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Do you think there is a difference between the changing trends taking place in the private sector and that of public behavioral healthcare inpatient facilities? Based on your understanding about behavioral health services and the populations being served by them, do you agree that both private and public organizations are able to provide the necessary clinical services? Provide a rationale in support of your response. •In behavioral healthcare, outcomes are the established norm for measuring the success or lack of services. What are some of the major challenges in collecting the data needed to support and report behavioral health outcomes? Provide a rationale for your response. •Quality of care and services is an important part of an outcome-based strategy. The objective behind maintaining and improving quality is to provide competent and efficient services to consumers. In your opinion, do the current regulatory and accreditation standards for the behavioral health industry help to meet that objective? How?

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Deanna Hettinger
Deanna HettingerLv2
28 Sep 2019
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Related questions

Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) The overarching goal of public health informatics is to apply computer science and information technology to promote health and minimize disease and injury at the population level. Public health informatics uses data from surveys, vital statistics, hospital and clinical statistics, private and public data sources, and government data sources for analysis in improving population health. Key concepts of public health informatics include: •Data collection •Storage •Retrieval Using the required readings and websites for this week, respond to the following:

1. Describe the most significant milestone(s) in the history of public health informatics. Refer to the CDC and WHO websites and state the similarities and differences between the types of public health data available with both these organizations.

2. Explain the different kinds of statistics and data available with the CDC and WHO. In addition, explain the various methods of research that they use.

3. Explain some of the major roadblocks that the field of public health informatics has encountered during the course of its development.

4. Describe the most salient issues facing the field of public health informatics today.

5. List and describe the various web-based data query programs that are available for different states, including your own (michigan).

CASE STUDY 7 **** WHAT DID YOU LEARN FROM THE CASE STUDY? ( ****basically just summarize what the case study is about)

Transforming the Clinical Process at Farmington Endoscopy Center William C. Kinney

Transforming the clinical work process in healthcare is not going to be a simple task, as many of today’s work solutions are rooted in decades-long and even century-old autonomous and hierarchical structures. As mentioned in the chapter, Paul Starr’s The Social Transformation of American Medicine explained how US healthcare evolved into a system that separates the business side and clinical side of care delivery. Separating the two functions ultimately created two diverging approaches, leaving the patient caught in the middle. Regulations from both the insurance industry and federal government are trying to bring the two sides together in the interest of what is best for the healthcare system as a whole.

The IOM’s reports on medical quality highlighted the inefficiencies and mistakes that resulted from the increased complexity of healthcare. Although IT exists to change the system, it has lacked the leadership and skills needed to bring about a redesign that, in turn, could transform existing processes and structures. The IOM reports and subsequent analyses have highlighted IT as a tool to improve quality and efficiency. Clinical decision support system (CDSS), in particular, has been identified as a priority health IT, as it pushes evidence-based health recommendations that lead not only to better clinical processes, quality, and outcomes but also to lower healthcare costs. The challenge in adopting CDSS is determining where and how to apply the evidence.

This case highlights the use of health IT to transform the clinical and business processes. Readers should take note of who the relevant players are, the information needs in care delivery, and the method of leveraging information to make care delivery more efficient and effective.

Farmington Endoscopy Center

Farmington is a Midwest college town with a population of more than 100,000 and a large and productive medical community supported by a local medical school. The medical community serves not only the residents of Farmington but also the residents of the surrounding rural communities, some of whom drive more than two hours to get to their respective clinic or hospital. The limited number of primary care physicians who work in rural settings, lack of supporting facilities, and varying socioeconomic backgrounds all add to the complexities of rural medicine. Rural communities also have few manufacturers and corporations that hire employees and provide employer-sponsored, private health insurance. This leaves many rural patients no choice but to enroll in government- supported healthcare programs. Farmington Endoscopy Center (FEC) is a freestanding, physician- owned endoscopy facility that serves both adult and pediatric patients. The main procedures—esophagogastroduodenoscopy (EGD) and colonoscopy—are performed by six gastroenterologist (the owners). Last year, it completed almost 5,000 cases, and this year it is anticipating a 5 percent growth in volume by adding a new physician. FEC is owned and managed by the physicians, but a full-time administrator is in charge of day-to-day operations, compliance with state and federal safety/account- ability standards, billing and collections, and staffing. Rounding out the staff are eight nurses, four receptionists, one billing specialist, and one certified registered nurse anesthetist (CRNA).

