4213 Exam 4 Mod 11 and 12
This area within AHIMA contains published articles, convention proceedings, and practice briefs that all members may access for continuing education and research needs: Body of Knowledge Council on Educational Excellence House of Delegates Professional Development Inventory
Body of knowledge
Emerging Roles in Health Information Management: The emergence of computer-assisted coding (CAC) technologies will change the role of the traditional coding professional as well.
CAC is the process of extracting and translating diagnostic and procedural information from electronic health records into ICD and CPT evaluation and management codes for billing and coding purposes. HIM coding professionals will need to develop skills to assess automated coding workflows as electronic documentation is captured, stored, and transformed into coded data. Coding professionals will also need to understand the mapping between a natural language process (NLP) and classification systems that occurs within the CAC. Coders will need to have in-depth knowledge of the structure and content of electronic health record documentation and what source documents are used during the CAC process. Two new job titles that may emerge with the use of CAC will be the clinical coding editor and the clinical coding analyst. The skills required by these new coding professionals will specifically require skills in automated coding workflow design and critical thinking skills to discern if code selection by the tool provides a clear clinical depiction of the documentation
Emerging Roles in Health Information Management: Clinical documentation improvement (CDI) roles, for both inpatient and outpatient coding specialists, are emerging roles that HIM departments are incorporating within coding workflows.
CDI helps "facilitate the accurate representation of a patient's clinical status that translates into coded data. Coded data is then translated into quality reporting, physician report cards, reimbursement, public health data, and disease tracking and trending" HIM professionals' familiarity with coding compliance and accreditation standards on timely documentation align well with developing clinical documentation improvement programs. HIM professionals must also work with coding vendors to ensure that appropriate CDI technology is in place along with CAC technology to create effective CDI programs. AHIMA has several CDI toolkits that can assist healthcare organizations in developing inpatient and outpatient clinical documentation programs.
An index creates a definition for terms that are within a database. True or False?
False.
Healthcare organizations do not need to evaluate the purpose of data collection for assuring data quality. True or False?
False.
Information governance and data governance are the same concept and can be used interchangeable. True or False?
False.
The response from a query will never go into the health record as it is just communication between the CDI professional and the provider. True or False?
False.
There is usually only one source of data within a healthcare organization. True or False?
False.
when creating provider contracts, healthcare organizations should not define disciplinary actions in the event that the contract requirements are not met. True or False?
False.
The competencies represent progression across all academic levels. The domains are listed below:
• Domain I. Data Structure, Content, and Information Governance • Domain II. Information Protection: Access, Use, Disclosure, Privacy, and Security • Domain III. Informatics, Analytics, and Data Use • Domain IV. Revenue Cycle Management • Domain V. Health Law & Compliance • Domain VI. Organizational Management & Leadership
AHIMA is the leading source of HIM knowledge and it is a respected authority for rigorous education and training.
- AHIMA is the premier association to which HIM professionals should belong in order to benefit from the multitude of resources available. AHIMA is working to advance the implementation of electronic health records by leading key initiatives and advocating for consistent standards. - AHIMA keeps HIM professionals informed on healthcare industry trends and provides members the resources in order to develop the knowledge, skills, and abilities necessary to manage these changes.
There are committees that are a requirement of accrediting bodies:
- Joint Commission - Health Facilities Accreditation Program (HFAP) - Det Norske Veritas Healthcare, Inc. (also known as National Integrated Accreditation for Health Care Organizations [NIAHO]) - Commission on Accreditation for Rehabilitation Facilities (CARF) - Accreditation Association for Ambulatory Health Care (AAAHC) - Accreditation Commission for Health Care (ACHC) - and other accrediting bodies specific to the particular categories of healthcare organizations. Committees also are required for providing information and guidance to governmental entities and licensure organizations in terms of healthcare operations. - Examples of governmental entities are the Centers for Medicaid and Medicare Services (CMS), Department of Public Health, and the Agency for Healthcare Research and Quality.
The four data management domains are:
1. applications. 2. collection. 3. warehousing. 4. analysis.
