Original PaperWho Uses Mobile Phone Health Apps and Does U.docx

Original Paper
Who Uses Mobile Phone Health Apps and Does Use Matter? A
Secondary Data Analytics Approach
Jennifer K Carroll1, MPH, MD; Anne Moorhead2, MSc, MA,
MICR, CSci, FNutr (Public Health), PhD; Raymond
Bond3, PhD; William G LeBlanc1, PhD; Robert J Petrella4,
MD, PhD, FCFP, FACSM; Kevin Fiscella5, MPH, MD
1Department of Family Medicine, University of Colorado,
Aurora, CO, United States
2School of Communication, Ulster University, Newtownabbey,
United Kingdom
3School of Computing & Maths, University of Ulster,
Newtownabbey, United Kingdom
4Lawson Health Research Institute, Family Medicine,
Kinesiology and Cardiology, Western University, London, ON,
Canada
5Family Medicine, Public Health Sciences and Community
Health, University of Rochester Medical Center, Rochester, NY,
United States
Corresponding Author:
Jennifer K Carroll, MPH, MD
Department of Family Medicine
University of Colorado
Mail Stop F496
12631 E. 17th Ave
Aurora, CO, 80045
United States
Phone: 1 303 724 9232

Fax: 1 303 724 9747
Email: [email protected]
Abstract
Background: Mobile phone use and the adoption of healthy
lifestyle software apps (“health apps”) are rapidly proliferating.
There is limited information on the users of health apps in terms
of their social demographic and health characteristics,
intentions
to change, and actual health behaviors.
Objective: The objectives of our study were to (1) to describe
the sociodemographic characteristics associated with health app
use in a recent US nationally representative sample; (2) to
assess the attitudinal and behavioral predictors of the use of
health
apps for health promotion; and (3) to examine the association
between the use of health-related apps and meeting the
recommended
guidelines for fruit and vegetable intake and physical activity.
Methods: Data on users of mobile devices and health apps were
analyzed from the National Cancer Institute’s 2015 Health
Information National Trends Survey (HINTS), which was
designed to provide nationally representative estimates for
health
information in the United States and is publicly available on the
Internet. We used multivariable logistic regression models to
assess sociodemographic predictors of mobile device and health
app use and examine the associations between app use,
intentions
to change behavior, and actual behavioral change for fruit and
vegetable consumption, physical activity, and weight loss.
Results: From the 3677 total HINTS respondents, older
individuals (45-64 years, odds ratio, OR 0.56, 95% CI 0.47-68;

65+
years, OR 0.19, 95% CI 0.14-0.24), males (OR 0.80, 95% CI
0.66-0.94), and having degree (OR 2.83, 95% CI 2.18-3.70) or
less
than high school education (OR 0.43, 95% CI 0.24-0.72) were
all significantly associated with a reduced likelihood of having
adopted health apps. Similarly, both age and education were
significant variables for predicting whether a person had
adopted a
mobile device, especially if that person was a college graduate
(OR 3.30). Individuals with apps were significantly more likely
to report intentions to improve fruit (63.8% with apps vs 58.5%
without apps, P=.01) and vegetable (74.9% vs 64.3%, P<.01)
consumption, physical activity (83.0% vs 65.4%, P<.01), and
weight loss (83.4% vs 71.8%, P<.01). Individuals with apps
were
also more likely to meet recommendations for physical activity
compared with those without a device or health apps (56.2%
with
apps vs 47.8% without apps, P<.01).
Conclusions: The main users of health apps were individuals
who were younger, had more education, reported excellent
health,
and had a higher income. Although differences persist for
gender, age, and educational attainment, many individual
sociodemographic factors are becoming less potent in
influencing engagement with mobile devices and health app use.
App use
was associated with intentions to change diet and physical
activity and meeting physical activity recommendations.
J Med Internet Res 2017 | vol. 19 | iss. 4 | e125 | p.
1http://www.jmir.org/2017/4/e125/
(page number not for citation purposes)

Carroll et alJOURNAL OF MEDICAL INTERNET RESEARCH
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(J Med Internet Res 2017;19(4):e125) doi: 10.2196/jmir.5604
KEYWORDS
smartphone; cell phone; Internet; mobile applications; health
promotion; health behavior
Introduction
As of 2015, nearly two-thirds (64%) of the American public
owned a mobile phone, which is an increase from 35% in 2011
[1]. It is estimated that 90% of the worldwide population will
own a mobile phone by 2020 [1]. Current UK data reveals that
mobile phone usage is increasing as 66% adults aged more than
18 years owned a mobile phone in 2015, up from 61% in 2014
[2]. Mobile phone ownership is higher among younger people,
with 77% ownership for those aged 16-24 years [3]. Although
mobile phone ownership is especially high among younger
persons and those with higher educational attainment and
income [4], those with lower income and educational attainment
are now likely to be “mobile phone dependent,” meaning that
they do not have broadband access at home and have few other
options for Web-based access other than via mobile phone.
As mobile phone ownership rapidly proliferates, so does the
number of mobile phone software apps grown in the

marketplace
[5]. Apps focused on health promotion are quite common: more
than 100,000 health apps are available in the iTunes and Google
Play stores [6]. This staggering number speaks to both the huge
market and ongoing demand for new tools to help the public
manage their diet, fitness, and weight-related goals, and the
limitations of the current health care system to provide such
resources. A recent study found that 53% of cell phone users
owned a smartphone—this translates to 45% of all American
adults—and that half of those (or about 1 in 4 Americans) have
used their phone to look up health information [7]. There is
increasing usage of health apps among health care
professionals,
patients and general public [8], and apps can play a role in
patient education, disease self-management, remote monitoring
of patients, and collection of dietary data [9-12]. Using mobile
phones and apps, social media also can be easily accessed, and
increasing numbers of individuals are using social media for
health information with reported benefits and limitations [8].
Despite the massive uptake in mobile phone ownership and
health app usage and their potential for improving health,
important limitations of health apps are the lack of evidence of
clinical effectiveness, lack of integration with the health care
delivery system, the need for formal evaluation and review, and
potential threats to safety and privacy [6,13-17]. Although
previous studies have described the sociodemographic factors
associated with mobile health and app use [7,18,19], it is a
rapidly changing field with the most recent published reports
reflecting data at least four to five years old. Additionally, there
is a lack of information on the users of health apps in terms of
their sociodemographic and health characteristics and health
behaviors. Furthermore, to our knowledge, there have been no
previous publications reporting on the association between the
use of health apps, behavioral or attitudinal factors (ie,
readiness

or intentions to change), and health outcomes. This information
is important for future health-improving initiatives and for
identifying appropriate use of health apps among population
groups.
Therefore, the aim for our study was 3-fold: (1) to describe the
sociodemographic characteristics associated with health app
use in a recent US nationally representative sample; (2) to
assess
the attitudinal and behavioral predictors of the use of health
apps for health promotion; and (3) to examine the association
between the use of health-related apps and meeting the
recommended guidelines for fruit and vegetable intake and
physical activity. Given the increasing focus on new models
for integrating technology into health care and the need to
expand the evidence base on the role of health apps for health
and wellness promotion, these research questions are timely
and relevant to inform the development of health app
interventions.
Methods
Data Source
The National Cancer Institute’s Health Information National
Trends Survey (HINTS) is a national probability sample of US
adults that assesses usage and trends in health information
access
and understanding. HINTS was first administered in 2002-2003
as a cross-sectional survey of US civilians and
noninstitutionalized adults. It has since been iteratively
administered in 2003, 2005, 2008, 2011, 2012, 2013, and 2014.
We used data from HINTS 4 Cycle 4 data released in June 2015,
which corresponded to surveys administered in
August-November, 2014. Publicly available datasets and
information about methodology are available at the HINTS

website [20]. The 2014 iteration reported herein contained
questions about whether participants used mobile phone or
tablet
technology and software apps for health-related reasons. The
overall response rate was 34.44%. This study was reviewed and
qualified for an Exemption by the American Academy of Family
Physicians Institutional Review Board.
Participants
A total of 3677 individuals completed the 2014 HINTS survey.
From this sample, 148 respondents were considered partial
completers, in that they completed 50%-79% of the questions
in Sections A and B. We included all 3677 respondents in our
analysis. We used sampling weights from the HINTS dataset
that were incorporated into the regression analyses.
Measures
Demographics
We used participants’ self-report of their age, sex, race,
ethnicity, income, level of education, English proficiency,
height, and weight. We converted height and weight into body
mass index (BMI), using weight (kg)/height (m2)×10,000, and
classified participants as obese (≥30), overweight (29.9-26), or
normal weight or underweight (<26).
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http://dx.doi.org/10.2196/jmir.5604
Usage of Mobile Devices and Health Apps
We used participants’ responses to the 3 questions to
characterize the distribution of subjects who used health-related
software apps on their mobile devices. The participants were
asked whether they had a tablet computer, smartphone, basic
cell phone only, or none of the above. We examined factors for
those with and without mobile devices, since previous studies
have shown differences in seeking health information on the
Internet related to access (eg, availability of a computer)
[21,22],
HINTS dataset is a nationally representative sample, and we
wished to put our findings on app use in the larger population
context. We categorized participants who had a mobile phone
or a tablet device under the label “Device+.” Similarly,
participants who did not report having a mobile phone or a
tablet
device were labeled “Device-.” Of the Device+ group, we also
categorized them according to whether they had health apps on
their device (Device+/App+) or did not have health apps on
their device (Device+/App-).
Fruit and Vegetable Intake
We assessed fruit and vegetable intake using the 2 questions:
amount of fruit consumed per day and amount of vegetables
consumed per day (7 response options for each ranging from
none to >4 cups per day). We reclassified the response options
for both questions into a single dichotomous outcome variable,
that is, the subject either (1) meets recommendations for fruit
or vegetables (4 or more cups for each) or (2) does not meet
recommendations for fruit or vegetables (all other response
options). Fruit and vegetable scores were analyzed separately.

