Question

Identify and describe the three types of utilization reviews of managed care organizations?

What are the three main components of a fully developed electronic health record (EHR) according to the Institute of Medicine?

Answer 1

Utilization review involves a coordinator that effectively provide expedite care to a patient after hospital admission. He will aid in avoiding he delays of services needed and finally to ensure that the patient should be treated with effective and appropriate level of care until he/she is ready to move back to home. There are 3 main types of UR(utilization review) :

1. Prospective review - It is the review for selective services that are prior to further services. They include the confirmations for the process in call and in writing too.

2. Concurrent review - the review of running services for the treatment of patient that how long the patient will stay on hospital, whether there is a need of extention or not, etc, is in Concurrent review.

3. Retrospective review - This review is done when the patient is treated with full effectiveness using the medical chart of the patient.

EHR( electronic health record) is the record of a patient collected and maintained electronically. There are three basic components of EHR:-

• Patient Management Component--It is needed during the admission or registration and during relieving or discharge of a patient involving his/her insurance policies, contact informations, etc
• Clinical Component- It is further of 3 subtypes, a) Computerised provide order entry- It enters the requirement of patient directly in the computer using multiple options or sets of combinations, b) Electronic document- It helps in providing electronic document to create history or other notes of a patient, c) Nursing component- It creates the nursing charts for medications, patient's sign, etc.
• Laboratory Component- It aids in collecting data from laboratory machines and creating bills concerned.