Contents
Table of Contents
About the Volume Editors and Chapter Authors xxvi
Preface xxxii
Student and Instructor Online Resources xxxv
Acknowledgments xxxvi
Foreword xxxvii
Part I Foundational Concepts 1
Chapter 1 Health Information Management Profession 3
Early History of Health Information Management 4
Hospital Standardization 4
Organization of the Association of Record Librarians 4
Approval of Formal Education and Certification Programs 5
Evolution of Practice 5
AHIMA Support of Training and Education 14
AHIMA Career Map 15
AHIMA Foundation 16
Commission on Accreditation for Health Informatics and Information Management Education 16
Health Information Management Specialty Professional Organizations 16
Healthcare Information and Management Systems Society 17
Association for Healthcare Documentation Integrity 17
American Academy of Professional Coders 17
National Cancer Registrars Association 17 Real-World Case 1.1 18 Real-World Case 1.2 18
References 19
Local, State, and Federal Policies 52
Modern Healthcare Delivery in the United States 54
Social Security Act of 1935 54
Public Law 89–97 of 1965 54
Public Law 92–603 of 1972 55
Utilization Review Act of 1977 55
Peer Review Improvement Act of 1982 55 Tax Equity and Fiscal Responsibility Act of 1982 56
Law 98–21 of
References 59
Chapter 3 Health Information Functions, Purpose, and Users 63
Purposes of the Health Record 64
Primary Purposes 64
Secondary Purposes 65
Formats of the Health Record 65
Users of the Health Record 66
Individual Users 66
Institutional Users 67
Overview of HIM Functions 68
Medical Transcription and Voice Recognition 69
Disclosure of Health Information 69
Clinical Coding and Reimbursement 70
Record Storage and Retrieval Functions 70
Master Patient Index 70
Record Storage and Retrieval Functions in a Paper
Environment 72
Record Storage and Retrieval in an Electronic
Environment 81
Identification Systems 84
Paper Health Record – Serial Numbering System 84
Paper Health Record – Unit Numbering System 85
Paper Health Record – Serial-Unit Numbering System 85
Paper Health Record – Alphabetic Filing System 85
Electronic Health Record 85
Statistics and Research 85
Registries 85
Birth and Death Certificates 85 HIM Interdepartmental Relationships 86 Virtual HIM 86
Information Systems 87
Disclosure of Health Information 87
Chart Tracking 87
Coding 87
Registries 87
Billing 87
Quality Improvement 87
Electronic Health Records 87
Personal Health Records 88
World Case 3.2 89 References 89 Part II Data Content, Structures and Standards 91
Chapter 4 Health Record Content and Documentation 93 Role of Documentation 95 Documentation Standards 95
Standards 95
Medical Staff Bylaws 96
Accreditation 97
Joint Commission 99
State Statutes 100
Legal Health Record 100
General Documentation Guidelines 101
Documentation by Settings 103
Inpatient Health Record 103
Medical and Surgical 104
Ambulatory Surgery Record 110
Ancillary Departments 110
Physician Office Record 111
Long-Term Care 111
Rehabilitation 112
Behavioral Health 113
Home Health 113
Federal and State Initiatives on Documentation 115
Health Information Media 116
Paper Health Record Documentation 116
Electronic Health Record Documentation 117
Web-Based Document Imaging 117
Healthcare Providers in Documentation 118
Physicians 118
Nurses 118
Allied Health Professionals 118
HIM and Documentation 119
HIM Roles 120
Real-World Case 4.1 120
Real-World Case 4.2 121
References 121
Chapter 5 Clinical Terminologies, Classifications, and Code Systems 123
History and Importance of Clinical Terminologies, Classifications, and Code Systems 124
Clinical Terminologies 126
SNOMED Clinical Terms 127
SNOMED CT Purpose and Use 127
SNOMED CT Content and Structure 127
Current Procedural Terminology 129
