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AUGUST 2014
A HIM A2014
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HOW TO BECOM
A L E A DE R A ND
R
DECISION-MAKE
IN HE ALTHCARE
Welcome
TO THE DIGITAL EDITION OF THE
JOURNAL AHIMA
OF
A Conversation with the 2014 AHIMA Nominating

Committee Chair
Tim Keough, MPA, RHIA, FAHIMA, discusses the issues affected

by the upcoming AHIMA election and voting as a professional
responsibility.
Three Myths of ICD-10-CM/PCS
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Contents August 2014
Cover
18
Taking Your Seat

(at the Head of
the Table)
How to become a leader

and decision-maker in
healthcare
By Lisa A. Eramo
Vol. 85, no. 8

Departments
10
Presidents Message
Using Our Influence to Lead for the
Greater Good
12
pg. 26
In the theater of HIM, information governance is a
coming attraction thats generating ample buzz.
Features
22
How to Lead Your Organization in

Compliance, Ethics, and Customer Service
HIM professionals can help organizations
create a culture of compliance
Bulletin Board
17
Inside Look
HIM Must Shoot for the Moon
62
Calendar
By Ben Burton, JD, MBA, RHIA, CHP, CHC
26
Coming Soon to Your Healthcare Facility:

Information Governance
A look at healthcare information governance
trends through practical case studies
63
Keep Informed
64
Volunteer Leaders
By Lesley Kadlec, MA, RHIA
34
Realigning HIM to the New Healthcare

Environment
Case studies in HIM transformation due to
accountable care and pay-for-outcomes
initiatives
By Patricia Bower-Jernigan, RHIA, Ann Chenoweth, MBA, RHIA, and

Jaime James, MHA, RHIA
68
AHIMA Career Center
72
Addendum
Less for the Executive,
More for the Entry-Level
40
Three Myths of ICD-10-CM/PCS

Addressing why it is not feasible to use
SNOMED CT in place of ICD-10 or to wait
for ICD-11and other misperceptions
By Sue Bowman, MJ, RHIA, CCS, FAHIMA
46
Roles for HIM Professionals in HIOs
By Linda Bailey-Woods, RHIA, CPHIMS; Julie Dooling, RHIA;

Diane Fabian, MBA, MS, RHIA; Tanya Kuehnast, MA, RHIA, CHPS;
Stephanie Luthi-Terry, MA, RHIA, FAHIMA; Jackie Raymond, RHIA;
Harry B. Rhodes, MBA, RHIA, CHPS, CDIP, CPHIMS, FAHIMA;
and Kathy J. Westhafer, RHIA, CHPS
50
Federal Changes Proposed for eDiscovery

Litigation Rules
Several modifications will directly impact HIM
By Ron Hedges, JD
54
Leveraging the Leader-Member Exchange

Theory in HIM
By T.J. Hunt, MBA, RHIA, CHTS-IM
56
2014 AHIMA Election Ballot
pg. 40
The myth that SNOWMED CT can be used in place of ICD-10 has
again reared its ugly head.
4/Journal of AHIMA August 14
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http://journal.ahima.org
Approaching the IT-asa-Service ModelSome
healthcare providers are
turning to IT-as-a-Service as
a way to supplement their IT
staff. The move is necessary
in order to better support high
maintenance EHRs and ensure
health information privacy
and security remains intact.
Video: A Conversation with the

2014 AHIMA Nominating Committee
ChairTim Keough, MPA, RHIA, FAHIMA, discusses the issues affected by the upcoming AHIMA
election and voting as a professional responsibility.
Coverage from AHIMAs Clinical

Documentation Improvement Summit
Review major news from the CDI Summit, dedicated
to leading the documentation improvement journey in
healthcare, being held August 4-5 in Washington, DC.
Share and Connect with AHIMA

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The Journal of AHIMA is an official publication of AHIMA
AHIMA CEO
EDITORIAL DIRECTOR
EDITOR-IN-CHIEF
Lynne Thomas Gordon, MBA, RHIA, FACHE, CAE, FAHIMA

Anne Zender, MA
Chris Dimick

ASSISTANT EDITOR/
ADVERTISING COORDINATOR Sarah Sheber

ASSOCIATE EDITOR

CONTRIBUTING EDITORS

Mary Butler
Meryl Bloomrosen, MBA, RHIA, FAHIMA
Sue Bowman, MJ, RHIA, CCS, FAHIMA
Angie Comfort, RHIT, CDIP, CCS
Angela Dinh Rose, MHA, RHIA, CHPS, FAHIMA
Julie Dooling, RHIA
Katherine Downing, MA, RHIA, CHP, PMP
Deborah Green, MBA, RHIA
Jewelle Hicks
Lesley Kadlec, MA, RHIA
Paula Mauro
Anna Orlova, PhD
Kim Osborne, RHIA, PMP
Harry Rhodes, MBA, RHIA, CHPS
Maria Ward, MEd, RHIT, CCS-P
Diana Warner, MS, RHIA, CHPS, FAHIMA
Lydia Washington, MS, RHIA
Lou Ann Wiedemann, MS, RHIA, CHDA, CDIP, CPEHR,
FAHIMA
ART DIRECTOR Graham Simpson
EDITORIAL ADVISORY BOARD

Linda Belli, RHIA

Gerry Berenholz, RHIA, MPH
Carol A. Campbell, DBA, RHIA
Rose T. Dunn, CPA, RHIA, FACHE
Teri Jorwic, RHIA, CCS
Diane A. Kriewall, RHIA
Frances Wickham Lee, DBA, RHIA
Glenda Lyle, RHIA
Susan R. Mitchell, RHIA
Daniel J. Pothen, MS, RHIA
Cheryl Tabatabai Stachura, RHIA
Tricia Truscott, MBA, RHIA, CHP
Carolyn R. Valo, MS, RHIT, FAHIMA
Valerie Watzlaf, PhD, RHIA, FAHIMA
ADVERTISING REPRESENTATIVES
Network Media Partners
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(410) 584-1940; Fax: (410) 584-8353
jrhodes@networkmediapartners.com
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(410) 584-1941; Fax: (410) 316-9865
bsullivan@networkmediapartners.com
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AHIMA ONLINE: www.ahima.org
JOURNAL OF AHIMA: journal@ahima.org
JOURNAL OF AHIMA MISSION
The Journal of AHIMA serves as a professional development tool
for health information managers. It keeps its readers current on
issues that affect the practice of health information management.
Furthermore, the Journal contributes to the field by publishing work
that disseminates best practices and presents new knowledge.
Articles are grounded in experience or applied research, and they
represent the diversity of health information management roles and
healthcare settings. Finally, the Journal contains news on the work
of the American Health Information Management Association.
EDUCATIONAL PROGRAMS
The Commission on Accreditation for Health Informatics and
Information Management Education (www.cahiim.org) accredits
degree-granting programs at the associate, baccalaureate, and
masters degree levels.
AHIMA recognizes coding certificate programs approved by the
Approval Committee for Certificate Programs. For a complete list of
AHIMA-approved coding programs and HIM career pathways go to
www.hicareers.com.
Journal of AHIMA (ISSN 1060-5487) is published monthly, except for the combined issue of November/December, by the American Health Information Management Association, 233 North Michigan
Avenue, 21st Floor, Chicago, IL 60601-5800. Subscription Rates: Included in AHIMA membership dues is a subscription to the Journal. The annual member subscription rate is $22.00 for active and
graduate members, and $10.00 for student members. Subscription for nonmembers is $100 (domestic), $110 (Canada), $120 (all other outside the U.S.). Postmaster: Send address changes to Journal
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Periodicals postage is paid in Chicago, IL, and additional mailing offices.
Notice of Policy
Editorialviews expressed in articles contributed to the Journal of AHIMA are those of the author(s) and do not necessarily reflect the policies and opinions of the Association, editorial review
board, or staff. Articles are not to be construed as endorsing any particular product or service. Advertisingproducts, services, and educational institutions advertised in the Journal do not imply
endorsement by the Association.
Copyright 2014 American Health Information Management Association Reg. US Pat. Off.
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Presidents Message
Using Our Influence to Lead for

the Greater Good
By Angela C. Kennedy, EdD, MBA, RHIA
In a healthcare ecosystem where volume-based models are shifting to valuebased ones, organizations will depend
more and more on the use of informatics to drive decisions. Our success will
depend on our ability to drill down to the
level of detail required to support evidence-based medicine and better business decisions.
As HIM professionals, our fundamental understanding of information governance positions us as a key resource
in facilitating related best practices for
our organizations. Greater access to secure data will be a catalyst for improving
overall population health. We are acutely
aware of how ICD-10-CM will help shape
population health and the great benefit
consumers and organizations will derive
from making the switch from ICD-9-CM
to ICD-10-CM/PCS.
At this point you are probably thinking
this is old news, right? I have addressed
all of the issues outlined above before,
and each of them are threaded into the
pillars of AHIMAs strategic planinformation governance, informatics, innovation, public good, and leadership. (Note:
leadership is the driving force behind the
success of the other pillars.)
But leadership isnt about obtaining a
degree, a credential, or even a position.
Its not management, a career path, or
even self-promotion. Its about using influence to achieve common goals for the
greater good.
As professionals, its imperative that
we break down silos and rivalries. We
know that the walls of HIM are barely
noticeable today and that there is no
value in territory. To gain influence you
have to build relationships and earn
trust. Educator and author Stephen R.
Covey, PhD, said, The job of a leader
is to build a complementary team where
every strength is made effective and ev10/Journal of AHIMA August 14
ery weakness is made irrelevant.

It takes more than skill to lead. Presence has impact and health information
professionals must show and demonstrate the value of their leadership in an
environment that is rapidly evolving. It
wont be an easy taskwe must leave
our comfort zone, take risks, and conquer new territory. We cant build upon
the decisions we fail to ever make. Successful people arent afraid of failure
perfection isnt likely to show up at the
start of the journey.
I have a saying that I share with my
children often: Your character is the
sum of your actions. Leadership relies
upon a persons character and integrity.
You cant build influence if you cant be
trusted. As HIM professionals, we must
be committed to doing the right thing for
the right reason. Integrity is a key ingredient to influence. To be a leader, you
have to commit to core values and you
must be genuine.
Dedicate yourself to learning and personal growth, focus on the professions
mission, and shift from rules to relationships. As Starbucks Chairman and
CEO Howard D. Schultz said, Victory
is much more meaningful when it comes
not just from one person, but from the
joint achievements of many. The euphoria is lasting when all participants lead
with their hearts, winning not for just
themselves but for one another.
HIM professionals are poised to step
up as a unifying force leading the charge
forward as healthcare organizations
face the many challenges ahead.
As always, dream big, believe, and
LEAD.
Angela Kennedy (angela.kennedy@ahima.org) is
head and professor, department of health informatics and information management, at Louisiana Tech University.
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Bulletin Board whats happening in healthcare
AHRQ Report: Healthcare Quality Improving in Hospitals

The quality of care provided by US
hospitals is improving, according
to a new report from the Agency for
Healthcare Research and Quality
(AHRQ).
According to the recently released
AHRQ 2013 National Healthcare Quality and Disparities Report, hospitals
are leading the movement to improve
the quality of care delivered to patients, outpacing improvements measured in other care settings like home
health and nursing homes. A look at
AHRQ quality measures recorded for
hospitals revealed 75 percent showed
significant improvement, compared
with a 60 percent improvement for
measures tracking home health and
nursing home care, and a 50 percent

improvement for ambulatory care, according to an AHRQ press release.
The improvement was shown
through data collected from hundreds
of healthcare measures in various
categories of quality, such as effectiveness, patient safety, timeliness,
patient-centeredness, care coordination, health system infrastructure, and
access.
The higher quality improvement recorded in hospitals can be attributed
to various quality improvement initiatives that focus on that care setting,
AHRQ reported, such as the Department of Health and Human Services
Partnership for Patients, the Centers
Rule Changes Considered for Handling

Substance Abuse, Mental Health Records
A government health regulatory panel
is considering updating federal privacy laws governing substance abuse
and behavioral health records that
would potentially increase the ability
to access sensitive information without a patients consent.
The Office of the National Coordinator for Health ITs Health IT Policy
Committee approved recommendations by its Privacy and Security Tiger
Team workgroup that would require
behavioral health providers using
electronic health records (EHRs) to
tag documents containing sensitive
information, according to a notice in
the Federal Register. The move would
make it easier for the records to be
electronically exchanged via health
information exchange organizations.
Medical records concerning substance abuse and behavioral health
issues enjoy more stringent protections, which some stakeholders worry
could present barriers to health information exchange (HIE) and account12/Journal of AHIMA August 14
able care organization (ACO) plans.

In its own comments submitted to
the Substance Abuse and Mental
Health Services Administration (SAMHSA) at the Department of Health
and Human Services, AHIMA said it
agreed with updating the regulations,
but believes SAMHSA should consider limiting the changes to information related to current medications,
medication history, diagnosis, patient
encounters, and allergies. Without
this limitation, AHIMA believes that
the proposed definition based on services could negatively impact providers, as it would expand the current
definition to providers and facilities
that provide services but do not meet
current facility definitions.
Additionally, AHIMA urged SAMHSA to work with outside provider and
vendor groups to make these changes possible and to maintain patient
privacy. It also warns that making the
law too broad or too specific could
have unintended consequences.
for Medicare and Medicaid Services

(CMS) Hospital Inpatient and Outpatient Quality Reporting Programs, and
private sector initiatives like the work
of the Institute for Healthcare Improvements. The increasing ability of
the public to monitor and use hospital
quality measures may have also contributed to the improvements. According to the report, 14 of the 16 quality
measures that reached a 95 percent
performance level were publicly reported by CMS Hospital Compare
website. Only 60 percent of hospital
quality measures that are not publicly
reported by CMS showed improvement.
The intense national focus on qual-
CMS Aims to Simplify

RAC Queries with
New Role
The Centers for Medicare and Medicaid
Services (CMS) has created a new position to help streamline and manage the
concerns of healthcare providers undergoing a review by Medicare Recovery Audit Contractors (RAC). According
to a CMS announcement in June, the
role of provider relations coordinator
was created to help increase program transparency and offer more efficient resolutions to providers affected
by the medical review process. CMS
clarified that providers with questions
about specific claims should go directly
to their RAC auditor or the Medicare
Administrative Contractor (MAC) who
conducted the review, while questions
about larger process issues should be
directed to the provider relations coordinator. The coordinator could also respond to concerns about auditors that
are failing to comply with documentation request limits or that have a pattern
of not issuing timely review results.
ity improvement in hospitals is starting to pay off, but much work remains
to make sure that all Americans have
access to high-quality care in every
setting, said AHRQ Director Richard
Kronick, PhD, in a press release.
US patients are receiving recommended medical services 70 percent
of the time, the report said. This percentagewhich shows the number
of individuals who did not delay or
defer recommended medical serviceshas remained the same since
2009. The study showed that rates of
some hospital-acquired infections are
beginning to drop while processes to
prevent hospital readmissions are
improving, such as adolescent vac-
cination, HIV treatment, and hospital

care for patients with heart problems.
Quality worsened in measures on diabetes checkups, Pap smears, maternal deaths at delivery, and preventive
care for asthma patients.
The quality care outlook wasnt
completely positive. With regards to
healthcare access disparity, 26 percent of Americansespecially racial
and ethnic minorities and low-income
individualsreported difficulties receiving care. Most disparities in the
quality of care related to race, ethnicity, or income showed no significant
change from previous years. AHRQ
has released these reports annually
since 2003.
Cloud-Based Services on the Rise in

Healthcare
A significant majority of healthcare providers use cloud-based services, with
many planning to move more systems and data to the cloud, according to a
HIMSS Analytics survey presented at the Privacy and Security Forum in San
Diego, CA in June. Common cloud services discussed in the survey results
include health information exchange, human resource applications, and data
backup and recovery. Despite the large number of providers using cloud-based
services, only 2.4 percent reported using platform-as-a-service technologies. The survey also addressed challenges that face cloud adopters, such as
vendor unwillingness to sign a HIPAA-required business associate agreement
and physical and technical security concerns.
Healthcare Providers Using Cloud-Based Services
The Veterans Affairs Department now

plans to purchase a new scheduling
system to integrate with their VistA
electronic health record system.
The American Hospital Association sent
a letter to the Centers for Medicare and
Medicaid Services urging the agency to
create a centralized repository on public health agency readiness to accommodate the data hospitals are required
to submit under the meaningful use
EHR Incentive Program.
Electronic health record company
Drchrono, based in Mountain View,
CA, has developed an app for Google
Glass that allows doctors to record
consultations and surgeries with patient permission.
Federal health IT policymakers are
looking to move to a more flexible
approach to EHR quality improvement, according to Jacob Reider,
MD, deputy national coordinator and
chief medical officer for the Office of the
National Coordinator for Health IT.
The US Department of Defense has
released the third draft of its Healthcare
Management System Modernization solicitation, taking another step towards
acquiring its own health record system.
The Energy and Commerce Committee
hosted its second 21st Century Cures
roundtable in June to discuss steps
Congress can take to advance health
technology and create related regulatory policies.
The Indian Health Service has contributed
its open source EHR technology to the
VistA code base.
83%
As part of the American Health Information

Management Associations endorsement
of Learning Health System core values,
the association has joined the Learning
Health Community.
The Food and Drug Administration is using
electronic health data to monitor drug
and medical device safety in its MiniSentinel pilot program.
Source: HIMSS Analytics. 2014 HIMSS Analytics Cloud Survey. June 2014. www.himssanalytics.org/research.
Journal of AHIMA August 14/13
Bulletin Board whats happening in healthcare
Breach Enforcement May Increase as Wall of

Shame Logs Thousandth Entry
ITS ONLY A COMPUTER: VIRTUAL HUMANS
INCREASE WILLINGNESS TO DISCLOSE
www.sciencedirect.com/science/article/pii/S0747563214002647
Researchers found that patients were
more willing to disclose information
on medical history to virtual humans
in clinical interviews, according to this
study, including information related
to mental health. When participants
believed they were interacting with a
computer instead of a human or human-controlled system, they reported
lower fear of self-disclosure, lower
impression management, displayed
their sadness more intensely, and were
rated by observers as more willing to
disclose.
FIRST NATIONAL SURVEY OF ACOS FINDS
THAT PHYSICIANS ARE PLAYING STRONG
LEADERSHIP AND OWNERSHIP ROLES
http://content.healthaffairs.org/content/33/6/964.abstract
A study in Health Affairs finds that 51
percent of accountable care organizations (ACOs) were physician-led last
year. In addition, 78 percent of ACOs
included physicians as a majority of
the governing board. It seems likely
that the challenge of fundamentally
changing care delivery as the country
moves away from fee-for-service payment will not be accomplished without
strong, effective leadership from physicians, the studys authors wrote.
INTERACTIVE WEB-BASED PORTALS TO
IMPROVE PATIENT NAVIGATION AND CONNECT PATIENTS WITH PRIMARY CARE AND
SPECIALTY SERVICES IN UNDERSERVED
COMMUNITIES
http://perspectives.ahima.org/
interactive-web-based-portals-toimprove-patient-navigation-and-connect-patients-with-primary-care-andspecialty-services-in-underservedcommunities/#.U62vtVPag-8
A case study investigates the redesign,
development, and implementation of
a web-based healthcare clinic search
tool for virtual patient navigation for
underserved populations in Texas. The
study focuses on the use of health IT to
bridge the gap between underserved
populations and healthcare access.
The infamous Department of Health

and Human Services (HHS) Office for
Civil Rights (OCR) breach notification
websiteinformally known as the wall
of shame for HIPAA-covered entitieslogged its one thousandth entry
in June. The milestone hit shortly before a HHS chief regional civil rights attorney told members of the American
Bar Association (ABA) that OCR was
ramping up breach enforcement in the
coming months.
As of June, a total of 31.7 million
people have had their health records
exposed in 1,026 major breaches since
OCR launched the breach notification
website in September 2009 under the
American Recovery and Reinvestment
Act (ARRA), according to an article
in Modern Healthcare. Under ARRA,
HIPAA-covered entities are required
to report breaches impacting over 500
people to OCR for posting on the site.
Since June 2013 OCR has collected
over $10 million in breach settlements

from HIPAA-covered entities, including a record $4.8 million settlement in
May 2014, according to an article in
Data Privacy Monitor. But this ramp
up in OCR enforcement could be just
the beginning. During his presentation to the ABA, Jerome Meites, HHS
chief regional civil rights counsel for
the upper Midwest region, said the
last 12 months of enforcement activity will pale in comparison to the next
12 months, according to Data Privacy
Monitor.
While not a member of OCRs staff,
Meites has represented OCR in several high-profile breach settlement
cases, according to Modern Healthcare. Meites said OCR had increased
enforcement efforts and several highprofile cases are in the works that they
hoped will shock the healthcare industry into more effective breach prevention efforts.
Apple Launches Health App Linked to EHRs

Apple announced in June that it will
be partnering with electronic health
record (EHR) vendor Epic Systems as
part of the companys foray into the
world of mobile fitness tracking. The
partnership allows Apple to integrate
patients actual health records into
their new platform. The deal has the
potential to revolutionize how patients
access their medical history, according to an article in Vox.
About 40 percent of Americans already have medical information digitally stored via Epics EHR systems, accounting for millions of patient records,
according to the article. As Apple integrates its new native health tracking
platform, HealthKit, with those millions
of records, the app will have a significant advantage in identifying people
whose health is a problem and have a
sizeable opportunity for improvement.
The Mayo Clinic has already developed an app to integrate with HealthKit. When a patient undergoes a blood
pressure reading, for example, the
integrated app is automatically able
to check whether that reading is in
that patients personalized healthcare
parameters threshold, according to
a statement from Apple Senior Vice
President of Software Engineering
Craig Federighi. And if not, it can contact the hospital proactively.
Some experts have raised concerns
that in a market already largely controlled by Epic, providers could start to
feel pressure to adopt systems that are
compatible with the new Apple system.
HealthKit looks to move the information gathered by wellness apps beyond
a silo existence, giving consumers a
comprehensive picture of their health,
according to Federighi.
Research Studies Show Healthcare Benefits

of Social Media
Medical professionals are starting to
embrace social media as a means of
monitoring and educating patients,
disseminating health research and information, and gathering and tracking
data on public health hazards.
Ruthi Moore, director of nursing for
the Navy-Marine Corps Relief Society,
and a team of 52 nurses created their
own Twitter and Facebook accounts
and invited patients to follow them so
they could track their patients mood
and state of mind, according to a US
News and World Report article. The
nurses use the sites to post links to
articles on post-traumatic stress disorder, common among the Marines they
treat, but also to look for signs of depression and suicidal thoughts based
on comments their patients post.
Moore estimates that her team has
prevented 12 suicides through social
media monitoring.
When patients were discharged, we

always worried about where they were
going, who they were going to see,
whether they knew what they were supposed to be doing, said Judy Murphy,
the Office of the National Coordinator
for Health IT deputy national coordinator for programs and policy, in remarks
delivered at a Microsoft-sponsored forum on nursing and health IT, according
to US News and World Report. Now,
we do it more overtly, we do it in a more
organized fashion, we use health IT to
be able to do that.
A recent Health Affairs study on social media and medical research also
concluded that as healthcare reform
evolves, health policy makers and researchers should use social media to
bridge the communication gap with
consumers. Some researchers were
hesitant to use social media since they
perceived the sites as non-scientific.
AMA Approves Telehealth Guidelines

