Background

Informatics team X was assigned the complex task of maintaining accurate clinical data over a patient’s lifetime. The informatics team had to identify the challenges Missionville Hospital would face when patient records would include reconciling longitudinal patient data as well as patient referrals. The team should address the accuracy of information concerning the incorporation of legacy systems between two hospitals, as well as the changes in medical protocol over time; including correction of chart errors and ensuring that the record is complete while following state law and regulatory standards. The team must include any information pertaining to the way in which records should be released, and any information pertinent to quality reporting and policy recommendations that need to be adjusted. If Missionville Hospital can include these aspects, they will be able to maintain accurate clinical data across a patient’s lifetime. Moreover, the advantages to reconciling EHRs and providing longitudinal patient health records are important to successful maintenance of this valuable data, which include an all-inclusive patient health history; thereby allowing for patient-record visibility, thus providing longitudinal record analytics for the improvement of population health (Bennett, 2016).

First, I will examine the case study and provide my own perspective on the issues. I will then examine the Group X informatics team findings and offer any suggestions necessary to complete the task of reconciling healthcare data across time.

Findings

Establishing a medical records management system to enable reconciling healthcare data across time for patients

The importance of linking data between legacy systems and the inclusion of patient identity management

Creating a compliance program in the organization to define policies and procedures, establish communication guidelines, and provide staff training

EHRs must provide the most updated version of clinical protocol and guidelines

Using clinical decision support to provide an accurate longitudinal medical record

To ensure accuracy, errors must be kept, the correction noted, and verified by signature

The importance of HIPAA privacy, security regulations, records release, data encryption, firewalls, and electronic auditing

Establishing a data management strategy to provide EHR and Health Information Management related policies

The inclusion of an integration engine and physician portal

The accuracy of patient information is a major concern while reconciling EHRs and providing longitudinal patient health records. If an EHRs integrity is compromised, it shows throughout the entire organization. “If clinical documentation was wrong when it was used for billing or legal purposes, it was wrong when it was used by another clinician, researcher, public health authority or quality reporting agency” (Bresnick, 2013). Informatics team X recommended following the American Health Information Management Associations’ model to manage the quality of data. Along with following AHIMA’s model, accuracy can be managed by health information management professionals, through the establishment of a medical records management system, and the implementation of a compliance program. The medical records management system includes the capturing and of storing information, dissemination of records, preserving historical information, as well as the ability to transfer information or release records. Likewise, a medical records management system follows an electronic health record from creation to disposal (Smartsheet). Linking data between legacy systems and the referral hospital will be a key component to maintain accurate clinical data across a patient’s lifetime. The medical records management system will include the aspect of patient identity management (PIM). For example, PIM enables providers to view trusted health records and reduces redundant information (NCBI). In addition, the medical records management system coupled with a compliance program should provide governance, methods of patient identification, authorship validation, ability to correct records, and record auditing. Within the compliance program, policies and procedures should be well-defined, guidelines concerning communication should be established, and staff training completed (MedBridge, 2017). Thus, Missionville Hospital should provide educational strategies to help healthcare providers understand the importance of compliance with laws and regulations concerning medical information accuracy. Furthermore, policy and procedures should be established to include information about the electronic health record system and the functions to prevent documenting erroneous information (AHIMA). Policy and procedure guidelines in association with an electronic health record with the capabilities of clinical decision support (CDS) would be crucial to provide an accurate longitudinal medical record (Stutman, 2010). EHRs should encompass CDS to allow for change in work processes (Silverstone, Paek, Kogan, Essaihi, & Shiffmann, 2005). Considering that CDS involves medical data, patient-specific information, and an inferencing mechanism to produce information to healthcare providers in real-time, it is imperative to include this function within the EHR. “This information must be filtered, organized, and presented in a way that supports the current workflow, allowing the user to make an informed decision quickly and take action” (Healthit.gov, 2018). Overall, CDS helps to reduce the number of errors and adverse events.

Given that clinical guidelines change over a period of time, it is imperative that EHR standards are up-to-date. For instance, the guidelines of blood pressure ranges for prehypertension and hypertension, as well as glucose ranges for gestational diabetes have changed dramatically over the years. It is extremely important that electronic health records can adapt to these changes in protocol. Informatics team X has recommended tagging data with a data definition which will define parameters within the electronic health record. Furthermore, the electronic health record needs to have the most updated version of clinical protocol and guidelines. Also, the EHR must have the ability of documenting deviations from guidelines, as well as error detection capabilities. When corrections are made within the EHR, it is also important that the original error should not be completely deleted. Health care providers will need to add an addendum note to the entry along with the correction and provide authentication by signature, date, and time (EMR Industry).

