By Julie A. Pursley, MSHI, RHIA, CHDA, FAHIMA, director of health information thought leadership, AHIMA.
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.
Despite gains in medical technology and the use of electronic health records (EHRs), medical errors related to patient identification continue to pose significant, and in some cases, fatal risks for patients across the U.S.
Medical errors are the third-highest cause of death in the U.S., with 250,000 deaths per year, according to a Johns Hopkins University report.
Mismatched patient records and duplicate patient records are the two biggest forms of error that can lead to misidentification, according to a study by the Pew Charitable Trusts and Massachusetts eHealth Collaborative. Misidentification may result in the wrong surgery or medication, duplicate or unnecessary testing, unintended surgery, inaccurate prescriptions, and higher medical costs. The study also found medical errors occur more frequently within urban health systems where patients are more likely to be seen at more than one medical facility.
The Pew study cited patient misidentification as a nationwide crisis, with matching rates as low as 50 percent in some healthcare facilities.
We must do better.
The collective outcry of our patient population demands we do more. Our patients deserve more. As CEO of the American Health Information Management Association (AHIMA), and with the full support from our Board of Directors, I will continue to advocate for the adoption of a nationwide patient identification solution that addresses the need to accurately identify patients as they move through our healthcare systems.
We are not there yet, but help is on the way.
In June of last year, the U.S. House of Representatives passed an amendment to the Labor-HSS Appropriations bill that removed a ban prohibiting federal dollars from being used to adopt a national patient identifier. In December 2019, when Congress passed the 2020 spending package, language was included to address patient safety, and efforts in furtherance of a nationwide patient identification strategy:
Patient matching: The general provision limiting funds for actions related to promulgation or adoption of a standard providing for the assignment of a unique health identifier does not prohibit efforts to address the growing problems faced by health systems with patient matching. The agreement encourages HHS to continue to provide technical assistance to private-sector-led initiatives to develop a coordinated national strategy that will promote patient safety by accurately identifying patients to their health information.
At the AHIMA19: Health Data and Information Conference, leaders in health information management (HIM) shared innovations in healthcare and addressed issues affecting patient access to their health records including the privacy, accuracy and interoperability of that information.
The annual meeting for the American Health Information Management Association (AHIMA), AHIMA19, also highlighted inspiring stories of perseverance, empowerment and shared details of AHIMA’s global leadership.
Patient advocate Doug Lindsay shared his gripping story of transitioning from a wheelchair to walking again; Alexandra Mugge, deputy chief health informatics officer at the Centers for Medicare & Medicaid Services (CMS), outlined the benefits of interoperability and patient access; healthcare innovators pitched their ideas to a panel of experts for a $5,000 prize; and exhibitors and industry speakers shared their spectrum of knowledge with attendees gathered from across the globe.
Nearly three thousand HIM professionals gathered for the annual conference in September, held at Chicago’s historic McCormick Place, the largest convention center in North America.
Information and Inspiration
Speakers addressed clinical documentation, data ownership, patient access to their medical records, interoperability and cybersecurity. These presentations provided important insights and updates on technology to help HIM professionals continue leading the industry in improving healthcare and changing lives.
Mugge told the crowd that interoperability and greater access to medical data is integral to improving healthcare outcomes for payers, patients, and providers.
“We believe electronic data exchange is the future of healthcare, and interoperability is the foundation of value-based care,” Mugge said. “Patients should know that the way they interact with the healthcare industry is changing. 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 decision about their health.”
Mugge assured attendees that privacy and security safeguards would remain in place as HIM professionals help shape the landscape of interoperability.
Lindsay found his own way to improve his health, seemingly against all odds. He was bedridden and home-bound for 11 years because of a debilitating illness that forced him to drop out of college at 21 years old.
Although Lindsay’s body was limited, his mind was strong and he was determined to walk again, and to live again.
That determination led Lindsay to create a surgery for what he learned was bilateral adrenal medullary hyperplasia. He then assembled a team of experts to perform the surgery, which eventually led to his recovery.
When hiring professionals for clinical documentation improvement (CDI) programs, managers seek candidates with a background in both clinical and health information management (HIM) knowledge—challenging a common perception that a clinical background alone is sufficient, according to a recent survey by the American Health Information Management Association (AHIMA).
Respondents also said that while registered nurse and certified coding specialist are the most frequently required credentials, one of the highest preferred is AHIMA’s certified documentation improvement practitioner (CDIP) credential, indicating a growing understanding of the value and need for a higher level of educational certification, according to the research.
The article, “The State of CDI,” in the April issue of the Journal of AHIMA, analyzes key takeaways from the AHIMA survey conducted by the AHIMA Clinical Documentation Improvement Practice Council and performed to identify the current landscape and practices in the CDI industry.
The survey examined the type of organizations where CDI employees work, the departments under which teams are managed, professional backgrounds and the common credentials of CDI professionals.
Results found that most CDI programs fall under the HIM department. More than half of survey respondents also stated they hire HIM and certified coding professionals for positions in their CDI programs.
“The advancement of CDI programs and practices is essential to the delivery of quality patient care,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “The survey results show that not only do managers in these programs understand CDI professionals must have both a coding and clinical background, but that it’s becoming increasingly important for these professionals to have advanced credentials. With their knowledge and experience, HIM professionals are well positioned to lead the CDI path forward.”
The survey also examined the type of health records reviewed by CDI programs, with inpatient records accounting for the majority. The second-highest was a combination of inpatient, outpatient and professional records reaffirming that the industry is beginning to shift toward CDI reviews of outpatient health records. Full survey results are available to members here.
Beginning Oct. 1, 2019, the Centers for Medicare and Medicaid Services (CMS) will change the reimbursement model for SNFs to a new, value-based Patient Driven Payment Model (PDPM) that will require CDI skillsets and knowledge of ICD-10-CM diagnosis codes in order to accurately support the qualifying stay and demonstrate the need for care and treatment best suited for each patient.
AHCA enlisted AHIMA to help develop in-depth coding and CDI education courses to help prepare SNF providers for the major payment overhaul. The courses include two options: the first provides webinars for coding in ICD-10-CM and requirements in CDI case studies and concludes with a 50-question assessment. The second option is a shorter course for non-coders that includes a webinar with a high-level review and basic information on ICD-10-CM coding guidelines to provide an introduction to the PDPM reimbursement model. Both courses offer AHIMA CEUs and CNE contact hours. In addition, the non-coder course offers NAB continuing education credits.
“To stay up-to-date with the ever-changing healthcare industry, it is critical that professionals have the resources they need to continue to provide exceptional care,” said AHIMA CEO Wylecia Wiggs Harris, PhD, CAE. “This is why we’re happy to work with AHCA on this important training program, which will equip professionals working in skilled nursing facilities with the knowledge and understanding of ICD-10 needed to thrive under the new payment system, and ultimately improve patient outcomes.”
“ICD-10 is a driving force behind the new PDPM payment system for skilled nursing care,” said Jennifer Shimer, AHCA/NCAL COO and senior vice president, member services. “AHCA partnered with AHIMA to develop the best ICD-10 curriculum possible to prepare our members for this massive Medicare payment change.”
CDI is at the core of every patient encounter and through this collaboration, AHIMA and AHCA will help SNFs understand ICD-10-CM guidelines for coding and reporting and how to apply the guidelines to coding for the PDPM Medicare reimbursement. The courses will also help SNFs assess coding and diagnostic perspectives when identifying high quality clinical documentation and classify SNFs into appropriate clinical categories as defined by the PDPM.
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.
“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