As use of telemedicine services becomes more popular and clinicians
start to take telehealth more seriously,
there have been more calls to develop
guidelines and regulate its use.
The American Medical Association (AMA) recently endorsed remote
monitoring and physician interactive
services and approved a list of guiding principles for telemedicine, noting
that, Whether a patient is seeing his
or her physician in person or via telemedicine, the same standards of care
for the patient must be maintained,
said AMA President Robert Wah, MD,
in a statement.
The AMA recommends that before
starting telemedicine consults, a patient should have a face-to-face conversation with their provider. The
face-to-face encounter could occur
in person or virtually through realtime audio and video technology, the

guidelines state. The guidelines also
recommend that physicians make patients aware of cost-sharing responsibilities and limitations in drugs that can
be prescribed via telemedicine.
Telemedicine can strengthen the
patient-physician relationship and improve access to receive care remotely,
as medically appropriate, including
treatment for chronic conditions, which
are proven ways to improve health outcomes and reduce health care costs,
Wah said.
In an interview with EHR Intelligence,
Wendy Diebert, RN, BSN, vice president of Mercy Health Systems Telehealth Services, said telehealth allows
physicians to share better resources
and reach more patients.
TRACKING HEALTH REFORM IN CALIFORNIA

www.chcf.org/aca-411
An interactive data tool from the California HealthCare Foundation, ACA
411, provides policy makers, providers,
and healthcare delivery stakeholders
with a resource to gauge the progress
of the Affordable Care Act. Data provided includes rates of uninsured, private
and public coverage levels, insurance
status and Covered California enrollment, quality of care, barriers to care,
use of care, and consumer spending
and premium sharing for employees.
WEBINAR: CMS PAY FOR PERFORMANCE
METHODOLOGY
www.ahimastore.org/ProductDetailAudioSeminars.aspx?ProductID=17472
AHIMA offers webinars that provide reliable, expert, and timely information. In
September, CMS Pay for Performance
Methodology covers at a high level the
elements and methodology for CMS
pay-for-performance quality components that have been changed, as well
as key strategies related to documentation and coding that will impact these
measures.
CMS WEBINARS TO EASE ICD-10 TRANSITION
www.roadto10.org/?page_id=3504#fam
The Centers for Medicare and Medicaid
Services has created a series of webinars designed to ease providers into
the transition to ICD-10-CM/PCS. The
webinars cover a variety of specialties.
MOBILE ADVISOR APP
www.lippincottsolutions.com
Wolters Kluwer Health has released
the Lippincott Advisor App for institutional users of the Lippincott Advisor
clinical decision-support point-of-care
software. The mobile application was
developed to allow hospitals and other healthcare provider institutions to
give staff full access to the Lippincott
Advisor from both Android and Apple
smartphones and tablet devices.
86th
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September 27October 2 | San Diego, CA
Where Healthcare Leaders Meet
16
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Exciting, Inspiring and Informative Keynote Speakers:
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MSc, National Coordinator
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Eric Topol, MD, Director,

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Rich Bluni, RN,

Studer Group
Jeff Arnold, Co-Founder

and CEO, Sharecare
Gather with healthcare leaders, colleagues, and friends to discuss

how health information is driving healthcare!
ATTENDEES CAN EXPECT:
Thought provoking educational sessions on topics such as:
data analytics, informatics, information governance, meaningful use, ICD-10,
and privacy and security, among others
Exciting, inspiring, and informative speakers
Opportunities for networking and collaboration
Appreciation Celebration: Rockin in the Park: 60s and 70s
A Go-Go at Petco Park
Sunny San Diegos fine dining, culture, entertainment and
world-class shopping!
ahima.org/convention
#AHIMACON14
MX9727
Inside Look
HIM Must Shoot for the Moon

By Lynne Thomas Gordon, MBA, RHIA, FACHE, CAE, FAHIMA, chief executive officer
ONE OF MY fathers favorite sayings

was: Shoot for the moon. If you only get
to the stars, its better than never having
gone at all.
Its a saying that kept coming back to
me as I was getting ready to write this
column for the Journal issue on leadership. If youve heard me talk about our
big, audacious goals at AHIMA, then
this will make perfect sense to you.
Leaders Turn Goals Into Successes

While you dont have to have big, audacious goals to be a leader, it does take
leaders to get a big, audacious goal accomplished.
No wonder, then, that leadership is
one of AHIMAs key values as an organization. Weve got a lot of big, audacious
goals to accomplish. The good news:
You dont have to be a CEO, a director,
or even a manager to be a leaderas this
issue of the Journal shows.
An In-Depth Look at Leadership

Each August we publish a special issue
of the Journal with extended features on
a selected subject. This year we feature
a broad selection of articles giving examples of ways HIM professionals can
be leaders in their organizations. In our
cover story, Taking Your Seat (at the
Head of the Table), by Lisa Eramo, one
interviewee points out that its not just a
question of being at the table but asking
What does the organization need, and
can I meet that need?
What may be needed in the broader
sense is a willingness to step into transformational roles, both inside and outside the traditional HIM department.
Several articles touch on this theme,
including Realigning HIM to the New
Healthcare Environment, by Patricia
Bower-Jernigan, Ann Chenoweth, and
Jaime James, How to Lead Your Or-
ganization in Compliance, Ethics, and

Customer Service by Ben Burton, and
Roles for HIM Professionals in HIOs,
written by a cross-section of HIM professionals from AHIMAs Health Information
Exchange Practice Council.
At other times, what may be needed is
a laser focus in one specific area, such
as information governance (IG). As part
of AHIMAs ongoing effort to build the
industry body of knowledge in IG, Lesley Kadlec presents the results of four
case studies in Coming Soon to Your
Healthcare Facility: Information Governance. (You can find the IG case studies
online as well.) IG-centric themes such
as information preservation and retention also emerge in Ron Hedgess look at
potential changes to the Federal Rules of
Civil Procedure in Federal Changes Proposed for eDiscovery Litigation Rules.
On another important topic, Sue Bowman positions readers to become knowledge leaders on the ICD-10 code set by
taking on the task of dispelling myths
and misperceptions in Three Myths of
ICD-10-CM/PCS.
AHIMA has published an online-only
research journal, Perspectives in HIM,
for a decade. We are pleased to excerpt
Leader-Member Exchange Relationships in HIM, by T.J. Hunt, in this issue
an article that offers a look at a proven
leadership method that gets results.
Finally, this issue contains details on
this years AHIMA election, including information on voting and biographies of
the candidates. Further information on
the candidates can be found on the official AHIMA ballot at ivote.ahima.org. I
urge you to read these carefully and cast
your vote for the future leaders of our association.
I hope you, too, will give some thought
to what your own big, audacious goals
may beand ready your rocket ship.
e Table)
(at the Head of th
By Lisa A. Eramo
OME A
HOW TO BEC
DECISIOND
N
A
R
E
D
A
E
L
ALTHCARE
MAKER IN HE
Taking Your Seat
LEADERS ARE INNOVATIVE, strategic, and collaborative.

Leaders are confident and creative problem solvers. Theyve
worked hard to hone their knowledge and earn the respect of
others. Leaders are known for their subject matter expertise, as
well as their business savvy.
In healthcare, leadership opportunities for HIM professionals abound. As healthcare changes and evolves commensurate
with technology, HIM professionals must be able to rise to the
top within their organizations and advocate for privacy, security, data integrity, and more. However, even the most knowledgeable and confident HIM professionals sometimes feel overlooked, and perhaps even ignored, when important initiatives
are launched. Just why this happens to such a talented group
of professionalsnot getting a seat at the proverbial decisionmaking tableis not just due to chance.
Experts say one reason could be that HIM as a profession is
undergoing an identity transformation. Professionals and the
facilities in which they work dont always know how HIM fits
into the larger picture as both a process and function. The profession has become more technology-driven and de-centralized, touching nearly every department within an organization
and in some places moving outside the traditional centralized
HIM department.
The challenge for HIM professionals to move into leadership
roles has been present for decades, and something that experts
say must be addressed directly if HIM professionals want to remain relevant in healthcare and see long-lasting change. Professionals need to leave their comfort zones and embrace the
new HIM leadership identity, industry experts say.
A New and Emerging Identity

The HIM profession has adapted to the point that its interests,
particularly privacy and security and data management, must
be represented when major decisions are made at healthcare
organizationsor else. Our profession is changing, and our
identity is changing. I think traditional HIM has evolved, says
Victoria Weaver, assistant vice president of clinical data management at Hospital Corporation of America (HCA), based in
Nashville, TN. Weve had this call for active leadership for
quite some time, and I think some of our colleagues are choosing to accept the challenge, and some of our colleagues are
choosing not to.
However, HIM professionals who will be successful in the
long-term are those who look beyond traditional HIM functions of coding and documentation, says Andretta Reed, MHA,
RHIA, assistant vice president of HIM operations and coding at
Capella Healthcare, based in Franklin, TN. Todays HIM leaders
should be involved in choosing and designing electronic health
record (EHR) systems, developing compliance policies and procedures, launching population health monitoring programs,
implementing patient portals, purchasing new equipment, integrating personal health devices, and more, Reed says.
Any time that youre looking at a service line or product that
affects documentation or quality of care, HIM does need to be at
the table to have these discussions, she says.
Major decisions cant always come down to what is best for
just physicians. Some of these purchasing and operational decisions are made based on the best workflow for the clinician,
but HIM needs to incorporate standard requirements for good
documentation, Weaver says.
HIM professionals should also play a key role in acquisition
decisionsthat is, the decisions to purchase other facilities or
physician practices. Reed says organizations must defer to HIM
to answer questions such as Do the other organizations charts
meet compliance standards? and How does the other organization fit into the acquiring organizations mission and goals?
These questions will be incredibly important as accountable
care organizations, which allow different healthcare entities to
partner in the care of patients in order to reduce costs, continue to grow and providers become more consolidated as part of
larger healthcare systems.
Given their expertise theres no reason why HIM professionals shouldnt function at the top level in todays healthcare organizations, says Leslie Fox, MA, RHIA, CEO of Care Communications, based in Chicago, IL. In order to really be able to
influence more strategic decisions, you need to work alongside
the other C-suite professionals, she says. Every organization
should have a chief information management officer [CIMO].
I think its time. Fox says HIM professionals need to step up
and into this CIMO role as data becomes more important in
healthcare.
Still, experts agree that being a strong leader doesnt necessarily mean that one must serve in a specific leadership role such
as vice president, president, or even CIMO. You can be a leader
without being in a leadership position, Weaver says. You can
be a subject matter expert and someone who other people can
rely on.
HIM subject matter expertise is just as important as being able
to demonstrate strategic alignment to the business of healthcare, says Sean Stowers, director of learning services at Pearson
Learning Solutions. AHIMA is working with Pearson Learning
Solutions to develop a series of leadership courses that aim to
advance the careers of HIM professionals.
The courses will focus on faculty development, which educational professionals can use to help develop curriculum and
create a motivating environment; business and career courses,
which focus on business functions, career success, and critical
thinking; workforce education courses, which focus on areas
like communication, innovation, and accountability; and workplace learning courses in areas like leadership, negotiation,
managing teams, and coaching. The more that HIM professionals can embrace the idea that the sanctity of the data has
meaning for the healthcare organization or the payer, the more
theyll be able to adopt that strategic mindset, Stowers says.
HIM professionals have much to learn from other professions
that have already undergone similar transformations and tread
the path to leadership, says Stowers. If you look at the rise of the
IT initiative and the time when IT really became the imperative,
youre really talking about Y2K, he says. That was the late 90s
when there were big massive systems changes. Stowers says IT
professionals moved into the spotlight because they possessed
the technical knowledge necessary to achieve this major conJournal of AHIMA August 14/19
Taking Your Seat
version. HIM can learn from this experience and use the healthcare data revolution to achieve greater recognition as well.
In the late 80s, organizations didnt even have an IT department, says Doug Harward, CEO of Training Industry, Inc.
Now, in many organizations and companies the chief technology officer or chief information officer is one of the most powerful functional leaders.
Ironically, there is often tension between IT and HIM. This
tension sometimes results in the omission of HIM from certain
conversations or initiatives, Reed says. Consider the federal governments meaningful use EHR Incentive Program. Although
IT can implement the technical requirements for meaningful use, the act of reporting and releasing data out of the EHR
to meet the Centers for Medicare and Medicaid Services program requirements falls under HIMs domain. HIM professionals must advocate for the value that they bring to the table and
learn to work together with IT as well as all departments within
the organization, Reed says.
Its important to acknowledge that being a leader doesnt also
necessarily equate to serving on a specific committee or attending a specific meeting, Fox says. Its about being present in the
organization all the time engaging in conversations, she says.
You have to have a voice, but its up to you to have that voice
and to make your voice heard.
Fox says that in many organizations, decisions are made long
before the actual meeting in which theyre formalized. HIM professionals must be involved in these discussions from the beginning, she adds.
Strategies for Leadership Success

In todays healthcare environment there are many opportunities for HIM professionals to step into leadership roles. Doing
so, however, takes both time and ongoing effort. There is no
magic formula for how to become a great leader, Harward says.
Theres a fundamental question that has been, is now, and will
continue to be at the heart and soul of leadership development,
and that is, Can you teach people to lead or must they be natural leaders, and then you can hatch their abilities?
This question remains largely unanswered. However, experts
agree that there are definite steps that HIM professionals can
take to advocate for themselves and their profession. By doing
so, theyll likely begin to be perceived by others as a leader and
soon follow by doing leadership-oriented work.
Tips for Becoming a Good Leader

Consider the following strategies for becoming a good leader:
K now your organization. Understand who the decisionmakers are within the organization. Who holds the power? What is the internal process for making important decisions? HIM professionals must be able to answer these
questions if they want to move into leadership roles, Fox
says.
Strategically align with hospital executives. If someone
isnt helping you navigate the waters of your facility, youre
not going to be successful, Weaver adds.
I dentify your organizations specific pain points. Superb leaders know how to address pain points in a highly
articulate and efficient manner. For some organizations,
the pain point is the conversion to ICD-10-CM/PCS. For
others, its meaningful use, or an EHR implementation, or
a whole host of other initiatives going on in healthcare today. HIM professionals must scope out the pain point and
then identify specific ways in which they can contribute to
solving that pain point, Weaver says.
Identify these pain points by having direct and open
conversations with hospital executives. HIM professionals can ask their CEO to identify the organizations shortterm and long-term visions and goals and then brainstorm
ways in which they can help meet these goals, Fox says.
Add Value to the Organization

Being a leader should not be solely a selfish act. Its not How
do I get myself, personally, at the table? but rather What does
the organization need, and can I meet that need? Thats what
people need to ask themselves, Fox says. The HIM professional who is consistently envisioning how health information will
transform their organization and who informally explores ideas
with their colleagues every day will have influence. HIM professionals will be at the table when they regularly demonstrate
their knowledge not only of HIM but of the entire organization.
As healthcare data becomes increasingly more important,
HIM professionals need to think about how this data can be
used to solve actual problems within the organization.
Everything is about data and the patient, Weaver says. I
find it hard to believe that most of the business problems that
we face within our hospitals today dont correlate at some level
to this. Its about figuring out how HIM professionals can add
value to the problem-solving.
Adding value may simply be a matter of looking at a particular
problem objectively. It could also mean ensuring that executives have all of the data thats necessary to make a good decision or that they understand how and by whom that data was
compiled.
If they dont have the information, this is a role that HIM can
fill, Fox says. Do some research and offer up the information.
HIM professionals need to be viewed by others not only as the
custodian of the patients health record but also a research and
data gurusomeone who can solve problems, ask good questions, and interpret the data, she adds.
Seek Opportunities, Dont Wait for Them

There are always opportunities to share information, Reed says.
When HIM professionals share information, others naturally
begin to perceive them as leaders.
One must be present and accounted for every daynot as
a heads down operations manager but as a strategic thinker
someone who is constantly scanning the environment for opportunities and threats. Thats what a leader does, Fox says.
For example, consider drafting a brief weekly newsletter for
other staff members that includes information about important
Taking Your Seat
regulations that affect strategic goals and initiatives. E-mail relevant articles to members of the C-suite regularly. Ensure that
others, including the C-suite, understand the importantand
evolvingrole of HIM, Reed says.
Build Relationships with Non-HIMers

Take every opportunity to converse with colleagues and ask
open-ended questions such as What are the challenges you
face on a daily basis?; How are things going in your department?; and How is your profession changing?
Leaders must engage with other people all the time in a way
that inspires them to function at a higher level, Fox says.
These conversations can be short but meaningful. Not only
does this help identify potential pain points with which HIM
professionals can assist, but it helps earn the respect of others.
Leaders need to have the emotional maturity to ask thoughtful
questions, listen, and observe, Fox says.
Sometimes a healthy dose of self-awareness and organizational-savvy is the price of admission [to the decision-making
table], Stowers says.
Fox agrees, saying HIM professionals should ask if they can
see yourself as others see you, she says. If you stay in your
own area, you will never be perceived as a strategic leader in the
larger organization. You have to get out, get to know people, and
contribute to discussions about the strategic issues of the day.
Network Outside of Your Own Organization

Not only does networking outside of ones own facility and
health system provide a glimpse into innovative strategies from
which your own organization could benefit, it also helps develop contacts who can provide advice and expertise, Fox says.
For example, contact other organizations to determine how
they are addressing patient portals, telemedicine, or ICD-10CM/PCS. Try to identify the larger environmental factors that
could affect your organization. What is your region doing to implement health information exchange? What are the accountable care organizations that exist in your region, and how are
they functioning?
Constant Change a Reality

In healthcare there will always be new regulations, new technologies, and new codes. The clich that the only constant
is change couldnt be truer for todays healthcare providers.
Those HIM professionals who take the initiative to read regulations, ask questions, and share information will be viewed by
others as leaders.
We live in a world thats constantly changing, and we each
need to be responsible for our own learning, Fox says. If we
really want to be a part of leading the organization, we have to
broaden our perspective beyond HIM in terms of our knowledge of the healthcare industry and our own organization.
Lisa A. Eramo (leramo@hotmail.com) is a freelance writer and editor
based in Cranston, RI, who specializes in healthcare regulatory topics,
HIM, and medical coding.
Improve
documentation,
and watch your
revenue soar.
Never Stop Learning

Although a two- or four-year degree will get your foot in the
leadership door, HIM professionals will likely need higher education (i.e., a masters degree in business, healthcare administration, health informatics, or clinical informatics) if they intend
to move into leadership roles, Reed says.
Aside from formal education, true HIM leaders must always
be on the lookout for learning opportunitiesmany of which
are regularly provided by AHIMA. The idea of being a lifelong
learner of your profession is something that cannot be underestimated, Stowers says. I think its one of the crucial elements
of setting yourself on the pathway to changing your profession.
The most powerful leaders demonstrate a constant thirst for
knowledge, Harward says. Great leaders and students will tell
you that the more they know, the more they realize they dont
know, he says.
Regardless of the code set youre

required to use, revenue begins
with coding, and coding begins
with clinical documentation.
Ask the coding and documentation
experts at HRS how our
clinical documentation gap analysis,
coding compliance reviews
and remote coding services
can help you increase
your revenue stream.
HOW TO
Lead Your
Organization in
Compliance,
Ethics, and
Customer Service
HEALTH INFORMATION MANAGEMENT PROFESSIONALS CAN HELP
ORGANIZATIONS CREATE A CULTURE OF COMPLIANCE
By Ben Burton, JD, MBA, RHIA, CHP, CHC
PLEASE PRESS
FOR MORE INFO
How to Lead Your

Organization
TODAYS HEALTHCARE ORGANIZATIONS must field a constant bombardment of both new and evolving regulations that
dictate how, when, or where patients may receive care. The
changing regulatory landscapecombined with the fact that
the government is recovering $16 for every dollar spent to combat fraudis forcing healthcare entities to search for better ways
to keep current with these standards, minimize the likelihood
an employee or department will engage in non-compliant activity, and reduce fines that may be imposed should the organization be convicted of violating the law.1 As a result, healthcare
organizations are increasingly choosing to create a corporate
compliance program.
Government Provides Compliance Guidance

Corporate compliance programs provide a framework that organizations may leverage for support in keeping up-to-date
with changes imposed by legal and regulatory processes. The
programs can also be used to address internal issues and correct problems identified by the compliance process. While compliance programs do need to constantly evolve and adapt to an
ever-changing healthcare environment, most programs created
since 1991 have started with the same basic framework built
upon seven elements of an effective compliance and ethics program. These elements are outlined in chapter eight of the federal
sentencing guidelinesand are discussed in detail below:2
1. Standards and Procedures
2. Reasonable Oversight
3. Communication
4. Auditing
5. A Method of Reporting
6. Consistent Enforcement of the Rules
7. A Process to Address and Mitigate Issues
These guidelines, released in 1991 by the United States Sentencing Commission (USSC), were the first time that the federal
government offered private corporations any advice on developing an effective compliance and ethics program outside a
corporate integrity agreement or similar legal settlement.3
These guidelines are more than 20 years old, however, and
are not specific to healthcare. The seven elements in the USSC
guidelines were originally created to offer general guidance on
how any corporation can prevent and react to illegal activity.
Subsequent amendments have clarified these elements, and in
2010 the USSC made it clear that an organization with an effective compliance program may receive a lesser fine if convicted
of criminal conduct.4
In addition to these guidelines, the US Department of Health
and Human Services Office of Inspector General (OIG) offers
compliance guidance tailored to specific healthcare industries
on its website at www.oig.hhs.gov.5 Compliance programs are
currently not legally required for many healthcare entities, but
regulations such as the Health Insurance Portability and Accountability Act (HIPAA) and the Affordable Care Act (ACA)
mandate health entities to create systems to address at least
some of the elements included in the purview of a compliance
program (i.e., risk assessment, system of reporting complaints,
standards and procedures).

Healthcare organizations need professionals with the skills
necessary to create and enforce a compliance plan tailored specifically to the organization. In order for compliance programs
to be effective, they must include all staff and flow seamlessly
within the culture of the organization. Health information management (HIM) professionals have an important part to play in
developing, updating, and enforcing this compliance plan.
AHIMA has created an interactive HIM Career Map that categorizes more than 60 of the most common health information
roles into six broad categories:
Compliance/Risk Management
Education/Communication
Informatics/Data Analysis
IT/Infrastructure
Operations/Medical Records Administration
Revenue Cycle Management/Coding and Billing 6
Each of these roles can assist organizations with one or more
of the seven framework elements and help create a culture of
compliance. Each of the seven framework elements are detailed
in the following sections with a description of related HIM roles.
Standards and Procedures Provide Direction

The first of the seven elements outlined in the federal guidelines
state, The organization shall establish standards and procedures to prevent and detect criminal conduct.7 The guidelines
further require an organization to formally adopt these standards and procedures. Standards provide direction to members
of management as well as employees and describe how the
organization will carry out its compliance program. Standards
and procedures should be reviewed regularly and evolve along
with the organization.
HIM Roles Related to Standards and Procedures

Every HIM position, whether entry-level or upper management, is responsible for ensuring compliance with organization
standards on some level. Thus, all six categories included in the
Career Map relate to the support of organization standards and
procedures. Individual policies and procedures should be written so they support these standards, and organizations need
employees well versed in health information management who
understand how to translate high level organizational policies
to compliant operational procedures and effectively communicate these procedures to other members of the organization.
Reasonable Oversight Ensures Compliance

Throughout the Organization
Compliance activities need to permeate all levels of the organization and staff. For the most effective approach, organizations
must implement the reasonable oversight element of a compliance program with the top-level staff first educating the governing authority (usually the board of directors) and designating a
point person to oversee the compliance program. Entities may
choose to either designate an existing executive as the compliance officer or hire a new employee with experience or training
How to Lead Your

Organization
in compliance. Healthcare entities that are larger or more complex may choose to appoint numerous local compliance officers
who report to one chief compliance officer.
HIM Roles Related to Reasonable Oversight

Supervisory, auditing, or analyst positions for HIM professionals
all contribute to the reasonable oversight of a compliance framework, in addition to roles in compliance and risk management,
revenue cycle management, and coding and billing. Roles in
these areas support the compliance officers function in administering the corporate compliance plan. Auditors and analysts
review how the organization is operating to ensure that departments are complying with all laws, regulations, standards, and
procedures. Revenue cycle management and coding and billing
professionals closely monitor billing activitiesand this area is
of particular importance as coding and billing can be high risk
areas. Professionals in supervisory positions are responsible for
creating workflows and procedures that support the compliance
program and work to ensure that staff members follow these
workflows and procedures. Compliance and risk management
professionals perform this function at the organizational level.
Communication Keeps Staff on the Same Page

Communication should be the cornerstone of every compliance program. Employees cant comply with standards and
procedures that they do not know exist. The organization must
orient new employees and periodically remind existing employees about compliance policies and procedures. HIPAA requires
covered entities to train their workforce on any policies and procedures related to protected health information.8
HIM Roles Related to Communication

Compliance, privacy, and security officers are responsible for
training employees when they are hired, as well as reinforcing
that training periodicallyusually at least annuallyand providing updated training if the compliance program changes
at any time. Directors and managers are responsible for daily
operations and must educate front line staff on appropriate responses to the unique issues that each individual department
will face. Roles that fall under the education and communication category are responsible for scheduling and facilitating
training sessions, conducting organization-wide education efforts, and training future compliance professionals.
Monitoring, Auditing Systems Identify Non-Compliance

