Ashley Rolison Portfolio

Ashley Rolison
Health Information Technician
Fall 2015
Portfolio

Contents of My Portfolio
Introduction
• PORTFOLIO INTRODUCTION
• ACCOMPLISHED CURRICULUM
EVIDENCE OF COMPETENCY
INFORMATION TECHNOLOGY
• GUIDED EXERCISE
• DATABASE PROJECTS
• PERSONAL HEALTH RECORD SERVICE EVALUATION
ICD-9 & CPT AMBULATORY CODING
• DATA PRESENTATION OF CASE MIX ANALYSIS
• CODING AND REIMBURSEMENT SYSTEM – DRG’S
Health Care Data Analysis
• CANCER REGISTRY-ANALYZE AND GRAPH DATA
SURVEY OF DISEASE
• RESEARCH PAPER-RHEUMATOID
ARTHRISTIS
DIRECTED PRACTICE
• DIRECTED PRATICE I
• ON SITE ACTIVITY
• POWER POINT PRESENTATIONS
• DIRECTED PRACTICE II
• ASSIGNED DIRECTED PRACTICE SITE
• BUDGET EXPENSE ACTIVITY
PERSONAL ACCOMPLISHMENTS AND REFLECTIONS
• RESUME’
• CERTIFICATES
• FINAL REFLECTION

Introduction
• PORTFOLIO INTRODUCTION
• ACCOMPLISHED CURRICULUM

Introduction
Health Information Technology
Cypress College
My name is Ashley Rolison, I am a returning student to school after a many
years. I am graduating from Cypress College in December 2015 with a degree in
Health Information Technology. After graduation I plan on taking the RHIT exam and
continuing my education in hopes to receive my bachelor’s degree in Health
Information Technology. I love working with people and the great outdoors. This
portfolio is a representation of my personality and my work throughout the semester.
My portfolio is a collection of information, examples of work and received
certificates completed during this program. This portfolio was the most practical way
to organize and maintain information about myself as well as the experiences I've had
in my classes.
I appreciate this process because it has given me the opportunity to develop
an awareness of my skills and gave me the ability to tell other people what I am good
at and where I learned particular skills. This portfolio has assisted my goal setting
skills and has helped me become more aware of my progress. By presenting this
professional portfolio I can show others that I am prepared and capable
This portfolio consist of all the work I’ve completed during my time at Cypress
College. It has always given me the platform to make use of the skills learned in my
classes. I once thought that the term Heath Information Technology only applied to
computers. The opportunity to create this portfolio and to be out in the field gave me
the chance to really see how many avenues this degree can take me. I enjoy the hands
on opportunities we are given in classes such as directed practice, coding skills lab
and ICD 9 coding classes. The ability to see the records, touch the records and be in
the environment makes the drive to get in the industry so much greater.
During my time spent at Cypress College I have been able to experience
different aspects of the Health Information through a number of courses. Just a few
examples include, Health Information Science (HI 101 C), Beginning Coding (HI 204
C), Legal Aspects (HI 102 C) and Management Quality (HI 203 C). With in all these
courses I have been able to confidently abstract information found in health records,
apply official guidelines, legal aspects of records, query the physician when additional
information is needed and assign POA’s. I have supplied a list of courses successfully
completed as of this 2015 Fall Semester in this portfolio.
I invite you to look through my portfolio and read some of the work I have
accomplished through out my time in the Health Information program at Cypress
College. I hope that you appreciate my work and I encourage any feedback you could
give me.

Cypress College Accomplished Curriculum Fall 2015
Course Code Course Name
BIO 160 Introduction to Biology
HS 145 Survey of Medical Terminology
ENGL 100 College Writing
HI 100 Trends in Health Care Delivery
HI 101 Health Information Management
BIOL 210 Anatomy and Physiology
MATH 120 Introduction to Probability and
Statistics
HS 147 Survey of Disease
HI 102 Legal Aspects of Health Care
HI 103 Health Care Data Analysis
HI 204 Beginning ICD-9 Coding
HI 220 Advanced ICD-9 Coding
HI 245 Coding Skills Lab
HI 214 CPT/Ambulatory Care Coding
HI 225 Information Technology
HI 230 Directed Practice I
HI 203 Medical Quality Management
CIS 236 Introduction to Oracle
HI 240 Directed Practice II
HI 110 Medical Insurance Billing
CIS 111 Computer Information Systems
CIS 101 Intro MS Word Formatting

EVIDENCE OF COMPETENCY
INFORMATION TECHNOLOGY
• GUIDED EXERCISE
• DATABASE PROJECTS
• PERSONAL HEALTH RECORD SERVICE EVALUATION
ICD-9 & CPT AMBULATORY CODING
• DATA PRESENTATION OF CASE MIX ANALYSIS
• CODING AND REIMBURSEMENT SYSTEM – DRG’S
• CANCER REGISTRY-ANALYZE AND GRAPH DATA
SURVEY OF DISEASE
• RESEARCH PAPER-RHEUMATOID
ARTHRISTIS
DIRECTED PRACTICE
• DIRECTED PRATICE I
• ON SITE ACTIVITY
• POWER POINT PRESENTATIONS
• DIRECTED PRACTICE II
• ASSIGNED DIRECTED PRACTICE SITE
• BUDGET EXPENSE ACTIVITY

Information Technology
Electronic Health Records
Guided Exercises
Completed
By
Ashley Rolison
HI 225

Brenda Green 108889 11/10/2015
Ashley Rolison 12:38
Student: Ashley Rolison
Patient: Brenda Green: F: 12/02/1957: 6/01/2012 10:14AM
Chief complaint
The Chief Complaint is: Patient reports leg pain after exercise.
History of present illness
Brenda Green is a 54 year old female.
She reported: Intermittent leg claudication and both feet are cold.
Pain in the middle of the thigh and in the thigh near the knee.
Past medical/surgical history
Reported:
Tests: A cholesterol test was high.
Physical findings
Vital Signs:
Vital Signs/Measurements Value Normal Range
Oral temperature 98.6 F 97.6 - 99.6
RR 22 breaths/min 18 - 26
PR 78 bpm 50 - 100
Blood pressure 130/90 mmHg 100-120/56-80
Weight 210 lbs 98 - 183
Eyes:
General/bilateral:
Optic Disc: ° Normal.
Retina: ° Normal.
Cardiovascular:
Heart Rate And Rhythm: ° Normal.
Heart Sounds: ° S1 normal. ° S2 normal. ° No S3 heard. ° No S4 heard.
Murmurs: ° No murmurs were heard.
Heart Borders: ° By percussion, heart size and position were normal.
Musculoskeletal System:
Ankle:
Left Ankle: • Swelling.
Tests
Urinalysis Was Performed:
Urinalysis Results: Value Normal Range
Urine protein 0 +
Blood Analysis:
Blood Counts - CBC: Value Normal Range
Hematocrit level 51% 37 - 47
Hemoglobin level 16.2 g/dl 12 - 16
Blood Chemistry:
Electrolytes: Value Normal Range
Potassium level 4.8 mEq/l 3.5 - 5.5
Total calcium level 9.8 mg/dl 8.5 - 10.5
Endocrine Laboratory Tests: Value Normal Range
Random blood glucose level 120 mg/dl 75 - 110
Metabolic Tests: Value Normal Range
Serum creatinine level 1.4 mg/dl 0.6 - 1.3
Total plasma cholesterol level 205 mg/dl 140 - 200
Plasma HDL cholesterol level 65 mg/dl 30 - 80
Plasma LDL cholesterol level 130 mg/dl 80 - 130
Laboratory Studies:
Page 1 of 2

Brenda Green 108889 11/10/2015
Pulmonary Function Tests: Value Normal Range
Pulse oximetry with ankle/brachial index .94
Assessment
● Hypertension
● Atherosclerosis of the femoral artery
Counseling/Education
● Low fat diet
● Low fat cooking
● Changing eating habits
Plan
● Urinalysis
● CBC
● An electrolyte panel
● A lipid profile
● Random blood glucose level
● Bilateral angiography of the extremity
● Warfarin sodium (Coumadin)
2 mg tab (1 qd 30) DISP:30 Refill:3 Generic:Y Using:Coumadin Mfg: Du Pont Pharma
Practice Management
Estab outpatient comprehensive h&p - high complex decisions 99215; Follow-up with anticoagulant
management in 2 weeks; Total face to face time 50 min; Counseling and coordination of care was more than
50% of encounter time 30 minutes of visit spent on dietary and Coumadin counseling
Page 2 of 2

Imager Drawing 11/10/2015
Imager Drawing
Medcin® Student Edition - Brenda Green - 06/1/12 10:14 (Office Visit)
Page 1 of 1

Brenda Green 11/10/2015
Data Points
4/7/2012 280.0 mg/dl
4/21/2012 265.0 mg/dl
5/17/2012 205.0 mg/dl
Page 1 of 1

Brenda Green 11/10/2015
Data Points
4/7/2012 215.0 lbs
4/21/2012 222.0 lbs
5/17/2012 231.0 lbs
Page 1 of 1

Guy Daniels 10/22/2015
Data Points
8/19/2011 1.2 mg/dl
11/23/2011 1.3 mg/dl
2/14/2012 1.4 mg/dl
5/23/2012 1.4 mg/dl
Page 1 of 1

Guy Daniels 10/22/2015
Data Points
8/19/2011 130.0 mmHg 90.0 mmHg
11/23/2011 140.0 mmHg 90.0 mmHg
2/14/2012 135.0 mmHg 95.0 mmHg
5/23/2012 156.0 mmHg 104.0 mmHg
Page 1 of 1

Harold Baker 101398 10/1/2015
01355411 17:30
Student: 01355411
Patient: Harold Baker: M: 1/18/1974: 10/01/2015 05:22PM
Chief complaint
The Chief Complaint is: Return visit for cold.
Reported:
Medical: A recent URI.
Medications: Not taking medication.
Personal history
Behavioral: Not a current smoker.
Review of systems
Systemic: Mild fever.
Head: Headache and sinus pain.
Otolaryngeal: Nasal discharge and nasal passage blockage.
Pulmonary: Cough while lying down and worse at night.
Physical findings
Vital Signs:
Oral temperature 99.7 F 97.6 - 99.6
PR 65 bpm 50 - 100
Blood pressure 120/80 mmHg 100-120/60-80
Weight 175 lbs 125 - 225
Height 72 in 64.96 - 73.62
Ears:
General/bilateral:
Tympanic Membrane: ° Both tympanic membranes were normal.
Nose:
General/bilateral:
Discharge: • Nasal discharge seen. • Purulent nasal discharge.
Cavity: ° Nasal septum normal. ° Nasal turbinate not swollen.
Sinus Tenderness: • Tenderness of sinuses.
Pharynx:
Oropharynx: ° Tonsils showed no abnormalities.
Mucosal: ° Pharynx was not inflamed.
Lymph Nodes:
° Normal.
Lungs:
° Respiratory movements were normal. ° Chest was normal to percussion. ° No wheezing was heard. ° No
rhonchi were heard. ° No rales/crackles were heard.
Assessment
● Acute sinusitis
Allergies
No allergies.
Plan
● Cool mist vaporizer and instruct patient not to run it unattended with children
● Fluids
Page 1 of 1

