Describe the impact of the risk occurring and discuss how it could be prevented, mitigated, or recovered from if it happens.

Risks are best handled by developing a risk matrix, which is a plan for identifying and managing potential risks. Develop and post a risk matrix for the project you proposed in Week 4 or for the Hard Rock hotel under construction collapses: Buildings around Canal Street site evacuated. In your risk matrix, state the risk, describe it and what might cause it, and note the risk of occurrence (probability) as high, medium, or low. Describe the impact of the risk occurring and discuss how it could be prevented, mitigated, or recovered from if it happens.Be sure to respond to at least one of your classmates’ postsWebsite link below: Hard Rock hotel under construction collapses: Buildings around Canal Street site evacuatedhttps://www.proquest.com/docview/2304420241?accountid=30530&parentSessionId=Pkh30MeEaYqVdCz39dcnSVBlbOdOlxLqXP0jOL5PPyU%3D

Specify the key requirements for police officers in determining the lawfulness of the use of force in making an arrest and what is meant by “reasonableness.”

IntroductionA controversial issue today in the American legal system is the justification of the use of force by police officers, given the actions and conduct of citizens. In this assignment, you will explore the requirements for use of force, constitutional rights pursuant to the Bill of Rights when it comes to free speech, and criminal defenses justifying actions.InstructionsWrite a 2–3-page paper in which you:Specify the key requirements for police officers in determining the lawfulness of the use of force in making an arrest and what is meant by “reasonableness.”Evaluate how free speech rights clash with the rights of others and the need for public order today.Argue for or against the regulation of the First Amendment when it comes to speech that could or might incite “imminent lawless action or conduct.”Analyze the defenses within today’s criminal law system.Evaluate the fairness of the common law defense of necessity when citizens use deadly force.Use at least three sources to support your writing. Choose sources that are credible, relevant, and appropriate. Cite each source listed on your source page at least one time within your assignment

Determine the fundamental ways in which the NCAA’s ethics program failed to prevent the scandals at Penn State, Ohio State, and the University of Arkansas.

Case Study 2: National Collegiate Athletic Association Ethics and Compliance ProgramDue Week 6 and worth 200 pointsRead “Case Study 6: National Collegiate Athletic Association Ethics and Compliance Program,” located on page 444 of the textbook.Write a four to six (4-6) page paper in which you:Determine the fundamental ways in which the NCAA’s ethics program failed to prevent the scandals at Penn State, Ohio State, and the University of Arkansas. Support your response with one (1) example from each of these schools’ scandals.Examine the principal ways in which the leadership of the NCAA contributed to the ethical violations of Penn State, Ohio State, and the University of Arkansas. Support your response with one (1) example from each of these schools’ scandals.Predict the key differences in the scenarios that occurred at Penn State, Ohio State, and the University of Arkansas if an effective ethics program was in place. Provide a rationale for your response.Postulate on two (2) actions that the NCAA leadership should take in order to regain the trust and confidence of students and stakeholders.Recommend two (2) measures that the HR departments of colleges and universities should take to prevent similar incidents from occurring in the future. Provide a rationale for your response.Use at least three (3) quality academic resources in this assignment. Note: Wikipedia and other similar Websites do not qualify as academic resources.Your assignment must follow these formatting requirements:Be typed, double spaced, using Times New Roman font (size 12), with one-inch margins on all sides; citations and references must follow APA or school-specific format. Check with your professor for any additional instructions.Include a cover page containing the title of the assignment, the student’s name, the professor’s name, the course title, and the date. The cover page and the reference page are not included in the required assignment page length.

Describe how you could attempt to correct this issue without greatly increasing costs.

250 wordsReadingsUse your Social Policy and Social Programs text to complete the following:Read Chapter 5, “Who Gets What, How Much, Under What Conditions: Analysis of Eligibility Benefits,” pages 80–105.Use the Capella Library to complete the following:For this discussion, consider the following:A public program requires prior contributions to meet a minimal threshold amount before it distributes benefits. However, the contribution amount is excessively high for many families, especially minorities in your community. Describe how you could attempt to correct this issue without greatly increasing costs.Use this unit’s readings to inform your post and discussion.

Discuss how the security principles of deception and separation can be applied at the national level to protect against attacks from hostile foreign nations.