Physical Activity
We assessed physical activity using the 2 questions: (1) in a
typical week how many days do you do any physical activity
or exercise of at least moderate intensity, such as brisk walking,
bicycling at a regular pace, and swimming at a regular pace? (8
response options ranging from none to 7 days per week) and
(2) on the days that you do any physical activity or exercise of
at least moderate intensity how long do you do these activities?
(2 response options for minutes and hours). We reclassified the
response options into a single dichotomous outcome variable
for physical activity, that is, whether the subject (1) met
physical
activity recommendations (≥150 minutes per week) or did not
meet the physical activity recommendations (<150 minutes per
week).
Intentions to Change Behavior
We examined participants’ intentions to change behavior based
on the 5 questions (all with yes or no responses): At any time
in the last year, have you intentionally tried to (1) increase the
amount of fruit or 100% fruit juice you eat or drink, (2) increase
the amount of vegetables or 100% vegetable juice you eat or
drink, (3) decrease the amount of regular soda or pop you
usually drink in a week, (4) lose weight, and (5) increase the
amount of exercise you get in a typical week?
Statistical Analysis
The outcome variable (OUTCOME) was a composite derived
from 3 survey variables: (1) own a smartphone (an
Internet-enabled mobile phone “such as iPhone android
BlackBerry or Windows phone” differentiated from a “basic
cell phone,” hereafter referred to as “mobile phone”) or device,
(2) have health apps on mobile phone or device, and (3) use of
health apps. Own a mobile phone or device was a

system-supplied derived variable to categorize responses given
to question B4 (possession of a mobile phone or tablet device).
Have health apps on mobile phone or device (question B5)
asked about health apps on a tablet or mobile phone. Use of
health apps (question B6a) asked whether the apps on a mobile
phone or tablet helped in achieving a health-related goal.
OUTCOME consisted of 3 levels: Device-/App- (33.2% of
respondents), Device+/App- (44% of respondents), and
Device+/App+ (22.77% of respondents). Device referred to
having a tablet or mobile phone, and App referred to having a
health-related app that ran on a tablet or mobile phone. A total
of 93 of 3677 respondents were unable to be classified due to
missing data. These people were not used in the analyses. To
assess the relationship between OUTCOME and the
demographic or health behavior variables, simple unweighted
2-way crosstab tables were generated and tested with a
chi-square test of association. We used a cutoff of P<.05 to
determine statistical significance for all analyses.
We used the R programming language (R-Studio) and SPSS
(SPSS Inc) for all data modeling and analysis carried out in this
study.
Results
Principal Findings
From the 3677 total HINTS respondents, 3584 answered
questions about whether or not they had a tablet computer or
mobile phone, or used apps. Figure 1 shows the participants in
this study.

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Figure 1. Health Information National Trends Survey (HINTS)
respondents’ use of mobile phones, tablets, and apps.
Demographic Variables Associated With App Use
Table 1 compares respondents grouped into Device+/App+,
Device+/App-, and Device-, according to sociodemographic
characteristics. As shown in Table 1, those who used health
apps (compared with those who either did not have apps or did
not have the necessary equipment) were more likely to be
younger, live in metropolitan areas, have more education, have
higher income, speak English well, be Asian, and report
excellent health. There was no significant association between
both BMI and smoking status and app use.
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Table 1. Demographic variables associated with app usage.
P valueDevice-
n (%)
Device+/App-
n (%)
Device+/App+
nb,c (%)d
Demographic variables
.391156 (55.29)1555 (50.23)808 (51.62)Sex (female vs male;
na,c=3519)
<.0011111 (21.92)1552 (52.25)782 (65.62)Age (18-44 years vs
45+ years; n=3415)
<.011121 (51.82)1535 (27.95)788 (12.72)Education (high
school or less vs some college or college graduate, n=3444)
<.0011162 (75.12)1560 (42.20)808 (31.72)Income (US $0-
49,999 vs 50,000 or greater; n=3530)
<.011057 (83.68)1453 (78.52)763 (71.85)Race or ethnicity
(white vs other; n=3273)
.491114 (33.82)1524 (36.98)782 (33.71)BMI (normal vs
overweight, obese; n=3420)
<.0011191 (78.93)1577 (85.67)816 (92.10)Metro vs nonmetro
(n=3584)

<.0011089 (90.37)1497 (97.13)759 (99.37)Speak English (very
well or well vs not well or not at all; n=3584)
<.0011138 (74.99)1544 (89.74)795 (92.85)Self-rated health
(excellent, very good, good vs fair or poor; n=3477)
aThe sample sizes (n’s) listed for each variable in the far left
column represent the total number of respondents across all
app-usage categories
(Device+/App+, Device +/App-, Device-) who answered that
question.
bThe sample sizes (n’s) listed for each variable within each cell
represent the total number of respondents within a given app-
usage category (either
Device+/App+, Device +/App-, or Device-) who answered that
question.
cSample sizes vary for each variable due to missing values.
dPopulation estimates were used for the numerators and
denominators in the calculation of percentages. Row
percentages do not add to 100%, as the
table shows percentages within a given app-usage category
(Device+/App+, Device +/App-, or Device-).
Association Between the Use of Apps and Intentions
to Change Diet, Perform Physical Activity, and Lose
Weight
Table 2 shows the association between the use of apps (versus
Device+/App- or Device-) with intentions to change diet,
perform physical activity, or lose weight. As Table 2 shows,
participants with apps were significantly more likely to report
intentions to improve fruit (P=.01) and vegetable consumption
(P<.01), physical activity (P<.01), and weight loss (P<.01)
compared with those in the Device+/App- or Device- groups.

Table 2. Association between the usage of apps for health-
related goal and intentions to change diet, physical activity, or
lose weight.
P valueaDevice-
n (%)
Device+/App-
n (%)
Device+/App+
n (%)
Health-related intention
.01654 (48.94)885 (58.50)545 (63.76)Increase fruit
<.01717 (50.02)1023 (64.26)621 (74.92)Increase vegetables
.06754 (77.36)1135 (82.76)630 (84.96)Decrease soda
<.01769 (49.94)1237 (65.42)707 (82.99)Increase physical
activity
<.01881 (60.02)1259 (71.75)692 (83.36)Lose weight
aSignificance between participants with apps (Device+/App+)
compared with those not using apps or devices (Device+/App-
or Device- groups).
Association Between the Use of Apps and Meeting
Recommendations for Fruit and Vegetable Intake and
Physical Activity

Table 3 shows the association between the use of apps (versus
Device+/App- or Device-) and meeting the recommendations
for fruit and vegetable intake and physical activity. Participants
in the Device+/App+ group were not significantly more likely
to meet recommendations for fruit and vegetables compared
with those in the Device+/App- or Device- groups; however,
they were significantly more likely to exercise more than 2
hours per week.
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Table 3. Association between the use of apps for health-related
goal and meeting recommendations for fruit and vegetables and
physical activity.
P valueaDevice-
n (%)
Device+/App-
n (%)
Device+/App+

n (%)
Percent respondents meeting recommendations
.251161 (5.43)1560 (7.96)804 (8.87)Fruit
.271155 (3.48)1557 (3.01)809 (4.81)Vegetables
<.011144 (37.69)1552 (47.79)801 (56.23)Physical activity
aSignificance between participants with apps (Device+/App+)
compared with those not using apps or devices (Device+/App-
or Device- groups).
Predicting Health App Adoption Only (Binary
Classification)
Table 4 presents the statistically significant odds ratios (ORs)
as derived using multivariate logistic regression when applied
to the entire dataset. As expected, those aged 45-64 years (OR
0.56) or 65+ years (OR 0.19) had a reduced likelihood of having
adopted health apps relative to younger persons. It also showed
that males were slightly less likely (OR 0.80) to have a health
app compared with females. The most significant finding was
the confirmation that graduates had significantly higher odds
(OR 2.83) of having a health app especially when compared
with those who had attained an education that was considered
“less than high school” (OR 0.43). The results also indicated
that the category “completed high school only” had no
predictive
ability for estimating whether a person had adopted a health
app.
Table 4. Statistically significant odds ratios derived using
multivariate logistic regression when applied to the entire

dataset for predicting health app
adoption only.
P valueOdds ratio
(95% CI)
Variable
<.0010.56
(0.47-0.68)
Age (45-64 years)
<.0010.19
(0.14-0.24)
Age (65+ years)
<.010.80
(0.66-0.94)
Sex (male)
<.0012.83
(2.18-3.70)
Education (college graduate or higher)
<.010.43
(0.24-0.72)

