HC Admin Final

Administrative information systems

systems designed to assist in carrying out financial and administrative support activities such as payroll, patient accounting, materials management, and office automation

Asynchronous technology

use of store-and-forward technology that allows the user to review the information at a later time

Biologics

biological products such as vaccines, blood and blood components, allergenics, somatic cells, gene therapy, tissues, and recombinant therapeutic proteins

Clinical information systems

systems that provide for organized processing, storage, and retrieval of information to support patient care processes

Clinical trials

a research study generally based on random assignments, designed to study the effectiveness of a new drug, device, or treatment

Cost-benefit analysis

evaluation of benefits in relation to costs when both are expressed in dollar terms

Cost-effectiveness analysis

analysis that goes into a step beyond the determination of efficacy by evaluating the additional benefits to be derived in relation to the additional costs to be incurred

Cost-efficiency

(cost-effectiveness) a state in which the benefit received from a service is greater than the cost incurred to provide that service

Cost-utility analysis

analysis that includes the use of quality-adjusted life years

Decision support systems

computer based information and analytical tools to support managerial decision making in healthcare organizations

E-health

healthcare information and services offered over the internet by professionals and non professionals alike

E-therapy

any type of professional therapeutic interaction that makes use of the internet to connect qualified mental health professionals and their clients

Effectiveness

the health benefits of a medical intervention

Efficacy

(effectiveness)

Electronic health records (EHRs)

4 main components 1. Collection and storage of health info on patients over time 2. Immediate electronic access to person and population level information 3. Availability of knowledge and decision support. 4. Support of efficient processes for healthcare delivery

Benefits of EHRs

major cost savings, improved health, promote time efficiencies

Drawbacks of EHRs

changed the emphasis from patient centeredness to institutional priorities

Flat of the curve

medical care that produces relatively few or no benefits for the patient because of diminishing marginal returns

Health informatics

the application of information science to improve the efficiency, accuracy, and reliability of healthcare services. Requires the use of information technology but it goes beyond IT by emphasizing the improvement of healthcare delivery

Health information organization (HIO)

an independent organization that brings together healthcare stakeholders within a defined geographic area and governs electronic information exchange among these stakeholders, with the objective of improving the delivery of healthcare in the community

Health technology assessment (HTA)

any process of examining and reporting the properties of a medical technology used in healthcare, such as safety, effectiveness, feasibility, and indications for use, cost, and cost effectiveness, as well as social, economic, and ethical consequences, whether intended or unintended

Information technology (IT)

technology used for the transformation of data into useful information, it focuses on determining data needs, gathering appropriate data, storing and analyzing the data, and reporting the generated data in a user-friendly format.

M-health

mobile health. The use of wireless communication devices to support public health and clinical practice

Medical technology

a practical application of the scientific body of knowledge for the purpose of improving health and creating efficiencies in the delivery of healthcare

Nanomedicine

a new area, still in its infancy, which involves the application of nanotechnology for medical use. The cutting edge advancement within science and engineering is not a single field, but rather an intense collaboration between disciplines to manipulate materials on the atomic and molecular level

Orphan drugs

certain new drug therapies for conditions that affect fewer fewer than 200,000 people in the U.S.

Quality-adjusted life year (QALY)

the value of 1 year of high quality life, used as a measure of health benefit

Self-referral

the practice in which physicians order services from labs or other medical facilities in which they have a direct financial interest, usually w/o disclosing this conflict of interest to the patient

Smart card

a credit card like device with an embedded computer chip and memory to hold personal medical information that can be accessed and updated at a hospital or physician's office

Synchronous technology

technology in which telecommunications occur in real time

Technological imperative

the use of technology w/o cost considerations, especially when the benefits to be derived from the use of technology are small compared to the costs

Technology diffusion

the proliferation of technology once it is developed

Telehealth

educational, research and administrative uses of telecommunications tech in healthcare. Telehealth involves a variety of caregivers