Recently, the Pentagon has concluded that computer sabotage coming from another country can constitute an act of war. The pentagon’s first formal cyber strategy, unclassified portions of which became public in June of 2011, represents an early attempt to grapple with a changing world in which a hacker could pose a significant threat to U.S nuclear reactors, subways or pipelines from a hostile country’s military. Recent cyber-attacks on the Pentagon’s systems by another foreign country have given new urgency to U.S efforts to develop a more formalized approach to cyber-attacks.Read more https://www.judiciary.senate.gov/imo/media/doc/08-21-18%20Lewis%20Testimony.pdfIn this week, you learned about the security principles of deception and separation.Discuss how the security principles of deception and separation can be applied at the national level to protect against attacks from hostile foreign nations. Identify the four stages of deceptions and how this can employed at the national level. Also, in discussing the concept of separation, ensure to identify how the concept of separation would be different in the context of national infrastructure protection. Please provide examples to support your discussion.Please make sure this is of 300 words and with no plagiarism in APA format with references.

Determine the annual percentage yield for bank? A’s money market account.

INTEREST8.Elisa needs money to repair her home air? conditioner, so she pawns her bicycle. The pawnbroker loans Elisa $270. Ten days? later, Elisa gets her bicycle back by paying the pawnbroker $280.50. What annual simple interest rate did the pawnbroker charge? Elisa? Assume 360 days in a year. The pawnbroker charged Elisa a simple interest rate of what %?9.A partial payment is made on the date indicated. Use the United States rule to determine the balance due on the note at the date of maturity.? (The Effective Date is the date the note was? written.) Assume the year is not a leap year.Principal: 4,000 Rate:5% Effective date:May 1rst Partial payment: 2,000 on June 1rst Maturity date:July 1rstThe balance due on the note at the date of maturity is ?How many dollars?10.Determine the effective annual yield for? $1 invested for 1 year at 7.3?% compounded quarterly.The effective annual yield is what ?%?11.Bank A advertises a money market account that pays 1.9%compounded quarterly. Bank B advertises a money market account that pays 1.8%compounded daily.?a) Determine the annual percentage yield for bank? A’s money market account.?b) Determine the annual percentage yield for bank? B’s money market account.?c) Assuming all other factors are? equal, which? bank’s money market account would be the better? investment?12.Suppose you saw a sign at your local bank that? said, ?”6.3?%rate compounded quarterly–6.6?%Annual Percentage Yield? (APY).” Is there anything wrong with the? sign? Explain.Select the correct choice below? and, if? necessary, fill in the answer box to complete your choice.A.Yes. The APY is incorrect. The correct APY is what ?%??(Round to the nearest hundredth as? needed.)B.Yes. The number of compounding periods is incorrect. Interest should be compounded daily.C.No. The information on the sign is correct.12.A village recently completed the construction of a new water tower. The entire cost of the water tower was ?$948,000?,and the government paid ?$370,000of the total cost through the awarding of a grant. In? addition, the village can delay paying the balance of the cost for 30years? (without paying any interest during the 30?years). To finance the? balance, the village board will at this time assess its 674homeowners a? one-time flat fee surcharge and then invest this money in a 30?-yearCD paying 6.2?%interest compounded monthly.?a) What is the balance due on the water? tower?13.A simple formula can help you estimate the number of years required to double your money.? It’s called the rule of 72. You simply divide 72 by the interest rate? (without the percent? sign). For? example, with an interest rate of? 4%, your money would double in approximately 72÷?4,or 18 years.?a) How many years would it take ?$1000to double at an interest rate of 2?%?Installment Loans1.Determine the monthly payment for the installment loan.Amount Financed:700$?, Annual Percentage Rate:7.5%?, Number of Payments per Year:12?, Time in Years: 1?The monthly payment is ?how much $?2.Landon Wallin is an auto mechanic who wishes to start his own business. He will need ?$4600to purchase tools and equipment. Landon decides to finance the purchase with a 36?-monthfixed installment loan with an APR of 4.5?%.?a) Determine? Landon’s finance charge.?b) Determine? Landon’s monthly payment.3.Travis Thompson uses his credit card to obtain a cash advance of? $600 to pay for his textbooks in medical school. The interest rate charged for the loan is 0.04203?%per day. Travis repays the money plus the interest after 30days.?a) Determine the interest charged for the cash advance.?b) When he repaid the? loan, how much did he pay the credit card? company?4.Jamie needs a new roof on her house. The cash cost is ?$6000.She decides to finance the project by paying 15.0?%?down, with the balance paid in 24monthly payments of ?$234.?a) What finance charge will Jamie? pay??b) What is the APR to the nearest half? percent?5.Ray Flagg took out a? 60-month fixed installment loan of? $12,000 to open a new pet store. He paid no money down and began making monthly payments of?