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Workaday
Informatics
HOW HEALTHCARE IS APPLYING
PRACTICAL INFORMATICS TO
SAVE DOLLARS AND LIVES
Welcome
TO THE DIGITAL EDITION OF THE
JOURNAL AHIMA
OF
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Cover
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Workaday Informatics
Presidents Message
The Evolving Practice of
Health Informatics
10
Bulletin Board
pg. 34
Features
22
28
34
14
17
Inside Look
Informatics Poses Challenges,
But Promises Rewards
72
Calendar
73
Keep Informed
74
Volunteer Leaders
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77
80
Addendum
Beware the Dark Side of the Web
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Standards Strategies
The Standardization of Standards
By Anna Orlova, PhD
54
Quality Care
Healthcare Moving Toward an
Information Ecosystem
By Christine Kowalski, EdD, RHIA, CP-EHR
Coding Notes
Quizzes
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Practice Brief
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EDITOR-IN-CHIEF
ASSISTANT EDITOR/
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ASSOCIATE EDITOR
Mary Butler
CONTRIBUTING EDITORS
Sue Bowman, MJ, RHIA, CCS, FAHIMA
Patricia Buttner, RHIA, CDIP, CCS
`
Angie Comfort, RHIA, CDIP, CCS
Crystal Clack, MS, RHIA, CCS
Julie Dooling, RHIA, CHDA
Melanie Endicott, MBA/HCM, RHIA, CCS, CCS-P, CDIP,
FAHIMA
Katherine Downing, MA, RHIA, CHP, PMP
Deborah Green, MBA, RHIA
Jewelle Hicks
Lesley Kadlec, MA, RHIA
Carol Maimone, RHIT, CCS
Paula Mauro
Anna Orlova, PhD
Kim Osborne, RHIA, PMP
Harry Rhodes, MBA, RHIA, CHPS, CDIP, CPHIMS, FAHIMA
Angela Rose, MHA, RHIA, CHPS, FAHIMA
Maria Ward, MEd, RHIT, CCS-P
Diana Warner, MS, RHIA, CHPS, FAHIMA
Lydia Washington, MS, RHIA
Lou Ann Wiedemann, MS, RHIA, CHDA, CDIP, CPEHR,
FAHIMA
Jill A. Blacketer
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JOURNAL OF AHIMA MISSION
The Journal of AHIMA serves as a professional development tool
for health information managers. It keeps its readers current on
issues that affect the practice of health information management.
Furthermore, the Journal contributes to the field by publishing work
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Articles are grounded in experience or applied research, and they
represent the diversity of health information management roles and
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What ONCs approach lacks, however, is a broader information governance or data governance strategy.
Without the integration of information
and data governance in this plan, the
US will be hampered in its sharing,
use, and protection of health information, AHIMA warns. AHIMA commented that the association would like to
see the following issues addressed
with more specificity:
The use of standards that support
interoperability, particularly those
that address terminologies, classification (ICD-10-CM, SNOMED,
LOINC, etc.), and common metadata structures. Currently, the
plan understates the need for
C
oordination of laws relating to
privacy and security between the
federal government and the states
to remove confusion, inconsistency, and conflicting laws and regulations in a world in which health
data and information must follow
the individual without respect to
state jurisdictions.
At its core, effective information governance is about managing the costs
and risks associated with information
management and enabling the entities
that collect, use, and share it to extract
maximum value from the information as
well as the technology used to create
it, AHIMA concluded.
49%
Source: Mullen, Brian M. Study: 49 percent of patients withhold clinically sensitive information. Clemson University media release. December 17, 2014. http://newsstand.clemson.edu/mediarelations/study-49-percent-of-patients-withholdclinically-sensitive-information/.
is one health plan helping physician practices and institutions as they prepare for the transition. Since October 2013,
Florida Blue has conducted extensive end-to-end testing
in which providers re-code previously processed claims to
ICD-10 using the original medical record.
We wanted to make it as simple as possible for physicians
and providers who rely on us for their revenue stream to be
able to test easily without creating heartburn on their side,
says George Vancore, Florida Blues senior manager of delivery systems, mandates, and compliance. Vancore is encouraged that recent testing has revealed no financial anomalies
for physician practices.
To promote better knowledge of ICD-10, Florida Blue
conducts monthly calls with physicians, providers, and
even other payers. Known as ICD-10 Open Line Friday,
these calls provide case studies and other resources to
help stakeholders prepare for the transition. We want to
create a mindset for ICD-10 around the three Cscollaboration, coordination, and cooperationacross the industry, Vancore says.
Additionally, Florida Blue has been working with industry
associations and medical societies to educate and engage
physicians. In 18 months, Vancore has visited 70 groups to
help support providers across Florida. During his visits, Vancore conveys one clear message: We have solutions, and at
the end of the day, we can and must do this.
Inside Look
informatics that are being used in healthcare facilities every day to improve care
processes and information management.
In Data Analysis Starter Kit, Diane
Dolezel, MSCS, RHIA, helps demystify
some of the tools used in data analysis
and provides a practical starting point.
Donald M. Voltz, MD, suggests the industry take another look at middleware
as a solution to the perennial problem of
connecting disconnected EHR systems
in Connecting the Disparate: Middlewares Role in Solving Healthcares EHR
Interoperability Problems.
Priscilla Keeton, MS, RHIT, and Patricia Pierson, RHIA, offer practical steps
everyone can use to land the HIM jobs
of the future in e-HIM Professionals
Wanted. And for the 50,000-foot view,
Scanning the HIM Environment, by
Anna Desai, MHA, CAE, summarizes the
latest environmental scan report created
by the House of Delegates Envisioning
Collaborative.
Informatics is more than a buzzword. It
poses new challenges but also promises
great rewards. With our knowledge and
insights into data, HIM professionals can
help make the promise a reality.
Notes
1. The White House, Office of the
Press Secretary. Fact Sheet:
President Obamas Precision Medicine Initiative. January 30, 2015.
www.whitehouse.gov/the-pressoffice/2015/01/30/fact-sheet-president-obama-s-precision-medicineinitiative.
2. Steenhuysen, Julie. NIH director sees solving data puzzle as
key to U.S. precision medicine.
Reuters. March 6, 2015. www.
reuters.com/ar ticle/2015/03/07/
us-usa-health-precision-idUSKBN0M302520150307.
Journal of AHIMA May 15/17
Workaday
Informatics
HOW HEALTHCARE IS APPLYING
PRACTICAL INFORMATICS TO SAVE
DOLLARS AND LIVES
By Mary Butler
Workaday Informatics
Workaday Informatics
Workaday Informatics
Note
1. Berwick, Donald M. et al. The Triple AIM: Care, Health
and Cost. Health Affairs 27, no. 3 (May 2008): 759-769.
http://content.healthaffairs.org/content/27/3/759.full.
Mary Butler (mary.butler@ahima.org) is associate editor at the Journal of
AHIMA.
