PERFORMANCE AND QUALITY EVALUATION AND IMPROVEMENT OF THE
HIM DEPARTMENT
SCENARIO: You have just been hired as the HIM QualityCoordinator. This is a new position in the HIM Department. Your jobtasks read as follows:
• Develop and implement the HIM Department Quality Plan
• Develop data collection, date analysis, and data presentationtools for use in the quality plan.
• Report findings to the HIM Director, Administration, MedicalStaff Director, and Medical Staff Committees as appropriate.
• Other duties as assigned.
The facility is a 338-bed hospital with active ER and outpatientservices. There are 45 employees in the HIM Department. About 75%of the medical record is electronic. Those documents are notprinted out. The remaining 25% of the record is paper and isscanned into the system by the HIM Department. These documents arescheduled for destruction in the 60 days from scanning.
The former Director of HIM was successful in working withadministration to get the EHR and imaging in place and to getapproval to destroy the paper records. She failed at managing theday-to-day of the department. Now, the department has qualityissues in the HIM functions. The former director also did a greatjob preparing the medical staff for the EHR, and the transitionwent smoothly; however, many physicians and other users arefrustrated by the quality issues. Administration is also becomingconcerned with the high billing hold report. The director’sposition was vacant for 5 months before the new director startedwork. She has only been here a month.
Today is your first day. The HIM Director has her instructionsfrom administration and the medical staff. She has passed theseinstructions on to you. Your instructions boil down to twowords—FIX IT. While the director will be actively involved in theclean-up, she cannot do it by herself with the other demands on hertime. This is why she requested your position. It is almost unheardof for a new position to be approved in the middle of the fiscalyear. Adding the extra position shows how serious administration isabout 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 pagesare not always scanned.
? This requires 100% audit, which 3 months behind.
? The staff members conducting the quality audits do not catchall 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 programand 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 repeatedcomplaints that the wrong information is being sent. The errorsinclude:
? 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 troublerecruiting and retaining qualified transcriptionists.
o Although the transcription is current, the quality of work isinconsistent. Most of the reports are perfect, but a significantnumber 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 rightmedications
Your assignment for this project is to develop a plan to solvethe problems identified above and to prevent them and otherproblems from occurring in the future. Your plan should include ATLEAST:
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 foryour project. If you make assumptions, identify the assumptions inyour narrative. Please take into consideration
