By Julie A. Pursley, MSHI, RHIA, CHDA, FAHIMA, director of health information thought leadership, AHIMA.
Julie A. Pursley
Reading news articles about vulnerable communities disproportionately affected by COVID-19 has been heartbreaking. My organization, the American Health Information Management Association (AHIMA), believes that social determinants of health (SDOH)—the socio-economic behavioral elements that affect health—play in role in explaining why poorer communities have experienced more negative impacts during the pandemic than other areas. We also believe it’s vital for SDOH information to be recorded in medical records.
It’s not difficult to imagine why low-income Americans may face increased exposure to the novel coronavirus. Perhaps most critically, people experiencing poverty are more likely to not have health insurance or be underinsured.
In addition, while many office workers have worked from home during the pandemic, people who earn lower incomes often work in public-facing jobs like restaurants and grocery stores and have no choice other than to take public transit to get to work. And the millions of Americans who have lost jobs may be dealing with food insecurity and a lack of money available to secure food and other goods at home.
Communities of color often comprise low income workers who encounter many of the situations mentioned above (and more). At AHIMA we support collecting race and ethnicity data for optimal public health reporting because recording SDOH information in a patient’s medical record can lead to better healthcare outcomes. SDOH information in a patient record offers providers a more complete story and can influence how they approach treatment, education, and care management.
“We’ve had physicians across our practices reach out to patients living alone during this time of social isolation, those who were identified as potentially being isolated and without support,” William Torkildsen, MD, chairman at South-Texas-based independent physician association Valley Organized Physicians (VOP), recently told the Journal of AHIMA. “We recorded those results and have been able to take action on the patient’s behalf, connecting them to necessary resources.”
By Julie Pursley Dooling, MSHI, RHIA, CHDA, FAHIMA, director of HIM practice excellence; AHIMA.
Release of patient information during COVID-19
What insiders have long known has become clear during the COVID-19 pandemic: health data is a vital element of health care, including efforts to curb the pandemic. Of course, that data is important to patients, providers, and healthcare staff. And even during COVID-19, if a patient wants to access their data, release of information services (ROI) teams must comply with a strict set of processes set forth by the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH). These regulations ensure that patients retain safe and secure control of their personal health information and record requests are timely, accurate, and complete.
So, what should providers and patients expect during this time? For years, patients have been able to walk into a provider’s office or a health records office and request a copy of their records. During a stay at home order, however, that’s not such a good idea.
The American Health Information Management Association (AHIMA) recommends that organizations temporarily suspend walk-in access for medical records inquiries during COVID-19. Organizations should work closely with their ROI vendor (if they have one) to ensure continuity, while also displaying signage on doors and windows to redirect patients and families to alternative resources. In addition, it would be prudent to post process changes to the organization’s website and through automated messaging systems, while alerting the patient access staff.
It’s important for organizations to provide patients and their families with alternate record request options during COVID-19. All requests via phone should be authorized by health information staff who witness and document it in the patient’s record. And voicemails should be directed to a patient portal so they can be returned.
And just how can a health professional be assured they’re talking to a patient or one of their relatives? They should ask the caller to verify their patient demographic data such as a date of birth, home address or the last four digits of a social security number (if applicable). Other examples of data may include cell phone numbers, nicknames or another reliable data source that is consistently collected.
With clinical documentation integrity (CDI) professionals playing a key role in efforts to “flatten the curve” of the COVID-19 pandemic, the American Health Information Management Association (AHIMA) has developed tools designed to ease administrative burdens during this difficult time.
AHIMA’s two new COVID-19 CDI query templates will help CDI professionals ensure the integrity and quality of a patient’s health record. With data being such an important element in the fight against COVID-19, the new templates provide a clear guideline of what critical data needs to be obtained to accurately document for the virus. The templates are similar to those CDI professionals use to document other diseases.
“I feel immense pride when I see the important work CDI professionals are doing during this pandemic,” said Wylecia Wiggs Harris, PhD, CAE, AHIMA CEO. “We believe these clear, concise, and compliant templates will make it easier for CDI professionals to document this virus, which in turn gives courageous medical providers more time to focus on patient care.”
The new templates are designed to capture high-quality documentation to support the continuum of care in this complicated healthcare environment. Clinical documentation integrity is critical during the pandemic because it can impact research efforts to curb COVID-19 and provides government and healthcare leaders with key information for their decision-making processes.
