ad the HIM Best Practices for Engaging Consumers in Their Overall Healthcare practice brief.Preview the document Using APA format, respond to the following prompt in 1 1/2 to 2 double-spaced pages:In your own words, respond to the following: What is the role of the HIM professional in consumer education and advocacy? How will the HIM professional fit in with a facility or healthcare organization’s information governance plan? What role will HIM play? Plagiarized paper will not receive credit. Per APA formatting, in-text citations are expected, as are a reference list page and a cover page. These pages are extra and in addition to the 1 1/2 to 2 double-spaced pages noted above. You are welcome to cite and use sources in addition to the brief; just be sure to cite them appropriately in the APA format and include them in your reference list. HIM Best Practices for Engaging Consumers in Their Overall Healthcare As a nation, the United States has been focused heavily on engaging consumers in their overall health and wellness. This has been propelled by federal initiatives such as the “meaningful use” Electronic Health Record (EHR) Incentive Program, mandated clinical quality measures based on the value of care provided, and programs such as the Centers for Medicare and Medicaid Services’ (CMS’) Hospital Compare, which now includes star ratings on patients’ experience of care.1, 2, 3 Stage 2 of meaningful use includes the objective to “provide patients the ability to view online, download and transmit their health information within four business days of the information being available to the eligible provider (EP).”4 This is measured by patients’ or authorized representatives’ online access to their health information. Federally mandated clinical quality measures and the measures included in the meaningful use program suggest that patients receive better outcomes and care coordination and management when they are engaged in their healthcare.5 Patients’ and caregivers’ ability to access their health information electronically helps to facilitate this engagement. Technology has propelled consumer engagement by making patient records easily accessible to consumers through patient portals. Advanced technology has also allowed for information to be shared more easily between care providers. Technology is enabling patients to “consult with physicians, receive diagnoses and even get prescriptions via videoconference. Additionally, mobile health tools, including wearable sensors and phone applications that qualify as medical devices, allow better monitoring of patient conditions.”6 Though interoperability between EHR systems exists as a barrier, health information management (HIM) professionals are able to mitigate this hurdle by serving as stewards of patient records and assisting physicians in patient advocacy. This Practice Brief discusses the challenges of engaging healthcare consumers and offers best practices for HIM professionals to assist consumers in becoming more engaged in their own healthcare. It is designed to support and guide healthcare organizations, HIM professionals, and healthcare providers on how to assist consumers in improving communication as well as providing insight into how technology is shaping the role consumers play in healthcare. Outlining the Role of HIM in Consumer Education and Advocacy Due to increased regulatory demands on healthcare providers, HIM professionals are in a unique position to facilitate consumer engagement from admission to discharge in any type of healthcare setting. There are numerous tools available that assist in educating the consumer regarding their health information, including: Consumer Health Information Bill of Rights: This resource is available online via AHIMA’s HIM Body of Knowledge to educate consumers on the protections and safeguards related to their personal health information (PHI). AHIMA’s Engage Consumer Engagement and Personal Health Information Community: This online community, at engage.ahima.org, is accessible to the public to discuss issues related to consumer access to Copyright © 2015 by The American Health Information Management Association. All Rights Reserved. their health information, including personal health records (PHRs), PHI, patient portals, personal health monitoring technologies, care coordination, and case management. MyPHR: The MyPHR.com website offers a wealth of information for consumers, caregivers, and healthcare professionals including information on how to start a PHR, health literacy tools, and tips to navigate the healthcare system. This site can be used to educate HIM staff, consumers, and caregivers. Blue Button: This initiative offers consumers a way to get their health records electronically. Regardless of the type of healthcare setting, HIM professionals should discuss taking the Blue Button pledge with their organization to empower consumers to be partners in their healthcare through health IT. Consumers will be able to access their health data, improve their health and healthcare experience, and understand ways to safeguard and protect their health information. More information on Blue Button is available at http://healthit.gov/patients-families/your-health-data. ShareCare: The ShareCare.com website is an online health profile and community where consumers can find experts to answer health questions, find doctors, and learn from the top experts in health and medicine. AHIMA is partnering with ShareCare to offer resources and answers on consumers’ right to access and protect their health information. More information is available at www.sharecare.com/group/ahima. Medical Identity Theft Response Checklist for Consumers: Consumer awareness is vital for detection of and timely response to a medical identity theft incident. Consumers may consult this checklist, available online in AHIMA’s HIM Body of Knowledge, for practical guidance and rapid action. Another