Tyrell Williams 189001 10/22/2015
Student: Ashley Rolison
Patient: Tyrell Williams: M: 11/10/2011: 5/25/2012 11:00AM
Chief complaint
The Chief Complaint is: 6 month check up.
History of present illness
Tyrell Williams is a 6 month old male. Source of patient information was mother.
No constipation. A normal number of wet diapers per day.
Reported:
Past medical history - No significant past medical history.
Surgical / Procedural: Prior surgery - No significant surgical history.
Exposure: No exposure to tuberculosis.
Environmental Exposure: No exposure to lead.
Dietary: Infant is breast-feeding.
Pediatric: No difficulty breast-feeding, rice cereal introduced, with pureed fruit introduced, and with pureed
vegetables introduced.
Personal history
Habits: A normal sleep pattern.
Home Environment: Lives with parents and the living environment has secondhand tobacco smoke.
Family history
Family medical history - No significant family history
Tobacco use
Alcohol
Not using drugs.
Review of systems
Gastrointestinal: No gastrointestinal symptoms.
Physical findings
Vital Signs:
Tympanic membrane temperature 99 F 99 - 101
PR 128 bpm 110 - 175
Weight 8.7 kg 6.136 - 10
Body length 27.5 in 25.59 - 29.13
Head circumference 43.9 cm 42 - 47
General Appearance:
° Alert. ° Well hydrated. ° Active.
Head:
Injuries: ° No cephalohematoma.
Appearance: ° No skull molding was seen. ° Fontanelle was normal.
Neck:
Appearance: ° Neck was not swollen.
Suppleness: ° Neck demonstrated no decrease in suppleness.
Eyes:
General/bilateral:
Extraocular Movements: ° Normal.
Pupils: ° Normal.
Ears:
General/bilateral:
Outer Ear: ° Auricle normal.
External Auditory Canal: ° External auditory meatus normal.
Tympanic Membrane: ° Normal.
Page 1 of 2

Tyrell Williams 189001 10/22/2015
Nose:
General/bilateral:
Discharge: ° No nasal discharge seen.
External Deformities: ° No external nose deformities.
Oral Cavity:
° Normal.
Pharynx:
° Normal.
Lungs:
° Clear to auscultation.
Cardiovascular:
Heart Rate And Rhythm: ° Normal.
Heart Sounds: ° Normal.
Murmurs: ° No murmurs were heard.
Arterial Pulses: ° Equal bilaterally and normal.
Venous Filling Time: ° Normal.
Abdomen:
Auscultation: ° Bowel sounds were normal.
Palpation: ° Abdomen was soft. ° No mass was palpated in the abdomen.
Liver: ° Normal to palpation.
Spleen: ° Normal to palpation.
Hernia: ° No umbilical hernia was discovered.
Genitalia:
Penis: ° Normal.
Testes: ° No cryptorchism was observed.
Musculoskeletal System:
General/bilateral: ° Normal movement of all extremities.
Hips:
General/bilateral: ° Hips showed no abnormalities.
Neurological:
° System: normal.
Skin:
° General appearance was normal. ° Showed no erythema. ° No cyanosis. ° Not dry. ° No exfoliation was
seen.
Growth And Development:
° Normal. ° Babbles. ° Rolls over from back to front. ° Passes objects from hand to hand. ° Sits
independently. ° Pulls self to a standing position. ° Shy with strangers.
Counseling/Education
● Discussed safety practices
● Discussed stranger safety
● Discussed nutritional needs
● Discussed concerns about teething
● Discussed concerns about dental hygiene
Reason for Visit
Visit for: 6-month visit.
Page 2 of 2

Tyrell Williams 10/22/2015
Data Points
11/29/2011 54.6 cm 138.7 in
1/10/2012 58.4 cm 148.4 in
3/14/2012 62.5 cm 158.7 in
5/25/2012 69.9 cm 177.4 in
Page 1 of 1

Working with Excel Spreadsheets
Created
By
Ashley Rolison
HI 225

Cypress General Hospital
Ashley Rolison 1
001 Heart Transplant or Implant ofHeart Assist System W MCC 25.3920 20
002
Heart Transplant or Implant ofHeart Assist System W/O
MCC
15.6820 10
003
ECMO or Trach W MV 96 + HRS or PDX EXS Face, Mouth
& Neck MAJ O.R.
17.6399 15
004
ECMO or Trach W MV 96 + HRS or PDX EXS Face, Mouth
& Neck W/O MAJ O.R.
10.8533 15
005 Liver Transplant or Intestinal Transplant W MCC 10.4973 30
006 Liver Transplant or Intestinal Transplant W/O MCC 4.7461 25
007 Liver Trasnsplant 9.2986 10
008
SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANT
5.3302 5
010 Pancreas Transplant 4.0849 10
TOTAL 140
MS-DRG Listing Cypress General Hospital
MS-DRG MS-DRG Discriptions CMS Weight Number of Cases
Case Mix
Index
12.04368214
0.0000
5.0000
10.0000
15.0000
20.0000
25.0000
30.0000
HeartTransplantorImplantofHeartAssistSystemWMCC
HeartTransplantorImplantofHeartAssistSystemW/OMCC
ECMOorTrachWMV96+HRSorPDXEXSFace,Mouth&
NeckMAJO.R.
ECMOorTrachWMV96+HRSorPDXEXSFace,Mouth&
NeckW/OMAJO.R.
LiverTransplantorIntestinalTransplantWMCC
LiverTransplantorIntestinalTransplantW/OMCC
LiverTrasnsplant
SIMULTANEOUSPANCREAS/KIDNEYTRANSPLANT
PancreasTransplant
001 002 003 004 005 006 007 008 010
CMS WEIGHT VS. NUMBER OF CASES
CMS Weight
Number of Cases
Ashley Rolison:
This graph reflects the number of patients with in a sample of DRG,s at Cypress General Hospital. A comparison of the CMS-
Weight to number of cases for transplant services completed.

2
Service
# of
Beds
Discharges
Discharge
Days
Pt. Days
% of
Occupancy
Average
LOS
Average Daily
Census
Internal
Medicine
45 155 1483 1261 90% 10 41
Pediatrics 10 97 317 378 122% 3 12
Orthopedics 30 59 187 173 19% 3 6
General
Surgery
55 119 640 724 42% 5 23
Urology 1 11 96 90 290% 9 3
Ear/Nose/Thro
at
3 40 63 57 61% 2 2
Ophthalmolog
y
2 10 33 34 55% 3 1
Gynecology 24 96 428 464 62% 4 15
Obstetrics 20 110 200 616 99% 2 20
Total: Adults
& Children
190 697 3447 3797 64% 122
Newborns 20 97 20 672 108% 0 22
Monday, August 01, 2011
Monthly Statistical Report for Cypress General Hospital
0 50 100 150 200
Internal Medicine
Pediatrics
Orthopedics
General Surgery
Urology
Ear/Nose/Throat
Ophthalmology
Gynecology
Obstetrics
Discharges
Discharges
Comparing the discharges with services

2
Internal
Medicine
24% Pediatrics
5%
Orthopedics
16%
General Surgery
29%
Urology
0%
Ear/Nose/Throa
t
2%
Ophthalmology
1%
Gynecology
13%
Obstetrics
10%
# Of Beds
0
200
400
600
800
1000
1200
1400
Pt. Days
Pt. Days
0%
50%
100%
150%
200%
250%
300%
350%
Occupancy
Occupancy
Comparing the # of beds occupied by the services
Comparing the occupancy with the services
Comparing the Pt Days with the services

Ashley Rolison 4
OSHPD_ID Facility Name # of Discharges
100717 COMMUNITY REGIONAL MEDICAL CENTERFRESNO 43,284
100899 ST. AGNES MEDICAL CENTER 29,351
010739 ALTA BATES SUMMIT MED CTRALTA BATES CAMPUS 25,112
150722 BAKERSFIELD MEMORIAL HOSPITAL34TH STREET 20,620
010856 KAISER FND HOSP OAKLAND CAMPUS 20,512
150788 SAN JOAQUIN COMMUNITY HOSPITAL 20,187
070988 JOHN MUIR MEDICAL CENTERWALNUT CREEK CAMPUS 19,555
070990 KAISER FND HOSP WALNUT CREEK 18,322
010858 KAISER FND HOSP HAYWARD/FREMONT 18,010
040962 ENLOE MEDICAL CENTERESPLANADE CAMPUS 16,124
150736 KERN MEDICAL CENTER 15,212
AVERAGE FOR TOP TEN HOSPITALS 23,108
Discharges by Facility January-December 2013
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
45,000
50,000
2013 Top Ten Hospitals with Largest Number of
Discharges

Ashley Rolison 5
Teaching Hospital in Los Angelas Total Hospital Beds Hospital Discharges Average Daily Census
CEDARS SINAI MEDICAL CENTER 958 347816 755.4082192
LAC/HARBOR-UCLA MEDICAL CENTER 570 208050 347.9178082
LAC+USC MEDICAL CENTER 724 264260 564.5315068
LONG BEACH MEMORIAL MEDICAL CENTER 462 168630 313.4931507
LOS ANGELES COUNTY OLIVE VIEW-UCLA MEDICAL CENTER 377 137605 188.3917808
RONALD REAGAN UCLA MEDICAL CENTER 456 166440 447.3013699
WHITE MEMORIAL MEDICAL CENTER 353 128845 234.9616438
Grand Total 3900 1421646 2852.005479

Working with Visio
Flow Chart in Visio
Created
By
Ashley Rolison
HI 225

START
Flow Diagram Constructions Steps
DISCUSS INTENTED USE
DETERMINESESSION OUTCOME
DEFINE PROCESS BOUNDARIES
SHOW FIRSTSTEP
IS STEP A BRANCH? CHOOSE BRANCH AND CONTINUE
IS NEXTSEGMENT
UNFAMILIAR?
MAKENOTEAND SKIP TO FAMILIAR PORTION
AT PROCESS BOUNDARY? ANY BRANCHES REMANINING?
SOW NEXT STEP
REVIEW CHART FOR SPECIAL CASES
SPECIAL CASES?
ASSIGN REVIEW ITEMS
END
INACCURACIES OR INCOMPLETENESS FOUND?
ANALYZE DIAGRAM
YES
YES
YES YES
YES
YES

Working with Access
Created
By
Ashley Rolison
HI 225

Cypress General Hospital- Patient Information
Medical Record # Last Name First Name DOB Address City State Zip Code Phone Number
01-34-2345 Black Adam 01/02/1967 21345 Apple Lake Forest CA 92630 949-123-4567
01-35-2346 Blue Allen 03/24/1977 45312 Pear Mission Viejo CA 92682 949-543-3475
01-36-2347 Yellow Pam 09/12/1987 76402 Cantalope Laguna Niguel CA 92688 949-234-6547
01-37-2348 Purple Bob 08/23/1968 55541 Peach Laguna Beach CA 96265 949-234-6655
01-38-2349 Red Salli 09/17/1956 44543 Banana Laguna Niguel CA 92677 949-435-2343
01-39-2350 White Chris 12/23/1989 76432 Orange Mission Viejo CA 92630 949-345-2211
01-40-2351 Pink Bella 05/12/1990 22313 Water
Melon
Lake Forest CA 92634 949-223-1253
01-41-2352 Brown Kelly 06/03/1978 43532 Plum San Clemente CA 92679 949-456-7865
01-42-2353 Green Mary 08/12/1956 82345 Mango Mission Viejo CA 92636 949-543-2398
01-43-2354 Red Greg 10/12/1977 56834 Guava Oceanside CA 93456 949-765-2255
Sunday, October 04, 2015 Page 1 of 1

Cypress General Hospital Patient Information
Medical Record # 01-34-2345
First Name Adam
Last Name Black
Address 21345 Apple
City Lake Forest
State CA
Zip Code 92630
Phone Number 949-123-4567
DOB 01/02/1967
First Name Allen
Last Name Blue
Address 45312 Pear
City Mission Viejo
State CA
Zip Code 92682
DOB 03/24/1977