$221.?Ray’s business does better than expected and instead of making his 30th ?payment, Ray wishes to repay his loan in full. a) Determine the APR of the installment loan.APR=what percent?6.Shiing Shen? Chern’s credit card company determines his minimum monthly payment by adding all new interest to? 1% of the outstanding principal. The credit card company charges an interest rate of 0.043028% per day. On March 17?, Shiing uses his credit card to purchase airline tickets for his family for $3900. He makes no other purchases during March. Use the given information and the rule that minimum payments are rounded up to the nearest dollar to answer part a.a) Assuming Shiing had no new? interest, determine? Shiing’s minimum payment due on April? 1, his billing date.?Shiing’s minimum payment due on April 1 is ?what amount?7.On the April 3billing? date, Michaelle Chappell had a balance due of $950.02on her credit card. From April 3through May 2?,Michaelle charged an additional $266.69and made a payment of $600.?a) Find the finance charge on May 3?,using the previous balance method. Assume that the interest rate is 1.8%per month.?b) Find the new balance on May 3.8.The balance on Ramon? Felipe’s credit card on January 11?,his billing? date, was $238.49.For the period ending February 11?,Ramon had the following transactions to the right.?a) Find the average daily balance for the billing period.?b) Find the finance charge to be paid on February 11.Assume an interest rate of? 1.2% per month.?c) Find the balance due on February 11January 20?Charge:Restaurant meal?$40.51January 27Payment?$100.00February 5?Charge:Lawn ornaments?$36.89February 6?Charge: Microwave oven?$196.849.On September 6?,the billing? date, Verna had a balance due of ?$566.95on her credit card. Assume that the interest rate is? 1.1% per month. Suppose that? Verna’s bank uses the average daily balance method. Sept. 8Payment?$280.00Sept. 23?Charge: Airline ticket?$329.00Sept. 25?Charge: Hotel bill?$191.52Oct. 2?Charge: Clothing?$84.64Determine? Verna’s average daily balance for the billing period from September 6to October 6.The average daily balance for the billing period was how much?Mortgages1.Determine the monthly principal and interest payment for a 15?-year mortgage when the amount financed is ?$65,000 and the annual percentage rate? (APR) is 5.0?%.The monthly principal and interest payment is what amount?2.Anna is buying a house selling for ?$295,000.To obtain the? mortgage, Anna is required to make a 20?%down payment. Anna obtains a 25?-yearmortgage with an interest rate of 4?%.?a) Determine the amount of the required down payment.?b) Determine the amount of the mortgage.?c) Determine the monthly payment for principal and interest.3.The Nicols are buying a house selling for ?$435,000.They pay a down payment of ?$35,000from the sale of their current house. To obtain a 20?-yearmortgage at a 6.5?%interest? rate, the Nicols must pay 1.5points at the time of closing.?a) What is the amount of the? mortgage??b) What is the cost of the 1.5?points?4.The? Adeeva’s gross monthly income is ?$6900.They have 18 remaining payments of $210on a new car. They are applying for a 30?-year,?$223,000mortgage at 7.5?%.The taxes and insurance on the house are ?$400per month. The bank will only approve a loan that has a total monthly mortgage payment of? principal, interest, property? taxes, and? homeowners’ insurance that is less than or equal to? 28% of their adjusted monthly income.?a) Determine? 28% of the? Adeeva’s adjusted monthly income.?(Round to the nearest? cent.)5.Laura and Martin obtain a 30?-year,?$160,000conventional mortgage at 8.5?%on a house selling for ?$200,000.Their monthly mortgage? payment, including principal and? interest, is ?$1230.40.?a) Determine the total amount they will pay for their house.?b) How much of the cost will be? interest??c) How much of the first payment on the mortgage is applied to the? principal?6.The Bells obtain a 25?-year,?$110,000conventional mortgage at a 9.0?%rate on a house selling for ?$150,000.Their monthly mortgage? payment, including principal and? interest, is ?$924.00.They also pay 3points at closing.?a) Determine the total amount the Bells will pay for their house.?b) How much of the cost will be interest? (including the 3?points)??c) How much of the first payment on the mortgage is applied to the? principal?7.Kathy wants to buy a condominium selling for ?$95,000. The taxes on the property are ?$1400 per? year, and? homeowners’ insurance is ?$326 per year.? Kathy’s gross monthly income is ?$4500. She has 15 monthly payments of $145 remaining on her van. The bank is requiring? 20% down and is charging a? 9.5% interest rate with no points. Her bank will approve a loan that has a total monthly mortgage payment of? principal, interest, property? taxes, and? homeowners’ insurance that is less than or equal to? 28% of her adjusted monthly income.a) Determine the required down payment.8.The Ruffins are negotiating with two banks for a mortgage to buy a house selling for $185,000. The terms at bank A are a 15?% down? payment, an interest rate of 10?%, a 25-year conventional? mortgage, and 2 points to be paid at the time of closing. The terms at bank B are a 10?% down? payment, an interest rate of 11.0?%, a 30?-year conventional? mortgage, and no points. Which loan should the Ruffins select in order for the total cost of the house to be? less?9.The Bhatts purchased a new home for ?$238,000with a down payment of ?$46,000.They obtained a 20?-yearadjustable rate mortgage with the following terms. The interest rate is based on the? one-year Treasury bill? rate, which is currently at 0.5?%,and the? add-on rate, which is 3.5?%.The initial rate period is 5? years, and thereafter the interest rate is adjusted once a year and a new monthly mortgage payment is calculated.?a) Determine the? Bhatts’ initial ARM rate.?b) Determine the? Bhatts’ initial monthly payment for principal and interest.?c) ?If, after the? 5-year initial rate? period, the rate of the? one-year Treasury bill rises to 2.0?%,determine the? Bhatts’ new ARM rate.

