22 Community Health Applications - SORS

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Chapter 22::

Chapter 22: Community Health Application

Definition of CHN:

Definition of CHN A synthesis of nursing practice and public health practice applied to promoting and preserving the health of populations. Requires a comprehensive understanding and knowledge of the framework of the community, its resources and the sociocultural issues impacting people within a community.

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Focus on the population as a whole. Standards of CHN incorporate health promotion, health maintenance, health education, health management, coordination and continuity of care using a holistic approach. It is practice in public health departments, ambulatory care settings, group practices, outpatient clinics, freestanding community-based clinics, and in homes.

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Applications are often targeted toward specific function such as population focus, continuity of care needs, or billing services for documenting home health care assessment to create a home health- related group (HHRG) Information system structures developed may offer functions for simple tracking for clinical data more complex applications related to portable medical data, billing, financial applications, statistical reporting and decision support.

CHN System Development:

CHN System Development CHN Agencies used computers since late 1960. Focus on regulatory compliance, billing applications, and statistical reporting related to community health. Grew primarily due to consumer choice, cost control initiatives, and the increase of numbers of healthcare recipients with chronic illness.

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Contributes to management information system (MISs) that transforms data into information to measure outcomes, track client progress, exchange healthcare information among physicians, nurses, insurers, managed care companies, regulatory agencies and public reporting, and analyze financial data. These systems supported clinical care delivery, electronic billing, and had the potential for multiple user access.

4 Domains of MISs for practice::

4 Domains of MISs for practice: Public health that focused on population interventions and the outcomes related to epidemiologic or mortality/morbidity trends. Home health that focused on skilled nursing care for individuals at the home and the outcomes related to care delivery for individuals or aggregated populations Special population community practices that focused on the specific domestic care or treatment needs and the outcomes related to

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care delivery for individuals, diagnostic groups, or aggregate populations. outpatient care that focus on intermittent, episodic, or preventative care for individuals, and the outcomes related to interventions for individual or aggregate groups, inclusive of national health prevention standards. MISs offer clinical documentation capabilities at the point of care, provided billing functions, supported submission, provide statistical reporting, and developed decision support features.

Medicare and Medicaid Legislation (1965):

Medicare and Medicaid Legislation (1965) Home Healthcare- provision of preventive, therapeutic, restorative, and supportive healthcare in the home. This legislation expanded the demand for homecare services, increased the no. of home health agencies (HHAs) and increase the information needs that created the driving force for computer systems. These data was design to satisfy the basic need for reporting to payers and regulatory bodies, process info required for billing,

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Monitor the certification requirements and managing the home health services allowed by Medicare, Medicaid and third party payers. These system captured patient demographics, visits, accounts payable, and journal entries for the purposes of producing standard reports, billing forms, regulatory documents, visit summaries, and financial balances.

Balanced Budget Act:

Balanced Budget Act The need for information moved beyond billing information, statistical information, and the tracking of clinical data. Oct. 1, 2000, the Center for Medicare and Medicaid Services(CMS) instituted a prospective payment system (PPS) for Medicare Home health Beneficiaries as part of the BBA. The HHA relied on a 80-category case-mix adjuster to set (OASIS) in the domains of clinical severity, functional status, and service utilization (CMS,2003)

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This integrated payment system necessitated linkages between clinical, administrative, operations and billing functions. It create a need for linkage among and between other home care providers, state regulatory bodies and the fiscal intermediary responsible for paying Medicare. PUBLIC HEALTH- coordinated effort at local, state and federal levels whose mission is fulfilling society’s interest in assuring conditions in which people can be healthy, as defined by the Institute of Medicine (IOM)

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It focus on: 1.preventing, identifying, investigating and eliminating community health problems; 2. Assuring that the community has access to competent personal healthcare services 3. Educating and empowering individuals to adopt more healthy behaviors. STATE AND LOCAL HEALTH DEPARTMENTS- developed statistical reporting systems for processing information on nursing personnel, programs, and services.