AHIMA's Guidance for HIM Professionals
AHIMA's primary goal is to provide the knowledge, resources, and tools to advance health information professional practice and standards for the delivery of quality healthcare. The AHIMA mission, as noted by the AHIMA in 2019 is empowering people to impact health. The AHIMA vision is a world where trusted information transforms health and healthcare by connecting people, systems, and ideas. The HIM professionals in a healthcare organization should be viewed as the leaders in managing health information at all levels.
Jon is an HIM professional interested in healthcare informatics and biomedical issues. Which of the following professional organizations would Jon be most likely to join to further his career in these areas? AMIA HIMSS NCRA NAHQ
AMIA
What are the components of AHIMA's principles of information governance?
Accountability and integrity.
Ad hoc taskforces
Ad hoc taskforces are groups formed for a specific task or objective and are assembled as needed. These task forces or committees perform the tasks assigned and then disband when the work is done
Purposes of Committees
Committees may be temporary or permanent. The purposes and uses of committees in general are to engage a multidisciplinary group of healthcare individuals in decision-making processes that impact a multitude of services within a healthcare organization. Discussions and decisions about healthcare operations need to be made outside of the patient care settings, and committees are where this type of coordination can occur in a very neutral manner. Committees also play a role in ensuring that all departments within a healthcare organization have a mechanism to collaborate regarding healthcare operations.
Emerging technologies
Computer-assisted coding
This data quality characteristics means all data items are included within the information collected?
Consistency.
Six domains
Data Structure, Content, and Information Governance •Information Protection: Access, Use, Disclosure, Privacy, and Security •Informatics, Analytics, and Data Use •Revenue Cycle Management •Health Law and Compliance •Organizational Management and Leadership
Forces impacting HIM
External Forces & Internal Forces see image
External and Internal Influences on Health Information Management
External forces are the influences, resources, and activities that exist outside of the healthcare organization but significantly impact and affect HIM. Internal forces are the areas of focus the manager needs to address on a daily basis so the HIM department performs at its peak level. Reflecting on internal and external forces allows the HIM manager to make operational decisions in line with the organizational model. HIM managers will need to embrace the following strategies in order to mitigate the effects of these influences on the day-to-day operations: • Provide better opportunities for "integration of healthcare information across the continuum of care • Develop processes and systems that promote the understanding and use of health information by patients and families • Reframe the way coded data and information is used to obtain payment in a system that rewards quality and efficiency of services over the traditional emphasis on the quantity of services
Professional Organizations
HIM has access to a variety of professional organizations that can offer assistance and support to HIM professionals depending on the job roles that might require additional support outside of the traditional HIM field. Professional organizations do not provide overall governance for HIM operations, but they do provide guidance and support for interested, qualified individuals in terms of offering best practices, lobbying and advocacy for the profession, and advanced credentials.
Committees
HIM professionals need to know the impact of organizational models and how they relate to health information operations. They also need to know how the committee structure within the healthcare organization affects HIM operations. A committee is a "body of persons delegated to consider, investigate, take action on, or report on some matter" Committees provide a framework for interdisciplinary teams: -manage process outcomes, - assess quality, - offer guidance in ethical decision-making, - review appropriate consumption of resources, - and provide administrative guidance for healthcare operations. Silos develop within healthcare organizations because of the specialized nature of the tasks each department or area performs. - Committees help mitigate the effect of silos on healthcare operations and they bridge the gaps that occur between medical or clinical and administrative or support departments. - committees can provide support for the overall operations in the healthcare organization.
HIM professionals play an important role within healthcare organizational committees as custodians of the health records.
HIM professionals provide a role in patient advocacy ensuring the healthcare organization is always acting in the best interest of the patient in terms of managing protected health information (PHI). It is important to understand the functions that each of the committees perform so when health records issues arise, concerns can be triaged to the appropriate committee.
A goal of a CDI program:
Identify and clarify missing, conflicting, or nonspecific physician documentation related to diagnoses and procedures.
Information assets are:
Information considered to add value to an organization.
