Healthcare information has been defined in different texts and articled differently. The Health Insurance Portability and Accountability Act (HIPAA) defined health information as, any information, whether or recorded in any form or medium, that (A) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; (B) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.
Internal Data and Information: Patient Specific-Clinical
The majority of clinical, patient-specific information created and used in healthcare organizations can be found in or has originated in patients’ medical record. All types of healthcare organizations- inpatient, outpatient, long-term care, and so forth have patient medical records. These records may be in electronic or paper format, but the purpose and basic content are similar regardless of record or organizational type.
Internal Data and Information: Patient Specific-Administrative
Healthcare organizations need to be paid for the care they provide and to plan for the efficient provision of services to ensure that the operations remain viable. Healthcare organizations need data to effectively perform the tasks associated with the patient revenue cycle, tasks such as scheduling, precertification and insurance eligibility determination, billing, and payment verification.
Internal Data and Information: Patient Specific-Combining Clinical and Administrative
As mentioned earlier, diagnostic and procedural information is captured during the patient encounter to track clinical progress and to document care for reimbursement and other administrative purposes. This diagnostic and procedural information is initially captured in narrative form through physicians’ and other healthcare providers’ documentation in the patient record. This documentation is subsequently translated into numerical codes. Coding facilitates the classification of diagnosis and procedures not only for reimbursement purposes but also for clinical research and comparative study. There are two major coding systems are employed by healthcare providers today:
ICD-10-CM (International Classification of Diseases, Tenth Revision, Clinical Modification) published by the National Center for Health Statistics
CPT (Current Procedural Terminology), published by the American Medical Association
Internal Data and Information: Aggregate-Clinical
Patient records, uniform billing information, and discharge data sets are the main sources of the data that go into the literally hundreds of aggregate reports or queries that are developed and used by providers and executives in healthcare organizations. There are some common categories of aggregate reports that will likely encounter such as Disease and Procedure Index and Specialized registers.
Internal Data and Information: Aggregate-Administrative
A limitless number of reports can be created for administrative functions from today’s databases and data repositories. Commonly used administrative aggregate reports include basic healthcare statistical reports, claims denial reports, and cost reports.
The categories of statistics that are routinely gathered for healthcare executives include:
Census statistics. These data reveal the number of patients present at any one time in a facility. Some commonly computed rates based on census statistics are the average daily census and bed occupancy rates.
Discharge statistics. This group of statistics is calculated from data accumulated when patients are discharged. Some commonly computed rates based on discharge statistics are the average length of stay, death rates, infection rates, and consultation rates.
Internal Data and Information: Aggregate-Combining Clinical and Administrative
Healthcare executives are often interested in aggregate reports that combine clinical and administrative data. For example, Ad hoc statistical reports and trend analysis may draw from both clinical and administrative data sources. These reports may be used for the purpose of improving customer service, quality of patient care, or overall operational efficiency. With today’s computerized clinical and administrative databases, any number of ad-hoc queries, statistical reports, and trend analysis should be readily available to healthcare executives.
External Data and Information: Comparative
Comparative data and information are often aligned with organization’s quality improvement efforts. For example, an organization might collect data on specific outcome measures and then use this information in a benchmarking process. Organizations may select from many publicly and privately available healthcare data sets for benchmarking such as; Patient satisfaction data, practice pattern, health plans, clinical indicators, and population measures.
External Data and Information: Expert or Knowledge based
The Joint Commission defines knowledge-based information as, “A collection of sorted facts, models, and information that can be used for designing and redesigning processes and for problem solving. Healthcare executives and healthcare providers rely on knowledge-based information to maintain their professional competence and to discover the latest techniques and procedures. Knowledge-based information can also be incorporated into electronic medical records or healthcare organization web sites.