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It is primarily developed to manage the information requirements for the agency’s CHN services. The collection, analysis, use and communication of health-related information has been called “quintessential public health service,” because all public health activities depend to some extent on the availability of accurate, comparable, and timely information. Used for collecting electronic birth and death data, communicable disease reporting, immunization tracking, survey analysis, and incident and exposure tracking .

Public Health Challenges:

Public Health Challenges Develops IT System for the ff: Relational database that facilitate the retrieval of data for multiple purposes without rekeying. Manipulation of data to create information and knowledge Point-of care devices, computerized patient records (CPrs), and/or electronic health records (EHRs) Electronic interfacing systems to facilitate the sharing of data.

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Electronic IT system increase the access to detailed information regarding community healthcare practice. This drives the need for many new applications for integrated community information networks which can merge registries, support local and federal initiatives for national public health information, provide linkage to healthcare providers and integrate data from key regulatory or public reporting systems.

Data Sets:

Data Sets It is a minimum set of items of information with uniform definition and categories, concerning the specific dimension of the service or practice setting that meets the essential information needs of multiple data users within the scope of the service or practice setting. Criteria that define a data set includes: Utility for multiple users Terms that can be defined and measured Common or shared language that is universally understood

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Relevance to national or local needs Uniformity with other applicable data sets Data can be coded for computer processing Data has portability to other applicable data Data can be structured in compliance with Health Insurance Portability and Accountability Act (HIPAA) Data can be collected easily and accurately through the functions of service delivery .

Selected Data Sets:

Selected Data Sets The National League for Nursing developed one of the first prototypes for basic minimum data set for CHN even though it is not longer used. The nursing minimum data set (NMDS) developed by Werley and Lang was designed for all healthcare settings but focused primarily on the hospital setting. It consisted of 12 major elements and four specific nursing care: nursing diagnosis, intervention, outcome and intensity.

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Uniform Data Set for Homecare and Hospice The data set is organized into two major categories of organizational level, the data set includes items that describe the organizational and individual level data elements. On an organizational level, the data set includes items that describe the organization, its services, its aggregate utilization and its financial and personnel data. On individual level includes demographic, clinical, service and utilization data for patients.

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Outcome and Assessment Information Set -is a group of items that represents the core items of a comprehensive assessment for an adult home health patient outcomes purposes of OBQI. Community Health Intensity Rating Scale - also predicated on the nursing process. The original was 15 parameters that represent the same 4 home health domains on the Ohama system- the environment, psychosocial, physiological and health behaviors.

Community Health Systems:

Community Health Systems Connotes the computerized IT systems specifically designed and developed for use by community health agencies, local and state health departments, community programs and services. Addressed the broad areas of 1) healthcare programs, 2) agencies and 3) settings. They support health promotion and disease-preventive programs, statistical information for federal block grants, categorical grants or other grant programs.

The following are some of the typically used Community Health Settings::

The following are some of the typically used Community Health Settings: Categorical systems Screening programs Client registration systems MISs Statistical reporting systems Special purpose system

Stand-alone systems:

Stand-alone systems Are commercial systems developed for direct installation and implementation in an HHA. They develop software for processing data, maintains, updates and supports all software programs as well as ensures that the software programs meet state and federal regulation.

Portability of data:

Portability of data Is another important aspect of home health. Point-of –care technology uses a computer input device to input and retrieve clinical data at the point of care at home. The data can be transferred remotely to the main database through a client server w/c is a multiuser processor with shared memory that provides services to the user such as shared communication and database access.

Point-of-Care Systems:

Point-of-Care Systems Offers software-aided care planning and critical pathways allowing for care delivery based on evidence-based practice standards to reach a desired clinical outcome. This differs from the traditional care planning process by outlining a systematic plan for interventions and teaching through diagnostic categories. Laptop systems or personal digital assistants (PDAs) are designed to collect and transmit patient data.