AHIMA has created more than 130 CDI templates for use in multiple healthcare settings. These templates (not related to COVID-19) are available through the Artifact Health platform.
Five startups in the health information management (HIM) field pitched their ideas for a new product, service or business that harnesses health data and information to advance healthcare at the AHIMA19: Health Data and Information Conference. The winner, Drugviu, presented their population health platform that empowers communities of color to use their data to improve health outcomes.
The American Health Information Management Association’s (AHIMA) Pitch Competition, hosted in collaboration with MATTER, the health technology incubator based in Chicago, underscored the conference’s focus on innovation and change. The event served as an opportunity to inspire creative thinking at AHIMA19 and provide startups with a platform to present their health data and information solutions to a group of leading HIM experts.
Only six percent of clinical trials and research involves minorities. Drugviu, which received $5,000 for winning the competition, aims to end this under representation and improve health outcomes among minority communities by sourcing more minorities into clinical trials, providing education tailored to people of color and empowering people to share their medication experiences with their online community engagement platform.
Kwaku Owusu
“This award money will allow us to pursue our mission of expanding the data set of medication and health experiences to include minorities,” said Drugviu CEO Kwaku Owusu.
“Innovations that help connect people, health systems and ideas are key to improving health outcomes,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “With the inaugural AHIMA pitch competition, we’re putting the power to impact health in the hands of enterprising HIM professionals who are developing solutions to advance the healthcare industry. We congratulate Drugviu on their impressive platform to engage more minorities in clinical trials and research.”
Valhalla Healthcare received second place, winning $2,500 for its product Allevia, a fully patient-driven, AI-powered intake solution that automates clinical documentation for healthcare providers. Uppstroms received third place and $1,500 for their machine-learning application that addresses upstream social risk for promoting better health.
Additional semi-finalists included:
Smarter Health: A digital health startup aimed at transforming the way people collaborate to improve value-based healthcare
Tapcloud: A remote patient monitoring and engagement platform that helps patients and their clinicians achieve better health outcomes
“The best solutions to improve the healthcare experience are developed through collaboration between entrepreneurs and industry leaders,” said MATTER CEO Steven Collens. “Winning this competition is a great recognition for Drugviu and gives them the opportunity to work closely with leading health information professionals to further develop their solution.”
Access to data and the interoperability of health information has the power to change the face of healthcare, according to Alexandra Mugge, deputy chief health informatics officer at the Centers for Medicare & Medicaid Services (CMS).
Addressing leaders in health information management (HIM) at the AHIMA19: Health Data and Information Conference, the American Health Information Management Association’s (AHIMA) annual conference, Mugge outlined CMS’ Interoperability and Patient Access Initiative efforts and what the agency will focus on next.
“We believe electronic data exchange is the future of healthcare, and interoperability is the foundation of value-based care,” Mugge said. “CMS is dedicated to advancing interoperability throughout healthcare.”
Emphasizing that the privacy and security of health records underpins all CMS activity on interoperability, Mugge pointed to several initiatives in 2019 aimed at improving data exchange among providers, payers and patients, including:
The CMS interoperability and patient access proposed rule addressing new policies to expand the exchange of information across all aspects of healthcare
The Office of the National Coordinator for Health Information Technology (ONC) 21st Century Cures Act proposed rule
The Blue Button 2.0 initiative, an application programming interface (API) containing four years of Medicare Part A, B and D data for 53 million Medicare beneficiaries that allows patient access to their health information.
Looking ahead to 2020, Mugge said CMS will focus on addressing challenges to patient matching, updating provider directories, expanding data elements to be standardized and incorporating behavioral and public health social determinants in healthcare.
HIM professionals are essential to ensuring access to health information where and when it is needed, Mugge said, adding that HIM professionals are responsible for shaping the data that ultimately comes together as a part of a patient’s complete healthcare picture.
“CMS is a valued contributor to our ongoing support of interoperability and its benefits to patients, providers and payers,” said Wylecia Wiggs Harris, AHIMA CEO, PhD, CAE. “AHIMA stands in alignment with the goals of interoperability in helping people to live healthier lives and creating access to health information that empowers people to impact health.”
The digitization and expansion of access to data and health information will continue to change healthcare, making this an exciting time in the industry, Mugge added.
“Patients are no longer passive participants in their care, they now have the ability to be empowered consumers of the healthcare industry through access to data that puts them in the driver’s seat to make the best and most informed decisions about their health,” Mugge said. “And providers who have historically been forced to work with incomplete information can now unlock large amounts of data about their patients that will improve care.”
