Dana W. McWay, JD, RHIA
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Unit 4
Specialized Areas of Concern in Health Information Management
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Chapter 12
Risk Management, Quality Management, and Utilization Management
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
Introduction
Health information professional’s role is broad
Focus on patient health information
Focus not exclusive
HIM role involves participation in non-patient record-keeping issues as well
Risk management
Quality management
Utilization management
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
4
General Principles (1 of 2)
Risk management designed to
Identify areas of operational and financial risk
To health care facility
To patients, visitors, employees, property, and equipment
Implement methods to reduce and avoid risks
Outcome-oriented approach
Growth and development over 40 years
Loss of charitable immunity
Malpractice insurance crisis
Joint Commission requirements
State laws setting program requirements
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
5
General Principles (2 of 2)
Risk management function varies by institution
May report to finance, operations, or safety
Often works with in-house counsel
HIM has important role
Enforcing patient record requirements
Use of incident reports
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
6
Patient Record Requirements (1 of 4)
Documentation
Proper record-keeping reduces risks
Assists caregivers to give appropriate care
Health records are used as evidence in litigation
Good documentation benefits defense
Timely and complete
Meets requirements for record content
Only approved abbreviations are used
Corrections are made properly
McWay, Legal and Ethical Aspects of Health Information Management 5th edition, © 2020 Cengage. All Rights Reserved. May not be scanned, copied or duplicated, or posted to a publicly accessible website, in whole or in part.
7
Patient Record Requirements (2 of 4)
Security
Availability of records for patient care
Necessary for timely, accurate communication
Health care providers depend on record to make careful decisions
Access to health information by patients
Ensure staff is trained to respond to requests
Release made only to one with right to access
Retention of records
Compliance with state and federal laws
Negligent loss or premat
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