Today's Health Information Management: An

Integrated Approach 3th Edition- eBook PDF

download

https://ebooksecure.com/download/todays-health-information-
management-an-integrated-approach-third-edition-ebook-pdf/

Download more ebook from https://ebooksecure.com

We believe these products will be a great fit for you. Click
the link to download now, or visit ebooksecure.com
to discover even more!

(eBook PDF) Management: An Integrated Approach 2nd

Edition

http://ebooksecure.com/product/ebook-pdf-management-an-
integrated-approach-2nd-edition-2/

(eBook PDF) Management: An Integrated Approach 2nd

Edition

http://ebooksecure.com/product/ebook-pdf-management-an-
integrated-approach-2nd-edition/

(eBook PDF) Operations Management: An Integrated

Approach, 6th Edition

http://ebooksecure.com/product/ebook-pdf-operations-management-
an-integrated-approach-6th-edition/

Operations Management: An Integrated Approach 6th

Edition (eBook PDF)

http://ebooksecure.com/product/operations-management-an-
integrated-approach-6th-edition-ebook-pdf/
(Original PDF) Management Employment Relations An
Integrated Approach 2st Australia

http://ebooksecure.com/product/original-pdf-management-
employment-relations-an-integrated-approach-2st-australia/

(eBook PDF) Strategic Management: Theory & Cases: An

Integrated Approach 12th Edition

http://ebooksecure.com/product/ebook-pdf-strategic-management-
theory-cases-an-integrated-approach-12th-edition/

Strategic Management: Theory & Cases: An Integrated

Approach 13th Edition (eBook PDF)

http://ebooksecure.com/product/strategic-management-theory-cases-
an-integrated-approach-13th-edition-ebook-pdf/

(eBook PDF) Water Resources: An Integrated Approach

http://ebooksecure.com/product/ebook-pdf-water-resources-an-
integrated-approach/

(eBook PDF) Nutrition, Exercise, and Behavior: An

Integrated Approach to Weight Management 3rd Edition

http://ebooksecure.com/product/ebook-pdf-nutrition-exercise-and-
behavior-an-integrated-approach-to-weight-management-3rd-edition/
 �-'�
·-
CENGAGE

THIRD EDITION
.. Today's

I HEALTH INFORMATION
MANAGEMENT
An Integrated Approach

Dana C. Mc Way, JD, RHIA, FAHIMA

�-'#
, ..,
CENGAGE

Today's Health Information © 2022, 2014 Cengage Learning, Inc.

Management: An Integrated Approach,

Unless otherwise noted, all content is© Cengage.
Third Edition
Dana C. McWay ALL RIGHTS RESERVED. No part of this work covered by the copyright herein
may be reproduced or distributed in any form or by any means, except as
SVP, Higher Education & Skills Product: permitted by U.S. copyright law, without the prior written permission of the
Erin Joyner copyright owner.

VP, Higher Education & Skills Product:

Michael Schenk For product information and technology assistance, contact us at
Cengage Customer & Sales Support, 1-800-354-9706 or
Product Director: Matthew Seeley
support.cengage.com.
Senior Product Manager: Stephen Smith
For permission to use material from this text or product,
Product Assistant: Dallas Wilkes submit all requests online at www.cengage.com/permissions.

Senior Content Manager: Sharib Asrar,

MPS Limited

Library of Congress Control Number: 2020952225

Digital Delivery Lead: Lisa Christopher

ISBN: 978-0-3575-1008-7
Director, Marketing: Courtney Cozzy

IP Analyst: Ashley Maynard

Cengage
IP Project Manager: Nick Barrows 200 Pier 4 Boulevard
Boston, MA 02210
Production Service: MPS Limited
USA

·Designer: Angela Sheehan

Cengage is a leading provider of customized learning solutions with employees
Cover and Interior Image Source:
residing in nearly 40 different countries and sales in more than 125 countries
iStock.com/4X-image
around the world. Find your local representative at www.cengage.com.

To learn more about Cengage platforms and services, register or access

your online learning solution, or purchase materials for your course, visit

www.cengage.com.

Notice to the Reader

Publisher does not warrant or guarantee any of the products described herein

or perform any independent analysis in connection with any of the product

information contained herein. Publisher does not assume, and expressly

disclaims, any obligation to obtain and include information other than that

provided to it by the manufacturer. The reader is expressly warned to consider

and adopt all safety precautions that might be indicated by the activities

described herein and to avoid all potential hazards. By following the instructions

contained herein, the reader willingly assumes all risks in connection with such

instructions. The publisher makes no representations or warranties of any kind,

including but not limited to, the warranties of fitness for particular purpose or

merchantability, nor are any such representations implied with respect to the

material set forth herein, and the publisher takes no responsibility with respect

to such material. The publisher shall not be liable for any special, consequential,

or exemplary damages resulting, in whole or part, from the readers' use of, or

reliance upon, this material.

Printed in the United States of America

Print Number: 01 Print Year: 2021
 BRIEF CONTENTS

Preface XVII

PART1 Introduction to Health Information Management 1

1 Health Care Delivery Systems 2
2 T he Health Information Management Profession 42
3 Legal Issues 66
4 Ethical Standards 126
PART2 Clinical Data Management 167
5 Health Care Data Content and Structures 168
6 Nomenclatures and Classification Systems 203
7 Quality Health Care Management 232
8 Health Statistics 273
9 Research 320
PART3 Technology 361
10 Database Management 362
11 Information Systems and Technology 397
12 Informatics 428
PART4 Management 455
13 Management Organization 456
14 Human Resource Management 510
15 Financial Management 559
16 Reimbursement Methodologies 583
APPENDICES
APPENDIX A: Common HIM Abbreviations 609
APPENDIX B: Web Resources by Subject Matter 618
APPENDIX C: Sample HIPPA Notices of Privacy Practices 627
APPENDIX D: Selected Laws Affecting HIM 648
APPENDIX E: Selected HIPAA Regulations 650
Glossary 727
I n dex 760

iii
 CONTENTS

Preface xv11
PART 1 INTRODUCTION TO HEALTH INFORMATION MANAGEMENT 1

1 Health Care Delivery Systems 2

Learning Objectives 2

Outline 2

Key Concepts 3

INTRODUCTION 3

HISTORICAL DEVELOPMENT 4

Early History 4

Health Care in the United States 6

Public Health 14

Mental Health 15

Occupational Health 20

HEALTH CARE DELIVERY SYSTEMS 21

Professional Associations 21

Voluntary Health Agencies 22

Philanthropic Foundations 24

International Health Agencies 24

Variety of Delivery Systems 25

Settings 25
Health Care Professionals 30

MEDICAL STAFF 34

Medical Staff Organization 34

Bylaws, Rules, and Regulations 35

Privileges and Credentialing 36

CONCLUSION 37

CHAPTER SUMMARY 37

CASE STUDY 38

REVIEW QUESTIONS 38

ENRICH M ENT ACTIVITIES 38

WEBSITES 39

REFERENCES 40

NOTES 41

iv
 Contents v

2 The Health Information Management Profession 42

Learning Objectives 42

Outline 42

Key Concepts 42

INTRODUCTION 43

HEALTH INFORMATION 43

Historical Development of the Profession 43

Educational and Certification Requirements 46

CAREERS 5 3

Traditional Settings 53

Nontraditional Settings 58
Direct Patient Care Settings 58
Settings Not Involving Direct Patient Care 61

