and approval by the compliance officer if not otherwise allowed by law. A written record is kept by the complaisance officer and available for audits. Information Integrity (I) Maintain information in a A4. Full chart management TBD manner that ensures functionality (i.e. Record Lifecycle confidence in its authenticity, Management) to verify the timeliness, accuracy, and identification of location of the source completeness. of the release, completeness of the documents being released, and destination for the release or review are available in the release of information software. Ability to maintain integrity A6. Accurate capture of patient data of information to comply with by electronic health record system. safety, quality of care, and Reduction of medical errors that compliance with applicable cause inaccurate recording of patients' voluntary, regulatory and legal allergies and medications, requirements, compromising quality of care and patient safety. Ability to maintain integrity I1. Performance of a duplicate of information in adherence to the medical record number and account organization’s policies and number validity checking process in procedures. place. Enterprise-wide process exists for notification of duplications. Process of merging paper and electronic records. Ability to provide appropriate I2. Proper training and support of workforce training on information system user is paramount to management and governance to preventing system errors that can support integrity of information. potentially contribute to suboptimal healthcare quality. Enable trust of requestor in A1. All documents can be accounted A1.1. All documents can be the integrity of information by for and the record closed as complete accounted for within a ability to ensure the authenticity, within a specific time period post specific time period post timeliness, accuracy, and patient discharge in accordance with completion episode of completeness, admissibility of State and Federal regulations, care/encounter records for litigation purposes accreditation organizations (e.g. Joint Commission, Det Norske Veritas Record is closed as A1.2. Healthcare - ISO 9000), or complete within a specific organizational policy. time period post completion of the episode of care/encounter Ability to ensure integrity of information through reliable system controls that support the organization’s ongoing activities across various systems.
and approval by the compliance officer if not otherwise allowed by law. A written record is kept by the complaisance officer and available for audits. Information Integrity (I) Maintain information in a manner that ensures confidence in its authenticity, timeliness, accuracy, and completeness. A4. Full chart management functionality (i.e. Record Lifecycle Management) to verify the identification of location of the source of the release, completeness of the documents being released, and destination for the release or review are available in the release of information software. TBD Ability to maintain integrity of information to comply with safety, quality of care, and compliance with applicable voluntary, regulatory and legal requirements, A6. Accurate capture of patient data by electronic health record system. Reduction of medical errors that cause inaccurate recording of patients' allergies and medications, compromising quality of care and patient safety. Ability to maintain integrity of information in adherence to the organization’s policies and procedures. I1. Performance of a duplicate medical record number and account number validity checking process in place. Enterprise-wide process exists for notification of duplications. Process of merging paper and electronic records. Ability to provide appropriate workforce training on information management and governance to support integrity of information. I2. Proper training and support of system user is paramount to preventing system errors that can potentially contribute to suboptimal healthcare quality. Enable trust of requestor in the integrity of information by ability to ensure the authenticity, timeliness, accuracy, and completeness, admissibility of records for litigation purposes A1. All documents can be accounted for and the record closed as complete within a specific time period post patient discharge in accordance with State and Federal regulations, accreditation organizations (e.g. Joint Commission, Det Norske Veritas Healthcare - ISO 9000), or organizational policy. A1.1. All documents can be accounted for within a specific time period post completion episode of care/encounter A1.2. Record is closed as complete within a specific time period post completion of the episode of care/encounter Ability to ensure integrity of information through reliable system controls that support the organization’s ongoing activities across various systems.
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