Introduction to Healthcare Information Technology Chapter Six Document Imaging and Problem Solving Objectives • Describe frequently used healthcare image file types and their characteristics • Identify medical interface components • Explain the interface diagnosis process • Describe the clinical software troubleshooting process • Explain the need for and use of change control in the clinical environment Introduction to Healthcare Information Technology 2 Healthcare IT: Challenges and Opportunities • Recent study results: – Fewer than two percent of hospitals employ a comprehensive EHR system • Challenges to integration of an EHR system – Interfacing dissimilar systems • Example: x-rays produce images on cellulose or polyester film – Film image must be digitized – Alternatively, x-ray machine modified to output digital images Introduction to Healthcare Information Technology 3 Document Imaging • Images must be organized into standardized format for storage • Image files may be composed of: – – – – Pixels (small picture elements) Bitmap data Vector (geometric) data Combination of these data types Introduction to Healthcare Information Technology 4 File Types • Different applications for image files – Reason for existence of different file types • Characteristics of image files – – – – Quality Size Resolution Compression Introduction to Healthcare Information Technology 5 Characteristics • Image quality – Describes how well the image file maintains fidelity of the source image – High-quality images appear more like the source than low-quality • File size – Described by number of bytes needed to store data • Compression – Technique to reduce size of a digital image file Introduction to Healthcare Information Technology 6 Characteristics (cont’d.) • Image resolution – Refers to the number of pixels in an image – Typically stated as number of pixels high by number wide – Multiplying pixel counts gives a single resolution number • Example: digital camera with resolution of 2048 x 1536 pixels – Said to have resolution of three megapixels Introduction to Healthcare Information Technology 7 Characteristics (cont’d.) • Four image file types commonly used in health care – – – – Graphics Interchange Format (GIF) Joint Photographic Experts Group (JPG or JPEG) Portable Document Format (PDF) Tagged Image File Format (TIFF) Introduction to Healthcare Information Technology 8 Table 6-1 Image file formats and characteristics © Cengage Learning 2013 Scanning and Indexing • Storing image data in data files – Key part of creating an electronic document storage and retrieval system • Typical hospital can create hundreds to thousands of electronic images per day • Scanning – Process of converting paper–based data into electronic format Introduction to Healthcare Information Technology 10 Figure 6-1 Desktop scanner © Konstantin Shevtsov/www.Shutterstock.com Scanning and Indexing (cont’d.) • Electronic file considered protected health information • Metadata – – – – Data used to describe image attributes Examples: creation date, patient ID Data is included with the image file Will vary greatly, depending on application, how data is used, and applicable regulations Introduction to Healthcare Information Technology 12 Scanning and Indexing (cont’d.) • Storage – Process of saving data for future retrieval and use • Database – Structure used to store data • Index – Data structure that allows for fast data retrieval Introduction to Healthcare Information Technology 13 Optical Character Recognition (OCR) and Structured Data • Structured data – Data arranged in a defined manner • Unstructured data – No predefined arrangement – Examples: bitmap images, audio files, most text files • Optical character recognition – Process of converting scanned images of handwritten or printed text into computer readable text Introduction to Healthcare Information Technology 14 Medical Interface Components • Health Level Seven (HL7) – Nonprofit, accredited standards development organization – Develops standard languages for formatting electronic messages between healthcare providers • HL7 message components – Segments presented in a defined sequence – Segments may be optional, required, and/or repeatable Introduction to Healthcare Information Technology 15 Medical Interface Components (cont’d.) • HL7 message segment example Introduction to Healthcare Information Technology 16 Medical Interface Components (cont’d.) • HL7 message example Introduction to Healthcare Information Technology 17 Medical Interface Components (cont’d.) • Commonly used HL7 message types – – – – ACK: general acknowledgment ADT: admit, discharge, transfer BAR: add/change billing amount DFT: detailed financial transaction • Example ADT message subtypes – – – – A01: patient admit A02: patient transfer A03: patient discharge A04: patient registration Introduction to Healthcare Information Technology 18 Medical Interface Components (cont’d.) • HL7 message segment standard contents – – – – MSH: message