American Health Information Management Association Educational Curriculum Competencies in Practice
It is the responsibility of an HIM manager to maintain his or her own skills as well as develop his or her employees' skills. The HIM educational curricula competences can also assist HIM professionals in connecting the career progression with learning needs (AHIMA Council in Excellence for Education 2018). -In response to the AHIMA's HIM Reimagined (HIMR) initiative, the American Health Information Management Association (AHIMA) and the Council for Excellence in Education (CEE) developed the 2018 AHIMA Health Information Management Curricula Competencies and revised the required Bloom's Taxonomy levels. The competencies aim to align HIM education with the skills and knowledge required to meet long-term future HIM workforce needs. - Each academic level is comprised of six common domains, representing the areas of mastery important for all HIM students and practitioners, regardless of academic degree. At the associate degree level, programs can choose one or both specialty tracks which include Data Management and Revenue Management. The Supporting Body of Knowledge has been updated to include math and statistics. Associate degree level academic programs may elect to teach one or both specialty tracks: Data Management (DM) and Revenue Management (RM). The DM and/or RM competencies are to be completed in addition to the competencies of the common domains listed above.
Emerging Roles in Health Information Management contd
Job roles are changing for HIM professionals as quickly as health information technology is advancing. Continuing education and advanced formal education needs to be embraced by all HIM professionals in order to keep pace with the healthcare industry
Emily is a coder who reports directly to the assistant director of HIM. The assistant director reports directly to the director of HIM. This reporting structure illustrates which organizational model? Interconnected management Line management Horizontal network Nonhierarchical organization
Line management
Line Management or the Hierarchical Organizational Model
Line management, or the hierarchical organizational structure, clearly defines the chain of command (a hierarchical reporting structure within an organization) within and outside of HIM departments and is hierarchical from the executive to front-line level. Line management is the traditional and least complex management structure in which top management has total and direct authority and employees report to only one supervisor. Managers in this type of organizational structure have direct responsibility to give orders to their subordinates. The lowest managerial level in an organization following the line management structure is supervisory management. Hierarchical organizations tend to be stable and predictable as work rules are documented and strictly enforced. Classical management styles are deployed in these organizations, and career progression is linear. The span of control is clearly defined in line management organizations and decision-making is centralized with each manager. Span of control is the area of activity and number of duties and employees for which an individual or organization is responsible for managing. Span of control is a concept of classical organization theory that suggests managers are capable of supervising only a limited number of employees.
Competitors for Health Information Management Roles
Many of the components of implementation of health information technology require technical information services skills such as those dealing with hardware, software, and interfaces. There are other components that require HIM skills such as designing documentation templates that meet accreditation and licensure guidelines, designing reports that can extract appropriate health information for release of information activities, and coding and billing workflow activities. HIM professionals need to step up and advocate for the skills and job roles that are appropriate for the HIM profession so others do not assume HIM roles within healthcare organizations.
Which of the following committees is responsible for overseeing medical staff activity within an organization? Accreditation Committee Medical Executive Committee Patient Care Committee Pharmacy and Therapeutics
Medical Executive Committee
Nonhierarchical Organizational Model
Nonhierarchical organizations are emerging as a healthcare organizational model because they allow for more responsiveness within a changing healthcare environment. Nonhierarchical organizations are relatively flat with very few layers and each layer reports to a single individual. In a nonhierarchical organizational model, there is no true line or hierarchy to reporting within the organization. - Nonhierarchical organizations reflect a combination of interconnected horizontal networks. -The nonhierarchical organizational structure combines aspects of functional and divisional hierarchies to create a rather complex structure where an employee may report to one or more managers. -management within a nonhierarchical organization is decentralized where the authority to make decisions will be spread throughout the organization rather than vested in one individual
The organizational model of the healthcare organization provides a framework for the facility's management structure and provides guidance to the HIM professional as to where he or she fits within the facility.
Organizational models are depicted in healthcare organizations as visual organizational charts. An organizational chart is a graphic representation of an organization's formal reporting structure; it aids in understanding the reporting relationships and functional responsibilities throughout the healthcare organization. Each department will have an organizational chart showing reporting relationships and functional responsibilities specific to the tasks performed within this area. Organizational charts typically represent two distinct organizational models within healthcare organizations—hierarchical (line management) and nonhierarchical. Some healthcare organizations use a mix of both models, and frequently healthcare organizations transition from the use of a line management or hierarchical model to a nonhierarchical model. The two distinct organizational models will be outlined as well as strategic guidance for transitioning from one model to another.