Education (less than high school)
<.011.70
(1.30-2.26)
Education (some college)
.051.25
(0.99-1.55)
Race (black)
Predicting Mobile Technology Adoption Only (Binary
Classification)
Table 5 presents the statistically significant ORs that increased
or decreased the likelihood that a person had adopted mobile
technology (tablet or mobile phone). Interestingly, there were
no statistically significant ORs for gender or racial categories.
However, similar to predicting health app adoption, both age
and education were significant variables for predicting whether
a person had adopted a mobile device, especially if that person
was a college graduate (OR 3.30). In addition, the results
indicated that the category “completed high school only” had
no predictive ability for estimating whether a person had
adopted
a mobile device.

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Table 5. Statistically significant odds ratios derived using
multivariate logistic regression when applied to the entire
dataset for predicting mobile device
adoption only.
P valueOdds ratio (95% CI)Variable
<.0010.35 (0.28-0.45)Age (45-64 years)
<.0010.09 (0.07-0.12)Age (65+ years)
<.0013.30 (2.65-4.11)Education (college graduate or higher)
<.0010.51 (0.37-0.70)Education (less than high school)
<.0011.87 (1.50-2.32)Education (some college)
Discussion
Principal Findings
Our first objective was to describe the sociodemographic and
health behavior characteristics associated with health app use
in a recent US nationally representative sample. Consistent with
previous findings [7], we found that those who were younger,
had more education, reported excellent health, and had a higher
income were more likely to use health apps. Our predictive
modeling using multivariate logistic regression showed that
education, sex, gender, and race were only mildly to moderately

potent in predicting mobile technology adoption.
Our second objective was to assess the behavioral and
attitudinal
predictors of the use of health apps for health promotion. We
found that participants with apps were also more likely to report
intentions to improve fruit and vegetable consumption, physical
activity, and weight loss. Finally, the third objective was to
examine the association between the use of health-related apps
and meeting the recommended guidelines for fruit and vegetable
intake and physical activity. We found that participants in the
health apps group were significantly more likely to meet
recommendations for physical activity compared with those
without a device or health apps.
Comparison With Prior Work
This study shares some similarities with previous HINTS
analyses. For example, McCully et al [19] reported that users
of the Internet for diet, weight, and physical activity tended to
be younger and more educated and that Internet use for these
purposes was more likely to be associated with higher fruit and
vegetable intake and moderate exercise. However in that study,
women were no more likely than men to use the Internet for
diet, weight, and physical activity, which was different from
our findings. In that study, minorities were more likely to use
the Internet; in our study, we found no such association.
Consistent with our findings, Kontos et al found that males,
those with lower education, and older US adults were less likely
to engage in a number of eHealth activities [18]. Similar to their
findings 3 years ago, our findings pointed to differences by
education for app use for health promotion.
The association between app use, intention to change lifestyle
behaviors, and actually meeting recommendations for healthy
lifestyle factors is interesting and could be due to several
reasons. First, it is possible that there are preexisting

differences
in individuals who engage with health apps compared with those
who do not. Users of health apps may have greater motivation
and interest in changing their diet, weight, or physical activity.
A recent review found that very few available apps provided
evidence-based support to meet lifestyle recommendations [13].
It could also be that app users are engaging with health apps to
help them simply track or self-manage differently than their
counterparts; thus, there could be differences in preferences or
needs. Due to the correlational nature of the data, we cannot
draw conclusions about the relationships or causal pathways.
Similar observations have been reported in a study of users of
the Internet for diet, weight, and physical activity promotion
[19].
The prevalence of app usage in our study was 22% (816/3677).
This is a doubling from the Kontos study in which 11.7%
downloaded info onto a mobile device. Although the questions
in these 2 HINTS datasets were worded differently (eg,
“downloaded” is broader and not referring exclusively to
downloading an app), it suggests that demand for apps continues
to rise and offers potential for reaching a growing segment of
the US population.
Our findings provide evidence for educational, age, and gender
differences in the use of mobile devices and health apps.
Educational attainment, age, and gender have been previously
shown to be important predictors of adoption of mobile devices
and apps [18]. Educational attainment appears more important
than other variables commonly used as proxies for
socioeconomic position (eg, income, race or ethnicity). The
reasons for the educational differences are unclear, but may
reflect skills and confidence with the use of devices and
possibly
social norms related to perceived value. Similarly, age likely

reflects both social norms and cohort effects, that is, exposure
during younger ages to these devices and apps. The reasons for
gender differences are less clear, but may reflect differences in
health-seeking behavior, and interest and participation in
healthy
lifestyle interventions generally.
Limitations
This study had limitations that should be kept in mind when
interpreting results. First, HINTS is a cross-sectional survey;
although it is a nationally representative cohort of individuals,
we were not able to evaluate the trends in an individual’s health
app use over time. There is the possibility of unmeasured
confounding, that is, unidentified factors that might be
associated with app use and intentions or health behaviors,
which could influence the interpretation of results. Although
the results showed association, it did not indicate a causal
relationship. This study could not answer the question of
whether more motivated individuals sought out apps, or whether
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app use improved motivation and health outcomes. Furthermore,
some of the cells for subgroups were small, thereby limiting
the generalizability of some of the subanalyses. As with all

cross-sectional surveys, this was a study of association, not
causation. Finally, we were limited by the questions that were
asked in the HINTS survey. For example, we did not have
details
about specific health apps or features of apps used, the intensity
of use, whether the apps were interactive and linked to other
health promotion supports (eg, telehealth), and other strategies
used for health behavior change. Despite these limitations, the
results did identify areas for future research and add to the
knowledge base about predictors of the use of health apps.
Conclusions
Compared with previous studies, many individual
sociodemographic factors are becoming less important in
influencing engagement with mobile devices and health app
use; however, differences persist for gender, age, and
educational attainment. As health care undergoes technological
transformation with its electronic health records systems and
individuals’ access to their records, there are many
opportunities
for clinical care models to be expanded and improved, perhaps
through the use of apps as a means for sharing data, although
this remains an unanswered question. This study contributes to
the literature by providing up-to-date information on
populations
most and least likely to use health apps to guide clinical
interventions, commercial developers, and public health
programs when designing eHealth technology.
Conflicts of Interest
None declared.
References
1. Ericsson. 2015. Ericsson Mobility Report: On the pulse of the
networked society URL:http://www.ericsson.com/res/docs/

2015/ericsson-mobility-report-june-2015.pdf [accessed 2016-
01-22] [WebCite Cache ID 6ejSFiicz]
2. OfCom. 2015. Smartphone usage
URL:http://media.ofcom.org.uk/facts/ [accessed 2016-01-22]
[WebCite Cache ID
6ejSSqrN7]
3. OfCom. Belfast: OfCom; 2014. Telecommunications facts
and figures URL:https://www.ofcom.org.uk/ [accessed 2017-02-
27]
[WebCite Cache ID 6ob5yNLrU]
4. Smith A. Pew Research Center. 2015. The Smartphone
Difference URL:http://www.pewinternet.org/2015/04/01/
us-smartphone-use-in-2015/ [accessed 2017-02-28] [WebCite
Cache ID 6ejS9bn6M]
5. Boudreaux ED, Waring ME, Hayes RB, Sadasivam RS,
Mullen S, Pagoto S. Evaluating and selecting mobile health
apps:
strategies for healthcare providers and healthcare organizations.
Transl Behav Med 2014 Dec;4(4):363-371 [FREE Full
text] [doi: 10.1007/s13142-014-0293-9] [Medline: 25584085]
6. Research2guidance. Research2guidance
URL:http://research2guidance.com [accessed 2016-01-22]
[WebCite Cache ID
6ejS4CO9X]
7. Fox S, Duggan M. Pew Research Center. Mobile Health 2012:
Half of smartphone owners use their devices to get health
informationone-fifth of smartphone owners have health apps
URL:http://www.pewinternet.org/2012/11/08/
mobile-health-2012/ [accessed 2017-02-27] [WebCite Cache ID
6ob6C9mfG]

