The Johns Hopkins Hospital is a teaching hospital and a biomedical research institute located in Baltimore, Maryland, in the United States of America. It was founded by a philanthropist known as Johns Hopkins in the year 1889, hence, its name. The hospital has a school of medicine that is the founding institution of modern medicine in America and the place of birth for traditions in medicine such as residents and ward rounds. Various specialties were developed from the institution including child psychiatry by Leo Kanner, neurosurgery by Harvey Cushing and cardiac surgery by Alfred Blalock. It is a non-profit hospital, is a teaching hospital and has an affiliated university- Johns Hopkins School of Medicine. John Hopkins Hospital occupies about 20 of the sixty buildings in the Johns Hopkins Campus. It is known to receive over 80,000 visitors in a week, hosing more than 1000 inpatient beds and more than 30,000 workers including 1,700 doctors. Apart from the main hospital, four other hospitals are operated and several outpatient facilities from the main system (Garibaldi et al., 2016) . The hospital also provides remote consultations globally through the grand ground platform, which they also use to help the patients find the ideal consultant specialist for their needs.
It is ranked at second place in the top overall hospitals in the United States from Massachusetts general hospital. It provides various specialties including ear, nose and throat, geriatrics, neurosurgery, dermatology, and psychiatry among others. It would be important to state that it tops in rheumatology according to the United States news and world report rankings by medical specialties 2016-2017 (Al Kiyumi, Walker, Tariq, & FitzGerald, 2017) . The Johns Hopkins University hospital is considered to be the first research university in the United States of America. The institution is organized into ten divisions on the campuses in Maryland and Washington Dc and also has internationals centers located in China, Italy and Singapore. The medical and nursing schools, as well as the Bloomberg School of public health, are found in East Baltimore. As alluded to earlier, Johns Hopkins is structured as two corporations, the Johns Hopkins Hospital and the Johns Hopkins University. The president of the university is the chief executive officer of the hospitals (Lim, 2016) . The institution offers several clinical services such as the general internal medicine clinical service.
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The main focus for the general internal medicine faculty is delivering excellent primary and hospital best care while serving as excellent clinical role models for students and staff. The clinical faculty aims at providing up-to-date, patient-focused and evidence-based care to the diverse client population from the surrounding communities and Baltimore city. Outpatient services are offered in several settings and through a variety of programs such as the hypertension program which provides specialized care for patients with high blood pressure that have proven difficult to diagnose and treat (Al Kiyumi, Walker, Tariq, & FitzGerald, 2017) . Inpatient services at the institution also run through different programs such as the inpatient medical consultation service that helps other hospital departments to manage medical problems and the substance use disorders consultation service that improves the health and quality of the life of patients with substance abuse and addiction among others (Gibson, Dixon, & Abrams, 2015) .
The running of a health care institution such as the Johns Hopkins hospital requires competent administration, excellent case management and a firm network of doctors, and other healthcare provides (Skurka, 2017) . Communication is a constant challenge and very long periods of time may be taken to implement even the smallest changes (Fernandez-Gracia et al., 2017) . Failure to comply with some procedures may be a source of frustration and may interfere with the procedures such as those focused on patient-centered care. Areas that are important to improve in a hospital such as Johns Hopkins is to make sure all staff members understand their roles to achieve patient-centered care by avoiding every employee believing it’s up to someone else to provide the care. The setting of departmental and hospital-wide goals is also an area of improvement. Working closely with patient advocates rewarding staffs that meet the set goals and setting clear guidelines are areas that would greatly improve the institutional mission and vision.
Health facilities, in general, are any location where there is a provision of healthcare. They range from small clinics, doctor's offices to large hospitals with very elaborate trauma facilities and emergency rooms. A healthcare facility can be either an outpatient or an inpatient facility (Gibson, Dixon, & Abrams, 2015) . An inpatient facility is that which offers medical services that require admission in hospital. Inpatient care in the facilities tends to be directed more towards serious ailments and trauma that require several days of overnight stay at the hospital (Fernandez-Gracia et al., 2017) . In the cases of health care coverage, the insurance plans require that one is admitted formally in the facility for it to be considered inpatient. Admission requires that the doctor writes a note that gives the order for admission. Most of the admissions go through the hospital's emergency department (Skurka, 2017) . This is important because when it comes to insurance coverage, the health insurance plans separate the emergency room interventions and the inpatient facility care when sharing of cost arises.