way to facilitate consumer engagement is to become involved in facility-based committees that address the multiple areas that intersect with consumer access, amendments, and sharing of personal health information. This could include an organization’s policy, procedure, and contract committees that ensure consumers are able to access their information within a reasonable timeframe and that assistance can be provided if necessary. If this type of service is outsourced to an EHR or patient portal company, HIM professionals should make sure the contracts specify that consumers have access to their health information and provides education on the importance of having access. HIM professionals should be involved in developing the patient portal functionalities, assisting in creating a program at their facility that provides tangible information on the importance of patients having secure access to their information, as well as supporting consumers through the portal sign-up process.7,8,9 Because patients are becoming more involved in their own healthcare, HIM professionals will need to collaborate with the medical, nursing, and other clinical staff who have direct contact with the patient in ensuring they are receiving copies of their discharge and aftercare instructions and that their laboratory test results are available in the patient portal where applicable. HIM professionals also need to consider allowing patients to review their medical record while they are still at inpatient status or still on campus, such as patients in outpatient surgery recovery or those being held at the hospital for observation.10 Outlining the Role of HIM in Assisting Physicians with Patient Advocacy The role of the HIM professional as steward of the patient record is vital in assisting the physician in patient advocacy. The HIM professional should be part of a team of care professionals at the organization that promotes a culture of valuable service to the patient. As a third party, the HIM professional is the keeper of the record and is well positioned to assist the physician with his consumer—the patient. Promoting HIM Services The HIM professional can serve the patient through the physician by promoting the best quality standards in information governance (IG). An example would be to produce data analytics for patient populations to establish Copyright © 2015 by The American Health Information Management Association. All Rights Reserved. new patient services and to support business decisions made based on the information captured. HIM professionals have their eyes on the details to ensure data integrity and completeness. HIM professionals should: Be open to patient interaction through health information, patient research, auditing, input, and collaboration. Assist in the avoidance of duplicate tests; audit and improve quality care by auditing records for quality discrepancies. Ensure timely and accessible information so that the best medical decisions can be made by care providers. Establish practices that are designed with the patient perspective in mind. Information Governance Supports Health Record Stewardship The presence of a strong information governance (IG) program in a facility supports the ability of HIM professionals to serve as stewards of patient records, as well as assist in patient advocacy roles, as illustrated through two of the Information Governance Principles for Healthcare (IGPHC)™ — Transparency and Availability. The IGPHC are industry-specific IG principles adapted from ARMA International’s Generally Accepted Recordkeeping Principles. Principle of Transparency An organization’s processes and activities relating to information governance should be documented in an open and verifiable manner. Documentation shall be available to the organization’s workforce and other appropriate interested parties within any legal or regulatory limitations and consistent with the organization’s business needs. Principle of Availability An organization shall maintain information in a manner that ensures timely, accurate, and efficient retrieval. Employing a Consumer Engagement Campaign The HIM professional can serve as a resource for the physician by way of consumer assistance. To introduce this concept, a consumer assistance campaign could be developed and marketed to physicians and staff. This campaign should acknowledge consumers and the need to empower patients to become collaborators in their care and medical decision making. It is essential that an explanation of services offered is included, and that the use of health information as a communication tool is promoted. The HIM professional should promote complete and timely documentation, ensure proper documentation and coding for reimbursement, and ensure proper billing of services. The HIM department should create a culture of trusting engagement by providing a secure environment that allows the patient to feel comfortable when accessing and requesting their patient information. Staff should be trained to understand consumers and their needs. Resources should be allocated so that time is devoted to the needs of the patient. HIPAA rights should be clearly stated in the view of the patient. Publishing a standard fee for photocopies (whatever is established for your state) and providing a courtesy copy for first requests would be beneficial for all involved. Establish a team of experts in coding, release of information, and problem resolution to assist the patient with questions regarding their care and bill denials and appeals. Copyright © 2015 by The American Health Information Management Association. All Rights Reserved. Opening the door to a culture of patient advocacy and building a team that is recognized for patient engagement is essential. HIM professionals have many responsibilities to fill in making this a reality, from accurately abstracting the medication list, problem list, allergies, and other