CHAPTER 22:

COMMUNITY HEALTH
APPLICATIONS
BY: BONDAD,SHEHADA M
 OBJECTIVES:

1. Define the scope of community healthy nursing

(CHN).
2. Describe the vocabularies and classifications used
for community health systems.
3. Discuss data sets and their use in CHN.
4. Discuss computer systems for community health.
5. Discuss use of telemedicine in community health.
6. Discuss future trends.
 DEFINITION OF CHN

• A synthesis of nursing practice and

public health practice applied to
promoting and preserving the health of
populations.
• Requires a comprehensive
understanding and knowledge of the
framework of the community, its
resources and the sociocultural issues
impacting people within a community.
 FOCUS: THE POPULATION
• Standards of CHN incorporate :
health promotion
health maintenance
health education
health management
coordination continuity of care using a holistic
approach.
• It is practice in public health departments,
ambulatory care settings, group practices,
outpatient clinics, freestanding community-
based clinics, and in homes.
 TARGETS:
• Usually targeted at a specific function like
population focus, continuity of care needs, or
billing services for documenting home health
care assessment to create a home health related
group (HHRG)
• Information system structure have other functions
like a simple tracking for clinical data or more
complex applications related to portable
medical data, billing, financial applications and,
statistical reporting and decision support
 CHN SYSTEM DEVELOPMENT

• CHN agencies used computers since the late 1960s.

• Mostly functioned for regulatory compliance, billing
applications, and statistical reporting related to
community health.
• Grew primarily due to consumer choice, cost
control initiatives, and the increase of numbers of
healthcare recipients with chronic illness.
CHN SYSTEM DEVELOPMENT (CONT’D)

• The CHN System Development contributes to

management information system (MISs)
transforms data into information to measure
outcomes, track client progress, exchange
healthcare information among physicians,
nurses, insurers, managed care companies,
regulatory agencies and public reporting, and
analyze financial data.
• These systems supported clinical care delivery,
electronic billing, and had the potential for
multiple user access.
4 DOMAINS OF MISS FOR PRACTICE

1. Public Health focused on population interventions

and outcomes related to epidemiologic and/or
mortality and morbidity trends
2. Home Health focused on skilled nursing care for
individuals in the home and the outcomes
related to care delivery for individuals or
aggregated populations
 4 DOMAINS OF MISS FOR PRACTICE
(CONT’D)
3. Special Population Community Practice (mental
health) focused on specific diagnostic care
and/or treatment needs and outcomes related to
the care provided to those groups
4. Outpatient Care focused on intermittent, episodic,
and preventive care for individuals and/or put
together groups inclusive of national health
prevention standards.
 HOME HEALTH

• Medicare and Medicaid Legislation (1965)

Home health describe the provision of
preventive, therapeutic, restorative and
supportive healthcare in the home
 new legislation increased HHAs (home health
agencies)
Systems captured patient demographics ,visits,
accounts payable, journal entries for the
purpose of producing standard reports, billing
forms, regulatory documents, visit summaries,
and financial balances.
 HOME HEALTH (CONT’D)

• Balanced Budget Act (BBA of 1997)

 With its enactment need for info moved beyond billing
info, stats info, and the tracking of clinical data
 Center for Medicare and Medicaid Services (CMS)
instituted prospective payment system (PPS) forms are
based on OASIS (clinical severity, functional status, &
service utilization
 Integrated form of payment allows for linkages between
home healthcare providers, state regulatory bodies, and
the fiscal intermediary responsible for paying Medicare
reimbursement directly to the agency.
 HOME HEALTH (CONT’D)

• Outcome Measures
 CMS started using OASIS data set in order to monitor
outcomes and adverse events based on risk-adjusted
patient characteristics for all Medicare-certified HHAs
 JCAHO (Joint Commission on accreditation of Health Care
Organizations) under outcome-based quality improvement
supported it as indicator of quality and improvement.
 PUBLIC HEALTH

Definition:
 coordinated effort at local, state and federal levels
whose mission is fulfilling society’s interest in assuring
conditions in which people can be healthy, as defined
by the Institute of Medicine (IOM)
Focuses on :
1. Preventing, identifying, investigating and eliminating
community health problems;
2. Assuring that the community has access to
competent personal healthcare services
3. Educating and empowering individuals to adopt
more healthy behaviors.
 PUBLIC HEALTH (CONT’D)
State and Local Health Departments
 1970s-1980s state/local official health depts. Developed
statistical reporting system for processing info on nursing
personnel, programs and services
 Florida Client Information (first statewide computerized
community health systems)
 PUBLIC HEALTH (CONT’D)

Public Health Challenges

• Issues of bioterrorism,
• Health plans recognizing need to evaluate
prevention activities to improve quality of live and
reduce costs
• Healthcare providers recognizing need to integrate
public data into individual health records
• Health depts. Needing to monitor impact of
community-wide interventions for improving the
health of populations in communities.
 PUBLIC HEALTH CHALLENGES
(CONT’D)
• Software developers responded with developing
electronic IT systems instead of outdated data
processing/computer systems.
• Allow for:
1. Relational databases that facilitate retrieval of data for
multiple purposes without rekeying
2. Manipulation of data to create information and
knowledge
3. Point of care devices, computerized patient records
(CPRs) and/or EHRs
4. Clinical repositories as a strategic resource for quality and
justice
5. Electronic interfacing systems to facilitate the sharing of
data.
 DATA SETS

