health information technology program health data … · 2013. 1. 31. · 4. identify regulatory...

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HEALTH INFORMATION TECHNOLOGY PROGRAM

HITT 1301

HEALTH DATA CONTENT AND STRUCTURE/CRN: 30544

Spring 2013/Distance Education

Syllabus is subject to change at the discretion of the instructor.

Carolyn Stariha, RHIA

Office: 2nd

Floor, Room 227

Telephone: 713-718-7349

Office Hours: Student Conferences by appointment.

This is an online class except the Midterm Exam, Final Exam, and

Individual Projects are completed at the Coleman College. Also, student

must be in attendance for Simulation Day and HITT Week.

The class will meet on Wednesdays for the Midterm Exam, Final

Exam, and Individual Project at the Coleman College at 4:00pm.

Also, the GoToMeetings will be on Wednesdays from 5:30pm-

6:30pm.

Course Description:

Introduction to system and processes for collecting maintaining and

disseminating primary and secondary health related information.

Introduction in delivery and organizational structure to include content

of health record, documentation requirements, registries, indices,

licensing, regulatory agencies forms, and screens.

Course Objectives:

AHIMA DOMAINS, SUBTASKS, AND TASKS for the Registered

Health Information Technician

I. Domain: Healthcare Data

A. Subdomain: Data Structure, Content and Use

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1. Verify timeliness, completeness, accuracy, and appropriateness of

data and data sources

2. Conduct qualitative analysis to assure that documentation in the health

record supports the diagnosis and reflects the progress, clinical findings,

and discharge status

II. Domain: Health Information Analysis

1.Abstract records for department

5. Present data in verbal and written forms

III. Domain: Healthcare Environment

Healthcare Information Requirements and Standards

Assist in developing health record documentation

Perform quantitative analysis of health records to evaluate compliance

with regulations and standards

Perform qualitative analysis of health records to evaluate compliance

Assist in preparing the facility for an accreditation, licensing, and/or

certification survey

Ensure facility-wide adherence to health information services

compliance with regulatory requirements

Domain: Information Technology & Systems

Subdomain: Health Information Systems

Collect and report data on incomplete records and

Timeliness of record completion

1. Maintain filing and retrieval systems for paper-based patient records

Maintain integrity of master patient/client index

Maintain integrity of patient numbering and filing systems

Design forms, computer input screens & other health record

documentation tools

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Course Goals:

*US Department of Labor, Secretary’s Commission on Achieving

Necessary Skills

1. Trace the history of medical record management and describe the

evolution of healthcare.

2. Discuss the health information profession, code of ethics, and

organizational structure.

3. Define the term (health record), understand its purpose, uses, and the

content therein.

4. Identify regulatory bodies that impact health record documentation.

5. Analyze health records qualitatively and quantitatively.

6. Describe advantages and disadvantages of the filing, storage, and

retention methods. Describe the filing systems.

7. Collect data on the quality of documentation in the health record.

8. Collect data on the status of incomplete records.

9. Identify design rules for data collection forms.

10. Describe construction considerations that must be made for paper

forms.

11. Describe the function of indexes and registries, the way in which

data is collected, and the types which must be maintained.

Scans Competencies:

1. F1 Reading, F2 Writing, F3 Listening, F10 Seeing things in the

mind’s eye, C5 Acquires and Evaluates Information.

2. F1 Reading, F2 Writing, C9 Participates as a member of a team, F12

Reasoning.

3. F12 Reasoning, F1 Reading, F2 Writing, C5 Acquires and Evaluate.

4. F12 Reasoning.

5. C7 Interprets and communicates information.

6. F12 Reasoning, Acquires and Evaluates Information, F9

Problem Solving.

7. C7 Interprets and communicates information.

8. F8 Decision Making, C7 Interprets and Communicates.

9. F12 Reasoning, F9 Problems Solving.

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10. C5 Acquires and Evaluates Reasoning.

