Midland College
Fall 2008 Syllabus
HITT 1401- Health Data Content and Structure
(4-0-0)
Course
Description
This course is an introduction to systems and processes for collecting, maintaining, and
disseminating primary and secondary health related information. The course will cover
instruction in delivery and organizational structure to include content of health record,
documentation requirements, registries, indices, licensing, regulatory agencies, forms, and
screens.
Text,
References
and Supplies
Textbooks:
Essentials of Health Information Management: Principles and Practices with Lab Manual
and Blackboard Access Code, Michelle Green & Mary Jo Bowie, Thomson-Delmar
Learning, 2005. (Referenced in Course Schedule as “Green” and “Green LM”)
Health Information Management Technology: An Applied Approach, 2nd edition, Johns,
Merida, Managing Editor. AHIMA, 2007 with Accompanying Student Workbook.
(Referenced in Course Schedule as “Johns” and “Johns WB”)
Supplies (optional) for Virtual Office: Headset with microphone. To use SKYPE,
students need to purchase either a headset with microphone, or a separate microphone to
add to your PC (the PC must also have speakers). Headsets can be purchased at most
outlets stores that sell electronics (Wal-Mart, Radio Shack, etc). The headsets cost
approximately $15.00 to $20.00, and the stand-alone microphones cost approximately
$26.00. The LogiTech brand is recommended. Using this option, students will be able to
speak to the instructor or other students (or anyone in the world) using SKYPE free of
charge through the internet. You will need to go to www.SKYPE.com and download the
program. (Most HITT courses have elected to use SKYPE as an additional communication
option for students).
Course Goals/
Objectives
Upon completion of this course, students will be able to:
1.
Describe the purpose, organization, structure and functions of a health care facility
and medical record department.
2.
Describe the job title, correlating duties and certifications of personnel in the medical
records department.
3.
List and distinguish the accrediting and governing bodies of a medical facility
including the State Health Department, Medicare, JCAHO and the hospital
requirements to meet those standards.
4.
Explain the different purposes and uses of medical records.
5.
Describe the components of a medical record and describe the purpose of each
(including advanced directives and patients rights) and identify the persons
responsible for completion of each components of a record.
6.
Trace the flow of a medical record from the time it arrives into a medical records
department until it is archived.
7.
Perform quantitative analysis.
8.
Explain the purpose of reports in specialty and secondary records.
9.
Explain medical record filing systems.
10. Collect data on the quality of documentation in the medical record.
11. Trace the location of medical records (i.e. chart tracking systems and MPI=s.)
12. Explain how to retrieve and file medical records and maintain integrity.
13. Describe concurrent medical record review.
14. Describe edit checks to monitor data accuracy.
15. List the sequence of notifying physicians of incomplete records and the result of
delinquent records.
16. Describe health care data sets which include UHDDS, HEDIS, and DEEDS.
17. Explain the functions of a tumor registrar, which include accession registry and
follow-up requirements.
DOMAINS, SUBDOMAINS, AND TASKS:
I. Domain: Healthcare Data Management
A. Subdomain: Health Data Structure, Content and Standards
I.A.1. Collect and maintain health data (such as data elements, data sets and databases).
I.A.2. Conduct analysis to ensure that documentation in the health record supports the
diagnosis and reflects the patient’s progress, clinical findings and discharge status.
I.A.3. Apply policies and procedures to ensure the accuracy of health data.
I.A.4. Contribute to the definitions for and apply clinical vocabularies and terminologies
used in the organization’s health information systems.
I.A.5. Verify timeliness, completeness, accuracy, and appropriateness of data and data
sources for patient care, management, billing reports, registries and/or databases.
B. Subdomain: Healthcare Information Requirements and Standards
I.B.1. Monitor and apply organization-wide health record documentation guidelines.
I.B.2. Apply policies and procedures to ensure organizational compliance with regulations
and standards.
I.B.4. Maintain the accuracy and completeness of the patient record as defined by
organizational policy and external regulations and standards.
I.B.5. Assist in preparing the organization for accreditation, licensing and/or certification
surveys.
II. Domain: Health Statistics, Biomedical Research and Quality Management
A. Subdomain: Healthcare Statistics and Research
II.A.1. Abstract and maintain data for clinical indices/databases/registries.