First Name Pam
Last Name Yellow
Address 76402
Cantalope
City Laguna Niguel
State CA
Zip Code 92688
DOB 09/12/1987
First Name Bob
Last Name Purple
Address 55541 Peach
City Laguna Beach
State CA
Zip Code 96265
DOB 08/23/1968

First Name Salli
Last Name Red
Address 44543
Banana
City Laguna Niguel
State CA
Zip Code 92677
DOB 09/17/1956
First Name Chris
Last Name White
Address 76432
Orange
City Mission Viejo
State CA
Zip Code 92630
DOB 12/23/1989

First Name Bella
Last Name Pink
Address 22313 Water
Melon
City Lake Forest
State CA
Zip Code 92634
DOB 05/12/1990
First Name Kelly
Last Name Brown
Address 43532 Plum
City San Clemente
State CA
Zip Code 92679
DOB 06/03/1978

First Name Mary
Last Name Green
Address 82345 Mango
City Mission Viejo
State CA
Zip Code 92636
DOB 08/12/1956
First Name Greg
Last Name Red
Address 56834 Guava
City Oceanside
State CA
Zip Code 93456
DOB 10/12/1977

Information Technology
Personal Health Record Service Evaluation
Written and Presented
By
Ashley Rolison
HI 225

Personal Health
Record Services
Evaluation Report
Jakoter Health Organizer
So Tell Me Medical Organizer
Dossia
Written by:
Ashley Rolison

Over! the! recent! years! the! way! we! live! our! day3to3day! lives! have! changed!
drastically!with!the!ever3growing!technology.!The!medical!industry!is!no!different!from!
others.!The!importance!of!keeping!up!to!date!with!fast!growing!industry!is!a!not!only!
essential! but! challenging.! However,! the! significance! of! maintaining! our! loved! ones,!
family!members!and!our!own!health!needs!has!remained!stable.!In!fact,!as!the!new!
generations!have!progressed!as!well!as!advances!in!technology,!we!notice!that!more!
and! more! people! are! taking! an! interest! in! maintaining! their! own! records.! Personal!
records! including! but! not! limited! to! financial,! personal! or! medical! are! rapidly!
becoming!high!priority!in!households.!Individuals!that!utilize!website!based!services!
are!not!always!aware!of!the!potential!risks!that!can!be!associated.!!
As! we! get! older! the! responsibility! to! start! taking! care! of! our! own! family!
members!whether!it’s!our!grandparents,!parents!or!children!becomes!a!priority.!!There!
are! so! many! resources! and! websites! out! there! now! that! finding! an! easy,! safe! and!
affordable!manner!to!maintain!PHR!should!be!a!no!brainer!when!in!fact!it!is!difficult.!
This! process! can! be! very! tedious! and! requires! knowledge! of! what! to! look! for! when!
starting!to!organize!a!PHR.!!
There! are! many! formats! to! pick! from! when! looking! to! start! organizing! and!
putting!together!your!own!PHR.!Yes,!of!course!there!are!those!individuals!out!there!
that! will! say,! “My! doctors! keep! all! my! records,! so! I! don’t! need! to! be! bothered! with!
doing! it! myself.”! ! Wrong!! We! are! all! human! and! as! humans! we! all! make! mistakes.!
Doctor’s! offices! are! no! different.! Our! paperwork,! files! and! personal! information! are!
rotated!through!a!number!of!portals!in!any!given!day!at!the!doctor’s!office,!hospital,!
specialists,!etc.!The!only!way!to!guarantee!we!have!our!own!accurate!information!is!to!
put!together!our!own!PHR’s.!In!doing!this!we!are!saving!time!from!calling!around!to!
different!offices!we!have!visited!for!that!one!x3ray!image!or!the!list!of!our!past!shots!or!
medications! from! a! few! years! ago.! ! Life! is! busy! enough! so! why! not! try! to! simplify!
anywhere!we!have!the!opportunity?!!
!We!had!an!opportunity!to!evaluate!just!a!handful!of!websites!out!there!that!
offer!different!ways!to!maintain!PHR’s.!There!are!items!as!simple!as!binders!to!USB’s!to!
web3based! formats.! Depending! on! the! consumer’s! ability! to! navigate! throughout!
technology!and!desire!will!determine!the!format!in!which!will!be!used.!Of!course!with!
anything!that!requires!going!on!the!web,!also!requires!research.!Just!like!anything!else!
out! there,! we! should! not! trust! the! first! thing! we! read,! especially! when! it! comes! to!
sharing!our!personal!information.!!
!Jakoter( Health( Organizer,! a! paper! based! for! purchase! PHR! is! an!
organizational!binder.!This!particular!product!was!located!on!a!website!called,!Life!
Made!Simple.!We!found!this!website!to!be!very!dull!in!colors!and!not!eye!catching.!!We!
did!not!care!for!layout!of!the!site,!as!it!was!difficult!to!navigate!and!locate!this!product.!
This!is!a!commercially!driven!company!offering!this!service!with!a!low!pricing.!!For!the!
average! person,! this! Health! Organizer! might! not! be! necessary.! We! would! not!
recommend!this!site!nor!this!product!as!it!was!hard!to!locate!and!the!product!is!limited!
to!only!paper!based,!no!options!for!digital!back!up.!!!!

2!
So(Tell(Me(is!a!Personal!Health!Organizer!paper!based!for!purchase!PHR.!They!
offer! binders,! dividers! and! USB’s.! ! We! found! this! website! to! be! user! friendly,! bright!
colors!and!their!descriptions!of!products!were!straightforward.!The!confusing!part!of!
the! website! for! us! came! while! searching! for! products.! As! a! consumer! their! name!
indicates! to! us! that! they! are! selling! “Personal! Health! Organizers”,! not! random!
products! such! as! dining! utensils! and! stuffed! animals.! This! is! a! commercially! driven!
company! offering! this! service.! ! Excluding! the! random! products! offered! by! this!
company,! we! would! recommend! them! to! others.! The! reason! for! this! is! because! if!
patients! want! a! simple! and! straightforward! way! to! organize! their! medical!
information,!the!So!Tell!Me!system!may!be!a!good!option.!Patients!can!choose!between!
a! CD! and! flash! drive! for! storage.! Alternatively,! the! traditional! paper! system! can! be!
used!to!organize!health!records.!
Dossia(is!a!web!based!and!digital!based!company.!Dossia!is!and!organization!is!
backed!by!some!of!the!largest,!most!respected!brands!in!the!world!3!Applied!Materials,!
AT&T,!BP,!Cardinal!Health,!Intel,!Pitney!Bowes,!Vanguard!Health!Systems,!NantWorks!
and!Wal3Mart.!
Dossia’s!Website!is!well!laid!out!and!easy!to!navigate,!however!the!links!to!some!
of!the!main!features!for!The!Health!Manger!product!were!not!working!and!did!not!link!
to!the!marketplace!where!the!user!is!supposed!to!find!applications!to!choose!from..!
They! offer! three! primary! products! that! cater! to! different! market! segments.! For!
personal!and!private!use!they!offer!a!Health!Manager!and!for!employers,!health!plans,!
third! party3administrators! and! health! care! providers! they! offer! The! Dashboard.! A!
third!product!they!offer!is!Livli,!which!is!a!free!On3!line!social!community!and!resource!
center!where!anybody!can!share!their!ideas.!
Individual!users!of!The!Health!Manager!are!provided!with!myriad!of!options!
provided!by!an!entire!ecosystem!of!third!party!applications,!ranging!from!apps!that!
offer!tips!for!expecting!mothers!to!financial!management!tools!that!help!users!obtain!
higher!value!healthcare.!With!Dossia's!open!API,!the!system!allows!for!the!integration!
of!any!health!application!vendor!on!the!market.!
The! Dossia! Dashboard! provides! organizations! with! detailed! analysis! of! the!
health! of! a! population! and! is! focused! on3Employers,! health! plans,! third! party3
administrators!and!health!care!providers.!!!
The! third! product! is! a! free! On3! line! social! community! and! resource! center!
where!anybody!can!share!his!or!her!ideas.!The!site!is!full!of!ideas!from!a!community!of!
people!that!share!similar!interests!in!regards!to!health!care!and!well!being.!

! 3!
!
! In!conclusion,!this!assignment!has!been!invaluable!in!helping!us!determine!and!
understand!the!beginning!stages!of!putting!together!our!own!PHR’s.!After!being!able!
to!evaluate!our!assigned!websites!and!know!what!to!look!for,!choosing!a!format!and!
evaluating! a! particular! service! for! our! own! PHR! will! be! less! challenging.! ! Prior! to!
choosing!a!PHR!format!and/or!service!for!ourselves,!it!is!necessary!to!look!into!more!
than!just!the!few!we!were!assigned!for!this!group!assignment.!!As!mentioned!earlier,!
the!options!are!endless.!As!our!evaluation!proved,!not!all!are!safe!and/or!reliable!and!
performing! due! diligence! on! the! service! or! product! we! choose! to! entrust! with! our!
Health!Information!is!very!valuable.!This!is!our!personal!information!and!our!family!
members!personal!information!we!are!responsible!for,!which!makes!the!evaluation!of!
these!options!so!much!more!important.!!
!

PERSONAL HEALTH
RECORD SERVICE
EVALUATION
 Jakoter Health Organizer
 SoTell Me Medical Organizer
 Dossia
Presented by:
Ashley Rolison

JAKOTER HEALTH ORGANIZER
 PHR FORMAT- Paper Based
 We did not like the lay out of the website.
The product was difficult to locate and is
offered along with many other non-
relative organizational products.
 This is a commercially available product to
the general public that is based on
outdated technology offered by Life Made
Simple.
 Costs- from $34.95 with an optional two
add on inserts at $5.95 each.

JAKOTER HEALTH ORGANIZER
 Privacy and security- Not applicable
 URAC accredited: No
 HON certified: No
 This product offers no interoperability
with other health care providers.
 Recommendations: We would not
recommend this product
 ONC Privacy template- Not applicable

SO TELL ME MEDICAL ORGANIZER
 PHR FORMAT- Paper Based/USBThumb
Drive
 We did like the look of the website and it
was very user friendly, however this is also
a mixed use site that offers an abundance
of other un -related products
 This is a commercially available product to
the general public offered by Pozen,Inc.
 Cost-The wide range of binders and
inserts provides for a range of budgets.
We liked the usb drive for $5.99 and all
the forms in a digital format.

SO TELL ME MEDICAL ORGANIZER
 Privacy and security- Not applicable
 This product offers no interoperability
with other health care providers.
 Recommendations: We would
recommend this product
 ONC Privacy template- Not applicable

DOSSIA
 PHR FORMAT- Web/digital based as well
as device based.
 Dossia is organization that is backed by
some of the largest, most respected
brands in the world .
 We liked the look of the website,
however the hyperlinks to all of their
Health Manager products and applications
for individual use were broken.
 Dossia’s website is easy to navigate and
contains a wealth of knowledge including
webinars and white papers.