Journal of AHIMA May 15/21
DATA
A
N
STAR ALYSIS
TER K
IT
HOW TO APPLY INFORMATICS
AND ANALYZE ROI AS AN
E-HIM PROFESSIONAL
By Diane Dolezel, MSCS, RHIA
making. Excel has a powerful tool called a PivotTable that efficiently summarizes worksheet data into a table by fields.23
An e-HIM analyst should ensure that all data columns have
headers, and that the data selected for analysis does not have
any empty cells. To begin, select all the table data, including the
headers, click the Insert tab, and click on Recommended PivotTables to see the pop-up shown in Figure 11, which allows
you to see how the recommended chart(s) would look.
Scroll until the chart shown in Figure 11 is displayed, then
click the OK button.
The PivotTable in Figure 12, which summarizes the data, will
be displayed on a separate worksheet.
In summary, this is a powerful, highly customizable tool
that facilitates comparing different categories of data such as
length of stay in days and age group, or age group and payer
class. This PivotTable provides an easy method for summarizing data for multiple clinics for the same time in order to visualize their differences.
For example, Figure 12 indicates that Clinic 1 had a higher
total of e-ROI costs (i.e., $7,700) than Clinic 2 (i.e., $7,100) during this 10-week stretch. At this point, descriptive statistics
(i.e., average ROI weekly costs) and histograms showing average business days to fulfill requests could be completed for
both clinics in order to further analyze the differences.
Notes
1. Orlova, Anna and Harold Lehmann. Informatics Education for HIM Professionals in the Era of Interoperable
Standards-Based HIEs. Journal of AHIMA 86, no. 2 (February 2015): 48-51.
2. Dimick, Chris. Health Information Management 2025:
Current Health IT Revolution Drastically Changes HIM
in the Near Future. Journal of AHIMA 83, no. 8 (August
2012): 24-31.
3. Fernandes, Lorraine, OConnor, Michele, and Victoria
Weaver. Big Data, Bigger Outcomes. Journal of AHIMA
83, no. 10 (October 2012): 38-43.
4. Ibid.
5. Centers for Medicare and Medicaid Services. Affordable
Care Act Implementation FAQs Set 1. Center for Consumer Information and Insurance Oversight. www.cms.
gov/CCIIO/Resources/Fact-Sheets-and-FAQs/aca_implementation_faqs.html.
6. Centers for Medicare and Medicaid Services. Pay-forPerformance/Quality Incentives. May 24, 2005. www.cms.
gov/Regulations-and-Guidance/Guidance/FACA/downloads/tab_H.pdf.
7. AHIMA. HIM Functions in Healthcare Quality and Patient Safety. Journal of AHIMA 82, no. 8 (August 2011):
42-45.
8. Shaw, Patricia L. and Chris Elliot. Quality and Performance Improvement Healthcare: A Tool for Programmed Learning. 5th ed. Chicago, IL: AHIMA
Press, 2012.
9. Joint Commission. 2015 Hospital National Patient Safety
Goals. www.jointcommission.org/assets/1/6/2015_HAP_
NPSG_ER.pdf.
10. Sandefer, Ryan H. et al. Keeping Current in the Electronic
Era: Data Age Transforming HIMs Mandatory Workforce
Competencies. Journal of AHIMA 85, no. 11 (November
December 2014): 38-44.
11. Office of the National Coordinator for Health IT.
Patient Ability to Electronically View, Download &
Transmit (VDT) Health Information. February 2014.
w w w.healthit.gov/providers-professionals/achievemeaning f u l-use/core-measures-2/pat ient-abilit yelectronically-view-download-transmit-vdt-healthinformation.
12. Centers for Medicare and Medicaid Services. Eligible Professional Meaningful Use Core Measures, Measure 7 of 17.
August 2014. www.cms.gov/Regulations-and-Guidance/
Legislation/EHRIncentivePrograms/downloads/Stage2_
EPCore_7_PatientElectronicAccess.pdf.
13. Microsoft. Excel when and where you need it. 2015.
http://products.office.com/en-us/excel.
14. Microsoft. Basic tasks in Excel 2013. https://support.
office.microsoft.com/en-us/article/Basic-tasks-in-Excel2013-363600c5-55be-4d6e-82cf-b0a41e294054?Correla
tionId=484fa17b-4e38-4109-b9c4-f47af572112c&ui=enUS&rs=en-US&ad=US.
15. Microsoft. Use the Analysis TookPak to perform com-
Connecting
the Disparate
BS in Health
Information Management
e-HIM
Professionals
WANTED
STEPS TO LAND A JOB AND
BUILD A CAREER IN TODAYS
MODERN HIM JOB MARKET
By Priscilla Keeton, MS, RHIT, and Patricia Pierson, RHIA
STEP 1
STEP 2
STEP 3
vation. When the interviewer asks if you have any questions, refer
to the list of questions you prepared ahead of time and see if there
are any outstanding topics you would like to discuss. Finally, remember to thank the interviewer for his or her time and ask when
you might hear back from them or what the next step will be.
References
Bowe, Hertencia. Developing Skills for a New Era. For The
Record 23, no. 3 (February 2011): 8.
Hansen, Katherine. Avoid These 10 Resume Mistakes.
QuintCareers. www.quintcareers.com/resume_mistakes.html.
Polk-Lepson Research Group. 2013 National Professionalism
Survey Workplace Report. Center for Professional
Excellence at York College of Pennsylvania. January 2013.
w w w.ycp.edu/media/york-website/cpe/York-CollegeProfessionalism-in-the-Workplace-Study-2013.pdf.
Sundberg, Jorgen. How Interviewers Know When to
Hire You in 90 Seconds. Undercover Recruiter. http://
theundercoverrecruiter.com/infographic-how-interviewersknow-when-hire-you-90-seconds/.
Thompson, Greg. Building a Better Resume. Advance for
Health Information Professionals. March 26, 2013. http://
health-information.advanceweb.com/Student-New-GradCenter/Student-and-New-Grad-Center/Student-Top-Story/
Building-a-Better-Resume.aspx.
Priscilla Keeton (priscillakeeton@texashealth.org) is project analyst for
health information management services at Texas Health Resources, located
in Arlington, TX. Patricia Pierson (ppierson@collin.edu) is a full-time faculty
member in the health information management department at Collin College, located in McKinney, TX.
Study online
MASTER OF SCIENCE IN
Medical Informatics
Apply today
applications are accepted quarterly.
medinformatics.northwestern.edu
877-664-3347
SCANNING
the HIM
ENVIRONMENT
AHIMAS 2015 REPORT OFFERS INSIGHT
ON EMERGING INDUSTRY TRENDS
AND CHALLENGES
By Anna Desai, MHA, CAE
that the average growth rate for 2015-2023 would be six percent.
That is up slightly from 2014.16 These findings also suggest that
healthcare will outpace growth in the gross domestic product
(GDP) over the next decade. Healthcares share of the GDP,
which has remained stable since 2009, will increase from 17
percent in 2012 to more than 19 percent in 2023.17
Millennials
In 2015, millennials are set to become the largest percentage of
the workforce for the first time.21 Millennials will play a pivotal
role in changing the culture of traditional employment. The top
three choices millennials view as most important regarding career choices are:
1. Work/life balance
2. Health benefits
3. Compensation
A generation that is vocal about their demand for a better
work/life balance have and will continue to place a higher value
on a flexible and mobile work environment. Many companies
are investing in virtual project management tools that aim to
streamline the logistics of managing virtual teams.