Compliance programs are created in an effort to monitor current operations and identify any activity that may be non-compliant or illegalor has the potential to lead to such activity.
Therefore, the fourth of the seven elements requires organizations to develop a means to audit and monitor relevant ongoing
organization operations. The most common example of this is
in the area of billing and coding, where reviewing a sample of
records helps ensure the documentation adequately supports
the codes assigned. After developing a risk assessment tool to
identify activities that pose a risk to the organization, executives
can rank these risks by the likelihood of occurrence and deter24/Journal of AHIMA August 14
mine where the most focus should be applied from auditing

and monitoring resources. OIG uses a similar approach when
developing the annual OIG Work Plan, which describes areas
the government will audit in the coming fiscal year.9 These areas
are determined based on risks, emerging issues, and available
resources. Organizations should review the OIG work plan prior
to developing their own audit plan.
HIM Roles Related to Systems Monitoring and Auditing

Auditing is a fundamental operation necessary in all compliance programs. HIM professionals are well versed in the audit
process, from health record quality audits to coding audits. Professionals in operations or health records administration roles
must review health records and be able to audit other functions
to make sure the organization is capturing data (i.e., perform
health record audits and report findings to the hospital medical
staff committee).
Regulatory agencies and accrediting bodies often require this
information to be monitored and tracked. Revenue cycle management and coding and billing professionals must constantly
review records to ensure the documentation matches the codes
assigned. Compliance and risk management professionals are
in charge of developing and performing the risk analysis and
overseeing activities that review or audit the riskier areas. Compliance and risk management professionals may choose to perform audits separate from the coding and billing department.
While this practice may seem redundant, it allows the compliance department to maintain a necessary level of independence.
Reporting Methods Impact Program Effectiveness

One way to measure the effectiveness of any compliance program is to see how well it addresses known or reported issues,
but the organization must first create a system by which issues
can be reported and addressed. A compliance hotline such as
a secured number regularly monitored by members of the compliance department offers a quick and easy way for employees
to anonymously report potential non-compliant activity. Compliance plans often require employees to report any issues that
may be related to compliancea requirement that reduces the
risk of an employee becoming a whistleblower.
HIM Roles Related to Methods of Reporting

To be effective, methods of reporting need to be communicated
to all employees. All employees involved in communicating information about the compliance program to organization staff
are vital to the implementation of a method of reporting. The
compliance officer must take an active role in encouraging and
supporting employees to report issues freely, all the way down
to asking employees to report anything that simply doesnt feel
right. Its the compliance officer and not the employee who
must determine if the activity is compliant or not. Even if the
activity is found to be legally permissible, it is an opportunity
for the organization to examine the workflow to see if it makes
the most business sense or if there is an opportunity for the organization to improve. Employees in information technology
and infrastructure roles are responsible for creating and main-
How to Lead Your

Organization
taining the medium through which employees can report these

issues. The organization should examine how employees communicate within the organization and develop systems that are
easy to use and readily accessible to all employees.
Consistent Rule Enforcement Keeps Compliance

Programs Fair and Honest
Any compliance program needs to be both fair and consistent.
We live in a nation of laws, and just as the judicial and executive branches of government are responsible for equitably
enforcing all laws, the compliance department is similarly responsible for fairly applying policies and procedures throughout an organization.
HIM Roles Related to Consistent Enforcement

Though the compliance officer may recommend a course of
action, enforcement and discipline are usually the responsibility of direct managers at the department level. Managers must
work with human resources personnel to establish a disciplinary system that treats all employees within the department
equally regardless of title or position. Higher level compliance
and risk management professionals should work with the human resources department to establish guidelines and policies
regarding discipline for compliance violations. It may be more
difficult to have the same standard for all employees across different departments. For example, there may be slightly different standards for physician employees than those that apply to
non-clinical staff.
Processes for Response and Prevention Mitigate

Future Issues
A compliance program must not only work to uncover compliance issues, but address them as they occur and prevent similar
issues from arising in the future. The compliance program must
develop a standard that describes how the organization will address problems, including who is responsible for the investigation, how it should be documented, and how to correct the process that allowed the problem to occur.
HIM Roles Related to Response and Prevention

The response portion of a compliance program is largely the
responsibility of compliance and risk management professionals, but all HIM professionals should always work to prevent
non-compliant activity. Compliance and risk management professionals are responsible for coordinating investigations and
responses to reported activity. They need to research the rules
that govern the reported activity, verify that the activity is illegal
or non-compliant, and make sure that any reporting or remediation is carried out in a timely manner. For example, if a reportable privacy breach is discovered, the privacy officer must
follow the notification steps outlined in federal law 45 CFR 164
subpart D. Prevention needs to include all employees of the organization. To be truly effective and compliant, solutions need
to be practical and easily implemented. The best solutions are
often those created by employees who perform the tasks that
need to be modified.
Compliance Programs Mitigate Illegal Activity

Compliance programs will continue to grow as more and
more healthcare provider organizations choose to develop
them. The primary purpose of a compliance program is to detect, prevent, and respond to illegal activity. The skill set that
belongs to qualified HIM professionals is essential in guiding
healthcare organizations through effectively creating a culture of compliance and adopting a successful compliance and
ethics program.
These HIM professionals can help an organization set standards, provide oversight, communicate with employees, audit
processes, respond fairly to reported issues, and prevent noncompliant activitythereby decreasing the risk that they will
be convicted of violating the law, minimizing the penalties if
they are, and showing that the provider is a fair and ethical
organization.
Notes
1. Gamble, Molly. U.S. Recovers $16 for Every $1 it Spends
Fighting Civil Healthcare Fraud. Beckers Hospital Review.
October 22, 2013. http://www.beckershospitalreview.
com/legal-regulatory-issues/u-s-recovers-16-for-every1-it-spends-fighting-civil-healthcare-fraud.html.
2. United States Sentencing Commission. Chapter Eight
Sentencing of Organizations: Part B Remedying Harm
from Criminal Conduct, and Effective Compliance and
Ethics Program. 2012 Guidelines Manual. November 1,
2012. http://www.ussc.gov/Guidelines/2012_Guidelines/
Manual_HTML/8b2_1.htm.
3. Office of Inspector General. Corporate Integrity Agreements. https://www.oig.hhs.gov/compliance/corporateintegrity-agreements/index.asp.
Ethics Program.
5. Office of Inspector General. Compliance Guideance.
https://www.oig.hhs.gov/compliance/compliance-guidance/index.asp.
6. AHIMA. HIM Career Map. Health Information Careers.
http://www.hicareers.com/CareerMap/.
Ethics Program.
8. Department of Health and Human Services. Breach Notification for Unsecured Protected Health Information.
Federal Register 74, no. 162. (August 24, 2009): 45 CFR
164.530. http://www.gpo.gov/fdsys/pkg/FR-2009-08-24/
pdf/E9-20169.pdf.
9. Office of Inspector General. Work Plan for Fiscal Year
2014.
http://oig.hhs.gov/reports-and-publications/archives/workplan/2014/Work-Plan-2014.pdf.
Ben Burton (bburton@intermed.com) is director of health information
and compliance at InterMed.
COMING SOON TO YOUR HEALTHCARE FACILITY:
INFORMATION GOVERNANCE
A LOOK AT HEALTHCARE INFORMATION GOVERNANCE
TRENDS THROUGH PRACTICAL CASE STUDIES
By Lesley Kadlec, MA, RHIA
THE GROWING MOMENTUM of information governance (IG)

initiatives in healthcare provider organizations raises many
questions. What are the goals of information governance? Why
have some organizations decided they need formal IG programs? How do healthcare organizations expect to benefit from
IG? How are they implementing IG? What role does executive
leadership play in the success of IG strategies?
As a relatively new concept in healthcare, IG can be somewhat
of a mystery to health information management (HIM) professionals. To better understand the issues associated with IG and
how it is being implemented in healthcare, AHIMA has developed case studies based on the experiences of four healthcare
organizations with active IG programs. The aim of these case
studies is to begin to answer the above common questions and
identify some overarching goals related to the implementation
of IG in healthcare organizations. The case studies also provide
a preview into IG activities that many healthcare organizations
may adopt in the near futureand are meant to encourage HIM

professionals to take the lead in developing similar programs at
their facilities.
Defining IG and Why it is Needed

The healthcare industry is undergoing rapid transformational
change, and as a result is faced with a host of new requirements
that are driving the need for accurate and actionable information.1
Information is the lifeblood of the healthcare organizationessential for fulfilling its primary mission of providing
healthcare services. It is a critical asset that must be managed
and optimized to ensure safe, cost-effective, high quality care
delivery.
Information governance can help healthcare organizations
pave the way toward business intelligence because information governance provides the framework to ensure the effec-
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tive management of information assets.2,3

Gartner defines information governance as the specification
of decision rights and an accountability framework to ensure
appropriate behavior in the valuation, creation, storage, use, archiving and deletion of information. It includes the processes,
roles and policies, standards and metrics that ensure the effective and efficient use of information in enabling an organization
to achieve its goals.4
According to the IG case studies collected by AHIMA in
the summer of 2013, healthcare organizations are initiating
information governance programs to support a wide range
of business strategies related to managing quality, improving financial outcomes, maintaining regulatory compliance,
mitigating risk and the potential for litigation, fostering patient engagement, and enabling business intelligence. The organizations are also currently in the process of shifting from
fee-for-service payment to value-based care and population
health management, and they have indentified an increasing
need to use analytics based on solid data in order to manage
financial risk.
The IG case studies, as well as a new white paper detailing the
industrys first IG benchmarking survey, are available on AHIMAs information governance website at www.ahima.org/topics/infogovernance.
IG Case Study Methodology

In order to identify healthcare organizations with IG initiatives,
AHIMA asked members of the associations 2013 EHR and Physician Practice Councils whether they were employed in an organization that had undertaken an IG initiative and whether
they would be willing to participate in an interview about their
organizations efforts. Other healthcare organizations with
known information governance programs were also invited to
participate.
AHIMA agreed that the organizations would remain anonymous in the case study reports. A set of interview questions was
developed in collaboration with the members of the AHIMA
Information Governance Workgroup, and telephone interviews
were conducted with each organization that agreed to participate. Information governance leaders from four healthcare organizations of varying types and geographic locales agreed to
participate in the case study interviews. The intent of the case
studies was to identify the drivers for IG; identify structures,
functions, and roles; and understand the benefits associated
with an IG program. AHIMA officials hope other healthcare
associations will use the case studies to launch similar IG programs in their organizations.
It is important to acknowledge that there are limitations to the
case studies and the results obtained from them. The scope of
this review was limited to four healthcare organizations, and
doesnt attempt to summarize the IG efforts of all healthcare organizations. The organizations studied included two acute care
hospital systems, one regional healthcare system and one very
large integrated delivery system. Since the interviewees were
HIM professionals involved in IG, the case studies are reflective
of an HIM perspective.
Initiatives Driving IG
WITH THE CURRENT environment of incentives and requirements for adoption and implementation of health information technology becoming more complex, the need
to ensure the quality and integrity of healthcare information
has become even more important.
Some of the programs and initiatives driving the need for
information governance include:
ICD-10-CM/PCS implementation
Accountable care organizations
Meaningful use EHR Incentive Program
E-discovery
A desire to realize the full benefits of EHR implementation
Study Findings Illustrate IG Structure, Benefits,

Challenges
The case study organizations reported a variety of reasons for
developing and implementing IG. The study showed that electronic health record systems (EHRs) were a key impetus in the
development of information governance programs. Ensuring
that information from the EHR supports safe patient care, meets
the administrative and financial needs of the organization, reduces risk, and can be used for business needs such as analytics or health information exchange were identified as drivers for
establishing information governance.
Additional reasons why the organizations established an IG
program include:
Sharing of information across facilities with different geographic locations
Developing a shared master patient index
Planning for population health management with analytics
Ensuring accurate data for quality measurement and reporting
Meeting the requirements of the meaningful use program
Participating in health information exchanges
Developing a centralized approach to managing supplies
and medical equipment
Addressing data integrity issues
Improving reimbursement
Tracking physician productivity
The case studies revealed that rapid EHR implementations
had resulted in significant health information integrity issues
that needed to be addressed through governance processes. Examples of these issues included:
Errors that resulted from inadequate user training on how
to use the system
Inability to capture information necessary for required
reporting from the EHR
Inaccurate release of information for litigation and business purposes that had resulted from poor systems integration

A mplification of pre-existing issues associated with a
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Scale and Size of Organizations in IG Case Study

Admissions
Outpatient Visits
Staff
Inpatient Beds
Case Study 1 Academic

Medical Center System
20,000
300,000
4,000
600
Case Study 2 Interstate

Integrated Delivery System
600,000
70,000,000
300,000
20,000
Case Study 3 Large Regional

200,000
10,000,000
40,000
5,000
Case Study 4 Four Hospital

34,000
100,000 (ER visits)
5,000
500
high rate of patient matching errors in the enterprise master patient index
Need for updating access controls that ensured appropriate security levels for those caring for patients
Need for better security of protected health information
in order to comply with stricter regulatory requirements
While these organizations focused initial efforts on patient
data and EHRs, future initiatives within these organizations will
also include the implementation of additional processes that
support some of the other IG business drivers cited above.
IG Challenges Identified
The organizations that were studied reported many challenges
that led to the development of an IG program. There were challenges associated with the management of health information
in the electronic environment because of problems like duplicate patients that had gone unnoticed in the paper environment, as well as a lack of staff training on appropriate use of the
documentation tools in the EHR.
Challenges noted in setting up an IG program included creating a culture of change, ensuring that communication was
reaching staff at all levels of the organization, and prioritizing
incoming requestssuch as report requests, requests for new
technology, or upgrades to existing systemsto ensure that the
work that was most important was completed first.
Once the challenges had been identified, change management was addressed through organization-wide and department level meetings to explain the program to staff and solicit
their feedback. To ensure that the most important work was
completed quickly, the IG teams prioritized the requests they
received based on such criteria as organizational need, regulatory requirements, and the alignment of the product or process
with strategic goals, budgets, or staffing. Communication had
been difficult because many entities within the same organization viewed themselves as independent and often desired to
remain autonomous. These challenges with communication
were addressed through the development of organization-wide
scorecards that shared the goals and results of the IG program
with all staff at every location within the organization.
IG Goals Identified
The goals of the information governance programs included
developing processes to ensure better coordination of care
throughout the entire organization; a desire to maintain a competitive advantage in the geographical regions that were being
served; and ensuring that the organizations were analytics-driven, leading to better performance and outcomes.
The act of managing information at the individual entity level
was not allowing these organizations to capitalize effectively on
the economy of scale that could be realized through a centralized governance process, the case study revealed. The organizations said prior to the IG program they were not nimble and
could not respond quickly enough to information requests. They
also had difficulty obtaining accurate information for reporting.
A shared IG goal was to be able to rapidly respond to requests
for information and ensure that it was reliable and complete.
These organizations recognized a need for formal information
governance initiatives. They hoped to benefit by using trustworthy information to improve decision making, patient care, and
safety. They needed to be able to protect sensitive data while at
the same time allowing necessary access to eliminate impediments for staff that made it difficult to accomplish job duties.
Clinical staff desired better and more accurate information on
outcomes, and financial leadership needed more precise information to ensure the organizations could meet financial goals.
Structure and Function of IG Programs

Each of the organizations had designed an IG structure that included an executive in a leadership position. The executive had
responsibility for managing the program, which included ensuring that projects were completed on time and within budget,
making certain that communication was reaching all levels of
the organization, prioritizing projects appropriately, and ensuring that policies were being written and updated when needed.
In some instances this was a defined role. In other organizations this executive had a dual role with responsibility for IG
functions as well as other job duties. Most of the organizations
surveyed assigned IG responsibilities to a leader in an existing
position within the organization and updated the title and job
description to include the addition of IG responsibilities.
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Sample IG Organizational Structure
Team or Subgroup:
Technology, Systems,
and Processes (may
include ad hoc groups)
Executive Leadership
IG Core Team
(IT, HIM, Business
Office, Finance, Risk,
Clinicians, Nursing,
Legal, Compliance)
Team or Subgroup:
Policies, Procedures,
and Workflow (may
include ad hoc groups)
Department Leaders/
Data Stewards
For most organizations, a program charter or similar document was drafted and approved, and a core committee with
representatives from appropriate business areas was then
assembled. Activities were undertaken to finalize processes
based on the unique strategic needs and capabilities of each
organization.
The core committee was characterized by executive leadership with representation from HIM, clinical areas including
nursing staff as well as physicians and staff from the business
office, risk management, legal, finance, IT, quality, and compliance areas. The core team functioned as the approval body
for any new policies, technology recommendations, and report requests. The core team was also responsible for oversight
of the resolution of any identified problems or information-related issues that were identified by subgroups or department
leadership.
The executive leadership ensured that all necessary resources
were allocated and that team goals were aligned with organizational strategy.
Common functions of the IG core team included:
O versight of the processes and policies related to information access, security, and confidentiality
Information integrity and quality
Information design and capture
Technology review and recommendations
Record content and information management
Information analysis, use, and exchange
In addition to core IG committees meeting regularly, sub-
groups from operational areas were commonly utilized to assist when needed to develop policies, review report requests, or
evaluate proposed technology. The subgroup members would
make recommendations to the core team regarding the purchase of additional technology, needed system modifications,
design of new workflows, development of new order sets or documentation flow sheets, etc. This allowed the end users to be
involved in the design or purchase decisions related to the new
tools. Additional staff members were also brought in to participate on these various subgroups at the request of the core team.
As a supplement to the core team and subgroups, these organizations often designated individual department leaders as
data stewards for their respective business units, with those department leaders then reporting up to the IG core committee.
The data stewards role included:
Creating and maintaining policies and procedures such
as defining access requirements or developing new workflows for their areas of responsibility
Monitoring reports as published in scorecards with responsibility for implementing any necessary improvements
Resolving any data integrity or quality issues
Providing communication to staff related to IG initiatives
Identifying existing data or information sources
Recommending and testing any new technology in their
respective area of responsibility
Each organizations program design was reflective of its structure. The organizations typically utilized existing staff to fulfill
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Terminology Reflects Focus of IG Program

VARIATION WAS NOTED in the use of the terms information governance and data governance among the
organizations studied. It was noted that one organization
labeled its program as an information governance initiative when the focus was specifically on IT and data. Another
organization, which was taking a much broader approach
and was clearly engaged in information governance, had
chosen to name its program data governance. The terminology chosen to represent an information governance
effort may be a reflection of organizational culture.7
However, the terminology chosen by each organization
may have been determined by the focus or orientation of
the stakeholders in the program. Different perspectives on
the scope of the IG program typically determine what the
program is called. For example, an IT executives focus on
IT and activities like metadata management may lead to a
program focus on data governance, whereas a privacy officers global view of information and a focus on privacy
policies and business rules would trend more toward use
of the information governance term. The name chosen for
the program may ultimately drive some of the work that the
team is expected to accomplish.8
IG functions, depending on the identified problems and the

availability of staff to respond to the identified gaps. Executive
leadership, as well as collaboration between legal, risk management, HIM, and IT departments, was consistently noted as essential to ensuring that work was being completed.
Typical responsibilities of the individual department leaders
or data stewards from each organization were to review the policies, procedures, and technology within their areas of responsibility. This information was then shared with the core team
members for monitoring. Each core team member was then
responsible for reviewing the elements of the information that
were being shared from the department leaders or data stewards and addressing any areas of risk or correcting any identified errors. These core team members met periodically as a
group under the direction of executive leadership.
Beyond functions related to EHR data and information, there
was variation noted among the organizations as to what other
types of information were being addressed through their information governance processes. Some had begun to address
other types of information such as physical assets, physician
productivity, and coding quality.
All of the information governance programs studied for AHIMAs IG project were continuing to evolve, regardless of the
length of time that the IG program had been in place. Future enhancements were planned, such as master data management,
predictive analytics, collaboration with payers, participation in
health information exchange, and continued development or
refinement of additional IG policies and procedures.
Regardless of the type of structure or the goals of the program,
executive leadership played a key role in the development, on30/Journal of AHIMA August 14
going support, and communication of the goals of the information governance programs in all of the organizations studied.
Use of IG Consultants in Program Design

Some organizations had enlisted the assistance of consulting
firms in designing their programs. The consulting firms assisted
with developing tools and policies for information security and
developing reports and scorecards that allowed for better sharing of the information throughout the organizations. The consultants provided guidance with developing archival systems
and plans for appropriate retention and destruction of information. Some of the organizations planned to engage consultants
again periodically in the future as they updated or expanded
their IG programs, including future planning for analytics and
metadata management.
Role of Health Information Management in IG

In the majority of the organizations surveyed, HIM professionals had been working closely with executive leadership prior
to the establishment of the information governance programs
and often played a key role in their initial development. This
was likely due to the recognition that these HIM professionals
possessed in-depth knowledge of information management
practices that could be leveraged as the IG initiatives were
rolled out. This included skill sets in information security, privacy, coding, data capture and management, and maintaining
information integrity for regulatory compliance and business
and legal needs. AHIMA staff observed through the case studies that the specific role HIM professionals played in initiating
the information governance programs could be related to preestablished trust of the departments skills within the organization and prior working relationships with executive leadership
in these organizations.
IG Benefits Realized
Some of the benefits reported in the case studies due to the implementation of an IG program included:
Improved ability to track quality outcomes and quicker
turnaround times on report requests

Ability to participate in health information exchange
by addressing the accuracy of patient data for improved
identity matching
Increased patient engagement accomplished through the
ability to share data with patients
Greater collaboration with physicians, leading to overall
better care documentation
Lower costs due to shared purchasing of equipment and
supplies
The organizations that participated in the AHIMA study said
they have made progress with improving their quality measures
due to the IG program. Some have plans to start using predictive
analytics to improve population health management. Physician
productivity reporting is in place, as are more accurate master
patient indices that allow sharing of patient information across
each enterprise due to the programs. EHR functionality has
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been improved and physician documentation tools have been

created to improve charge capture and reimbursement, the organizations reported.
Most of the benefits cited were related to improvements
in the use of health data. Because the subjects interviewed
worked predominantly in the field of HIM, it was not clear
whether there had been any impact on other areas of the organization, such as business intelligence functions or data analytics. However, an information governance program has the
ability to enhance the use of information across all business
units, and this may be more evident in organizations where
other functional areas in the organization play a greater role
in governance.5
Program Success Factors

In all the case studies, executive leadership and support was
a critical success factor in the implementation of information
governance. This is consistent with surveys of executives from
other industries, where executive leadership in IG is viewed as
critical to navigate any budget constraints, ensure cross-functional collaboration, and lead change management.6
Another success factor that was repeatedly noted was ongoing
communication with staff and clinicians to maintain the momentum of the programs. Results were regularly shared through
a balanced scorecard or through reports that are distributed to
the various stakeholders that allows them to monitor results at
the entity level. Reporting was done through department level
leadership so all staff were informed of the work being undertaken. Some organizations used formal scorecards, and others
used individual departmental reports.
IG as an Enabler
The case studies reflected that organizations view IG as an enabler of business strategies. IG programs are seen as a strategic
necessity that allow organizations to implement information
capture enhancements that help meet initiatives like ICD-10CM/PCS, meaningful use, health information exchange, quality measures, participation in ACOs and other new care delivery
and payment models, and the use of analytics for population
health management. Each organization that was studied has
already incorporated information governance into enterprisewide strategic planning, and all are keeping the entire organization informed of the success of the program.
IGs Master Goal: Manage Growing Data Volume

Based on the findings from the case studies, the overarching
goal of information governance programs in healthcare is to
proactively and effectively manage the growing volume of information that is being collected and maintained on a daily basis.
Some healthcare organizations studied decided that they needed formal information governance due to the implementation
of EHRs and the need to manage the quality, integrity, and volumes of information that the EHR now contained. In fact, EHRs
appear to be driving the adoption of IG in healthcare, at least in
these case studies.
Information governance is a clear strategic enabler for en-
suring that information is usable and of high quality for all

of the transformational changes that healthcare is currently
undergoing. As such, these healthcare organizations expect
to benefit from IG through their improvement in quality measurement, ability to maintain a competitive advantage in the
marketplace, and ability to promote community wellness
through such initiatives as predictive analytics for population
health management. Healthcare organizations are beginning
to implement IG by identifying business problems and using
formal information governance structure and process to address them. Executive leadership plays a critical role in the
success of information governance strategies by providing
the necessary tools to obtain vital information and promoting ongoing IG efforts through formal organizational strategy.
Finally, information governance requires an organizational
structure that promotes governance effectiveness.
The ability to implement and sustain a strong IG program
is reflective of an organizations culture, where there is open
Lead
ead
at a higher
level
Our online program provides:

A career-focused education
Experienced faculty in the HIM feld
Tuition rates on average 1520%
less than major for-proft online
universities
Supportive advisors who
understand your needs
Rolling admissions and monthly
start dates
BEGIN
TODAY
BA IN HEALTH
INFORMATION MANAGEMENT
Visit online.sjcme.edu/ahima or call 800-752-4723
for more information.
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communication and an acceptance of the changes that are

necessary to make and maintain the improvements that a formal IG program brings to an organization.
Notes
1. American Medical Association. Getting the Most for Our
Health Care DollarsHealth Information Technology.
www.ama-assn.org/resources/doc/health-care-costs/
health-info-technology.pdf.
2. Thomas Gordon, Lynne. Information Governance for
the Health Care Industry Now Is the Time. iHealthBeat.
February 3, 2014. http://www.ihealthbeat.org/perspectives/2014/information-governance-for-the-health-careindustry-now-is-the-time.
3. Iron Mountain. When Health Systems Merge, Smarter
Healthcare Information Management Keeps the Peace.
www.ironmountain.com/Knowledge-Center/ReferenceLibrary/View-by-Document-Type/General-Articles/W/
When-Health-Systems-Merge-Smarter-Healthcare-Information-Management-Keeps-the-Peace.aspx.
4. Gartner. IT Glossary: Information Governance. www.
gartner.com/it-glossary/information-governance.
5. SAP. Governance from the Ground Up: Launching Your
Information Governance Initiative. 2011. http://www.
sapexecutivenetwork.com/files/Governance_from_the_
Ground_Up_(EN).pdf.
6. CGOC. Information Governance Benchmark Report in

Global 1000 Companies. October 2010. http://public.
dhe.ibm.com/software/data/sw-library/ecm-programs/
CGOC.pdf.
7. Van Beneden, Pierre. Impact Your Organisation: How Information Governance Drives Value and Profits. iQ. May
2013. http://www.rsd.com/en/sites/default/files/pdf/inthe-news/IQ-impact-organisation-how-ig-drives-valueand-profits-may-2013.pdf.
8. SAP. Governance from the Ground Up: Launching Your
Information Governance Initiative.
Lesley Kadlec (lesley.kadlec@ahima.org) is a director of HIM practice excellence at AHIMA.
Read More
Information Governance Program Case Studies
www.ahima.org/topics/infogovernance
The complete information governance program case studies summarized in this feature article are available on the AHIMA websites
information governance page. The case studies include additional
details on how four different healthcare systems instituted information
governance programs. AHIMA developed the case studies to serve as
an example for other healthcare organizations interested in implementing their own information governance programs.
Ad Space
NAME
33
Realigning
HIM to the
New Healthcare
Environment
CASE STUDIES IN HIM TRANSFORMATION
DUE TO ACCOUNTABLE CARE AND
PAY-FOR-OUTCOMES INITIATIVES
By Patricia Bower-Jernigan, RHIA, Ann Chenoweth, MBA, RHIA, and Jaime James, MHA, RHIA
THE AFFORDABLE CARE Act has been a catalyst for the transition to pay
for outcomes. Through the Centers for Medicare and Medicaid Services
(CMS) Innovation Center, dozens of new payment and service models
have emerged that promise to deliver better care throughout the United
States at a lower cost. Changes in healthcare payment have also been fueled by state-level and commercial payer initiatives. These initiatives go
by many namesvalue-based purchasing, accountable care, quality collaboratives, shared savings, patient-centered medical homes, and bundled payments. Although these programs differ in significant ways, they
share a common objective in measuring, comparing, and incentivizing
the quality of care.
The challenges associated with evolving care delivery models and outcomes-based payment are further compounded by an unprecedented
information explosion owing to the proliferation of data from clinical
information systems, electronic health records (EHRs), and connected
health devices. To advance population health and other quality initiatives, this data must be accessed from disparate entities across healthcare
and turned into actionable intelligence.
In todays changing healthcare environment, health information management (HIM) is being called on to innovate to support care transformation. Advancing organizational goals around population health and
accountable care, ensuring data integrity, and better management of enterprise information requires a new brand of leadership.
Two large US health systems, Banner Health and Allina Health, have
spent the past five to seven years confronting the profound changes oc34/Journal of AHIMA August 14
Realigning HIM to the New

Healthcare Environment
curring in healthcare. For Banner Health, this involved a systemwide reorganization of care delivery that led the HIM services
(HIMS) department to begin its own process of transformation.
At Allina Health, the inefficiencies of fragmented coding teams
and competing reporting structures caused Allina executive
management to look for innovative ways to achieve integration.
Using case study examples from both organizations, the following examines different approaches to HIM transformation,
evaluates lessons learned, reports on the results of both organizations efforts, and makes recommendations for HIM colleagues about to embark on a similar journey.
Who is Banner Health?

BANNER HEALTH, ONE of the largest nonprofit healthcare systems in the country, owns or manages 24 acutecare hospitals, long-term care centers, outpatient surgery
centers and an array of other services including physician
clinics and home care and hospice services. Banner Medical Group (BMG) employs over 1,000 providers across 12
healthcare centers and many clinics. Banner Health is in
seven states: Alaska, Arizona, California, Colorado, Nebraska, Nevada, and Wyoming.
Responding to the Call for Change

In 2004, Banner Health launched Care Transformation, a system-wide initiative that combined standardized technology
systems, work redesign, cultural changes, and clinical content
development to improve patient care delivery. The new model
was deployed across 24 acute care hospitals in seven western
states. To ensure its long-term sustainability as the organization grew through acquisitions and mergers, centralized
reporting structures were implemented for certain departments, such as HIMS. A corporate HIMS senior director position was created at the end of 2007, and with the support of
senior leadership and staff, Banner HIMS began its own care
transformation process.
Across the country, Allina Health began to address the many
process complexities and differing cultures across its organization. On the hospital side there were 11 coding managers
reporting to a number of HIM directors who then reported to
different vice presidents across the systems 11 hospitals. Allina
had 11 separate quality departments, each with its own items to
be abstracted and no uniformity of definition within the quality indicator. On the clinic side, 100 professional coders were already consolidated under one coding director at the corporate
office, but staff was assigned to a number of separate hub locations, each with different workflows and processes.
Consolidating HIM Work Across the Care Continuum

The first step in the change process was consolidating and centralizing operations beyond traditional HIM department walls
into integrated HIM practices throughout the care continuum.
Allinas primary objective was not cost containment. Instead,
the goal was standardizing coding processes and achieving a
common understanding of accurate coding and useful data abstraction across the entire Allina organization.
In supporting Banner Healths Care Transformation model,
HIMS leadership began creating a vision for HIM in an EHR environment. The initial goal was to develop and deploy a systemwide franchise model for HIMS related processes and services.
The outcome of this model would be improved operational efficiency and enhanced physician and clinical workflows. This
model is reviewed and revised every year by the HIM leadership
team and has continually changed in support of the changing
healthcare environment.
For both organizations, success depended on innovative approaches to four key elements:
Staff assignments and reporting structures
Communication and buy-in
Workflow standardization
Education
Staff Assignments and Reporting Structures

One of Banners more recent HIM changes has been expanding their scope into ambulatory services. This has included
centralizing its ambulatory professional practice coding team
of approximately 130 coders along with its HIMS ambulatory
operations team. Challenges are inherent in this kind of effort: titles varied across the organization; coders shared other
responsibilities within their clinics; some clinics had coders,
some did not; and there was hesitation and concern among
physician practice leadership that a centralized structure
would not work.
One challenge was to define the specific responsibilities of
HIMS operations staff in the clinics and determine parameters
for how large a clinic needs to be to support an onsite HIMS staff
member. This was especially true as clinics transitioned from
paper to the EHR and as some HIMS functions such as release of
information and enterprise master patient index (EMPI) management transitioned to the centralized HIMS teams.
Allina encountered similar issues as it began consolidating 11
hospital coding departments into one corporate department reporting to the vice president of revenue cycle management. An
organization-wide clinical documentation improvement (CDI)
program was also initiated, and a few years later professional
coders were brought under the department umbrella. A major
concern for Allinas HIM leadership was the physician/coder
relationship, which was not always positive. There was minimal
interaction between both roles and it was not unusual for providers to object when a coder asked a clarifying question about
documentation.
Consolidation at both institutions opened up promotional
opportunities for staff, although some roles did change. Given
HIMs growing involvement in enterprise information management, staff had the chance to be cross trained and moved
to a number of locations in support of the EHR. Job reassignJournal of AHIMA August 14/35
14_Aug.indd 35
7/22/14 2:37 PM

Who is Allina Health?

A NONPROFIT HEALTHCARE system serving Minnesota
and western Wisconsin, Allina Health cares for patients
from beginning to end of life through itsmore than 90 clinics,12 hospitals,15 pharmacies, and several specialty care
centers and specialty medical services that providehome
care, senior transitions, hospice care, home oxygen and
medical equipment, andemergency medical transportation
services.
ments and promotions within new centralized structures meant

a number of coding positions had to be filled. Training a new
coder takes time, which required patience among the team.
Communication and Buy-in

Regular communication is essential to effective change management, but too often communication plans are poorly executed. There is no question that proactive and transparent communication was perhaps the most critical element in achieving
success for each health systems consolidation initiative. Both
Allina and Banner had to address staff uncertainty about the
future, as well as staff loyalty to past management or to one hospital location.
A first step in overcoming concerns was to meet one-on-one
with the coders and practice managers to discuss the goals and
benefits of centralization and provide transparency to the process. An intensive, off-site retreat for coding leaders proved to be
an effective kick-start to Allinas consolidation effort. Creating a
safe environment outside of the workplace where everyone was
encouraged to voice concerns and offer opinions helped the
team take ownership of the project and become invested in its
success.
In addition, to gain leadership and staff buy-in through oneon-one and team meetings, Banner focused on implementing
quick wins such as resolving equipment issues and finding a resource to quickly answer coding or HIMS-related process questions. In doing so, the Banner HIMS team went beyond abstract
concepts to actually demonstrate the value of centralization.
Communicating outcomes on a routine basis, such as lag days
and the centralization efforts status, also encouraged support
for the changes specifically with senior leadership.
Additional meet-and-greets, informal team meetings, and
frequent updates and e-mail communication promoted milestones while reminding staff members that while environments
may appear unique, consolidation can succeed. In time HIM
and coding staff learned to discuss their issues, freely ask questions, and have faith in the process.
Workflow Standardization
Since Banner works with three EHRs, each with various interface models, Banners clinics had come up with specific processes and workarounds to achieve their specific goals. HIMS
management scheduled a coding visioning session with department administrators and physician leaders to set the foundation for workflow standardization. The session focused on key
assumptions, such as gaining consensus that providers would
have coding support and that technology would be used to reduce the use of paper fee slips. These are still being passed to
coders in some clinics despite having the information documented in the ambulatory EHR. Next, Banner documented best
practices within the existing workflows. By engaging practice
administrators, clinic staff, and the coding team early on, they
felt part of the process and the solution. As a result, Banner was
able to reduce more than 70 workflows down to approximately
10 workflows.
Confusing and competing workflows were the norm at Allina, given that 11 different coding managers reported up
through different chains of command. Throughout its consolidation initiative, Allina standardized workflows, focusing on
coder efficiency and accurate data for hospital profiling, reimbursement, risk adjustment, and quality reporting. Efficiency gains allowed for decisions to be made more quickly and
opened the door for further standardization. Home-grown,
web-based software measures productivity against standards
developed using time studies, and regular and random reviews of quality outcomes data have been instituted to track
coder competency.
Despite significant differences between ambulatory and acute
care/hospital processes, neither organization wished to reinvent the wheel. Successful workflows from the acute care setting
were applied to the ambulatory environment, modified where
appropriate, and then periodically reassessed to ensure ongoing effectiveness.
Education
In consolidating operations, both organizations identified the
need for a centralized structure that provides education to coders, providers, and office staff on documentation, coding, and
billing practices. This includes establishing unified processes to
monitor and ensure that documentation and records support
the charges and diagnoses coded and billed.
At Allina, providers now receive one-on-one education within
the first week of joining the health system. Training covers the
basics of CDI and includes a review of the providers actual documentation over a number of days. Education emphasizes how
essential the partnership is between the provider and the coder.
There is one-to-one follow-up with providers during the month
after initial training to reinforce training principles. Allina also
implemented a new coder education process, which consists of
a robust training hub that establishes coding proficiency according to service, allowing the coder time to achieve accuracy
by practicing with training examples. After testing, the coder
moves on to the next service.
HIMS leadership at Banner recognized the need for enhancing its education process upon reviewing the results of audits
conducted by the organizations ethics and compliance team,

Lessons Learned Amidst Care Transformation

D
EVELOP A CLEAR vision and determine metrics for regular measurement of progress against goals. Revisit how you
want to achieve this vision on a regular basis. What is changing in the industry and how is this impacting how you do
business? What do you need to learn as healthcare changes?
Consolidate quickly. Delays allow for more anxiety and confusion among staff.
Establish ownership and accountability. The road will get bumpy, so its essential to have clear performance objectives
to help staff stay on task.
Communicate outcomes on a regular basis. If there is opportunity for improvement, communicate the action plans.
Quantify any and all return on investment and efficiencies gained.
Be transparent about your plans. Create a safe, open environment for expressing concerns and opinions.
Seek input from other departments, teams, and individuals impacted by the consolidation. Report back with regular
updates of progress to date.
Demonstrate the value of centralized HIM practices through quick wins. Accepting change is easier when theres clear
evidence of benefits.
Take advantage of expertise throughout your organization. Functions like management engineering, compliance, and
clinical and medical informatics can provide unexpected insight and assistance.
Celebrate your successes with the entire team to encourage ongoing commitment to change management.
as well as an external audit simulating a US Department of

Health and Human Services Office of Inspector General review. These audits showed an opportunity for both providers
and coders to improve on topics including evaluation and
management (E&M) documentation and assignment, incident
to services, surgical assistant coding and charging, and copy/
paste use. Another factor was HIMS growing involvement
with the Banner Health accountable care organization from a
risk adjustment factor (RAF)/hierarchical condition category
(HCC) perspective.
In the fall of 2013, Banner HIMS management proposed a
new education, training, and compliance ambulatory coding structure to the Banner Health executive team. Return on
investment metrics were tied to the new structure to address
risk mitigation, which helped secure buy-in for the proposal.
Banner is now in the process of building this team and implementing the education, training, and compliance components
of the program.
Data Integrity and Enterprise Information Management

Consolidation of HIM practices drives data integrity and enables
enterprise-wide information governance, which has emerged
as a critical area for HIM leadership. Banner has a centralized
HIMS team that focuses on these issues, as well as forms management, including the reduction of paper forms, transcription and the transition to speech recognition, and EMPI management. A system-wide EHR committee was established and
charged with lifecycle management of EHRs across all Banner
Health facilities. The teams success has been tied to its multidisciplinary make-up, which includes HIMS, risk management,
legal, physician and clinical informatics, and IT representation.
Since the committees formation in 2007 participants have
proactively identified issues that need resolution, including the
use of scribes and lack of standardization in applications that
feed the EHR such as endoscopy, cardiac rehab, and patient

photo capture. An EHR Map was created to reflect that although
Banner has implemented a franchise model EHR there are still
other clinical applications that impact Banners ability to manage the official, legal, health record.
Recently Banners EHR committee was changed to the Banner enterprise information management (EIM) team to reflect
its shift to strategic and operational leadership for EHR systems
across the enterprise. The shift in focus from the EHR to EIM
did not occur overnight. Extensive work was done to articulate a
new vision for this team and determine the responsibilities that
would stay the same and those that would change. Drafting a
revised charter was a key to the shifts success, as was finding an
influential stakeholder to support this new vision.
The teams new charter makes it accountable for information
governance, life cycle management, information use/data governance, information integrity, and privacy and confidentiality.
HIM Innovation to Support New Payment Models,

Population Health
Increasingly facilities are looking to HIM for leadership in accessing and effectively leveraging the clinical, financial, and
administrative data needed for the analysis of quality outcomes
and population health.
Allina and the Minnesota RARE campaign

Accurate data provided by Allinas HIM function is the foundation for the organizations participation in a major quality initiative to reduce potentially preventable readmissions at 82 hospitals across the state of Minnesota. Sponsored by the Minnesota
Hospital Association and several Minnesota-based quality organizations, the Reducing Avoidable Readmissions Effectively
(RARE) Campaign seeks to prevent avoidable hospital readmissions within 30 days of hospital discharge.The project evaluates

clinically-related readmissions based on relationships between

the indexed discharge APR-DRG and the APR-DRG of the readmission.
As of December 31, 2013, more than 7,000 readmissions have
been prevented and patients have spent more than 31,000 nights
of sleep at home rather than in a hospital, according to information posted on the RARE website. The PPR data sets help identify quality improvement opportunities that help achieve healthcares famous triple aim of better outcomes, lower cost, and
higher satisfaction. Once an Allina hospital has implemented
an EHR and is using an enterprise data warehouse, HIM leadership is able to help operationalize analytic solutions and match
them to business strategies.
Supporting Banners Medicare Advantage Plans

In 2013 the Banner Health HIMS ambulatory coding team began
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developing a structure to support Banners Medicare Advantage

plans that are being paid under the Medicare risk-adjustment
model. This model focuses on documenting and coding all patient conditions so that a HCC can be assigned and a RAF score
can be calculated. Payment is then based on the risk score. Like
DRGs, a higher score reflects a sicker patient which results in a
more appropriate reimbursement.
This effort has challenged the Banner coding team to not
only focus on E&M documentation and coding, but also diagnosis documentation and coding to support the new payment
methodology. A training infrastructure specific to RAF/HCC
concepts, documentation, and coding was established for both
providers and coders. Experts were enlisted to assist with understanding the impact of RAF/HCC across Banners enterprise.
For instance, HIMS solicited the assistance of Banners management engineering department to document the entire RAF/
HCC process and the flow of diagnoses through automated systems. This has allowed HIM to connect the dots within the Banner organization and discuss RAF/HCC opportunities with the
organizations CDI specialists.
Leadership in Changing Times

Change can be difficult. Allina and Banner found that success
comes down to system-wide engagement, collaboration, and
open, transparent communication. They also learned that it is
important not to go it alone. Engaging senior leadership, providers, and practice managers early in the process can be the
defining factor in whether an organization will succeed or fail
during a change.
Clear performance objectives are essential. The road gets
bumpy at times and its easy for change to take longer than
planned, which has led to some targeted goals being missed.
As leaders, HIM professionals must reinforce a vision of quality care by determining measures of success and assigning
accountability. They should seek out opportunities to articulate and promote the skills that HIM professionals bring to the
table. HIM skills are essential and valuable across the continuum of care.
Today the transformation journey continues at Banner Health
and Allina Health. HIM leadership must continually assess the
need to transform in support of healthcare reform and organizational initiatives such as accountable care and population
health management. There is a growing emphasis on patient
wellness, which will bring dramatic shifts from a payment perspective. More importantly, the two organizations HIM departments recognize that they are no longer just acute care organizations. The hospitals future and success is tied to the entire
care continuum.
Patricia Bower-Jernigan (patricia.bower-jernigan@allina.com) is systemwide coding director at Allina Health. Ann Chenoweth (afchenoweth@
mmm.com) is senior director of industry relations at 3M Health Information Systems. Jaime James (jaime.james@bannerhealth.org) is senior director of health information management services at Banner Health.
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Myths of
ICD-10-CM/PCS
ADDRESSING WHY IT IS NOT

FEASIBLE TO USE SNOMED CT
IN PLACE OF ICD-10 OR WAIT
FOR ICD-11AND OTHER
MISPERCEPTIONS
By Sue Bowman, MJ, RHIA, CCS, FAHIMA
Three Myths of
ICD-10-CM/PCS
AS THE US healthcare industry experiences yet another delay

in ICD-10-CM/PCS implementation, misunderstandings surrounding the ICD-10-CM/PCS transition continue to perpetuate. This article addresses a few of the most common misperceptionsmyths that need to be exposed with fact-based
evidence:
The idea that replacement of ICD-9-CM is not a necessity.
The increase in the number of codes from ICD-9 to ICD-10
increases the difficulty of using new the code set.
SNOMED CT or ICD-11 represent viable alternatives to
ICD-10-CM/PCS implementation.
ICD-9-CM Must Be Replaced

Replacing ICD-9-CM is not optional. Almost 25 years ago, the
National Committee on Vital and Health Statistics (NCVHS)
expressed concern that the ICD classification might be stressed
to a point where the quality of the system would soon be compromised.1 More than 10 years ago, NCVHS sent a letter to the
Secretary of the US Department of Health and Human Services
(HHS) recommending the ICD-10 code sets be adopted as replacements for the ICD-9-CM code set.2
Both costs and dangers are associated with continued use of
the outdated ICD-9-CM coding system. ICD-9-CM is obsolete
and no longer reflects current clinical knowledge, contemporary medical terminology, or the modern practice of medicine.
Its limited structural design lacks the flexibility to keep pace
with changes in medical practice and technology. The longer
ICD-9-CM is in use, the more the quality of healthcare data will
decline, leading to faulty decisions based on inaccurate or imprecise data.3
After reviewing ICD-9-CM codes, healthcare providers often
dont know precisely what was wrong with patients or what
treatments they received. By continuing to use this outdated
code set, US healthcare providers have a limited ability to extract the information that will optimize public health surveillance, exchange meaningful healthcare data for individual and
population health improvement, or move to a payment system
that is based on quality and outcomes.
An inability to uniquely capture new technologies and services, along with using codes that do not reflect current clinical
knowledge and practice, severely restricts the reliability and validity of US healthcare data. The ability to accurately analyze the
provision of healthcare services and whether reimbursement is
fair and equitable is compromised. If data on new diseases and
technology or important distinctions in diagnoses and procedures cannot be captured, it is not possible to effectively analyze
healthcare costs or outcomes.
Electronic health records (EHRs) and interoperability require
a modern coding system for summarizing and reporting data.
Without ICD-10-CM/PCS, the US investment in EHRs will be
greatly diminished, as the value of more comprehensive and
detailed information will be lost if it is aggregated into outdated,
broad, and ambiguous codes such as those in ICD-9-CM.
Further declines in coding productivity and accuracy can also
be expected as long as ICD-9-CM is in use. The ambiguity and

obsolete clinical terminology used in many ICD-9-CM codes
make the system difficult to use and leave reported codes open
to interpretation.4
ICD-10-CM/PCS Facilitates Accurate and Efficient

Code Reporting
Just as the size of a dictionary or phone book does not make it
more difficult to look up a word or phone number, an increased
number of codes does not make it harder to find the right code.
In fact, the correct code is easier to find in a more comprehensive and detailed code setjust as it is easier to find a word in a
comprehensive dictionary. Coding is easier when detailed and
precise codes are available.5 If a dictionary is incomplete, or the
words are vague or nonspecific, it is more difficult to find the
correct definitionjust as the inability to find a code that accurately describes a particular health condition is frustrating.
As noted above, the ambiguity of ICD-9-CM and the use of outdated terminology makes ICD-9-CM more difficult to use since
the codes are open to multiple interpretations. Greater specificity and clinical accuracy makes ICD-10-CM/PCS easier to use
than ICD-9-CM. Increased specificity, clinical accuracy, and a
logical structure facilitaterather than complicatethe use of
a code set.
When the expansion of codes in ICD-10-CM is examined
more closely, it is much less daunting. The major reason for
much of the code expansion is identification of the affected
side of the body. This specification of laterality accounts for
46 percent of the total increase in the number of codes.6 And
for those ICD-10-CM codes with greater clinical detail than
is found in ICD-9-CM, much of that detail was requested by
organizations representing clinicians because this level of
detail was thought to be clinically significant.7 With the growing emphasis on linking quality and payment, and the movement toward value-based purchasing, it is clear this additional
clinical detail will be important.8 For example, ICD-10-CM
contains significantly more detail than ICD-9-CM regarding
specific types of surgical complications and types of devices,
implants, or grafts involved.
The Alphabetic Index and electronic tools will continue to facilitate proper code selection. The improved structure and specificity of the ICD-10 code sets will facilitate the development of
increasingly sophisticated electronic tools to aid the coding process. An individual provider will never use all of the codes in a
given code set, but instead will only use those relevant to their
specific patient population.9
SNOMED CT and ICD-10 are Complementary