Patients are referred to FEC for an endoscopy procedure by the six physicians, each of whom runs a separate outpatient clinic, or by independent primary care or specialty physicians. The independent primary or specialty care physician assumes patient-management responsibilities for the results of the endoscopy, so the gastroenterologist who performs the procedure is essentially a technician whose responsibility to the patient ends at the completion of the procedure. Both EGD and colonoscopy are not painful, but they are uncomfortable and thus require sedation. Administered by the CRNA, sedation techniques range from applying topical anesthetic to running an intravenous line of light anesthesia (where the patient stays awake and can communicate) or a heavy dose of anesthesia (where the patient is unconscious and could stop breathing and may need respiratory support). The CRNA is licensed by the state but cannot act as an independent provider and must be under the close supervision of the gastroenterologist. Throughout the procedure, the gastroenterologist is ultimately responsible for the patient’s well being.

Areas of Improvement

Susan Michaels, the FEC administrator, is reviewing last year’s reports to find ways to increase volume. Both private and public insurance have changed their rules, resulting in lower reimbursements. Meanwhile, healthcare costs continue to rise, further cutting into profits. Needless to say, the FEC physician owners are concerned. Susan identifies two problem areas in the reports:

1. The center has a day-of-procedure cancellation rate of 8 to 12 per- cent. These patients show up for their scheduled procedure only to be cancelled by the clinic because of some factors that were not known before their arrival. The top-five factors are blood-thinner usage, unidentified cardiovascular risk, failure to adhere to NPO (latin for “nil per os,” which means no food or drink hours before a procedure), improper guardianship, and lack of bowel prep.

2. Regulations have doubled the amount of required paperwork to be completed for each patient. Explanation of patient rights and privacy policies, medication-reconciliation process, deep venous thrombosis evaluation, and complication reporting are just some of the tasks or forms that must be completed before a case can be closed. The planned addition of another physician to the practice would increase the number of cases, exacerbating the paperwork problem. Susan is considering hiring another nurse to help the existing staff with the workload, a move that would enable the FEC to accommodate more patients and complete the paperwork quicker. Fortunately, Susan just returned

Fortunately, Susan just returned from a health IT workshop that presented a new logic and tools for how to define the dimensions of a problem and derive workable solutions.

Information Needs

Evaluating and managing patient health needs is about acquiring information and making a decision based on that information. A wise physician once stated that 90 percent of the information a physician consults to arrive at a diagnosis is contained in the patient’s medical history. Much of today’s health IT efforts pay attention to the physician’s information needs for two reasons: (1) The doctor is ultimately responsible for health- care evaluation and management, and (2) the doctor gets paid based on a certain level of information she gathers. A careful review of current EMRs shows that information is maintained in vertical silos or “buckets” and based on billing and collection needs. Information is compartmentalized and cannot be shared easily among all players in the care delivery process. Compartmentalization also hinders the use of the information and masks the time-sensitive value of that information. Time, in this case, is chronologic and pertains to information that must be gathered and acted upon before an event.

In the case of scheduled procedures, decisions need to be made days before the encounter. Anticoagulation therapy, for example, is information that must be relayed before a patient’s appointed surgery or intervention. Appropriately managing anticoagulation is not necessarily straightforward, and a new healthcare player (e.g., a cardiologist) may need more information or guidance. CDSS can ensure that relevant patient information, research evidence, and best practice are available at the right time, a system that is infinitely valuable to a freestanding endoscopy center or ambulatory surgery center.