Explain some of the possible barriers to learning one might encounter in this course.

Create a report on teaching strategies to apply in the course.Create three learning outcomes for the course. Conduct research on the course topic as necessary to create these outcomes. Summarize general course content and how these outcomes will relate to overall course content and how they align with learner expectations.Identify and evaluate at least three teaching strategies that could be used in the course and that are a good fit for the learner population, course topic, outcomes, and content. Explain which are the most appropriate teaching strategies for the course and audience, and why they are the most appropriate. Be sure to describe the advantages of using the selected strategies. Support these assertions with research from the field.Explain some of the possible barriers to learning one might encounter in this course. Identify the strategies that could be used to overcome those barriers and to keep learners motivated.

How do we communicate location on the human body, and why is it not feasible to simply use the terms “up/down” and “above/below”? Why is important that medical terminology is consistent and uniform throughout the world?

Answer both questions below. Post on three separate days to the discussion board. Make an initial post that answers both questions, and then make two more posts on separate days to two different classmates. It is important to review the Discussion Board rubric to understand the expectations and grading criteria. Include at least one reference and citation using APA 6th edition format.1) How do we communicate location on the human body, and why is it not feasible to simply use the terms “up/down” and “above/below”?Whyis important that medical terminology is consistent and uniform throughout the world?2)Choose any two positional or directional terms and use them in two different sentences. For example, Supine: The patient was placed in the supine position. Superficial: The wound was superficial.

What neurological disorder, disease, or accident took place to interrupt this individual’s ability?

Select a well documented historical case study of an individual who experienced a neurological disorder, disease, or accident that resulted in an interruption in his or her vision, hearing, or motor control.Prepare a 7- to 10-slide Microsoft® PowerPoint® presentation addressing the following questions:What neurological disorder, disease, or accident took place to interrupt this individual’s ability?What behaviors were exhibited by this individual following the disorder, disease, or accident?What were the individual’s deficits as a result of this disorder, disease, or accident?What treatments did the individual seek? Were any available at the time?What are the research implications of the case study? How did this help scientists and doctors better understand the disorder or disease? How did this case help scientists and doctors better understand how the brain works?Note. Online students: Include substantive speaker notes.

Identify and develop a methodology to collect data that will guide or influence strategic and/or organizational management.  Identify key data points, rates, indicators that can be used to measure EMPI data quality.