Textbook Reference:

-Health Information Management Technology, 4th Edition-Merida Johns

-Health Information: Management of a Strategic Resource, 4th Edition-

Abdelhak, Grostick, Hankens, & Jacobs.

-Professional Review Guide, PRG, 2012 Edition (Latest Edition)

-Comprehensive Review Guide for Health Information RHIA & RHIT

Exam Prep-Tyson-Howard & Thomas

Class Time: Distance Education

Students will meet on Wednesdays at the Coleman College to take the

Midterm, Final exam, and to present the Individual Projects. The exams

will be scheduled for 4:00pm in Room 538 on the 5th floor.

Class Requirements:

1. Read the assignments outlined on the attached schedule.

2. Turn in assignments in a timely manner.

3. Have necessary materials to complete assignments.

4. Participate actively in class discussions.

5. Conduct research.

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Course Methodology:

Distance Learning/Powerpoints

Classroom Participation

Student Research

Videos

Exams:

Exams are multiple choice, true and false, fill in the blank, matching

and essay (40-100 questions). There will be approximately 5 exams

including the mid-term and the final. Exams need to be taken on the

date assigned. Make-up exams may not be taken for the Mid-term

or Final Exams. All make-up exams must be approved by the

instructor and 20 points will be deducted from each make-up exam.

Mid-term and Final exam must be taken at the Coleman College

from (4:00 pm until 7:00 pm). ****Please Note: All assignments are

due on the dates stated. No late assignments accepted. Any

assignment which is submitted late will not be graded. If you do not

turn in your assignments, group project assignments, and

homework on time then you will receive an automatic F. Do not

submit any assignment via Eagle online email or instructor’s HCC

email. Once again, please do not email any assignments in email

because they will not be graded. Do not ask if a late assignment can

be submitted. Students need to use time management and complete

their assignments in a timely fashion.

“Houston Community College System seeks to provide equal education

opportunities without regard to race, color, religion, national origin, sex,

age, or handicap. This policy extends to employment, admission, and all

programs and activities supported by the college."

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ADA STATEMENT:

“Any student with a documented disability (e.g. physical, learning,

psychiatric, vision, hearing, etc.) who needs to arrange reasonable

accommodations must contact Disability Services Office at (713) 718-

7082 at the beginning of each semester. Faculty is authorized to provide

only the accommodations requested by the Disability support services

office.”

NOTICE: Students who repeat a course for a third or more time may

soon face significant tuition/see increases at HCC and other Texas

public colleges and universities. Please ask your instructor/counselor

about opportunities for tutoring/other assistance prior to considering

course withdrawal or if you are not receiving passing grades.

Early Alert:

Students having difficulty academic difficulty or personal difficulties

that affect academic performance will be referred to an advisor.

Once a referral is made counselors will then contact students to discuss

the issues and possible solutions to their academic difficulties.

Tutor- Ms. Sheridan (Hours are listed outside of the HITT Lab on the 5th

floor, Room 538). See Student Success Center for further details.

Academic Success Center-Ms. Alvarez (713-718-7506)

Academic Dishonesty will not be tolerated. Exams and assignments are

individual assignments. Plagiarized and copied papers will be handled in

accordance with established HCCS college policy. Do not copy the work

of other professionals.

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Attendance Policy:

It is the responsibility of the student to formally withdraw from a class.

The instructor checks attendance weekly. The instructor is required to

report all absences for all students receiving financial aid (grants, VA,

Social Security, etc.). Distance education student need to send the

instructor a weekly email stating how they are doing in the class.

It is the responsibility of the student to formally withdraw from a

class not the instructor. Students must actively participate in Eagle

online. If the student does not participate then they will be

considered an absent student.