Future Roles 62

CONCLUSION 63

CHAPTER SUMMARY 63

CASE STUDY 64

REVIEW QUESTIONS 64

ENRICHMENT ACTIVITIES 64

WEBSITES 65

REFERENCES 65

NOTES 65

3 Legal Issues 66
Learning Objectives 66

Outline 67

Key Concepts 67

INTRODUCTION 68

OVERVIEW OF EXTERNAL FORCES 68

Roles of Governmental Entities 70

Roles of Nongovernmental Entities 72

Role Application 74

UNDERSTANDING THE COURT SYSTEM 75

The Court System 75

Administrative Bodies 75

HEALTH RECORDS AS EVIDENCE 80

Hearsay 82

Privilege 82

Exclusions 8 3

Legal Procedures 84

e-Discovery 85
vi Contents

Additional Steps in Litigation 90

PRINCIPLES OF LIABILITY 91

Intentional Torts 91

Nonintentional Torts 93

Social Media 96

LEGAL ISSUES IN HIM 97

HIPAA 97
Administrative Simplification 98
Fraud and Abuse 1 02

Privacy and Confidentiality 105

Access to Health Care Data 107

Ownership and Disclosure 1 07
Identity Theft 1 1 0
Informed Consent 111

Judicial Process 113

FRAUD AND ABUSE 115

Fraud and Abuse Laws 116

Resources to Combat Fraud and Abuse 118

CONCLUSION 122

CHAPTER SUM MARY 122

CASE STUDY 122

REVIEW QUESTIONS 122

ENRICHMENT ACTIVITIES 123

WEBSITES 124

REFERENCES 124

NOTES 124

4 Ethical Standards 126

Learning Objectives 126

Outline 126

Key Concepts 126

INTRODUCTION 127

ETHICAL OVERVIEW 127

Ethical Models 129

· Ethical Concepts 1 29
Ethical T heories 1 35

ETHICAL DECISION MA KING 136

Influencing Factors. 136

Codes of Ethics 1 37
Patient Rights 1 41
Other Factors 1 43

Decision-Making Process 144

BIOETHICAL ISSUES 147

 Contents vii

Related to the Beginning of Life 147

Family Planning 1 47
Abortion 1 48
Perinatal Ethics 1 49
Eugenics 1 50

Related to Sustaining or Improving the Quality of Life 151

HIV/AIDS 1 51
Organ Transplantation 1 51
Genetic Science 1 52

Related to Death and Dying 154

Planning for End of Life 1 54
Euthanasia 1 54
Withholding/Withdrawing Treatment 1 55
ETHICAL CHALLENGES 156

General Challenges 156

Role of Ethics in Supervision 158

Health Care Challenges 160

Health Information Management Challenges 162

CONCLUSION 163

CHAPTER SUMMARY 163

CASE STUDY 164

REVIEW QUESTIONS 164

ENRICHMENT ACTIVITIES 164

WEBSITES 165

REFERENCES 166

NOTES 166

PART 2 CLINICAL DATA MANAGEMENT 167

5 Health Care Data Content and Structures 168

Learning Objectives 168

Outline 168

Key Concepts 168

INTRODUCTION 169

TYPES, USERS, USES, AND FLOW OF DATA 169

Types of Data 170

Users and Uses of Data 176

Patient Users 1 78

Data Flow 180

FORMS DESIGN AND CONTROL 183

DATA STORAGE, RETENTION, AND DESTRUCTION 188

Data Storage 188

Data Retention and Destruction 190

viii Contents

INDICES AND REGISTRIES 193

Indices 194

Registries 196
Registry Types 1 99

CONCLUSION 200

CHAPTER SUMMARY 200

CASE STUDY 200

REVIEW QUESTIONS 200

ENRICHMENT ACTIVITIES 201

WEBSITES 201

REFERENCES 201

NOTES 202

6 Nomenclatures and Classification Systems 203

Learning Objectives 203

Outline 203

Key Concepts 203

INTRODUCTION 204

LANGUAGES, VOCABULARIES, AND NOMENCLATURES 205

Nomenclature Development 207

CLASSIFICATION SYSTEMS 209

History and Application of Classification Systems 209

Diagnosis-Related Groups 21 4

HIM Transformation 217

Other Classification and Coding Systems 223

TRENDS 226

CONCLUSION 228

CHAPTER SUMMARY 228

CASE STUDY 229

REVIEW QUESTIONS 229

ENRICHMENT ACTIVITIES 229

WEBSITES 230

REFERENCES 230

NOTES 231

7 Quality Health Care Management 232

Learning Objectives 232

Outline 232

Key Concepts 232

INTRODUCTION 233

DATA QUALITY 233

 Contents ix

Historical Development 233

Federal Efforts 238
Private Efforts 240

Tools 243
Applications 249
PERFORMANCE IMPROVEMENT AND RISK MANAGEMENT 256

Performance Improvement 256

Risk Management 258

UTILIZATION MANAGEMENT 262

Utilization Review Process 264

CONCLUSION 268

CHAPTER SUMMARY 269

CASE STUDY 269

REVIEW QUESTIONS 270

ENRICHMENT ACTIVITIES 270

WEBSITES 271

REFERENCES 271

NOTES 272

8 Health Statistics 273

Learning Objectives 27 3

Outline 27 3

Key Concepts 27 3

INTRODUCTION 274

OVERVIEW 27 5

Statistical Types 27 5

STATISTICAL LITERACY 278

Statistical Basics 280

Measures of Central Tendency 283
Other Mathematical Concepts 284
Data Collection 286
Statistical Formulas 289

Data Presentation 294

Regression Analysis 301

Regression Analysis Models 302

HEALTH INFORMATION MANAGEMENT STATISTICS 307

Productivity 307
Statistical Tools 309
Control Charts 31 0
Trend Charts 31 1
Process Capability Analysis 31 2

CONCLUSION 313
x Contents

CHAPTER SUMMARY 314

CASE STUDIES 314

REVIEW QUESTIONS 316

·ENRICHMENT ACTIVITIES 317

WEBSITES 319

REFERENCES 319

NOTES 319

9 Research 320
Learning Objectives 320

Outline 320

Key Concepts 320

INTRODUCTION 321

RESEARCH PRINCIPLES 322

Historical Overview 322

Methodology 323
Qualitative and Quantitative Research 324
Study Types 327

RESEARCH STUDY PROCESS 331

Research Design 331

Publication Process 334

INSTITUTIONAL REVIEW BOARDS 336

Historical Overview 337

Review Process 340

Review of Research on Animals 344

Emerging Trends 345

EPIDEMIOLOGY 347

Historical Overview 350

Epidemiological Basics 351

Disease Progression 352
Types of Epidemiology 354
Descriptive Epidemiology 354
Analytic and Experimental Epidemiology 355

CONCLUSION 356

CHAPTER SUMMARY 357

CASE STUDY 357

REVIEW QUESTIONS 357

ENRICHMENT ACTIVITIES 358

WEBSITES 358

REFERENCES 359

NOTES 359
 Contents xi

PART 3 TECHNOLOGY 361

10 Database Management 362

Learning Objectives 362

Outline 362

Key Concepts 362

INTRODUCTION 363

CONCEPTS AND FUNCTIONS 364

Database Design 367

Controls 370

Data Standards 370

Retrieval and Analysis Methods 375

DATA SETS 377

Health Care Databases 385

DATA EXCHANGE 386

State and Local Data Exchange Efforts 391

CONCLUSION 393

CHAPTER SUMMARY 394

CASE STUDY 394

REVIEW QUESTIONS 394

ENRICHMENT ACTIVITIES 395

WEBSITES 395

REFERENCES 396

NOTES 396

11 Information Systems and Technology 397

Learning Objectives 397

Outline 397

Key Concepts 397

INTRODUCTION 398

INFORMATION SYSTEMS 399

Computer Concepts 399

Hardware 399
Software 404
Assistive Technology 405
Units of Measure and Standards 405

