Question

PERFORMANCE AND QUALITY EVALUATION AND IMPROVEMENT OF THE

HIM DEPARTMENT

SCENARIO: You have just been hired as the HIM Quality Coordinator. This is a new position in the HIM Department. Your job tasks read as follows:

• Develop and implement the HIM Department Quality Plan

• Develop data collection, date analysis, and data presentation tools for use in the quality plan.

• Report findings to the HIM Director, Administration, Medical Staff Director, and Medical Staff Committees as appropriate.

• Other duties as assigned.

The facility is a 338-bed hospital with active ER and outpatient services. There are 45 employees in the HIM Department. About 75% of the medical record is electronic. Those documents are not printed out. The remaining 25% of the record is paper and is scanned into the system by the HIM Department. These documents are scheduled for destruction in the 60 days from scanning.

The former Director of HIM was successful in working with administration to get the EHR and imaging in place and to get approval to destroy the paper records. She failed at managing the day-to-day of the department. Now, the department has quality issues in the HIM functions. The former director also did a great job preparing the medical staff for the EHR, and the transition went smoothly; however, many physicians and other users are frustrated by the quality issues. Administration is also becoming concerned with the high billing hold report. The director’s position was vacant for 5 months before the new director started work. She has only been here a month.

Today is your first day. The HIM Director has her instructions from administration and the medical staff. She has passed these instructions on to you. Your instructions boil down to two words—FIX IT. While the director will be actively involved in the clean-up, she cannot do it by herself with the other demands on her time. This is why she requested your position. It is almost unheard of for a new position to be approved in the middle of the fiscal year. Adding the extra position shows how serious administration is about getting the problems solved. The problems are as follows:

• Scanning:

o There is a 2-month backlog in scanning the paper records

o The quality of the scanning has problems

▪ Sometimes pages are fed two at a time, and the backs of pages are not always scanned.

▪ This requires 100% audit, which 3 months behind.

▪ The staff members conducting the quality audits do not catch all of the errors.

• Billing:

o The billing hold report is over $2,000,000.00.

o Administration wants the billing hold report held at $500.000.00.

• Coding:

o Coding is 2 weeks behind.

o There are three vacancies in the coding area.

o One of your coders is a new graduate of the local HIT program and is slower than the experienced coders.

o The last coding audit conducted by corporate showed an 80% coding accuracy report.

• Release of information:

o The release of information area is 2 days behind.

o The release of information area has received repeated complaints that the wrong information is being sent. The errors include:

▪ Not everything requested was released.

▪ Wrong admissions are being released.

▪ Information on wrong patients is being released.

▪ Wrong documents are being released.

• Transcription:

o An outsourcing company in used, since the hospital had trouble recruiting and retaining qualified transcriptionists.

o Although the transcription is current, the quality of work is inconsistent. Most of the reports are perfect, but a significant number of reports are totally inaccurate because of:

▪ Multiple typos

▪ Abbreviations that are not spelled out

▪ Poor grammar

▪ In some cases, wrong medications with names similar to right medications

Your assignment for this project is to develop a plan to solve the problems identified above and to prevent them and other problems from occurring in the future. Your plan should include AT LEAST:

1. Who should be involved

2. What reporting mechanism you should have

3. Who you should report to

4. What accuracy rates you expect

5. What you will do to solve problems (training, outsourcing, new policies, etc)

6. What will be monitored

7. Frequency of monitoring

8. Frequency of reporting

9. What investigations you will do

10. How you will build quality into your process

11. How you prioritize problems to be addressed

12. Forms

13. Graphs

Be creative, but use sound HIM principles as the foundation for your project. If you make assumptions, identify the assumptions in your narrative. Please take into consideration

Answer 1

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Plan as a HIM Quality coordinator :

Have important roles and responsibilities in maintaining and protecting the health care and related documents and information for quality management.To become successful in this position, he should first of all understand the work list and prioritize the task , can include new plans to complete the task and evaluate the completeness of the work.From the above case it is clear that scanning, billing,coding,Release of information and transcription are the bending works he needs to complete and additionally to complete the daily tasks.Previous coordinator had 80% accuracy in work so he should also have this amount of accuracy or more than that.

Answers:

1. All health care professionals who are involved in patient care must be involved in HIM.The one who is providing any service to the patient should code the service in the patient electronic health record.Example:Physician should record about the routine visit and patient status.Likewise all other department must record their services hence the personnel in the HIM department can understand the services provided and prepare patient health record and proceed with billing and other process.
2. Reporting must be in the electronic form.The Organisation must use a software for hospital management system.No verbal and written reporting system are accepted.only the digital form of reporting is accepted.The health care professional can enter into the software by username and password they record information by their account in the software.By this digital reporting system the mistakes are easily identified.
3. Reporting is done to the superiors of the hospital about the quality management in HIM department. It is important to report to the HIM director.
4. Expectation of Accuracy rate is always 100% or atleast more than 90 %.The previous coordinator maintained 80% of accuracy rate hence it should not reduce from 80 %.
5. To overcome the problems and to finish the work training and guidance is enough .previous year work organization is satisfied hence training of the staffs is enough.Additionally can include deadline policy to workers hence they complete the task on time.
6. He should monitor the work status and completeness of the work.He should monitor the quality management in his department.
7. Frequency of monitoring should be weekly basis.Work accomplishment should be monitored at the end of the month.This practice will make the employees to accomplish the tasks.
8. Monthly once reporting should be made.This will show one month work of HIM department.This is easy to find and analyse any document from the month list of work.
9. As an investigation, during internal audit in the hospital can invest the work of all professionals who are performing digital reporting.Also audit the HIM department professionals about the protocol maintaining and the organization system of work.
10. For building quality, should make everyone to follow the protocol and provide guidance in performing work.Periodically conduct audit and staff training classes.
11. In this information management system, prioritizing the problems should be addressed from the initial phase.then only it is easy find the problems and can rectify it.
12. Only the digital form of information is included.
13. Graphs can be presented for quality management in month-wise,or can be work accomplishment etc.

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