telehealth opportunities in a myriad of ways. As an industry
we are moving very quickly into EHRs. We’re trying to develop
ways for our records to talk to offices and hospitals and payer
systems without the benefit of the meaningful use payments
that other settings have benefited from… Having that broader
sense of IG as a whole would be beneficial for helping people
to frame the work that they’re doing and see the strategic long-term plan,” Pierotti says.
HIM in Public Health
State and county health departments offer a range of health
services, such as mental health treatment centers, domestic
crisis housing, physician clinics, inpatient substance abuse
treatment facilities, nursing homes, and group homes for the
disabled. Such is the case for Lake County, IL, the third most
populous county in the state and home to many of Chicago’s
sprawling suburbs. Lake County’s health department is expanding its population health efforts—which include monitoring immunization rates, studying trends in income disparities and access to care, and monitoring mortality rates in
different parts of the county.
The sheer diversity of the services provided has obvious opportunities for HIM professionals. On any given day, Shalina
Richie, RHIA, the health information manager at the Lake
County Health Department, is immersed in multiple HIM
tasks. She offers training and assistance to coders, and guidance to providers who have questions about coding mental
health records—clearing up confusion about coding with
DSM- 5 codes and ICD- 10 diagnosis codes. Richie also helps
process release of information (ROI) requests with an outside vendor, assists providers with patient portals, and scans
paper records from patients who see providers outside the
county system. She offers feedback on the department’s discussions around joining health information exchanges (HIEs)
and keeps fellow staff members aware of regulatory changes
that affect their work, including quality measure reporting required under the Medicare Access and CHIP Reauthorization
Act (MACRA) and new regulations issued by the Substance
Abuse and Mental Health Services Administration (SAMHSA).
Given the nature of working in public health, Richie notes that
patient education has a heightened importance—especially as
it relates to release of patient information processes and rights.
“If a patient walks in and requests their record, it’s not just,
‘Here’s your record.’ It’s, ‘Do you want your substance abuse
records, mental health records? Do you want your immunization records?’ It takes a lot more probing to find out what they
need and where they need to go,” Richie says.
The department also has to carefully educate patients about
authorizing the release of behavioral health and substance
abuse records under new SAMHSA regulations, which are designed to make it easier for researchers studying these issues
to have access to patient identifying information.
For example, a patient may come in and ask for their full psy-
chiatric history in order to prove that they qualify for disability
housing. HIM has to advise them why a brief diagnosis note
is more prudent than the full record. While SAMHSA changes
might make it easier for researchers studying this, it can com-
plicate matters when deciding how to protect information
when participating in an HIE.
HIM in University Health Clinics
Students on the campuses of larger universities often have access to healthcare facilities that rival the size of major medical
centers’ ambulatory clinics. Yet, student health isn’t a setting
one normally associates with HIM professionals. Lisa Teel,
RHIA, manager of HIM services at Northwestern University in
Evanston, IL, performs all of the activities you’d expect from
an HIM manager. Northwestern’s Health Service has a pharmacy, a laboratory, a radiology department, a women’s health
clinic, a sports medicine department, an insurance department, and—until several years ago—had overnight observation beds in a setup similar to that of a hospital.
The biggest difference between student health at Northwestern and a more traditional ambulatory clinic comes down to
to comply with the Family Education Rights and Privacy Act
(FERPA), which predates HIPAA and is frequently employed
by educational institutions. FERPA is more conservative in the
sense that written authorizations are required in more release
of information scenarios than under HIPAA. All Northwestern
students are required to have health insurance, either through
their parents’ plans or through plans offered by the university,
which is contracted with a payer offering university plans. In
essence, the student health service deals with one payer—the
contracted insurance company. Students with other plans pay
in cash up front and submit claims to their insurer after wards.
As a result, while it’s still important that ICD- 10 and CPT coding is accurate, the concern about losing revenue from the
switch of ICD- 9 to ICD- 10 was less stressful in this setting as it
was with other providers.
“I took the physician training for ICD- 10 so I could see suggestions they were making for physicians and modeled my
training after that, and did training to give physicians a heads
up,” Teel says.
While the university itself complies with FERPA, it does have
to be HIPAA-compliant as well when it comes to release of information forms sent to other providers the students may see,
such as allergists and other specialists. Additionally, like any
other healthcare entity, student health centers have business
associates and the university develops the FERPA equivalent
of a HIPAA-compliant business associate agreement.
College health centers can decide at their own discretion
whether to comply with HIPAA or FERPA. If the health center
limits their treatment to just students, as Northwestern’s center does, they only have to comply with FERPA. According to
Department of Health and Human Services guidance, if a student health center treats only students, then they can comply
with just FERPA—which again is more strict than HIPAA since