Baby Boomers
The baby boomer retirement wave will continue to have a significant effect on organizational workloads. Also the aging work-
26
2006
42
2008
57
2010
119
2012
20
40
60
80
100
120
140
Sources: eHealth Initiative. The State of Health Information Exchange in 2010: Connecting the Nation to Achieve Meaningful Use. 2010. http://ihealthtran.
com/pdf/eHI%20-%20HIE%20Final%20Report.pdf; Operational Health Information Exchanges Show Substantial Growth, But Long-Term Funding Remains
a Concern. Health Affairs 32, no. 8 (August 2013): 1486-1492. http://content.healthaffairs.org/content/32/8/1486.full?keytype=ref&siteid=healthaff&ijkey=d
EAYexYtxoPP.
Troubleshooting errors 4%
Patient matching 21%
Normalizing data fees 22%
Unrealistic end user expectations 26%
Identifying/implementing standards 31%
Technical challenges 48%
Consistent and timely response from EHR 64%
Financial costs 74%
10%
20%
30%
40%
50%
60%
70%
80%
Source: eHealth Initiative. 2014 Results from Survey on Health Data Exchange. October 8, 2014. http://assets.fiercemarkets.com/public/healthit/ehidataexchange2014.pdf.
for Americans. Issues include patient safety, better, wider access to care, quality measures, and cost reduction. Health IT
and EHRs are tools to achieve these goals and HIM professionals are right in the middle. Many of these federal agencies are working together to become more coordinated than
in the past.
Notes
1. PricewaterhouseCoopers Health Research Institute. Top
Health Industry Issues of 2014: A New Health Economy
Takes Shape. December 2013. www.pwc.com/en_US/
us/health-industries/assets/pwc-top-health-industryissues-of-2014.pdf.
2. HIMSS Analytics. 2014 HIMSS Analytics Cloud Survey.
June 2014. http://apps.himss.org/content/files/HIMSSAnalytics2014CloudSurvey.pdf.
3. Ibid.
4. TechTarget. Analytics: Moving health care forward.
SearchHealthIT.com. www.techtarget.com/downloads/
Health_IT_BI_report.pdf.
5. Groves, Peter et al. The Big Data Revolution in Healthcare: Accelerating Value and Innovation. Center for US
Health System Reform Business Technology Office. January 2013.
6. Eramo, Lisa A. Healthcares Data Revolution: How Data is
Changing the Industry and Reshaping HIMs Roles. Journal of AHIMA 84, no. 9 (Sept 2013): 26-32.
7. IBM. Big Data at the Speed of Business. www-01.ibm.
com/software/data/bigdata/industry-healthcare.html.
8. Miliard, Mike. Top Ten Health IT Predictions for 2015.
Healthcare IT News. November 26, 2014. www.healthcareitnews.com/news/top-10-health-it-predictions-2015.
9. Ibid.
10. mHealth App Developer Economics 2014: The State of
21.
PricewaterhouseCoopers Health Research Institute.
Medical cost trend: Behind the numbers 2015.
22. AHIMA. Embracing the Future: New Times, New Opportunities for Health Information Managers. Summary Findings from the HIM Workforce Study. 2005. http://library.
ahima.org/xpedio/groups/public/documents/ahima/
bok1_027397.hcsp?dDocName=bok1_027397.
23. Burning Glass Technologies. Missed Opportunities? The
Labor Market in Health Informatics, 2014. December 10,
2014. www.burning-glass.com/research/health-informatics-2014/.
24. Ibid.
25. University of Illinois at Chicago. Health Informatics. http://
healthinformatics.uic.edu/intersection-of-healthcare-it/.
26. AHIMA Foundation. Reality 2016: The Council for Excellence in Educations Recommendation for HIM Education. September 26, 2012. www.ecu.edu/cs-dhs/hsim/
upload/Reality_2016_Presentation-9_26_12_NC.pdf.
27. Health Resources and Services Administration Bureau of
Health Professions. Projecting the Supply and Demand
for Primary Care Practitioners Through 2020. National
Center for Health Workforce Analysis. November 2013.
http://bhpr.hrsa.gov/healthworkforce/supplydemand/
usworkforce/primarycare/projectingprimarycare.pdf.
28. Viola, Allison and Lydia Washington. Accountable Care:
Implications for Managing Health Information. AHIMA
Thought Leadership Series. 2011.
29. Ibid.
Anna Desai (anna.desai@ahima.org) is manager of profession governance at AHIMA.
Read More
Read the Full 2015 Environment Scan Report
http://engage.ahima.org
To access the 2015 Environmental Scan report, visit the Engage topic
Environmental Scan Reports.
Responding to
Requests from
Law Enforcement
Officials for
Release of PHI
By Dana DeMasters, MN, RN, CHPS
Figure 1: Request from Law Enforcement for Release of Protected Health Information (PHI)
Used with permission from Barb Beckett, RHIT, CHPS, system privacy officer at Saint Lukes Health System, based in Kansas City, MO.
The officer will complete the upper portion of the form, check
the appropriate legal exception, and sign the form. The privacy
officer or designee would then review the request to ensure it
aligns with what may be released. If approved, the individual
who releases the information to the officer signs the form and
places it in the patients record. An associated policy that lists
the regulations in detail and notes what limited information
may be released should also be in place.
Its important to note that staff must understand that the form
is used to gather information to evaluate whether PHI may be
released. An officer merely completing and signing the form
does not equate to an immediate release and/or release of all
requested information.
Notes
D I S C E R N I N G
Identities
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46/Journal of AHIMA May 15
ADVANCING
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NAME
47
will help. But the devil is in the details. The truth is there are
many different types of data involved in healthcareindividual healthcare records, large databases of pharmaceutical trials, and multi-decade collections of prescriptions and
outcomes data.
Data sets are expected to grow with the popularity of fitness
trackers such as the Fitbit, Nike Fuelband, and soon-to-be-released Apple Watch. In addition to variances in the data sets,
different users may pose dramatically different questions and
analyses to their data sets. Not surprisingly, not all tools or all
techniques work for all data sets and all questions.
Before organizations look for the best tools, they should start
by understanding their data. Some key considerations include:
Quantity. Does data size exceed recommended specifications for standard storage, computer memory, or database
record counts?
Structure. Is the data highly structured, such as a database with well defined fields of information, or highly unstructured, such as physician notes and e-mail communications?
Integrity. Is the data clean? Was it collected in a manner
that had sufficient controls that maintained consistent
and accurate values or use of fields in the data?
Once an organization has assessed its data, it should also
consider what its looking to get out of the data. Data searches
could include the following, many of which come from the field
of data mining:
Retrieval. Are users trying to retrieve known records?
Classification. Can certain patient behaviors be classified
as more risky or less risky?