II.A.5. Use specialized databases to meet specific organization needs such as medical
research and disease registries.
III. Domain: Health Services Organization and Delivery
A. Subdomain: Healthcare Delivery Systems
III.A.1. Apply information system policies and procedures required by national health
information initiatives on the healthcare delivery system.
III.A.2. Apply current laws, accreditation, licensure and certification standards related to
health information initiatives from the national, state, local and facility levels.
IV. Domain: Information Technology & Systems
A. Subdomain: Information and Communication Technologies
IV.A.2. Use common software applications such as spreadsheets, databases, word processing,
graphics, presentation, email and so on in the execution of work processes.
IV.A.3. Use specialized software in the completion of HIM processes such as record tracking,
release of information, coding, grouping, registries, billing, quality improvement, and
imaging.
IV.A.4. Apply policies and procedures to the use of networks, including intranet and internet
applications to facilitate the electronic health record (EHR), personal health record (PHR),
public health, and other administrative applications.
B. Subdomain: Data, Information, File Structures
IV.B.1. Apply knowledge of data base architecture and design (such as data dictionary, data
modeling, data warehousing) to meet departmental needs.
C. Subdomain: Data Storage and Retrieval
IV.C.1. Use appropriate electronic or imaging technology for data/record storage.
IV.C.3. Design and generate reports using appropriate software.
IV.C.4. Maintain archival and retrieval systems for patient information stored in multiple
formats.
V. Domain: Organizational Resources
A. Subdomain: Human Resources
V.A.7. Prioritize job functions and activities.
B. Subdomain: Financial and Physical Resources
V.B.1. Make recommendations for items to include in budgets and contracts.
V.B.2. Monitor and order supplies needed for work processes.
V.B.4. Recommend cost-saving and efficient means of achieving work processes and
goals.
V.B.5. Contribute to work plans, policies, procedures, and resource requisitions in relation
to job functions.
Student
Contributions
and Class
Policies
ACCESSING AN ONLINE CLASS: Refer to www.bb01.edu
1.Using Microsoft Mozilla or Netscape 7.0 Navigator, access the Midland College Home
page at www.midland.edu. There have been problems in the past with Internet
Explorer and AOL browsers.
2. On the right side of the Midland College home page, click “Blackboard.”
3. Update your personal profile by clicking on “Edit Personal Profile”. Verify that your
contact information is correct especially your web address and your address and phone
number.
4. When the Blackboard page appears, you will need to login to the program. In order to
login you must have a login name and password. Your login name will be the first
letter of your first name plus the first 3 letters of your last name and the last three
numbers of your social security number. For example: the login name for John Smith,
social security number 101-000-1111, will be jsmi111. Your password will be your
social security number using dashes. (101-00-1111)
5. After you have logged in, your home page will appear on the screen. On the right side
of the page in the box titles “My Courses” double click on the course you want to
view.
6. The course home page will appear. Areas you will want to check frequently are:
Announcements, Course Documents, and Assignments. Do not open exams until you
are ready to take the test. You can access each exam only one time.
7. In the tools section you can access your grades once they are submitted. Go to “Tools”
then “Check Grades”. Click on the test or assignment to see comments and feedback.
DISCUSSION BOARD: This is the online classroom. Students will respond to discussion
questions, post weekly summaries, and communicate with your instructor in the discussion
board. Questions about content and assignments should be posted on the discussion board.
The posts will be answered daily. Please allow 24 hours for a response. Posts made on the
weekend MAY NOT BE answered until Monday. This form of communication is
important in online courses. This tool will help you stay “connected” to other classmates
and it will help students to ask those questions just as if you were in an actual classroom
setting. Discussion board will also be used as a participation tool, and part of the semester
grade is based on participation. When posting a response to the discussion board about a
topic, post your original response before reviewing other classmate’s postings. Then, read
the other postings and respond to at least two other students for full credit for participation.
Only when the content of the question is personal in nature should the instructor be
emailed. When sending email, use the Course Name such as QA in your subject line so that
the instructor can identify the course being addressed in the email followed by the subject
matter.
Example:
To:
Instructor’s email address
From: Your email address
Subject: HITT 1401 – Regarding _________________________
Also be sure to sign your name at the end of the email. Remember some email addresses
give instructors absolutely no clue as to who sent it.