Overview/Scenario:TheHealth Information Exchange Organization (HIEO)was launched several years ago with the goal of helping to lower the state’s staggering healthcare expenses and improve the state’s consistent poor rankings in leading health indicators, including obesity, smoking, diabetes and heart disease. Improving healthcare through the enhanced use of information technology and data exchange is the heart of what we do. We manage one of the country’s largest and most successful health information exchange (HIE) networks, provide advisory services that help healthcare professionals effectively use technology and improve care delivery, and supply health plans and accountable care organizations (ACOs) with valuable data that enhance analytics and population health programs. We’ve been in existence for several years and now have the majority of the state’s hospital providers and have many physicians, reference lab, diagnostic radiology centers, mental health providers and other providers participating in our exchange. All participating organizations send electronic health information to the exchange including hospital transcribed documents (H&Ps, Discharge Summaries, Operative Reports, etc.), lab results, diagnostic radiology results, and other clinical documentation.As an independent, nonprofit organization, we are dedicated to serving all of the state’s healthcare stakeholders including physicians, hospitals, behavioral health, emergency medical services, public health, long-term care, laboratories,imaging centers, health plans, communities, and patients. We are self-sustaining and our funding comes from a fee-based subscription model. We were previously the recipient of three grants focused on building capacity for statewide health information exchange, including two grants from theAmerican Recovery & Reinvestment Act (ARRA) HITECH program.Our Mission is: Through information exchange, we improve health and healthcare.Our Vision is: Patients will be measurably healthier as organizations and individuals that contribute to health and healthcare effectively utilize information provided by the HIEO to continuously improve patient care and population health.Type of organization: State Health Information ExchangeNumber of patients served, number of admissions etc.: Over 4.5M patients are represented in our exchange database, representing over 75% of the state’s population.Staff: The executive team is comprised of our CEO, CIO, and CFO. We also have marketing and sales staff, administrative and finance staff and technology staff who support our exchange database and create and manage HL7 interfaces between our database and each participating organization’s system. In the past year, with the launch of our Information Governance (IG) program, we have added a Chief Data Officer (CDO) and five Data Integrity Specialists to our team.IG Program Description:In partnership with the communities and people we serve, we have expanded our data use policies with the goal of improving the integrity and quality of the data we store on each patient. We created an HIM Steering Committee, chaired by the CDO, to provide oversight to our IG activities and it is comprised of HIM and IT professionals from our member organizations. This Steering Committee creates a report on a quarterly basis that is presented at the HIEO board’s meeting and a more detailed report presented monthly to the HIEO’s executive team. We have developed policies and procedures to guide our Data Management processes. These policies cover data management oversight, data management responsibilities, types of data management staffing required, staff training requirements, quality assurance processes and reporting, and accountability and authority of the HIEO, the Steering Committee, and the CDO.We are also a participant in theeHealth Exchangeinitiative, a group collaborating on and working toward interoperable health information exchange, andDirectTrust, a non-profit, competitively neutral entity created by and for participants in the Direct community, including HISPs, CAs and RAs, doctors, patients, and vendors.Staff: Currently 6 FTEs; Chief Data Officer is required to be a Registered Health Information AdministratorHow long in place: Chief Data Officer for 2 years; Data Integrity Specialists for 2-6 monthsCulture: The first few years of the HIEO’s existence showed an entrepreneurial culture where each employee was empowered to make decisions to support growing the HIEO. While initially supportive of the growth, after time as it grew, the organization became disorganized as their efforts were too much in silos. We began receiving complaints from our members about not being able to find all of one patient’s information in the database. The executive team pulled together and developed a strategic plan to not only focus on growth but also on developing a culture of teamwork, mutual trust, and quality services.Data System: The HIEO utilizes a centralized model for its data exchange. It stores the clinical data for each patient and organizes that data in a single record for the patient. This is accomplished through the databases “backbone”, its Enterprise Master Patient Index (EMPI). Its exchange capability provides the sharing of continuity of care documents (CCD), results, transcribed documents, medication and problem lists and links to diagnostic images.Prior State Analysis:How was information organized prior to the IG program?Participating organizations send interface transactions into the HIEO’s database and contain information such as lab results, diagnostic imaging results, etc. These interface transactions had to meet basic record match criteria such as matching on the Assigning Authority from the sending organization and medical record number (or other unique patient identifiers for that organization.) If the transaction did not meet that first level of record match a demographic data match was attempted. The last name, first name, date of birth and address was used to determine if a record for that patient already existed in the database. If these four elements matched exactly, the transaction was posted to the existing record. If it did not meet these four criteria, a new person/patient level record was created in the HIEO database and the transaction information