Information Systems Life Cycle 406

Communication Technologies 409

Security 413
Hf PAA Security Rule 41 6
xii Contents

SYSTEMS ARCHITECTURE 420

Systems Architecture Specifics 420

FUTURE TRENDS 423

Data and Privacy 423

Digital Access 424

CONCLUSION 425

CHAPTER SUMMARY 425

CASE STUDY 425

REVIEW QUESTIONS 426

ENRICHMENT ACTIVITIES 426

WEBSITES 427

REFERENCES 427

NOTES 427

12 Informatics 428
Learning Objectives 428

Outline 428

Key Concepts 428

INTRODUCTION 429

OVERVIEW 429

ELECTRONIC HEALTH RECORDS 432

Promoting Interoperability and Meaningful Use 436

Legal Health Record 439

TECHNOLOGY APPLICATIONS AND TRENDS 441

Role of Social Media in Health Care 446

CONCLUSION 450

CHAPTER SUMMARY 451

CASE STUDY 451

REVIEW QUESTIONS 451

ENRICHMENT ACTIVITY 451

WEBSITES 452

REFERENCES 452

NOTES 452

PART 4 MANAGEMENT 455

13 Management Organization 456

Learning Objectives 456

Outline 456

Key Concepts 456

 Contents xiii

INTRODUCTION 457

PRINCIPLES OF MANAGEMENT 457

Planning 458
Strategic Planning 458
Management Planning 460
Operational Planning 461
Disaster Planning 462
Planning Tools 466

Organizing 468
Design and Structure 469
Organizing People 470
Organizing the Type of Work 474
Organizing Work Performance 475
Organizing the Work Environment 476

Directing 477
Decision Making 477
Instructing Others 478
Work Simplification 479

Controlling 480
Types of Controls 481
Setting Standards 481
Monitoring Performance 482

Leading 483
Motivating 484
Directing Others 486
Resolving Conflicts 486
Effective Communication 489

MANAGEMENT THEORIES 489

Historical Overview 489

Specialized Management Theories 491

Change Management 491
Project Management 493
Process Improvement 494
Knowledge Management 502
Effective Meeting Management 505

CONCLUSION 506

CHAPTER SUMMARY 506

CASE STUDY 507

REVIEW QUESTIONS 507

ENRICHMENT ACTIVITIES 507

WEBSITES 508

REFERENCES 508

NOTES 509
xiv Contents

14 Human Resource Management 510

Learning Objectives 510

Outline 510

Key Concepts 510

INTRODUCTION 511

EMPLOYMENT 511

STAFFING 517

Recruitment 517

Selection 518

Compensation 520

Orientation and Training 521

Retention 522

Separation 524

EMPLOYEE RIGHTS 525

Overview 525

Employment Law Application 529

Discrimination 529
Sex Discrimination 529
Racial, Religious, and National Origin Discrimination 530
Age Discrimination 531
Disability Discrimination 532
Genetic Discrimination 535
Workplace Protections 537
Health and Safety 537
Hours, Pay, and Conditions of Employment 538
Social Media 541

SUPERVISION 541

Performance Evaluations 542

Problem Behaviors 544

Discipline and Grievance 545

Developing Others 547

Career Development 547
Coaching 548
Mentoring 548

Team Building 549

Telework 550

WORKFORCE DIVERSITY 553

CONCLUSION 555

CHAPTER SUMMARY 555

CASE STUDY 556

REVIEW QUESTIONS 556

ENRICHMENT ACTIVITIES 556

WEBSITES 557
 Contents xv

REFERENCES 557

NOTES 557

15 Financial Management 559

Learning Objectives 559

Outline 559

Key Concepts 559

INTRODUCTION 560

OVERVIEW 560

ACCOUNTING 563

Managerial Accounting 563

Financial Accounting 566

BUDGETS 572

PROCUREMENT 575

Procurement Requests 579·

CONCLUSION 580

CHAPTER SUMMARY 581

CASE STUDY A 581

CASE STUDY B 581

REVIEW QUESTIONS 581

ENRICHMENT ACTIVITIES 582

WEBSITES 582

REFERENCES 582

16 Reimbursement Methodologies 583

Learning Objectives 583

Outline 583

Key Concepts 583

INTRODUCTION 584

THIRD-PARTY PAYERS 584

Governmental Payers 585

Nongovernmental Payers 587

Managed Care Organizations 590
Health Maintenance Organizations 592
Preferred and Exclusive Provider Organizations 593
Point-of-Service Plans 593
Integrated Delivery Systems 593
Health Insurance Exchanges 593

PAYMENT METHODOLOGIES ·595

Fee for Service 595

Prospective Payment Systems 597

Resource-Based Relative Value Systems 599

Capitation 599
xvi Contents

REVENUE CYCLE MANAGEMENT 602

CONCLUSION 605

CHAPTER SUMMARY 606

CASE STUDY A 606

CASE STUDY B 606

REVIEW QUESTIONS 606

ENRICHMENT ACTIVITIES 607

WEBSITES 607

REFERENCES 608

NOTES 608

APPENDICES
APPENDIX A: Common HIM Abbreviations 609
APP ENDIX B: Web Resources by Subject Matter 618
APP ENDIX C: Sample HIPPA Notices of Privacy Practices 627
APP ENDIX D: Selected Laws Affecting HIM 648
APP ENDIX E: Selected HIPAA Regulations 650
Glossary 727
Index 760
 PREFACE

·� - :....
:t'*'
:
. • ,·

�" � : ::

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
professional play s 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 management discipline and does
not presume that the learner is already versed in the subject matter. The text is designed to
incorporate the model curriculum of the American Health Information Management Association for
both the health information administrator 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. Instructors
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 management, and as a research tool for other allied
health and medical disciplines.
Although this text is intended to be comprehensive, one textbook could not possibly
encompass all the details of the broad discipline of health information management. Long past is
the time when one textbook could cover all matters and issues associated 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 y ears.
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 applicable, five areas that are significant to health information management: the American
Recovery and Reinvestment Act (ARRA), including HITECH; the Health Insurance Portability and
Accountability Act (HIPAA); the Genetic Information Nondiscrimination Act (GINA); ethics,· and
informatics. This approach is taken so that while the student is learning the substantive matter, the
student can also understand the interplay between these areas and the substantive matter. Boxes
for each of these five areas are found near the text d{scussion 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:

xvii
xviii Preface

Part 1 serves as an introduction to health information management. 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 followed 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, 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 five
chapters and begins with a discussion 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 discussion
of trends completes the chapter. Quality management, performance ·improvement, risk
management, and utilization management form the basis of the next chapter. H ealth statistics
is the focus of the next chapter, addressing statistical literacy in general, and regression analysis
and H IM statistics in particular. Research issues complete the unit, with sections addressing
research principles, the research study process, 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 concepts
and functions, data sets, and data exchange efforts. Information systems and technology is
the subject of the next chapter, including a discussion of various information systems, systems
architecture, and future trends in IT. Informatics completes the unit, with sections addressing
electronic health records, interoperability, and technological applications and trends, including
the role of social media in health care.
Part 4 serves as an overview of management issues. This L!nit 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 ( R H IA) and registered health information technicians ( R H IT).
I make this choice consciously, because the experience of the health information management
profession during the last three decades has shown that professionals at both levels hold a
variety of positions 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. 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:

Critical Thinking exercises that pose questions designed to stretch the reader's analytical skills
Text alerts highlight issues related to A R RA, H I PAA, GINA, ethics, and informatics throughout
the subject matter as appropriate
Learning objectives
 Preface xix

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 to real-world situations
Confirm & Clarify Understanding exercises designed to reinforce essential concepts presented
in the textbook
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 ofterms

A list of abbreviations commonly used in HIM
Web site resources, organized by subject matter and in alphabetical order
Sample H I PAA privacy notices
A table of selected federal laws applicable to H I M
Selected H IPAA regulations

