Author: Hurley, Brenda J.; Sims, Lea

Source: AHIMA Convention

Publication Date: October 31, 2006

Clinical documentation and health records play a vital role in every aspect of healthcare delivery and decision making, no matter what the setting. Complete and accurate documentation is also a central focus in current efforts to improve healthcare quality and patient safety as well as the ef....

Author: Miller, Grace; Gabard, Carlotta

Source: Journal of AHIMA

Publication Date: October 2006

About five years ago, Integrated Health Associates’ (IHA) antiquated technology was hampering staff efforts to make the most of clinical and administrative data. To correct the situation, the 100-physician, multispecialty practice based in Ann Arbor, MI, embarked on an 18-month search t....

Author: AHIMA Clinical Terminology and Classification Practice Council; Garrett, Gail S.; Johnson, Laurine; Johnson, Kathy M

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: October 2006

This practice brief has been retired. It is made available for historical purposes only.

Author: AHIMA e-HIM Work Group on e-Discovery

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: September 2006

This practice brief has been retired. It is made available for historical purposes only.

Author: Pritts, Joy

Source: Journal of AHIMA

Publication Date: September 2006

You receive a request for medical information from a third party. Generally HIPAA would prohibit releasing the information, but would allow disclosure when “required by law.” State law, however, generally requires disclosing the information, unless disclosure is prohibited by another law.

Author: Johns, Merida L.

Source: Journal of AHIMA

Publication Date: September 2006

HIM professionals have weathered dramatic structural, environmental, and technological winds of change due to several reasons, but the profession’s fundamental principles, remain unchanged even as they apply to each new method of practice. Our passions are the winds
that propel our vessel....

Author: Amatayakul, Margret; Work, Mitch

Source: AHIMA

Publication Date: September 01, 2006

Author: Blevins, Alicia; Davis, Nancy; Hjort, Beth M.; Lemery, Chrisann; Mangin, Wendy L; Mikels, Debra A; Nicholas, Cindy

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: August 2006

This practice brief has been retired. It is made available for historical purposes only.

Author: Boucher, Anne; Bowman, Sue E; Piselli, Caroline; Scichilone, Rita A

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: July 2006

This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.

Author: Demster, Barbara

Source: Journal of AHIMA

Publication Date: July 2006

The breadth of available privacy and security literature can be daunting to even the most dedicated HIM professional. With the explosion of information on the Internet, access to authoritative-as well as questionable-resources is easy and instantaneous. The problem of access has morphed into o....

Author: Fenton, Susan H.; Giannangelo, Kathy; Stanfill, Mary H

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: June 2006

This practice brief has been retired. It is made available for historical purposes only.

Author: Burrington-Brown, Jill

Source: Journal of AHIMA

Publication Date: June 2006

AHIMA’s e-HIM work groups have had great success in bringing together groups of HIM professionals to explore and create guidance on cutting-edge e-HIM practices and technology. These groups also teach us lessons about the factors of successful teamwork that we can apply to our own work si....

Author: Harker, Kathy

Source: Journal of AHIMA

Publication Date: June 2006

Northwest Health System followed a smooth launch of a coding product with something a little more ambitious—a beta version of a document management system.
In April 2005 Northwest Health System in Springdale, AR, implemented Web-based coding to boost productivity. The system....

Author: Bedrosian, Dan; McCoy, Michael J.

Source: Journal of AHIMA

Publication Date: May 2006

The RFP is a time-honored rite of vendor selection. But it has its drawbacks, and alternative strategies can offer advantages.
In the fast-changing world of health IT, vendor selection would seem to be a rare well-established procedure. But the traditional selection process has its pitfa....

Author: Barbera, Linda

Source: Journal of AHIMA

Publication Date: May 2006

The hospice setting is no stranger to the challenges of transitioning from paper to electronic documentation. Ensuring that hybrid medical records provide complete and accurate documentation is a significant issue, particularly for reimbursement processes. In order for the documentation to prov....

Author: Quinsey, Carol Ann

Source: Journal of AHIMA

Publication Date: May 2006

On February 16, 2006, the Department of Health and Human Services published the final rule adopting policies enforcing the HIPAA provisions. The rule imposes civil monetary penalties on covered entities that violate any of the HIPAA administrative simplification rules, not just the privacy rul....

