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Transcription Beyond Transcription: Health IT allows transcriptionists to assist with CDI, other HIM functions

Author: Carnrite, Michael; Sumner, Susan

Source: Journal of AHIMA

Publication Date: October 2012


For decades Medical transcription has been an important fixture of the health information management (HIM) department. Compiling, managing, and retaining transcribed documents as a subset of the entire patient medical record is a foundational role for HIM professionals. And while the electron....

Electronic Documentation Templates Support ICD-10-CM/PCS Implementation. Appendix A: Electronic Note Title and Template Policy Considerations

Author: AHIMA

Source: AHIMA practice brief attachment

Publication Date: October 2012


This model policy recommends important legal and compliance considerations for healthcare organizations when establishing electronic note titles, templates, and/or prompts.


PURPOSE: To provide guidance on the development and maintenance of electronic note titles, templates, and p....

Enhance the Accuracy of Medication Histories for the Elderly by Using an Electronic Medication Checklist

Author: Wang, Tiankai; Biedermann, Sue E.

Source: Perspectives in Health Information Management

Publication Date: October 2012

Abstract

Medication errors may result in serious safety issues for patients. Medication error issues are more prevalent among elderly patients, who take more medications and have prescriptions that change frequently. The challenge of obtaining accurate medication histories for the elderly....

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