P
rediction. Are users trying to forecast outcomes
from inputs?
Exploration. Are users trying to understand trends and
segments within a data set?
A ffinity. Are there two or more activities that are correlated? Is there a query as to causation?
ingthe timely, accurate, and efficient retrieval of information may be better addressed by referring to the science of
information retrieval.
The science of information retrieval has developed a rich language of tools and techniques to facilitate the timely, accurate, and efficient retrieval of information. The terminology
of information retrieval is a great place to find ways to implement timely, accurate, and efficient processes based on
the IGPHC.
In information retrieval, accuracy is determined by measuring
recall and precision. These concepts can be confusing to the
uninitiated, but, essentially, they represent the questions: Did
you find ALL of what you were looking for (recall) and did you
find ONLY what you were looking for (precision).
If you are searching for patients admitted after midnight and
you identify 4 out of 5 of those patients, but also identify another
4 who were admitted before midnight, then your recall was 80
percent (you found most but not all) and your precision was 50
percent (you found most, but not only).
In practice, it is very possible to have 100 percent recall or 100
percent precision, but it is difficult to have both. This is where
trade-offs occur. The need for timeliness and efficiency can
affect recall and precision. Wanting results faster, or cheaper,
can result in lowering the recall, lowering the precision, or
lowering both.
Returning to our example of searching for patients admitted after midnight, you may be able to quickly identify many of
the patients admitted after midnight, but to find both ALL and
ONLY those patients may take more time or resources.
In 2014, the American Health Information Management Association (AHIMA) published the Information Governance
Principles for Healthcare (IGPHC), which outlines broad and
comprehensive principles of information governance for
healthcare. One of those principles is the Principle of Availability, which states that [a]n organization shall maintain
information in a manner that ensures timely, accurate, and
efficient retrieval.
The language and context of the IGPHC imply that the principles contemplate only a simple retrieval. But different organizations have different needs that may be more complex.
Either way, a given organizations data characteristics will still
impact their choices regarding tools and techniques.
The IGPHC expands on these concepts, but each one touches
on a much larger discipline of knowledge that goes far beyond
the 2014 publication. Whereas the principles appropriately
identify the value of metadata and disaster recovery, as well as
the challenges of conducting federated searches across multiple
independently designed systems, its overall guidance speaks
more to goals than specific techniques.
The actual techniques for measuringand then improv-
istrative data standards); Digital Imaging and Communications in Medicine (DICOM); National Council for Prescription Drug Programs (NCPDP); Clinical Data Interchange
Standards Consortium (CDISC) for clinical research standards; and others.
At the International Organization for Standardization
(ISO), founded in 1946, the Technical Committee 215 Health
Informatics was created in 1998 for standardization in the
field of health informatics, to facilitate the coherent and consistent interchange and use of health-related data, information, and knowledge to support and enable all aspects of the
health system.1
International agencies also develop standards. For example, the World Health Organization (WHO) develops the
family of International Classification of Diseases (ICD) standards. International organizations originally focused on
information and communication technology, such as the
International Telecommunication Union (ITU) and the International Electrotechnical Commission (IEC), have also
begun working on standards for healthcare, creating liaisons
with healthcare SDOs.
Each of these entities operates various committees and
workgroups of experts that produce a variety of standardsrelated documents, such as guidelines, standard specifications, technical reports, technical specifications, and implementation guides. Each standard is developed through
a consensus-based process that consists of the following
three phases:
1. Propose New Standard
2. Develop Standard
3. Maintain Standard
All these standards are produced as books, that is, published documents originally distributed as books and now
available for download from correspondent SDO websites
in PDF format. Some documents are free, others are for
sale. Figure 1 above presents examples of data standards
(volcabularies and terminology standards) in healthcare.
Thousands of various standards in health information technology (HIT) and health informatics have been published in
the past 40 years.
The adoption of standards in HIT products has been slow and
inconsistent. As the adoption of non-standards based HIT products grew, a critical tipping point was reached when the global
Journal of AHIMA May 15/51
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Notes
1. Liaw, S. Clinical decision support systems: data quality
management and governance. Studies in Health Technology and Informatics 193 (2013): 362-369.
2. LaTour, Kathleen M. et al. Health Information Management: Concepts, Principles, and Practice. 4th edition. Chicago, IL: AHIMA Press, 2013.
3. Mohammed, Siti and Maryati Yusof. Towards an evaluation framework for information quality management
(IQM) practices for health information systemsEvaluation criteria for effective IQM practices. Journal of Evaluation in Clinical Practice 19, no. 2 (2013): 379-387.
4. Halamka, John. Connecting patients, providers, and payers improves quality, safety, and efficiency. Journal of
General Internal Medicine 28, no. 2 (2013): 167-168.
5. Matthews, Christopher. Healthcares Triple Aim: How
technology is facilitating collaboration among members,
providers and payers. Health Management Technology.
January 2013. www.healthmgttech.com/articles/201301/
healthcares-triple-aim.php.
6. Barrington, Randy. Navigating an Ocean of Information:
How Community Care of North Carolina Uses Data to Improve Care and Control Costs. North Carolina Medical
Journal 75, no. 3 (May/June 2014): 183-187. www.ncmedicaljournal.com/wp-content/uploads/2014/05/75305.pdf.
7. Congdon, Ken. Moving Beyond the EHR. Health IT Outcomes. January 23, 2015. www.healthitoutcomes.com/
doc/moving-beyond-the-ehr-0001.
8. Congdon, Ken. Telemedicine: The Next Big Thing in Health IT.
Health IT Outcomes. January 23, 2015. www.healthitoutcomes.
com/doc/telemedicine-the-next-big-thing-in-health-it-0001.
Christine Kowalski (christine.kowalski@wgu.edu) is a HIM program
course mentor at Western Governors University, in Salt Lake City, UT.
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PRACTICE BRIEF
practice guidelines for managing health information
Editors Note: This Practice Brief supersedes the March 2007 Practice Brief Assessing and Improving EHR Data Quality.
THE UNITED STATES-BASED Institute of Medicine (IOM) reported in 1999 that at least 44,000 people, and perhaps as many
as 98,000 people, die in hospitals each year as a result of medical
errors that could have been prevented, according to estimates
from two major studies.1 A new study published in 2013 by the
Journal of Patient Safety states that four times as many people
die from preventable medical errors than originally thoughtas
many as 440,000 a year.2
The delivery of quality healthcare depends on the availability
of quality data. Poor documentation, inaccurate data, and insufficient communication can result in errors and adverse incidents.3 Inaccurate data threatens patient safety and can lead to
increased costs, inefficiencies, and poor financial performance.
Furthermore, inaccurate or insufficient data also inhibits reimbursement, payments, and health information exchange (HIE),
and hinders clinical research, performance improvement, and
quality measurement initiatives. The impact of poor data on
care will only increase with the implementation of ICD-10-CM/
PCS, as well as the roll out of the meaningful use EHR Incentive Program. In addition, introduction of new payment reform
models such as accountable care organizations (ACOs) and value-based purchasing emphasize the need for more specific and
meaningful data collection, sharing, and reporting.