Author: McLendon, Kelly

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: May 2006

This practice brief has been retired. It is made available for historical purposes only.

Author: Connecting for Health

Source: External - used with permission

Publication Date: April 06, 2006

Author: Quinsey, Carol Ann

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: April 2006

This practice brief has been retired. It is made available for historical purposes only.

Author: AHIMA

Source: Journal of AHIMA

Publication Date: April 2006

This Software license agreement is entered into by and between Sample Software, Inc, a Delaware corporation with principal offices located at 100 Maple Lane, Chicago, Illinois 60601 ("Sample") and _________________, a corporation with principal offices located at ________________ ("Licensee") a....

Author: Brick, Frank

Source: Journal of AHIMA

Publication Date: April 2006

Computer systems are feeling the effects of HIPAA. That's because the act's privacy and security rules require covered entities to securely store and manage more data than ever before. The latest computers to feel the effect are those in small covered entities, where the security rule takes ef....

Author: Amatayakul, Margret

Source: Journal of AHIMA

Publication Date: March 2006

A new study identifies the HIM best practices that influence revenue cycle management.
Revenue cycle management (RCM) has been defined as "all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue."1 RCM in hospitals is....

Author: AHIMA e-HIM Work Group on Regional Health Information Organizations (RHIOs)

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: March 2006

This practice brief has been retired. It is made available for historical purposes only.

Author: Green-Shook, Sheila; Quinsey, Carol Ann

Source: Journal of AHIMA

Publication Date: March 2006

Group Health Cooperative (GHC) is an integrated healthcare system with 29 primary care clinics, four specialty centers, two hospitals, 10,000 employees, and 700 physicians. GHC serves 540,000 patients across Washington state and northern Idaho.

In 2003 GHC began implementing an elec....

Author: AHIMA e-HIM Work Group on EHR Data Content

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: February 2006

This practice brief has been retired. It is made available for historical purposes only.

Author: McBride, Susan; Gilder, Richard; Davis, Robert; Fenton, Susan H.

Source: Journal of AHIMA

Publication Date: February 2006

Exchanging health data electronically requires some cartography. HIM professionals not involved with data mapping now will be soon.



One essential component of health IT interoperability, and the improved care and efficiency it offers, is data mapping. Data mapping....

Author: Stein, Todd

Source: Journal of AHIMA

Publication Date: February 2006

Fledgling RHIOs get a head start with new model policies and technical guidelines from Connecting for Health.
When Chuck Fitch first began to promote a regional health information network for Memphis’s far-flung hospitals, medical centers, county clinics, and physician groups thre....

Author: E-HIM Work Group on Patient Identification in RHIOs

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: January 2006

This practice brief has been retired. It is made available for historical purposes only.

Author: AHIMA

Source: AHIMA sample form

Publication Date: 2006

Author: AHIMA

Source: AHIMA

Publication Date: 2006

Author: E-HIM Work Group on Maintaining the Legal EHR

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: November 2005

This practice brief has been retired. It is made available for historical purposes only.

Author: Hall, Terri

Source: Journal of AHIMA

Publication Date: November 2005

The Billings Area Indian Health Service (IHS) began implementing an electronic health record (EHR) about three years ago, beginning with the Crow Acute Care Hospital and its Wind River outpatient clinics. This article outlines the steps the organization took to reach “go live.”

Author: Grebner, Leah A.; Stanfill, Mary H

Source: Journal of AHIMA - Coding Notes

Publication Date: November 2005

The term coagulopathy can be confusing for coding professionals because it may refer to a myriad of conditions that are classified differently in ICD-9-CM. Take for example a patient who has bleeding somewhere (e.g., hematuria or epistaxis). The physician lists “coumadin coagulopathy&rd....

Author: Hirschl, Nancy

Source: AHIMA Convention

Publication Date: October 21, 2005

Introduction


Revenue management and coding compliance for emergency department (ED) services have become increasingly difficult to handle. Factors contributing to this include lack of mandated evaluation and management (E/M) coding guidelines, EMTALA regulations, demands for cash....