NEW TO THE THIRD EDITION

Revised chapter content meets CAH llM standards and competencies for accreditation and
reflect the latest trends in health care.
Feature boxes call for the use of critical thinking skills to answer questions that cause the reader
to apply the text material to real world situations. Suggested answers to each Critical Thinking
exercises are provided in the Instructor Manua.1 for use in stimulating class discussion.
Confirm & Clarify Understanding exercises in every chapter are designed to reinforce essential
concepts presented in the textbook. Exercises include acronym review, True & False questions,
multiple choice questions, and matching pair review. Answers to these exercises are provided
in the Instructor Manual.
Substantial revision to Chapter 2, The Health Information Management Profession, reflects
changes to the profession, addresses how knowing the flow of data influences HIM and its
future, and includes a revised careers section.
Substantial revision to Chapter 6, Nomenclatures and Classification Systems, incorporates
experience with ICD-10, the interplay of ethics with the coding function, and includes an
updated explanation of various coding systems.
Substantial revision to Chapter 10, Database Management, incorporates a discussion of scaling
solutions to address the large size of databases and their proliferation, updates to the discussion
of data sets, new material on health care data sets, and updates regarding data exchange.
Substantial revision to Chapter 11, Information Systems and Technology, incorporates material
on new trends affecting IT - Data and privacy: blockchain, CRIS P R, nanobots, nanomedicine,
satellite modems; digital divide and digital literacy; and the use of assistive technology.
Substantial revision to Chapter 12, Informatics, addresses the promoting of interoperability as
the natural progression from meaningful use, the role of de-identified data in interoperability,
and technology trends including the digital divide as it applies to telemedicine.
Revisions to other chapters include an explanation of the European General Data Protection
Regulation and the California Consumer Privacy Act in Chapter 3 , Legal Issues; discussion
of the strengthening of patient rights in the home health care context in Chapter 4, Ethical
Standards; new material on information governance in Chapter 5 , Health Care Data Content
and Structures, and Chapter 12, Informatics; and new material on the use of data dashboards
as part of data presentation discussion in Chapter 8, Health Statistics.
 xx Preface

INSTRUCTOR AND STUDENT COMPANION SITES

Additional instructor and student resources for this product are available through an online
companion site. Instructor assets include an Instructor's Manual, Power Point® slides, and a test
bank powered by Cognero®. Student assets include the American Hospital Association's Patient
Care Partnership. Sign up or sign in at www.cengage.com to search for and access this product
and its online resources.
The Instructor's Manual provides answer keys for the Review Questions and Confirm & Clarify
Understanding exercises in the text; a curriculum crosswalk for each chapter with links to the
AHIMA domains, curricular competencies, and guidance; a summary of each chapter; suggested
responses for the Critical Thinking exercises; and additional Enrichment Activities. Materials
involving recent changes to patient access to the patient's health information found in the 21st
Century Cures Act and additional changes to H I PAA regulations are addressed in selected chapters
of the Instructor Manual.

ACKNOWLEDGMENTS
Many persons have played a role in the creation of this textbook, including family, friends, and
colleagues. A special thank you is warranted for my family, who showed patience, understanding,
and support for the long hours spent on this, my second 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, R H IA , and Patt
Petersen, MA, R H IA, 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 strengthening this text.

Dana C. McWay, JD, R HIA

CONTRIBUTORS

I The author and publisher would like to acknowledge the following health information management
educators for their contributions to the content of this text:
I Sharon Farley, R H IA
Contributing material to Chapter 7

Patt Peterson, MA, RH IA

Contributing material to Chapter 8

ABOUT THE AUTHOR

Dana C. McWay, JD, RHIA, is both a lawyer and a health information 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.
Dana 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

I •
 Preface xxi

electronic case filing system, resulting in widespread acceptance by end users. This success led to
her appointment as member and, later, chair of the Case Management/Electronic Case Filing (CM/
EC F) Working Group, an entity within the federal judiciary responsible for providing guidance and
assistance in all phases of the development of bankruptcy CM/ ECF software releases. She serves
on numerous national committees and working groups within the federal judiciary, including those
involved in identifying the impact of new legislation upon judicial operations and those involved
in advising on the education and training needs of court staff. Prior to this position, 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.
Dana began her legal career as a judicial law clerk to the Honorable Myron H. Bright of the U. S .
Court o f Appeals for the Eighth Circuit. She then became a n associate with the law firm o f Peper,
Martin, Jensen, Maichel, & Hetlage, a multi-specialty firm located in St. Louis, Missouri. Dana'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, Dana worked in health information management as both a director
and assistant director of medical records in a large teaching hospital and a for-profit psychiatric
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 (MO H I MA) and as a
member of MO H I MA's Legislative Committee. On the national level, she served as a director on the
Board of Directors of A H I MA and has served as faculty for A HIMA continuing education seminars, a
peer reviewer of A HIMA book proposals 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 Professional Development and the Triumph Awards Committee of AH I MA.
Dana is both an author and an editor. Her textbook, Legal and Ethical Aspects of Health
Information Management, is in its fifth edition. With the Peper Martin law firm, she revised The
Legal Manual to Medical Record Practice in Missouri in 199 1. She has authored numerous other
publications and served as co-editor 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 serves as a professional practice experience
site coordinator for health information management students and currently serves on the Advisory
Boards of two Health Information Management academic programs. She has served as an
adjunct faculty member in the Master's of Health Informatics at Saint Louis University and Logan
University; at the Law School of Saint Louis University, and in the PreLaw Studies program at Saint
Louis University, and as a guest lecturer at several area colleges and universities, focusing on the
intersection of legal issues and health care practices.
Dana is a magna cum laude graduate of the Saint Louis University School of Allied H ealth
Professions, with a degree in medical record administration, and a cum laude graduate of the Saint
Louis University School of Law. While in law school, Dana served as the health law editor of the
Saint Louis University Law Journal 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 has received the Missouri Health Information Management
Association's Distinguished Member and Outstanding Volunteer Awards. She is the recipient of the
Director's Award for O utstanding Leadership to the federal judiciary and the Director's Award for
Excellence in Operations- Mission Requirements.
 . -- , ! . ..,' , . . , i.F ))j) � � '•• ,.,_.I�- ...
���
• ' .
�-:!.t'
_:_ ...
·-u• • -

•
. !.nL"t;.. """
�- .... ' ..'' ! ·-ua . :::
• • • • • •
- •
·
...;c:...r:.
i\- �._. ..., ..:i • -
�;F ::��.:2
• .i � •
___ • •
• :. � -i: ,' ' - "•o I
- .•
'
---
• • ' '91 ' ...
.
:::: ::: -:- .
•

..
• • • ' •

;,_- . I
. .
"
.....
•
• .
: : : �
·.

� ...
_ . '
• • • • • • �i_,...,�--·-T�� :::E �-�.- �
. -
,:!!.

HOW TO USE THE TEXTBOOK

. ..
.
�; ....---.
.,. _;.
. . ...
,....
.
• •
•

•
•

•
•
.
•

• •'•.,
I.
.. ::_.:..
.·
.• '�
�
f
• �''.ii:°t�'.-
--� ;�·��. � . :·:;
. �.,,-... -
-
• • • • •
•.
..-.
...,� ,
•
. . ' '-.:
',,

.-. - '" .:�

"11�'.
m-r
.

• • -
&.-;. . • • • �
CHAPTER

NOMENCLATURES AND
© CLASSIFICATION SYSTEMS
Learning Objectives at the
beginning of each chapter list
After reading this chapter, the learner should be able to: the theoretical and practical
1. Differentiate between the terms medical language, vocabulary, and
nomendature. goals of the chapter.
2. List nomenclatures that are prominent in the health information
management field.

3. Understand the goal of the Unified Medical Language System.

4. List and explain the three Knowledge Sources of the Unified Medical
The Outline lists major headings
Language System.

5. Identify the major classification systems Currently in use.

to provide a roadmap for the
6. Understand how the introduction of the prospective payment system and
diagnosis�related groups affected the health information management chapter content. Important
field.