CPT Purpose and Use 129
CPT Content and Structure 131
Nursing Terminologies 131
Nursing Terminologies Purpose and Use 131
Nursing Terminologies Content and Structure 132
Classifications 133
International Classification of Diseases, Tenth Revision, Clinical Modification 133
ICD-10-CM Purpose and Use 133
ICD-10-CM Content and Structure 134
ICD-10-Procedure Coding System 134
ICD-10-PCS Purpose and Use 135
ICD-10-PCS Content and Structure 135
International Classification of Diseases 11
th Revision 136
ICD-11 Foundation Component and ICD-11-MMS
Purpose and Use 137
ICD-11 Foundation Component and ICD-11-MMS
Content and Structure 137
International Classification of Functioning, Disability, and Health 138
ICF Purpose and Use 138
ICF Content and Structure 138
International Classification of Diseases for Oncology, Third Edition 139
ICD-O-3 Purpose and Use 139
ICD-O-3 Content and Structure 139
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition 140
DSM-5 Purpose and Use 140
DSM-5 Content and Structure 140
Code Systems 141
Logical Observation Identifiers, Names, and Codes 141
LOINC Purpose and Use 141
LOINC Content and Structure 142
Healthcare Common Procedure Coding System Level II 142
HCPCS Purpose and Use 142
HCPCS Content and Structure 143
RxNorm 143
RxNorm Purpose and Use 144
RxNorm Content and Structure 144
Clinical Terminologies, Classifications, and Code
Systems Found in Health
Data and Information Sets 145
Outcomes and Assessment Information Set 145
Healthcare Effectiveness Data and Information Set 146
Uniform Hospital Discharge Data Set 146
Common Clinical Data Set 146
Database of Clinical Terminologies, Classifications, and Code Systems 147
Data Sources 154
Data Management 155
Data Elements 155
Data Sets 156
Databases 159
Indices 162
Data Mapping 163
Data Warehousing 164
Information Governance 166
Valued Strategic Asset 167
Business Intelligence 167
Situation, Background, Assessment, Recommendation (SBAR) 167
Enterprise Information Management 168
Information Governance Principles for Healthcare 168
AHIMA’s Information Governance Adoption Model
Competencies 169
Data Governance 171
Data Stewardship 171
Data Integrity 172
Data Sharing 173
Data Interchange Standards 174
Information and Data Strategy Methods and Techniques 174
Data Visualization and Presentation 176
Critical Thinking Skills 176
Data Quality 177
AHIMA’s Data Quality Management Model 178
Accuracy 179
Accessibility 179
Comprehensiveness 179
Consistency 179
Currency 179
Definition 179
Granularity 179
Precision 180
Relevancy 180
Timeliness 180
Data Collection Tools 180
Screen Design 180
Forms Design 181
Clinical Documentation Integrity 183
CDI Tools 185
Data Management and Bylaws 189
Provider Contracts with Healthcare Organizations 190
Hospital Bylaws 190
Data Management and Technology 190
HIM Roles 191
Real-World Case 6.1 191
Real-World Case 6.2 192
References 193
Chapter 7 Secondary Data Sources 197
Differences between Primary and Secondary Data
Sources 198
Purposes and Users of Secondary Data Sources 199
Internal Users 199
External Users 199
Types of Secondary Data Sources 200
Facility-Specific Indexes 200
Disease and Operation Indexes 200
Physician Index 201
Registries 201
Cancer Registries 202
Trauma Registries 204
Birth Defects Registries 206
Diabetes Registries 206
Implant Registries 207
Transplant Registries 208
Immunization Registries 208
Other Registries 211
Healthcare Databases 211
National and State Administrative Databases 211
National, State, and County Public Health Databases
212
HIM Roles 215
Real-World Case 7.1 217
Real-World Case 7.2 217
References 218
Part III Information Protection: Access, Disclosure and Archival, Privacy and Security 221
Chapter 8 Health Law 223
Basic Legal Concepts 224