posted to the new record.Additionally, transactions were evaluated to determine that minimum record and patient identity data fields were populated including assigning authority, medical record number (or corporate medical record number), patient’s last name, first name, date of birth and gender. If these basic minimum requirements did not exist, the transaction failed to post to the HIEO database.No communication was sent to the participating organization regarding failed messages. Additionally, no data integrity assessment was done on transactions received to determine whether data values were populated with default data values and therefore no reporting was provided back to the sending organization on the quality of the data they sent.Describe data management program:Following the completion of the HIEO’s new strategic plan, the CDO was hired to implement a new data management program. Initially, she had queries run on the HIEO database to identify the volume of records with the inadequate population of key record matching data fields including the patient’s last name, first name, middle name, date of birth, gender, last four of the SSN, address and telephone number. She analyzed the results of these queries to stratify them by members, date ranges of transactions received and each individual data field.New policies and procedures were then developed to describe minimum data requirements for patient identity, record matching guidelines, duplicate record validity decision-making, interface requirements related to minimum data and data mapping, interface test plans with scenario use cases and testing scripts, data integrity evaluation and maintenance processes, record correction/merging procedures, reporting of data integrity issues and duplicates to provider members and data integrity reporting. These policies and procedures were presented by the CDO to the executive team. Following the initial approval by the executive team, the CDO presented the program and the policies to the full board and they were approved. The data management program was now official.Eighteen months ago the CDO began presenting to the executive team monthly reports on member data integrity and quality. A high-level data integrity report was provided a year ago to the HIEO board which showed by members (anonymously) the percent of transactions the HIEO received with blank or default values on key demographic data values. Additionally, research into new record matching algorithm and data integrity products was completed and a product was selected that can be integrated into the existing HIEO platform. After receiving the data integrity report and the financial proposal for the record matching/data integrity product (“identity management” product), the board approved the acquisition of this new technology. This new product utilizes an advanced record matching algorithm that is error-tolerant of typical data discrepancies across multiple records for the same patient. It also has a workflow tool that allows for efficient review of possible duplicate records, error queues for data integrity issues and the evaluation and reporting of such and to support management reporting needs. It was implemented six months ago.Additionally, in the past year, the CDO began hiring data integrity staff to monitor the daily error logs and aggregate results from these error logs weekly and provide this data to the CDO. Initially, these specialists were only able to monitor and aggregate results from the error logs. Subsequent to the implementation of the new identity management product the specialists are now reviewing the potential duplicate queue in addition to working the transaction error queues. One specialist was appointed as Data Manager and she is responsible for compiling the reports to each member organization regarding the summary of data integrity issues on a monthly basis. Additionally, she provides a list of the data integrity issues for the applicable member’s records. Another responsibility she has is to summarize the intra-facility duplicates sent to the HIEO by each organization and provide that report monthly to the CDO. She also provides each member with a list of their intra-facility duplicates in order for the member organization to resolve these possible duplicates in their source system.The CDO designed dashboard reports for presentation to the executive team and the board generated from the identity management product. These reports will address the HIEO’s strategic initiatives and goals set forth by the executive team, HIM steering committee, and board.After the implementation of the identity management product, a data analysis of the entire HIEO EMPI database was completed. This analysis identified a 30% cross-organization duplicate rate, intra-organization duplicate rate of 8% and several data integrity issues including 35% of the records having a blank value in the last 4 digits of the SSN, 70% of the records missing a middle name value and 10% having a default value in the date of birth field. All of these data integrity issues severely compromise the HIEO in successfully matching records for the same patient from different member organizations. The HIEO set a goal of reducing cross-organization duplicate rates to less than 5% which was approved by its board and communicated to its members.The CDO created a plan to resolve the duplicates, work with member organizations to improve patient identity data capture processes in each organization and begin a monthly reporting process to the members, the executive team and the board. The plan included creating a data dictionary with definitions of key patient identity demographic data elements to be shared with all members, documenting the HIEO’s EMPI data model, working with the HIEO technical team to ensure appropriate data mapping of values in transaction messages sent into the HIEO, contracting with an identity management cleanup company to resolve cross-member duplicates, providing members with their intra-organization duplicates and summary reports. Summary reports included data integrity statistics and data patterns, member duplicate rates and overall cross-organizations duplicates with the HIEO database created due to incomplete or discrepant data.Following the initiation of the