7. Describe the concept of case mix management. terms, ideas, and acronyms are
Identify the impact of technology upon the coding function.
presented in the Key Concepts
8.

Languages, Vocabularies, and HIM Transformation

list, and they are highlighted
Nomenclatures Other Classification and Coding
Nomenclature Development Systems the first time they appear in the
Trends
Classification Systems

History and Application of

chapter content.
Classification Systems

Critical Thinking exercises, Confirm

&
Coding Eponyms

ABC codes
Coding compliance Evaluation Clarify Understanding exercises,
program General equivalency
Case mix
Case mix index
Compliance
CPT
mappings
Groupers
Enrichment Activities, and Case Studies
Case mix management
CDT
Data mapping
Dataset
HCPCS
Health care fraud and
provide opportun1t1es to use critical
Classification systems
DiagnosiHelated abuse
Clinical data representation
group ICD thinking skills to reflect on the material and
Clinical terminology
DSM-V ICD-0-3
Clinical vocabulary
Encoders ICD-9-CM relate the concepts to real-life situations.
203

You are eating lunch in the hospital's cafeteria and a woman sits down
next to you and starts to cry. She turns to you unexpectedly and tells
you that her husband is dying and she has been asked to remove life
support. You are vehemently opposed to withdrawing life support.
What would you say to her?

CONFIRM & CLARIFY UNDERSTANDING Acronym Review

Write out the foll

1. Visit the Web site of the American Health Information Management
1. PSDA:
2.
Association, https://www.ahima.org, to search for information
HIPAA:
about position statements or practice·briefs that they have issued.
3. HIV:
Write a short summary of one position statement or practice brief
4. AIDS:
for your instructor. Alternatively, research student membership
5. HGP:
opportunities-including benefits and rates-using the same
6. DNR: Web site. If you are already a student member of AHliylA, join the
student member community of practice offered on the same Web
site and explore its offerin s includin the student newsletter.

2. Review the job listi You are a health information manager in a financially troubled acute

newspaper or an o care hospital, responsible for coding functions. The hospital's admin­
com, https://www. istration has retained an independent consultant who has promised to

com. Identify whic increase the hospital's financial reimbursement under Medicare. The
of the hea Ith infor consultant recommends that your staff be more aggressive in apply­

outside the traditio ing diagnostic codes in order to elevate reimbursement. Furthermore,
your ambitions for the consultant shares with you methods that can be used to avoid
detection of the aggressive coding scheme. You believe this more
aggressive approach is, at minimum, inappropriate-and at worst,
illegal. You have further learned that the consultant's fee is based in
large measure on a percentage of the hospital's increased reimburse­
ment under Medicare. Identify the ethical challenge and discuss how
you would handle this situation.

xxiii
 xxiv How to Use the Textbook

CHAPTER
This chapter focuses on the role of data in the health care field.
SUMMARY
The different types of data, the uses to which these data are put,
and the number of data users seem to grow every passing year.
Accompanying this gr ' -------------------------
REVIEW
1. How can one distinguish between legal and ethical issues?

I
from a paper-based sy QUESTIONS
that relies upon electr
2. Identify the strengths and weaknesses of utilitarianism.
the design and control
and destroyed. Mainta 3. Identify the strengths and weaknesses of deontology.
of the health informati
I plished through the us 4. What does a profession's code of ethics signify to the broader
implementation of ele community?
importance of the ma
5. Compare the steps typically taken in the ethical decision-making
process shown in Table 4-2 with the additional steps listed in the
last section of the text.

6. Why should health care providers be aware of bioethical issues?

7. What three significant ethical challenges are often encountered in

At the end of each chapter, the workplace? ·

reinforce your understanding 8. Name the three direct ethical roles that supervisors play in
organizations.
of the covered concepts
using the Summary and 9. What are the most frequent ethical challenges in health
,I' information management?
Review Questions.
10. How can health information managers experience ethical
challenges from third parties?
I

The book highlights the interplay of informatics, ethics, the Health Insurance Portability and
Accountability Act (HIPAA), American Recovery & Reimbursement Act (ARRA), and Genetic
Information Nondiscrimination Act (GINA) with the subject matter of each chapter in special
boxes.

l
Health care informatics differs from health information management in INFORMATICS
that informatics focuses primarily on the use of technology to support
data, whereas HIM focuses primarily on the quality and content of the
data itself.

Compliance programs may be grounded in an ethics-based approach. ETHICS

1I
The Security Rule establishes security safeguards for protected health
information (PHI) that a covered entity creates, receives, maintains, or
transmits in an electronic format.

The Genetic Information Nondiscrimination Act addresses confidentiality GINA

of genetic information.

Provisions of the American Recovery and Reinvestment Act of 2009

require the executive branch to report to Congress on compliance with
the act.
PART

INTRODUCTION TO
HEALTH INFORMATION
MANAGEMENT

1 Health Care Deliv.ery Systems

2 The Health Information Management

Profession

3 Legal Issues

4 Ethical Standards
Discovering Diverse Content Through
Random Scribd Documents
Binhart himself very well knew; and knowing that, he
would continue to move as he had been moving, with
the utmost secrecy, or at least protected by some
adequate disguise.

It would be from the underworld that the echo would [84]

come. And next to New York, Blake knew, Chicago
would make as good a central exchange for this
underworld as could be desired. Knowing that city of the
Middle West, and knowing it well, he at once “went
down the line,” making his rounds stolidly and
systematically, first visiting a West Side faro-room and
casually interviewing the “stools” of Custom House Place
and South Clark Street, and then dropping in at the Café
Acropolis, in Halsted Street, and lodging houses in even
less savory quarters. He duly canvassed every likely
dive, every “melina,” every gambling house and yegg
hang out. He engaged in leisurely games of pool with
stone-getters and gopher men. He visited bucket-shops
and barrooms, and dingy little Ghetto cafés. He
“buzzed” tipsters and floaters and mouthpieces. He
fraternized with till tappers and single-drillers. He
always made his inquiries after Binhart seem accidental,
a case apparently subsidiary to two or three others
which he kept always to the foreground.

He did not despair over the discovery that no one [85]

seemed to know of Binhart or his movements. He
merely waited his time, and extended new ramifications
into newer territory. His word still carried its weight of
official authority. There was still an army of obsequious
underlings compelled to respect his wishes. It was
merely a matter of time and mathematics. Then the law
of averages would ordain its end; the needed card
would ultimately be turned up, the right dial-twist would
at last complete the right combination.
The first faint glimmer of life, in all those seemingly
dead wires, came from a gambler named Mattie
Sherwin, who reported that he had met Binhart, two
weeks before, in the café of the Brown Palace in Denver.
He was traveling under the name of Bannerman, wore
his hair in a pomadour, and had grown a beard.

Blake took the first train out of Chicago for Denver. In [86]
this latter city an Elks’ Convention was supplying blue-
bird weather for underground “haymakers,” busy with
bunco-steering, “rushing” street-cars and “lifting
leathers.” Before the stampede at the news of his
approach, he picked up Biff Edwards and Lefty Stivers,
put on the screws, and learned nothing. He went next
to Glory McShane, a Market Street acquaintance
indebted for certain old favors, and from her, too,
learned nothing of moment. He continued the quest in
other quarters, and the results were equally
discouraging.

Then began the real detective work about which, Blake

knew, newspaper stories were seldom written. This
work involved a laborious and monotonous examination
of hotel registers, a canvassing of ticket agencies and
cab stands and transfer companies. It was anything but
story-book sleuthing. It was a dispiriting tread-mill
round, but he was still sifting doggedly through the
tailings of possibilities when a code-wire came from St.
Louis, saying Binhart had been seen the day before at
the Planters’ Hotel.