header SFT: software segment EVN: event type PID: patient identification Introduction to Healthcare Information Technology 19 Table 6-2 Common HL7 message segments © Cengage Learning 2013 E-Prescribing • Electronic transmission of a prescription to a pharmacy from the point of care • Can lower the cost of medication transactions • Improves management of traditional medication administration problems • Medication reconciliation – Process of avoiding medication inconsistencies across care settings – Can be accomplished with process integrated with an EMR Introduction to Healthcare Information Technology 21 E-Prescribing (cont’d.) • Bedside medication verification (BMV) – Method of verifying correct medications are administered to the right patient – Commonly accomplished with barcodes and barcode scanner • Drug allergy interactions (DAI) – Certain drugs or drug combinations can cause allergic reactions in some patients – Helpful to maintain accurate database of patient allergy list • May be accomplished using CPOE system Introduction to Healthcare Information Technology 22 E-Prescribing (cont’d.) • Formulary – List of medications covered by a third-party payer • Formulary checking – Part of an e-prescribing process – Verifies prescribed medications are in the formulary Introduction to Healthcare Information Technology 23 Billing • Medical information from the provider’s EMR/EHR system – Used to create an electronic version of the bill – Transmits to third-party payer (outbound communication) • HL7 billing segments – – – – PID: patient information PV1: visit information FT1: financial transaction IN1: insurance information Introduction to Healthcare Information Technology 24 Billing (cont’d.) • HL7 billing segments (cont’d.) – – – – IN2: additional insurance information IN3: additional insurance information, certification GT1: guarantor AUT: authorization information • Billing clearinghouse – Validates claims to ensure free of errors – Then transmits to specified payer over secure connection Introduction to Healthcare Information Technology 25 Diagnosing Interface Problems • Troubleshooting – Systematic approach to determine source of problem • Four troubleshooting steps – – – – Identification Generation Determination Confirmation Introduction to Healthcare Information Technology 26 HL7 Message Problems • Common problem with HL7 messages – Improperly formatted patient demographics – Example: patient’s SSN is 123-4T-5678 when it should be 123-45-6789 • Communication link errors – Generated as a result of failure in a fax, network, or Internet connection – Common in areas with aging communications infrastructure or frequent power interruptions Introduction to Healthcare Information Technology 27 E-Prescribing Problems • Inaccurate patient demographics – Patient medical history may be inaccurate – Variety of causes • National standard for e-prescribing – Developed by the National Council for Prescription Drug Programs (NCPDP) • SCRIPT Standard Implementation – E-prescribing messaging standard using segments and fields Introduction to Healthcare Information Technology 28 E-Prescribing Problems (cont’d.) • SCRIPT message example Introduction to Healthcare Information Technology 29 Billing Problems • Superbill – Form used by providers to quickly list patient’s procedures and diagnosis for reimbursement – Commonly adapted for a specific provider – Includes patient demographic data, CPT procedure codes, ICD diagnostic codes – May cause errors if data is inconsistent with other data Introduction to Healthcare Information Technology 30 Billing Problems (cont’d.) • Billing software configuration settings examples – – – – – – – Bill patient for missed copays? Display diagnosis description? Display procedure description? Rendering provider? Scheduling provider? Service location? Supervising provider? • Some configuration settings are important for accurate data transmission Introduction to Healthcare Information Technology 31 Medical Device Problems • Check for power first • Brownouts or voltage sags may cause medical device interface issues • Less common power problems – – – – Blackouts Spikes Surges Electrical noise • Use an uninterruptible power supply (UPS) on the device or central power system Introduction to Healthcare Information Technology 32 Table 6-3 Less common power problems © Cengage Learning 2013 Medical Device Problems (cont’d.) • Network and communication problems – Network failure can cause data corruption • Some devices can be configured to perform differently by adjusting configuration settings Introduction to Healthcare Information Technology 34 Troubleshooting Clinical Software Problems • Types of clinical software – – – – – – – Auditing systems Billing systems Coding systems CPOE systems EMR/EHR systems Lab information system (LIS) Patient care planning systems Introduction to Healthcare Information Technology 35 Troubleshooting Clinical Software Problems (cont’d.) • Types of clinical software (cont’d.) – – – – – Pharmacy information system (PIS) Patient tracking systems Patient scheduling systems Radiology information system (RIS) Workflow management systems • Defined plan for troubleshooting integrated software systems – Imperative for the HIT professional Introduction to Healthcare Information Technology 36 Locate the Affected Modules or Fields • Troubleshooting process steps – – – – Identify system malfunctions or symptoms List possible causes Determine cause of the problem Develop and test solution • Confirm the problem has been solved • Approach for first step – Divide the problem into smaller domains – Work backward in the system from where the problem appears Introduction to Healthcare Information Technology 37 Determine Data Types • Data type error – Data classified based on properties (text, numeric, binary) • Database and software applications expect data to be of a certain type • Check configuration to ensure user inputs have been checked for correct data types – Manual configuration change may have allowed errors to be introduced into the system Introduction to Healthcare Information Technology 38 Escalate When Necessary • When software problem cannot be solved through normal troubleshooting methods: – May need to be escalated (reported) to another technical support group • Problem escalation process – Describes who should be contacted first • Technical support groups often organized into tiers – Initial call to support group will encounter Tier 1 support – Escalates to Tier 2 if problem cannot be resolved Introduction to Healthcare Information Technology 39 Table 6-4 Tiered technical support © Cengage Learning 2013 Change Control • Clinical software modules used together – Integrated system – Increases overall system complexity exponentially • Software regularly changes over time – New requirements and regulations – Bug fixes or performance improvements Introduction to Healthcare Information Technology 41 Procedural Systematic Customization • Change control system – Procedure for systematic software customization • Specifics required for a change control system – – – – – – Change compliance reporting Defining specific change process activities Delineating testing and cutover processes Developing a change schedule Identifying impacts of change Specifying staff roles regarding change control Introduction to Healthcare Information Technology 42 Governance Board • Risk and cost of failure with software change may be quite high • Governance – Alignment around objectives, strategies, tools and methods to minimize change failure • Change management governance board (CMGB) – Group with responsibility to approve changes that may result in critical service interruption Introduction to Healthcare Information Technology 43 System Patching and Updates • Types of software changes – Patch • Fix for specific software problem – Update • Includes larger changes than patches • Can add features or functionality • Issued less frequently than patches Introduction to Healthcare Information Technology 44 Change Scheduling • Scheduling software changes – Challenging in a highly integrated environment • Some clinical software systems are used around the clock, every day of the year Introduction to Healthcare Information Technology 45 Change Scheduling (cont’d.) • Change scheduling process questions – Is there a backup system? – Can collected data be recovered during the system downtime? – Will the downtime impact any life support systems? – Were all impacted departments notified, and did they approve the proposed schedule? – Can the old system be rolled back if the updates are not functional? • Answers to above questions will affect the update schedule Introduction to Healthcare Information Technology 46 Change-Control Environments • Four stages in software change process – Development • Writing new program code to address need – Quality assurance (QA) test • Ensures software meets functional requirements and defined performance behaviors – User test • Assesses whether software meets user requirements – Production (live) • Software is released to be used in a live environment Introduction to Healthcare Information Technology 47 Summary • Images must be organized into a standard format for storage • Scanning is the process of converting printed data into electronic format • Data can be classified as structured or unstructured • For information to be shared, a common language or format must be used • Health Level 7 is a standards development organization Introduction to Healthcare Information Technology 48 Summary (cont’d.) • An HL7 message is composed of groups of message segments presented in a predefined sequence • Troubleshooting uses a systematic approach to determine the source of a problem • Software regularly changes over time – Increases complexity of clinical software management – Change control process is needed Introduction to Healthcare Information Technology 49
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