Information Gathering Process for an Integrated IT

Susan decides to use IT to address FEC’s two problems. She identifies the information needs of each player (i.e., physicians, CRNA, and nurses), and then she breaks down the problems into components to better under- stand the clinical processes and find ways to integrate them to improve efficiencies and patient satisfaction. The ultimate goal is to create a sophisticated data-capture and management IT with an integrated CDSS. The steps she takes are as follows:

1. List each team member involved in an endoscopy procedure. Does the team composition change according to who initiated the patient referral? What steps do the physicians follow to refer patients to FEC? The referring physicians’ information needs must be considered so that a better request-for-procedure ordering process can be developed.

2. List the information needs of each team member, including the supporting players who perform billing, collections, and other administrative tasks. Here are a few examples of these needs:

- The gastroenterologist needs to know why the patient is there. Is this a screening colonoscopy because of a family history of colon cancer? Is this a patient with anemia and guaiac-positive stools?

- The nurse needs to know if the patient had surgery in the last 30 days, as this increases the patient’s risk of deep venous thrombosis. The nurse also needs a current list of medications to complete the medication-reconciliation process.

The CRNA needs to know if the patient is taking an angiotensin- converting enzyme inhibitor. Current recommendations are for patients to not take this medication on the morning of a procedure. The CRNA must know the patient’s cardiac history and be able to identify potential risk factors that would affect the patient’s choice of sedation.

The referring physician needs a system for telling the FEC gastroenterologist, nurses, and CRNA information on the patient, including tests, medications, and risk factors, that could affect the patient’s ability to receive the procedure on the day it is scheduled.

Scheduling needs to know which patients are scheduled for what procedure and how long the procedure is estimated to take. Scheduling staff is responsible for reminding the patient of the appointment time, date, and any preparation (such as the NPO).

Registration needs to know the patient’s demographic and social status. Is the patient a minor? Who will be present to sign the consent? If the child is in foster care, does FEC need to obtain a court order to do the procedure? If the patient is an adult, is he of sound mind and body, or does he have a legal guardian?

Procedure room nurses need to know the capability of supplies and equipment to meet the needs of the patient. Is the patient wheelchair bound, and if so, should more time be added to the schedule? Does the patient have an artificial joint, as this will affect where the electrocautery-grounding pad is placed?

Construct a timeline of the information needs across the encounter. Identify overlapping information needs between players.

As a final step, Susan determines the time component of each information need to ensure that it is available at the appropriate time, which could reduce cancellations. Susan considers available consumer technology, such as the Internet, smart phones, and apps, to enhance the IT option. Susan also looks into outsourcing.

A successful health IT solution for FEC results in a significant reduction in cancellation rates and in a faster or same-day completion of the administrative, regulatory, and nursing paperwork. Such improvements enable FEC to schedule more patients and complete more procedures.

I will like you do grammar check, and rewrite it in another form. This is to avoid plagirsm. Thank you.

