Chapter 25

Question 1

Diagnosis-related groups

Answer 1

Groups certain diagnosis so professionals can know certain exams/procedures to expect related to a diagnosis and when something stands out

Question 2

Electronic health record (EHR)/ Electronic medical record (EMR)

Answer 2

Electronic health record system generally considered as the portal through which clinicians access a patients health record, order treatments or therapy, and document care delivered to patients; allows providers to gather multiple types of data about a patient

Question 3

HIPAA

Answer 3

1996. Federal legislation passed to improve the efficiency and effectiveness of the health care system; components that affect health information include privacy, security, and the establishment of standards and requirements for the electronic transmission of certain health information

Question 4

Health records

Answer 4

Permanent or long lasting documentation of all patient care information that applies to individual patients

Question 5

The joint commission (TJC) jaco

Answer 5

Organization that accredits hospital and other health care institution in the United States. Says what actually has to be in a health record