Methodist Healthcare Policy and Procedure Manual

The terms medical record, health record, and medical chart are used interchangeably when describing the systematic documentation of a single patient's medical history and care across time within one particular health care provider's jurisdiction. Medical records includes a variety of types of "notes" entered over time by health care professionals, recording observations and administration of drugs and therapies, orders for the administration of drugs and therapies, test results, x-rays, reports, etc, according to an online dictionary. A patient's individual medical record identifies the patient and contains information regarding the patient's case history at a particular provider. “The U.S. health care system is in the midst of transforming from a fee-for-service system to a value-based system that delivers high-quality and cost-effective care.” (Koltov, M. K., & Damle, N. S. 2014) According to, the Handbook for Physicians and Medical Office Staff handbook, liability insurers, defense attorneys, and third-party payers remind physicians and other health professionals that the safety of patients, the outcome of litigation and the promptness of reimbursement depend on the adequacy, legibility, completeness, timeliness and accuracy of medical records. Firstly, medical records documentation is important for multiple reasons and has various operational and functional roles in the medical industry. Patient safety and provider protection are both protected by the information that is captured in the patient’s medical record. Every time you visit a hospital, physician or other health care provider, a record of your visit is made. This record may include your symptoms, examination and test results, diagnosis, treatment and plans for future care or treatment. Secondly, Methodist Healthcare organization addresses these issues by fostering the concept of top quality and continuity of care. Methodist Healthcare organization creates a means of communication between it’s’ providers and members about patient’s health status, preventive health services, treatment, planning, and delivery of care. In addition, Methodist Healthcare medical record standards reflect the importance of confidentiality and accessibility by authorized users only. Methodist healthcare weaknesses unfavorably are within the ability to oversee and manage risk management concerns relating to the mismanagement of records or improper disclosure of protected health information (PHI) that can lead to regulatory sanctions, network exclusions, and could affect licensure, accreditation, and Medicare and Medicaid reimbursement and participation. Medical records aide physicians in medical malpractice claims management and loss prevention activities. Upon any request being made, a complete documentation of any medical encounter must be made available. Promotion of continuous quality improvements includes good sound record documentation standards that reflect the importance of complete, timely, and accurate health information and are as follows: Member identifiers appear on every piece of documentation Entries are legible to others and are recorded in black or blue ink if on paper Entries are dated and authenticated by the author Documentation is made at the time service is provided Documentation must support all codes submitted Only standard medical abbreviations should be used in documentation All patient encounters, including telephone, fax, and electronic message exchanges are documented Documentation of any advance directives is in a prominent part of a member's medical record and includes whether or not a member has executed an advance directive, as well as documentation of any information about advance directives that was made available to the member Promptly forwarding the records ensures that the personal physician has a complete medical record on file The strength of Methodist healthcare is the ability to ensure compliance with laws, rules and regulations, and other benchmarks such as healthcare policies and procedures, Methodist healthcare managers are able to protect against unauthorized access and release, medical record management policies should address the physical security of paper-based documents, electronic record system security measures, and personnel access to both electronic and paper records. Methodist healthcare has a significant number of policies and procedures to cover all of the requirements that need to be covered. Certain responsibilities that meet and exceed customer expectation are as follows: Maintaining the privacy of your health record; Providing you with a copy of this Notice; Abiding by the terms of this Notice; Notifying you if we are unable to agree to a requested amendment or restriction; and Accommodating reasonable requests you may have to communicate health information by alternative means or at alternative locations. In conclusion, sound medical record documentation is important because it is being governed by gobs of laws on both state and federal levels. Medical records contain sensitive information, and increasing computerization and other policy factors have increased threats to their privacy. There are threats to privacy from modern record-keeping systems and from legislation. “Electronic health record systems contain clinically detailed data from large populations of patients that could significantly enrich public health surveillance.” (Vogel, J., Brown, J. S., Land, T., Platt, R., & Klompas, M. 2014) In order to protect patients these protectors have been established and are as follows:  Medical Ethics  The privacy portion of the Hippocratic Oath: "Whatsoever I shall see or hear in the course of my intercourse with men, if it be what should not be published abroad, I will never divulge, holding such things to be holy secrets."  The 1992 AMA statement, which states that medical information must be confidential to the greatest possible degree.  Laws and Other Legal Protection  The Privacy Act of 1974, which states that no federal agency may disclose information without the consent of the person. Agencies must also meet certain requirements for protecting the information. Federal Laws only cover federal agencies, such as Medicare and Medicaid. The bulk of medical records are covered by various, inconsistent and often ineffectual state laws. State Laws , this document allows you to look at the privacy laws, including medical privacy laws, for each state. Only about half of the states guarantee patients the right to see their medical records (CR, Oct. 1994, p. 629). You can obtain more information by looking in your state code or by contacting Privacy Journal.  Tort Law. This may include defamation, breach of contract, and other privacy-related torts. To determine whether your policies comply with state and federal laws regarding the storage and release of PHI, consult with an attorney about the following issues: Creating policies and procedures pertaining to both the on-site and off-site storage of medical records. Accurately labeling and storing records to aid in record retrieval and prevent improper access and/or destruction. Establishing functional redundancy to allow for medical record storage system back-up should the primary storage system fail Entering into Business Associate Agreements with any outside vendors with whom the practice may contract to store, retrieve, and/or destroy medical records on behalf of the practice. Tailoring policies and procedures to address special considerations pertaining to the electronic medical records (e.g., protections by password and encryption, storage and protection of metadata, etc.). Nevertheless, the biggest challenges are with implementing and using electronic medical records. Healthcare providers are experiencing difficulty with using the new systems and therefore, seek other individuals to enter the data into the systems for them. “A failure by physicians to take a lead on this will mean that they may become victims of pressure or legislation.” (Patrick, K. 2014). Documenting the information on both paper and in a computer system has overwhelmed some providers. Furthermore, the lacks of familiarity with the systems have impeded the progress and therefore some users are reluctant to the change. However, opportunities for improvements are possible if the providers will buy into the quality initiative and get the best results out of the system. References 1.) Patrick, K. (2014). Patients and their medical records: it is time to embrace transparency. CMAJ: Canadian Medical Association Journal = Journal De L'association Medicale Canadienne, 186(11), 811. doi:10.1503/cmaj.140834 2.) Koltov, M. K., & Damle, N. S. (2014). Health policy basics: physician quality reporting system. Annals Of Internal Medicine, 161(5), 365-367. doi:10.7326/M14-0786 3.) Vogel, J., Brown, J. S., Land, T., Platt, R., & Klompas, M. (2014). MDPHnet: Secure, Distributed Sharing of Electronic Health Record Data for Public Health Surveillance, Evaluation, and Planning. American Journal Of Public Health, 104(12), 2265-2270. doi:10.2105/AJPH.2014.302103