Telemedicine

using tech to transit digital images such as xrays and MRIs. Synchronous or asynchronous

Tele-ICU

centralized or remotely based critical care team

Value

provision of greater benefits of higher quality at the same or lower price levels

Virtual physicians visits

online clinical encounters between patient and physician

Comparative effectiveness research

a concept in which a chosen medical intervention is guided by scientific evidence on how well it would work compared to other available treatments

Gene therapy

a therapeutic technique in which a functioning gene is inserted into targeted cells to correct an inborn defect or to provide the cell with a new function

Genetic medicine

in the treatment of certain diseases, the association of genes with specific disease traits

High risk pools

state-based pools, which existed before 2014, to make health insurance available to people who otherwise would have been uninsurable because of preexisting health conditions

Patient activation

a person's ability to manage their own health and utilization of healthcare

Patient centralized care

delivery of healthcare that respects and responds to patients wants, needs, and preferences so that they can make choices about their care that best fit their individual circumstance

Personalized medicine

a treatment approach in which gene variations among patients are matched with responses to selected medications to increase effectiveness and reduce unwanted side effects

Precision medicine

a treatment approach that takes into account not only variability in genes, but also the environment and lifestyle factors

Single payer system

a national healthcare program in which the financing and insurance functions are taken over by the federal govt

Universal access

the ability to all citizens to obtain healthcare when needed. It is a misnomer because timely access to certain services may still be a problem because of supply-side rationing

Xenotransplantation

xenografting, transplantation of animal tissue on to humans

Zoonoses

any disease/infection that is naturally transmittable from vertebrae animals to humans

Accountability

the responsibility of clinicians and patients, respectively, for the provision and receipt of efficient & quality healthcare services

Adult day care

a community based long term care service that provides a wide range of health, social, and recreational services to elderly adults who require supervision and care while members of the family or other informal caregivers are away at work

Alternative medicine

(complementary medicine) non traditional remedies such as acupuncture, homeopathy, naturopathy, biofeedback, yoga exercises, chiropractic, and herbal therapy

Ambulatory care

(aka outpatient services) 1. Services rendered to patients who come to physicians offices, outpatient departments of hospitals, and health centers to receive care 2. Outpatient services intended to serve the surrounding community 3. Certain services that are transported to the patient

Hospitals provided the majority of outpatient care

ambulatory/outpatient care

The Affordable Care Act addresses access to HC for the poor and vulnerable

ambulatory/outpatient care

Case management

an organized approach to evaluating and coordinating care, particularly for patients who have complex, potentially costly problems that require a variety of services from multiple providers over an extended period of time

Community oriented primary care (COPC)

the combination of the elements of good primary care delivery with a population-based approach to identifying and addressing community health problems

Durable medical equipment

supplies and equipment not immediately consumed, such as ostomy supplies, wheel chairs, and oxygen tanks

Emergent conditions

acute conditions that require immediate medical attention

Free clinic

a general ambulatory care center serving primarily the poor and homeless who may live next to affluent neighborhoods.

3 characteristics of free clinics

1. care is given for free or at nominal charge 2. Clinic not directly supported or operated by a govt agency 3.Services delivered by trained volunteer staff

Gatekeeping

the use of primary care physicians to coordinate health care services needed by enrollees in a managed care plan

Home healthcare

services such as nursing, therapy, and health-related homemaker or social services that are brought to patients in their own homes bc such patients are unable to leave their homes safely to get the care they need

Hospice

a cluster of special services for the dying, which blends medical, spiritual, legal, financial, and family-support services. The venue in which services are provided can vary from a specialized facility to a nursing home to the patient's own home

Medical home

the quality features of primary healthcare delivery in settings such as a physicians office or community health center

Medically underserved

a designmation determined by the federal govt that indicates the dearth of primary care providers and delivery settings, as well as poor health indicators of the populace. The majority of this group are medicaid recipients