reporting and post the cleanup, the HIEO was able to reduce the cross-organization duplicate creation rate to less than 10%, and an improvement in data capture of SSN, middle name and date of birth. Intra-organization duplicate rates only dropped to 6%. These results allowed the data integrity team to successfully manage these issues and provided the needed information for the CDO to continue to work with member organizations on data integrity improvements in each organization. The number of complaints filed by member organizations and providers dropped 50% and it is expected they will continue to decrease as subsequent efforts by the HIEO and member organizations continues.IG Drivers:The HIEO began to get complaints from participating physicians and other organization members regarding four major issues:Results and other information from the incoming transactions were posting to the wrong patient (overlaid records)Duplicate records existed in the HIEO’s database for the same patient sent from each sending organization.Lack of accountability to “cleanse” source system to assure information is valid.No reporting back to sending organizations regarding the quality of the data they’re submitting or the sending organization’s duplicate records.As specific examples were researched, a fifth challenge was identified. This was related to the HIEO’s system having immature tools to identify, resolve duplicate records and pull apart data from an overlaid record.IG Program Structure:The Executive Vice President (EVP) for HIE Network Integration serves as the accountable executive for the exchange program. S/he shall have the authority to delegate strategic alignment to other accountable executives in the HIEO. The Chief Data Officer (CDO) is the strategic executive charged with the strategic development of the IG program as noted previously.As a clinical data repository (CDR), our HIE is structured as a “centralized” exchange model. Participating organizations shall sign a Business Associates Agreement (BAA) which outlines the accountabilities of the HIEO and the participant. Our organization has established an infrastructure and IT governance process that manages and keeps secure all data contained within the CDR. The HIEO is accountable for assuring version control of software, DURSA requirements for exchange, any necessary dispute resolution. The CDR meets all of the Direct Trust requirements for interoperability. The exchange of information is done via continuity of care documents (CCD’s) and a subset of information from each participating organization’s electronic medical record (EMR). All organizations must have attested to meaningful use and have a fully functional EMR which can interface with the HIE; a “common” EMR is not a requirement. The participant organization is responsible for managing all IT interface connection testing while incorporating the HIEO testing standards and “build”. Participating organizations are responsible for managing their consent and authorization process consistent with state/federal requirements, maintaining appropriate auditing processes for users, maintaining secure log-on requirements and complex password maintenance. The HIEO and the provider organization will work in a collaborative manner to resolve any security threats or breach events that might result. The HIEO shall stipulate to “good maintenance” requirements as a part of their oversight and administrative duties. Servers with maintaining the CDR data is maintained off-premise in the organization’s data center with redundant servers located in a separate location.The HIEO has an established information governance (IG) program to support the EMR and the CDR. The framework for IG follows the tenants described by the American Health Information Management Association (AHIMA) and the American Record Management Association (ARMA).The IG program has established a HIM steering committee as its governing body. At the time of development, a project management (PM) approach was taken in order to ensure stakeholder involvement and strategic alignment. This organization has a centralized approach to IG within the organization. There is a centralized authority led by the EVP and CDO with a secondary group of leaders from across the organization that provides control and decision-making authority for information obtained at the enterprise level. There are subgroups with responsibilities for data within their respective business areas, and additional staff can be brought into the program to design workflows. (from AHIMA IG toolkit).Project components in establishing our IG program included: (from AHIMA toolkit)Identification of accountable executiveCharter development: A charter provides the framework for a project and is intended to include and identify:Executive summaryProject definitionProject approachMeasures of successStakeholders,Budget,Approval processProject Plan Developmentto includeInitiation: The initiation phase sets up the framework for the program. Components to our initiation phase included the creation of the charter, a communications plan, defining the core team and the accountable oversight committee, and identification of the project manager.Planning:The planning phase informed the development of our project plan. We initially created a preliminary scope statement to allow us to evaluate and prioritize ad hoc requests for work. An IG project plan was developed and continues to be updated as new initiatives are undertaken. The team defined time periods for planning and then adjusted as the project moved forwardExecution: Execution of IG plans can take many forms. Our organization defined the project deliverables, focus, and quick wins we could achieve to keep the momentum going for all of our activities. Throughout the execution phase, the team focused on deliverables that built value and created a compelling story for success. We created processes, developed policies and procedures and trained our team.Monitoring/Control: Assessment of schedules, scope, budget and change management process was ongoing throughout the implementation of our IG programProject closure: project was completed, the project manager took steps to appropriately close each milestone and deliverable. As each deliverable was closed we updated the status report