ATTENDANCE: Because this is strictly an internet course, attendance will be substituted
by participating on the discussion board. You will be required to respond to 2 posts in the
discussion board 4 out of 7 days of the week. Answers to the discussion questions, and
weekly summaries are counted as a posting. Participation is part of your semester grade.
ACADEMIC HONESTY: Students are expected to follow the Academic Honesty policy
of Midland College. Using textbooks, assignments and other students, or assistance from
others while taking an exam is cheating. Any student cheating will be removed from the
class, given an “F”, and reported to the Registrar’s office. Plagiarism will not be tolerated.
For more information, review Student Conduct/Misconduct in the MC catalog at
http://www.midland.edu/adminssions/images/mc_cataolg 2008-2009.pdf .
TESTING PHILOSOPHY: Students may politely challenge the instructor on questions
they feel were poorly worded. If the instructor concedes the argument, scores will be
adjusted for the entire class. Assignments consist of multiple formats including multiple
choice, open-ended questions and some true/false. The final examination will be
comprehensive over all the material presented during the course.
ADA POLICY: Students needing additional time to test due to a documented learning
disability, contact Dale Williams, Counselor, at 432-685-5598 or dwilliams@midland.edu
at the beginning of the course to make accommodations. See the current Midland College
catalog for more information.
COURSE WITHDRAWAL: Students electing to withdraw from course are required to
complete a Course Withdraw Form to receive a grade of “W” at
http://www.midland.edu/admissions/forms.php before the last day to withdraw.
The last day to withdrawal for this semester: November 13, 2008.
ONLINE COURSE INFORMATION:
PERSONAL INFORMATION: Every semester it is important to update your personal
information listed in Blackboard. Check your personal information by going to Personal
Information under the MY MC BLACKBOARD tab located directly below the Midland
College Logo on your Blackboard screen. Go to Edit Personal Information and update.
Once updated, scroll to the bottom of the page and click SUBMIT. Next, click OK. This
information is used to contact students. Be sure your e-mail address (the one you choose to
use for this class) is correct.
As stated in the student handbook, “Midland College encourages high academic standards,
including student responsibility for original work.” See the Midland College Student
Handbook for more information on the definitions and consequences of cheating,
plagiarism, and collusion. Any student found cheating in this course will be removed and a
letter grade of “F” will be posted for the course along with a letter of explanation added in
the student file for the offense.
COMPUTER REQUIREMENTS: Students should have access to Microsoft Word and
Excel for assignment submission. Students taking online courses are responsible to have
access to a computer for submission of assignments and postings. For specific computer
requirements, see Blackboard System Requirements for Midland College courses at
www.bb01.edu. AOL, MSN, and Prodigy browsers will not work with Blackboard.
These browsers will lock up or lock you out of assignments and tests. Instead, download
Mozilla at www.mozilla.com or Netscape 7.0.
COMPUTER DOWNTIME: This is an online course. Each student is required to have a
functioning computer for the entirety of the semester. Having computer problems does not
exempt students from completing work by the due date. If the Blackboard system goes
down or is unavailable, an announcement will be posted as the due date will be extended.
If your system goes down, find another computer to submit your homework/posts before
the due date. It is strongly suggested that assignments are to be submitted early to avoid
any technical difficulties.
SUBMITTING ASSIGNMENTS IN BLACKBOARD:
1. Use a word document format.
2. Save assignment in a rich text file (.rtf). You will find this on your computer under File,
Save As, Save Type As (under the name of your document). If you have questions
about rtf files, see Course Documents for more information.
3. Each assignment should be submitted through Blackboard under “View/Complete
Assignment” as an attachment. If there is more than one task due with the assignment
such as CH1A (Workbook 1-1, 1-3, and 1-4), all these tasks should be submitted in one
word document. DO NOT send three different files.
4. Each assignment should have a header that includes your name, date, course number,
and assignment name. Failure to include this content will result in points deducted
from your grade.