Outpatient health facilities are those that are designed for the treatment of patients that do not require admission (Oh et al., 2016) . The people with health problems visit the facility for diagnosis or treatment but do not require hospitalization or overnight care. Modern outpatient departments like the Johns Hopkins hospital offer a wide range of treatment services, diagnostic tests, and minor surgical procedures. Hospitals with inpatient care also have outpatient care departments (Gibson, Dixon, & Abrams, 2015) . This is different from outpatient facilities and clinics that are unattached to hospitals and that are almost exclusively designed for outpatient care (Wier, Steiner, & Owens, 2015) . They are also referred to as outpatient clinics. In a hospital, the outpatient department is often integrated with the inpatient department and is managed by physicians and surgeons who also are the ones who attend to inpatient services in ward rounds and inpatient procedures (Skurka, 2017) . The patients are examined and put on medication before being admitted as inpatients. Inpatients also have to attend outpatient clinics after being discharged. The outpatient is usually in the ground floor of any facility (Oh et al., 2016) . For the non-ambulatory patients, wheelchairs are, and stretchers are available for them. The procedure usually involves registration at the reception desk then waiting to be called by the doctor for consultation. Laboratory, x-ray, pharmacy and the medical records office are usually close to the outpatient for ease of proximity.
In the past decade, there has been an increase in the outpatient clinics all over the United States creating competition that as a result has increased consumer expectations of more convenience (Lim, 2016) . More elective surgeries have since been scheduled as outpatient procedures. Complicated procedures and surgeries have been made possible in the past decade in the outpatient setting due to new and more advanced medical technologies such as the minimally invasive surgical techniques, pain control techniques, and anesthesia among others that prevent complications and enable patients to go home quicker (Wier, Steiner, & Owens, 2015) . As the number of outpatients visits grow, the inpatient visits have fallen markedly in the past decade (Fernandez-Gracia et al., 2017) . As a result, there has been a shift of focus by hospitals where they are spending more time and resources on what is happening outside in the community, developing initiatives and programs that help keep the community healthier (Wier, Steiner, & Owens, 2015) .
In the health facilities, health information management is very vital. It is the practice of acquiring, analyzing and protecting medical information that is extremely crucial in providing quality care for patients (Al Kiyumi, Walker, Tariq, & FitzGerald, 2017) . The tools in health information are improving from the traditional paper-based records to the computerized health records, that is, the electronic health records. All of this is tasked to the health information management professionals to plan the information systems, develop health policies and identify current and future needs for information management (Garibaldi et al., 2016) . Moreover, they may have to apply the sciences such as informatics to the collection, analysis, storage, use and transmission of the information to meet the legal, professional, administrative and ethical recordkeeping requirements of health care delivery (Skurka, 2017) .
At the Johns Hopkins hospital, medical records are managed by the health information management department. The department has healthcare management professional that include the health information management director, the health information system manager, the information security officer, the chief privacy officer, the health data analyst, the health records technician specialists and the patient information coordinator among other professionals (Fernandez-Gracia et al., 2017) . The role of the health information system manager within the framework of health information management include, the basics of medical coding, medical transcription of patient histories, radiology reports and operative reports, medical necessities for the patients, medical staff support, assembly of medical records and maintenance of medical records (Garibaldi et al., 2016) . Apart from that, the health information systems manager at Johns Hopkins Hospital have other roles such as filing of records, maintaining privacy and security, the release of information and maintenance of high levels of confidentiality.
The health duty analyst at the institution has roles that involve gathering and integrating data from different sources within the hospital, the building of models and analyzing data to unearth trends and patterns as well as presenting and explaining information and suggesting improvements to health information management.
References
Al Kiyumi, R., Walker, S. M., Tariq, A., & FitzGerald, G. (2017). Health information management professionals [Present circumstances and future expectations].
Fernández-Gracia, J., Onnela, J. P., Barnett, M. L., Eguíluz, V. M., & Christakis, N. A. (2017). Influence of a patient transfer network of US inpatient facilities on the incidence of nosocomial infections. Scientific reports , 7 (1), 2930.
Garibaldi, B. T., Kelen, G. D., Brower, R. G., Bova, G., Ernst, N., Reimers, M., ... & MacConnell, S. (2016). The creation of a biocontainment unit at a tertiary care hospital. The Johns Hopkins medicine experience. Annals of the American Thoracic Society , 13 (5), 600-608.
Gibson, C. J., Dixon, B. E., & Abrams, K. (2015). Convergent evolution of health information management and health informatics: a perspective on the future of information professionals in health care. Applied clinical informatics , 6 (1), 163.
Lim, K. (2016). U.S. Patent No. 9,407,662 . Washington, DC: U.S. Patent and Trademark Office.
Oh, J., Perlas, A., Lau, J., Gandhi, R., & Chan, V. W. (2016). Functional outcome and cost- effectiveness of outpatient vs inpatient care for complex hind-foot and ankle surgery. A retrospective cohort study. Journal of clinical anesthesia , 35 , 20-25.
Skurka, M. A. (Ed.). (2017). Health information management: principles and organization for health information services . John Wiley & Sons.
Wier, L. M., Steiner, C. A., & Owens, P. L. (2015). Surgeries in hospital-owned outpatient facilities, 2012. HCUP Statistical Brief , 188 .