DOSSIA-Costs
 Dossia offers three primary products
 Dossia Health Manager-Individual use
 Dossia Dashboard-Employers, health plans, third
party-administrators and health care providers.
 Livli™- On- line social community and resource
center where anybody can share their ideas.
 Dossia Health Manger offers a wide variety of
applications and devices.
 Free
 Available for individual purchase
 Sponsored by a health plan or provider
 Percentage covered by your health plan
 Dossia Dashboard
 Prices are not listed instead it directs the
reader to request a demo, please contact
them
 Livli- Free Service

DOSSIA
 Privacy and security-Yes. Dossia has achieved the
SysTrust certification
 This product offers significant interoperability with
other health care providers and users
 Recommendations:
 Health Manager-We were unable to
provide a proper evaluation.
 The Dashboard product has some very
impressive features that large organizations
can utilize.
 Livli™- Indicates this company is in tune
with today’s technology and a remarkable
feature that adds to it’s credibility.
 ONC Privacy template-Yes
DOSSIA Health Manager
DOSSIA Dashboard &
Livli™

SO WHICH PHR ISTHE BEST OPTION ?
THINGSTO CONSIDER LESSONS LEARNED
 Format – Paper vs. Digital
 Availability- Lots of options
 Costs-Wide range
 Usability- Depends on format/product
 Interoperability-Not always needed
 Privacy and Security – Be careful all are not
created equal.

ICD-9 & CPT Ambulatory Coding
Computed
By
Ashley Rolison
HI 204/HI 214

Cypress General Hospital Profit/Loss by DRG
12/7/2015
Case # DRG # DRG Title CHARGES
DRG
RELATIVE
WEIGHT
REIMBURSEMENT
PROFIT/
LOSS
HOSPITAL
Specific
Prospective
Payment Rate
Case Mix
Index
1 194
Simple Pneumonia
& Pleurisy w/CC $10,278.89 0.9996 $9,996.00 -$282.89
2 481
Hip & Femur
Procedure Except
Major Joint w CC $12,043.17 1.9345 $19,345.00 $7,301.83
3 065
Intracranial
Hemorrhage or
Cerebral Infarction
w CC $11,172.56 1.1345 $11,345.00 $172.44
4 405
Pancreas, Liver &
Shunt Procedures
w MCC $15,876.42 5.5575 $55,575.00 $39,698.58
$49,371.04 $96,261.00 $46,889.96
2.406525
TOTALS
$10,000.00
$10,278.89 $12,043.17 $11,172.56 $15,876.42$9,996.00
$19,345.00 $11,345.00
$55,575.00
Simple Pneumonia & Pleurisy
w/CC
Hip & Femur Procedure Except
Major Joint w CC
Intracranial Hemorrhage or
Cerebral Infarction w CC
Pancreas, Liver & Shunt
Procedures w MCC
Total Hospital Charges -vs- Actual Reimbursement
for MS DRG
CHARGES REIMBURSEMENT
Porportion of total profit by MS-DRG

Cypress General Hospital Analysis of Case Mix
PATIENT NAME MR #
MS-
DRG DRG Title CHARGES
DRG RELATIVE
WEIGHT
REIMBURSEME
NT PROFIT/LOSS
HOSPITAL
PROSPECTIV
E WEIGHT Case Mix Index
Willis, Thomas 842693 194 Simple Pneumonia & Pleurisy w/CC 10278.89 0.9996 =$I$2*F2 =G2-E2
Barnes, Barbara 428314 481
Hip & Femur Procedure Except
Major Joint w CC 12043.17 1.9345 =$I$2*F3 =G3-E3
James, Joanne 271806 65
Intracranial Hemorrhage or Cerebral
Infarction w CC 11172.56 1.1345 =$I$2*F4 =G4-E4
Donnin, Robert 487601 405
Pancreas, Liver & Shunt Procedures
w MCC 15876.42 5.5575 =$I$2*F5 =G5-E5 =(F2*1+F3*1+F4*1+F5*1)/4=10000

Case # DRG # DRG Title CHARGES
DRG RELATIVE
WEIGHT
REIMBURSEMENT PROFIT/ LOSS
HOSPITAL Specific
Prospective Payment
Rate
Case Mix Index
1 194
Simple Pneumonia & Pleurisy
w/CC 10278.89 0.9996 =$H$3*E3 =F3-D3
2 481
Hip & Femur Procedure
Except Major Joint w CC 12043.17 1.9345 =$H$3*E4 =F4-D4
3 65
Intracranial Hemorrhage or
Cerebral Infarction w CC 11172.56 1.1345 =$H$3*E5 =F5-D5
4 405
Procedures w MCC 15876.42 5.5575 =$H$3*E6 =F6-D6
=SUM(D3:D6) =SUM(F3:F6) =SUM(G3:G6)
=10000 =(E3*1+E4*1+E5*1+E6*1)/4
TOTALS
Formulas Used for Bar Graph

DRG Title Percent of Total
HOSPITAL
Specific
Prospective
Case Mix Index CHARGES
DRG RELATIVE
WEIGHT
REIMBURSEMENT
PROFIT/
LOSS
Hip & Femur Procedure
Except Major Joint w CC =I4/$I$7 12043.17 1.9345 =$D$3*G4 =H4-F4
or Cerebral Infarction w
CC =I5/$I$7 11172.56 1.1345 =$D$3*G5 =H5-F5
Procedures w MCC =I6/$I$7 15876.42 5.5575 =$D$3*G6 =H6-F6
TOTALS =SUM(C4:C6) =SUM(F3:F6) =SUM(H3:H6) =SUM(I3:I6)
=10000 =(G3*1+G4*1+G5*1+G6*1)/4
Formula's for pie chart

Print Date : 03/11/2014
AR - #1-1
Gender : Male
Age : 76
Admit Date: 10/04/2014
Disch Date: 10/04/2014
LOS : 1
Claim Type (Medicare APC - HOPD)
01 Single day procedure claim (Status = S and/or T, without V)
APC Overall Claim Disposition
4 Claim denied, rejected, suspended or returned to provider, or single day claim w all
line items denied or rejected, w only pre-payment edits.
APC Claim Edit
3122 OCE(1)- Primary diagnosis code is blank; must be a valid code. (RTP)
APC Bill Type
13X Hospital Outpatient
APC Condition Code
9999 No/Unknown Condition Code
APC Detailed CPT Procedures
11606 Excision malignant lesion trunk/arm/leg > 4.0 cm
APC: 00021 - Level III Excision/ Biopsy
REV: 9999 - No Rev Code entered; partial OCE edits only
Status: T - Procedure or service, multiple reduction applies.
15220 Fth/gft free w/direct closure s/a/l 20 cm/<
APC: 00328 - Level III Skin Repair
15221 Fth/gft fr w/dir clsr s/a/l ea addl 20 cm/<
APC: 19900 - Incidental services packaged into APC rate
Status: N - Items and Services packaged into APC rates.
ICD-9-CM Procedures
864 Radical excision of skin lesion
863 Local excision/destruction of lesion/tissue of skin & subcutaneous tissue
CPT-4 five-digit codes and/or nomenclature are copyright 2012 American Medical Association.
Page 1 of 1Coding and Reimbursement System
3/11/2014http://hs3m.cypresscollege.edu./webcrs

Print Date : 03/12/2014
AR- #1-4
Gender : Male
Age : 47
Admit Date: 10/13/2014
Disch Date: 10/13/2014
LOS : 1
Claim Type (Medicare APC - HOPD)
01 Single day procedure claim (Status = S and/or T, without V)
APC Overall Claim Disposition
0 No edits present on claim.
APC Bill Type
13X Hospital Outpatient
APC Condition Code
9999 No/Unknown Condition Code
APC Detailed CPT Procedures
29881-LT Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including
meniscal shaving) including debridement/shaving of articular cartilage, same or
separate compartment(s), when performed; (-LT Left side of body)
APC: 00041 - Level I Arthroscopy
Admit Dx
S83262A Peripheral tear of lateral meniscus, current injury, left knee, initial encounter
Dx Reason for Visit
Primary Diagnosis
Secondary Diagnoses
M2242 Chondromalacia patellae, left knee
CPT-4 five-digit codes and/or nomenclature are copyright 2012 American Medical Association.
Page 1 of 1Coding and Reimbursement System
3/12/2014http://hs3m.cypresscollege.edu/webcrs

Cancer Registry
Calculated and Constructed
By
Ashley Rolison
HI 103

Ashley Rolison HI 103 Final Assessment Spring 2015 Part II
Race/Gender Type of Cancer 1990 1995 2000 2005 2010
White Males Colorectal 58.7 63.4 59 53 48.1
Pancreatic 11.1 10.7 10.1 9.8 9.2
Lung&Brochial 82.2 82 80.9 74.5 71.2
Non-Hodgkin's lymphoma 12.6 15.9 19.6 20.6 20.8
Prostate 78.8 87.1 133 140 129
Black Males Colorectal 63.5 60.8 59.7 59.8 53.5
Pancreatic 17.6 19.7 15.4 17.4 15.1
Lung&Brochial 131 131.3 118.6 113.3 115.7
Non-Hodgkin's lymphoma 9.3 10 14.2 17.9 18.6
Prostate 126.7 133.6 173.3 245.7 210.1
White Females Colorectal 44.7 45.9 40.2 37 36.4
Pancreatic 7.3 8.1 7.7 7.6 7.2
Lung&Bronchial 28.2 35.9 52.5 44.5 44
Breast 87.8 107.2 114.4 114.8 115.7
Black Females Colorectal 49.6 45.9 49.5 46.9 43.3
Pancreatic 13 11.3 10.3 12 12.5
Lung&Bronchial 33.8 40.2 46.9 49.3 42.7
Non-Hodgkin's lymphoma 6 7.1 9.3 7.2 9.5
Breast 74.3 92.5 97.7 101.9 101.3
Prostate
Breast
Black Males
SEE PIE CHART
SEE PIE CHART
SEE CHART
Prostate
White Females/Breast
Prostate
Prostate
Cancer Regisry Data Display
The state cancer registry program has collected the following data. Design a series of charts to answer the following
questions listed below the table.
New Cancer Cases per 100,000 population Anystate, USA
6a. What type of cancer is growing the fastest in the black population?
Use Excel charts to graphically display the answers to each of the following questions. It will
be necessary to do additional calculations on the above data to arrive at the answers.
Prepare your charts/graphs for the CEO of your organization (your audience). Clearly label the charts and
make certain they do not cross several pages when viewed/printed. You might want to consider adding
new sheets to display your Charts. If you do this, please label the sheet so that I know where to find your
answers for grading. Type the answers to 6a-6j in the yellow box when appropriate. Extra credit will be
given if you use Pivot Charts.
6j. What is the percentage distribution of new cancer cases reported for all races and genders for
each type of cancer?
6b. Which type of cancer is growing the fastest in the white male population?
6c. In which population is the cancer incidence the highest for the five periods?
6d. What is the percentage distribution of new cancer cases in white females in 2000?
6e. What is the percentage distribution of new cancer cases in black females in 2010?
6f. Compare the distribution of new cancer cases for black and white females in 2005?
6g. What type of cancer has the greatest number of new cases reported for all males in 2010?
6h. Which race accounts for the most new cases for each type of cancer in females?
6i. Which type of cancer has the most new cases reported for all races and genders?