health maintenance areas to providing an avenue for patients to make amendments to his or her health information. HIM professionals also have a role in pushing portal messages out to patients. HIM Code of Ethics Applies to Consumer Engagement The AHIMA Code of Ethics provides HIM professionals with ethical principles to guide professional conduct based on the core values of the organization. These principles include facilitating interdisciplinary collaboration in situations supporting health information practices and respecting the inherent dignity and worth of every person. When in a professional setting, HIM professionals should provide only facts and refrain from including personal opinions. And in all interactions, it is important to be kind and professional. Through their skills, knowledge, and patient advocacy support, HIM professionals can add great value to the physician-patient relationship. Establishing an HIM-Physician Relationship The HIM professional and the physician should be working in a collaborative manner to serve the patient. This working relationship begins by establishing a customer-friendly relationship between HIM and the physician and their staff. Allow the physician to use HIM as a valuable resource to attain a high level of patient satisfaction. Develop a positive direct relationship with the office staff by hosting an open house or ask to speak during their lunch. Contact the physician if there are legal actions or concerns. Assist in keeping patients out of the hospital by performing audits with established measurable criteria around patient conditions, medication, and test results. Promote patient choice on medical decisions by providing a copy of the clinical summary with physician comments to the patient. Ensure that the physician links the patient’s understanding of medication interactions for improved compliance. Participate in compliance of prescribed medication by auditing and informing the physician of discrepancies. The HIM professional can provide valuable information to the physician and staff via outcome studies and results. Areas of training that HIM staff could provide include: Training front office staff or physicians on how to use the patient portal Training front office staff on how to respond to denials and payments Providing training on patient rights under HIPAA Explaining caregiver benefits Giving tips on navigating through the HIM world Helping physicians understand the importance of consumer engagement and providing education to physicians on engaging consumers Educating on the importance of quality and legal documentation Explaining the importance of data sharing Communicating with physicians about telephone visits—encourage physicians to be willing to accept those appointments and how to properly document and receive reimbursement; create policies that address written documentation of these phone calls, including policies that allow a patient to get a copy of a phone note Offering patient training on patient rights Developing a train-the-trainer curriculum for patient care staff or a simple fact sheet for consumers Providing a tutorial to staff on the components needed to complete a patient authorization for release of information Copyright © 2015 by The American Health Information Management Association. All Rights Reserved. Outlining the Role of HIM in Consumer Engagement Organization-Wide HIM professionals play an important role in making sure the correct information is included in inpatient discharge papers—or in the “after visit summary” document that is provided at the end of an outpatient appointment. Discharge notices should also correctly indicate the type of provider facility, such as a long-term care or inpatient services provider. Getting advance notice of an upcoming discharge from a hospital or long-term care setting is vital to advocating on behalf of patients who are planning to be discharged, especially if the patients or their caregivers feel that the discharge is not appropriate. Good discharge planning on the part of patients, their caregivers, and their providers is essential for a successful transition from one care setting to another. Notice can be given through a written or verbal discussion of the patient’s rights, especially with respect to anticipated out-of-pocket costs, the types of treatment that may be needed, and when identifying the setting in which care will be received (i.e., inpatient, outpatient, or long-term care). It is important that this type of notification is provided as far in advance of discharge as reasonable. The discharge notice should be provided in writing, even if first given verbally. It should be given in a way that is understood by the patient and it should be available in multiple languages. Notice can be provided to the patient or it can be provided to a caregiver who, with patient permission, can explain the discharge information to the patient. HIM professionals should be involved in assisting with developing the appropriate language for the written discharge notice. The discharge notice should include: Expected date of discharge Any information that is needed for patients who wish to object to a planned discharge, such as where to file an objection, what agency or who will review the objection, and the address and telephone number of the appropriate person to contact The written discharge plan should explain at a minimum the following information in easy-to-read verbiage: Where the patient can get additional healthcare after discharge What the patient and caregivers can do to help provide for the patient’s ongoing healthcare needs Steps to take for any questions that arise, or help in identifying any complications or problems that should be reported to their healthcare provider A list of medications with instructions for taking them correctly Instructions on how to make arrangements for home health equipment or other medical supplies if