EGLS3 -- Evaluation for Greater Learning Student Survey System At Houston Community College, professors believe that thoughtful

student feedback is necessary to improve teaching and learning. During

a designated time, you will be asked to answer a short online survey of

research-based questions related to instruction. The anonymous results

of the survey will be made available to your professors and division

chairs for continual improvement of instruction. Look for the survey as

part of the Houston Community College Student System online near the

end of the term

Grading Policy:

Homework Assignments (Discussion Postings, Video Assignments)- 4%

Journal Assignment- 3%

HIM Interviews- 4%

Quizzes- 16%

Individual Projects-5%

(All of the above assignments are worth 32% of your grade)

Tests (including Mid-term) 36%

Final Exam 28%

Simulation Day-2%

Health Information Professionals Week-2%

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NO Make-Up Examinations for the Midterm and/or Final

Grading Scale

A 90-100

B 80-89

C 75-79

74-Below F

The letter grade of “D” cannot be earned in the Health Information

Technology Program

Test Scores:

Students in the Health Information Technology Program may not keep

test, nor test results that have been taken within the program. Upon

receiving test outcomes, students must record their test scores so they

are able to remember their grades. Also, students will not be able to

review the results of tests taken online. Students will be able to

review the midterm exam and final only.

Cover Sheet:

All assignments must have a coversheet. Assignments turned in

without a coversheet will result in points being deducted. The cover

sheet must be centered on the sheet of paper and must include the

following:

Student’s Name

Student’s ID #

Class Name and Class CRN #

Assignment Title

Date Due

Instructor’s Name

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JOURNAL ASSIGNMENT:

Students are to prepare at least a two (2) page, doubled spaced typed

journal summary. One of the following Health Information Journals

must be utilized “The American Health Information Management

Association Journal, Advance, or For the Record.” A copy of the article

must be attached to the summary. The student must include a Cover

Sheet & a Works Cited Page. References need to be cited according to

APA guidelines. Students will need to answer the questions listed on

the assignment. Submit assignment via Eagle online.

Date Due: February 10, 2013

HOMEWORK:

Assignments are listed under the objectives. Students must answer all

questions fully in order to receive credit. The questions should be

answered to assist the student with learning and being successful within

the classroom. Homework is due as assigned. Due as assigned (Sunday

11:30pm). The homework will be graded at the end of the semester.

HIM INTERVIEWS:

Each student will interview a credentialed Health Information

practitioner (RHIA, RHIT, CCS) of the students’ choice. Students must

notify practitioners to schedule the interview. Interviews need to be done

in person not by phone, faxes, or e-mail. Students will be given 5

questions to ask at their interview. The student will need to make-up 5

questions of their own to ask at the interview. The interview is 4% of

your grade. Interview questions and answers must be submitted to the

instructor on the date they are due. Be sure to include the practitioner’s

name, title, place of business, and phone number. Students are not

allowed to interview practitioners at the same time. This is an individual

project and should be treated as such. Students will present questions to

the class. Practitioners should be someone other than the student's

preceptor for the Practicum I. Submit assignment via Eagle online. .

Date Due: April 14, 2013

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QUIZZES:

Students will be quizzed weekly over the assigned readings.

INDIVIDUAL PROJECTS:

Each student will be assigned a Health Information topic. Students are at

liberty to research any related journals, books, the internet, magazines,

etc. Students may also interview professionals in the field. Creativity is

strongly encouraged. Please include a bibliography or works cited page

with your report. Students will present their topic in class. You will lose

30 points if you do not present your individual project in class. If a

student is not in attendance for both days of presentations then 15 points

will be deducted from their grade. The student needs to have a

powerpoint to present the information or another form of a visual aid.

The presentations should be 10 to 15 minutes in length. The report

should have a cover sheet, 5 pages of information discussing the topic,

and a bibliography or works cited page. The work cited page needs to be

referenced according to APA (American Psychological Association).

The student must have at least four references with only 1 from the

internet.

Due Date: March 6, 2013

DISCUSSION POSTINGS:

Students will do research on 6 topics and post on the course board. The

discussions must consist of at least one page of research and references

must be cited according to APA. The topics include:

Discussion 1: The evolution, from the medical records to health

information. Be sure to include information regarding HIPAA and the

electronic medical record.