An electronic health record (EHR) has the potential to minimize medical errors if the data are accurate and meet quality
criteria. The goal is for EHRs to help healthcare professionals
use quality data for evidence-based knowledge management
and decision making for patient care.
EHRs can have a positive impact on quality of care, patient
safety, and efficiency. Without accurate and appropriate information in a usable and accessible form, however, these benefits
will not be realized. Integrity of information is directly related to
the organizations ability to prove that information is authentic,
timely, accurate, and complete.
This Practice Brief discusses the challenges of maintaining
quality data in the EHR and offers best practice guidance for ensuring the integrity of the healthcare data. It is designed to support and guide organizations, health information management
(HIM) professionals, and providers to better assess, improve,
and maintain the integrity of electronic health information.
Practice Brief
ner throughout documentation so that the patient is treated appropriately. Healthcare organizations should have an approved
abbreviation list as part of their internal policies and procedures. It should be noted that some organizations are going to
an unapproved list. For example, The Joint Commission has a
Do Not Use abbreviation list.13
Data integrity policies and procedures must be followed. These
policies may include (but are not limited to) registration processes, standards for handling duplicate records, and processes
for addressing overlays. It is important to implement policies
and procedures to maintain the integrity of the data throughout the patient encounter for all information entered into the
EHR, whether by people or systems. Individuals dedicated to
the continuous auditing of the record, as well as EHR correction
processes that monitor the system proactively and correct errors as they are identified, play an important role in fine-tuning
processes and ensuring the overall quality of the data.
Practice Brief
nizational policies and procedures mirror standardization decisions and should be followed by designated staff. The Joint
Commissions Information Management and Record of Care
standards, HIPAA standards, Centers for Medicare and Medicaid Services (CMS) Conditions of Participation, and Federal
Rules of Civil Procedure related to electronic discovery are just a
few of the standards that should be kept in mind when developing ones own facility standards and procedures.
1. Patient Identification
Ensuring that health information is associated with the patient
to whom it pertains is a key component to ensuring patient
safety. EHR systems should have alerts and prompts that notify
the user when the potential for an incorrect association exists.
For example, the EHR system should alert users when several
patients have similar names and dates of birth, such as in the
case of multiple birth siblings. Access controls strictly limiting
who can enter and update/change key enduring demographic
elements (such as name, date of birth, or place of birth) must
also be in place. Capabilities to limit medical identity theft must
also be implemented.
Simply matching demographic information supplied by the
patient is not sufficient. Additional identifiers or biometrics,
such as patient photographs, palm vein scanning, or fingerprinting should be utilized when possible. Standardized naming
convention policies or formats for using the patients legal name
must also be developed and employed (i.e., standardizing the
spelling of suffixes such as Jr., Junior, and JR) to help minimize the risk for error. Policies and procedures for baby naming,
for unidentified emergency patients, for the use and exclusions
of hyphens, and for handling celebrities or notable individuals
(and the additional complication of considering whether to use
an alias for the patient) should also be developed.
Thorough training for all front-end usersespecially those
in registration and scheduling rolesand proactive surveillance by data integrity analysts for any patient identification
errors should be given the utmost attention to ensure proper
patient identification.
For more information on patient identification and patient
matching, refer to the Practice Brief Managing the Integrity
Practice Brief
2. Copy Functionality
In early 2014, the Department of Health and Human Services
Office of Inspector General (OIG) highlighted copy and paste
as a common practice in EHR documentation practices, noting
that it can lead to adding false or irrelevant documentation.15
Since bringing this to light, many EHRs have started evaluating and addressing copy/paste functionality. The importance
of strong information governance and internal policy and procedures regarding the use of copy and paste is critical. Organizational policies and procedures should be developed for
proper use of EHR documentation to ensure compliance with
governmental, regulatory, and industry standards, including
acceptable copy/paste practices. Such practices include identification of origin and author of copied information, provider
responsibility, error notification, and sanctions for violating
copy/paste policies.16
Use of copy functionality (also known as copy/paste, copy
forward, or cloning) has been promoted in the clinicians
EHR workflow to improve the ease of consistent use of static
health information, such as past medical history. But when
misused, copy functionality can lead to redundant, misleading,
inaccurate, irrelevant, inconsistent, and unnecessarily lengthy
documentation that may jeopardize quality of care, increase
risk for medical error, or result in allegationsand even chargesof fraud.
For example, problems occur when a clinician copies and
pastes progress notes from the patients first day of care to the
second day of care and does not take the time to review and edit
out procedures, medication, treatments administered, and/or
documents specific to that specific date of service (DOS). In addition to the impact on care quality, dangers extend to the audit
arena where retrospective case reviews may focus on the high
frequency of copy/paste use, which can indicate possible fraud.
The ability to limit copy functionality in an EHR system is vital
for the accuracy of data. Limitations of copy functionality must
include measures such as:
C learly labeling the information as copied from another source
L imiting the ability for data to be copied and pasted from
other systems
L imiting the ability of one author to copy from another authors documentation
Allowing a provider to mark specific results as reviewed
A llowing only key predefined elements of reports and results to be copied or imported
The ability to monitor a clinicians use of copy and paste
Monitoring the EHR audit trail
More information on policies and procedures related to copy
4. Standalone Devices
Whenever possible, quality information from standalone devices should be incorporated into the EHR. However, certain devices or equipment that contain health data might not interface
with the EHR. The lack of availability of health information contained in standalone devices can potentially impact data quality by restricting certain types of data from view or making the
viewing of data difficult. In such cases it is important to assess
what standalone data is not integrated into a single EHR view
and ensure those who have a need to know such information
have the ability to access it.
Organizations must closely monitor standalone systems to
ensure data quality and accuracy between the EHR and the
standalone system. For example, scanning results into a document imaging system for viewing, or possibly embedding a link
from the EHR directly to the standalone system, may be considered to ensure that all the data is available when needed. Having
information in disparate systems with no link or viewing ability
could lead to patient safety concerns.
5. Legacy Systems
Legacy systems must be carefully evaluated before undergoing
a data transmission to the EHR. Many organizations have legacy
systems that contain patient information or that feed information into the current EHR. Prior to retiring a legacy system, a
thorough assessment of stored data must be undertaken and a
plan to transition required data elements must be developed.
A legacy system may also feed data to an EHR or be retired via
converting data into an EHR to eliminate system redundancy.
When errors in data are discovered, they must be corrected at
the source as well as in any and all systems that contain the erroneous data, such as a data mart or data warehouse that feeds
other information systems in the enterprise. Clear policies and
Journal of AHIMA May 15/61
Practice Brief
procedures for determining the source of truth when differences exist between interfaced and integrated systems is critical.
This includes any legacy systems that have not been evaluated,
cleansed, and converted.
Practice Brief
Notes
1. Kohn, Linda T. et al. To Err Is Human: Building a Safer
Health System. Institute of Medicine. November 1999.
www.iom.edu/~/media/Files/Report%20Files/1999/ToErr-is-Human/To%20Err%20is%20Human%201999%20
%20report%20brief.pdf.