Criteria:
 Utility for multiples users
 Terms that can be defined and measured
 Common or shared language that is universally understood
 Relevance to national or local needs
 Uniformity with other applicable data sets
 Data can be structured in compliance with Health Insurance
Portability and Accountability Act (HIPAA)
 Data can be collected easily and accurately through
functions of service delivery.
 SELECTED DATA SETS

National League of Nursing developed first

prototypes for basic minimum data set for CHN
even though it is no longer used.
The nursing minimum data set (NMDS) made by
Weley and Lang (1988) focused on 12 major
elements
 Uniform Data Set for Home Care and Hospice
 Outcome and Assessment In formation Set (OASIS)
 Outcome-Based Quality Improvement
 Health Plan Employer Data and Information Set (HEDIS)
 VOCABULARY LANGUAGES

• Vocabularies are validated clinical reference

languages, taxonomies, or terminologies that make
healthcare knowledge more usable and
accessible.
• Intensity Classifications
• Clinical Class Classification System (CCC)
• Clinical Care Pathway
 OMAHA SYSTEM

• Research-based, comprehensive taxonomy

designed to generate meaningful data following
usual or routine documentation of client care
• Consist of Three Components:
1. Problem classification scheme
2. Intervention scheme
3. Problem rating scale for outcomes
 COMMUNITY HEALTH INTENSITY
RATING SCALE
• Original CHIRS was prototype classification tool that
included 15 parameters that that represented the
same 4 Home Health System Domains in the Omaha
System: environment, psychosocial, physiological,
and health behaviors
 COMMUNITY HEALTH SYSTEMS

• Categorical Program Systems

• Screening Programs
• Registration Systems
• Management Information Systems
• Statistical Reporting Systems
• National Electronic Disease Surveillance System
• Special Purpose System
• School Health System
 HOME HEALTH INFORMATION
SYSTEMS

• Time-sharing Systems
• Stand-Alone systems
• Portability of Data
• Point of Care Systems
• Reimbursable Models
• Managed Care
• Scheduling Systems
 TELEMEDICINE
• Being implemented to replace face-to-face home
visits. Refers to electronic transfer of medical info
and services (voice, data, and video) from one
site to another using telecommunications
technology.
• Technology includes:
 Telemonitors with peripheral biometric attachments
 Videophone with two-way audio-video connectivity
 In home message devices with disease management
education, advice, and vital sign monitoring
 Video cameras for monitoring all aspects of care delivery
particularly on focusing on wound management and
home care aide supervision
 PCs with internet connectivity
 Video conferencing
COMMUNITY HEALTH TELEMEDICINE
SYSTEMS

• Internet Applications
1. Assist in self-diagnosis and preventive medicine
2. Reduce unnecessary outpatient visits
3. Provide self-directed triage
4. Eliminate the “worried-well” aspects of many patient-
provider interactions
Benefits:
 Improved patient and provider satisfaction
 Patient time savings in tracking and receiving info
 Reduced need to see a healthcare provider personally
 Reduced info calls
 More cost-effective care
• Telemedicine Devices
 COMMUNITY HEALTH NETWORK
SYSTEMS
• An innovative ambulatory care system developed
to provide services via computer
• Performs actions but not diagnoses:
• Download the patient record from hospital to the home
database
• Enter a series of questions about symptoms
• Track self-care
• Provide additional info on the condition if self-care is
chosen to assist the client to resolve the problem
 HOME HIGH-TECH MONITORING
SYSTEMS

• Using computers to link patients at

home to healthcare facilities
Monitors biophysical parameters
Remote defibrillator
Digitalized x-rays, ECG, electronic
stethoscopes, and interactive video
equipment
Alert systems
EDUCATIONAL TECHNOLOGY SYSTEMS

• Applications of these systems provide communication

linkages, information access, and educational materials
• Meets the need for clients to reach beyond their
environment to see and hear(experience, view, visualize)
• Healthy Town (program of VNAHPO)
• Healthy town is a unique program of the VNAHPO. It is a
partnership with the Area Agencies on Aging (AAA) who
serve seniors at neighborhood nutrition sites.
 Website: www.vnahealthytown.org
• Baby Care Link is a multifaceted telemedicine
communication application of Beth Israel Deaconess
Medical Center design to provide individualized
information to families of very low birth weight infants.
 FUTURE TRENDS

• Community health information networks will link

multiple providers, patient info, and regulatory
bodies on a single system allowing for integration of
data, continuity of care, and the tracking of
outcomes across service providers.
• Decision support systems will become more
sophisticated
• Geographic information system technology will also
be incorporated
 THE END

Thanks For Listening! 