Nonurgent conditions

conditions that don't require the resources of an emergency service, and in which disorder is a non acute or minor in severity

Outpatient services

any health service that are not provided based on an overnight stay in which room and board costs are incurred

Types of outpatient care settings/delivery methods

Private practice, Retal clinics, home healthcare

Types of outpatient care settings/delivery methods

Hospital based services: ex - clinical services, surgical services, emergency services, home healthcare

Types of outpatient care settings/delivery methods

Freestanding facilities: ex - walk in clinics, urgent cares

Types of outpatient care settings/delivery methods

Mobile medical, diagnostic, and screenings: ex - EMTs & paramedics

Types of outpatient care settings/delivery methods

Hospice services: ex - comprehensive services for the terminally ill w/ life expectancy of 6 months or less

Types of outpatient care settings/delivery methods

Ambulatory long-term care services: ex - nursing homes, case management, adult day health

Types of outpatient care settings/delivery methods

Public health services, Community health centers, Free clinics, Telephone access

Palliation

serving to alleviate or relieve, such as pharma pain management and nausea relief

Primary healthcare

essential healthcare that constitutes the first level of contact by a patient with the health delivery system and the first element of a continuing healthcare process. Primary care is the foundation for ambulatory health services. Secondary & tertiary care is more complex and specialized

Primary healthcare

Tech advancements allow treatments to be provided in ambulatory care settings

3 elements for understanding primary care

1. Point of entry 2. Coordination of care 3. Essential care

Secondary care

routine hospitalization, routine surgery, and specialized outpatient care, such as consultations w/ specialists and rehabilitation.. Compared to primary care these services are usually brief and more complex, involving advanced diagnostic and therapeutic procedures

Tertiary care

most complex level of care. Mostly for uncommon conditions, institution based, highly specialized, technology driven, and rendered in large teaching hospitals

Surgicenters

freestanding, ambulatory surgery centers that perform various types of surgical procedures on an outpatient basis

Telephone triage

telephone access to a trained nurse for expert opinion and advice, especially during the hours where physicians offices are usually closed

Urgent care centers

walk in clinics that are usually open to see patients after normal business hours in the evenings and weekends, and for which patients do not have to make an appointment

Urgent conditions

conditions that require medical attention within a few hours; a longer delay presents possible danger to the patient. Not necessarily acute but not necessarily severe

Walk-in clinic

a freestanding, ambulatory clinic in which patients are seen without appointments on a first come - first serve basis

Adjusted community rating

(aka modified community rating) a method of determining health insurance premiums that takes into account demographic factors such as age, gender, geography, and family composition

Adverse selection

a phenomenon in which individuals who are likely to use more health care services than other persons due to their poor health enroll in health insurance plans in greater numbers, compared to people who are healthy

Balance bill

the practice in which the provider bills the patient for the leftover sum after insurance has only partially paid the charge initially billed

Beneficiary

anyone covered under a particular health insurance plan

Benefit period

the period of illness beginning with hospitalization and ending when the beneficiary has not been in an inpatient in a hospital or a skilled nursing facility for 60 consecutive days

Benefits

services covered by an insurance plan

Capitation

a reimbursement mechanism under which the provider is paid a set monthly fee per enrollee regardless of whether the enrollee sees the provider and how often the enrollee sees the provider

Case mix

an aggregate of the severity of conditions requiring medical intervention. Case-mix categories are mutually exclusive and differentiate patients according to the extent of resource use

Categorical programs

public healthcare programs designed to benefit only a certain category of people

Charge

the amount a provider bills for rendering a service

Churning

a phenomenon in which people gain and lose health insurance periodically

Claim

a demand for payment of covered medical expenses sent to an insurance company

Coinsurance

a set proportion of the medical costs that the insured must pay out of pocket when healthcare services are received

Community rating

a system in which all members of a community are charged the same insurance rate