Medical Acronyms Allow People In The Healthcare Industry

In the health care system, there are a lot of codes that help diagnose, treat, and discharge patients daily. Codes help nurses

The electronic health record (EHR) is a digital record of a patient’s health history that may be made up of records from many locations and/or sources, such as hospitals, providers, clinics, and public health agencies. The EHR is available 24 hours a day, 7 days a week and has built-in safeguards to assure patient health information confidentiality and security. (Huston, 2013)

Electronic health records (EHR) are health records that are generated by health care professionals when a patient is seen at a medical facility such as a hospital, mental health clinic, or pharmacy. The EHR contains the same information as paper based medical records like demographics, medical complaints and prescriptions. There are so many more benefits to the EHR than paper based medical records. Accuracy of diagnosis, quality and convenience of patient care, and patient participation are a few examples of the

After decades of paper based medical records, a new type of record keeping has surfaced - the Electronic Health Record (EHR). EHR is an electronic or digital format concept of an individual’s past and present medical history. It is the principle storage place for data and information about the health care services provided to an individual patient. It is maintained by a provider over time and capable of being shared across different healthcare settings by network-connected information systems. Such records may include key administrative and clinical data relevant to that persons care under a particular provider. Examples of such records may include: demographics, physician notes, problems or injuries, medications and allergies, vital

The Affordable Care Act created a new approach to care which is called the Accountable Care Organization. ACO is a system of doctors and hospitals that share a financial and medical responsibilities. If the ACO is successful in meeting quality and cost savings targets, these organizations qualify for financial incentives or shared saving from Medicare programs. The goal of the ACO is to coordinate

Accountable care organizations (ACOs) are consist of providers who are jointly held accountable for achieving measured quality improvements and reductions in the rate of spending growth.

An electronic health record (EHR) defines as the permissible patient record created in hospitals that serve as the data source for all health records. It is an electronic version of a paper chart that includes the patient’s medical history, maintained by the provider over time, and may include all of the key administrative clinical data relevant to that persons care. Information that is readily available includes information such as demographics, progress notes, allergies, medications, vital signs, past medical history, immunizations, laboratory data, & radiology reports. The intent of an EHR can be understood as a complete record of patient

MEDICAL CODING QUALIFICATIONS AND CERTIFICATION Medical Coding is a career in which professionals use numeric and alphabetic codes to help submit and process medical claims. The coder abstracts information from the patient records and combines that information with coding guidelines to assign the right code for the information provided by physicians, hospitals, and other healthcare professionals. Insurance companies look at these codes to understand the diagnosis, treatment, and prescriptions for proper payment of these services. Accordingly, the medical coding profession requires a worker to have a strong grasp of numbers and be detailed oriented. (AC Search & Media, Inc.)

An Electronic Health Record is a computerized form of a patient’s medical chart. These records allow information to be readily available to authorized providers during a patient’s encounter with the healthcare system. These systems do not only contain medical histories, current medications and insurance information, they also track patients’ diagnoses, treatment plans, immunization dates, allergies, radiology images and lab tests/results (source). The fundamental aspect of EHRs is that they are able to share a patient’s information quickly across service lines and even between different healthcare organizations. Information is at the fingertips of lab techs, primary care physicians, pharmacies, clinics, etc. The

The article Alternate Health Care Coding Systems gave brief descriptions and examples of alternate coding systems. All the alternative coding systems and medical nomenclatures are used as another way to properly diagnose patients, and proper billing and reimbursement. Although, I was a bit confused retaining all the information but in my take away from the readings is that nomenclatures and coding systems are used to allow medical terminology, codes, procedures, and diagnoses to be more descriptive. Two patients could have the same exact tumor but depending on size and where the tumor originated from could be the difference in coding that certain patient.

In any medical record, it is normal to have a lot of abbreviations to support the diagnosis or reasons behind them. In my own opinion, they are used to save time and space while writing the patients’ medical record, which is why taking medical terminology for any career in the medical field is important. Medical abbreviations have many benefits and limitations, and the limitations definitely over rule the benefits. The benefits for using the abbreviations are the saving of time and space when recording data or information, like I said before in my opinion. Another benefit for medical abbreviations is that only the medical personnel will know what is being described. It is an efficient way to keep a patients’ privacy. However, there are many

Amanda I agree that altering or destroying medical records is illegal but also unethical. Destroying medical records can cause serious issues regarding patient safety and can create a vast amount of work for the patient as well as the provider. I agree that there would be a breach in confidentiality if a medical record was improper discarded, it raises questions as to why the record was destroyed in the first place, and if discarded incorrectly could make the patient vulnerable by giving individuals’ unauthorized access to their records.

Being fluent as a Billing and Coder in Medical Terminology is very imperative to the success of our career. One slip up because of a incorrect term can lead to a number of different issues, and most importantly it can lead to rejection and non-payment which is a big NO for the office. There are even simple terms that can be mixed up. According to Quizlet some terms that are commonly mixed up are 'ilium and ileum' 'palpation and palpitation' and 'viral and virile' just to name a few (1).

Electronic medical records (EMR) software is a rapidly changing and often misunderstood technology with the potential to cause great change within the medical field. Unfortunately, many healthcare providers fail to understand the complex functions of EMRs, and they rather choose to use them as a mere alternative to paper records. EMRs, however, have many functionalities and uses that could help to improve the patient-physician relationship and the overall quality of patient care. In order for this potential to be realized, both the patient and the healthcare provider must have a deeper understanding of EMR purpose and function. In this paper will highlights the historical developments and its potential effects on the patient physician relationship in order to

EHR in its simplest form is a digital version of a patient’s paper chart. EHRs have been defined as “real-time, patient-centered records that make information available instantly and securely to authorized users”[19]. It can allow patient information to be more easily shared between clinicians in different organisations, such as between ???, thus improving patient safety and clinicians’ decision-making.[20, 21] EHR can be combined with an electronic prescribing system, which can provide clinical decision support to physicians in the form of highlighting tests that are abnormal and advising on the ordering of specific drugs for the patient.