Healthcare Organizational Models and Health Information Management
Organizational structure is the "hierarchical arrangement of the lines of authority, communications, rights and duties of an organization" HIM is an organizational department "without walls" and is becoming decentralized in healthcare organizations. Healthcare professionals can be found within information technology, quality, financial services, revenue cycle, compliance, and utilization review departments. HIM professionals may manage the information, coding, and billing and general operations for particular clinical divisions such as cardiology and home health. organizations may elect to centralize all HIM functions. The key to surviving as an HIM professional in any of these venues is identifying the role of the job tasks being performed and how they relate to the overall healthcare operations.
Creation of a drug formulary for organizational use is the responsibility of which committee? Infection Control Committee Pharmacy and Therapeutics Committee Quality Management Committee Sentinel Events Committee
Pharmacy and Therapeutics Committee
Allison's position at the Department of Public Health requires that she perform coding and data analysis on infectious disease reporting forms. As an HIM professional, Allison is involved in what emerging role? Computer-assisted coding Enterprise information management Information governance Population health
Population health
Emerging Roles in Health Information Management: Population health information management (PHIM) is another job role that fits the skills and talents inherent to HIM professionals.
Population health is the capture and reporting of healthcare data that is used for public health purposes. It allows the healthcare provider to report infectious diseases, immunizations, cancer, and other reportable conditions to public health professionals. A strategic initiative of PHIM should include optimal clinical documentation along with accurate and compliant coding using appropriate classification systems and terminologies. The data created from this initiative will allow data from diverse sources to be extrapolated and aggregated to create information and knowledge related to the management of population health. HIM professionals excelling in PHIM will be able to innovatively assist organizations in developing EHRs that collect longitudinal data regarding public health issues as well as creatively assess patient demographics and coded data to aid clinicians in studying population health
Mary is an RHIT who has just been promoted to a coding manager position within her healthcare organization. Mary realizes that she needs to obtain a bachelors' degree in order to manage her employees more effectively. Mary is working toward _______________. Leading in data analytics Leading in informatics Championing information governance Preparing HIM professionals for the future
Preparing HIM professionals for the future
Michelle was recently elected to the position of president-elect in her state HIM association. Michelle is meeting which of AHIMA's strategic goals? Leading in data analytics Leading in informatics Championing information governance Preparing HIM professionals for the future
Preparing HIM professionals for the future
Documentation within medical staff bylaws defines how what type of practitioner should document within the record?
Providers.
Which of the following is not an internal force impacting HIM? Budget Span of control Staffing State regulations
State regulations
The AHIMA Body of Knowledge is the official repository of peer-reviewed information created by HIM professionals.
The AHIMA Body of Knowledge contains the most current and relevant articles, white papers, conference proceedings, and practice briefs supporting HIM initiatives. AHIMA provides the oversight of HIM certifications like registered health information technician (RHIT) and registered health information administrator (RHIA) by monitoring continuing education (CE) compliance. - AHIMA provides opportunities for HIM professionals to gain additional credentials that provide credence to advanced skills such as certified coding associate (CCA), certified coding specialist (CCS), certified coding specialist—physician-based (CCSP), certified health data analyst (CHDA), certified in healthcare privacy and security (CHPS), certified documentation improvement practitioner (CDIP), and certified health technology specialist (CHTS)
Limitations and Disadvantages to Committees
The committee structure and activities in the healthcare organization must be supported by the executive management team in order for this model to be constructive. The time to make decisions within a committee is slow as group deliberation and participation is required in all decision-making activities. If a decision needs to be made quickly on patient care, the committee structure is not the right venue for this action. Each committee member should engage in discussions at the meeting and strive to limit any sidebar discussions. Outside of the committee, committee members should only share final outcomes or committee decisions that are necessary for healthcare operations. A committee should review its purpose and function on a regular basis, assess membership, and revise as necessary. All committee members should be versed on the mission and vision of the committee and play a key role in ensuring that the committee functions are carried out appropriately. Committee structure is an effective way of managing complex healthcare organizational issues and HIM professionals should be aware of the role that it plays in regard to this model.