Types and Sources of Laws 224
Constitutions 225
Statutes 225
Administrative Law 226
Judicial Decisions 226
Legal Process 226
Initiation of Lawsuit 226
Discovery 227
E-Discovery 227
Trial 228
Evidence 229
Causes of Action in Professional Liability 229
Patient Rights Regarding Healthcare Decisions 231
Advance Directives 231
Overview
of
Legal Issues in Health Information
Management 234
Creation and Maintenance of Health Records 234
Ownership and Control of Health Records, Including
Use and Disclosure 234
Use and Disclosure Under State and Federal Law 235
Use of Health Records in Judicial Proceedings 236
Legal Health Record 236
Importance of the Legal Health Record 236
Content of the Legal Health Record 237
Retention of the Legal Health Record 237
AHIMA Retention Recommendations 238
Destruction 238
Medical Staff Credentialing 239
Licensure 240
Certification 240
Accreditation 240
HIM Roles 241
Real-World Case 8.1 243 Real-World Case 8.2 244
References 244
Chapter 9 Data Privacy and Confidentiality 247
Use and Disclosure 248
State Laws—Privacy 248
HIPAA Privacy Rule and ARRA 249
HIPAA and ARRA Overview 249
Office of the National Coordinator for Health Information Technology (ONC) 249
Applicability of the Privacy Rule 250
Covered Entities 250
Business Associates 250
Workforce Members 251
Protected Health Information 251
Deidentified Information 252
Other Basic Concepts 252
Individual 252
Personal Representative 253
Designated Record Set 253
Minimum Necessary 253
Treatment, Payment, and Operations 253
Individual Rights 254
Right of Access 254
Right to Request Amendment of PHI 255
Right to Request Accounting of Disclosures 256
Right to Request Restrictions of PHI 258
Right to Request Confidential Communications 258
Right to Complain of Privacy Rule Violations 258
HIPAA Privacy Rule Documents 260
Notice of Privacy Practices 260
Consent to Use or Disclose PHI 262
Authorization 263
Uses and Disclosures of Health Information:
Authorization and Patient
Right of Access 263
Patient Has Opportunity to Agree or Object 264
Patient Does Not Have Opportunity to Agree or Object 265
Breach Notification 270
Definition of Breach 270
Notification Requirements 271
Requirements Related to Commercial Uses:
Marketing, Sale of Information, and Fundraising 271
HIPAA Privacy Rule Administrative Requirements 272
Designation of Privacy Officer 272
Standards for Policies and Procedures 273
Privacy Training 273
Enforcement of Federal Privacy Legislation and Rules
273
Penalties 273
Legal Action by State Attorneys General 274
Audits 274
Disclosure of Health Information 274
The Disclosure of Health Information Function 274
Disclosure of Health Information Quality Control 275
Authorizations 276
Valid Authorization 276
Who Can Authorize Release 277
Medical Identity Theft 277
Patient Verification 278
Fair and Accurate Credit Transactions Act (FACTA) 278
Patient Advocacy 279
Compliance 279
HIM Roles 279
Real-World Case 9.1 281
Real-World Case 9.2 281
References 282
Chapter 10 Data Security 285
Ensuring the Integrity of Data 286
Ensuring the Availability of Data 287
Data Security Threats 288
Threats Caused by People 288
Social Engineering 289
Threats Caused by Environmental and Hardware or Software Factors 290
Strategies for Minimizing Security Threats 291
Components of a Security Program 294
Employee Awareness 295
Risk Management Program 296
Risk Analysis 296
Incident Detection 296
Incident Response Plan and Procedures 297
Access Safeguards 297
Identification 298
Authentication 298
Authorization 299
Physical Safeguards 299
Administrative Safeguards 300
Software Application Safeguards 301
Network Safeguards 301
Firewalls 301
Cryptographic Technologies 301
Web Security Protocols 303
Intrusion Detection Systems 303
