Alphabet Soup Has Joined Chicken Soup for Health

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Alphabet Soup Has Joined Chicken Soup for Health

• Carol J. Bickford, PhD, RN,BC
• cbickfor_at_ana.org

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Health Care Today

• Structure
• Process
• Outcomes

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Structure In Flux

• Inpatient
• Outpatient
• Ambulatory Care
• Office Practice
• Home Care/Home Health

• Nursing Home
• Skilled Nursing Care
• Rehabilitation
• Longterm Care
• Assisted Living
• Telehealth

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Care Process Evolving

• Hospitals are critical care centers
• Same day surgery and home care burden
• Remote monitoring
• Call for healthcare reform and national coverage
• Who pays the bill? CMS, insurance plans,
  employers, individual pockets

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First Alphabet Terms

• MD, DO, PA
• Registered Nurse
• Advanced Practice Registered Nurse
• CRNA - Certified Registered Nurse Anesthetist
• CNM - Certified Nurse Midwife
• NP - Nurse Practitioner
• CNS - Clinical Nurse Specialist

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Paper Versus Electronic

• Paper record format still predominant
• CPR, EMR, EHR finally gaining implementation
  momentum long after 1991 IOM report
• The Computer-Based Patient Record An Essential
  Technology for Health Care, Revised Edition
  (1997, http//www.nap.edu)

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Outcomes Quality-JCAHO
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Outcomes Quality-NCQA
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Outcomes Quality-URAC
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Outcomes Quality-URAC
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Outcomes Quality-NQF
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Outcomes Quality-AHRQ
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Outcomes Quality-National Quality Measures
Clearinghouse
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Evidence-based Practice/Medicine

• NIH Roadmap-research to practice
• National Guidelines Clearinghouse
• National Library of Medicine

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Outcomes Quality-National Guideline
Clearinghouse
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National Health Information Infrastructure (NHII)

• Has been under discussion by National Committee
  on Vital and Health Statistics (NCVHS) for many
  years http//www.ncvhs.hhs.gov/
• Includes healthcare provider, population health,
  and personal health components http//www.ncvhs.hh
  s.gov/nhiilayo.pdf

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NHII Includes Work About

• CHI - Consolidated Health Informatics
• RHIO - Regional Health Information Organizations

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Office of the National Health Information
Technology Coordinator (ONCHIT)

• Framework for strategic action
• Inform clinical practice
• Interconnect clinicians
• Personalize care and
• Improve population health
• David Brailer, MD, PhD, National Health
  Information Technology Coordinator
• http//www.hhs.gov/onchit/

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Critical Standards Work

• HL7 Health Level 7 message format and now
  content
• ICD-9 and ICD-10 diagnosis
• CPT-4 outpatient procedures
• HCPCS inpatient procedures
• SNOMED NLM secured low cost national license
• ABCcodes complementary and alternative care

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Electronic Format

• ASTM E-31, ISO TC-215, ANSI
• E-mail and Instant Messaging
• ANSI/ARMA 9-2004, Requirements for Managing
  Electronic Messages as Records

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Action Plan

• Confirm who is your healthcare provider and what
  are their qualifications
• Ask your healthcare provider about their
  implementation of the EHR
• Monitor the NCVHS testimony via webcast or
  personal attendance

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Action Plan

• Express your concerns/decisions about a unique
  personal identifier
• Monitor CMS, DHHS, HIPAA, and other health
  related websites for opportunities to provide
  public comment
• Check out ARMAs Health Industry ISG