Best Practices and Recommendations
The following are best practices and recommendations for CEs to follow with regard to managing amendments in an HIE environment.
Review HIE Agreements. Prior to joining an HIE within the
organization, it is recommended that the agreement between
the CE and HIE be clearly reviewed and understood. Policies,
procedures, and internal processes addressing how EHR corrections are handled within the provider/HIE communication
infrastructure must be addressed and thoroughly tested to
ensure that all parties can track and display the request, final
decision, actual correction, and current patient information.
Additionally, these transactions should be incorporated into
the organization’s performance improvement processes where
audits are routinely conducted to ensure that defined workflow
processes are working as designed.
Define Procedures. It is recommended that the organization have clear procedures defined for processing amendment
requests and accountability must be transparent within each
organization (HIE and/or provider). A designated point person
should be assigned responsibility for ensuring that the amendment request has been processed, from initial request through
final decision. This includes the process for handling a request
that has been denied. These processes must be clearly documented and displayed within the HIE to ensure that the patient
request is known to all providers of care.
Monitor Compliance. Healthcare organizations must have a
process for monitoring compliance of amendments, notification, and denial of amendments in place. Periodic reviews or
audits should be conducted to ensure systems and procedures
are working as expected.
Understand the Escalation Process. Escalation processes
must be in place when patient safety is at risk. The escalation
process could include a 24/7 hotline number, a special email
address that is continuously monitored, an instant messaging
address, or on-call staff.
Provide a Standard Request Form. State law, in addition to
HIPAA, may play a role in the process patients use to request
amendments from HIEs. Therefore, it is important to check the
applicable state laws for any additional guidance. Some HIEs
provide a standard amendment request form which is a good
practice to document the request (see Appendix B in the online
version of this Practice Brief). In addition, there is the opportunity for the patient to disagree (see Appendix C).
Use an Internal Checklist for EHR Correction Notifications.
Many organizations use some kind of internal checklist to track
places to check and/or verify when corrections are required.
Below are some examples of areas that may need to be notified
based on the type of amendment request:
Internal patient EHR portal
Compliance and Privacy Office
Pro Fee Coding
Enterprise Master Patient Index
EHR, clinical, and ancillary systems
HIE release (opt-in or opt-out)
Following the above best practices and recommendations will
help ensure that healthcare organizations manage amendments
in a HIE environment in the most effective way possible. ¢
1. Department of Health and Human Services Office for Civil
The HIPAA Privacy Rule and Electronic Health In-formation Exchange in a Networked Environment: Correction.” www.hhs.gov/sites/default/files/ocr/privacy/
2. AHIMA. “Breach Management Toolkit: A Comprehensive Guide for Compliance.” 2014. http://bok.ahima.org/
3. Remote Operations. “SecureFlow ProTM HL7 Specifications: ORM, ORU and ACK Message Types.” October 17,
4. Corepoint Health. “HL7 Messages.” https://corepointhealth.
Janelle Burns, JD, CHPS
Stephanie Costello, MS, RHIA
Sharon Lewis, MBA, RHIA, CHPS, CPHQ, FAHIMA
Melanie Meyer, PhD, MHA, RHIT, CCS, CPHQ
Deanna Panzarella, CHC, CHPS
Kathy Westhafer, RHIA, CHPS
Aurae Beidler, MHA, RHIA
Becky Buegel, RHIA, CHP, CDIP, CHC
Nancy Davis, MS, RHIA, CHPS
Andrew Dionne, CHTS-PW Paralegal
Christine Edwards, RHIA, CHP
Lynn Edwards, MBA, RHIT, CHSP
Elisa Gorton, MAHSM, RHIA, CHPS, CHC
Beth Liette, MS, RHIA
Laurie Peters, RHIA, CCS
Sharon Slivochka, RHIA
Margie Stackhouse, RHIA, CPC
Christina Wallner, MS, RHIA
Diana Warner, MS, RHIA, CHPS, FAHIMA
Appendices Available Online
Three appendices are available in the online version of this Practice
Brief in AHIMA’s HIM Body of Knowledge:
Appendix A: Checklist: Questions to Consider Before Participating in an HIE
Appendix B: AHIMA Sample Patient Request to Amend the Health Record
Appendix C: AHIMA Sample Patient Statement of Disagreement