Systems
Clinical terminology and classification systems play separate
but equally important roles in healthcare delivery. Neither a
clinical terminology nor a classification can serve all current
and future uses for coded data required in the US healthcare
delivery system. Terminologies and classifications are designed
Three Myths of
ICD-10-CM/PCS
for distinctly different purposes and satisfy diverse user requirements. A standard clinical terminology enables clinicians to
represent detailed information in a consistent, reliable, and
comprehensive way.10
A clinical terminology such as SNOMED CT is an input system designed for the primary documentation of clinical care.11
It is the global clinical terminology that adds processable meaning to the EHR.12 When implemented in software applications,
SNOMED CT can be used to represent clinically relevant information consistently, reliably, and comprehensively as an integral part of producing EHRs.13
The International Classification of Diseases (ICD) is the international standard diagnostic classification that organizes content into meaningful standardized criteria and enables the storage and retrieval of diagnostic information for epidemiological
and research purposes.14 ICD is the foundation for the identification of health trends and statistics on a global scale. The ICD
defines the universe of diseases, disorders, injuries, and other
related health conditions. It organizes information into standard groupings of diseases, which allows for:
Easy storage, retrieval, and analysis of health information
for evidenced-based decision-making
Sharing and comparing health information between hospitals, regions, settings, and countries
Data comparisons in the same location across different
time periods15
ICD allows the counting of deaths as well as diseases, injuries,
symptoms, reasons for encounters, factors that influence health
status, and external causes of disease. It is the diagnostic classification standard for clinical and research purposes. These include monitoring of the incidence and prevalence of diseases,
observing reimbursement and resource allocation trends, and
keeping track of safety and quality guidelines.16
The International Classification of Diseases and Related
Health Problems, 10th Revision, Clinical Modification (ICD-10CM) is a US version of the World Health Organizations ICD-10
and was developed for use in reporting morbidity data in all
healthcare settings. The International Classification of Diseases
10th Revision Procedure Coding System (ICD-10-PCS) has been
developed as a replacement for Volume 3 of the International
Classification of Diseases 9th Revision (ICD-9-CM).
Classification systems are output rather than input systems and are not designed for the primary documentation of
clinical care. Classification systems group together similar diseases and procedures and organize related entities for easy retrieval.17 They group ideas for aggregation and analysis and add
statistical value to data.18 Essential to the big picture of healthcare, classification systems are intended for secondary data
uses, including:
Measurement of quality of care
Reimbursement
Statistical and public health reporting
Operational and strategic planning
Other administrative reporting functions19
SNOMED CT and ICD are designed for different purposes and

each should be used for the purpose for which it is designed.
While ICDs focus is statistical, SNOMED CT is clinically-based
and focused on capturing the information needed for clinical
care.20 The standard vocabulary afforded by SNOMED CT supports meaningful information exchange to meet clinical requirements. ICD-10-CM and ICD-10-PCS, with their classification structure and conventions and reporting rules, are useful
for classifying healthcare data for administrative purposes, including reimbursement claims, health statistics, and other uses
where data aggregation is advantageous.
A clinical terminology intended to support clinical care processes should not be manipulated to meet reimbursement and
other external reporting requirements. Such manipulation represents the potential to adversely affect patient care, the development and use of decision support tools, and the practice
of evidence-based medicine. Clinical terminologies are not
well-suited for the secondary purposes for which classification
systems are used because of their immense size, considerable
granularity, complex hierarchies, and lack of reporting rules.21
Health records created and stored in electronic environments (i.e., electronic health records) require the use of uniform health information standards, including a common
medical language. Together terminologies and classification
systems provide the common medical language necessary for
interoperability and the effective sharing of clinical data.22 The
benefits of health information technology investments cannot
be achieved without using the latest available versions of terminology and classification standards. SNOMED CT and ICD10-CM/PCS used together in EHR systems can contribute to
patient safety and evidence-based high-quality care provided
at lower cost by leveraging a capture once, use many times
process.
Information captured in SNOMED CT can be repurposed
through linkage to ICD. Classification systems allow granular
clinical concepts captured by a terminology to be aggregated
into manageable categories for secondary data purposes.23
Clinical data input into EHR systems can be transformed by
ICD into output governed by reporting rules and guidelines
for use. The benefits of using SNOMED CT increase exponentially if it is linked to modern, standard classification systems
for the purpose of generating health information necessary for
secondary uses such as statistical and epidemiological analyses, external reporting requirements, measuring quality of care,
monitoring resource utilization, and processing claims for reimbursement.24
HHS does not believe SNOMED CT qualifies as a standard
for reporting medical diagnoses and hospital inpatient procedures for purposes of administrative transactions.25 HHS has
consistently maintained that it does not consider adoption
of SNOMED CT to be a viable alternative to ICD-10-CM/PCS
implementation because these code sets are designed for distinctly different purposes.
To maximize the value of health information, classifications
and terminologies should be used appropriately according
to their purpose and design. Instead of selecting a single clas-
Three Myths of
ICD-10-CM/PCS
sification or terminology to serve all clinical functions, multiple classifications and terminologies should be used for the
functions for which they are ideally suited, and only linked as
needed. Together terminologies and classifications provide the
common medical language necessary for interoperability and
the effective sharing of clinical data.26 Linked together, ICD
and SNOMED CT support better data collection, more efficient
reporting, data interoperability, and reliable information exchange in health information systems. Healthcare systems will
benefit from better data while reducing data capture and reporting costs. ICD-10-CM/PCS and SNOMED CT can both contribute to the improvement of the quality and safety of healthcare
and provide effective access to information required for decision support and consistent reporting and analysis.27
US Cant Afford to Wait for ICD-11

Based on the World Health Organizations current timeline,
ICD-11 is expected to be finalized and released in 2017.28 For
the US, that date is the beginning, not the end, of the process
toward adoption of ICD-11. Regardless of the benefits of ICD11, the US would still need to evaluate the code set for national
use and likely develop a national version to allow for the annual
updating demanded by Congress and US stakeholders.29 Also,
since ICD-11 does not include a procedure classification system, a procedure coding system for use in the US would need
to be developed.
The process of evaluating ICD-11 for use in the US, developing a national modification to meet US information needs, and
developing a procedure coding system would take at least a decade, followed by the rulemaking process to adopt ICD-11 as
a HIPAA code set standard. In the case of ICD-10, it took eight
years to develop a US modification of ICD-10 and a procedure
coding system, and 19 years for a final rule to be published. Five
years after publication of this final rule, and 24 years after the
World Health Assembly endorsed ICD-10, the US has still not
implemented ICD-10-CM/PCS.
The US cannot wait another 10-25 years to replace the ICD-9CM code set. As noted above, replacement of ICD-9-CM is long
overdue. Waiting until ICD-11 is ready for implementation in
the US is not a viable option, as waiting that long to replace
the ICD-9-CM code set would seriously jeopardize the countrys ability to evaluate quality and control healthcare costs.30
US healthcare data is being allowed to deteriorate while the
demand increases for high-quality data that can support new
healthcare initiatives such as the meaningful use EHR Incentive Program, value-based purchasing, and other initiatives aimed at improving quality and patient safety and decreasing costs.31
In a 2013 report on the feasibility of skipping ICD-10 and going right to ICD-11, the American Medical Association Board of
Trustees recommended against skipping ICD-10 and moving
directly to ICD-11, as this approach is fraught with its own pitfalls.32 Concerns cited in this report included:
ICD-9 is outdated today and continuing to use the outdated
codes limits the ability to use diagnosis codes to advance
the understanding of diseases and treatments, identify
quality care, drive better treatments for populations of patients, and develop new payment delivery models.
The US market will miss out on the improvements in the
ICD-10 codes that align with todays diagnosis coding
needs, including the addition of laterality, updated medical terminology, greater specificity of the information in a
single code, and flexibility to add more codes.
Skipping ICD-10 will impede the ability of the industry to
build on their knowledge and experience of ICD-10, which
is expected to be needed for ICD-11. Learning the medical
concepts, training efforts, and overall implementation efforts for ICD-11 will be more challenging if ICD-10 is not
implemented first.
Implementing ICD-10 is expected to reduce payers reliance on requesting additional information, known as attachments, which could reduce burdens on physicians,
but this opportunity would be delayed until ICD-11 if ICD10 is not implemented.
The timeframe to have ICD-11 fully implemented could be
as long as 20 years, unless there is a strong commitment
by the industry to implement it faster.33
Implementing ICD-10-CM/PCS is an important step on the

pathway to ICD-11. ICD-10-CM has informed ICD-11 development, as updated clinical knowledge and additional detail
considered important for use cases such as quality and patient
safety monitoring have been incorporated into the US code
sets.34 Transitioning to ICD-10-CM/PCS in 2015 will provide
an easier and smoother transition to ICD-11 at some point in
the future.
By preparing information systems now to accommodate
ICD-10-CM/PCS, they will also be better able to accommodate the transition to ICD-11.35 And just as modifications to
ICD-10 have been incorporated into ICD-10-CM through the
annual update cycles, it is anticipated that content additions
in ICD-11 that are not already included in ICD-10-CM will be
incorporated into ICD-10-CM over time, which will facilitate
the transition to ICD-11. Due to the structural limitations and
obsolescence of ICD-9-CM, modifications to ICD-9-CM to reflect changes in the World Health Organization version of ICD
would be impossible, complicating and disrupting a future
transition to ICD-11 if the ICD-10-CM/PCS code sets are not
implemented first.36
Notes
1. AHIMA. ICD Timeline. May 15, 2014. http://library.
ahima.org/xpedio/groups/public/documents/ahima/
bok1_050688.pdf.
2. Ibid.
3. Bowman, Sue. Why We Cant Skip ICD-10. Journal of
AHIMA website. April 5, 2012. http://journal.ahima.
org/2012/04/05/why-we-cant-skip-icd-10/.
4. Averill, Richard and Rhonda Butler. Misperceptions,
Misinformation, and Misrepresentations: The ICD-10CM/PCS Saga. Journal of AHIMA website. June 20, 2013.
http://journal.ahima.org/wp-content/uploads/Week-3_
Three Myths of
ICD-10-CM/PCS
Averill-and-Butler_final.pdf.
5. Ibid.
6. Ibid.
7. Averill, Richard and Sue Bowman. There Are Critical Reasons for Not Further Delaying the Implementation of the
New ICD-10 Coding System. Journal of AHIMA 83, no. 7
(July 2012): 42-48.
8. Averill, Richard and Rhonda Butler. Misperceptions, Misinformation, and Misrepresentations: The ICD-10-CM/
PCS Saga.
9. Ibid.
10. WHO-FIC. International Classification of Diseases (ICD)
and Standard Clinical Reference Terminologies: A 21st
Century Informatics Solution. May 2013. http://www.cdc.
gov/nchs/data/icd/Class_Term_InfoShee_May2013.pdf.
11. Bowman, Sue. Coordination of SNOMED-CT and ICD10: Getting the Most out of Electronic Health Record Systems. Perspectives in Health Information Management
Spring 2005 (May 25, 2005). http://library.ahima.org/xpedio/groups/public/documents/ahima/bok1_027171.pdf.
12. International Health Terminology Standards Development
Organisation. SNOMED-CT Adding Value to Electronic
Health Records. February 2014. http://ihtsdo.org/fileadmin/user_upload/Docs_01/Publications/SNOMED_CT/
SnomedCt_Benefits_20140219.pdf.
13. International Health Terminology Standards Develop-
ment Organisation. About SNOMED CT. http://www.

ihtsdo.org/snomed-ct/snomed-ct0/.
Century Informatics Solution.
15. World Health Organization. International Classification
of Diseases (ICD) Information Sheet. http://www.who.
int/classifications/icd/factsheet/en/.
16. Ibid.
17. Bowman, Sue. Coordination of SNOMED-CT and ICD-10:
Getting the Most out of Electronic Health Record Systems.
18. Ibid.
19. Ibid.
20. Fung, Kin Wah. How the SNOMED-CT to ICD-10 Map
facilitated the map to a national extension of ICD-10.
National Library of Medicine. 2012. http://ihtsdo.org/fileadmin/user_upload/doc/slides/Ihtsdo_Showcase2012_
MappingNationalExtensionICD10.pdf.
21. Bowman, Sue. Coordination of SNOMED-CT and ICD-10:
Getting the Most out of Electronic Health Record Systems.
22. Ibid.
23. Ibid.
24. Ibid.
25. Department of Health and Human Services. HIPAA Administrative Simplification: Modification to Medical Data
Code Set Standards To Adopt ICD10CM and ICD10
PCS; Proposed Rule. Federal Register 73, no. 164 (August
22, 2008). http://www.gpo.gov/fdsys/pkg/FR-2008-08-22/
pdf/E8-19298.pdf.
26. Bowman, Sue. Coordination of SNOMED-CT and ICD10: Getting the Most out of Electronic Health Record Systems.
Century Informatics Solution.
28. World Health Organization. International Classification
of Diseases (ICD) Information Sheet.
New ICD-10 Coding System.
30. Ibid.
31. Bowman, Sue. Why We Cant Skip ICD-10.
32. American Medical Association. Evaluation of ICD-11 as
a New Diagnostic Coding System. Report of the Board
of Trustees. 2013. http://www.ama-assn.org/assets/
meeting/2013a/a13-bot-25.pdf.
33. Ibid.
New ICD-10 Coding System.
Sue Bowman (sue.bowman@ahima.org) is a senior director, coding policy
and compliance, public policy at AHIMA.
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Roles for HIM

Professionals
in HIOs
By Linda Bailey-Woods, RHIA, CPHIMS; Julie Dooling, RHIA; Diane Fabian, MBA, MS, RHIA; Tanya Kuehnast, MA, RHIA, CHPS; Stephanie
Luthi-Terry, MA, RHIA, FAHIMA; Jackie Raymond, RHIA; Harry B. Rhodes, MBA, RHIA, CHPS, CDIP, CPHIMS, FAHIMA; and Kathy J. Westhafer, RHIA, CHPS
SIMPLY STATED THE goal of health information exchange

(HIE) is very clear-cut and easy to understandestablish networks that connect healthcare providers electronically in order
to facilitate higher quality healthcare.
However, actual implementation of HIE business models and
methods are constantly evolving. Adding to the complexity are
the many and often conflicting federal, state, local, community,
and private initiatives underway to foster and enable interoperable electronic health information exchange. Scant attention
has been paid to the professional education, knowledge, and
experience necessary to staff health information exchange organizations (HIOs). Realizing this gap in AHIMAs HIM Body
of Knowledge, the AHIMA HIE Practice Council decided to
identify and interview HIM professionals that had successfully
transitioned into the emerging domain of health information
exchange. By providing examples of health information management (HIM) professionals who have begun working in HIOs,
the practice council hopes others will follow in their footsteps
and become HIM expert leaders in the growing and increasingly
important field of health information exchange.
Partnership Formed to Study HIO Roles

Since January 2009 the HIE Practice Council has played a vital
role in addressing the impact of HIE on HIM and healthcare
professionals who work in HIO environments. The recent 2013
HIE Practice Council aspired to continue this work and provide
research that would extend the findings of a 2012 white paper
titled, Trends in Health Information Exchange Organizational
Staffing: AHIMA/HIMSS HIE Staffing Model Environmental
Scan.
The 2012 white paper was the result of a collaboration between
AHIMA and the Healthcare Information and Management Systems Society (HIMSS). The organizations came together to form
the joint HIE Staffing Model Environmental Scan Workgroup in
order to study and analyze job opportunities and skill sets required in the HIO setting.
The joint AHIMA/HIMSS project approached data collection
for this research project through the use of one-on-one inter-
Roles for HIM

Professionals in HIOs
views with targeted individuals who were responsible for staffing HIOs. The results of the project focused on data exchange
and HIE activities, including those exploring opportunities in
education, training, and certification to enhance their knowledge and skills in this area.
The joint HIE workgroup recognized the need for additional
research beyond the findings of this research study to clarify
and refine the education, training, resource talent, and work experience necessary to provide a clear understanding of the professional skill sets and experience required for HIOs.
The joint HIE Staffing Model Environmental Scan Workgroup
recommended that future studies should be conducted on the
staffing and skill sets needed to support HIOs. The recommendations for future research topics that would benefit the industry included:
A focus on the evolutionary paths of HIOs over an extended period of time, including trends and shifts in staffing
needs as the HIO matures and service offerings are added.
Identification of any major differences in services and
staffing requirements between for-profit and not-for-profit HIOs.
Identification of key differences between regional, state,
and other (i.e., interstate or national) HIOs.
Identification of the staffing and skills required for service
offerings that include both traditional and emerging registries (i.e., cancers, transplants, etc.). These were not specifically identified as areas of growth by the participating HIOs.
Insufficient research exists regarding the professional education, knowledge, and experience necessary to staff HIOs. Identifying this gap in the research, the 2013 AHIMA HIE Practice
Council decided to identify the HIM roles and skill sets needed
for the HIO environment and to enhance the research started by
the joint AHIMA/HIMSS workgroup in 2012.
To do this, the 2013 HIE Practice Council voted to form the
Roles for HIM Professionals HIE Workgroup. This workgroup
then conducted focused one-on-one interviews with six HIM
professionals that had successfully transitioned into the emerging domain of health information exchange.
Interviews Used to Find Common HIO Role Themes

Workgroup volunteers contacted identified HIM professionals working in HIE roles via an introductory e-mail or personal
telephone call requesting their participation. Selected volunteer research participants took part in one-on-one telephone
interviews. All six participants were administered the same
open-ended questions, which are highlighted below along with
a summary of the workgroups findings.
Question #1: Work Experience

What was your prior work experience before working for the
health information exchange? Please list your current job title/
role, years on the job, how many employees hold HIM credentials,
and their highest level of education.
From the interviews conducted it was apparent that the HIM
roles currently staffed in HIOs and other HIE areas are concen-
trated within either information technology or privacy areas.

The backgrounds of the six interviewees were varied, representing directors of HIM, hospital system implementation analysts,
hospital information coordinators, and medical center information system privacy and security officers.
The roles the participants currently hold within their HIE
organizations ranged from the catch-all title of health information management professional and director of the office of
health information integrity to the very specific role of HIE analyst responsible for developing and implementing interfaces
between physician practices and patient portals with corresponding personal health records (PHR). One participant, a
CEO of a consultant firm, provided consulting to private, regional, and state HIOs.
Most of the participants had been employed by their HIOs for
just one or two years, which is not surprising since most HIOs
have only been in existence since state-designated entities HIE
were first funded by an Office of the National Coordinator for
Health IT (ONC) program in 2010.
Question #2: Preparing for the HIE Job Role

What about your past experiences prepared you for your HIE job
role?
All interviewees had obtained bachelors degrees and had
credentials in HIM. Two interviewees had a masters of science
degree. They felt their experience with data governance, privacy
and security, and release of information (ROI), along with HIM
administration experience, prepared them for their HIO roles.
The skill sets they most often relied upon included leadership
and organization skills, patient identity management, master
patient index (MPI) management, and correction of medical
record information. Knowledge of HIPAA was also a significant
benefit, the interviewees said.
Question #3: Securing an HIE Job

How did you secure your job in the HIE domain?
The majority of the study participants were recruited for their
HIO position through recommendations or word of mouth.
They were all hired in their HIO roles due to their HIM credentials and background. For example, Sonia I. Flores, whose title
is HIM professional in her current position with the Puerto Rico
HIE, noted that her previous position was privacy and security
officer for a medical center. Flores shared that the local HIO
contacted her, seeking her privacy and security skills.
Pamela Lane, MS, RHIA, CPHIMS, deputy secretary of health
information exchange at the California Health and Human Services Agency (HHS), Office of Health Information Integrity, was
another participant in the study and secured her role by personal referral. A previous CIO (a physician) was a visionary and
recommended me for this position and appreciated the HIM
profession, and saw how the state could use an HIM professional in leadership, Lane says.
Based upon the interview responses, it is a trend for HIOs to
seek out candidates with a HIM background. This is a positive
outlook for HIM professionals looking for opportunities in an
HIO role. The survey findings give credence to the expertise of
Roles for HIM

credentialed HIM professionals.
Question #4: Apply HIM Skills in the HIO Domain

How do you apply your HIM skill set to your current position?
The HIM professionals working in an HIE capacity are all applying the traditional HIM skill set in their current roles, according to the study. As the deputy secretary of HIE for Californias
HHS, Lane said she has leaned on her HIM experience to lead
the collaboration efforts between state agencies in order to establish data use and sharing principles.
Margaret Strader, RHIA, health information exchange analyst
at Hardin Memorial Hospital in Elizabethtown, KY, said during
the study interview that her work in HIE isnt all that different
from other HIM work. Many of the processes are the same, but
are used in a different format or venue, Strader says.
Mastery in core HIM principles as well as general leadership
and organizational skills are critical in HIE roles. HIM professionals are accustomed to leading the collaboration between
disciplines. Katherine Sutton, RHIT, CCS, clinical informatics
manager at Health Language, Inc., stressed during the interview that in her current role at an HIO it helps to be a jack of all
trades. Sutton was quick to point out the more we know about
the health information exchange operations, the more successful we can be in delivering information to our clients and helping them with any issues that might come up.
Question #5: Learning New Skills for the HIE World

What new job roles or functions did you have to learn for your
new HIE role?
Those interviewed largely expressed a need to hone their data
management skills. They shared that standardization of terminology and data definitions are paramount to multiple providers working with various EHR systems, and are essential to providing consistent and reliable information across multiple care
settings for continuity of care. These skills will be critical when
the HIO begins to aggregate data for analytics and create a data
governance structure.
Additionally, knowledge of project management methodologies and project management skills are particularly important
to the execution of the HIE initiatives. One individual interviewed also expressed the need to learn to speak the language of
IT. The ability to understand terms such as HL7 messages: Order Result and Patient Identification, respectively allowed the
respondent to work side-by-side withand even have greater
respect forher IT colleagues. Another interviewee noted that
learning how to gather IT system and network requirements,
and having a good understanding of workflows as well as technical transport protocols and integration engines, has helped
her succeed in her role providing consulting services to private,
regional, and state exchanges.
Question #6: Opportunities for HIM Professionals in HIE

What type of opportunities do you see for HIM professionals as
HIOs develop?
Interviewees encouraged HIM professionals to look at opportunities beyond the traditional HIM jobs in a formal HIM
department. Health IT, HIE and the meaningful use EHR

Incentive Program have opened many doors for HIM professionals who are interested in moving the profession forward
into new places. Several of those interviewed for the study
expressed that the healthcare industry is in the early stages
of developing HIE and HIOs, and now is the time to embrace
these opportunities.
Cynthia Hilterbrand, MBA, RHIA, director of technology
and operations for Yeaman and Associates, shared that her
current position as HIE Network Coordinator for the Greater
Oklahoma City Hospital Council began as a web portal coordinator role.
Roles like data integrity specialist and HIE coordinator as well
as roles in privacy, security, and transport protocols like DIRECT
are emerging in the HIE domain. As in the traditional HIM department, roles in data and master data management and analytics are beginning to be recognized as a necessity for HIOs.
Stacie Durkin, RN, RHIA, CEO of Durkin and Associates, suggested that landing a role in an HIO or working with HIE in
some capacity can offer upward career mobility. There is room
for advancement working with HIOs, Durkin says. The most
difficult aspect is securing a seat at the table. This, many times,
requires volunteering your time.
Question #7: Preparing for the Unexpected

What was your biggest surprise after taking on the HIE job role?
The study participants had a variety of experiences to share
when asked about their biggest surprise after taking on an HIE
job role. One individual noted she was surprised that she was
the lone HIM representative at the HIO. Others noted surprise
that the implementation of something when it comes to
health IT seems to have taken priority over creating a strategy
for what will be needed in the future.
The amount of work to be done and the tendency to work in
silos was noted as unexpected by study participants, as was the
pressure to implement solutions in a short time frame regardless of the challenges of interoperability and data sharing. In
addition, respondents relayed seeing the need for increased access to data, but parties were not always willing to share their
data when asked due to fear of competition.
One individual said they were surprised by the different
ways that generated data is used by payers and providers and
witnessed the importance of understanding why the requested information is needed for operations. Another individual
expressed surprise at not having to sell the value of moving
dataeveryone they encountered agreed this functionality
has to happen.
Another insight from respondents, though not that surprising, is that everyone on the HIO staff understood that the value
of the health information exchange depends upon the quality
and interoperability of data. Everyone realized that they could
potentially be the patient or family member depending upon
the accuracy and timeliness of health information. As a result
there was widespread support for the organizations mission
and vision. This commitment and sense of urgency translated
into a willingness to be innovative and try new things at the HIO,
Roles for HIM

respondents said. Leadership at one HIO capitalized on their

staffs eagerness and can do spirit by stressing that Imagination plus innovation equals realization.
HIE Roles Offer Bright Future

