HIM Professional Establish Data Standards

Marsha McMillen Unit 2 Assignment Healthcare Compliance I would think that the passage of CLIA would be very important to patients. CLIA is just one guarantee that their labs are accurate and reliable. “Congress passed CLIA in 1988 to establish quality standards for all non-research laboratory testing.” Knowing that CLIAs regulation have ten different standards would and should be important to the patient. These standard are guarantees that when the patient has test done in the doctor’s office that they will be done correctly and efficiently.

The accredited standards committee has been charged with developing the standards for EDI. The department of health and human services embraced the ASC X12 standards. The goal of EDI standards is to make seamless transfers of information between providers and healthcare plans and payers. ASX X12N 837 is a messaging standard that covers the electronic submission of healthcare claims (Sayles, 2013). The Pan American EDIFACT Board (PAEB) directs activities regionally for EDI message development, maintenance, and technical assessment.

Activity to be Audited 5.4.3 Request Form Information: a) Does the request form contain: I. Forename and surname II. Gender III. Date of birth IV. Address V. Hospital number b) Name or other unique identifier of clinician or other person legally authorized to request examinations & Destination of report: c) Type of primary sample and the anatomic site of origin, where appropriate; d) Examinations requested; e) Clinical information relevant to the patient, which should include gender and date of birth, as a minimum, for interpretation purposes; f) Date and time of primary sample collection; g) Date and time of receipt of sample by the laboratory.

The Center for Medicare and Medicaid Services (CMS) oversees multiple government programs. As part of the Health and Human Services (HHS), CMS finances healthcare for more Americans than any other single entity. CMS's influences come from both regulatory and legislative decisions made by congress. This can cause problems when Medical decisions are influenced by whatever government parties in charge. CMS is also in charge of the program transmittals to communicate new or changed policies and producing the quarterly provider updates.

Among the wide range of standards available for the integration and interoperability of medical information systems is data exchange or messaging standards. The purpose is to broadly provide instructions or specifications for the structure, format, and elements for data pertaining to health related operations that involve clinical, financial and administrative data. More specifically messaging standards defines the relationship among data elements for structuring data as they are interchanged. 7.1.1 HL7. V3 - Health Level 7 Messaging Standards Version 3

Whether professional standards should be principles-based rather than rules-based is an unresolved issue. The general belief is that, by relying on bright-line and quantifiable evidence, rules-based standards often provides a vehicle for circumventing the intention of the standard (SEC, 2003). However, others have argued that, by relying on auditors' professional judgment, principles-based standards require auditors to be competent and independent. For example, Robert Herz, former chairman of the Financial Accounting Standards Board (FASB), has cited the recent events in the U.S. as evidence that preparers and auditors cannot be trusted to properly exercise professional judgment with objectivity and courage" (Herz, 2003). Furthermore, principles-based

Response to Compliance Management Scenario Compliance management is a complicated and ever expanding portion of the Health Information Management (HIM) field. As federal, state and local laws are created and revised, HIM professionals must stay current of not only the regulations but also the consequences of non-compliance. Along with federal, state and local laws, attention must be paid to the guidelines of various accreditation and credentialing bodies. Scenario Mistakes, Type of Violation and Preventative Solution There are several mistakes made in the provided Compliance Management Scenario.

Patient fall was serious alarming threat in patient safety. The author was a state registered nurse in private hospital in Kuala Lumpur, Malaysia with seven years of working experienced. Based on the statistic showed from 0.04% in January 2017 increased to 0.10% in February 2017 (Quality Department, Author’s Hospital, March 2017). The management had gathered a team and conducted the root cause analysis (RCA). The result of the RCA showed it was due to communication failure between patient and nurse during orientation, inadequate patient fall risk assessment done by nurses, understaffing and latest technology devices to prevent fall were not available.

Quality improvement in healthcare is to improve patient outcomes by standardizing evidenced-based patient-centered care (Centers for Medicare and Medicaid Services [CMS], 2017). To accomplish improvement of the quality of care one must be able to measure the improvements, which is quality measurement (CMS, 2017). Quality improvement and quality measurement are essential components of a quality improvement initiatives to assist a healthcare organization to acquire and transform patient-centered care interventions to improve quality of care, patient safety, and patient satisfaction (Institute for Healthcare Improvement [IHI], 2018). Healthcare Concern The Labor and Delivery Unit (LDU), is a small rural hospital specialty unit in Northeastern

The Strategy is Accreditation to Change the Culture Strategic planning is a process to formulate fundamental decisions and actions. One key factor for a successful long-term strategic planning process is identification of the required core competencies, based on systematic analysis, and then start working on acquiring these core competencies so that the organization will be a strongly positioned for the environment and competition in the future (Mintzberg, 1987). As the organization must focus on specific activities to be effective and efficient towards the desired outcomes, strategic choices must be well defined.

While reviewing the posts for team one discussion this week it looks like they are all agreed that standardization would have a positive within the healthcare system. Collecting data and the exchanging of health information are essential in improving patient safety and quality care. Having standardized terminology will simplify the transference of data among providers and decrease misunderstandings. I feel that only a few individuals directly mentioned how big of an impact standardization will have on overall clinical workflow. Standardization will allow clinicians to dedicate more time to patient