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System Structures Overview

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System Structures Overview
HCS/533 Health Information Systems

I have aforementioned that I was previously employed with hospice within the health care industry for several years. Within that experience, I have had the pleasure of using a few information systems. I have also had the pleasure of gaining insight and a better understanding of these systems and how and why they were implemented within the industry as well as how beneficial they have been throughout the years. If I may, I would like to report on a system that was not discussed during Week 2 of this course but is very imperative within the hospice industry which is Disease Classification Structure. Disease Classification Structures are very essential for compensation. The data system is one that classifies and provides diagnostic codes that help classify diseases. The ICD-9 (international classification of disease) was actually elected in the United States and the purpose was to “classify disease and health conditions on health care claims and is the basis for prospective payment to hospitals, other health care facilities and health care providers. (Overview of ICD-9, p.1). Every decade, the World Health Organization revises to include morbid and mortal conditions. The DRG (diagnosis related group) was put into motion in the early eighties with the intent of creating a classification system that identified the products that the patient received. (Medicare, 2013). Since that period of time, diverse systems have developed. In order to track and monitor disease improvement, it is very important to augment systems to categorize diseases. This is also vital for insurance compensation resolutions. The international classification of disease (ICD) is the standard diagnostic tool for epidemiology, health management and clinical purposes. (“World Health Organization”, 2013). ICD is in use to monitor disease prevalence and health problems as well as recording vital information, including death certificates and health records. (“World Health Organization”, 2013). ICD9 is central when making determinations for insurance compensations and distribution of resources. Diagnosis Related Group (DRG) is a classification system that divides the possible diagnosis into major body systems and subdivides into groups for the purpose of Medicare. Services are in groups, according to the resources in need and a dollar value assign as a basis for payment. (Medicare, 2013). This system influences compensation as the dollar amount does not replicate the care that the patient receives while being hospitalized. The importance behind the disease clarification structure is to construct codes and categorize diagnosis. These codes are very vital to the compensation process because physicians compensate in accordance to the code submitted. Since each diagnosis has been given its own specified code, epidemiological data can be acquired. I specifically selected this topic simply because there are various factors that need to be affirmed in regards to coding and how it actually influences the compensation process and epidemiological data. This topic helps one understand and conclude how the structure actually works within the health care industry as well as its relation to disease classification. A diagnosis related group (DRG) is extremely useful as well as vital in the reimbursement, monitoring of quality and the setting of financial rates for health organizations everywhere according to Fleschler, Knight & Ray (2001). In addition to aiding with the compensation for services being delivered to patients, DRG also assists with defining the condition of the patient via a coded system that accompanies it. Previously, many companies made calculations of relevant situations which confirmed to be disturbing for those involved. In the health care industry, DRG is a tool that has various advantages. The benefit of disease classification structure incorporates the compensation system which emphasizes processing claims for reimbursement. It provides and monitors the use of resources while cultivating clinical, financial and administrative conduct. Health care clientele use this system to assemble data regarding costs and outcomes of various treatment alternatives. The system also benefits communities in its ability to track, manage and identify public health risks and disease progressions. The system is beneficial in its use to conduct health care research, clinical trials and participation of epidemiological studies. Disease classification systems are intended to increase the ease of describing diseases in patients in various countries and of various ethnicities. It is a very tedious task to place every disease into a group that studies disease management and aftereffects. The number of revisions has proven the potential for errors which could vastly affect the results of medical research. One small error is essential to codes assigned to a small population which if improperly allocated, the reimbursement for care would result in improper payment. The systems serve as a vital tool to that identifies diseases, track disease management and compensate for health related services received. It is imperative to enhance as technology evolves. Upgrading ensures that accurate data is being collected which in return yields adequate compensation. Though many improvements are needed to enhance both ICD and DRG, both systems are valuable and beneficial to the status of health care.

Fleschler, R. G., Knight, S. A., and Ray, G. (2001). Severity and risk adjusting relating to
Obstetric outcomes, DRG assignment, and reimbursement. Journal of Obstetric Gynecologic Neonatal Nursing/National Center for Biotechnology Information, 30(1), 98-109. Retrieved from
Medicare. (2013). Acute Inpatient PPS. Retrieved from
World Health Organization. (2013). Classification of diseases. Retrieved from from…...

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