8. Moorhead SA, Hazlett DE, Harrison L, Carroll JK, Irwin A,
Hoving C. A new dimension of health care: systematic review
of the uses, benefits, and limitations of social media for health
communication. J Med Internet Res 2013;15(4):e85 [FREE
Full text] [doi: 10.2196/jmir.1933] [Medline: 23615206]
9. Zhu F, Bosch M, Woo I, Kim S, Boushey CJ, Ebert DS, et al.
The use of mobile devices in aiding dietary assessment and
evaluation. IEEE J Sel Top Signal Process 2010 Aug;4(4):756-
766 [FREE Full text] [doi: 10.1109/JSTSP.2010.2051471]
[Medline: 20862266]
10. Mosa AS, Yoo I, Sheets L. A systematic review of
healthcare applications for smartphones. BMC Med Inform
Decis Mak
2012;12:67 [FREE Full text] [doi: 10.1186/1472-6947-12-67]
[Medline: 22781312]
11. O'Malley G, Dowdall G, Burls A, Perry IJ, Curran N.
Exploring the usability of a mobile app for adolescent obesity
management. JMIR Mhealth Uhealth 2014;2(2):e29 [FREE Full
text] [doi: 10.2196/mhealth.3262] [Medline: 25098237]
12. O'Malley G, Clarke M, Burls A, Murphy S, Murphy N, Perry
IJ. A smartphone intervention for adolescent obesity: study
protocol for a randomised controlled non-inferiority trial. Trials
2014;15:43 [FREE Full text] [doi: 10.1186/1745-6215-15-43]
[Medline: 24485327]
13. Knight E, Stuckey MI, Prapavessis H, Petrella RJ. Public
health guidelines for physical activity: is there an app for that?
A review of android and apple app stores. JMIR Mhealth
Uhealth 2015;3(2):e43 [FREE Full text] [doi:
10.2196/mhealth.4003]
[Medline: 25998158]

14. Pagoto S, Schneider K, Jojic M, DeBiasse M, Mann D.
Evidence-based strategies in weight-loss mobile apps. Am J
Prev
Med 2013 Nov;45(5):576-582. [doi:
10.1016/j.amepre.2013.04.025] [Medline: 24139770]
15. Breton ER, Fuemmeler BF, Abroms LC. Weight loss-there is
an app for that! But does it adhere to evidence-informed
practices? Transl Behav Med 2011 Dec;1(4):523-529 [FREE
Full text] [doi: 10.1007/s13142-011-0076-5] [Medline:
24073074]
XSL•FO
RenderX
http://www.ericsson.com/res/docs/2015/ericsson-mobility-
report-june-2015.pdf
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report-june-2015.pdf
http://www.webcitation.org/
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b=PubMed&list_uids=25584085&dopt=Abstract
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6ob6C9mfG
http://www.jmir.org/2013/4/e85/
http://dx.doi.org/10.1109/JSTSP.2010.2051471
http://www.biomedcentral.com/1472-6947/12/67
http://dx.doi.org/10.1186/1472-6947-12-67
http://mhealth.jmir.org/2014/2/e29/
http://dx.doi.org/10.2196/mhealth.3262

http://www.trialsjournal.com/content/15//43
http://dx.doi.org/10.1186/1745-6215-15-43
http://mhealth.jmir.org/2015/2/e43/
http://dx.doi.org/10.2196/mhealth.4003
http://dx.doi.org/10.1016/j.amepre.2013.04.025
http://dx.doi.org/10.1007/s13142-011-0076-5
16. Abroms LC, Padmanabhan N, Thaweethai L, Phillips T.
iPhone apps for smoking cessation: a content analysis. Am J
Prev
Med 2011 Mar;40(3):279-285 [FREE Full text] [doi:
10.1016/j.amepre.2010.10.032] [Medline: 21335258]
17. Eng DS, Lee JM. The promise and peril of mobile health
applications for diabetes and endocrinology. Pediatr Diabetes
2013 Jun;14(4):231-238 [FREE Full text] [doi:
10.1111/pedi.12034] [Medline: 23627878]
18. Kontos E, Blake KD, Chou WS, Prestin A. Predictors of
eHealth usage: insights on the digital divide from the Health
Information National Trends Survey 2012. J Med Internet Res
2014;16(7):e172 [FREE Full text] [doi: 10.2196/jmir.3117]
[Medline: 25048379]

19. McCully SN, Don BP, Updegraff JA. Using the Internet to
help with diet, weight, and physical activity: results from the
Health Information National Trends Survey (HINTS). J Med
Internet Res 2013;15(8):e148 [FREE Full text] [doi:
10.2196/jmir.2612] [Medline: 23906945]
20. HINTS. 2015. Health Information National Trends Survey
URL:http://hints.cancer.gov/ [accessed 2016-01-22] [WebCite
Cache ID 6ejRyxj9Y]
21. Finney RL, Hesse BW, Moser RP, Ortiz MA, Kornfeld J,
Vanderpool RC, et al. Socioeconomic and geographic disparities
in health information seeking and Internet use in Puerto Rico. J
Med Internet Res 2012 Jul;14(4):e104 [FREE Full text]
[doi: 10.2196/jmir.2007] [Medline: 22849971]
22. Kontos EZ, Bennett GG, Viswanath K. Barriers and
facilitators to home computer and internet use among urban
novice
computer users of low socioeconomic position. J Med Internet
Res 2007;9(4):e31 [FREE Full text] [doi: 10.2196/jmir.9.4.e31]
[Medline: 17951215]
Abbreviations
HINTS: Health Information National Trends Survey
Edited by G Eysenbach; submitted 04.02.16; peer-reviewed by J
Updegraff, A Burls, B Fuemmeler; comments to author
06.04.16;
revised version received 18.05.16; accepted 21.06.16; published
19.04.17
Please cite as:
Carroll JK, Moorhead A, Bond R, LeBlanc WG, Petrella RJ,
Fiscella K

Who Uses Mobile Phone Health Apps and Does Use Matter? A
Secondary Data Analytics Approach
J Med Internet Res 2017;19(4):e125
URL: http://www.jmir.org/2017/4/e125/
doi: 10.2196/jmir.5604
PMID: 28428170
©Jennifer K Carroll, Anne Moorhead, Raymond Bond, William
G LeBlanc, Robert J Petrella, Kevin Fiscella. Originally
published
in the Journal of Medical Internet Research
(http://www.jmir.org), 19.04.2017. This is an open-access
article distributed under
the terms of the Creative Commons Attribution License
(http://creativecommons.org/licenses/by/2.0/), which permits
unrestricted
use, distribution, and reproduction in any medium, provided the
original work, first published in the Journal of Medical Internet
Research, is properly cited. The complete bibliographic
information, a link to the original publication on
http://www.jmir.org/,
as well as this copyright and license information must be
included.
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http://hints.cancer.gov/
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6ejRyxj9Y
http://dx.doi.org/10.2196/jmir.9.4.e31

TODAY’S
HEALTH
INFORMATION
MANAGEMENT
AN INTEGRATED APPROACH, SECOND EDITION
by Dana C. McWay,
JD, RHIA
Australia Brazil Japan Korea Mexico Singapore Spain
United Kingdom United States
92471_fm_ptg01.indd 1 2/1/13 9:12 AM
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Today’s Health Information Management:
An Integrated Approach, Second Edition
Dana C. McWay
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Printed in the United States of America
1 2 3 4 5 6 7 17 16 15 14 13

BRIEF CONTENTS
iii
P A R T 1 INTRODUCTION TO HEALTH INFORMATION
MANAGEMENT
1 Health Care Delivery Systems 3
2 The Health Information Management Profession 29
3 Legal Issues 47
4 Ethical Standards 87
CLINICAL DATA MANAGEMENT
5 Health Care Data Content and Structures 121
6 Nomenclatures and Classification Systems 147
7 Quality Health Care Management 169
8 Health Statistics 199
9 Research 231
TECHNOLOGY
10 Database Management 259
11 Information Systems and Technology 279
12 Informatics 299
MANAGEMENT
13 Management Organization 321
14 Human Resource Management 355
15 Financial Management 387
16 Reimbursement Methodologies 405

Appendix A Common HIM Abbreviations 423
Appendix B Web Resources 433
Appendix C Sample HIPPA Notices of Privacy practices 443
Appendix D Selected Laws Affecting HIM 451
Appendix E Selected HIPAA Regulations 455
Glossar y 499
Index 527
P A R T 2
P A R T 3
P A R T 4

