health informatics (11/12)

demographic data

elements that distinguish one pt from another

DOB, SSN, full name, address

indicative data

socioeconomic data

elements pertaining to pt’s personal life

marital status, religion, culture

socioeconomic class/status?

financial data

elements describing the payer

name, address, group #, phone #, member #, charges, fees paid, co-pays, co-insurance, deductibles, etc

clinical data

all medical data that has been recorded about pt’s stay or visit

MIPS categories

quality

improvement activities

cost

promoting interoperability

documentation

critical

if not documented, it didnt happen

justify medically necessary services

avoid civil/criminal penalties

communication of info to other practitioners

security

password protection

do you have a legitimate reason to view the file

clinical pathways, part of quality & improvement activities

clinical pathways assisted by IT (improvement)→document-based tools that provide a link btwn best avail evidence and clinical practice

improves workflow

helps determine appropriateness of care

quality measures tracking outcomes

proportion of pts failing to achieve MCID in KOS, NPRS, LEFS, NDI, modified LBP questionnaire, DASH, fxl status assess in pts with OA

hipaa

policy that protects security & privacy of health info and provides indivs w/ certain rights to their PHI

privacy rule: sets standards when PHI may be used/disclosed

security rule: safeguards that covered entities must implement to protect confidentiality, integrity, availability of PHI

breach notif rule: entities should notify affected ppl in event of a breach

protects pts & providers

digital health modalities

synchronous: real time video/audio telehealth visits

asynchronous: store-and-forward video review, messaging

remote data streams: device-based, software-enabled physiology and behavioral tracking

challenge: ensuring equity, access, health literacy

remote physiologic monitoring

allows clinicians/HC team the ability to monitor wt, BP, BG, pulse, temp, oximetry, resp flow rates, and more in variety of settings, incl pt’s home

ex. pt with CHF & CAD in cardiac rehab has a cell-connected pulse ox & BP cuff, clinical data is transmitted to PT to adjust excs intensity, CPT codes when using real-time communication to modify HEP

remote therapeutic monitoring

RTM codes developed to report pt mgmt using RTM devices that collect nonphysiological data

describes the monitoring of health conditions, incl msk system status, therapy adherence, therapy response

pts can self-report, manually enter, digitally upload RTM data

ex. pt w/ chronic LBP has a mobile app that tracks excs completion rates & daily numeric pain ratings, data transmitted to PT via dashboard w/ CPT codes when using real-time comms to modify HEP

AI

generative for pt reports

predictive for predicting disease/pt needs

operations: scheduling, enhance documentation/analyze video visit to write note, optimize reimbursement

clinical: movement capture & analysis, assist w/ pt selection in ventilator usage, analyze pt info to assist in making accurate dx

large language models understands & generates natural language text

AI issues

pt privacy (hipaa standards if using for documentation)

research considerations: check references/who wrote the paper?

source of data?

assessing AI

know data source: where did the data come from

know data company: do they have understanding of HC & technology & validation behind it

does tool add value w/o adding complexity?

telehealth in rehab

use of electronic info, telecommunication tech to support long distance clinical HC, pt & professional health-related edu, health admin, public health

regulations: state specific regs, licensure compact

documentation: consent, risk

tech reqs: hipaa compliant platform

billing/coding reqs

telehealth rec 1

telerehabilitation or hybrid care at least equivalent to in person PT w/ respect to pt acceptability & satisfaction; superior to in person PT w/ respect to adherence & attendance for certain conditions

telehealth rec 2

PTs & pts should discuss whether telehealth is cost-effective option compared to in person in context of pt’s circumstances & conditions

cost low in THA/TKA pts—generalizable?

cost for whom?: pt needs hardware, connectivity vs travel distance to clinic; hospital/clinic costs, insurer costs

telehealth rec 3

PTs should ID & work to reduce barriers, promote facilitators IDed from pt’s perspective & experiences when planning/providing telehealth services

facilitators: better access to care, incr scheduling flexibility, convenience of in person care for rural pts

telehealth rec 4

PTs should ID & work to reduce clinician & organizational barriers, promote facilitators to support delivery of telehealth

facilitators: attitude, skills/knowledge, telehealth setting

barriers: unable to perform comprehensive tx, pt safety (ex. neuro assess), tech, cost

telehealth rec 5

when PTs perform components of exam via telehealth, may use results to inform dx w/ comparable accuracy to in person visit for certain health conditions: ROM, s/s w/ SLR, posture better in person

telehealth rec 6

PTs should use telehealth to achieve outcomes similar to in person care for certain conditions

telehealth rec 7

PTs should anticipate/prevent/manage/document occurrences of adverse events specific to telehealth as mode of delivery

post-session fatigue/pain is no different in person vs virtual