Given Data
Pancreatic 17.6 19.7 15.4 17.4 15.1
Lung&Brochial 131 131.3 118.6 113.3 115.7
Prostate 126.7 133.6 173.3 245.7 210.1
Pancreatic 13 11.3 10.3 12 12.5
Lung&Bronchial 33.8 40.2 46.9 49.3 42.7
Breast 74.3 92.5 97.7 101.9 101.3
Question
Prostate
Aranged Data
Black Population Type of Cancer 1990 1995 2000 2005 2010
Colorectal 113.1 106.7 109.2 106.7 96.8
Pancreatic 30.6 31 25.7 29.4 27.6
Lung&Brochial 164.8 171.5 165.5 162.6 158.4
Prostate 201 226.1 271 347.6 311.4
Black Population Totals
6a. What type of cancer is growing the fastest in the black population?
Graphical Representation
0
50
100
150
200
250
300
350
400
1990 1995 2000 2005 2010
NumberofCases
YEARS
Cancer Cases Among The Black Population From 1990-2010
Black Population Colorectal
Black Population Pancreatic
Black Population Lung&Brochial
Black Population Non-Hodgkin's lymphoma
Black Population Prostate

Given Data
Pancreatic 11.1 10.7 10.1 9.8 9.2
Lung&Brochial 82.2 82 80.9 74.5 71.2
Prostate 78.8 87.1 133 140 129
Pancreatic 7.3 8.1 7.7 7.6 7.2
Lung&Bronchial 28.2 35.9 52.5 44.5 44
Breast 87.8 107.2 114.4 114.8 115.7
Question
6b. Which type of cancer is growing the fastest in the white male population? Breast
Aranged Data
Race Type of Cancer 1990 1995 2000 2005 2010
White Population Colorectal 103.4 109.3 99.2 90 84.5
Pancreatic 18.4 18.8 17.8 17.4 16.4
Lung&Bronchial 110.4 117.9 133.4 119 115.2
Breast 166.6 194.3 247.4 254.8 244.7
White Population Totals
0
100
200
300
400
500
600
1990 1995 2000 2005 2010
NumberofCases
Years
Cancer Cases Among White Population From 1990 -
2010
Colorectal Pancreatic Lung&Bronchial Non-Hodgkin's lymphoma Breast

Given Data
Pancreatic 11.1 10.7 10.1 9.8 9.2
Lung&Brochial 82.2 82 80.9 74.5 71.2
Prostate 78.8 87.1 133 140 129
Pancreatic 17.6 19.7 15.4 17.4 15.1
Lung&Brochial 131 131.3 118.6 113.3 115.7
Prostate 126.7 133.6 173.3 245.7 210.1
Pancreatic 7.3 8.1 7.7 7.6 7.2
Lung&Bronchial 28.2 35.9 52.5 44.5 44
Breast 87.8 107.2 114.4 114.8 115.7
Pancreatic 13 11.3 10.3 12 12.5
Lung&Bronchial 33.8 40.2 46.9 49.3 42.7
Breast 74.3 92.5 97.7 101.9 101.3
Question
Aranged Data
Years White Females
White
Males
Black
Males
1990 177.2 243.4 348.1
1995 208.5 259.1 355.4
2000 227.7 302.6 381.2
2005 217.4 297.9 454.1
2010 215.7 278.3 413
Total Incidences 1046.5 1381.3 1951.8
Black Females
6c. In which population is the cancer incidence the highest for the five periods?
176.7
208.5
227.7
217.4
215.7
1046
Black Males
Cancer Incidence Totals

0
50
100
150
200
250
300
350
400
450
500
1990 1995 2000 2005 2010
NumberofIncidences
Periods
Number of Cancer Incedences for All 5 Periods
White Females Black Females White Males Black Males

Given Data
Pancreatic 7.3 8.1 7.7 7.6 7.2
Lung&Bronchial 28.2 35.9 52.5 44.5 44
Breast 87.8 107.2 114.4 114.8 115.7
Question
SEE PIE CHART
Aranged Data
Type of Cancer Number of Cases in 2000
Colorectal 40.2
Pancreatic 7.7
Lung&Bronchial 52.5
Non-Hodgkin's
lymphoma 12.9
Breast 114.4
Total Population 100000
New cancer cases in white females in 2000
6d. What is the percentage distribution of new cancer cases in white females in 2000?
Percentage of Distribution
0.04%
0.01%
0.05%
0.01%
0.11%
Colorectal
17.65%
Pancreatic
3.38%
Lung&Bronchial
23.06%
Non-Hodgkin's
lymphoma
5.67%
Breast
50.24%
New Cancer Cases Among White Females In 2000
Colorectal Pancreatic Lung&Bronchial Non-Hodgkin's lymphoma Breast

Given Data
Pancreatic 13 11.3 10.3 12 12.5
Lung&Bronchial 33.8 40.2 46.9 49.3 42.7
Breast 74.3 92.5 97.7 101.9 101.3
Question
Aranged Data
Type of Cancer Number of Cases in 2010
Colorectal 43.3
Pancreatic 12.5
Lung&Bronchial 42.7
Non-Hodgkin's
lymphoma 9.5
Breast 101.3
Total Population 100000
New cancer cases in black females in 2010
Percentage of Distribution
0.04%
6e. What is the percentage distribution of new cancer cases in black females in 2010?
0.01%
0.04%
0.01%
0.10%
SEE PIE CHART
Colorectal
21%
Pancreatic
6%
Lung&Bronchial
20%
Non-Hodgkin's
lymphoma
5%
Breast
48%
NEW CANCER CASES AMONG BLACK FEMALES IN 2010

Given Data
Race/Gender Type of Cancer 2005
White Females Colorectal 37
Pancreatic 7.6
Lung&Bronchial 44.5
Non-Hodgkin's lymphoma 13.5
Breast 114.8
Black Females Colorectal 46.9
Pancreatic 12
Lung&Bronchial 49.3
Breast 101.9
Question
SEE CHART
Aranged Data
Type of Cancer White Females
Colorectal 37
Pancreatic 7.6
Lung&Bronchial 44.5
Non-Hodgkin's
lymphoma 13.5
Breast 114.8
New cancer cases in Black & White Females in 2005
6f. Compare the distribution of new cancer cases for black and white females in 2005?
Black Females
46.9
12
49.3
7.2
101.9
0
20
40
60
80
100
120
140
Colorectal Pancreatic Lung&Bronchial Non-Hodgkin's
lymphoma
Breast
NumberofNewCancerCases
Race/Gender
New Cancer Cases among Black & White Females in 2005
White Females Black Females

Given Data
Race/Gender Type of Cancer 2010
White Males Colorectal 48.1
Pancreatic 9.2
Lung&Brochial 71.2
Prostate 129
Black Males Colorectal 53.5
Pancreatic 15.1
Lung&Brochial 115.7
Prostate 210.1
Question
6g. What type of cancer has the greatest number of new cases reported for all males in 2010?
Prostate
Aranged Data
Type of Cancer
New Male Cancer Cases
In 2010
Colorectal 101.6
Pancreatic 24.3
Lung & Brochial 186.9
Non-Hodgkin's
lymphoma
39.4
Prostate 339.1
New Cancer Cases per 100,000 population Anystate,
USA
0 50 100 150 200 250 300 350 400
Colorectal
Pancreatic
Lung & Brochial
Non-Hodgkin's lymphoma
Prostate
Number of Cases
TypeofCancer
New Male Cancer Cases In 2010

Given Data
Pancreatic 7.3 8.1 7.7 7.6 7.2
Lung&Bronchial 28.2 35.9 52.5 44.5 44
Breast 87.8 107.2 114.4 114.8 115.7
Pancreatic 13 11.3 10.3 12 12.5
Lung&Bronchial 33.8 40.2 46.9 49.3 42.7
Breast 74.3 92.5 97.7 101.9 101.3
Question
Aranged Data
Type of Cancer White Females
Colorectal 204.2
Pancreatic 37.9
Lung&Bronchial 205.1
Non-Hodgkin's
lymphoma 59.4
Breast 539.9
Total of Cases 1046.5
6h. Which race accounts for the most new cases for each type of cancer in females?
1014
White females/Breast
Black Females
235.2
59.1
212.9
39.1
467.7
0 100 200 300 400 500 600
Colorectal
Pancreatic
Lung&Bronchial
Non-Hodgkin's lymphoma
Breast
Number of Cases
TypesOfCancers
New Cancer Cases For White & Black Females
Black Females White Females

Given Data
Pancreatic 11.1 10.7 10.1 9.8 9.2
Lung&Brochial 82.2 82 80.9 74.5 71.2
Prostate 78.8 87.1 133 140 129
Pancreatic 17.6 19.7 15.4 17.4 15.1
Lung&Brochial 131 131.3 118.6 113.3 115.7
Prostate 126.7 133.6 173.3 245.7 210.1
Pancreatic 7.3 8.1 7.7 7.6 7.2
Lung&Bronchial 28.2 35.9 52.5 44.5 44
Breast 87.8 107.2 114.4 114.8 115.7
Pancreatic 13 11.3 10.3 12 12.5
Lung&Bronchial 33.8 40.2 46.9 49.3 42.7
Breast 74.3 92.5 97.7 101.9 101.3
Question
6i. Which type of cancer has the most new cases reported for all races and genders? Prostate
Aranged Data
Type of Cancer White Males
White
Females
Black
Males
Black
Females
Totals
Colorectal 282.2 204.2 297.3 235.2 1018.9
Pancreatic 50.9 37.9 85.2 59.1 233.1
Lung&Brochial 390.8 205.1 609.9 212.9 1418.7
Non-Hodgkin's
lymphoma 89.5 205.1 70 39.1 403.7
Prostate 567.9 889.4 1457.3
Breast 539.9 467.7 1007.6
ALL Cancer 5539.3

1018.9
233.1
1418.7
403.7
1457.3
1007.6
0 200 400 600 800 1000 1200 1400 1600
TypesofCancer
Number of Cases Reported
TYPES OF CANCER REPORTED FOR ALL RACES AND GENDERS
Breast
Prostate
Non-Hodgkin's
lymphoma
Lung&Brochial
Pancreatic
Colorectal

Given Data
Pancreatic 11.1 10.7 10.1 9.8 9.2
Lung&Brochial 82.2 82 80.9 74.5 71.2
Prostate 78.8 87.1 133 140 129
Pancreatic 17.6 19.7 15.4 17.4 15.1
Lung&Brochial 131 131.3 118.6 113.3 115.7
Prostate 126.7 133.6 173.3 245.7 210.1
Pancreatic 7.3 8.1 7.7 7.6 7.2
Lung&Bronchial 28.2 35.9 52.5 44.5 44
Breast 87.8 107.2 114.4 114.8 115.7
Pancreatic 13 11.3 10.3 12 12.5
Lung&Bronchial 33.8 40.2 46.9 49.3 42.7
Breast 74.3 92.5 97.7 101.9 101.3
Question
Prostate
Aranged Data
Type of Cancer White Males
White
Females
Black
Males
Black
Females
Totals Case %
Colorectal 282.2 204.2 297.3 235.2 1018.9 18.39%
Pancreatic 50.9 37.9 85.2 59.1 233.1 4.21%
Lung&Brochial 390.8 205.1 609.9 212.9 1418.7 25.61%
Non-Hodgkin's
lymphoma 89.5 205.1 70 39.1 403.7 7.29%
Prostate 567.9 889.4 1457.3 26.31%
Breast 539.9 467.7 1007.6 18.19%
ALL Cancer 5539.3 100.00%
6i. Which type of cancer has the most new cases reported for all races and genders?