Discussion 2: Ethics in Health Information Technology

Discussion 3: The evolving job functions of the Health Information

Professional. Be sure to include past job functions and present job

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functions such as the Privacy Officer. Also, review all of the credentials

which AHIMA offers.

Discussion 4: The future of the Health Information Profession. How is

the electronic record changing Health Information Technology? Where

is the future of HIM going? How will the electronic record affect the

future? How will Universal Health Care affect health care in general and

the HIM profession? Pros and Cons of an Electronic Health Record.

Discussion 5: The importance of Health Information. The importance of

Privacy and Security of Health Records. Be sure to include legal

information, HIPAA, and information related to confidentiality. Also,

include information about Health Care Reform, HI-Tech Act, and

Stimulus Act.

Discussion 5: HIPAA and the Electronic Health Record

Discussion 6: Personal Health Record

HAHIMA Meetings-Attendance will give students 3 points overall

on their final grade. The student must be a member in good

standing and pay all fees related to the meeting. Also, student will

need to prepare a 2 page typed summary of the information that

was presented at the meeting. The original CE Form needs to be

turned into the instructor immediately after the HAHIMA meeting.

Simulation Day (April 3, 2013-Mandatory Attendance)

Students will be placed in groups. Groups will design handouts and

posters on the personal health record and electronic health record.

Health Information Professionals Week- (March 18-March 22)

Students will be placed in groups. Groups will design handouts and

posters on the electronic health record.

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HITT 1301

Health Data Content and Structure\

Fall 2012

SCHEDULE

Please note: Quizzes and Exams are posted on Tuesdays (4:00pm) and

close on Sundays (11:30pm) except for the Midterm and Final Exams.

Lesson 1: January 7, 2013-January 13, 2013

Introduction to Course

Gotomeeting to review the syllabus will be on Wednesday (January 9,

2013 at 5:30pm-6:30pm.

Lesson 2: January 14, 2013-January 20, 2013

Evolution of Health Care and Health Information

Quiz 1-(Jan 15-Jan 20)

Discussion Posting 1/Homework Assignment

Lesson 3: January 22, 2013-January 27, 2013 (Jan 21st Holiday)

Forms Design/Ethics in Healthcare

Quiz-2-(Jan 22-Jan 27)

Discussion Posting 2/Homework Assignment/Video Assignment

Lesson 4: January 28, 2013-February 3, 2013

Exam I (Covers information from Lesson 2-Evoluation of Health

Care and Health Information). (Jan 29-Feb 3)

Flow of the Health Record/Health Record

Content/Ethics in Health Care

Quiz 3-(Jan 29-Feb 3)

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Lesson 5: February 4, 2013-February 10, 2013

Journal Assignment Due: February 10, 2013

(Flow of the Health Record /Health Record

Content/Format Types/Management of Health

Record Documentation)

Quiz 4-(Feb 5-Feb 10)

Discussion Posting 3/Homework Assignment/Video Assignment

Lesson 6: February 11, 2013-February 17, 2013

HIPAA Quiz 5- (Feb 12-Feb 17)

Homework Assignment/Video Assignment

Lesson 7: February 19, 2013-February 24, 2013 (Feb 18 Holiday)

Exam II (Covers Information from Lesson 3)-Forms Design and

Ethics. (Feb 19-Feb 24)

Filing and Numbering Systems/Record Storage and

Retention/Record Problems.

Quiz 6-(Feb 19-Feb 24)

Homework Assignment

Lesson 8: February 25, 2013-March 3, 2013

Exam III (MID-TERM) will cover information

From Lessons 2-Lesson 6. The exam

will be taken on February 27, 2013 at 4:00pm in Room

538, on the 5th floor.

