Health Information Management

Topic: Understand information workflow when implementing electronic health record forms

HIM-HIPAA Insider, June 18, 2007

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Vendors often allow hospitals to customize electronic health records (EHRs) that allow patient data to flow in the manner that best suits the hospital. Therefore, it is important to document how the present system works and help with the configuration of the new electronic system. HIM managers are best suited for that job.

For an EHR to successfully replace paper-based documentation, the HIM team must work with the forms committee and clinical, ancillary, and administrative departments to complete a forms inventory for all medical record types. The HIM team should inventory the following information for each form:

  • The name of the form
  • An internal forms control number
  • The name of the individual and the department that "own" the form
  • The type of medical records for which the form is used
  • The filing location of the form within the chart
  • The purpose of the form
  • The location of the inventory/supply stock of the form
  • The location or department that prints copies/orders the form
  • The last date of form revision/printing
  • Presence of a bar code (yes/no) and index code name

Editor's note: This article was adapted from HCPro's book The HIM Director's Handbook. For more information, click here.

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