Author: Rivera, Madeline; Zusman, Irina; Kogan, Susanna; Sichalov, Nadia; Spector, Michelle

Source: AHIMA Convention

Publication Date: October 21, 2005

Summary


Maimonides Medical Center (MMC) in Brooklyn, NY, implemented a successful documentation improvement program in 2001. Under the auspices of the Case Management Department, documentation specialists, who are credentialed HIM professionals (RHIA, CCS), perform concurrent and....

Author: Whitaker, Lisa Lowe

Source: AHIMA Convention

Publication Date: October 21, 2005

Introduction
Six Sigma is the new kid on the block for performance improvement in healthcare; however, it is not new to the manufacturing world. Companies such as Motorola, Toyota, and GE have used Six Sigma since the 1980s to improve their business processes. Six Sigma is defined as “an....

Author: Hirschl, Nancy; Belton, Paul

Source: AHIMA Convention

Publication Date: October 21, 2005

Introduction


Traditionally, compliance programs have focused on the seven required elements from auditing and monitoring to hotline investigations. Most of these elements have become routine and solidified into every compliance program. In truth, seasoned compliance officers often....

Author: Osborn, Carol E.; Curtis, Elizabeth

Source: AHIMA Convention

Publication Date: October 21, 2005

Background

Of late, there has been much interest in the relationship between medical record documentation, coding, and the organization’s case-mix index (CMI). Many organizations have implemented documentation improvement programs with the goal of obtaining more specificity in codin....

Author: AHIMA e-HIM Work Group on the Legal Health Record

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: October 2005

The custodian of an electronic health record (EHR) has the same concerns as the custodian of a paper health record when the record becomes involved in the legal process. Most often this occurs in some form of lawsuit in which a party seeks to discover and introduce evidence from the record. The....

Author: Tomes, Jonathan P.

Source: Journal of AHIMA

Publication Date: October 2005

To avoid the improper destruction or alteration of records, HIM departments must follow a retention schedule, train personnel, and ensure that corrections leave original entries intact.
Although the legal concept known as spoliation of evidence has been a part of the American legal syste....

Author: Bronnert, June

Source: Journal of AHIMA - Coding Notes

Publication Date: October 2005

With the many reimbursement issues and regulatory requirements surrounding coding, it is sometimes necessary for coders to refamiliarize themselves with what it means to code ethically. AHIMA’s Coding Policy and Strategy Committee developed the Standards of Ethical Coding, which were app....

Author: AHIMA Professional Practice Team

Source: AHIMA

Publication Date: September 19, 2005

September 19, 2005

The following information is provided by the American Health Information Management Association in the aftermath of Hurricane Katrina.

When people are displaced by disasters, it can be difficult to begin or resume medical care without healthcare informatio....

Author: Westhafer, Kathy J

Source: Journal of AHIMA

Publication Date: September 2005

Have you given any thought to how your medical record committee and forms management process need to transition with electronic health record (EHR) development? At the Christiana Care Health System, we have. Here’s our evolving story.

Christiana Care is a two-hospital health s....

Author: AHIMA e-HIM Work Group on the Legal Health Record

Source: AHIMA practice brief | Journal of AHIMA

Publication Date: September 2005

This practice brief has been retired. It is made available for historical purposes only.

Author: Amatayakul, Margret; Work, Mitch

Source: AHIMA

Publication Date: August 01, 2005

Author: AHIMA e-HIM Personal Health Record Work Group

Source: AHIMA practice brief

Publication Date: July 2005

This practice brief has been updated. See the latest version here. This version is made available for historical purposes only.

Author: Sedona Conference. Working Group on Best Practices for Electronic Documnet Retention & Production

Source: External web site

Publication Date: July 02, 2005

This is the post public-comment version of The Sedona Principles. The Working Group on Electronic Document Production was conceived to develop principles to guide organizational practices and legal doctrine.

Author: Brandt, Mary D.

Source: AHIMA sample form

Publication Date: June 14, 2005

Sample form for sending to patient when critical information missing from the patient-submitted authorization form for release of information.

Author: Brandt, Mary D.

Source: AHIMA sample form

Publication Date: June 14, 2005

Author: Brandt, Mary D.

Source: AHIMA sample form

Publication Date: June 14, 2005