To save:
Ch1mct.rtf
Ch2jwj.rtf
Chapter 1 by Melody Cheryl Thompson (rtf file)
Chapter 2 by James W. Johnson (rtf file)
Header:
Your name
Date
Course
Assignment Name
Example:
Mary Martinez
9-21-06
HITT1401
WB: 5-1
EMAIL: Individual email is discouraged when it involves course assignments and
questions about the reading material. These should be posted on the discussion board
under the thread “Questions to Instructor” so that the class may also receive the
information since many questions posed to the instructor are commonly asked by more
than one individual. In sharing responses with the class, there is equal opportunity (or
equitable responses) to receive information from the instructor.
If, however, there is a need to send an email to the instructor, (due to a personal nature)
include in the subject line the course number and the content of the question such as
“HITT1401 Question on Ch1 assignment”. It is also important that you sign your name at
the end of the email since many emails give no indication of the author.
Evaluation of
Students
Assignments
Exams
Participation/Discussion Boards
Group Projects
Quizzes
Final Exam
Total
25%
20%
10%
10%
15%
20%
100%
SCANS
Information
The following SCANS skills will be taught and/or reinforced in this course:
reading, writing, listening/speaking, thinking skills, and personal qualities.
Safety
Statement
Students will receive annual training in the following: blood and air borne pathogens,
electrical safety, back safety, hazardous chemicals, latex allergies, fire and disaster
procedures, security and personal safety procedures and safety requirements of clinical
facilities. Students must maintain current CPR, immunizations, and health insurance during
all clinical courses.
Instructors
Information
Name: Shawnda Meshirer, RHIT, CCS
Office Location: A15 Aaron Medical Science Building
E-mail Address: smeshirer@midland.edu
Office Telephone: 432-685-5578 or SKYPE @ smeshirer
Office Hours: Monday 9:00–11:00 a.m. & 1:00-3:00 p.m.;
Wednesday & Thursday 9:00-11:00 am
Virtual Office Hours on SKYPE @ shawnda.him:
Monday Evenings 7:00-8:00 p.m. and Tuesday 9:00-11:00 am
HITT Director
Information
Program Director: Melinda Teel, BSHIM, RHIT, CCS
Office Location: A33 Aaron Medical Science Building
Office Telephone: 432-685-5573
E-mail Address: mteel@midland.edu
Health
Sciences
Division Dean
Information
Division Dean: Dr. Becky Hammack
Health Sciences Division Secretary and Clerk: Kay Floyd and Alma Guyse
Division Office Location and Telephone: 209 Davidson Health Sciences Building
Office Telephone: 432-685-4600
Students are encouraged to contact the instructor at any time; however, making an
appointment will guarantee the instructor’s availability at a specific time.
Course
Schedule
The course schedule has due dates and each student is expected to submit assignments on
or before midnight Central Standard Time of the due date. There is no formal provision
for make-up work or extra credit in this course. Work submitted after the deadline will
not be accepted. Once the assignment date closes, assignments cannot be submitted.
A zero will be placed in the grade book for late assignments.
Please do not wait until the last minute to attempt assignments. Computers and computer
networks have a bad habit of crashing at the very time you need them the most.
HITT 1401 Health Data Content Course Reading, Assignment and Test Schedule:
(Due dates and assignments may change at the discretion of the instructor. Any changes will be posted on Blackboard
in Announcements.)
Due Date
8/28
Section #1
9/2
9/9
Task
Read &
Complete
Read
Complete
Read
Complete
9/16
Read
Complete
9/18
TEST
Read
Complete
Section #2
9/23
Read
Complete
9/30
Read
Complete
10/7
10/9
TEST
Assignment/Exams
Pre-Test and Orientation Quiz
DB: Introduce Yourself
Johns: Chapters 1 and 2 Intro/Functions of the Health Record
Johns WB: Complete Ch 1 & 2 Review Quizzes, Ch 2 Real World Case #1
Discussion Questions, Ch 2 Application Exercise #3.
DB: Speech Recognition/Maintenance of Health Records: AE 5 or 6
Johns: Ch 13 Healthcare Delivery Systems
Johns WB: Complete Ch 13 Real World Case Discussion Questions and Review
Quiz
DB: Governmental Role in Healthcare: AE #1
Johns: Ch 3: Content and Structure of Health Record
Johns WB: Complete Ch 3 Real World Case Discussion Questions and Review
Quiz
DB: AHA Organization
Section 1A Exam
Green: Chapters 1 and 2: History/Ownership/Structure/Licensure, Regulation,
and Accreditation
Green LM: Complete:
Lab Assignment 2-4 Ethics 1-6 on discussion board. Submit 7 – 12 and
Lab Assignment 2-5 Journal Abstracts for AHIMA.