Blake was eastbound on his way to St. Louis one hour [87]
after the receipt of this wire. And an hour after his
arrival in St. Louis he was engaged in an apparently
care free and leisurely game of pool with one Loony
Ryan, an old-time “box man” who was allowed to roam
with a clipped wing in the form of a suspended
indictment. Loony, for the liberty thus doled out to him,
rewarded his benefactors by an occasional indulgence in
the “pigeon-act.”

“Draw for lead?” asked Blake, lighting a cigar.

“Sure,” said Loony.

Blake pushed his ball to the top cushion, won the draw,
and broke.

“Seen anything of Wolf Yonkholm?” he casually inquired,

as he turned to chalk his cue. But his eye, with one
quick sweep, had made sure of every face in the room.

Loony studied the balls for a second or two. Wolf was a

“dip” with an international record.

“Last time I saw Wolf he was out at ’Frisco, workin’ the

Beaches,” was Loony’s reply.

Blake ventured an inquiry or two about other worthies [88]

of the underworld. The players went on with their
game, placid, self-immured, matter-of-fact.

“Where’s Angel McGlory these days?” asked Blake, as he

reached over to place a ball.

“What’s she been doin’?” demanded Loony, with his cue

on the rail.

“She’s traveling with a bank sneak named Blanchard or

Binhart,” explained Blake. “And I want her.”

Loony Ryan made his stroke.

“Hep Roony saw Binhart this mornin’, beatin’ it for N’
Orleans. But he wasn’t travelin’ wit’ any moll that Hep
spoke of.”

Blake made his shot, chalked his cue again, and glanced
down at his watch. His eyes were on the green baize,
but his thoughts were elsewhere.

“I got ’o leave you, Wolf,” he announced as he put his

cue back in the rack. He spoke slowly and calmly. But
Wolf’s quick gaze circled the room, promptly checking
over every face between the four walls.

“What’s up?” he demanded. “Who’d you spot?”

“Nothing, Wolf, nothing! But this game o’ yours blamed [89]

near made me forget an appointment o’ mine!”

Twenty minutes after he had left the bewildered Wolf

Ryan in the pool parlor he was in a New Orleans sleeper,
southward bound. He knew that he was getting within
striking distance of Binhart, at last. The zest of the
chase took possession of him. The trail was no longer a
“cold” one. He knew which way Binhart was headed.
And he knew he was not more than a day behind his
man.

[90]
 VI

The moment Blake arrived in New Orleans he shut

himself in a telephone booth, called up six somewhat
startled acquaintances, learned nothing to his
advantage, and went quickly but quietly to the St.
Charles. There he closeted himself with two dependable
“elbows,” started his detectives on a round of the
hotels, and himself repaired to the Levee district, where
he held off-handed and ponderously facetious
conversations with certain unsavory characters. Then
came a visit to certain equally unsavory wharf-rats and
a call or two on South Rampart Street. But still no
inkling of Binhart or his intended movements came to
the detective’s ears.

It was not until the next morning, as he stepped into [91]

Antoine’s, on St. Louis Street just off the Rue Royal, that
anything of importance occurred. The moment he
entered that bare and cloistral restaurant where
Monsieur Jules could dish up such startling uncloistral
dishes, his eyes fell on Abe Sheiner, a drum snuffer with
whom he had had previous and somewhat painful
encounters. Sheiner, it was plain to see, was in clover,
for he was breakfasting regally, on squares of toast
covered with shrimp and picked crab meat creamed,
with a bisque of cray-fish and papa-bottes in ribbons of
bacon, to say nothing of fruit and bruilleau.
Blake insisted on joining his old friend Sheiner, much to
the latter’s secret discomfiture. It was obvious that the
drum snuffer, having made a recent haul, would be
amenable to persuasion. And, like all yeggs, he was an
upholder of the “moccasin telegraph,” a wanderer and a
carrier of stray tidings as to the movements of others
along the undergrooves of the world. So while Blake
breakfasted on shrimp and crab meat and French
artichokes stuffed with caviar and anchovies, he
intimated to the uneasy-minded Sheiner certain
knowledge as to a certain recent coup. In the face of
this charge Sheiner indignantly claimed that he had only
been playing the ponies and having a run of greenhorn’s
luck.

“Abe, I’ve come down to gather you in,” announced the [92]
calmly mendacious detective. He continued to sip his
bruilleau with fraternal unconcern.

“You got nothing on me, Jim,” protested the other,

losing his taste for the delicacies arrayed about him.

“Well, we got ’o go down to Headquarters and talk that

over,” calmly persisted Blake.

“What’s the use of pounding me, when I’m on the

square again?” persisted the ex-drum snuffer.

“That’s the line o’ talk they all hand out. That’s what
Connie Binhart said when we had it out up in St. Louis.”

“Did you bump into Binhart in St. Louis?”

“We had a talk, three days ago.”

“Then why’d he blow through this town as though he

had a regiment o’ bulls and singed cats behind him!”
Blake’s heart went down like an elevator with a broken [93]
cable. But he gave no outward sign of this inward
commotion.

“Because he wants to get down to Colon before the

Hamburg-American boat hits the port,” ventured Blake.
“His moll’s aboard!”

“But he blew out for ’Frisco this morning,” contended

the puzzled Sheiner. “Shot through as though he’d just
had a rumble!”

“Oh, he said that, but he went south, all right.”

“Then he went in an oyster sloop. There’s nothing

sailing from this port to-day.”

“Well, what’s Binhart got to do with our trouble anyway?

What I want—”

“But I saw him start,” persisted the other. “He ducked

for a day coach and said he was traveling for his health.
And he sure looked like a man in a hurry!”

Blake sipped his bruilleau, glanced casually at his watch, [94]

and took out a cigar and lighted it. He blinked
contentedly across the table at the man he was
“buzzing.” The trick had been turned. The word had
been given. He knew that Binhart was headed westward
again. He also knew that Binhart had awakened to the
fact that he was being followed, that his feverish
movements were born of a stampeding fear of capture.

Yet Binhart was not a coward. Flight, in fact, was his

only resource. It was only the low-brow criminal, Blake
knew, who ran for a hole and hid in it until he was
dragged out. The more intellectual type of offender
preferred the open. And Binhart was of this type. He
was suave and artful; he was active bodied and
experienced in the ways of the world. What counted still
more, he was well heeled with money. Just how much
he had planted away after the Newcomb coup no one
knew. But no one denied that it was a fortune. It was
ten to one that Binhart would now try to get out of the
country. He would make his way to some territory
without an extradition treaty. He would look for a land
where he could live in peace, where his ill-gotten wealth
would make exile endurable.

Blake, as he smoked his cigar and turned these [95]

thoughts over in his mind, could afford to smile. There
would be no peace and no rest for Connie Binhart; he
himself would see to that. And he would “get” his man;
whether it was in a week’s time or a month’s time, he
would “get” his man and take him back in triumph to
New York. He would show Copeland and the
Commissioner and the world in general that there was
still a little life in the old dog, that there was still a haul
or two he could make.

So engrossing were these thoughts that Blake scarcely

heard the drum snuffer across the table from him,
protesting the innocence of his ways and the purity of
his intentions. Then for the second time that morning
Blake completely bewildered him, by suddenly accepting
those protestations and agreeing to let everything drop.
It was necessary, of course, to warn Sheiner, to exact a
promise of better living. But Blake’s interest in the man
had already departed. He dropped him from his scheme
of things, once he had yielded up his data. He tossed
him aside like a sucked orange, a smoked cigar, a burnt-
out match. Binhart, in all the movements of all the
stellar system, was the one name and the one man that
interested him.