CONTENTS
v
1
Preface xv
PART INTRODUCTION TO HEALTH INFORMATION
MANAGEMENT 1
Health Care Delivery Systems 3
Introduction 5
Historical Development 5
Early History 5
Health Care in the United States 6
Public Health 11
Mental Health 12
Occupational Health 14
Health Care Delivery Systems 15
Professional Associations 15
Voluntary Health Agencies 16
Philanthropic Foundations 17
International Health Agencies 17
Variety of Delivery Systems 17
Settings 17

Health Care Professionals 20
Medical Staff 22
Medical Staff Organization 22
Bylaws, Rules, and Regulations 23
Privileges and Credentialing 23
Conclusion 25
Chapter Summary 25
Case Study 25
Review Questions 25
Enrichment Activity 26
Web Sites 26
References 26
Notes 26
C H A P T E R 1
vi C O N T E N T S
The Health Information Management Profession 29
Introduction 31
Health Information 31

Historical Development of the Profession 31
Educational and Certification Requirements 33
Careers 37
Traditional Settings 39
Nontraditional Settings 41
Direct Patient Care Settings 42
Settings Not Involving Direct Patient Care 43
Conclusion 44
Chapter Summary 44
Case Study 44
Review Questions 44
Enrichment Activities 45
Web Sites 45
References 45
Notes 45
Legal Issues 47
Introduction 49
Overview of External Forces 49
Roles of Governmental Entities 50
Roles of Nongovernmental Entities 52
Role Application 53
Understanding the Court System 53
The Court System 53
Administrative Bodies 55
Health Records as Evidence 58
Hearsay 58
Privilege 59
Exclusions 60

Legal Procedures 60
e-Discovery 61
Additional Steps in Litigation 63
Principles of Liability 64
Intentional Torts 64
Nonintentional Torts 65
Social Media 67
Legal Issues in HIM 67
HIPAA 68
Administrative Simplification 68
Fraud and Abuse 71
Privacy and Confidentiality 71
Access to Health Care Data 73
Ownership and Disclosure 73
Identity Theft 75
Informed Consent 76
Judicial Process 77
Fraud and Abuse 78
Fraud and Abuse Laws 79
Resources to Combat Fraud and Abuse 80
C H A P T E R 2
C H A P T E R 3

C O N T E N T S vii
Conclusion 82
Chapter Summary 82
Case Study 83
Review Questions 83
Web Sites 83
References 84
Notes 84
Ethical Standards 87
Introduction 89
Ethical Overview 89
Ethical Models 90
Ethical Concepts 90
Ethical Theories 93
Ethical Decision Making 94
Influencing Factors 95
Codes of Ethics 95
Patient Rights 103
Other Factors 104
Decision-Making Process 104
Bioethical Issues 106

Related to the Beginning of Life 106
Family Planning 106
Abortion 107
Perinatal Ethics 108
Eugenics 108
Related to Sustaining or Improving the Quality of Life 108
HIV/AIDS 109
Organ Transplantation 109
Genetic Science 110
Related to Death and Dying 110
Planning for End of Life 111
Euthanasia 111
Withholding/Withdrawing Treatment 111
Ethical Challenges 112
General Challenges 112
Role of Ethics in Supervision 113
Health Care Challenges 114
Health Information Management Challenges 115
Conclusion 116
Chapter Summary 116
Case Study 116
Review Questions 116
Web Sites 117
References 117
Notes 117
C H A P T E R 4

viii C O N T E N T S
2
PART CLINICAL DATA MANAGEMENT 119
Health Care Data Content and Structures 121
Introduction 123
Types, Users, Uses, and Flow of Data 123
Types of Data 123
Users and Uses of Data 127
Patient Users 128
Data Flow 129
Forms Design and Control 131
Data Storage, Retention, and Destruction 132
Data Storage 134
Data Retention and Destruction 136
Indices and Registries 139
Indices 139
Registries 140
Registry Types 142

Conclusion 143
Chapter Summary 143
Case Study 143
Web Sites 144
References 144
Notes 144
Nomenclatures and Classification Systems 147
Introduction 149
Languages, Vocabularies, and Nomenclatures 149
Nomenclature Development 150
Classification Systems 152
History and Application of Classification Systems 152
Diagnosis-Related Groups 155
HIM Transformation 157
Other Classification Systems 163
Emerging Issues 164
Conclusion 166
Chapter Summary 166
Case Study 166
Web Sites 167
References 167
Notes 168
C H A P T E R 6
viii C O N T E N T S

C H A P T E R 5
C O N T E N T S ix
Quality Health Care Management 169
Introduction 171
Data Quality 171
Historical Development 171
Federal Efforts 175
Private Efforts 176
Tools 178
Performance Improvement and Risk Management 187
Performance Improvement 187
Risk Management 189
Utilization Management 191
Utilization Review Process 192
Conclusion 195
Chapter Summary 195

Case Study 196
Web Sites 197
References 197
Notes 197
Health Statistics 199
Introduction 201
Overview 201
Statistical Types 202
Statistical Literacy 203
Statistical Basics 204
Measures of Central Tendency 205
Other Mathematical Concepts 206
Data Collection 208
Statistical Formulas 209
Data Presentation 212
Regression Analysis 215
Regression Analysis Models 217
Health Information Management Statistics 221
Productivity 221
Statistical Tools 223
Conclusion 226
Chapter Summary 226
Case Studies 226
Web Sites 230

References 230
Notes 230
C H A P T E R 7
C H A P T E R 8
x C O N T E N T S
3
x C O N T E N T S
Research 231
Introduction 233
Research Principles 233
Historical Overview 233
Methodology 234
Qualitative and Quantitative Research 234
Study Types 235
Research Study Process 239

Research Design 239
Publication Process 240
Institutional Review Boards 241
Review Process 243
Review of Research on Animals 246
Emerging Trends 247
Epidemiology 248
Epidemiological Basics 250
Disease Progression 251
Types of Epidemiology 252
Descriptive Epidemiology 252
Analytic and Experimental Epidemiology 253
Conclusion 254
Chapter Summary 254
Case Study 254
Web Sites 255
References 255
Notes 255
PART TECHNOLOGY 257
Database Management 259
Introduction 261
Concepts and Functions 261
Database Design 263

Controls 265
Data Standards 265
Retrieval and Analysis Methods 267
Data Sets 268
Data Exchange 272
State and Local Data Exchange Efforts 274
Conclusion 275
Chapter Summary 276
Case Study 276
Web Sites 276
References 277
Notes 277
C H A P T E R 9
C H A P T E R 1 0
C O N T E N T S xi
Information Systems and Technology 279

Introduction 281
Information Systems 281
Computer Concepts 281
Hardware 282
Software 285
Units of Measure and Standards 285
Information Systems Life Cycle 286
Communication Technologies 288
Security 290
HIPAA Security Rule 291
Systems Architecture 293
Systems Architecture Specifics 293
Conclusion 295
Chapter Summary 295
Case Study 295
Web Sites 296
References 296
Notes 297
Informatics 299
Introduction 301
Overview 301
Electronic Health Records 302
Meaningful Use 305
Legal Health Record 310
Technology Applications and Trends 311
Role of Social Media in Health Care 313

Conclusion 316
Chapter Summary 316
Case Study 316
Web Sites 317
References 317
Notes 317
C H A P T E R 1 1
C H A P T E R 1 2
xii C O N T E N T S
4C H A P T E R 1 3
PART MANAGEMENT 319
Management Organization 321
Introduction 323
Principles of Management 323
Planning 323

Strategic Planning 323
Management Planning 325
Operational Planning 326
Disaster Planning 326
Planning Tools 329
Organizing 329
Design and Structure 330
Organizing People 331
Organizing the Type of Work 335
Organizing Work Performance 335
Organizing the Work Environment 335
Directing 336
Decision Making 336
Instructing Others 337
Work Simplification 338
Controlling 338
Types of Controls 338
Setting Standards 339
Monitoring Performance 339
Leading 340
Motivating 340
Directing Others 341
Resolving Conflicts 342
Effective Communication 342
Management Theories 343
Specialized Management Theories 344
Change Management 344
Project Management 345
Process Improvement 346

Knowledge Management 348
Effective Meeting Management 351
Conclusion 351
Chapter Summary 352
Case Study 352
Web Sites 353
References 353
Notes 353
xii C O N T E N T S
C O N T E N T S xiii
Human Resource Management 355
Introduction 357
Employment 357
Staffing 358
Recruitment 358
Selection 358
Compensation 364