Review Quiz Green Chapters 1 & 2
DB: Reply to 2 questions on ETHICS as posted and respond to at least 2 other
student’s responses.
Green Ch 5: Patient Record: Inpatient/Outpatient/Physician
Green LM: Complete:
Lab Assignment 5-2 Quantitative and Qualitative Analysis of Patient Records and
Lab Assignment 5-3 Forms Design
DB: Forms Design and Data (page 186 Green)
Green: Ch 4: Patient Record: Hospital/Physician Office/Alternative Care Setting
Green LM: Review all lab assignments for Chapter 4. Complete:
Lab Assignment 4-2 Provider Documentation Guidelines and
Lab Assignment 4-4 Medicare Conditions of Participation
Review Quiz Green Chapters 4 & 5
DB: Medicare and You
Section 2B Exam
Page 19
HITT 1401 Health Data Content Course Reading, Assignment and Test Schedule:
(Due dates and assignments may change at the discretion of the instructor. Any changes will be posted on Blackboard
in Announcements.)
Section #3
10/14
Read
Complete
Read
Complete
10/21
10/28
Read
Complete
Read
Complete
11/4
11/6
TEST
Read
Complete
Section #4
11/11
11/16
Complete
Read
Complete
11/18
11-20
Section #5
11/24
TEST
Read
Complete
Read
Complete
12/2
12/3
12/8
TEST
Johns: Ch 4 Electronic Health Records
Johns WB: Complete Ch 4 Real World Case Discussion Questions and Review
Quiz
DB: AE - Decision support systems, EHR
Johns: Ch 5 Healthcare Data Sets
Johns WB: Complete Ch 5 Real World Case Discussion Questions and Review
Quiz and
Application Exercise #4 (ORYX and HEDIS) and
Application Exercise #5 (Health Informatics Standards)
DB: NCHIT
Johns: Ch 6 Clinical Vocabularies and Classification Systems
Johns WB : Complete Ch 6 Real World Case Discussion Questions and Review
Quiz
DB: Coding Functions/Software
Johns: Ch 8 Health Information Technology Functions
Johns WB: Complete Ch 8 Real World Case Discussion Questions and Review
Quiz
Group Project: #1: Vendors of Filing Systems…(Johns WB page 40)
DB: No discussion board this week. Work on Group Project.
Section 3C Exam
Green: Ch 6 Numbering & Filing Systems and Record Storage and Circulation
Green LM: Complete:
Lab Assignment 6-1 Part I and II Numeric and Terminal-Digit Filing Systems
Lab Assignment 6-2 Calculating Record Storage Needs
Lab Assignment 6-3 Guiding Terminal-Digit Files
Review Quiz Green Chapter 6
DB: EHR Technology
Cancer Registry – Tutorial See assignment for more details.
Green: Ch 7 Indexes, Registries, and Health Data Collection
Green LM: Complete:
Lab Assignment 7-1 Case Abstracting
Lab Assignment 7-2 Master Patient Index Data Entry
Lab Assignment 7-3 Disease, Procedure and Physician Indexes
Review Quiz Green Chapter 7
DB: Data Sets and Organizations (extra credit)
Section 4D Exam
Johns: Ch 9 Secondary Data Sources
Johns WB: Complete Ch 9 Real World Case Discussion Questions and Review
Quiz
DB: Research and Registries (Johns WB Page 46)
Green: Ch 8 Legal Aspects of Health Information
Green: Ch 9 Coding and Reimbursement
Green LM: Complete Group Project #2:
Lab Assignment 8-1 Notice of Privacy Practices
Lab Assignment 8-2 Release of Patient Information
Lab Assignment 8-3 Release of Information Correspondence Log
Lab Assignment 8-4 Telephone Calls for ROI Processing
Lab Assignment 9-1 Hospital Financial Reports
Review Quiz Green Chapters 8 and 9
DB: Reflection
Student Evaluation Survey and Post-Test
Final Examination