Loony Sheiner was still sitting at that table in Antoine’s [96]

when Blake, having wired his messages to San Pedro
and San Francisco, caught the first train out of New
Orleans. As he sped across the face of the world,
crawling nearer and nearer the Pacific Coast, no thought
of the magnitude of that journey oppressed him. His
imagination remained untouched. He neither fretted nor
fumed at the time this travel was taking. In spite of the
electric fans at each end of his Pullman, it is true, he
suffered greatly from the heat, especially during the ride
across the Arizona Desert. He accepted it without
complaint, stolidly thanking his lucky stars that men
weren’t still traveling across America’s deserts by ox-
team. He was glad when he reached the Colorado River
and wound up into California, leaving the alkali and
sage brush and yucca palms of the Mojave well behind
him. He was glad in his placid way when he reached his
hotel in San Francisco and washed the grit and grime
from his heat-nettled body.

But once that body had been bathed and fed, he started [97]
on his rounds of the underworld, seined the entire
harbor-front without effect, and then set out his night-
lines as cautiously as a fisherman in forbidden waters.
He did not overlook the shipping offices and railway
stations, neither did he neglect the hotels and ferries.
Then he quietly lunched at Martenelli’s with the much-
honored but most-uncomfortable Wolf Yonkholm, who
promptly suspended his “dip” operations at the Beaches
out of respect to Blake’s sudden call.

Nothing of moment, however, was learned from the [98]

startled Wolf, and at Coppa’s six hours later, Blake dined
with a Chink-smuggler named Goldie Hopper. Goldie,
after his fifth glass of wine and an adroit decoying of
the talk along the channels which most interested his
portly host, casually announced that an Eastern crook
named Blanchard had got away, the day before, on the
Pacific mail steamer Manchuria. He was clean shaven
and traveled as a clergyman. That struck Goldie as the
height of humor, a bank sneak having the nerve to deck
himself out as a gospel-spieler.

His elucidation of it, however, brought no answering

smile from the diffident-eyed Blake, who confessed that
he was rounding up a couple of nickel-coiners and
would be going East in a day or two.

Instead of going East, however, he hurriedly consulted

maps and timetables, found a train that would land him
in Portland in twenty-six hours, and started north. He
could eventually save time, he found, by hastening on
to Seattle and catching a Great Northern steamer from
that port. When a hot-box held his train up for over half
an hour, Blake stood with his timepiece in his hand,
watching the train crew in their efforts to “freeze the
hub.” They continued to lose time, during the night. At
Seattle, when he reached the Great Northern docks, he
found that his steamer had sailed two hours before he
stepped from his sleeper.

His one remaining resource was a Canadian Pacific [99]

steamer from Victoria. This, he figured out, would get
him to Hong Kong even earlier than the steamer which
he had already missed. He had a hunch that Hong Kong
was the port he wanted. Just why, he could not explain.
But he felt sure that Binhart would not drop off at
Manila. Once on the run, he would keep out of
American quarters. It was a gamble; it was a rough
guess. But then all life was that. And Blake had a
dogged and inarticulate faith in his “hunches.”

Crossing the Sound, he reached Victoria in time to see

the Empress of China under way, and heading out to
sea. Blake hired a tug and overtook her. He reached the
steamer’s deck by means of a Jacob’s ladder that swung
along her side plates like a mason’s plumbline along a
factory wall.

Binhart, he told himself, was by this time in mid-Pacific, [100]

untold miles away, heading for that vast and mysterious
East into which a man could so easily disappear. He was
approaching gloomy and tangled waterways that
threaded between islands which could not even be
counted. He was fleeing towards dark rivers which led
off through barbaric and mysterious silence, into the
heart of darkness. He was drawing nearer and nearer to
those regions of mystery where a white man might be
swallowed up as easily as a rice grain is lost in a shore
lagoon. He would soon be in those teeming alien cities
as under-burrowed as a gopher village.

But Blake did not despair. Their whole barbaric East, he [101]
told himself, was only a Chinatown slum on a large
scale. And he had never yet seen the slum that
remained forever impervious to the right dragnet. He
did not know how or where the end would be. But he
knew there would be an end. He still hugged to his
bosom the placid conviction that the world was small,
that somewhere along the frontiers of watchfulness the
impact would be recorded and the alarm would be
given. A man of Binhart’s type, with the money Binhart
had, would never divorce himself completely from
civilization. He would always crave a white man’s world;
he would always hunger for what that world stood for
and represented. He would always creep back to it. He
might hide in his heathen burrow, for a time; but there
would be a limit to that exile. A power stronger than his
own will would drive him back to his own land, back to
civilization. And civilization, to Blake, was merely a
rather large and rambling house equipped with a rather
efficient burglar-alarm system, so that each time it was
entered, early or late, the tell-tale summons would
eventually go to the right quarter. And when the
summons came Blake would be waiting for it.

[102]
 VII

It was by wireless that Blake made what efforts he

could to confirm his suspicions that Binhart had not
dropped off at any port of call between San Francisco
and Hong Kong. In due time the reply came back to
“Bishop MacKishnie,” on board the westbound Empress
of China that the Reverend Caleb Simpson had safely
landed from the Manchuria at Hong Kong, and was
about to leave for the mission field in the interior.

The so-called bishop, sitting in the wireless-room of the

Empress of China, with a lacerated black cigar between
his teeth, received this much relayed message with
mixed feelings. He proceeded to send out three Secret
Service code-despatches to Shanghai, Amoy and Hong
Kong, which, being picked up by a German cruiser, were
worried over and argued over and finally referred back
to an intelligence bureau for explanation.

But at Yokohama, Blake hurried ashore in a sampan, [103]

met an agent who seemed to be awaiting him, and
caught a train for Kobe. He hurried on, indifferent to the
beauties of the country through which he wound,
unimpressed by the oddities of the civilization with
which he found himself confronted. His mind, intent on
one thing, seemed unable to react to the stimuli of side-
issues. From Kobe he caught a Toyo Kisen Kaisha
steamer for Nagasaki and Shanghai. This steamer, he
found, lay over at the former port for thirteen hours, so
he shifted again to an outbound boat headed for
Woosung.

It was not until he was on the tender, making the hour-

long run from Woosung up the Whangpoo to Shanghai
itself, that he seemed to emerge from his half-cataleptic
indifference to his environment. He began to realize that
he was at last in the Orient.

As they wound up the river past sharp-nosed and [104]

round-hooded sampans, and archaic Chinese battle-
ships and sea-going junks and gunboats flying their
unknown foreign flags, Blake at last began to realize
that he was in a new world. The very air smelt exotic;
the very colors, the tints of the sails, the hues of
clothing, the forms of things, land and sky itself—all
were different. This depressed him only vaguely. He was
too intent on the future, on the task before him, to give
his surroundings much thought.

Blake had entirely shaken off this vague uneasiness, in

fact, when twenty minutes after landing he found
himself in a red-brick hotel known as The Astor, and
guardedly shaking hands with an incredulously thin and
sallow-faced man of about forty. Although this man
spoke with an English accent and exile seemed to have
foreigneered him in both appearance and outlook, his
knowledge of America was active and intimate. He
passed over to the detective two despatches in cipher,
handed him a confidential list of Hong Kong addresses,
gave him certain information as to Macao, and an hour
later conducted him down the river to the steamer
which started that night for Hong Kong.
As Blake trod that steamer’s deck and plowed on [105]
through strange seas, surrounded by strange faces,
intent on his strange chase, no sense of vast adventure
entered his soul. No appreciation of a great hazard
bewildered his emotions. The kingdom of romance
dwells in the heart, in the heart roomy enough to house
it. And Blake’s heart was taken up with more material
things. He was preoccupied with his new list of
addresses, with his new lines of procedure, with the
men he must interview and the dives and clubs and
bazars he must visit. He had his day’s work to do, and
he intended to do it.