necessary Information about where and when follow up should occur A discharge plan does not have to follow an exact format, but it should be understandable and brief. It should be shared with the patient and any caregivers that the patient designates. The discharge plan should be included as a part of the patient’s medical record. Educating Staff on EMTALA The Emergency Medical Treatment and Active Labor Act (EMTALA) was passed in 1986 as part of the Consolidated Omnibus Budget Reconciliation Act (COBRA).11 It requires hospitals that accept Medicare payments to provide emergency treatment to anyone needing it regardless of their ability to pay. Any hospital that accepts Medicare may not transfer or discharge any patients that request emergency treatment, except with patient consent, or after providing a medical screening exam to evaluate the need for emergency care, or when the patient’s medical Copyright © 2015 by The American Health Information Management Association. All Rights Reserved. condition requires transfer to a different hospital that is better prepared to provide appropriate treatment. The essence of the EMTALA law states that if patients say it’s an emergency, then it is considered an emergency and should be treated as an emergency. HIM professionals should educate all staff in the organization to tell patients to come in and be seen if they feel they are having a medical emergency. It is critical that all registrars and all nursing or patient care staff are aware of the rules of EMTALA. The desired outcome is for the general public to also know that they have a right to determine whether or not they have a medical emergency that requires emergency treatment. Hospitals have three requirements under EMTALA: 1. Patients who request emergency treatment (or the patient’s representative who makes the request if the patient is unable to do so), must be provided with a screening exam to decide whether or not a medical emergency exists. The hospital cannot wait to provide the exam and any needed treatment to ask about payment or to get information about insurance coverage. The hospital may begin the process of asking payment questions or inquiring about insurance coverage once the patient has been screened to ensure that obtaining the payment information will not interfere with the patient’s care. 2. The emergency room (or another unit within the hospital if it is better equipped to handle the patient) must treat a patient with an emergent condition until the condition is stable or resolved, and the patient has the ability to provide their own care after discharge, or until they can receive after-care. If the hospital provides inpatient care, it must be provided at an equal level for all patients, regardless of their ability to pay. Hospitals may not discharge a patient prior to making sure they are stable, even if the patient’s insurance is canceled or if the patient otherwise stops being able to pay during the course of the inpatient stay. 3. If the hospital does not have the ability to treat the patient’s condition, the hospital must make an appropriate transfer to another hospital which has the ability to treat the patient’s condition. This includes a long-term or rehab facility for patients who are unable to care for themselves at home. Hospitals that have specialized capability must accept the patient in transfer and cannot discharge the patient until the condition is resolved and the patient is able to provide care for themselves, or until such time that they are transferred to a different facility. The Role of HIM Before, After, and Between Patient Visits E-mail is now a part of our everyday lives. We use e-mail at work to communicate with coworkers. We use e-mail at home to keep in touch with friends and family. Today, many healthcare professionals are also communicating with patients through e-mail. Provider-patient communications were traditionally done through in-person meetings, such as during an office visit or on the telephone, or by providing written information. Home computer technology adds another convenient form of communication—the ability to communicate through e-mail or the Internet with a patient portal. There are a number of advantages to using e-mail or a patient portal to communicate with patients: E-mail or portals allow for routine types of questions to be answered quickly without the need for an office visit Test results can be provided efficiently, along with follow-up instructions and medication information Follow-up can be done after an office visit, as well as clarification or explanation of information that was provided during an office setting after the patient is home Links can be provided for helpful articles or websites that can help answer questions Communicating by e-mail has many advantages, but there are some important considerations of which it is important to be aware. The use of e-mail technology must be balanced with patient confidentiality and the patient’s right to Copyright © 2015 by The American Health Information Management Association. All Rights Reserved. privacy. HIM professionals can assist in developing policies and procedures for use of e-mail as well as the patient portal to ensure that patient rights are met, while still allowing for efficient use of technology to enhance patient care. If using e-mail to communicate with patients, it must be encrypted to ensure that it is secure. Scheduling Appointments Scheduling patient appointments is an essential part of daily work for healthcare providers, from small family practices to large multi-specialty clinics, in all types of care settings, including physician offices and hospital outpatient departments. Customer service representatives or medical receptionists may schedule patients for all types of dental visits, optometrists, surgeons, psychiatrists, and any other type of general medical or specialist appointment. Scheduling can get