Colorectal
18.39%
Pancreatic
4.21%
Lung&Brochial
25.61%
Non-Hodgkin's
lymphoma
7.29%
Prostate
26.31%
Breast
18.19%
Types of cancer reported for all races and genders
Colorectal
Pancreatic
Lung&Brochial
Non-Hodgkin's
lymphoma
Prostate

Survey of Disease
Rheumatoid Arthritis
Research Paper
Written
By
Ashley Rolison
HS 147

ASHLEY ROLISON 01355411
RHEUMATOID ARTHRITIS
OUTLINE
Introduction:
This report will review the history, symptoms, and treatment of Rheumatoid arthritis, and
the major headway made in treatment in just the last 10 years.
Report:
1. Definition: Rheumatoid Arthritis (RA) is one of many autoimmune diseases.
Autoimmune diseases all have in common an attack of tissue by the immune
system…
2. Pathogenesis: That genetic environmental factors participate in mechanisms of
rheumatoid arthritis pathogenesis is well established…
3. Etiology: The exact cause of autoimmune disease is unknown. RA appears to be
a genetic disease, with the likelihood that is passes down generations…
4. Manifestations: The clinical manifestations of RA are highly variable, but joint
symptoms usually predominate.
5. Lab findings: Anti-CCP antibodies and rheumatoid factor, an IgM anti-body
directed against the Fc fragment of IgG, are present in 70-80% of patients with
established rheumatoid arthritis.

6. Diagnosis: There is no one method of determining the existence of RA as
opposed to another cause for swelling or another autoimmune disease. However a
blood test showing sediment-rate (sed rate) with several of the other common
symptoms is a reliable determining factor…
7. Treatment: Rheumatologists find that there is not a common treatment that works
for all patients. Until the last ten years treatment was pain medication, anti-
inflammatory medication and steroids. The new biologic medications are now
successful in putting the disease into remission…
8. Prognosis: The success of allowing RA patients to live a normal life is now
possible. Often joint damage can be stopped if not reversed as periods of
remission increase.
References
Davis III, J. M., & Matteson, E. L. (2012, July). My Treatment Approach to Rheumatoid Arthritis. Retrieved
September 27, 2015, from mayoclinicproceedings.org:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538478/pdf/main.pdf
Drugs.com. (2015, September 14). Rheumetoid Artritis: Symptoms, Diagnosis & Treatment Options.
Retrieved October 26, 2015, from Drugs.com: http://www.drugs.com/rheumatoid-arthritis.html
Hemmerle, T., Doll, F., & Neri, D. (2014, July 1). Antibody-based delivery of IL4 to the neovasculature cure
mice with arthitis. (R. A. Lerner, Ed.) Retrieved October 14, 2015, from Proceedings of the
National Acedemy of Sciences of the United States of America:
http://www.pnas.org/content/111/33/12008.full
Lee, E., Fleischmann, R., Hall, S., & ....., .. (2014, June 19). Tofacitinib versus Methotrexate in Rheumatoid
Arthistis. Retrieved October 14, 2015, from The New England Journal of Medicine:
http:/www.nejm.org/doi/pdf/10.1056/NEJMoa1310476
O'Dell, J. R. (Updated 2012, Agust 16). Round 25: Rheumatoid Arthritis Treatment: It was the best of
Times and the Worst of Times. Retrieved September 19, 2015, from John Hopkins Arthritis
Center: http://www.hopkinsarthritis.org/physcian-corner/rheumatology-rounds/round25-
rheumatoid-arthritis-treatment-it-is-the-best-of-times-and-the-worst-of-times/

O'Dell, J. R., Mikuls, T. R., & ..., .. (2013, July 25). Therapies for Active Rheumatoid after Methotrexate
Failure. Retrieved October 14, 2015, from The New England Journal of Medicine:
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1303006
Papadakis, M. A., & McPhee, S. J. (2015). Current Medical Diagnosis & Treatment. (M. W. Rabow, Ed.)
New York City, New York: McGraw-Hill Education/ Medical. Retrieved October 26, 2005
Pieringer, H., & Benke, A. (2013, March 1). What is causing my arthritis, doctor? A glimpse beyond the
ususal suspects in the pathogenesis of rheumatoid arthritis. Retrieved October 14, 2015, from
QJM An International Jounal of Medicine:
http://qjmed.oxfordjournals.org/content/qjmed/106/3/219.full.pdf
University of Marland Medical Center. (2013, March 18). Rheumatoid arthritis-An in depth report... (H.
Simon, & D. Zieve, Eds.) Retrieved September 9, 2015, from University of Maryland Medical
Center: http://umm.edu/health/medical/reports/articles/rheumatoid-arthritis
Viatte, S., Plant, D., & Raychaudhuri, S. (2014, March 1). Genetics and epigenetics of rheumatoid
arthritis. Retrieved September 27, 2015, from National Center for Biotechnology Information,
U.S. National Library of Science: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694322/

Rheumatoid Arthritis 1
Cypress College
HS147
Survey of Disease
Course#11149 001
Rheumatoid Arthritis
Ashley Rolison
01355411
Monday, December 07, 2015
Word Count: 1983

Abstract
This report will review and discuss the latest developments in diagnosis and treatment of
rheumatoid arthritis (RA), and conditions that often accompany the disease. Amazing strides in
RA treatment have been made in the last 20 years. Biologic drugs now block tumor necrosis
factor (TNF) which are necessary for the inflammatory process and are widely used to put the
disease into remission. Only 10 years ago pain medication and anti-inflammatory medication
were the only common treatment for RA. Now, human trials have begun with the latest drug,
dexamethasome, which has reportedly cured RA in mice at the rate of 100%.
Keywords: autoimmune diseases, rheumatoid arthritis, felty’s, arthritis medication, tumor
necrosis factor (TNF) blockers, arthritis medication side effects, joint disease, sjogren syndrome,
Cox 2 inhibitors,

Definition: Rheumatoid arthritis (RA) is one of many autoimmune diseases. Autoimmune
diseases all have the common characteristic of attacking tissue in the body. Worldwide,
approximately 1% of the population is affected. (Davis III & Matteson, 2012) RA causes
chronic inflammation of the joints. Normally the inflammation is to tissue around joints;
however, RA can also cause inflammation and injury to other organs in the body.
Etiology: The exact cause of RA is unknown (Drugs.com, 2015). It generally becomes
manifested around the age of 40, but can also be found in juveniles as young as early teens. It is
two to three times more common in women. Moreover, while some autoimmune diseases seem
to have a connection to race that is not true of RA. Environmental agents, bacteria, viruses, and
fungi have often been suspected as the source of the disease, but, despite it being studied for
decades, no researcher has been able to prove there is a link between any external sources and
the disease. In some families multiple members may be affected, suggesting a genetic link;
however, years of studies have not made that conclusive. Prior exposures to immunizations,
medications, or other triggers have been inconclusive. Some experts have a belief that hormones
play a part in the development and severity of RA. Smoking has been linked to the severity of
the symptoms of the disease, but not necessarily the cause. It is certain, though, that the disease
is caused by the immune system attacking joint tissue. Other tests have suggested that it is not
the attack of the joint tissue, but the immune system attempting to protect it from the perceived
damage that causes inflammation. Specifically, the white blood cells move from the
bloodstream into the synovium—the fluid surrounding and protecting the joint—making it swell
and become tender. The inflammation then causes proteins to be released that over time causes

the synovium to get thick. It is these proteins that damage cartilage, bone, tendons, and
ligaments. RA lasts for life, but patients may experience periods of remission. Typically, it is
progressive and can cause significant joint dysfunction and even disability. This was historically
so as little as 20 to 30 years ago.
Pathogenesis: It is well established that genetic environmental factors participate in
mechanisms of RA (Viatte, Plant, & Raychaudhuri, 2014). This has historically been
investigated through analysis of family pedigree. Twin studies found disease concordance of
15.4% in monozygotic twins and 3.6% in dizygotic twins (Viatte, Plant, & Raychaudhuri, 2014).
Using quantitative genetic analysis, the heritability of RA was estimated to be ~60%, meaning
genes account for ~60% of the “RA burden” in the population (Pieringer & Benke, 2013).
Researchers and investigators are currently developing testable hypotheses to explain disease
pathogenesis. GWAS Central (i.e., a comprehensive resource for the comparison and
interrogation of genome-wide association studies) and other studies indicate new pathogenic
pathways have been revealed and the mechanisms of some of the existing drugs used to treat RA
are clearer. While key advances in RA genetics have been made in the past 10 years, such as
better genotyping and accurate phenotyping, challenges still remain in genetic risk prediction
accuracy to a degree that inhibits entrance into clinical practice.
Environmental influences include smoking, which had been demonstrated to have a RR of ~1.4
to develop RA when compared with non-smokers (Pieringer & Benke, 2013). It has been
hypothesized that smoking in the presence of shared epitope (SE) is linked to increase in
citrullination, which in turn may lead to the development of anti-citrullinated protein antibody

(ACPA) (Pieringer & Benke, 2013). Other environmental factors include infections such as
periodontal disease.
Manifestations: The symptoms of RA tend to go into remission and exacerbation. While it can
appear suddenly, generally it appears gradually and affects the smaller joints first. The main
symptom is pain and tenderness in all of the inflamed joints. While it generally affects hands,
feet, wrists, elbows, and ankles, it can occur in any joint, including the back, neck, shoulders, and
even jaw. Other symptoms are low-grade fever, changes in appearance of joints, difficulty
sleeping due to pain, and feeling tired and fatigued. Small lumps known as rheumatoid nodules
may form under the skin at pressure points such as elbows, hands, feet, and Achilles tendons.
RA is not like osteoarthritis, which results from wear and tear on the joints, but is an
inflammatory condition. RA affects joints on both sides of the body equally. Wrists, fingers,
knees, feet, and ankles are the most commonly affected. For instance, if the right wrist is
affected, the left is generally equally affected. Most patients commonly have morning stiffness.
Over time, joints might lose their range of motion and become deformed. RA can affect nearly
every part of the body. It can cause damage to the lungs, hardening of the arteries, spinal injuries
resulting from inflammation, inflammation to blood vessels that may lead to skin, nerve, heart
and brain problems, and swelling and inflammation of the outer lining of the heart. Some RA
patients have an extraordinarily low white blood cell count, which is a condition known as
Felty’s disease, usually accompanied by an enlarged spleen. The cause of Felty’s is also not
known, and treatment is different for every patient. Other RA patients also suffer from dry eyes
and mouth, called Sjogren syndrome, or numbness or tingling in the hands and feet.

Generally, RA begins gradually with fatigue, morning stiffness, widespread muscle aches,
weakness, and loss of appetite. This is followed with degrees of joint pain with warm, tender,
and stiff joints. Additional symptoms are low grade fever, loss of range of motion, deformities
in hands and feet, nodules under the skin—usually a sign of severity of the disease—swollen
glands, burning and itching eyes, numbness and tingling, and anemia. It is a disease that with
aggressive treatment is likely to impair the quality of life. Furthermore, it is estimated that more
than 1.3 to 2.1 million people in this country suffer from RA (University of Maryland Medical
Center, 2013).
Lab Findings: Anti-CPP antibodies are the most specific blood test for RA (specifically 95%)
(Papadakis & McPhee, 2015). Anti-CCP antibodies and rheumatoid factor, an IgM anti-body
directed against the Fc fragment of IgG, are present in 70-80% of patients with established RA
(Papadakis & McPhee, 2015). Approximately 20% of RA patients have antinuclear antibodies
(Papadakis & McPhee, 2015). The prevalence of RA rises with age in healthy individuals.
Diagnosis: There is no specific test that can determine RA. Most of the common symptoms
such as low fever, joint pain, stiffness, and swelling are common to more than one autoimmune
disease. Two lab tests of a patient’s blood: A Rheumatoid Factor Test and Anti-CCP antibody
test are often used to help determine the presence of the disease. Although it seems that the tests
are not separately conclusive, the exhibition of several rheumatoid factors tends to show whether
a patient has RA. These tests can be conducted with other tests such as Erythrocyte
sedimentation rate, blood count, and C-reactive protein tests. The common symptoms generally
lead to a reliable diagnosis.