Orientation and Training 364
Retention 365
Separation 366
Employee Rights 367
Overview 367
Employment Law Application 368
Discrimination 368
Sex Discrimination 368
Racial, Religious, and National Origin Discrimination 369
Age Discrimination 370
Disability Discrimination 370
Genetic Discrimination 372
Workplace Protections 372
Social Media 375
Supervision 376
Performance Evaluations 376
Problem Behaviors 377
Discipline and Grievance 378
Developing Others 379
Career Development 379
Coaching 379
Mentoring 380
Team Building 380
Telework 381
Workforce Diversity 383
Conclusion 384
Chapter Summary 384
Case Study 384

Web Sites 385
References 385
Notes 385
C H A P T E R 1 4
xiv C O N T E N T S
Financial Management 387
Introduction 389
Overview 389
Accounting 391
Managerial Accounting 391
Financial Accounting 393
Budgets 395
Procurement 399
Procurement Requests 400
Conclusion 402
Chapter Summary 402
Case Study 402

Web Sites 403
References 403
Reimbursement Methodologies 405
Introduction 407
Third-Party Payers 407
Governmental Payers 408
Nongovernmental Payers 409
Managed Care Organizations 411
Health Insurance Exchanges 413
Payment Methodologies 414
Fee for Service 414
Prospective Payment Systems 415
Resource-Based Relative Value Systems 416
Capitation 416
Revenue Cycle Management 417
Conclusion 419
Chapter Summary 419
Case Study 420
Web Sites 420
References 421
Notes 421
Common HIM Abbreviations 423
Web Resources 433
Sample HIPPA Notices of Privacy Practices 443

Selected Laws Affecting HIM 451
Selected HIPAA Regulations 455
Glossary 499
Index 527
C H A P T E R 1 5
C H A P T E R 1 6
A P P E N D I X A
A P P E N D I X B
A P P E N D I X C
A P P E N D I X D
A P P E N D I X E
xv

BRIEF CONTENTS
Over the past quarter century, new developments in technology,
law, and organizational management have changed the
profession
of health information management (HIM). Once seen as the
guardian of a paper-based health record, the health information
management profession has evolved as health care has evolved,
expanding to include the development and implementation of
the
electronic health record and management of the data contained
within it. As the need for health information has grown, so has
the
need to manage that information. The health information profes-
sional plays a more central role in the delivery of health care
than
ever before.
For those interested in learning about health information
management, this text provides a comprehensive discussion of
the
principles and practices presented in a user-friendly manner. It
is
designed to serve as a broad text for the health information
man-
agement discipline and does not presume that the learner is
already versed in the subject matter. The text is designed to
incor-
porate the model curriculum of the American Health
Information
Management Association for both the health information admin-
istrator and health information technician programs. Although
differences exist in curricula between the programs, it is my
belief
that the content of this book is applicable to students in both
groups because it is written with multiple levels of detail.

Instruc-
tors may determine the emphasis level of each chapter as it is
taught during the semester. This text also serves as a reference
point for professionals in the health care field who need to
acquire a general understanding of health information manage-
ment, and as a research tool for other allied health and medical
disciplines.
Although this text is intended to be comprehensive, one text-
book could not possibly encompass all of the details of the
broad
discipline of health information management. Long past is the
time when one textbook could cover all matters and issues
associ-
ated with a single discipline—the evolution of the HIM
profession
is such that other specialized texts are needed to complement
this
text. Every effort has been made to capture the significant
changes
and trends that the HIM field and profession have undergone in
recent years.
Two things set this text apart from others in the field. First,
the book is authored by only one person, allowing for a
consistent
voice and tone across the chapters. It also means that one
chapter
will not contradict the contents of another chapter within the
same
book, and that the difficulty level will not vary from one
chapter to
the next. Second, the text integrates into each chapter, as
applica-
ble, five areas that are significant to health information manage-

ment: the American Recovery and Reinvestment Act (ARRA),
including HITECH; the Health Insurance Portability and
Account-
ability Act (HIPAA); electronic health information management
(e-HIM); the Genetic Information Nondiscrimination Act
(GINA); and informatics. This approach is taken so that while
the
student is learning the substantive matter, he or she can also
understand the interplay between these three areas and the sub-
stantive matter. Boxes for each of these five areas are found
near
the text discussion to highlight this interplay.
BOOK STRUCTURE
This text offers a comprehensive, sequential approach to the
study
of health information management. Although each chapter is
designed to stand alone, it is grouped with related chapters to
form units of study. Four major units of study are presented in
this text:
Part 1 serves as an introduction to health information man-
agement. This unit of study comprises four chapters, beginning
with a discussion of health care delivery systems, both
historically
and in the present day, and the health information management
profession, including various career paths. These chapters are
fol-
lowed by a discussion of legal issues, including an overview of
the
court systems, the principles of liability, HIPAA, and health
care
fraud and abuse. The last chapter addresses ethical standards,
PREFACE

xvi C O N T E N T S
outlining the basis for ethical concepts and theories and their
role
in decision making, explaining various ethical challenges, and
highlighting bioethics issues.
Part 2 serves as an overview of clinical data management.
This unit of study consists of six chapters and begins with a dis-
cussion of health data content and structures, including types
and uses; forms design and control; data storage, retention, and
destruction; and indices and registries. Nomenclatures and
classification systems make up the next chapter, and a discus-
sion of emerging issues completes the chapter. Quality manage-
ment, performance improvement, risk management, and
utilization management form the basis of the next chapter.
Health statistics is the focus of the next chapter, addressing sta-
tistical literacy in general, and regression analysis and HIM sta-
tistics in particular. Research issues complete the unit, with
sections addressing research principles, the research study pro-
cess, the role of institutional review boards, and the discipline
of epidemiology.
Part 3 serves as an overview of information technology
issues. This unit of study is comprised of three chapters and

begins with a discussion of database management, including
con-
cepts and functions, data sets, and data exchange efforts.
Informa-
tion systems and technology is the subject of the next chapter,
including a discussion of various information systems and sys-
tems architecture. New to this edition, informatics completes
the
unit, with sections addressing electronic health records and
tech-
nological applications and trends, including the role of social
media in health care.
Part 3 serves as an overview of management issues. This unit
of study consists of four chapters, beginning with management
principles and theories, including change, project, and
knowledge
management. A discussion of human resource management
follows, focusing on staffing, employee rights, supervision, and
workforce diversity. The financial management chapter
addresses
the fundamental concepts that drive financial management,
including accounting, budgets, and procurement. The last
chapter
provides a basis in reimbursement methodologies, including
how
third-party payers and the revenue cycle function in the health
care world.
Wherever the term health information manager is used in this
text, I refer to both registered health information administrators
(RHIA) and registered health information technicians (RHIT). I
make this choice consciously, because the experience of the
health
information management profession during the last two decades
has shown that professionals at both levels hold a variety of

posi-
tions within the discipline. Additionally, care has been
exercised to
use the terms health record and health information management
in
lieu of medical record and medical record management, because
these are the terms in use in the 21st century. Each chapter
alter-
nates in the use of the male and female pronouns. Information
contained in the text boxes within the chapter provides a quick
grasp of concepts that may be new to the learner.
PEDAGOGICAL FEATURES
Each chapter contains:
An integration of ARRA, HIPAA, e-health information
management, GINA, and informatics throughout the
subject matter as appropriate
Learning objectives
A listing of key concepts that are further explained in
the text
Figures and tables that provide details to illustrate the
content of the text
Case studies to apply concepts learned
Review questions designed to test comprehension
Enrichment activities designed to assist critical
thinking
A list of Web sites that relate to the chapter’s subject
matter for the learner’s easy reference

Additionally, appendices contain:
An extensive glossary of terms
A list of abbreviations commonly used in HIM
Web site resources, organized by subject matter and in
alphabetical order
Sample HIPAA privacy notices
A table of selected federal laws applicable to HIM
Selected HIPAA regulations
TEACHING AND LEARNING
RESOURCES FOR TODAY’S
HEALTH INFORMATION
MANAGEMENT
Additional textbook resources for students and instructors can
be
found online by going to www.cengagebrain.com and typing in
the
book’s ISBN. The available resources are also listed as follows
for your
convenience. Please note: all instructor resources can be
accessed by
going to www.cengagebrain.com. You will need to create a
unique
login. If you need assistance, please contact your sales
representative.
Student Workbook
The Student Workbook contains additional application-based
exer-

cises to help reinforce the essential concepts presented in the
textbook.
Test your knowledge through activities such as abbreviations
and key
terms review, chapter quiz material, case explorations, and
more.
ISBN: 9781133592495
xvi P R E F A C E
C O N T E N T S xvii
CourseMate
Go beyond the textbook and complement your text and course
content with study and practice materials through CourseMate.
CourseMate includes:
Interactive eBook with highlighting, note taking, and an
interactive glossary
Additional assignable chapter quizzes, flashcards, and
games
Engagement Tracker tool that monitors student engage-

ment in the course
Want to give CourseMate a try? Go to www.cengagebrain.com,
enter the ISBN of this textbook (978-1-1335-9247-1), and you
can access a free sample of the CourseMate available with this
textbook.
ISBN: 9781133595243
Instructor’s Manual
The Instructor’s Manual provides answer keys for the text and
workbook; a curriculum crosswalk for each chapter with links to
the AHIMA domains, subdomains, and knowledge clusters; and
additional enrichment activities.
ISBN: 9781133592488
Instructor Resources (Online)
All instructor resources can be accessed by going to
www.cengagebrain.com to create a unique user login. Contact
your sales representative for more information. Online instruc-
tor resources are password-protected and include all resources
found on the Instructor Resources CD-ROM, including the test
bank, PowerPoint presentations, and the electronic Instructor’s
Manual.
Use the electronic Instructor’s Manual files to
help prepare for class.
Customizable instructor support slide presentations in
PowerPoint® format focus in on key points for each
chapter.
The testbank written In ExamView® makes generating
tests and quizzes a snap.