rather complex if the doctor is practicing in multiple clinics or sees patients at more than one medical facility. Appointments need to be well coordinated and the support staff must be kept abreast of all new patients or any changes in provider schedules. One way patient scheduling can be simplified is with the use of an online scheduling tool as a part of a patient portal. Regardless of size, medical practices can allow patients to self-schedule medical appointments via an online portal or use of other online scheduling software. Many medical offices have already established portals, and the addition of online scheduling is a great feature that can enhance patient convenience and reduce the need for office staff to manually appoint patients to the provider’s schedule. Some patients may want to be able to schedule appointments around the clock even when the provider’s office is closed or when phone lines are busy. Increasingly, patients do not have time to schedule appointments during business hours. Patients may be given the option of requesting an appointment online via the patient portal, and then waiting to be offered an appointment time from the scheduling staff. Alternatively, patients may be allowed to schedule their own appointments directly into the provider’s system after viewing openings in the schedule. Healthcare organizations can manage how the online appointment system is used by implementing a variety of system controls that limit or maximize capability for self-scheduling. Building and managing a patient portal requires HIM expertise and knowledge. HIM professionals are responsible for the integrity of the healthcare record, and the creation of the record of care starts at the time the appointment is made. It is essential that HIM professionals get involved in portal functionality design from the moment patients sign up to access the portal through the patient’s actual use of the portal and for all of its intended purposes. HIM a Key Player in Consumer Engagement Greater patient engagement ultimately contributes to better outcomes, and health information management professionals play a key role in supporting patient engagement. HIM professionals can prepare healthcare providers to connect with patients and caregivers through adoption and management of patient portals, encouraging the use of secure e-mail for provider communications, facilitating and supporting online scheduling software, and helping develop policies and procedures to assist with the adoption of other emerging technologies. Additional Resources For further reading on this topic, please see the following additional resources from AHIMA: Assessing and Improving EHR Data Quality (Updated) Appendix B: Vendor Questionnaire for EHR System Selection Copyright © 2015 by The American Health Information Management Association. All Rights Reserved. Integrity of the Healthcare Record: Best Practices for EHR Documentation Rules for Handling and Maintaining Metadata in the EHR Managing Copy Functionality and Information Integrity in the EHR Evolving ROI Specialists into Health Record Ambassadors Notes 1 Centers for Medicare and Medicaid Services. “EHR Incentive Programs: The Official Web Site for the Medicare and Medicaid Electronic Health Records (EHR) Incentive Programs.” June 29, 2015. www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. 2 HealthIT.gov. “Standards and Certification Regulations: Clinical Quality Measures.” www.healthit.gov/policy-researchers-implementers/clinical-quality-measures#quality_measure_code_sets. 3 Medicare.gov. “Hospital Compare.” www.medicare.gov/hospitalcompare/search.html? AspxAutoDetectCookieSupport=1. 4 HealthIT.gov. “Patient Ability to Electronically View, Download, and Transmit Health Information.” February 24, 2014. www.healthit.gov/providers-professionals/achieve-meaningful-use/core-measures-2/patient-ability-electronically-view-download-transmit-vdt-health-information. 5 Rulon, Vera. “Obtaining Quality Healthcare through Patient and Caregiver Engagement.” Journal of AHIMA 86, no. 1 (January 2015): 48-51. 6 “Health IT SmartBrief Special Report: Connected Care.” Health IT SmartBrief. April 8, 2015. www2.smartbrief.com/servlet/ArchiveServlet?issueid=FD150D63-D306-43F6-92FC-9BBC6418F5A9&lmid=archives. 7 Baldwin, Kevin et al. “The Implementation and Management of Patient Portals.” Journal of AHIMA 86, no. 4 (April 2015): 50-55. 8 AHIMA. “Preparing for a Doctor’s Visit: A Reference Guide for Patients, Caregivers, and Advocates.” http://myphr.com/Resources/MX10172%20Patient%20Resource%20Guide_FINAL.pdf. 9 AHIMA. “Understanding Your Medical Record.” 2015. www.myphr.com/HealthLiteracy/understanding.aspx. 10 Crawford, Mark. “Declassifying Doctors’ Notes.” Journal of AHIMA 84, no. 5 (May 2013): 22-25.. 11 Centers for Medicare and Medicaid Services. “Emergency Medical Treatment and Labor Act (EMTALA).” March 26, 2012. www.cms.gov/Regulations-and-Guidance/Legislation/EMTALA/index.html?redirect=/EMTALA/. Prepared By Lesley Kadlec, MA, RHIA Annessa Kirby Heidi Shaffer, RHIA Paula Warren, RHIA Copyright © 2015 by The American Health Information Management Association. All Rights Reserved. Acknowledgments Lucia Aschettino, CHTS-CP, CHTS-IM, CHTS-TR, HITPRO-CP Patricia Buttner, RHIA, CDIP, CHDA, CCS Susan Casperson, RHIT Susan Clark, RHIT, CHTS-IM, CHTS-PW Marlisa Coloso, RHIA, CCS Angie Comfort, RHIA, CDIP, CCS Jane DeSpiegelaere, MBA, RHIA, CCS, FAHIMA Karen Gibson, RHIA, FAHIMA Laurie Miller, RHIT, CCS-P Angela Rose, MHA, RHIA, CHPS, FAHIMA Donna J. Rugg, RHIT, CCS Alisha R. Smith, MS, RHIA, CHPS Lou Ann Wiedemann, MS, RHIA, CDIP, CHDA, CPEHR, FAHIMA Article citation: Kadlec, Lesley; Kirby, Annessa; Shaffer, Heidi; Warren, Paula. "HIM Best Practices for Engaging Consumers in Their Overall Healthcare" Journal of AHIMA 86, no.9 (September 2015): 50-56. Copyright © 2015 by The American Health Information Management Association. All Rights Reserved.