Treatment: Until recently, the hope for a cure for RA was minimal. Now, with the testing of
dexamethasome there is a potential cure on the horizon. Still, for now, rheumatologists treat
patients with a series of treatments. However, there is no single treatment that works for every
patient. In the last 20 years caring for patients has changed drastically. In the mid-90’s a patient
would generally be prescribed one drug, usually an anti-inflammatory along with pain
medication. If that didn’t work or if it stopped working another would be tried. There was, and
even now, is no specific standard of measuring success. There was little hope of avoiding the
ultimate disfigured joints or stopping the progression of the disease. Today, even though it is
widely accepted that RA cannot be cured, remission is a realistic goal.
As stated by O’Dell (2012), who studied and reviewed clinical testing in RA patients, there were
6,683 possible choices of treatment. At the time there were 17 disease modifying drugs, 6 of
which were biological. When using them individually, two at a time, three at a time and four at a
time, there are 6,683 possibilities. In the last three years there have been additional medications
added to the list, making the possibilities even greater. Today, aggressive use of two, three, or
four combinations of these medications simultaneously is tested and used until a combination
successfully results in remission and a halt to the progression of the damage caused in the past.
O’Dell noted that 10 years ago there were only a few choices and 20 years ago only two or three.
RA requires lifelong treatment with medications, physical therapy, exercise, and even surgery.
Until recently treatment was an anti-inflammatory drug such as ibuprofen and an oral or injection
of corticosteroids to give symptomatic relief. These helped to control pain but did little to halt
the progression of joint damage or disease and permanent harm to organs.

Today disease modifying anti rheumatic drugs (DMARDs) are standard treatment. Methotrexate
is the most frequently used of this class of drugs. These have been found to slow or even halt the
progression of the disease. However, they tend to lose their effectiveness over time and must be
substituted for other combinations of modifying drugs. The possible side effects are also
significant, these include: liver damage, kidney damage, increase risk for infection, and lung
disease. Nausea, diarrhea, hair loss, rash, and intestinal distress are also possible. Regular blood
testing is required to monitor the possible development of serious side effects.
Moreover, the biologic drugs Enbrel, Remicade, Humira, Simponi and Cimzia block what is
known as TNF, which is a cytokine that is necessary for the inflammatory process. However,
this does not alter the autoimmune, but it does stop the inflammation and halt the joint damage
and pain. In the event that the TNF blockers don’t work there are newly developed drugs that
block other immune factors with more serious side effects. Less common side effects are non-
melanoma skin cancer, lymphoma, heart failure, blood disorders, lung disease, and liver damage.
Corticosteroids are used for symptomatic relief most often used for flare-ups and are usually
injected directly into inflamed joints. These steroids also have serious side effects such as
myocardial infarction and cerebrovascular accident. Since two thirds of people with RA rank
pain as the primary reason for seeking help (University of Maryland Medical Center, 2013) anti-
inflammatory drugs such as ibuprofen, naproxen, and ketoprophen, are often used to reduce pain.
The side effects for these medications include ulcers and bruising, as well as the risk of
myocardial infarction.

A fairly recent drug, Cox-2 Inhibitors, was supposed to be an answer for inflammation while
causing less gastrointestinal distress. And, although initially promising, almost all Cox-2
Inhibitors have been removed from the US marketplace by the Food and Drug Administration
(FDA). Celebrex is still available but contains warnings of heart issues and internal bleeding
(University of Maryland Medical Center, 2013). Generally, exercise and sleep are mandatory to
help manage the disease; however, that must be accompanied by aggressive treatment.
Prognosis: In serious cases, joint replacement and joint fusion may be necessary to repair
damaged joints. However, the prognosis for living a normal lifestyle with manageable pain is
promising.
The FDA has very recently approved for human testing with an innovative biopharmaceutical
agent that is a disease-homing antibody-cytokine fusion proteins for therapy of cancer and
chronic inflammatory conditions such as RA. When used in arthritic mice with another existing
and approved drug, dexamethasome, it cured 100% of treated mice (Hemmerle, Doll, & Neri,
2014). This appears to be the first report of durable and complete regression in mice with
established RA. A fully human version is currently being developed for clinical investigation,
and although approval may be years away, it gives promise of a possible cure of RA for future
generations.

References
Davis III, J. M., & Matteson, E. L. (2012, July). My Treatment Approach to Rheumatoid
Arthritis. Retrieved September 27, 2015, from mayoclinicproceedings.org:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538478/pdf/main.pdf
Drugs.com. (2015, September 14). Rheumetoid Artritis: Symptoms, Diagnosis & Treatment
Options. Retrieved October 26, 2015, from Drugs.com:
http://www.drugs.com/rheumatoid-arthritis.html
Hemmerle, T., Doll, F., & Neri, D. (2014, July 1). Antibody-based delivery of IL4 to the
neovasculature cure mice with arthitis. (R. A. Lerner, Ed.) Retrieved October 14, 2015,
from Proceedings of the National Acedemy of Sciences of the United States of America:
http://www.pnas.org/content/111/33/12008.full
Lee, E., Fleischmann, R., Hall, S., & ....., .. (2014, June 19). Tofacitinib versus Methotrexate in
Rheumatoid Arthistis. Retrieved October 14, 2015, from The New England Journal of
Medicine: http:/www.nejm.org/doi/pdf/10.1056/NEJMoa1310476
O'Dell, J. R. (Updated 2012, Agust 16). Round 25: Rheumatoid Arthritis Treatment: It was the
best of Times and the Worst of Times. Retrieved September 19, 2015, from John Hopkins
Arthritis Center: http://www.hopkinsarthritis.org/physcian-corner/rheumatology-
rounds/round25-rheumatoid-arthritis-treatment-it-is-the-best-of-times-and-the-worst-of-
times/
O'Dell, J. R., Mikuls, T. R., & ..., .. (2013, July 25). Therapies for Active Rheumatoid after
Methotrexate Failure. Retrieved October 14, 2015, from The New England Journal of
Medicine: http://www.nejm.org/doi/pdf/10.1056/NEJMoa1303006

Papadakis, M. A., & McPhee, S. J. (2015). Current Medical Diagnosis & Treatment. (M. W.
Rabow, Ed.) New York City, New York: McGraw-Hill Education/ Medical.
Pieringer, H., & Benke, A. (2013, March 1). What is causing my arthritis, doctor? A glimpse
beyond the ususal suspects in the pathogenesis of rheumatoid arthritis. Retrieved October
14, 2015, from QJM An International Jounal of Medicine:
http://qjmed.oxfordjournals.org/content/qjmed/106/3/219.full.pdf
University of Maryland Medical Center. (2013, March 18). Rheumatoid arthritis-An in depth
report... (H. Simon, & D. Zieve, Eds.) Retrieved September 9, 2015, from University of
Maryland Medical Center: http://umm.edu/health/medical/reports/articles/rheumatoid-
arthritis
Viatte, S., Plant, D., & Raychaudhuri, S. (2014, March 1). Genetics and epigenetics of
rheumatoid arthritis. Retrieved September 27, 2015, from National Center for
Biotechnology Information, U.S. National Library of Science:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3694322/

Directed Practice I
On Site Activity
Write up
By
Ashley Rolison
HI 230

Directed Practice I Vermont Care Center
On November 26, 2013 I was able to spend a few hours at Vermont Care
Center in Torrance, California with Audrey Duncan.
Audrey is an RHIT herself and works as a consultant. She is responsible for
up to 30 facilities around the Los Angela’s area. While in these facilities she will at
random pick anywhere from five to seven records, go through each one and informs
the facility if they are missing required information. We were able to see the facility,
meet other staff members and located the medical records for each patient.
The information Audrey looks at during her time at the facility is as follows:
 Care plan complete
 Change of Conditions
 Consents
 Logging of nurses/doctors
 Signatures
 Completion of records
During our time with Audrey we were able to pull a total of six charts and
complete the checklists, similar to what she does on each visit. Each chart had to be
signed in and out. It was clear that HIPPA compliance was very well implemented
and performed through out the facility in regards to the actual patient records. A
great example of this was when Audrey collected our work sheets that included
patient information and shredded them as opposed to just tossing them in the trash.
Being able to see these physical charts was a great experience for myself. I
had never stepped foot in a medical facility as an employee but only as a patient.
Coming out of the food industry and owning a pet sitting business I’ve not been able
to physically be involved like I was during my visit to Vermont Care Center. As we
do code charts and see charts in our class, we were able to physical see current
ongoing charts.
The state does come in once a year. When the state comes out to a facility
they are checking for a number of things. Just a few examples are:
 Number of residents
 Number of licensed nurse staff hours per resident per day
 Total number of Health Deficiencies
 Percentage of short-stay residents with Pressure ulcers that
are new or worsened
 Percentage of short-stay residents assessed and given
appropriately, the seasonal influenza vaccine.
 Percentage of short-stay residents who self report moderate
severe pain.

Directed Practice I Vermont Care Center
Last semester I was able to take Management Quality with Carol Wilhelm.
One of our projects in this class was to visit Medicare.gov and compare three
facilities in our area. Beings that I was already exposed to this experience I took
upon myself to look up Vermont Care Center. The two areas that this facility was
above average were staffing and quality measures. On this website the public is able
to the number of beds in the facility, if the participate in Medicare and Medicaid. We
also can find the answers to the list above from the states inspection. However, if an
individual is interested in a facility to put their loved one its always a good idea to
visit the facility while keeping information from this website in mind.
Upon admission each patient goes through an assessment. A full body check
is completed as well as psychiatric. This body check includes looking for pre-existing
conditions such as ulcers, oral, hydration and any other markings on the body. They
also assess urinary/bowel output, self-administered medication, weight and
wandering. Vermont Care Center has the ability to house up to 200 patients; they
are one of the biggest facilities in the area. Among these 200 potential patients there
are multiple different medical conditions. The facility needs to be staffed for these
different conditions. These conditions include but not limited to, dementia,
schizophrenia, and chronic health conditions. All of this information is recorded in
the patient’s records. This is a vital part of the admitting of a resident. On a daily
basis each resident are being looked after and any change in conditions is to be
documented by the nurse at that time. Along with the change of condition there
needs to be documentation of the actions to correct the issue. Within the six charts
we pulled there were a number of these change of conditions. We didn’t see changes
in physical appearance more of the pain and psychiatric changes. The actions that
were taken to correct these issues were documented. Changes in prescription
dosage, physical activity and change of routine were documented in the charts.
In conclusion, this experience was appreciated by all three of us who were
able to visit Vermont Care Center. Audrey gave us a lot of information concerning
the actual facility, her job description and how she got to the position she is at today.
Personally, I left there with a better understanding of the direction I would like to go
after completing my RHIT program at Cypress College. The records we were
exposed to were very well maintained. Only minor problem that were seen among
the 6 records was legible writing on the nurse’s notes. The treatment books,
medication books and the records logbooks were easy accessible to staff.

Directed Practice I
Power Point Presentations
Created
By
Ashley Rolison
HI 230

Molina
Healthcare
Medical Records QA Specialist
Ashley Rolison

About Molina
Heathcare
• It was in 1980 when as an emergency room
physician, C. David Molina, MD, noticed that low-
income, uninsured or non-English speaking
patients were coming to the emergency room in
need of general health care services. Without
family doctors, they were not always getting the
right care and information. These families
deserved better and Dr. Molina set out to do
something about it.
• He opened a clinic in Long Beach, California to
provide low-income individuals and families with
a place to go to get personalized health care from
Molina doctors. Two more clinics opened that
same year and today our health plans and clinics
serve patients across the country.
Molina Healthcare's mission is to
provide quality health services to
financially vulnerable families and
individuals covered by government
programs. Molina Healthcare has health
plans, medical clinics and a health
information management solution. No
other organization of its kind does all
three.

