Patient-Centered Medical Home Graduate Internship, Benefits to a Practice Manager: Case Study.

Graduate Health Information Management students can and should be involved in collaborations with the Patient-Centered Medical Home at primary care clinics. In this case, the student is not from a Health Services Management background as it was in the first internship article, but rather from a Health Information Management background. This case study is the second of 2 Patient-Centered Medical Home internship studies where the value of an intern to a practice manager is demonstrated.

Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

E-Scripts and Cell Phones: A Blessing or Curse?

E-scripts have been used as part of computerized provider order entry implementation for several years now, particularly with the passage of the American Recovery and Reinvestment Act, Meaningful Use, the Health Information Portability and Accountability Act, the Health Information Technology for Economic and Clinical Health Act, and other laws and regulations. This case study seeks to focus on 2 specific aspects of the effect of increasing electronic technology within health care: e-prescriptions and cell phones or smartphones.

International classification of diseases, 10th revision training: what coders are saying.

On September 30, 2014, the US health care system will assign the last International Classification of Diseases, Ninth Revision, Clinical Modification code. The new system, International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System, will become effective on October 1, 2014. A 3-question prepresentation and postpresentation survey was completed by attendants at 11 workshops on the new system; this article discusses the results of the surveys, revealing what coders and billing staff are saying about the new International Classification of Diseases, 10th Revision system.

Associations between social determinants of health and diabetes self-care behaviors among insured adult patients.

AIMS: This study explored the association between social determinants of health (SDOH) and diabetes care behaviors among individuals with health insurance. METHODS: Data from 57,206 US residents, representing a population of over 25.58 million adults with health insurance and diagnosed diabetes, were included in this cross-sectional analysis of data from the 2017 Behavioral Risk Factor Surveillance System. Logistic regression models were constructed to evaluate the likelihood of various diabetes care behaviors given the presence of several SDOH (e.g., food insecurity, poverty, housing insecurity, rurality). RESULTS: Most respondents exercised, ate vegetables, saw a provider for diabetes-related care in the last year, and reported checking their feet and testing their blood sugar daily. Not feeling safe (odds ratio (OR) 1.77, 95 % confidence interval (CI) 1.04, 3.01) was related to never checking blood sugar. Experiencing frequent stress was associated with a lower likelihood of exercise (OR .77, 95% CI 0.60, 0.999) and lower likelihood of checking blood sugar at least once a day (OR 0.73, 95% CI 0.54, 0.99). Food insecurity was associated with lower likelihood of vegetable consumption (OR 0.63, 95 % CI 0.47, 0.85) but a higher likelihood of checking blood sugar (OR 1.80, 95 % CI 1.26, 2.57). Low-income respondents were less likely to exercise (OR 0.72, 95 % CI 0.64, 0.80) or eat vegetables (OR 0.83, 95 % CI 0.75, 0.93) but more likely to check their feet (OR 1.19, 95 % CI 1.04, 1.35) and blood sugar at least once per day (OR 1.15, 95% CI 1.01, 1.31). Those who rent their home were also more likely to check their blood sugar (OR 1.22, 95% CI 1.07, 1.37) but less likely to have eaten vegetables in the last week (OR 0.87, 95% CI 0.78, 0.97). Respondents living in rural areas were more likely to have visited a provider in the last year (OR 1.21 95% CI 1.00, 1.47). CONCLUSIONS: SDOH can adversely affect diabetes self-care behaviors, providers should assist vulnerable patients by connecting them with community resources and providing individualized care.

How to set up an international classification of diseases, 10th revision training workshop: case study.

On September 30, 2014, the US health care system is to assign the last International Classification of Diseases, Ninth Revision, Clinical Modification code. The new system, International Classification of Diseases, 10th Revision (ICD-10), Clinical Modification/Procedure Coding System, will become effective on October 1, 2014. We are embracing one of the largest health care changes in the past 30 years. This article describes the steps in setting up and implementing an efficient and effective ICD-10 training workshop. A 2-day North Carolina ICD-10 workshop is used as a case study. Following the initial workshop, 11 additional workshops were conducted throughout North Carolina.

Living with diabetes: what patients are saying.

The purpose of this study was to explore the thoughts and feelings of patients with diabetes. The study analyzed the responses to an open-ended question, which was the last item (Question 43) on a diabetes survey that was mailed to 2,615 persons, 534 (22%) with diabetes in eastern North Carolina. Content analysis of the data revealed the following themes: coping/prayer, support, effects of diabetes, metaphors, controlling comorbidities, and appreciation/thankfulness.

International Classification of Diseases, 10th Revision: it's coming, ready or not.

The current diagnostic and inpatient procedure coding system, International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM), has been used in the United States since 1979. The coding system has become insufficient because of many medical and technological improvements that have occurred since then. On September 20, 2013, the US health care system will assign the final ICD-9-CM code. The new system, International Classification of Diseases, 10th Revision, Clinical Modification, Procedure Classification System, will become effective on October 1, 2013, including more codes and other differences. Although October 2013 is the implementation deadline, facilities should start preparing for the change at this time. A thorough understanding of the new official guidelines is key to a successful transition from ICD-9-CM to International Classification of Diseases, 10th Revision, Clinical Modification, Procedure Classification System. As we are embracing 1 of the greatest health care changes in 30 years, specific considerations are offered for initiating implementation and ensuring a smooth transition.

Weighing the odds: Assessing underdiagnosis of adult obesity via electronic medical record problem list omissions.