The purpose of this research is to explain some advantages and disadvantages of the implementation of the electronic medical record in a general hospital and specific units such as Neonatal intensive care unit. Also, it will emphasize different challenges that physician face when using the eMR as well as some solutions they offered in order to help them to overcome the challenge of typing. Most importantly, it will focus on the beneficial use of the eMR such as reduced time when charting specially in nursing as they spend a lot of time when documenting, it will reduce the time in half when using electronic medical record. Also, the research will review how the electronic medical record can enhance the quality of care to the patient. The electronic medical record will provide all the information needed by the physicians or any health care provider when giving care especially the critical patient who needs a quick intervention. This reseach will provide some information on how the eMR can improve quality of care. On the other hand, it will be discussed how the use of eMR can affect the relationship between a health care provider and the patient. As we know, health care providers have to keep a professional but close relationship with their patients in order to provide care and give the best intervention. However, when a health care provider uses electronic medical record some information might be lost when typing from a paper-based system into the eMR. The journals discuss multiple solutions to overcome and to reduce the risk of losing important information of our patient when typing or scanning the information into the eMR. Ventura, M.L., Battan, A.M., Zorloni, C., Abbiati, L., Colombo, M. Farina, S., & Tagliabue, P. (2011). The electronic medical record: pros and cons. The journal of maternal- fetal and neonatal medicine, 24(1), 163-166. doi: 10.3109/14767058.2011.607582 In this journal, researchers want to implement an electronic medical record in a neonatal intensive care unit. This system will enhance critical patient’s treatment because it will implement bedside clinical observation with machine monitoring data, and results from the laboratory. The time of charting for nurses was reduced but medical staff complained about the lack of automation in the reports. Through this journal researchers demonstrate that even though electronic medical record is beneficial because it reduces the charting time, it also can increase the risk for system error which can be fatal for the patients. In conclusion, electronic medical record should be reviewed for any complication that can influence patient’s life. Fox, G. S. (2014). The people versus the electronic medical record, last Thursday. Acad Pshychiatry, 38, 368-372. doi: 10.1007/s40596-014-0042-x In this journal, physicians express their concern about the use of electronic medical record. Physicians believe that the use of technology interferes with the face to face discussion between patients and doctors. Physician stated that the essential and precious communication has been diminished for both care givers and patients. Indeed, I believe with the use of electronic medical record, the lack of interaction and eye contact between the care giver and patient is increasing. This journal is really relevant within the nursing profession because it raises awareness of how important it is to keep the essential of communication between patients and health care providers. In brief, health care providers should find other way to obtain and record patient information to support the doctors and patient relationship. Ossoff, R. H., Thomason, C. D., & Appleton, J. (2010). Challenges with the electronic medical record. Journal of Health Care Compliance, 12(6), 51-54. Retrieved from http://search.proquest.com/docview/822639350?accountid=3455 The authors in this article examine the different challenges that doctors are facing with the use of electronic medical record. Firstly, physicians have to take training to learn how to use the system. However, to overcome the challenge of typing, physicians proposed an idea of creating well detailed templates that list all organs systems. Indeed, templates should be used just as a baseline of information, to help the users to remember the key elements while adding the patient’s information. This is a good point in documentation because even though templates are easier to fill out, medical staff should keep in mind that documentation should be well detailed. Although the templates might be well detailed, it is better to write your own finding when assessing a client. As the authors mention, templates should be used only as a baseline information. The population of interest regarding this journal will be health care providers and people that might want to go into the health care profession. Perez, S., & Keijzers, G. (2012). Missing data in the electronic medical record. Emergency medicine Australasia, 24 (4), 465. doi: 10.1111/j.1742-6723.2012.01564.x The authors of this research explain the problems that caused the transition from paper-based system to electronic medical record. With the implementation of the eMR all paper-based data are scanned into the eMR using pdf files and then destroyed. This caused many missing information in the eMR because they were destroyed before being verified in the eMR. Some solutions were addressed in this journal including; depositing the data collection sheets and separating them from the medical charts and placing them in the data collection boxes. This might decrease the loss of a patient’s important information. In brief, this journal addresses a very important topic about the importance of completely transferring the patient’s information into the eMR. Also, it creates an awareness to keep paper documentation even though the eMR is present. Hoffman, M.A., & Williams, M.S. (2011). Electronic medical records and personalized medicine. Hum genet, 130, 33-39. doi: 10.1007/s00439-011-0992-y The authors emphasize two important aspects of a fully functional electronic medical record. Firstly, it is necessary to present patients or clinicians with a high quality context detailed information when providing care. Secondly, the users must combine clinical information from different sources in order to guide the clinician to improve intervention for a given patient. According to this journal, the use of electronic medical record can increase quality of providing care. As health care professionals our main goal is to provide the best intervention to our patient and this journal proved that the use of eMR can improve the intervention given to the patient. This is because it can give doctors a quick access to patient’s information in a critical scenario or even when just proving care.

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