Tuesday, October 31, 2017

Ohio House Bill 172: Modify Law Governing Access to Patient Medical Records

UPDATE: The organizations in support of HB 172 (Ohio Hospital Association, Ohio State Medical Association) decided to pull this bill in May 2018.  If they re-introduce a similar bill, they have said they will involve OHIMA in that process. 

Ohio House Bill 172, sponsored by Representative Kirk Schuring, had its second hearing in the House Health Committee on October 18th.  OHIMA’s Executive Director, Lauren Manson, has been in contact with Representative Schuring regarding this bill.  After analysis, OHIMA does not currently support nor oppose this bill.  The bill was reviewed and HIPAA already defines the “designated record set” and in its current state, HB 172 does not appear to add anything more than what HIPAA already requires. 

HB 172 came about in response to Griffith v. Aultman Hospital where the Ohio Supreme Court decision interpreted Ohio's definition of "medical record." In this case, the daughter of a patient sued the hospital alleging that it did not provide her with all of the medical record as she had requested. Missing from the record were cardiac monitoring strips printed after the patient's discharge from the hospital and maintained by the hospital's risk management division, rather than its medical records department. 

The trial court ruled in favor of the hospital, concluding that it had produced the medical record as defined by state law.  The appeals court agreed, noting that only records that a hospital determines need to be maintained in the process of caring for a patient and not everything having to do with the patient must be disclosed. It held that a patient's medical record consists of what is maintained by the medical records department; any information the health care provider decides not to maintain is not part of that record.

In a 5-2 decision, the Ohio Supreme Court reversed the appeals court, holding that the physical location of data is not relevant to determining whether it qualifies as a medical record. Instead, the issue is whether a health care provider decides to keep data that is generated in the process of a patient's treatment and that pertains to the patient's medical history, diagnosis, prognosis, or medical condition. The Supreme Court concluded that for purposes of the medical record definition, whether data is "maintained" by a healthcare provider (and therefore must be provided) is determined by whether the provider made a decision to keep or preserve the data.  Basically stating that “if it exists, it could be considered part of the medical record.”  Ohio HIM professionals have expressed that, logistically, this is near impossible to put into practice. 

HB 172 was developed in response to Griffith v. Aultman Hospital and is meant to limit the definition of "medical record" for purposes of the law governing access to patient medical records.  For more information on this bill and to follow its progression in the House, see The Ohio Legislature website.

Tuesday, October 24, 2017

Cancer Registry Professionals – Get Ready for Changes in 2018

By Laura Vondenhuevel, BS, RHIT, CTR
You know the old saying, “change is the only constant in life?” Well as cancer registry professionals, don’t we know it! Every year we see tweaks being made to our manuals, code descriptions being added and new drugs being introduced to the oncology market. So change is something to which we cancer registrars have grown accustomed. And 2018 promises to be an interesting year for us.
Flash Back to 2010
If you were part of the cancer registry community back in 2010, you remember our last big change: the move from American Joint Committee on Cancer (AJCC) Staging Manual 6th edition to the 7th edition. The effects of this change were a big adjustment and even effected other cancer data collection manuals such as the Facility Oncology Registry Data Standards (FORDS) and Collaborative Staging. Cancer registry professionals who were around for this transition will remember an added challenge was that data items were released very close to the go live date of January 1, 2010, so many software providers were not ready to go live with their updates until months later in 2010. Do you remember the widespread suggestion to use paper abstracts to fill this gap? SMH. It was not fun and we were stuck abstracting, for the most part, at six months from date of first contact.
What’s Coming in 2018
Fast forward to 2018. The age of “Concurrent Abstracting” (or at least more concurrent than six months) is upon us with many hospital cancer registry professionals abstracting cases anywhere from “in real time” to six months from the date of first contact. And, if you have been reading your emails from our standard setters, you know another big change is on the way. The North American Association of Central Cancer Registries (NAACCR) has established a website to locate 2018 implementation information in one central location – that has been a big help for those of us cancer registry professionals who are trying to keep up! If you’re trying to keep track of what is being updated, here are some details that should definitely be on your list:

  • Staging: AJCC 8th Edition, Summary Stage 2018, Extent of Disease, and Site Specific Data Items (SSDI)
  • Coding: ICD-O 3 Revisions, Solid Tumor Rules (formerly the Multiple Primary and Histology (MP/H) Rules), Hematopoietic Database and Manual, and Standards for Oncology Registry Entry (STORE) Manual (formerly FORDS)

Many of these items will not be released until November 2017 or later. So what is a concurrently abstracting cancer registry professional to do? In my next blog post, I hope to share some ideas to prep your cancer registry for these changes. It’s always better to be prepared as possible! Stay tuned…
This article was originally featured on the CHAMPS Oncology Outlook blog on October 3, 2017 and reprinted with permission.  

Tuesday, October 17, 2017

Watch for New Medicare Numbers & Cards in 2018!

By Dana Markley, RHIA  

Did you know that the Centers for Medicare & Medicaid Services (CMS) is removing Social Security numbers from Medicare cards?

