patient statements Processing insurance claims Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 120 Appointment System Handles all procedures related to appointment scheduling: Making an appointment Canceling an appointment Rescheduling an appointment Finding an appointment Printing an appointment log Printing a patient reminder card Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 121 Appointment System Occasionally: medical office uses an appointment book When written record is preferred • In the event of a computer breakdown: written record is still accessible Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 122 Appointment System Advantages of a computer scheduling program: Easier to change an appointment on a computer than with pencil and paper Appointment schedule can be printed out • Does not have to be generated manually from the appointment book Easier to schedule patients who need regular weekly or monthly visits • Computer automatically records the patient's name in that time slot – for as many visits as needed Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 123 Posting Transactions System Used to post charges for all the services and procedures performed on a patient MA enters the services and procedures provided to the patient • From the encounter form – lists all services and procedures performed during the visit Computer has codes for all services and procedures in its database • Automatically posts charge for each service or procedure Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 124 Posting Transactions System Used to post payments made by: Patient (e.g., copayment) Third-party payer Used to print out a patient receipt Time-of-service (TOS) charges and payments Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 125 Patient Billing System Prepares bills and prints billing statements Patient charges, payments, and adjustments are posted Stored in computer Available when needed by patient billing system Searches database to obtain information to generate bills Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 126 Insurance Billing System Prepares and generates insurance claims Procedures and diagnoses are entered into computer (posting transactions) Stored in medical practice database Available when needed to prepare insurance claims • Computer automatically fills out every portion of insurance claim Insurance claims submitted to insurance companies Mailing paper claim forms Sending them electronically Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 127 Insurance Billing System Electronic filing of insurance claims Becoming more widespread Sent using electronic data interchange • Type of computer protocol Biggest barrier: data security Allows electronic payment of claims • Insurance company transfers payment electronically to medical practice bank account Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 128 Reports System SUsed to generate a variety of reports for the medical practice Information in reports Accessed by the computer from the medical practice database Allows physician to review and analyze business and practice activities Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 129 File Maintenance System Start-up tasks must be performed: before program becomes operational Customizes program • To meet the specific requirements of a medical office Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 130 File Maintenance System Start-up tasks include: Entering practice information Assigning user passwords Entering provider information Entering diagnosis and procedure codes Entering insurance carriers Entering place of service information Entering referring physicians Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 131 File Maintenance System Most offices are already computerized Start-up tasks required: Start-up tasks have previously been performed Office is just opening Office has purchased a new practice management program Once program is operational File maintenance is used to: • • Add information Review, edit, delete information previously entered Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 132 Lesson 38.4 Electronic Medical Record, Computer Maintenance, and Computer Security 20. 21. 22. List the general functions of electronic medical record (EMR) software. Explain the advantages and disadvantages of EMRs. Describe the processes required to produce or convert each administrative and clinical document in a medical record into a digital format. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 133 Lesson 38.4 Electronic Medical Record, Computer Maintenance, and Computer Security (cont’d) 23. 24. 25. Discuss concepts of networking and electronic transfer of information. List the procedures performed by the physician and medical assistant using an EMR. Describe the methods used to maintain security of the medical office computer system. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 134 Lesson 38.4 Electronic Medical Record, Computer Maintenance, and Computer Security (cont’d) 26. 27. 28. List and describe methods used to back up computer data in the medical office. State the various types of system maintenance that should be performed on a computer system. List the various types of service agreements available for a computer system. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 135 Electronic Medical Record Also known as electronic health record (EHR) Consists of a computerized record of the important health information regarding a patient Includes: • • Care of the individual Progress of the patient’s condition Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 136 Electronic Medical Record Major undertaking to convert to an EMR Deterrents: • • Financial investment Time investment EMR software can perform following medical record functions: Creation Storage Organization Editing Retrieval Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 137 Electronic Medical Record Usually linked to the practice management software Allows the EMR to facilitate certain administrative tasks • Examples: billing and insurance Each document in the medical record has a specific function PPR: some documents consist of preprinted forms • Information is entered on a form EMR: forms (templates) are displayed on computer screen • Information completed in same way as paper form – field: space on the form for entering information Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 138 Advantages of the Electronic Medical Record Often leads to better quality care due to: Improved communication Faster access to data Clearer and better documentation Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 139 Advantages of the Electronic Medical Record Speed and productivity Can retrieve requested documents from a patient’s record very quickly • Documents from outside facilities can be stored very quickly • Avoids having to manually hunt through the record Example: laboratory reports Records do not need to be filed • • • Saves time Frees up office space needed to store records Paper costs are reduced Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 140 Advantages of the Electronic Medical Record Efficiency Facilitates the entry of data into the patient’s medical record • Point and click technology is used to enter data (check-boxes; drop-down lists) Prints customized patient education instructions and handouts Generates prescriptions Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 141 Advantages of the Electronic Medical Record Accessibility Provides ready access to patient’s medical record • Available at any EMR computer workstation More than one person can view chart at the same time Readily accessible if patient telephones office • Avoids having to find record and call patient back Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 142 Disadvantages of the Electronic Medical Record Initial cost Initial investment required for the purchase of hardware and EMR software Office must have a sufficient number of computers • To accommodate the number of health care providers in the office Expense can easily fall into thousands of dollars Must periodically upgrade the EMR software • Leads to further expenses Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 143 Disadvantages of the Electronic Medical Record Time investment Takes considerable time to learn an EMR program • Up to several months or more Most software vendors provide: • • On-site training Technical support for problems Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 144 Disadvantages of the Electronic Medical Record Operational tasks Certain tasks must be performed • Before EMR program becomes operational Scanner • Used to scan older records into the computer (paper records may be shredded) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 145 Disadvantages of the Electronic Medical Record What Would You Do? What Would You Not Do? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 146 Disadvantages of the Electronic Medical Record What Would You Do? What Would You Not Do? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 147 Electronic Medical Record Documents EMR documents Come from many locations and sources Two categories: • • Administrative documents Clinical documents EMR documents must be in a digital format Modifications are needed to: • • Produce them in a digital format Convert them into a digital format Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 148 Electronic Medical Record Administrative Documents Information necessary for efficient management of the medical office Patient registration record Consists of demographic and billing information In most EMR offices: • • • Patient completes a paper/pencil registration form Data entered into a patient registration “computer” form Paper form may be shredded (based on medical office policy) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 149 Electronic Medical Record Administrative Documents Patient registration record Patient may be asked to enter this information directly into the computer • • Provide a private area for this task MA must be available to answer patient questions Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 150 Electronic Medical Record Administrative Documents NPP Acknowledgement Form Notice of privacy practices (NPP): written document – explains to patients: • How their protected health information will be used and protected by the medical office Patient signs a form: acknowledgement of receiving a NPP NPP form is scanned into the computer • Filed in the patient’s EMR Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 151 Electronic Medical Record Administrative Documents Correspondence Correspondence received from a number of individuals or facilities – examples: • • • Patient’s insurance company Patient’s attorney Patient himself Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 152 Electronic Medical Record Administrative Documents Correspondence Correspondence transmitted electronically to office • Already in a digital format – transferred to patient’s EMR (example: letter from an insurance company sent as an attachment to an email) Correspondence received in a paper form • MA must convert to a digital format (scan it into computer; file in patient’s EMR) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 153 Electronic Medical Record Administrative Documents Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 154 Electronic Medical Record Administrative Documents Correspondence Copy of correspondence sent out of the office • • Examples: referral letter, collection letter Generated in an electronic format (word processing) – can easily be transferred to the patient’s EMR Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 155 Emergency Medical Record Clinical Documents Records and reports that assist physician in the care and treatment of the patient Health History Report Collection of subjective data about the patient Patient may complete