2. Binder, Leah. Stunning News On Preventable Deaths In
Hospitals. September 23, 2013. www.forbes.com/sites/
leahbinder/2013/09/23/stunning-news-on-preventabledeaths-in-hospitals/.
3. Kohn, Linda T. et al. To Err Is Human: Building a Safer
Health System.
4. AHIMA. Information Governance Principles for Healthcare. 2014. www.ahima.org/~/media/AHIMA/Files/HIMTrends/IG_Principles.ashx.
5. Committee on Data Standards for Patient Safety. Key Capabilities of an Electronic Health Record System: Letter
Report. Institute of Medicine. 2003. www.nap.edu/catalog.php?record_id=10781.
6. Markle. T5: Background Issues on Data Quality. April
2006. www.markle.org/health/markle-common-framework/connecting-professionals/t5.
7. Orlova, Anna. An Overview of Health IT Standards. Journal of AHIMA 86, no. 3 (March 2015): 38-40. http://library.
ahima.org/xpedio/groups/secure/documents/ahima/
bok1_050860.hcsp?dDocName=bok1_050860.
8. Wrenn, Jesse O. et al. Quantifying Clinical Narrative Redundancy in an Electronic Health Record. Journal of
the American Medical Informatics Association 17, no. 1
(January/February 2010): 49-53. www.ncbi.nlm.nih.gov/
pubmed/20064801.
9. Hahn, Jin et al. Rapid Implementation of Inpatient Electronic Physician Documentation at an Academic Hospital. Applied Clinical Informatics 3, no. 2 (2012): 175-185.
www.ncbi.nlm.nih.gov/pmc/articles/PMC3613016/.
10. White, Susan. A Practical Approach to Analyzing Healthcare
References
AHIMA. Health Data Analysis Toolkit. 2014. http://library.
ahima.org/xpedio/groups/secure/documents/ahima/
bok1_050751.pdf.
Bowman, Sue. Impact of Electronic Health Record Systems
on Information Integrity: Quality and Safety Implications.
Perspectives in Health Information Management. October
1, 2013 (Fall 2013). www.ncbi.nlm.nih.gov/pmc/articles/
PMC3797550/.
Brown, Linda et al. Amendments in the Electronic Health
Record Toolkit. Chicago, IL: AHIMA Press, 2012. http://
librar y.ahima.org/xpedio/groups/secure/documents/
ahima/bok1_049731.pdf.
Gelzer, Reed et al. Copy Functionality Toolkit. Chicago, IL:
AHIMA Press, 2012. http://library.ahima.org/xpedio/
groups/secure/documents/ahima/bok1_049706.pdf.
Lusk, Katherine G. et al. Patient Matching in Health
Information Exchange. Perspectives in Health Information
Management. 2014. http://perspectives.ahima.org/wpcontent/uploads/2014/12/PatientMatchinginHIEs.pdf.
Practice Brief
Prepared by (Update)
Sion Davoudi
Julie A. Dooling, RHIA, CHDA
Lisa Kogan, MS, MHA, CCS-P, CDIP
Kerry Ruben, RN, BSN, PHN
Kathleen E. Wall, MS, RHIA
Annemarie Wendicke, MPH
Acknowledgements (Update)
Kathleen Addison, CHIM
Patricia Buttner, RHIA, CDIP, CCS
Jill S. Clark, MBA, RHIA, CHDA
Susan Clark, BS, RHIT, CHTS-PW, CHTS-IM
Katherine Downing, MA, RHIA, CHPS, PMP
Suzanne P. Drake, RHIT, CCS
Terri Eichelmann, MBA, RHIA
Elisa R. Gorton, MSHSM, RHIA, CHPS
Lesley Kadlec, MA, RHIA
Jeanne E. Mansell, RHIT, RAC-CT
Raymound Mikaelian, RHIA
Cindy C. Parman, CPC, CPC-H, RCC
Angela Rose, MHA, RHIA, CHPS, FAHIMA
Bibiana VonMalder, RHIT
Lou Ann Wiedemann, MS, RHIA, CDIP, CHDA, FAHIMA
Henri Wynne, MA, RHIT
Originally Prepared by
Catherine Baxter
Regina Dell, RHIT, CCS
Sylvia Publ, RHIA
Ranae Race, RHIT
Original Contributors
Ashley Austin, RHIT
Stacie Durkin, MBA, RN, RHIA
Kathy Giannangelo, MA, RHIA, CCS
Pawan Goyal, MD, MHA, MS, PMP, CPHIMS
Shelly Hurst, RHIA, CCS
Karl Koob, RHIA
Karanne Lambton, CCHRA(C)
Therese McCarthy
Mary Rausch-Walter, RHIT
Kathy Schleis, RHIT, CHP
Jennifer Schunke, MS, RHIA
Sonya Stasiuk, CCHRA(C)
Dolores Stephens, MS, RHIT
Doreen Swadley, RHIA, MA, MBA, FACHE
Maggie Williams
Original Acknowledgments
Crystal Kallem, RHIT
Don Mon, PhD, FHIMSS
Michael Putkovich, RHIA
Rita Scichilone, MHSA, RHIA, CCS, CCS-P
The information contained in this Practice Brief reflects the consensus opinion of the professionals who developed it. It has not been validated through scientific research.
64/Journal of AHIMA May 15
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Coding Notes
THE IMPLICATIONS OF ICD-10-CM/PCS for healthcare reimbursement is a topic at the top of everyones mind in the
healthcare industry these days. As healthcare organizations
continue to prepare for the transition to ICD-10-CM/PCS on
October 1, 2015, an essential and important element of a successful transition is the understanding of the implications
that this transition will have on reimbursement for healthcare organizations.
United Audit Systems, Inc. (UASI), a vendor specializing
in coding and revenue cycle solutions, has been performing ICD-10-CM/PCS documentation gap analysis projects
for the past three years. In addition to assisting healthcare
organizations with identifying and understanding specific
gaps in their clinical documentation, these projects also included the performance of a financial simulation comparing the ICD-9-CM MS-DRG assignment to the ICD-10-CM/
PCS MS-DRG assignment. Overall, the financial simulation
findings for various healthcare organizations have revealed
only modest changes in the organizations case mix index
(CMI), holding consistent with the Centers for Medicare
and Medicaid Services goal of a revenue neutral transition
to ICD-10-CM/PCS.
This article will discuss some potential MS-DRG changes related to the organization and structure of ICD-10-CM/PCS, as
well as the native MS-DRG grouper logic.
Coding Notes
teral calculus with hydronephrosis and undergoes a transurethral removal of the ureteral calculus with an insertion
of a ureteral stent. In ICD-9-CM the MS-DRG assigned to this
case is 669 (RW 1.2662). In ICD-10-CM/PCS the MS-DRG assigned is 670 (RW 0.8957). The reason for the lower MS-DRG
assignment is the result of the loss of the CC for the secondary diagnosis of hydronephrosis.
