HNE will begin conducting HEDIS®¹ reviews on randomly selected medical records in March 2007. HEDIS measures are used to evaluate performance in areas ranging from preventive care and consumer experience to heart disease and cancer.

Medical record reviews are a required component of the HEDIS process. These abstractions supplement data collected from our administrative/claims systems ensuring that complete and accurate information is reported. More importantly, these reviews allow us to gather data on where to direct activities aimed at improving the health care provided to our members.

HNE may request access to a member’s medical record based on the following:

• Practitioner/Provider agreements which permit inspection, audit and duplication of data and other records.
• A routine consent signed by members provides for use and disclosure of health records including authorization for information related to medical history and exams, services rendered, treatment given, coordination of care and quality assessment and measurement, including member surveys.
• The HIPAA Privacy Rule builds on customary health practices rather than replacing them. Quality assessment and improvement activities (such as HEDIS chart reviews) are specifically mentioned in the regulations under the definition of allowable health care operations (164.501 Definition of Health Care Operations). 

Your cooperation in the HEDIS chart review process is critical to the success of HNE’s quality improvement efforts.  If your office receives a request to provide information, please respond no later than April 15, 2007.  This will allow HNE to meet regulatory quality reporting requirements. 

For additional information, please contact Pat Scheer, HNE Quality Operations Manager at
413-233-3435 (email: PSCHEER@hne.com).

¹HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).