Committees are a part of the formal structure of a healthcare organization with assigned distinct purposes and functions.
The formality of the committee structure affords healthcare organizations the ability to require committees to be accountable for their actions. Table 11.1 reflects typical committees that function within a healthcare organization and outlines the functions HIM might perform for each of these committees see page 225 for chart
Emerging Roles in Health Information Management
The foundational curriculum competencies provide a baseline for new HIM graduates as well as a guide for practicing HIM professionals. Mastery of all competencies is not possible for any one individual because of the wide array of knowledge competencies identified for HIM professionals. HIM professionals need to develop a career plan and develop skills based on a career trajectory One emerging role that is best suited to the skill set of HIM professionals is enterprise information management (EIM) and governance. "EIM aligns people, processes, data, and technology with information policies and practices throughout an entire healthcare organization" A broader range of knowledge is required for embarking on an EIM manager role as skills should include a combination of the following items: • Leadership skills in gaining collaboration and cooperation from others in terms of managing and governing enterprise information • Privacy and security issues associated with EIM need to be addressed on a larger scale as there are compliance issues and risks within enterprise-wide data • Understanding and applying the concepts of data quality and integrity for enterprise-wide data is essential • Development of clear and concise data dictionaries for managing enterprise-wide information are imperative • Creation of information policies and standards that can be utilized by healthcare organizations to meet operational needs will be key to effective EIM
Introduction
The largest single change for the HIM professional is the implementation of health information technology and the bearing this technology has on the tasks and job roles needed in healthcare organizations.
A specific HIM example of the need to transition to a nonhierarchical model is when coding is moved into the revenue cycle management division, which may be comprised of coding, patient financial services, professional billing, and case management.
The managers within this department become a horizontal, interconnected network where responsibility for managing the cash flow within the healthcare organization is shared by all entities within this department. Figure 11.2 reflects what the organizational chart will resemble in a nonhierarchical structure such as the revenue cycle management functions. see image HIM plays an integral role in the overall functions of a healthcare organization so knowing the reporting relationships that exist within the organization is essential for creating a collaborative work environment with other departments.
Accreditation Committee
The purpose of the accreditation committee is to provide oversight and guidance in preparation for accreditation and licensure surveys. The major functions of this committee include: - assuring that hospital policies and procedures are in alignment with accreditation standards - reviewing accrediting or licensing body standards for updates - communicating changes to the standards to the healthcare organization - performing ongoing mock accreditation surveys - hosting the accreditation team as it arrives on-site for a review. HIM will participate in accreditation mock surveys and develop policies and procedures in relation to the management and access of health information throughout the organization.
Quality Management Committee
The quality management committee reviews all incident reports on a regular basis and initiates hospital-wide quality improvement initiatives based on incident report data and patient safety outcomes. The quality management committee may be combined with the patient safety committee in many organizations. HIM may provide a committee member and reports on pre- and post-quality improvement initiatives.
Committee Structure
The structure for most committees includes an appointed chair of the committee and often this role is rotated throughout the membership of the committee annually. Agendas and minutes of the committee meetings are created and used as a guide for managing each committee meeting. These documents are saved in an appropriate manner and are accessible to the committee members and the healthcare organization's executive team. Agendas are created based on the functions and requirements of the committee and are sent out to all committee members prior to the meeting. -Some of the committees may discuss issues that have protected status such as physician peer review committees, so the minutes from these meetings should be retained in a confidential manner.
Emerging Roles in Health Information Management: A vast array of job roles that are emerging within HIM departments are focused around data analytics and data informatics.
The titles for these new data analytics and informatics jobs greatly vary depending on the type of healthcare organization. Data mapping is another fast-growing field that clearly matches the attention to detail skills as well as knowledge of classification systems and terminologies that HIM professionals possess.
Staying Relevant as an Health Information Management Professional
There will be an increased need for HIM professionals to perform in the following areas: coding skills (CDI, revenue cycle, and registry), data and information governance skills, and leadership skills. HIM professionals will require further education, analytical and critical thinking skills, and additional clinical knowledge. A new HIM graduate has the advantage of being exposed to new HIM curriculum competencies that address emerging workforce issues. As an example, information technology professionals are assuming roles of extracting and reporting on coded dated because of their information technology background, but they have no knowledge of what this data means. Practicing HIM professionals have the advantage of work experience although many have a limited scope of the different types of health information roles emerging in today's healthcare environment due to limited job duties and tasks within their own healthcare organizations.