For the second scenario, a patient is admitted with a right
ureteral calculus with hydronephrosis and undergoes extracorporeal shock wave lithotripsy. In ICD-9-CM the MS-DRG
assignment for this case is 691 (RW 1.6238). In ICD-10-CM/PCS
the MS-DRG assignment is 692 (RW 1.1286). Again, the reason
for the lower MS-DRG assignment is the result of the loss of the
CC for the secondary diagnosis of hydronephrosis.
ondary CC code.
In ICD-9-CM, the above case scenario with a CC secondary
diagnosis code results in the assignment of MS-DRG 835 (RW
2.1042) and a MCC secondary diagnosis code results in the
assignment of MS-DRG 834 (RW 5.2735). In comparison, the
above case scenario coded in ICD-10-CM with a secondary
MCC diagnosis code results in the assignment of MS-DRG
808 (RW 2.226).
Coding Notes
Coding Notes
Each chapter of the NCCI manual contains extensive discussions and guidance on appropriate reporting for the specific
CPT code range/chapter represented.
Some useful guidance that is discussed across multiple chapters and applies to multiple services includes:
Scout procedures are discussed in multiple chapters
of the NCCI manual including chapters one and four
through nine for surgical and radiological scout procedures. Each chapter notes that scout procedures performed prior to another procedure to assess the surgical field and visualize the anatomic landmarks are not
reported separately.
I f a biopsy of a lesion is performed, and then a more extensive procedure is performed at that same site, the
biopsy procedure cannot be reported separately unless
that biopsy result was the determining factor used by
the physician to perform the more extensive procedure.
This guidance is repeated in almost every chapter of the
NCCI manual.
-- If a biopsy of one lesion is performed and a more extensive procedure is performed on a separate lesion,
both services can be reported. One good example is a
colonoscopy with biopsy of one lesion, then polypectomy of another. In that instance both the biopsy and
the polypectomy would be appropriate to report.
T he use of multiple approaches to complete the same
procedure should not be reported separately. One example provided in chapter one of the manual includes
a vaginal and abdominal hysterectomy. Chapters four
and six also have detailed discussions involving arthroscopic and laparoscopic procedures converted to
open procedures, and in keeping with this provision instruct that only an open procedure should be reported
in these instances.
Complications that occur during the primary surgical
procedure can sometimes be reported; but, caution the
reader, the surgical package includes all of the services
necessary to perform a procedure, including the postoperative period. If the complication results in the performance of an additional procedure significantly outside
of the scope of the planned procedure, that additional
procedure would be appropriate to report. However,
if the procedures performed to treat the complication
are usual and customary components of the primary
service, or if a complication occurs postoperatively but
does not require a return to the operating room, the procedure should not be reported separately. One example
discussed in multiple chapters is the control of a post-
Coding Notes
References
American Medical Association. CPT 2015 Professional Edition.
Chicago, IL: American Medical Association, 2015.
Centers for Medicare and Medicaid Services. How to Use
the Medicare National Correct Coding Initiative (NCCI)
Tools. January 2013. http://www.cms.gov/Outreacha nd-Educat ion/Med ica re-L ea r n i ng-Net work-ML N/
MLNProducts/Downloads/How-To-Use-NCCI-Tools.pdf.
Centers for Medicare and Medicaid Services. Modifier
59
Article.
http://www.cms.gov/Medicare/Coding/
NationalCorrectCodInitEd/downloads/modifier59.pdf.
Centers for Medicare and Medicaid Services. National
Correct Coding Initiative Edits. December 8, 2014. www.
cms.gov/Medicare/Coding/NationalCorrectCodInitEd/
index.html?redirect=/nationalcorrectcodinited/.
Centers for Medicare and Medicaid Services. Specific
Modifiers for Distinct Procedural Services. CMS Manual
System, Transmittal 1422. August 15, 2014. www.cms.
gov/Regulations-and-Guidance/Guidance/Transmittals/
downloads/R1422OTN.pdf.
Suzanne P. Drake (Suzanne_Drake@Bshsi.org) is coding quality and RAC
coordinator at Bon Secours Health System, based in Richmond, VA.
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A new issue of AHIMAs scholarly journal Perspectives in Health Information Management is now
available. The Spring 2015 issue of Perspectives
features the latest research on topics such as meaningful use, patient matching, and mobile health.
To read the full issue and to learn more about submission guidelines, visit http://perspectives.ahima.org.
Nominating Committee
Jill A. Finkelstein, MBA, RHIA, CHTS-TR
(954) 418-0938
jfinkelstein@browardhealth.org
Fellowship Committee
Mona Y. Calhoun, MEd, MS, RHIA, FAHIMA
(301) 352-0304
mcalhoun@coppin.edu
Envisioning Collaborative
Laura W. Pait, RHIA, CDIP, CCS
(336) 946-1750
lpait@novanthealth.org
House Leadership
Elizabeth A. Delahoussaye, RHIA, CHPS
(865) 659-5059
edelahoussaye@iodincorporated.com
AHIMA volunteers also make valuable contributions as facilitators for Engage Online Communities. To locate the facilitator(s), go to a particular community, click on the Members tab, then click on the
community administrator link.
