Healthcare Ecosystems

In today’s society, the accuracy of health information, the availability of health records, and the professional resources in which one live are vital in decision making for health conditions. Meaningful Use (MU) is a program developed by CMS Medicare and Medicaid that awards, incentives in the health care industry in which the certified electronic health records (EHRs) are used to improve patient care (Practice Fusion, 2016). These incentives are for professionals that care for about 30% of their adult patient volume or 20% of their children’s volume for Medicare and Medicaid patients (CMS, 2016). In addition, adjusting from paper charts to electronic charts of patient’s information is beneficial for MU. Furthermore, the American

The Clinical Documentation Improvement (CDI) has emerged as the most vital drive for overcoming the issues associated with maintaining a complete and good sound medical record in the U.S healthcare system. The main focus of CDI is to enhance clinical clarity of the health records which usually involves the process of improving the medical/health records documentation in order to promote effective patient outcome, data quality measures and accurate reimbursement for services and care rendered. For a medical record to be meaningful and mirror the scope of treatment and services provided, it must be accurate and meet the established guidelines set forth by the governing bodies such as the Centers for Medicare and Medicare.

In response to the “Patient Protection and Affordable Care Act (ACA) amended by the Health Care and Education Reconciliation Act (Reconciliation Act), collectively referred to as healthcare reform” (); Wishard-Eskenazi Health of Indianapolis, Indiana has begun to make milestone changes to meet the requirements of the healthcare reform. Being a leader in today’s technology which began thirty years ago with development of one of the nation’s first electronic medical record and continues to excel in the healthcare informatics technology today continues to use this technology in quality improvement initiatives, support for future technology research and improving the quality care of the patient.

Baptist Health, headquartered in Louisville, Kentucky is the largest not-for-profit healthcare organization in the state. The vision of this HCO is to be nationally recognized as a healthcare leader in the state of Kentucky. Baptist Health was originally founded in 1924 as a single 120 bed hospital in Louisville, Kentucky. Expansions in 1953 with the addition of Western Baptist Hospital in Paducah, Kentucky and in 1954 with the addition of Central Baptist Hospital in Lexington, Kentucky created the foundation for the HCO known today as Baptist Health (Welcome to Baptist Health hospitals and clinics in Kentucky, 2013).

In order for a hospital to be eligible for reimbursement through Medicare, they have to show that they are compliant by way of the Conditions of Participation. One way to show this is by getting an accreditation through The Joint Commission who meets the Medicare Condition of Participation standards. (La Tour, 2013).

insurance for Americans that are aged 65 and over and younger people with disabilities. It was the

The value of CDI clinical documentation improvement (CDI) programs are important to any facility that recognizes the requirement of complete and accurate patient documentation. Documentation is very critical because it validates the care that was given. Furthermore, it shares important data to the caregiver and improve claims processing (Leventhal,2014). The three challenges are getting physicians to buy into the program, physicians are extremely busy so they are not connecting the dots on clinical documentation, and training the physicians to get them to understand they need to do better documenting (Leventhal,2014).

When people think of health care, they often think up images from their own experiences in doctors' offices, clinics, and hospitals. Then there are the images of intense drama and hustling and bustling in hospitals and emergency rooms such as those presented on television and in the movies. These are all part of the health care arena, but it extends far beyond the emergency room. Health care agencies and governmental agencies mission is to improve the quality, safety, efficiency, and effectiveness of

Modification of the requirements for electronic health care helps to improve the effectiveness and efficiency. Health Insurance Portability and Accountability Act of 1996 (HIPAA), requires any provider who accepts payment from health plans to have written agreements to make sure the medical facility complies with their rules (Kongstvedt, 2013). In other words, it helps protect the patients by making coverage available to anyone who wants to be covered as long as the eligibility requirements are met. The ACA extended these guarantee availability requirements back in 2014.

The health care sector is impacted by numerous changes and challenges, such as increasing need for health care provision, changing demands from patients or rapidly evolving technologies. In the context of evolving technologies, the developments occur not only in the actual provision of the medical act, but also at the level of the complementary operations, such as health care information management.

Quality physician documentation is not only essential to providing superior clinical communication, but also allows for the delivery of useful data that “supports quality metrics, acuity of care, billing, and accurate representation of medical conditions” (Rosenbaum et al., 2014). The Centers for Medicare and Medicaid Services (CMS) uses a system to classify Medicare patient’s hospital stays into various groups in order to facilitate payment of services called Medicare Severity-Diagnosis Related Group (MS-DRG). Some payers also use all patient refined (APR)-DRG reimbursement systems. MS-DRG groups are outlined by a specific collection of patient characteristics which include areas specific to the “principle diagnosis, specific secondary diagnoses,

Documentation records is related to the quality of patient care provided. It signifies the primary communication among multidisciplinary caregivers for efficient and effective intial treatment, for continuing care, and for the evidence that care and treatment occure. Regulatory agencies use the documentation as a means to measure the quality of services before granting accreditation or certification to healthcare organiztions. Some of those agencies include:

The issue of quality improvement should be addressed with a multi-faceted approach. Once implemented, continuous oversight and monitoring must be conducted by an experienced staff member/case manager who can verify data in the EHR, as well as conduct a daily Braden Score assessment and confer with the staff nurse and physician, as needed. While HAPU/Braden

The modern day health care system is currently faced with a wide array of challenges, such as the aging of the population and the intensified need for medical care, the rapidly evolving technologies and the increasing costs of the medical act.

The Institute of Medicine (IOM) Committee to Design a Strategy for Quality Review and Assurance in Medicare defines quality of care to be “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge” (Ransom, Joshi, Nash & Ransom, 2008). Making sure to have current knowledge on healthcare services is crucial to the quality of care provided, and health care professionals are expected to continuously stay updated on the changing trends. The IOM later released six aims for improvement, or also known as the six dimensions of quality, which are safe, effective, efficient, timely, patient-centered, and equitable.