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• Timely and accurate documentation, along with operational efficiencies, is the key for revenue cycle success.
• The speakers shared a case study of how they looked for HIM efficiencies in record analysis, Coding and Abstracting, Transcription and staffing.
• In this particular case study, the presenters focused on formalizing their internal coding quality reviews with the use of cross-coding. Basically each coder would code an account and then pass that same account to another coder to make sure they both agreed with the codes to be assigned.
• The speakers provided ways to stabilize staffing with the use of the following techniques:
• Internal training programs;
• Enhanced salary and benefits;
• Creative and flexible staffing
• Finally, the speaker spoke about how to leverage technology to increase accuracy, stage productivity, rapidly adapt for regulatory compliance and ensure supporting documentation for coding.

• Currently there are 150 coders working in Ireland, including part-time and full time staff with varying levels of experience. During the pilot there were 900,000 records submitted for coding. Coders are required to code from 7000-8000 records per year (depending on experience and specialty).
• There are four support personnel in the Central Office to provide training and education to these 150 coders nationally.
• Ireland was excited about moving to ICD-10 based on the following reasons:
  • Better coding scheme;
  • Keep up with medical and surgical advances;
  • International comparability;
  • Best possible quality data;
  • More specificity
• For ICD-10 training, the Central office provided:
  • Two-day workshops (15 courses held nationally);
  • Continued feedback and support services;
  • Educational material via a Coding Newsletter
• At the conclusion of the pilot, there was more detailed information collected, the coders actually liked the new coding methodology, and the coders gained confidence and speed quickly.

• Dr. David Brailer, the nation's first Health Information Technology Coordinator was appointed by President Bush in April 2004
• In July 2004, Brailer's office released The Decade of Health Information Technology: Delivering Consumer-centric and Information-rich Health Care. A Framework for Strategic Action
• The strategic plan highlights four goals or "building blocks" for the future of healthcare.
• Informed Clinical Practice - clinical information must be complete, portable, factual, organized, point of care information.
• Interconnecting care - there must be "symmetry of information" between buyers and sellers of healthcare services. Patients need good information to make decisions about their care, and interoperability makes this possible.
• Personalizing Care - Systems have to be usable, especially in the realm of chronic disease.
• Smarter & Safer - The architecture of the healthcare industry needs to ensure that realistic designs are built into systems so that there will be better quality monitoring and reporting.
• According to Brailer, the time for change is now. In that vein, he has recommended the creation of a certifying group for ERH products. This step led to the creation of the Certification Commission for Healthcare Information Technology by AHIMA and other industry leader groups.
• Brailer has also recommended the creation of regional health information organizations (RHIOs). These are independent entities in a municipality or state that would support and oversee data interoperability.
• The final challenge according to Brailer is to "make things connect". This means changing work flows and business processes to accommodate electronic records. It also means connecting with users and helping them understand the significance of change.

• Current AHIMA initiatives in e-HIM:
  • E-Health Task Force
  • E-HIM Task Force
  • E-HIM Strategic Planning Meeting
  • Summer 2003 - Workgroups established to develop standards for transition to EHRs.
• What is e-Health?
  • The application of the internet and it's related technologies to the healthcare industry to improve the efficiency, effectiveness, and quality of clinical and business processes within an organization, between organizations, and with patients and consumers.
• What is e-HIM?
  • Transactions in which health care information is accessed, processed, stored, and transferred using electronic technologies to facilitate the business of healthcare.
• E-HIM Initiative:
  • Promote the migration from paper to electronic health information infrastructure
  • Reinvent how institutional and personal health information and records are managed
  • Deliver measureable cost and quality results from improved information management
• AHIMA Vision for e-HIM
  • HIM professionals will reinvent traditional roles and functions:
  • The patient is part of the documentation team;
  • A personal health record may be designed and maintained by a third party organization or by patients themselves; and
  • Individually identifiable data will be transmitted and accessed via the internet.
• The Personal Health Information Card (PHICard)
  • Owned by Personal Health Information Systems, Inc.
  • Portable, light, fits in wallet and carried on person/ patient
  • Easily updated
  • Industry standard access
• How does it work?
  • Patient purchases card from company and provides all healthcare information to company.
  • Company has standard, generic, format and request for information.
  • Company inputs patient's healthcare information onto card and then forward card back to patient.
  • Card is in CD/DVD format and can be read by most PCs.
  • Patient maintains contract with company for provision of updated healthcare information. Only company can update "card".

• Baccalaureate degree and a minimum of four years experience in healthcare management
• Master's or a related degree (JD, MD, PhD, etc,) and two years experience in healthcare management
• HIM credential (RHIT, RHIA, CPHIMS) with a baccalaureate or higher degree and a minimum of two years experience in healthcare management
• Managers of health information and technology with five or more years experience in healthcare management (available only through March 1, 2005)

• Disclosures to Law Enforcement: When making disclosures to law enforcement officials, it is important to remember that the HIPAA privacy regulations permit disclosures to law enforcement officials under certain circumstances but they do not require such disclosures. Some other federal or state law may require disclosure, and the Privacy Rule does not interfere with these laws. Unless disclosure is required by some other law, covered entities should use their professional judgment to decide whether or not to disclosure protected health information, based on their own policies and ethical principles.
• Subpoenas and Qualified Protective Orders: To protect the rights of individuals with respect to their health information, the privacy regulations require that information be released in response to a subpoena or discovery request only if the covered entity receives "satisfactory assurance." This assurance, which must be provided by the party seeking the information, must indicate that reasonable efforts have been made to notify the individual that his health information has been requested or that a qualified protective order has been obtained. (Note: Satisfactory assurance is not needed if the patient has authorized the release of his health information for the subpoena.)
  
  

  Under the privacy regulations, qualified protective orders do not require assurance that the patient has been notified and given an opportunity to object. Qualified protective orders include orders from a court or