Electronic Health Records

Course Number:
MA 114
Transcript Title:
Electronic Health Records
Created:
May 02, 2023
Updated:
Jun 01, 2023
Total Credits:
2
Lecture Hours:
0
Lecture / Lab Hours:
40
Lab Hours:
0
Satisfies Cultural Literacy requirement:
No
Satisfies General Education requirement:
No
Grading Options
A-F
Default Grading Options
A-F
Repeats available for credit:
0

Course Description

Discusses basic concepts of use and maintenance of an Electronic Health Records (EHR) system.  Provides hands-on experience performing the EHR tasks required of a medical office professional. Explores issues around EHR implementation, troubleshooting, HIPAA compliance, and claims submissions. Familiarizes students with administrative, clinical, and billing/coding skills.

Course Outcomes

Upon successful completion of this course, students will be able to:

  1. Describe the basic content of a typical electronic health record (EHR).
  2. Recognize the differences between confidentiality and privacy, and apply each appropriately.
  3. Identify patients' rights under HIPAA.
  4. Outline the procedure for the management of electronic health records.
  5. Complete clinical documentation in the patient record.
  6. Use the electronic health record (EHR) to perform reimbursement procedures.

Suggested Outcome Assessment Strategies

The determination of assessment strategies is generally left to the discretion of the instructor. Here are some strategies that you might consider when designing your course: writings (journals, self-reflections, pre writing exercises, essays), quizzes, tests, midterm and final exams, group projects, presentations (in person, videos, etc), self-assessments, experimentations, lab reports, peer critiques, responses (to texts, podcasts, videos, films, etc), student generated questions, Escape Room, interviews, and/or portfolios.

Additional department recommended strategies:

Students will demonstrate the learning outcomes using a combination of strategies that may include the following conducted individually and in cooperation with other students. 

  • Answer theoretical and application questions on chapter-specific quizzes and comprehensive tests given throughout the term.
  • Complete actual hands-on exercises using the EHR.

Course Activities and Design

The determination of teaching strategies used in the delivery of outcomes is generally left to the discretion of the instructor. Here are some strategies that you might consider when designing your course: lecture, small group/forum discussion, flipped classroom, dyads, oral presentation, role play, simulation scenarios, group projects, service learning projects, hands-on lab, peer review/workshops, cooperative learning (jigsaw, fishbowl), inquiry based instruction, differentiated instruction (learning centers), graphic organizers, etc.

Course Content

Outcome #1: Describe the basic content of a typical electronic health record (EHR).

  • Clinical Information
  • Administrative Information
  • Legal Documents

Outcome #2: Recognize the differences between confidentiality and privacy, and apply each appropriately.

  • Confidential Versus Anonymous
  • Privacy Rule
  • Covered Entities and Business Associates
  • Minimum Necessary Standard
  • Authorization Versus Consent
  • Security Rule

Outcome #3: Identify patients' rights under HIPAA

  • View or receive copies of the health record.
  • Have inaccurate health information corrected.
  • Receive a notice of privacy practices.
  • Opt out of sharing certain information with certain people.
  • Have certain information withheld from certain third parties.

Outcome #4: Outline the procedure for the management of electronic health records.

  • Eliminating duplicate charts
  • Purging closed patient records
  • Backing up the EHR.

Outcome #5: Complete clinical documentation in the patient record

  • Allergies
  • Patient History
  • Chief Complaint
  • Medications
  • Immunization History
  • Vital Signs
  • Order Entry

Outcome #6: Use the electronic health record (EHR) to perform reimbursement procedures

  • Superbill
  • Post charges, payments, and adjustments to a patient ledger
  • Complete 5010 claim processing

Suggested Texts and Materials

  • The Electronic Health Record for the Physician’s Office: For Simchart for the Medical Office current edition  Published by Elsevier
  • Simchart for the Medical Office  Published by Elsevier