paper/pencil health history • MA enters data into the computer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 156 Emergency Medical Record Clinical Documents Health History Report Alternatives: • • MA enters information directly into computer – asks patient questions related to his or her health status Patient completes health history on a computer – using a computer-guided questionnaire (private area must be provided for patient; MA must be available to answer questions) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 157 Emergency Medical Record Clinical Documents Physical Examination Report An assessment by the physician of each part of the patient’s body Physician records findings on a computer screen using: • • • Free-text entry Drop-down lists Check-boxes Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 158 Emergency Medical Record Clinical Documents Physical Examination Report EMR uses this information • To generate the PE report At the end of the examination • • PE report is complete Physician does not need to dictate findings – alleviates need for transcribing Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 159 Emergency Medical Record Clinical Documents Progress Notes Update the medical record with new information • Each time the patient visits or telephones the medical office Information is entered directly into the computer using: • • • Free-text entry Drop-down lists Check-boxes Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 160 Emergency Medical Record Clinical Documents Medication Record Consists of detailed information related to the patient’s medications MA enters information into the computer using: • • • • Free-text entry Drop-down lists Fill-in boxes Check-boxes Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 161 Emergency Medical Record Clinical Documents Medication Record – prescription program Reduces amount of time needed to prescribe and refill medication Generates and prints prescriptions • • Signed by the physician Given to the patient Transmits prescriptions electronically to pharmacy • • E-fax E-mail Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 162 Emergency Medical Record Clinical Documents Medication Record – prescription program Advantages • • • • • Eliminate need for pharmacist to decipher physician’s handwriting Can compare prescription to list of drugs covered by patient’s insurance plan Program provides access to product information Can quickly refill a prescription Can print a list of prescriptions being taken by the patient Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 163 Emergency Medical Record Clinical Documents Medication Record – prescription program Using an EMR prescription program: • • • Program displays list of available dosage strength and preparation forms Physician highlights dosage, strength, and preparation desired – enters information into computer Physician selects additional information required (dosage frequency; number of refills) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 164 Emergency Medical Record Clinical Documents Medication Record – prescription program Using an EMR prescription program: • • • • • Program automatically checks prescription against drug allergies and potential interactions with other medications taken by patient Once prescription entered into the computer, medication recorded in the patient’s medication list Prescription is printed out Signed by physician Given to patient or sent electronically to pharmacy Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 165 Emergency Medical Record Clinical Documents What Would You Do? What Would You Not Do? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 166 Emergency Medical Record Clinical Documents What Would You Do? What Would You Not Do? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 167 Emergency Medical Record Clinical Documents Consultation Report A narrative report of a clinical opinion about a patient’s condition other than the primary physician If received as an electronic report: • MA transfers to patient's EMR If received in paper format: • • MA must scan letter into computer Transfer report to patient's EMR Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 168 Emergency Medical Record Clinical Documents Home Health Care Report Home health care: the provisions of medical and nonmedical care in a patient’s home or place of residence Most home health care reports: in paper format • • Must be scanned into the computer Transfer report to patient's EMR Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 169 Emergency Medical Record Clinical Documents Laboratory Documents A report of the analysis or examination of body specimens Office may communicate electronically with outside laboratory – Request form: • • Completed on a form displayed on the screen Transmitted electronically to medical laboratory Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 170 Emergency Medical Record Clinical Documents Laboratory Documents Once patient’s tests have been completed: • • • Results are sent electronically to office – EMR files report in patient’s EMR Copy of report placed in physician’s “electronic review bin” – for review and electronic signature Abnormal values are highlighted on the report Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 171 Emergency Medical Record Clinical Documents Laboratory Documents Advantages • • Can quickly view laboratory results in chronological order Results performed on a routine basis can be graphed (e.g., blood glucose) – permits abnormal trend to be identified early If medical office is not networked by computers to outside laboratory: • Laboratory reports must be scanned into computer and filed in patient’s EMR Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 172 Emergency Medical Record Clinical Documents Diagnostic Procedure Documents Consist of a narrative description and interpretation of a diagnostic procedure Reports may be sent electronically to office • Easy to store