Disaster Planning and Recovery 303
Risk Analysis 303
Disaster Planning 303
Disaster Recovery 304
Data Quality Control Processes 304
Coordinated Security Program 306
HIPAA Security Provisions 306
General Rules 307
Administrative Safeguards 308
Physical Safeguards 309
Technical Safeguards 310
Organizational Requirements 311
Policies and Procedures and Documentation
Requirements 312
American Recovery and Reinvestment Act of 2009
Provisions 313
Forensics 313
HIM Roles 315
Real-World Case 10.1 315
Real-World Case 10.2 316
References 316
Part IV Informatics, Analytics, and Data Use 319
Chapter 11 Health Information Systems 321
Health Information Systems 323
Current State of Health Information Systems 325
Scope of Health Information Systems 327
Source Systems 327
Administrative and Financial Applications 327
Clinical Departmental Applications 331
Specialty Clinical Systems 332 “Smart” Peripherals 332
Core Clinical EHR Systems 333
Results Management 333
Point of Care Documentation 333
Medication Management 335
Clinical Decision Support 338
Analytics and Reporting 339
Supporting Infrastructure 342
Connectivity Systems 344
Telehealth and Newer Forms of Healthcare Delivery 345
Patient-Exchanged Health Information 345
Health Information Exchange 347
Systems Development Life Cycle 349
Identify Needs 350
Specify Requirements 351
Design or Acquire 351
Develop and Implement 354
Maintain 355
Monitor Results 355
HIM Roles 356
Real-World Case 11.1 357
Real-World Case 11.2 358
References 359
Data Visualization 366
Dashboard 367
Data Capture Tools 367
Quality Measurement 371
Clinical Research 372
Consumers and Healthcare Information 372
Introduction to Consumer Health Informatics 373
Health Literacy 373
Telehealth 374
Information Access and Navigational Tools 376
Mobile Devices 376
Patient Portals 377
Social Media 377
Personal Health Records 378
Information in Personal Health Records 378
Models of Personal Health Records 378
Patient Safety 379
Health Information Exchange 380
Impact of HIE 380
Interoperability 381
Forms of Health Information Exchange 381
Benefits of Health Information Exchange 381
Users of Health Information Exchange 382
eHealth Exchange 382
Challenges with Sharing Healthcare Information 382
Patient Identity 383
Data Standards 383
HIM Roles 386
Real-World Case 12.1 387
Real-World Case 12.2 387
References 387
Chapter 13 Research and Data Analysis 391
Presentation of Statistical Data 392
Tables 393
Charts and Graphs 394
Bar Charts 394
Pareto Charts 397
Pie Charts 397
Line Graphs 398
Histograms 398
Frequency Polygons 398
Scatter Charts 399
Bubble Charts 401
Stem and Leaf Plots 402
Box-and-Whisker Plots 403
Statistical Packages and Presentation Software 403
Descriptive Statistics 405
Frequency and Percentile 406
Measures of Central Tendency 406
Mean 406
Median 407
Mode 407
Measures of Variability 407
Range 407
Variance 407
Standard Deviation 407
Normal Distribution 408
Inferential Statistics 410
t-tests 410
Chi-square Tests 411
Regression Equations 411
Analysis of Variance 411
How to Analyze Information 413
Quality, Safety, and Effectiveness of Healthcare 413
Structure and Use of Health Information and Healthcare Outcomes 414
Individual Data 414
Comparative Data 414
Aggregate Data 415
Research Methodologies 416
Quantitative Studies 416
Descriptive Studies 416
Correlational Studies 416
Retrospective Studies 417
Prospective Studies 417
Experimental Studies 419
Quasi-Experimental Studies 419
Qualitative Research 420
Grounded Theory 420
Ethnography 420
Mixed-Methods Approach 421
Randomization 421
Institutional Review Board 422
Healthcare Research Organizations 423
Centers for Disease Control and Prevention 423
World Health Organization 423
Agency for Healthcare Research and Quality 424