Health
information management leaders told members of Congress today that removal of a
nearly two-decade ban on the use of federal funds to adopt a nationwide unique
patient identifier would allow collaboration between the U.S. Department of
Health and Human Services (HHS) and the private sector to identify solutions
for reducing medical errors and protecting patient privacy.
During the
briefing, members of the American Medical Informatics Association and the
American College of Surgeons joined AHIMA and CHIME in recounting existing
patient identification challenges and the patient safety implications when data
is matched to the wrong patient and/or when essential data is lacking from a
patient’s record due to identity issues.
“Critical to
patient safety and care coordination is ensuring patients are accurately
identified and matched to their data,” said AHIMA CEO Wylecia Wiggs Harris,
PhD, CAE. “The time has come to remove this archaic ban and empower HHS to
explore a full range of patient matching solutions hand in hand with the
private sector focused on increasing patient safety and moving us closer to
achieving nationwide interoperability.”
“Now more than
ever we need a nationwide unique patient identifier to ensure that patients are
correctly identified in our increasingly digital healthcare ecosystem,” said
CHIME President and CEO Russell Branzell. “This is a top priority for our
members. We applaud the House for taking a leadership role on this issue by
removing the ban and we strongly encourage the Senate to do the same.”
The Health Insurance Portability and
Accountability Act (HIPAA) originally required the creation of a unique health
identifier in 1998. However, Congress included language as part of the annual
appropriations process that prohibited the US Department of Health and Human
Services from using federal funds intended for the creation of a unique patient
identifier out of privacy concerns.
Not having a unique patient
identifier system means that healthcare providers typically rely on a patient’s
name and date of birth to identify their medical records in electronic health
record (EHR) systems—information that is often not unique to one individual.
This means that providers often have a difficult time properly identifying
patients and often incorporate medical information into the wrong health
record.
“Those of us
who work in provider organizations have seen the serious consequences of this
ban on patients and their families,” said Marc Probst, CIO at Intermountain
Healthcare and a member of the CHIME Policy Steering Committee.
“Misidentifications threaten patient safety and drive unnecessary costs to
health systems in an era when the industry and Congress are trying to lower
healthcare costs. Congress has an opportunity to fix this, but only if the
Senate also removes the ban on a unique patient identifier.”
Speakers at the
briefing included:
Marc Probst, MBA, CHCIO, chief information officer and vice president, Intermountain Healthcare
Shaun Grannis, MD, MS, FAAFP, director, Center for Biomedical Informatics, Regenstrief Institute, Inc.
Frank G. Opelka, MD, FACS, medical director, Quality and Health Policy, American College of Surgeons
Katherine Lusk, MHSM, RHIA, FAHIMA, chief health information management and exchange officer, Children’s Health System of Texas
Moderators, Leslie Krigstein, vice president congressional affairs, CHIME and Lauren Riplinger, vice president policy and government affairs, AHIMA
Seeking to recognize a healthcare delivery organization that takes an outstanding and innovative approach to health information management (HIM), the American Health Information Management Association (AHIMA) is calling for applications for the eighth annual Grace Award.
Interested applicants can submit their entries via ahima.org/grace through May 31.
Ninety years ago, Grace Whiting Myers acted on a sincere conviction to improve the quality of our nation’s health records by founding the association now known as AHIMA. The idea was simple–that advancements in the collection and organization of health information will invariably help to improve public health. As a tribute to Myers’ prescient vision, AHIMA’s annual HIM award bears her name: The Grace Award.
Past winners of the Grace Award regularly demonstrated transformative journeys toward new and innovative HIM practices that also delivered better patient outcomes.
Wylecia Wiggs Harris, PhD
“AHIMA is excited to open nominations for an organization that is taking innovative and novel approaches to using HIM to deliver high-quality care to patients,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “This process furthers an industry dialogue about innovation and excellence and invites us to learn from each other.”
The 2019 award will be presented at AHIMA’s Health Data and Information Conference in Chicago, September 14-18.
A committee of judges, representing healthcare delivery organizations, health information professionals and HIM associations, selects the Grace Award. This year’s judges are:
(CHAIR) Sandra Pearson, RHIA, CHDA, MHA, CPEHR, CDI & Data Governance Director, SCL Health
By Julie Pursley Dooling, MSHI, RHIA, CHDA, FAHIMA, director of HIM practice excellence; 