CMS recently published an article about the transition to new Medicare numbers and cards. CMS has been tasked with removing all social security numbers from all Medicare cards from April 2019. A new unique Medicare number called a "Medicare Beneficiary Identifier (MBI)" will replace the current Health Insurance Claim Number (HICN).  The MBI will assist in protecting patients from identity theft and illegal use. New cards will start being mailed in April 2018.  Beginning in April 2018, first-time Medicare recipients will receive a card with a new Medicare number. You will no longer will be to identify a patient who qualifies for Railroad Retirement Board (RRB) by the number listed on their card.  Going forward we will be able to identify this by the logo on their card.

In anticipation of October 2018, organizations should prepare to update their systems to accept this new number. MBIs will have 11 characters and will be randomly generated to include numbers and uppercase letters. An example of a new number is: 1EG4-TE5-MK73

CMS states they will release the new card design in September 2017.  The gender and signature line will be removed from new cards.  Latest details about this transition will be posted on this site : https://www.cms.gov/Medicare/new-Medicare-card/

Thursday, October 12, 2017

Cannabis Abuse/Dependence

 by Lynn Slocik, CCS

This article originally appeared in the Allegheny Health Network's monthly newsletter.   Article reprinted with permission. 

Thursday, October 5, 2017

ASK HIM: I Have My RHIA, Now What Do I Do?

Question submitted: After years of being an RHIT, I went back to school, passed the certification test and earned my RHIA credential!  Now what do I do?

Answer from Megan Patton:
So you went back to school to earn a higher degree and RHIA credential.  Like many, you probably sacrificed time with your family and friends, and likely had to give up sleep in order to fit in work, family, and school.  You wrote many papers, took many tests, and ultimately studied hard to pass the RHIA exam.  Now what? 

First, consider your motivation for going back to school.  Was it to earn a promotion?  Find a new job?  Open new doors of opportunity? Or fulfill a dream?  The reasoning behind your education will likely help guide your next steps.   A Forbes’ blog writer quoted a VP as telling them to “Make a plan-or someone else will make one for you (Miller, 2014)."

Next, update your resume.  If your goal was to find a new job, this will be a key opportunity to show off your new skills and abilities.  You have likely acquired many new skills in your course of study.  Some schools will have a career services department that can help review your resume and offer tips, take advantage of that opportunity before graduating.   There are also many helpful tips in the AHIMA Career Prep Workbook found under the Career Prep Tools. Don’t forget to think about your personal brand.  According to AHIMA’s Career Prep Workbook  “your personal brand is how you are perceived externally; your reputation, values, and vision all wrapped up together.”
One of the best ways to boost your resume and find a new job is to volunteer.  Volunteer for your local and state organizations.  OHIMA offers a wide variety of volunteer opportunities.  Run for a position on your local or state board.  Look for volunteer opportunities with AHIMA.  Most importantly, network!  Staying active with other professionals in your field will open many new doors and opportunities you had not considered or which you may not have been aware.  Check out the OHIMA blog post on volunteering.

One way to visualize your career is to use the AHIMA Career Map.  The Career Map will help you envision opportunities at all levels from entry to master.   Maybe you have been considering a change from coding to IT or from management to education.  This map will help you see potential options.  In the instructional design world we call this “storyboarding.”  Storyboarding is a visualization of how to get students from point A to point B.  The same can be done in your career.  Think about where you are now and where you want to be and create your storyboard of how you will get there.  Another way to see the possibilities is to check out job banks.  OHIMA and AHIMA both offer great job banks to search for potential opportunities.  

Another way to help obtain a new role or promotion is to create a portfolio.  Many college programs will have you keep a portfolio during your time in their program.  Some students will walk away without ever realizing the true potential value of that portfolio!  Maintaining samples of your best work in your program and samples from your work experience is a great addition to any portfolio.  Keep the portfolio going throughout your career.  When you are asked to provide an example of a project you worked on or how you meet a qualification you can use that portfolio to recall the information or better yet, show the employer!  Consider adding your portfolio link to your resume.

Think about finding a mentor in the field.  Even if you have been in the field for many years before earning your RHIA, you may still find having a mentor will help you on your path.  You may find a mentor in your workplace, through volunteering at your local, state or national associations, or through networking.  Find someone who is currently where you want to be.  Speak up!  A potential mentor will not seek you out, you have to look for one.

If your primary goal was to earn a promotion at your current workplace, then let your immediate supervisor know you passed your RHIA exam.  Maybe there are already opportunities you want to apply for, but your supervisor may know of opportunities on the horizon. So be open about wanting to learn new things and take on new responsibilities.   Schedule a time to meet with your supervisor and let them know you would like to discuss potential opportunities and what skills you have acquired. 

The most important thing to keep in mind is that you have already accomplished amazing things...and the rest is still unwritten. 



AHIMA. (n.d.) Career prep workbook. Retrieved from http://bok.ahima.org/doc?oid=302448#.XwTS4JNKg0o.

Halpern, M. (n.d.) Moving on up: How to ask for a promotion.  Retrieved from https://www.themuse.com/advice/moving-on-up-how-to-ask-for-a-promotion

Miller, J. (2014). 4 things your boss won’t tell you about advancing your career.  Retrieved from https://www.forbes.com/sites/dailymuse/2014/07/03/4-things-your-boss-wont-tell-you-about-advancing-your-career/2/#3b1d525874cf

About the Author 

Megan Patton, MEd, RHIA is an Assistant Professor at the University of Cincinnati's online HIM program.  She is currently serving her second term as an OHIMA Board Director focusing on Leadership and acting as the Committee Chair of the Summer Meeting Committee.  

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