Lesson 9: March 4, 2013-March 10, 2013

Individual Projects Presentations will be presented

at the Coleman College at 4:00pm in Room 538, 5th

floor on March

6, 2013 Discussion Posting 4

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March 11, 2013-March 17, 2013 Spring Break


Health Information Professionals Week-Date to be announced.

(Mandatory Attendance)

Index and Registries

Quiz 7-(March 19-March 24)

Homework Assignment

March 25: Last Day for Administrative/Student Withdrawals-4:00pm


Continued: Individual Projects Presentations will be presented

at the Coleman College at 4:00pm in Room 538, 5th

floor on March

27, 2013

Exam 4 will cover information Lesson 7-(Filing

and Numbering Systems/Record Storage And

Retention/Record Problems/Indexes and

Registries) (March 26-March 31)

Electronic Medical Record

Quiz 8-(March 26-March 31)

Discussion Posting 5/Homework Assignment

Lesson 12: April 1, 2013-April 7, 2013

Simulation Day-Wednesday (April 3, 2013) Mandatory Attendance

Electronic Health Record

Discussion Posting 6


Electronic Health Record HIM Interviews due on April 14, 2013

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Review for the Final Exam

Lesson 15: April 24, 2013

Final Exam (Comprehensive)

The Final Exam will be taken at the Coleman

College on April 24, 2013 at 4:00pm in Room 538.

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Health Information Technology

HITT 1301

Health Data Content and Structure

Objectives

Mastery of all objectives will be demonstrated by student obtaining at

least 75% accuracy rate on written exams.

Lesson 1: No Reading Assignment.

Lesson 2- Evolution of Health Care and Health Information.

READING ASSIGNMENT

Abdelhak Ch. 1, 2, 3 (3rd & 4th edition)

Johns Ch. 1 & Ch.2

Homework Assignment: Answer the following questions. The student will:

Trace evolution of the following: Health care in the United States, Joint

Commission, and the American Health Information Management

Association (AHIMA).

Know the essential characteristics of a hospital.

Discuss the health care consumer.

Know regulatory agencies and Department of Health and Human

Services.

Know the purpose, value, uses, and responsibility of the health record.

Know the educational requirements for the RHIA and RHIT.

Know the continuing education requirements for the RHIA and RHIT.

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Understand the Health Information practitioner roles in the work place.

Lesson 3:

Forms Design and Ethics in Health Care

READING ASSIGNMENT

Abdelhak- Ch. 2 & 4

Johns Ch. 5, Ch.14 AND Ch. 8

Homework Assignment: The student will answer the following

questions. The student will:

Know the purpose of forms.

List the basic rules to be considered in forms design.

Know the members of the forms or views team.

Know why the forms or view team exist.

Know and understand all special considerations for computer forms

design.

List the objectives of forms control.

Understand forms control.

Know and understand forms analysis, inventory, identification, and

purchasing.

Understand why forms are reviewed.

What does an ethic mean?

What is ethical and what is not ethical?

Know and Understand AHIMA’s Code of Ethics and Bylaws.

Name some unethical things that a health information professional can

do.

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Lesson 4:

Flow of the Health Record/Health Record Content/Ethics in Health

Care READING ASSIGNMENT

ABDELHAK- Ch. 3 & 4

Johns Ch.3 & Ch.14

Homework Assignment:

The student will answer the following questions. Student Will:

Know and understand the professional code of ethics.

Health Record Flow

Student Will:

Trace the flow of the medical record.

Know documents generated by the medical service, nursing service, and

ancillary services.

List, understand, and know administrative data.

List, understand, and know clinical data.

Know report guidelines and time limits.

Lesson 5:

Format Types/Management of Health Record Documentation READING ASSIGNMENTS

ABDELHAK Ch. 4

Johns Ch. 3

Homework Assignment:

The student will answer the following questions. Define, understand, and know problem oriented, source oriented, and

integrated medical record.

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Know the advantage and disadvantage of each.

Define SOAP.