as well as identified any operational owners who will manage these steps in the future.Organizational Impact:The IG program has created new synergy in managing information that supports care delivery for HIEO participants. The project plan, once implemented, created a standard for information maintenance and accountability. During the implementation period, there was significant focus on “quick wins” for the program and notably, there were several challenges that were positively impacted.After initiation of the project and a period of normalization, identified gaps in some of the types of analytic reports, a deeper understanding of consent management, operational accountability for contributing partners for consent values and managing problem lists and medication reconciliation were identified. The initial project plan had identified “accountability” but did not describe specific requirements and analysis needs. This has unfortunately resulted in unresolved redundant data in the EDW which has created dissatisfaction and concerns of data accuracy and integrity. Audit tools exist within the HIE process but the reports are difficult to interpret and need to be re-tooled to be more user-friendly. Patient matching has worked well, however, the process for individual organizations to manage respective EMR transactions has been problematic. Consideration is underway by the CDO to implement a new project plan to identify gaps and mediation strategies, specifically related to contributing partner consent management.IG Challenges Resolved:Reportingas a result of the governance tactics employed and working with the respective provider groups, standard reports have been developed for each of the practices. These provide information related to numbers of individual patients contributed by the organization, query results, required fields which need completion, user ID access. Importantly, reporting has now expanded to include patients who appear to have duplicate records and need to be merged. These are provided to the organization in a “work queue” daily in order to be addressed by the contributor.Data Management: Patient consent management is a significant component of any exchange of information between providers. Best practice standards have been established by the HIEO, which are shared with the participating organizations for consideration in their doors to manage duplicate patients, problem lists, medication lists (expired vs current), allergies.Patient Identity management solutions: Policies and procedures, rules related to patient identity, merge criteria, data correction/moves have been established by the HIEO. Individual participant organizations must develop P&P for management of their individual patient data. Measurable improvements in patient identity data quality were realized. The level of complaints from member organizations and providers dropped.Benefits Realized:Following the implementation of the IG program and its related activities, the HIEO gained knowledge regarding key data quality initiatives needed to effectively manage its record matching. The staffing required to manage error queues and duplicates was able to be maintained with increases, even as the HIEO membership grew and volume of EMPI records increased. This was a direct cost savings to the organization. The HIEO’s reputation within the state improved and additional member organizations joined.Summary:The IG program has created new synergy and partnership in managing information that supports care delivery for HIEO participants. Providers have a broader clinical profile that supports population health and works to decrease costs. Patient matching tools and initiatives have been implemented which has significantly improved the provider experience, patient experience, decreased the need for redundant testing and improved the care continuum for the patient.Deliverables:Submit one (1) single Microsoft Word documentIdentify and develop a methodology to collect data that will guide or influence strategic and/or organizational management. Identify key data points, rates, indicators that can be used to measure EMPI data quality.This effective exchange of medical information amongst HIEO members relies on their trusting that each patient has one and only one unique identifier within the HIEO system. Management of the HIEO’s Enterprise Master Person/Patient Index (E/MPI) is a key strategic activity because the E/MPI is the backbone of the HIEO’s clinical repository The Enterprise Data Integrity Team is accountable to the HIEO Information Governance Committee. Describe those individuals/ departments that should be involved and define what each of their roles is. Define the purpose and the value to the organization of an Enterprise Data Integrity team. Explain the Enterprise Data Integrity team’s accountability within the enterprise.Create an organizational guideline to measure data quality checks that promote the accuracy of cross-organizational patient identity matching. Define the organizational burden and accountability for each HIEO member to assure integrity, completeness, and accuracy of patient identification data.Prepare an HIEO policy which provides clear guidance to all contributors in the HIEO on the use of patient consent. Use the statutory guidance for consent in your state in developing the policy. Is your state assumed to have patient consent “opt-in” unless they specifically decline or is your state an “opt out” which assumes no consent for disclosure unless a consent has been signed? In the policy, discuss how the consent value is managed by the contributing parties, e.g., collected, stored, updated and sent to the HIE. Identify any other specific types of consent values which need to be considered for consent management (e.g., 42 CFR part 2 and others specific to your state such as HIV, STD, genetic testing).Create a business flow chart which identifies and describes the accountable owner, information source system, and transaction flow to the HIEO; see attachment A as an example of an HIE transactional database. Identify and describe the inbound and outbound interface transactions from the central model of the HIE. Note additional components may be used to describe the transactions.

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