Ethics in Research 424
HIM Roles 425
Real-World Case 13.1 426
Real-World Case 13.2 427
References 427
Chapter 14 Healthcare Statistics 429
Discrete versus Continuous Data 431
Common Statistical Measures Used in Healthcare 432
Three Common Examples of Ratio-Level Data: Ratios, Proportions, and Rates 433
Ratio 433
Proportion 433
Rate 433
Acute-Care Statistical Data 435
Administrative Statistical Data 435
Inpatient Census Data 436
Inpatient Bed Occupancy Rate 438
Bed Turnover Rate 439
Length of Stay Data 440
Patient Care and Clinical Statistical Data 443
Hospital Death (Mortality) Rates 443
Gross Death Rate 443
Net Death Rate 443
Newborn Death Rate 443
Fetal Death Rate 444
Maternal Death Rate 444
Autopsy Rates 446
Gross Autopsy Rates 446
Net Autopsy Rates 446
Hospital Autopsy Rates 447
Newborn Autopsy Rates 447
Fetal Autopsy Rates 448
Healthcare-Associated Infection Rates 449
Healthcare-Associated Infection Rates 449
Postoperative Infection Rates 450
Consultation Rates 451
Case-Mix Statistical Data 451
Ambulatory Care Statistical Data 454
Public Health Statistics and Epidemiological Information 455
National Vital Statistics System 456
Population-Based Statistics 460
Birth Rates and Measures of Infant Mortality 460
Other Death (Mortality) Rates 462
Measures of Morbidity 464
National Notifiable Diseases Surveillance System 466
HIM Roles 468 Real-World Case 14.1 468
Case 14.2 469 References 469
Commercial Insurance 479
Private Healthcare Insurance 480
Employer-Based Coverage 480
Employer-Based Self-Insurance Plans 480
Not-for-Profit and For-Profit Healthcare Plans 480
Managed Care 481
Health Maintenance Organizations 481
Preferred Provider Organizations 482
Point-of-Service Plans 482
Exclusive Provider Organizations 482
Government-Sponsored Healthcare Plans 482
Medicare 483
Medicaid 484
The Medicare–Medicaid Relationship 484
TRICARE 485
Veterans Health Administration 485
Civilian Health and Medical Program of the Department of Veterans Affairs 485
Indian Health Services 486
Workers’ Compensation 487
New Trends 488
Health Insurance Marketplace or Exchange 488
Consumer-Directed Health Plans 488
Hospital-Acquired Conditions and Present on Admission Indicator Reporting 489
Medicare Access and CHIP Reauthorization Act 489
Patient Protection and the Affordable Care Act 490
Utilization Management 490
Case Management 490
Healthcare Reimbursement Methodologies 491
Fee-for-Service Reimbursement 491
Value-Based Purchasing 491
Traditional Fee-for-Service Reimbursement 491
Managed Fee-for-Service Reimbursement 492
Episode-of-Care Reimbursement Methodologies 492
Capitation 492
Global Payment 492
Prospective Payment 492
Medicare Acute Inpatient Prospective Payment System 493
Medicare Severity Diagnosis-Related Groups 493
Resource-Based Relative Value Scale System 494
Skilled Nursing Facility Prospective Payment System 494
Outpatient Prospective Payment System 494
Ambulatory Surgery Center Prospective Payment System 494
Home Health Prospective Payment System 494
Ambulance Fee Schedule 495
HIM Roles 495
Real-World Case 15.1 496
Real-World Case 15.2 496
References 496
Chapter 16 Fraud and Abuse Compliance 499
Federal Regulations and Initiatives 502
Office of the Inspector General 502
False Claims Act 504
Whistleblower Protection Act 504
Anti-Kickback Statute 504
The Stark Law 504
Balanced Budget Act of 1997 and the Exclusions Program 505
Health Insurance Portability and Accountability Act 505
Health Care Fraud Prevention and Enforcement Action Team 506
Recovery Audit Contractor 506
Quality Improvement Organization 508
Merit-Based Incentive Payment System 509
Compliance Program 511
Fraud and Abuse Prevention Strategies 512
Audits 513
Types of Audits 513
Preparing for and Conducting Audits 515
External Audits 517
