Medical Records and the Law

426 CHAPTER 12: RISK MANAGEMENT AND QUALITY MANAGEMENT• Incident and accident reports• Data on members who utilize greater than average levels of service• Length of stay data• Unexpected patient returns for acute care• Variations from clinical practice guidelines and outcome indicators• Patient complaints and patient satisfaction surveys• Accreditation and federal/state inspection reports• Credentialing, recredentialing, and clinical privileges files• Audit reports of internal committees or insurance surveyors 3The health information management department plays an importantrole in the risk management function. The department can be responsiblefor performing the following tasks:• Supervising data gathering, with documentation of the data producedat all levels• Training clerical personnel engaged in locating the most usefulsources of required information• Determining the incidence of relevant data requested for the use ofcommittees and individuals• Screening medical records for compliance with established clinicalcriteria and designated exceptions or equivalents as established bythe medical staff• Participating in the selection and design of forms used in the medicalrecord and in the determination of the sequence and format ofthe contents of the medical record• Suggesting to the professional staff methods of improving the collectionand organization of primary source data so as to facilitate retrieval,analysis, tabulation, and display• Performing continuing informational surveillance of practice indicatorsor monitors for medical staff review• Ensuring the provision of a mechanism to protect the privacy of patientsand practitioners whose records are involved in quality assessmentactivities• Reviewing all requests for access to or copies of medical records bypatients and third parties to determine their validity under applicablestate law3See C.Benda and F. Rozovsky, Liability and Risk Management in Managed Care(Gaithersburg, Md.: Aspen Publishers, 1998), 15:3.