Motivation Touchstone

My plan to survive Will be a dive While I Let my Soul drive Not to look back It will only set me back But to look ahead Instead Written By: Kenya Nichols

International Management Considerations

From: Kenya Nichols Date: 1/2/2015 As the global marketplace continues to develop, companies engage in international business for many reasons. The main reason is to gain value for their organizations which, is the primary motive. In addition, expanding sales, acquiring resources and minimizing risk are also some important factors that are taken into consideration. The pursuit of international sales usually increases the potential market and potential profits. However, acquiring resources requires that the producers and distributors track down products, services, resources and other components from foreign companies. To gain a competitive edge companies often promote resources that cut cost. The prospect of gaining a competitive advantage can be improved by improving the quality of the product or by differentiating your products from those of competitors. One significant reason the global market makes sense is it is techchnological because of improved transportation and communication opportunities today, trade is now more practical. As a result, consumers and businesses now have access to the best products from many different countries. On the other hand, regrettably, culture is ambiguous concern for many marketers since it is inherently obscure and often strenuous to perceive. One may breach the cultural patterns of another country without being in the know. Foreign sources propositions companies with lower costs new or better products and additional operating knowledge. In essential, minimizing risk involving sales and profits is the key when negotiating different business cycles in foreign operating companies. The culminating facts are that sales decrease or grow more slowly in a country that’s in a recession and increase or grow more rapidly in one that’s sound economically. Merchandising exports and imports are some of the most notable modes if international business amongst small companies, which is also the companies most international economic transactions. Presently, services exports and imports take many forms, and is the fastest growth sector in international trade. Service exports and imports are international non-product sales and purchases. The most important are tourism and transportation, service performance and asset use. There are variances of operating modes that companies can employ in international business operations. Some of the modes of operation include exporting and importing merchandise and services, direct and portfolio investments, and collaborative arrangements with other companies. Furthermore, managers that operate within a company’s external environment must possess not only knowledge of business operations ,but also be enlightened about some of the basic social sciences. Therefore, managers within a corporation should be acknowledged as trustees and guardians of the investments made by the shareholders. In addition, the managers have a corporate social responsibility as well as responses to stakeholders. To be acquainted, it was suggested, that managers have been categorized into three types of moral values: immoral, amoral, and moral. Usually, managers carried out varied management styles with the stakeholders. Noteworthy enough, there are certain social responsibilities that come into play in the decision making of managers. Social responsibility can be examined by identifying these major components economic, legal, ethical and discretionary responsibilities. To meet these obligations, communication with external and internal stakeholders ,is vital to the organizations survival. Conflict within companies and within international organizations is one of the main problems in International Business. Also, the difference of opinion in strategies between different management levels in international business also poses a problem. Therefore, if support is inadequate the international business proposal fails. Richard Welford, identified four overall areas that can be used in assessing corporate policies for corporate social responsibility and they are as follows: internal aspects, external aspects, accountability, and citizenship. Integrating corporate responsibility into the company’s strategy can be a challenge for many companies that have never considered the benefits and effects of being a responsible citizen. “Global manufacturing and supply-chain management are important in companies’ international business strategies.” (Edition 569) There are some major issues related to supply chain management that should be mentioned. Some specific issues that have materialized included effective global manufacturing strategy, the role of information technology in global supply-chain management, quality, supplier networks, and inventory management, including the importance of effective transportation networks. “The success of a global manufacturing strategy depends on four key factors: compatibility, configuration, coordination, and control”. (Edition 571) Activities such as coordination and control include everything along the global supply chain from purchasing to warehousing to shipment. When a strong commitment to information technology is in order, the supply chain strategy is most effective. Companies that pursue international sales and marketing also go after global sourcing for the self same reasons. “As noted, quality and safety are other concerns with global sourcing.” (Edition 584) Unfortunately, as a result of the countries producing cheap products they also lack adequate regulations, enforcement, and logistical infrastructure, thus leaving it up to the purchasing companies to ensure quality and safety. References Javalgi, R. G., Granot, E., & Brashear Alejandro, T. G. (2011). Qualitative Methods in International Sales Research: Cross-Cultural Considerations. Journal Of Personal Selling & Sales Management, 31(2), 157-170. Edition, Custom. SKS 5000-Business Strategies for Organizational Effectiveness within the Global Perspective VitalSource eBook for Northcentral University. Pearson Learning Solutions. VitalBook file. Conceptual and Normative Aspects of International Management Endel J. Kolde and Richard E. Hill The Academy of Management Journal Vol.10, No. 2 (Jun., 1967), pp. 1190128 Published by: Academy of Management Article Stable URL:http://www.jstor.org/stable/254631