8/6/2019 HIM Department Rebuilt to Maximize Efficiency and Performance

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With the speed and accuracy of health record processingbelow desired levels, this not-for-profit hospital hiredB. E. Smith to assess and restructure its health informationmanagement (HIM) procedures.

Frequent turnover of HIM directors three in less than four years coupled with insufficient training on the hospitalselectronic health record system had impeded the organizationsefforts to operate an efficient, effective HIM department.

A B. E. Smith interim HIM director joined the team. In threemonths, this seasoned professional assessed the departmentschallenges, designed strategies to improve performance, andhelped implement new processes to achieve positive change.

Case Study

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HIM Department Rebuilt to Maximize Efficiency and Performance

Specific Protocols, Comprehensive TrainingChallenge: The hospital sought to improve its unbilled coding days,a metric that should stand at about two days but in fact stood at 15days and climbing. A record-scanning backlog (exceeding two days)and imprecise chart reconciliation caused inconsistencies in document naming that resulted in only some of the total discharged recordsbeing handled by the HIM staff. Many accounts, inconsistently coded,required correction before they could be dropped.Solution: The interim HIM leader assessed chart processingprocedures and helped implement concrete changes. Theseincluded initiating required timeframes for record processing,

such as retrieving ER accounts first thing in the morning androutinely stipulating their processing by 9 a.m. Inpatient accountswere now expected to be scanned into the system by noon,while daily records, including outpatient surgeries, must becompleted by 4 p.m. The interim leader also initiated a thoroughchart retrieval process for all chart types. The leader began torequire a daily monitoring and correction of coding items, suchas missing registration information. The staff also began utilizingcensus sheets to reconcile charts. The increased rigor surround-ing chart processing enabled the organization to reduce unbilledcoding days from more than 15 to two, and to decrease A/Rdays from 85 to 58.

Challenge: Faced with chart processing deficiencies and delays,the hospital had attempted resolution by hiring additional staff.But without comprehensive training, this led to an overstaffed department still insufficiently prepared to achieve the desired quality measures. A HIM department of six FTEs would be expected to successfully support a 100-bed organization with about 22inpatient discharges per day. Instead, 15 inconsistently trained FTEs continued to struggle to process charts.Solution: The B. E. Smith interim leader helped the hospitalunderstand that the hiring of additional staff especially in light

of a tight cash situation with less than 10 days of cash on hand did not actually contribute to resolution of HIM concerns. Instead,the leader emphasized the critical importance of comprehensivetraining to enable the optimal number of staff to be effective intheir roles. A formal training and certification program unfolded inthree sessions: chart reconciliation, scanning techniques and qual-ity requirements, proper and consistent document naming andclassification. This thorough and consistent understanding of thesystem and procedures equipped the staff with skills for success.

Challenge: A lack of confidence in the quality of record-keepingcaused concerns and morale issues. HIM staff did not feel suitably empowered to fully function in their roles and the medical staff expe-rienced doubts regarding the accuracy of medical record processing.Solution: With comprehensive process guidelines and detailedtraining opportunities now absorbed by the medical recordsstaff, the interim HIM leader initiated proactive communicationswith the medical staff. The leader shared HIMs goals, changesand accomplishments and pledged to the medical staff that all ERrecords would now be complete and in the system by a set timeeach morning. Once clinicians began seeing this metric realized,their confidence rose significantly, and their appreciation of theHIM staffs renewed efforts and commitment became evident.

4 essential tipsB. E. Smith suggests the following tips to help healthcare leadersmaximize performance in the HIM department:

Collaborate closely with staff. Take the time to truly understandwhy deficiencies and inconsistencies occur.

Provide comprehensive training in a formal setting. Ensureleadership discusses proper protocols in detail and complementstraining with well-documented supporting materials and guidelines.

Build the staff upin their roles and empower them to understand theirimportant contributions to the organizations overall success.

Communicate successes Collaboration between the HIM staff and the medical staff helps to achieve shared goals.

Productivity and Accountability:

13days

27days

Reduced A/Rdays from 85 days

to 58 days.

Reduced coded,unbilled days

from more than15 days totwo days.

by the numbers