These focused interviews represent a sampling of HIM professionals who have successfully made the transition to roles in the
HIE area. The results confirm that a strong HIM knowledge base
is critical to support this important national initiative to connect
the information ties of disparate health systems.
The current roles of the interviewees highlighted the need in
HIOs for those experienced in privacy, operations, and technology implementation. The core foundation HIM experience
brings to HIE includes data governance, privacy and security,
and release of information skills, as well as skill sets centering
on leadership, organization, patient identity management, and
knowledge of master patient index oversight and maintenance.
Networking and word-of-mouth was found to be the key factor in how the majority of respondents learned about the HIE
and HIO opportunities, and the trends show that the HIM background and skills were sought out as part of HIE-area recruiting
efforts.
Data management and analytics skills were at the top of the
recommended list for HIM professionals to maintain and enhance if they were interested in moving into an HIE-based role.
Interviewees voiced the importance of standardized terminolo-
D I S C E R N I N G
gies and data definition consistency throughout multiple care

settings, with various EHR systems, for the care continuum.
Project management skills and methods were also noted to be a
very important part of making the transition to HIE roles.
Surprises from interviewees included the amount of work left
to be performed in the HIE space and the pressure to implement systems overriding the need for creating a long term strategy. General consensus revealed that HIE opportunities will be
on the rise in the coming years, and that HIM professionals are
well-suited for these career opportunities.
Linda Bailey-Woods (linda.bailey-woods@navigant.com) is director of
healthcare at Navigant. Julie Dooling (Julie.dooling@ahima.org) is a director of HIM practice excellence at AHIMA. Diane Fabian (fabiand@sunysuffolk.edu) is the HIT program director at Suffolk County Community
College in Brentwood, NY. Tanya Kuehnast (Tanya.Kuehnast@healthfirst.org) is the corporate director of health information management and
chief privacy officer for Health First. Stephanie Luthi-Terry (Stephanie.Luthi-Terry@allina.com) is director of eHIM business solutions at Allina Hospitals and Clinics. Jackie Raymond (jraymond@partners.org) is executive
director of health information services and privacy officer at Brigham and
Womens Healthcare and is also interim enterprise director of health information services at Partners HealthCare. Harry Rhodes (harry.rhodes@
ahima.org) is a director of HIM practice excellence at AHIMA. Kathy
Westhafer (kwesthafer@christianacare.org) is manager of enterprise data
management at Christiana Care Health System in Wilmington, DE.
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Federal Changes
Proposed for
eDiscovery
Litigation Rules
SEVERAL MODIFICATIONS WILL DIRECTLY IMPACT HIM
By Ron Hedges, JD
eDiscovery Litigation Rules
COURTS DONT REMAIN civil on their own. It takes well-crafted procedural rules, enforced by knowledgeable attorneys and
judges, to keep the American legal system humming along in
an orderly fashion. Aiding with the civility of the law is the Federal Rules of Civil Procedure (Federal Rules), a wide-reaching
set of congressionally approved court-based procedural rules
that govern civil lawsuits. In part, these rules govern processes
related to eDiscovery of health information, as well as set standards for preservation and spoliation of health information that
is, or could be, part of a civil lawsuit.
To help health information management (HIM) professionalswho often can be pulled into healthcare lawsuits due to
their work with patient records and health information systemsbecome leaders on these federal rules, the following
describes the framework of the Federal Rules, how the Federal
Rules control civil litigation in the United States courts, and how
this framework may change on December 1, 2015.
Federal Rules Primer

The Federal Rules govern procedure in the United States district
courts. They do not address substantive law, and the procedural
rules cannot create rights that can be enforced in the United
States courts. That is the province of Congress. The rules determine the how of litigation, not the why.
These Federal Rules are not applicable in state courts. Every
state has its own procedural rules, although a number of states
have adopted, in whole or in part, the text of the Federal Rules.
What procedural rules apply to a given civil action depend on
the court where the action is pending.
Framework of the Federal Rules

In order to describe the changes that may be coming to the Federal Rules, one must first focus on several aspects of the Federal Rules as they exist today. The focus will be on those specific
rules that health information management professionals would
likely find to be of interest.
First, according to the rules themselves, the Federal Rules
should be construed and administrated to secure the just,
speedy, and inexpensive determination of every action. Second, the Federal Rules allow a lot of discovery between parties
and from non-parties through subpoenasincluding discovery for both paper and electronic health records. The scope of
discovery is broad to allow for any relevant information to be
found in the adversary process.
The Federal Rules require parties to meet-and-confer in the
early stages of a civil action to, among other things, discuss any
issues about preserving discoverable information and develop
a proposed discovery plan. The plan is submitted to a judge
assigned to the action, who issues a scheduling order that can
incorporate agreements between the parties and controls the
progress of the action toward final disposition.
The Federal Rules speak about proportionality of discovery.
A party can request a lot in discovery from another party. The
latter can object to the discovery request for a number of reasons, including that the burden or expense of the proposed discovery outweighs its likely benefit, considering the needs of the
case, the amount in controversy, the parties resources, the importance of the issues at stake in the action, and the importance
of the discovery in resolving the issues, according to the Federal
Rules. Proportionality also applies when information is sought
from a non-party by subpoena. Whoever seeks the information
must take reasonable steps to avoid imposing undue burden
or expense on a person subject to the subpoena, according to
Federal Rule 45(c)(1).
The Federal Rules were amended on December 1, 2006 to explicitly address discovery of electronically stored information
(ESI)such as health information stored in an electronic health
record system. Rules 16(b) and 26(f )(2) were among those
amended that modified the eDiscovery procedures.
In 2006 Federal Rule 37(e) was adopted, intended to limit the
imposition of eDiscovery-related sanctions: Absent extraordinary circumstances, a court may not impose sanctions under
these rules on a party for failing to provide [ESI] lost as a result
of the routine, good-faith operation of an electronic information
system.
While the eDiscovery amendments are less than eight years
old, there may be more eDiscovery amendments coming soon.
History of Recently Proposed Federal Rule Changes

In 2010 a conference was held at Duke University School of Law
that kicked off discussion of the 2006 amendments. The Judicial
Conference of the United Stateswhich governs the Judicial
Branch of the federal governmentrequested that its Standing Committee on Rules of Practice and Procedure work with
its Civil Rules Advisory Committee to sponsor a conference at
Duke University School of Law on May 1011, 2010, to explore
the current costs of civil litigationparticularly discoveryand
to discuss possible solutions.
The conference considered empirical research done by the
Federal Judicial Center and others to assess the degree of satisfaction with the performance of the present system as well
as suggestions from lawyers and academics as to how the system could be improved. This research was supplemented by
additional empirical data. A major portion of the conference
was devoted to an assessment and discussion of the empirical
research.
The conference drew on insights and perspectives from lawyers, judges, and academics concerning improvements that
could be made to the federal civil litigation process to better
effectuate the purposes of the Federal Rules, which are, again,
to secure the just, speedy, and inexpensive determination of
every action and proceeding. In addition to considering the results of the empirical research, panels of experts considered the
range of issues in the federal civil litigation process that could be
used more efficiently to accomplish the purposes of the Federal
Rules, including the discovery and eDiscovery process, pleadings, and dispositive motions. Other topics considered include
judicial management and the tools available to judges to expedite the process, the process of settlement, and the experience
of the states.
There has been widespread dissatisfaction, principally within the corporate community, with the perceived failure of the
2006 eDiscovery amendments to address the scope of preservation and spoliation. Given the increasing volumes of ESI that
might be discoverable, there was a widespread concern about
over-preservationthat is, a party erring on the side of keeping
expansive amounts of ESI rather than risking spoliation sanctions. Moreover, there was a widespread concern that the safe
harbor that Federal Rule 37(e) was intended to provide for the
routine loss of ESI turned out to be unavailable to most parties who faced a spoliation sanction. This dissatisfaction, among
other things, led to pending proposals to amend the Federal
Rulesseveral of which are discussed below.
Proportionality and Scope of Discovery

Amendments Proposed
As mentioned before, one concern raised at the Duke conference was the propensity of corporate organizations to take part
in the over-preservation of ESI. Several proposed amendments
address that concern. These include:
A mended Federal Rules 26(f) and 16(b) would add preservation to the topics to be addressed in a discovery plan
and included in a scheduling order. In other words, parties would be encouraged to think about the scope of
preservation early in the litigation and reach agreement
on scope while judges would understand that scope
whether through party agreement or a ruling on a dispute
about scopeshould be the subject of a scheduling order.

Th
e proportionality principle now in Federeal Rule 26(b)
(2)(C) would be moved to Federal Rule 26(b)(1), which defines the scope of discovery. The intent of this move is to
encourage parties to consider proportionality when making discovery requests and to emphasize that proportionality is a central factor in discovery.
Rule 26(b)(1) would also be amended to read, in the final
sentence, that information within this scope of discovery
need not be admissible in evidence to be discoverable.
This will replace the current sentence relevant information
need not be admissible at the trial if the discovery appears
reasonably calculated to lead to the discovery of admissible
evidence. This change is intended to avoid a partys reliance on the reasonable calculated language to argue for
discovery that is not relevant to a claim or defense and to
impose some limitation on the scope of discovery.
Proposed Spoliation Sanctions Amendments

Amending Federal Rule 37(e), which governs sanctions imposed due to the spoliation of evidence, proved to be remarkably contentious. Over 2,000 written comments were received
by the Civil Rules Advisory Committee and over 100 individuals testified to the committee about the proposed amendment.
If the proposed changes are implemented, Federal Rule 37(e)
would be completely rewritten. It would apply only to the loss of
ESI and would read:
If electronically stored information that should have been
preserved in the anticipation or conduct of litigation is lost because a party failed to take reasonable steps to preserve it, and
it cannot be restored or replaced through additional discovery,
the court may:
1. Upon finding of prejudice to another party from loss of the
information, order measures no greater than necessary to
cure the prejudice; or
2. Only upon finding that the party acted with the intent to
deprive another party of the informations use in the litigation;
A. Presume that the lost information was unfavorable to
the party;
B. Instruct the jury that it may or must presume the information was unfavorable to the party; or
C. Dismiss the action or enter a default judgment
The new Federal Rule 37(e) makes specific reference to information that should have been preserved. In other words,
this phrase would relate back to the tightened definition of
scope of discovery in amended Federal Rule 26(b)(1). The proposed rule speaks of a party having taken reasonable steps to
avoid the loss of ESI. In other words, the amendment would not
require perfection.
The proposed rule also distinguishes between the mere loss
of ESI and the loss of ESI with the intent to deprive another party of the informations use. So for something really bad to hap-
pen, a party has to lose ESI with a specific state of mind. The rule
permits various unspecified remedial measures to be used if a
party is prejudiced by the loss of ESI.
all have a role to play in the amendment process, and there is no

guarantee that the proposed amendments as they are presented
will be adopted.
Timeline on Proposed Amendments
Rule Changes Impact on HIM
So what is holding up these proposed amendments from not

becoming effective until December 1, 2015? The amendment
process takes a long time. There has been significant written
comment, and three hearings have been conducted at which a
number of individuals testified on the amendments. Two committees consisting of federal judges and learned individuals
have approved the proposed amendments. The amendments
will next be considered by the Judicial Conference of the United
States when it meets in September. If the Judicial Conference
approves the proposed amendments, the amendments then go
to the United States Supreme Court for review and approval or
rejection. If adopted in whole or in part, the amendments are
lodged with Congress who can then either approve, change, or
strike down the amendments. Unless Congress acts, the amendments will become effective December 1, 2015. These stages
take place over long time periods, hence the effective five-yearsin-the making implementation date of December 1, 2015.
The amendments themselves can be modified during the process. The Judicial Conference, the Supreme Court, and Congress
These and other proposed Federal Rules changes have a direct

impact on HIM professionals. For example, reasonableness is
the key to avoiding any sanction connected to these rules. Developing a defensible records retention policy, perhaps within
an overall information governance structure, that anticipates
the imposition of a duty to preserve is vital for all HIM departments. Staff must document that policy, implement it, and
monitor it.
Also, HIM professionals can avoid ad hoc decision-making
about health information preservation with a formal policy. Ad
hoc decision-making, or giving discretion to individual employees or business units to make decisions about what or how to
preserve information, could be seen by the courts as unreasonable and a violation of its preservation rules.
Ron Hedges (r_hedges@live.com) is a former United States Magistrate Judge
in the District of New Jersey and is currently a writer, lecturer, and consultant
on topics related to electronic information.This article is intended solely for
educational purposes; it is not intended to provide legal advice.
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Get where the world is going

Leveraging the
LEADER-MEMBER
EXCHANGE
THEORY in HIM
By T.J. Hunt, MBA, RHIA, CHTS-IM
Editors note: This article is an excerpt from Leader-Member Exchange Relationships in Health Information Management, published
in the Spring 2014 issue of AHIMAs scholarly research journal Perspectives in Health Information Management.
FOLLOWING THE LEADER-MEMBER exchange (LMX) theory

of leadership could potentially benefit the health information
management (HIM) profession. However, a recent literature
review of LMX research in multiple disciplines spanning 19752011 found that although there were significant findings on
LMX benefits, no peer-reviewed studies addressed its use in the
HIM profession. The review, as detailed in this article, ultimately identified a need for further scholarly work to build the HIM
industrys body of knowledge on the use and benefits of LMX.
What is LMX?
The LMX theory emphasizes the leadership process of interaction between leaders and followers. It asserts that leaders have
a unique relationship with each follower, rather than one leadership style or method that is applied to everyone. Leadership
on a dyadic level refers to effective relationships between a
leader and individual followers based on mutual trust, respect,
and commitment. Therefore LMX theory is different from other
theories of leadership that focus only on the leaders activities or
on the situation and environment. Building individual personal
relationships with high levels of mutual trust, respect, and commitment shared by both parties provides demonstrable benefits
to both leaders and followers.
Exploring HIM Leadership

Just as there is no universal definition or approach to leadership,
there has not been one common approach to leadership accepted and utilized by HIM practitioners, educators, and researchers. Few leadership theories have been published regarding the
HIM profession specifically. The literature review conducted on
LMX and HIM is not intended to recommend one leadership
method or theory exclusively, but simply to bring attention to
the need for leadership preparation as well as the need for further methods that strengthen leadership in the HIM profession.
As the field continues to evolve there is a need to prepare HIM
professionals for increased leadership capabilities in order to
meet future healthcare challenges.
Research States Benefits of LMX Relationships

The literature review and additional research indicates that
leaders with high-quality LMX relationships with coworkers
experience positive benefits such as lower turnover, higher job
satisfaction, and more positive employee behaviors. Conversely, benefits for followers include an increase in career growth,
higher organizational influence, and more complex roles.
Several factorsincluding organizational culture and practices, type of work, location, length of assignments, and the num-
Leveraging Leader-Member
Exchange Theory in HIM
ber of team memberscan affect LMX. Others feel that LMX is

related more to satisfaction with the leader than to the actual
quality of the exchange relationship.
An instrument called the LMX-7, which was developed by researchers George B. Graen and Mary Uhl-Bien in order to measure leader-member exchange, can provide even deeper insight
into relationships. The instrument employs seven questions
that can be answered from a leader or follower perspective on
a five-point Likert scale.
Questions such as how would you characterize your working relationship with your leader/follower and what are the
chances your leader/follower would use their power to help you
solve work problems, are designed to gauge trust, respect, and a
sense of obligation between people. Therefore, communication
is found to be a large part of high-quality LMX relationships.
Focusing on LMX could be an

asset for HIM professionals when
leading an HIM department, a
team of remote employees, a
project implementation, or when
seeking to influence the direction
of ones healthcare organization.
More about Perspectives

PERSPECTIVES IN HEALTH Information Management is a
scholarly peer-reviewed journal referred to by professors,
professionals, public officials, industry leaders, and policymakers. Since 2004 it has been one of the most credible
and respected journals of the HIM industry, and is referenced in notable indices such as PubMed Central (PMC),
the Cumulative Index to Nursing and Allied Health (CINAHL), and Google Scholar.
To help celebrate Perspectives 10 years of scholarly
publishing that has advanced the health information practice, Journal of AHIMA will be running additional excerpts
throughout 2014with the next appearing in the November/December 2014 issue of the magazine.
and success in any role. LMX may also benefit the professional workforce as a whole domestically and internationally. An
awareness of the potential benefits of the LMX concept in HIM
may support further inclusion of, or attention to, this theory in
formal degree and continuing education offerings.
T.J. Hunt (tj.hunt@davenport.edu) is an associate dean and assistant professor of health information management at Davenport University College
of Health Professions in Grand Rapids, MI.
Leveraging LMX Tools in the Workplace

Factors that research has found are related to high-quality
LMX relationships could be used by HIM professionals as
tools to leverage in the workforce, whether in leading a team
or working with direct supervisors. When preparing HIM professionals to succeed in the workplace, it may be important to
focus not only on technical competency but also on building
mutual trust, respect, commitment in interpersonal relationships, and leadership.
Focusing on LMX could be an asset for HIM professionals
when leading an HIM department, a team of remote employees,
a project implementation, or when seeking to influence the direction of ones healthcare organization.
Evidence in multiple cultures suggests that high-quality LMX
relationships are beneficial for individual career advancement
Read More
Access the Full Text of this Article and Other
Research Pieces Online Now
http://perspectives.ahima.org/leader-member-exchangerelationships-in-health-information-management/
Access the complete Leader-Member Exchange Relationships in

Health Information Management article online for full details of how
the LMX theory of leadership can be utilized in HIM. Read the complete
Spring and Summer 2014 issues of Perspectives at http://perspectives.ahima.org, and learn more about submission guidelines for the
scholarly research journal.
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Presidents Message
ELEC
T
2014ION
DREAM BIG, BELIEVE, AND LEAD

THE TIME HAS come to visit AHIMAs virtual polling booth and cast your vote for the leaders you think best advance
the associations work in the HIM profession. Voting for the 2014 AHIMA Election begins at 12 a.m. CT, Monday, August 4, 2014 and lasts through 11:59 p.m. CT, Monday, August 18, 2014. All active AHIMA members are eligible to vote.
(Student members are not eligible to vote.) To access the ballot, visit ivote.ahima.org and enter your AHIMA ID number
and password.
This issue of the Journal of AHIMA includes brief candidate biographies, photographs, and position statements for
each ballot position. The candidates responses to the 2014 AHIMA Nominating Committees questions and more
detailed biographies are available via the AHIMA Ballot at ivote.ahima.org. Each candidates brief biography, photo,
and position statement response can also be reviewed in the AHIMA Membership and Business Engage Community.
To access Engage, visit www.ahima.org and locate the myAHIMA login box. Enter your AHIMA ID number and password, then select the Engage Online Communities box. Locate the AHIMA Membership and Business Community,
select Libraries, and locate the topic AHIMA Election 2014.
President/Chair-elect
Vote for 1 of the 2 candidates
Chrisann K. Lemery, MSE, RHIA, CHPS, FAHIMA is senior health solutions

consultant and privacy officer at Avastone Technologies in Wisconsin. She has HIM
experience serving in the roles of management, privacy and security, and compliance in the insurance industry, a technology firm, acute care, behavioral health,
long-term care, student health, and human services. She served as a director and
secretary of the AHIMA Board of Directors from 2010 to 2012, and serves as a director
on the HIPAA COW Board. She served as Wisconsin Health Information Management Association (WHIMA) president, and chair of the AHIMA State Advocacy
Council and Privacy and Security Practice Council. She is a speaker on various topics
and co-author of the AHIMA publication Medical Identity Theft: The State of the Industry. She serves on Wisconsins HIMT Program Advisory Committee. Lemery was
a member of the Wisconsin Governors e-Health Board workgroup and other state
advisory committees on HIM issues. Lemery accepted the AHIMA Triumph Award
for HIPAA COW and is the recipient of the WHIMA Distinguished Member and Outstanding Educator Awards.
Chrisann K. Lemery
MSE, RHIA, CHPS, FAHIMA
Melissa M. Martin, RHIA, CCS, CHTS-IM is chief privacy officer and HIM director for West Virginia University Hospitals. She is a third-year director with the
AHIMA Board of Directors (BOD) and serves as treasurer and finance committee
chair. Martin has also served on the governance and audit committees of the AHIMA
BOD. Martin is a past president and Distinguished Member of the West Virginia
Health Information Management Association (WVHIMA), having served as director
and secretary as well as chairperson for many committees. Martin co-authored the
HFMA Journal article Redeploying Your Workforce, and worked with Service Documentation Monthly Editors to publish the article WVUH Remote Coding Program.
She has presented recently on information governance, recovery audit contractors
(RACs), AHIMA volunteerism, leadership, and coding education programs to various groups such as the 3M Users Group, WVHIMSS, WVONE, WVHFMA, and various
AHIMA CSAs. She also participated in interviews with ADVANCE Magazine regarding information governance and co-presented Working Outside the Box: HomeBased Employees at the Annual National Institute for HFMA.
How to Vote
Visit ivote.ahima.org between

12 a.m. CT, Monday, August 4, 2014
and 11:59 p.m. CT, Monday, August
18, 2014
Enter your AHIMA ID number and
password to log in
After logging in, a link will take you to
the 2014 AHIMA Election ballot
Voters Must:
Be an active AHIMA member
Enter their AHIMA ID number and
password for security purposes
Cast a vote before 11:59 p.m. CT on
Monday, August 18, 2014
Melissa M. Martin
RHIA, CCS, CHTS-IM
For assistance, please contact AHIMAs