Denials and Appeals 517
Coding and Fraud and Abuse 518
Coding Compliance 518
Queries 519
Computer-Assisted Coding 519
Clinical Documentation Integrity 521
Information Systems and CDI 521
Clinical Documentation Integrity Monitoring and Metrics 521
HIM Roles 522
Real-World Case 16.1 522
Real-World Case 16.2 522
References 522
Part VI Leadership 525
Chapter 17 Management 527
Management 528
Organizational Behavior 530
Organizational Structure 530
Management Levels 531
Organizational Tools 531
Organizational Chart 531
Mission, Vision, and Values Statements 531
Policies and Procedures 532
Strategic and Operational Planning 534
Developing Strategic and Operational Plans 535
Information Management Strategic Plan 535
Strategic Information Systems Planning 535
Work Analysis, Change Management, and Project Management 536
Work Analysis and Design 536
Change Management 537
Project Management 538
Project Management Life Cycle 538
Project Management Tools 538
Project Management Professional 539
Financial Management 540
Accounting 541
Budgets 541
Supply management 542
Staffing 542
Management of Resources and Allocation 542
Management of Vendors and Contracts 543
Enterprise Information Management 543
Management of Mergers 543
Management of Corporate Compliance and Patient
Safety 544
Risk Management and Risk Analysis 544
Customer Satisfaction 545
HIM Roles 546
Sentinel Events 553
Quality Dimensions of Performance Improvement 553
Contemporary Approach to Process Improvement 554
Fundamental Principles of Continuous Performance
Improvement 555
The Problem Is Usually the System 556
Variation Is Constant 556
Data Must Support Performance Improvement Activities and Decisions
Support Must Come from the Top Down 557
The Organization Must Have a Shared Vision 557
Staff and Management Must Be Involved in the Process 557
Setting Goals Is Critical 558
Effective Communication Is Important 558
Success Should Be Celebrated 558
Formal Performance Improvement Activities 558
Checksheets 559
Data Abstracts 559
Time Ladders 559
Statistics-Based Modeling Techniques 560
Team-Based Performance Improvement 562
Identifying Customers and Their Requirements 562
Documenting Current Processes and Identifying Barriers 562
Benchmarking 562
Collecting Current Process Data 563
Flow Chart Current Process 563
Brainstorm Problem Areas 563
Cause-and-Effect Diagram 565
Force-Field Analysis 565
Analyzing Process Data 566
Process Redesign 566
Recommendations for Process Change 566
Managing Quality and Performance Improvement 568
Organizational Components of PI 568
Standards of Organizational Quality in Healthcare 569
Clinical Practice Guidelines and Protocols 569
Accreditation Standards 569
Government Regulations and Licensure Requirements 571
Utilization Management 572
Risk Management 572
Risk Identification and Analysis 572
Loss Prevention and Reduction 573
Claims Management 573
Patient Advocacy 573
Accreditation Requirements for Risk Management in
Acute-Care Hospitals 573
Clinical Quality Management Initiatives 576
Accountable Care Organizations 577
Robust Process Improvement Methodologies 577
Lean 577
Six Sigma 578
Lean Six Sigma 578
High Reliability Organizations 578
ISO 9001 Certification 578
Medication Reconciliation 579
HIM Roles 579
Real-World Case 18.1 580
Real-World Case 18.2 581
References 581
Chapter 19 Leadership 583
Leadership Theories 584
Trait Theory 585
Behavior Theory 585
Contingency Theory 585
Power and Influence Theory 586
Leadership Styles 587
Patterns of Leadership 588
Transformational and Transactional Leadership 589
Change Management 590
Methods of Change Management 590
Kotter’s Eight-Step Method to Leading Change 590
Lewin’s Change Management Model 590
Bridge’s Transitional Model of Change 591
Mergers 592