Which of the following is not an external force impacting HIM? Patient portals Privacy of personal health information (PHI) Training and development Changes in workforce demographics
Training and development
A data element is a single or individual fact that represents the smallest unique subset or larger data. True or False?
True.
Data granularity is the detailed level of the data where the attributes and values of the healthcare data are defined and documented. True or False?
True.
Data sharing is defined in multiple requirements under the meaningful use programs. True of False?
True.
Data stewardship is defined as principles and practices established to ensure the knowledgeable and appropriate use of data derived from individuals' personal health information. True or False?
True.
When creating bylaws for the medical staff, expectations of data quality should be established and documented within the bylaws. True or False?
True.
Without proper definition and requirements of data quality and data collection, healthcare organizations are challenged with the ability to hold providers and other patient care professionals accountable for documentation. True or False?
True.
Transitioning from a Line Management or Hierarchical Organization Model to a Nonhierarchical Organizational Model
Typically the executive leadership in a healthcare organization decides on the organizational structure, but HIM professionals may have a chance to provide input regarding the structure as mergers, acquisitions, and combining of related services occurs within a facility. HIM professionals should be judicial in setting the organizational model for a department. The most important element when transitioning between organizational models is to provide facts and data that support the need for the change and keep all individuals involved in the decision-making processes. Overall, the keys to success for transitioning from a line management or hierarchical model to a nonhierarchical organizational model include building strategic relationships throughout the organization rather than just reporting relationships and developing solid collaboration skills that can be applied within the HIM team as well as throughout the organization. An HIM manager can develop an innovative culture that fosters employees who can work in a complex, flexible, and adaptable work environment
A data set is ...
a recommended list of data elements that support a specific healthcare industry.
This is not a recommended guideline for maintaining the integrity in the health record?
assuring documentation that is being changed permanently deleted from the record.
Which of the following is a purpose of the creation of a data dictionary?
create support for structured data collection.
The two types of queries:
paper & electronic.
The two most common types of databases found in healthcare...
relational and object-oriented databases.
When creating requirements of documentation for the hospital bylaws, which of the following should be evaluated?
the documentation needs based on accrediting bodies.
Specific Health Information Management Committees
• Employee activities committee. This committee will provide support for ongoing employee social activities throughout the department such as planning potlucks, managing the office coffee pot and snacks, providing policies for when flowers should be sent to employees (for congratulations or consolation), and organizing parties for employee life events such as wedding showers and baby showers. Sometimes this committee also works through suggestions for department improvements and communicates employee requests for department improvements to management. • Health information professionals' (HIP) week committee. HIP week is a nationally recognized week (usually celebrated the third week of March in conjunction with the American Health Information Management Association Hill Day) honoring and raising awareness regarding HIM professionals who work in a variety of healthcare settings. The HIP week theme is developed by AHIMA and AHIMA provides a variety of tools for HIM professionals to employ for marketing the week in the healthcare organization and to the public. • Performance improvement committees. This committee can help organize and manage a variety of performance initiatives that cross multiple areas of the HIM department. A project manager or facilitator who is trained in the use of the performance improvement tools may be assigned to this committee. • HIM committee. This is an organization-wide committee that is required by The Joint Commission and is usually chaired or co-chaired by the HIM director. This committee provides healthcare organizational support in terms of managing all aspects of health information including approval of documentation templates, paper forms management, physician chart completion issues, record and retention policies, and copy and paste policies. It is very important that the HIM director keeps the HIM committee well informed on the issues impacting health information throughout the organization. • Specific HIM workgroup committees. These teams may meet on a regular basis to discuss specific job tasks, provide training and ongoing education, and develop team cohesiveness. Examples of HIM workgroups that might meet on a regular basis are the coding team and CDI team. These teams meet to discuss specific coding and documentations issues along with providing coding education on clinical or process topics impacting the coding or CDI area. The size and complexity of the HIM department will impact the type and number of committees that need to be in place.