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Reimbursable Models Home health systems often integrate clinical, financial, and billing functions to support the Medicare episodic reimbursement model and fee-per-visit models still in use for private pay or manage care payers. the functions are designed to furnish information essential for reimbursement of services provided to patients eligible for Medicare, Medicaid and other third-party payers.

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Managed Care The increase of managed care in the home health arena and the PPS for homecare services had an impact on the financial and billing systems. Scheduling Systems Is used to enhance HHA services. They are design to schedule the clinicians providing services with the patients requiring the visit matching the clinician capacity with the required patient care.


Telemedicine This was implemented to replace face-to-face home visits and includes: Telemonitors w/ peripheral biometric attachments for remotely monitoring biophysical parameters. Videophone w/ two-way audio-video connectivity w/c allows for the visualization of client activity. In-home message devices with disease management education, advice and vital sign monitoring.

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Video cameras for monitoring all aspect of care delivery particularly focusing on wound management and home care supervision. PC’s with Internet connectivity for supervised communication. Video conferencing that allows clinicians, physicians, and other healthcare provider to communicate about patient specific care. This applicability is important for hospice care as interdisciplinary conferences are a requirement of service delivery.

Community Health Telemedicine Systems:

Community Health Telemedicine Systems Communication telemedicine systems link patients 'home to healthcare facilities and healthcare professionals, home care workers to their supervisors and patients and families with community resources. Communication systems make it possible for patients to communicate with providers.

Internet Application:

Internet Application Using access to a computer terminal with Internet applications can be used by patients to: Assist in self-diagnosis and preventive medicine Reduce unnecessary outpatient visits Provide self-directed triage and Eliminate the “worried well” aspects of many patient-provider interactions.

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This leads to the ff. benefits: Improved patient and provider satisfaction Patient time savings in tracking and receiving information Reduce the need to see a healthcare provider “face to face” Increase reliance on computer-based information Reduced information calls More cost-effective care

Telemedicine Devices:

Telemedicine Devices HHAs are increasingly using devices that allow healthcare providers to communicate with patients in their homes. Communication technology is used to transmit x-rays, electrocardiograms, and other clinical data for analysis by the specialists.

Community Health Network Systems:

Community Health Network Systems It is an innovative ambulatory care system specially developed to provide services by computer. It includes the ff: Download the patient record from hospital to the home database. Enter a series of questions about symptoms using expert system logic until the pathways are concluded.

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Track self-care and, depending on the responses to questions, call or make an appointment with an clinician. Provide additional information on the condition if self-care is chosen to assist the client to resolve the problem. The computer linked offered homecare users information, communication, and decision support to enhance self-care and promote home-based treatment of their study patients. It served as a “support group without walls.”

Home High-Tech Monitoring Systems:

Home High-Tech Monitoring Systems Uses computers at home to link patients at home to healthcare facilities. Monitoring devices that transmit vital signs and other critical data are used in the home to conduct postsurgical checkups, for example. Another home device is a defibrillator that allows hospital to diagnose and resuscitate a homebound patient who has suffered a cardiac arrest.

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Sophisticated telemetry devices such as digitized x-rays and ECG, electronic telescopes and interactive video equipment are using telecommunications technology to enable specialists at a teaching hospitals to examine patients in a remote clinic. Another type of monitoring device is alert systems that are widely used in home settings. Alert systems are primarily communication devices that allow the home bound to signal for help in an emergency.

Educational Technology Systems:

Educational Technology Systems It provides communication linkages, information access and educational materials. These technologies meet the need for client to reach beyond their environments to “see” and “hear”, to experience, view and visualize situations. These systems may also offer screening for compliance with health prevention standards and linkages to education.

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Healthy town is a unique program of the VNAHPO. It is a partnership with the Area Agencies on Aging (AAA) who serve seniors at neighborhood nutrition sites. Baby Care Link is a multifaceted telemedicine communication application of Beth Israel Deaconess Medical Center design to provide individualized information to families of very low birth weight infants. Video-conferencing includes the transmission of video image with a voice in a real time and visual, interactive discussion between 2 parties in different locations.

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