HI510 Unit 9 Seminar Reflection Example

"A Bed Is a Bed" Did Not Survive One Question: A Unit 9 Seminar Reflection on Extending a Hospital Patient Flow Application to a Nursing Facility

[Student Name]

Purdue University Global

HI510: Health Information Applications and Systems

Unit 9 Seminar Reflection

[Instructor Name]

[Date]

The case and Ostervale Health are composite; the regulation and sources cited are real.

The Case

For anyone who completed the written alternative, the seminar case was short. Ostervale Health bought a patient flow application for its two hospitals: a real-time board showing which beds are occupied, which patients are expected to leave, which beds are being cleaned and which are ready. It works well in the hospitals, where the question that matters is how fast a bed can be turned over. The system then extended it to its 96-bed nursing facility to put every bed in the system on one board. Within three months, the facility's business office manager was keeping a separate spreadsheet every day, because the board could not tell her what she needed to bill.

My Position on Arrival

I walked in ready to defend the decision. One system, one board, one source of truth for beds seemed like exactly the kind of standardization this course has praised. Duplicate applications cost money, need separate interfaces and split the data. In my notes I had written, and then said aloud, "A bed is a bed." I thought the business office's spreadsheet was a training problem or a reluctance to give up an old habit, and that a few more weeks would settle it.

The Question

The instructor let me finish and then asked one question: what does a nursing facility bill and report for each resident day? I started to answer and could not. The instructor walked us through it. In a hospital, a bed is occupied or not, and payment is mostly by the stay. In a nursing facility, every resident day carries a payer, and the payer can change during a stay, from Medicare Part A to Medicaid to private pay. Some days are leave days, when a resident is away for a family visit, and some are bed-hold days, when a resident is in the hospital but the facility holds the bed. Federal rules require the facility to tell residents its bed-hold policy before and at the time of a hospital transfer (42 C.F.R. § 483.15), and state Medicaid programs set whether and how they pay for those days. The census in a nursing facility is a billing document as much as an occupancy count. The board answered the hospital's question, which bed is free, and had nothing to say about the facility's question, who pays for this day.

The Bed-Hold Example

A student from a long-term care finance office added the detail that made it concrete. When a resident goes to the hospital for three days on a bed hold, the hospital's board shows a new admission, and the facility's board shows an empty bed that should be offered to the next referral. In fact the bed is held and may be paid. The flow application treated the bed as available because that is what an empty bed means in a hospital. The business office's spreadsheet was not resistance. It was the only place the facility's census still existed.

A Census Is Not One Thing

I had treated standardization as good in itself. What I missed is that a census is not one thing across settings. The data elements look alike, a bed, a patient, a date, but the obligations behind them differ completely. Sociotechnical models of health IT warn that technology, workflow, people, organizational rules and external regulation interact, and that a system fitted to one setting's rules can fail in another even when the technology itself works (Sittig & Singh, 2010). That is exactly what happened here. The flow application did its job perfectly; it was simply doing a hospital's job in a building with a different one. The cost of the mistake was not the license fee but the business office manager's hour every morning, the risk of a billing error when the spreadsheet and the board disagreed and a referral nearly accepted into a held bed. Reflection is supposed to surface the assumptions inside one's own reasoning (Rolfe et al., 2001), and mine was that a data element means the same thing wherever it appears.

Two Habits I Am Keeping

Before I recommend extending any application to a new setting, I will list what that setting must bill and report for each unit of its record and check whether the application can produce it, as we did in our requirements brief earlier in the course. I will also treat a parallel spreadsheet as evidence, not as resistance, and ask what it holds that the system does not. In this case, the answer was the facility's entire reason for keeping a census.

References

42 C.F.R. § 483.15 (2024). https://www.ecfr.gov/current/title-42/section-483.15

Rolfe, G., Freshwater, D., & Jasper, M. (2001). Critical reflection for nursing and the helping professions: A user's guide. Palgrave Macmillan.

Sittig, D. F., & Singh, H. (2010). A new sociotechnical model for studying health information technology in complex adaptive healthcare systems. Quality and Safety in Health Care, 19(Suppl 3), i68-i74. https://doi.org/10.1136/qshc.2010.042085