The result was that of Hong Kong he carried away no [106]

immediate personal impression, beyond a vague jumble,
in the background of consciousness, of Buddhist
temples and British red-jackets, of stately parks and
granite buildings, of mixed nationalities and native
theaters, of anchored warships and a floating city of
houseboats. For it was the same hour that he landed in
this orderly and strangely English city that the discovery
he was drawing close to Binhart again swept clean the
slate of his emotions. The response had come from a
consulate secretary. One wire in all his sentinel network
had proved a live one. Binhart was not in Hong Kong,
but he had been seen in Macao; he was known to be
still there. And beyond that there was little that Never-
Fail Blake cared to know.

His one side-movement in Hong Kong was to purchase

an American revolver, for it began to percolate even
through his indurated sensibilities that he was at last in
a land where his name might not be sufficiently
respected and his office sufficiently honored. For the
first time in seven long years he packed a gun, he
condescended to go heeled. Yet no minutest tingle of
excitement spread through his lethargic body as he
examined this gun, carefully loaded it, and stowed it
away in his wallet-pocket. It meant no more to him than
the stowing away of a sandwich against the emergency
of a possible lost meal.

[107]
 VIII

By the time he was on the noon boat that left for

Macao, Blake had quite forgotten about the revolver. As
he steamed southward over smooth seas, threading a
way through boulder-strewn islands and skirting
mountainous cliffs, his movements seemed to take on a
sense of finality. He stood at the rail, watching the hazy
blue islands, the forests of fishing-boats and high-
pooped junks floating lazily at anchor, the indolent
figures which he could catch glimpses of on deck, the
green waters of the China Sea. He watched them with
intent, yet abstracted, eyes. Some echo of the witchery
of those Eastern waters at times penetrated his own
preoccupied soul. A vague sense of his remoteness from
his old life at last crept in to him.

He thought of the watching green lights that were [108]

flaring up, dusk by dusk, in the shrill New York night,
the lamps of the precinct stations, the lamps of
Headquarters, where the great building was full of
moving feet and shifting faces, where telephones were
ringing and detectives were coming and going, and
policemen in uniform were passing up and down the
great stone steps, clean-cut, ruddy-faced, strong-limbed
policemen, talking and laughing as they started out on
their night details. He could follow them as they went,
those confident-striding “flatties” with their ash night-
sticks at their side, soldiers without bugles or banner,
going out to do the goodly tasks of the Law, soldiers of
whom he was once the leader, the pride, the man to
whom they pointed as the Vidoc of America.

And he would go back to them as great as ever. He

would again compel their admiration. The newspaper
boys would again come filing into his office and shake
hands with him and smoke his cigars and ask how much
he could tell them about his last haul. And he would
recount to them how he shadowed Binhart half way
round the world, and gathered him in, and brought him
back to Justice.

It was three o’clock in the afternoon when Blake’s [109]

steamer drew near Macao. Against a background of dim
blue hills he could make out the green and blue and
white of the houses in the Portuguese quarters, guarded
on one side by a lighthouse and on the other by a stolid
square fort. Swinging around a sharp point, the boat
entered the inner harbor, crowded with Chinese craft
and coasters and dingy tramps of the sea.

Blake seemed in no hurry to disembark. The sampan

into which he stepped, in fact, did not creep up to the
shore until evening. There, ignoring the rickshaw coolies
who awaited him as he passed an obnoxiously officious
trio of customs officers, he disappeared up one of the
narrow and slippery side streets of the Chinese quarter.

He followed this street for some distance, assailed by [110]

the smell of its mud and rotting sewerage, twisting and
turning deeper into the darkness, past dogs and
chattering coolies and oil lamps and gaming-house
doors. Into one of these gaming houses he turned,
passing through the blackwood sliding door and
climbing the narrow stairway to the floor above. There,
from a small quadrangular gallery, he could look down
on the “well” of the fan-tan lay out below.

He made his way to a seat at the rail, took out a cigar,

lighted it, and let his veiled gaze wander about the
place, point by point, until he had inspected and
weighed and appraised every man in the building. He
continued to smoke, listlessly, like a sightseer with time
on his hands and in no mood for movement. The brim
of his black boulder shadowed his eyes. His thumbs
rested carelessly in the arm-holes of his waistcoat. He
lounged back torpidly, listening to the drone and clatter
of voices below, lazily inspecting each newcomer,
pretending to drop off into a doze of ennui. But all the
while he was most acutely awake.

For somewhere in that gathering, he knew, there was a [111]

messenger awaiting him. Whether he was English or
Portuguese, white or yellow, Blake could not say. But
from some one there some word or signal was to come.

He peered down at the few white men in the pit below.

He watched the man at the head of the carved
blackwood table, beside his heap of brass “cash,”
watched him again and again as he took up his handful
of coins, covered them with a brass hat while the
betting began, removed the hat, and seemed to be
dividing the pile, with the wand in his hand, into fours.
The last number of the last four, apparently, was the
object of the wagers.

Blake could not understand the game. It puzzled him,

just as the yellow men so stoically playing it puzzled
him, just as the entire country puzzled him. Yet, obtuse
as he was, he felt the gulf of centuries that divided the
two races. These yellow men about him seemed as far
away from his humanity, as detached from his manner
of life and thought, as were the animals he sometimes
stared at through the bars of the Bronx Zoo cages.

A white man would have to be pretty far gone, Blake [112]

decided, to fall into their ways, to be satisfied with the
life of those yellow men. He would have to be a terrible
failure, or he would have to be hounded by a terrible
fear, to live out his life so far away from his own kind.
And he felt now that Binhart could never do it, that a
life sentence there would be worse than a life sentence
to “stir.” So he took another cigar, lighted it, and sat
back watching the faces about him.

For no apparent reason, and at no decipherable sign,

one of the yellow faces across the smoke-filled room
detached itself from its fellows. This face showed no
curiosity, no haste. Blake watched it as it calmly
approached him. He watched until he felt a finger
against his arm.

“You clum b’long me,” was the enigmatic message

uttered in the detective’s ear.

“Why should I go along with you?” Blake calmly

inquired.

“You clum b’long me,” reiterated the Chinaman. The

finger again touched the detective’s arm. “Clismas!”

Blake rose, at once. He recognized the code word of [113]

“Christmas.” This was the messenger he had been
awaiting.

He followed the figure down the narrow stairway,

through the sliding door, out into the many-odored
street, foul with refuse, bisected by its open sewer of
filth, took a turning into a still narrower street, climbed
a precipitous hill cobbled with stone, turned still again,
always overshadowed and hemmed in by tall houses
close together, with black-beamed lattice doors through
which he could catch glimpses of gloomy interiors. He
turned again down a wooden-walled hallway that
reminded him of a Mott Street burrow. When the
Chinaman touched him on the sleeve he came to a stop.

His guide was pointing to a closed door in front of them.

“You sabby?” he demanded.

Blake hesitated. He had no idea of what was behind

that door, but he gathered from the Chinaman’s motion
that he was to enter. Before he could turn to make
further inquiry the Chinaman had slipped away like a
shadow.

[114]
Welcome to Our Bookstore - The Ultimate Destination for Book Lovers
Are you passionate about testbank and eager to explore new worlds of
knowledge? At our website, we offer a vast collection of books that
cater to every interest and age group. From classic literature to
specialized publications, self-help books, and children’s stories, we
have it all! Each book is a gateway to new adventures, helping you
expand your knowledge and nourish your soul
Experience Convenient and Enjoyable Book Shopping Our website is more
than just an online bookstore—it’s a bridge connecting readers to the
timeless values of culture and wisdom. With a sleek and user-friendly
interface and a smart search system, you can find your favorite books
quickly and easily. Enjoy special promotions, fast home delivery, and
a seamless shopping experience that saves you time and enhances your
love for reading.
Let us accompany you on the journey of exploring knowledge and
personal growth!

ebooksecure.com