Management of Health Information READING ASSIGNMENT

ABDELHAK Ch. 4

Johns Ch. 15

Homework:

The student will answer the following questions. The student will know:

Know documentation requirements.

Understand the different types of analysis.

Understand documentation requirements by JCAHO.

Know the components of Quantitative and Qualitative Analysis.

Know and understand potentially compensable events.

Know and understand incomplete and delinquent medical records.

Lesson 6:

HIPAA

Reading materials will be provided by Ms. Stariha


What is HIPAA?

Why is HIPAA important?

What is the privacy rule?

Lesson 7: Filing and Numbering Systems

READING ASSIGNMENT

Abdelhak Ch. 7 (3rd edition)

4th edition-None in this addition

Johns Ch. 8 (3rd Edition)

Homework Assignment-

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Know and Understand the different filing systems.

Know and Understand the different Numbering Systems.

Know and Understand the advantages and disadvantages of each.

Know Centralization and Decentralization.

Understand the elements of Record Control.

Understand the elements of Record Retention.

Lesson 10:

Indexes and Registers

READING ASSIGNMENT

Abdelhak Ch. 14 (3rd edition)

4th edition Ch. 13

Johns Ch. 9

Homework:

The student will answer the following questions: Student will know:

Define Index.

Define Register.

Understand and know the Master Patient Index. What is the content and

arrangement?

Understand and know the Number Index. What is the content and

arrangement?

Understand and know the Disease and Operation Index. What is the

content and arrangement?

Know uses of Indexes.

Know the uses of automated and manual indexes.

Know the different types of indexes and their uses.

Know the different types of registers and their uses.

Know and Understand Database Management, Case Eligibility, Case-

finding, Abstracting, Coding, Staging, automation, and uses of the

discussed registries. i.e., AIDS, Diabetes, Birth Defects etc.

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Lesson 11:

Electronic Medical Record

READING ASSIGNMENT

Abdelhak Chapter 5, 8, 9 & 10 (3rd edition)

Abdelhak 4th ed. Ch. 5, 7, 8, 9

Johns Ch. 4, 5, 15 & 16

Homework:

The student will answer the following questions: Student will know:

-Understand the concept and evolution of the electronic health record

(EHR).

-Identify and define terms associated with EHRs.

-Relate the various initiatives local, regional, and national adoption of

the EHR and health information technology.

-Discuss the EHR challenges and the supporting roles of health

information management professionals in addressing them, especially

with respect to privacy, security, and legal aspects.

-Develop an appreciation for the planning and implementation aspects of

EHRs.

-Provide examples of EHR systems as they may be implemented in

various types of care settings.

-Discuss clinician and other user needs in an electronic health record

environment.

-Identify common health information management operational issues in

a hybrid and electronic health record environment.

-Identify resources and strategies needed by health information

management professionals to lead and participate in electronic health

record projects.

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Health Information Technology

HITT 1301

Data Content and Structure

Individual Projects

Please Note: Only one person per topic

1. Organizational Charts _______________________

2. Administrative & Clinical Records ______________________

3. AHIMA Professional Code of Ethics _____________________

4. Proper Documentation Guidelines _______________________

5. Chart Assembly (Types of Record Design) ________________

6. Quantitative & Qualitative Analysis __________________

7. Forms Design ______________________

8. Straight Numeric & Terminal Digit Filing ________________

9. Case Abstracting (Indexes & Registries) __________________

10. Health Information Management Professionals:

Credentials, HIM Career Opportunities, Professional

Organizations ________________________________

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11. Patient Record Formats (Advantages & Disadvantages) -

_________________________________

12. Record Storage Methods including Filing equipment

_________________________________

13. Electronic Health Record _______________________

14. Electronic Health Record _______________________

15. Numbering Systems _______________________

16. Traditional Paper-Based Record vs. Electronic Health Record

_____________________

17. HIPAA __________________________

18. Professionalism ___________________________

health information technology program health data … · 2013. 1. 31. · 4. identify regulatory...

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