ISBN: 9781133595786
Web Tutor™ Course Cartridges
WebTutor™ is a course management and delivery sys-
tem designed to accompany this textbook. It is available
to supplement on-campus course delivery or to serve as
the course management platform for an online course.
The WebTutor for this title contains:
Online quizzes for each chapter
Discussion topics and learning links
Online glossary
Instructor support slides using PowerPoint™
Computerized test bank
Communication tools, including a course calendar,
chat, e-mail, and threaded discussions
Web Tutor on Blackboard ISBN: 9781133595861
Web Tutor on Angel ISBN: 9781133595878
InfoHealth Connect Community Site
InfoHealth Connect is a Cengage Learning community Web site
that
gathers resources for educators, professionals, and students
working
in the Health Information and Insurance, Billing & Coding
arenas.
Need a research topic? Get news from the cutting
edge via our Healthcare news links and video

newsfeed
Have a burning question? Post your question to our dis-
cussion board
Looking for pearls of wisdom? Read blogs from sea-
soned professionals
Want to network? Create a member profile to connect
with other members
Too busy to visit regularly? Add the site RSS
feed to your reader or follow us on Twitter
@infohlthconnect
Go to http://community.cengage.com/Site/infohealthconnect/ to
join our community today!
P R E F A C E xvii
xviii C O N T E N T S
ACKNOWLEDGMENTS
Many persons have played a role in the creation of this text-
book, including family, friends, and colleagues. A special thank

you is warranted for my family, who showed patience, under-
standing, and support for the long hours spent on this, my sec-
ond textbook. My children, Conor, William, and Ryan, spent
many hours at libraries, learning the intricacies of research
and authorship. My husband, Patrick, whose patience and
encouragement sustained me throughout the development of
this text, deserves my unending love. Two HIM professionals,
Sharon Farley, RHIA, and Patt Petersen, MA, RHIA, provided
valuable assistance in the subjects of quality management and
statistics, respectively. My appreciation is extended to the
reviewers of my manuscript. Your comments aided in strength-
ening this text.
Dana C. McWay, JD, RHIA
CONTRIBUTORS
The author and publisher would like to acknowledge the
following
health information management educators for their contributions
to the content of this text:
Sharon Farley, RHIA
Contributing material to Chapter 7
Patt Peterson, MA, RHIA
Contributing material to Chapter 9
REVIEWERS
The following health information management educators
provided
invaluable feedback and suggestions during the development of
this text:
Julie Alles, RHIA
Adjunct Instructor
Health Administration Programs

Ferris State University
Big Rapids, MI 49307
Marie A. Janes, MEd, RHIA
Associate Lecturer
University of Toledo
Toledo, OH
Rachel Minatee, MBA, RHIA
Professor of Health Information Technology
Rose State College
Midwest City, OK
Kelly Rinker, MA, RHIA, CPHIMS
Faculty
Regis University
Denver, CO
Jeanne Sands, MBA, RHIT
Adjunct Professor
Herzing University Online
Milwaukee, WI
xviii P R E F A C E

C O N T E N T S xix
ABOUT THE AUTHOR
Dana C. McWay, JD, RHIA, is both a lawyer and a health
informa-
tion management professional. With training and experience in
both disciplines, experience as a member of the Institutional
Review Board at Washington University Medical School from
1992
to present, and experience in converting a paper-based record
management system to an electronic record management system,
she brings a wide-ranging perspective to this textbook.
Ms. McWay serves as the Court Executive/Clerk of Court for
the U.S. Bankruptcy Court for the Eastern District of Missouri,
an
executive position responsible for all operational,
administrative,
financial, and technological matters of the court. In this
capacity,
she organized the court’s conversion to an electronic case filing
system, resulting in widespread acceptance by end users. This
suc-
cess led to her appointment as member and, later, chair of the
Case
Management/Electronic Case Filing (CM/ECF) Working Group,
an entity within the federal judiciary responsible for providing
guidance and assistance in all phases of the development of
bank-
ruptcy CM/ECF software releases. She serves on numerous
national committees and working groups within the judiciary,
including those involved in identifying the impact of new
legisla-
tion upon judicial operations and those involved in advising on
the education and training needs of court staff. Prior to this
posi-

tion, she worked as the Chief Deputy Clerk of Court for the
U.S.
Court of Appeals for the Eighth Circuit, responsible for daily
operations of the court.
Ms. McWay began her legal career as a judicial law clerk to
the Honorable Myron H. Bright of the U.S. Court of Appeals for
the Eighth Circuit. She then became an associate with the law
firm
of Peper, Martin, Jensen, Maichel, & Hetlage, a multi-specialty
firm located in St. Louis, Missouri. Ms. McWay’s legal practice
encompassed a variety of health law topics, including contracts,
medical records, and physician practice issues. She is admitted
to
practice in both Illinois and Missouri.
Prior to her legal career, Ms. McWay worked in health infor-
mation management as both a director and assistant director of
medical records in a large teaching hospital and a for-profit
psy-
chiatric and substance abuse facility. She continues to
participate
in the HIM profession, having served as a project manager for
the Missouri Health Information Management Association
(MHIMA) and as a member of MHIMA’s Legislative
Committee.
On the national level, she serves as a director on the Board of
Directors of AHIMA and has served as faculty for AHIMA con-
tinuing education seminars, a peer reviewer of AHIMA book
pro-
posals and texts, a contributing author to AHIMA’s HIM
Practice
Standards, chair and former member of the Professional Ethics
Committee, and a member of both the Committee for Profes-
sional Development and the Triumph Awards Committee

of AHIMA.
Ms. McWay is both an author and an editor. Her textbook,
Legal Aspects of Health Information Management, is in its
second
edition. With the Peper Martin law firm, she revised The Legal
Manual to Medical Record Practice in Missouri in 1991. She has
authored numerous other publications and served as coeditor of
several online continuing education modules presented by the
American Health Information Management Association. She has
also presented numerous seminars, serving as faculty and panel
presenter. She has served as an adjunct faculty member in a
mas-
ter’s program in health informatics and a pre-law studies
program,
and as a guest lecturer at several area colleges and universities,
focusing on the intersection of legal issues and health care
practices.
Ms. McWay is a magna cum laude graduate of the St. Louis
University School of Allied Health Professions, with a degree in
medical record administration, and a cum laude graduate of the
St.
Louis University School of Law. While in law school, Ms.
McWay
served as the health law editor of the St. Louis University Law
Jour-
nal and as a faculty research fellow. She is a recipient of the
Alumni
Merit Award from the School of Allied Health Professions and a
Triumph Award (the Legacy Award) from the American Health
Information Management Association for her textbook, Legal
Aspects of Health Information Management. She is one of three
recipients of the 2010 Outstanding Leadership Award from the
Federal Judiciary.

P R E F A C E xix
HOW TO USE THE TEXTBOOK
Learning Objectives at the beginning
of each chapter list the theoretical and
practical goals of the chapter. The
Certification Connection ties the chapter
material to the RHIA and RHIT exam
outlines.
Important terms, ideas, and acro-
nyms are presented in the Key
Concepts list, and they are high-
lighted the first time they appear in
the chapter content. The Outline
lists major headings to provide a
roadmap for the chapter content.

At the end of each chapter, reinforce your understanding of the
covered concepts using the Summary and Review Questions.
Enrichment Activities and Case Studies provide opportunities to
use critical thinking
skills to reflect on the material and relate the concepts to real-
life situations.
The book highlights the interplay of informatics, electronic
health information (e-HIM), the Health Insurance
Portability and Accountability Act (HIPAA), American
Recovery & Reimbursement Act (ARRA), and Genetic
Information Nondiscrimination Act (GINA) with the sub-
ject matter of each chapter in special boxes.

