Question

CASE 6-34 Performance and Quality Evaluation and Improvement of the Health Information Management Department 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, data analysis, and data presentation tools for use in the quality plan.

• Report findings to the HIM director and medical staff director and administration, as well as medical staff committees, as appropriate.

• Other duties are 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 remain- ing 25% of the record is paper and is scanned into the system by the HIM department. These documents are scheduled for destruction 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. However, the former director failed at managing the day-to-day operations 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 becom- ing concerned with the high billing hold report. The director’s position was vacant for five 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 this cleanup, 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 FY. Adding the extra position shows how serious administration is about getting the problems solved. The problems are as follows:

• Scanning: •

• There is a two-month backlog in scanning the paper records. The quality of the scanning has problems.

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

2. This requires 100% audit, which is three months behind.

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

old report is over $2,000,000.00.

• Administration wants the billing hold report held at $500,000.00.

• Coding: • Coding is two weeks behind.

• There are three vacancies in the coding area.

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

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

• ROI: • The ROI area is two days behind.

• TheROIareahasreceivedrepeatedcomplaintsthatthewronginformationisbeingsent.

The errors include the following: 1. Not everything requested was released.

2. Wrong admissions are being released.

3. Information on wrong patients is being released.

4. Wrong documents are being released.

• Transcription: • An outsourcing company is used since the hospital had trouble recruiting and retaining qualified transcriptionists.

• Althoughthetranscriptioniscurrent,thequalityoftheworkisinconsistent.Mostofthereportsare perfect, but a significant number of reports are totally inaccurate due to the following:

1. Multiple typographical errors

2. Abbreviations that are not spelled out

3. Poor grammar

4. Wrong medications with names similar to the 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 the following:

• Who should be involved?

• What reporting mechanism should you have?

• Who should you report to?

• What accuracy rates you should expect?

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

• What will be monitored? • What will be the frequency of monitoring?

• What will be the frequency of reporting?

• What investigations will you perform?

• How will you build quality into your process?

• How will you prioritize problems to be addressed?

Answer 1

Who should be involved?

All the department like pharmacy, medical recording, radiology, billing, scanning, outsourcing , IT along with assistant directors and hospital director.

What reporting mechanism should you have? Who should you report to?

All departments should report to their directors individually and those directors should report to hospital director and assistant hospital directors. For example if there is lack of payment in pharmacy a reminder should be displayed in pharmacy department and billing section to collect the payment. If coding is two weeks behind send them reminders to finish it soon ,also provide them with new support system to increase their efficiency and report it to their director. Once all pending issues are over report it to the hospital director. New support training may improve the efficacy and performance

What accuracy rates you should expect?

Accuracy may improve as there is new sequence of reporting and also implementation of training program helps in over all improvisation of issues .

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

The new training program implemented for all staffs will provide them motivation and improvement of their performance. The training program for all departments will help in speedy recovery of the problems and pending issues in the departments

What will be monitored? What will be the frequency of monitoring?

The outcomes in the departments should be monitored regularly. Example Check whether the back of the pages are scanned and whether scanning paper records are completed. Conduct regular audit .Daily monitoring helps in resolving issues as soon as possible .

What will be the frequency of reporting?

First analyse the past and present outcomes so that we can evaluate the point from which problem arises. After finding it , resolve the problem . Then monitor the recurrence of problem after implementing new plans as said earlier. Once all problem resolves start documentation of the new issues and its frequency.Report accordingly , whenever a problem arise report it immediately.

What investigations will you perform?

Already monitoring is done and audit are conducted.

How will you build quality into your process?

The new training plan is introduced to improve performance and efficacy of staffs which is necessary for quality improvement .

How will you prioritize problems to be addressed?

• Clear the billing issues
• Implement new training program
• Appoint staffs in coding department
• Scanning should be done appropriate
• Update the servers to resolve the typo errors default
• Monitoring the ROI department regularly to decrease the errors
• After all changes if still there is no improvement change the outsourcing provider