Indiana
Deborah Grider, CDIP, CCS-P
McCordsville, IN
(317) 908-5992
deborahgrider@mac.com
Nevada
Gregory Schultz, RHIA
North Las Vegas, NV
(702) 526-8361
gschultz00@aol.com
South Dakota
Sheila Hargens, MSHI, CMT
Parkston, SD
(605) 928-3741
sheila.hargens@avera.org
Alaska
Janie Batres, RHIA, CDIP
Anchorage, AK
(907) 252-7228
janieleigh44@hotmail.com
Iowa
Mari Beth Schneider Lane, MS, RHIA
Sheldon, IA
(712) 324-5061
mlane@nwicc.edu
New Hampshire
Jean Wolf, RHIT, CHP
Gorham, NH
(603) 466-5406
jean.wolf@avhnh.org
Tennessee
Lela McFerrin, RHIA
Chattanooga, TN
(423) 493-1637
lela.mcferrin@hcahealthcare.com
Arizona
Christine Steigerwald, RHIA
Gilbert, AZ
(480) 292-8293
Christine.Steigerwald@bannerhealth.com
Kansas
Julie Hatesohl, RHIA
Junction City, KS
(785) 210-3498
phoebehat@cox.net
New Jersey
Carolyn Magnotta, RHIA
New Egypt, NJ
(609) 758-8890
magnottac@deborah.org
Texas
Terri Frnka, RHIT
Bryan, TX
terrifrnka@yahoo.com
Arkansas
Marilynn Frazier, RHIA, CHPS
Ozark, AR
(479) 667-5153
mfrazier@ftsm.mercy.net
Kentucky
Diba Thakali, RHIA
Lexington, KY
(859) 979-3049
diba.thakali@bhsi.com
New Mexico
Vicki Delgado, RHIT
Albuquerque, NM
(505) 948-6711
vicki.delgado@kindredhealthcare.com
California
Shirley Lewis, DPA, RHIA, CCS, CPHQ
Upland, CA
(909) 608-7657
shirley.lewis5@verizon.net
Louisiana
Lisa Delhomme, MHA, RHIA
Rayne, LA
(337) 277-5544
delhomme@louisiana.edu
New York
Sandra Macica, RHIA
Saratoga Springs, NY
(518) 584-0389
s.macica@elsevier.com
Colorado
Melinda Patten, CDIP, CHPS
Aurora, CO
(720) 777-6657
melinda.patten@childrenscolorado.org
Maine
Nora Brennen, RHIT
Topsham, ME
(207) 751-1853
Nora.Brennen@va.gov
North Carolina
Jolene Jarrell, RHIA, CCS
Apex, NC
jolene@drgreview.com
Connecticut
Elizabeth A. Taylor, MS, RHIT
East Hartford, CT
(860) 364-4417
liz.taylor@sharonhospital.com
Maryland
Sarah Allinson, RHIA
Baltimore, MD
(410) 499-7281
sarahballinson@gmail.com
Delaware
Marion Gentul, RHIA, CCS
Lewes, DE
(302) 827-1098
mgs60mga@yahoo.com
Massachusetts
Walter Houlihan, MBA, RHIA, CCS
Springfield, MA
(413) 322-4309
Walter.Houlihan@bhs.org
District of Columbia
Jeanne Mansell, RHIT, CHTS-CP, CHTS-PW,
CHTS-IM, CHTS-IS, CHTS-TS, CHTS-TR
Washington, DC
(202) 421-5172
jeanne87@hotmail.com
Michigan
Thomas Hunt, RHIA
Owosso, MI
(989) 725-8279
thunt@davenport.edu
Florida
Anita Doupnik, RHIA
Tampa, FL
(813) 907-9380
anita.doupnik@nuance.com
Minnesota
Jean MacDonell, RHIA
Grand Rapids, MN
(612) 719-3697
jean.macdonell@granditasca.org
Georgia
Allyson Welsh, MHA/INF
Decatur, GA
Allysonwelsh@gmail.com
Mississippi
Phyllis Spiers, RHIT
Carriere, MS
(601) 347-6318
pspiers@forrestgeneral.com
Hawaii
Marlisa Coloso, RHIA, CCS
Wailuku, HI
(808) 442-5509
mcoloso@hhsc.org
Missouri
Angela Talton, RHIA, CCS
Florissant, MO
(314) 276-4180
afranks@swbell.net
Idaho
Mona P. Doan, RHIT, CCS-P
Boise, ID
(208) 484-7076
monadoan@hotmail.com
Montana
Vicki Willcut, RHIA
Kalispell, MT
(406) 756-4758
vwillcut@krmc.org
Illinois
Teresa Phillips, RHIA
Effingham, IL
(217) 347-2806
teri.phillips@hshs.org
Nebraska
Shirley Carmichael, RHIT
Fairbury, NE
(402) 729-6854
shirley.carmichael@jchc.us
Utah
Vickie Griffin, RHIT, CCS
Bountiful, UT
vickie.griffin@Parallon.com
Vermont
Charmaine S. Vinton, RHIT, CCS, CPC
West Chesterfield, NH
(603) 357-0170
cvinto@bmhvt.org
Virginia
Darcell Campbell, RHIA
Hampton, VA
(757) 788-0052
DACampbell@cox.net
North Dakota
Tracey Regimbal, RHIT
Grand Forks, ND
traceyregimbal@hotmail.com
Washington
Sheryl Rose, RHIT
Spokane, WA
(509) 624-4109
sherylrose622@hotmail.com
Ohio
Pamela Greenstone, MEd, RHIA
Mason, OH
(513) 403-9014
Pamela.Greenstone@uc.edu
West Virgnia
Kathy Johnson, RHIA
Sinks Grove, WV
(304) 772-5312
kjohnson@care-communications.com
Oklahoma
Christy Hileman, MBA, RHIA, CCS
Mustang, OK
(405) 954-2824
christy.hileman@faa.gov
Wisconsin
Susan Casperson, RHIT
Cecil, WI
(715) 853-1370
susan.casperson@thedacare.org
Oregon
William Watkins, RHIA
Oregon City, OR
(503) 867-5173
william.w.watkins@kp.org
Wyoming
Kimberle Johnson, RHIA
Gillette, WY
(307) 682-1251
kim.johnson@ccmh.net
Pennsylvania
Laurine Johnson, MS, RHIA, FAHIMA
Sarver, PA
(724) 295-9429
ljohnson@peakhs.com
Puerto Rico
Brunilda Velazquez, RHIA, CCS
Guayanilla, PR
(787) 505-1433
Rhode Island
Patti Nenna, RHIT
Bristol, RI
(401) 253-1686
pnenna@cox.net
South Carolina
Karen B. Farmer, RHIT
Greenville, SC
(864) 277-1982
kfarmer@ghs.org
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UNLESS THEY KNOW EXACTLY WHAT to look for, most Internet users wouldnt know that a Dark Web
exists or what it islet alone the potential for harm that can be done with it.
But the dark side of the web is out there, and its proprietors want your medical information.
In short, the Dark Webor deep web, as it is known to cyber security professionalsrefers to a class of
content that has been intentionally hidden and is not indexed by search engines like Google, according to a
new report titled The Impact of the Dark Web on Internet Governance and Cyber Security.1
Websites on the Dark Web have addresses that end with .su and .so, rather than .com or .org. As one might
suspect, these sites are hidden because would-be criminals use them to sell illegal productsincluding Social
Security numbers, weapons, drugs, and pornography.
Even though the Dark Web hasnt become an epidemic problem yet, the healthcare industry does need to be on
alert, according to security experts. The Dark Web has become a popular domain for sales of protected health
information (PHI) and Medicare numbers. A recent National Public Radio (NPR) story about healthcare data on
the Dark Web offered dire predictions about the security of that information.2 The financial services sector has
made strides in protecting financial data, but at least one expert says healthcare is nowhere near as prepared.
In the NPR piece, healthcare security expert Jeanie Larson warned that cyber security standards for hospitals and other healthcare providers are too low. They dont have the internal cyber security operations,
Larson says, noting that some providers interpret HIPAA too loosely and avoid encryption practices. A lot of
healthcare organizations that Ive talked to do not encrypt data within their own networks, in their internal
networks, she said.
If healthcare security professionals dont take the proper steps to protect their data, the industry can expect
to see breaches as big as the recent Anthem breachwhich exposed the health information of 80 million
peopleto become much more common, and possibly see that data float onto the Dark Web for sale.
Notes
1. Chertoff, Michael and Tobby Simon. The Impact of the Dark Web on Internet Governance and Cyber Security. Global Commission on Internet Governance. February 2015. https://ourinternet-files.s3.amazonaws.
com/publications/GCIG_Paper_No6.pdf.
2. National Public Radio. The Black Market For Stolen Health Care Data. February 13, 2015. www.npr.org/
blogs/alltechconsidered/2015/02/13/385901377/the-black-market-for-stolen-health-care-data.
80/Journal of AHIMA May 15
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