Medical Records QA
Specialist - Remote
Job Summary
• Review Medical Records
• Determines Errors in the Records
Job Description
• Review medical records and identifies gaps against national Molina
Standards
• Identify gaps against external auditor standards
• Performs simple assessment calculations to determine if errors are a
pattern or one-off typos
• Escalates errors to Mgr, AVP and VP in timely way so corrective actions can
be considered.

Medical Records QA
Specialist - Remote
Knowledge/Skills/Abilities
• Ability to manage quality work and to enforce quality healthcare
throughout the organization.
• Ability to demonstrate mastery of multiple healthcare knowledge areas
including clinical, coding, business operations, and IT analytics. Mastery of
common programing languages (SQL,SAS,etc.) and low level facility with
programming concepts desirable (entry level).
• Ability to maintain confidentiality and comply with HIPPA regulations.

Medical Records QA
Specialist - Remote
Job Qualifications
Required Education:
• High School Diploma or equivalent
Required Experience:
• 1 + years of health plan experience
• 1 + years of medical record review experience
Required Licensure/Certification/Associations:
• Clinical degree highly preferred, including, but not limited to, RN, LVN, CCC, MA, RHIT, EMT,
LCSW
• Preferred Education:
• 1 + years of HEDIS medical records review experience.
• Preferred Licensure/Certification/Associations:
• CPHQ

Benefits
• Flexible Spending Accounts
• Income Protection Benefits
• Retirement Savings Plan
• Educational Reimbursement
• Up to $2,500 per year for course
work that relates to your current, or
likely future position.
• Six-Degrees Employee Referral Program
• Employee Stock Purchase Plan
• Volunteer Time Off
• Above the Branch
• A point based rewards program where
supervisors can reward employees with points that
can later be cashed in for gift certificates and
other merchandise.

Molina Averages 12% higher pay for Healthcare jobs

Salary Ranges from $57,000 - $95,000 for Medical Record QA Specialist

Working Hours
This position is a work from home
position that allow great flexibility,
However it does require:
1. You are available by phone during
normal business working hours
(Monday through Friday 9 to 5)
2. You put in 40 working hours per
week but actual hours worked can
be at any time during the week.

My Dream Job
• Work from home
• Be able to continue running
my pet sitting business
• Be able to work anywhere
from 30 - 40 per week
• Reasonable salary
• Health benefits

Taking Control of your personal
health and helping others
Welcome to the world of PHr’s
Presented by
Ashley Rolison
Cypress College, HIT Program

3 Different ideas on how to Keep your
Personal Health Records
 Simply gather your information and
place it in a file folder
 Transfer the information to a
Password Protected USB drive or
Flash drive that plugs into most
computers
 Subscribe to a Web-based
service that allows you to access
and enter your health
information anytime into their
online tools from your computer

You Will Need the following:
 A heavy 3 – ring binder
 Colored tab dividers
 Loose Leaf Paper
 Business card pages
 CD holders
 Calendar
 Sticky note tabs
 Plastic folder sleeves
Getting Started on a File Folder

Contents for your file folder
• Heavy 3-Ring Binder
• I think a 1.5″ binder is a good size to start.
This size will allow you to easily access
reports and pages and have room for the
calendar. It will look big at first but you
won’t believe how quickly you will fill it up.
• Colored Tab Dividers
• I like these to be erasable. I think 8 is the
minimum number you will need. If you
have a lot of specialists you will need more.
The categories you think you will need at
the outset may change. It’s easy to erase
and reorganize them. Put the categories
you will be accessing the most in the front
so you aren’t always having to flip to the
back. Once the binder is full it will make a
difference.
• Loose Leaf Paper
• Perfect for note-taking at appointments,
jotting down questions you have for each
doctor. You can file them in the appropriate
category so when you arrive at a doctor
your questions are all in one place.
• Business Card Pages
• These are one of my best ideas. At every
doctor’s office, ask for a business card. Keep a
card from every doctor you visit even if you
ultimately decide not to return to them. If you
have had any consultation or blood work there,
you should have a card. That way, you will
always have contact information when filling
out forms at each doctor’s office. For hospitals,
get cards from the radiology department and
medical records department so if you need to
contact them you will have it. Also, you want
contact information for all pathology
departments that have seen slides from any
biopsy you have had. You may need to contact
them to have your slides sent out for a second
opinion.
• This is also a good place to keep your
appointment reminder cards.

• CD Holders
• At CT, MRI or other imaging tests, ask
them to burn a CD for your records.
Hospitals are used to making copies
for patients these days and often
don’t charge for it. Keep one copy for
yourself of each test that you do not
give away. If you need a copy to bring
to a physician, get an extra made,
don’t give yours up. If you need to get
it from medical records from the
hospital, do that. You want to know
you always have a copy of these
images.
• Keep a copy of most recent
bloodworm (especially during
chemo), operative notes from your
surgeries (you usually have to ask for
these), pathology reports, and
radiology reports of interpretations
of any test (MRI, CT, mammogram,
etc.) you may have had. Pathology
reports are vital.
• Calendar
• I suggest a 3-hole calendar to keep in your
binder. This will serve not only to keep all of
your appointments in one place but also
allow you to put reminders of when you need
to have follow-up visits. Sometimes doctor’s
offices do not have their schedules set 3, 6, or
12 months in advance. You can put a
reminder notice to yourself in the
appropriate month to call ahead to
check/schedule the appointment.
• Similarly you can document when you had
certain tests (mammograms, bone density,
blood work) so you will have the date
available. I usually keep a piece of lined paper
in the “scheduling” section of my binder that
lists by month and year every
test/appointment that is due and also every
test I’ve had and when I had it.

• Sticky Note Tabs
• These can be used to easily identify
important papers that you will refer to
often, including diagnosis and pathology.
These stick on the side of the page and can
be removed easily. As your binder fills up,
they can be very helpful to identify your
most recent blood work, for example.
• Plastic Folder Sleeves
• These are clear plastic sleeves that you
access from the top. They can be useful for
storing prescriptions or small notes that
your doctor may give you. The sleeves make
them easy to see/find and you won’t lose
the small slips of paper. Also a good place to
store any lab orders that might be given to
you ahead of time.
• The above suggestions are a good working
start to being organized during your cancer
treatment. If you want to do something for a
friend who is newly diagnosed, go out and
buy the supplies, organize the binder and
give it to your friend. He or she will most
likely appreciate being given a ready-made
tool to use in the difficult days ahead.
• I also believe a modified version is
equally useful for diagnoses other
than cancer. When our youngest son
was born with defects in his spine
and hands it took many specialists
and lots of tests to get a correct
diagnosis. Having all of his tests and
papers in a binder like this was
instrumental in keeping his care
coordinated. In fact, at his first
surgery at The Children’s Hospital of
Pennsylvania they gave us a binder to
assist in this process. I know some
hospitals do this for newly diagnosed
patients already. Maybe my tips will
help you or a friend know how to
better use the one you already have.
You may not need all of these
elements depending on the
complexity of your case, but I hope
you will find some of these
suggestions useful.

Medical Records on
USB Flash Drives
Kaiser Permanente, a nonprofit health care system,
is now offering about 3.3 million of its 8.6 million
members a USB flash drive that contains their
personal medical information.
The read-only drive, designed for use while a
person is traveling or during a health emergency, is
a sort of stopgap effort as the U.S. works to build a
national electronic health records system that can
provide easy access to patient health information
anywhere.
The flash drive, which costs members $5, does not
contain a patient's entire health record, but it does
hold emergency contacts, past hospitalizations
(with the diagnoses and procedures performed),
physicians and contact information, medical issues,
immunization records, allergies, current
medications, lab results for the past year, and
readings and images from recent EKGs and chest X-
rays.
Creating your own drive is another option. The key here would be to get as many
of your records form your providers as possible in a digital format. If this is not
possible you can also purchase a scanner the would be able to digitize all of your
paper based records and put them in a digital format. The only draw back to this
approach is that could be a bit cumbersome and time consuming. Keeping all the
files updated would also be imperative. It would be important to know and
understand how the encrypting work so that you can share the information on the
drive with those who you wish. One great advantage would be the portability of
the device.

Summary of MS Health Vault
The Good
• Offers a cloud based place to
keep everything
• Easy to update
• Easy to give others access
• Offers Interoperability with
other devices, applications and
providers
The Bad
• Not good for anybody that is not
technically inclined.
• Can seem a bit overwhelming at
first because of its complexity
• Must have access to the Internet

Advanced Health Care Directive
• An advance health care directive, also known as living will, personal directive, advance
directive, or advance decision, is a set of written instructions that a person gives that
specify what actions should be taken for their health, if they are no longer able to make
decisions due to illness or incapacity.
• A living will is one form of advance directive, leaving instructions for treatment. Another
form is a specific type of power of attorney or health care proxy, in which the person
authorizes someone (an agent) to make decisions on their behalf when they are
incapacitated. People are often encouraged to complete both documents to provide
comprehensive guidance regarding their care. Examples of combination documents
include the Five Wishes and MyDirectives advance directives in the United States.
• You can download the form provided by the State of California Department of Justice
Office of the Attorney General at this link:
http://ag.ca.gov/consumers/pdf/AHCDS1.pdf

Directed Practice II
Saddleback Memorial
Assigned Site
Written
By
Ashley Rolison
HI 240

Saddleback Memorial Medical Center
HEALTH INFORMATION DEPARTMENT
Saddleback Memorial is located in Laguna Hills California. The hospital consists of 252 beds this
count includes newborns. The Health Information Manager at this facility is Janie Stacey. There are a
total of 23 FTE’s within the medical records department.
They currently offer services including:
 Blood Donation Center
 Diabetic Clinic
 Emergency Department
 Hospice
 Pulmonary Rehabilitation
 Neonatal Intensive Care Unit
 Orthopedic Service
 Surgical Center
 Wellness Center
The medical record numbers are assigned randomly through their database system called EPIC.
The hospital has hired an outside agency to monitor the accuracy of the numbers. Any findings are sent
to medical records. At this point any duplication of medical record numbers will be analyzed by one of
three scanners, each assigned to different departments of the hospital, ER, Inpatient or Outpatient. Due
to the fact that medical record numbers are unit based rather than serial unit, the patient will have only
one medical record number throughout his/her hospitalization at any given time. Duplications often
occur with Jane Does or if the patient came in by ambulance.
A majority of companies whether medical, legal, education institutions, government facilities,
etc., paper based files are rapidly becoming obsolete. The use of electronic based records has replaced
the paper-based records. Each unit of the hospital will bring down a full days’ worth of medical records
that need to be scanned into the patients file. Prior to scanning each record needs to go through an
assembly process.
The assembly process begins with a stack of records dedicated to a specific department and day.
In the medical records department at Saddleback Memorial there are three separate individuals that
scan inpatient, outpatient and ER. The radiologists scan their own records. As soon as every record is
accounted for that day, assembly process can begin. On average there will be 100 to 150 records on any
given day per department. Due to these individual records going to scanning it is important to follow the
order in which the record should be assembled. Each record is being arranged in the correct order,
staples are removed, torn edges get taped, and signature pages placed in the correct order, pictures and
advanced directives are tabbed for easy recognition. Once the records are scanned, the scanner looks
over every page to assure legibility, patient names consistent and date of birth before indexing. The
paper records are only kept in the office for three months after the scanning process. As soon as the
scanner double-checks every page of every record they can index them into EPIC.

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