 Moreover, it is essential that the medical record be complete and in accordance with quality agency regulations, such as CMS, and comply with Joint Commission standards, state and federal laws, and HIPAA regulations. To comply, Missionville Hospital must establish policies that state the criteria for records to be considered complete and comprehensive.

To illustrate, The Centers for Medicare and Medicaid Services requires accurate and complete information for reporting and reimbursement. Informatics team X has recommended following reporting guidelines according to the requirements of the 2015 Edition Certified Electronic Health Record Technology (CEHRT) of the Promoting Interoperability Program, as well as the electronic clinical quality measures (eCQM’s). The health information management team, informaticists, and healthcare professionals will play an integral part to ensure that electronic health records are accurate and meet the quality measures needed for reporting.

 Along with CMS requirements for reimbursement, the process of reconciling records must include that legal standards are met, record retention laws are upheld, and HIPAA privacy and security guidelines are followed. Working with a legal team is an essential part of reconciling electronic health records, and since medical record retention laws vary by state, and it is recommended that the healthcare organization establishes a legacy data management strategy (Health Data Archiver). For instance, medical laws in South Carolina state that hospitals must retain patient records for adults for a minimum of ten years. However, minor patients’ records must be retained “until the minor reaches age 18 and the “period of election” expires, which is usually 1 year after the minor reaches the age of majority” (Healthit.gov, n.d.). When transferring information between a hospital system and referral hospital, HIPAA guidelines must be followed. Guidelines concerning privacy rules permit health care providers to share patient information for treatment purposes. As a result, Missionville Hospital must follow HIPAA guidelines and refer to state laws when transferring information to the referral hospital. Thus, information being transferred will need to be encrypted to protect patient information. As a case in point, data encryption allows for safe transfer and storage of patient information and guarantees that only the intended recipient is capable of viewing the transferred information. With this in mind, Missionville Hospital will need to ensure other safeguards are in place as well, such as firewalls and electronic auditing systems. Electronic auditing systems require user verification for certain sets of electronic health records that need to be accessed. Through these safety measures, as well as auditing systems, Missionville Hospital will avoid penalties and guarantee a high level of compliance (National Center for Medical Records). Missionville Hospital will have to follow HIPAA guidelines to allow for successful reconciling of electronic health records over a long period of time. HIPAA requirements not only cover privacy and security, but it entails the aspects of records release. In fact, HIPAA allows patients to receive their health information, and organizations that are covered under HIPAA must grant access to records within thirty days of the request of release (HIPAA Help Center). Patients can set limits on the release of their records, and health care organizations will be penalized if not following HIPAA regulations (National Center for Medical Records).

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Informatics Team X recommended several important aspects to include for the reconciliation of longitudinal electronic health records. They have included the need for the adoption of data standards and a data dictionary, using data quality management model, and creating a data quality program. The team recommended standardization of data entry fields, quality checking with validation loops, and data elements such as user interfaces and algorithms. The team recommended evaluating the current EMR system for meeting CEHRT criteria, participating in payment programs, establishing a number of policies, as well as the inclusion of various stakeholders.

However, I would like to recommend the addition of technological aspects, such as an integration engine, as this would provide a path to connect systems. Also, I would recommend a physician portal between Missionville Hospital and SubSpecialty Center. Ultimately, these technological aspects would improve workflows and patient care while meeting quality measure requirements, as well as record analytics for the improvement of population health. “This interoperability makes patient-level data standardization—and the integration of providers with different data types—possible, while facilitating notifications that support population health and public health initiatives for quality measurement tracking and reporting” (Orion Health, 2017). I would also recommend establishing a medical record management system and establishing patient identity management.

Along with Informatics Team X’s policy recommendations, Missionville Hospital would need to establish a medical record management system. This would be an all-encompassing strategy for the management of legacy data coupled with a quality compliance program. Ultimately, this would provide the organization with governance of structuring electronic health records, ensuring quality measures are met, guaranteeing HIPAA regulations are followed, and auditing being completed. The informatics team will need to collaborate with the legal department to ensure legal standards are met and that records are being retained correctly. A medical record management system provides a data management strategy in accordance with the EHR and HIM-related policies. The medical record management system should include patient identity management for linking patient data between legacy systems.

