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Clinical documentation improvement (CDI), also known as "clinical documentation integrity", is the best practices, processes, technology, people, and joint effort between providers and billers that advocates the completeness, precision, and validity of provider documentation inherent to transaction code sets (e.g. ICD-10-CM, ICD-10-PCS, CPT, HCPCS) sanctioned by the Health Insurance ...
AHIMA describes its foundation as a sister organization to the Association for Healthcare Documentation Integrity (AHDI) and states the foundation has a charitable and educational nature. The foundation formulates and issues opinions, supports education, conducts research and compiles its contributions into the AHIMA BoK ( body of knowledge ).
Health information management's standards history is dated back to the introduction of the American Health Information Management Association, founded in 1928 "when the American College of Surgeons established the Association of Record Librarians of North America (ARLNA) to 'elevate the standards of clinical records in hospitals and other medical institutions.'" [3]
Moreover, as far as patient health records are concerned, there are always potential threats of information leakages, data hacking, information destruction, manipulation or even blackmailing of patients by the external or internal users. Since the consequences of Information leaks are comparatively high in contrast to information alterations ...
The Certification Commission for Health Information Technology (CCHIT) was an independent, 501(c)(3) nonprofit organization with the public mission of accelerating adoption of robust, interoperable health information technology in the United States. The Commission certified electronic health record technology (EHR
The information contained in the medical record allows health care providers to determine the patient's medical history and provide informed care. The medical record serves as the central repository for planning patient care and documenting communication among patient and health care provider and professionals contributing to the patient's care.
AHIMA also offers a registered health information technician (RHIT) certification for coding professionals with two-year associate degrees and with less emphasis on management responsibilities. In 2005 researchers found that the differences in these certifications, in addition to other accreditations offered by AHIMA and the need for ongoing ...
The 2018 Verizon Protected Health Information Data Breach Report (PHIDBR) examined 27 countries and 1368 incidents, detailing that the focus of healthcare breaches was mainly the patients, their identities, health histories, and treatment plans. According to HIPAA, 255.18 million people were affected from 3051 healthcare data breach incidents ...