Electronic Record Systems 592
Leadership 592
Leadership Competencies 592
Emotional Intelligence 593
Leading Others 593
Critical-Thinking Skills 593
C-Suite 594
Chief Executive Officer 594
Chief Information Officer 594
Chief Financial Officer 594
Team Leadership 595
Team Charter 596
Team Purpose 596
Team Selection 596
Team and Member Participation 597
Team Norms 598
Team Meetings 598
Scheduling of Meetings 598
Conducting Effective Meetings 598
Consensus Building 599
Communication 599
Business-Related Partnerships 601
Internal Business Partnerships 602
External Business Partnerships 602
Leadership Roles 602
HIM Roles 603
Real-World Case 19.1 604
Real-World Case 19.2 605
References 605
Chapter 20 Human Resources Management 607
Human Resources Management 608
Roles and Responsibilities 609
Employment Law and Ethics 609
Ethical Principles 610
Fair Labor Standards Act of 1938 610
Equal Pay Act of 1963 610
Title VII of the Civil Rights Act of 1964 611
Harassment 612
Pregnancy Discrimination Act of 1978 612
Age Discrimination in Employment Act of 1967 612
Occupational Safety and Health Act of 1970 612
Americans with Disabilities Act of 1990 613
Civil Rights Act of 1991 613
Family and Medical Leave Act of 1993 613
Genetic Nondiscrimination Act of 2008 614
Major Labor Laws 614
Workforce Planning and Job Analysis 616
Workforce Planning 617
Job Analysis 617
Job Description and Job Specifications 618
Recruitment and Selection 621
Recruitment 621
Selection 621
Testing 622
Interviewing 623
Staffing 625
Organizing Work 625
Scheduling Work 626
Measuring and Improving Performance 627
Performance Management 628
Performance Measurement 628
Developing Standards 628
Measuring Performance 629
Performance Appraisal 630
Performance Appraisal Methods 631
Employee Engagement and Retention 635
Employee Engagement 635
Reducing Turnover 635
Employee Relations and Fair Treatment 636
Communication Strategies 636
Conflict Management 636
Disciplinary Action 637
Handling Grievances 637
Dismissal 638
Labor Relations 639
Union Organization 640
Supervising in a Union Environment 640
Training and Development 642
New Employee Orientation 643
Employee Training and Development 643
Planning and Implementation 644
Delivery Methods 645
Career Development 647
Employer Role 648
Employee Role 648
Return on Investment: Training and Development 649
HIM Roles 650
Real-World Case 20.1 651
Real-World Case 20.2 651
References 651
Chapter 21 Ethical Issues in Health Information
Management 655
Moral Values and Ethical Principles 656
Cultural Competence in the Healthcare Environment
658
Cultural Disparities in US Healthcare 658
Healthcare Professionals and Cultural Competence 659
Healthcare Organization Cultural Competence
Awareness 660
Training Programs 662
Regulations for Cultural Awareness 662
Ethical Foundations of Health Information
Management 663
Professional Code of Ethics for the Health Information
Management Professional 664
Professional Values and Obligations 664
Ethical Issues Related to Medical Identity Theft 666
Ethical Decision Making 668
Breach of Healthcare Ethics 669
Important Health Information Ethical Problems 670
Ethical Issues Related to Documentation and Privacy 670
Ethical Issues Related to Disclosure of Health Information 670
Ethical Issues Related to Coding 671
Ethical Issues Related to Quality Management, Decision Support, and Public Health 672
Ethical Issues Related to Managed Care 672
Ethical Issues Related to Sensitive Health Information 673
Ethical Issues Related to Research 673
Ethical Issues Related to Electronic Health Record Systems 674
HIM Roles 675
Real-World Case 21.1 675
Real-World Case 21.2 676
References 676
Appendix A Check Your Understanding Answer Key 679
Appendix B Glossary 715
Index 765