Furthermore, healthcare organizations must establish a team and records management system which will be responsible for implementing policies, managing information, and provide proactive decision-making. (AHIMA). Finally, I would recommend Missionville Hospital establish key performance indicators (KPIs) upon completion of the task to assess the success of reconciling patient data and providing longitudinal patient health records. Clinical performance KPIs could measure record accuracy, completion, and compliance with regulatory requirements. Missionville Hospital could also include revenue cycle KPIs as well. These could be included to determine if Missionville Hospital successfully improved efficiency upon completion of their task, and to measure progress towards the organizations’ goals (Application Performance Management, 2019).

In conclusion, necessary policy recommendations have been made and Missionville Hospital will need to incorporate a data quality management model, establish data governance, launch a medical records management system, create a compliance program to define policies, use clinical decision support, maintain record accuracy, preserve record privacy and security, and establish a data management strategy in order to successfully reconcile patient records over time. Thus, these factors will aide in providing an all-inclusive patient health history, allowing for patient-record visibility, and provide longitudinal record analytics for the improvement of population health to promote patient-centered and value-based care.

References

AHIMA. (2013). Integrity of the Healthcare Record: Best Practices for HER Documentation. American Health Information Management Association. Retrieved from http://library.ahima.org/doc?oid=300257#.XRHmiHdFyUk

Application Performance Management. (2019). Key Performance Indicators. Retrieved from https://www.applicationperformancemanagement.org/performance-testing/key-performance-indicators/

Bennett, D. (2016, November 3). The Longitudinal Patient Record Dramatically Affects Population Health: 2 Ways Its Impact is Being Realized. [Blog Post]. Orion Health. Retrieved from https://orionhealth.com/us/knowledge-hub/blogs/the-longitudinal-patient-record-dramatically-affects-population-health-2-ways-its-impact-is-being-realized/

Bresnick, J. (2013, February 14). AHIMA: Quality documentation is key for useful, accurate EHR. EHR Intelligence. Retrieved from https://ehrintelligence.com/news/ahima-quality-documentation-is-key-for-useful-accurate-ehr/

EMR Industry. (2013, June 21). Methods to Make Corrections to an Electronic Medical Record. Retrieved from http://www.emrindustry.com/methods-to-make-corrections-to-an-electronic-medical-record/

Health Data Archiver. (2018, August 5). Record Retention for Physicians No Longer in Practice. Data Archive. Retrieved from https://www.healthdataarchiver.com/record-retention-for-physicians-no-longer-in-practice/

HIPAA Help Center. (n.d.). Failing to release information to patients. Retrieved from https://www.hipaahelpcenter.com/violations/failing-to-release-information-to-patients

MedBridge. (2017, June 21). Creating a Culture of Compliance: 5 Tips for Implementing an Effective Compliance Program. Retrieved from https://www.medbridgeeducation.com/blog/2017/06/creating-culture-compliance-5-tips-implementing-effective-compliance-program/

National Center for Medical Records. (n.d.) HIPAA Requirements. Retrieved from https://www.medicalrecords.com/emr-buyers-guide/hipaa-requirements)

NCBI. (2014, April 17). Managing Patient Identity Across Data Sources. Registries for Evaluating Patient Outcomes: A User’s Guide. 3rd edition. Rockville, MD. Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK208618/

Orion Health. (2017). HealthInfoNet Ensures the Rapid Delivery of HIE Services to Maine Patients and Their HealthCare Providers: A Case Study. [PDF]. Retrieved from file:///C:/Users/webba/AppData/Local/Packages/Microsoft.MicrosoftEdge_8wekyb3d8bbwe/TempState/Downloads/maine-healthinfonet-case-study%20(1).pdf

Silverstone, D, Paek, H.M., Kogan, Y, Essaihi, A., and Shiffman, R.N. (2005). The Incorporation of Clinical Practice Guidelines for Glaucoma into an Opthalmology Electronic Medical Record. AMIA Annual Symposium Proceedings Archive: American Medical Informatics Association. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1560790/

Smartsheet. (n.d.). The Importance of Medical Records Management. Retrieved from

Stutman, H. (2010, November 5). A Longitudinal Medical Record Is Key to Clinical Decision Support. AI in Healthcare: Innovation to Transform Healthcare. Retrieved from https://www.aiin.healthcare/topics/ehr-emr/longitudinal-medical-record-key-clinical-decision-support

Healthit.gov. (n.d.) State Medical Record Laws: Minimum Medical Record Retention Periods for Records Held by Medical Doctors and Hospitals. [PDF]. Retrieved from https://www.healthit.gov/sites/default/files/appa7-1.pdf

Healthit.gov. (2018, April 10). Clinical Decision Support. Retrieved from https://www.healthit.gov/topic/safety/clinical-decision-support