Customer Relations Department at
1-800-335-5535 or email
volunteer.services@ahima.org.
Directors
Sheila M. Green-Shook, MHA, RHIA, CHP is director of HIM and privacy offi-
Sheila M. Green-Shook
MHA, RHIA, CHP
cer at Evergreen Health in Kirkland, WA. Green-Shook was a member of the AHIMA
Convention Program Committee for six years and served as chair in 2008 when the
convention was held in Seattle, WA. She has served in many positions on the Washington State Health Information Management Association (WSHIMA) Board of Directors,
including advocacy and delegate positions, two consecutive terms as president, and
currently works as part of the Collaborative Task Force. The task force helped WSHIMA
co-host the third Future of Healthcare one-day conference in partnership with local
chapters of HIMSS, HFMA, and WSHEF. She is chair of the advisory board for the HIHIM program at Shoreline Community College and a member of the advisory board
for the University of Washingtons baccalaureate and masters HIHIM programs. In
2014 she received the WSHIMA Presidents Award.
Barbara J. Manor, MA, RHIA is vice president of HIM at Sisters of Charity Health
Barbara J. Manor
MA, RHIA
System based in Denver, CO, which is comprised of eight acute care hospitals and 200
clinics in Colorado, Kansas, and Montana. She has served two terms as president of the
Colorado Health Information Management Association (CHIMA). Manor has been
the recipient of the CHIMA Distinguished Member Award and the AHIMA Mentor Triumph Award. Past service for AHIMA includes many years as CHIMA Delegate in the
House of Delegates and serving on the AHIMA Nominating Committee, AHIMA Triumph Awards Committee, and eHIM Task Force. She is an adjunct faculty member at
Regis University in the HIM program, and is a noted speaker and writer on subjects of
HIM transformation, data stewardship, meaningful use, privacy, and ICD-10.
Debra K. Primeau, MA, RHIA, FAHIMA has over 35 years of experience in health
Debra K. Primeau
MA, RHIA, FAHIMA
information management. She began her career as an accredited record technician,

attained a bachelors degree in business management and a masters degree in organizational management. She is the past president of the California Health Information
Association (CHIA) and received the CHIA Distinguished Member Award in June
2013. Primeau has served as an CHIA Delegate numerous times and has volunteered
on AHIMA House of Delegates task forces. She has also served on AHIMAs EHR Practice Council, and the Advocacy Council. Primeau has given numerous presentations
in the US and internationally and written many articles for national healthcare publications on a variety of HIM topics. Primeau founded Primeau Consulting Group in
2011, which provides compliance, privacy and security, clinical documentation improvement, ICD-10, and enterprise information management consulting, and serves
as its president. She previously held leadership positions in acute and ambulatory settings and has worked in HIM consulting since 1997.
Steven J. Steindel, PhD, FACMI recently retired as senior advisor for standards
and vocabulary at the Centers for Disease Control and Prevention (CDC). Steindel has
a doctorate in synthetic organic chemistry and has spent his career combining laboratory medicine and computer science. He has 10 years of clinical experience, most recently working at Piedmont Hospital, a 500-bed tertiary care center. For 10 years he
served as a computer consultant to the medical care industry, leading development of
commercial custom software for electronic data exchange and laboratory quality control and assurance. After joining CDC, he served on numerous internal and external
standards groups including X12, HL7, SNOMED, LOINC, WHO, and NCVHS subcommittees and workgroups. He has written over 100 articles on laboratory medicine quality control and assurance issues, terminology, and standards. Steindel is a board member of CAHIIM and is its current past-chair. He is also a Fellow of the American College
of Medical Informatics.
Steven J. Steindel
PhD, FACMI
Dwan A. Thomas-Flowers, MBA, RHIA, CCS is an independent contractor offering expertise in coding, management and general HIM operations, quality management, and revenue cycle. She currently serves as an ICD-10 consultant and as co-chair
of AHIMAs Clinical Terminology and Classification Practice Council. Other AHIMA
activities include serving on the Professional Ethics and Triumph Awards Committees,
the House of Delegates Best Practices and Standards and Operations Teams, and has
received an ACE designation. Involved in several professional associations, shes held
positions in AHIMA, Florida Health Information Management Association (FHIMA),
HIMSS, National Association of Health Services Executives (NAHSE), and Florida Association for Healthcare Quality (FAHQ). Thomas-Flowers is former chair of the
HIMSS ICD-10 Task Force, past president of FHIMA, and a recipient of multiple industry awards including two AHIMA Triumph Awards for Leadership and Mentoring and
two FHIMA Distinguished Member designations. A frequent instructor for CCS preparatory workshops and a sought-after presenter within healthcare, Thomas-Flowers
also publishes on coding and management in industry magazines.
Dwan A. Thomas-Flowers
MBA, RHIA, CCS
Susan White, PhD, RHIA, CHDA is an associate professor in the HIM and systems division at The Ohio State University where she teaches data analytics, healthcare
finance, and database courses and provides statistical support for researchers. She is
currently a member of the Council for Excellence in Education (CEE) Curriculum
Workgroup, has co-chaired AHIMAs Data Governance and Analytics Practice Council,
and served as a member of the Quality Initiatives and Secondary Data Use Practice
Council. White is the author of AHIMA Press books A Practical Approach to Analyzing
Healthcare Data and Principles of Finance for Health Information and Informatics Professionals. She presents regularly at the state and national level on data analytics, data
governance, and quality measurement. She is also the president and founder of Health
Policy Analytics, a consulting firm dedicated to assisting clients in analyzing large
claims databases to understand the impact of payment policy changes.
Susan White
PhD, RHIA, CHDA
CCHIIM Commissioners
Stacey Butler, RHIA, CDIP, CCS, CCS-P began her career in HIM over 17 years
Stacey Butler
RHIA, CDIP, CCS, CCS-P
ago. She is currently the coding and clinical documentation improvement (CDI) manager at Arkansas Childrens Hospital (ACH). Butler developed the ICD-10-CM/PCS
education plan for ACH coders and also held a leadership role in the implementation
of computer-assisted coding and the CDI program. She also works as a coding consultant for Nearterm Healthcare Solutions. Butler enjoys training and sharing information on coding and CDI, and had the opportunity to teach as an adjunct coding instructor at the University of Arkansas for Medical Sciences. Butler has served on the
Arkansas Health Information Management Association (ArHIMA) Professional Development Committee, AHIMAs CCS Exam Construction Committee, AHIMAs CCS
Exam Job Analysis Task Force, and is a program reviewer for the AHIMA Professional
Certificate Approval Program. Butler is an AHIMA-approved ICD-10-CM/PCS trainer
and a published writer on the subject of coding and coding education.
Diane E. Ferry, MS, RHIA is president and chief executive officer of Star-Med, a
Diane E. Ferry
MS, RHIA
regional health information management services and consulting company. She has a
bachelors degree in health information management and a masters degree in health
services administration. Ferry has been a director of HIM at two academic medical
centers and has been the chief operating officer of two national release of information
management companies. She founded her own release of information management
company in 2002 and serves as its president/CEO. She has been president of the Delaware Health Information Management Association twice and president of the Delaware chapter of the National Association of Women Business Owners twice. She is also
an adjunct faculty member in a HIM college program.
Committee Chair:
Tim Keough, MPA, RHIA, FAHIMA
KS
TH A N
IAL
ating
SPEC2014 Nomin
to the
ittee
Comm
Committee Members:
Gloryanne Bryant, RHIA, CDIP, CCS, CCDS
Jill Finkelstein, MBA, RHIA, CHTS-TR
Video Extra
A Conversation with
the 2014 AHIMA
Nominating Committee Chair
journal.ahima.org
Laura Rizzo, MHA, RHIA

Ann Nowlin, RHIT
Bryon Pickard, MBA, RHIA
Patrice Spath, MA, RHIT, CHTS-IM
Patty Thierry Sheridan, MBA, RHIA, FAHIMA
Bill Thieleman, RHIA, CHP
14_Aug.indd 60
8/4/14 2:01 PM
Sally A. Gibbs, MA, RHIA, CCS is an AHIMA-approved ICD-10-CM/PCS trainer
Sally A. Gibbs
MA, RHIA, CCS
and the documentation and data quality manager for Sutter Health Ethics and Compliance Services. Her professional background is diverse, including working in corporate compliance, information services, consulting, acute care HIM, coding and coding
management, and HIM education. She also has clinical experience as a respiratory
therapist which provides a wealth of practical experience to draw on when evaluating
and setting standards for the certification of HIM professionals. Her team member and
leadership experience at AHIMA, the California Health Information Association, and
her local association have given Gibbs a broad perspective of the group decision making process as well as issues facing the healthcare industryparticularly HIM.
Erin Head, MBA, RHIA, CHTS-TR is a HIM professional, mentor, educator, vol-
Erin Head
MBA, RHIA, CHTS-TR
unteer, and leader. Head is director of health information management and prospective payment systems at UF Health Shands Psychiatric Hospital and UF Health Shands
Rehabilitation Hospital in Gainesville, FL. Head is also an adjunct instructor of the
health IT program at College of Central Florida. Head has served in multiple roles with
the Florida Health Information Management Association (FHIMA) including director,
AHIMA chief delegate, and committee chair. She has served on several AHIMA committees including House Leadership, the Electronic Health Record Practice Council,
and the Professional Certificate Approval Program, and has served as facilitator for
AHIMA House of Delegates breakout sessions. As an accomplished speaker, Head has
presented on many topics including professional development, HIPAA, prospective
payment systems, electronic health records, and leadership. Head is a HIM graduate of
the University of Cincinnati and received her MBA from Saint Leo University.
Rosann M. ODell, D.H.Sc., MS, RHIA, CDIP is an HIM professional with expe-
Rosann M. ODell
D.H.Sc., MS, RHIA, CDIP
rience in release of information, cancer registry, clinical coding, healthcare documentation support, and education. She is also an AHIMA-approved ICD-10-CM/PCS
trainer. ODell currently serves on the AHIMA Consumer Engagement Practice Council and previously served on the Clinical Terminology and Classification Practice
Council as well as the Research and Periodicals Workgroup. She has authored journal
articles and presented on topics such as health policy, ethics, and consumer health
informatics. ODells other recent contributions to the profession include serving as a
reviewer for the journal Educational Perspectives in Health Informatics and Information Management, as well as providing expert review for a textbook on the topic of
electronic health records. ODell recently became a clinical assistant professor of
health information management at the University of Kansas Medical Center.
ELECTION RESULTS WILL BE ANNOUNCED

VIA E-ALERT IN EARLY OCTOBER
Calendar
SUNDAY
MONDAY
TUESDAY
WEBINAR:
WEDNESDAY
How Vendor
Neutral Archives
Meet HIM
Needs: Is VNA
Right for You?
THURSDAY
FRIDAY
SATURDAY
CDIP Exam Prep Workshop,

Washington, DC
Faculty Development Regional
Meeting, San Diego, CA
CDI Summit: Leading the

Documentation Journey,
Washington, DC
AHIMAs National Election Polls Open
10
11
12
13
14
15
16
20
21
22
23
29
30
AHIMAs National Election Polls Open
17
18
WEBINAR:
19
CSA MEETING: GEORGIA, Athens, GA
CMS Pay for

Performance
Methodology
AHIMAs National
Election Polls Open
24
25
26
27
28
CSA MEETING: CONNECTICUT,
Mystic, CT
31
AHIMA Annual Convention

2015 New Orleans, LA
September 26October 1
A Look Ahead
Keep Informed
SEPTEMBER
Institute Covers Critical Industry Privacy and

Security Topics
September 2728, San Diego, CA
Upcoming AHIMA Institutes, Seminars, Workshops,

and Webinars
Webinar: The Missing Ingredient: Effective Internal

Communications
18-19
CSA Meeting: Maine, Bar Harbor, ME
18-19
CSA Meeting: North Dakota, Fargo, ND
23
Webinar: Keeping CompliantHIPAA, the

Omnibus Rule and Data Privacy, Confidentiality,
and Security
24-26
AHIMA Academy for ICD-10-CM/PCS: Building

Expert Trainers in Diagnosis and Procedure
Coding, San Diego, CA
27-28
CHDA Exam Prep Workshop, San Diego, CA
27-28
Privacy and Security Institute, San Diego, CA
27-28
Clinical Coding Meeting, San Diego, CA
27October 2
2014 AHIMA Convention and Exhibit, San Diego,

CA
UPCOMING INSTITUTES, SEMINARS,

WORKSHOPS, AND WEBINARS
October 16
Webinar: Using Social Media to Resolve Healthcare Issues Within and Across Organizations
October
22-24

Coding, Orlando, FL
October 23
Webinar: How to Avoid Greatly Increased Liability

in the Business Associate Relationship
November
13
Webinar: Six Strategies to Protect Your EHR

Investment
November
17-18
AHIMA Academy for ICD-10-CM: Building Expert

Trainers in Diagnosis Coding: Chicago, IL
November
17-19

Coding, Chicago, IL
December
1-3
CHPS Exam Prep Workshop, Las Vegas, NV
December
1-3

Training, Las Vegas, NV
December 9 Webinar: Stop the Madness! Simplify Healthcare

Provider Business Intelligence
Check www.ahima.org/events for the latest schedule of
institutes, seminars, and workshops.
Resources and News from AHIMA
Registration is now open for the Privacy and Security Institute, which takes place immediately before AHIMAs 2014 Annual Convention and Exhibit.
Every day, privacy and security officers must balance confidentiality, privacy, and security issues
of healthcare reform, advances in technology, and
workflow accommodations with the complexities of
regulatory disparity and laws such as HIPAA and
the final HITECH Omnibus Rules. Consumer education is critical and consumer trust issues continue
amidst a lack of industry standards and mandated
reporting of health information breaches.
Participants will learn from a line-up of experts
investigating critical industry privacy and security
topics. This meeting is an opportunity to expand
ones knowledge and stay abreast of the hottest
privacy and security trends today. More information
is available at www.ahima.org/events/2014septPrivacyInstitute.
CHDA Exam Prep Workshop Taking Place

Before Convention
September 2728, San Diego, CA
With the emphasis that ARRA places on the use
of electronic health records, the healthcare industry is continuing to become more data-driven. As
a result, health data analysts are more valuable
to providers than ever before. The CHDA credential recognizes expertise in health data analysis.
CHDA-credentialed professionals exhibit broad organizational knowledge and the ability to communicate with individuals and groups at multiple levels,
both internal and external to their organization. This
prestigious certification provides practitioners with
the knowledge to acquire, manage, analyze, interpret, and transform data into accurate, consistent,
and timely information, while balancing the big
picture strategic vision with day-to-day details.
For more information on the workshop, visit www.
ahima.org/events/2014Sept-CHDA-sandiego.
To learn more about AHIMA credentials and eligibility to sit for the examinations, visit the AHIMA
certification site at www.ahima.org/certification.
AHIMA Volunteer Leaders
AHIMA BOARD OF DIRECTORS

President/Chair
Angela C. Kennedy, EdD, MBA, RHIA
Head and Professor, LA Tech University
Ruston, LA
(318) 257-2854
angela.kennedy@ahima.org
CEO, AHIMA
Lynne Thomas Gordon, MBA, RHIA, CAE,
FACHE, FAHIMA
Chicago, IL
(312) 233-1165
lynne.thomasgordon@ahima.org
President/Chair-elect
Cassi Birnbaum, MS, RHIA, CPHQ, FAHIMA
Senior Vice President of Health Information
Management and Consulting,
Peak Health Solutions, Inc.
San Diego, CA
(858) 746-7298
cassi.birnbaum@ahima.org
Advisor to the Board

David S. Muntz, CHCIO, FCHIME, LCHIME,
FHIMSS
Senior Vice President/CIO, GetWellNetwork
Bethesda, MD
(240) 482-3192
David.muntz@getwellnetwork.com
Speaker of the House of Delegates

Jennifer A. McManis, RHIT
Healthcare Consultant, Crowley Fleck Attorneys
Bozeman, MT
(406) 522-4501
jmcmanis@crowleyfleck.com
TERM ENDS 2014DIRECTORS

Ann Chenoweth, MBA, RHIA
Senior Director of Industry Relations and
Market Research, 3M Health Information
Systems
Murray, UT
(801) 265-4390
afchenoweth@mmm.com
Dwayne M. Lewis, RHIT, CCS

President/CEO, DML Consulting, Inc.
Broken Arrow, OK
(918) 249-0101
dmlewisconsult@hotmail.com
Treasurer
Melissa M. Martin, RHIA, CCS
Chief Privacy Officer and Director of Health
Information Management, West Virginia
University Hospitals
Morgantown, WV
(304) 598-4109 x73716
martinme@wvuhealthcare.com
Secretary
Dana C. McWay, JD, RHIA
Court Executive/Clerk of Court, US Bankruptcy
Court for the Eastern District of Missouri
(314) 244-4600
danahimlaw@aol.com
Susan J. Carey, RHIT, PMP
System Director, HIM, Norton Healthcare
Louisville, KY
(502) 629-8913
susan.carey@nortonhealthcare.org
Cindy Zak, MS, RHIA, PMP, FAHIMA

Executive Director Corporate HIM,
Yale New Haven Health System
Woodbridge, CT
(203) 688-5466
cindy.zak@ynhh.org
Zinethia L. Clemmons, MBA, MHA, RHIA, PMP
Senior Health Information Privacy Specialist,
Department of Health and Human Services/OCR
Washington, DC
(202) 495-0533
zinethia.clemmons@hhs.gov
Ginna E. Evans, MBA, RHIA, FAHIMA
Business Analyst, Revenue Cycle Development,
Emory Healthcare
Avondale Estates, GA
(404) 778-7960
ginna.evans@emoryhealthcare.org
Colleen A. Goethals, MS, RHIA, FAHIMA
HIM Consultant, Cardone Record Services, Inc.
Belvidere, IL
(815) 378-2632
cgoethals@mmrainc.com
2014 CHAIRS OF AHIMA VOLUNTEER GROUPS

AHIMA Grace Awards Committee
Mark S. Dietz, RHIA
(763) 377-6720
markdietz2@msn.com
Engage Advisory Committee

Seth J. Katz, RHIA, MPH
(913) 526-4987
SJKatz5@hotmail.com
Nominating Committee
Tim J. Keough, MPA, RHIA, FAHIMA
(609) 936-2222
tkeo2@aol.com
AHIMA Triumph Awards Committee

Marion K. Gentul, RHIA, CCS
(302) 827-1098
mgs60mga@yahoo.com
Exhibit Advisory Committee

Julie W. Clark
(770) 205-6198
jclark@creativelyclark.com
Professional Ethics Committee

Laurie A. Rinehart-Thompson, JD, RHIA, CHP, FAHIMA
(614) 292-3694
Laurie.Rinehart-Thompson@osumc.edu
Annual Convention Program Committee

Adrienne A. Beauvois, RHIT
(626) 836-6634
abeauvois@coh.org
Fellowship Review Committee

Julie Wolter, MA, RHIA, FAHIMA
(314) 977-8720
wolterjl@slu.edu
State Advocacy Council

Sue (Jensen) Nathe, RHIT
(320) 231-3655
sue@medsuppliestrucare.com
2014 CHAIRS OF AFFILIATE VOLUNTEER GROUPS

AHIMA Foundation
Warren A. Jones, MD, FAAFP
(312) 233-1131
drwajones@bellsouth.net
Commission on Accreditation for

Health Informatics and Information
Management Education
Mervat Abdelhak, PhD, RHIA, FAHIMA
(312) 233-1548
info@cahiim.org
Commission on Certification for Health

Informatics and Information Management
Donna Rugg, RHIT, CCS
(585) 396-6784
donna.rugg@thompsonhealth.org
Council for Excellence in Education

Ellen Shakespeare Karl, MBA, RHIA, CHDA,
FAHIMA
(646) 344-7324
ellen.shakespeare@mail.cuny.edu
Envisioning Collaborative
(406) 522-4501
House Leadership
Laura W. Pait, RHIA, CDIP, CCS
(336) 946-1750
lpait@novanthealth.org
20142015 HOUSE OF DELEGATES

Speaker of the House of Delegates
(406) 522-4501
Speaker-elect of the House of Delegates

Laura W. Pait, RHIA, CDIP, CCS
(336) 946-1750
lpait@novanthealth.org
2014 PRACTICE COUNCIL VOLUNTEER CONTACTS

Care Coordination
Barbara M. Bosler, JD, MHE, RHIA
(313) 331-1902
Bbosler3@aol.com
Lee A. Wise, RHIA
(760) 880-7518
leewise2008@hotmail.com
Clinical Terminology & Classification
Tammy R. Love, RHIA, CDIP, CCS
(501) 472-6634
Tammy.Love@hcahealthcare.com
Dwan A. Thomas-Flowers, MBA, RHIA, CCS

(904) 607-6610
HIMprofexcel@bellsouth.net
Consumer Engagement
Anne L. Tegen, MHA, HRM
(952) 474-1780
anne.tegen@childrensmn.org
Beth A. Friedman, RHIT
(770) 335-8570
beth@ten22pr.com
Enterprise Information Management

Kathleen Addison
(403) 943-0940
kathleen.addison@albertahealthservices.ca
Health Information Exchange

Sheldon Wolf
(701) 328-1991
shwolf@nd.gov
Jill S. Clark, MBA, RHIA, CHDA, FAHIMA

(717) 246-9472
jclark@e4-services.com
Privacy and Security

Sharon Lewis, MBA, RHIA, CHPS, CPHQ,
FAHIMA
(805) 542-0160
sharonlewisrhia@att.net
Lori McNeil Tolley, MEd, BS, RHIA

(508) 822-1432
loriamcneil@gmail.com
Susan M. Lucci, RHIT, CHPS, CMT, AHDI-F

(303) 646-3355
slucci128@hotmail.com
AHIMA volunteers also make valuable contributions as facilitators for Engage Online Communities. To locate the facilitator(s), go to a particular community, click on the Members tab, then click on the
community administrator link.
AHIMA Volunteer Leaders
COMPONENT STATE ASSOCIATION PRESIDENTS

Alabama
Sharon Horton, RHIT
Cullman, AL
(256) 352-8337
sharon.horton@wallacestate.edu
Indiana
Deborah Grider, CDIP, CCS-P
McCordsville, IN
(317) 908-5992
deborahgrider@mac.com
New Hampshire
Jean Wolf, RHIT, CHP
Gorham, NH
(603) 466-5406
jean.wolf@avhnh.org
Tennessee
Lela McFerrin, RHIA
Chattanooga, TN
(423) 493-1637
lela.mcferrin@hcahealthcare.com
Alaska
Janie Batres, RHIA, CDIP
Anchorage, AK
(907) 252-7228
janieleigh44@hotmail.com
Kansas
Julie Hatesohl, RHIA
Junction City, KS
(785) 210-3498
phoebehat@cox.net
New Jersey
Carolyn Magnotta, RHIA
New Egypt, NJ
(609) 758-8890
magnottac@deborah.org
Texas
Terri Frnka, RHIT
Bryan, TX
terrifrnka@yahoo.com
Arizona
Christine Steigerwald, RHIA
Gilbert, AZ
(480) 292-8293
Christine.Steigerwald@bannerhealth.com
Kentucky
Meloney Mantsch, RHIA
Pittsburgh, PA
(603) 494-3429
mmantsch@css.edu
New Mexico
Vicki Delgado, RHIT
Albuquerque, NM
(505) 948-6711
vicki.delgado@kindredhealthcare.com
Arkansas
Marilynn Frazier, RHIA, CHPS
Ozark, AR
(479) 667-5153
mfrazier@ftsm.mercy.net
Louisiana
Lisa Delhomme, MHA, RHIA
Rayne, LA
(337) 277-5544
delhomme@louisiana.edu
New York
Sandra Macica, RHIA
Saratoga Springs, NY
(518) 584-0389
s.macica@elsevier.com
California
Shirley Lewis, RHIA, CCS
Upland, CA
(909) 608-7657
shirley.lewis5@verizon.net
Maine
Nora Brennen, RHIT
Topsham, ME
(207) 751-1853
Nora.Brennen@va.gov
North Carolina
Jolene Jarrell, RHIA, CCS
Apex, NC
jolene@drgreview.com
Colorado
Melinda Patten, CDIP, CHPS
Aurora, CO
(720) 777-6657
melinda.patten@childrenscolorado.org
Maryland
Sarah Allinson, RHIA
Baltimore, MD
(410) 499-7281
sarahballinson@gmail.com
Connecticut
To Be Determined
Massachusetts
Walter Houlihan, MBA, RHIA, CCS
Springfield, MA
(413) 322-4309
Walter.Houlihan@bhs.org
Delaware
Marion Gentul, RHIA, CCS
Lewes, DE
(302) 827-1098
mgs60mga@yahoo.com
District of Columbia
Jeanne Mansell, RHIT, CHTS-CP, CHTS-PW,
CHTS-IM, CHTS-IS, CHTS-TS, CHTS-TR
Washington, DC
(202) 421-5172
jeanne87@hotmail.com
Florida
Anita Doupnik, RHIA
Tampa, FL
(813) 907-9380
anita.doupnik@nuance.com
Georgia
Allyson Welsh, MHA/INF
Decatur, GA
Allysonwelsh@gmail.com
Hawaii
Marlisa Coloso, RHIA, CCS
Wailuku, HI
(808) 442-5509
mcoloso@hhsc.org
Idaho
Sandra Johnson, RHIT
Rigby, ID
(208) 317-4987
brynnesmum@gmail.com
Illinois
Teresa Phillips, RHIA
Effingham, IL
(217) 347-2806
teri.phillips@hshs.org
Michigan
Thomas Hunt, RHIA
Owosso, MI
(989) 725-8279
thunt@davenport.edu
Minnesota
Jean MacDonell, RHIA
Grand Rapids, MN
(612) 719-3697
jean.macdonell@granditasca.org
Mississippi
Phyllis Spiers, RHIT
Carriere, MS
(601) 347-6318
pspiers@forrestgeneral.com
Missouri
Angela Talton, RHIA, CCS
Florissant, MO
(314) 276-4180
afranks@swbell.net
Montana
Vicki Willcut, RHIA
Kalispell, MT
(406) 756-4758
vwillcut@krmc.org
Nebraska
Shirley Carmichael, RHIT
Fairbury, NE
(402) 729-6854
shirley.carmichael@jchc.us
Nevada
Gregory Schultz, RHIA
North Las Vegas, NV
(702) 526-8361
gschultz00@aol.com
Utah
Vickie Griffin, RHIT, CCS
Bountiful, UT
vickie.griffin@Parallon.com
Vermont
To Be Determined
Virginia
Darcell Campbell, RHIA
Hampton, VA
(757) 788-0052
DACampbell@cox.net
North Dakota
Tracey Regimbal, RHIT
Grand Forks, ND
traceyregimbal@hotmail.com
Ohio
Gail Wright, RHIT
Mansfield, OH
(419) 526-0439
gail.wright@kindred.com
Oklahoma
Christy Hileman, RHIA, CCS
Mustang, OK
(405) 954-2824
christy.hileman@faa.gov
Oregon
William Watkins, RHIA
Oregon City, OR
(503) 867-5173
william.w.watkins@kp.org
Washington
Sheryl Rose, RHIT
Spokane, WA
(509) 624-4109
sherylrose622@hotmail.com
West Virgnia
Kathy Johnson, RHIA
Sinks Grove, WV
(304) 772-5312
kjohnson@care-communications.com
Wisconsin
Susan Casperson, RHIT
Cecil, WI
(715) 853-1370
susan.casperson@thedacare.org
Wyoming
Kimberle Johnson, RHIA
Gillette, WY
(307) 682-1251
kim.johnson@ccmh.net
Pennsylvania
Laurine Johnson, RHIA, FAHIMA
Sarver, PA
(724) 295-9429
ljohnson@peakhs.com
Puerto Rico
Yanet Soto
Arecibo, PR
(787) 879-2835
ysoto@wilmamed.com
Rhode Island
Patti Nenna, RHIT
Bristol, RI
(401) 253-1686
pnenna@cox.net
South Carolina
To Be Determined
South Dakota
Sheila Hargens, MSHI, CMT
Parkston, SD
(605) 928-3741
sheila.hargens@avera.org
E-mail changes to your listing to journal@ahima.org