P A R T 1
1 Health Care Delivery Systems
2 The Health Information
Management Profession
3 Legal Issues
4 Ethical Standards
INTRODUCTION TO HEALTH
INFORMATION MANAGEMENT
iStock.com

3
Health Care Delivery Systems
LEARNING OBJECTIVES
After reading this chapter, the learner should be able to:
1. Trace the historical development of the health
care delivery system in early times.
2. Describe the four-stage progression of the
health care delivery system in the United
States.
3. Describe the increase in stature of hospitals
after World War II.
4. Explain the standardization movement of the
early 20th century.
5. Define the term accreditation and explain its
significance to health care organizations.
6. Compare and contrast the federal government’s
role in health care during stages three and four.
7. Define the concept of managed care and dif-
ferentiate between the three main types.

8. Trace the historical development of public,
mental, and occupational health.
9. Compare and contrast professional associa-
tions, voluntary health agencies, philan-
thropic foundations, and international health
agencies.
10. Differentiate between the variety of settings
where health care is delivered.
11. Compare and contrast physicians, dentists, chiro-
practors, podiatrists, optometrists, physician as-
sistants, nurses, and allied health professionals.
12. Understand the organization of a hospital’s
medical staff, the importance of its bylaws,
and the use of the credentialing process in
granting clinical privileges.
1C H A P T E R > >
CERTIFICATION
CONNECTION
RHIA
Accreditation, licensure, and certification
Continuum of health care services
Health care delivery systems
Organizational compliance
Regulatory and licensure requirements
RHIT
Accreditation, licensure, and certification

Health care delivery systems
Health care organizations and structure
Provider roles and disciplines
Public health
T H E H E A L T H I N F O R M A T I O N M A N A G E M
E N T P R O F E S S I O N
Outline Key ConceptsOutline Key Concepts
Accountable care
organization
Accreditation
Adult day care
services
Allied health
professional
Ambulatory health
care
Block grants

Board certified
Bylaws
Capitation
Chiropractor
Clinical privileges
Community mental
health care
Complementary and
alternative medicine
Continuum of care
Credentialing process
Dentist
Fee for service
Fringe benefits
Generalists
Health insurance
exchange
Health savings
accounts
HMO

Home health agency
Hospice care
Hospital
IPA
International health
agencies
Licensing
Long-term care facility
Managed care
Medicaid
Medicare
Medical staff
Medical staff
coordinator
Mental health
Mental illness
Mobile diagnostic
services
Nurse

Nurse practitioner
Occupational health
Optometrist
Outsourcing
Palliative care
Philanthropic
foundations
Physician
Physician assistant
Podiatrist
PPO
Primary care
Professional
associations
Public health
Quaternary care
Registration
Regulations
Rehabilitation care
facility

Respite care
Rules
Secondary care
Specialists
Surgical assistant
Tertiary care
Tracer methodology
Voluntary health
agencies
Historical Development
Early History
Health Care in the United States
Public Health
Mental Health
Occupational Health
Health Care Deliver y Systems
Professional Associations
Voluntary Health Agencies
Philanthropic Foundations

International Health Agencies
Variety of Delivery Systems
Medical Staff
Medical Staff Organization
Bylaws, Rules, and Regulations
Privileges and Credentialing
4 P A R T 1 I N T R O D U C T I O N T O H E A L T H I
N F O R M A T I O N M A N A G E M E N T
INTRODUCTION
C H A P T E R 1 H E A L T H C A R E D E L I V E R Y S Y
S T E M S 5
HISTORICAL DEVELOPMENT
The number and quality of professionals, organizations, and
enti-
ties involved in health care has varied significantly over time.
In
large measure, this variety is attributable to the knowledge of

dis-
eases and their causes possessed by individuals and
communities.
With the advent of technology and advancements in medicine,
an
ever-expanding knowledge base has resulted in more, rather
than
less, complexity in health care.
Early History
To understand the development of health care in the United
States,
one must first look to the development of health care in earlier
times and in other regions of the world. Anthropological studies
have helped to trace health care back thousands of years. Table
1-1
illustrates the early history of health care.
In primitive times, human society responded to disease in one
of three ways. First, humans looked to nature for answers,
determin-
ing that disease was a result of offended forces of nature such
as
storms, volcanic eruptions, and earthquakes. Second, they
looked to
the supernatural for answers, determining that disease may be a
way
of “possessing” human beings. Third, they looked to the
offended
spirits of gods or the dead, concluding that disease was a logical
result of any offense incurred. In response to any of these three
ways,
primitive peoples treated disease with prayers, offerings,
religious
ceremonies, diet, or medicinal herbs. Furthermore, they

attempted
to frighten demons—and, therefore, disease—away with
dancing,
drumming, and fearful masks. They employed resources such as
amulets, charmed stones, and songs in efforts to banish disease.
As humans made the connection between cause and effect,
treatments evolved to improve or cure disease. A medicine man
or
shaman employed methods such as applying warm ashes to
induce
sweating, applying a tight band around the head to treat a head-
ache, and bandaging the chest to the point of partial
immobiliza-
tion to treat tuberculosis. Man incised wounds to remove
foreign
bodies such as stones and splinters, doing so by sucking out the
foreign body. Fractured bones were splinted with stiffened mud
bandages or tree branches. Midwives became recognized figures
among primitive peoples.
As civilization emerged, instructions relating to health care
were
written down. The earliest known written materials—stone
tablets,
papyri, and inscriptions on monuments and tombs—have been
found
in Egypt, dating to 2700 b.c. These materials recognize the
existence
INTRODUCTION
The health care delivery system of the 21st century is both
varied and complex. No one organization or entity is respon-
sible for delivering all health care in the United States. It is
important to understand the origins of the health care delivery

system in the United States so that the relationships between
organizations, entities, and health care professionals be-
comes clear. This chapter provides that understanding through
an overview of the historical development of the health
care delivery system, both in the United States and other
regions of the world. Some focus is given to specified areas of
health care, including public health, mental health, and
occupational health. A discussion of the organizations, entities,
and professionals who deliver health care services and the
settings in which they work follows, allowing the learner to
better understand the complexity of health care. A section
concerning a hospital’s medical staff explains its organization,
its governing mechanisms, and the credentialing process.
Integrated as appropriate within the entire chapter is a discus-
sion of the influences of technology, financing concerns, and
the role of the federal government in the health care
delivery system.
6 P A R T 1 I N T R O D U C T I O N T O H E A L T H I
N F O R M A T I O N M A N A G E M E N T
of physicians and dentists working under the authority of gods.
As
such, physicians were considered priests who received training
in

temple schools in areas such as diagnosis and treatment. Priests
fol-
lowed the case approach beginning with a preliminary
diagnosis,
examination of the patient, diagnosis and prognosis, and
indication of
treatment measures to be employed. An example of such an
approach
can be found in the famous Ebers Papyrus illustrated in Figure
1-1.
Although this description speaks to a rational approach to med-
icine, a magical approach to medicine was involved as well.
Because
of the prevailing belief that disease was caused by demons and
evil
spirits, curing of disease could only occur through the
intervention
of the gods. Accordingly, physicians in ancient Egypt
recognized one
god over all others as the most important with regard to
healing—
Imhotep, who they referred to as the god of medicine.
As Egyptian civilization declined, other civilizations adopted
and expanded the Egyptians’ knowledge of medicine. Arabians
refined the concept of pharmacology, and, in another part of the
world, the Chinese did the same. The Jewish people became pre-
eminent in the area of public hygiene. The Babylonians codified
fees for physician practice and punishments for malpractice in
the
Hammurabi Code. Eventually, each of these civilizations
declined
or dispersed.
The next notable civilization to make an impact on medicine

was the Greeks, the forerunners of modern Western medicine.
The
Greeks were the first to reduce and then shed the supernatural
view of disease and approach medicine from a rational and
scien-
tific point of view. Among the greatest Greek physicians was
Hippocrates, from whom the famous oath originates (see
Figure 1-2). Hippocrates is famous for codifying medicine
through
the publication of numerous books, promoting medicine as one
of
the highest ethical and spiritual endeavors, and establishing the
principle that knowledge of disease can be obtained from
careful
observation and notation of symptoms.
Between the 6th century and the 16th century, little advance-
ment in medicine occurred. Alchemy, magic, and astronomy
were
prominently identified with medicine. To the extent that
medicine
existed as we now understand it, the clergy were its
practitioners.
Religious orders established hospitals to offer hospitality and
refuge
to old, disabled, and homeless pilgrims. Soon a vast network of
hos-
pitals emerged, mainly offering rest and shelter rather than
treatment.
Toward the end of the 16th century, a renaissance occurred in
many areas of culture, including medicine. Advancements were
made in understanding the anatomy of the human body, clinical
observations of diseases, and bedside teaching methods. Efforts
were made to not only identify disease but to discover specific
remedies that could be applied to the patient. The concept of

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