Patient Data Review Stakeholders and their contribution

The number of people and organizations that contribute to the review of patient data is constantly growing. As the healthcare industry becomes more complex, the need for accurate and timely data review increases. There is a comprehensive team of data managers, working on-site and off-site to manage the data. The following is a list of some of the key stakeholders, which can be categorized into the core and supporting roles depending upon their position in the process and their respective contributions.?

Core Roles: Hospitals, Health Information Management (HIM) Professionals, Clinical Documentation Specialists(CDS), and the Clinicians.?

?Supporting Roles: Medical Coders, Insurance Companies, Regulators, and Researchers?

Hospitals

Hospitals collect a vast amount of data on their patients, including medical records, insurance information, billing records, and more. This data must be reviewed regularly to ensure accuracy and completeness. Additionally, hospitals must comply with federal regulations regarding patient privacy and security (HIPAA). As such, they typically have a team of dedicated staff who are responsible for conducting reviews.?

Health Information Management (HIM) Professionals?

These are the individuals responsible for ensuring that patient data is accurate and complete. They work with clinicians and other members of the healthcare team to ensure that all documentation is correct and up-to-date. In addition, HIM professionals also play a key role in protecting patient privacy and ensuring that only authorized personnel to have access to protected health information (PHI).?

Clinicians

Clinicians are responsible for providing care to patients and are often the first point of contact for patient data. They are tasked with reviewing data to ensure that it is accurate and up to date, as well as making sure that all pertinent information is timely recorded into EDC (electronic data capture) tools. Often, clinicians will work with other stakeholders in the review process to ensure that the most comprehensive information possible is captured.?

Clinical Documentation Specialists (CDS)?

These professionals are responsible for reviewing patient chart documentation and ensuring that it meets all required standards. They work closely with HIM professionals to ensure the accuracy and completeness of data. In addition, CDSs also provide education and training to clinicians on best practices for documenting patient care per protocol requirements.?

Medical Coders?

Medical term coders are responsible for interpreting clinical reports into a traceable code that can be used for billing and reimbursement purposes. They use classification systems such as the International Classification of Diseases (ICD) to assign codes to diagnoses and procedures. ICD dictionary acts as a ready reckoner to map the diagnosis and procedures to an appropriate code. In addition, coders also play a key role in quality improvement initiatives by identifying patterns of errors and areas for improvement.?

Insurance companies

Insurance companies play a critical role in the healthcare industry by helping to cover the cost of health care/treatment for millions of patients. To do this effectively, they need access to accurate patient data. Insurance companies typically have teams of employees who conduct regular reviews of patient files to verify coverage eligibility and determine rates.?

Regulators

Regulators are responsible for ensuring that patient data is compliant, real-time, and meets all the legal requirements.?

Researchers

Researchers use patient data to study trends and develop new treatment protocols.?

?“ The data review should specifically focus on Clinical Trial Data Review. One key role is Medical Monitor.”?

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