13.QC.2371_1_13.QC.2371_1 7/8/13 12:14 PM Page 1
Advertising Index
Delivering
quality-focused
people, responses
and results.
AHIMA..................................................................16, 67, 71
Amphion Medical Solutions............................................ 32
Were dedicated to providing cost-effective solutions

for all of your coding and reimbursement concerns.
Caban Resources, LLC................................................... 52

Channel Publishing......................................................... 55
MEDICAL CODING SERVICES

Inpatient & Outpatient: Onsite & Remote
HCC Medicare Advantage Coding
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CODING COMPLIANCE AUDITS
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DRG/Coding Quality Audits

Evaluation & Management Audits
- Emergency Room
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First Class Solutions.......................................................38

Health Information Associates.......................................... 7
EDUCATION AND TRAINING

ICD-10-CM/PCS
HealthPort....................................................................... 11
212.368.6200 www.qualcodeinc.com
HRS................................................................................. 21
AHIMA Thanks Its Loyalty Program Members
In Record Time, Inc........................................................... 1

Just Associates, Inc........................................................ 49
EXECUTIVE LEVEL
M*Modal..........................................................................33
MedData, Inc.......................................... inside back cover
Nuance Communications, Inc........................................... 9
DIRECTOR LEVEL
OPTUM....................................................... 45, back cover

PLATOCODE, LLC............................................................ 5
MANAGER LEVEL
QualCode, Inc.................................................................66
St. Josephs College of Maine........................................ 31
TruCode...................................................inside front cover
University of Phoenix......................................................39
AHIMA 2014 Webinars
Ad Space
January 23
Creating an Effective Compliance Program
January 28
Focus on Behavioral and Physician Coding

in ICD-10-CM
January 30
Writing Effective and Compliant Physician Queries
February 13
Electronic Content Management (ECM)A Game

Changer for Healthcare
February 20
Using Data and Analytics to Improve Quality and

Financial Outcomes across the Healthcare Continuum
HOUSE
March 11
Managing Big Data in Healthcare
March 25
Understanding Encephalopathy
March 27
Business Associate Agreements: The Basics
April 1
Safety Assurance Factors for Electronic Health Record

Resilience (SAFER): Study Protocol
67
April 3
The Five Most Dangerous HIE Practices
April 8
Mobile Device Security
April 22
The Anatomy of a Preventable Breach
April 24
Consumer Engagement and Personal Health

Information
May 1
Information Governance and Standards
May 8
Patient Identity and Matching
June 5
How to Handle HIPAA Security Breaches Properly
June 10
Systems-Based Model for the Instruction of

ICD-10-CM and ICD-10-PCS Coding
June 12
Preparing for PHI Request for Restrictions
June 19
Going Forward Into the PastInformation Governance

and Standards Enterprise Information Management
June 24
How to Use the HIPAA Breaches after the Omnibus

Rule
June 26
Establishing a Second Level Review Process
July 10
An ICD-10 Contingency Coding Staff Recruitment and

Retention Plan Success Story
July 15
Looking Behind the Curtain: Value-Based Cares Impact

on the Revenue Cycle
July 22
Mental Gymnastics with Root Operations:

Release and Replacement
July 24

Extirpation and Dilation
July 29

Resection and Reposition
July 31
Mental Gymnastics with Select Root Operations from

the Administration and Imaging Sections of PCS
August 5
How Vendor Neutral Archives Meet HIM Need
Webinars last 60 minutes, beginning at:

1 p.m. ET 12 noon CT 11 a.m. MT 10 a.m. PT
August 19
CMS Pay for Performance Methodology
August 21
An Introduction to Information Governance
Webinars broadcast earlier in the year and prior

years are available as on-demand recordings.
August 26
ICD-10-PCS and Physician Coders: Bridging the Gap
September 9
The Missing Ingredient:

Effective Internal Communications
September 23
Keeping Compliant: HIPAA, The Omnibus Rule, and

Data Privacy, Confidentiality, and Security
October 16
Using Social Media to Resolve Healthcare Issues Within

and Across Organizations
October 23
How to Avoid Greatly Increased Liability

in the Business Associate Relationship
November 13
Six Strategies to Protect Your EHR Investment
December 9
Stop the Madness! Simplify Healthcare Provider

Business Intelligence
Convenient, Cost-Effective,
and Compelling Learning
Reliable, expert, and timely
information
Receive two AHIMA CEUs
regardless of format
Several people at the same
facility can participate for one
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Registration starts at just $125
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AHIMA Career Center

For classified advertising information, call Alyssa Blackwell: 410-584-1961 | e-mail: ablackwell@networkmediapartners.com
While the ads in this section are deemed to be from reputable sources, the publisher accepts no responsibility for the offers made.
All copy must conform to equal employment opportunity guidelines, and the publisher reserves the right to reject, withdraw, or modify copy.
A current rate card is available on request.
Want to fill your open position,

or promote your office as a
great place to work?
Contact Alyssa Blackwell at 410-584-1961 for pricing and options, or
leave her an email at ABlackwell@NetworkMediaPartners.com.
Adreima is seeking FT/PT

experienced coders to join our
team. Adreima partners with
more than 600 hospitals and
offers: sign-on bonus/ medical/
dental/ vision/ 401K.
www.adreima.com/careers/
Upcoming Issues:
September
Consumer Engagement
October
Information Governance
Advertise in
the AHIMA
Career Center!
November/December
E-Compliance
Contact Alyssa Blackwell at 410-584-1961

or ablackwell@networkmediapartners.com
68/Journal
68
/ Journal of AHIMA August 14
Custom Packages available to fit your goals and budget.
IMMEDIATE JOB OPENINGS
Credentialled Coding Professionals

Adreima, the nations largest, independent revenue cycle services
company, is seeking full and part time experienced coders to join our
team of more than 1,100 employees nationwide. Adreima partners with
more than 600+ hospitals and health systems to help them capture
full value for the services they offer. Depending on the assignment,
Adreima coders work on client site or remotely to assign appropriate
diagnostic and procedural (ICD-9-CM and CPT-4) codes to individual
patient health information for data retrieval, analysis, and claims
processing. Charts include IP, ER, OP Surgery. Diagnostic and
Observation. May also perform audit activities.
Immediate Positions
Competitive Pay
Excellent Benefts
Great Place to Work!
Knowledge and experience with ICD-9/10 CM and CPT-4/HCPCS coding
rules and federal guidelines
Conduct coding classes for clinicians, clinical and business office staff
Support ongoing charge/revenue and coding related questions
Interact with medical staff members to explain medical chart audit results
Develop and present recommendations for changes to policies, proce
dures, and standards that would enhance the review process.
Stay abreast of industry coding & compliance issues
adreima.com
602-636-5531
Health First is Central Florida's only fully integrated health

system located in Brevard County on Florida's Space Coast.
Health First, with our team of more than 7,800 associates,
four outstanding hospitals, large multi-specialty physician
group, extensive outpatient and wellness services and nationally
recognized health insurance plans is devoted to delivering
quality healthcare.
Health First is seeking experienced certifed professional Inpatient
Coders to provide complete and accurate data collection for
quality clinical analysis and revenue enhancement. These are
full time positions to include full beneftsMedical, Dental,
Life, Personal/Sick Leave, 401K and more! Opportunity to work
remotely in the State of Florida.
R equ iR ements:
4 years inpatient and/or outpatient coding experience
with one of the following: RHIA, RHIT, CCS, CPC-H (ICD-10
Certifcation through AAPC preferred for those with AAPC coding
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1 year of employment).
Apply online at www.Health-First.org/careers or email
resume to: Jody.Thames@Health-First.org
HEALTH INSURANCE
HOSPITALS
MEDICAL GROUP
OUTPATIENT SERVICES

4 / 69
AHIMA Career Center

You are the future of HIM
NATIONAL
OPPORTUNITIES
AVAILABLE
To the qualified
candidate we offer:
Flexible schedules
Competitive earnings and
benefits package
Free CEs and generous
continuing education allowance
Computer equipment and
in-house IT team
Travel pay and corporate credit
card for traveling employees
Care Communications, Inc., a nationally

recognized health information and data
management consulting company, is
recruiting dynamic professionals who
eagerly embrace new challenges in HIM.
Inpatient Remote Coders
RHIA, RHIT, or CCS certification,
a minimum of 3 years coding experience,
knowledge of ICD-9/CPT-4/DRGs
necessary. Excellent computer skills
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Coding Quality Review and

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RHIA, RHIT, or CCS certification, a
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Apply online at
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email your resume to
Presentation and computer skills a must!
hr@care-communications.com
or fax to 312-229-7277
Senior HIM Consultant
RHIA or RHIT certification, a
minimum of 8 years of experience with
Equal
excellent management and leadership
skills. Excellent communication and
Opportunity/Affirmative
computer skills required!
Action Employer
Find the perfect employee.

Advertise in the AHIMA Career Center!
Contact Alyssa Blackwell at 410-584-1961
or ablackwell@networkmediapartners.com
70/Journal
70
/ Journal of AHIMA August 14
AHIMA Press ICD-9 and ICD-10 Coding Publications Help

You Manage the Delay and Prepare for the Transition.
The ICD-10 delay has put pressure on current and future HIM professionals to learn (or relearn)
the ICD-9 coding systems and maintain their ICD-10 knowledge. To assist during the delay,
AHIMA Press is re-releasing books and other resources containing ICD-9 and ICD-9/ICD-10
coding content. Visit ahimastore.org for the following titles:
Coding Publications:
2012 Edition
Basic Basic ICD-9-CM

Coding Exercises
ICD-10-CM/PCS
and ICD-9-CM
Coding
FOURTH EDITION
Basic ICD-9-CM
Basic ICD-10-CM/PCS
Coding ExercisesCoding Exercises
Lou Ann Schraffenberger, MBA, RHIA, CCS, CCS-P, FAHIMA
Basic ICD-9-CM Coding Exercises trains students to make

realistic diagnostic and procedural coding decisions by
presenting coding cases that come from real healthcare
encounters and reflect the reality of coding today.
New exercises have been added to every chapter, and the
entire book has been updated to reflect code changes
effective October 1, 2010.
Basic ICD-9-CM Coding Exercises
workbook for students new to coding practice.
Presents de-identified records of

patient care encountersrather than
one-line diagnosis statementsto
build realistic decision-making skills
Offers the next step in coding
practice for increased proficiency
Provides professional knowledge and
the practice needed to master the
effective application ICD-9-CM codes
Includes full answer key at the back
of the book
About the Author

Lou Ann Schraffenberger, MBA, RHIA, CSS, CCS-P, FAHIMA, is a leading expert in
ICD-9-CM coding.
press
AHIMA is the premier association of health information management (HIM) professionals. AHIMAs more than 59,000 members
to make realistic diagnostic and procedural coding

real healthcare encounters and reflect the reality of
Exercises and chapters are organized by the
S
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FAHIMA, is a leading expert in ICD-10-CM/PCS coding.
5/19/14 11:47 AM
claim forms and difficulties working with

third-party payers
ement, in addition
zelwood have
ICD-10-CM and
ICD-10
ICD-9-CM Diagnostic
Coding and
Reimbursement for
Physician Services
ICD-10
Anita C. Hazelwood,
Carol A. Venable,
Practice Exercises for

Skill Development
j HIM and coding students can use the exercises for self-directed
learning
l
l
j Coding professionals can use the exercises to gain additional coding

experience in inpatient, ambulatory, physician practice, and nonacute
care settings
l
l
j Employers can use this resource to challenge new coding professionals

who are ready to sharpen their skills
j Coding managers can use this material as a tool to assess the

competency of coding staff for complex coding practice
l
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AC201212
Anita C. Hazelwood, MLS, RHIA, FAHIMA
l. Chicago, IL 60601 (800) 335-5535
Carol A. Venable, MPH, RHIA, FAHIMA
EALTH INFORMATION MANAGEMENT (HIM) PROFESSIONALS. AHIMAS MORE THAN

EFFECTIVE MANAGEMENT OF PERSONAL HEALTH INFORMATION NEEDED TO DELIVER
UNDED IN 1928 TO IMPROVE THE QUALITY OF MEDICAL RECORDS, AHIMA IS COMMITTED
N INCREASINGLY ELECTRONIC AND GLOBAL ENVIRONMENT THROUGH LEADERSHIP IN
ND LIFELONG LEARNING.
j HIM educators can use the exercises to supplement basic- and

intermediate-level course materials
Key features
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IC ICD
> Coding for present on admission and

MS-DRGs
> Subsections addressing specific body
systems and diseases, providing
targeted practice
> Case studies with multiple choice and
open-ended questions that address skills
at all levels
> An online answer key explaining
correct and incorrect answers in detail
AC201514
ISBN 978-1-58426-417-0
AHIMA PRESS 233 N. Michigan Ave., 21st Fl. Chicago, IL 60601

(800) 335-5535 www.AHIMA.org
AHIMA is the premier association of health information management (HIM) professionals. AHIMAs more than 64,000 members are dedicated
to the effective management of personal health information needed to deliver quality healthcare to the public. Founded in 1928 to improve the
quality of medical records, AHIMA is committed to advancing the him profession in an increasingly electronic and global environment through
leadership in advocacy, education, certification, and lifelong learning.

9 781584 264170
CCW AC201514.indd 1
9/21/12 3:23 PM
Prod. No. AC201212

ISBN: 9781584263883
Price: $99.95
Member Price: $79.95
with answers
KEY FEATURES
> Practice of dual coding in both
ICD-9-CM and ICD-10-CM/PCS
j Preparing to sit for the mastery-level coding exams offered by AHIMA

(CCS and CCS-P) to gain additional insight into a variety of specialty
coding topics
S
A IN
NT -10
O
C ICD
2013
2013
Clinical Coding Workout challenges coding students and professionals

with more than 1,500 coding scenarios and exercises to develop the
expert skills required for coding accuracy. Questions are presented by
code set, including exercises from the 2013 editions of ICD-9-CM,
ICD-10-CM/PCS, CPT, and HCPCS Level II. Ways in which this valuable
resource can be used include:
ICD-10
hed articles in
urnal of AHIMA.
2013
2014
CLINICAL
Diagnostic Coding
CODING
for Physician Services:
WORKOUT
Prod. No. AC201213

ISBN: 9781584260769
Price: $99.95
2013
CLINICAL
CODING
WORKOUT
2014
CLINICAL
CODING
CLINICAL
WORKOUT
CODING

Skill Development
Clinical Coding Workout challenges coding students and professionals

with more than 1,500 coding scenarios and exercises to develop the
expert skills required for coding accuracy. Questions are presented by
code set, including exercises from the 2013 editions of ICD-9-CM,
ICD-10-CM/PCS, CPT, and HCPCS Level II. Ways in which this valuable
resource can be used include:
j HIM educators can use the exercises to supplement basic- and

Skill Development
S
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WORKOUT
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experience in inpatient, ambulatory, physician practice, and nonacute
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who are ready to sharpen their skills

Skill Development
> Practice of dual coding in both

ICD-9-CM and ICD-10-CM/PCS
> Coding for present on admission and
MS-DRGs
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AHIMA PRESS 233 N. Michigan Ave., 21st Fl. Chicago, IL 60601

(800) 335-5535 www.AHIMA.org
AHIMA is the premier association of health information management (HIM) professionals. AHIMAs more than 64,000 members are dedicated
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WITH ONLINE ANSWERS
CCW AC201614.indd 1
CLINICAL2014
CODING
CliniCal
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> Subsections addressing specific body

s Without
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KEY FEATURES
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Skill Development
2013
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Key Features

Skill Development
Practice of coding in iCD-10-CM/PCS
to prepare for the october 1, 2014
implementation
Coding for present on admission
and MS-Drgs
Subsections addressing specific body
systems and diseases, providing
targeted practice
Case studies with multiple choice and
open-ended questions that address
skills at all levels
S
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IC ICD
hiM educators can use the exercises to supplement basic- and

hiM and coding students can use the exercises for self-directed
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Coding professionals can use the exercises to gain additional
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and nonacutecare
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AC201614
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ISBN 978-1-58426-418-7
professionals who are ready to sharpen their skills
Practice Exercises for Skill Development
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AHIMA IS THE PREMIER ASSOCIATION OF HEALTH INFORMATION MANAGEMENT (HIM) PROFESSIONALS. AHIMAS MORE THAN
64,000 MEMBERS ARE DEDICATED TO THE EFFECTIVE MANAGEMENT OF PERSONAL HEALTH INFORMATION NEEDED TO DELIVER
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21-chapter ICD-10-CM tabular list

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PUBLICATIONS
Key Points
Chapter organization to conform with the
can be used as a companion to Basic ICD 10-CM/PCS

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AC210511
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are dedicated to the effective management of personal health information needed to deliver quality healthcare to the public.
Founded in 1928 to improve the quality of medical records, AHIMA is committed to advancing the HIM profession in an increasingly
electronic and global environment through leadership in advocacy, education, certification, and lifelong learning.
PUBLICATIONS
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233 N. Michigan Ave., 21st Fl.

Chicago, IL 60601
(800) 335-5535
www.ahima.org
to give beginning coders practical, skill-building

experience. Designed with industry expert input, it
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Basic ICD-10-CM/PCS Coding Exercises was created
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FOURTH EDITION
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Basic ICD-10-CM/PCS and ICD-9-CM Coding
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THIRD EDITION REVISED REPRINT
Fourth Edition
Anita C. Hazelwood, MLS, RHIA, FAHIMA; Lynn Kuehn, MS, RHIA, CCS-P,
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Whether youre still a student or already on the job, Certified Coding SpecialistPhysician-based
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Domain I: Health Information Documentation
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233 n. Michigan Ave., 21st fl. chicago, Il 60601 (800) 335-5535
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quAlIty HeAltHcAre to tHe publIc. founded In 1928 to IMprove tHe quAlIty of MedIcAl records, AHIMA Is coMMItted
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About the Authors
icago, IL 60601 (800) 335-5535
Includes Online Assessments
Online
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Paired with the AHIMA publications

ICD-10-CM and ICD-9-CM Diagnostic Coding
and Reimbursement for Physician Services
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Procedural Terminology and HCPCS, CCSP
Exam Preparation offers everything you need to
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AnitA C. HAzelwood, MLS, RHIA, FAHIMA, is an HIM department head and professor, author, and leading expert in ICD-9-CM coding.
INFORMATION MANAGEMENT (HIM) PROFESSIONALS. AHIMAS MORE THAN

TIVE MANAGEMENT OF PERSONAL HEALTH INFORMATION NEEDED TO DELIVER
IN 1928 TO IMPROVE THE QUALITY OF MEDICAL RECORDS, AHIMA IS COMMITTED
EASINGLY ELECTRONIC AND GLOBAL ENVIRONMENT THROUGH LEADERSHIP IN
ELONG LEARNING.
IN
EP
R
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EV
IS
Answers include rationales

and references to enhance
learning
FIFTH EDITION REVISED REPRINT
Certified Coding
Associate (CCA)
Exam Preparation
ReVised
RepRint
Certified Coding SpecialistPhysicianbased (CCSP) Exam Preparation
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ffective October 1, 2011 or
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oding Associate
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Lynn Kuehn, MS, RHIA, CCS-P, FAHIMA
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Addendum
Less for the Executive,

More for the Entry-Level
Critical Safety-Net Hospital Bets Big on Pay Shift
A DALLAS, TX SAFETY-NET HOSPITAL made itself part of the national debate on minimum wage and
executive pay recently when its board voted to increase the wages of entry-level workers from a minimum
of $8.78 per hour to $10.25 per hour.
Board members of Parkland Health and Hospital Systemwhich has seen its share of financial woes in
recent yearsalso agreed to pay for the increase that impacted 230 of its workers by taking the money
out of executive compensation packages, the Dallas Morning News reported. The increase, which at press
time was expected to go into effect July 1, is expected to cost about $350,000 for the first year and will
impact employees working in dietary, linens, and environmental services. The pay hike is also potentially
good news for those health information management (HIM) professionals working in entry-level positions,
such as intake, registration, and clerical positions.
Hospital officials cited hopes that the pay increase would boost employee retention and improve job satisfaction. The change was also a recognition that entry-level healthcare workers do impact the quality of
care patients receive, and should be trained, retained, and motivated to excel in their positions.
Experts on executive pay in healthcare told Modern Healthcare that Parklands decision is without precedent in the industry. Jim Otto, a senior principal at salary consultant organization Hay Group, told the magazine that I would be surprised if it becomes some kind of large movement, but I would not be surprised
if individual systems take a look at this and think seriously about doing something similar. Just given how
wages have stagnated for a good chunk of our employed population in the US, this may be the kind of
innovative approach that boards and senior management would be interested in at least talking through.
While the debate around raising the national minimum wage rages onand is poised to be an election
year issuecompanies such as Costco, Gap, and In-N-Out Burger have increased entry-level wages without
waiting for a requirement from state and federal governments.
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AUGUST 2014

A Conversation with the 2014 AHIMA Nominating

Tim Keough, MPA, RHIA, FAHIMA, discusses the issues affected

Three Myths of ICD-10-CM/PCS

Contents August 2014

Taking Your Seat

How to become a leader

Vol. 85, no. 8

How to Lead Your Organization in

By Ben Burton, JD, MBA, RHIA, CHP, CHC

Coming Soon to Your Healthcare Facility:

By Lesley Kadlec, MA, RHIA

Realigning HIM to the New Healthcare

By Patricia Bower-Jernigan, RHIA, Ann Chenoweth, MBA, RHIA, and

AHIMA Career Center

Contents August 2014

Three Myths of ICD-10-CM/PCS

Roles for HIM Professionals in HIOs

By Linda Bailey-Woods, RHIA, CPHIMS; Julie Dooling, RHIA;

Federal Changes Proposed for eDiscovery

Leveraging the Leader-Member Exchange

2014 AHIMA Election Ballot

Not all CAC is created equal

Computer-Assisted Coding (CAC)

515 S. Flower Street, 36th Floor, Los Angeles California 90071

Contents August 2014

Video: A Conversation with the

Coverage from AHIMAs Clinical

Share and Connect with AHIMA

6/Journal of AHIMA August 14

The Journal of AHIMA is an official publication of AHIMA

Lynne Thomas Gordon, MBA, RHIA, FACHE, CAE, FAHIMA

ART DIRECTOR Graham Simpson

EDITORIAL ADVISORY BOARD

Linda Belli, RHIA

8/Journal of AHIMA August 14

Reinventing Clinical Documentation

Using Our Influence to Lead for

ery weakness is made irrelevant.

HOSPITALS and CLINICS

Look for HealthPort at

keeping PHI safe

Bulletin Board whats happening in healthcare

AHRQ Report: Healthcare Quality Improving in Hospitals

nursing home care, and a 50 percent

Rule Changes Considered for Handling

able care organization (ACO) plans.

for Medicare and Medicaid Services

CMS Aims to Simplify

cination, HIV treatment, and hospital

Cloud-Based Services on the Rise in

Healthcare Providers Using Cloud-Based Services

The Veterans Affairs Department now

As part of the American Health Information

Journal of AHIMA August 14/13

Bulletin Board whats happening in healthcare

Breach Enforcement May Increase as Wall of

14/Journal of AHIMA August 14

The infamous Department of Health

over $10 million in breach settlements

Apple Launches Health App Linked to EHRs

Research Studies Show Healthcare Benefits

When patients were discharged, we

ART DIRECTOR Graham Simpson