report in patient's EMR Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 173 Emergency Medical Record Clinical Documents Diagnostic Procedure Documents Paper report • • MA must scan into computer File report in patient's record Image of diagnostic procedure (x-ray, CAT scan, MRI, ECG) • • Can be stored as a digital image Can be displayed on a computer screen Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 174 Emergency Medical Record Clinical Documents Therapeutic Service Documents Document the assessments and treatments designed to restore a patient’s ability to function Include: • • • Physical therapy report Occupational therapy report Speech therapy report Most reports are in paper format • • MA must scan into computer File report in patient's EMR Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 175 Emergency Medical Record Clinical Documents Hospital Documents Prepared by the physician responsible for the care of a patient while at the hospital Include a history and physical report, operative reports, discharge summary report, pathology report, emergency department report If hospital documents received in electronic format: • MA files in patient's record If hospital documents received in paper format: • • MA must scan into computer File document in patient's EMR Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 176 Emergency Medical Record Clinical Documents Consent Forms Legal documents required to: • • Perform certain procedures Release information contained in the patient’s medical record Most consent forms are in paper format that patient signs • • MA must scan into computer File form in patient's EMR Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 177 Internet Global system of interconnected computer networks Connected by routers Broadband router Digital subscriber line (DSL) Cable modem Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 178 Internet World Wide Web Webpages can be accessed by a Web browser • • Internet Explorer Firefox Input URL Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 179 E-mail Messages sent over the Internet Files can be attached Security and confidentiality are issues MA should assume email may be read by someone else E-mail should not be used for private messages or information in the medical office Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 180 Clinical Messaging E-mail within the EMR Links directly to clinical and laboratory data regarding patients Physician can identify which medications a patient’s insurance will cover. Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 181 Electronic Transmission of Billing and Insurance Information Must maintain a secure network and use an encryption system Facilitate transition to ICD-10-CM in 2014 Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 182 E-Prescribing Either a stand-alone program or a function of an EMR Computer program can access Drug information Information about patient’s insurance coverage Information about patient history and allergies Information about drug interactions Penalties for physicians who do not use this method E-prescribing controlled substances will soon be reality Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 183 Medical Assistant’s Use of the Electronic Medical Record EMR programs include an index Allow MA to access the various areas of information MA first selects the patient who is being seen Enters information about the visit Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 184 Medical Assistant’s Use of the Electronic Medical Record Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 185 Medical Assistant’s Use of the Electronic Medical Record Once MA begins working with the patient: Mechanism within the EMR program to select an activity or topic – selection made through: • • Set of tabs on the screen Drop-down list Example: selecting the “Medical History” tab • • Moves user to a screen containing information about patient’s medical history Ability to move to other screens with more specific information Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 186 Functions Performed by the Medical Assistant Access the daily schedule Select a patient Enter the time that the patient has checked in Enter the examination room number Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 187 Functions Performed by the Medical Assistant Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 188 Functions Performed by the Medical Assistant Enter the patient’s chief complaint Enter or review the patient history Enter or review patient allergies Enter or review the patient’s current medications Enter vital signs Enter measurements, such as height and weight Enter results of tests, such as vision screening or hearing screening Enter results of laboratory tests performed at the office (e.g., urinalysis, hemoglobin, strep testing) Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 189 Functions Performed by the Medical Assistant Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 190 Physician’s Use of the Electronic Medical Record Physician enters data into the EMR about: Examination of patient Assessments Plan for the patient Physician can review and update all information entered by MA Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 191 Physician’s Use of the Electronic Medical Record If EMR program is linked to the practice management software Physician is able to specify type of visit and patient diagnosis • Assists in billing as part of check-out procedure Physician can print a summary of the visit for the patient By selecting information from a list on the screen – examples: • • • • Physical examination findings Laboratory test results Vital signs Treatment recommendations Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 192 Physician’s Use of the Electronic Medical Record Physician can enter notes or reminders EMR provides ability to send electronic messages To other physicians/staff members in the system – similar to e-mail • Example: message to MA to schedule a patient for a test/procedure Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 193 Computer Network Security All HIPAA regulations apply to the EMR Medical office must provide secure access to patient health information Stored in the computer's database Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 194 Authentification Each health care worker with permission to use the computer network Must have a password Must log in to access the network Passwords should be changed at regular intervals May be a system function that requires this Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 195 Authentification MA should not share password with anyone else Effective passwords include: Random series of digits, letters, and symbols • Rather than English words, telephone numbers, or other combinations that have meaning Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 196 Levels of Authorization Specific levels of authorization within the computer network Certain screens and certain functions Only available to users with the correct level of authorization Example: at the end of a patient visit: Physician must electronically sign the record • Closes the visit: information cannot be changed Only the physician has this level of authority Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 197 Automatic Logoff All users should log out of the computer network When their workstations are unattended • If user forgets to do this: program automatically logs off a user after a predetermined period of inactivity Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 198 Audit Controls Practice management programs and EMR programs Have the ability to track the activity of individuals using the system Used to: Determine if security violations have occurred Identify the individuals with whom those violations may be associated Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 199 Antivirus Software Type of system software known as a utility program Installed on the computer system to scan for computer viruses Computer virus: software designed to penetrate a computer or network without consent • Can access information and/or cause damage Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 200 Antivirus Software Operates in the background Monitors all files for viruses Updates itself regularly New computer viruses are developed constantly • Can be spread quickly through the Internet Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 201 Firewall A system that protects a computer network from unauthorized access by Users on its own network Users on another network (e.g., Internet) May be in the form of: A utility software program A firewall hardware device that connects to the computer Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 202 Firewall All inquiries and messages entering or leaving the computer system Must pass through the firewall • • Examines each inquiry or message – blocks those that do not meet firewall’s security criteria If firewall unsure about whether or not to grant access – displays a screen message: user decides whether or not to grant access Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 203 Firewall What Would You Do? What Would You Not Do? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 204 Firewall What Would You Do? What Would You Not Do? Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 205 Backups Backup: a duplicate copy of a program or data kept for reference In case the original is damaged, lost, or destroyed Many medical offices contract with an online backup service Provides secure backups of all files used in the office for a monthly fee • • May be performed every few hours or at scheduled times Information is encrypted Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 206 Backups Large health care facilities May back up information from individual computers • Using their own network system External hard drives, CD-RWs, and DVDRWs Can be used to create physical backup copies • Must be stored in a safe place: physically remote from computer system – example: physician or MA takes backup home Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 207 System Maintenance System maintenance: involves setting up and overseeing the computer system Three aspects of system maintenance: Disk cleanup Disk defragmentation System administration Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 208 Disk Cleanup Unneeded files stored on the hard drive Slow down system performance Accomplished by a utility program: usually comes with the computer Frees up significant amounts of hard drive space and can significantly improve system performance Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 209 Disk Defragmentation Rearranges information on the hard disk Files and programs are stored closer together Allows the computer to locate information on the hard disk in a shorter period of time Results in improved system performance Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 210 System Administration System administrator: person designated to maintain the computer system Usually a computer specialist: known as an information technologist (IT) Small offices: often use a consultant Practices with several sites, health maintenance organizations, and community health centers Often have an IT specialist, or even an IT department Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 211 Service Agreements MA usually responsible for maintaining the service agreements For the office's computer systems Types of service agreements Maintenance agreements for the hardware System support agreements for the software Training of personnel on the software Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 212 Service Agreements Should designate an area in the medical office For the storage of user manuals for: • • • • Computers Printers Scanners Application programs Copyright © 2013 by Saunders, an imprint of Elsevier Inc. All rights reserved 213