As a Nurse Case Manager Specialist for Cigna HealthSpring health insurance company, I engage with patient’s telephonically 95% of the time. I access patient information via 10 or more electronic patient information systems daily. Needless to say, Informatics and technology are essential to my daily nursing practice/care. One of the primary electronic health systems we use is called “Lumeris”. “Lumeris helps health systems, providers and payers deliver value-based care and improve outcomes through population health management (Lumeris.com).” Lumeris collects data from submitted electronic claims for medical services provided to our patients and creates care reminders for quality measures (Blood Pressure, A1C, mammograms, colonoscopy, BMI, etc.) that have not been completed for the measurement year. We prioritize are patient care based on the outcomes and/or lack of outcomes found in Lumeris. Prior to the incorporation of Lumeris, the only way we could access patient information was via primary care office (PCP) notes (paper record and/or EMR). Although we continue to make PCP office visits to retrieve information, Lumeris has significantly assisted with streamlining information and making our workflow more efficient and effective.
I believe more population health systems like Lumeris are the future of healthcare. Population health management systems are a collaboration of the health care plan and the health system (hospital/PCP). When we share patient information in an ethical manner we can manage patient care more efficiently. This could possibly reduce cost and promote safety by preventing duplication of medical treatment/services, medication prescriptions, etc. Duplicative treatment/medication is one of the greatest challenges we face with our patients. This is due lack of communication and improper transition of care.
“The same ethical principles that apply to verbal and written information also apply to information stored in technology. The Health Insurance Portability and Accountability Act (HIPAA) apply to all communications, including electronic (Week 6: Lesson: Ethics in Informatics and Technology).” I remember there was a Licensed Practical Nurse (LPN) assigned to help our team with The Healthcare Effectiveness Data and Information Set (HEDIS) project. The HEDIS project sends patient records that were submitted for claims from healthcare provider from the previous measurement year, to CMS for auditing purposes. The nurse took a picture of a patient’s medical record, sent it to their personal e-mail, and then sent it to their work e-mail for submission. This was a clear violation of Patient Health information (PHI). As nurses, we have to remember that technology is a tool that can be our greatest ally or our worst enemy.
Hood, L. J. (2018). Leddy & Peppers professional nursing. Philadelphia: Wolters Kluwer
Week 6: Lesson: Informatics and technology