BACKGROUND: Obesity is a continuing national epidemic, and the condition can have a physical, psychological, as well as social impact on one's well-being. Consequently, it is critical to diagnose and document obesity accurately in the patient's electronic medical record (EMR), so that the information can be used and shared to improve clinical decision making and health communication and, in turn, the patient's prognosis. It is therefore worthwhile identifying the various factors that play a role in documenting obesity diagnosis and the methods to improve current documentation practices. METHOD: We used a retrospective cross-sectional design to analyze outpatient EMRs of patients at an academic outpatient clinic. Obese patients were identified using the measured body mass index (BMI; ≥30 kg/m2) entry in the EMR, recorded at each visit, and checked for documentation of obesity in the EMR problem list. Patients were categorized into two groups (diagnosed or undiagnosed) based on a documented diagnosis (or omission) of obesity in the EMR problem list and compared. RESULTS: A total of 10,208 unique patient records of obese patients were included for analysis, of which 4119 (40%) did not have any documentation of obesity in their problem list. Chi-square analysis between the diagnosed and undiagnosed groups revealed significant associations between documentation of obesity in the EMR and patient characteristics. CONCLUSION: EMR designers and developers must consider employing automated decision support techniques to populate and update problem lists based on the existing recorded BMI in the EMR in order to prevent omissions occurring from manual entry.

Street Smart. Understanding the context of emergency medical services communication and documentation.

HIM professionals can expand their understanding of the healthcare continuum by becoming more familiar with hospital emergency care and documentation.

An 81-year-old woman with chronic illnesses and a strong faith.

Mrs. Smith is an 81-year-old woman who has several medical problems. Despite these problems, however, her faith and spirituality strength give her the strength and determination to move forward in life. She stresses that, "My faith helps me cope with my illnesses." This article describes Mrs. Smith's roller coaster life and how faith, prayer, and hope have allowed her to continue to press forward. She interprets pain and illnesses as challenges, not obstacles. Her physician who has been treating her for about 20 years indicates that she has continued to have multiple chronic health issues and has maintained an incredibly positive spirit, particularly when traditional medicine has failed to make a difference. Spiritual care is being increasingly documented as an important component of whole person medicine. For some, religiosity and spirituality are important aspects of patient-provider relationship. God, faith, and hope are essential factors to Mrs. Smith who uses spirituality and religion daily to cope with her chronic illnesses.

Using an audience response system (ARS) in a face-to-face and distance education CPT/HCPCS coding course.

We report the use of an audience response system (ARS) in an undergraduate health information management course. The ARS converts a standard PowerPoint presentation into an interactive learning system that engages students in active participation, and it allows instructors to display questions, surveys, opinion polls, and games. We used the ARS in a 2008 course, Health Services Coding, for lecture and test reviews. The class consisted of 15 students; nine were on-campus students and six were distance education students. All of the responding students agreed that the ARS software facilitated learning and made lectures and reviews more interesting and interactive, and they preferred taking a class using an ARS.

The experience of teaching in a diabetes program.

Diabetes care accounts for $132 billion of total health care expenditures, and the prevalence of diabetes is increasing. Preparing and managing diabetes educators are a serious challenge for health care managers. A phenomenological approach was used to explore the teaching experiences of 3 diabetes program staff members. Data were collected through 3 face-to-face interviews and 20 e-mail messages over a 6-week period. The individuals included 2 second year marriage and family therapist doctoral students and 1 certified diabetes educator. Reflexivity, triangulation by peers, and member checks were used to ensure trustworthiness. The 4 themes found in this study were roles, awareness, sense of importance, and challenges and frustrations.

The importance of encounter form design.

Encounter forms are a key component in accurate billing and collections. They document services rendered by capturing the diagnosis and procedure codes, which serve as the basis for billing and receipt of payment for services. This article addresses the negative impact of outdated encounter forms on reimbursement and describes current best practices related to coding, the use of electronic encounter forms, and management of missed appointments. Specific recommendations are offered for ensuring that encounter forms are appropriately maintained and up-to-date.

Using wiki in an online record documentation systems course.

We report a case study using a wiki tool, Confluence, including a brief history, current status, and motivations for using Confluence. We describe how we created two spaces on Confluence for two consecutive classes, 2006 and 2007, in a health information management baccalaureate online course, Record Documentation Systems. The 2006 class contained 12 groups consisting of 52 students. The 2007 class contained six groups consisting of 30 students. We describe how two collaborative pages for each of the groups are created and used by the groups for the group project. Survey results illustrated that 44 percent of the students in 2006 and 50 percent in 2007 agree Confluence is a tool for facilitating learning; 58 percent in 2006 and 50 percent in 2007 agree it is a tool for student activities; 52 percent in 2006 and 36 percent in 2007 agree it is a medium for reflective group interaction; and 38 percent in 2006 and 36 percent in 2007 want to see its application in other courses.

Managed care and the bottom line of your practice.

Managed care has greatly influenced the health care industry, particularly with regard to reimbursement for medical services. Managed care has had and continues to have a significant impact on reimbursement for physician services. When contractual relations with managed care companies are initiated and managed by medical practice administrators, the result can be beneficial to a physician practice's financial bottom line. This article discusses the necessity to develop effective working relationships with managed care companies and suggests strategies for establishing fee schedules and negotiating reimbursement contracts.

Blogging in an online health information technology class.

In this article we introduce blogs, including their brief history, their current status, and motivations for blogging. We describe how we created a course blog in one online Health information management (HIM) baccalaureate course. We describe three pedagogical purposes (online discussion, digital drop box, and class project management tool) of the course blog. We report the results of our after-class survey on using the blog as a learning tool. Survey results illustrated that 55 percent of the students agree that the blog can be a tool for facilitating learning, 50 percent agree it can be used as a tool for student activities, 60 percent agree it can serve as a medium for reflective thinking and writing, and 60 percent want to see its application in other courses.